undifferentiated large cell lung cancer

关注并星标CPHI制药在线 日前，阿斯利康递交的「甲磺酸奥希替尼片」的2.4类进口申请获CDE受理，这是奥希替尼在国内递交的第五项上市申请，其中前四项上市申请已被批准：EGFR-TKI治疗时或治疗后出现疾病进展，并且经检测确认存在EGFR T790M突变阳性的局部晚期或转移性成人NSCLC（2017.03)；一线治疗EGFR突变阳性晚期或转移性成人NSCLC（2019.08）；EGFR敏感突变的NSCLC成人患者肿瘤切除术后的辅助治疗(2021.04)；联合化疗一线治疗携带EGFR突变的NSCLC（2024.06）。 根据奥希替尼在国内的临床试验进展，笔者推测其申报的第五项适应症分别是：接受含铂根治性放化疗后未出现疾病进展、具有EGFR外显子19缺失（Ex19del）或外显子21（L858R）置换突变的 III 期不可切除成人NSCLC。该适应症于今年6月被CDE纳入突破性治疗品种程序。 奥希替尼（osimertinib，Tagrisso）是阿斯利康开发的一种不可逆第三代表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI），自2015年11月在美国获批以来，已在NSCLC领域获批多项适应症，其中联合铂类化疗一线治疗具有EGFR外显子19缺失或外显子21（L858R）置换突变的局部晚期或转移性NSCLC的上市申请已于今年2月在美国获批。 作为首个上市的第三代EGFR-TKI，Tagrisso（奥希替尼）的市场潜力还没有被完全挖掘，销售额不断刷新，2023年达到57.99亿美元。预计随着新适应症的拓展，Tagrisso销售额还将持续增长。 EGFR-TKIs现状 EGFR是NSCLC最常见的驱动基因。外显子19缺失（Del19）和外显子21 L858R突变是最常见的EGFR突变类型，称为经典突变，约占85%。此外，还有7%-23%的NSCLC患者伴EGFR非经典突变，如外显子20插入（~6%）、G719X （~3%）、L861Q （~1%）、S768I （~1%）和外显子19插入（0.6%）等。 EGFR -TKIs是EGFR敏感突变晚期NSCLC的标准治疗，目前全球监管机构已批准多款EGFR-TKIs，详见下表。EGFR-TKIs的研发非常内卷，目前已上市产品可分为三代，其中第三代EGFR-TKIs的开发主要是针对第一代和第二代EGFR-TKIs使用后出线的EGFR T790M耐药突变。 从产品数量上看，第三代EGFR-TKIs竞争十分激烈，全球已获批产品高达7款，其中国内已批准6款。从表格可以看出，国内已批准的6款EGFR-TKIs均被批准用于既往经EGFR-TKI治疗时或治疗后出现疾病进展，并且经检测确认存在EGFR T790M突变阳性的局部晚期或转移性NSCLC成人患者的治疗，其中奥希替尼获批适应症最多，还被批准一线治疗EGFR突变NSCLC和EGFR敏感突变NSCLC的术后辅助治疗，阿美替尼和伏美替尼还被批准一线治疗EGFR外显子19缺失或外显子 21（L858R）置换突变的NSCLC。 市场表现上，奥希替尼表现最佳，2023年其在国内销售额大约在70亿元左右。阿美替尼次之，约35亿元。伏美替尼排名第三，约19.8亿元。贝福替尼上市较晚，约有0.6亿元。这四款EGFR-TKIs均已进入国家医保，且已开始打价格战，其中奥希替尼、阿美替尼和伏美替尼的月治疗费用在5000元左右，贝福替尼月治疗费用为8400元。随着新一轮医保谈判的到来，瑞齐替尼、瑞厄替尼预计也将加入价格战。新竞争对手的入局势必将加速国内第三代EGFR-TKIs之争。 此外，目前国内还有多款在研第三代EGFR-TKIs，其中limertinib（奥赛康）、兰泽替尼（强生）已在国内申请上市。TY-9591（同源康医药）、FHND-9041（正大丰海）、艾维替尼（艾森医药）等进入3期临床试验阶段。 在激烈的竞争中要想胜出，差异化布局非常关键。以上三代EGFR-TKIs中，奥希替尼占据先发优势，也是后继者想分杯羹的存在。从结构和现有临床数据来看，阿美替尼较奥希替尼似乎并未表现出明显优势。伏美替尼是以三氟乙氧基吡啶取代奥希替尼中的甲氧基苯，具有更高的药效和更好的跨血脑屏障，其还打破了三代EGFR-TKIs一线治疗20个月的mPFS。此外，伏美替尼一线治疗EGFR 20外显子插入突变的局部晚期或转移性NSCLC的适应症先后被FDA和CDE授予突破性疗法认定。贝福替尼在一线治疗EGFR突变晚期NSCLC、二线治疗EGFR T790M突变阳性NSCLC的临床试验中都刷新了奥希替尼、阿美替尼和伏美替尼的纪录，而且其在一线治疗21外显子突变NSCLC中有优势，PFS长达17.9个月（奥希替尼14.4个月，阿美替尼13.4个月）。 三代EGFR-TKIs耐药的破局法 耐药是临床上无可避免会遇到的问题，第三代EGFR-TKIs也不例外。以奥希替尼为例，其耐药机制主要分为四类：EGFR通路突变；旁路激活；组织学转化；原因未明的耐药机制。EGFR通路突变包括EGFR C797S突变、T790M减少或消失、EGFR扩增等，其中EGFR C797突变最常见。旁路激活主要发生在一线治疗中，主要包括MET扩增、MET突变（H1094Y） 、KRAS突变（G12A） 、BRAF融合、RET融合等。组织学转化包括小细胞肺癌转化、上皮细胞-间充质转化、大细胞肺癌和鳞癌转化等。至于原因未明的耐药在一线治疗中比较常见，高达60%（不同研究数据有差异）的患者找不到耐药原因。 而针对EGFR -TKIs耐药的药物研发方向主要包括以下三种：开发靶向EGFR驱动的耐药突变的药物、靶向特定分子驱动的耐药突变的药物以及EGFR抑制剂与其他类型药物联合治疗策略。由此诞生了针对奥希替尼耐药的第四代EGFR -TKIs，如BLU-945和BBT-176，不过由于临床数据不理想，这两款药物相关试验被暂停或终止。此外，第四代EGFR -TKIs还针对一些罕见的EGFR突变，其中BDTX-1535可靶向NSCLC一系列经典/非经典EGFR驱动基因突变和耐药突变（包括C797S、G719X和S768I等），且具有很强的脑渗透性，其治疗EGFR突变NSCLC的1期初步临床数据（排除了EGFR T790M突变，外显子20插入突变，KRAS突变，MET扩增）显示：在12例可评估患者中，5例经 RECIST 1.1 确认实现了放射学部分缓解，另有1名患者表现出未经证实的PR等待确认，其余6名患者病情稳定，ORR达到50%，DCR为100%。 总结 肺癌是全球第一大癌，EGFR是一种常见的肺癌驱动基因。全球针对EGFR靶点不仅开发除了小分子化药，还开出了单抗、双抗。其中小分子EGFR-TKIs是NSCLC治疗领域非常重要的一类靶向药，目前已取得巨大成功，且经历了三代更迭。据Frost&Sullivan预计，2021年我国EGFR-TKIs市场规模达130亿元年，预计2025年和2030年有望分别达到285亿元和522亿元。鉴于目前国内EGFR-TKIs的市场格局，尤其是第三代EGFR-TKIs，未来该领域的竞争必将更加白热化。 来源：CPHI制药在线 声明：本文仅代表作者观点，并不代表制药在线立场。本网站内容仅出于传递更多信息之目的。如需转载，请务必注明文章来源和作者。 投稿邮箱：Kelly.Xiao@imsinoexpo.com ▼更多制药资讯，请关注CPHI制药在线▼ 点击阅读原文，进入智药研习社~

