探析代谢活化在酪氨酸激酶抑制剂所致肝毒性的作用及防治对策

酪氨酸激酶抑制剂作为新型靶向抗肿瘤药物,现已成为恶性肿瘤药物治疗的研究热点。但这类靶向药物会产生一些毒副作用,尤其是肝毒性较为突出。已有文献报道,多种酪氨酸激酶抑制剂(吉非替尼、厄洛替尼、埃克替尼、阿法替尼和克唑替尼等)在治疗恶性肿瘤过程中产生显著的肝毒性,严重限制了其临床应用。目前研究认为,代谢活化是酪氨酸激酶抑制剂产生肝毒性的主要诱因。本文综述有关酪氨酸激酶抑制剂引起肝损伤的国内外文献,探析代谢活化导致肝损伤的机制,为酪氨酸激酶抑制剂临床用药提供参考。     

EGFR和ErbB2双重酪氨酸激酶拉帕替尼二甲苯磺酸酯的研究进展

拉帕替尼是一种人源2型表皮生长因子受体(HER2)和表皮生长因子受体(EGFR)双重酪氨酸激酶抑制剂,与卡培他滨联用治疗女性HER2阳性的乳腺癌.我们利用MEDLINE进行关键词为拉帕替尼的文献检索,对其药理作用、药动学、临床疗效及安全性,药物相互作用等进行综述.     

第二代表皮生长因子受体酪氨酸激酶抑制剂治疗非小细胞肺癌的研究进展

在非小细胞肺癌的分子靶向治疗中,表皮生长因子受体是有前景的治疗靶标.吉非替尼、尔洛替尼虽已批准上市用于临床,但其治疗的临床受益率较低.现对正在研发的第二代表皮生长因子受体酪氨酸激酶抑制剂的临床试验作一综述.     

新型非小细胞肺癌靶向治疗药吉非替尼的研究进展

吉非替尼是一种表皮生长因子受体(EGFR)酪氨酸激酶抑制剂,对晚期非小细胞肺癌的治疗在一定范围内有显著的效果,而EGFR突变有望成为吉非替尼敏感性的预测指标。国内外临床和基础研究有助于对吉非替尼的合理使用奠定坚实基础。     

抗肿瘤药物吉非替尼的研究进展

吉非替尼(gefitinib,Iressa,ZD1839)是一种口服选择性表皮生长因子受体酪氨酸激酶抑制剂.临床前研究发现它能抑制多种类型肿瘤细胞的生长,临床Ⅰ、Ⅱ期研究表明在晚期非小细胞肺癌(NSCLC)患者中,吉非替尼单独应用显示出明显的抗瘤活性并使症状减轻.2003年5月FDA批准其上市.综述了吉非替尼的分子作用机制、体内外抗肿瘤作用以及临床试验等方面的最新进展.     

达可替尼在真实世界中治疗EGFR突变阳性晚期非小细胞肺癌患者的临床疗效和安全性

目的 探讨达可替尼在表皮生长因子受体(EGFR)突变阳性晚期非小细胞肺癌(NSCLC)患者的治疗效果及安全性.方法 回顾性分析50例EGFR突变阳性晚期NSCLC患者的临床资料,其中的24例(A组)给予达可替尼治疗,26例(B组)给予第一代表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)治疗.比较两组患者临床结局和...     

EGFR和ErbB2双重酪氨酸激酶

拉帕替尼是一种人源2型表皮生长因子受体(HER2)和表皮生长因子受体(EGFR)双重酪氨酸激酶抑制剂,与卡培他滨联用治疗女性HER2阳性的乳腺癌。我们利用MEDLINE进行关键词为拉帕替尼的文献检索,对其药理作用、药动学、临床疗效及安全性,药物相互作用等进行综述。     

表皮生长因子受体酪氨酸激酶抑制剂吉非替尼

吉非替尼(ZD1839,Iressa)是一种表皮生长因子受体酪氨酸激酶抑制剂,通过阻断酪氨酸激酶信号传导通路抑制肿瘤生长.2个大型的Ⅱ期临床试验(IDEAL)证实了其对于晚期非小细胞肺癌具有应用前景,可以改善症状,延长患者的生存期.此外,在对多种恶性实体瘤的Ⅰ期和Ⅱ期临床研究中也初步证实了该药具有抗肿瘤活性.     

