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非小细胞肺癌(NSCLC)为最常见的肺癌病理类型,约占肺癌总数的 85%。大多数肺癌患者在确诊时已属晚期,失去手术机会, 保守治疗成为其重要治疗手段,但晚期肺癌患者的预后仍不理想。近年来,分子靶向治疗在肿瘤治疗领域取得重要进展,亦有研究显示 其在 NSCLC 的临床实践中发挥显著疗效。除表皮生长因子受体(EGFR)和间变淋巴瘤激酶(ALK)等主要基因突变之外,血管内皮生 长因子(VEGF)、ROS1、c-MET、RET、K-RAS、BRAF 也是目前 NSCLC 分子靶向治疗的相关靶点。综述 NSCLC 分子靶向药物治疗 的研究进展,旨在为该疾病的治疗提供参考。 相似文献
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卵巢癌死亡率居女性生殖系统恶性肿瘤之首,早期诊断困难,晚期患者治疗效果差,分子靶向药物成为近年的研究热点。目前许多靶向药物已经进入临床试验阶段,给卵巢癌特别是术后复发及化疗耐药患者的治疗带来新的希望。本文主要对单克隆抗体,酪氨酸激酶抑制剂等几种药物在卵巢癌的研究进行综述。 相似文献
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T 细胞介导的肿瘤免疫至少需要 T 细胞受体和共刺激分子“双信号”参与的学说目前得到了广泛支持。共抑制或共刺激分子提供的
共信号决定了 T 细胞受体信号介导的免疫应答的最终效应。近年来,靶向共抑制分子如 CTLA-4 和 PD-1 开发的抗体药物在临床应用中获
得了巨大成功,使得肿瘤免疫治疗成为最令人瞩目的研究领域,并被美国《科学》杂志评为 2013 年度十大科学突破之首。肿瘤免疫治疗有
望成为与手术、放化疗和靶向治疗并驾齐驱的抗肿瘤主流治疗方案。针对共抑制分子 CTLA-4、PD-1、PD-L1 和共刺激分子 CD137,综述
其发挥免疫调节作用的分子机制及其相关靶向药物在肿瘤治疗方面的最新进展和应用。 相似文献
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随着分子生物学研究的进展,分子靶向治疗已成为除手术、放疗、化疗之外的第4种治疗方法,越来越多的用于临床治疗恶性肿瘤。分子靶向药物进入体内能够特异地选择致癌位点,杀伤肿瘤细胞,而不会波及周围正常的组织细胞,因此分子靶向治疗又被称为"生物导弹"。与传统化疗药物相比,分子靶向药物具有特异性强、疗效明显、副作用少等优点。按照分子靶向药物的性质主要归为两大类:一类是单克隆抗体,如西妥昔单抗等;另一类是单靶点或多靶点的小分子抑制剂,如吉非替尼等。表皮生长因子受体(EGFR)对肿瘤的生长、发展以及肿瘤干细胞的维持都有着非常重要的作用,并且在多种实体瘤中存在过表达或异常表达,因此在肿瘤治疗中,EGFR成为一个非常重要的用药靶点。现主要对目前国内已上市的针对EGFR的分子靶向药物最新的临床研究进展作一简要综述。 相似文献
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转移性肾癌(mRCC)作为一种高度恶性的疾病,以进展快、病死率高为特点,且一直以来临床上对其治疗效果并不理想.联合化疗和(或)放疗也不能显著提高反应率或改善生存.在分子靶向药物诞生之前,临床上应用以细胞因子为基础的免疫治疗作为mRCC的一线治疗.分子靶向药物的问世,彻底打破了传统细胞因子免疫治疗mRCC的局面,使mRCC患者获得较好的临床治疗效果.本文将系统阐述mRCC的免疫治疗与靶向治疗的进展,详细介绍目前靶向治疗的临床应用情况,以期为mRCC治疗药物的合理选择提供参考. 相似文献
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胃癌是消化系统最常见的恶性肿瘤之一,全球每年胃癌新发病例数接近百万,严重影响着人类健康.近年来医学领域发展迅速,不管是胃癌的手术方式,还是放疗、化疗等治疗手段均获得了较大提高.但是由于缺乏有效早期诊断方法,大多数胃癌患者确诊时已进入疾病晚期,所以尽管医学技术不断发展,胃癌的死亡率依然居高不下.随着对胃癌分子机制的不断深入研究,一种直接作用于胃癌主要信号转导通路上某一特定靶点的新型治疗方式-分子靶向治疗逐渐成为当前肿瘤研究的热点.目前已有多种单克隆抗体及小分子靶向药物进入临床,用于人体多种肿瘤的治疗并呈现较好疗效.分子靶向治疗的出现为进展期肿瘤患者带来了新的希望.本文主要就进展期胃癌分子靶向治疗现状以及最新研究进展作一综述. 相似文献
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丙型肝炎由丙型肝炎病毒(hepatitis C virus,HCV)感染所致,约80%感染者可发展成慢性肝炎,甚至肝硬化和肝癌。目前,临床主要应用干扰素结合利巴韦林联合疗法治疗丙型肝炎,但治疗后病毒有效应答率不高,并伴有明显的副作用产生,迫切需要研发靶向药物。随着HCV体外细胞培养技术获得的突破性进展以及在此基础上各种药物筛选方法的建立,利用现有的筛选模型筛选靶向药物成为抗病毒药物研发的重要途径。近年来,将GFP、hRLuc等报告基因插入HCV基因组中改造成具有明显标记的高通量药物筛选体系,已初步筛选出一些有效的HCV靶向药物,就现有抗丙型肝炎病毒靶向药物及抗病毒药物筛选方法进行综述。 相似文献
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The anti-CTLA-4 Mab ipilimumab is an efficient treatment of metastatic melanoma as a single agent and combined with dacarbazine chemotherapy. The benefit is observed in 10 to 20?% of the patients but it is the only drug to demonstrate an increase in overall survival of patients with metastatic melanoma. The pattern of response is new with delayed and prolonged responses over time. New evaluation criteria have been proposed to evaluate the efficacy of this new therapy. The safety profile is new also with frequent and potentially severe side effects related to the activation of the immune system. The challenges are now to identify biomarkers able to predict ipilimumab benefit and to know how to use ipilimumab in combination with new targeted therapies of melanoma in order to optimize the treatment efficacy. 相似文献
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Robert Mason Helen C. Dearden Bella Nguyen Jennifer A. Soon Jessica Louise Smith Manreet Randhawa Andrew Mant Lydai Warburton Serigne Lo Tarek Meniawy Alexander Guminski Phillip Parente Sayed Ali Andrew Haydon Georgina V. Long Matteo S. Carlino Michael Millward Victoria G. Atkinson Alexander M. Menzies 《Pigment cell & melanoma research》2020,33(2):358-365
