表皮生长因子受体酪氨酸激酶抑制剂治疗晚期非小细胞肺癌研究进展

表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)已成为晚期非小细胞肺癌治疗的研究热点.在有EGFR突变的患者中,一线单药EGFR-TKI能显著延长患者无进展生存期;EGFR突变是EGFR-TKI治疗获益的有效预测指标.虽然EGFR-TKI与化疗同步联合未能显示出生存优势,但在序贯联合的研究中能延长无进展生存期.EG...     

表皮生长因子受体酪氨酸激酶抑制剂与化疗联合应用治疗非小细胞肺癌的研究进展

吉非替尼联合化疗的Ⅲ期临床试验INTACT1和INTACT2的结果表明,与单纯化疗相比,吉非替尼与健择+顺铂或紫衫醇+卡铂联合,不能提高非小细胞肺癌治疗的有效率和生存率.对于这一阴性结果,部分学者认为是由于缺乏对敏感人群的选择以及化疗药与表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrasine kinase inhibitors,EGFR-TKI)同时使用可能存在相互拮抗作用.基础实验及临床试验表明,化疗后序贯给予EGFR-TKI维持或化疗间期间断给予EGFR-TKI的联合治疗方式,有较好的临床应用前景.     

表皮生长因子受体对支气管哮喘小鼠气道黏液分泌的影响及机制

目的 探讨支气管哮喘(简称哮喘)小鼠气道黏液分泌与表皮生长因子受体(EGFR)、转化生长因子α(TGF-α)的关系以及表皮生长因子受体酪氨酸激酶抑制剂(AG1478)的干预作用.方法 32只小鼠随机分为4组:正常对照组、哮喘模型组、AG1478组和地塞米松干预组.建立哮喘小鼠模型,对肺组织切片行过碘酸雪夫染色显示气道黏膜杯状细胞的增生情况.应用免疫组织化学方法检测TGF-α的蛋白及RT-PCR方法检测EGFR mRNA表达的变化.结果 哮喘组出现气道壁增厚、杯状细胞增多、黏液分泌增加,EGFR、TGF-α水平增高.地塞米松组和AG1478组较哮喘组均有所改善,EGFR、TGF-α表达降低(P<0.05).结论 EGFR、TGF-α参与哮喘小鼠气道黏液分泌过程,AG1478可抑制气道黏液分泌.AG1478可能通过下调EGFR、TGF-α的表达以及抑制依赖于EGFR下游的细胞信号转导级联反应来发挥其效应.     

表皮生长因子受体对支气管哮喘小鼠气道黏液分泌的影响及机制

目的探讨支气管哮喘（简称哮喘）小鼠气道黏液分泌与表皮生长因子受体（EGFR）、转化生长因子α（TGFα）的关系以及表皮生长因子受体酪氨酸激酶抑制剂（AG1478）的干预作用。方法32只小鼠随机分为4组：正常对照组、哮喘模型组、AG1478组和地塞米松干预组。建立哮喘小鼠模型,对肺组织切片行过碘酸雪夫染色显示气道黏膜杯状细胞的增生情况。应用免疫组织化学方法检测TGF—α的蛋白及RTPCR方法检测EGFR mRNA表达的变化。结果哮喘组出现气道壁增厚、杯状细胞增多、黏液分泌增加,EGFR、TGF—α水平增高。地塞米松组和AG1478组较哮喘组均有所改善,EGFR、TGF—α表达降低（P〈0．05）。结论EGFR、TGF—α参与哮喘小鼠气道黏液分泌过程,AG1478可抑制气道黏液分泌。AG1478可能通过下调EGFR、TGF-α的表达以及抑制依赖于EGFR下游的细胞信号转导级联反应来发挥其效应。     

Epidermal growth factor receptor (EGFR) in lung cancer: an overview and update

Epidermal growth factor receptor is a trans-membrane glycoprotein with an extracellular epidermal growth factor binding domain and an intracellular tyrosine kinase domain that regulates signaling pathways to control cellular proliferation. Epidermal growth factor receptor binding to its ligand results in autophosphorylation by intrinsic tyrosine/kinase activity, triggering several signal transduction cascades. Constitutive or sustained activation of these sequences of downstream targets is thought to yield more aggressive tumor phenotypes. Mutations in epidermal growth factor receptor have been discovered in association with some lung cancers. Lung adenocarcinomas with mutated epidermal growth factor receptor have significant responses to tyrosine kinase inhibitors, although for unselected patients it does not appear to have a survival benefit. However, in a subset of patients (non-smoking Asian women with adenocarcinoma, particularly with a bronchioloalveolar carcinoma), there appears to be a significant survival advantage. Both EGFR mutation and gene amplification status may be important in determining which tumors will respond to tyrosine kinase inhibitors.     

