非小细胞肺癌中EGFR突变与EGFR-TKI临床敏感性及耐药性的研究进展

目的阐述非小细胞肺癌(NSCLC)中表皮生长因子受体(EGFR)突变与表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)临床敏感性及耐药性之间的关系。方法分析总结已经发表的国内外相关文献,对非小细胞肺癌治疗中EGFR-TKI的敏感性和耐药性进行介绍。结果在NSCLC患者中用EGFR-TKI治疗有效性和EGFR活化性突变有着紧密的联系,二者都在亚洲人种,女性,不吸烟,腺癌患者中发生率较高;患者对EGFR-TKI耐药不仅与EGFR二次突变有关,还与KRAS突变,HER2过表达,蛋白酪氨酸磷酸酶基因(PTEN)缺失,胰岛素样生长因子受体1(IGFR-1)过表达等有联系。结论EGFR突变可作为临床衡量EGFR-TKI敏感性指标;耐药机制复杂多变,目前还没有完全研究清楚。     

EGFR-TKI类药物治疗晚期非小细胞肺癌的研究进展

表皮生长因子受体酪氨酸激酶抑制剂（epithelial growth factor receptor tyrosine kinase inhibitors,EGFR-TKI）引领EGFR突变的晚期非小细胞肺癌精准治疗十多年,EGFR-TKI对EGFR常见突变的晚期非小细胞肺癌的疗效已得到明确的证实。然而对于EGFR罕见突变,EGFR-TKI的疗效在临床上存在众多争议。本文列举了目前已经进入临床阶段的EGFR-TKI类药物在EGFR突变阳性晚期非小细胞肺癌中的中位无进展及总生存期并进行比较,增加了EGFR罕见突变对EGFR-TKI疗效的相关研究,以期为临床EGFR-TKI的合理使用提供参考。     

表皮生长因子受体突变诱导吉非替尼获得性耐药机制分析

吉非替尼作为表皮生长因子受体络氨酸激酶抑制剂（EGFR-TKI）类靶向药物,广泛用于临床非小细胞肺癌（NSCLC）的治疗,但近几年的临床应用发现,肿瘤细胞对该类药物的敏感度逐渐下降,药物作用疗效呈现减低趋势,临床耐药问题逐渐凸显。近几年的深入研究表明,吉非替尼的耐药机制可能与表皮生长因子受体（EGFR）旁路效应、EGFR信号传导路径和EGFR靶基因的二次突变有关,基于此以吉非替尼作用机制为出发点对其获得性耐药机制进行归纳总结。     

F84, a quinazoline derivative,exhibits high potent antitumor activity against human gynecologic malignancies

EGFR overexpression in gynecologic cancer has been associated with poor prognosis. Targeted inhibition of EGFR via its tyrosine kinase domain is a successful treatment in lung cancer. However, the results of existing clinical trials in gynecologic cancers do not show a significant clinical response to EGFR inhibition alone in unscreened patients. Novel EGFR-TKI might be beneficial for patients with gynecologic cancers. In this article, the in vitro and in vivo effects of a newly synthesized novel EGFR tyrosine kinase inhibitor N-(3-bromophenyl)-N-(7-methoxy-6-(3-morpholinopropoxy)quinazolin-4-yl)-3,3-dimethylbutanamide (F84) is being reported. In vitro, F84 and PD153035 significantly inhibited the growth of four different human gynecologic cancer cell lines in a dose-dependent manner. In vivo, F84 exhibited an inhibitory effect on gynecologic malignancies. While the mechanism of action is still unclear, it might be related to inhibition of EGFR signaling pathway, delay in cell cycle progression and a G1 arrest together with a partial G2/M block and induction of apoptosis. These results suggest that F84 could be a potential drug candidate for the treatment of human gynecologic malignancies.     

