Tumor heterogeneity: morphological, molecular and clinical implications

Malignant tumors are characterized by their great heterogeneity and variability. There are hundreds of different types of malignant tumors that harbour many oncogenic alterations. The tumor heterogeneity has important morphological, molecular and clinical implications. Except for some hematopoietic and lymphoproliferative processes and small cell infant tumors, there are not specific molecular alterations for most human tumors. In this review we summarize the most important aspects of carcinogenesis and chemoradiosensitivity of malignant cells. In this regard, some oncogenes such as neu, ras and bcl-2 have been associated with cellular resistance to treatment with anticancer agents. The knowledge of oncogenic alterations involved in each tumor can be important to correlate the morphological features, the genetic background, the prognosis and the clinical response to treatment with anticancer agents. Based on the molecular background of the tumor there are new cancer gene therapy protocols. For example using adenovirus Ela in tumors with overexpression of neu oncogene, inhibitors of tyrosine kinase specific for the PDGF receptor in glioma, inhibitors of farnesil transferase to prevent ras activity in tumors with mutations in the ras gene.     

CAR-T cell therapy and its application in clinical cancer treatment

Immunotherapy is regarded as the most significant method for cancer treatment in recent years. Chimeric antigen receptor T cells (CAR-T) technology, one form of target immunotherapy, has made a great breakthrough in hematological malignancies treatment and also a few progress in solid tumor treatment. This article reviews the history and mechanism of CAR-T, as well as the advantages and limitations of CAR-T in clinical cancer treatment. Then the review mainly discussed the clinical trial progress of CAR-T cell therapy in solid tumor treatment. A primary obstacle of CAR-T therapy is the heterogeneity in solid tumors. With an increasing number of solid tumor surface antigens being discovered, different varieties of CARs have been designed to treat solid tumors and have made some progress in clinical trial. In the end, this review puts forward a possible development direction of CAR-T.     

双特异性抗体构建在肿瘤临床治疗中的应用

双特异性抗体(Bispecific antibody,BsAb)是具有两个不同抗原结合位点的抗体,可分为含Fc段和不含Fc段的BsAb,不同结构的BsAb具有不同的特点和应用领域。相比于传统的单克隆抗体,BsAb的灵敏度和特异性更高。更重要的是,BsAb具有募集免疫细胞、双重阻断信号通路等功能,在免疫诊断和治疗中扮演重要角色。随着全球环境的恶化以及人们生活习惯的不规律,肿瘤的发病率越来越高,成为仅次于心脑血管疾病的全球第二大致死疾病,全球每年有1200万新发癌症病例。肿瘤的治疗手段包括手术切除、放化疗和靶向治疗等。肿瘤免疫疗法是近几年新兴的治疗方法,其通过激发自身免疫系统的能力来清除肿瘤细胞。传统的单抗药物虽在肿瘤靶向治疗和免疫治疗中取得了一定的疗效,但肿瘤具有高度的异质性和可塑性,常常引发肿瘤耐药性的出现。双特异性抗体能够同时靶向多个靶点,目前已用于肿瘤的临床治疗,并取得了一定的治疗效果。文中就双特异性抗体在肿瘤临床治疗中的研究进展和应用作一综述。     

Novel antigens of CAR T cell therapy: New roads; old destination

Chimeric antigen receptor T cell (CAR-T) therapy has so far proved itself as a reliable therapeutic option for the treatment of relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL), diffuse large B-cell lymphoma (DLBCL), multiple myeloma (MM), and mantle cell lymphoma (MCL). However, this picture is not as colorful when it comes to the treatment of solid tumors mainly due to the lack of definitive tumor antigens, as well as the immunosuppressive tumor microenvironments and poor CAR-T infiltration. The recent developments in bioinformatics and cell biology, such as single-cell RNA sequencing, have offered silver linings in the subject of tumor antigen discovery. In the current review, we summarize the development of some CAR-T therapies that target novel tumor antigens, rather than the traditionally CAR-T-targeted ones, and briefly discuss the clinical antitumor achievements of those evaluated in patients, so far. Furthermore, we propose some tumor antigens that might someday be therapeutically beneficial while targeted by CAR-Ts based on the experimental evaluations of their specific monoclonal antibodies.     

