复发性和耐药性慢性淋巴细胞白血病/小淋巴细胞淋巴瘤的当前治疗选择:一篇综述
1Memorial Sloan Kettering Cancer Center, 530 E 74th St, New York, NY, 10021, USA. islamp@mskcc.org.
Current treatment options in oncology
|July 5, 2023
概括
复发性/耐药性慢性淋巴细胞白血病/小淋巴细胞淋巴瘤 (CLL) 的治疗策略现在包括针对性口服药物,如BTK和BCL2抑制剂. 之前的治疗指导当前治疗选择,对双重耐药患者推临床试验.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 复发性和耐药性 (R/R) 慢性淋巴细胞白血病/小淋巴细胞淋巴瘤 (CLL) 治疗已经被新型口服向药物彻底改变.
- 关键药物类别包括布鲁顿的氨酸激酶 (BTK) 抑制剂,BCL2抑制剂,PI3K抑制剂和单克隆抗体.
- 对R/R CLL/SLL的治疗决策越来越多地根据先前的治疗暴露和患者反应进行个性化.
研究的目的:
- 根据不断变化的治疗环境,概述R/R CLL/SLL患者的治疗方法.
- 根据先前的治疗史和药物类别,指导选择向药物的选择.
- 强调对耐火性疾病患者的临床试验的重要性.
主要方法:
- 描述的方法是基于临床经验和对R/R CLL/SLL的向疗法的当前理解.
- 治疗顺序优先考虑BTK或BCL2抑制剂治疗方案,用于新型治疗先验患者.
- 讨论了BTK抑制剂不耐受症,BCL2抑制剂再治疗和"双重耐火性"疾病的策略.
主要成果:
- 没有先前新疗法的患者接受BTK或BCL2抑制剂治疗方案.
- 之前的BTK抑制剂暴露表明BCL2抑制剂治疗方案,反之亦然.
- PI3K 抑制剂是没有临床试验的双重耐药患者的选择,但具有显著的毒性.
结论:
- 对于R/R CLL/SLL的治疗选择必须考虑先前的治疗方法,针对不同患者子组的特定算法.
- 在某些情况下,可以考虑使用BCL2抑制剂进行再治疗,尽管数据有限.
- 强烈建议对双重耐药患者和那些患有像里希特变异这样高风险疾病的患者进行临床试验.
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