Professor Lu Wei, Department of Oncology, Department of Thoracic Hospital, Shanghai Jiaotong University
Hu Xueyan, "The doctor told me that in this case, I suggest that you try to take targeted drugs. I bought a certain medicine for a month. As a result, the tumor has not been controlled, and it continues to grow up. Professor Lu, is it not? I am not suitable for targeted drugs? Professor Lu Wei, director of the Department of Oncology, Shanghai Chest Hospital, Shanghai Jiaotong University (Shanghai Lung Cancer Clinical Medical Center) often encounters such patients in the clinic, which makes him very helpless. "How can a targeted drug be tried? For example, a lung cancer patient with ALK mutations does not benefit from the use of EGFR targeted drugs, and there is some toxicity." Lu said that in the past 10 years, humans have The research in the field of lung cancer is the fastest growing in the field of solid tumors. The treatment of lung cancer has entered the era of precision medicine . Only by implementing the normative and precise concept to treat lung cancer can patients benefit to the greatest extent.
Tumor treatment should be detected first and then treated. "We have enough evidence to tell patients that the treatment of tumors should be treated first and then after treatment." Lu Yan told the author, "Based on imaging, the era of treating lung cancer with CT and PET-CT films has ended. Today's precision medicine is based on the molecular characteristics of each tumor patient. It can accurately tell us what can be used and what can't. Through testing, we can understand that patients have different types of lung cancer, What is pathologically positive, what are the genetic mutations, and how the immune characteristics are... so that the patient can be tailored to his treatment plan. So I must first tell the patient that you have to accept a concept: precision medicine is based on testing. There is no precise medical treatment without detection.†The accurate medical treatment in Lushaokou refers to the precise detection of the cause of the disease and the target of treatment through various medical detection techniques, so as to carry out targeted treatment and use precise drugs to improve the disease. The benefits of diagnosis and treatment. Accurate medical care is actually carried out in all aspects of diagnosis, testing, treatment and so on.
"At present, in China's big cities, for advanced lung cancer, targeted therapy is already mainstream, and acceptance is very high." Lu Wei told the author that targeted therapy is part of precision medicine and is the key to clearing the door of precision medicine. He pointed out that lung cancer is a group of diseases, not a disease. Different types of lung cancer treatment programs are different. The treatment of lung cancer must be based on molecular typing and staging. For non-small cell lung cancer, the molecular targets of the two most mature types of targeted therapies are EGFR and ALK. Therefore, genetic testing is also mainly done EGFR and ALK. "The reason is very simple, there are medicines." Lu Hao also pointed out that different types of genes, the choice of drugs, treatment methods are completely different. We recommend that patients have at least simultaneous detection of EGFR and ALK, giving patients informed choice. The methods of EGFR detection include PCR, sequencing, etc. Alk's current routine detection methods include Ventana, Fish, PCR, etc., and they are relatively economical. And such testing can be done directly in the hospital.
In the records of more than 5,000 patients with lung cancer led by Lu Wei, there were 2110 patients with non-small cell lung cancer, of which 45% belonged to the EGFR mutation, 8.25% of the ALK mutation, higher than the average, and the second biopsy The proportion has also reached about 40%. He believes that genetic testing should be done before the patient begins treatment, that is, at the stage of diagnosis, and a second biopsy is performed when the condition progresses.
Human life science has two foundations, the discovery of DNA double helix structure and the research of gene sequencing technology. The breakthrough of precision medical care in the future must be based on the molecular characteristics associated with disease and big data. At present, the academic community is beginning to realize that we need to do more detection of biomarkers related to precision medicine. Not only targeted therapies, but also a wider range of possible tests. Perhaps after the failure of targeted therapy, more resistance tests, tissue tests, liquid biopsies, etc., are used to observe changes in the disease, and even include the detection of immune markers such as PD1 and PDL1. â€
However, precision medicine cannot be equated with genetic testing. Genetic testing must be consistent with medical ethics and a confidential approach to the detected data. "We only do lung cancer-related genetic testing for lung cancer patients." In terms of specific classification, 100% of patients with adenocarcinoma are currently tested, while only about 50% of patients with squamous cell carcinoma need to be tested.
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