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Mechanisms and treatment of cancer therapy-induced peripheral and central neurotoxicity 癌症治疗诱导的周围和中枢神经毒性的机制和治疗
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-09-09 DOI: 10.1038/s41568-025-00863-2
Philipp Karschnia, Thomas A. Nelson, Jorg Dietrich
Neurotoxicity is a common and potentially severe adverse effect from conventional and novel cancer therapy. The mechanisms that underlie clinical symptoms of central and peripheral nervous system injury remain incompletely understood. For conventional cytotoxic chemotherapy or radiotherapy, direct toxicities to brain structures and neurovascular damage may result in myelin degradation and impaired neurogenesis, which eventually translates into delayed neurodegeneration accompanied by cognitive symptoms. Chemotherapy-induced peripheral neuropathy is one of the most prevalent adverse events of chemotherapy, seen specifically with platinum- and taxane-based regimens, vinca alkaloids, thalidomide and bortezomib, and is also emerging as a concerning feature of novel targeted therapies and immunotherapies. In patients treated with molecularly targeted compounds or immune-activating agents, on-target but off-tumour effects and systemic inflammation characterize a distinct clinical profile with predominantly acute neurological symptoms with a phenotype defined by the specific antigen target. The development of mechanistically driven treatment strategies for both central and peripheral nervous system injury from cancer therapies is a major unmet medical need. Clinical trials designed to test pharmacotherapeutic interventions (including anti-dementia drugs or cognitive stimulants) for cognitive symptoms after conventional chemotherapy have produced conflicting results. In the case of acute neurotoxic adverse events from immunotherapies, reversal of T cell expansion together with drugs targeting specific pro-inflammatory interleukins have shown beneficial effects in selected patients. Large clinical trials to test novel strategies and pharmacotherapeutic interventions for acute or delayed neurotoxicity are ongoing. Informed by data derived from clinical trials and preclinical models, promising treatment strategies are on the horizon. Neurotoxicity impacting the central and peripheral nervous systems is a considerable adverse effect of both conventional and novel cancer therapies. In this Review, Karschnia et al. outline what is currently known about the mechanisms that underlie the clinical symptoms of central nervous system injury and peripheral neuropathy and the ongoing development of interventions to treat and prevent this unmet medical need.
神经毒性是传统和新型癌症治疗中常见的潜在严重不良反应。中枢和周围神经系统损伤的临床症状的机制仍然不完全清楚。对于传统的细胞毒性化疗或放疗,对脑结构和神经血管的直接毒性可导致髓磷脂降解和神经发生受损,最终转化为伴认知症状的迟发性神经变性。化疗引起的周围神经病变是化疗最常见的不良事件之一,特别是以铂和紫杉烷为基础的方案,长春花生物碱,沙利度胺和硼替佐米,也正在成为新的靶向治疗和免疫治疗的一个令人关注的特征。在接受分子靶向化合物或免疫激活剂治疗的患者中,靶向但非肿瘤效应和全身性炎症具有明显的临床特征,主要是急性神经系统症状,其表型由特定抗原靶点定义。癌症治疗引起的中枢和周围神经系统损伤的机械驱动治疗策略的发展是一个主要的未满足的医疗需求。旨在测试常规化疗后认知症状的药物治疗干预(包括抗痴呆药物或认知兴奋剂)的临床试验产生了相互矛盾的结果。在免疫治疗急性神经毒性不良事件的情况下,逆转T细胞扩增和靶向特异性促炎白细胞介素的药物在选定的患者中显示出有益的效果。目前正在进行大型临床试验,以测试急性或延迟性神经毒性的新策略和药物治疗干预措施。根据来自临床试验和临床前模型的数据,有希望的治疗策略即将出现。
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引用次数: 0
Aggregating premalignancy 聚合初癌
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-09-08 DOI: 10.1038/s41568-025-00876-x
Daniela Senft
In a recent study, Salomó Coll et al. demonstrate that impaired ER-phagy in Kras-mutant pancreatic acinar cells leads to the accumulation of protein aggregates and disruption of acinar cell homeostasis, thereby cooperating with oncogenic KRAS to promote cellular transformation.