酪氨酸激酶抑制剂(吉非替尼、厄洛替尼、阿法替尼和奥希替尼)一线治疗表皮生长因子受体突变的晚期非小细胞肺癌的成本-效果分析

吉非替尼、厄洛替尼、阿法替尼和奥希替尼已被推荐为表皮生长因子受体突变的晚期非小细胞肺癌的一线治疗药物,但同时比较这四种酪氨酸激酶抑制剂在中国的经济性目前尚无研究.本研究旨在评价吉非替尼、厄洛替尼、阿法替尼和奥希替尼一线治疗表皮生长因子受体突变的晚期非小细胞肺癌的成本-效果性.通过构建马尔科夫模型,从中国医疗系统角度评价...     

奥希替尼获得性耐药的研究进展

奥希替尼作为第三代表皮生长因子受体酪氨酸激酶抑制剂,对表皮生长因子受体(EGFR)T790M突变型肺腺癌有显著疗效。随着临床研究的深入,奥希替尼的耐药逐渐出现。如何应对奥希替尼耐药已成为临床工作者必须关注的问题。本文就奥希替尼获得性耐药机制及应对措施的最新研究进展进行综述。     

Biochemical and cellular effects of c-Src kinase-selective pyrido[2, 3-d]pyrimidine tyrosine kinase inhibitors

Increased expression or activity of c-Src tyrosine kinase has been associated with the transformed phenotype in tumor cells and with progression of neoplastic disease. A number of pyrido[2, 3-d]pyrimidines have been characterized biochemically and in cells as part of an assessment of their potential as anti-tumor agents. The compounds were ATP-competitive inhibitors of c-Src kinase with IC(50) values < 10 nM and from 6 to >100-fold selectivity for c-Src tyrosine kinase relative to basic fibroblast growth factor receptor (bFGFr) tyrosine kinase, platelet-derived growth factor receptor (PDGFr) tyrosine kinase, and epidermal growth factor receptor (EGFr) tyrosine kinase. The compounds yielded IC(50) values < 5 nM against Lck. Human colon tumor cell growth in culture was inhibited, as was colony formation in soft agar at concentrations < 1 microM. Phosphorylation of the c-Src cellular substrates paxillin, p130(cas), and Stat3 was also inhibited at concentrations < 1 microM. Autophosphorylation of EGFr tyrosine kinase or PDGFr tyrosine kinase was not inhibited by c-Src inhibitors, thus showing the selective nature of the compounds in cells. In a mitogenesis assay measuring thymidine incorporation stimulated by specific mitogens, the c-Src tyrosine kinase inhibitors reduced incorporated thymidine in a manner consistent with previously reported roles of c-Src in mitogenic signaling. Progression through the cell cycle was inhibited at G(2)/M in human colon tumor cells treated with two of the c-Src-selective compounds, which is also consistent with earlier reports describing a requirement for active c-Src tyrosine kinase for G(2) to M phase progression. The compounds described here are selective inhibitors of c-Src tyrosine kinase and have antiproliferative effects in tumor cells consistent with inhibition of c-Src.     

Inhibitors targeting hepatocyte growth factor receptor and vascular endothelial growth factor receptor tyrosine kinases

Amgen disclosed a series of 4-heteroaryloxy quinoline/quinazoline compounds as multiple kinase inhibitors, including hepatocyte growth factor (HGF) receptor tyrosine kinase c-Met and vascular endothelial growth factor (VEGF) receptor tyrosine kinase. These compounds are stated to have wide therapeutic applications for the treatment of a variety of cancers, hypertension, arteriosclerosis, myocardial infarction and rheumatoid arthritis.     

Small molecule tyrosine kinase inhibitors: clinical development of anticancer agents

Numerous small molecule synthetic tyrosine kinase inhibitors are in clinical development for the treatment of human cancers. These fall into three broad categories: inhibitors of the epidermal growth factor receptor tyrosine kinase family (e.g., Iressa trade mark and Tarceva trade mark ), inhibitors of the split kinase domain receptor tyrosine kinase subgroup (e.g., PTK787/ZK 222584 and SU11248) and inhibitors of tyrosine kinases from multiple subgroups (e.g., Gleevec trade mark ). In addition, agents targeting other tyrosine kinases implicated in cancer, such as Met, Tie-2 and Src, are in preclinical development. As experience is gained in the clinic, it has become clear that unleashing the full therapeutic potential of tyrosine kinase inhibitors will require patient preselection, better assays to guide dose selection, knowledge of mechanism-based side effects and ways to predict and overcome drug resistance.     

