SGT-53

The prevalence of pancreatic cancer has been rising since the past few years, which prompts the growing demand for treatment options. The increasing prevalence of cancer, the robust pipeline, and the growing research and development activities to develop novel therapies to treat Pancreatic Cancer drive the market. The companies developing the potential therapies in the last stage of development include FibroGen, Eli Lilly and Company, CARsgen Therapeutics, and several others. LAS VEGAS, Jan. 2, 2023 /PRNewswire/ -- DelveInsight's ' Pancreatic Cancer Pipeline Insight – 2022 ' report provides comprehensive global coverage of available, marketed, and pipeline pancreatic cancer therapies in various stages of clinical development, major pharmaceutical companies are working to advance the pipeline space and future growth potential of the pancreatic cancer pipeline domain. Key Takeaways from the Pancreatic Cancer Pipeline Report DelveInsight's pancreatic cancer pipeline report depicts a robust space with 150+ active players working to develop 170+ pipeline therapies for pancreatic cancer treatment. Key pancreatic cancer companies such as FibroGen, Innovent Biologics, CARsgen Therapeutics, Ascentage Pharma, NGM Biopharmaceuticals, TME Pharma AG, Lee's Pharmaceutical Limited, ImmunityBio, Inc., Rgene Corporation, CSPC ZhongQi Pharmaceutical Technology Co., Ltd., CanBas Co. Ltd., Jiangsu HengRui Medicine Co., Ltd., Bristol-Myers Squibb, SynerGene Therapeutics, Inc., AbbVie, Silenseed Ltd, Galera Therapeutics, Inc., Helix BioPharma, Golden Biotechnology Corporation, Eli Lilly and Company, Innovent Biologics (Suzhou) Co. Ltd., Panbela Therapeutics, Inc., GlaxoSmithKline, Chia Tai Tianqing Pharmaceutical Group, Roche, Prestige Biopharma Limited, Everfront Biotech Co., Ltd., XBiotech, Inc., Incyte Corporation, Ability Pharmaceuticals SL, Lokon Pharma, HCW Biologics, Amplia Therapeutics Limited, BioLineRx, Ltd., Taiho Pharmaceutical, Sanofi, Scandion Oncology, Nelum, Celldex Therapeutics, Merus N.V., Seagen Inc., GC Cell Corporation, MetiMedi Pharmaceuticals, Lumicell, Nuvation Bio Inc., ENB Therapeutics, BioNTech SE, Bayer, Genentech, Inc., Rise Biopharmaceuticals, Inc., Prestige Biopharma Limited, iOnctura, Shanghai Unicar-Therapy Bio-medicine Technology, Shanghai Hengrui Pharmaceutical Co., Ltd., Hangzhou Neoantigen Therapeutics Co., Ltd., EUSA Pharma, Inc.,Agenus Inc., Arcus Biosciences, Inc.Amgen, Biomea Fusion, and others are evaluating pancreatic cancer drugs to improve the treatment landscape. Promising pancreatic cancer pipeline therapies in various stages