広範なゲノムシーケンシングと,コミュニティ・オンコロジーの環境における進行した非小細胞肺がん患者の生存との関連
Carolyn J Presley1, Daiwei Tang2, Pamela R Soulos3
1The Ohio State University, Medical Oncology, Columbus.
JAMA
|August 9, 2018
まとめ
先進性非小細胞肺がん (NSCLC) の広範なゲノムシーケンシングは,コミュニティ環境での生存結果を改善しませんでした. この包括的な試験は少数患者での治療に情報を与え,さらなる研究の必要性を強調しました.
科学分野:
- 腫瘍学
- ゲノミクス
- 臨床研究
背景:
- 広範なゲノムシーケンシング (BGS) は,先進的な非小細胞肺がん (NSCLC) の治療にますます利用されています.
- 地域腫瘍学における治療選択と生存に対するBGSの影響に関するデータは限られている.
研究 の 目的:
- 進行性NSCLCの患者と,通常のEGFR/ ALK検査を受けた患者との臨床結果を比較する.
- BGSと生存の関連性を評価する
主な方法:
- 2011年1月から2016年7月にかけて進行したNSCLC患者 (ステージIIIB/IVまたは切除不能) の遡及コホート研究.
- BGS (≥30遺伝子) を受けた患者と,通常のEGFR/ALK検査を比較した結果
- 主要アウトカム: 12ヶ月の死亡率と全生存期; 二次的アウトカム: 治療パターンと遺伝的変異.
主要な成果:
- 5688人の患者のうち15. 4%がBGSを受けた. BGSの結果に基づく標的治療は,BGS患者の4. 5%しか受けなかった.
- 調整されていない12ヶ月の死亡率は,通常の検査 (35. 9%) よりもBGS群で高かった.
- インストゥルメンタル変数と傾向スコアを合わせた分析では,BGSと12ヶ月の死亡率または全生存率の改善との間に有意な関連性は示されなかった.
結論:
- コミュニティ腫瘍学では,BGSは進行したNSCLC患者の少数派に対する治療に直接影響を与えた.
- この患者群では,BGSは独立して生存率の改善と関連していなかった.
- 先進的なNSCLCの治療決定におけるBGSの有用性を最適化するためにさらなる研究が必要である.
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