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该综述探讨了分子靶向药物、免疫检查点抑制剂（ICIs）和抗体偶联物（ADCs）的作用机制、个体化治疗策略及临床进展。分子靶向药物通过针对肿瘤特定靶点抑制肿瘤生长，如吉非替尼和厄洛替尼在非小细胞肺癌（NSCLC）中对表皮生长因子受体（EGFR）突变患者有效，而外显子20插入突变则会导致耐药。ICIs通过解除免疫抑制激活免疫系统对肿瘤的攻击，但患者反应差异较大，需依赖生物标志物如程序性死亡受体1(PD-L1)表达筛选适应者。近年来，ICIs在黑色素瘤、NSCLC和肾癌治疗中取得显著成果，但联合疗法的安全性和有效性仍需进一步研究。ADCs结合单克隆抗体特异性和细胞毒性药物的优势，通过肿瘤抗原识别释放药物发挥作用。尽管2024年多项ADCs进展在美国癌症研究协会年会上展示，肿瘤耐药性和脱靶毒性仍是其临床应用的障碍。总体而言，新型抗肿瘤药物展现出巨大潜力，但面临耐药、成本和免疫不良反应等挑战。未来可聚焦肿瘤微环境与免疫细胞相互作用、精准药物递送系统及中药与靶向免疫治疗的协同策略，以克服耐药并提升治疗效果。
Abstract：This review explores the mechanisms, personalized treatment strategies, and clinical progress ofmolecular targeted drugs, immune checkpoint inhibitors(ICIs), and antibody-drug conjugates(ADCs). Molecular targeteddrugs inhibit tumor growth by targeting specific tumor markers, such as gefitinib and erlotinib, which are effective inpatients with epidermal growth factor receptor(EGFR) mutations in non-small cell lung cancer(NSCLC). However,exon 20 insertion mutations lead to resistance. ICIs activate the immune system to attack tumors by alleviating immunesuppression, but patient responses vary. Biomarkers like programmed death ligand-1(PD-L1) expression are needed toselect suitable patients. In recent years, ICIs have achieved significant results in melanoma, NSCLC, and renal cancertreatment, but the safety and efficacy of combination therapies still require further research. ADCs combine the specificityof monoclonal antibodies with the advantages of cytotoxic drugs, releasing drugs upon recognizing tumor antigens therebyexerting the therapeutic effects. Although many advancements in ADCs were presented at the 2024 American Associationfor Cancer Research Annual Meeting, tumor resistance and off-target toxicity remain obstacles to their clinical application.Overall, novel antineoplastic agents show great potential but face challenges such as resistance, cost, and immune-related adverse reactions. Future research may focus on tumor microenvironment and immune cell interactions, precisedrug delivery systems, and synergistic strategies involving traditional Chinese medicine and targeted immunotherapy to overcome resistance and enhance therapeutic efficacy.
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基本信息:
DOI：10.19577/j.1007-4406.2025.04.016
中图分类号:R979.1
引用信息:
[1]吴涵,姜德春.新型抗肿瘤药物的个体化治疗基础与临床研究新进展[J].中国临床药学杂志,2025,34(04):315-320.DOI:10.19577/j.1007-4406.2025.04.016.
2025-04-25
2025-04-25