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- W2000429411 abstract "Les sarcomes des tissus mous (STM) sont un ensemble de tumeurs très hétérogènes présentant de nombreux sous-types histologiques. Le développement de la biologie moléculaire a permis d’identifier des anomalies moléculaires récurrentes dans certains sous-groupes de sarcomes, pouvant représenter des outils diagnostiques, pronostiques et thérapeutiques. La classification moléculaire des STM retient 5 grands types d’anomalies : les sarcomes dits « à génétique simple » porteurs de (1) translocation réciproque, (2) mutation activatrice, (3) mutation inhibitrice ou (4) amplification simple ; (5) les sarcomes dits « à génétique complexe » pouvant présenter plusieurs dizaines d’anomalies moléculaires. Le développement d’une nouvelle thérapie ciblée repose sur l’identification d’une cible, spécifique d’un sous-groupe de tumeurs et impliquée dans les phénomènes de carcinogénèse et/ou croissance tumorale. La recherche clinique tente alors d’établir la preuve du concept avec des essais cliniques démontrant le bénéfice apporté au patient et permettant ainsi commercialisation du médicament dans cette indication. Cette preuve du concept a été clairement établie pour l’imatinib, le sunitinib et le regorafenib dans les tumeurs stromales gastrointestinales, l’imatinib dans les dermatofibrosarcoma protuberans et les synovites pigmentées vilo-nodulaires, le denosumab dans les tumeurs à cellules géantes de l’os. Elle est en cours et prometteuse pour les anti-IGF-1R dans les sarcomes d’Ewing, le crizotinib dans les tumeurs myofibroblastiques inflammatoires, les inhibiteurs de mTOR dans les PEComes etc… Nous détaillerons, dans cet article, l’implication des anomalies moléculaires identifiées dans les mécanismes de progression tumorale des sarcomes et leurs éventuelles répercussions thérapeutiques. Soft tissue sarcomas (STS) are a set of very heterogeneous tumors with numerous histological categories. The development of the molecular biology allowed identifying recurring molecular anomalies in certain subgroups of sarcomas, being able to represent diagnostic, prognosis and therapeutic tools. The molecular classification of STS includes until today 5 main groups of abnormalities: sarcomas with “simple genomic profile” showing reciprocal (1) chromosomal translocations, (2) activating mutation, (3) inhibitive mutation or (4) simple amplification; (5) sarcomas with “complex genomic profile” can include several tens of molecular abnormalities. The development of new-targeted therapies is based on the identification of a target, specific of a tumors subgroup and involved in carcinogenesis mechanisms and/or tumoral growth. Then, the aim of clinical research is to establish the proof of the concept through clinical trials, demonstrating the benefit brought to the patient and ending in the marketing of the drug. This proof of the concept was clearly established for imatinib, sunitinib and regorafenib in gastrointestinal stromal tumors, for imatinib in dermatofibrosarcoma protuberans and pigmented vilo-nodular synovitis, for denosumab in giant cell tumors of the bone, ending in the authorization to use these new therapies in these indications. It is in progress and promising for anti-IGF-1R in Ewing sarcomas, for crizotinib in myofibroblastic inflammatory tumors, for mTOR inhibitor in PEComas… The role of molecular abnormalities identified in the mechanisms of tumoral progress for sarcomas and their potential therapeutic impact will be detailed." @default.
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- W2000429411 date "2015-01-01" @default.
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- W2000429411 title "Biologie moléculaire des sarcomes et choix thérapeutiques" @default.
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