of development include Pamrevlumab, Niraparib, CT041, APG-1387, BNT141, ENB003, NUV-868, MCLA-128, LUM015, tisotumab vedotin, OMT-111, tusamitamab ravtansine, SCO-101, NGM120, CDX-301, NLM-001, TAS 102, Olaptesed pegol, BL-8040, Gimatecan, AMP945, N-803, HCW9218, BLEX 404, delolimogene mupadenorepvec, Mitoxantrone Hydrochloride Liposome injection, ABTL0812, CBP501, Pemigatinib, SHR-1701, Fluzoparib, XB2001, Cabiralizumab, EF-009, SGT-53, ABBV-927, PBP1510, Vemurafenib, siG12D-LODER, Penpulimab, GC4711, GSK2256098, L-DOS47, SBP-101, Antroquinonol, LY3214996, Sintilimab, RP72, PBP1510, IOA-289, U87, MVT-5873, SHR-A1904, iNeo-Vac-P01, iNeo-Vac-P01, TQB2858, Siltuximab, AGEN1423, AB680, AMG 199, BMF-219, and others. In December 2022, Targovax ASA announced that it has entered into a collaboration agreement with The University of Kansas Cancer Center (KU Cancer Center) and Agenus Inc. to run a clinical trial testing mutant RAS vaccine TG01 in combination with PD-1 CPI balstilimab in pancreatic cancer following surgery and standard-of-care (SoC) chemotherapy. In December 2022, Bluestar Genomics, Inc. announced the initiation of the New Onset Diabetes Management for Earlier Detection (NODMED) trial, one of the largest clinical studies in pancreatic cancer to date. The trial will use Bluestar Genomics' proprietary epigenomic methods for the detection of the disease. In December 2022, iOnctura BV, a clinical-stage biotech developing novel cancer therapies, had been granted €17.5 million ($18.6 million) funding from the European Investment Council's (EIC) accelerator program to develop IOA-289 for pancreatic cancer.The EIC's funding consists of a grant of €2.5 million ($2.7 million) and €15 million ($16 million) of equity investment. In December 2022, In the Phase I/II CodeBreaK 100 trial, the KRAS G12C inhibitor sotorasib achieved meaningful anticancer activity with an acceptable safety profile in heavily pretreated patients with KRAS G12C-mutated metastatic pancreatic cancer, according to researchers at The University of Texas MD Anderson Cancer Center. The results of the trial, published in the The New England Journal of Medicine, indicate an objective response rate of 21.1% and a median time-to-response of 1.5 months, with 84% of patients experiencing disease control. Median progression-free survival was 4 months, and overall survival was 6.9 months. In December 2022, Oncolytics Biotech® Inc. announced that the U.S. Food and Drug Administration (FDA) has granted Fast Track designation to pelareorep in combination with Roche's anti-PD-L1 checkpoint inhibitor