HER2单抗曲妥珠单抗耐药机制研究进展

约1/4的浸润性乳腺癌过表达HER2,过表达HER2的肿瘤更具侵袭性,病人生存期更短。HER2单抗曲妥珠单抗的应用使部分HER2过表达乳腺癌病人获得临床受益,但大部分病人在1 a内产生耐药。本文综述导致曲妥珠单抗耐药的可能机制。     

HER2阳性晚期乳腺癌治疗新药——曲妥珠单抗共轭复合物

摘要 曲妥珠单抗共轭复合物（T DM1）是抗体和药物的复合物,结合了曲妥珠单抗的抗肿瘤活性和DM1对HER 2有针对性的结合,有效地将曲妥珠单抗运送到靶点。临床试验表明,对于曲妥珠单抗、帕妥珠单抗耐药的HER2阳性晚期乳腺癌有效,对于接受过曲妥珠单抗和紫杉烷类药物治疗的HER2阳性晚期乳腺癌的患者,T DM1比拉帕替尼联合卡培他滨显著延长无进展生存期。对曲妥珠单抗耐药的HER2阳性乳腺癌患者,其耐受性更好并且更为有效,同时不会导致脱发,不良反应在可接受的范围内。     

曲妥珠单抗对多西他赛或长春瑞滨辅助治疗乳腺癌的不同疗效

曲妥珠单抗(trastuzumab,Herceptin)是罗氏公司开发的针对HER2蛋白的单克隆抗体。本研究对比了多西他赛(docetaxel)和长春瑞滨(vinorebine)对早期乳腺癌的辅助治疗效果,并且对其中过度表达HER2/neu的女性患者联用曲妥珠单抗与不用曲妥珠单抗治疗的疗效进行比较。随机挑选1010名     

跨线曲妥珠单抗治疗HER2阳性乳腺癌疗效分析

目的:评价应用曲妥珠单抗治疗后进展的人类表皮生长因子受体2(human epidermal growth factor receptor2,HER2)阳性乳腺癌继续曲妥珠单抗治疗的疗效。方法:回顾性分析中国癌症基金会赫赛汀援助项目中接受曲妥珠单抗治疗进展的HER2阳性乳腺癌患者的临床资料,以疾病进展后是否继续应用曲妥珠单抗治疗为分组标准,通过组间显著性差异比较评价跨线曲妥珠单抗治疗疗效。结果:在符合纳入标准的195例HER2阳性晚期乳腺癌患者中,一线继续曲妥珠单抗治疗可延长患者无进展生存期(progression free survival,PFS)及总生存期(overall survival,OS)(继续曲妥珠单抗或不用2组PFS分别为9个月和6个月,P=0.027; OS分别为20个月和16个月,P=0.031),二线继续曲妥珠单抗治疗可延长PFS(用或不用2组PFS分别为9个月和5个月,P=0.026),对OS无明显影响,三线继续曲妥珠单抗治疗对PFS、OS均无明显改善。基于辅助阶段存在曲妥珠单抗原发耐药,一线继续曲妥珠单抗治疗可延长PFS,而对OS无明显影响。对于一线治疗存在曲妥珠单抗原发耐药的患者,二线继续曲妥珠单抗治疗对PFS、OS均无明显改善。结论:经曲妥珠单抗治疗进展的HER2阳性乳腺癌患者,跨线曲妥珠单抗治疗有较好的临床获益。     

靶向HER2胞外结构域Ⅳ的单克隆抗体在乳腺癌中的应用进展

人表皮生长因子受体2(HER2)阳性乳腺癌侵袭性强且易转移,抗HER2靶向药物的应用能显著改善HER2阳性乳腺癌患者的预后。在已上市的HER2靶向药物中,靶向HER2胞外结构域Ⅳ的大分子单克隆抗体是治疗HER2阳性乳腺癌的基础靶向药物,主要包括曲妥珠单抗、伊尼妥单抗和马吉妥昔单抗。曲妥珠单抗用于乳腺癌全线治疗,循证医学证据充分,实践经验充足且安全性可控;伊尼妥单抗与曲妥珠单抗在HER2阳性转移性乳腺癌和新辅助/辅助治疗中疗效相似,且安全性可控;马吉妥昔单抗聚焦于携带CD16A-158F等位基因的患者,是晚期乳腺癌后线治疗的选择。临床上需根据患者具体病情选择最适合的药物。     

