Oncology Frontier: If we’re finding that there are different mutations and different types of cells within a tumor， we’re going to obviously change the way we’re treating cancer and tumors. There’s combination now， but this will give us a better idea of making better combinations of drugs then. Is that possibly a future thing with this as it goes further?

　　Dr. Navin: Yeah， absolutely. So it’s moved from a lot of systemic chemotherapies， where a lot of patients get the same treatments， to personalized medicine， which means that for every patient you try to find out what mutations they have and give them targeted therapies， and now we’re moving to very personalized medicine， where you’re also looking at whether a certain therapy is going to affect all the tumor cells or just a small population of those cells. And so it’s useful for guiding therapeutic targeting; certainly that’s one big clinical application.

　　And the other exciting clinical applications are non-invasive monitoring. So in the blood there are circulating tumor cells， but there are usually only a few in each patient. But if you can remove those and sequence them， then you can find out what mutations might be present back in the primary tumor site from which the cells are shedding. Then you can take blood at many different time points over the course of a disease and see which mutations are rising and which are recessing， and you might change your therapeutic strategy at that point.

　　And another big clinical application is just early detection. So if you can detect tumor cells early in the blood or other bodily fluids， then even in prostate cancer maybe in prostate fluid， you might be able to very early on treat that tumor， try to do imaging and find out where it is and determine whether it’s likely to be a malignant growth or not.

　　《肿瘤瞭望》：如果我们发现肿瘤中存在不同的突变和不同类型的细胞，我们就能够改变治疗癌症和肿瘤的方法。虽然现在已经提倡联合治疗，但这将为我们选择药物进行更好的联合治疗提供更好的思路。随着研究的深入，这在未来是否有可能呢？

　　Navin博士：完全可能。我们现在正在从大量的系统性化疗（即许多患者都按照相同的方法治疗）向个体化治疗转变。个体化治疗意味着尝试找到每位患者的突变，并且为他们提供靶向治疗。目前我们正向个体化治疗努力，未来将会看到某种治疗影响的是所有肿瘤细胞还是仅仅其中的一小部分。这对于指导肿瘤的靶向治疗是非常有用的，是一个重大的临床应用。

　　另外一项令人兴奋的临床应用是非侵入性检测。血液中存在循环的肿瘤细胞，但是在每位患者中通常只有很少一部分。如果能够将其分离并进行测序，就可能找出细胞脱落的原发肿瘤部位中隐藏的细胞突变。这样我们可以在疾病过程中的不同时间点取血，看到哪些突变出现，哪些突变消退，然后据此改变治疗策略。

　　还有一个重大的临床应用是早期检测。如果能够早期在血液或其他体液，如前列腺液中检测到肿瘤细胞，在肿瘤的治疗上我们就可能抢得了先机，可尝试做影像学检查、对肿瘤进行定位、确定其恶性特征等。