第二代Bcr/Abl酪氨酸激酶抑制剂巴氟替尼

酪氨酸激酶抑制剂伊马替尼对于断裂点集中区/艾贝尔森（Bcr-Abl）阳性白血病有着显著的治疗效果,但由于抗药性的原因影响了其在临床上的应用。作为第二代Bcr-Abl酪氨酸激酶抑制剂巴氟替尼在一系列临床前和临床后研究中表现出了良好的应用前景。     

以c-Met为肿瘤治疗靶点的受体酪氨酸激酶抑制剂的研究进展

受体酪氨酸激酶c-Met在细胞的增殖、代谢以及肿瘤的产生、转移、血管生成中扮演着重要角色,c-Met成为抗肿瘤治疗的重要靶点。HGF/c-Met信号通路与VEGFR等其他通路的相互作用(cross-talk)影响了抗肿瘤药物的作用效果,产生耐药性,因此,多激酶靶点联合用药成为新的抗肿瘤治疗手段。本文介绍了c-Met信号通路与多种膜受体间的相互作用以及由这种相互作用引起的对激酶抑制剂的耐药性,并综述了单靶点和多靶点的小分子c-Met抑制剂的研究进展。     

已上市酪氨酸激酶抑制剂抗肿瘤作用机制及构效关系研究

在人类基因组中发现了大约2000个激酶,其中超过90个为蛋白酪氨酸激酶,在靶向性抗肿瘤药物中,靶向酪氨酸激酶类的药物已成为研发热点,并且已获得巨大成功.本文综述了一类已上市的酪氨酸激酶抑制剂的研究进展,介绍了抑制剂结合受体蛋白的方式及其作用机制,重点讨论了这类药物的构效关系,发现分子对接的结构与真实构效关系基本一致.     

新型2-吲哚酮类c-Met激酶抑制剂的设计、合成及活性研究

目的 设计合成新型2-吲哚酮类c-Met激酶抑制剂.方法 以c-Met激酶抑制剂SU11274为先导化合物,利用生物电子等排原理设计出系列2-吲哚酮类衍生物.以2-吲哚酮为起始原料,先后经历与氯磺酸的氯磺酰化、与3的磺酰胺化、与6a~6h,7a~7h和4a~4b的缩合反应制得目标产物10a~10r,并测定它们对c-Met激酶和MCF-7细胞增殖的抑制活性.结果与结论 成功合成了设计的18个2-吲哚酮类化合物,产物结构经1H NMR和ESI-MS确证.部分化合物显示出一定的c-Met激酶和MCF-7细胞增殖抑制活性.对目标产物进行了初步构效关系分析,为该类化合物进一步的结构优化奠定了基础.     

抗肿瘤药物dacomitinib的合成工艺

对抗肿瘤药物dacomitinib合成工艺进行改进。以4-氟-2-氨基苯甲酸为原料,经环合、硝化、卤代、偶联以及还原等反应,得到dacomitinib。目标化合物经质谱、核磁共振氢谱确证化学结构。以11步反应总收率36.1%,单步收率75%~90%合成目标化合物,无需特殊试剂和复杂分离纯化过程,降低了成本,优化了反应条件,操作更加简单实用。     

Genistein对体外培养兔软骨细胞一氧化氮表达的影响

目的：观察受体酪氨酸激酶抑制剂genistein对体外培养兔软骨细胞一氧化氮（NO）表达的影响。方法：兔膝关节软骨细胞传代培养,应用不同浓度genistein干预1、2、3、4天后,通过亚硝酸盐测定检测培养上清液NO表达水平。结果：形态学、甲苯胺蓝染色显示3代以内体外培养软骨细胞保持细胞表型的稳定。在genistein干预后上清液中NO水平下降,下降水平与genistein干预浓度和时间相关。结论：体外培养兔软骨细胞三代以内的细胞具有较好的活性,genistein能有效降低兔软骨细胞NO的表达水平。     

