肿瘤精准诊疗的挑战与应对

New challenges for precision oncology

肿瘤的精准诊疗是指应用生物学、遗传学、分子影像等现代高新技术,结合宿主内外环境和临床大数据实现精确的、实时动态的肿瘤分类与诊断,制定个性化的预防、诊疗方案。肿瘤的异质性是恶性肿瘤的特征之一,也是实现指肿瘤个体化治疗的最大障碍。在过去的几十年里,尽管人们在鉴定肿瘤致癌基因方面已作出了极大的努力,但何时开始肿瘤治疗、针对哪些靶点、选取哪一类患者及如何检测肿瘤的复发等重大问题仍未得到解决。肿瘤精准诊疗的开展需要大数据的积累与深度挖掘、肿瘤精确的分子分型、精准的机制研究以及国际化规范的临床研究。一些新技术的出现将使多途径、多靶点、多时空的干预方式成为可能,也使抗肿瘤治疗更为精准,疗效更好。

Due to the heterogeneous nature of tumors, molecular profiling is crucial to our understanding of how genomics plays a role in the cause or development of an individual cancer. Such tumor profiles can subsequently be applied to exclusively tailor cancer therapies to directly target a causative mutation for a malignancy, ultimately achieving a personalized and precise approach to cancer treatment. This approach is termed precision oncology. Precision oncology has made progress in leaps and bounds in recent years and is currently at the heart of revolutionizing cancer research. However, emerging data suggest that a major refinement is needed in the theory and practice of precise oncology frameworks. There is no doubt that thoroughly understanding of the complex mechanism and systematically defining the cancers with innumerable molecular and epigenetic alterations are crucial to precision treatment. Integrated monitoring and analysis gene expression profiling, epigenetic profiling, proteomic profiling, immune and metabolism profile could provide a more comprehensive overview of an individual tumor. Meanwhile, efforts in precision oncology should be held to the bar of traditional medicine, and meaningful improvements in clinical outcomes ought to be tested in rigorous clinical trials. All the efforts and resources would help to accomplish precision medicine in a truly personalized manner.