Raf激酶抑制剂研究进展

随着细胞分子生物学的发展，肿瘤的分子靶向治疗已成为目前抗肿瘤药物研究的重要领域之一，其中，表皮生长因子受体（EGFR）抑制剂、血管内皮生长因子受体（VEG-FR）抑制剂等许多药物已成功上市或已进入临床研究。Raf激酶介导的Ras／Raf／MEK／ERK通路是迄今为止研究的最为广泛的信号通路之一，在肿瘤的发生、发展与转移中起着重要的作用，Raf激酶抑制剂已成为目前抗肿瘤药物研究的热点。     

新型抗肿瘤药物的临床应用及研究进展

恶性肿瘤是当今世界严重威胁人类生命健康的常见疾病之一。其发病率逐年增加。随着新型抗肿瘤药物包括分子靶向药物(蛋白酪氨酸激酶抑制剂、肿瘤新生血管生成抑制剂)、新型内分泌治疗药物、新型化疗药物及基因治疗药物等研发,出现更多治疗恶性肿瘤新的有效方法,文中针对新型抗肿瘤药物的临床应用及研究进展进行综述。     

蛋白酪氨酸激酶抑制剂的研究进展

蛋白酪氨酸激酶（PTK）抑制剂是一类作用于细胞信号转导通路的分子靶向药物,针对特定靶点发挥抗肿瘤作用。目前已有十余种蛋白酪氨酸激酶抑制剂上市,且它们在多种实体瘤的治疗中显示出较好的疗效。该文对近年来蛋白酪氨酸激酶抑制剂的研究进展做简要综述。     

开发中的多靶点酪氨酸激酶抑制剂

多靶点酪氨酸激酶抑制剂是目前抗肿瘤药物研发的热点.相对于单靶点酪氨酸激酶抑制剂,其在疗效及患者耐受性方面都有很大的优势.本文综述蛋白酪氨酸激酶及其与肿瘤的关系,并简要介绍几种开发中的多靶点酪氨酸激酶抑制剂.     

不可逆性酪氨酸激酶抑制剂的研究进展

酪氨酸激酶的过度表达和过度激活在许多肿瘤的发生和发展中具有重要意义,因此,多种酪氨酸激酶成为抗肿瘤药物的靶点。目前已经上市的小分子酪氨酸激酶抑制剂多属于可逆性抑制剂,这些药物具有选择性差、药效不够强烈和持久以及易引发耐药性等缺点。近些年,不可逆性酪氨酸激酶抑制剂的研究正方兴未艾。这一类药物分子以不可逆的共价键与酪氨酸激酶上ATP结合域进行结合,从而使该靶点永久性失活。由于其独特的作用机制,不可逆性酪氨酸激酶抑制剂可以有效地解决可逆性酪氨酸激酶抑制剂的几个缺点。目前,已经有一批不可逆性酪氨酸激酶抑制剂进入市场或临床研究阶段。该篇综述是对不可逆性酪氨酸激酶抑制剂的结构、药理和药化特征及其研究进展等进行总结和阐述。     

三唑类抗肿瘤药物的研究进展

综述了三唑类化合物作为芳香化酶抑制剂、CYP26A1和CYPlA抑制剂、蛋白激酶抑制剂、碳酸酐酶抑制剂、血管生成抑制剂、微管蛋白聚合抑制剂和法呢基转移酶抑制剂等多个抗肿瘤领域的研究开发现状.     