三羟基异黄酮对关节软骨细胞合成胶原和蛋白多糖的影响

目的 通过对体外培养软骨细胞的实验研究,探寻受体酪氨酸激酶抑制剂对软骨细胞在细胞分子水平的影响及其可能机制。方法 对软骨细胞进行原代及传代培养,通过对培养细胞形态学及甲苯胺蓝染色观察,选择适合传代软骨细胞,应用三羟基异黄酮干预后1、2、3、4天RT-PCR、ICC及甲苯胺蓝染色观察法比较药物干预对体外培养软骨细胞Ⅰ、Ⅱ型胶原的转录和翻译水平及蛋白多糖的表达变化。结果 20 μg/mL及25 μg/mL三羟基异黄酮干预可以抑制Ⅰ型胶原表达,同时增加Ⅱ型胶原及蛋白多糖的表达。结论 三羟基异黄酮可以抑制脂多糖刺激诱导的软骨细胞反分化,对体外培养关节软骨细胞的正常表型具有一定的保护作用,其保护作用与三羟基异黄酮浓度呈现一定的相关性。     

The epidermal growth factor receptor-tyrosine kinase inhibitor era has changed the causes of death of patients with advanced non-small-cell lung cancer

BackgroundEpidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are effective against tumor EGFR-mutated non-small cell lung cancer (NSCLC). Patients with the tumor EGFR-activating mutation (EGFRmu) had superior survival, compared to patients with EGFR wild-type tumors (EGFRwt). Many patients with the EGFRmu have had disease progression with EGFR-TKI treatment because of central nervous system (CNS) metastases. The objective of this retrospective study was to compare the causes of death in patients with a known tumor EGFR mutation status who had been treated with EGFR-TKIs.MethodsWe retrospectively reviewed the chart records of our patients with advanced NSCLC who had received diagnosis, treatment, and supportive and hospice care in our hospital between July 2005 and June 2010. The tumor EGFR mutation status was analyzed by using a DNA sequence method. All enrolled patients had a documented cause of death.ResultsNinety-four patients had documented tumor EGFR data, had received EGFR-TKI treatment (either erlotinib or gefitinib), and were with or without previous or salvage systemic chemotherapy. Of the 94 patients, 36 patients had EGFRwt and 58 patients had EGFRmu. The overall patient survival after starting EGFR-TKI treatment was significantly longer in the EGFRmu patients (median 17.2 months) than in the EGFRwt patients (median 11.6 months; p = 0.0058). Twenty-nine patients died of CNS metastases and 65 died of organ failure (other than the CNS). Patients who died of CNS metastases had undergone EGFR-TKI treatment significantly longer than patients who died of other organ failure (median, 8 months vs. 1.9 months; p = 0.0003) with a hazard ratio of 2.308 [95% confidence interval (C.I.), 1.452–3.668; p = 0.0004]. A significantly higher proportion of EGFRmu patients (26 of 58 patients; 44.8%) than EGFRwt patients (3 of 36 patients; 8.3%) (p < 0.001) died of CNS metastases.ConclusionThe EGFRmu NSCLC patients survived longer and had a significantly higher probability of mortality due to CNS metastases, compared to the EGFRwt patients. This change in the causes of death was noted after the era of EGFR-TKI treatment, and will have an important impact on the strategies and management of supportive and hospice care for patients.     

核素标记受体酪氨酸激酶靶向药物显像研究进展

跨膜受体酪氨酸激酶信号在肿瘤细胞增殖、抑制凋亡和促进新生血管形成中具有重要作用,多种恶性肿瘤过度表达该受体。随着对受体酪氨酸激酶通路的认知,已设计出众多靶向该靶点的抗肿瘤药物,如单克隆抗体、小分子酪氨酸激酶抑制剂等,临床应用证明这些药物能显著提高抗肿瘤效果,提高患者生存率。但靶向药物靶点专一、价格昂贵,早期监测靶向药物的疗效,对提供临床诊疗决策、减少药物不良反应及节约患者开支具有重要意义。核素标记受体酪氨酸激酶靶向药物显像已用于临床监测靶向药物的疗效,该文就此方面的研究进展进行综述。     

拉帕替尼合成工艺研究

报道了拉帕替尼二对甲苯磺酸盐一水合物( 1 )的合成工艺研究。以6-碘喹唑啉-4-酮( 3 )为起始原料,依次经氯化反应(收率88%)、与5-甲酰基呋喃-2-硼酸的Suzuki偶联反应(收率96%)、与2-(甲砜基)乙胺的还原胺化(收率94%)、与一水合对甲苯磺酸成盐(收率87%)和四氢呋喃-水（8∶2）结晶(收率70%)等5步操作制备目标产物 1 ,总收率48%。各中间体和目标产物经¹H NMR、¹³C NMR、ESI-MS表征。在工艺优化中革除了柱色谱及对环境不友好的过量氯化剂、含卤溶剂,采用易于回收的非均相催化剂钯炭替代昂贵和难以处理的均相催化剂。所研制的合成工艺路线各步收率均较高,而且操作简便,无需特殊试剂和条件,预期适合工业化生产的要求。     