CAR-T联合疗法治疗实体瘤的研究进展

CAR-T疗法(chimeric antigen receptor T-cell immunotherapy)即嵌合抗原受体T细胞免疫疗法,是目前肿瘤免疫治疗中较有潜力的策略之一^[1],已成功应用于多种血液肿瘤的治疗。但CAR-T疗法在治疗实体瘤领域进展缓慢,存在肿瘤微环境的限制、细胞因子释放综合征以及严重的脱靶效应等诸多挑战^[2]。与单一靶向治疗相比,CAR-T联合疗法为改进肿瘤治疗方法提供了新的方向。综述目前常用的CAR-T联合治疗策略,针对CAR-T疗法在实体瘤治疗领域面临的主要挑战,探讨提高CAR-T疗效的潜在方案。     

CAR T targets and microenvironmental barriers of osteosarcoma

Osteosarcoma (OS) is one of the most common malignancies in children and adolescents. Multimodal chemotherapy and aggressive surgical resection have improved the prognosis of patients with osteosarcoma. However, the prognosis of OS patients with unresectable advanced tumors, distant metastasis or chemotherapy is still poor. Chimeric antigen receptor (CAR) T cells have achieved remarkable success in the treatment of hematologic malignancies, injecting new vitality into the field of adoptive cell therapy. However, the efficacy in solid tumors has been largely limited. The reason for the poor curative effect of solid tumors is mainly the heterogeneity of solid tumor antigen, immune escape, tumor microenvironment barrier, resistance of immunosuppressive cells and inhibitory factors, which lead to the obstruction of CAR T cell infiltration and the aggravation of failure. Potential antigenic targets for osteosarcoma CAR T cell therapy are under continuous exploration. Some of the antigenic targets, such as anti-HER2-CAR T cells, have achieved good results in preclinical studies, and some of them have entered clinical studies and achieved certain clinical effects. In this review, we discuss the research progress of potential antigen targets and osteosarcoma microenvironment of CAR T cells in the treatment of osteosarcoma.     

Dendritic Cell-Based Immunotherapy for Solid Tumors

As a treatment for solid tumors, dendritic cell (DC)-based immunotherapy has not been as effective as expected. Here, we review the reasons underlying the limitations of DC-based immunotherapy for solid tumors and ask what can be done to improve immune cell-based cancer therapies. Several reports show that, rather than a lack of immune induction, the limited efficacy of DC-based immunotherapy in cases of renal cell carcinoma (RCC) likely results from inhibition of immune responses by tumor-secreted TGF-β and an increase in the number of regulatory T (Treg) cells in and around the solid tumor. Indeed, unlike DC therapy for solid tumors, cytotoxic T lymphocyte (CTL) responses induced by DC therapy inhibit tumor recurrence after surgery; CTL responses also limit tumor metastasis induced by additional tumor-challenge in RCC tumor-bearing mice. Here, we discuss the mechanisms underlying the poor efficacy of DC-based therapy for solid tumors and stress the need for new and improved DC immunotherapies and/or combination therapies with killer cells to treat resistant solid tumors.     

Targets for active immunotherapy against pediatric solid tumors

The potential role of antibodies and T lymphocytes in the eradication of cancer has been demonstrated in numerous animal models and clinical trials. In the last decennia new strategies have been developed for the use of tumor-specific T cells and antibodies in cancer therapy. Effective anti-tumor immunotherapy requires the identification of suitable target antigens. The expression of tumor-specific antigens has been extensively studied for most types of adult tumors. Pediatric patients should be excellent candidates for immunotherapy since their immune system is more potent and flexible as compared to that of adults. So far, these patients do not benefit enough from the progresses in cancer immunotherapy, and one of the reasons is the paucity of tumor-specific antigens identified on pediatric tumors. In this review we discuss the current status of cancer immunotherapy in children, focusing on the identification of tumor-specific antigens on pediatric solid tumors.     