Epidermal growth factor receptor gene mutation,amplification and protein expression in malignant pleural mesothelioma

Epidermal growth factor receptor (EGFR) is overexpressed in a variety of epithelial malignancies. In lung cancer cases, EGFR gene mutation at the kinase domain and EGFR gene amplification are reported to be predictors of the response to EGFR tyrosine kinase inhibitors. In malignant pleural mesothelioma (MPM), the role of EGFR is less clear. We studied EGFR gene mutation, amplification and protein expression in 25 Japanese patients with MPM. None had previously reported EGFR mutations detected by the TaqMan PCR assay. Using immunohistochemistry, 8/25 (32%) cases were positive for the EGFR protein. The cases of sarcomatous type and desmoplastic type were all negative. Fluorescence in situ hybridization analysis revealed three low polysomy cases and one high polysomy case. The low polysomy cases included one biphasic type and two epithelial types, and the high polysomy case was epithelial type. These four cases expressed EGFR protein. In MPM, EGFR seems to play a role in a limited subset of patients. To identify possible candidates for EGFR tyrosine kinase in inhibitor therapy, the information on the EGFR gene status may be valuable.     

Factors that predict progression-free survival in Chinese lung adenocarcinoma patients treated with epidermal growth factor receptor tyrosine kinase inhibitors

Background

Although first-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have shown efficacy in patients with advanced lung cancers, survival predictors with these drugs have not been extensively investigated. This study was performed to explore factors that may predict progression-free survival (PFS) in Chinese lung adenocarcinoma patients treated with EGFR-TKIs.

Methods

We retrospectively collected clinicopathologic data on 208 patients who received either gefitinib, erlotinib or icotinib, including the patients’ EGFR mutation status and levels of six serum tumor markers [carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cancer antigen 125 (CA125), squamous cell carcinoma antigen (SCC), cytokeratin-19 fragments (CYFRA21-1) and lactate dehydrogenase (LDH)]. Univariate and multivariate survival analyses were performed to identify independent prognostic factors associated with PFS.

Results

At the study cutoff date, 189 (90.9%) of the patients met the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 criteria for progressive disease (PD), while 19 (9.1%) had stable disease (SD). The median PFS of the 208 patients was 12.4 months (95% CI, 11.0–13.8 months). In the multivariate analysis using a Cox proportional hazard model, a non-smoking history [hazard ratio (HR) =2.460; 95% CI, 1.484–4.079; P<0.001], first-line treatment (HR =1.500; 95% CI, 1.062–2.119; P=0.021), and a high pretreatment serum level of CEA (HR =1.424; 95% CI 1.026–1.977; P=0.035) were found to be significant predictors of a longer PFS.

Conclusions

In Chinese lung adenocarcinoma patients treated with EGFR-TKIs, a non-smoking history, first-line EGFR-TKIs treatment and a high serum level of CEA were independent predictors of a longer PFS along with an EGFR-activating mutation.     

气管腺样囊性癌表皮生长因子受体基因突变的检测

目的了解气管腺样囊性癌肿瘤组织表皮生长因子受体（EGFR）18、19、20、21位点基因突变情况,为气管腺样囊性癌的分子靶向治疗奠定基础。方法将自2004年至2013年在煤炭总医院经气管镜下取出的气管腺样囊性癌共36例蜡块标本,提取肿瘤细胞DNA,采用ARMS法进行EGFRl8、19、20、21位点基因突变检测。采用Fisher精确概率法比较两组之间阳性率的差别。P〈0．05为差异有统计学意义。结果36例气管腺样囊性癌蜡块包埋标本中,EGFR基因突变阳性率为31％（11／36）。14％（5／36）存在双突变（19外显子缺失突变及21外显子突变）,0％（0／36）出现EGFR基因20外显子突变。临床分期为Ⅳ期的标本EGFR基因突变率为63％（5／8）,临床分期为Ⅱ～Ⅲ期的标本中EGFR基因突变率为21％（6／28）,两组间有明显差异（P〈0．05）。结论气管腺样囊性癌EGFR基因突变率介于肺腺癌与鳞癌之间。气管腺样囊性癌EGFR基因突变在已有血行转移的患者中阳性率明显高于无血行转移者,晚期气管腺样囊性癌患者可能从EGFR-酪氨酸激酶抑制剂治疗中获益。     

