在第二代ALK-TKI时代,ALK阳性NSCLC的进展模式,耐药机制和随后的治疗
Lige Wu1, Zihua Zou1,2, Yan Li3
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No 17 Panjiayuan Nanli, Chaoyang district, Beijing, 100021, P.R. China.
与crizotinib相比,一线alectinib显著降低了ALK阳性非小细胞肺癌中中枢神经系统的进展. 随后的ALK-TKIs改善了耐药突变患者的结果.
科学领域:
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
- 遗传学 是一个遗传学.
背景情况:
- 关于ALK阳性非小细胞肺癌 (NSCLC) 用第二代ALK氨酸激酶抑制剂 (ALK-TKI) 治疗的进展模式和耐药性机制的数据有限.
- 了解这些模式对于优化高级ALK+ NSCLC的治疗策略至关重要.
研究的目的:
- 研究ALK阳性NSCLC患者的进展模式,耐药性机制和随后的治疗结果,这些患者接受了第一线alectinib治疗,而不是顺序crizotinib和第二代ALK-TKI.
- 根据ALK抗性突变的存在或不存在来评估后续疗法的疗效.
主要方法:
- 晚期ALK+NSCLC患者的回顾性分析.
- 队列1:在一线阿莱克提尼布 (n=20) 后的进展情况.
- 队列2:在crizotinib和第二代ALK-TKI (n=53) 之后的进展.
- 分析包括中枢神经系统 (CNS) 的进展,通过下一代测序的抵抗机制,以及生存结果.
主要成果:
- 与基于crizotinib的治疗相比,一线alectinib的中枢神经系统进展率 (15.0%) 和症状性中枢神经系统进展率 (5.0%) 显着较低 (分别为56.6%和32.1%).
- 在第二代ALK-TKI失败后,二次ALK激酶域突变是主要的抵抗机制 (56.8%).
- 随后的ALK-TKIs显著改善了ALK耐药突变患者的无进展生存期 (8.6个月与2.7个月相比) 与没有突变的患者相比.
结论:
- 与crizotinib相比,一线alectinib在ALK+NSCLC中提供了优越的中枢神经系统保护.
- 对于患有抗药性突变的患者,建议使用向ALK-TKI.
- 对于没有耐药突变的患者,治疗选择 (化疗或第三代ALK-TKI) 应根据患者的因素进行个性化.
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