PT217 is Phanes' first-in-class bispecific antibody targeting DLL3 and CD47; atezolizumab ( TECENTRIQ® ) is Roche's anti-PD-L1 monoclonal antibody The clinical supply agreement will focus on evaluating PT217 in combination with atezolizumab for the treatment of small cell lung cancer (SCLC), large cell neuroendocrine carcinoma of the lung (LCNEC) and extrapulmonary neuroendocrine carcinomas (EP-NECs) PT217 was recently granted Fast Track designation by the FDA for the treatment of patients with extensive-stage small cell lung cancer (ES-SCLC) with disease progression following platinum chemotherapy with or without a checkpoint inhibitor SAN DIEGO, May 8, 2024 /PRNewswire/ -- Phanes Therapeutics, Inc. (Phanes), a clinical stage biotech company focused on innovative drug discovery and development in oncology, announced today that it has entered into a clinical supply agreement with Roche to study PT217, its first-in-class bispecific antibody targeting DLL3 and CD47, in combination with Roche's anti-PD-L1 therapy, atezolizumab, in patients with small cell lung cancer (SCLC), large cell neuroendocrine carcinoma of the lung (LCNEC) and extrapulmonary neuroendocrine carcinomas (EP-NECs). PT217 was granted orphan drug designation (ODD) for the treatment of SCLC by the FDA in 2022, and recently granted Fast Track designation by the agency for the treatment of patients with extensive-stage small cell lung cancer (ES-SCLC) with disease progression following platinum chemotherapy with or without a checkpoint inhibitor. Phanes is currently enrolling patients in a multi-center Phase I clinical trial of PT217. The Phase I clinical trial (NCT05652686), known as the SKYBRIDGE study, is currently evaluating the safety, tolerability, pharmacokinetics and preliminary efficacy of PT217 in patients with advanced or refractory cancers expressing DLL3. The next phase of Phanes' study is investigating the therapeutic potential of PT217 as a combination therapy in SCLC, LCNEC and EP-NECs. The clinical collaboration with Roche will evaluate PT217 in combination with atezolizumab in these patients. "Phanes is very excited about partnering with Roche on this novel approach to treat patients with SCLC, LCNEC and EP-NECs," said Rita Laeufle, MD, PhD, Chief Medical Officer (CMO) of Phanes. "DLL3 is highly expressed in SCLC, LCNEC and EP-NECs and an important target for treating these cancers. We believe the mechanisms of PT217 and atezolizumab are complementary and the combination has the potential to improve outcomes for patients. This collaboration marks another milestone for Phanes in fulfilling our vision of developing innovative approaches to treat cancer." TECENTRIQ ® is a registered trademark of Roche. ABOUT PHANES THERAPEUTICS Phanes Therapeutics, Inc. is a clinical stage biotech company focused on innovative drug discovery and development in oncology. Currently, it is conducting three Phase I clinical trials, including the MORNINGSTAR study with its best-in-class monoclonal antibody (mAb) program, PT199, the TWINPEAK study with PT886 and the SKYBRIDGE study with PT217. Both PT886 and PT217 are first-in-class bispecific antibodies and have been granted orphan drug designation as well as Fast Track designation by the FDA. The company has built a strong pipeline by leveraging its proprietary technology platforms: PACbody®, SPECpair® and ATACCbody® to develop novel biologics that address high unmet medical needs in cancer. For more information about Phanes Therapeutics, please visit For business development or media inquiries, please contact [email protected] or [email protected], respectively. SOURCE Phanes Therapeutics

