์•”์ข…๋ณ„ ํƒ€๊ฒŸ ์š”์•ฝํ‘œ
2025. 4. 25. 15:20
๋ฐ˜์‘ํ˜•

๐Ÿ“Š ์•”์ข…๋ณ„ ํƒ€๊ฒŸ ์š”์•ฝํ‘œ

์•”์ข… ์ฃผ์š” ํƒ€๊ฒŸ ๋Œ€ํ‘œ ์•ฝ๋ฌผ ์ž‘์šฉ๊ธฐ์ „ ์ƒ๋ฌผํ•™์  ํŠน์ง• ๋‚ด์„ฑ ๊ธฐ์ „

NSCLC EGFR, ALK, MET, PD-1 Osimertinib, Crizotinib ์„ฑ์žฅ์‹ ํ˜ธ/๋ฉด์—ญํšŒํ”ผ ์–ต์ œ EGFR mutation, PD-L1 ↑ T790M, bypass ํ™œ์„ฑํ™”
์œ ๋ฐฉ์•” HER2, ER, CDK4/6 Trastuzumab, Palbociclib HER2 ์–ต์ œ, ์„ธํฌ์ฃผ๊ธฐ ์ฐจ๋‹จ HER2+, ER+, PIK3CA mutation ESR1 mutation, RB loss
๋Œ€์žฅ์•” EGFR, VEGF, BRAF Cetuximab, Bevacizumab ์„ฑ์žฅ์‹ ํ˜ธ ์–ต์ œ KRAS/BRAF mutation ์—ฌ๋ถ€ VEGF ๋Œ€์ฒด์ธ์ž ํ™œ์„ฑํ™”
ํ‘์ƒ‰์ข… BRAF, MEK, PD-1 Vemurafenib, Nivolumab MAPK ์–ต์ œ, ๋ฉด์—ญํ™œ์„ฑํ™” BRAF V600E, ๋ฉด์—ญ๋ฐ˜์‘ ↑ MAPK ์šฐํšŒ๊ฒฝ๋กœ
AML/CLL FLT3, BCL-2, IDH Midostaurin, Venetoclax ์„ธํฌ์‚ฌ๋ฉธ ์œ ๋„, ๋Œ€์‚ฌ์กฐ์ ˆ FLT3 mutation, IDH1/2 mutation MCL-1 ๋ณด์ƒ๋ฐœํ˜„

๐Ÿงฌ ์•”์ข…๋ณ„ ํ•ญ์•”์ œ ํƒ€๊ฒŸ ๊ธฐ์ „ ์ •๋ฆฌ


1๏ธโƒฃ ๋น„์†Œ์„ธํฌํ์•” (NSCLC)

  • ๐Ÿ” ์ฃผ์š” ํƒ€๊ฒŸ: EGFR, ALK, ROS1, MET, PD-1
  • ๐Ÿ’Š ๋Œ€ํ‘œ ์•ฝ๋ฌผ:
    • EGFR: Erlotinib, Osimertinib
    • ALK: Crizotinib, Alectinib
    • MET exon14: Capmatinib
    • PD-1: Nivolumab, Pembrolizumab

๐Ÿงช ๊ธฐ์ „ ์„ค๋ช…:

  • EGFR mutation → ์ง€์†์  TK ํ™œ์„ฑํ™” → RAS/RAF/ERK ๊ฒฝ๋กœ ๊ณผํ™œ์„ฑ
  • ALK/ROS1 fusion → ์„ฑ์žฅ์‹ ํ˜ธ ์ง€์†
  • MET exon14 skipping → MET ๋ฐœํ˜„ ์ฆ๊ฐ€
  • PD-L1 overexpression → ๋ฉด์—ญํšŒํ”ผ

๐Ÿงฌ ๋‚ด์„ฑ๊ธฐ์ „:

  • EGFR T790M mutation → Osimertinib ์‚ฌ์šฉ
  • C797S mutation → 3์„ธ๋Œ€ TKI ๋‚ด์„ฑ
  • bypass ํ™œ์„ฑํ™” (HER2, MET)

2๏ธโƒฃ ์œ ๋ฐฉ์•”

  • ๐Ÿ” ์ฃผ์š” ํƒ€๊ฒŸ: ER, HER2, CDK4/6, PI3K
  • ๐Ÿ’Š ๋Œ€ํ‘œ ์•ฝ๋ฌผ:
    • HER2+: Trastuzumab, Pertuzumab
    • ER+: Tamoxifen, Fulvestrant
    • CDK4/6: Palbociclib
    • PI3K: Alpelisib

๐Ÿงช ๊ธฐ์ „ ์„ค๋ช…:

  • HER2 overexpression → MAPK & PI3K ๊ฒฝ๋กœ ๊ณผํ™œ์„ฑ
  • ER(+) → ํ•ต ๋‚ด ์ „์‚ฌ ์œ ๋„
  • CDK4/6 → ์„ธํฌ์ฃผ๊ธฐ G1/S ์ง„์ž… ์–ต์ œ
  • PI3K-CA mutation → mTOR ๊ฒฝ๋กœ ๊ณผํ™œ์„ฑ

๐Ÿงฌ ๋‚ด์„ฑ๊ธฐ์ „:

  • HER2 ๋ฐœํ˜„ ์†Œ์‹ค
  • ESR1 mutation
  • RB loss → CDK ์–ต์ œ์ œ ๋‚ด์„ฑ

3๏ธโƒฃ ๋Œ€์žฅ์•” (CRC)

