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以循环瘤DNA分析为指导的向治疗,用于晚期胃肠道瘤

Yoshiaki Nakamura^1,2,3, Hiroshi Ozaki², Makoto Ueno⁴

¹International Research Promotion Office, National Cancer Center Hospital East, Kashiwa, Japan.

Nature medicine

|September 16, 2024

概括

在先进的固体瘤中循环瘤DNA (ctDNA) 分析显著改善了结果. 基于ctDNA分析的匹配向治疗导致了更好的整体存活率,突出了其在精确瘤学中的临床实用性.

科学领域:

在瘤学瘤学.
基因组学就是基因组学.
分子诊断学分子诊断

背景情况:

对于先进的实体瘤来说,全面的基因组分析是标准的,但循环瘤DNA (ctDNA) 分析的临床影响未得到充分利用.
之前的GOZILA研究显示,液体活检与组织查的临床试验入学率更高.
内异质性评估和ctDNA在指导治疗选择中的作用需要进一步的证据.

研究的目的:

在先进的固体瘤中描述ctDNA分析的临床实用性.
评估ctDNA引导的向治疗对患者结果的影响.
使用ctDNA特征识别治疗疗效的预测因素.

主要方法:

全国范围的前性观察性研究 (GOZILA) 分析了4037名晚期固体瘤患者.
针对性治疗匹配的ctDNA分析.
对接受匹配治疗与未匹配治疗的患者的整体存活率的分析.
评估生物标志物克隆性和调整的血拷贝数作为疗效预测指标.

主要成果:

使用ctDNA分析,针对性治疗的匹配率达到了24%.
与未匹配治疗相比,接受ctDNA匹配向治疗的患者的整体存活率 (危险比率,0.54) 显著改善.
生物标志物的克隆性和调整后的血拷贝数预测了治疗疗效.

结论:

ctDNA剖析提高了患者在先进的固体瘤的结果,超出了初始招募的好处.
ctDNA分析有效捕捉瘤异质性,支持精确的治疗决策.
建议更广泛地采用ctDNA导向治疗,以提高精确瘤学的生存率.

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