在高级不匹配的修复缺陷/微卫星不稳定性高的非结肠直肠癌中,尼沃卢马布和伊皮利马布:非随机临床试验
Matteo S Carlino1,2, Bo Gao1, Michael Michael3
1Department of Medical Oncology, Blacktown and Westmead Hospitals, Sydney, Australia.
JAMA oncology
|November 13, 2025
概括
与尼沃卢马布和伊皮利穆马布的联合免疫疗法在不匹配修复缺陷 (dMMR) /微卫星不稳定性高 (MSI-H) 的非结肠直肠癌中显示出高响应率. 这种方法提供了持久的反应,并可能是对这些罕见的免疫性瘤单一治疗的有价值的替代方案.
科学领域:
- 免疫治疗是一种免疫疗法.
- 在瘤学瘤学.
- 临床试验 临床试验
背景情况:
- 不匹配修复缺陷 (dMMR) /微卫星不稳定性高 (MSI-H) 癌症具有高度的免疫性.
- 反编程细胞死亡1 (PD-1) 单疗法在大约三分之一的患有高级dMMR/MSI-H非结肠直肠癌的患者中产生持久反应.
- 联合抗PD-1/细胞毒性淋巴细胞抗原4 (CTLA-4) 阻断已在其他免疫性癌症中表现出优于抗PD-1单一治疗的优势.
研究的目的:
- 评估结合nivolumab (抗PD-1) 和ipilimumab (抗CTLA-4) 在高级dMMR/MSI-H非结肠直肠癌中的疗效和安全性.
- 为患有这些罕见和免疫性瘤的患者建立新的治疗选择.
主要方法:
- MOST-CIRCUIT试验是一项前性,多中心,非随机的第二阶段研究,招募了52名患者.
- 参与者每3周服用4次尼沃卢马布 (3毫克/千克) 加上伊皮利穆马布 (1毫克/千克),然后每4周服用尼沃卢马布 (480毫克).
- 同主终点包括客观应答率 (ORR) 和6个月无进展生存期 (6-PFS).
主要成果:
- 观察到的客观反应率 (ORR) 为63%,其中79%的反应正在进行中,并且没有达到响应的中位持续时间.
- 6个月无进展生存期 (6-PFS) 为71%,中位数无进展生存期 (PFS) 和总生存期 (OS) 尚未达到.
- 在23%的患者中发生了3/4级免疫相关的不良事件.
结论:
- 综合抗PD-1/CTLA-4阻塞在先进的dMMR/MSI-H非结肠直肠癌中显示出高持续性反应率.
- 这种组合疗法在已发表的试验中与抗PD-1 / 1单一疗法相比较有利.
- 尼沃卢马布和伊皮利穆马布的联合治疗对这种患者群体来说是一种潜在的替代治疗方法.
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