表皮生长因子与胃肠道疾病

表皮生长因子(EGF)是重要的促细胞生长因子之一,消化道中EGF的含量远远高于血液循环中的浓度,本文就EGF的结构、性质、生理作用、合成部位、分布情况以及与良恶性胃病的关系和对胃肠道疾病的治疗作用做一综述。     

非小细胞肺癌患者血清血管内皮生长因子、血小板衍生生长因子和表皮生长因子受体测定的临床意义

目的 探讨血清血管内皮生长因子(vascular endothelial growth factor,VEGF)、血小板衍生生长因子(platelet-derived growth factor,PDGF)和表皮生长因子受体(epidermal growth factor receptor,EGFR)测定在非小细胞肺癌(non-small cell lung cancer,NSCLC)诊断和预后判定中的意义.方法 采用双抗体夹心ABC-ELISA法测定31例NSCLC患者及30名健康者血清VEGF、PDGF和EGFR的含量.结果 NSCLC患者血清VEGF、PDGF和EGFR测定值均高于健康对照组(P值均＜0.01).血清VEGF、PDGF和EGFR测定值与NSCLC病理分型无关(P值均＞0.05),与远处转移有关,远处转移组的测定值高于未转移组(P＜0.05～0.01).NSCLC患者血清VEGF与PDGF测定值之间呈显著正相关(r=0.641,P＜0.01),血清VEGF和EGFR测定值呈正相关(r=0.369,P＜0.05).结论 检测血清VEGF、PDGF和EGFR水平对NSCLC的诊断和预后判定具有一定价值.     

Biomarkers of skin toxicity induced by anti-epidermal growth factor receptor antibody treatment in colorectal cancer

Skin toxicity is a common symptom of anti-epidermal rowth factor receptor(EGFR) antibody treatment and is also a predictive marker of its efficacy in colorectal cancer patients. However, severe skin disorders induced by such antibodies negatively impact on the quality of life of patients and decreases drug compliance during treatment. If we can predict the high-risk group susceptible to severe skin toxicity before treatment, we can undertake the early management of any arising skin disorders and formulate a more accurate prognosis for anti-EGFR antibody treatment. Previous studies have identified molecular markers of skin toxicity induced by anti-EGFR antibody, such as EGFR polymorphisms, the expression of inflammatory chemokines and serum levels of EGFR ligands. A clinical trial was undertaken involving the escalation of cetuximab doses, guided by the grade of skin toxicity observed, such as no or low-grade, in metastatic colorectal cancer(the EVEREST study). The dose escalation of cetuximab was confirmed by a safety profile and had the tendency to achieve a higher response rate in KRAS wild-type patients. A large, prospective randomized trial is now ongoing(EVEREST 2) and the results of this trial may contribute to personalized medicine in KRAS wild-type colorectal cancer patients.     

Epidermal growth factor receptor and metastatic colorectal cancer: Insights into target therapies

Colorectal cancer(CRC)has high incidence and mortality worldwide.In 2012,CRC was the second most prevalent cancer among males(9%)and the third among females(8%).In recent decades,standard chemotherapies protocols combining 5-fluorouracil,leucovorin,irinotecan and oxaliplatin were important for improve survival in this set of patients.Further,biological drugs throughout epidermal growth factor receptor(EGFR)pathways showed interesting results in metastatic disease(mCRC)control when in association to standard chemotherapy regimens.Cetuximab and panitumumab are two cornerstones for mCRC treatment and are both approved in Europe and United States based on previous results phaseⅢtrials.This paper will briefly summarize those anti-EGFR therapies framework in mCRC and discusses some issues in this regard.     