PDTX模型的研究进展

细胞源性异种移植(cell line-derived xenografts,CDX)与原发肿瘤相比失去了肿瘤的异质性和基因的多样性,在临床前的实验中不能有效评估肿瘤药物的疗效和安全性,致使临床药物高消耗而没有达到治疗疾病的目的,严重阻碍了临床药物的发展;人源性肿瘤组织异种移植(patient-derived tumor xenografts,PDTX)保持了原发肿瘤的分子学、基因学和病理学特征,而且经过在小鼠体内传代它仍保持了原发肿瘤的这些特性,为肿瘤的个体化治疗提供了更好的模型。PDTX模型的这些特性与CDX模型相比在肿瘤的个体化治疗方面更具有指导意义。本文将就PDTX模型的特征及其在肿瘤研究领域中的应用作系统阐述。     

An overview of the role of cancer stem cells in spine tumors with a special focus on chordoma简

Primary malignant tumors of the spine are relatively rare, less than 5% of all spinal column tumors. However, these lesions are often among the most difficult to treat and encompass challenging pathologies such as chordoma and a variety of invasive sarcomas. The mechanisms of tumor recurrence after surgical intervention, as well as resistance to radiation and chemotherapy, remain a pervasive and costly problem. Recent evidence has emerged supporting the hypothesis that solid tumors contain a sub-population of cancer cells that possess characteristics normally associated with stem cells. Particularly, the potential for long-term proliferation appears to be restricted to subpopulations of cancer stem cells (CSCs) functionally defined by their capacity to self-renew and give rise to differentiated cells that phenotypically recapitulate the original tumor, thereby causing relapse and patient death. These cancer stem cells present a unique opportunity to better understand the biology of solid tumors in general, as well as targets for future therapeutics. The general objective of the current study is to discuss the fundamental concepts for understanding the role of CSCs with respect to chemoresistance, radioresistance, special cell surface markers, cancer recurrence and metastasis in tumors of the osseous spine. This discussion is followed by a specific review of what is known about the role of CSCs in chordoma, the most common primary malignant osseous tumor of the spine.     

The use of radionuclides for tumor therapy

The successful use of radionuclides for tumor therapy depends to a major extent on the ability to achieve a high concentration of radioactivity in the tumor relative to other radiosensitive organs not involved by tumor, such as bone marrow, intestinal mucosa, liver, and kidneys. Techniques designed to achieve such differential localization of the radionuclides include the use of (1) radiopharmaceuticals that enter specific metabolic pathways unique to certain tumor types; (2) radiolabeled antibodies that attach to tumor-associated antigens present on tumor cell surfaces; (3) heterologous antibodies that attach to tumor-associated antigens present on tumor cell surfaces and which are then identified by radiolabeled antibodies directed against the species in which the original, unlabeled antibody was made; and (4) radiolabeled compounds injected regionally at the tumor site. Although both clinical and experimental evidence on the use of radionuclides for tumor therapy is encouraging in preliminary studies, extensive further research needs to be done in this area to insure the clinical efficacy of radionuclides for tumor therapy.     

Monoclonal antibody drug immunoconjugates for targeted treatment of cancer

Monoclonal antibodies (mAb) directed to tumor-associated antigens (TAA) or antigens differentially expressed on the tumor vasculature have been covalently linked to drugs that have different mechanisms of action and various levels of potency. The use of these mAb immunoconjugates to selectively deliver drugs to tumors has the potential to both improve antitumor efficacy and reduce the systemic toxicity of therapy. Several immunoconjugates, particularly those that incorporate internalizing antibodies and tumor-selective linkers, have demonstrated impressive activity in preclinical models. Immunoconjugates that deliver doxorubicin, maytansine and calicheamicin are currently being evaluated in clinical trials. The feasibility of using immunoconjugates as cancer therapeutics has been clearly demonstrated. Gemtuzumab ozogamicin, a calicheamicin conjugate that targets CD33, has recently been approved by the Food and Drug Administration (FDA) for treatment of acute myelogenous leukemia (AML). This review concentrates on the properties of the tumor and the characteristics of the mAb, linker, and drugs that influence the efficacy, potency, and selectivity of immunconjugates selected for cancer treatment.     

