Wagstaff William, Mwamba Rimel N, Grullon Karina, Armstrong Mikhayla, Zhao Piao, Hendren-Santiago Bryce, Qin Kevin H, Li Alexander J, Hu Daniel A, Youssef Andrew, Reid Russell R, Luu Hue H, Shen Le, He Tong-Chuan, Haydon Rex C
The Pritzker School of Medicine, and the Medical Scientist Training Program, The University of Chicago Medical Center, Chicago, IL 60637, USA.
Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA.
Genes Dis. 2022 Apr 27;9(6):1608-1623. doi: 10.1016/j.gendis.2022.04.004. eCollection 2022 Nov.
Cutaneous melanoma is a common cancer and cases have steadily increased since the mid 70s. For some patients, early diagnosis and surgical removal of melanomas is lifesaving, while other patients typically turn to molecular targeted therapies and immunotherapies as treatment options. Easy sampling of melanomas allows the scientific community to identify the most prevalent mutations that initiate melanoma such as the BRAF, NRAS, and TERT genes, some of which can be therapeutically targeted. Though initially effective, many tumors acquire resistance to the targeted therapies demonstrating the need to investigate compensatory pathways. Immunotherapies represent an alternative to molecular targeted therapies. However, inter-tumoral immune cell populations dictate initial therapeutic response and even tumors that responded to treatment develop resistance in the long term. As the protocol for combination therapies develop, so will our scientific understanding of the many pathways at play in the progression of melanoma. The future direction of the field may be to find a molecule that connects all of the pathways. Meanwhile, noncoding RNAs have been shown to play important roles in melanoma development and progression. Studying noncoding RNAs may help us to understand how resistance - both primary and acquired - develops; ultimately allow us to harness the true potential of current therapies. This review will cover the basic structure of the skin, the mutations and pathways responsible for transforming melanocytes into melanomas, the process by which melanomas metastasize, targeted therapeutics, and the potential that noncoding RNAs have as a prognostic and treatment tool.
皮肤黑色素瘤是一种常见癌症,自20世纪70年代中期以来病例数一直在稳步增加。对于一些患者来说,黑色素瘤的早期诊断和手术切除可以挽救生命,而其他患者通常会选择分子靶向治疗和免疫治疗作为治疗方案。黑色素瘤易于取样,这使得科学界能够识别引发黑色素瘤的最常见突变,如BRAF、NRAS和TERT基因,其中一些基因可以作为治疗靶点。尽管最初有效,但许多肿瘤会对靶向治疗产生耐药性,这表明需要研究补偿途径。免疫治疗是分子靶向治疗的一种替代方案。然而,肿瘤内免疫细胞群体决定了初始治疗反应,甚至对治疗有反应的肿瘤长期也会产生耐药性。随着联合治疗方案的发展,我们对黑色素瘤进展过程中诸多发挥作用的途径的科学理解也会随之加深。该领域未来的方向可能是找到一个连接所有途径的分子。与此同时,非编码RNA已被证明在黑色素瘤的发生和发展中发挥重要作用。研究非编码RNA可能有助于我们了解原发性和获得性耐药是如何产生的;最终使我们能够充分发挥当前治疗方法的真正潜力。本综述将涵盖皮肤的基本结构、将黑素细胞转化为黑色素瘤的突变和途径、黑色素瘤转移的过程、靶向治疗以及非编码RNA作为预后和治疗工具的潜力。