Cyclin-Dependent Kinase Inhibitor Proteins

细胞周期蛋白依赖性激酶抑制蛋白
  • 文章类型: Journal Article
    细胞周期蛋白依赖性激酶抑制剂3(CDKN3)基因,在肾细胞癌(RCC)中过度表达。然而,RCC的细胞生物学功能尚不清楚。本研究旨在通过体外实验验证CDKN3促进RCC增殖和迁移的能力。随后,使用癌症基因组图谱(TCGA;https://www.cancer.gov/)和基因表达综合(GEO;https://www.ncbi.nlm.nih.gov/geo/)。螯合剂,二-2-吡啶基酮4,4-二甲基-3-氨基硫脲(Dp44mT),抗肿瘤剂的类似物,通过生物信息学分析进行筛选。CDKN3的表达与Dp44mT的IC50呈正相关。在两个RCC细胞系中,786-0和Caki-1,我们通过转染质粒进行了CDKN3的小干扰RNA(siRNA)敲低和CDKN3的过表达。随后,我们使用Dp44mT来检查细胞增殖的结果变化,迁移,和细胞凋亡,从而阐明CDKN3和Dp44mT在这些过程中的作用。实验结果表明,CDKN3表达与RCC细胞系的增殖之间存在正相关。下调CDKN3可显著提高786-0和Caki-1细胞的凋亡率并抑制细胞迁移。此外,生物信息学分析显示CDKN3在RCC中高表达,CDKN3表达与生存之间呈负相关。基因集富集分析(GSEA)揭示了高CDKN3表达与细胞周期途径之间的显着关联。此外,我们通过数据库确定Dp44mT是与CDKN3高度相关的药物.随后添加Dp44mT导致与在CDKN3敲低时观察到的相似的发现。我们的发现对RCC中CDKN3的诊断和治疗具有重要意义。此外,Dp44mT可能是未来临床应用的有希望的候选者。
    The cyclin-dependent kinase inhibitor 3 (CDKN3) gene, is over expressed in renal cell carcinoma (RCC). However, the cell biology functions of RCC are not well understood. The present study aimed to verify the ability of CDKN3 to promote the proliferation and migration of RCC through in vitro experiments. Subsequently, the clinical prognostic effects were analyzed using The Cancer Genome Atlas (TCGA; https://www.cancer.gov/) and Gene Expression Omnibus (GEO; https://www.ncbi.nlm.nih.gov/geo/). The chelators, di-2-pyridylketone 4,4-dimethyl-3-thiosemicarbazone (Dp44mT), an analogue of the anti-tumor agent, were screened through bioinformatics analysis. The expression of CDKN3 is positively correlated with the IC50 of Dp44mT. In two RCC cell lines, 786-0 and Caki-1, we conducted small interfering RNA (siRNA) knockdown of CDKN3 and overexpression of CDKN3 by transfection plasmid. Subsequently, we administered Dp44mT to examine the resulting alterations in cell proliferation, migration, and apoptosis, thereby elucidating the role of CDKN3 and Dp44mT in these processes. The results of the experiment revealed a positive association between CDKN3 expression and the proliferation of RCC cell lines. Down-regulating CDKN3 significantly increased the apoptosis rate and inhibited cell migration in 786-0 and Caki-1 cells. Furthermore, bioinformatics analysis revealed a high expression of CDKN3 in RCC and a negative association between CDKN3 expression and survival. Gene set enrichment analysis (GSEA) revealed a significant association between high CDKN3 expression and the cell cycle pathway. Furthermore, we identified Dp44mT as a drug highly correlated with CDKN3 through the database. Subsequent addition of Dp44mT resulted in similar findings to those observed upon CDKN3 knockdown. Our findings have important implications for the diagnosis and treatment of CDKN3 in RCC. Additionally, Dp44mT is likely to be a promising candidate for future clinical applications.
