Lefranc Florence, Facchini Vincenzo, Kiss Robert
Department of Neurosurgery, Erasmus Academic Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium.
Oncologist. 2007 Dec;12(12):1395-403. doi: 10.1634/theoncologist.12-12-1395.
The therapeutic goal of cancer treatment has been to trigger tumor-selective cell death. Although cell death can be achieved not only by apoptosis (type I programmed cell death) but also by necrosis, mitotic catastrophe, and autophagy, drugs inducing apoptosis remain the main chemotherapeutic agents in medical oncology. However, cancer cells in their relentless drive to survive, hijack cell processes, resulting in apoptosis resistance, which underlies not only tumorigenesis but also the inherent resistance of certain cancers to radiotherapy and chemotherapy. Unlike apoptosis, which is a caspase-dependent process characterized by nuclear condensation and fragmentation, autophagic cell death is a caspase-independent process characterized by the accumulation of autophagic vacuoles in the cytoplasm accompanied by extensive degradation of the Golgi apparatus, the polyribosomes, and the endoplasmic reticulum, which precedes the destruction of the nucleus. The most striking evidence for proautophagic chemotherapy to overcome apoptosis resistance in cancer cells comes from the use of temozolomide, a proautophagic cytotoxic drug, which has demonstrated real therapeutic benefits in glioblastoma patients and is in clinical trials for several types of apoptosis-resistant cancers. A number of potential common targets in autophagy and apoptosis resistance pathways, that is, mammalian target of rapamycin (mTOR), phosphatidylinositol 3' kinase (PI3K), and Akt have been identified. Thus, further success in certain devastating cancers might be achieved by the combination of proautophagic drugs such as temozolomide with mTOR, PI3K, or Akt inhibitors, or with endoplasmic reticulum stress inhibitors as adjuvant chemotherapies.
癌症治疗的目标是引发肿瘤选择性细胞死亡。虽然细胞死亡不仅可以通过凋亡(I型程序性细胞死亡)实现,还可以通过坏死、有丝分裂灾难和自噬实现,但诱导凋亡的药物仍然是医学肿瘤学中的主要化疗药物。然而,癌细胞为了生存而不懈努力,劫持细胞进程,导致凋亡抗性,这不仅是肿瘤发生的基础,也是某些癌症对放疗和化疗具有固有抗性的原因。与凋亡不同,凋亡是一个依赖半胱天冬酶的过程,其特征是细胞核浓缩和碎片化,自噬性细胞死亡是一个不依赖半胱天冬酶的过程,其特征是细胞质中自噬泡的积累,同时伴随着高尔基体、多聚核糖体和内质网的广泛降解,这在细胞核破坏之前发生。自噬性化疗克服癌细胞凋亡抗性的最显著证据来自替莫唑胺的使用,替莫唑胺是一种自噬性细胞毒性药物,已在胶质母细胞瘤患者中显示出实际治疗益处,并且正在针对几种凋亡抗性癌症进行临床试验。已经确定了自噬和凋亡抗性途径中的一些潜在共同靶点,即哺乳动物雷帕霉素靶蛋白(mTOR)、磷脂酰肌醇3'激酶(PI3K)和Akt。因此,通过将替莫唑胺等自噬性药物与mTOR、PI3K或Akt抑制剂,或与内质网应激抑制剂联合作为辅助化疗,可能在某些毁灭性癌症中取得进一步成功。
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