Release date: 2016-01-14 In recent years, epigenetics is turning people's attention to a new and exciting scene! It plays an important role in many fields such as tumor formation and treatment, stem cell differentiation, etc. The development of oncology drugs using epigenetics has also become a hot topic. In addition, the arrival of the era of precision medicine has enabled more scientists to make unremitting efforts to benefit more cancer patients. During the 2015 CSCO Annual Meeting, CCMTV-Clinical Channel "Super Access" program invited Professor Jiang Zefei from the Affiliated Hospital of Academy of Military Medical Sciences, Professor Zhu Jun from Peking University Cancer Hospital, and Dr. Lu Xianping from Shenzhen Microcore Biotechnology Co., Ltd. for "diagnosis of tumors" The revolution 'from precision medicine to epigenetics' has been a wonderful topic. Guest host: Professor Jiang Zefei, Affiliated Hospital of Academy of Military Medical Sciences Interview guests: Professor Zhu Jun, Peking University Cancer Hospital Dr. Lu Xianping, Shenzhen Weixin Biotechnology Co., Ltd. Accurate medicine interprets "different diseases from the same path" from the genetic level The traditional Chinese medicine treatment under the guidance of syndrome differentiation and treatment has the phenomenon of "different diseases and the same treatment". Western medicine has different tumors in the treatment of tumors because of the same genotyping, and the same treatment plan is selected, and there are also cases of "different diseases and the same treatment". There is a commonality between the "testimony" of TCM "different disease and the same treatment" and the genes for individualized treatment of different tumors. In the relationship between precision medicine and individual treatment and "different treatment of different diseases," three experts elaborated their views. Professor Jiang Zefei: The same disease and different treatments are the origin of precision medicine. Precision medicine is a direction based on individualized medicine, but it is still an ideal and dream for cancer treatment. We still have a long way to go. Need to go. Professor Zhu Jun said: "With the advancement of medical development, the treatment of lymphoma has also emerged in recent years. Some new drugs have emerged in recent years, especially in the past two years. The concept of precision medicine has made us look forward to the development of new drugs. But from a From the perspective of physicians, I believe that precision medicine is still a dream for us. We still have a long way to go to realize this dream. Scientists, drug development experts and clinicians who need our basic research are slowly looking for cooperation. It is unlikely To achieve this goal in the short term. We hope that our clinicians will be calm and sensible to find a point where precision medicine and patients can bring the greatest benefit to patients, both in terms of benefits and valence." Dr. Lu Xianping: In 1971, when the US President Nixon signed the National Cancer Act, humanity officially declared war on cancer, but after so many years, it is clear that we did not win in this battle. In fact, so far, basic biomedical research has made great progress. We already know that tumors are heterogeneous. Many types of tumors have both genetic and biological mutations. This is what we say. mutation. Apparent mutations are associated with tumor resistance, metastasis, and recurrence. Therefore, in this sense, if we block the pathway of this mutation in heterogeneous tumors, it will bring the greatest benefit to patients, which is the meaning of precision medicine that I understand. From the perspective of epigenetics, the relationship between precision medicine and individualized medicine, targeted therapy Individualized treatment addresses tumor heterogeneity, which is the genetic instability of the tumor and environmental factors leading to molecular diversity. In the era of precision medicine, what is the relationship between epigenetics, precision medicine, individualized medicine, and targeted therapy? Professor Zhu Jun: From my point of view, individualized medicine and precision medicine are very similar, that is, we find the most suitable treatment for each disease and every patient. This method needs to consider economic conditions from a wide range. Many factors, such as cultural background; from a disease point of view, we can't simply know which type of lymphoma, for example, belongs to which type of lymphoma, and which aspects of lymphoma change. We now have such "weapons" that we can personalize "cutting" treatments and work in a precise direction. Professor Jiang Zefei: From the epigenetics of targeted therapy, I personally understand that for example, CD20 treatment of lymphoma, trastuzumab treatment of breast cancer is the beginning of personalized medicine, but it can not be said to be completely accurate medicine. I understand that precision medicine is not