CYP17抑制作为前列腺癌的一种激素治疗策略。

CYP17 inhibition as a hormonal strategy for prostate cancer.

作者信息

Reid Alison Hm, Attard Gerhardt, Barrie Elaine, de Bono Johann S

机构信息

Institute of Cancer Research and the Royal Marsden Hospital, Surrey, UK.

出版信息

Nat Clin Pract Urol. 2008 Nov;5(11):610-20. doi: 10.1038/ncpuro1237.

Abstract

Androgen receptor (AR) signaling has a key role in the pathogenesis of prostate cancer. AR gene amplification, AR overexpression, and activating mutations in the AR occur more frequently as castration-resistant prostate cancer (CRPC) evolves, with intratumoral androgen levels remaining sufficient for AR activation despite castration. The source of these androgens might be either adrenal or intratumoral. AR signaling, therefore, remains a valid treatment target for patients with CRPC. CYP17 is a key enzyme for androgen biosynthesis. The imidazole antifungal agent ketoconazole weakly and nonspecifically inhibits CYP17, but remains unlicensed for this indication. Chemists at the Cancer Research UK Centre for Cancer Therapeutics have designed a novel, selective, irreversible inhibitor of CYP17 called abiraterone, which is more than 20 times more potent than ketoconazole. Abiraterone acetate, a prodrug, has undergone phase I assessment, and is rapidly progressing from phase II to phase III trials, in view of its high level of antitumor activity. This agent is safe and well tolerated, and activity profiles suggest that approximately 50% of CRPC remains AR-ligand driven. Other CYP17 inhibitors with alternative mechanisms of action, for example VN/124-1, are in preclinical development. The rationale for and implications of CYP17 inhibition and the CYP17-targeting agents in development are discussed in this Review.

摘要

雄激素受体(AR)信号传导在前列腺癌的发病机制中起关键作用。随着去势抵抗性前列腺癌(CRPC)的进展,AR基因扩增、AR过表达以及AR中的激活突变更为频繁地出现,尽管进行了去势,但肿瘤内雄激素水平仍足以激活AR。这些雄激素的来源可能是肾上腺或肿瘤内源性的。因此,AR信号传导仍然是CRPC患者的一个有效的治疗靶点。CYP17是雄激素生物合成的关键酶。咪唑类抗真菌药酮康唑对CYP17有微弱且非特异性的抑制作用,但尚未获得该适应证的许可。英国癌症研究中心癌症治疗部的化学家们设计了一种新型的、选择性的、不可逆的CYP17抑制剂阿比特龙,其效力比酮康唑高20多倍。醋酸阿比特龙是一种前体药物,已经历了I期评估,鉴于其较高的抗肿瘤活性,正迅速从II期试验进入III期试验。该药物安全且耐受性良好,活性谱表明约50%的CRPC仍然由AR配体驱动。其他具有不同作用机制的CYP17抑制剂,例如VN/124-1,正处于临床前开发阶段。本综述讨论了CYP17抑制的原理及其在开发中的CYP17靶向药物的意义。

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