OS获益-陆舜教授谈达可替尼上市对EGFR突变晚期NSCLC全程管理影响

2019-06-22 佚名 肿瘤资讯

ARCHER 1050研究公布的总生存(OS)数据显示,相比于一代EGFR TKI吉非替尼,达可替尼(Dacomitinib)治疗能给EGFR敏感突变患者带来的OS获益。就达可替尼对EGFR敏感突变晚期NSCLC全程管理影响等热点话题作一专访。

ARCHER 1050研究公布的总生存(OS)数据显示,相比于一代EGFR TKI吉非替尼,达可替尼(Dacomitinib)治疗能给EGFR敏感突变患者带来的OS获益。就达可替尼对EGFR敏感突变晚期NSCLC全程管理影响等热点话题作一专访。

陆舜教授,上海交通大学附属胸科医院肿瘤科(上海市肺部肿瘤临床医学中心)主任、主任医师、博士生导师,国际肺癌研究会官方杂志Journal of Thoracic Oncology副主编,The Oncologist杂志编委,国务院特殊津贴获得者,国家重点项目首席专家,中国抗癌协会肺癌专业委员会主任委员,希斯科基金会副理事长,中国医药生物技术协会精准医疗分会副主任委员,中国医师协会临床精疗医学专业委员会委员,中国抗癌协会姑息治疗委员会委员,上海市医学会肿瘤学会主任委员,上海市医师协会肿瘤科分会副会长,肿瘤内科规培组长,上海市医学会理事,上海市抗癌协会理事,上海市领军人才,上海市优秀学术带头人。

二代EGFR TKI 达可替尼成功上市对EGFR敏感突变晚期NSCLC全程管理影响

众所周知,对于EGFR敏感突变晚期NSCLC患者而言,一代、二代和三代EGFR TKI均可以给患者带来无进展生存(PFS)获益。ARCHER 1050研究结果显示,相比于一代EGFR TKI,二代TKI 达可替尼治疗给患者带来的OS获益更明显。三代EGFR TKI奥希替尼与一代EGFR TKI头对头比较的OS数据尚不成熟,预计会在今年的ESMO会议报道。目前,对于EGFR敏感突变晚期NSCLC的最佳给药顺序尚未达成统一,这取决于EGFR突变的类型以及是否合并其他基因突变,对此也期待FLAURA研究结果的最终公布。

2+3治疗模式探索

对于EGFR敏感突变晚期NSCLC患者而言,2+3(二代EGFR TKI+三代EGFR TKI)、1+3(一代EGFR TKI+三代EGFR TKI)或者是直接3+X(三代EGFR TKI+其他治疗),何种治疗模式更优、更能给患者带来生存获益,目前还不得而知。目前的研究现状为,有一些相关研究结果会率先被揭露,而其他研究还在进行当中,EGFR敏感突变晚期NSCLC患者的最佳给药顺序还有待于进一步研究证实。

达克替尼对脑转移治疗疗效

ARCHER 1050研究在最初入组时是将脑转移患者排除在外的,后续回顾性分析发现达可替尼治疗组患者脑转移的发生率低于吉非替尼治疗组。针对发生脑转移的EGFR敏感突变晚期NSCLC患者而言,三代EGFR TKI奥希替尼被证实具有确切的临床疗效。

达克替尼治疗疗效和安全性分析

在ARCHER 1050研究过程中,我们课题组同样入组了一部分患者,结果显示,相比于吉非替尼, 达可替尼治疗可以给患者带来更长的PFS获益。与此同时,达可替尼治疗组患者的皮疹、腹泻以及肠道等毒副反应发生率比吉非替尼要更高一些。

三代EGFR TKI耐药后全程管理

目前而言,三代EGFR TKI耐药后的相关研究已经取得了很大进展。刚刚结束的AACR会议报道到,在三代EGFR TKI耐药后,约有1/4患者会出现MET扩增,对于这部分患者而言,MET抑制剂联合奥希替尼继续应用仍然可以给患者带来20%以上的缓解率。

达克替尼在中国人群中的应用前景

ARCHER 1050研究亚组分析结果显示,中国人群达可替尼治疗组患者PFS更高,研究者评估达到18.4个月,获益更加明显。但是,我们还是要更加关注整体人群数据。达可替尼基于ARCHER 1050研究结果,达可替尼是可以用于EGFR敏感突变晚期NSCLC患者的,但是如何全程管理,取决于其临床疗效、安全性和价格等。

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    2019-06-24 liuyiping
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    2019-06-23 肿肿

    NSCLC下一步突破在于新靶点了,靶向治疗和免疫治疗基本见顶了,再有新的就需要新机制了

    0