Ward Antonio B, Keeton Adam B, Chen Xi, Mattox Tyler E, Coley Alex B, Maxuitenko Yulia Y, Buchsbaum Donald J, Randall Troy D, Zhou Gang, Piazza Gary A
Drug Discovery Research Center, Department of Pharmacology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL.
Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL.
MedComm (2020). 2020 Sep;1(2):121-128. doi: 10.1002/mco2.10. Epub 2020 Jun 25.
Approximately 30% of human cancers harbor a gain-in-function mutation in the RAS gene, resulting in constitutive activation of the RAS protein to stimulate downstream signaling, including the RAS-mitogen activated protein kinase pathway that drives cancer cells to proliferate and metastasize. RAS-driven oncogenesis also promotes immune evasion by increasing the expression of programmed cell death ligand-1, reducing the expression of major histocompatibility complex molecules that present antigens to T-lymphocytes and altering the expression of cytokines that promote the differentiation and accumulation of immune suppressive cell types such as myeloid-derived suppressor cells, regulatory T-cells, and cancer-associated fibroblasts. Together, these changes lead to an immune suppressive tumor microenvironment that impedes T-cell activation and infiltration and promotes the outgrowth and metastasis of tumor cells. As a result, despite the growing success of checkpoint immunotherapy, many patients with RAS-driven tumors experience resistance to therapy and poor clinical outcomes. Therefore, RAS inhibitors in development have the potential to weaken cancer cell immune evasion and enhance the antitumor immune response to improve survival of patients with RAS-driven cancers. This review highlights the potential of RAS inhibitors to enhance or broaden the anti-cancer activity of currently available checkpoint immunotherapy.
大约30%的人类癌症在RAS基因中存在功能获得性突变,导致RAS蛋白组成性激活,从而刺激下游信号传导,包括驱动癌细胞增殖和转移的RAS-丝裂原活化蛋白激酶途径。RAS驱动的肿瘤发生还通过增加程序性细胞死亡配体-1的表达、降低向T淋巴细胞呈递抗原的主要组织相容性复合体分子的表达以及改变促进免疫抑制细胞类型(如髓源性抑制细胞、调节性T细胞和癌症相关成纤维细胞)分化和积累的细胞因子的表达来促进免疫逃逸。这些变化共同导致免疫抑制性肿瘤微环境,阻碍T细胞活化和浸润,并促进肿瘤细胞的生长和转移。因此,尽管检查点免疫疗法越来越成功,但许多RAS驱动肿瘤患者仍对治疗产生耐药性,临床结果不佳。因此,正在研发的RAS抑制剂有可能削弱癌细胞的免疫逃逸并增强抗肿瘤免疫反应,以提高RAS驱动癌症患者的生存率。本综述强调了RAS抑制剂增强或拓宽当前可用检查点免疫疗法抗癌活性的潜力。