在鼻癌中以动态ctDNA为指导的风险适应性治疗
Jiawei Lv1, Dan-Xue Zheng1, Jin-Hui Liang2
1Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Centre for Cancer, Guangzhou, P. R. China.
使用循环瘤DNA (ctDNA) 动态的新型风险适应性治疗 (RAT) 策略显著改善了鼻癌患者的无故障生存率. 这种以ctDNA为导向的方法为标准静态处理方案提供了一个有希望的替代方案.
科学领域:
- 在瘤学瘤学.
- 分子诊断学 分子诊断学
- 临床试验设计 临床试验设计
背景情况:
- 在治疗期间循环瘤DNA (ctDNA) 动态显示了实时响应评估和复发风险预测的潜力.
- 将ctDNA洞察力转化为可行的临床决策仍然是一个挑战.
研究的目的:
- 评估风险适应性治疗 (RAT) 策略,以鼻癌的治疗时ctDNA动态为指导.
- 为了确定这种ctDNA驱动的方法是否可以改善与标准护理相比的生存结果.
主要方法:
- 一项多中心,非随机的II期研究 (EP-STAR) 招募了鼻癌患者.
- 患者接受了标准的新辅助化疗,其次是RAT或基于ctDNA清除轨迹的标准化疗.
- 同时没有接受RAT的外部队列作为对照剂.
主要成果:
- 在RAT组的3年无故障生存率 (FFS) 为89.1%.
- 与没有RAT的外部队列相比,接受RAT的患者表现出明显改善的FFS (HR=0.41,P=0.004).
- RAT策略被人很好地容忍,没有与治疗相关的死亡.
结论:
- 一个ctDNA驱动的风险适应性治疗范式显示了改善鼻癌存活率的希望.
- 这种方法挑战了传统的固定疗程治疗策略.
- ctDNA动态可以指导适应性治疗决策,以获得更好的患者结果.
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