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Nanotechnology in the development of small and large molecule tyrosine kinase inhibitors and immunotherapy for the treatment of HER2-positive breast cancer. 纳米技术在治疗 HER2 阳性乳腺癌的小分子和大分子酪氨酸激酶抑制剂和免疫疗法开发中的应用。
Pub Date : 2022-01-01 Epub Date: 2022-04-28
Victor Ejigah, Bharathi Mandala, Emmanuel O Akala

The HER2 receptor tyrosine kinase is a member of the epidermal growth factor receptor family which includes EGFR, HER3 and HER4. They are known to play critical roles in both normal development and cancer. A subset of breast cancers is associated with the HER2 gene, which is amplified and/or overexpressed in 20-25% of invasive breast cancers and is correlated with tumor resistance to chemotherapy, Metastatic Breast Cancer (MBC) and poor patient survival. The advent of receptor tyrosine kinase inhibitors has improved the prognosis of HER2-postive breast cancers; however, HER2+MBC invariably progresses (acquired resistance or de novo resistance). The monoclonal antibody-based drugs (large molecule TKIs) target the extracellular binding domain of HER2; while the small molecule TKIs act intracellularly to inhibit proliferation and survival signals. We reviewed the modes of action of the TKIs with a view to showing which of the TKIs could be combined in nanoparticles to benefit from the power of nanotechnology (reduced toxicity, improved solubility of hydrophobic drugs, long circulation half-lives, circumventing efflux pumps and preventing capture by the reticuloendothelial system (mononuclear phagocyte system). Nanotherapeutics also mediate the synchronization of the pharmacokinetics and biodistribution of multiple drugs incorporated in the nanoparticles. Novel TKIs that are currently under investigation with or without nanoparticle delivery are mentioned, and nano-based strategies to improve their delivery are suggested. Immunotherapies currently in clinical practice, clinical trials or at the preclinical stage are discussed. However, immunotherapy only works well in relatively small subsets of patients. Combining nanomedicine with immunotherapy can boost therapeutic outcomes, by turning "cold" non-immunoresponsive tumors and metastases into "hot" immunoresponsive lesions.

HER2 受体酪氨酸激酶是表皮生长因子受体家族(包括表皮生长因子受体、HER3 和 HER4)的成员。众所周知,它们在正常发育和癌症中都起着至关重要的作用。有一部分乳腺癌与 HER2 基因有关,在 20-25% 的浸润性乳腺癌中,HER2 基因被扩增和/或过表达,这与肿瘤对化疗的耐药性、转移性乳腺癌(MBC)和患者生存率低有关。受体酪氨酸激酶抑制剂的出现改善了 HER2 阳性乳腺癌的预后;然而,HER2+MBC 总是会发生进展(获得性耐药或新生耐药)。基于单克隆抗体的药物(大分子 TKIs)靶向 HER2 的细胞外结合域;而小分子 TKIs 则作用于细胞内,抑制增殖和生存信号。我们回顾了 TKIs 的作用模式,旨在说明哪些 TKIs 可与纳米颗粒相结合,从而受益于纳米技术的力量(降低毒性、提高疏水性药物的溶解度、延长循环半衰期、避开外排泵和防止被网状内皮系统(单核吞噬细胞系统)捕获)。纳米疗法还能使纳米颗粒中多种药物的药代动力学和生物分布同步进行。本文提到了目前正在研究的新型 TKIs,无论是否使用纳米颗粒给药,并提出了改进给药的纳米策略。还讨论了目前正在临床实践、临床试验或处于临床前阶段的免疫疗法。然而,免疫疗法只对相对较少的患者有效。将纳米药物与免疫疗法相结合,可将 "冷 "的非免疫反应性肿瘤和转移灶转变为 "热 "的免疫反应性病变,从而提高治疗效果。
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Journal of cancer & metastasis research
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