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司美替尼用于携带KRAS突变的晚期非小细胞肺癌(NSCLC):KRAS突变型NSCLC面临的无尽临床挑战。

Selumetinib in advanced non small cell lung cancer (NSCLC) harbouring KRAS mutation: endless clinical challenge to KRAS-mutant NSCLC.

作者信息

Paolo Maione, Assunta Sgambato, Antonio Rossi, Claudia Sacco Paola, Anna Bareschino Maria, Clorinda Schettino, Francesca Casaluce, Fortunato Ciardiello, Cesare Gridelli

机构信息

Division of Medical Oncology, "S.G. Moscati" Hospital, Contrada Amoretta - 83100 Avellino Italy.

出版信息

Rev Recent Clin Trials. 2013 Jun;8(2):93-100. doi: 10.2174/15748871113089990047.

Abstract

During the past few years, oncologists have witnessed the reclassification of non small cell lung cancer (NSCLC) as not one disease, but several molecularly defined subsets of disease with relevant therapeutic implications in the field of molecularly targeted therapies. Two not very common genetically defined subsets of NSCLC, including those with EGFR or ALK activating mutations, and show high sensitivity to tyrosine-kinase inhibitors such that patients frequently have sustained clinical responses to therapy. However, the largest subset harbours an activating KRAS mutation and up to now, no successful targeted therapy has been developed for RAS-mutant lung cancer, with few compounds being assessed by clinical trials. In fact, KRAS has remained an elusive target for cancer therapy for biologic reasons. The chief value of KRAS lies in providing information about the other biomarkers that are directly druggable, that is, EGFR and ALK. The presence of mutated KRAS rules out ALK and EGFR, and KRAS may therefore form part of an efficient pathway in a testing algorithm. Currently, KRAS itself remains undruggable despite decades of effort, but attention has recently focused on inhibition of the Ras-contingent downstream signalling. Selumetinib (AZD6244; ARRY-142886) is an oral, tight-binding, uncompetitive inhibitor of mitogen-activated protein kinase kinases (MEK) 1 and 2, downstream of KRAS, with preclinical evidence of synergistic activity with docetaxel in KRAS-mutant cancers and currently in clinical development. The Ras/RAF/MEK/ERK pathway is frequently deregulated in cancer and a number of inhibitors that target this pathway are currently in clinical development. Recently, in a randomised, phase II trial selumetinib plus docetaxel has proven to improve progression free survival compared to docetaxel alone in previously treated patients with advanced KRAS-mutant NSCLC.

摘要

在过去几年中,肿瘤学家见证了非小细胞肺癌(NSCLC)不再被视为单一疾病,而是被重新分类为几个分子定义的疾病亚组,这在分子靶向治疗领域具有相关的治疗意义。非小细胞肺癌有两个不太常见的基因定义亚组,包括那些具有表皮生长因子受体(EGFR)或间变性淋巴瘤激酶(ALK)激活突变的亚组,它们对酪氨酸激酶抑制剂表现出高度敏感性,因此患者对治疗常常有持续的临床反应。然而,最大的亚组存在KRAS激活突变,到目前为止,尚未开发出针对RAS突变型肺癌的成功靶向治疗方法,只有少数化合物正在进行临床试验评估。事实上,由于生物学原因,KRAS仍然是癌症治疗中难以捉摸的靶点。KRAS的主要价值在于提供有关其他可直接用药的生物标志物(即EGFR和ALK)的信息。KRAS突变的存在排除了ALK和EGFR,因此KRAS可能构成检测算法中有效途径的一部分。目前,尽管经过数十年努力,KRAS本身仍然无法用药,但最近注意力已集中在抑制依赖Ras的下游信号传导上。司美替尼(AZD6244;ARRY-142886)是一种口服、紧密结合、非竞争性的丝裂原活化蛋白激酶激酶(MEK)1和2抑制剂,位于KRAS下游,临床前证据表明其在KRAS突变型癌症中与多西他赛具有协同活性,目前正处于临床开发阶段。Ras/RAF/MEK/ERK途径在癌症中经常失调,目前有多种针对该途径的抑制剂正在进行临床开发。最近,在一项随机II期试验中,与单独使用多西他赛相比,司美替尼联合多西他赛已被证明可改善先前治疗的晚期KRAS突变型非小细胞肺癌患者的无进展生存期。

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