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Radium-223 mechanism of action: implications for use in treatment combinations

机译:镭-223行动机制:用于治疗组合的影响

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The targeted alpha therapy radium-223 (Ra-223) can prolong survival in men with castration-resistant prostate cancer (CRPC) who have symptomatic bone metastases and no known visceral metastases. Preclinical studies demonstrate that Ra-223 preferentially incorporates into newly formed bone matrix within osteoblastic metastatic lesions. The emitted high-energy alpha particles induce DNA double-strand breaks that might be irreparable and lead to cell death in nearby exposed tumour cells, osteoblasts and osteoclasts. Consequently, tumour growth and abnormal bone formation are inhibited by these direct effects and by the disruption of positive-feedback loops between tumour cells and the bone microenvironment. Ra-223 might also modulate immune responses within the bone. The clinical utility of Ra-223 has encouraged the development of other anticancer targeted alpha therapies. A thorough understanding of the mechanism of action could inform the design of new combinatorial treatment strategies that might be more efficacious than monotherapy. On the basis of the current mechanistic knowledge and potential clinical benefits, combination therapies of Ra-223 with microtubule-stabilizing cytotoxic drugs and agents targeting the androgen receptor axis, immune checkpoint receptors or DNA damage response proteins are being explored in patients with CRPC and metastatic bone disease.
机译:靶向α治疗镭-223(RA-223)可以延长具有抗痉挛的前列腺癌(CRPC)的男性中生存,患有症状性骨转移和未知的内脏转移。临床前研究表明,RA-223优选地将新成形的骨基质纳入骨细胞囊性转移性病变中。发出的高能α颗粒诱导DNA双链断裂,这可能是无法弥补的,并且在附近暴露的肿瘤细胞,成骨细胞和骨壳细胞中导致细胞死亡。因此,这些直接效应抑制了肿瘤生长和异常骨形成,并通过肿瘤细胞与骨微环境之间的正反馈环中断。 RA-223也可能调节骨内的免疫应答。 RA-223的临床效用鼓励了其他抗癌目标α疗法的发展。彻底了解行动机制可以为新的组合治疗策略设计,这些策略可能比单一疗法更有效。在目前的机械知识和潜在的临床效益的基础上,在CRPC和转移性的患者中探讨了靶向雄激素受体轴,免疫检查点受体或DNA损伤蛋白质的微管稳定细胞毒性药物和药剂的联合疗法。骨病。

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