美国约翰·霍普金斯医学院进展期胰腺癌治疗经验及研究趋势

Progress and experience about advanced pancreatic cancer at the Johns Hopkins

目前,临床对胰腺癌的治疗效果有限。精准医学展示出在胰腺癌治疗应用方面的巨大前景,包括基于基因组学和转录组学对胰腺癌重新分类,通过微创"液体活检"检测循环肿瘤细胞、游离循环DNA和外泌体,以监测胰腺癌的发展并指导其治疗。美国约翰·霍普金斯医学院进行过多项临床试验,在基于化疗敏感性的研究中发现进行化疗药物代谢相关的基因检测,有助于选择更精准、更高反应率的方案;在肿瘤基因组和转录组研究中发现,胰腺癌基因谱具有独特性,对突变基因的深入探讨有助于选择最佳治疗方案;基于宿主免疫反应的研究中,应用全基因组的突变基因序列设计的免疫治疗,将有利于进一步实现病人免疫治疗的精准化,目前已将胰腺癌疫苗与化疗药物联合应用并取得一定的研究成果。

Current therapies for pancreatic cancer have limited effects. Precision medicine has shown great potential for clinical applications, include new pancreatic cancer classification based on genomics and transcriptomics, through a minimally invasive ＂liquid biopsy＂ to detect circulatingtumor cells, circulating cell-free DNA, and exosomes, which are permited to monitor of the clonal evolution of individual pancreatic cancer during the course of treatment and disease progression. Various strategies are being tested in clinical trials in Johns Hopkins, examining genes that are involved in the metabolism of chemotherapeutic agents help to select a more accurate, higher response rate of chemotherapy. Based on tumor genome and transcriptome, the landscape of the pancreatic ductal adenocarcinoma genome is notable, study of mutant genes will be helpful in selecting the best treatment. Treatment selection based on host immune response, designed based on whole-exome sequencing of mutated genes, will facilitate further tailoring of vaccine therapies for individual patients, at present, the combination of pancreatic cancer vaccine and chemotherapy drugs has achieved some positive results, and further studies are being carried out.