B5, a novel pyrrole-substituted indolinone,exerts potent antitumor efficacy through G2/M cell cycle arrest

(E)-Ethyl 3,5-dimethyl-4-[(indolin-2-one-3-ylidene)methyl]-1H-pyrrole-2-carboxylate (B5) was one of the novel pyrrole-substituted indolinones synthesized in our research with the initial aim of developing selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKIs). However, B5 exhibited weak inhibitory potency against a variety of protein tyrosine kinases including EGFR, but potent kinase inhibition against several members of the cyclin-dependent kinase (CDK) family. The results of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay demonstrated that B5 had approximately 500 times more potent antitumor activity than PD153035, a known standard EGFR-TKI, in a panel of ten epithelial cancer cell lines. B5 did not inhibit the phosphorylation of EGFR induced by EGF in vitro. DNA flow cytometric analysis revealed that B5 induced cell cycle arrest at G2/M phase and western blot analysis indicated that both CDK1 (Cdc2) and cyclin B1 proteins were decreased after B5 treatment. Our findings suggested the potential therapeutic applications of B5 in numerous cancers and a promising new template for further development of antitumor agents.     

EGFR-TKIs在NSCLC中的耐药机制及治疗策略研究进展

表皮生长因子受体（EGFR）抑制剂是目前临床治疗非小细胞肺癌（NSCLC）的一线小分子靶向药物,随着EGFR酪氨酸激酶抑制剂（EGFR-TKI）的广泛使用,其耐药现象也日趋明显,已成为其治疗NSCLC的巨大挑战。本文总结了EGFR-TKIs在NSCLC中的主要耐药机制,并对相关逆转策略的研究进展进行综述。     

非小细胞肺癌EGFR-TKI耐药后转化为小细胞肺癌2例

摘 要 表皮生长因子受体-酪氨酸激酶抑制药 (EGFR-TKI) 治疗晚期非小细胞肺癌 （NSCLC）的耐药机制逐渐明了,其中小细胞肺癌（SCLC）转化引发了学者极大关注。本文详细报道2例女性EGFR基因19外显子缺失突变肺腺癌患者,在EGFR-TKI靶向治疗耐药后伴随血清神经元特异性烯醇化酶（NSE）水平的显著升高;同时,二次活检发现小细胞肺癌（SCLC）的转化,予以标准SCLC化疗方案治疗有效。提示医生应考虑NSCLC EGFR-TKI 治疗失败后 SCLC 转化的可能,并重视NSE动态监测及二次活检病理分析的重要性。     

Icotinib enhances lung cancer cell radiosensitivity in vitro and in vivo by inhibiting MAPK/ERK and AKT activation

Icotinib hydrochloride is a small epidermal growth factor receptor‐tyrosine kinase inhibitor (EGFR‐TKI) that was developed by Chinese scientists. While clinical trials have revealed its efficacy in the treatment of lung cancer, very little is known about its role in enhancing radiosensitivity. In this study, we investigated the effectiveness of Icotinib in enhancing lung cancer cell radiosensitivity and have detailed its underlying molecular mechanism. The lung cancer cell line H1650 was pretreated with or without Icotinib for 24 hours before radiation, and clonogenic survival assay was performed. Cell apoptosis was also analyzed by flow cytometry, while western blotting was performed to examine the activation of EGFR and its downstream kinases in H1650 cells after Icotinib and radiation treatment. Furthermore, a xenograft animal model was established to evaluate the radiosensitivity of Icotinib in vivo and to confirm its mechanism. Our results demonstrate that pretreatment with Icotinib reduced clonogenic survival after radiation, inhibited EGFR activation, and increased radiation‐induced apoptosis in H1650 cells. The phosphorylation of protein kinase B (AKT), extracellular regulated protein kinase 1/2 (ERK1/2), and EGFR was inhibited after Icotinib and radiation combination treatment in vitro and in vivo compared with individual treatments. Combination treatment also affected the expression of the DNA repair protein H2A histone family member X (γ‐H2AX). In conclusion, our results reveal that Icotinib enhances radiosensitivity in lung cancers in vitro and in vivo and the mechanism of this may involve blocking the EGFR‐AKT and MAPK‐ERK pathways and limiting DNA repair.     

