文章：

循环肿瘤DNA在EGFR突变非小细胞肺癌评估与管理中的应用

ctDNA for the Evaluation and Management of EGFR-Mutant Non-Small Cell Lung Cancer

原文发布日期：26 February 2024

DOI: 10.3390/cancers16050940

类型: Article

开放获取: 是

英文摘要：

Circulating tumor DNA (ctDNA) offers a new paradigm in optimizing treatment strategies for epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC). Its potential spans early-stage disease, influencing adjuvant therapy, to advanced disease, where it aids in identifying genomic markers and resistance mechanisms. This review explores the evolving landscape of utilizing liquid biopsies, specifically circulating tumor DNA (ctDNA), in the management of NSCLC withEGFRmutations. While tissue-based genomic testing remains the cornerstone for clinical decision-making, liquid biopsies offer a well-validated, guideline-recommended alternative approach. Ongoing trials integrating ctDNA forEGFR-mutant NSCLC management are also discussed, shedding light on the potential of ctDNA in early-stage disease, including its applications in prognostication, risk stratification, and minimal residual disease detection post-curative intent treatment. For advanced disease, the role of ctDNA in identifying resistance mechanisms to EGFR tyrosine kinase inhibitors (TKIs) is explored, providing insights into disease progression and guiding treatment decisions. This review also addresses the challenges, including the limitations in sensitivity of current assays for disease recurrence detection, and calls for future studies to refine treatment approaches, standardize reporting, and explore alternative biofluids for enhanced sensitivity. A systematic approach is crucial to address barriers to ctDNA deployment, ensuring equitable access, and facilitating its integration into routine clinical practice.

摘要翻译： 

循环肿瘤DNA（ctDNA）为优化表皮生长因子受体（EGFR）突变非小细胞肺癌（NSCLC）的治疗策略提供了新范式。其应用潜力涵盖从早期疾病（影响辅助治疗决策）到晚期疾病（协助识别基因组标志物与耐药机制）的全病程管理。本综述探讨了液体活检技术——特别是循环肿瘤DNA（ctDNA）——在EGFR突变非小细胞肺癌诊疗中不断发展的应用格局。尽管组织基因组检测仍是临床决策的基石，但液体活检已成为经过充分验证且获指南推荐的替代方案。本文同时讨论了正在进行的整合ctDNA检测管理EGFR突变非小细胞肺癌的临床试验，揭示了ctDNA在早期疾病中的应用潜力，包括其在预后评估、风险分层及根治性治疗后微小残留病灶检测等方面的应用。对于晚期疾病，本文探讨了ctDNA在识别EGFR酪氨酸激酶抑制剂（TKIs）耐药机制中的作用，为理解疾病进展和指导治疗决策提供依据。本综述亦指出当前面临的挑战，包括现有检测方法在疾病复发监测中敏感度的局限性，呼吁未来研究应致力于优化治疗方案、标准化检测报告体系，并探索可提升检测敏感度的替代性生物体液。建立系统性实施路径对突破ctDNA临床应用障碍、确保可及性公平、推动其融入常规临床实践至关重要。

原文链接：

ctDNA for the Evaluation and Management of EGFR-Mutant Non-Small Cell Lung Cancer