The combination of ipilimumab and nivolumab is a highly active systemic therapy for metastatic melanoma but can cause significant toxicity. We explore the safety and efficacy of this treatment in routine clinical practice, particularly in the setting of serine/threonine‐protein kinase B‐Raf (BRAF)‐targeted therapy. Consecutive patients with unresectable stage IIIC/IV melanoma commenced on ipilimumab and nivolumab across 10 tertiary melanoma institutions in Australia were identified retrospectively. Data collected included demographics, response and survival outcomes. A total of 152 patients were included for analysis, 39% were treatment‐naïve and 22% failed first‐line BRAF/MEK inhibitors. Treatment‐related adverse events occurred in 67% of patients, grade 3–5 in 38%. The overall objective response rate was 41%, 57% in treatment‐naïve and 21% in BRAF/MEK failure patients. Median progression‐free survival was 4.0 months (95% CI, 3.0–6.0) in the whole cohort, 11.0 months (95% CI, 6.0‐NR) in treatment‐naïve and 2.0 months (95% CI, 1.4–4.6) in BRAF/MEK failure patients. The combination of ipilimumab and nivolumab can be used safely and effectively in a real‐world population. While first‐line efficacy appears comparable to trial populations, BRAF‐mutant patients failing prior BRAF/MEK inhibitors show less response. 相似文献
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Anna Maria Di Giacomo Riccardo Danielli Massimo Guidoboni Luana Calabrò Dora Carlucci Clelia Miracco Luca Volterrani Maria Antonietta Mazzei Maurizio Biagioli Maresa Altomonte Michele Maio 《Cancer immunology, immunotherapy : CII》2009,58(8):1297-1306
The management of unresectable metastatic melanoma is a major clinical challenge because of the lack of reliably effective
systemic therapies. Blocking cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has recently been proposed as a strategy
to enhance cell-mediated immune responses to cancer, and clinical trials have demonstrated that anti-CTLA-4 therapy can produce
durable outcomes with different response patterns than cytotoxic chemotherapy. We enrolled eight out of 155 patients with
advanced melanoma in a multicentre phase II trial that evaluated the activity and tolerability of ipilimumab, a fully human,
anti-CTLA-4 monoclonal antibody (; NCT00289627; CA184-008). Here we report our experience with three of these patients, who experienced progressive disease
after a variety of previous therapies, including prior immunotherapies, and who achieved good outcomes with ipilimumab. One
patient had a partial response ongoing at 17+ months on ipilimumab despite failure with four prior therapies, and the other
two patients showed durable stable disease, both still ongoing at 17+ and 20+ months, respectively. The patient achieving
a partial response experienced no side effects while receiving ipilimumab. The other two patients developed immune-related
adverse events (irAEs) including rash (one case; grade 2) and diarrhoea (both cases; grades 1 and 2, respectively); the histopathology
of colon biopsy samples from both was suggestive of colitis, with an abundant CD8+ T-cell infiltrate. Nausea, vomiting and
acute pancreatitis were also observed in one patient. In addition, immunohistochemical findings of a dense CD8+, TIA1+ and
granzyme B+ lymphoid infiltrate within a biopsied lesion provide indirect evidence of functional T-cell activation induced
by treatment. These case reports highlight the potential for anti-CTLA-4-based therapy in previously treated patients with
advanced melanoma. Moreover, because the patterns of response to ipilimumab differ from chemotherapy, we need to understand
how and when patients may respond to treatment so that appropriate clinical decisions can be made. 相似文献
