在RET驱动的癌症中,适应性达尔文的目标外耐药机制对选择性RET抑制产生了选择性RET抑制
Vivek Subbiah1,2, Mohamed A Gouda3, J Bryan Iorgulescu4
1Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Vivek.Subbiah@scri.com.
在甲状腺髓癌中对RET氨酸激酶抑制剂 (TKIs) 的耐药性可以通过组合疗法克服. 针对获得的NTRK和ALK融合以及RET突变,提供了个性化的治疗策略.
科学领域:
- 在瘤学瘤学.
- 分子生物学分子生物学
- 遗传学 遗传学 是一个
背景情况:
- 在转移性髓性甲状腺癌 (MTC) 中对RET氨酸激酶抑制剂 (TKIs) (如selpercatinib和pralsetinib) 的耐药性是一个重要的临床挑战.
- 获得的替代性瘤基因,而不是二次RET突变,代表了更复杂的抵抗机制.
- 了解耐药机制对于开发先进的MTC中有效的治疗策略至关重要.
研究的目的:
- 为了研究患有转移性MTC的患者的治疗反应和耐药机制,该患者患有RET激活循环突变.
- 评估针对RET,NTRK和ALK变化的组合疗法的疗效.
- 为了证明实时分子分析对个性化癌症护理的实用性.
主要方法:
- 使用组织活检和循环无细胞DNA (cfDNA) 进行分子变化的纵向监测.
- 用selpercatinib治疗,然后用larotrectinib进行组合治疗,然后用entrectinib进行治疗.
- 对抗特定遗传变化的药物疗效的临床前验证.
主要成果:
- 患者最初对selpercatinib有反应,但发展了获得的ETV6:NTRK3融合,通过添加larotrectinib来控制.
- 随着EML4::ALK融合的后续进展,通过将selpercatinib与entrektinib相结合来管理.
- 临床前模型证实,塞尔珀卡提尼布加因特雷克提尼布对三重RET/NTRK3/ALK变异有效.
结论:
- 收购的ETV6::NTRK3和EML4::ALK合并可以推动MTC中对RET TKIs的阻力.
- 与塞尔珀卡提尼布和恩特雷克提尼布的联合治疗可以克服由多个致癌融合介导的耐药性.
- 实时分子分析和个性化N-of-1护理对于管理癌症适应性抵抗至关重要.
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