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Thomas Powles¹, Zoe June Assaf², Nicole Davarpanah²

¹Barts Cancer Institute, Queen Mary University of London ECMC, Barts Health, London, UK. thomas.powles1@nhs.net.

|June 17, 2021

概括

循环瘤DNA (ctDNA) 测试可以识别高复发风险的泌尿器癌患者. 辅助性阿特佐利祖马布改善了ctDNA阳性患者的生存率,这表明了个性化的术后治疗方法.

科学领域:

癌症学
分子诊断
癌症生物标志物

背景情况:

对于识别患有转移性复发风险的癌症患者来说,最少侵入性检测最小残留疾病至关重要.
循环瘤DNA (ctDNA) 显示为分子残留疾病和预测复发的生物标志物.
目前的术后治疗策略需要改进以改善患者的治疗结果.

研究的目的:

在接受辅助治疗的可手术泌尿器癌患者中评估ctDNA的预后和预测价值.
根据ctDNA状态分层的患者的观察结果,评估阿特佐利祖马布的疗效.
探索ctDNA,瘤转录和治疗反应之间的关系.

主要方法:

在辅助性阿特佐利祖马布的随机III期试验中,对581名患者的ctDNA进行了分析.
在治疗开始时进行了ctDNA测试 (循环1日1).
对ctDNA阳性患者的瘤进行了转录组分析.

主要成果:

在观察组中,ctDNA检测发现37%的患者具有ctDNA阳性,预后明显较差 (HR=6. 3,P< 0. 0001).
与观察结果相比,ctDNA阳性患者的无病存活率 (HR=0. 58,P=0. 0024) 和整体存活率 (HR=0. 59,P=0. 0086) 得到改善.
在ctDNA阴性患者的治疗组之间没有观察到显著的生存差异.
在第6周,阿特佐利祖马布的ctDNA清除率较高 (18%) 与观察结果相比 (4%) (P=0. 0204).
在ctDNA阳性的患者中,瘤转录组显示细胞循环和角质蛋白基因的表达较高.

结论:

在可手术的尿道癌症中,ctDNA是一种强大的预后生物标志物,可识别患有复发风险较高的患者.
在ctDNA阳性患者中,辅助性阿特佐利祖马布显著提高了生存率,这表明它在个性化术后护理中发挥了作用.
如果这些发现得到验证,可以通过使风险分层辅助疗法重新塑造术后癌症管理.

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