新乳腺检测方式问世有助于更个性化治疗决策制定

近期,FDA批准一项测定乳腺肿瘤组织中人类表皮生长因子受体-2(HER2)基因拷贝数的检测。若Inform Dual ISH检测呈阳性,患者就适合选用曲妥珠单抗治疗,该药是直接针对HER2的重组单克隆抗体,商品名为赫赛汀,用于治疗HER2过表达的乳腺癌。该检测试剂盒由Ventana集团生产。     

帕妥珠单抗、曲妥珠单抗联合白蛋白紫杉醇治疗1例转移性乳腺癌患者致指甲脱落案例报道

<正>帕妥珠单抗于2018年12月18日在我国正式上市,帕妥珠单抗联合曲妥珠单抗和紫杉醇类药物可能作为人表皮生长因子受体-2(human epidermal growth factor receptor-2,HER2)阳性晚期乳腺癌患者的一线治疗选择~([1-4]),未来会有越来越多的转移性乳腺癌患者使用曲妥珠单抗、帕妥珠单抗联合紫杉醇类药物的治疗方案,其不良反应也可能越来越常见。本文报道1例转移性乳腺癌患者采用曲妥珠单抗、帕妥珠单抗联合白蛋白     

抗体偶联药物在乳腺癌治疗中的研究进展

抗体偶联药物(ADC)是一类治疗乳腺癌的新型靶向药物,由连接子将化疗药物同单克隆抗体(单抗抗偶联而成,以单抗作为载体将化疗药物靶向运输至目标肿瘤细胞内发挥抗肿瘤作用。根据ADC作用于不同靶点的抗原,分为靶向人表皮生长因子受体2(HER2)、人滋养细胞表面抗原2 (Trop-2)及其他分子等类型。目前,全球范围内已有3种ADC获批治疗乳腺癌,除用于HER2阳性乳腺癌的曲妥珠单抗-美坦新偶联物(T-DM1)、曲妥珠单抗-德鲁替康(T-DXd)外,还有可使三阴性乳腺癌(TNBC)获益的戈沙妥珠单抗(SG)。ADC在HER2阳性乳腺癌治疗中疗效显著,同时在治疗晚期TNBC和部分HER2低表达的乳腺癌中也取得了重要进展,为不同乳腺癌分子分型的人群提供了更多选择。     

乳腺癌的分子靶向药物及进展

目的：通过文献复习探讨乳腺癌的分子靶向治疗现状和进展。方法：查询近几年国内外乳腺癌分子靶向药物治疗进展的关键性文献并进行分析。结果：在乳腺癌的治疗中有明显疗效的分子靶向药物有人表皮生长因子受体2（HER2）的抗靶点药物曲妥珠单抗、拉帕替尼、帕妥珠单抗和曲妥珠单抗一DMl;有表皮生长因子受体( EGFR)靶向治疗的药物吉非替尼和西妥昔单抗,其他的靶点药物有血管内皮生长因子(VEGF)的靶向治疗(贝伐珠单抗)等。结论：目前不少分子靶向药物进入乳腺癌的临床应用,明显降低了乳腺癌患者的疾病复发风险,延长了晚期乳腺癌患者的生存期,其中抗HER2的靶向药物曲妥珠单抗是乳腺癌治疗最成功的靶向药物。分子靶向治疗是乳腺癌术后辅助治疗和晚期乳腺癌解救治疗中新的重要治疗手段。     

