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。     

免疫检查点抑制剂治疗非小细胞肺癌的热点问题

免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)在临床上是治疗晚期非小细胞肺癌(nonsmall cell lung cancer,NSCLC)的重要手段之一。近年来,越来越多的研究开始聚焦ICIs的耐药性和免疫相关不良事件(immune-related adverse events,irAEs)以及ICIs预后相关的生物标记物等问题。本文结合近年的研究结果,总结了现阶段ICIs的主要应用、ICIs相关耐药性的主要机制和治疗策略、irAEs的相关研究进展以及现阶段一些有潜力的预后生物标记物。     

TEM1mRNA 在非小细胞肺癌中的表达及临床意义*

目的:揭示TEM1其与非小细胞肺癌侵袭和转移的可能关系,为靶向治疗提供理想的药物作用靶点。方法:实时荧光定量PCR方法检测56例非小细胞肺癌肿瘤组织及癌旁组织中TEM1 mRNA表达水平,分析其在不同组中的表达差异。结果:TEM1在56例非小细胞肺癌组织中都有表达。TEM1表达水平在肿瘤组织中比癌旁组织表达高,并且其表达水平与淋巴结转移及肿瘤分期密切相关(P<0.05),但与患者的病理类型,年龄及性别无关(P>0.05)。结论:TEM1表达水平与非小细胞肺癌分期密切相关,表明其可能是一个参与非小细胞肺癌侵袭及转移有价值的分子标记物。TEM1可能成为潜在的基因治疗靶点。     

Livin 蛋白在非小细胞肺癌中的表达及其临床意义

目的：研究livin 蛋白在非小细胞肺癌中的表达及其与非小细胞肺癌的生物学特性及临床预后的关系。方法：通过免疫组化 的方法检测和比较88 例非小细胞肺癌组织和20例癌旁正常肺组织中livin 蛋白的表达,并分析其与非小细胞肺癌的临床病理特 征和预后的相关性。结果：非小细胞肺癌组织及癌旁正常肺组织中livin 蛋白的阳性表达率分别为54.55%和5%,差异有显著统计 学差异(P<0.05)。非小细胞肺癌组织中livin 蛋白的表达水平与淋巴结转移、TNM分期显著相关(P<0.05),但与患者的性别、年龄、 分化程度及病理学类型无关(P>0.05)。Livin 高表达的非小细胞肺癌患者生存时间显著短于livin 低表达的患者(P<0.05)。结论： Livin 蛋白在非小细胞肺癌的发生及发展中起重要作用并与患者的预后相关,可能作为非小细胞肺癌新的防治靶点。     

Girdin 表达与非小细胞肺癌侵袭转移及预后的关系

目的:探讨肌动蛋白结合蛋白Girdin与非小细胞肺癌(Non small cell lung cancer,NSCLC)侵袭转移的关系及其对预后的影响。方法:应用免疫组织化学法检测167例非小细胞肺癌患者的病理组织标本中Girdin蛋白和MMP-9的表达。结果:在167例组织标本中Girdin蛋白高表达率为38.9%,其表达水平与患者分期、淋巴结转移、远处转移及生存状况密切相关,差异有统计学意义(P0.05),而与患者性别、年龄、吸烟指数、评分、病理类型及分化程度均无关(P均0.05)。Girdin蛋白的高表达往往伴有MMP-9的高表达,两者显著相关,且差异有统计学意义(P0.05)。Kaplan-Meier单因素生存分析显示Girdin高表达为非小细胞肺癌患者预后的不良因素(P0.05)。COX多因素回归分析显示Girdin的表达水平和分期是判断预后的独立指标(P0.05)。结论:Girdin蛋白在非小细胞肺癌的侵袭和转移中可能发挥着重要的作用,在判断非小细胞肺癌患者预后方面具有一定的价值。     

