Editor's note: As one of the most common malignant tumors in the world, the diagnosis and treatment of lung cancer has always been one of the important challenges in the medical community. In recent years, the development of liquid biopsy technology has brought new possibilities for the diagnosis and treatment of lung cancer.
In the fifth issue, Professor Li Gaofeng from Yunnan Cancer Hospital will discuss the application value of ctDNA in the diagnosis and treatment of lung cancer, including its role in early diagnosis, disease monitoring, treatment selection and prognosis assessment, and look forward to its future development to provide more references for doctors and patients.
About the Speaker
Li Gaofeng
Vice President of Yunnan Hospital, Peking University Cancer Hospital (Yunnan Provincial Cancer Hospital, Third Affiliated Hospital of Kunming Medical University).
Doctoral supervisor, postdoctoral cooperative supervisor, second-level professor, chief physician
Yunnan Health Guard, Provincial Association for Science and Technology Outstanding Society Worker
President of Yunnan Translational Medicine Society
Vice Chairman of Yunnan Anti-Cancer Association
Chairman of the Thoracic and Cardiovascular Surgery Branch of Yunnan Medical Association
Chairman of the Minimally Invasive Treatment Committee of Thoracic Tumors of Yunnan Anti-Cancer Association
Executive Director of Yunnan Preventive Medicine Association and Chairman of Lung Cancer Professional Committee
Member of the International Association for the Study of Lung Cancer
He is a member of the Standing Committee of the Mediastinal Tumor Professional Committee of the Chinese Anti-Cancer Association
Member of the Thoracoscopic Surgery Group of the Thoracic and Cardiovascular Surgery Branch of the Chinese Medical Association
Member of the Working Committee of the Medical Consortium of the Chinese Hospital Association
Member of the National Lung Cancer MDT Expert Committee
National outstanding scientific and technological worker, expert enjoying special allowance of the State Council
Winner of the National May Day Labor Medal, Yunnan Provincial Medical Leading Talent, Yunling Famous Doctor
Yunnan Province has outstanding professional and technical personnel with outstanding contributions and experts contacted by the provincial party committee
Wang Shuting
Department of Thoracic Surgery, Yunnan Hospital, Peking University Cancer Hospital (Yunnan Provincial Cancer Hospital, Third Affiliated Hospital of Kunming Medical University).
Ph.D. in Surgery
He is a member of the Chinese Anti-Cancer Association
Phase V: Clinical application of circulating tumor DNA in the diagnosis and treatment of lung cancer
◾ Li Gaofeng, Wang Shuting, Yunnan Provincial Cancer Hospital
As one of the most common malignant tumors in the world, the diagnosis and treatment of lung cancer has always been one of the important challenges in the medical community. In recent years, the development of liquid biopsy technology has brought new possibilities for the diagnosis and treatment of lung cancer. Among them, circulating tumor DNA (ctDNA), as a non-invasive biomarker, has shown great potential in the diagnosis and treatment of lung cancer. In this article, we will discuss the application value of ctDNA in the diagnosis and treatment of lung cancer, including its role in early diagnosis, disease surveillance, treatment selection, and prognosis assessment, and look forward to its future development.
1. Introduction to ctDNA
ctDNA is a fragment of DNA that circulates in body fluids and originates from tumor cells. When tumor cells die, apoptosis, or divide, they release fragments of DNA that can enter the circulatory system. As a result, ctDNA can be detected in body fluids such as blood, saliva, and urine. The ctDNA test can be performed by blood sampling without the need for invasive tissue biopsy, so it is non-invasive and easy to perform. It carries tumor-specific mutations, genetic alterations and other information, and can be used as a biomarker for tumor diagnosis, disease monitoring, treatment selection, and prognosis evaluation. In the diagnosis and treatment of malignant tumors such as lung cancer, the application of ctDNA has attracted more and more attention. By testing ctDNA, doctors can obtain more information about the tumor and help formulate a more individualized and precise treatment plan to improve treatment effectiveness and survival rates.
2. Application of ctDNA in the early diagnosis of lung cancer
Compared with traditional lung cancer diagnosis methods, such as histopathological examination, ctDNA testing has the advantage of being more non-invasive. Genetic information about the tumor can be obtained by simply taking a blood sampling, without the need for surgery or other invasive tests. Because the early symptoms of lung cancer are not obvious, it is often easy to be overlooked, resulting in the detection of lung cancer at an advanced stage. The detection of ctDNA can improve the diagnosis rate of early lung cancer. Even in cases where tumors are small and not easily detected by imaging tests, the presence of tumors can be detected by ctDNA in the blood. ctDNA can also be used as an adjunct to other lung cancer screening methods, such as low-dose CT screening. In cases where CT screening results are inconclusive or misdiagnosed, ctDNA testing can provide additional information to help doctors make a more accurate diagnosis.
