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免疫疗法和靶向疗法在转移性结直肠癌治疗中的应用

Immunotherapies and Targeted Therapies in the Treatment of Metastatic Colorectal Cancer.

作者信息

Rawla Prashanth, Barsouk Adam, Hadjinicolaou Andreas V, Barsouk Alexander

机构信息

Department of Medicine, Sovah Health, Martinsville, VA 24112, USA.

Hillman Cancer Center, University of Pittsburgh, PA 15232, USA.

出版信息

Med Sci (Basel). 2019 Jul 30;7(8):83. doi: 10.3390/medsci7080083.

Abstract

Colorectal cancer (CRC) is the third leading cause of cancer deaths, and while mortality has largely improved in the developed world, five-year survival for metastatic disease remains dismally low at only 15%. Fortunately, nearly a dozen targeted therapies and immunotherapies have been FDA approved in the past decade for certain patient profiles with metastatic CRC (mCRC), and many others are under development. Checkpoint inhibitors such as pembrolizumab have proven effective at extending survival for mismatch repair (MMR)-deficient and high microsatellite instability (MSI) mCRC patients. In combination with chemotherapy in first- and second-line treatment, antiangiogenic (anti-vascular endothelial growth factor (anti-VGEF)) agent bevacizumab has been shown to increase mCRC survival. Anti-epidermal growth factor receptor (anti-EGFR) agents panitumumab and cetuximab, in combination with chemotherapy, have also prolonged survival among and all wild-type mCRC patients. Among these patients, anti-EGFR therapy has been found to be more efficacious than bevacizumab. Improved selectivity has allowed small-molecule receptor tyrosine kinase (RTK) inhibitors to target VEGF and EGFR with greater efficacy and tolerability. Combinations of immunotherapies, RTKs, monoclonal antibodies, and cytotoxic drugs are being investigated to provide broad-spectrum protection against relapse by simultaneously targeting many cancer hallmarks. Lastly, human epidermal growth factor receptor 2 (HER2) therapy has shown promise for HER2-positive mCRC patients, though larger clinical trials are required to secure FDA approval.

摘要

结直肠癌(CRC)是癌症死亡的第三大主要原因。虽然在发达国家死亡率已大幅改善,但转移性疾病的五年生存率仍然极低,仅为15%。幸运的是,在过去十年中,已有近十二种靶向疗法和免疫疗法获美国食品药品监督管理局(FDA)批准用于特定的转移性结直肠癌(mCRC)患者群体,还有许多其他疗法正在研发中。派姆单抗等检查点抑制剂已被证明可有效延长错配修复(MMR)缺陷和高微卫星不稳定性(MSI)的mCRC患者的生存期。在一线和二线治疗中与化疗联合使用时,抗血管生成(抗血管内皮生长因子(抗VGEF))药物贝伐单抗已显示可提高mCRC患者的生存率。抗表皮生长因子受体(抗EGFR)药物帕尼单抗和西妥昔单抗与化疗联合使用,也延长了KRAS野生型和NRAS野生型mCRC患者的生存期。在这些患者中,已发现抗EGFR疗法比贝伐单抗更有效。提高的选择性使小分子受体酪氨酸激酶(RTK)抑制剂能够更有效且更耐受地靶向VEGF和EGFR。正在研究免疫疗法、RTK、单克隆抗体和细胞毒性药物的组合,以通过同时靶向多种癌症特征来提供针对复发的广谱保护。最后,人表皮生长因子受体2(HER2)疗法已显示对HER2阳性的mCRC患者有前景,不过需要更大规模的临床试验来获得FDA批准。

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