atezolizumab, and the chemotherapeutic agents gemcitabine and nab-paclitaxel, for the treatment of advanced/metastatic pancreatic ductal adenocarcinoma (PDAC). This represents pelareorep's second FDA Fast Track designation. In December 2022, RemeGen Co., Ltd. announced that its latest antibody-drug conjugate (ADC), RC118 for injection, has been granted two orphan drug designations (ODD) by the United States Food and Drug Administration (FDA) for gastric cancer (including gastroesophageal junction cancer) and pancreatic cancer. This marks the Company's fourth, having previously been granted ODD twice for Disitamab Vedotin (RC48) and Telitacicept (RC18) earlier this year. In December 2022, Panbela Therapeutics, Inc. announced that the European Medicines Agency (EMA) Committee for Orphan Medicinal Products issued a positive opinion on Panbela's application for orphan designation of ivospemin ( SBP-101) in combination with gemcitabine and nab-Paclitaxel in patients with metastatic pancreatic ductal adenocarcinoma (PDA). In September 2022, Qualigen Therapeutics, Inc. announced the presentation of two posters on QN-302 at the AACR 8th Special Conference on Pancreatic Cancer. The data presented include information on the compound's safety, tolerability, and efficacy in a pancreatic cancer model. The poster included preclinical toxicology data that showed QN-302 does not produce adverse toxicological reactions in mouse models at therapeutic doses. In in vitro tests, QN-302 inhibits acetylcholinesterase (AChE) by 53% and muscarinic receptor (M2) by 70% at 1 µM. Request a sample and discover the recent advances in pancreatic cancer drugs @ Pancreatic Cancer Pipeline Report The pancreatic cancer pipeline report provides detailed profiles of pipeline assets, a comparative analysis of clinical and non-clinical stage pancreatic cancer drugs, inactive and dormant assets, a comprehensive assessment of driving and restraining factors, and an assessment of opportunities and risks in the pancreatic cancer clinical trial landscape. Pancreatic Cancer Overview Pancreatic cancer develops in the pancreas tissues, an abdomen organ located behind the stomach's bottom portion. The pancreas secretes hormones that help control blood sugar and enzymes that aid digestion. Pancreatic cancer is a condition in which malignant (cancer) cells develop in pancreatic tissues. The pancreas can develop tumors in various ways, including malignant and noncancerous tumors. However, the precise causes of pancreatic cancer are unknown. Individuals diagnosed with pancreatic cancer before the tumor develops or