a medicine to test, but to know more targets in the initial treatment and then choose which path to take. There are too many tumor pathways, we must be careful. Dr. Lu Xianping: In fact, there is a commonality between the treatment of different diseases and precision medicine. Epigenetic mutations are directly related to the malignancy and long-term survival of the disease prognosis. If we block it, most patients can achieve better therapeutic effects. Sidabenamine overcomes the background of relapsed and refractory peripheral T-cell lymphoma When talking about the first indication for the selection of T-cell lymphoma as the clinical entry of sidabenamine, Dr. Lu Xianping said that 12 years ago we first discovered that sidaben has three characteristics: first it Directly inhibits blood and lymphoid tumor cell cycle and induce apoptosis; second induces and activates natural killer (NK) and antigen-specific cytotoxic T cell (CTL)-mediated tumor killing, and anti-tumor cell immunity It has an overall regulatory activity; the third through the epigenetic regulation mechanism, induces tumor stem cell differentiation, reverses the epithelial mesenchymal phenotypic transformation (EMT) of tumor cells, and further restores drug sensitivity and inhibition of drug-resistant tumor cells. The potential role of tumor metastasis, recurrence, etc., these three biological characteristics are not available to any other tumor treatment drugs 12 years ago. Based on this reason, in clinical stage I, we found that the use of citabenamine can stabilize the effect of many solid tumors. Individual tumors such as the jaw adenocarcinoma will also achieve objective relief, but it is particularly good for lymphoma. The efficacy made us choose it first. More importantly, T-cell lymphoma is drug-free at the time and is the fastest way to be approved from a business perspective. Professor Zhu Jun talked about the clinical experience and thoughts of sidabenamine. T-cell lymphoma is a disease in China and Asia higher than in Western countries. There is no standard first-line treatment plan, and the curative effect is relatively poor. Sidabenamine is the first choice for testing, which is a question of choice of direction and path. However, it is clear that the indications for sidabenamine will not stop at T-cell lymphoma. We have already started some other types of lymphoma and some spike tests or expanded trials of solid tumors including lung cancer and breast cancer. I believe there will be very good result. Precision Medicine "Basket Program" The research method of the basket plan is to treat different diseases. Different tumors with the same gene target are given the same treatment, and the same drug is used to treat the target of the basket plan as long as the same gene target is present. Dr. Lu Xianping hopes to define what kind of tumors have epigenetic variations and mutations in a precise way, which is the support for providing the first layer of imperial examinations. He said that sidabenamine will undergo ongoing clinical research in lung cancer, adenocarcinoma, breast cancer and gastric cancer. A good medicine must have been through clinical research. For us, it must be based on the scientific evidence already available. On this basis, we also need clinicians to listen more to our scientific thinking and then turn the research into a more precise treatment. Tumors are complex and variable, and it is impossible to have all the effects of a single pathway. At present, everyone has recognized the importance of epigenetics in the treatment of cancer. As companies and products, we are also committed to more precise "targeting" these pathways. Professor Zhu Jun said that in addition to the indications for relapsed or refractory peripheral T-cell lymphoma, the indications for other diseases require further clinical research and observation, and it is determined that it is suitable for Sidaben among many tumors. The type of amine tumor. We have now gained clinical recognition for T-cell lymphoma and are actively working to promote clinical applications in a variety of diffuse large B-cell lymphomas. Diffuse large B-cell lymphoma is a highly heterogeneous tumor, and our research hopes to distinguish it on specific signaling pathways. Professor Jiang Zefei: When we talk about the precision medicine basket plan and the umbrella plan, the research method of the basket plan is to treat the same disease, that is, different tumors with the same gene target give the same treatment, as long as they have the same gene target. Treated with the same drug. The umbrella-like plan is to treat the same disease, that is, to classify different gene targets contained in the same tumor, and to treat different tumors containing different genes. Therefore, in the "basket" and "umbrella", what needs precision medicine, individualized medicine and epigenetics to go deep into research, thinking and experimentation. 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