Expert Review of Precision Medicine and Drug Development最新文献

{"title":"Deep sequencing as an approach to understanding the complexity and improving the treatment of multiple myeloma","authors":"Louis Williams, J. Caro, B. Razzo, E. Boyle, G. Morgan","doi":"10.1080/23808993.2020.1792285","DOIUrl":"https://doi.org/10.1080/23808993.2020.1792285","url":null,"abstract":"ABSTRACT Introduction Multiple myeloma (MM) is plasma cell dyscrasia with marked variability in its clinical presentation and outcome, both of which are dictated by its underlying genetics. Next-generation sequencing techniques (NGS) have become essential to understanding the genomics of multiple myeloma. The exploitation of these advances in the clinic will require new clinical trial designs with endpoints that facilitate rapid readouts of success or failure and capture the impact of rare mutational events on outcomes. An understanding of NGS and its applications in multiple myeloma is therefore significant for both researchers and clinicians alike. Areas covered In this review, we summarize the significant advances that NGS has yielded in our understanding of the prognosis, clonal evolution, treatment and response assessment of multiple myeloma and its precursor conditions. We synthesize the relevant literature related to both genomics and the clinical management of MM, with articles selected based on our experience in the field. Expert opinion In the opinion of these authors, NGS will play a significant role in the future of precision medicine in multiple myeloma, especially as disease-specific panels and response adapted approaches to therapy gain traction. In the process, challenges related to cost, quality control, and standardization will need to be overcome.","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1792285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49370900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pharmacogenetics of tacrolimus and its implications for personalized therapy in kidney transplant recipients","authors":"M. Francke, B. D. de Winter, L. Elens, N. Lloberas, D. Hesselink","doi":"10.1080/23808993.2020.1776107","DOIUrl":"https://doi.org/10.1080/23808993.2020.1776107","url":null,"abstract":"Twenty-five years after its approval by the FDA and EMA, tacrolimus remains the cornerstone of immunosuppressive treatment following solid organ transplantation [1,2]. The drug is highly effective ...","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1776107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45737291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating central nervous system lymphoma in the era of precision medicine","authors":"Y. Garcilazo-Reyes, M. Ibañez-Juliá, I. Hernández-Verdin, L. Nguyen-Them, N. Younan, C. Houillier, K. Hoang-Xuan, A. Alentorn","doi":"10.1080/23808993.2020.1777853","DOIUrl":"https://doi.org/10.1080/23808993.2020.1777853","url":null,"abstract":"ABSTRACT Introduction Primary central nervous system lymphoma (PCNSL) is a rare extra-nodal non-Hodgkin lymphoma that in the vast majority of cases belongs to diffuse large B-cell lymphoma (DLBCL) histology. The standard first-line treatment is based on high-dose methotrexate (HD-MTX) regimens. However, the majority of patients will relapse, leading to a poor prognosis of the disease. Areas covered Reviewed are the potential new therapeutic approaches in PCNSL. With the advent of tailored treatment, immunomodulators and immunotherapies are appearing as new promising therapeutic approaches for this orphan disease. This review seeks to summarize the novel approaches currently under evaluation. Expert opinion The therapeutic management of PCNSL is rapidly evolving with the description of PCNSL molecular alterations. However, due to the rarity of this disease, phase III clinical trials using new therapeutic drugs are still lacking. In addition, the vast majority of newly diagnosed PCNSL affect elderly patients, and specific and adapted clinical trials for this fragile population are warranted. Currently, the use of targeted therapies or immune-mediated treatments is only studied in relapsed/refractory (R/R) PCNSL, but the use of these approaches as a first-line treatment (compared with HD-MTX) could also be used as new promising approaches to decrease the toxicity associated with MTX regimens.","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1777853","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44387843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The outlook for precision medicine for the treatment of chronic hepatitis C infection: challenges and opportunities","authors":"M. Frías, A. Rivero-Juarez, I. Machuca, Á. Camacho, A. Rivero","doi":"10.1080/23808993.2020.1764346","DOIUrl":"https://doi.org/10.1080/23808993.2020.1764346","url":null,"abstract":"ABSTRACT Introduction This review focuses on the milestones and challenges of precision medicine in the natural history of HCV infection. Areas covered The manuscript summarizes the genetic and viral factors identified as predictive of outcome in HCV patients and discusses opportunities for a precision medicine approach to the management of patients with HCV infection. Special emphasis will be placed on the factors associated with response to treatment as well as other factors that can help the clinician in the management of patients after sustained virological response. Expert opinion The establishment of DAAs in recent years has led to a paradigmatic change in the natural history of hepatitis C virus infection. However, there are still challenges that precision medicine must solve, especially in the management of patients at high risk of liver complications after sustained virological response.","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1764346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43337561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotyping severe asthma: a rationale for biologic therapy","authors":"A. Vatrella, A. Maglio, S. Pellegrino, C. Pelaia, C. Stellato, G. Pelaia, C. Vitale","doi":"10.1080/23808993.2020.1776106","DOIUrl":"https://doi.org/10.1080/23808993.2020.1776106","url":null,"abstract":"ABSTRACT Introduction Asthma is a complex disease with heterogeneity in etiology, triggers, clinical characteristics and different responses to pharmacological therapies. Areas covered Patients with severe uncontrolled asthma constitute a relatively small percentage, ranging from 5 to 10% of all asthmatics. These patients can benefit from targeted biological therapies developed in recent years. In fact, a better understanding of the etiopathological mechanisms of different phenotypes and endotypes of severe asthma have led to the availability of innovative biological therapies, able to modify the natural history of the disease by targeting molecules involved in airway inflammation. Several phenotypes based on clinical and physiologic variables and on inflammatory markers have been reported. Expert opinion The priority is to define the molecular process underlying the disease. In this context the recognition of T2 and non T2 inflammatory pathways, so called molecular phenotypes, represents the most reliable approach to drive the use of novel biological therapies. For this purpose, several biomarkers have been validated for identifying severe asthma phenotypes and for guiding the choice of the most appropriate treatment. The purpose of this review is to discuss the current knowledge about the molecular phenotypes of severe asthma, as well as the rationale underlying the use of existing biological drugs.","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1776106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44896154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The emerging role of precision medicine in the treatment of ovarian cancer","authors":"G. Santangelo, G. Caruso, I. Palaia, F. Tomao, G. Perniola, V. Di Donato, M. Fischetti, L. Muzii, P. Benedetti Panici","doi":"10.1080/23808993.2020.1777854","DOIUrl":"https://doi.org/10.1080/23808993.2020.1777854","url":null,"abstract":"ABSTRACT Introduction Ovarian cancer is the primary cause of gynecologic cancer death in women worldwide and it is generally diagnosed at an advanced stage. Although the current standard treatment based on extensive cytoreductive surgery and systemic chemotherapy results in a high complete remission rate, recurrences are extremely frequent and exhibit progressive chemotherapy resistance, thus posing a difficult clinical challenge. Areas covered In the era of precision medicine, the increasing knowledge of cancer genomics, proteomics, and immune milieu facilitated the development of new targeted therapies (e.g. antiangiogenic drugs, PARP inhibitors, immunotherapy, folate receptor inhibitors, growth factor signaling inhibitors), that could improve ovarian cancer paradigm of care. Expert opinion In this review article, we discuss recent advances in the management of ovarian cancer, highlighting the need for a modern, personalized, and multi-disciplinary approach and for new predictive biological markers that will allow to choose the best therapeutic option between chemotherapy, molecular targeted agents, and immunotherapy for each patient. In the future, modern combinations of targeted therapies will open new chances for ovarian cancer patients. The main goal is to turn an aggressive disease eventually into a manageable chronic condition.","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1777854","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42610334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic models to help predict patient responses to intravesical immunotherapy","authors":"E. Laukhtina, D. D’andrea, B. Pradère, D. Enikeev, M. Abufaraj, S. Shariat","doi":"10.1080/23808993.2020.1768845","DOIUrl":"https://doi.org/10.1080/23808993.2020.1768845","url":null,"abstract":"ABSTRACT Introduction Approximately 30–60% of patients treated with Bacillus Calmette-Guérin (BCG) for non-muscle invasive bladder cancer (NMIBC) eventually experience disease recurrence within 2 years. Parsimonious use of BCG and accurate identification of those patients who might benefit from this therapy is of paramount importance in order to avoid BCG wastage, improve patient counseling regarding alternative therapy, patient’s survival and quality of life. We summarized the current literature on predictive and prognostic models on intravesical BCG therapy for NMIBC. Areas covered Clinicopathologic features are the strongest predictors of BCG response. In addition, several tissue, serum and urinary biomarkers have been investigated. However, they have not been shown to be robust enough to be implemented in daily clinical routine. Therefore, genetic and epigenetic markers and features of the tumor microenvironment have been investigated. The relationship between Th1 and Th2 microenvironments, as well as its related serum and urine biomarkers, was shown to play an important role in prediction of response to BCG treatment. Expert opinion No single tumor biomarker has been shown to be robust enough to change clinical decision making. Discoveries in the genetic signature profile of bladder cancer and immunological pathways represent the new frontiers in biomarker discovery and possible improvement in patient selection in the era of personalized medicine.","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1768845","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41655368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacogenetic considerations in antiplatelet