Pralatrexate

点击蓝字 关注我们 李志铭（中山大学肿瘤防治中心 内科，广东 广州 510060） 基金项目：国家自然科学基金项目（82073917)；广东省基础与应用基础研究基金项目（2023A1515011525） 通信作者：李志铭 E-mail ：lizhm@sysucc.org.cn 作者简介 李志铭  教授 中山大学肿瘤防治中心内科 教授 主任医师 博士生导师 中国老年保健协会肿瘤免疫治疗专业委员会 主任委员 中国老年保健协会淋巴瘤专业委员会 秘书长 中国抗癌协会青年理事会 常务理事 中国临床肿瘤学会抗淋巴瘤联盟 副秘书长、常委 中国抗癌协会淋巴瘤专业委员会 常委 中国抗癌协会淋巴瘤专业委员会青年委员会 副主任委员 中国医师协会肿瘤医师分会青年委员会 副主任委员 中国临床肿瘤学会头颈肿瘤专家委员会 常委 中国医药教育协会淋巴瘤分会 常委 中国抗癌协会神经肿瘤专业委员会中枢神经系统淋巴瘤学组 副组长 广东省抗癌协会淋巴瘤专业委员会 主任委员 广东省临床医学学会头颈肿瘤综合治疗专业委员会 主任委员 广东省抗癌协会靶向与个体化治疗专业委员会 副主任委员 广东省中西医结合学会肿瘤免疫专业委员会 副主任委员 广东省健康管理学会生育力保护专业委员会 副主任委员 广东省抗癌协会化疗专业委员会 常委 广东省临床医学学会咽喉肿瘤专业委员会 常委 【摘要】  为探寻淋巴瘤更有效的治疗途径及靶点，2024年研究人员针对基础和临床领域均开展深入探索。多项研究改变了淋巴瘤现有的治疗格局，霍奇金淋巴瘤和非霍奇金淋巴瘤治疗方面均取得了令人瞩目的进展。本文旨在综述2024年度淋巴瘤治疗研究进展。 【关键字】  非霍奇金淋巴瘤；霍奇金淋巴瘤；治疗进展 淋巴瘤是一组起源于淋巴结和淋巴组织的免疫系统恶性肿瘤的总称，也是中国常见恶性肿瘤之一。美国癌症协会利用癌症中央登记处收集的发病率数据（到2020年）和国家卫生统计中心收集的死亡率数据（到2021年），预计2024年美国新发霍奇金淋巴瘤（Hodgkin lymphoma，HL）8 570例，死亡910例；预计新发非霍奇金淋巴瘤（non-Hodgkin lymphoma，NHL）80 620例，死亡20 140例，淋巴瘤分别居男性和女性恶性肿瘤新发病例的第7位和第6位[1]。中国国家癌症中心定期报告全国癌症发病率和死亡率的统计数据，2022年中国新发HL 6 984例，死亡2 948例；新发NHL 97 788例，居我国所有恶性肿瘤的第13位[2]。近年来我国淋巴瘤发病率逐年增高，尽管我国淋巴瘤患者5年总生存（overall survival，OS）率从2003—2005年的32.6%逐渐提高到2013—2015年的37.2%，但仍存在明显地域、年龄、性别等差异[3-4]。淋巴瘤主要表现为无痛性淋巴结肿大，肝脾肿大，全身各组织器官均可受累，伴发热、盗汗、不明原因的体重减轻等症状，诊断时首选淋巴结切除活检。鉴于淋巴瘤病理类型复杂，治疗方案众多，预后转归差异较大，国内外学者近年来开展诸多研究探索各种类型淋巴瘤治疗新型靶点及方案，基于此，本文旨在总结2024年淋巴瘤领域治疗相关研究进展。 1. 霍奇金淋巴瘤 1.1 初治HL 初治HL的治疗目标为治愈，同时在不影响疗效的情况下尽可能减轻治疗相关毒性反应，降低早期及晚期并发症发生风险[5]。HL应采用综合治疗及个体化治疗的原则，依据分期及有无预后不良因素进行分层治疗，Ⅰ～Ⅱ期HL采用以化疗联合放射治疗（以下简称放疗）为主的综合治疗，单纯化疗适用于部分放疗长期毒性风险超过疾病短期控制获益的患者。Ⅲ～Ⅳ期HL治疗通常以化疗为基础，局部放疗仅限于化疗后残存病灶超过2.5 cm者。