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  • 文章类型: Journal Article
    子宫内膜癌是女性生殖系统常见的恶性肿瘤。环状RNA(circularRNAs)和N6-甲基腺苷(m6A)修饰广泛参与癌症进展。然而,circ-NAB1和m6A之间的串扰以及circ-NAB1在EC中的生物学功能仍不清楚.通过RT-qPCR观察到Circ-NAB1在EC组织和细胞中上调。MeRIP和RNA下拉测定用于检测circ-NAB1的m6A修饰。还检测了circ-NAB1与RNA之间的相互作用。殖民地的形成,transwell,流式细胞术,和蛋白质印迹用于测量EC细胞行为。机械上,我们证明了m6A去甲基酶烷基化修复同源蛋白5(ALKBH5)可以通过m6A-YTHDF2依赖性方式介导circ-NAB1的表达。Circ-NAB1过表达可促进细胞增殖,迁移,入侵,上皮-间质转化(EMT)过程,和细胞周期通过功能测定。Circ-NAB1敲低对EC细胞发挥相反的功能。此外,我们证明circ-NAB1可以海绵miR-876-3p上调EC细胞中的靶基因细胞周期蛋白依赖性激酶抑制剂3(CDKN3).CDKN3过表达可以逆转circ-NAB1耗竭对EC细胞行为的影响。总的来说,我们证明ALKBH5介导的circ-NAB1的m6A修饰通过靶向miR-876-3p/CDKN3轴促进EC的EMT过程和细胞周期。
    Endometrial cancer (EC) is a common malignant tumor in the female reproductive system. Circular RNAs (circRNAs) and N6-methyladenosine (m6A) modification are widely involved in cancer progression. Nevertheless, the cross-talk between circ-NAB1 and m6A as well as the biological functions of circ-NAB1 in EC remain unclear. Circ-NAB1 was observed to be upregulated in EC tissues and cells by RT-qPCR. MeRIP and RNA pull-down assays were utilized for detecting the m6A modification of circ-NAB1. The interaction between circ-NAB1 and RNAs was also detected. Colony formation, transwell, flow cytometry, and western blot were utilized for measuring EC cell behaviors. Mechanically, we proved the m6A demethylase alkylation repair homolog protein 5 (ALKBH5) can mediate circ-NAB1 expression through an m6A-YTHDF2-dependent manner. Circ-NAB1 overexpression can promote cell proliferation, migration, invasion, epithelial-mesenchymal transition (EMT) process, and cell cycle through functional assays. Circ-NAB1 knockdown exerts the opposite function on EC cells. Furthermore, we proved that circ-NAB1 can sponge miR-876-3p to upregulate the target gene cyclin-dependent kinase inhibitor 3 (CDKN3) in EC cells. CDKN3 overexpression can reverse the impacts of circ-NAB1 depletion on EC cell behaviors. Collectively, we proved that ALKBH5-mediated m6A modification of circ-NAB1 promoted EMT process and cell cycle in EC via targeting the miR-876-3p/CDKN3 axis.
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  • 文章类型: Journal Article
    背景:细胞周期蛋白依赖性激酶抑制剂蛋白3(CDKN3),作为蛋白激酶家族的一员,已被证明在几种肿瘤中表现出致癌特性。然而,没有对CDKN3的泛致癌分析。
    方法:使用生物信息学工具,如癌症基因组图谱(TCGA)和UCSCXena数据库,对CDKN3进行了全面的泛癌症分析.倒置包括对33种不同类型肿瘤的CDKN3功能的检查,以及基因表达的探索,生存预后状态,临床意义,DNA甲基化,免疫浸润,和相关的信号通路。
    结果:CDKN3在大多数肿瘤中显著上调,并与患者的总生存期(OS)相关。CDKN3的甲基化水平在肿瘤和正常组织之间显著不同。此外,CD4+T细胞浸润,癌症相关成纤维细胞,巨噬细胞,内皮细胞与CDKN3表达相关。机械上,CDKN3与P53、PI3K-AKT、细胞周期检查点,有丝分裂纺锤体检查点,和染色体维持。
    结论:我们在研究中进行的泛癌症分析提供了对CDKN3基因在肿瘤发生中的参与的全面理解。研究结果表明,靶向CDKN3可能会导致治疗肿瘤的新治疗策略。
    BACKGROUND: Cell cycle protein-dependent kinase inhibitor protein 3 (CDKN3), as a member of the protein kinase family, has been demonstrated to exhibit oncogenic properties in several tumors. However, there are no pan-carcinogenic analyses for CDKN3.
