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非V600 BRAF突变型结直肠癌的靶向治疗:精准肿瘤学的前景

Targeted Therapy for Colorectal Cancers With Non-V600 BRAF Mutations: Perspectives for Precision Oncology.

作者信息

Dankner Matthew

机构信息

Matthew Dankner, McGill University, Montreal, Quebec, Canada.

出版信息

JCO Precis Oncol. 2018 Nov;2:1-12. doi: 10.1200/PO.18.00195.

Abstract

BRAF mutations are found in up to 10% of colorectal cancers (CRC). Whereas the majority of BRAF mutant CRCs harbor V600 mutations, up to 25% express non-V600 BRAF mutations. It has been established that BRAF V600E mutations in CRC predict unresponsiveness to epidermal growth factor receptor (EGFR) inhibition-cetuximab and/or panitumumab-as a result of the constitutive activation of the mitogen-activated protein kinase pathway downstream of EGFR signaling. As more centers begin using next-generation sequencing assays to detect BRAF mutations, oncologists are more frequently confronted with treating patients with non-V600 BRAF mutations. In many instances, clinicians may be hesitant to use EGFR inhibitors for these patients, as it is largely assumed that tumors with non-V600 BRAF mutations activate the mitogen-activated protein kinase pathway in a similar manner to RAS or BRAF V600E mutations and would therefore be equally refractory to EGFR inhibition; however, the evidence that currently exists to substantiate this claim is mixed and incomplete. Recent data demonstrate that non-V600 BRAF mutant CRC is a distinct clinical entity with a favorable prognosis compared with CRC with V600E mutations. Preclinical data and several case reports suggest that a subset of BRAF non-V600 mutations that impair the protein's kinase activity may in fact confer heightened sensitivity to EGFR inhibition because of dependency on upstream receptor tyrosine kinase signaling. This review summarizes the clinical characteristics and targeted therapy approaches for non-V600 BRAF mutant CRCs, speculates on the value of non-V600 BRAF mutations as predictive biomarkers of responsiveness to EGFR inhibitors, and highlights outstanding questions in this emerging area of precision oncology.

摘要

高达10%的结直肠癌(CRC)中可发现BRAF突变。虽然大多数BRAF突变型CRC存在V600突变,但高达25%的病例表达非V600 BRAF突变。已经证实,CRC中的BRAF V600E突变预示着对表皮生长因子受体(EGFR)抑制药物西妥昔单抗和/或帕尼单抗无反应,这是由于EGFR信号下游的丝裂原活化蛋白激酶途径的组成性激活所致。随着越来越多的中心开始使用下一代测序检测BRAF突变,肿瘤学家在治疗非V600 BRAF突变患者时面临的情况越来越多。在许多情况下,临床医生可能会犹豫是否对这些患者使用EGFR抑制剂,因为人们普遍认为,具有非V600 BRAF突变的肿瘤以与RAS或BRAF V600E突变相似的方式激活丝裂原活化蛋白激酶途径,因此对EGFR抑制同样难治;然而,目前支持这一说法的证据参差不齐且不完整。最近的数据表明,与具有V600E突变的CRC相比,非V600 BRAF突变型CRC是一种具有良好预后的独特临床实体。临床前数据和一些病例报告表明,损害蛋白质激酶活性的一部分BRAF非V600突变实际上可能由于对上游受体酪氨酸激酶信号的依赖性而对EGFR抑制具有更高的敏感性。本综述总结了非V600 BRAF突变型CRC的临床特征和靶向治疗方法,推测了非V600 BRAF突变作为EGFR抑制剂反应性预测生物标志物的价值,并强调了这一新兴的精准肿瘤学领域中尚未解决的问题。

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