From scientific research to clinical practice, precision medicine is effective

Medical Network November 28, the World Health Organization's latest global cancer data show that in 2018, there were 18.1 million new cancer patients worldwide, because the number of cancer deaths was 9.6 million. The number of new cases in China is 3.804 million, accounting for more than 20% of the total number of new cancers in the world. The situation of prevention and control is not optimistic. Recently, it was sponsored by Tianjin Cancer Hospital, China Anti-Cancer Association, US-China Anti-Cancer Association, American Moffett Cancer Center, MD Anderson Cancer Center of the University of Texas, and the University of Nebraska Medical Center. The 3rd International Conference on Tumor-Transforming Medicine was held in Tianjin. Wang Ping, president of the conference and president of Tianjin Cancer Hospital, pointed out at the meeting that at present, China's cancer treatment has gradually entered the era of precision medicine, and the diagnosis and treatment technology has made great progress. Basic medical research has also achieved important developments, but there are still some shortcomings in translating research results into clinical applications. There is still a certain gap between the treatment effects and the international advanced level.

Building a big data center to accelerate the transformation of scientific research achievements

It is understood that translational medicine is the key research direction in the medical field in the past 10 years. Its purpose is to break the barrier between basic research and clinical diagnosis, technological innovation and drug development, and shorten the process from theoretical experiment to clinical guidance so that patients can enjoy it as soon as possible. To the latest scientific research results, the ultimate realization of precision medicine.

"Building a big data center can accelerate the transformation of scientific research results." Wang Ping said that today's cancer diagnosis and treatment has entered the era of precision medicine based on individual genomics characteristics, environment and living habits to intervene and treat, to achieve accurate cancer treatment, relying on massive Construction of a clinical data platform for cancer.

Wang Ping said that China is a country with a large population and a country with high incidence of cancer. The number of cancer patients accounts for about one-fifth of the world. No matter the number of cases or the diversity of diseases, it is uniquely suited to the development of precision medical big data research platforms. Advantage. In 2016, Tianjin Cancer Hospital took the lead in establishing the first “Big Precision Medical Data Center” in China, and began to build a clinical and omics big data platform covering the common malignant tumors in China. Under the mechanism of integration and sharing of clinical big data and biological sample data, it provides powerful resources and technical support for the development of tumor precision medicine.

According to Chen Kexin, deputy director of the Tianjin Cancer Hospital, the center relies on a high-quality tumor biological sample library covering 20 common malignant tumors, collecting more than 55,000 tissue samples and more than 80,000 blood samples. It is now beginning to see scale. In terms of clinical data, it has broken the “island” phenomenon in which medical information, test diagnosis, treatment plan and other information are stored independently and difficult to share. The medical record information is integrated and integrated according to the time axis, and the international standard is established and the collection is 2.2 million. Clinical data center for patient data; in genomics, the complete exome sequencing of tissue samples from more than 500 cases of lung, kidney, and liver cancer was initially completed. It is expected to be officially online and docked at the beginning of next year; On the other hand, the first cases of more than 10 diseases associated with the sample were followed up after discharge. More than 20,000 cases of the first batch of pilot projects were completed. In the future, retrospective survival analysis can be used to provide a corresponding model for tumor treatment and drug use. in accordance with.

Early diagnosis and early treatment to fight against cancer

Because the early symptoms of the tumor are not obvious, most patients are in advanced stage at the time of treatment, and miss the best time for treatment. Chen Kexin said that in the era of precision medicine, the cancer prevention and control strategy is more advocating the advancement of the barrier, and more and more attention to the early diagnosis and early warning and early warning of the disease. Targeted screening for cancer is an effective way to help early warning of cancer.

“Taking the highest incidence of lung cancer in China as an example, if the early detection and standardized treatment can be achieved, the 5-year survival rate of the patient can reach more than 90%, but about 70% of the patients in the clinic are already in the middle and late stage. I missed the best time for surgery." Chen Kexin said that with the development of screening work and people's awareness of cancer prevention, the discovery rate of early lung cancer has been greatly improved. Nearly 60% of patients admitted to hospitals today are lung cancer. Early patients.

Xu Bo, deputy dean of the Tianjin Cancer Hospital, also said that women with high-risk breast cancer are also the same. As early as the 1960s, developed countries in Europe and the United States had carried out large-scale molybdenum target screening for breast cancer. The prevention and treatment of breast cancer in Asia started late and is still in the exploratory stage. There is still no breast cancer screening guarantee mechanism for the general public. China is a country with a large population, and the distribution of medical resources is still uneven. There are still some shortcomings in the early diagnosis and treatment of malignant tumors. It is reported that the detection rate of stage I in early stage breast cancer in China is only 20% to 25%, while that in developed countries such as Europe and America is close to 80%. "In the early stage of standardized diagnosis and treatment, the 5-year survival rate can reach 95%, and the stage II patients can reach more than 70%. It can be seen that early screening is of great significance for cancer prevention and treatment." Xu Bo pointed out.

　　 "Classification and treatment" to promote accurate diagnosis and treatment of cancer

At present, the tumors show a trend of precision and individualization in terms of diagnostic classification and treatment strategies. Due to different gene types, the characteristics of tumors in China have their own characteristics compared with those in Western countries. The treatment plan should not adopt a uniform pattern of uniformity, but should emphasize the coordinated development of multidisciplinary.

Taking radiotherapy as an example, the precise treatment of individualized radiotherapy under the guidance of molecular biology has become a new trend in the development of tumor radiotherapy. Radiation therapy is moving from physical precision to biological precision. Wang Ping introduced that the original emphasis on individualized radiotherapy is mainly based on the patient's physical condition, lesion size, location, pathological type to develop treatment plans, but now more emphasis on the integration of molecular biology information, combined with gene phenotype, molecular biomarker values Comprehensive consideration of factors such as radiosensitivity, tumor heterogeneity, and patient injury to develop a precise treatment plan.

Xu Bo also stressed that under the guidance of molecular biology, the precise diagnosis and treatment of tumors at home and abroad have placed more emphasis on “typing and treating”. Taking breast cancer as an example, precise diagnosis and treatment presents the following three trends:

In terms of detection, with the advancement of medicine and technology, the diagnosis and classification of breast cancer will be classified from the disease phenotype into the molecular typing stage;

In terms of treatment, based on the promotion and popularization of accurate classification of adenocarcinoma and molecular targeted therapy, the treatment of breast cancer has gradually evolved from the past experience-based treatment to the comprehensive treatment under the premise of precise and individualized;

In terms of the quality of life of patients, with the maturity of breast-conserving and breast-reforming technologies and the emergence of new targeted drugs, surgical methods, radiotherapy and chemotherapy regimens, endocrine therapy, and lymph node dissection have all been selected from the past. Tolerance "turns to "minimum treatable". This move makes treatment not only limited to survival, but also focuses on improving the quality of life of patients under the premise of standardized diagnosis and treatment of diseases.