放射性药物在肿瘤靶向治疗中的应用

放射性药物指供临床诊断或治疗用的放射性核素制剂或其标记化合物。放射性核素靶向治疗是利用对肿瘤细胞具有特异高亲和力的分子载体将核素定向导入特定的肿瘤组织,对肿瘤进行治疗。与传统的放疗和化疗相比,其具有选择性杀伤肿瘤细胞的特点。随着核医学的发展,SPECT/CT、PET/CT的普及,新靶点的发现和新型放射性药物的研发,利用放射性药物进行靶向治疗在肿瘤临床治疗中占据的地位越来越重要。本文简述了放射性药物的分类、组成及特点;综述了针对肿瘤相关抗原的放射免疫药物在非霍奇金淋巴瘤、结直肠癌和前列腺癌中的应用;受体介导的放射性核素药物在治疗神经内分泌肿瘤、前列腺癌和乳腺癌中的临床应用以及基于基因修饰的放射性药物在肿瘤靶向治疗中的实验研究进展。最后总结了放射性药物在肿瘤靶向治疗中的应用前景与面临的挑战,以期为靶向治疗肿瘤的放射性药物的开发和临床应用提供一些参考。     

Science:SOX2促进前列腺癌产生治疗抵抗性机制

正前列腺癌生长是由雄激素促发的。基于靶向雄激素受体(androgen receptor,AR)的药物的雄激素剥夺治疗(androgen deprivation therapy,ADT)是治疗转移性前列腺癌患者的常用方法。虽然大多数患者会在开始治疗的时候产生应答,但是癌症几乎总会复发并且变得更具侵袭性。一些癌症通过一种被称作细胞谱系可塑性的机制逃避靶向药物治疗,通过这种机制,肿瘤细胞获得一种存活不再依赖于药物靶标的细胞谱系的表型特征。     

靶向蛋白质泛素修饰及降解在前列腺癌治疗中的机遇与挑战

前列腺癌是中国发病率增长最快的男性肿瘤,抗雄激素治疗耐药是导致前列腺癌患者预后差的主要原因。因此,解决耐药性难题是前列腺癌转化研究的关键问题。哺乳动物细胞利用泛素-蛋白酶体系统实现蛋白质的靶向降解。因此,前列腺癌中关键的癌基因如雄激素受体（AR）的上游泛素化调控因子（如去泛素化酶）是潜在的治疗靶点。然而,这些酶具有较广的底物谱系,存在脱靶的可能性。近来,基于泛素-蛋白酶体系统开发的蛋白质降解靶向嵌合体（proteolysis-targeting chimeras,PROTAC）技术是最具前景和革命性的新型抗癌药物研发技术,能够利用特定E3泛素连接酶对靶蛋白进行降解而不影响其他底物。与传统小分子抑制剂相比,PROTAC分子在克服耐药性以及针对不可成药的靶点方面拥有巨大优势。目前,针对AR的PROTAC降解剂已在II期临床取得了成功,靶向蛋白质泛素化及降解途径的新技术将有望为前列腺癌的临床治疗带来新的突破。     

PSCA与前列腺癌研究进展

前列腺干细胞抗原(prostate stem cell antigen,PSCA)是一种前列腺癌相关肿瘤抗原,也是一种GPI(gly-cosyl phosphatidylinositol)锚定蛋白,通过其C端的GPI锚定结构锚定到细胞膜表面.PSCA在正常前列腺组织中的表达较低,提高的PSCA表达伴随着增加的肿瘤分期、分级以及雄激素非依赖性和转移癌的形成,且不随癌症进展而降低,是前列腺癌诊断和治疗的理想靶抗原.动物实验显示,PSCA抗体和疫苗可能在前列腺癌免疫靶向治疗中具有重要价值.     