spreads have an average life expectancy of pancreatic cancer of 3 to 3.5 years. Pancreatic cancer symptoms may include jaundice, dark urine, weight loss, loss of appetite, fatigue, and others. A pancreatic cancer diagnosis is difficult because symptoms are frequently confused with those of other disorders, such as irritable bowel syndrome. The extent of the cancer determines the treatment of pancreatic cancer options. Pancreatic cancer treatment options may include surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these. Learn more about the diseases and pancreatic cancer diet @ Pancreatic Cancer Tests A snapshot of the Pancreatic Cancer Pipeline Drugs mentioned in the report: Learn more about the emerging pancreatic cancer treatment options @ Pancreatic Cancer Clinical Trials Pancreatic Cancer Therapeutics Assessment The pancreatic cancer pipeline report proffers an integral view of pancreatic cancer emerging novel therapies segmented by stage, product type, molecule type, mechanism of action, and route of administration. Scope of the Pancreatic Cancer Pipeline Report Coverage: Global Therapeutic Assessment By Product Type: Mono, Combination, Mono/Combination Therapeutic Assessment By Clinical Stages: Discovery, Pre-clinical, Phase I, Phase II, Phase III Therapeutics Assessment By Route of Administration: Inhalation, Intranasal, Intravenous, Oral, Parenteral, Subcutaneous Therapeutics Assessment By Molecule Type: Antibody, Antisense oligonucleotides, Immunotherapy, Monoclonal antibody, Peptides, Protein, Recombinant protein, Small molecule, Stem Cell, Vaccine Therapeutics Assessment By Mechanism of Action: Connective tissue growth factor inhibitors, Poly(ADP-ribose) polymerase 1 inhibitors, Poly(ADP-ribose) polymerase 2 inhibitors, Immunologic cytotoxicity, T lymphocyte replacements, Growth differentiation factor 15 inhibitors, Endothelin B receptor antagonists, Image enhancers Key Pancreatic Cancer Companies: FibroGen, Innovent Biologics, CARsgen Therapeutics, Ascentage Pharma, NGM Biopharmaceuticals, TME Pharma AG, Lee's Pharmaceutical Limited, ImmunityBio, Inc., Rgene Corporation, CSPC ZhongQi Pharmaceutical Technology Co., Ltd., CanBas Co. Ltd., Jiangsu HengRui Medicine Co., Ltd., Bristol-Myers Squibb, SynerGene Therapeutics, Inc., AbbVie, Silenseed Ltd, Galera Therapeutics, Inc., Helix BioPharma, Golden Biotechnology Corporation, Eli Lilly and Company, Innovent Biologics (Suzhou) Co. Ltd., Panbela Therapeutics, Inc., GlaxoSmithKline, Chia Tai Tianqing Pharmaceutical Group, Roche, Prestige Biopharma Limited, Everfront Biotech Co., Ltd., XBiotech, Inc., Incyte