在最近的一项研究中,Salomó Coll等人发现,KRAS突变的胰腺腺泡细胞er吞噬受损,导致蛋白聚集体的积累和腺泡细胞稳态的破坏,从而与致癌的KRAS协同促进细胞转化。
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引用次数: 0
Unravelling the genetics and epigenetics of the ageing tumour microenvironment in cancer 揭示癌症中衰老肿瘤微环境的遗传学和表观遗传学
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-09-08 DOI: 10.1038/s41568-025-00868-x
Hariharan Easwaran, Ashani T. Weeraratna
Somatic mutations in several genes, including key oncogenes and tumour suppressor genes, are present from early life and can accumulate as an individual ages, indicating that the potential for cancer is present and growing throughout life. However, the risk of developing cancer rises sharply after 50–60 years of age, suggesting that the ability of these mutations to undergo clonal expansion and drive cancer development is dependent on the progressive changes in the epigenome and microenvironment that occur during ageing. Epigenetic changes, including DNA methylation and histone modifications, can drive various hallmarks of ageing in precancerous cells, including induction of senescence, the senescence-associated secretory phenotype, genomic instability and reduction of nuclear integrity, metabolic and inflammatory stress responses, stem cell function and differentiation potential, and redox balance. This can also alter the normal immune and stromal cells in the tissue microenvironment, which cumulatively enhances the effects of cancer driver mutations, ultimately promoting cancer development and progression in aged individuals. Unravelling these mechanisms will provide novel preventive and therapeutic strategies to limit the burden and progression of cancer in aged individuals. In this Review, Easwaran and Weeraratna outline how ageing leads to epigenetic alterations in the tissue microenvironment, enhancing clonal expansion of mutations and ultimately increasing cancer risk.
一些基因的体细胞突变,包括关键的致癌基因和肿瘤抑制基因,从生命早期就存在,并随着个体年龄的增长而积累,这表明癌症的可能性是存在的,并且在一生中都在增长。然而,在50-60岁之后,患癌症的风险急剧上升,这表明这些突变进行克隆扩增和驱动癌症发展的能力取决于衰老过程中表观基因组和微环境的渐进式变化。表观遗传变化,包括DNA甲基化和组蛋白修饰,可以驱动癌前细胞衰老的各种特征,包括衰老的诱导、衰老相关的分泌表型、基因组不稳定和核完整性的降低、代谢和炎症应激反应、干细胞功能和分化潜力,以及氧化还原平衡。这也可以改变组织微环境中正常的免疫细胞和基质细胞,从而累积增强癌症驱动突变的影响,最终促进老年人癌症的发生和进展。揭示这些机制将提供新的预防和治疗策略,以限制老年人癌症的负担和进展。
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引用次数: 0
3D chromatin architecture as a predictor of somatic mutations in cancer genomes 三维染色质结构作为癌症基因组体细胞突变的预测因子
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-09-01 DOI: 10.1038/s41568-025-00875-y
Karan Bansal, Aprotim Mazumder
In this Journal Club, Bansal and Mazumder discuss a study that investigated the interplay between three-dimensional genome structure and mutational load in cancer.
在这个杂志俱乐部中,Bansal和Mazumder讨论了一项研究,该研究调查了癌症中三维基因组结构和突变负荷之间的相互作用。
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引用次数: 0
The evolution of cancer and ageing: a history of constraint 癌症和衰老的演变:约束的历史
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-08-26 DOI: 10.1038/s41568-025-00861-4
João Pedro de Magalhães
Ageing and cancer are ubiquitous in animals. They are fundamental and generally intrinsic to multicellular life. Nonetheless, ageing and cancer rates vary widely across species and understanding their evolution and interaction is of great biological interest. Although cancer arises from uncontrolled cell proliferation, ageing involves cell loss and degeneration, making them seemingly opposite yet interconnected processes. Because cancer can affect young individuals, natural selection will favour the evolution of cancer resistance over processes that maintain health in later life. As such, I propose that species evolve longer lifespans under the constraints imposed by the need to reduce cancer risk. Mechanisms that suppress cancer, such as telomere shortening and cellular senescence, may inadvertently promote ageing by limiting cell proliferation and tissue regeneration. Selection for tumour suppression may also impact stem cell ageing and contribute to the limited ability of adult tissues to regenerate. Overall, although cancer resistance is essential for the evolution of longevity, tumour suppression mechanisms may also contribute to ageing-related tissue degeneration and functional decline. Studying the trade-offs between the evolution of tumour suppression processes and their impact later in life may provide important insights into ageing processes. In this Perspective, de Magalhães explores the evolutionary relationship between cancer and ageing, proposing that the need to minimize cancer risk early in life may contribute to tissue degeneration later on, representing a trade-off that constrains the evolution of longer lifespans.
