Patient stratification is the process of categorizing patients into subgroups based on specific biological, clinical, or molecular characteristics in order to:
Optimize treatment selection
Predict therapy response
Improve clinical outcomes
Reduce adverse effects
Applications
Precision oncology: Identifying patients with molecular alterations (e.g., EGFR mutations) for targeted therapies
Clinical trials: Selecting suitable patients for inclusion or treatment arms
Risk prediction: Estimating prognosis or likelihood of disease progression
Stratification Criteria
Genetic and molecular markers:
EGFR, ALK, KRAS mutations in NSCLC
IDH1/IDH2 mutations in gliomas
BRCA1/2 status in breast/ovarian cancer
Tumor characteristics:
Grade, stage, histology
Proliferation index (e.g., Ki-67)
Patient-specific factors:
Age, performance status
Comorbidities
Smoking history, environmental exposures
Example: EGFR Stratification in NSCLC
Patients with activating EGFR mutations (e.g., exon 19 deletion, L858R) are eligible for EGFR-TKI therapy.
Patients with T790M mutation post-resistance may benefit from third-generation TKIs like Osimertinib.