胰岛素抵抗在前列腺癌治疗前后动态变化的临床观察

目的:探讨胰岛素抵抗程度在前列腺癌治疗过程中动态变化及胰岛素抵抗程度与前列腺癌预后的关系。方法:选择前列腺癌惠者50名。平均年龄72岁。将前列腺癌患者根据治疗方法分为前列腺癌根治术组、手术去势组、药物去势组;根据有无复发转移分为复发转移组、无复发转移组。采用己糖激酶法测定空腹葡萄糖,放免法测定空腹胰岛素(Fasting serum insulin FINS)水平。运用HOMA模型中的胰岛素抵抗计算公式计算胰岛素抵抗指数(insulin resistance index IRI)。组间比较采用配对t检验。结果:前列腺癌患者在手术后的胰岛素抵抗指数明显下降,与手术前胰岛素抵抗指数存在统计学差异(P<0.05)。前列腺癌根治组的IRI值和手术去势组与药物去势组都存在统计学差异(P<0.05),但手术去势组和药物去势组两组之间不存在统计学差异(P>0.05)。前列腺癌治疗后无复发转移组的IRI值明显低于复发转移组,两组间IRI存在统计学差异(P<0.05)。结论:前列腺癌患者胰岛素抵抗程度与肿瘤治疗经过、效果有关。胰岛素抵抗指数有助于前列腺癌患者判断治疗效果,判断预后。     

组织特异性启动子介导的反义FGF8b RNA对前列腺癌细胞生长增殖能力的影响

利用启动子的组织特异性和治疗基因组织特异表达的特点 ,设计出前列腺癌靶向基因治疗的新方案 .利用DNA重组技术将前列腺组织特异性启动子 (probasin基因启动子 )和在前列腺癌细胞中高表达成纤维细胞生长因子 (FGF) 8b反义cDNA克隆到逆转录病毒载体pSIR中构建成重组体PB 反义FGF8b pSIR .经转染包装细胞PT 6 7后将产生的复制缺陷型逆转录病毒体外感染前列腺癌细胞系PC 3M ,体外检测其生长增殖和侵袭转移能力的变化 .结果表明 ,与对照组相比 ,前列腺癌细胞感染产生反义FGF8bRNA的逆转录病毒后生长速度减慢 ,集落形成能力下降 ,体外侵袭转移能力降低 (P <0 0 1) .体外试验表明 ,前列腺组织特异性启动子介导的反义FGF8bRNA可有效降低前列腺癌细胞的体外生长增殖和转移能力 ,这为体内靶向前列腺癌基因治疗奠定了可靠的基础 .     

纳米药物递送系统在前列腺癌治疗中的应用

前列腺癌（PCa）是全球最常见的男性泌尿生殖系统恶性肿瘤。手术、内分泌治疗、放疗和化疗是PCa的主要临床治疗选择。纳米药物递送系统具有良好的可控释放特性和较好的肿瘤靶向能力，并可通过增强的渗透性和保留（EPR）效应被动靶向肿瘤。通过精巧的设计组装和外表修饰赋予纳米递药系统与众不同的肿瘤治疗效果。本文介绍用于PCa治疗的先进纳米药物递送系统以及未来发展。     

分子靶向治疗在前列腺癌中的研究进展

前列腺癌是目前在全球男性中第二位最常见的肿瘤,其在恶性肿瘤死亡率中排名第六位[1]。在发病率方面,我国虽然不及西方国家,但是随着生活水平和诊疗技术的提高,也表现出了逐渐上升的态势。靶向治疗是以肿瘤细胞的特有位点作为治疗靶点,在纠正病变、稳定细胞、发挥更强的抗肿瘤活性的同时,能够对正常细胞减少毒副作用[2]。由于我们对于肿瘤发生发展的分子途径认知的逐渐提高,以及更好的利用这些途径作为有效的药物作用靶点,我们已经看到了越来越多的分子靶向药物的开发和生产随之增加。本文着重探讨了分子靶向药物对肿瘤的治疗起作用的不同的靶向机制,以及它们的研究现状及临床应用。     

前列腺癌体内实验模型的研究进展

前列腺癌是男性最为常见的恶性肿瘤之一。近年来有关前列腺癌的相关研究取得了较大突破,但由于缺少有效的体内实验模型,导致研究成果向临床应用的转化受到严重阻碍。人源性前列腺癌移植(patient derived prostate tumor xenograft,PDPTX)模型是将患者新鲜的肿瘤组织移植于免疫缺陷小鼠而建立的体内模型,该模型能较好地复制原发肿瘤的异质性,保持肿瘤在分子学、基因学和病理学的复杂性。特别是采用肾包膜移植建立PDPTX模型的方法较好地解决了传统皮下移植建模成功率低、低级别肿瘤成瘤难、无法实现移植瘤转移等缺点,为前列腺癌研究提供了更为理想的体内模型。尤其是在靶向治疗、新型药物筛选、个体化治疗等方面具有不可取代的优势。     

