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[BRAF突变在黑色素瘤、甲状腺乳头状癌和结肠腺癌进展及治疗中的作用]

[BRAF mutation in progression and therapy of melanoma, papillary thyroid carcinoma and colorectal adenocarcinoma].

作者信息

Zaleśna Izabela, Hartman Mariusz L, Czyż Małgorzata

机构信息

Zakład Biologii Molekularnej Nowotworów, Uniwersytet Medyczny w Łodzi.

出版信息

Postepy Hig Med Dosw (Online). 2016 May 9;70:471-88. doi: 10.5604/17322693.1201719.

Abstract

BRAF is mutated at a high frequency in various malignancies, including melanoma, papillary thyroid carcinoma and colorectal adenocarcinoma. BRAF is an element of the RAS/RAF/MEK/ERK (MAPK) pathway, which when constitutively active can lead to increased proliferation rate, enhanced survival, invasion and metastasis. The development of small molecule inhibitors of mutant BRAF kinase has changed the care of patients, especially with melanoma. Despite the success in treating melanoma with inhibitors of mutant BRAF and other elements of RAS/RAF/MEK/ERK (MAPK) pathway, resistance limits the long-term responsiveness to these drugs. The resistance mechanisms to MAPK pathway inhibition are complex, occur at genomic and phenotypic levels, and frequently the same patient can simultaneously develop diverse mechanisms of resistance in different progressive metastases or even in the same lesion. In the current review, we summarize recent research on mutations in BRAF and their importance for the development of tumor. This review will also give an overview on the current knowledge concerning therapies for patients harboring mutation in BRAF and discusses the diverse mechanisms of resistance developed in response to these targeted therapies.

摘要

BRAF在多种恶性肿瘤中高频突变,包括黑色素瘤、甲状腺乳头状癌和结直肠腺癌。BRAF是RAS/RAF/MEK/ERK(MAPK)信号通路的一个组成部分,该信号通路持续激活时可导致增殖率增加、存活率提高、侵袭和转移增强。突变型BRAF激酶小分子抑制剂的研发改变了患者的治疗方式,尤其是黑色素瘤患者。尽管使用突变型BRAF抑制剂和RAS/RAF/MEK/ERK(MAPK)信号通路的其他组成部分治疗黑色素瘤取得了成功,但耐药性限制了对这些药物的长期反应。MAPK信号通路抑制的耐药机制复杂,发生在基因组和表型水平,而且同一患者在不同的进展性转移灶甚至同一病灶中常常会同时出现多种耐药机制。在本综述中,我们总结了BRAF突变的最新研究及其在肿瘤发生中的重要性。本综述还将概述目前关于BRAF突变患者治疗的知识,并讨论针对这些靶向治疗产生的多种耐药机制。

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