Discovery of WS-157 as a highly potent,selective and orally active EGFR inhibitor

EGFR tyrosine kinase inhibitor (EGFR-TKI) has been used successfully in clinic for the treatment of solid tumors. In the present study, we reported the discovery of WS-157 from our in-house diverse compound library, which was validated to be a potent and selective EGFR-TKI. WS-157 showed excellent inhibitory activities against EGFR (IC₅₀ = 0.81 nmol/L), EGFR^[d746−750] (IC₅₀ = 1.2 nmol/L) and EGFR^[L858R] (IC₅₀ = 1.1 nmol/L), but was less effective or even inactive against other nine kinases. WS-157 also displayed excellent antiproliferative activities against a panel of human cancer cell lines, and exhibited the ability to reduce colony formation and wound healing the same as gefitinib. We found that WS-157 upon oral administration showed better anti-tumor activity in A431 bearing xenograft mouse models compared to gefitinib. In addition, WS-157 showed better intestinal absorption than gefitinib and had favorable pharmacokinetic properties and microsomal metabolic stability in different species. These studies indicate that WS-157 has strong antitumor activity in vitro and in vivo, and could be used for the development of anti-lung cancer agent targeting EGFR.     

EGFR突变肺癌脑膜转移奥希替尼加量治疗1例

非小细胞肺癌（NSCLC）脑膜转移患者的生存期短,治疗方法有限。奥希替尼是第三代表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）,可高效抑制EGFR敏感突变和EGFR T790M耐药突变,同时对EGFR突变的NSCLC软脑膜转移患者也有很好的疗效。本文报道1例奥希替尼加量至160 mg·d^-1治疗EGFR突变肺腺癌脑膜转移,为临床治疗NSCLC难治性软脑膜转移提供参考。     

Estrone analogs as potential inhibitors targeting EGFR-MAPK pathway in non-small-cell lung cancer

Lung cancer is the deadliest human cancer globally, with non-small-cell lung cancer (NSCLC) being the most frequent type. Epidermal growth factor receptor (EGFR), a central regulator of tumor progression is frequently overexpressed in NSCLC and is a key drug target along with its downstream pathways. Here, we describe the biological evaluation of previously synthesized estrone analogs as potent inhibitors of NCI-H226 cells. Two of the analogs, MMA307 and MM320, significantly inhibited the proliferation of NCI-H226 cells with IC₅₀ doses of 2.88 ± 0.21 and 9.68 ± 0.24 μM, respectively, compared with the positive control and chemotherapy, sorafenib, IC₅₀ of 20.62 ± 1.32 μM. Exposing NCI-H226 cells to IC₅₀ concentration of MMA307 and MMA320 resulted in the downregulation of EGFR and phospho-EGFR expression levels, and suppression of activated MAPK-ERK_1/2 signaling proteins; phospho-B-Raf, phospho-MEK_1/2, and phospho-ERK_1/2. Furthermore, the downregulation of cyclin D₁ and concomitant upregulation of phospho-cyclin D₁ and p21^waf1/cip1 were observed after the compounds' addition to NCI-H226 cells resulting in G₁ phase cell cycle arrest. MMA320 but not MMA307 downregulated the expression levels of Dyrk1B, a checkpoint kinase at the G₁–S phase transition of the cell cycle. Additionally, molecular dynamic simulations were performed and found that MMA307 and MMA320 have higher binding affinities than sorafenib in MEK, BRAF, cyclin D₁, and Dyrk1B (dual-specificity tyrosine phosphorylation-regulated kinase 1B). To conclude, the present study is the first to report on the antiproliferative potential of novel estrone analogs and provide evidence that MMA307 and MMA320 are promising novel lead candidates for the development of antilung cancer drugs.     

