下一代肿瘤不可知靶点即将出现
Next-generation tumor-agnostic targets on the horizon.
肿瘤不可知药物开发将肿瘤学重新聚焦于共享的分子依赖性而非组织来源,从而能够针对跨肿瘤的罕见可操作驱动因素进行高效开发。
英文原题:New targets and new drugs for hepatobiliary cancers.
肝胆管癌的治疗已迅速进展,新的治疗方法正在积极开发中。
肝胆肿瘤的治疗进展迅速,新的治疗方法正在积极开发中。当前药物研发根据其作用机制可分为两大主要策略。第一种策略聚焦于超越传统免疫检查点(如programmed death-1和cytotoxic T-lymphocyte-associated protein 4)的新型免疫系统靶向疗法。这包括针对新免疫检查点的抗体以及参与肿瘤免疫应答调节的细胞因子。II期和III期临床试验正在探索这些抗体与已获批免疫治疗方案联合应用的效果。细胞疗法,包括CAR-T 细胞和TIL(肿瘤浸润淋巴细胞),也正在肝细胞癌(HCC)和胆道癌(BTC)的早期临床研究中进行测试。抗体工程的进步也使得双特异性T细胞衔接器的设计成为可能。第二种方向针对新靶点或对传统上不可成药的靶点采用改良方法,如过氧化物酶体增殖物激活受体-α、Kirsten大鼠肉瘤病毒癌基因、组蛋白去乙酰化酶和β-catenin。在其它癌症中已取得成功的表达human epidermal growth factor receptor-2或nectin-4的抗体药物偶联物也正在针对BTC进行开发。值得注意的是,这些进展的分类在某种程度上是人为的,因为新出现的证据揭示了这些疗法具有新的免疫调节作用。最后,这些治疗进展提示了少见肝脏癌症(如肉瘤样HCC和混合型HCC-胆管癌)治疗方式的转变。近期临床经验和基因组数据表明这些亚型可能对免疫检查点抑制剂有应答。将这些亚型纳入临床试验可能有助于加速针对这些少见病种的有效治疗方法的开发。
The treatment of hepatobiliary cancers has advanced rapidly, with novel approaches under active development. Current drug development can be classified into two primary strategies, based on their underlying mechanisms of action. The first focuses on novel therapies targeting the immune system beyond conventional immune checkpoints like programmed death-1 and cytotoxic T-lymphocyte-associated protein 4. This includes antibodies targeting new immune checkpoints and cytokines involved in tumour immune response regulation. Phase II and III clinical trials are exploring combinations of these antibodies with approved immunotherapy regimens. Cellular therapies, including chimeric antigen receptor-T cells and tumour-infiltrating lymphocytes, are also being tested in early clinical studies for hepatocellular carcinoma (HCC) and biliary tract cancer (BTC). Advances in antibody engineering have also enabled the design of bispecific T-cell engagers. The second direction addresses new targets or revised approaches to traditionally undruggable targets, such as peroxisome proliferator-activated receptor-α, Kirsten rat sarcoma viral oncogene, histone deacetylase, and β-catenin. Successful in other cancers, antibody-drug conjugates expressing human epidermal growth factor receptor-2 or nectin-4 are also being developed for BTC. Notably, the classification of these advances is somewhat arbitrary, as emerging evidence reveals new immunomodulatory roles for these therapies. Finally, these therapeutic advances suggest a change in the treatment approach for less common liver cancers, such as sarcomatoid HCC and combined HCC-cholangiocarcinoma. Recent clinical experiences and genomic data indicate potential responsiveness to immune checkpoint inhibitors. Including these subtypes in clinical trials may help accelerate the development of effective treatments for these uncommon entities.
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