Corporation, Ability Pharmaceuticals SL, Lokon Pharma, HCW Biologics, Amplia Therapeutics Limited, BioLineRx, Ltd., Taiho Pharmaceutical, Sanofi, Scandion Oncology, Nelum, Celldex Therapeutics, Merus N.V., Seagen Inc., GC Cell Corporation, MetiMedi Pharmaceuticals, Lumicell, Nuvation Bio Inc., ENB Therapeutics, BioNTech SE, Bayer, Genentech, Inc., Rise Biopharmaceuticals, Inc., Prestige Biopharma Limited, iOnctura, Shanghai Unicar-Therapy Bio-medicine Technology, Shanghai Hengrui Pharmaceutical Co., Ltd., Hangzhou Neoantigen Therapeutics Co., Ltd., EUSA Pharma, Inc.,Agenus Inc., Arcus Biosciences, Inc., Amgen, Biomea Fusion, and others. Key Pancreatic Cancer Pipeline Therapies: Pamrevlumab, Niraparib, CT041, APG-1387, BNT141, ENB003, NUV-868, MCLA-128, LUM015, tisotumab vedotin, OMT-111, tusamitamab ravtansine, SCO-101, NGM120, CDX-301, NLM-001, TAS 102, Olaptesed pegol, BL-8040, Gimatecan, AMP945, N-803, HCW9218, BLEX 404, delolimogene mupadenorepvec, Mitoxantrone Hydrochloride Liposome injection, ABTL0812, CBP501, Pemigatinib, SHR-1701, Fluzoparib, XB2001, Cabiralizumab, EF-009, SGT-53, ABBV-927, PBP1510, Vemurafenib, siG12D-LODER, Penpulimab, GC4711, GSK2256098, L-DOS47, SBP-101, Antroquinonol, LY3214996, Sintilimab, RP72,PBP1510, IOA-289, U87, MVT-5873, SHR-A1904, iNeo-Vac-P01, iNeo-Vac-P01, TQB2858, Siltuximab, AGEN1423, AB680, AMG 199, BMF-219, and others. Dive deep into rich insights for pancreatic cancer research; visit @ New Treatment for Pancreatic Cancer Table of Contents For further information on pancreatic cancer prevention, reach out @ Pancreatic Cancer Drug Treatment Related Reports Pancreatic Cancer Epidemiology Pancreatic Cancer Epidemiology Forecast – 2032 report delivers an in-depth understanding of the disease, historical, and forecasted pancreatic cancer epidemiology in the 7MM. Pancreatic Cancer Market Pancreatic Cancer Market Insight, Epidemiology, and Market Forecast – 2032 report delivers an in-depth understanding of the market trends, market drivers, market barriers, and key pancreatic cancer companies, including FibroGen, NeoImmuneTech, NOXXON Pharma, Silenseed Ltd., Amgen, NGM Biopharmaceuticals, among others. Advanced Pancreatic Cancer Market Advanced Pancreatic Cancer Market Insight, Epidemiology, and Market Forecast – 2032 report delivers an in-depth understanding of the market trends, market drivers, market barriers, and key advanced pancreatic cancer companies, including AstraZeneca, Merck Sharp & Dohme LLC, Bayer, Roche, among others. Advanced Pancreatic Cancer Pipeline Advanced Pancreatic Cancer Pipeline Insight – 2022 report provides comprehensive insights about the pipeline landscape, pipeline drug profiles, including clinical and non-clinical stage products, and the key advanced pancreatic cancer companies, including FibroGen, NeoImmuneTech, NOXXON Pharma, Silenseed Ltd., Amgen, NGM Biopharmaceuticals, among others. Metastatic Pancreatic Cancer Market Metastatic Pancreatic Cancer Market Insight, Epidemiology, and Market Forecast – 2032 report delivers an in-depth understanding of the market trends, market drivers, market barriers, and key metastatic pancreatic cancer companies, including Takeda Oncology, Salspera, Eli Lilly and Company, among others. Metastatic Pancreatic Cancer Pipeline Metastatic Pancreatic Cancer Pipeline Insight – 2022 report provides comprehensive insights about the pipeline landscape, pipeline drug profiles, including clinical and non-clinical stage products, and the key metastatic pancreatic cancer companies, including Takeda Oncology, Salspera, Eli Lilly and Company, among others. Other Trending Oncology Reports Follicular lymphoma | Indolent lymphoma | Severe Toxicities In Lymphoma | Marginal Zone Lymphoma | Vulvar Squamous Cell Carcinoma | Cholangiocarcinoma | Metastatic Cutaneous Squamous cell Carcinoma | Nasopharyngeal Carcinoma | Ductal Carcinoma in Situ | Oncolytic Virus Cancer Therapy | Cancer Cachexia | Intratumoral Cancer Therapies | Brain Cancer Related Healthcare Blogs Upcoming Oncology Drugs Oncology Market Outlook Future of Oncology Market Related Cases Studies Competitive Intelligence Market Assessment Product Assessment Epidemiology Assessment Related Healthcare Services Healthcare Business Consulting Healthcare Competitive Intelligence Services Healthcare Asset Prioritization Services About DelveInsight DelveInsight is a leading Business Consultant and Market Research firm focused exclusively on life sciences. Connect with us at LinkedIn Contact Us Shruti Thakur [email protected] +1(919)321-6187 Logo: SOURCE DelveInsight Business Research, LLP

开发基于p53的治疗方法已经进行了近三十年，尽管目前还没有基于p53的癌症药物获批，但是基于p53基因在人类癌症中的中心地位，如果取得成功，则有可能彻底改变癌症治疗。 自1979年被发现以来，p53基因一直是肿瘤学研究的焦点之一。在Pubmed数据库中用p53为关键词搜索，可以找到超过十万篇文献。在Nature杂志2017年的一项统计中，p53基因以绝对优势位列过去几十年最热门研究基因榜第一名。 在多种肿瘤中，p53是一个拥有广泛而强大功能的抑癌基因，被誉为“基因组守护者”。p53会响应细胞中的各种应激源（例如DNA损伤）而被激活。p53的激活会促进DNA修复，或促进异常的细胞受控死亡，从而阻止癌症的发生和发展。因此，p53基因突变在许多癌症中非常常见，超过一半的癌症患者携带了p53基因突变。p53基因的突变是癌症发生、发展、治疗耐药性和预后不良的重要驱动力。 近日，以色列威茨曼科学研究所的 Moshe Oren 等人在 Nature 系列综述期刊 Nature Reviews Drug Discovery 上发表了题为：Drugging p53 in cancer: one protein, many targets 的综述论文。 这篇综述重新评估了科学界针对p53功能失调性癌症所做的努力，并讨论了在临床开发过程中遇到的挑战。 