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胶质母细胞瘤的多激酶治疗:评估瑞戈非尼的理论依据。

Multikinase Treatment of Glioblastoma: Evaluating the Rationale for Regorafenib.

作者信息

Muñoz-Mármol Ana Maria, Meléndez Bárbara, Hernandez Ainhoa, Sanz Carolina, Domenech Marta, Arpí-Llucia Oriol, Gut Marta, Esteve Anna, Esteve-Codina Anna, Parra Genis, Carrato Cristina, Aldecoa Iban, Mallo Mar, Pineda Estela, Alameda Francesc, de la Iglesia Nuria, Martinez-Balibrea Eva, Martinez-Cardús Anna, Estival-Gonzalez Anna, Balana Carmen

机构信息

Pathology Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain.

Molecular Pathology Research Unit, Hospital Universitario de Toledo, 45005 Toledo, Spain.

出版信息

Cancers (Basel). 2025 Jan 23;17(3):375. doi: 10.3390/cancers17030375.

Abstract

We explored the rationale for treating glioblastoma (GBM) with regorafenib. In 103 newly diagnosed GBM patients, we assessed mutations, copy number variants (CNVs), fusions, and overexpression in 46 genes encoding protein kinases (PKs) potentially targeted by regorafenib or its metabolites and performed a functional enrichment analysis to assess their implications in angiogenesis. We analyzed regorafenib's binding inhibitory activity and target affinity for these 46 PKs and focused on a subset of 18 genes inhibited by regorafenib at clinically achievable concentrations and on 19 genes involved in angiogenesis. Putative oncogenic alterations were defined as oncogenic/likely oncogenic mutations, oncogenic fusions, CNVs > 5, and/or gene overexpression. Regorafenib did not target all 46 PKs. For the 46-gene set, 40 genes (86.9%) and 73 patients (70.8%) harbored at least one alteration in genes encoding targetable PKs, but putative oncogenic alterations were present in only 34 patients (33%). In the 18-gene set, 18 genes (100%) and 48 patients (46.6%) harbored alterations, but putative oncogenic alterations were detected in only 26 patients (25.2%). Thirty patients (29.1%) had oncogenic alterations in the 18-gene set and/or in angiogenesis-related genes. Around 33% of patients had oncogenic alterations in any of the 46 potential targets. Additionally, the suboptimal dosing of regorafenib, due to its poor penetration of the blood-brain barrier, may reduce the likelihood of effectively targeting certain PKs. Future use of multi-target drugs must be guided by a thorough understanding of target presence, effective inhibition, and the drug's ability to reach brain tumors at adequate concentrations.

摘要

我们探究了用瑞戈非尼治疗胶质母细胞瘤(GBM)的理论依据。在103例新诊断的GBM患者中,我们评估了46个编码蛋白激酶(PK)的基因中的突变、拷贝数变异(CNV)、融合和过表达情况,这些基因可能是瑞戈非尼或其代谢产物的潜在靶点,并进行了功能富集分析以评估它们在血管生成中的意义。我们分析了瑞戈非尼对这46种PK的结合抑制活性和靶点亲和力,并聚焦于在临床可达到的浓度下被瑞戈非尼抑制的18个基因子集以及19个参与血管生成的基因。推定的致癌改变被定义为致癌/可能致癌的突变、致癌融合、CNV>5和/或基因过表达。瑞戈非尼并非靶向所有46种PK。对于46个基因的集合,40个基因(86.9%)和73例患者(70.8%)在编码可靶向PK的基因中存在至少一种改变,但仅34例患者(33%)存在推定的致癌改变。在18个基因的集合中,18个基因(100%)和48例患者(46.6%)存在改变,但仅在26例患者(25.2%)中检测到推定的致癌改变。30例患者(29.1%)在18个基因的集合和/或血管生成相关基因中存在致癌改变。约33%的患者在46个潜在靶点中的任何一个中存在致癌改变。此外,由于瑞戈非尼血脑屏障穿透性差,其给药剂量欠佳可能会降低有效靶向某些PK的可能性。未来多靶点药物的使用必须以对靶点存在情况、有效抑制以及药物在足够浓度下到达脑肿瘤的能力的透彻理解为指导。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef2b/11816343/7601e55042cc/cancers-17-00375-g001.jpg

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