非小细胞肺癌靶向药物研究的新进展

NSCLC是最常见的恶性肿瘤之一,化学治疗对NSCLC的疗效已经达到平台期,但本世纪初靶向治疗研究的突破性进展为人们带来了新的希望。根据靶点的不同将靶向药物分为:以EGFR为靶点、以VEGF为靶点及多靶点药物等,本文将介绍吉非替尼、厄洛替尼、西妥昔单抗等代表药物在NSCLC靶向一线、二线及维持治疗中的新进展。     

埃克替尼联合化疗治疗EGFR突变型晚期非小细胞肺癌的疗效及对生活质量和血清肿瘤标志物的影响

目的:观察表皮生长因子受体(EGFR)突变型晚期非小细胞肺癌(NSCLC)经化疗联合埃克替尼治疗后的临床效果.方法:122例研究对象均为我院于2015年3月～2019年3月期间收治的晚期NSCLC患者且为EGFR突变型.采用随机数字表法将患者分为对照组(单药埃克替尼靶向药物治疗)和实验组(埃克替尼联合化疗),各61例....     

胃肠道间质瘤的分子分型及靶向治疗

胃肠道间质瘤(gastrointestinal stromal tumors,GISTs)是消化道常见的间叶肿瘤,不同于消化道真正的平滑肌瘤、神经源性肿瘤,其发生主要与Kit基因和血小板衍生生长因子受体α(platelet-derived growth factor receptor alpha,PDGFRα)基因突变有关。KIT靶点的发现使得胃肠道间质瘤治疗进入新治疗模式。伊马替尼与舒尼替尼,均为酪氨酸激酶抑制剂,分别被批准为进展期GISTs治疗的第一线及第二线靶向治疗药物。本文就GISTs的分子生物学分型以及分子靶向药物治疗进展作一概述。     

胃肠道间质瘤的分子分型及靶向治疗

胃肠道间质瘤（gastrointestinal stromal tumors,GISTs）是消化道常见的间叶肿瘤,不同于消化道真正的平滑肌瘤、神经源性肿瘤,其发生主要与Kit基因和血小板衍生生长因子受体α（platelet-derived growth factor receptor alpha,PDGFRα）基因突变有关。KIT靶点的发现使得胃肠道间质瘤治疗进入新治疗模式。伊马替尼与舒尼替尼,均为酪氨酸激酶抑制剂,分别被批准为进展期GISTs治疗的第一线及第二线靶向治疗药物。本文就GISTs的分子生物学分型以及分子靶向药物治疗进展作一概述。     

非小细胞肺癌分子靶向药物治疗的研究进展

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。     

细胞自噬与非小细胞肺癌的研究进展

自噬不仅与NSCLC的增殖、侵袭及转移密切相关,而且在抗肿瘤药物介导的细胞死亡中发挥重要作用,因此,研发以自噬为靶点的药物可能是人类疾病治疗应用的新趋势。多种信号通路参与了细胞自噬的调控,明确细胞自噬的调控机制能为NSCLC的靶向治疗提供新思路。     

奥美拉唑诱导非小细胞肺癌细胞对新型分子靶向药物仑伐替尼的耐受

目的:检测奥美拉唑对新型分子靶向药物仑伐替尼杀伤非小细胞肺癌(NSCLC)的影响并阐明其分子机制。方法:体外培养人NSCLC细胞系A549和H460,用奥美拉唑处理细胞,检测奥美拉唑对芳香烃受体(AhR)转录因子活性及下游基因表达的影响;在此基础上用奥美拉唑及仑伐替尼处理A549、H460细胞,检测奥美拉唑对仑伐替尼杀伤A549、H460细胞的影响;培养A549、H460细胞接种免疫缺陷裸鼠后,灌胃给予动物奥美拉唑和仑伐替尼,确定奥美拉唑对仑伐替尼抑制A549、H460细胞皮下肿瘤形成的影响。结果:奥美拉唑能够在A549、H460细胞中上调AhR的转录因子活性及下游基因表达;仑伐替尼能够剂量依赖地杀伤A549、H460细胞,用奥美拉唑处理A549、H460细胞能够显著下调仑伐替尼对细胞的杀伤作用;裸鼠成瘤实验显示,口服给予裸鼠奥美拉唑能够下调仑伐替尼对A549、H460细胞在裸鼠皮下的成瘤的杀伤作用;分子机制实验显示,奥美拉唑以AhR依赖的方式诱导A549、H460细胞对仑伐替尼的耐受作用。结论:奥美拉唑诱导非小细胞肺癌细胞A549、H460对分子靶向药物仑伐替尼的耐受。     

以EGFR为靶点的肿瘤分子靶向药物研究进展

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。     

抗-VEGF和抗-EGFR药物在进展期非小细胞肺癌治疗中的应用

化疗对非小细胞肺癌的疗效已到达平台期,研发更为有效、易耐受的治疗策略势在必行.肿瘤生物学分子机制研究孕育了分子靶向治疗.VEGF、EGFR相关信号通路在肿瘤发生、发展中发挥重要作用,是抗肿瘤药物的重要分子靶点.贝伐单抗联合化疗和小分子酪氨酸激酶抑制剂(埃罗替尼和吉非替尼)分别成为非小细胞肺癌的一、二线治疗方案.本文将综述多种抗-VEGF和抗-EGFR新药在进展期非小细胞肺癌治疗中的临床应用.     