几十年来，人们一直尝试将p53在肿瘤中的功能恢复作为一种治疗策略。然而，这些努力未能取得成功，很少有p53药物开发进入到临床后期阶段，迄今为止还没有一项获得FDA或EMA批准。这可能是因为，作为一种核转录因子，p53不具有典型的药物靶点特征，因此长期以来被认为是不可成药的。 然而，近年来出现了几种基于p53的治疗新策略和新方法，针对特定类型p53突变的药物正在出现。与此同时，人们对基因治疗策略和基于p53的免疫治疗方法也产生了浓厚的兴趣。获得靶向p53的肿瘤治疗药物指日可待。 p53的肿瘤生物学 自1979年首次发现p53以来，人们对p53蛋白的功能及其与癌症的关系有了广泛的了解。毫无疑问，p53是一种强大的肿瘤抑制因子，可以通过多种方式抑制肿瘤生长。作为一种转录因子，p53调控靶基因的表达，这些靶基因可以促进细胞周期阻滞、凋亡、DNA修复等。此外，p53还可以通过独立转录机制发挥抗增殖作用。事实上，据报道，p53几乎影响所有细胞室和细胞器，包括线粒体、溶酶体、内质网等。 重要的是，当TP53突变时，p53的这些活性受到影响。与其他肿瘤抑制基因的观察结果不同，肿瘤相关的TP53突变主要是错义突变，导致单个氨基酸替换。大量研究的综合数据显示，在30%-50%的人类肿瘤中都存在p53基因的突变。 实际上，在迄今所以人类肿瘤细胞基因组中，p53是发生突变频率最高的基因，在几乎1/3的人类肿瘤中都以突变的形式存在。 此外，越来越多的证据表明，除了野生型p53的抑癌活性丧失外，一些p53突变体还可以获得新的功能活性，从而进一步促进癌症。与野生型p53类似，突变型p53可以影响多种细胞进程。虽然失去了与DNA中p53结合位点直接相互作用的能力，但突变型p53仍然可以依赖其他转录因子来驱动促肿瘤基因转录。除了自身的直接活性外，突变型p53还可以调节肿瘤微环境（TME）。例如， 突变型p53可以通过调节外泌体含量来支持肿瘤的进展，从而导致巨噬细胞重新编程为M2型，产生更有利肿瘤进展的TME。 靶向p53的小分子药物 不同TP53状态的肿瘤需要非常不同的小分子靶向策略。对于含有TP53错义突变的肿瘤，小分子药物开发主要侧重于恢复突变型p53蛋白野生型构象和活性。相反，对于保持野生型p53的癌症，主要的策略将p53从其负调控因子的抑制中释放出来，从而释放出p53的全部活性。 靶向TP53错义突变 TP53错义突变在人类癌症中异常常见，约占所有TP53突变的70%。由此产生的结构或构象突变体被视为小分子的潜在靶点，可以恢复突变型p53的正确折叠和功能。1999年，辉瑞公司筛选出了第一个具有突变型p53再激活能力的化合物CP31398。从机理上，CP31398稳定了p53的野生型构象，并通过抑制其泛素化防止其降解。然而，后来的研究揭示了更复杂的作用，包括药物嵌入DNA引起的非特异性毒性和p53非依赖性上调促凋亡蛋白BAX。因此，CP31398未被纳入临床研究。尽管如此，这个药物标志着靶向突变型p53的小分子时代的开始。 多年来，人们发现了许多突变型p53的激活药物。包括MIRA-1，其含有可参与亲核加成反应的马来酰亚胺基团，以及STIMA-1，一种2-苯乙烯基喹唑啉-4（3H）-酮相关衍生物。尽管这两种化合物在体外和体内均表现出p53依赖性效应，但由于溶解度问题和对正常细胞的毒性，这两种药物均未进入临床试验。 在报道的突变型p53激活小分子中，只有少数被纳入临床试验。第一个进入临床试验的是PRIMA-1 MET，它是PRIMA-1的甲基化衍生物，也称为APR-246。在体外和临床前研究中，APR-244表现出比PRIMA-1更好的活性，在急性髓细胞白血病（AML）细胞系和患者的原代细胞中增强了凋亡作用。目前正在进行APR-246的两个I/II期临床试验，与阿扎胞苷联合治疗携带p53突变的MDS或AML患者，均显示出实质性疗效。2020年1月，FDA授予APR-246治疗MDS的突破性疗法。最近，一项评估APR-246联合阿扎胞苷的II期试验宣布了令人鼓舞的结果。APR-246和阿扎胞苷的联合治疗实现了58%的1年无复发生存率（RFS），中位OS为19.3个月。目前正在进行或计划进行更多以APR-246为单药或联合用药的临床试验。 靶向野生型p53的肿瘤 在保持野生型p53表达的肿瘤中，最广泛采用的p53靶向治疗方法是抑制p53的降解。p53降解的机制涉及E3泛素连接酶MDM2对p53的泛素化，导致p53的蛋白酶体降解。MDM2介导的泛素化依赖于其与p53的直接结合，促使人们寻找抑制MDM2–p53结合的小分子，作为稳定p53并使其恢复效力的手段。 第一类抑制剂是Nutlins，可诱导野生型p53癌细胞中的p53激活，但对mutp53细胞无影响。Nutlins的衍生物RG7112是临床试验中测试的第一个MDM2抑制剂。在难治性复发性AML和CML患者中，RG7112可触发wtp53激活，并提高许多p53靶基因的表达，在许多患者中观察到RG7112的抗白血病活性。然而，需要大剂量的RG7112才能达到疗效，导致不良事件发生，如胃肠道不耐受和血小板生成抑制。随后，RG7112被第三代衍生产品idasanutlin（RG7388）取代。目前，有几项临床试验正在测试idasanutlin对各种癌症的安全性和疗效。 除了Nutlins衍生物，许多其他干扰MDM2–p53结合的分子也在开发和测试中。例如，APG-115是一种口服的MDM2抑制剂，在AML临床前模型和放射治疗致敏的胃癌异种移植物中显示出强大的抗肿瘤作用。APG-115目前正在几个临床试验中进行评估（如NCT02935907、NCT03611868、NCT04785196、NCT0037816），单药或联合化疗和免疫检查点抑制剂。 AMG-232是另一种口服的MDM2抑制剂，显示可促进骨肉瘤细胞的野生型p53功能和肿瘤消退。目前，已经启动了十多项AMG-232（后更名为KRT-232）的临床试验，包括JNK抑制剂失效后骨髓纤维化的III期试验以及其他癌症的早期试验。其他MDM2抑制剂，包括siremadlin和milademetan，也在临床试验中（NCT03634228、NCT04116541）。 