对于早期患者应追求更低的毒性，减少并发症，降低继发性肿瘤风险，降低心脏及肺脏毒性，而晚期患者应尽量提高治愈率。近年来随着维布妥昔单抗（brentuximab vedotin，BV）和程序性死亡受体1（programmed death-1，PD-1）抑制剂的问世，HL的治疗格局发生了显著改变。 ECHELON-1研究奠定了BV-AVD方案（BV＋多柔比星＋长春花碱＋达卡巴嗪）在晚期HL的一线治疗地位[6]，但BV增加了成人患者治疗的毒性作用，接受该药治疗的儿童患者中50%以上接受了巩固性放疗，同时远期复发仍是临床面临的重要挑战。PD-1抑制剂正在挑战BV-AVD方案的基石地位。一项国际多中心、开放标签、随机对照Ⅲ期临床研究（S1826）（NCT03907488）纳入≥12岁初治为Ⅲ期或Ⅳ期经典型HL患者共994例，随机分配至BV＋AVD组或纳武利尤单抗＋AVD组，以无进展生存（progression-free survival，PFS）率为主要终点，不良事件发生率、OS时间及无事件生存（event-free survival，EFS）率为次要终点。结果显示，中位随访时间为12.1个月（95%CI为0～38.6个月），纳武利尤单抗＋AVD组患者的2年PFS率为92%（95%CI为89%-94%），而BV+AVD组为83% （95%CI为79%-86%）（HR=0.45，95%CI为0.30-0.65）。而在安全性方面，除中性粒细胞减少及关节痛外，BV＋AVD组患者大部分不良事件发生率均相对更高，提示对于≥12岁Ⅲ期或Ⅳ期晚期经典型HL患者接受纳武利尤单抗＋AVD方案治疗较BV＋AVD方案可显著提高PFS率，且安全性更佳，故可作为该类人群潜在优选治疗方案[7]。 1.2 复发/难治性（recurrent/refractory，R/R）HL 研究表明，R/R HL治疗首选二线挽救方案化疗后进行大剂量化疗联合自体造血干细胞移植（autologous stem cell transplantation，ASCT），二线化疗可尽可能达到完全缓解（complete response，CR）。例如，BV联合化疗方案如ICE方案（异环磷酰胺＋卡铂＋依托泊苷）[8]、ESHAP方案（依托泊苷＋甲泼尼龙＋顺铂＋阿糖胞苷）[9]、DHAP方案（地塞米松＋顺铂＋阿糖胞苷）[10]的CR率分别为88%、70%、81%，即使更高比例患者获得CR，增加了ASCT治疗成功率。此外，PD-1抑制剂联合GVD方案（吉西他滨＋长春瑞滨＋多柔比星）（CR率85.2%）[11]、PD-1抑制剂联合ICE方案（CR率86.5%）[12]、PD-1抑制剂联合Gemox方案（吉西他滨＋奥沙利铂）（CR率90%）[13]均在R/R HL患者中具有良好疗效。 对于不符合ASCT条件的患者，可选择化疗、BV±化疗、PD-1抑制剂±化疗和（或）放疗。Janus激酶（Janus kinase，JAK）-信号传导及转录激活蛋白途径的细胞因子信号传导被认为与检查点免疫治疗耐药性相关。一项Ⅰ/Ⅱ期临床研究（NCT03681561）证实，R/R HL患者接受JAK抑制剂（芦可替尼）口服治疗，并在第8天及之后每4周联合纳武利尤单抗，治疗持续2年或直至疾病进展，客观缓解率（objective response rate，ORR）可达53%（10/19），其中31.6%（6/19）患者达到CR；中位随访时间为16.8个月，2年PFS率为46%，2年OS率高达87%，提示这一JAK抑制剂联合纳武利尤单抗能显著改善R/R HL患者临床预后，特别是免疫检查点抑制剂单药治疗反应不佳人群，为R/R HL人群治疗探索提供新的方向[14]。 