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ObjectiveTo present a case series of ipilimumabrelated secondary adrenal insufficiency.MethodsIn this cases series, we review the presentation, evaluation, diagnosis, and management of patients with advanced melanoma who received ipilimumab and were referred to our endocrinology clinic for evaluation of hormonal abnormalities.ResultsSeven patients presented with symptoms, signs, or biochemical evidence of adrenal insufficiency 6 to 12 weeks after starting ipilimumab therapy. Ipilimumab is a cytotoxic T-lymphocyte antigen 4 (CTLA-4) monoclonal antibody that is approved for the treatment of metastatic melanoma and has widespread use for this disease. All 7 patients had biochemical evidence of profound secondary adrenal insufficiency. Thyroid function abnormalities, central hypogonadism, and low insulinlike growth factor 1 levels were seen in a subset of patients. Only 2 patients had abnormal findings on pituitary magnetic resonance imaging. Posterior pituitary function remained normal.ConclusionsOur findings suggest that the enhanced immune response associated with ipilimumab therapy may have a predilection for corticotroph and possibly thyrotroph cells. We recommend periodic hypothalamic-pituitary-adrenal axis monitoring for patients on this therapy.(Endocr Pract. 2012;18:351-355) 相似文献
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Sander Kelderman Bianca Heemskerk Harm van Tinteren Rob R. H. van den Brom Geke A. P. Hospers Alfonsus J. M. van den Eertwegh Ellen W. Kapiteijn Jan Willem B. de Groot Patricia Soetekouw Rob L. Jansen Edward Fiets Andrew J. S. Furness Alexandra Renn Marcin Krzystanek Zoltan Szallasi Paul Lorigan Martin E. Gore Ton N. M. Schumacher John B. A. G. Haanen James M. G. Larkin Christian U. Blank 《Cancer immunology, immunotherapy : CII》2014,63(5):449-458
Introduction
Ipilimumab, a cytotoxic T lymphocyte-associated antigen-4 blocking antibody, has improved overall survival (OS) in metastatic melanoma in phase III trials. However, about 80 % of patients fail to respond, and no predictive markers for benefit from therapy have been identified. We analysed a ‘real world’ population of patients treated with ipilimumab to identify markers for treatment benefit.Methods
Patients with advanced cutaneous melanoma were treated in the Netherlands (NL) and the United Kingdom (UK) with ipilimumab at 3 mg/kg. Baseline characteristics and peripheral blood parameters were assessed, and patients were monitored for the occurrence of adverse events and outcomes.Results
A total of 166 patients were treated in the Netherlands. Best overall response and disease control rates were 17 and 35 %, respectively. Median follow-up was 17.9 months, with a median progression-free survival of 2.9 months. Median OS was 7.5 months, and OS at 1 year was 37.8 % and at 2 years was 22.9 %. In a multivariate model, baseline serum lactate dehydrogenase (LDH) was demonstrated to be the strongest predictive factor for OS. These findings were validated in an independent cohort of 64 patients from the UK.Conclusion
In both the NL and UK cohorts, long-term benefit of ipilimumab treatment was unlikely for patients with baseline serum LDH greater than twice the upper limit of normal. In the absence of prospective data, clinicians treating melanoma may wish to consider the data presented here to guide patient selection for ipilimumab therapy. 相似文献16.
Shahabi V Whitney G Hamid O Schmidt H Chasalow SD Alaparthy S Jackson JR 《Cancer immunology, immunotherapy : CII》2012,61(5):733-737
Ipilimumab, a fully human monoclonal antibody against cytotoxic T lymphocyte antigen-4, has demonstrated significant improvement
