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:Targeted Therapies for Each Subtype of Breast Cancer.
乳腺癌(BC)是一种临床异质性恶性肿瘤,也是全球女性癌症相关死亡的主要原因。
乳腺癌(BC)是一种临床异质性恶性肿瘤,也是全球女性癌症相关死亡的主要原因。根据分子生物标志物,它被分为激素受体(HR)阳性、人表皮生长因子受体2(HER2)阳性和三阴性(TNBC)亚型。这种异质性导致了不同的疾病进展和治疗反应,使得亚型特异性精准治疗成为改善患者预后的不可或缺的手段。尽管雌激素受体(ER)靶向药物和抗HER2治疗已取得显著成功,但仍存在关键挑战,包括耐药性、生物标志物不足以及TNBC治疗靶点有限。本综述全面总结了主要BC亚型靶向治疗的最新进展:HR阳性BC的内分泌治疗联合细胞周期蛋白依赖性激酶4/6(CDK4/6)或磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(AKT)/哺乳动物雷帕霉素靶蛋白(mTOR)抑制剂;HER2阳性BC的新型抗体药物偶联物(ADCs)如曲妥珠单抗德鲁替康(T-DXd)和酪氨酸激酶抑制剂(TKIs);以及TNBC的滋养层细胞表面抗原2(Trop-2)ADCs、免疫疗法和聚ADP核糖聚合酶(PARP)抑制剂。本综述还讨论了跨亚型治疗平台(ADCs、PI3K/AKT/mTOR通路)和新兴模式(嵌合抗原受体[CAR]T细胞疗法、蛋白水解靶向嵌合体[PROTACs])。通过分析成功经验、挑战和转化潜力,本综述为临床医生和研究人员提供了清晰的框架,推动个性化治疗优化并解决BC精准肿瘤学中未满足的临床需求。
Breast cancer (BC) is a clinically heterogeneous malignancy and a leading cause of cancer-related mortality in women worldwide. It is classified into hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-positive, and triple-negative (TNBC) subtypes based on molecular biomarkers. This heterogeneity drives distinct disease progression and treatment responses, making subtype-specific precision therapy indispensable for improving patient outcomes. While estrogen receptor (ER)-targeting agents and anti-HER2 therapies have achieved notable successes, critical challenges remain, including drug resistance, inadequate biomarkers, and limited therapeutic targets for TNBC. This review comprehensively summarizes recent advances in targeted therapies for major BC subtypes: endocrine therapy combined with cyclin-dependent kinase 4/6 (CDK4/6) or phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) inhibitors for HR-positive BC; novel antibody drug conjugates (ADCs) such as trastuzumab deruxtecan (T-DXd) and tyrosine kinase inhibitors (TKIs) for HER2-positive BC; and trophoblast cell-surface antigen 2 (Trop-2) ADCs, immunotherapies, and poly-ADP-ribose polymerase (PARP) inhibitors for TNBC. It also discusses cross-subtype therapeutic platforms (ADCs, PI3K/AKT/mTOR pathway) and emerging modalities (chimeric antigen receptor [CAR] T-cell therapy, proteolysis-targeting chimeras [PROTACs]). By analyzing successes, challenges, and translational potential, this review provides a clear framework for clinicians and researchers, advancing personalized treatment optimization and addressing unmet clinical needs in BC precision oncology.
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