    METHODS: Using bioinformatics tools such as The Cancer Genome Atlas (TCGA) and the UCSC Xena database, a comprehensive pan-cancer analysis of CDKN3 was conducted. The inverstigation encompassed the examination of CDKN3 function actoss 33 different kinds of tumors, as well as the exploration of gene expressions, survival prognosis status, clinical significance, DNA methylation, immune infiltration, and associated signal pathways.
    RESULTS: CDKN3 was significantly upregulated in most of tumors and correlated with overall survival (OS) of patients. Methylation levels of CDKN3 differed significantly between tumors and normal tissues. In addition, infiltration of CD4 + T cells, cancer-associated fibroblasts, macrophages, and endothelial cells were associated with CDKN3 expression in various tumors. Mechanistically, CDKN3 was associated with P53, PI3K-AKT, cell cycle checkpoints, mitotic spindle checkpoint, and chromosome maintenance.
    CONCLUSIONS: Our pan-cancer analysis conducted in the study provides a comprehensive understanding of the involvement of CDKN3 gene in tumorigenesis. The findings suggest that targeting CDKN3 may potentially lead to novel therapeutic strategies for the treatment of tumors.
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  • 文章类型: Journal Article
    作为植物特异性内复制调节因子,SIMESE相关(SMR)家族(细胞周期蛋白依赖性激酶抑制剂)在植物的生长发育和抗逆性中起着重要作用。尽管玉米(Zeamays)SMR家族的基因已被广泛研究,ZmSMR10(Zm00001eb231280)基因尚未见报道。在这项研究中,该基因的功能特征是过表达和沉默。与对照相比,转基因植物表现出早期成熟的表型,矮人,和抗旱。该蛋白在原核生物中的表达表明ZmSMR10是一种小蛋白,亚细胞定位的结果表明,它在细胞核中功能性传播。与ZmSMR4不同,酵母双杂交实验表明ZmSMR10与某些细胞周期蛋白依赖性蛋白激酶(CDK)家族成员ZmCDKA;1/ZmCDKA;3/ZmCDKB1;1没有强烈相互作用。相反,它与ZmPCNA2和ZmCSN5B强烈相互作用。基于这些结果,我们得出结论,ZmSMR10通过ZmPCNA2和ZmCSN5B的相互作用参与了内复制的调节。这些发现为理解内源复制的调控机制和利用分子技术提高玉米产量提供了理论依据。
    As a plant-specific endoreplication regulator, the SIAMESE-RELATED (SMR) family (a cyclin-dependent kinase inhibitor) plays an important role in plant growth and development and resistance to stress. Although the genes of the maize (Zea mays) SMR family have been studied extensively, the ZmSMR10 (Zm00001eb231280) gene has not been reported. In this study, the function of this gene was characterized by overexpression and silencing. Compared with the control, the transgenic plants exhibited the phenotypes of early maturation, dwarfing, and drought resistance. Expression of the protein in prokaryotes demonstrates that ZmSMR10 is a small protein, and the results of subcellular localization suggest that it travels functionally in the nucleus. Unlike ZmSMR4, yeast two-hybrid experiments demonstrated that ZmSMR10 does not interact strongly with with some cell cycle protein-dependent protein kinase (CDK) family members ZmCDKA;1/ZmCDKA;3/ZmCDKB1;1. Instead, it interacts strongly with ZmPCNA2 and ZmCSN5B. Based on these results, we concluded that ZmSMR10 is involved in the regulation of endoreplication through the interaction of ZmPCNA2 and ZmCSN5B. These findings provide a theoretical basis to understand the mechanism of the regulation of endoreplication and improve the yield of maize through the use of molecular techniques.
