Wasiak Katarzyna, Ciunowicz Damian, Kierasińska-Kałka Amelia, Węgierska Marta, Pacholczyk Marcin, Rieske Piotr, Stoczyńska-Fidelus Ewelina
Department of Research and Development, Personather Ltd., Inwestycyjna 7, Konstantynow Lodzki, 95 - 050, Poland.
Department of Tumor Biology, Chair of Medical Biology, Medical University of Lodz, Zeligowskiego 7/9 St., Lodz, 90 - 752, Poland.
BMC Cancer. 2025 Jul 1;25(1):1053. doi: 10.1186/s12885-025-14033-y.
Given the prevalence of RAS mutations in various cancers, personalized therapeutic approaches, guided by molecular markers, are essential. Farnesyltransferase inhibitors (FTIs) have emerged as potential therapeutic options; however, they also face obstacles such as toxicity and limited efficacy. Alternative strategies, such as direct inhibitors combined with pathway modulators, RNA interference, and gene-editing technologies, are under clinical investigation. The targeting of RAS, complicated by its structural nuances, particularly in the G domain, has advanced with the identification of druggable pockets such as the SW-II pocket. This breakthrough has led to the development of targeted therapeutics, such as sotorasib and adagrasib, for KRAS G12C-mutated non-small cell lung cancer (NSCLC). However, these advancements face challenges, including adaptive resistance and the necessity for isoform selectivity. New inhibitors, such as LY3537982 or GDC-6036, are promising, but achieving effective and selective RAS inhibition remains a significant challenge. Additionally, clinical trials have highlighted variability in patient responses, attributing limited treatment efficacy to resistance mechanisms, including on-target mutations and off-target pathway activations. Finally, the RAS oncogene, traditionally viewed as predominantly pro-cancerous, plays a complex role in oncogenesis, with recent evidence suggesting context-dependent effects, such as inducing senescence in certain cells. This shift in understanding underscores the therapeutic potential of manipulating the interplay between RAS and TP53 mutations in cancer. In conclusion, the complexity of effectively targeting the RAS-RAF-ERK pathway is exacerbated by the diverse resistance mechanisms. Challenges such as off-target effects and delivery issues remain significant barriers in the introduction of effective therapies based on RAS inhibitors. This overview highlights the evolving nature of targeting RAS in cancer therapy.
鉴于RAS突变在各种癌症中的普遍性,以分子标记为指导的个性化治疗方法至关重要。法尼基转移酶抑制剂(FTIs)已成为潜在的治疗选择;然而,它们也面临着毒性和疗效有限等障碍。直接抑制剂与通路调节剂、RNA干扰和基因编辑技术等替代策略正在临床研究中。RAS的靶向治疗因其结构细微差别而变得复杂,尤其是在G结构域,随着可成药口袋(如SW-II口袋)的发现,这一领域取得了进展。这一突破导致了针对KRAS G12C突变的非小细胞肺癌(NSCLC)的靶向治疗药物,如索托拉西布和阿达格拉西布的开发。然而,这些进展面临挑战,包括适应性耐药和对异构体选择性的需求。新的抑制剂,如LY3537982或GDC-6036,很有前景,但实现有效和选择性的RAS抑制仍然是一项重大挑战。此外,临床试验突出了患者反应的变异性,将有限的治疗效果归因于耐药机制,包括靶上突变和靶外通路激活。最后,传统上主要被视为促癌的RAS癌基因在肿瘤发生中发挥着复杂的作用,最近有证据表明其具有背景依赖性效应,如在某些细胞中诱导衰老。这种认识上的转变强调了在癌症中操纵RAS和TP53突变之间相互作用的治疗潜力。总之,多种耐药机制加剧了有效靶向RAS-RAF-ERK通路的复杂性。脱靶效应和递送问题等挑战仍然是引入基于RAS抑制剂的有效疗法的重大障碍。本综述强调了癌症治疗中靶向RAS的不断发展的性质。
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