Dossier thématique
Dossier thématique
83
La Lettre du Cancérologue - Vol. XVI - n° 3 - mars 2007
Cette approche s’avère extrêmement prometteuse. Elle est
d’autant plus réalisable que le tissu tumoral est largement
disponible après analyse de la pièce opératoire.
L’étude à grande échelle de l’expression génique offre la perspec-
tive d’amélioration du diagnostic clinique histopathologique et
des stratégies thérapeutiques, mais cela dépend du dévelop-
pement d’outils statistiques intégrant non seulement les données
d’expression génique, mais aussi, de façon concomitante, les
données plus classiques sur le profil clinique (clinicome), les
données thérapeutiques et les données du protéome.
La mise au point de ces techniques statistiques est délicate (26),
et nécessite des études dont les biais sont minimisés et qui, par
nature, devraient être prospectives.
CONCLUSION
La conjonction de progrès thérapeutiques, de progrès en anato-
mopathologie, en imagerie ainsi que la mise à disposition de
plates-formes d’analyses complexes, comme la génomique, créent
les conditions d’une recherche dynamique de facteurs pronos-
tiques et prédictifs. Cette recherche doit profiter des erreurs
du passé et ne pas s’éblouir de tel ou tel aspect séduisant des
hautes technologies. Au contraire, leur coût et la multiplicité
des ressources mises en œuvre doivent être le moteur d’une
recherche rigoureuse réalisée en association avec des études
cliniques contrôlées et randomisées. L’expérience des études
récentes comparant un placebo à un TKI de l’EGFR sert de
modèle pour les études cliniques mais aussi pronostiques et
prédictives (27, 28). ■
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