Design, synthesis, and evaluations of substituted 3-[(3- or 4-carboxyethylpyrrol-2-yl)methylidenyl]indolin-2-ones as inhibitors of VEGF, FGF, and PDGF receptor tyrosine kinases

Receptor tyrosine kinases (RTKs) have been implicated as therapeutic targets for the treatment of human diseases including cancers, inflammatory diseases, cardiovascular diseases including arterial restenosis, and fibrotic diseases of the lung, liver, and kidney. Three classes of 3-substituted indolin-2-ones containing propionic acid functionality attached to the pyrrole ring at the C-3 position of the core have been identified as catalytic inhibitors of the vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and platelet-derived growth factor (PDGF) RTKs. Some of the compounds were found to inhibit the tyrosine kinase activity associated with isolated vascular endothelial growth factor receptor 2 (VEGF-R2) [fetal liver tyrosine kinase 1 (Flk-1)/kinase insert domain-containing receptor (KDR)], fibroblast growth factor receptor (FGF-R), and platelet-derived growth factor receptor (PDGF-R) tyrosine kinase with IC(50) values at nanomolar level. Thus, compound 1 showed inhibition against VEGF-R2 (Flk-1/KDR) and FGF-R1 tyrosine kinase activity with IC(50) values of 20 and 30 nM, respectively, while compound 16f inhibited the PDGF-R tyrosine kinase activity with IC(50) value of 10 nM. Structural models and structure-activity relationship analysis of these compounds for the target receptors are discussed. The cellular activities of these compounds were profiled using cellular proliferation assays as measured by bromodeoxyuridine (BrdU) incorporation. Specific and potent inhibition of cell growth was observed for some of these compounds. These data provide evidence that these compounds can be used to inhibit the function of these target receptors.     

Receptor tyrosine kinases and anticancer therapy

Receptor and non-receptor protein tyrosine kinases (PTKs) are essential enzymes in cellular signaling processes and signal transduction pathways that regulate cell growth, differentiation, migration and metabolism by catalyzing protein phosphorylation and dephosphorylation. In recent years, different tyrosine kinase receptors were identified as regulators of tumor or tumor vessel growth. Their inhibition by specific tyrosine kinase inhibitors and antibodies targeting growth factors and their receptors were recently shown to constitute a new modality for treating cancers. The pathognomonic role of the inhibited tyrosine kinase defines the way of action, whereas the amount of expression in tumor tissue is thought to define the indication for the tumor entity. Various compounds targeting PTKs are under clinical investigation in phase I-III trials or are already approved. This review describes new drugs targeting BCR-Abl, c-kit, EGFR (epidermal growth factor receptor), tumor angiogenesis via VEGF (vascular endothelial growth factor), HER2/neu and "multitarget" tyrosine kinase inhibitors.     

Molecular design and clinical development of VEGFR kinase inhibitors

Vascular angiogenesis has been shown to play a key role in many solid tumors. The vascular endothelial growth factor (VEGF) isoforms and their tyrosine kinase receptors (VEGFRs) have been under intense research for effective anticancer drug candidates. Epidermal growth factor (EGF) and its receptor (EGFR) provide another pathway critical in monitoring angiogenesis. VEGF exerts its effect through binding to tyrosine kinase receptors, mainly VEGFR-1 (Flt-1, the fms-like tyrosine kinase-1) and VEGFR-2 (Flk-1/KDR, fetal liver kinase-1). This paper reviews the progress, mechanism, and binding modes of recently approved kinase inhibitors, such as sunitinib (Sutent), sorafenib (Nexavar) and dasatinib (Sprycel), as well as other inhibitors that are still under clinical development. Recent clinical treatments suggest that most inhibitors of VEGFR (and/or EGFR) exert their therapeutic effect through not only targeting the VEGFR (and/or EGFR) pathway, but also inhibiting other pathways, such as RAF/MEK/ERK pathway. A new pharmacophore model for second generation of type II tyrosine kinase inhibitors and recent advances in the combination of VEGFR tyrosine kinase inhibitors and other chemotherapeutics are also covered.     

Anti-epidermal growth factor receptor drugs in cancer therapy

The epidermal growth factor receptor is a cell membrane growth factor receptor that plays a key role in cancer development and progression. Epidermal growth factor receptor-activated signalling pathways control cell proliferation, apoptosis, angiogenesis and metastatic spread in the majority of human epithelial cancers. Targeting the epidermal growth factor receptor represents a valuable molecular approach to cancer therapy. Promising strategies in clinical development include monoclonal antibodies which block ligand binding and small molecule inhibitors of the tyrosine kinase enzymatic activity which prevent epidermal growth factor receptor autophosphorylation and propagation of downstream intracellular signals. Several anti-epidermal growth factor receptor agents are in clinical development for cancer therapy. Among these, IMC-225 (cetuximab), a chimeric human-mouse monoclonal IgG1 antibody, OSI-774 (Tarceva) and ZD1839 (Iressa), two small molecule epidermal growth factor receptor-selective tyrosine kinase inhibitors, are currently in Phase II and III development as single agents or in combination with conventional therapies, such as radiotherapy or chemotherapy. Results from Phase I - II trials in advanced cancer demonstrate that these drugs have an acceptable tolerability and an interesting clinical activity in patients with a variety of tumour types.     

