癌症中表皮生长因子受体靶向治疗的重要进展与新趋势
Critical update and emerging trends in epidermal growth factor receptor targeting in cancer.
作者信息
Baselga José, Arteaga Carlos L
机构信息
Medical Oncology Service, Vall d'Hebron Research Institute and Vall d'Hebron University Hospital, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain.
出版信息
J Clin Oncol. 2005 Apr 10;23(11):2445-59. doi: 10.1200/JCO.2005.11.890. Epub 2005 Mar 7.
The epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase of the ErbB receptor family that is abnormally activated in many epithelial tumors. The aberrant activation of the EGFR leads to enhanced proliferation and other tumor-promoting activities, which provide a strong rationale to target this receptor family. There are two classes of anti-EGFR agents: monoclonal antibodies (MAbs) directed at the extracellular domain of the receptor and small molecule, adenosine triphosphate-competitive inhibitors of the receptor's tyrosine kinase. Anti-EGFR MAbs have shown antitumor activity in advanced colorectal carcinoma, squamous cell carcinomas of the head and neck, non-small-cell lung cancer (NSCLC) and renal cell carcinomas. The tyrosine kinase inhibitors (TKIs) have a partially different activity profile. They are active against NSCLC, and a specific EGFR inhibitor has shown improvement in survival. Recently, mutations and amplifications of the EGFR gene have been identified in NSCLC and predict for enhanced sensitivity to anti-EGFR TKIs. In addition to specific anti-EGFR TKIs, there are broader acting inhibitors such as dual EGFR HER-2 inhibitors and combined anti-pan-ErbB and antivascular endothelial growth factor receptor inhibitors. Current research efforts are directed at selecting the optimal dose and schedule and identifying predictive factors of response and resistance beyond EGFR gene mutations and/or amplifications. Finally, there is a need for improved strategies to integrate anti-EGFR agents with conventional therapies and to explore combinations with other molecular targeted approaches including other antireceptor therapies, receptor-downstream signaling transduction inhibitors, and targeted approaches interfering with other essential drivers of cancer, such as angiogenesis.
表皮生长因子受体(EGFR)是ErbB受体家族的一种受体酪氨酸激酶,在许多上皮肿瘤中被异常激活。EGFR的异常激活导致增殖增强及其他促肿瘤活性,这为靶向该受体家族提供了有力依据。有两类抗EGFR药物:针对受体胞外结构域的单克隆抗体(MAb)和受体酪氨酸激酶的小分子三磷酸腺苷竞争性抑制剂。抗EGFR单克隆抗体已在晚期结直肠癌、头颈部鳞状细胞癌、非小细胞肺癌(NSCLC)和肾细胞癌中显示出抗肿瘤活性。酪氨酸激酶抑制剂(TKI)的活性谱部分不同。它们对NSCLC有活性,一种特异性EGFR抑制剂已显示出可改善生存期。最近,在NSCLC中已鉴定出EGFR基因的突变和扩增,并预测对抗EGFR TKI的敏感性增强。除了特异性抗EGFR TKI外,还有作用更广泛的抑制剂,如双EGFR HER-2抑制剂以及联合抗泛ErbB和抗血管内皮生长因子受体抑制剂。目前的研究工作旨在选择最佳剂量和给药方案,并确定除EGFR基因突变和/或扩增之外的反应和耐药预测因素。最后,需要改进策略,将抗EGFR药物与传统疗法相结合,并探索与其他分子靶向方法的联合应用,包括其他抗受体疗法、受体下游信号转导抑制剂,以及干扰癌症其他重要驱动因素(如血管生成)的靶向方法。