抗体药物偶联物在实体瘤脑转移中的应用:现状、治疗潜力与未来展望*

doi:10.3870/j.issn.1672-0741.26.05.023

摘要/Abstract

摘要： 脑转移是实体瘤常见且临床负担沉重的转移形式之一,患者总体预后较差,系统治疗选择仍需要进一步提升。受血脑屏障、血肿瘤屏障及脑转移灶特殊免疫微环境等因素影响,药物能否有效递送至颅内病灶仍是治疗中的关键难题。抗体药物偶联物(antibody-drug conjugates,ADCs)由单克隆抗体、化学连接子和细胞毒性有效载荷组成,近年来已在多种实体瘤中显示出明确的临床价值。随着新一代ADCs在乳腺癌、肺癌及其他实体瘤脑转移人群中的疗效证据不断积累,ADC有望为脑转移的系统治疗提供新的选择。本文系统综述ADCs治疗实体瘤脑转移的潜在作用机制、临床疗效证据、安全性问题及未来发展方向,以期为脑转移患者治疗策略的优化提供参考。

关键词: 抗体药物偶联物, 脑转移, 血脑屏障, 血肿瘤屏障, 放射性脑坏死, 旁观者效应, 软脑膜转移

Abstract: Brain metastases are a common and clinically challenging manifestation of solid tumors and are generally associated with poor prognosis and limited systemic treatment options.Effective intracranial drug delivery remains difficult because of the blood-brain barrier,the blood-tumor barrier,and the distinct immune microenvironment of brain metastases.Antibody-drug conjugates(ADCs),consisting of a monoclonal antibody,a chemical linker,and a cytotoxic payload,have shown substantial clinical value in multiple solid tumors.Accumulating evidence of intracranial activity in patients with brain metastases from breast cancer,lung cancer,and other solid tumors suggests that ADCs may provide new opportunities for systemic treatment in this setting.This review summarizes the potential mechanisms of action,clinical evidence,safety considerations,and future research directions of ADCs for brain metastases from solid tumors,aiming to inform optimization of therapeutic strategies for this patient population.

Key words: antibody-drug conjugates, brain metastases, blood-brain barrier, blood-tumor barrier, radiation necrosis, bystander effect, leptomeningeal disease

中图分类号:

R730.2

戴韵菲, 费晶. 抗体药物偶联物在实体瘤脑转移中的应用:现状、治疗潜力与未来展望^*[J]. 华中科技大学学报（医学版）, 2026, 55(4): 597-605.

Dai Yunfei, Fei Jing. Antibody-Drug Conjugates in Brain Metastases from Solid Tumors: Current Status,Therapeutic Potential,and Future Perspectives[J]. Acta Medicinae Universitatis Scientiae et Technologiae Huazhong, 2026, 55(4): 597-605.

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抗体药物偶联物在实体瘤脑转移中的应用:现状、治疗潜力与未来展望^*

Antibody-Drug Conjugates in Brain Metastases from Solid Tumors: Current Status,Therapeutic Potential,and Future Perspectives

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