2013个体化治疗进展.pdf
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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
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