Apoptosis has long been recognized as a mechanism that kills the cancer cells by cytotoxic drugs. In recent years, studies have proved that pyroptosis can also shrink tumors and inhibit cells proliferation. Both apoptosis and pyroptosis are caspase-dependent programmed cell death pathways. Cysteinyl aspartate specific proteinase-3 (Caspase-3) is a common key protein in the apoptosis and pyroptosis pathways, and when activated, the expression level of tumor suppressor gene Gasdermin E (GSDME) determines the mechanism of tumor cell death. When GSDME is highly expressed, the active caspase-3 cuts it and releases the N-terminal domain to punch holes in the cell membrane, resulting in cell swelling, rupture, and death. When the expression of GSDME is low, it will lead to the classical mechanism of tumor cell death, which is apoptosis. More interestingly, researchers have found that GSDME can also be located upstream of caspase-3, connecting extrinsic, and intrinsic apoptotic pathways. Then, promoting caspase-3 activation, and forming a self-amplifying feed-forward loop. GSDME-mediated pyroptosis is correlated with the side effects of chemotherapy and anti-tumor immunity. This article mainly reviews the caspase-3/GSDME signal pathway as a switch between apoptosis and pyroptosis in cancer, to provide new strategies and targets for cancer treatment.

细胞凋亡长期以来被认为是通过细胞毒性药物杀死癌细胞的一种机制。近年来研究证明焦亡还可以缩小肿瘤并抑制细胞增殖。细胞凋亡和细胞焦亡都是半胱天冬酶依赖性程序性细胞死亡途径。半胱氨酰天冬氨酸特异性蛋白酶-3（Caspase-3）是细胞凋亡和焦亡途径中常见的关键蛋白，当被激活时，抑癌基因Gasdermin E（GSDME）的表达水平决定肿瘤细胞死亡的机制。当 GSDME 高表达时，活性 caspase-3 将其切割并释放 N 末端结构域，在细胞膜上打孔，导致细胞肿胀、破裂和死亡。当GSDME表达低时，会导致肿瘤细胞死亡的经典机制，即细胞凋亡。更有趣的是，研究人员发现 GSDME 也可以位于 caspase-3 的上游，连接外源性和内源性凋亡途径。然后，促进caspase-3激活，形成自放大前馈环。GSDME介导的细胞焦亡与化疗和抗肿瘤免疫的副作用相关。本文主要综述caspase-3/GSDME信号通路作为癌症中细胞凋亡和焦亡的开关，为癌症治疗提供新的策略和靶点。