肿瘤干细胞及其靶向治疗

肿瘤组织中存在一小部分具有无限增殖、自我更新和多向分化能力的肿瘤干细胞。这些肿瘤干细胞,普通的放化疗很难将其根除,并成为肿瘤复发的主要原因。在许多针对肿瘤干细胞的治疗方法中,靶向治疗是目前研究的热点。靶向治疗是通过切断肿瘤干细胞传导通路,攻击肿瘤干细胞表面标志物或诱导肿瘤干细胞分化等途径,抑制或根除肿瘤干细胞,其为根治肿瘤开辟了新的研究方向。     

A critical update on the strategies towards modulators targeting androgen receptors

Prostate cancer is the most common carcinoma of the male urinary system in developed countries. Androgen deprivation therapy has been commonly used in the treatment of prostate cancer for decades, but most patients will inevitably develop into more aggressive castration-resistant prostate cancer. Therefore, novel strategies are urgent to address this resistance mechanism. In this review, we discussed some new strategies for targeting androgen receptors through degradation pathways as potential treatments for prostate cancer.     

Prostate biopsy: targeting cancer for detection and therapy

Despite improvements in cancer detection, prostate biopsy still lacks the ability to accurately map locations of cancer within the prostate. Improvements in prostate imaging may allow more accurate mapping of overall disease volume. Magnetic resonance (MR) spectroscopy allows improved specificity in detecting even small foci of disease within the peripheral zone. Improvements in MR-guided biopsy techniques may allow this technology to be adapted to therapeutics as well. Computer modeling of individual prostates serves as a means of designing optimized plans for prostate biopsy. The use of novel targeted biopsy schemes may allow an integration of available technologies in detection and localization of prostate cancer. Computer-directed needle biopsies based on anatomic landmarks within the prostate and computerized three-dimensional reconstruction of the gland may allow a highly reproducible means of identifying small foci of cancer, targeting them for therapy, and monitoring for recurrence. The TargetScan(R) system (Envisioneering Medical Technologies, St. Louis, MO) is the first technology to integrate available targeting methodologies in a systematic fashion.     

The role of Snail in prostate cancer

Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of death from cancer in men. Epithelial-mesenchymal transition (EMT) is a process by which cancer cells invade and migrate, and is characterized by loss of cell-cell adhesion molecules such as E-cadherin and increased expression of mesenchymal proteins such as vimentin; EMT is also associated with resistance to therapy. Snail, a master regulator of EMT, has been extensively studied and reported in cancers such as breast and colon; however, its role in prostate cancer is not as widely reported. The purpose of this review is to put together recent facts that summarize Snail signaling in human prostate cancer. Snail is overexpressed in prostate cancer and its expression and activity is controlled via phosphorylation and growth factor signaling. Snail is involved in its canonical role of inducing EMT in prostate cancer cells; however, it plays a role in non-canonical pathways that do not involve EMT such regulation of bone turnover and neuroendocrine differentiation. Thus, studies indicate that Snail signaling contributes to prostate cancer progression and metastasis and therapeutic targeting of Snail in prostate cancer holds promise in �future.     

The role of Snail in prostate cancer

Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of death from cancer in men. Epithelial-mesenchymal transition (EMT) is a process by which cancer cells invade and migrate, and is characterized by loss of cell-cell adhesion molecules such as E-cadherin and increased expression of mesenchymal proteins such as vimentin; EMT is also associated with resistance to therapy. Snail, a master regulator of EMT, has been extensively studied and reported in cancers such as breast and colon; however, its role in prostate cancer is not as widely reported. The purpose of this review is to put together recent facts that summarize Snail signaling in human prostate cancer. Snail is overexpressed in prostate cancer and its expression and activity is controlled via phosphorylation and growth factor signaling. Snail is involved in its canonical role of inducing EMT in prostate cancer cells; however, it plays a role in non-canonical pathways that do not involve EMT such regulation of bone turnover and neuroendocrine differentiation. Thus, studies indicate that Snail signaling contributes to prostate cancer progression and metastasis and therapeutic targeting of Snail in prostate cancer holds promise in ?future.     