靶向Pim蛋白激酶抗肿瘤药物的研究进展及设想

Pim原癌基因编码的丝／苏氨酸蛋白激酶在恶性血液病和实体瘤的发生发展过程中普遍过度表达．并被证明在细胞的增殖、分化、新陈代谢中起到重要调控作用。为了弄清Pim蛋白激酶的特性,以指导合成高成药性小分析靶向抑制剂,文章回顾了近年来国外在Pim蛋白激酶领域最新研究成果,着重分析了Pim激酶在分子层面上的功能和作用机制,以及Pim蛋白激酶抑制剂开发的前提条件,包括已获得的Pim蛋白三维晶体结构和Pim基因完整序列,提出了通过基于生物信息学、药理学的靶向小分子药物的设计、合成和筛选,人工合成Pim蛋白激酶抑制剂,研发新型抗肿瘤药物的思路。     

抗肿瘤分子靶向药物致化疗相关性腹泻的研究进展

化疗相关性腹泻（CRD）可导致治疗效果和患者依从性降低,影响肿瘤患者的长期治疗结局,甚至危及生命。除传统化疗药物外,许多分子靶向药物也可导致CRD,包括小分子表皮生长因子受体（EGFR）抑制剂、抗EGFR单克隆抗体、磷酸肌醇3-激酶抑制剂、血管内皮细胞生长因子受体小分子抑制剂、BCR-ABL1和KIT抑制剂、人表皮生长因子受体2靶点抑制剂、周期蛋白依赖性激酶抑制剂、抗体-药物偶联物等多种分子靶向药物。其发生机制可能与分子靶向治疗药物引起肠黏膜损伤或肠炎等有关,临床表现为大便频率增加和/或松散不成形,患者常伴有产气过多和/或肠绞痛。不同药物引起的CRD发生率不同,临床应重视病史采集和鉴别诊断,积极干预并进行动态评估,加强患者教育,以及时发现和预防肠毒性的发生。     

弥漫性大B细胞淋巴瘤常见致病信号通路及其靶向药物的研究进展

弥漫性大B细胞淋巴瘤是亚洲人最常见的淋巴肿瘤亚型,经过R-CHOP方案治疗后仍有相当一部分患者表现为难治或复发。弥漫性大B细胞淋巴瘤的常见致病信号通路有B细胞受体、Toll样受体4/髓样分子因子88/核因子-κB、磷脂酰肌醇3-激酶/蛋白激酶B信号通路,靶向药物包括Bruton酪氨酸激酶抑制剂、来那度胺、硼替佐米、凋亡蛋白抑制剂抑制剂、磷脂酰肌醇3-激酶抑制剂、蛋白激酶B抑制剂、哺乳动物雷帕霉素靶蛋白抑制剂。阐述了弥漫性大B细胞淋巴瘤中常见致病信号通路及其遗传学改变,并总结了相关通路常见的靶向药物的研究进展。     

多靶点蛋白酪氨酸激酶抑制剂类抗肿瘤药物的研究进展

多靶点的蛋白酪氮酸激酶抑制剂药物的研究成为近几年来抗肿瘤药物研究的热点。本文整合国内外相关文献资料,简要介绍了该类药物的抗肿瘤作用机理,综合阐述了酪氨酸激酶抑制剂的研究进展。     

Multi-targeted tyrosine kinase inhibitors in clinical development: focus on XL-184 (cabozantinib)

XL-184 (cabozantinib) is a novel, small-molecule, multitargeted receptor tyrosine kinase inhibitor with particular activity against hepatocyte growth factor receptor (tyrosine-protein kinase Met), vascular endothelial growth factor receptor 2 (VEGFR-2) and proto-oncogene tyrosine-protein kinase receptor Ret. There is ample evidence of Met, VEGFR-2 and Ret signaling in several tumor types. Preclinical data suggest that XL-184 has activity in tumors derived from both epithelial and mesenchymal origins. Phase I and II clinical studies support significant antitumor activity, particularly in medullary thyroid cancer and cancers metastatic to the bone. This review will evaluate XL-184's preclinical pharmacology, pharmacokinetics, drug interactions and clinical activity in phase I through phase III studies.     