Epidermal growth factor receptor tyrosine kinase inhibitors in previously treated advanced non-small-cell lung cancer with wild-type EGFR

Introduction: While epidermal growth factor receptor (EGFR) – tyrosine kinase inhibitors (TKIs) lead to longer progression-free survival (PFS) when compared with conventional chemotherapy in non-small-cell lung cancer (NSCLC) harboring activating EGFR mutations, the role of EGFR-TKI remains unclear in EGFR-wild-type (WT) NSCLC.

Areas covered: This article reviews selected data from randomized trials regarding the use of TKIs in EGFR-WT NSCLC. Nine randomized phase III trials have compared EGFR-TKI with chemotherapy in NSCLC patients in a second or later line setting. Two of these trials, TAILOR and DELTA, which were designed to investigate treatment benefits according to EGFR genotype, demonstrated that docetaxel chemotherapy displayed significantly better in progression-free survival (PFS) when compared with the EGFR-TKI erlotinib. Biomarkers to predict clinical benefits of the drug against EGFR WT tumor, and the efficacy of combination regimens using erlotinib or single-use afatinib against tumors are also covered in this article.

Expert opinion: Considering the modest benefits of erlotinib for EGFR-WT tumors, future studies are warranted, including the exploration of useful biomarkers and new treatment strategies for EGFT-TKI use, as well as the development of more sensitive EGFR mutation tests.     

EGFR基因靶向治疗非小细胞肺癌的研究进展

非小细胞肺癌(Non-small cell lung cancer,NSCLC)是现阶段临床发现的肺癌患者中发病率最高的一种类型,治疗手段匮乏,效果不甚理想,目前临床中研究热点是EGFR基因在NSCLC靶向治疗中的作用。表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)是基于EGFR基因作用而开发出来,用于治疗EGFR基因突变阳性的NSCLC患者。本文综述了EGFR基因靶向治疗非小细胞肺癌的研究进展。     

EGFR tyrosine kinase inhibitor "gefitinib (Iressa)" for cancer therapy

Many malignant tumors including non-small cell lung cancer (NSCLC) express or over-express EGFR that have shown correlations with rapid growth, metastases, resistance to conventional chemotherapy or radiotherapy, and poor prognosis. Gefitinib is a potent and selective inhibitor of EGFR tyrosine kinase (EGFRTK). Gefitinib specifically inhibited EGF-stimulated cell proliferation in vitro and it also exhibited a broad anti-tumor spectrum against NSCLC, prostate, colorectal, and ovarian cancers in vivo. Gefitinib showed dose-dependent and reversible reduction of c-fos mRNA level and decreased Ki67 significantly in tumors in vivo. In in vitro studies, gefitinib arrested the cell cycle at G1 phase by inducing intrinsic cyclin-dependent kinase (cdk) inhibitors and following inhibition of cdk2. Apoptosis was also seen in gefitinib-treated tumor cells and skin biopsy samples from clinical study. Gefitinib inhibited VEGF production in tumor cells through inhibition of EGFR signaling, leading to suppression of angiogenesis. In clinical studies, gefitinib demonstrated therapeutic benefit in patients who failed conventional chemotherapy. No correlation has been established between the anti-tumor activity of gefitinib and EGFR expression level, whilst sensitivity factors to gefitinib are yet to be elucidated. Identification of sensitivity factors will be a key for effective use of EGFRTK inhibitors including gefitinib for cancer treatment.     

Gefitinib for non-small-cell lung cancer treatment

Introduction: Gefitinib is an EGFR tyrosine kinase inhibitor (EGFR-TKI) that demonstrated efficacy in patients with advanced non-small cell lung cancer (NSCLC) across therapy lines. In the first-line setting, recent randomized Phase III trials comparing EGFR-TKIs versus platinum-based doublets demonstrated that in patients harboring an activating EGFR mutation, gefitinib is superior to chemotherapy in terms of response rate, progression-free survival, toxicity profile and quality of life, with a marginal positive effect on survival. In order to choose the best treatment, a molecular characterization is now mandatory, as part of baseline diagnostic procedures.