Presence of the seven transmembrane thrombin receptor on human tumour cells: effect of activation on tumour adhesion to platelets and tumour tyrosine phosphorylation

Thrombin-treated tumour cells enhance their adhesion to platelets, fibronectin and von Willebrand factor in vitro , and enhance their pulmonary metastasis in mice in vivo . A unique seven transmembrane spanning thrombin receptor has recently been cloned which is activated following thrombin proteolysis of the N-terminal end of the receptor with exposure of a tethered ligand. An N-terminal 14-mer (SFLLRNPNDKYEPF) or 6-mer (SFLLRN) of the tethered ligand can serve as a thrombin receptor activation peptide (TRAP) by mimicking the action of thrombin on platelets, endothelial cells and smooth muscle cells. We have examined six human tumour cell lines for their response to TRAP, for the presence of this thrombin receptor mRNA by RT-PCR, protein by immunoblot and for their in vitro and in vivo response to TRAP. All six cell lines contain the receptor mRNA, and when treated with 100 μ m 6-mer TRAP or 1 u/ml thrombin increase their adhesion to platelets 2–3-fold. Four of the six cell lines undergo tyrosine phosphorylation within 30 s to 1 min after exposure to 6-mer TRAP or thrombin. Thus tumour cells respond to thrombin via activation of their seven transmembrane spanning thrombin receptor.     

Epidermal growth factor receptor (EGFR) mutation testing is useful for primary lung cancer diagnosis and appropriate surgical resection: A case series

Primary lung cancer was suspected in three patients upon chest computed tomography (CT) and bronchoscopy. Wash cytology revealed that all patients had lesions categorized as class III or lower (Papanicolaou classification), and the wash solution was then subjected to an epidermal growth factor receptor (EGFR) mutation search. As a result, exon 19 deletion was found in two patients, whereas an exon 21 L858R mutation was found in one. Therefore, all three patients underwent surgery without pathological evidence, and surgical pathology subsequently confirmed the diagnosis of primary lung adenocarcinoma. As observed, EGFR mutation testing was useful for cancer diagnosis.     

Role of the fibroblast growth factor receptor axis in cholangiocarcinoma

Advanced cholangiocarcinoma (CCA) is a highly lethal disease with limited therapeutic options beyond cytotoxic chemotherapy. Molecular profiling of CCA has provided insights into the pathogenesis of this disease and identified potential therapeutic targets. The fibroblast growth factor receptor (FGFR) axis is important for maintaining tissue homeostasis. Aberrations in FGFR activity have been implicated in the development and progression of CCA and other malignancies, which has generated significant interest in exploring FGFR's therapeutic potential. FGFR2 fusion events are present in up to 17% of intrahepatic CCAs and appear to predict sensitivity to FGFR inhibitors even after progression on chemotherapy. These observations have led to a clinical trial evaluating FGFR inhibition in patients with CCA enriched for FGFR alterations. This review summarizes current knowledge about the role of the FGFR pathway in cholangiocarcinogenesis and ongoing work in developing FGFR‐directed therapies as an antineoplastic strategy for CCA.     

Epidermal growth factor receptor-targeted immune magnetic liposomes capture circulating colorectal tumor cells efficiently

AIM To compare the capacity of newly developed epidermal growth factor receptor(EGFR)-targeted immune magnetic liposomes(EILs) vs epithelial cell adhesion molecule(Ep CAM) immunomagnetic beads to capture colorectal circulating tumor cells(CTCs).METHODS EILs were prepared using a two-step method, and the magnetic and surface characteristics were confirmed. The efficiency of capturing colorectal CTCs as well as the specificity were compared between EILs and Ep CAM magnetic beads. RESULTS The obtained EILs had a lipid nanoparticle structure similar to cell membrane. Improved binding with cancer cells was seen in EILs compared with the method of coupling nano/microspheres with antibody. The binding increased as the contact time extended. Compared with Ep CAM immunomagnetic beads, EILs captured more CTCs in peripheral blood from colorectal cancer patients. The captured cells showed consistency with clinical diagnosis and pathology. Mutation analysis showed same results between captured CTCs and cancer tissues. CONCLUSION EGFR antibody-coated magnetic liposomes show high efficiency and specificity in capturing colorectal CTCs.     

