Smith Elizabeth R, Huang Marilyn, Schlumbrecht Matthew P, George Sophia H L, Xu Xiang-Xi
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States.
Department of Obstetrics, Gynecology and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, United States.
Front Oncol. 2022 Sep 15;12:907520. doi: 10.3389/fonc.2022.907520. eCollection 2022.
Taxanes and CDK4/6 inhibitors (CDK4/6i) are two families of successful anti-mitotic drugs used in the treatment of solid tumors. Paclitaxel, representing taxane compounds, has been used either alone or in combination with other agents (commonly carboplatin/cisplatin) in the treatment of many solid tumors including ovarian, breast, lung, prostate cancers, and Kaposi's sarcoma. Paclitaxel has been routinely prescribed in cancer treatment since the 1990s, and its prominent role is unlikely to be replaced in the foreseeable future. Paclitaxel and other taxanes work by binding to and stabilizing microtubules, causing mitotic arrest, aberrant mitosis, and cell death. CDK4/6i (palbociclib, ribociclib, abemaciclib) are relatively new cell cycle inhibitors that have been found to be effective in breast cancer treatment, and are currently being developed in other solid tumors. CDK4/6i blocks cell cycle progression at the G1 phase, resulting in cell death by mechanisms not yet fully elucidated. At first glance, paclitaxel and CDK4/6i are unlikely synergistic agents as both are cell cycle inhibitors that work at different phases of the cell cycle, and few clinical trials have yet considered adding CDK4/6i to existing paclitaxel chemotherapy. However, recent findings suggest the importance of a non-mitotic mechanism of paclitaxel in cancer cell death and pre-clinical data support rationale for a strategic paclitaxel and CDK4/6i combination. In mouse tumor model studies, drug sequencing resulted in differential efficacy, indicating complex biological interactions of the two drugs. This article reviews the rationales of combining paclitaxel with CDK4/6i as a potential therapeutic option in recurrent ovarian cancer.
紫杉烷类药物和细胞周期蛋白依赖性激酶4/6抑制剂(CDK4/6i)是两类成功用于治疗实体瘤的抗有丝分裂药物。以紫杉醇为代表的紫杉烷类化合物,已单独或与其他药物(通常是卡铂/顺铂)联合用于治疗多种实体瘤,包括卵巢癌、乳腺癌、肺癌、前列腺癌和卡波西肉瘤。自20世纪90年代以来,紫杉醇一直是癌症治疗中的常规用药,在可预见的未来,其突出作用不太可能被取代。紫杉醇和其他紫杉烷类药物通过结合并稳定微管发挥作用,导致有丝分裂停滞、异常有丝分裂和细胞死亡。CDK4/6i(帕博西尼、瑞博西尼、阿贝西利)是相对较新的细胞周期抑制剂,已被发现对乳腺癌治疗有效,目前正在其他实体瘤中进行研发。CDK4/6i在G1期阻断细胞周期进程,通过尚未完全阐明的机制导致细胞死亡。乍一看,紫杉醇和CDK4/6i不太可能是协同药物,因为两者都是在细胞周期不同阶段起作用的细胞周期抑制剂,而且很少有临床试验考虑将CDK4/6i添加到现有的紫杉醇化疗方案中。然而,最近的研究结果表明紫杉醇在癌细胞死亡中的非有丝分裂机制的重要性,临床前数据也支持紫杉醇与CDK4/6i进行策略性联合的理论依据。在小鼠肿瘤模型研究中,药物给药顺序导致了不同的疗效,表明这两种药物存在复杂的生物学相互作用。本文综述了将紫杉醇与CDK4/6i联合作为复发性卵巢癌潜在治疗方案的理论依据。