CTLA-4

CTLA - 4
  • 文章类型: Journal Article
    癌症与较高的发病率和死亡率相关,并且是美国第二大死亡原因。Further,在一些国家,癌症已经超过心脏病成为死亡的主要原因。癌细胞逃避T细胞介导的细胞毒性损伤的分子机制的鉴定导致了癌症治疗中免疫疗法的现代时代。释放这些免疫制动的试剂已经显示出恢复功能失调的T细胞和消退各种癌症的活性。细胞毒性T淋巴细胞相关蛋白4(CTLA-4)和程序性死亡-1(PD-1)都在不受约束的细胞毒性T效应子功能上发挥生理制动作用。CTLA-4(CD152)是B7/CD28家族;它通过间接减少通过共刺激受体CD28的信号传导来介导免疫抑制。Ipilimumab是第一个也是唯一的FDA批准的CTLA-4抑制剂;PD-1是在T细胞上表达的抑制性跨膜蛋白,B细胞,自然杀伤细胞(NK),和髓系来源的抑制细胞(MDSC)。程序性死亡配体1(PD-L1)在多种组织类型的表面表达,包括许多肿瘤细胞和造血细胞。PD-L2更限于造血细胞。PD-1/PDL-1途径的阻断可以增强抗肿瘤T细胞反应性并促进对癌细胞的免疫控制。自2011年FDA批准ipilimumab(人IgG1k抗CTLA-4单克隆抗体)以来,又有6种免疫检查点抑制剂(ICI)被批准用于癌症治疗。PD-1抑制剂nivolumab,pembrolizumab,cemiplimab和PD-L1抑制剂阿替珠单抗,阿维鲁单抗,除了ipilimumab之外,durvalumab也在目前批准的药物名单中.在这篇综述论文中,我们讨论了每种免疫检查点抑制剂(ICI)的作用,导致FDA批准的具有里程碑意义的试验,以及国家综合癌症网络(NCCN)的证据强度,这被医学肿瘤学家和血液学家在日常实践中广泛使用。
    Cancer is associated with higher morbidity and mortality and is the second leading cause of death in the US. Further, in some nations, cancer has overtaken heart disease as the leading cause of mortality. Identification of molecular mechanisms by which cancerous cells evade T cell-mediated cytotoxic damage has led to the modern era of immunotherapy in cancer treatment. Agents that release these immune brakes have shown activity to recover dysfunctional T cells and regress various cancer. Both cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and Programmed Death-1 (PD-1) play their role as physiologic brakes on unrestrained cytotoxic T effector function. CTLA-4 (CD 152) is a B7/CD28 family; it mediates immunosuppression by indirectly diminishing signaling through the co-stimulatory receptor CD28. Ipilimumab is the first and only FDA-approved CTLA-4 inhibitor; PD-1 is an inhibitory transmembrane protein expressed on T cells, B cells, Natural Killer cells (NKs), and Myeloid-Derived Suppressor Cells (MDSCs). Programmed Death-Ligand 1 (PD-L1) is expressed on the surface of multiple tissue types, including many tumor cells and hematopoietic cells. PD-L2 is more restricted to hematopoietic cells. Blockade of the PD-1 /PDL-1 pathway can enhance anti-tumor T cell reactivity and promotes immune control over the cancerous cells. Since the FDA approval of ipilimumab (human IgG1 k anti-CTLA-4 monoclonal antibody) in 2011, six more immune checkpoint inhibitors (ICIs) have been approved for cancer therapy. PD-1 inhibitors nivolumab, pembrolizumab, cemiplimab and PD-L1 inhibitors atezolizumab, avelumab, and durvalumab are in the current list of the approved agents in addition to ipilimumab. In this review paper, we discuss the role of each immune checkpoint inhibitor (ICI), the landmark trials which led to their FDA approval, and the strength of the evidence per National Comprehensive Cancer Network (NCCN), which is broadly utilized by medical oncologists and hematologists in their daily practice.
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