肿瘤巩固治疗临床研究现状

随着医学水平的不断进步,巩固治疗已广泛应用于造血系统肿瘤及各种实体瘤的临床治疗,治疗方案为巩固化疗/维持化疗、巩固放疗、免疫调节剂和中药巩固治疗。虽然巩固治疗在肿瘤治疗的应用中起到了积极地效果,但临床治疗中仍在探索抗肿瘤疗效确切、安全性高、毒副作用小、提高患者机体免疫功能且治疗费用经济的巩固治疗药物和方案,从而有效延长患者生存期。本文就这些药物的应用和研究进展进行综述。     

An overview of the role of cancer stem cells in spine tumors with a special focus on chordoma

Primary malignant tumors of the spine are relatively rare, less than 5% of all spinal column tumors. However, these lesions are often among the most difficult to treat and encompass challenging pathologies such as chordoma and a variety of invasive sarcomas. The mechanisms of tumor recurrence after surgical intervention, as well as resistance to radiation and chemotherapy, remain a pervasive and costly problem. Recent evidence has emerged supporting the hypothesis that solid tumors contain a sub-population of cancer cells that possess characteristics normally associated with stem cells. Particularly, the potential for long-term proliferation appears to be restricted to subpopulations of cancer stem cells(CSCs) functionally defined by their capacity to self-renew and give rise to differentiated cells that phenotypically recapitulate the original tumor, thereby causing relapse and patient death. These cancer stem cells present a unique opportunity to better understand the biology of solid tumors in general, as well as targets for future therapeutics. The general objective of the current study is to discuss the fundamental concepts for understanding the role of CSCs with respect to chemoresistance, radioresistance, special cell surface markers, cancer recurrence and metastasis intumors of the osseous spine. This discussion is followed by a specific review of what is known about the role of CSCs in chordoma, the most common primary malignant osseous tumor of the spine.     

Requirement of lipocalin 2 for hematopoietic and solid tumor malignancies

Our published studies indicate that lipocalin 2 is a critical factor for invasion of hematopoietic tissues by chronic myelogenous leukemia cells. Lipocalin 2 is secreted by Bcr-Abl+ chronic myeloid leukemia cells causing apoptosis in normal hematopoietic cells but not in Bcr-Abl+ cells. Secreted lipocalin 2 forms a complex with metalloproteinase MMP-9, and is reported to stabilize its activity, which implies that lipocalin 2 may have a role in solid tumor formation. Our studies indicate that Bcr-Abl+ mouse marrow cells lacking the lipocalin 2 gene are not only defective for leukemia induction but also are defective in forming solid tumors compared to Bcr-Abl marrow cells that express lipocalin 2. Thus, our findings indicate that lipocalin 2 has two functions in tumor malignancies: one involving induction of apoptosis in normal hematopoietic cells and the other to facilitate solid tumor formation.     

肿瘤免疫治疗研究现状及发展趋势

肿瘤免疫治疗是继传统的手术、化疗、放疗之后的一种新兴的肿瘤治疗手段,因其具有特异性高、疗效显著等优点而备受学者们的关注。随着对肿瘤微环境和肿瘤逃逸机制的深入了解,调动机体免疫系统去抵御肿瘤逐渐成为一种新的研究方向。肿瘤免疫治疗主要包括特异性疗法和非特异性疗法,目前以肿瘤疫苗和单克隆抗体为代表的特异性免疫疗法在临床上得到广泛应用,并显示出良好的发展前景。但肿瘤免疫治疗仍存在认识不足、临床适应证有限等问题,与此同时,我国肿瘤免疫治疗的发展较国外仍相对不足且面临一些特殊的问题。本文将对目前已有的肿瘤免疫治疗方法及评价体系进行综述,并对一些新的技术手段和治疗思路展开讨论,此外还将结合国内外最新研究进展深入探讨这一新兴疗法的缺陷及未来的发展趋势。     