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  • 文章类型: Case Reports
    背景:最近出现的细胞周期蛋白依赖性激酶(CDK)4/6抑制剂极大地发展了激素受体(HR)阳性/人表皮生长因子受体2(HER2)阴性的转移性乳腺癌治疗。Palbociclib,口服吡啶嘧啶衍生物,是第一个被引入日常临床实践的CDK4/6抑制剂与经典的内分泌骨干,基于关键的PALOMA系列随机临床试验中评估的无进展生存期(PFS)获益。关于它的安全性,中性粒细胞减少和白细胞减少是最常见和明确的不良反应,而心脏并发症相当罕见。
    方法:我们介绍了一例罕见的中年女性患者HR+/HER2-转移性乳腺癌,没有事先接触过心脏毒性抗肿瘤药物,他在palbociclib联合来曲唑的全身治疗中发展了Takotsubo心肌病(TTC)。
    结论:药物警戒和实验研究是必要的,以确认任何因果关系和探索潜在的病理生理学,分别。
    BACKGROUND: The recent advent of the cyclin-dependent kinase (CDK) 4/6 inhibitors has considerably evolved hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer treatment. Palbociclib, an orally administered pyridopyrimidine derivative, was the first CDK4/6 inhibitor to be introduced into daily clinical practice in combination with classic endocrine backbone, based on progression-free survival (PFS) benefit assessed in the pivotal PALOMA series of randomized clinical trials. Regarding its safety profile, neutropenia and leukopenia are the most common and well-defined adverse effects, while cardiac complications are rather scarce.
    METHODS: We present the rare case of a middle-aged female patient with HR+/HER2- metastatic breast cancer, without prior exposure to cardiotoxic antineoplastic agents, who developed Takotsubo cardiomyopathy (TTC) in the context of systemic therapy with palbociclib plus letrozole combination.
    CONCLUSIONS: Pharmacovigilance and experimental studies are warranted to confirm any causative relationship and to explore the underlying pathophysiology, respectively.
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  • 文章类型: Journal Article
    CDK4/6抑制剂(CDK4/6i)改善了雌激素受体阳性(ER)乳腺癌患者的生存率。然而,接受CDK4/6i治疗的患者最终会出现耐药性和进展。RB1功能丧失改变赋予CDK4/6i抗性,但这些患者的最佳治疗方法尚不清楚.通过全基因组CRISPR筛选,我们将蛋白质精氨酸甲基转移酶5(PRMT5)鉴定为ER+/RB1基因敲除乳腺癌细胞中的分子脆弱性.抑制PRMT5阻断细胞周期中G1到S的转变,而不依赖于RB,导致RB1敲除细胞的生长停滞。蛋白质组学分析揭示了在肉瘤(FUS)中融合为PRMT5的下游效应物。抑制PRMT5导致FUS从RNA聚合酶II中解离,导致RNA聚合酶II中丝氨酸2的过度磷酸化,内含子保留,以及随后参与DNA合成的蛋白质的下调。此外,用PRMT5抑制剂pemrametostat和选择性ER降解剂氟维司群协同抑制ER+/RB缺陷的细胞来源和患者来源的异种移植物的生长。这些发现强调了ER和PRMT5双重阻断作为克服ER+/RB缺陷型乳腺癌中CDK4/6i抗性的潜在治疗策略。
    CDK4/6 inhibitors (CDK4/6i) have improved survival of patients with estrogen receptor-positive (ER+) breast cancer. However, patients treated with CDK4/6i eventually develop drug resistance and progress. RB1 loss-of-function alterations confer resistance to CDK4/6i, but the optimal therapy for these patients is unclear. Through a genome-wide CRISPR screen, we identify protein arginine methyltransferase 5 (PRMT5) as a molecular vulnerability in ER+/RB1-knockout breast cancer cells. Inhibition of PRMT5 blocks the G1-to-S transition in the cell cycle independent of RB, leading to growth arrest in RB1-knockout cells. Proteomics analysis uncovers fused in sarcoma (FUS) as a downstream effector of PRMT5. Inhibition of PRMT5 results in dissociation of FUS from RNA polymerase II, leading to hyperphosphorylation of serine 2 in RNA polymerase II, intron retention, and subsequent downregulation of proteins involved in DNA synthesis. Furthermore, treatment with the PRMT5 inhibitor pemrametostat and a selective ER degrader fulvestrant synergistically inhibits growth of ER+/RB-deficient cell-derived and patient-derived xenografts. These findings highlight dual ER and PRMT5 blockade as a potential therapeutic strategy to overcome resistance to CDK4/6i in ER+/RB-deficient breast cancer.