Cell type-specific pharmacological kinase inhibition for cancer chemoprevention

Safety is prerequisite for preventive medicine, but non-toxic agents are generally ineffective as clinical chemoprevention. Here we propose a strategy overcoming this challenge by delivering molecular-targeted agent specifically to the effector cell type to achieve sufficient potency, while circumventing toxicity in the context of cancer chemoprevention. Hepatic myofibroblasts drive progressive fibrosis that results in cirrhosis and liver cancer. In a rat model of cirrhosis-driven liver cancer, a small molecule epidermal growth factor receptor inhibitor, erlotinib, was delivered specifically to myofibroblasts by a versatile nanoparticle-based system, targeting platelet-derived growth factor receptor-beta uniquely expressed on their surface in the liver. With systemic administration of erlotinib, tumor burden was reduced to 31%, which was further improved to 21% by myofibroblast-targeted delivery even with reduced erlotinib dose (7.3-fold reduction with equivalent erlotinib dose) and less hepatocyte damage. These findings demonstrate a strategy, cell type-specific kinase inhibition, for more effective and safer precision cancer chemoprevention.     

Aurora激酶抑制剂的研究进展

在有丝分裂的过程中,Aurora激酶参与纺锤体形成,中心体成熟,染色体分化和胞质分裂.Aurora激酶的过度表达或分化易导致有丝分裂异常,与形成肿瘤的基因组不稳定性密切相关.以Aurora激酶为靶点设计、合成的药物已成为近年来肿瘤药物治疗的研究热点.本文综述了已经进入临床研究的Aurora小分子抑制剂在临床前、临床的研究进展.     

Advances in Aurora kinase inhibitor patents

Background: Aurora-A, Aurora-B and Aurora-C, members of serine/threonine kinase family, play an important role in mitosis. They are essential for spindle assembly, centrosome maturation, chromosomal segregation and cytokinesis during mitosis. Abnormalities in the mitotic process as a result of overexpression/amplification of Aurora kinase have been linked to genomic instability leading to tumorigenesis. Hence, the use of Aurora kinase small-molecule inhibitors as a potential molecular-targeted therapeutic intervention for cancer is being pursued. Objective: A number of reviews focus on the biology of Aurora kinase; a few focus on the medicinal chemistry aspect of Aurora kinase inhibitor development. Here, we review the medicinal chemistry aspect of Aurora kinase inhibitors, with a particular emphasis on the patent literature. Method: The Scifinder^® and Delphion^® databases were used to search the literature for Aurora kinase inhibitors. Approximately 150 patents and 700 journal references are available, most of them published in the last 5 years. Conclusion/results: Analysis of the literature reveals three common strategies utilized by different groups in developing Aurora kinase inhibitors. These are discussed in detail and could be of use to medicinal chemists in laying out new strategies for developing novel Aurora kinase inhibitors.     

索拉非尼的药理及临床研究

索拉非尼是一种新型口服多靶点的抗肿瘤药,通过抑制Raf-1激酶从而靶向于细胞间信号传导通路直接抑制肿瘤生长,并通过抑制血管内皮生长因子受体-2(VEGF-2)和血小板衍生生长因子(PDGF)受体,阻断肿瘤血管生成途径。主要用于肾细胞癌的治疗。现综述其药理作用、药动学、临床研究、药物相互作用及不良反应的研究进展。     

Aurora kinase inhibitors in preclinical and clinical testing

Background: Mitosis is a key step in the cell cycle governing the distribution of genetic material to the daughter cells. Any aberration in this process could lead to genomic instability. Aurora A, B and C, are members of the serine/threonine kinase family. Aurora kinases are essential for spindle assembly, centrosome maturation, chromosomal segregation and cytokinesis during mitosis. Abnormalities in the mitotic process through overexpression/amplification of aurora kinase have been linked to genomic instability leading to tumorigenesis. Hence, use of aurora kinase small molecule inhibitors as potential molecular-targeted therapeutic intervention for cancer is being pursued by various researchers. Objective: To review the literature of aurora kinase inhibitors in clinical and preclinical testing. Method: Pubmed, Scifinder^® and www.clinicaltrials.gov databases were used to search the literature for aurora kinase. Conclusion/results: Approximately 13 aurora kinase inhibitors are under Phase I/II evaluation at present for various cancers of different origins; and several others are in preclinical testing. Details of their preclinical/clinical results and important considerations for future aurora kinase inhibitor development are discussed. Considering the fact that aurora kinase plays an important role in the mitosis process and is involved in tumorigenesis, development of aurora kinase inhibitors for the treatment of cancer, either as a single agent or in combination with existing cancer treatment is warranted.     