治疗性单克隆抗体药物的现状及发展趋势

治疗性单克隆抗体药物经历了三十多年的发展,已经成为生物医药的最重要组成部分之一.在疾病治疗上具有广阔的应用前景,成功用于治疗肿瘤、自身免疫性疾病、感染性疾病和移植排斥反应等多种疾病.截至2012年已有29种治疗性单克隆抗体药物通过FDA审批并上市销售.治疗性单抗的安全性和有效性很大程度上由其作用的靶点决定,上市和在研的单抗药物有些靶向相同的靶点,有些有自己独特的作用靶点,新的作用靶点也在不断出现.以治疗性单抗的作用靶点为切入点,对目前上市销售和研发中的此类药物进行了简要总结.详述了肿瘤坏死因子α、白细胞分化抗原20、表皮生长因子受体及血管内皮生长因子等4种靶点的特点及相关单克隆抗体药物的情况,并对我国单抗药物的现状进行了分析,提出未来发展对策.     

非小细胞肺癌免疫治疗的研究进展

肺癌(lung cancer)是全球发病率及死亡率最高的恶性肿瘤之一,非小细胞肺癌(non-small cell lung cancer,NSCLC)占肺癌的85%,其五年生存率只有15%,传统的抗肿瘤治疗方法(手术、放疗和化疗等)在抑制肿瘤进展中的作用有限,即使有手术机会,也有40%以上患者出现局部复发或远处转移。目前多学科治疗较大程度提高了晚期NSCLC的生存期,研究表明,免疫治疗(immunotherapy)可改善肺癌的预后,有望成为肺癌的重要辅助治疗方式。其中,治疗性肿瘤疫苗(vaccination)如MAGE-A3、L-BLP25、Belagenpum atucel-L等、免疫检查点抑制剂(immune checkpoint inhibition)如ipilimumab、nivolumab、pembrolizumab等得到广泛关注。一系列临床试验表明免疫治疗可以使非小细胞肺癌的死亡率得到缓解,本文就其原理、临床试验、不良反应及有待解决问题的临床研究作系统综述。     

The effect of HMGB1 A box on lung injury in mice with acute pancreatitis

The objective of this study is to observe the effect of high-mobility group protein B1 A Box (HMGB1 A) box on lung injury in mice with acute pancreatitis and its effect on the level of high-mobility group protein B1 (HMGB1) in lung, to explore the mechanism. A total of 60 male Institute of Cancer Research mice were randomly divided into control group (n = 30) and treatment group (n = 30). Severe acute pancreatitis mice model was induced by 20% L-Arg intraperitoneal injection. The recombination HMGB1 A box was used in treatment after modeling. All the mice were killed under anesthesia at 24 and 48 h after the modeling injection. The level of HMGB1 and activity of myeloperoxidase (MPO) in lung were measured. The pathological changes of lung were observed. The level of HMGB1 in lung of A box treatment group decreased more significantly 24 h and 48 h after modeling compared with control group. The activity of MPO in lung of A box treatment group decreased more significantly 24 h after modeling compared with control group. The lung tissue pathologic score of A box treatment group decreased more significantly 48 h after modeling compared with control group. HMGB1 expression levels in the lungs were positively related to histological score of injured lung in acute pancreatitis. It indicates that HMGB1 A box is remarkably protective to lung injury induced by acute pancreatitis.     

The role of p53 in treatment responses of lung cancer

Resistance to radio- and chemotherapy is a major problem in treatment responses of lung cancer. In this disease, biological markers, that can be predictive of response to treatment for guiding clinical practice, still need to be validated. Radiotherapy and most chemotherapeutic agents directly target DNA and in response to such therapies, p53 functions as a coordinator of the DNA repair process, cell cycle arrest, and apoptosis. In fact, it participates in the main DNA repair systems operative in cells, including NHEJ, HRR, NER, BER, and MMR. Given the high p53 mutation frequency in lung cancer which likely impairs some of the p53-mediated functions, a role of p53 as a predictive marker for treatment responses has been suggested. In this review, we summarize the conflicting results coming from preclinical and clinical studies on the role of p53 as a predictive marker of responses to chemotherapy or radiotherapy in lung cancer.     