  • ๐Ÿ” ์ฃผ์š” ํƒ€๊ฒŸ: EGFR, VEGF, BRAF, KRAS
  • ๐Ÿ’Š ๋Œ€ํ‘œ ์•ฝ๋ฌผ:
    • EGFR: Cetuximab (KRAS wt only)
    • VEGF: Bevacizumab
    • BRAF V600E: Encorafenib + Cetuximab

๐Ÿงช ๊ธฐ์ „ ์„ค๋ช…:

  • KRAS mutation ์œ ๋ฌด์— ๋”ฐ๋ผ EGFR ์–ต์ œ ํšจ๊ณผ ๊ฒฐ์ •๋จ
  • BRAF V600E → MEK/ERK ๊ฒฝ๋กœ ์ง€์† ํ™œ์„ฑํ™”
  • VEGF → ์ข…์–‘ ํ˜ˆ๊ด€ํ˜•์„ฑ

๐Ÿงฌ ๋‚ด์„ฑ๊ธฐ์ „:

  • KRAS mutation → EGFR ์–ต์ œ ๋ฌดํšจ
  • VEGF ์–ต์ œ ํ›„ FGF ํ™œ์„ฑํ™”

4๏ธโƒฃ ํ‘์ƒ‰์ข… (Melanoma)

  • ๐Ÿ” ์ฃผ์š” ํƒ€๊ฒŸ: BRAF V600E, MEK, PD-1, CTLA-4
  • ๐Ÿ’Š ๋Œ€ํ‘œ ์•ฝ๋ฌผ:
    • BRAF: Vemurafenib
    • MEK: Trametinib
    • PD-1: Nivolumab
    • CTLA-4: Ipilimumab

๐Ÿงช ๊ธฐ์ „ ์„ค๋ช…:

  • BRAF V600E → MAPK pathway ๊ณผํ™œ์„ฑ
  • ๋ฉด์—ญ๊ด€๋ฌธ ์–ต์ œ์ œ → T์„ธํฌ ํ™œ์„ฑํ™”

๐Ÿงฌ ๋‚ด์„ฑ๊ธฐ์ „:

  • MAPK ์šฐํšŒ ํ™œ์„ฑ
  • TME ๋ฉด์—ญ์–ต์ œ ์ธ์ž ์ฆ๊ฐ€

5๏ธโƒฃ ๊ธ‰์„ฑ๊ณจ์ˆ˜์„ฑ๋ฐฑํ˜ˆ๋ณ‘ (AML) & ๋งŒ์„ฑ๋ฆผํ”„๊ตฌ์„ฑ๋ฐฑํ˜ˆ๋ณ‘ (CLL)

  • ๐Ÿ” ์ฃผ์š” ํƒ€๊ฒŸ: FLT3, IDH1/2, BCL-2
  • ๐Ÿ’Š ๋Œ€ํ‘œ ์•ฝ๋ฌผ:
    • FLT3: Midostaurin
    • IDH1/2: Ivosidenib, Enasidenib
    • BCL-2: Venetoclax

๐Ÿงช ๊ธฐ์ „ ์„ค๋ช…:

  • FLT3-ITD → ์„ธํฌ ์ƒ์กด ์‹ ํ˜ธ ์ฆ๊ฐ€
  • IDH mutation → oncometabolite (2-HG) ์ƒ์„ฑ → ๋ถ„ํ™” ์–ต์ œ
  • BCL-2 → ์„ธํฌ์‚ฌ๋ฉธ ์–ต์ œ → ์ƒ์กด ์—ฐ์žฅ

๐Ÿงฌ ๋‚ด์„ฑ๊ธฐ์ „:

  • MCL-1 ๋ฐœํ˜„ ์ฆ๊ฐ€
  • BCL-xL ๋ณด์ƒ
  • ์ถ”๊ฐ€ ๋Œ์—ฐ๋ณ€์ด

๐Ÿ”ฌ ๋ถ„์ž์ƒ๋ฌผํ•™์  ๋ฐ ๋ฉด์—ญํ•™์  ์ดํ•ด ๊ธฐ๋ฐ˜ ์ž๋ฃŒ

  1. The Biology of Cancer (by Robert A. Weinberg, 2nd ed.) – ์•” ์ƒ๋ฌผํ•™์  ๊ธฐ์ „ ์„ค๋ช…
  2. Nature Reviews Cancer / Cell Reports / Cancer Cell – ์ตœ์‹  ๋…ผ๋ฌธ ๊ธฐ๋ฐ˜ ๋‚ด์„ฑ ๋ฐ ์ƒ๋ฌผํ•™์  ํŠน์„ฑ ์„ค๋ช…
  3. KEGG Pathway & Reactome – ๊ฐ ํƒ€๊ฒŸ๋ณ„ ์‹œ๊ทธ๋„๋ง ๊ฒฝ๋กœ ๋ฐ ๊ธฐ์ „ ํ™•์ธ
  4. PubMed ๋…ผ๋ฌธ ๊ฒ€์ƒ‰ (2020~2024) – ํŠน์ • ์•”์ข… ๋‚ด ๋‚ด์„ฑ๊ธฐ์ „ ๋ฐ ๋ฐ”์ด์˜ค๋งˆ์ปค ๊ด€๋ จ ๋ฆฌ๋ทฐ
  5. AACR / ASCO Annual Meeting Abstracts (2023~2024) – ํ‘œ์ ์น˜๋ฃŒ ์ตœ์‹  ์—…๋ฐ์ดํŠธ ๋ฐ ๋ณ‘์šฉ ์ „๋žต
๋ฐ˜์‘ํ˜•