非小细胞肺癌患者血中DNA片段的检测、定量及临床意义的研究

目的探讨非小细胞肺癌患者血中游离DNA片段在临床上早期诊断、分期、预后方面的意义。方法随机采集2004年10月至12月大连医科大学附属二院经病理确诊的初治Ⅲ、Ⅳ期非小细胞肺癌患者的血标本15份,门诊健康体检者血标本15份,通过酚/氯仿提取法定量检测两组的血浆DNA片段,进行对照比较,分析非小细胞肺癌组内各因素(包括与诊断相关的肿瘤标记物,与预后相关的年龄、性别、一般状况及病理类型、疾病分期、免疫指标、是否转移等)与血浆游离DNA片段水平的相关性。结果非小细胞肺癌组血浆游离DNA片段水平高于正常健康对照组,其血浆游离DNA片段的均值分别为:(384.8±99.36)μg/ml与(13.9±3.60)μg/ml,差异有显著性,Ⅲ期与Ⅳ期非小细胞肺癌患者的血浆游离DNA片段差异有显著性,均值分别为:(290.4±91.82)μg/ml与(481.2±196.44)μg/ml,且非小细胞肺癌患者的血浆游离DNA片段与肿瘤标记物CA199、CYFRA21-1、ALP呈正相关性;在预后因素分析中,显示非小细胞肺癌患者的血浆游离DNA片段水平与一般状态、免疫状态、病理类型及是否存在远处转移等因素有明显相关性,其中与一般状态、免疫状态呈负相关,与远处转移呈正相关,与性别、年龄、治疗疗效等因素无相关性。结论非小细胞肺癌患者血中的游离DNA片段水平较健康人高,且不同病期有一定差异,可能与患者自身状态、病理分型、疾病状态有关;游离DNA片段可以作为检测非小细胞肺癌的特异性指标,还可以替代一般状态、免疫状态、病理类型、是否存在远处转移等指标评价远期预后,并有取材方便、检测时间短、可以定量分析的优点,对临床有一定的指导意义和应用价值。     

基于生物信息学方法识别非小细胞肺癌(NSCLC)潜在治疗靶基因

本研究运用生物信息学方法识别非吸烟女性非小细胞肺癌(NSCLC)潜在的靶基因,并从分子水平探索其潜在的发病机制。从GEO数据库下载非吸烟女性非小细胞肺癌相关基因芯片数据集,经癌症组和癌旁对照组差异表达基因识别,并利用R软件对差异基因进行层次聚类分析,DAVID进行基因本体(gene ontology)和KEGG通路富集分析,STRING和Cytoscape软件构建蛋白-蛋白交互(PPI)网络,以及运用PASTAA分析,识别NSCLC相关转录因子,构建转录因子-基因共表达网络。结果表明,185个基因在NSCLC中差异表达,其中40个上调,145个下调;通过PASTAA分析识别出5个NSCLC基因相关转录因子。差异基因与胶原分解代谢过程、炎症反应的正调控等生物过程密切相关,基因的产物主要参与蛋白质细胞外基质、胶原三聚体等细胞组分,且主要发挥调节金属内肽酶活性、肝素结合和调节受体活性等分子功能;KEGG通路富集分析表明差异基因显著富集到胞外基质-受体信号通路、粘着斑信号通路、PPAR信号通和PI3K-Akt信号通路等,与非小细胞肺癌的发生发展密切相关。通过生物信息学方法,最终筛选到4个NSCLC关键基因:IL6、MMP1、COL1A1、CD36,其可能是非吸烟女性NSCLC潜在的治疗靶点。     

c-FLIP的分子调节机制

细胞型含死亡域的Fas结合蛋白样白介素-1β转换酶抑制蛋白(cellular FADD-like interleukin-1βconverting enzyme inhibitory protein,c-FLIP)是一类含有死亡效应结构域(the death effector domain,DED)的天然存在的胱天蛋白酶(caspase)抑制蛋白,广泛存在于各种生物物种中,其过量表达能抑制Fas和肿瘤坏死因子相关促凋亡配体(TRAIL)等死亡受体介导的细胞凋亡。目前认为c-FLIP与炎症、肿瘤及自身免疫性疾病的发生发展密切相关。对其分子调节机制的深入研究将有助于深化对这些疾病的认识,并为临床治疗这些疾病提供新的方法和思路。     

核不均一核糖核蛋白R基因沉默抑制非小细胞肺癌细胞恶性转化

核不均一核糖核蛋白R(hnRNPR)是一种与mRNA生物学功能密切相关的RNA结合蛋白质,与多种肿瘤细胞的恶性转化相关。然而,在非小细胞肺癌(NSCLC)中的作用机制尚不清楚。本研究通过检索公共数据库发现,hnRNPR蛋白主要在肺癌细胞核中表达,hnRNPR mRNA在非小细胞肺癌组织中高表达,并且与肺腺癌患者的生存率呈负相关;hnRNPR的表达与非小细胞肺癌患者的性别、T分期显著相关(P<0.05)。构建hnRNPR基因沉默的非小细胞肺癌稳定细胞株,检测细胞功能变化,结果显示,hnRNPR基因沉默抑制了细胞增殖、迁移和侵袭能力以及上皮-间质转化(EMT),并将细胞周期阻滞在G₁期(P<0.01)。生物信息学分析显示,非小细胞肺癌中hnRNPR基因与9 310个基因的表达正相关(皮尔逊相关系数>0,P<0.05),与10 680个基因的表达负相关(皮尔逊相关系数<0,P<0.05)。综上所述,hnRNPR在非小细胞肺癌中高表达,可能作为剪接体的组分,通过调节相关基因的表达,促进了NSCLC细胞的恶性转化。     

