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溴结构域和额外末端结构域抑制剂治疗血液系统恶性肿瘤和实体瘤的安全性与有效性:一项临床试验的系统研究

Safety and Efficacy of Bromodomain and Extra-Terminal Inhibitors for the Treatment of Hematological Malignancies and Solid Tumors: A Systematic Study of Clinical Trials.

作者信息

Sun Yanli, Han Jie, Wang Zhanzhao, Li Xuening, Sun Yanhua, Hu Zhenbo

机构信息

Laboratory for Stem Cell and Regenerative Medicine, Affiliated Hospital of Weifang Medical University, Weifang, China.

Department of Laboratory Medicine, Weifang Medical University, Weifang, China.

出版信息

Front Pharmacol. 2021 Jan 26;11:621093. doi: 10.3389/fphar.2020.621093. eCollection 2020.

Abstract

The upregulated expression of BET proteins is closely associated with the occurrence and development of hematological malignancies and solid tumors. Several BET inhibitors have been developed, and some have been in phase I/II of clinical trials. Here, the safety, efficacy, and pharmacodynamics of ten BET inhibitors currently in clinical trials were evaluated. We retrieved and reviewed published reports on the clinical trials of twelve BET inhibitors including AZD5153, ABBV-075, BMS-986158, CPI-0610, GSK525762, OTX-015, PLX51107, INCB054329, INCB057643, FT-1101, CC-90010, and ODM-207 for patients with hematological malignancies and solid tumors and summarized their published target genes. In the monotherapy of BET inhibitors, the most common and severe (grade ≥3) hematological adverse events (AEs) are thrombocytopenia, anemia, and neutropenia. The most common non-hematological syndromes are diarrhea, nausea, fatigue, dysgeusia, and decreased appetite, while the most severe AE is pneumonia. Additionally, of these BET inhibitors was between 0.5-6 h, but the range for varied significantly. According to published data, the rates of SD, PD, CR and PR were 27.4%, 37.6%, 3.5%, and 5.7%, respectively, which is not very satisfactory. In addition to BRD4, oncogene MYC is another common target gene of these BET inhibitors. Ninety-seven signaling pathways may be regulated by BET inhibitors. All BET inhibitors reviewed in our study exhibited exposure-dependent thrombocytopenia, which may limit their clinical application. Moreover, further efforts are necessary to explore the optimal dosing schemes and combinations to maximize the efficacy of BET inhibitors.

摘要

BET蛋白的表达上调与血液系统恶性肿瘤和实体瘤的发生发展密切相关。目前已开发出几种BET抑制剂,其中一些已进入临床试验I/II期。在此,我们对目前正在进行临床试验的10种BET抑制剂的安全性、有效性和药效学进行了评估。我们检索并回顾了已发表的关于12种BET抑制剂(包括AZD5153、ABBV-075、BMS-986158、CPI-0610、GSK525762、OTX-015、PLX51107、INCB054329、INCB057643、FT-1101、CC-90010和ODM-207)用于血液系统恶性肿瘤和实体瘤患者的临床试验报告,并总结了它们已发表的靶基因。在BET抑制剂的单药治疗中,最常见且严重(≥3级)的血液学不良事件(AE)是血小板减少、贫血和中性粒细胞减少。最常见的非血液学综合征是腹泻、恶心、疲劳、味觉障碍和食欲下降,而最严重的AE是肺炎。此外,这些BET抑制剂的半衰期在0.5 - 6小时之间,但清除率的范围差异很大。根据已发表的数据,疾病稳定(SD)、疾病进展(PD)、完全缓解(CR)和部分缓解(PR)的发生率分别为27.4%、37.6%、3.5%和5.7%,结果不太理想。除了BRD4,癌基因MYC是这些BET抑制剂的另一个常见靶基因。97条信号通路可能受BET抑制剂调控。我们研究中评估的所有BET抑制剂均表现出暴露依赖性血小板减少,这可能会限制它们的临床应用。此外,有必要进一步探索最佳给药方案和联合用药,以最大限度地提高BET抑制剂的疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0709/7870522/253ec603d25b/fphar-11-621093-g001.jpg

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