曲妥珠单抗辅助化疗治疗HER2阳性乳腺癌有效性和安全性的Meta分析

目的 系统评价曲妥珠单抗辅助化疗治疗HER2阳性乳腺癌的有效性和安全性。方法 计算机检索国内外1996-2013年发表的曲妥珠单抗辅助化疗治疗HER2 阳性乳腺癌的前瞻性随机对照研究,对符合纳入标准的研究以Jadad评分标准进行文献质量评价,并使用Review Manager 5.3进行Meta分析。结果 共纳入4项III 期临床随机对照试验(其中有两项试验为合并分析)。Meta分析结果显示,与单纯化疗相比,曲妥珠单抗联合化疗治疗HER2 阳性乳腺癌可以显著延长患者的无病生存期DFS(HR=0.63,95%CI [0.50,0.81],P<0.001)和总生存期OS(HR=0.69,95%CI [0.56,0.86],P=0.001)。在安全性方面,曲妥珠单抗联合化疗组心脏事件(RR=5.09,95% CI [3.23,8.03],P<0.00001)及充血性心力衰竭(RR=5.32,95% CI [2.28,12.44],P=0.0001)发生率显著高于单纯化疗组,而在心脏事件导致的死亡方面,两组没有显著差异。 结论 曲妥珠单抗联合化疗治疗HER2阳性乳腺癌的疗效显著优于单纯化疗,但心脏事件也显著增加。     

PI3K/Akt信号通路活化在曲妥珠单抗耐药机制意义的研究

目的探讨磷脂酰肌醇-3-激酶/丝苏氨酸蛋白激酶(PI3K/Akt)信号转导通路激活是曲妥珠单抗耐药的重要靶点之一,为乳腺癌曲妥珠单抗耐药的靶向治疗提供理论基础。方法对人乳腺癌细胞株BT474连续处理建立了耐曲妥珠单抗的耐药亚株BT-HerR,FISH法对耐药细胞株BT-HerR做Her-2表型分析,MTT法检测曲妥珠单抗对BT474和BT-HerR细胞的体外增殖抑制情况,流式细胞仪检测曲妥珠单抗干预后细胞的凋亡变化,PI3K/Akt抑制剂LY294002干预细胞后Western blot检测p-Akt表达。结果耐药细胞株BT-HerR Her-2基因表达为强阳性;曲妥珠单抗干预细胞72 h后,细胞的体外增殖受到抑制且随着浓度的升高而增强;经曲妥珠单抗处理后比较BT474与BT-HerR细胞凋亡率,差异具有显著性(P<0.01);曲妥珠单抗仅能抑制BT474的Akt蛋白磷酸化,LY294002则能同时抑制BT474的BT-HerR Akt蛋白磷酸化。结论曲妥珠单抗耐药细胞Akt蛋白磷酸化活化,PI3K/Akt抑制剂LY294002能明显抑制曲妥珠单抗耐药细胞Akt蛋白磷酸化,PI3K/Akt信号转导通路与曲妥珠单抗耐药存在明确相关性。     

Synergistic interaction between trastuzumab and EGFR/HER-2 tyrosine kinase inhibitors in HER-2 positive breast cancer cells

Overexpression of HER-2 in breast cancer is frequently associated with expression of EGFR, and EGFR expression influences response to HER-2 inhibition. The aim of this study was to examine the effects of combining dual inhibition of EGFR and HER-2, using trastuzumab, gefitinib and lapatinib, in HER-2 overexpressing breast cancer cells. Combination proliferation assays were performed in two HER-2 positive breast cancer cell lines, SKBR-3 and BT-474. Trastuzumab combined with lapatinib was also tested in BT-474 xenografts. In proliferation assays, dual targeting with trastuzumab and gefitinib or lapatinib showed synergy or additivity in both SKBR-3 and BT-474 cells. Trastuzumab (10 nM) or gefitinib (5 μM) alone did not induce significant apoptosis, whereas lapatinib (0.75 μM) induced significant apoptosis in SKBR-3 cells. Trastuzumab combined with lapatinib further enhanced apoptosis induction. Trastuzumab (10 nM) and gefitinib (5 μM) induced apoptosis comparable to lapatinib alone (0.75 μM), suggesting that inhibition of both EGFR and HER-2 may be required to induce apoptosis in these cells. Pre-treatment with trastuzumab and gefitinib or lapatinib enhanced response to chemotherapy in vitro. The combination of trastuzumab and lapatinib also effectively blocked tumour growth in vivo. Dual targeting of EGFR and HER-2, by combining trastuzumab with EGFR/HER-2 tyrosine kinase inhibitors, may improve response in HER-2 overexpressing breast cancer cells that also express EGFR.     

