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临床肿瘤学中的单克隆抗体

Monoclonal antibodies in clinical oncology.

作者信息

Dalle S, Thieblemont C, Thomas L, Dumontet C

机构信息

Hospices Civils de Lyon, Lyon, France.

出版信息

Anticancer Agents Med Chem. 2008 Jun;8(5):523-32. doi: 10.2174/187152008784533071.

Abstract

Monoclonal antibodies have yet considerably modified the field of clinical oncology. The growing knowledge of key cellular pathways in tumor induction and progression, targeted therapies represent an increasing proportion of new drugs entering clinical trials. Some molecules such as trastuzumab, rituximab, alemtuzumab, cetuximab are now widely used in clinical practice. These antibodies are now tested in different indications alone or in combination with standard chemotherapy. They are also developed for the treatment of inflammatory diseases (rituximab). Numerous others antibodies are currently in pre-clinical and clinical development phases for several malignancies including renal carcinoma, melanoma, lymphomas, leukaemia, breast, ovarian and colorectal cancer. An alternative approach is to conjugate the monoclonal antibody to a toxin, a cytotoxic agent, or a radioisotope. In other cases these antibodies aim to modify the tumour microenvironment through inhibition of angiogenesis or enhancing host immune response against cancer. If the molecule targeted by the antibodies is clearly identified, most often the precise mechanism of action of these immunoglobulins is not fully understood. They can have direct effects in inducing apoptosis or programmed cell death. They can block growth factor receptors, efficiently arresting proliferation of tumor cells. Indirect effects include recruiting cells that exert cytotoxicity, such as monocytes and macrophages (ADCC). Monoclonal antibodies also bind complement, leading to toxicity known as complement dependent cytotoxicity (CDC). The side effects associated with these new treatments were in part foreseeable depending on the affected cell or function. But new or surprising side effects emerged from clinical studies. We present an overview of the monoclonal antibodies used in clinical oncology or currently in development phases. We particularly focus on recent development including new indications, clinical trial results and specific side effects of monoclonal antibodies used in the treatment of cancer.

摘要

单克隆抗体已经极大地改变了临床肿瘤学领域。随着对肿瘤诱导和进展中关键细胞途径的认识不断增加,靶向治疗在进入临床试验的新药中所占比例越来越大。一些分子,如曲妥珠单抗、利妥昔单抗、阿仑单抗、西妥昔单抗,现在已广泛应用于临床实践。这些抗体目前正在单独或与标准化疗联合用于不同适应症的测试。它们也被开发用于治疗炎症性疾病(利妥昔单抗)。目前,许多其他抗体正处于针对包括肾癌、黑色素瘤、淋巴瘤、白血病、乳腺癌、卵巢癌和结直肠癌在内的多种恶性肿瘤的临床前和临床开发阶段。另一种方法是将单克隆抗体与毒素、细胞毒性剂或放射性同位素偶联。在其他情况下,这些抗体旨在通过抑制血管生成或增强宿主对癌症的免疫反应来改变肿瘤微环境。如果抗体所靶向的分子已被明确识别,那么这些免疫球蛋白的精确作用机制通常仍未被完全理解。它们可以直接诱导细胞凋亡或程序性细胞死亡。它们可以阻断生长因子受体,有效阻止肿瘤细胞增殖。间接作用包括募集发挥细胞毒性的细胞,如单核细胞和巨噬细胞(抗体依赖的细胞介导的细胞毒性作用)。单克隆抗体还能结合补体,导致称为补体依赖的细胞毒性作用。与这些新疗法相关的副作用在一定程度上取决于受影响的细胞或功能,是可以预见的。但临床研究也出现了新的或意想不到的副作用。我们概述了临床肿瘤学中使用的或目前处于开发阶段的单克隆抗体。我们特别关注近期的进展,包括新适应症、临床试验结果以及用于癌症治疗的单克隆抗体的特定副作用。

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