杜维利西布加罗米德素治疗复发性/耐药T细胞淋巴瘤:一项1b/2a期试验
Steven M Horwitz1,2, Ajit J Nirmal3, Jahan Rahman4
1Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. horwitzs@mskcc.org.
Nature medicine
|June 17, 2024
概括
将杜维利西布 (PI3K-δγ 抑制剂) 与罗米德结合使用,在T细胞淋巴瘤 (TCL) 中显示出更好的疗效和更低的毒性. 这种组合疗法为治疗复发性/耐药性TCL提供了一个有希望的策略,特别是在特定亚型中.
科学领域:
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
- 免疫学 免疫学 免疫学
背景情况:
- 氨酸酸3-酶三角酶 (PI3K-δ) 抑制剂在淋巴细胞恶性瘤中显示出有效性,但受到毒性限制.
- 杜维利西布是一种PI3K-δγ抑制剂,在T细胞淋巴瘤 (TCL) 中表现出活性,但与炎症性不良事件有关.
- 之前的研究强调了需要策略来减轻PI3K抑制剂相关的毒性,同时保持有效性.
研究的目的:
- 评估杜维利西布与罗米德素或博特佐米布结合的安全性和疗效,用于复发性/耐药性TCL患者.
- 为了确定杜维利西布与罗米德素或博特佐米布结合时的最大耐受剂量 (MTD).
- 探索PI3K和基因组脱乙酶 (HDAC) 联合抑制对治疗结果和毒性概况的影响.
主要方法:
- 进行了一项1b/2a期临床试验,涉及复发/耐药TCL的患者.
- 患者接受了杜维利西布与罗米德素 (n=66) 或博特佐米布 (n=32) 联合治疗.
- 安全终点包括确定MTD和监测不良事件;疗效终点包括整体和完整反应率.
主要成果:
- 杜维利西布的MTD是75毫克每天两次与罗米德素和25毫克每天两次与博特佐米布.
- 与杜维利西布-博特佐米布 (分别为34%和13%) 相比,杜维利西布-罗米德辛组合显示出更高的整体响应率 (55%) 和完整响应率 (34%).
- 与杜维利西布单独治疗 (40%) 相比,杜维利西布-罗米德素显示3/4级肝毒性降低 (14%) 并与炎症媒介的降低有关.
结论:
- 与杜维利西布和罗米德辛的联合治疗是有效的,并且在复发/耐药TCL患者中更好地耐受.
- PI3K和HDAC抑制的组合为治疗TCL提供了一个可行的策略,可能克服PI3K抑制剂的毒性.
- 这种组合的进一步开发是有必要的,在特定的TCL亚型中观察到潜在的益处,例如毛囊辅助T细胞淋巴瘤.
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