选择性EGFR酪氨酸激酶抑制剂-吉非替尼

吉非替尼（Gefitinib,ZD1839,Iressa）是一种口服选择性表皮生长因子受体（EGFR）酪氨酸激酶抑制剂。表皮生长因子受体在一些类型的人类肿瘤细胞中存在过度表达,吉非替尼通过抑制表皮生长因子受体酪氨酸激酶的ATP结合位点发挥抗肿瘤作用。2003年明经FDA批准上市,用于一线化疗失败的局部晚期或转移性非小细胞肺癌的治疗。     

PI3K/mTOR双重抑制剂的研究进展

磷脂酰肌醇3-激酶/哺乳动物雷帕霉素靶蛋白（phosphoinosmde-3-kinase/the mammalian target of rapamycin,PI3K/mTOR）双重抑制剂已经成为抗肿瘤药物研发的热点之一。本文介绍芳基脲类和3-吡啶基杂环类等PI3K/mTOR双重抑制剂的化学结构,根据其结构特点及其与PI3Kγ共结晶模式,剖析了两类抑制剂药效团的基本结构。     

整合素β1信号通路参与非小细胞肺癌吉非替尼获得性耐药

目的 探讨整合素β1及其下游信号转导通路在非小细胞肺癌表皮生长因子受体酪氨酸激酶抑制剂(EGFRTKI)吉非替尼获得性耐药中的作用.方法 以人肺腺癌细胞株PC-9和吉非替尼耐药株pC-9/G作为研究对象,免疫印迹分析检测整合素β1、Akt、磷酸化Akt蛋白的表达;用MTT法检测吉非替尼和(或)磷脂酰肌醇3激酶(PI3K)抑制剂LY294002、细胞外调节蛋白激酶(ERK)抑制剂PD98059对细胞增殖的影响;用Annexin V/PI试剂盒和TUNEL试剂盒检测细胞凋亡.结果 吉非替尼耐药株PC-9/G高表达整合素β1,RNA T扰抑制整合素β1表达能够抑制PC-9/G细胞的生长和促进凋亡.PC-9/G细胞中吉非替尼对Akt磷酸化的抑制作用弱于PC-9细胞,RNA干扰抑制整合素β1表达后Akt的磷酸化水平降低.ERK抑制剂PD98059不能恢复PC-9/G细胞对吉非替尼的敏感性,PI3K抑制剂LY294002能恢复PC-9/G细胞对吉非替尼的敏感性.结论 整合素β1过表达可以通过PI3K途径激活下游信号分子,这可能是一种重要的EGFR TKI耐药机制.     

Phase Ⅰ trial of icotinib, a novel epidermal growth factor receptor tyrosine kinase inhibitor, in Chinese patients with non-small cell lung cancer

Background The preclinical experiments and studies of congener drugs show icotinib, a new epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, can specifically bind to the tyrosine kinase domain of the EGFR, block the EGFR related signal, thereby inhibit the growth of tumor cell. The objective of this study was to investigate the safety, tolerability and dose-related biologic effects of icotinib in patients with non-small cell lung cancer (NSCLC) in a Chinese patient population.Methods This was an open-label, phase Ⅰ, dose escalation, safety/tolerability trial of oral icotinib (100 to 400 mg), administered twice per day for 28-continuous-day cycles until disease progression or undue toxiclty.Results Forty patients with stage ⅢB (15%) or Ⅳ (85%) NSCLC were included in the study. They had mainly adenocarcinoma (85%), with a performance status (PS) of 0 (45%) or 1 (55%) and less than half the patients (45%) had histories of smoking and all were pretreated by at least one regimen of chemotherapy. Patients were assigned to three dose levels of 150 mg b.i.d, 200 mg b.i.d, or 125 mg t.i.d. The follow-up periods ranged from 5 to 80 weeks. Adverse events were found in 35% patients, most of which were mild and reversible. The adverse events mainly occurred in the first 4 weeks and included rash (25%), diarrhea, nausea and abdominal distention. One definite interstitial lung disease (ILD) was found in a patient in the dose of 200 mg b.i.d. According to an 8-week assessment, one (2.5%) patient receiving 150 mg gained complete response (CR) that persisted for 44 weeks, seven (17.50%) patients had partial remission (PR), and 18 (45%) patients had stable disease (SD). The objective response including CR+PR was 20%. The median time of progression-free survival for the 40 patients was 20 weeks (range: 12 to 32 weeks). The response was not affected by pathological type, history of smoking, or numbers of previous therapeutic regimens. No relationship between dose, response, adverse effect, or duration of the study was observed.Conclusions Icotinib, given as oral twice daily, showed favorable safety and tolerability. Mild and reversible rash, diarrhea, and nausea were the main adverse events. Antitumor activity was obvious at each dose in heavily pretreated patients. Pharmacodynamic evaluations and further phase Ⅱ/Ⅲ trials are in progress.     