Translational Pharmacokinetic-Pharmacodynamic Modeling from Nonclinical to Clinical Development: A Case Study of Anticancer Drug, Crizotinib

Attrition risk related to efficacy is still a major reason why new chemical entities fail in clinical trials despite recently increased understanding of translational pharmacology. Pharmacokinetic-pharmacodynamic (PKPD) analysis is key to translating in vivo drug potency from nonclinical models to patients by providing a quantitative assessment of in vivo drug potency with mechanistic insight of drug action. The pharmaceutical industry is clearly moving toward more mechanistic and quantitative PKPD modeling to have a deeper understanding of translational pharmacology. This paper summarizes an anticancer drug case study describing the translational PKPD modeling of crizotinib, an orally available, potent small molecule inhibitor of multiple tyrosine kinases including anaplastic lymphoma kinase (ALK) and mesenchymal-epithelial transition factor (MET), from nonclinical to clinical development. Overall, the PKPD relationships among crizotinib systemic exposure, ALK or MET inhibition, and tumor growth inhibition (TGI) in human tumor xenograft models were well characterized in a quantitative manner using mathematical modeling: the results suggest that 50% ALK inhibition is required for >50% TGI whereas >90% MET inhibition is required for >50% TGI. Furthermore, >75% ALK inhibition and >95% MET inhibition in patient tumors were projected by PKPD modeling during the clinically recommended dosing regimen, twice daily doses of crizotinib 250 mg (500 mg/day). These simulation results of crizotinib-mediated ALK and MET inhibition appeared consistent with the currently reported clinical responses. In summary, the present paper presents an anticancer drug example to demonstrate that quantitative PKPD modeling can be used for predictive translational pharmacology from nonclinical to clinical development.     

酪氨酸激酶靶标治疗肝细胞肝癌的研究进展

肝细胞肝癌是肝细胞原发性恶性肿瘤,具有发现晚、死亡率高等特点。分子靶向药物如酪氨酸激酶抑制剂极有希望成为肝癌治疗药物,目前已引起特别关注,研究者已对酪氨酸激酶受体抑制剂进行了深入研究。本文对多种酪氨酸激酶受体作用于肝癌细胞的机制以及肿瘤细胞内在和外在的抵消激酶抑制剂作用的机制进行了讨论,同时对目前多靶标激酶抑制剂抗肝癌药物的优越性和可行性及其临床研究进展进行综述和展望。     

Evolution in the treatment landscape of non-small cell lung cancer with ALK gene alterations: from the first- to third-generation of ALK inhibitors

ABSTRACT

Introduction: The medical treatment of non-small cell lung cancer (NSCLC) has radically changed over the last 10 years thanks to new molecular-targeted drugs able to act on biological mechanisms involved in tumor development. One such mechanism is the aberrant anaplastic lymphoma kinase (ALK) activation: patients with ALK-driven NSCLC benefit from treatments that selectively inhibit its pathogenetic mechanism.

Areas covered: The first-generation ALK inhibitor is crizotinib, initially used in Europe as second-line treatment for ALK-positive metastatic NSCLC patients, then approved as the standard first-line (already approved in the USA as front-line therapy). However, most patients eventually experience disease progression due to the emergence of secondary resistance, partly linked to ALK-dependent mechanisms, hence the development of second- and third-generation ALK inhibitors: ceritinib, alectinib, and brigatinib are approved for ALK-positive NSCLC, lorlatinib is currently being evaluated while others are under development.

Expert opinion: Despite the considerable responses to these new inhibitors, however, resistance mechanisms are described. Thus, while the therapeutic scenario of NSCLC has been soon revolutionized introducing next-generation ALK inhibitors in the first-line setting, future research should identify combined therapies or new generation drugs overcoming resistance in pretreated patients.