Integrating liquid biopsies into the management of cancer
Key Points Patient selection is central to the success of targeted therapy; identification of tumour-specific molecular landscapes is pivotal to guiding treatment choices The genomic landscape of each individual tumour is heterogeneous and changes over time as a result of the Darwinian clonal evolut...
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| Veröffentlicht in: | Nature reviews. Clinical oncology Jg. 14; H. 9; S. 531 - 548 |
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| Hauptverfasser: | , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
London
Nature Publishing Group UK
01.09.2017
Nature Publishing Group |
| Schlagworte: | |
| ISSN: | 1759-4774, 1759-4782 |
| Online-Zugang: | Volltext |
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| Zusammenfassung: | Key Points
Patient selection is central to the success of targeted therapy; identification of tumour-specific molecular landscapes is pivotal to guiding treatment choices
The genomic landscape of each individual tumour is heterogeneous and changes over time as a result of the Darwinian clonal evolution imposed on cancer cells by selective pressures, including targeted therapy
Longitudinal surveillance of clonal evolution is essential for precision medicine, but cannot be effectively achieved using tissue biopsy specimens, owing to sampling issues
The blood of patients with cancer contains diverse tumour-derived materials, including circulating cell-free tumour DNA (ctDNA), circulating tumour cells, and exosomes
The sampling and analysis of ctDNA or other circulating tumour components present in biological fluids, termed 'liquid biopsy', enables minimally invasive monitoring of tumour evolution over time in the clinic
Two different liquid biopsy companion diagnostic tests for
EGFR
mutations in plasma ctDNA have been approved by the regulatory agencies in Europe and the USA for the selection of patients with non-small-cell lung cancer for anti-EGFR treatment in clinical practice
Analysis of circulating tumour components using liquid biopsy approaches holds considerable promise to improve the detection and treatment of cancer. In this Review, Alberto Bardelli and colleagues outline how different forms of liquid biopsy, and particularly the assessment of circulating tumour DNA, can be exploited to guide patient care, and discuss the progress made to date in integrating such analyses into the clinic.
During cancer progression and treatment, multiple subclonal populations of tumour cells compete with one another, with selective pressures leading to the emergence of predominant subclones that replicate and spread most proficiently, and are least susceptible to treatment. At present, the molecular landscapes of solid tumours are established using surgical or biopsy tissue samples. Tissue-based tumour profiles are, however, subject to sampling bias, provide only a snapshot of tumour heterogeneity, and cannot be obtained repeatedly. Genomic profiles of circulating cell-free tumour DNA (ctDNA) have been shown to closely match those of the corresponding tumours, with important implications for both molecular pathology and clinical oncology. Analyses of circulating nucleic acids, commonly referred to as 'liquid biopsies', can be used to monitor response to treatment, assess the emergence of drug resistance, and quantify minimal residual disease. In addition to blood, several other body fluids, such as urine, saliva, pleural effusions, and cerebrospinal fluid, can contain tumour-derived genetic information. The molecular profiles gathered from ctDNA can be further complemented with those obtained through analysis of circulating tumour cells (CTCs), as well as RNA, proteins, and lipids contained within vesicles, such as exosomes. In this Review, we examine how different forms of liquid biopsies can be exploited to guide patient care and should ultimately be integrated into clinical practice, focusing on liquid biopsy of ctDNA — arguably the most clinically advanced approach. |
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| Bibliographie: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
| ISSN: | 1759-4774 1759-4782 |
| DOI: | 10.1038/nrclinonc.2017.14 |