2013个体化治疗进展.pdf

2013年NSCLC个体化治疗进展 吴一龙 广东省肺癌研究所 广东省人民医院 广东省医学科学院 2014.03.01 上海 易瑞沙9周年庆典 2013年个体化治疗主要进展 ? 利用基因组学制定个体化治疗、定义癌症分子亚 型、鉴别可能的新治疗靶点 ? Using genomics to make treatment decisions for individual patients, discover new cancer subtypes, and identify potential targets for development of new therapies. ? 精确医学方法阻断癌症的治疗耐药 ? Tackling treatment-resistant forms of cancer through precision medicine approaches ? 增强患者自身免疫能力对抗癌症 ? Enhancing the ability of patients’ own immune systems to fight cancer CCA in 2013 JCO 2013 Dec 肺癌的个体化治疗进展 ? 驱动基因检测将患者和靶向治疗、临床试验精确 配对，提高肺癌患者生存 – Genomic testing helps physicians match patients with targeted treatments and clinical trials: Leads to improved lung cancer survival. ? 2期临床上试验显示，dabrafenib对BRAF V600E突变的 NSCLC具有良效 – Results from a phase II study show dabrafenibhas antitumor activity in patients with BRAF V600E–mutant NSCLC. ? 新的筛查策略有效发现晚期肺癌 RET和ROS1基 因改变 – New screening strategies identify RET and ROS1 gene alterations in patients with advanced lung cancers 肺鳞癌和肺腺癌不同的分子事件 Criello et al. Nature Gene 2013 突变型和扩增型肺癌的治疗策略 Criello et al. Nature Gene 2013 驱动基因检测将患者和靶向治疗、临床试验精确配对，提高 肺癌患者生存 Multi-institutional, Multiplex, Molecular testing platform KRAS EGFR BRAF HER2 PI3K MEK NRAS AKT1 ALK (FISH) MET (FISH) RET (FISH or NGS) ROS1 (FISH or NGS) PTEN (IHC* or NGS) MET (IHC**) Molecular data provided to treating physician to direct patients to available standard therapy or trial of agent directed to identified molecular target Kris et al. WCLC 2013 Matching Therapies and Drivers in Lung Cancers Oncogenic Drivers and Targeted Treatments Driver Any Genotyping (n=1007) Targeted Therapy (n=1007) Any Driver 622 (63%) 279 (28%) EGFR (sensitizing) 156 (16%) 129 (82%) EGFR (other) 53 (5%) 40 (75%) ALK 78 (8%) 51 (65%) KRAS 244 (24%) 22 (9%) HER2 19 (2%) 11 (58%) BRAF 18 (2%) (14- V600E) 3 (17%) PIK3CA 7 (1%) 0 MET Amplification 6 (1%) 3 (50%) NRAS