Increased resistance to cytotoxic agents in ZR75B human breast cancer cells transfected with epidermal growth factor receptor

Human breast cancer cells selected for multidrug resistance frequently overexpress ligands and receptors in the epidermal growth factor (EGF) receptor family. To determine whether this overexpression contributes to the drug resistant phenotype, EGF receptor transfected ZR75B human breast cancer cells were examined. Two EGF receptor overexpressing clones were evaluated: clone 11 with >1 × 10⁶ sites, and clone 13 with 310 000 receptor sites/cell. These were compared with clone 2-neo, which was transfected with the neomycin gene only and contained 43 000 receptor sites/cell. The EGF receptor overexpressing clones and the neo transfected control clone displayed comparable growth rates. Cytotoxicity analyses were performed with doxorubicin, vinblastine, cisplatin and 5-fluorouracil to determine the sensitivity of the clones to antineoplastic drugs. The EGF receptor overexpressing clones were found to be 1.5–5.6 times more resistant to the four drugs tested. This increase in the IC₅₀ conferred a selective advantage when grown in the presence of 2, 3 and 6 ng/ml doxorubicin. Clone 13 cells overtook a mixed population which began with clone 2-neo comprising 95% of the cells. Clone 2-neo remained the dominant clone in the absence of drug. Finally, after long-term selection of the clones with 6 ng/ml doxorubicin, clone 2-neo became fourfold more resistant than the unselected clone 2-neo, a level which was comparable to that found in the EGF receptor overexpressing clones 11 and 13. No additional increase in resistance was observed for these clones, suggesting that clone 2-neo had developed additional resistance mechanisms. These results support the hypothesis that the EGF receptor pathway is able to confer a selective advantage to cells during drug exposure and potentially participates in the multidrug resistant phenotype.     

转化生长因子α对小鼠气道平滑肌细胞的促增殖作用

目的 探讨转化生长因子α(transforming growth factog alphg,TGF-α)对小鼠气道平滑肌细胞(airway smooth muscle cells,ASMC)促增殖作用及其机制.方法 用四唑盐(MTT)比色法和3H-TdR掺人法测定加入TGF-α后小鼠ASMC的增殖情况.本实验采用3H-TdR掺入法和MTT比色法观察选择性表皮生长因子受体(epidermal growth factor receptor,EGFR)酪氨酸激酶抑制剂(AG1478)、EGFR中和抗体225(225mAb)、MEK抑制剂(U0126)、PI-3K抑制剂(Wonmannin)对加入TGF-α后促ASMC增殖的影响.通过Western Blot方法测定加入TGF-α及加用AG1478、225mAb后ASMC磷酸化EGFR蛋白表达.结果 用MTT比色法和3H-TdR掺入法测定ASMC培养液中加入TGF-α后ASMC增殖情况比对照组明显增加.加入AG1478、225mAb、U0126、Wortmannin可抑制TGF-α促ASMC增殖作用(P＜0.01).经Western Blot检测,TGF-α引起ASMC磷酸化EGFR蛋白表达增高.AG1478、225mAb抑制TGF-α所致ASMC磷酸化EGFR蛋白表达的增加(P＜0.01).结论 TGF-α激活EGFR为磷酸化EGFR,从而通过:①ras-raf-MEK-erk/MAPK途径;②PI3K-PKC-IKK途径;促进体外培养的小鼠ASMC的增殖.     

表皮生长因子受体及增殖细胞核抗原在胃癌中的表达及意义

为探讨表皮生长因子受体 ( EGFR)及增殖细胞核抗原 ( PCNA)在胃癌中的表达 ,应用免疫组织化学技术 ,对胃癌和胃良性肿瘤组织中 EGFR和 PCNA分别进行定性和半定量检测 ,分析其与临床病理参数的关系。结果显示 1在胃良性肿瘤组织中 EGFR的表达率为 2 3 .0 8% ,PCNA L I为 2 7.80± 12 .2 0 ,明显低于胃癌组织中的表达率 ( 49.0 9% ,PCNA L I5 2 .73± 12 .2 5 ,P<0 .0 1)。2胃癌组织中 EGFR和 PCNA的表达与患者性别、年龄、病变部位、分型、组织学类型及分化程度无关 ( P均 >0 .0 5 ) ,而与临床分期、浸润深度及淋巴结转移情况相关 ( P <0 .0 5 ) ,表明联合检测 EGFR和 PCNA可作为判断胃癌恶性程度、预测淋巴结转移、制定合理治疗方案及评估预后的重要指标