肺癌生存质量量表在晚期肺癌中使用的研究进展

近几年来,肺癌的发病率呈现逐年上升的趋势,成为癌症中的头号杀手。临床上针对不同类型肺癌有不同的治疗策略,由于临床上大部分病人在确诊为肺癌时已经为晚期,对于常规治疗方法难以达到效果时,关注肺癌患者的生存质量就显地尤为必要。肺癌生存质量量表可以反映病人临床治疗后的生存质量状况,达到反馈治疗效果的目的。在临床实验中使用肺癌生存质量量表可以帮助临床医师制定最优化的治疗方案。国际上的研究大多不是以生存质量为主要终点的研究,生存质量也不能全面的反映病人预后的状况,希望在今后的研究中,肺癌生存质量量表能够在临床中的使用更加普及、更加全面。本文就肺癌生存质量量表在晚期肺癌中使用的研究进展作一综述,以期更加促进我们对于晚期肺癌患者生存质量的思考与关注,更有利于适合我国国情的生存质量量表的研究和发展。     

Signaling pathways in the epithelial origins of pulmonary fibrosis

Pulmonary fibrosis complicates a number of disease processes and leads to substantial morbidity and mortality. Idiopathic pulmonary fibrosis (IPF) is perhaps the most pernicious and enigmatic form of the greater problem of lung fibrogenesis with a median survival of three years from diagnosis in affected patients. In this review, we will focus on the pathology of IPF as a model of pulmonary fibrotic processes, review possible cellular mechanisms, review current treatment approaches and review two transgenic mouse models of lung fibrosis to provide insight into processes that cause lung fibrosis. We will also summarize the potential utility of signaling pathway inhibitors as a future treatment in pulmonary fibrosis. Finally, we will present data demonstrating a minimal contribution of epithelial-mesenchymal transition in the development of fibrotic lesions in the transforming growth factor-alpha transgenic model of lung fibrosis.     

The role of collagenase in emphysema

The extracellular matrix is essential for the integrity of the lung and when disrupted can lead to the architectural changes seen in emphysema. The etiology of emphysema is believed to be due to an imbalance in the proteases and antiproteases within the lung. Studies have focused on elastolytic enzymes as the primary agents in disease pathogenesis, however, recent data suggest that collagenases may also be involved in the destruction of lung tissue in emphysema. It is hoped that this expanded understanding of the pathophysiology of emphysema will lead to improved therapy in the treatment of the disease.     

Potential role of apoptotic macrophages in pulmonary inflammation and fibrosis

Induction of apoptosis has been associated with a variety of exposures which result in inflammatory and fibrotic lung disorders. Macrophages are key regulatory cells in the lung; however, the role of apoptotic macrophages in those pulmonary disorders is not well characterized. In the present investigation, apoptotic macrophages were instilled into the lungs of rats to study directly the pulmonary responses to apoptotic cells. The effects of apoptotic macrophages on lung inflammation and fibrosis, as well as associated protein expression of TNF-alpha, TGF-beta, and matrix metalloproteinases (MMPs) were examined. Induction of macrophage apoptosis was carried out in vitro using a variety of known apoptosis inducers. Intratracheal administration of apoptotic macrophages (5 x 10(6) cells/rat) into the lung of rats caused an increase in pulmonary infiltration of macrophages and lung cell apoptosis 4 weeks after the treatment as indicated by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay. In contrast, pulmonary instillation of saline or normal control macrophages had no effect. Histological analysis of lung sections showed collagen deposition and fibrotic lesions after apoptotic cell treatment but not in control groups. Immunohistochemical studies revealed increased expression of TNF-alpha, TGF-beta, MMP2, and MMP9 in the treatment group 4 weeks after the treatment. These results suggest a role for macrophage apoptosis in the initiation of these lung disorders. This study provides direct evidence that apoptotic macrophages can induce lung inflammation and fibrosis and that this induction may be associated with increased expression of TNF-alpha, TGF-beta, MMP2, and MMP9. Published 2002 Wiley-Liss, Inc.     

Inhibition of endotoxin-induced lung inflammation by interleukin-10 gene transfer in mice

Interleukin (IL)-10 is an anti-inflammatory cytokine that has great potential for use in the treatment of inflammatory and immune illnesses. In this study, gene transfer was used to induce IL-10 transgene expression in murine lungs for treatment of endotoxin-induced lung inflammation. Gene transfer was performed with a cytomegalovirus (CMV)-IL-10 plasmid with the aid of the liposomal agents LipofectAMINE and N-[1-(2,3-dioleoyl)propyl]-N,N, N-trimethylammonium methylsulfate (DOTAP). Administration of the endotoxin caused a marked increase in lung inflammation as indicated by increased tumor necrosis factor (TNF)-alpha release and neutrophil count. Pretreatment of the mice with IL-10 plasmid with and without LipofectAMINE had no inhibitory effect on lung inflammation and IL-10 transgene expression. LipofectAMINE by itself induced lung inflammation, an effect that was not observed with DOTAP. IL-10 plasmid when codelivered with DOTAP expressed biologically active IL-10 protein and caused a reduction in endotoxin-induced inflammation. Transgene expression was observed as early as 3 h after administration, peaked at 12 h, and declined thereafter. We conclude that IL-10 gene transfer is a feasible approach for the treatment of lung inflammation.