张波液体活检在肠癌精准医疗中的应用.pptxVIP

液体活检在肠癌精准医疗中的应用;;;Metastatic colorectal cancer patient triage to anti-EGFR treatment in clinical practice;结直肠癌分子靶向治疗相关检测;结直肠癌分子检测概略;K-RAS突变;KRAS mutations in various cancer types;KRAS recurrent mutations in cancers;KRAS突变在原发及转移结肠癌灶 ;K-RAS基因突变检测;Anti-epidermal growth factor receptor (EGFR) treatment of Metastatic colorectal cancer (mCRC) patients;KRAS基因突变检测的意义;KRAS检测的有关问题;Clinical impact of minor mutant subpopulations ―KRAS突变定量化;结直肠癌治疗与Extended RAS检测;In addition to testing for mutations in KRAS exon 2 (codons 12 and 13) as recommended previously, before treatment with anti- EGFR antibody therapy, patients with mCRC should have their tumor tested for mutations in: ● KRAS exons 3 (codons 59 and 61) and 4 (codons 117 and 146) ● NRAS exons 2 (codons 12 and 13), 3 (codons 59 and 61), and 4 (codons 117 and 146).;Extended RAS analysisExtended RAS: KRAS (beyond exon 2) and NRAS;Ras family;Ras mutation and activation;PRIME study, primary end points of (PFS and OS) efficacy results according to RAS mutation status;PRIME study;FIRE 3 study;FIRE 3 study;KRAS检测的拓展;Dynamic monitoring and drugs using;Circulating tumor markers;RAS检测: 一线治疗决策的重要因素;肠癌原发灶与转移灶：基因突变不一致;既往治疗过的CRC原发灶与转移灶不一致;CRC肿瘤基因异质性;KRAS检测的方法;;Digital PCR （数字PCR）;二代测序仪(部分);生物信息学分析数据库比对;ASCO 2014 默克雪兰诺与Sysmex Inostics签订合作协议;Schematic of BEAMing;Photograph of a typical microemulsion;Density plots of flow-cytometric data obtained from BEAMing;Density plots of BEAMing with genomic DNA or RT-PCR products as template;Detection and validation of variants present in a minor fraction of the DNA population;配对的血和组织? 标本来自31例III/IV期CRC患者;ECC 2015荟萃分析: 液体活检*和组织检测mCRC的RAS突变具有高一致率;其他KRAS血检测研究：特异性高，敏感性差别较大;最初西妥昔单抗治疗有效，后进展;液体活检发现mCRC患者抗EGFR治疗获得性耐药机制;液体活检测出的mCRC耐药突变*;液体活检*: 快速和最小创伤的检测;KRAS突变等位基因与抗EGFR治疗的关系;;FIRE-4研究: II期随机对照西妥昔单抗再治疗(德国)1;液???活检 微创检测 标本易获取 避免肿瘤异质性影响 动态监测 部分平台敏感性较低 临床疗效相关性数据缺乏 平台或检测成本高;RAS检测意义：转化为患者最佳治疗决策