各个时期的特色技术发展都会促进精准医疗迈向新的高度,也代表了精准医疗的发展趋势。比如19世纪的细胞病理学(IHC等)、21世纪的分子病理学(NGS等)以及2022年兴起的空间病理学(mIHC/IF等)。
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▲ 精准医疗过去与未来 NGS,Next Generation Sequencing,下一代测序;NGP,Next Generation Pathology,下一代病理。
空间病理学也可以称为下一代病理学(NGP),代表了精准医疗的发展趋势。多重荧光免疫组化(mIHC)/多重免疫荧光(mIF)作为下一代病理学的典型代表技术,在学术界和工业界受到广泛关注,也是临床最能落地的下一代病理学技术之一。 近日,华大智造推出的“NGS+mIF”多组学分析仪MGISEQ-2000RS FluoXpert和阔然生物推出的“NGS+mIHC”多组学一体化临床解决方案,均意味着“NGS+NGP”才是精准医疗发展新风向。1,2 此前,《Nature Medicine》文章公开报道,尽管TMB,MSI和PD-L1表达是公认的免疫治疗生物标志物,但它们并不完美,一些PD-L1阴性的患者仍可获益于免疫治疗。3 在《JAMA Oncology》上的一篇文章亦报道,mIHC/IF相较于PD-L1单标IHC、TMB和GEP能够更精准地预测免疫治疗反应。4 这些都意味着传统“NGS+PD-L1”组合应向“NGS+NGP”方向转变。 
▲ mIHC/IF预测免疫治疗反应更精准
mIHC/IF是一种较为先进的伴随诊断技术,可在一张组织切片上对多个生物标志物进行标记(包括PD-L1),全景展示肿瘤免疫微环境以及细胞间原位空间信息,精准指导患者免疫治疗。目前,美国国家癌症研究所(NCI)已将mIHC/IF技术纳入肿瘤免疫疗法临床试验指南(CIMAC-CIDC),全球众多顶尖药企已积极采用此技术,以推动创新疗法和伴随诊断产品的研发进程。5
▼ 图说NGS+NGP引领精准医疗发展新风向! (通俗易懂) 
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参考资料:
1.https://mp.weixin.qq.com/s/LWG3S-gUteoyxBgA8ZvMtg 2.https://mp.weixin.qq.com/s/Omj_jFwGfxG60t4aufrVxw 3.Cancer immunotherapy: the quest for better biomarkers. Nat Med 28, 2437 (2022). 4.Lu S, Stein JE, Rimm DL, Wang DW, Bell JM, Johnson DB, Sosman JA, Schalper KA, Anders RA, Wang H, Hoyt C, Pardoll DM, Danilova L, Taube JM. Comparison of Biomarker Modalities for Predicting Response to PD-1/PD-L1 Checkpoint Blockade: A Systematic Review and Meta-analysis. JAMA Oncol. 2019 Aug 1;5(8):1195-1204. 5.https://dctd.cancer.gov/ResearchNetworks/cimacs_cidc_network.htm
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