Phase I trial of icotinib, a novel epidermal growth factor receptor tyrosine kinase inhibitor, in Chinese patients with non-small cell lung cancer

Background  The preclinical experiments and studies of congener drugs show icotinib, a new epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, can specifically bind to the tyrosine kinase domain of the EGFR, block the EGFR related signal, thereby inhibit the growth of tumor cell. The objective of this study was to investigate the safety, tolerability and dose-related biologic effects of icotinib in patients with non-small cell lung cancer (NSCLC) in a Chinese patient population.

Methods  This was an open-label, phase I, dose escalation, safety/tolerability trial of oral icotinib (100 to 400 mg), administered twice per day for 28-continuous-day cycles until disease progression or undue toxicity.

Results  Forty patients with stage IIIB (15%) or IV (85%) NSCLC were included in the study. They had mainly adenocarcinoma (85%), with a performance status (PS) of 0 (45%) or 1 (55%) and less than half the patients (45%) had histories of smoking and all were pretreated by at least one regimen of chemotherapy. Patients were assigned to three dose levels of 150 mg b.i.d, 200 mg b.i.d, or 125 mg t.i.d. The follow-up periods ranged from 5 to 80 weeks. Adverse events were found in 35% patients, most of which were mild and reversible. The adverse events mainly occurred in the first 4 weeks and included rash (25%), diarrhea, nausea and abdominal distention. One definite interstitial lung disease (ILD) was found in a patient in the dose of 200 mg b.i.d. According to an 8-week assessment, one (2.5%) patient receiving 150 mg gained complete response (CR) that persisted for 44 weeks, seven (17.50%) patients had partial remission (PR), and 18 (45%) patients had stable disease (SD). The objective response including CR+PR was 20%. The median time of progression-free survival for the 40 patients was 20 weeks (range: 12 to 32 weeks). The response was not affected by pathological type, history of smoking, or numbers of previous therapeutic regimens. No relationship between dose, response, adverse effect, or duration of the study was observed.

Conclusions  Icotinib, given as oral twice daily, showed favorable safety and tolerability. Mild and reversible rash, diarrhea, and nausea were the main adverse events. Antitumor activity was obvious at each dose in heavily pretreated patients. Pharmacodynamic evaluations and further phase II/III trials are in progress.

     

吉非替尼或紫杉醇-卡铂治疗肺腺癌

1文献来源 Mok TS, Wu YL, Thongprasert S, et at.Gefitinib or Carboplatin-Paclitaxel in pulmonaryadenocarcinoma [J]. N Engl J Med, 2009,361（10）：947-957.     