therapy","authors":"P. Gurbel, A. Rout, U. Tantry","doi":"10.1080/23808993.2020.1768844","DOIUrl":"https://doi.org/10.1080/23808993.2020.1768844","url":null,"abstract":"Oral antiplatelet therapy with aspirin and a P2Y12 receptor blocker constitutes a major strategy to prevent thrombotic events in patients with arterial diseases. Among available P2Y12 receptor blockers, ticagrelor is a potent direct-acting drug, whereas clopidogrel and prasugrel (thienopyridines) are prodrugs that require cytochrome (CYP) P450 based in vivo conversion to an active metabolite to irreversibly inhibit the P2Y12 receptor. Wide antiplatelet response variability was observed during clopidogrel treatment, with nearly one in three subjects exhibiting minimal or no inhibition of adenosine diphosphate-induced platelet aggregation. The latter phenomenon is termed clopidogrel non-responsiveness or resistance [1,2]. Despite these limitations and guideline recommendations for the preference of ticagrelor or prasugrel, clopidogrel remains the most used P2Y12 inhibitor in the current practice even in patients with acute coronary syndromes (ACS) [3–5]. Pharmacogenetics associated with P2Y12 receptor blocker therapy, especially clopidogrel, their clinical implications and potential utility of personalized antiplatelet therapy based on genetic testing are discussed here. Pharmacokinetic and pharmacodynamic studies have revealed that variable active metabolite generation is associated with clopidogrel response variability. The latter, in part, is affected by carriage of single nucleotide polymorphism (SNPs) of genes encoding CYPs that are responsible for clopidogrel metabolism. Among > 30 CYP2C19 alleles, CYP2C19 * 1, with normal activity, is the most prevalent allele. Carriage of a loss-of function allele (LoF) is associated with reduced clopidogrel active metabolite generation. In subjects with CYP2C19*2, the most common LoF, a guanine>adenine mutation in exon 5 of CYP2C19 (rs42442850) creates an aberrant splice site resulting in an altered reading frame at amino acid 215 and a premature stop codon 20 amino acids downstream. The final result is a nonfunctional truncated protein, lack of translation resulting from nonsense-mediated messenger RNA decay, or both. Other LoFs are *3-*8. LoF carriage is estimated at ~25%, ~33% and ~55% in Caucasians, African Americans and Asians, respectively. Carriage of a gain-of-function allele (GoF) (CYP2C19*17) is associated with increased clopidogrel active metabolite generation. Carriage of GoF is ~34%, 30% and 4% in Caucasians, African Americans and Asians, respectively [2]. In patients treated with clopidogrel, LoF allele carriage is associated with a reduced antiplatelet response, an increased prevalence of high platelet reactivity to ADP (HPR), and an increased risk for post-stenting ischemic event occurrence, including stent thrombosis. The relation between GoF allele carriage and clinical outcomes is less robust. The association between SNPs of paroxonase-1(PON-1) and ABCB1, clopidogrel metabolism, and clinical outcomes remains controversial [2]. CYP2C19 isoenzyme is not the only factor determining the anti","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1768844","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43858184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized approaches for the management of glaucoma","authors":"S. Balendra, Piero Zollet, Gloria Cisa Asinari Di Gresy E Casasca, M. Cordeiro","doi":"10.1080/23808993.2020.1756770","DOIUrl":"https://doi.org/10.1080/23808993.2020.1756770","url":null,"abstract":"ABSTRACT Introduction Personalized medicine is the future goal across all specialties. Accurate prediction of optimal treatment beneficial and adverse effects could transform patient management. This is of particular importance in chronic conditions, where a ‘trial and error’ approach over months and years can contribute to significant morbidity. Glaucoma is a chronic irreversible progressive optic neuropathy, a leading cause of blindness worldwide. An ideal personalized approach in glaucoma clinic would be to answer the inevitable question in a patient’s first visit: ‘Which treatment option will work best for me so that I won’t go blind?’ Areas covered This review will give an overview of the knowledge we have acquired to achieve this goal, particularly discussing using patient’s individual risk factors, their genetic profile, and different treatment modalities, including therapy compliance, to personalize care. Expert opinion Pharmacogenomics and genetic profiling are the most tangible ways in which glaucoma management can be personalized. Future challenges will include developing realistic animal models to reflect the underlying genetic patterns in glaucoma to investigate their interaction with different treatments.","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1756770","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41518431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can bioinformatics contribute to the routine application of personalized precision medicine?","authors":"C. Carretero-Puche, Santiago García-Martín, R. García-Carbonero, G. Gómez-López, F. Al-Shahrour","doi":"10.1080/23808993.2020.1758062","DOIUrl":"https://doi.org/10.1080/23808993.2020.1758062","url":null,"abstract":"The last few years have witnessed the emergence of personalized precision medicine (PPM), a novel approach to improve clinical decisions, integrating individual multi-omic profiles, and heterogeneo...","PeriodicalId":12124,"journal":{"name":"Expert Review of Precision Medicine and Drug Development","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2020-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/23808993.2020.1758062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44286489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}