For people known to be at high risk of lung cancer, such as smokers or people with a family history of lung cancer, cancer monitoring can be done by regular testing of ctDNA. Once ctDNA is found to be positive, the vigilance for early lung cancer can be increased and further diagnosis and treatment can be carried out in a timely manner. The concentration of ctDNA and the presence of specific gene mutations can reflect the degree of malignancy of the tumor. In early diagnosis, by evaluating the characteristics of ctDNA, it can help determine the biological characteristics of the tumor and provide a reference for the selection of treatment options.
3. Application of ctDNA in the treatment and monitoring of lung cancer
With the development of lung cancer treatment strategies, monitoring response and disease progression is essential to adjust treatment regimens and assess patient outcomes. The concentration of ctDNA and specific gene mutations can reflect the active changes of tumors, evaluate the response of lung cancer patients to treatment, and guide the adjustment of treatment regimens, so as to improve the treatment effect and quality of life of patients. During the treatment of lung cancer, dynamic monitoring of tumors can be achieved by regular testing of ctDNA. If treatment is effective, the concentration of ctDNA decreases or the signal of specific mutations decreases, and the tumor burden decreases; Conversely, if the tumor becomes resistant, relapses, or metastasizes, the concentration of ctDNA increases or new mutations appear. Even in cases where imaging tests can't clearly show changes in the tumor, the test of ctDNA can still provide important information that can help doctors more accurately understand the status of the tumor. In such cases, doctors may consider adjusting the treatment regimen to choose a more appropriate treatment or other treatment strategy.
4. Application of ctDNA in treatment selection
Individualized treatment is one of the important trends in lung cancer treatment, and ctDNA can be used as an auxiliary diagnostic means to help doctors choose the most appropriate treatment plan. By analyzing the mutation information in ctDNA, the genetic characteristics of the tumor can be determined, including the mutations in key oncogenes (such as EGFR, ALK, ROS1, etc.). This mutation information can guide the selection of targeted therapy drugs. As treatment progresses, tumor cells may become resistant to the drug, rendering previously effective treatment options ineffective. ctDNA analysis can monitor the mutations of tumors during treatment and detect signs of treatment resistance in time. This can help to adjust treatment in a timely manner, and more potent regimens or combinations may need to be considered to avoid treatment failure. Patients with lung cancer often have micrometastases, in which tumour cells have metastasized to other sites but have not yet formed visible metastases. Micrometastases are difficult to detect with traditional imaging tests, and the detection of ctDNA can detect these micrometastases earlier, providing an opportunity for timely intervention.
5. Application of ctDNA in prognostic assessment
Prognosis assessment of lung cancer patients is of great significance for the formulation of treatment plans and prediction of survival. As a blood marker, the concentration of ctDNA and the condition of specific gene mutations are closely related to the biological characteristics and prognosis of the tumor, and high levels of ctDNA concentration or specific mutations are often associated with the degree of malignancy and poor prognosis of the tumor. The degree of malignancy of the tumor and the patient's response to treatment can be evaluated by detecting its concentration and mutation, which provides an important reference for clinicians to evaluate the prognosis of patients. Even after surgical removal of the tumor, there may be tiny residual disease or micrometastatic lesions. The detection of ctDNA can help monitor the presence of these micrometastases or residual lesions, detect tumor recurrence early, and take corresponding treatment measures to improve the prognosis and quality of life of patients.
As a new type of biomarker, ctDNA is an important reference index for tumor treatment decision-making and prognosis prediction, and has shown broad application prospects in the diagnosis and treatment of lung cancer. Through the application of early diagnosis, disease monitoring, treatment selection and prognosis evaluation, according to the patient's tumor characteristics and treatment response, it can provide individualized and accurate diagnosis and treatment plan for lung cancer patients, so as to maximize the treatment effect and quality of life. Although ctDNA has shown great potential in the diagnosis and treatment of lung cancer, it still faces many challenges in clinical application. For example, the standardization of technology, the improvement of sensitivity and specificity, and the reduction of costs are all problems that need to be solved urgently. With the advancement of technology and the deepening of clinical practice, ctDNA will gradually be more widely recognized and applied in the clinical diagnosis and treatment of lung cancer, bringing more hope to patients.
Editor-in-Chief's comments
Early detection of lung cancer is essential to improve the survival rate of patients. Since ctDNA can detect the presence of tumors at an early stage, it can improve the diagnostic rate of early-stage lung cancer. Especially for patients who cannot undergo surgery or other invasive tests, ctDNA has important clinical significance as a non-invasive assay. In addition, the dynamic monitoring of ctDNA can realize real-time monitoring of tumor status during treatment, including tumor burden, treatment response and disease progression, so as to guide doctors to adjust the treatment plan, improve the treatment effect, and ultimately improve the survival prognosis and quality of life of patients.
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