经典Wnt信号通路与非小细胞肺癌潜在治疗靶点的研究新进展

经典Wnt信号通路在人类非小细胞肺癌(non-small cell lung cancer,NSCLC)的发病和病程进展中具有重要的调控作用,它与肿瘤组织的增殖、生长、代谢、侵袭和转移有着紧密联系。在NSCLC发生发展中,经典Wnt信号通路的相关蛋白表达发生较复杂的改变,并影响疾病预后,因此,研究这些相关蛋白的表达情况有助于明确NSCLC发病机制以及研究潜在治疗方法。现对经典Wnt通路中NSCLC相关蛋白表达情况和作用以及潜在治疗靶点进行了归纳。     

Markers of small cell lung cancer

Lung cancer is the number one cause of cancer death; however, no specific serum biomarker is available till date for detection of early lung cancer. Despite good initial response to chemotherapy, small-cell lung cancer (SCLC) has a poor prognosis. Therefore, it is important to identify molecular markers that might influence survival and may serve as potential therapeutic targets. The review aims to summarize the current knowledge of serum biomarkers in SCLC to improve diagnostic efficiency in the detection of tumor progression in lung cancer. The current knowledge on the known serum cytokines and tumor biomarkers of SCLC is emphasized. Recent findings in the search for novel diagnostic and therapeutic molecular markers using the emerging genomic technology for detecting lung cancer are also described. It is believed that implementing these new research techniques will facilitate and improve early detection, prognostication and better treatment of SCLC.     

Proteomics analysis of human serum of patients with non-small-cell lung cancer reveals proteins as diagnostic biomarker candidates

Non-small-cell lung carcinomas (NSCLC) is the most common type of lung cancer and it has a poor prognosis, because overall survival after 5 years is 20–25% for all stages. Thus, it is extremely important to increase the survival rate in the early stages NSCLC by focusing on novel screening tests of cancer identifying specific biomarkers expression associated with a more accurate tumor staging and patient prognosis. In this study, we focused our attention on quantitative proteomics of three heavily glycosylated serum proteins: AMBP, α2 macroglobulin, and SERPINA1. In particular, we analyzed serum samples from 20 NSCLC lung adenocarcinoma cancer patients in early and advanced stages, and 10 healthy donors to obtain a relative quantification through the MRM analysis of these proteins that have shown to be markers of cancer development and progression. AMBP, α2 macroglobulin, and SERPINA1 were chosen because all of them possess endopeptidase inhibitor activity and play key roles in cancer. We observe a variation in the expression of these proteins linked to the stage of the disease. Therefore, we believe that proteins like α2 macroglobulin, αmicroglobulin/bikunin, and SERPINA1 could be useful biomarkers for early detection of lung cancer and in monitoring its evolution.     

Detection of cytoskeletal proteins in small cell lung carcinoma

Small cell lung carcinoma (SCLC) is the most aggressive of lung tumors, metastasize widely and are virtually incurable by surgical means. Therefore, the classification of lung cancer into SCLC and non-small cell lung carcinoma is essential for disease prognosis and treatment. For this purpose we have compared the immunohistochemical distribution of different cytoskeletal proteins as tumor markers. Analysis was performed by using of monoclonal antibodies directed against cytokeratins, neurofilaments, betaIII-tubulin, epithelial membrane antigen and neuron-specific enolase. Our results indicate that keratin and epithelial membrane antigen are reliable epithelial markers for SCLC. In addition, the positive staining with monoclonal antibodies TU-20 against betaIII-tubulin and neuron-specific enolase was found in some cases of SCLC. We suggest, that these antibodies could be a useful tool for complex immunohistochemical diagnosis of SCLC.     

New insights into small‐cell lung cancer development and therapy

Small‐cell lung cancer (SCLC) accounts for approximately 15% of lung cancer cases; however, it is characterized by easy relapse and low survival rate, leading to one of the most intractable diseases in clinical practice. Despite decades of basic and clinical research, little progress has been made in the management of SCLC. The current standard first‐line regimens of SCLC still remain to be cisplatin or carboplatin combined with etoposide, and the adverse events of chemotherapy are by no means negligible. Besides, the immunotherapy on SCLC is still in an early stage and novel studies are urgently needed. In this review, we describe SCLC development and current therapy, aiming at providing useful advices on basic research and clinical strategy.     