衰老和癌症在动物中无处不在。它们是多细胞生命的基础和本质。尽管如此,不同物种的衰老和癌症发病率差异很大,了解它们的进化和相互作用具有很大的生物学意义。虽然癌症起源于不受控制的细胞增殖,但衰老涉及细胞损失和退化,使它们看似相反但相互关联的过程。因为癌症可以影响年轻人,自然选择将倾向于癌症抗性的进化,而不是在晚年保持健康的过程。因此,我建议物种在减少癌症风险的需要所施加的限制下进化出更长的寿命。抑制癌症的机制,如端粒缩短和细胞衰老,可能通过限制细胞增殖和组织再生而无意中促进衰老。肿瘤抑制的选择也可能影响干细胞老化,并导致成体组织再生能力有限。总体而言,尽管抗癌对长寿的进化至关重要,但肿瘤抑制机制也可能导致与衰老相关的组织退化和功能下降。研究肿瘤抑制过程的进化及其对以后生活的影响之间的权衡可能为衰老过程提供重要的见解。
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引用次数: 0
A viral wakeup call 病毒式的警钟
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-08-21 DOI: 10.1038/s41568-025-00871-2
Gabrielle Brewer
Chia, Johnson et al. outline a mechanism for how pulmonary viral infections can awaken dormant disseminated cancer cells to enhance metastatic burden.
Chia, Johnson等人概述了肺部病毒感染如何唤醒休眠的播散性癌细胞以增加转移负担的机制。
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引用次数: 0
Targeting the roots of myeloid malignancies with T cell receptors 用T细胞受体靶向髓系恶性肿瘤的根源
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-08-21 DOI: 10.1038/s41568-025-00857-0
Zsofia Foldvari, Margs S. Brennan, Aleksei Titov, Sten Eirik W. Jacobsen, Johanna Olweus
Myeloid malignancies are clonal diseases of haematopoietic stem cell or haematopoietic progenitor cell origin, for which allogeneic haematopoietic stem cell transplantation remains the only curative treatment for most patients. However, the severe side effects and high relapse rates underscore the need for novel therapies. The success of adoptive transfer of chimeric antigen receptor (CAR) T cells targeting B cell-specific cell surface molecules in B cell cancers has not been replicated in myeloid malignancies. T cells engineered to express cancer-directed T cell receptors (TCRs) could provide an alternative, enabling targeting also of the intracellular proteome. In this Perspective, we have collated and reviewed available data from clinical trials exploiting TCR-engineered T cells for the treatment of haematological malignancies and discuss specific characteristics that make myeloid malignancies attractive candidates for TCR-based therapies. We also highlight the need to efficiently target the rare and notoriously therapy-resistant leukaemic stem cells, which represent the roots of myeloid malignancies, to achieve cures. This will require identification of novel targets and TCRs, and we discuss different target categories and strategies that can be applied towards this goal. We also highlight the importance of standardized preclinical testing and publicly available data to enable rapid identification and clinical advancement of promising TCRs towards clinical application. Allogeneic haematopoietic stem cell transplantation remains the cornerstone of curative treatment for advanced myeloid malignancies. In this Perspective, Foldvari et al. propose that T cells engineered to express tumour-reactive T cell receptors (TCRs) may offer a safer and more effective alternative. They outline key considerations for identifying and validating suitable target antigens and matching TCRs, and for advancing these therapies towards clinical application.