Areas covered: All published data on gefitinib in lung cancer were analyzed using PubMed. The aim of this review is to summarize activity and safety data from major clinical trials of gefitinib in patients with advanced NSCLC.

Expert opinion: EGFR-TKIs including gefitinib are the best option we can offer today in patients with EGFR mutation, regardless of treatment line. Administration of gefitinib to patients with advanced NSCLC is usually well-tolerated and it also appears to be feasible in special populations characterized by a significantly poorer risk:benefit ratio with standard chemotherapy, like elderly patients and patients with poor performance status.     

抗非小细胞肺癌药物奥希替尼研究进展

年3月22日中国食品药品监督管理局(CFDA)批准表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)奥希替尼(Osimertinib)用于治疗EGFR T790M基因突变阳性的局部晚期或转移性非小细胞肺癌(NSCLC)。奥希替尼是第三代EGFR-TKI,治疗效果显著,副作用更小,尤其适用于对第一、二代EGFR-TKI耐药或者脑转移的病人。与含铂类治疗药物的二联化学疗法相比,奥希替尼可使NSCLC病人中位无进展生存期(PFS)延长5.7个月,疾病进展风险下降70%。该文就奥希替尼的作用机制、研究历程、药效学、药动学、不良反应,耐药机制进行综述,为临床使用提供参考。     

非小细胞肺癌EGFR-TKI治疗失败后小细胞肺癌转化

表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)治疗晚期非小细胞肺癌(NSCLC)的耐药分子机制逐渐明了,其中小细胞肺癌(SCLC)转化引发了学者极大关注。这种表型转化和伴发EGFR突变是肿瘤细胞异质性,或是肿瘤干细胞,或是某些分子事件使然,但无论那种机制均是推测且无直接证据。目前临床实践中对这种EGFR-TKI耐药转化为SCLC患者的治疗仅是经验分享,亦无更高级别的证据推荐。     

Synthesis of Novel 3,5-Disubstituted-2-oxindole Derivatives As Antitumor Agents against Human Nonsmall Cell Lung Cancer

相似文献   

Gefitinib for non-small-cell lung cancer treatment

INTRODUCTION: Gefitinib is an EGFR tyrosine kinase inhibitor (EGFR-TKI) that demonstrated efficacy in patients with advanced non-small cell lung cancer (NSCLC) across therapy lines. In the first-line setting, recent randomized Phase III trials comparing EGFR-TKIs versus platinum-based doublets demonstrated that in patients harboring an activating EGFR mutation, gefitinib is superior to chemotherapy in terms of response rate, progression-free survival, toxicity profile and quality of life, with a marginal positive effect on survival. In order to choose the best treatment, a molecular characterization is now mandatory, as part of baseline diagnostic procedures. AREAS COVERED: All published data on gefitinib in lung cancer were analyzed using PubMed. The aim of this review is to summarize activity and safety data from major clinical trials of gefitinib in patients with advanced NSCLC. EXPERT OPINION: EGFR-TKIs including gefitinib are the best option we can offer today in patients with EGFR mutation, regardless of treatment line. Administration of gefitinib to patients with advanced NSCLC is usually well-tolerated and it also appears to be feasible in special populations characterized by a significantly poorer risk:benefit ratio with standard chemotherapy, like elderly patients and patients with poor performance status.     

表皮生长因子受体多态性对酪氨酸激酶抑制剂药效学影响的研究进展

目前表皮生长因子受体（EGFR）的酪氨酸激酶抑制剂（TKI）在治疗非小细胞肺癌中得到广泛应用。本文回顾了影响酪氨酸激酶抑制剂药效的EGFR基因多态性以及相关的EGFR基因突变位点对酪氨酸激酶抑制剂吉非替尼治疗非小细胞肺癌的药效发挥产生何种影响的相关研究,说明EGFR的基因多态性对酪氨酸激酶抑制剂的药效发挥产生了重要的作用。