Antiandrogen gold nanoparticles dual-target and overcome treatment resistance in hormone-insensitive prostate cancer cells

Prostate cancer is the most commonly diagnosed cancer among men in the developed countries. (1) One in six males in the U.S. (2) and one in nine males in the U.K. (3) will develop the disease at some point during their lifetime. Despite advances in prostate cancer screening, more than a quarter of a million men die from the disease every year (1) due primarily to treatment-resistance and metastasis. Colloidal nanotechnologies can provide tremendous enhancements to existing targeting/treatment strategies for prostate cancer to which malignant cells are less sensitive. Here, we show that antiandrogen gold nanoparticles-multivalent analogues of antiandrogens currently used in clinical therapy for prostate cancer-selectively engage two distinct receptors, androgen receptor (AR), a target for the treatment of prostate cancer, as well as a novel G-protein coupled receptor, GPRC6A, that is also upregulated in prostate cancer. These nanoparticles selectively accumulated in hormone-insensitive and chemotherapy-resistant prostate cancer cells, bound androgen receptor with multivalent affinity, and exhibited greatly enhanced drug potency versus monovalent antiandrogens currently in clinical use. Further, antiandrogen gold nanoparticles selectively stimulated GPRC6A with multivalent affinity, demonstrating that the delivery of nanoscale antiandrogens can also be facilitated by the transmembrane receptor in order to realize increasingly selective, increasingly potent therapy for treatment-resistant prostate cancers.     

Prostate tumor-initiating cells: A new target for telomerase inhibition therapy?

Conventional therapies for prostate cancer, especially in its androgen-independent form, may result in the survival of small populations of resistant cells with tumor-initiating potential. These “cancer stem cells” are believed to be responsible for cancer relapse, and therapeutic strategies targeting these cells are of great importance. Telomerase is a ribonucleoprotein enzyme responsible for telomere elongation and is activated in the majority of malignancies, including prostate cancer, but is absent in most normal cells. Putative tumor-initiating cells have significant levels of telomerase, indicating that they are an excellent target for telomerase inhibition therapy. In this review, we present some evidence for the hypothesis that conventional therapies (standard chemotherapy and/or radiation therapy) in combination with telomerase inhibitors may result in effective and more durable responses.     

Immunotherapy of prostate cancer: should we be targeting stem cells and EMT?

Cancer stem cells have been implicated in a number of solid malignancies including prostate cancer. In the case of localised prostate cancer, patients are often treated with surgery (radical prostatectomy) and/or radiotherapy. However, disease recurrence is an issue in about 30% of patients, who will then go on to receive hormone ablation therapy. Hormone ablation therapy is often palliative in a vast proportion of individuals, and for hormone-refractory patients, there are several immunotherapies targeting a number of prostate tumour antigens which are currently in development. However, clinical responses in this setting are inconsistent, and it is believed that the failure to achieve full and permanent tumour eradication is due to a small, resistant population of cells known as ‘cancer stem cells’ (CSCs). The stochastic and clonal evolution models are among several models used to describe cancer development. The general consensus is that cancer may arise in any cell as a result of genetic mutations in oncogenes and tumour suppressor genes, which consequently result in uncontrolled cell growth. The cancer stem cell theory, however, challenges previous opinion and proposes that like normal tissues, tumours are hierarchical and only the rare subpopulation of cells at the top of the hierarchy possess the biological properties required to initiate tumourigenesis. Furthermore, where most cancer models infer that every cell within a tumour is equally malignant, i.e. equally capable of reconstituting new tumours, the cancer stem cell theory suggests that only the rare cancer stem cell component possess tumour-initiating capabilities. Hence, according to this model, cancer stem cells are implicated in both tumour initiation and progression. In recent years, the role of epithelial–mesenchymal transition (EMT) in the advancement of prostate cancer has become apparent. Therefore, CSCs and EMT are both likely to play critical roles in prostate cancer tumourigenesis. This review summarises the current immunotherapeutic strategies targeting prostate tumour antigens taking into account the need to consider treatments that target cancer stem cells and cells involved in epithelial–mesenchymal transition.