2. 非霍奇金淋巴瘤 2.1 弥漫性大B细胞淋巴瘤（diffuse large B­ ­­­­-cell lymphoma，DLBCL） 2.1.1 初治DLBCL DLBCL是一组在形态学、遗传学和临床表现等方面具有异质性的疾病。约1/3的局限期患者接受以利妥昔单抗（rituximab，R）为基础的免疫治疗预后良好[15]，5年PFS率可高达80%～90%，但仍有约1/3患者出现难治或复发[16]。近20年来基于R-CHOP方案（R＋环磷酰胺＋多柔比星＋长春新碱＋泼尼松）的强化免疫化疗方案及R-CHOP+X方案在初治DLBCL人群开展了诸多探索，但均未取得阳性结果，这可能与DLBCL的生物学异质性特征有关[17]。 维泊妥珠单抗（polatuzumab，Pola）是一类靶向CD79b的抗体药物偶联物（antibody-drug conjugate，ADC），POLARIX研究的结果显示，采用Pola-R-CHP方案（Pola＋R＋环磷酰胺＋多柔比星＋泼尼松）患者随访2年的PFS率相比采用R-CHOP方案的患者提高了6.5%，而3年PFS率提高7.7%，目前已被获批用于DLBCL一线治疗[18]。一项开放标签、单中心、随机、Ⅱ期研究（GUIDANCE-01）评估了基于不同疾病亚型采用R-CHOP-X方案的疗效及安全性，结果显示，相比于传统R-CHOP方案，R-CHOP-X方案显著提高了患者临床疗效且安全性可控，为初治中危或高危DLBCL患者精准治疗提供新的选择方向[19]。而西达本胺联合R-CHOP（西达本胺联合治疗组）用于初治MYC和BCL2双表达DLBCL的Ⅲ期DEB研究中期分析结果于2024年美国临床肿瘤学会年会上公布，中位随访时间13.9个月（95%CI为12.9～15.4个月），西达本胺联合治疗组较对照组（R-CHOP方案）在主要研究终点2年EFS率明显获益（58.9%∶46.2%，HR＝0.68，95%CI为0.49～0.94），同时安全性可控，为初治双表达DLBCL患者带来了新的治疗选择[20]。 2.1.2  R/R DLBCL 对于首次缓解后复发的适合移植DLBCL患者，挽救化疗后进行ASCT是标准的二线治疗方案，但面临两大突出挑战：一方面，尽管ASCT有可能治愈，但R/R或早期复发（定义为初次诊断后1年内复发或进展）患者的ASCT成功率往往不高，预后仍较差；另一方面，相关研究显示，移植前达到CR对改善患者长期生存具有重大意义，但挽救化疗作为二线治疗的CR率可能不足40%，亟需更有效的治疗方案。 此外3L（三线以上）＋R/R DLBCL患者的治疗手段极为有限，仅能借助异基因造血干细胞移植、入组临床试验或接受嵌合抗原受体T细胞（chimeric antigen receptor T cell，CAR-T）治疗等挽救性手段，迫切需要更多新型靶向、免疫药物以改善R/R DLBCL患者的临床预后。一项全球多中心随机Ⅲ期临床研究（STARGLO）评估Glofit-GemOx方案[格菲妥单抗（glofitamab，Glofit）＋吉西他滨＋奥沙利铂]治疗不适合移植R/R DLBCL患者中的疗效和安全性，主要研究终点为OS时间，关键次要终点包括PFS时间、CR率和完全缓解持续时间，安全性评估则关注不良事件的发生率、性质和严重程度。中位随访时间为20.7个月，采用Glofit-GemOx方案患者的OS时间显著长于采用R-GemOx方案患者（25.5个月∶12.9个月，HR＝0.62），PFS时间（13.8个月∶3.6个月），CR率（58.5%∶25.3%）及完全缓解持续时间（未达到 ：24.2个月）均显示了明显优势。