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  • 文章类型: Journal Article
    CDK4/6抑制剂(CDK4/6i)在某些人类恶性肿瘤中显示出抗癌活性,比如乳腺癌。然而,它们在其他肿瘤类型和固有耐药机制中的应用仍不清楚.这里,我们证明MYC扩增在膀胱中赋予对CDK4/6i的抗性,前列腺癌和乳腺癌细胞。机械上,MYC结合E3泛素连接酶KLHL42的启动子并增强其转录,通过诱导磷酸化和总pRB1泛素化和降解导致RB1缺乏。我们发现了一种能降解MYC的化合物,A80.2HCl,在纳摩尔浓度下诱导MYC降解,恢复pRB1蛋白水平并重新建立MYC高表达癌细胞对CDK4/6i的敏感性。CDK4/6i和A80.2HCl的组合导致体内肿瘤生长的显著消退。总之,这些结果揭示了MYC诱导对CDK4/6i耐药的分子机制,并提示利用MYC降解分子A80.2HCl来增强CDK4/6i的疗效.
    CDK4/6 inhibitors (CDK4/6i) show anticancer activity in certain human malignancies, such as breast cancer. However, their application to other tumor types and intrinsic resistance mechanisms are still unclear. Here, we demonstrate that MYC amplification confers resistance to CDK4/6i in bladder, prostate and breast cancer cells. Mechanistically, MYC binds to the promoter of the E3 ubiquitin ligase KLHL42 and enhances its transcription, leading to RB1 deficiency by inducing both phosphorylated and total pRB1 ubiquitination and degradation. We identify a compound that degrades MYC, A80.2HCl, which induces MYC degradation at nanomolar concentrations, restores pRB1 protein levels and re-establish sensitivity of MYC high-expressing cancer cells to CDK4/6i. The combination of CDK4/6i and A80.2HCl result in marked regression in tumor growth in vivo. Altogether, these results reveal the molecular mechanisms underlying MYC-induced resistance to CDK4/6i and suggest the utilization of the MYC degrading molecule A80.2HCl to potentiate the therapeutic efficacy of CDK4/6i.
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  • 文章类型: Journal Article
    目的:慢性淋巴细胞白血病是一种进展缓慢的疾病,其症状往往在发病数年后才显现。在高级阶段,感染和出血很常见。过去的研究表明,CDK4/6抑制剂与化疗药物之间的相互作用可以增强药物的抗肿瘤功效并限制毒性。因此,在这项研究中,体外研究了CDK4/6抑制剂LEE011与化疗药物苯达莫司汀或羟基脲的联合治疗效果。
    方法:用LEE011联合羟基脲或苯达莫司汀治疗小鼠淋巴细胞白血病细胞系L1210。进行蛋白质印迹和流式细胞术以阐明肿瘤抑制背后的机制。
    结果:LEE011联合羟基脲或苯达莫司汀以浓度和时间依赖性方式显著抑制L1210细胞系的增殖,并增加细胞在G1和S期的停滞。LEE011与羟基脲的组合还减少Rb的磷酸化,同时增加总Rb蛋白的表达。此外,GPX4的表达降低,GPX4是铁死亡的关键蛋白,表明该药物组合的肿瘤抑制作用可能涉及铁凋亡。
    结论:CDK4/6抑制剂LEE011单独治疗可能不是淋巴细胞白血病的合适治疗选择;然而,我们的研究结果在体外支持LEE011与化疗药物联合使用可增强淋巴细胞白血病的抗肿瘤活性.
