乳腺癌:当前的分子治疗靶点与新进展

Breast Cancer: Current Molecular Therapeutic Targets and New Players.

作者信息

Nagini Siddavaram

机构信息

Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar- 608 002, Tamil Nadu,India.

出版信息

Anticancer Agents Med Chem. 2017;17(2):152-163. doi: 10.2174/1871520616666160502122724.

Abstract

Breast cancer is the most common cancer and the most frequent cause of cancer death among women worldwide. Breast cancer is a complex, heterogeneous disease classified into hormone-receptor-positive, human epidermal growth factor receptor-2 overexpressing (HER2+) and triple-negative breast cancer (TNBC) based on histological features. Endocrine therapy, the mainstay of treatment for hormone-responsive breast cancer involves use of selective estrogen receptor modulators (SERMs), selective estrogen receptor downregulators (SERDs) and aromatase inhibitors (AIs). Agents that target estrogen receptor (ER) and HER2 such as tamoxifen and trastuzumab have been the most extensively used therapeutics for breast cancer. Crosstalk between ER and other signalling networks as well as epigenetic mechanisms have been envisaged to contribute to endocrine therapy resistance. TNBC, a complex, heterogeneous, aggressive form of breast cancer in which the cells do not express ER, progesterone receptor or HER2 is refractory to therapy. Several molecular targets are being explored to target TNBC including androgen receptor, epidermal growth factor receptor (EGFR), poly(ADP-ribose) polymerase (PARP), and vascular endothelial growth factor (VEGF). Receptors, protein tyrosine kinases, phosphatases, proteases, PI3K/Akt signalling pathway, microRNAs (miRs) and long noncoding RNAs (lncRNAs) are potential therapeutic targets. miR-based therapeutic approaches include inhibition of oncomiRs by antisense oligonucleotides, restoration of tumour suppressors using miR mimics, and chemical modification of miRs. The lnRNAs HOTAIR, SPRY4-IT1, GAS5, and PANDAR, new players in tumour development and prognosis may have theranostic applications in breast cancer. Several novel classes of mechanism-based drugs have been designed and synthesised for treatment of breast cancer. Integration of nucleic acid sequencing studies with mass spectrometry-based peptide sequencing and posttranslational modifications as well as rational drug design will provide a more comprehensive understanding of the pathophysiology of breast cancer and help in evolving therapeutic strategies.

摘要

乳腺癌是全球女性中最常见的癌症,也是癌症死亡的最常见原因。乳腺癌是一种复杂的异质性疾病,根据组织学特征可分为激素受体阳性、人表皮生长因子受体2过表达(HER2+)和三阴性乳腺癌(TNBC)。内分泌治疗是激素反应性乳腺癌的主要治疗方法,包括使用选择性雌激素受体调节剂(SERM)、选择性雌激素受体下调剂(SERD)和芳香化酶抑制剂(AI)。靶向雌激素受体(ER)和HER2的药物,如他莫昔芬和曲妥珠单抗,一直是乳腺癌最广泛使用的治疗药物。人们设想ER与其他信号网络之间的串扰以及表观遗传机制会导致内分泌治疗耐药。TNBC是一种复杂、异质、侵袭性的乳腺癌,其细胞不表达ER、孕激素受体或HER2,对治疗具有抗性。目前正在探索几种针对TNBC的分子靶点,包括雄激素受体、表皮生长因子受体(EGFR)、聚(ADP-核糖)聚合酶(PARP)和血管内皮生长因子(VEGF)。受体、蛋白酪氨酸激酶、磷酸酶、蛋白酶、PI3K/Akt信号通路、微小RNA(miR)和长链非编码RNA(lncRNA)是潜在的治疗靶点。基于miR的治疗方法包括通过反义寡核苷酸抑制致癌miR、使用miR模拟物恢复肿瘤抑制因子以及对miR进行化学修饰。lncRNA HOTAIR、SPRY4-IT1、GAS5和PANDAR是肿瘤发生和预后的新参与者,可能在乳腺癌的诊疗中具有应用价值。已经设计并合成了几类新型的基于机制的药物用于治疗乳腺癌。将核酸测序研究与基于质谱的肽测序和翻译后修饰以及合理的药物设计相结合,将提供对乳腺癌病理生理学更全面的理解,并有助于制定治疗策略。

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