Tyrosine kinases as targets in cancer therapy – successes and failures

Protein kinases play a crucial role in signal transduction and also in cellular proliferation, differentiation and various regulatory mechanisms. The inhibition of growth-related kinases, especially tyrosine kinases, might therefore provide new therapies for diseases such as cancer. Due to the enormous progress that has been made in the past few years in the identification of the human genome, in molecular and cell biology technologies, in structural biology and in bioinformatics, the number of receptor and non-receptor tyrosine kinases that have been identified as valuable molecular targets has greatly increased. Currently, more than 20 different tyrosine kinase targets are under evaluation in drug discovery projects in oncology. The progress made in the crystallisation of protein kinases, in most cases complexed with ATP-site-directed inhibitors, has confirmed that the ATPbinding domain of tyrosine kinases is an attractive target for rational drug design; more than 20 ATP-competitive, low molecular weight inhibitors are in various phases of clinical evaluation. Meanwhile, clinical proof-of-concept (POC) has been achieved with several antibodies and small molecules targeted against tyrosine kinases. With Herceptin, Glivec and Iressa (registered in Japan), the first kinase drugs have entered the market. This review describes the preclinical and clinical status of low molecular weight drugs targeted against different tyrosine kinases (e.g., epidermal growth factor receptor [EGFR], vascular endothelial growth factor receptor [VEGFR], platelet-derived growth factor receptor [PDGFR], Kit, Fms-like tyrosine kinase [Flt]-3), briefly describes new targets, and provides a critical analysis of the current situation in the area of tyrosine kinase inhibitors.     

Tyrosine kinases as targets in cancer therapy - successes and failures

Protein kinases play a crucial role in signal transduction and also in cellular proliferation, differentiation and various regulatory mechanisms. The inhibition of growth-related kinases, especially tyrosine kinases, might therefore provide new therapies for diseases such as cancer. Due to the enormous progress that has been made in the past few years in the identification of the human genome, in molecular and cell biology technologies, in structural biology and in bioinformatics, the number of receptor and non-receptor tyrosine kinases that have been identified as valuable molecular targets has greatly increased. Currently, more than 20 different tyrosine kinase targets are under evaluation in drug discovery projects in oncology. The progress made in the crystallisation of protein kinases, in most cases complexed with ATP-site-directed inhibitors, has confirmed that the ATPbinding domain of tyrosine kinases is an attractive target for rational drug design; more than 20 ATP-competitive, low molecular weight inhibitors are in various phases of clinical evaluation. Meanwhile, clinical proof-of-concept (POC) has been achieved with several antibodies and small molecules targeted against tyrosine kinases. With Herceptin, Glivec and Iressa (registered in Japan), the first kinase drugs have entered the market. This review describes the preclinical and clinical status of low molecular weight drugs targeted against different tyrosine kinases (e.g., epidermal growth factor receptor [EGFR], vascular endothelial growth factor receptor [VEGFR], platelet-derived growth factor receptor [PDGFR], Kit, Fms-like tyrosine kinase [Flt]-3), briefly describes new targets, and provides a critical analysis of the current situation in the area of tyrosine kinase inhibitors.     

Discovery of N-(4-(3-amino-1H-indazol-4-yl)phenyl)-N'-(2-fluoro-5-methylphenyl)urea (ABT-869), a 3-aminoindazole-based orally active multitargeted receptor tyrosine kinase inhibitor

In our continued efforts to search for potent and novel receptor tyrosine kinase (RTK) inhibitors as potential anticancer agents, we discovered, through a structure-based design, that 3-aminoindazole could serve as an efficient hinge-binding template for kinase inhibitors. By incorporating an N,N'-diaryl urea moiety at the C4-position of 3-aminodazole, a series of RTK inhibitors were generated, which potently inhibited the tyrosine kinase activity of the vascular endothelial growth factor receptor and the platelet-derived growth factor receptor families. A number of compounds with potent oral activity were identified by utilizing an estradiol-induced mouse uterine edema model and an HT1080 human fibrosarcoma xenograft tumor model. In particular, compound 17p (ABT-869) was found to possess favorable pharmacokinetic profiles across different species and display significant tumor growth inhibition in multiple preclinical animal models.