重组人血管内皮抑素增强EGFR-TKIs对肺癌的抗瘤作用

目的 研究重组人血管内皮抑素(恩度)联合表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)厄洛替尼对EGFR-TKIs耐药细胞系H1975(携带L858R和T790M)在体外及裸鼠移植瘤的抑制作用。 方法 对H1975细胞株进行细胞活性测定,确定厄洛替尼单药、恩度单药及厄洛替尼+恩度各组的吸光度值。建立H1975肺癌细胞系裸鼠移植瘤模型,将裸鼠随机分为4组(对照组、厄洛替尼组、恩度组及联合用药组),每组6只。从给药开始每3天测1次肿瘤直径,2周后处死所有实验鼠,取出肿瘤,测量、拍照。 结果 体外细胞实验中,厄洛替尼单药对H1975细胞增殖抑制作用差异有统计学意义(P=0.043),恩度单药对H1975细胞增殖的抑制作用差异无统计学意义(P=0.261),厄洛替尼+恩度的效应与单用厄洛替尼重合。体内动物实验中,恩度组不能抑制肿瘤细胞生长(P=0.112),厄洛替尼组可抑制肿瘤细胞生长(P=0.018),而联合用药组两药有协同作用(P=0.048)。组间两两比较结果显示,联合用药与对照组和厄洛替尼组之间差异有统计学意义(P=0.046,P=0.023)。 结论 恩度联合厄洛替尼可增强厄洛替尼的抗肿瘤作用,逆转T790M相关耐药;恩度联合厄洛替尼针对EGFR-TKIs耐药患者应用前景广阔。     

miR-30b and miR-30c expression predicted response to tyrosine kinase inhibitors as first line treatment in non-small cell lung cancer

Background Aberrantly expressed microRNAs are a hallmark of cancer,and microRNA expression profiling is associated with tumor progression and response to chemotherapy,suggesting their potential application as prognostic and predictive biomarkers.The role of microRNAs in lung cancer remains elusive.It has been recently reported that epidermal growth factor receptor （EGFR） and hepatocyte growth factor receptor （MET） tyrosine kinase can regulate expression of specific microRNAs including miR-30b,miR-30c,miR-221,miR-222,miR-103 and miR-203,and induce tumorigenesis and gefitinib resistance in lung cancers.We intend to study the role of miR-30b and miR-30c expression in predicting response to tyrosine kinase inhibitors （TKIs） in non-small cell lung cancer （NSCLC）.Methods We have therefore retrospectively examined expression of miR-30b miR-30c in 41 formalin fixed paraffin embedded tissue samples from NSCLC patients when TKIs were used as first line therapy.Results We found a significant correlation between expression of miR-30b and miR-30c.Furthermore,miR-30b and miR-30c expression correlated with short-term response.Kaplan-Meier analysis further revealed that the expression of miR-30b and miR-30c predicted progression free survival and the overall survival rate in the examined cohort.Conclusion Our study identified miR-30b and miR-30c as useful prognostic predictors in NSCLC patients who underwent first line treatment with TKIs.     

2,5-MC抑制支架植入术后内膜增殖的实验研究

目的评估酪氨酸蛋白激酶抑制剂2,5-MC抑制支架植入术后内膜增殖的效果。方法将含2,5-MC的F-127凝胶包裹于新西兰兔支架植入段颈动脉腔外,对侧包裹空白F-127凝胶作对照。通过RT-PCR、免疫组化染色检测核内癌基因c-myc和细胞核抗原Ki67的表达;通过三色染色观察内膜增厚情况,检测2,5-MC抑制内膜增殖的效果。结果2,5-MC治疗组核内癌基因c-mycmRNA和Ki67抗原的表达均显著低于对照组(P<0.05,P<0.01)。组织学检测显示治疗组内膜增生厚度明显低于对照组;植入术后3个月,治疗组内膜/中膜比为0.92±0.10,血管腔狭窄率(51.0±5.58)%;对照组内膜/中膜比为1.30±0.39,血管腔狭窄率(73.01±5.94)%,二组比较有显著差异(P<0.05,P<0.01)。结论腔外包裹酪氨酸蛋白激酶抑制剂2,5-MC具有抑制支架植入术后内膜增殖的效果。     

肝细胞癌(HCC)靶向治疗的研究进展

肝细胞癌(hepatocellular carcinoma,HCC)是最常见的恶性肿瘤之一,具有起病隐匿、进展快、复发早和预后差的临床特点,临床发现时大多已属晚期。随着对HCC分子信号通路研究的不断深入,靶向治疗在治疗晚期HCC方面已表现出明显优势,多靶点的酪氨酸激酶抑制剂索拉菲尼已在临床上广泛应用。本文归纳了HCC治疗的分子靶点、靶向治疗药物的作用机制、临床疗效、毒性作用和不良反应以及联合治疗方面的进展,并探讨目前研究中存在的机遇和挑战,以期为临床用药和进一步研究提供参考。