Cancer Genomics: The Road Ahead
نویسندگان
چکیده
Voltaire, after suffering an attack of smallpox, wrote in a letter to Baron de Breteuil, ‘‘.the diseases that afflict us are as different as the features on our faces’’ (1723). Systematic sequencing of cancer genomes in the last 5 years has unmasked the countless faces of cancer, laying bare the uniqueness of each patient’s tumor; in its cancer genes, its mutational processes, its clonal architecture. And yet, as Voltaire hints, we have known this— we have known the unpredictability of cancer outcomes in the clinic, the fact that two patients can have apparently identical cancers by every clinical measure and yet one die, one live. To understand clinical variability, wemust embrace the heterogeneity of cancer genomes. In their complexity lie the myriad causative mutations, each defining cellular behaviors that in toto dictate a cancer’s path. Histology, metastasis, treatment response, drug resistance—all are encoded in the cancer genome but in such intricacy that robustly decoding them requires sample sizes beyond those completed thus far. We must match cancer genomes to patients’ clinical outcomes on a massive scale. We should start with clinical trials, but explore the systematic collation of genomic and clinical data from routine hospital care as sequencing enters the clinic. As theGlobal Alliance intends, we should openly discuss the ethical challenges, the clinical descriptors, the database infrastructure, the quality assurance that such an endeavor entails. With a knowledge bank of a million patients or more, cancer’s many faces might become touchable. What’s Missing?
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ورودعنوان ژورنال:
- Cell
دوره 155 شماره
صفحات -
تاریخ انتشار 2013