解析三阴性乳腺癌的分子特性与化疗耐药性:迈向基于标志物的靶向治疗
Untangling Triple-Negative Breast Cancer Molecular Peculiarity and Chemo-Resistance: Trailing Towards Marker-Based Targeted Therapies.
作者信息
Kanwal Bushra
机构信息
Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA.
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C., USA.
出版信息
Cureus. 2021 Jul 26;13(7):e16636. doi: 10.7759/cureus.16636. eCollection 2021 Jul.
Triple-negative breast cancer (TNBC), characterized by the absence of estrogen receptor, progesterone receptor, or human epidermal growth factor receptor-2, affects nearly 15% of women with breast cancer. To date, the mainstay of treatment remains chemotherapy, with all the associated consequences, such as the significant toxicity and the suboptimal effect on the five-year survival rates. RNA-expression profiling showed that TNBC is biologically a heterogeneous malignancy. Therefore, predictive biomarkers matched with the diverse subtypes of TNBC could classify patients that would most benefit from a certain targeted treatment. Three biomarker-driven therapies are currently available: poly-adenosine diphosphate (ADP) ribose polymerase inhibitors for patients with germline BReast CAncer gene (BRCA) mutations, atezolizumab combined with nab-paclitaxel for patients expressing programmed death-ligand 1 (PD-L1) on tumor-infiltrating immune cells, and sacituzumab govitecan, an antibody-drug conjugate targeting human trophoblast cell-surface antigen 2 (TROP-2). Identifying predictive biomarkers is crucial for the optimum generation and implementation of targeted agents for TNBC, while further relevant treatments are in the pipeline given the promising results in clinical trials. Finally, newly developed immunotherapies and other targeted agents should also be investigated in earlier stages of the disease, especially in the neoadjuvant setting, broadening the therapeutic application of such regimens.
三阴性乳腺癌(TNBC)的特征是缺乏雌激素受体、孕激素受体或人表皮生长因子受体2,影响了近15%的乳腺癌女性患者。迄今为止,治疗的主要手段仍然是化疗,伴随着所有相关的后果,如显著的毒性以及对五年生存率的不理想效果。RNA表达谱分析表明,TNBC在生物学上是一种异质性恶性肿瘤。因此,与TNBC不同亚型相匹配的预测性生物标志物可以对最能从某种靶向治疗中获益的患者进行分类。目前有三种基于生物标志物的疗法:用于携带种系乳腺癌基因(BRCA)突变患者的聚腺苷二磷酸(ADP)核糖聚合酶抑制剂;用于肿瘤浸润免疫细胞上表达程序性死亡配体1(PD-L1)的患者的阿特珠单抗联合纳米白蛋白紫杉醇;以及戈沙妥珠单抗,一种靶向人滋养层细胞表面抗原2(TROP-2)的抗体药物偶联物。识别预测性生物标志物对于TNBC靶向药物的优化研发和应用至关重要,同时鉴于临床试验中的 promising 结果,更多相关治疗正在进行中。最后,新开发的免疫疗法和其他靶向药物也应在疾病的早期阶段进行研究,尤其是在新辅助治疗中,以拓宽此类治疗方案的应用范围。 (注:“promising”原文拼写错误,正确拼写为“promising”,这里按正确意思翻译为“有前景的”)