对抗癌症复发的创新方法:对抗休眠播散肿瘤细胞的新策略。

Innovative Approaches in the Battle Against Cancer Recurrence: Novel Strategies to Combat Dormant Disseminated Tumor Cells.

作者信息

Sauer Scott, Reed Damon R, Ihnat Michael, Hurst Robert E, Warshawsky David, Barkan Dalit

机构信息

Vuja De Sciences Inc., Hoboken, NJ, United States.

Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States.

出版信息

Front Oncol. 2021 Apr 27;11:659963. doi: 10.3389/fonc.2021.659963. eCollection 2021.

Abstract

Cancer recurrence remains a great fear for many cancer survivors following their initial, apparently successful, therapy. Despite significant improvement in the overall survival of many types of cancer, metastasis accounts for ~90% of all cancer mortality. There is a growing understanding that future therapeutic practices must accommodate this unmet medical need in preventing metastatic recurrence. Accumulating evidence supports dormant disseminated tumor cells (DTCs) as a source of cancer recurrence and recognizes the need for novel strategies to target these tumor cells. This review presents strategies to target dormant quiescent DTCs that reside at secondary sites. These strategies aim to prevent recurrence by maintaining dormant DTCs at bay, or eradicating them. Various approaches are presented, including: reinforcing the niche where dormant DTCs reside in order to keep dormant DTCs at bay; promoting cell intrinsic mechanisms to induce dormancy; preventing the engagement of dormant DTCs with their supportive niche in order to prevent their reactivation; targeting cell-intrinsic mechanisms mediating long-term survival of dormant DTCs; sensitizing dormant DTCs to chemotherapy treatments; and, inhibiting the immune evasion of dormant DTCs, leading to their demise. Various therapeutic approaches, some of which utilize drugs that are already approved, or have been tested in clinical trials and may be considered for repurposing, will be discussed. In addition, clinical evidence for the presence of dormant DTCs will be reviewed, along with potential prognostic biomarkers to enable the identification and stratification of patients who are at high risk of recurrence, and who could benefit from novel dormant DTCs targeting therapies. Finally, we will address the shortcomings of current trial designs for determining activity against dormant DTCs and provide novel approaches.

摘要

对于许多癌症幸存者来说,在他们最初看似成功的治疗之后,癌症复发仍然是一个巨大的担忧。尽管多种癌症的总体生存率有了显著提高,但转移导致了约90%的癌症死亡。人们越来越认识到,未来的治疗方法必须满足这一未被满足的医疗需求,即预防转移性复发。越来越多的证据支持休眠的播散肿瘤细胞(DTCs)是癌症复发的来源,并认识到需要新的策略来靶向这些肿瘤细胞。本综述介绍了针对驻留在次要部位的休眠静止DTCs的策略。这些策略旨在通过抑制或根除休眠DTCs来预防复发。文中介绍了各种方法,包括:加强休眠DTCs所在的微环境以抑制休眠DTCs;促进细胞内在机制以诱导休眠;阻止休眠DTCs与其支持性微环境的相互作用以防止其重新激活;靶向介导休眠DTCs长期存活的细胞内在机制;使休眠DTCs对化疗敏感;以及抑制休眠DTCs的免疫逃逸,导致其死亡。将讨论各种治疗方法,其中一些方法使用已获批的药物,或已在临床试验中进行过测试且可能考虑重新用途的药物。此外,还将综述休眠DTCs存在的临床证据,以及潜在的预后生物标志物,以识别和分层复发风险高且可能从针对休眠DTCs的新疗法中获益的患者。最后,我们将讨论当前针对休眠DTCs活性的试验设计的缺点,并提供新的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2604/8111294/60e024d209ba/fonc-11-659963-g001.jpg

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