Pharmacologic inhibition of mTOR improves lapatinib sensitivity in HER2-overexpressing breast cancer cells with primary trastuzumab resistance

Lapatinib, a dual EGFR/HER2 kinase inhibitor, is approved for use in patients with trastuzumab-refractory HER2- overexpressing breast cancer. Increased PI3K signaling has been associated with resistance to trastuzumab, although its role in lapatinib resistance remains unclear. The purpose of the current study was to determine if PI3K/mTOR activity affects lapatinib sensitivity. Reduced sensitivity to lapatinib was associated with an inability of lapatinib to inhibit Akt and p70S6K phosphorylation. Transfection of constitutively active Akt reduced lapatinib sensitivity, while kinase-dead Akt increased sensitivity. Knockdown of 4EBP1 also increased lapatinib sensitivity, in contrast to p70S6K knockdown, which did not affect response to lapatinib. Pharmacologic inhibition of mTOR using rapamycin or ridaforolimus increased lapatinib sensitivity and reduced phospho-Akt levels in cells that showed poor response to single-agent lapatinib, including those transfected with hyperactive Akt. Finally, combination mTOR inhibition plus lapatinib resulted in synergistic inhibition of proliferation, reduced anchorage-independent growth, and reduced in vivo tumor growth of HER2- overexpressing breast cancer cells that have primary trastuzumab resistance. Our data suggest that PI3K/mTOR inhibition is critical for achieving optimal response to lapatinib. Collectively, these experiments support evaluation of lapatinib in combination with pharmacologic mTOR inhibition as a potential strategy for inhibiting growth of HER2-overexpressing breast cancers that show resistance to trastuzumab and poor response to lapatinib.     

Additive effects of trastuzumab and genistein on human breast cancer cells

Soy isoflavone genistein, a tyrosine kinase inhibitor and agonist of estrogen receptor-β (ERβ), is known to have antitumoral properties. Given that ERβ often is coexpressed with HER2 in breast cancer, both functions of genistein might be able to enhance the antitumoral action of trastuzumab. In this in-vitro study, we tested whether combined treatment with genistein and trastuzumab exerts additive effects on breast cancer cells. HER2-overexpressing breast cancer cell lines were treated with genistein alone and in combination with trastuzumab. The effects of this treatment on proliferation and gene expression were analyzed. Treatment with high-dose genistein (10 μmol/l) significantly increased the growth-inhibitory effect of trastuzumab on HER2-overexpressing, ERα/β-positive BT-474 breast cancer cells. Combinatory treatment using lower doses of trastuzumab exerted similar effects as a single treatment with standard doses of this drug. In contrast, this effect was absent in ERα-negative SK-BR-3 cells. Similar results were obtained after cotreatment with the ERβ agonist, 2,3-bis(4-hydroxyphenyl)propionitrile. The growth-inhibitory effect of both drugs was accompanied by an increased expression of the putative tumor suppressor ERβ variant, cx, and their combination further elevated mRNA levels of this receptor. In conclusion, genistein significantly enhanced the antitumoral effect of trastuzumab on BT-474 breast cancer cells in vitro. The relevance of these data particularly for women with HER2-overexpressing and ERα/β-positive breast cancer has to be verified in animal or clinical studies.     

Antitumor Effect of Paclitaxel-Loaded PEGylated Immunoliposomes Against Human Breast Cancer Cells

Purpose The antitumor effect of paclitaxel-loaded PEGylated immunoliposome (PILs) was investigated in breast cancer cell lines and the xenograft model. Methods Herceptin was conjugated to paclitaxel-loaded PEGylated liposomes (PLs). In vitro cellular uptake and cytotoxicity of PILs were determined in breast cancer cell lines while in vivo antitumor efficacy was evaluated in the xenograft nude mouse model. Results The PILs formulation was able to significantly increase the HER2 mediated cellular uptake of paclitaxel compared to the PLs in cell lines overexpressing HER2 (BT-474 and SK-BR-3 cells). However, in the MDA-MB-231 cells, which express low levels of HER2, the difference between the PILs and PLs formulation was not significant. The biological activity of Herceptin was maintained throughout the conjugation process as exhibited by the antitumor dose–response curves determined for Herceptin itself, for the thiolated Herceptin alone and subsequently for the immunoliposome-coupled Herceptin. In BT-474 and SK-BR-3 cells, the cytotoxicity of the PILs was more potent than that of Taxol. Moreover, in in vivo studies, PILs showed significantly higher tumor tissue distribution of paclitaxel in the BT-474 xenograft model and more superior antitumor efficacy compared to Taxol and PLs. However, in the MDA-MB-231 xenograft model, PILs and PLs showed similar tumor tissue distribution as well as antitumor activity. Conclusions These results suggest that HER2-mediated endocytosis is involved in the PILs formulation. The ability of the PILs formulation to efficiently and specifically deliver paclitaxel to the HER2-overexpressing cancer cells implies that it is a promising strategy for tumor-specific therapy for HER2-overexpressing breast cancers.     

