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晚期 BRAF 突变型结直肠癌的治疗:现状与展望。

Treatment of Advanced BRAF-Mutated Colorectal Cancer: Where We Are and Where We Are Going.

机构信息

Department of Tumor Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, The Second Affiliated Hospital of Zhengzhou University. China.

Medical Oncology Department. Catalan Institute of Oncology: Institut Catala d'Oncologia Badalona, Barcelona, Spain.

出版信息

Clin Colorectal Cancer. 2022 Jun;21(2):71-79. doi: 10.1016/j.clcc.2022.01.009. Epub 2022 Feb 3.

Abstract

In recent years, studies on the molecular typing of colorectal cancer have matured, and the V-raf murine sarcoma viral oncogene homolog B (BRAF) of the mitogen-activated protein kinase pathway has been shown to be an important effector molecule of this pathway and regulates the occurrence and development of colorectal cancer. Clinical observations indicate that colorectal cancer patients harboring the BRAF V600E mutation have a worse prognosis than BRAF wild type patients. Several resistance mechanisms have been identified that have led to the development of different treatment strategies, which have shown encouraging activity in early clinical trials. Therefore, a reasonable combination of targeted therapies is expected to further enhance the efficacy of selective BRAF inhibitors. Moreover, some CRC patients with high microsatellite instability or a mismatch repair deficiency seem to be susceptible to checkpoint inhibitors with objective and sustained clinical responses, providing new opportunities for patients with advanced disease. This article primarily explores 3 aspects of the treatment strategies for advanced BRAF-mutated colorectal cancer; chemotherapy, targeted therapy, and immunotherapy.

摘要

近年来,结直肠癌的分子分型研究已经成熟,丝裂原活化蛋白激酶通路中的 V-raf 鼠肉瘤病毒致癌基因同源物 B(BRAF)已被证实是该通路的一个重要效应分子,调节结直肠癌的发生和发展。临床观察表明,携带 BRAF V600E 突变的结直肠癌患者的预后比 BRAF 野生型患者差。已经确定了几种耐药机制,导致了不同治疗策略的发展,这些策略在早期临床试验中显示出了令人鼓舞的活性。因此,合理的靶向治疗联合有望进一步提高选择性 BRAF 抑制剂的疗效。此外,一些微卫星高度不稳定或错配修复缺陷的 CRC 患者似乎对检查点抑制剂敏感,具有客观和持续的临床反应,为晚期疾病患者提供了新的机会。本文主要探讨了晚期 BRAF 突变型结直肠癌的 3 种治疗策略:化疗、靶向治疗和免疫治疗。

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