in overall survival in previously treated advanced melanoma patients. The BRAF inhibitor, vemurafenib, has shown up to 78%
objective response rates in melanoma patients harboring the BRAF-V600E mutation but not in patients lacking the mutation.
As an immune potentiator, the mechanism of action of ipilimumab may not be dependent of the activity of the BRAF pathway.
To test this, we investigated whether the clinical activity of ipilimumab would be affected by the BRAF-V600E mutation status
of the tumors. Thus, this retrospective analysis was carried using a set of tumor biopsies from a completed phase II clinical
trial. CA184004 was a randomized, double-blind, multicenter trial of 82 previously treated or untreated patients with unresectable
stage III/IV melanoma. Patients received ipilimumab 3 or 10 mg/kg every 3 weeks for four doses followed by maintenance dosing
in eligible patients. The BRAF-V600E mutation status for 80 patients was determined in tumor biopsies by PCR-based assays.
Data on disease control were available for 69 patients with evaluated BRAF-V600E mutation status. Rates of objective responses
and stable disease in patients with BRAF-V600E mutation positive tumors (30%) were comparable to those in patients with the
wild-type gene (~33%). Eleven patients displayed Durable Disease Control (DDC) of which 55% had BRAF-V600E mutation positive
tumors and 45% did not. In the 48 patients showing no DDC, the mutation frequency was 50%. In this study, no association between
BRAF-V600E mutation status of melanoma tumors and DDC after treatment with ipilimumab was detected. 相似文献
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Malignant melanoma is the most aggressive form of skin cancer and its incidence has increased dramatically in the last two decades. Even with a high rate of success in the treatment of early stages of this malignancy, currently there are no effective strategies for the treatment of advanced metastatic melanoma. Much effort has been put into the use of different target-specific drugs, among which BRAF kinase-specific small-molecule inhibitors have rendered promising results as therapeutic agents in metastatic melanoma. Nonetheless, some side effects, such as development of SCC (squamous cell carcinoma), as well as tumour resistance and recurrence, are common limitations of this therapeutic strategy. The use of combination treatments in which different regulatory pathways or the immunological response are targeted seems to be a promising tool for the future success of melanoma therapeutics. 相似文献
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ChuanLiang Cui Li Zhou Bin Lian Lu Si XiNan Sheng ZhiHong Chi Yan Kong Xuan Wang BiXia Tang LiLi Mao SiMing Li Jie Dai XieQiao Yan Xue Bai Jun Guo 《Translational oncology》2018,11(5):1155-1159
OBJECTIVE: Asian melanoma patients, predominantly comprised of acral and mucosal subtypes, might not benefit from immunotherapy and targeted therapy as much as Caucasian patients. Novel treatment strategies are demanded after conventional treatment failure. This was a prospective, single-arm, and single-center dose escalation study to investigate the safety and preliminary efficacy of apatinib combined with temozolomide in heavily treated advanced melanoma patients. METHODS: Patients were sequentially admitted to four dose-escalating groups of apatinib and temozolomide (three cases in each group) using a traditional 3?