髓系恶性肿瘤是源自造血干细胞或造血祖细胞的克隆性疾病,同种异体造血干细胞移植仍然是大多数患者唯一的治疗方法。然而,严重的副作用和高复发率强调了对新疗法的需求。靶向B细胞特异性细胞表面分子的嵌合抗原受体(CAR) T细胞过继转移在B细胞癌中的成功尚未在髓系恶性肿瘤中复制。T细胞工程表达癌症定向T细胞受体(TCRs)可以提供另一种选择,也可以靶向细胞内蛋白质组。从这个角度来看,我们整理和回顾了利用tcr工程T细胞治疗血液系统恶性肿瘤的临床试验的现有数据,并讨论了使髓系恶性肿瘤具有tcr基础治疗吸引力的具体特征。我们还强调需要有效地靶向罕见且众所周知的治疗耐药白血病干细胞,它们代表髓系恶性肿瘤的根源,以实现治愈。这将需要确定新的靶点和tcr,我们将讨论可用于实现这一目标的不同靶点类别和策略。我们还强调了标准化临床前测试和公开可用数据的重要性,以便快速识别和临床推进有希望的tcr临床应用。
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引用次数: 0
Ageing, immune fitness and cancer 衰老,免疫健康和癌症
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-08-14 DOI: 10.1038/s41568-025-00858-z
Melissa Dolan, Kendra A. Libby, Alison E. Ringel, Peter van Galen, Sandra S. McAllister
The immune system undergoes substantial changes throughout life, with ageing broadly impacting immune cell composition, function and regenerative capacity. Emerging evidence suggests that age-associated changes in immune fitness — the ability to respond to and eliminate infection, pathogens and malignancy while maintaining self-tolerance — reshape antitumour immunity and influence the efficacy of immunotherapies. Technological advances in high-dimensional immunoprofiling have begun to reveal the complex interplay between ageing, immune fitness and cancer biology, uncovering new therapeutic vulnerabilities and challenges. In this Review, we discuss recent insights derived from age-resolved immunoprofiling of the human tumour microenvironment, how ageing haematopoiesis affects immune cells that contribute to the microenvironment and impact cancer progression, and what is known from preclinical modelling about the functional consequences of immune ageing on tumour control. We further highlight emerging age-stratified analyses of treatment responses, which are beginning to inform hypotheses about how ageing shapes immunotherapy outcomes. Together, these perspectives provide a framework for integrating age as a critical biological variable, underscore the need to consider age in both preclinical models and clinical trial design, and identify key challenges and priorities for the field moving forward. Ageing reshapes immune composition, function and regenerative capacity, with profound effects on tumour immunity, cancer progression and treatment outcomes. In this Review, Dolan and colleagues examine how age-resolved immunoprofiling, insights from ageing haematopoiesis and preclinical modelling are uncovering immune ageing dynamics and therapeutic challenges — revealing new opportunities to optimize cancer therapy across diverse age groups.
免疫系统在整个生命过程中都会发生重大变化,衰老会广泛影响免疫细胞的组成、功能和再生能力。新出现的证据表明,与年龄相关的免疫适应性变化——在保持自身耐受性的同时对感染、病原体和恶性肿瘤作出反应和消除的能力——重塑了抗肿瘤免疫并影响免疫疗法的疗效。高维免疫图谱的技术进步已经开始揭示衰老、免疫适应性和癌症生物学之间复杂的相互作用,揭示新的治疗脆弱性和挑战。在这篇综述中,我们讨论了来自人类肿瘤微环境的年龄分解免疫谱的最新见解,衰老造血如何影响有助于微环境和影响癌症进展的免疫细胞,以及免疫衰老对肿瘤控制的功能后果的临床前建模。我们进一步强调了新出现的治疗反应的年龄分层分析,这开始为衰老如何影响免疫治疗结果的假设提供信息。总之,这些观点为将年龄作为一个关键的生物学变量提供了一个框架,强调了在临床前模型和临床试验设计中考虑年龄的必要性,并确定了该领域向前发展的关键挑战和优先事项。
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引用次数: 0
No climate havens: the expanding threat of climate change to cancer care 没有气候避风港:气候变化对癌症治疗的威胁日益扩大
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-08-14 DOI: 10.1038/s41568-025-00867-y
Leticia M. Nogueira, Renee N. Salas
Recent extreme weather events reached communities previously thought to be safe from climate hazards, illustrating the inescapability of climate change. These events increasingly threaten every aspect of cancer control, by disrupting cancer prevention, early detection, treatment, survivorship care and research efforts. The oncology community urgently needs to prioritize solution-focused adaptation and mitigation actions. Recent extreme weather events have impacted communities once considered safe from climate hazards, posing growing challenges to cancer control efforts. Here, Nogueira and Salas argue that the oncology community urgently needs to prioritize solution-focused adaptation and mitigation actions.
最近的极端天气事件袭击了以前被认为不受气候危害的社区,说明气候变化是不可避免的。这些事件通过破坏癌症预防、早期发现、治疗、幸存者护理和研究工作,日益威胁到癌症控制的各个方面。肿瘤学界迫切需要优先考虑以解决方案为重点的适应和缓解行动。最近的极端天气事件影响了曾经被认为不受气候危害影响的社区,给癌症控制工作带来了越来越大的挑战。在这里,Nogueira和Salas认为肿瘤学界迫切需要优先考虑以解决方案为重点的适应和减缓行动。
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引用次数: 0
The overlooked global reach of wildfire smoke: beyond local health and cancer risk 野火烟雾被忽视的全球影响:超越当地健康和癌症风险
IF 66.8 1区 医学 Q1 ONCOLOGY Pub Date : 2025-08-11 DOI: 10.1038/s41568-025-00865-0
Howard Lopes Ribeiro Junior, Júlio César Claudino dos Santos
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引用次数: 0
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Nature Reviews Cancer
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