SAN DIEGO, April 8, 2024 /PRNewswire/ -- Phanes Therapeutics, Inc. (Phanes), a clinical stage biotech company focused on innovative drug discovery and development in oncology, announced today that the U.S. Food and Drug Administration (FDA) has granted Fast Track designation to PT217 for the treatment of patients with extensive-stage small cell lung cancer (ES-SCLC) with disease progression following platinum chemotherapy with or without a checkpoint inhibitor. PT217 was also granted orphan drug designation for the treatment of small cell lung cancer by the FDA in 2022. PT217, a first-in-class native IgG-like bispecific antibody (bsAb) targeting DLL3 and CD47, is being developed for the treatment of patients with small cell lung cancer (SCLC), large cell neuroendocrine carcinoma of the lung (LCNEC), and extrapulmonary neuroendocrine carcinomas (EP-NECs). SCLC is an aggressive form of cancer characterized by high mortality rates and significant morbidities. The average survival for patients who present with ES-SCLC without treatment is 2-4 months after diagnosis; the median survival for patients with treatment is 7-11 months. "PT217 has the potential to be a transformative treatment option for patients with SCLC, LCNEC and EP-NECs in various settings," said Ming Wang, Founder and CEO of Phanes Therapeutics. "Now we have two Fast Track designations in our pipeline. Last month, PT886 was granted Fast Track designation for the treatment of patients with metastatic claudin 18.2-positive pancreatic adenocarcinoma. Both assets are from our optimized anti-CD47 bispecific antibody franchise and currently in clinical studies. We believe the optimized anti-CD47 bispecific antibody approach can unlock the full potential of the innate immunity in targeting solid tumors." The multi-center Phase I clinical trial of PT217 (NCT05652686), known as the SKYBRIDGE study, is currently evaluating the safety, tolerability, pharmacokinetics and preliminary efficacy of PT217 in patients with advanced or refractory cancers expressing DLL3. About Phanes Therapeutics Phanes Therapeutics, Inc. is a clinical stage biotech company focused on innovative drug discovery and development in oncology. Currently, it is conducting three Phase I clinical trials, including the MORNINGSTAR study with its best-in-class monoclonal antibody (mAb) program, PT199, the TWINPEAK study with PT886 and the SKYBRIDGE study with PT217. Both PT886 and PT217 are first-in-class bispecific antibodies and have been granted orphan drug designation as well as Fast Track designation by the FDA. The company has built a strong pipeline by leveraging its proprietary technology platforms: PACbody®, SPECpair® and ATACCbody® to develop novel biologics that address high unmet medical needs in cancer. For more information, please visit . For business development or media inquiries please contact [email protected] or [email protected], respectively. SOURCE Phanes Therapeutics