+?3 dose escalation design method. RESULTS: Twelve patients were enrolled between December 2016 and August 2017. Most patients with an acral or mucosal primary origin progressed after immunotherapy or targeted therapy. Dose escalation had been completed without dose-limiting toxicity. Common adverse events included hypertension, hand-foot syndrome, proteinuria, neutropenia, nausea, and fatigue. All adverse events were grade 1 or 2, while the maximum tolerated dose was not reached. Up to January 2018, 1 patient achieved partial response, 9 experienced stable disease, and 2 exhibited progressive disease. The objective response rate and disease control rate were 8.3% and 83%, respectively. CONCLUSIONS: In conclusion, apatinib combined with temozolomide was well tolerated and has demonstrated efficacy in advanced melanoma patients. 相似文献
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Masanobu Tsubaki Tomoya Takeda Naoya Obata Keishi Kawashima Mitsuki Tabata Motohiro Imano Takao Satou Shozo Nishida 《Journal of cellular physiology》2019,234(10):17975-17989
Malignant melanoma is a highly aggressive skin cancer, and the overall median survival in patients with metastatic melanoma is only 6–9 months. Although molecular targeted therapies have recently been developed and have improved the overall survival, melanoma patients may show no response and acquisition of resistance to these drugs. Thus, other molecular approaches are essential for the treatment of metastatic melanoma. In the present study, we investigated the effect of cotreatment with dacarbazine and statins on tumor growth, metastasis, and survival rate in mice with metastatic melanomas. We found that cotreatment with dacarbazine and statins significantly inhibited tumor growth and metastasis via suppression of the RhoA/RhoC/LIM domain kinase/serum response factor/c-Fos pathway and enhanced p53, p21, p27, cleaved caspase-3, and cleaved poly(ADP-ribose) polymerase 1 expression in vivo. Moreover, the cotreatment significantly improved the survival rate in metastasis-bearing mice. Importantly, treatment with dacarbazine plus 100 mg/kg simvastatin or fluvastatin prevented metastasis-associated death in 4/20 mice that received dacarbazine + simvastatin and in 8/20 mice that received dacarbazine + fluvastatin (survival rates, 20% and 40%, respectively). These results suggested that cotreatment with dacarbazine and statins may thus serve as a new therapeutic approach to control tumor growth and metastasis in melanoma patients. 相似文献
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Zeiser R Schnitzler M Andrlova H Hellige T Meiss F 《Current stem cell research & therapy》2012,7(3):217-228
Treatment of metastatic melanoma is a challenge for clinicians as most agents have failed to demonstrate improved survival in phase III trials. Despite the immunogenicity of this tumor entity, different immunological interventions including cytokine therapy, vaccination, biochemotherapy or allogeneic hematopoietic cell transplantation did not lead to a satisfactory response. However, continuous investigation on the immune mediated rejection of melanoma cells has led to the development of effective antibodies blocking cytotoxic T-lymphocyte antigen-4 (CTLA-4), a critical negative regulator of the antitumor T-cell response. Based on data from rodent models, the anti-CTLA-4 antibody ipilimumab was developed into clinical studies where it had encouraging activity in advanced melanoma with unusual response patterns. As in most immunostimulatory therapies, acute toxicities were severe and clearly mechanism-related. Although some patients developed signs of autoimmunity, the toxicities were overall manageable and mostly reversible. This review summarizes different immunotherapeutical approaches against melanoma that have been applied in the past and focuses on CTLA-4 blockade with respect to its mechanism, clinical effectiveness and immunological side effects. 相似文献