Tetrachlorobisphenol A and bisphenol AF induced cell migration by activating PI3K/Akt signaling pathway via G protein-coupled estrogen receptor 1 in SK-BR-3 cells

Different subtypes of breast cancer express positively G protein-coupled estrogen receptor 1 (GPER1). Our previous studies found that tetrachlorobisphenol A (TCBPA) and bisphenol AF (BPAF) significantly promoted SK-BR-3 cell proliferation by activating GPER1-regulated signals. The present study further investigated the effects of TCBPA and BPAF on the migration of SK-BR-3 cells and examined the role of phosphatidylinositol 3-kinase-protein kinase B (PI3K/Akt) and its downstream signal targets in this process. We found that low-concentration BPAF and TCBPA markedly accelerated the migration of SK-BR-3 cells and elevated the mRNA levels of target genes associated with PI3K/Akt and mitogen-activated protein kinase (MAPK) signals. TCBPA- and BPAF-induced upregulation of target genes was significantly reduced by GPER1 inhibitor G15, the PI3K/Akt inhibitor wortmannin (WM), and the epidermal growth factor receptor (EGFR) inhibitor ZD1839 (ZD). G15 and WM also decreased cell migration induced by TCBPA and BPAF. The findings revealed that TCBPA and BPAF promoted SK-BR-3 cell migration ability by activating PI3K/Akt signaling pathway via GPER1-EGFR.     

ST2325抑制HER2/neu受体酪氨酸激酶信号转导途径及其对乳腺癌细胞周期的影响

目的　本文研究ST2 32 5对HER2 /neu受体的下游信号转导途径的抑制作用及其对乳腺癌BT4 74细胞周期的影响。方法　免疫印迹法检测蛋白表达量和磷酸化蛋白量的变化 ;流式细胞术检测细胞周期的分布。结果　ST2 32 5抑制BT4 74细胞HER 2 /neu受体的自身磷酸化 ,IC50 为 8 7μmol·L-1,对HER2 /neu的表达没有任何影响。ST2 32 5抑制BT4 74细胞磷酸化的MAPK和AKT。ST2 32 5处理BT4 74细胞 2 4h后 ,流式细胞仪分析可见细胞周期停止于G1期 ;Westernblot法检测呈现在在ST2 32 5处理后 ,细胞中p2 7上调 ,Rb的高磷酸化状态下降 ,CyclinD1蛋白水平下降。 结论　ST2 32 5能抑制乳癌BT4 74细胞HER2 /neu受体酪氨酸激酶信号转导途径 ,诱导乳腺癌细胞BT4 74停止于G1期 ,且与 p2 7上调、Rb的高磷酸化状态下降、CyclinD1蛋白水平下降有关。     

Ablation of Breast Cancer Cells Using Trastuzumab‐Functionalized Multi‐Walled Carbon Nanotubes and Trastuzumab‐Diphtheria Toxin Conjugate