    OBJECTIVE: Chronic lymphocytic leukemia is a slowly-progressing disease in which symptoms often do not manifest until years after disease onset. In advanced stages, infection and bleeding are common. Past studies have shown that the interaction between CDK4/6 inhibitors and chemotherapy drugs can enhance the anti-tumor efficacy of drugs and limit toxicity. Therefore, in this study, the treatment effects of combining the CDK4/6 inhibitor LEE011 with chemotherapy drugs bendamustine or hydroxyurea were investigated in vitro.
    METHODS: The mouse lymphocytic leukemia cell line L1210 was treated with LEE011 combined with hydroxyurea or bendamustine. Western blot and flow cytometry were performed to elucidate the mechanisms behind tumor suppression.
    RESULTS: LEE011 combined with hydroxyurea or bendamustine significantly inhibited proliferation of L1210 cell lines in a concentration- and time-dependent manner as well as increased the arrest of cells in G1 and S phases. The combination of LEE011 with hydroxyurea also reduced the phosphorylation of Rb while increased the expression of total Rb protein. Furthermore, reduced expression of GPX4, which is a key protein in ferroptosis, indicates that the tumor suppression effects of this drug combination could involve ferroptosis.
    CONCLUSIONS: CDK4/6 inhibitor LEE011 treatment alone may not be a suitable treatment option for lymphocytic leukemia; however, our findings in vitro support the combination of LEE011 with chemotherapy drugs to enhance anti-tumor activity in lymphocytic leukemia.
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  • 文章类型: Journal Article
    细胞周期是一个高度调节的过程,其中参与细胞周期进程的蛋白质表现出周期性的表达模式,受特定机制如转录控制,翻译,和退化。然而,细胞周期调节因子中mRNA水平振荡的确切机制尚不完全清楚。在这项研究中,我们观察到细胞周期蛋白D1(CCND1)mRNA的稳定性在细胞周期中波动,在中间阶段稳定性增加,在M阶段稳定性降低。此外,我们确定了一个关键的RNA结合蛋白,正共激活剂4(PC4),在稳定CCND1mRNA和调节其周期性表达中起着至关重要的作用。此外,PC4与CCND1mRNA的结合亲和力受两种细胞周期特异性翻译后修饰的调节:K68的泛素化增强结合并在间期稳定CCND1转录本,而S17的磷酸化在M期抑制结合,导致CCND1mRNA降解。值得注意的是,PC4促进细胞周期从G1期过渡到S期,PC4的消耗增强了CDK4/6抑制剂在肝细胞癌中的疗效,表明PC4可以作为一个潜在的治疗靶点。这些发现为细胞周期动力学的复杂调节提供了有价值的见解。
    The cell cycle is a highly regulated process in which proteins involved in cell cycle progression exhibit periodic expression patterns, controlled by specific mechanisms such as transcription, translation, and degradation. However, the precise mechanisms underlying the oscillations of mRNA levels in cell cycle regulators are not fully understood. In this study, we observed that the stability of cyclin D1 (CCND1) mRNA fluctuates during the cell cycle, with increased stability during interphase and decreased stability during the M phase. Additionally, we identified a key RNA binding protein, positive coactivator 4 (PC4), which plays a crucial role in stabilizing CCND1 mRNA and regulating its periodic expression. Moreover, the binding affinity of PC4 to CCND1 mRNA is modulated by two cell cycle-specific posttranslational modifications: ubiquitination of K68 enhances binding and stabilizes the CCND1 transcript during interphase, while phosphorylation of S17 inhibits binding during the M phase, leading to degradation of CCND1 mRNA. Remarkably, PC4 promotes the transition from G1 to S phase in the cell cycle, and depletion of PC4 enhances the efficacy of CDK4/6 inhibitors in hepatocellular carcinoma, suggesting that PC4 could serve as a potential therapeutic target. These findings provide valuable insights into the intricate regulation of cell cycle dynamics.
