Primary and secondary brain tumors have always been a challenge due to their high morbidity and poor prognosis. The incidence of brain metastasis is also increasing with the advent of effective new treatments. Traditional systemic treatments have historically had limited success, partly due to poor central nervous system (CNS) penetration. However, the advent in recent decades of new therapies that have shown high encephalic response rates are challenging this paradigm. ADCs represent a new class of compounds revolutionizing cancer treatment with high systemic response rates and lower toxicities. The continuing evolution of ADCs has shown that certain structural features such as payload, linker, and drug-to-antibody ratio (DAR) are essential in determining their efficacy at the encephalic level, and some ADCs have started to exhibit promising efficacy in treating primary and secondary brain tumors. Unfortunately, most patients with untreated encephalic metastases are excluded from clinical trials, with data primarily from retrospective studies or post hoc analyses. This review describes the early signs of ADC efficacy in brain tumors, the role of complementary treatments like radiation therapy, and critical points to improve ADC efficacy in brain malignancies.
原发性与继发性脑肿瘤因其高发病率及不良预后，始终是临床诊疗中的重大挑战。随着新型有效疗法的出现，脑转移瘤的发生率亦呈上升趋势。传统全身性治疗方案历来疗效有限，部分原因在于其难以有效穿透中枢神经系统。然而近几十年来，多种新型疗法展现出较高的颅内应答率，正在挑战这一传统认知。抗体药物偶联物作为一类革命性的新型抗癌化合物，兼具高全身应答率和低毒性特征。该技术的持续发展表明，有效载荷、连接子及药物抗体比率等关键结构特征对其颅内疗效具有决定性影响，部分ADC药物已在原发性和继发性脑肿瘤治疗中展现出令人鼓舞的疗效。遗憾的是，当前多数未经治疗的脑转移患者被排除在临床试验之外，相关数据主要来源于回顾性研究或事后分析。本综述系统阐述了ADC在脑肿瘤治疗中的早期疗效证据、放疗等辅助治疗的作用机制，以及提升ADC对脑部恶性肿瘤疗效的关键要素。
肿瘤(癌症)患者之家