Trastuzumab (Herceptin^®) is a monoclonal antibody (mAb) for specific ablation of HER2‐overexpressing malignant breast cancer cells. Intensification of antiproliferative activity of trastuzumab through construction of immunotoxins and nano‐immunoconjugates is a promising approach for treatment of cancer. In this study, trastuzumab was directly conjugated to diphtheria toxin (DT). Also, conjugates of trastuzumab and multiwalled carbon nanotubes (MWCNT) were constructed by covalent immobilization of trastuzumab onto MWCNTs. Then, antiproliferative activity of the fusion constructs against HER2‐overexpressing SK‐BR‐3 and also HER2‐negative MCF‐7 cancer cell lines were examined. Cells treated with trastuzumab‐MWCNT conjugates were irradiated with near‐infrared (NIR) light. Efficient absorption of NIR radiation and its conversion to heat by MWCNTs can be resulted to thermal ablation of cancerous cells. Our results strongly showed that both trastuzumab‐MWCNT and trastuzumab‐DT conjugates were significantly efficient in the specific killing of SK‐BR‐3 cells. Targeting of MWCNTs to cancerous cells using trastuzumab followed by exposure of cells to NIR radiation was more efficient in repression of cell proliferation than treatment for cancer cells with trastuzumab‐DT. Our results also showed that conjugation linkers can significantly affect the cytotoxicity of MWCNT‐immunoconjugates. In conclusion, our data demonstrated that trastuzumab‐MWCNT is a promising nano‐immunoconjugate for killing of HER2‐overexpressing cancerous cells.     

Trastuzumab,a humanized anti-HER2 monoclonal antibody,for the treatment of breast cancer

The HER2/neu gene encodes a 185 kDa transmembrane receptor (HER2) that belongs to the epidermal growth factor receptor family and has intrinsic tyrosine kinase activity. HER2 is overexpressed in 25-30% of breast cancers and is suggested to have a direct role in the pathogenesis and clinical aggressiveness of HER2 overexpressing tumors. A murine monoclonal antibody, 4D5, directed against the extracellular domain of HER2, is a potent inhibitor of growth of human breast cancer cells overexpressing HER2 in vitro and in xenograft models. To facilitate clinical investigation, 4D5 was humanized by inserting the complementary determining regions of 4D5 into the framework of a consensus human IgG1. The resulting recombinant humanized anti-HER2 MAb, trastuzumab, was found to inhibit the growth of human cancer cells and tumor xenografts overexpressing HER2. Data from phase II trials in women with breast cancer whose tumors overexpress HER2 have shown that trastuzumab has a favorable toxicity profile, is active as a single agent and induces long-lasting objective tumor responses. In combination studies, there was no evidence that trastuzumab enhanced the toxicity of cisplatin and the pharmacokinetic parameters of trastuzumab were unaltered by coadministration of cisplatin. Furthermore, clinical response rates were higher than those reported with either agent alone in a similar patient population. Results of a multicenter, phase III clinical trial of chemotherapy (doxorubicin- or paclitaxel-based) plus trastuzumab as compared to chemotherapy alone in patients with advanced breast cancers overexpressing HER2 showed a significant enhancement in the effects of chemotherapy on time to disease progression, response rates and survival with coadministration of trastuzumab, without increases in overall severe adverse events. Myocardial dysfunction syndrome, similar to that observed with anthracyclines, was reported more commonly with chemotherapy plus trastuzumab. Positive results from clinical studies led to the approval of trastuzumab in the U.S in October 1998 for the treatment of metastatic breast cancer in patients with tumors overexpressing HER2. Since then, the MAb has also been marketed in Switzerland and Canada.     

Design,synthesis and anti-tumor activities of cyclic phosphoramidate mustard-quinazoline conjugates

A series of new cyclic phosphoramidate mustard-quinazolineconjugates were designed and synthesized based on the drug candidate EMB-3, a multi-target-directed ligand against tumor cells, and their anti-tumor activities were evaluated on breast cancer and lung cancer cells. Compound 6d exhibited the best anti-tumor performance with IC₅₀ = 0.6 μM(8-fold of EMB-3) on BT474breast tumor cells. Compound 6d inhibited epidermal growth factor receptor (EGFR, biomarker for NSCLC) and human epidermal growth factor 2 (HER2, biomarker for breast cancer) with IC₅₀ of 18 nM and 78 nM, respectively. The preliminary pharmacokinetic study revealed that 6d was more stable than EMB-3 during the in vivo metabolism. A single dose per os (PO) administration of 6d in rat model (10 mg/kg) resulted in a moderate t_1/2of 1.7 h. These results indicated that compound 6d was a potential lead compound for the treatment of breast cancer.