概述

乳腺癌精准医疗是一种诊断、治疗和预防方法,该方法会考虑您的先天基因(您的基因组成)以及癌细胞内存在的基因或其他标记。通过这种方法,可以收集您的血液或肿瘤组织进行分析(通常是遗传学分析)。该信息可以帮助预测或诊断疾病并指导治疗决策。

癌症护理是最早使用精准医疗的医学专业之一。有几种针对乳腺癌的基因和非基因检测可有助于个性化治疗。一些基因检测专门针对遗传风险,这意味着这种检测会检查您的遗传组成,以确定您一生中患乳腺癌或其他类型癌症的个人风险。遗传风险约占所有乳腺癌病例的 10%。

其他基因检测还可以检查癌细胞内的遗传变化或变异(有时称为突变),以帮助确定最有可能使您获益的治疗方法或者您是否需要某种治疗方法。例如,可以检测来自乳腺肿瘤的细胞,以确定它们是否会产生过量的 HER 2 蛋白。HER 2 阳性乳腺癌患者可能会对靶向该蛋白的药物产生反应。一些基因检测将表明您的身体是否会激发(激活)某些药物,从而有助于确定哪种疗法最适合您。

最终,随着精准医疗(也称为个体化或个性化医疗)的新发展,将出现更多更精确的选择。

目的

乳腺癌精准医疗的目标是根据您特定的基因组成和癌细胞中的基因变化进行定制化治疗。

乳腺癌精准医疗需要分析细胞的基因组成,如果您患有癌症,还需要分析癌细胞的组成。检查可能包括:

  • 药物基因检测。您的基因可能会影响您的身体处理药物的方式,包括用于治疗乳腺癌的药物。医生会利用您的细胞的基因检测信息确定哪种药物和剂量最适合您。药物基因相互作用的领域被称为药物基因组学。
  • 晚期癌症。如果您的癌症在治疗后仍在恶化,医生可能会建议您检测癌细胞的基因组成。这种检测被称为肿瘤测序,用于检查癌症有无变化或改变,以便医生针对您的肿瘤类型选择最合适的药物。
  • 家族史。对于有严重乳腺癌家族病史的患者,建议通过基因检测来检测可能增加乳腺癌发病风险的遗传基因突变,如 BRCA 基因。与普通人群相比,拥有这些基因的女性患乳腺癌的风险更高。这项检测也可以用于确定治疗转移性乳腺癌的特定药物(Parp 抑制剂)是否对您有效。另外,根据患者的家族癌症病史,也可以进行更新的基因检测。

在 Mayo Clinic 治疗

Oct. 19, 2021
  1. Alisertib with or without fulvestrant in treating patients with locally advanced or metastatic, endocrine-resistant breast cancer. https://clinicaltrials.gov/ct2/show/NCT02860000. Accessed Sept. 9, 2017.
  2. BRCA1 and BRCA2: Cancer risk and genetic testing. National Cancer Institute. http://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet. Accessed June 13, 2017.
  3. Luo K, et al. A phosphorylation-deubiquitination cascade regulates the BRCA2-RAD51 axis in homologous recombination. Genes & Development. 2016;30:1.
  4. Van Poznak C, et al. Use of biomarkers to guide decisions on systemic therapy for women with metastatic breast cancer: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Oncology Practice. 2015;11:514.
  5. Goetz MP (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 26, 2017.
  6. Gradishar WJ, et al. Invasive breast cancer version 1.2016. Clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2016;14:324.
  7. Studying genes. National Institute of General Medical Sciences. https://www.nigms.nih.gov/Education/pages/Factsheet_studyinggenes.aspx. Accessed June 13, 2017.
  8. AskMayoExpert. Genetic testing for BRCA1 and BRCA2 mutations. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  9. Mayo Clinic to be home of National Precision Medicine Initiative (PMI) Cohort Program Biobank. News release, Mayo Clinic, Rochester, Minnesota. Sept. 26, 2017.
  10. AskMayoExpert. Breast cancer. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
  11. Goetz MP, et al. Tumor sequencing and patient-derived xenografts in the neoadjuvant treatment of breast cancer. Journal of the National Cancer Institute. 2017;109:djw306. Accessed June 12, 2017.
  12. Couch FJ, et al. Associations between cancer predisposition testing panel genes and breast cancer. JAMA Oncology. 2017;3:1190.
  13. Hamburg MA, et al. The path to personalized medicine. New England Journal of Medicine. 2010;363:301.
  14. Electronic Medical Records and Genomics (eMERGE) Network. National Human Genome Research Institute. https://www.genome.gov/27540473/electronic-medical-records-and-genomics-emerge-network/#al-2. Accessed June 12, 2017.
  15. Pritchard DE, et al. Strategies for integrating personalized medicine into healthcare practice. Personalized Medicine. 2017;14:141.
  16. The Personalized Medicine Coalition. Personalized Medicine at FDA: 2016 Progress Report. http://www.personalizedmedicinecoalition.org/Resources/Personalized_Medicine_at_FDA. Accessed June 13, 2017.
  17. Peshkin BN. Genetic counseling and testing for hereditary breast and ovarian cancer. http://www.uptodate.com/contents/search. Accessed June 13, 2017.
  18. Raby BA. Personalized medicine. https://www.uptodate.com/contents/search. Accessed June 13, 2017.
  19. Liu T, et al. CDK4/6-dependent activation of DUB3 regulates cancer metastasis through SNAIL1. Nature Communication. 2017;8:13923.
  20. Ingle JN, et al. Genetic polymorphisms in the long noncoding RNA MIR2052HG offer a pharmacogenomics basis for the response of breast cancer patients to aromatase inhibitor therapy. Cancer Research. 2016;76:7012.
  21. Ingle JN, et al. Estrogens and their precursors in postmenopausal women with early breast cancer receiving anastrozole. Steroids. 2015;99:32.
  22. Goetz MP, et al. CYP2D6 metabolism and patient outcome in the Austrian Breast and Colorectal Cancer Study Group trial (ABCSG) 8. Clinical Cancer Research. 2013;19:500.
  23. Goetz MP, et al. First-in-human phase I study of the tamoxifen metabolite Z-endoxifen in women with endocrine-refractory metastatic breast cancer. Journal of Clinical Oncology. In press. Accessed Oct. 17, 2017.
  24. D'Assoro AB, et al. The mitotic kinase Aurora-A promotes distant metastases by inducing epithelial-to-mesenchymal transition in Era(+) breast cancer cells. Oncogene. 2014;33:599.

相关

产品与服务

乳腺癌精准医疗