약물유전학 및 양전자방출단층촬영을 이용한 항암화학요법 및 분자표적치료에 대한 반응 예측
Prediction of response in chemotherapy and molecular targeted therapy using pharmacogenetics and positron emission tomography
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초록
수술, 방사선요법 및 항암화학요법은 발전을 거듭하여 암 치료의 가장 기본적인 방법으로 정립되었다. 그러나, 암의 발생률 및 사망률은 현격하게 감소하지 않았고 기존의 치료 방법으로 암을 정복하는데 한계가 있다고 볼 수 있다. 최근에는 분자표 적치료가 개발되어 임상 시험을 거쳐 새로운 암의 치료로 발전하고 있으나 아직까지는 보다 많은 연구가 필요한 상황이다. 따라서, 현재 이용 가능한 방법을 적절하게 조합하여 가장 치료 효과가 뛰어나고 부작용이 적은 치료를 모색하는 것이 현명 한 선택이라고 할 수 있다. 즉, 같은 치료를 적용하더라도 환자마다의 치료 반응 및 부작용은 개개인마다 다를 수 있기 때문 에 치료 이전에 이를 예측하여 가장 효과적인 치료를 환자에게 적용하는 것이 궁극적인 목표라 할 수 있다. 특히 항암화학요 법 및 분자표적치료에서 치료 반응 및 부작용을 예측할 수 있는 방법이 연구되어 왔는데 그 중 약물유전학 및 양전자방출단 층촬영을 이용한 방법이 가장 활발하게 연구되고 있다. 약물유전학은 유전적인 소인에 따른 약물의 대사 및 제거의 차이로 인하여 치료 반응 및 부작용의 차이를 연구하는 학문으로 최근 유전자다형성 관련 연구가 활발하게 진행되고 있다. 양전자 방출단층촬영은 1~2회의 약물 투여로 인한 반응을 파악하여 이후의 약물 투여에 대한 반응을 예측하는 연구로 유방암, 식도 암, 폐암, 직장암 등을 대상으로 활발하게 연구되고 있다. 이러한 연구를 통하여 획일적인 치료에서 벗어나 개별적인 치료를 추구함으로써 암을 정복하는 데 한걸음 더 가까워 질 수 있을 것으로 사료된다.
Abstract
Standard treatment of cancer is composed of surgery, radiation therapy and chemotherapy. Although the standard treatment has been available till now, there has been no marked decrease in the incidence of cancer and cancer-related death till now. This fact demonstrates the limitation of the standard treatment for overcoming cancer. Predictive oncology is defined as the method that can identify the difference in drug response and toxicity before treatment, which has developed in the fields of chemotherapy and molecular targeted therapy. Especially, pharmacogenetics and positron emission tomography (PET) are important in predictive oncology. The former shows that drug metabolism affecting response and toxicity may be affected by genetic predisposition, especially genetic polymorphism. The latter evaluates response by use of PET after 1-2 cycle administration of drug and differentiates responders from non-responders among patients with breast, esophagus, lung and rectal cancers. In the near future, individualized treatment that is more effective than the standard treatment will be developed through predictive oncology and be applied in cancer patients for maximizing drug response and minimizing toxicities.
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