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  • 文章类型: Journal Article
    abemaciclib的个别试验,palbociclib,和ribociclib对无进展生存期的影响相似,但对总生存期(OS)有不同的统计学意义.对操作系统进行稳健的比较评估,安全,这三种药物的耐受性是有保证的。一项系统的文献检索确定了3期随机临床试验,报告了CDK4/6抑制剂(CDK4/6i)联合内分泌治疗在ER阳性/HER2阴性晚期乳腺癌中的OS。提取每种药物的OS和常见和严重不良事件(AE)的试验级数据。在没有直接比较的情况下,进行了网络荟萃分析,以评估成对比较疗效,安全,和每个CDK4/6i的耐受性。由4415名患者组成的7项研究符合纳入标准。中位随访时间为73.3个月(范围:48.7-97.2个月)。任何CDK4/6i之间的OS没有统计学上的显著差异。与palbociclib相比,ribociclib和abemaciclib的胃肠道毒性均显著较高(分别为1-2级呕吐或1.87[95%CI1.37-2.56]和2.27[95%CI1.59-3.23]).与palbociclib相比,abemaciclib与更多的3-4级腹泻OR118.06相关[95%CI7.28-1915.32]。相比之下,与瑞博西尼和abemaciclib相比,palbociclib与中性粒细胞减少显著相关,但3-4级感染的风险显著降低.Abemaciclib的3-4级转氨酶和3-4级中性粒细胞减少明显少于ribociclib。与palbociclib和ribociclib相比,abemaciclib的治疗中止和因AE引起的死亡显着升高。尽管个别试验的统计学显著性水平不同,但CDK4/6i之间的OS没有统计学上的显著差异。现实世界的数据分析可能有助于确定药效是否存在有意义的药物间差异。对于安全性和耐受性结果,观察到CDK4/6i之间的显著差异。
    Individual trials of abemaciclib, palbociclib, and ribociclib show a similar impact on progression-free survival yet differing statistical significance for overall survival (OS). A robust comparative evaluation of OS, safety, and tolerability of the three drugs is warranted. A systematic literature search identified phase 3 randomized clinical trials reporting OS of CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy in ER-positive/HER2-negative advanced breast cancer. Trial-level data on OS and common and serious adverse events (AE) were extracted for each drug. In the absence of direct comparisons, a network meta-analysis was performed to evaluate pairwise comparative efficacy, safety, and tolerability of each of the CDK4/6i. Seven studies comprising of 4415 patients met the inclusion criteria. Median follow-up was 73.3 months (range: 48.7-97.2 months). There were no statistically significant differences in OS between any of the CDK4/6i. Compared to palbociclib, ribociclib and abemaciclib both showed significantly higher GI toxicity (grade 1-2 vomiting OR 1.87 [95% CI 1.37-2.56] and OR 2.27 [95% CI 1.59-3.23] respectively). Compared to palbociclib, abemaciclib was associated with more grade 3-4 diarrhea OR 118.06 [95% CI 7.28-1915.32]. In contrast, palbociclib was associated with significantly more neutropenia than ribociclib and abemaciclib but significantly lower risk of grade 3-4 infections. Abemaciclib had significantly less grade 3-4 transaminitis and grade 3-4 neutropenia than ribociclib. Treatment discontinuation and death due to AE were significantly higher with abemaciclib than palbociclib and ribociclib. There is no statistically significant difference in OS between CDK4/6i despite differing statistical significance levels of individual trials. Real-world data analyses may help to identify if there is a meaningful inter-drug difference in efficacy. Significant differences between CDK4/6i are observed for safety and tolerability outcomes.
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