Chemokine networks modulating natural killer cell trafficking to solid tumors

Natural killer (NK) cell-based cell therapy has been emerging as a powerful weapon in the treatment of multiple malignancies. However, the inadequate infiltration of the therapeutic NK cells into solid tumors remains a big challenge to their clinical utility. Chemokine networks, which play essential roles in the migration of lymphocytes, have been recognized as critical in driving the intratumoral infiltration of NK cells via interactions between soluble chemokines and their receptors. Often, such interactions are complex and disease-specific. In the context of NK cells, chemokine receptors of note have included CCR2, CCR5, CCR7, CXCR3, and CX3CR1. The immunobiology of chemokine-receptor interactions has fueled the development of approaches that hope to improve the infiltration of NK cells into the microenvironment of solid tumors. Stimulation of NK cells ex vivo in the presence of various cytokines (such as IL-2, IL-15, and IL-21) and genetic engineering of NK cells have been utilized to alter the chemokine receptor profile and generate NK cells with higher infiltrating capacity. Additionally, the immune-suppressive tumor microenvironment has also been targeted, by introducing, either directly or indirectly, chemokine ligands which NK cells are able to respond to, ultimately creating a more hospitable niche for NK cell trafficking. Such strategies have promoted the infiltration and activity of infused NK cells into multiple solid tumors. In this review, we discuss how chemokine receptors and their ligands coordinate and how they can be manipulated to regulate the trafficking, distribution, and residence of NK cells in solid tumors.     

The roles of ASK family proteins in stress responses and diseases

The aim of palliative chemotherapy is to increase survival whilst maintaining maximum quality of life for the individual concerned. Although we are still continuing to explore the optimum use of traditional chemotherapy agents, the introduction of targeted therapies has significantly broadened the therapeutic options. Interestingly, the results from current trials put the underlying biological concept often into a new, less favorable perspective. Recent data suggested that altered pathways underlie cancer, and not just altered genes. Thus, an effective therapeutic agent will sometimes have to target downstream parts of a signaling pathway or physiological effects rather than individual genes. In addition, over the past few years increasing evidence has suggested that solid tumors represent a very heterogeneous group of cells with different susceptibility to cancer therapy. Thus, since therapeutic concepts and pathophysiological understanding are continuously evolving a combination of current concepts in tumor therapy and tumor biology is needed. This review aims to present current problems of cancer therapy by highlighting exemplary results from recent clinical trials with colorectal and pancreatic cancer patients and to discuss the current understanding of the underlying reasons.     

Innovative strategies for PBPC mobilization

Stem cell transplantation, whether autologous or allogeneic, improves the outcome of patients with a number of hematologic malignancies or solid tumors. A relevant proportion of these patients are excluded from this treatment because sufficient numbers of hematopoietic stem cells cannot be obtained by standard cytokine-assisted mobilization. In this article we review the physiology of peripheral blood progenitor cell (PBPC) mobilization and discuss the role of adhesion molecules, such as integrins and selectins, chemokines and their ligands, such as SDF-1alpha and CXCR4, and proteolytic enzymes. Based on this knowledge, several innovative pharmacologic approaches have been proposed to boost the stem cell harvest. Some of them (CTCE, C3a receptor agonist and GrobetaT) are still subject of pre-clinical development, others, such as chemokine receptor ligand AMD3100, have recently been introduced in clinical trials and already deliver promising results. It appears possible to harvest PBPC successfully in poor mobilizers and to cut down the number of collections required in the remaining PBPC donors.