The Potential Role of Pharmacogenomic and Genomic in the Adjuvant Treatment of Early Stage Non Small Cell Lung Cancer

Although notable progress has been made in the treatment of non-small-cell lung cancer (NSCLC) in recent years, this disease is still associated with a poor prognosis. Despite early-stage NSCLC is considered a potentially curable disease following complete resection, the majority of patients relapse and eventually die after surgery. Adjuvant chemotherapy prolongs survival, altough the absolute improvement in 5-year overall survival is only approximately 5%.Trying to understand the role of genes which could affect drug activity and response to treatment is a major challenge for establishing an individualised chemotherapy according to the specific genetic profile of each patient. Among genes involved in the DNA repair system, the excision repair cross-complementing 1 (ERCC1) is a useful markers of clinical resistance to platinum-based chemotherapy. In the International Lung Cancer Trial (IALT) adjuvant chemotherapy significantly prolonged survival among patients with ERCC1 negative tumors but not among ERCC1-positive patients. BRCA1 and ribonucleotide reductase M1 (RRM1), two other key enzymes in DNA synthesis and repair, appear to be modulators of drug sensitivity and may provide additional information for customizing adjuvant chemotherapy.Several clinical trials suggest that overexpression of class III β-tubulin is an adverse prognostic factor in cancer since it could be responsible for resistance to anti-tubulin agents. A retrospective analysis of NCIC JBR.10 trial showed that high tubulin III expression is associated with a higher risk of relapse following surgery alone but also with a higher probability of benefit from adjuvant cisplatin plus vinorelbine chemotherapy.Finally, the use of gene expression patterns such as the lung metagene model could provide a potential mechanism to refine the estimation of a patient’s risk of disease recurrence and could affect treatment decision in the management of early stage of NSCLC.In this review we will discuss the potential role of pharmacogenomic approaches to guide the medical treatment of early stage NSCLC.Key Words: NSCLC, adjuvant treatment, molecular markers, ERCC1, RRM1, β-tubulin, EGFR.     

Small-cell lung cancer brain metastasis: From molecular mechanisms to diagnosis and treatment

Lung cancer is the most malignant human cancer worldwide, also with the highest incidence rate. However, small-cell lung cancer (SCLC) accounts for 14 % of all lung cancer cases. Approximately 10 % of patients with SCLC have brain metastasis at the time of diagnosis, which is the leading cause of death of patients with SCLC worldwide. The median overall survival is only 4.9 months, and a long-tern cure exists for patients with SCLC brain metastasis due to limited common therapeutic options. Recent studies have enhanced our understanding of the molecular mechanisms leading to meningeal metastasis, and multimodality treatments have brought new hopes for a better cure for the disease. This review aimed to offer an insight into the cellular processes of different metastatic stages of SCLC revealed by the established animal models, and into the major diagnostic methods of SCLC. Additionally, it provided in-depth information on the recent advances in SCLC treatments, and highlighted several new models and biomarkers with promises to improve the prognosis of SCLC.     

Identification of natural compounds tubercidin and lycorine HCl against small‐cell lung cancer and BCAT1 as a therapeutic target

Although small‐cell lung cancer (SCLC) accounts for a small fraction of lung cancer cases (~15%), the prognosis of patients with SCLC is poor with an average overall survival period of a few months without treatment. Current treatments include standard chemotherapy, which has minimal efficacy and a newly developed immunotherapy that thus far, benefits a limited number of patients. In the current study, we screened a natural product library and identified 5 natural compounds, in particular tubercidin and lycorine HCl, that display prominent anti‐SCLC activities in vitro and in vivo. Subsequent RNA‐sequencing and functional validation assays revealed the anti‐SCLC mechanisms of these new compounds, and further identified new cellular factors such as BCAT1 as a potential therapeutic target with clinical implication in SCLC patients. Taken together, our study provides promising new directions for fighting this aggressive lung cancer.     

PI3K/Akt/mTOR signaling orchestrates the phenotypic transition and chemo-resistance of small cell lung cancer

Small cell lung cancer(SCLC) is a phenotypically heterogeneous disease with an extremely poor prognosis,which is mainly attributed to the rapid development of resistance to chemotherapy. However, the relation between the growth phenotypes and chemo-resistance of SCLC remains largely unclear. Through comprehensive bioinformatic analyses, we found that the heterogeneity of SCLC phenotype was significantly associated with different sensitivity to chemotherapy. Adherent or semiadherent SCLC cells were enriched with activation of the PI3K/Akt/mTOR pathway and were highly chemoresistant. Mechanistically,activation of the PI3K/Akt/mTOR pathway promotes the phenotypic transition from suspension to adhesion growth pattern and confers SCLC cells with chemo-resistance. Such chemo-resistance could be largely overcome by combining chemotherapy with PI3K/Akt/mTOR pathway inhibitors. Our findings support that the PI3K/Akt/mTOR pathway plays an important role in SCLC phenotype transition and chemo-resistance,which holds important clinical implications for improving SCLC treatment.