创新链/学科链/研发链/产业链

新药研发前沿动态 / 医药领域趋势进展

陈鹏, 陈小平. 急性髓系白血病治疗药物的药物基因组学研究进展[J]. 药学进展, 2018, 42(4): 259-268.
引用本文: 陈鹏, 陈小平. 急性髓系白血病治疗药物的药物基因组学研究进展[J]. 药学进展, 2018, 42(4): 259-268.
CHEN Peng, CHEN Xiaoping. Research Progress in the Pharmacogenomics of Agents for Treatment of Acute Myeloid Leukemia[J]. Progress in Pharmaceutical Sciences, 2018, 42(4): 259-268.
Citation: CHEN Peng, CHEN Xiaoping. Research Progress in the Pharmacogenomics of Agents for Treatment of Acute Myeloid Leukemia[J]. Progress in Pharmaceutical Sciences, 2018, 42(4): 259-268.

急性髓系白血病治疗药物的药物基因组学研究进展

Research Progress in the Pharmacogenomics of Agents for Treatment of Acute Myeloid Leukemia

  • 摘要: 急性髓系白血病(acute myeloid leukemia,AML)是成人最常见的急性白血病,具有恶性程度高、预后差的特点。阿糖胞苷(cytarabine,Ara-C)联合蒽环类药物化疗是目前治疗AML最主要的手段,诱导治疗后仍有20%~40%的患者不能达到完全缓解,多数患者会发生原发或获得性耐药。国内外学者已在AML治疗药物的药物基因组学方面开展了系列研究,涉及药物代谢、转运和作用靶点基因的遗传变异与AML化疗疗效和预后,并在机制上进行了探讨。随着基因测序技术的发展及其应用,临床研究发现FLT3TP53PML-RARα等基因的体细胞突变与AML的发生和预后密切相关,针对PML-RARα融合基因的靶向药物三氧化二砷已广泛应用于M3型AML的治疗并取得了理想的疗效,以FLT3为靶点的AML靶向治疗药物的研发如火如荼,其中米哚妥林和gilteritinib已被美国FDA批准为FLT3突变阳性AML患者的治疗药物。从药物代谢与转运、作用靶点相关的遗传变异、体细胞突变3个方面对AML治疗药物的药物基因组学研究进展进行综述,以期为AML个体化治疗提供更多依据。

     

    Abstract: Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults, which is characterized by aggressive biology and poor prognosis.The combined chemotherapy of Ara-C and anthracyclines is the most important treatment regimen for AML.However, 20%-40% of patients failed to achieve complete response after the induction chemotherapy, with primary or acquired drug resistance occurring in most of the patients.Researchers at home and abroad have carried out a series of pharmacogenomics studies on AML, focusing on the influence of genetic mutations in drug metabolism enzymes, drug transporters and drug targets on the efficacy of chemotherapy and prognosis of the disease.With the development and application of sequencing technology, clinical studies have shown that somatic mutations such as those in FLT3, TP53, and PML-RARα are associated with the pathogenesis and prognosis of AML.As a targeted therapy against PML-RARα fusion gene, As2O3 has been widely used for the treatment of M3 subtype of AML with satisfied efficacy.New drugs targeting FLT3 have been under intensive investigation, among which midostaurin and gilteritinib have been approved by FDA for the treatment of FLT3 mutation-positive AML patients.In this paper, the advancement in pharmacogenomics of agents for treatment of AML was reviewed from the aspects of mutations in drug transporters and metabolizers, mutations in molecular targets and AML somatic mutations, so as to provide more information for the AML individualized therapy.

     

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