靶向截短的p53 大约10%的TP53变异肿瘤携带无义突变，产生截短蛋白，通常很快降解。由于这些蛋白质的寿命很短，并且通常缺乏大部分p53蛋白序列，因此通过上述方法重新激活可能毫无意义。 因此，人们提出了两种替代方法来激活含有p53截短突变癌细胞中的p53信号通路。第一种方法是基于促进翻译通读的分子，使翻译机制绕过RNA终止密码子，产生全长p53蛋白。这些化合物包括氨基糖苷类抗生素及其衍生物，如G418和新一代合成衍生物NB124。用这些氨基糖苷治疗可挽救完整p53的合成，促进癌细胞凋亡。另一种替代方法是抑制无义介导的mRNA降解（NMD）过程。例如，NMD14靶向SMG7的结构口袋，SMG7是NMD机制的一个关键组成部分。类似的药物，如ataluren，已经进入囊性纤维化的III期临床试验。 靶向突变型p53 GOF 尽管大多数基于p53的药物开发都是为了恢复癌细胞中野生型p53的活性，但也有人试图通过靶向mutp53快速降解来消除突变型p53-GOF（gain-of-function）活性。鉴于HSP90热休克蛋白可以减弱突变型p53的降解，研究表明，长时间抑制HSP90可以提高携带突变型p53表达肿瘤小鼠的存活率。 基于p53的肿瘤免疫治疗 近年来，癌症免疫治疗取得了前所未有的成功，这也重新激发了人们对基于p53免疫治疗策略的兴趣，主要是提高免疫系统识别和根除含有不受调控的p53癌细胞的策略。 基于p53的疫苗 20世纪90年代，人们开始尝试旨在提高对含有过量p53的癌细胞免疫力的疫苗。一种合成长肽（SLP）疫苗由来自野生型p53序列的十个重叠肽组成，其在转移性结直肠癌中引发了以CD4+T细胞为主的T细胞反应，不良反应相对较轻。然而，临床试验未能显示SLP疫苗相对于历史对照的益处。 此外，编码野生型p53的改良痘苗病毒ankara（MVA）疫苗也在难治性胃肠道癌和卵巢癌患者的早期临床试验中进行了测试，在总共11名患者中，分别有6名和5名患者能诱导CD8+和CD4+T细胞反应。目前正在进行MVAp53疫苗和抗PD1抗体pembrolizumab的进一步临床试验（NCT03113487，NCT02432963）。 mRNA疫苗的成功也为p53 mRNA疫苗带来了新的希望。将自体TP53 mRNA转染的DC导入乳腺癌患者体内后，在18例高表达p53的肿瘤患者中，有13例在体外表现出p53特异性T细胞反应，这健康志愿者（1/10）和p53低表达乳腺癌患者（2/18）形成鲜明对比。 p53特异性抗体 其他基于p53的免疫治疗方法也正在出现。T细胞受体模拟物（TCRm）抗体，也称为TCR样抗体，是一种潜在的靶向细胞内蛋白质的策略。这些抗体识别MHC在细胞表面显示的表位，类似于TCR识别，从而能够识别来自细胞内蛋白质的肽。 双特异性抗体是另一种非常有前途的癌症免疫治疗方法。最近开发了一种基于mutp53的双特异性抗体，可以识别来自p53（R175H）热点突变和TCR–CD3复合物的新抗原。通过与癌细胞上的p53（R175H）肽-HLA复合物以及T细胞上的TCR-CD3复合物高亲和力结合，这种双特异性抗体可以克服新抗原提呈的缺乏，并选择性地重定向T细胞以识别展示突变肽的癌细胞。 p53与肿瘤微环境 最近的研究显示p53与癌症免疫治疗之间存在更广泛的联系。癌细胞中的p53状态会影响TME的免疫状态。 癌细胞中的功能性野生型p53倾向于支持癌症限制性TME，而野生型p53的缺失则使平衡朝着支持癌症的TME倾斜。此外，作为GOF活性的一部分，一些错义突变型p53蛋白可能会进一步限制免疫系统攻击癌细胞的能力。例如，野生型p53可以通过上调miR-34a间接降低PD-L1的水平，并诱导自然杀伤（NK）细胞激活性配体UL16结合蛋白1（ULBP1）和ULBP2的表达，使癌细胞更容易受到细胞毒性T细胞和NK细胞的攻击。 此外，通过调节细胞因子表达，野生型p53可以通过改变TIME的组成来发挥抗肿瘤作用。因此，肿瘤的TP53状态可能对与免疫治疗相关的患者用药非常重要。此外，恢复或增强癌细胞中p53功能的药物也可考虑与免疫治疗方案联合用药，以增加其成功的可能性。2022年7月，PMV制药公司宣布与默克公司合作进行PC14586与pembrolizumab的临床试验，以治疗携带p53（Y220C）突变的晚期实体瘤患者。 基于p53的基因治疗 第一个被批准用于临床的基因治疗就是基于p53的。Gendicine是深圳赛百诺公司开发的一种重组人p53腺病毒，于2003年被中国食品药品监督管理局（CFDA）批准用于HNSCC。据报道，当与化疗或放疗结合时，Gendicine的响应率明显高于标准护理。其他基于腺病毒的p53基因治疗，包括advexin和SCH-58500，也在临床试验中显示出良好的结果。 纳米颗粒也被探索用于p53基因治疗载体。与病毒不同，纳米颗粒具有低免疫原性，因此对抑制性抗体不敏感，从而延长其循环时间，同时减少免疫相关的副作用。此外，通过静脉注射，纳米颗粒比肿瘤内注射更适合治疗远处转移。SGT-53是一种由SynerGene Therapeutics开发的阳离子脂质体，携带野生型p53编码的DNA，通过抗转铁蛋白单链抗体片段选择性地归巢肿瘤细胞。在对11名患有不同类型晚期实体瘤的患者进行的一期临床试验中， 11名患者中有7名在6周评估时病情稳定。 p53 mRNA纳米颗粒也在开发中。在最近的一项研究中，在HCC和NSCLC小鼠模型中，通过纳米颗粒递送p53 mRNA使p53缺失的肺癌细胞存活率显著降低，肿瘤大小显著减小。此外，与单独的治疗相比，p53 mRNA纳米颗粒与免疫治疗相结合可提高抗癌效果。 小结 开发基于p53的治疗方法已经进行了近三十年，尽管目前还没有基于p53的癌症药物获批，但是基于p53基因在人类癌症中的中心地位，如果取得成功，则有可能彻底改变癌症治疗。近年来，一系列所取得的进展逐渐摒弃了p53不可成药的观点，最近KRAS抑制剂的成功也给我们带来了鼓舞。与p53一样，由于反复失败，KRAS也被许多人认为是不可成药的靶标。相信随着新技术的不断进步以及对p53更加深入的研究，靶向p53的癌症治疗药物将很快应用于临床，从而使更多的患者受益。