颜林林
(2022-05-29 23:45):
#paper doi:10.1016/j.ccell.2022.05.005 Cancer Cell, 2022, Redefining breast cancer subtypes to guide treatment prioritization and maximize response: Predictive biomarkers across 10 cancer therapies. 这篇论文是关于一项正在进行的、开放标签、适应性、随机II期、多中心的临床试验(NCT01042379)I-SPY2。该临床试验入组高危II期和III期乳腺癌患者,并用70基因MammaPrint测试来排除其中无法从化疗获益的患者,将她们随机分配到10个不同用药组,并在手术前的新辅助治疗期间的不同时间点,进行MRI检查、穿刺取样和/或外周血采集,新辅助治疗前的穿刺样本,同时开展了基因表达芯片、蛋白磷酸化和免疫组化/原位杂交的检测。通过这些检测数据和患者用药响应结果,本研究对入组的987例患者做了重新分类,定义出五种亚型:HER2-/Immune-/DRD-、HER2-/Immune+、HER2-/Immune-/DRD+、HER2+/BP-HER2_or_Basal及HER2+/BP-Luminal。这个重定义过程,除了纳入传统定义所采用的HR/HER2状态外,也包含了诸如增值、DRD、免疫等其他表型特征,在确保分型区分选取最佳治疗方案,即获得最高的pCR(病理完全缓解)的概率,同时也兼顾检测平台稳健性和临床实施简单。虽然目前每个单臂上的病例数还并不算特别多,但相信随着该临床试验的持续开展和更多病例数据的积累,这项研究将优化出相比当前指南建议更好的治疗决策路径。而相应的研究方法和数据分析套路,也预期可以套用到其他癌种上,并在各类高通量多组学检测方法快速发展的今天,持续产出更多精准医疗实践应用。
Redefining breast cancer subtypes to guide treatment prioritization and maximize response: Predictive biomarkers across 10 cancer therapies
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Abstract:
Using pre-treatment gene expression, protein/phosphoprotein, and clinical data from the I-SPY2 neoadjuvant platform trial (NCT01042379), we create alternative breast cancer subtypes incorporating tumor biology beyond clinical hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) status to better predict drug responses. We assess the predictive performance of mechanism-of-action biomarkers from ∼990 patients treated with 10 regimens targeting diverse biology. We explore >11 subtyping schemas and identify treatment-subtype pairs maximizing the pathologic complete response (pCR) rate over the population. The best performing schemas incorporate Immune, DNA repair, and HER2/Luminal phenotypes. Subsequent treatment allocation increases the overall pCR rate to 63% from 51% using HR/HER2-based treatment selection. pCR gains from reclassification and improved patient selection are highest in HR subsets (>15%). As new treatments are introduced, the subtyping schema determines the minimum response needed to show efficacy. This data platform provides an unprecedented resource and supports the usage of response-based subtypes to guide future treatment prioritization.
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