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Advisor(s)
Abstract(s)
Introdução: O cancro afeta uma proporção significativa da população e acarreta
morbilidade e mortalidade elevadas. Os cancros genito-urinários (rins, urotélio,
pro´stata, pénis e testículo) são uma área desafiante da Urologia, com impacto
socioeconómico relevante. Em estádios avançados as opções terapêuticas são limitadas.
Na última década tem havido um grande esforço na investigação nesta área. A medicina
de precisão é uma abordagem inovadora que procura otimizar o plano terapêutico,
adaptando-o ao doente e à sua patologia, e que poderá ser relevante nos cancros genitourinários.
Objetivos: Apresentar as estratégias terapêuticas atuais nos cancros genito-urinários e
descrever o estado da arte da medicina de precisão nesta área.
Metodologia: Realizou-se uma pesquisa sistemática da literatura através de várias
bases de dados, tendo-se pesquisado pelos termos “precision medicine”, “precision
oncology”, “genitourinary”, “bladder”, “penile”, “prostate”, “renal”, “testicle” e
“urothelial". Selecionaram-se apenas artigos publicados entre 01/01/2011 e
29/01/2021 e escritos em inglês, português ou espanhol. Consultaram-se os websites da
Associação Portuguesa de Urologia, Acta Urológica Portuguesa, European Association
of Urology e European Society for Medical Oncology para completar a pesquisa
bibliográfica e para aceder às guidelines mais recentes nesta área.
Resultados: Ainda há muito para compreender na patogénese dos cancros genitourinários, mas os avanços recentes na análise genética e molecular têm permitido
diminuir esta limitação. A evidência existente relativamente à medicina de precisão nos
cancros genito-urinários é, em geral, fraca, principalmente no que toca aos
biomarcadores preditivos e prognósticos. Os tratamentos mais promissores são os
inibidores da PARP, da tirosina-cinase, da mTOR, do PD-L1 e da CTLA-4, mas existem
outros atualmente em investigação.
Conclusões: As atuais aplicações da medicina de precisão são muito assimétricas
entre os diversos cancros genito-urinários, com alguns onde a evidência é reduzida e
outros onde já se utilizam terapêuticas de medicina de precisão. Há ainda um grande
potencial de desenvolvimento desta área nestes cancros. É necessário continuar a
investir na investigação de biomarcadores e intervenções terapêuticas. É também essencial desvendar a complexidade da heterogeneidade intratumoral e descobrir
formas de a superar.
Introduction: Cancer affects a significant proportion of the population and carries high morbidity and mortality. Genitourinary cancers (kidney, urothelium, prostate, penis and testicle) are a challenging field of Urology and have a high socio-economic impact. In advanced stages the therapeutic options are limited. In the past decade, there has been a huge effort in research in this field. Precision medicine is an innovative approach that attempts to optimize therapeutic interventions, adapting them to the patient and their disease. It may become a relevant approach in genitourinary cancers. Objectives: Presenting the current therapeutic strategies in genitourinary cancers and describing the state of the art of precision medicine in this field. Methodology: A systematic literature review was performed using various databases, by searching for the terms “precision medicine”, “precision oncology”, “genitourinary”, “bladder”, “penile”, “prostate”, “renal”, “testicle” and “urothelial". Only articles published between 01/01/2011 and 29/01/2021 and written in English, Portuguese or Spanish were selected. A search of the websites of Associação Portuguesa de Urologia, Acta Urológica Portuguesa, European Association of Urology and European Society for Medical Oncology was conducted to complete the literature review and access the latest guidelines in this field. Results: There is still a lot to be understood about the pathogenesis of genitourinary cancers. However, recent breakthroughs in genetic and molecular analysis allowed us to lessen this limitation. The existing evidence on precision medicine in genitourinary cancers is generally weak, particularly regarding predictive and prognostic biomarkers. The most promising treatments are PARP, tyrosine kinase, mTOR, PD-L1 and CTLA-4 inhibitors, but there are other treatments currently being researched. Conclusions: The current application of precision medicine in genitourinary cancers is quite asymmetrical between the different tumors, given that for some the evidence is small and for others there are already some precision medicine treatments being used. There is still great potential for the development of this field in genitourinary cancers. We must keep investing in the research of biomarkers and therapeutical options. It is also key that we unveil the complexity of intratumoral heterogeneity and discover ways to overcome it.
Introduction: Cancer affects a significant proportion of the population and carries high morbidity and mortality. Genitourinary cancers (kidney, urothelium, prostate, penis and testicle) are a challenging field of Urology and have a high socio-economic impact. In advanced stages the therapeutic options are limited. In the past decade, there has been a huge effort in research in this field. Precision medicine is an innovative approach that attempts to optimize therapeutic interventions, adapting them to the patient and their disease. It may become a relevant approach in genitourinary cancers. Objectives: Presenting the current therapeutic strategies in genitourinary cancers and describing the state of the art of precision medicine in this field. Methodology: A systematic literature review was performed using various databases, by searching for the terms “precision medicine”, “precision oncology”, “genitourinary”, “bladder”, “penile”, “prostate”, “renal”, “testicle” and “urothelial". Only articles published between 01/01/2011 and 29/01/2021 and written in English, Portuguese or Spanish were selected. A search of the websites of Associação Portuguesa de Urologia, Acta Urológica Portuguesa, European Association of Urology and European Society for Medical Oncology was conducted to complete the literature review and access the latest guidelines in this field. Results: There is still a lot to be understood about the pathogenesis of genitourinary cancers. However, recent breakthroughs in genetic and molecular analysis allowed us to lessen this limitation. The existing evidence on precision medicine in genitourinary cancers is generally weak, particularly regarding predictive and prognostic biomarkers. The most promising treatments are PARP, tyrosine kinase, mTOR, PD-L1 and CTLA-4 inhibitors, but there are other treatments currently being researched. Conclusions: The current application of precision medicine in genitourinary cancers is quite asymmetrical between the different tumors, given that for some the evidence is small and for others there are already some precision medicine treatments being used. There is still great potential for the development of this field in genitourinary cancers. We must keep investing in the research of biomarkers and therapeutical options. It is also key that we unveil the complexity of intratumoral heterogeneity and discover ways to overcome it.
Description
Keywords
Biomarcadores Cancros Genito-Urinários Intervenções Dirigidas Medicina de Precisão Uro-Oncologia