同时经暴露校正后，两组患者不良事件发生率相似，如每百例患者严重感染年发生率Glofit-GemOx组为47.95%，而R-GemOx组为61.07%。此外Glofit-GemOx方案中细胞因子释放综合征（cytokine release syndrome，CRS）主要发生在第1个周期，且大多为低级别。基于以上证据表明，Glofit-GemOx方案有望成为不适合移植的R/R DLBCL患者的新标准治疗方式[21]。另一项Ⅰb/Ⅱ期、单中心单臂临床研究采用无化疗靶向方案ViPOR方案（维奈克拉＋伊布替尼＋泼尼松＋奥妥珠单抗＋来那度胺）治疗R/R DLBCL患者的疗效及安全性。结果表明，48例可评估反应患者中ORR为54%，其中38%患者达到CR。中位缓解时间为0.66个月（95%CI为0.59～4.34）个月，其中78%患者达到CR持久且无需巩固；中位随访40个月，患者2年PFS率为34%（95%CI为21%～47%），2年持续缓解率为65%。安全性方面，67%患者发生任何级别的低钾血症，3～4级中性粒细胞减少、血小板减少及贫血发生率分别为24%、23%、7%。该研究进一步扩展了R/R DLBCL患者的无化疗方案选择，特别是对于高危的非生发中心型和高级别B细胞淋巴瘤双打击亚型患者具有潜在治愈的价值[22]。 2.2 滤泡性淋巴瘤（follicular lymphoma，FL） 2.2.1  初治FL Ⅰ～Ⅱ期FL患者积极治疗有望得到长期疾病控制。受累部位放疗（involved site radiation therapy，ISRT）是Ⅰ期和连续Ⅱ期患者的标准治疗，推荐放疗剂量为24 Gy，分12次。放疗结束后6个月内进行正电子发射断层显像/计算机断层扫描（positron emission tomography/ computed tomography，PET/CT）评估，约86%的患者可获得完全代谢缓解，5年PFS率为69%。对于有巨大肿块（≥7 cm）的Ⅰ～Ⅱ期和非连续性Ⅱ期患者可选择抗CD20单抗±化疗±放疗。对于不适合放疗的特殊部位（如腹膜后或肠系膜淋巴结）FL，可考虑抗CD20单抗±化疗。对于完全手术切除的Ⅰ期和不耐受系统治疗或ISRT不良反应的Ⅰ～Ⅱ期患者亦可选择等待观察。与Ⅰ～Ⅱ期不同，Ⅲ～Ⅳ期FL目前仍被认为不可治愈，故无治疗指征者，推荐观察等待；对于诊断时有治疗指征的患者，优先推荐抗CD20单抗＋化疗[23]。GALLIUM研究对比了G-化疗组（奥妥珠单抗联合化疗）和R-化疗组（R联合化疗）在初治FL中的疗效。中位随访时间为76.5个月，结果显示，G-化疗组患者PFS持续获益，疾病进展、复发或死相对风险较R-化疗组降低23%（HR=0.77，95%CI为0.64~0.93，P＝0.006）。对研究人群的次要研究终点分析显示，诱导治疗结束后，G-化疗组患者微小残留病阴性比例高于R-化疗组（92%∶85%，P＝0.004），且2年内出现疾病进展事件风险较R-化疗组降低46%，提示G-化疗组可更迅速清除肿瘤细胞并使疾病获得更深层的缓解[24]。 对于初治FL患者能否优化一线治疗方案，采用无化疗方案在保证疗效的前提下进一步提高治疗安全性及给药便捷性已成为临床关注的热点问题。一项mosunetuzumab联合来那度胺治疗初诊FL患者的Ⅰb/Ⅱ期临床研究显示，27例患者治疗后ORR为89%，22例（81.5%）患者达CR。16例（59.3%）患者中至少1例发生3～4级不良反应，最常见的是中性粒细胞减少症（7例）。共20例患者发生CRS，其中19例为1级CRS，1例为2级CRS，提示以mosunetuzumab为代表的双特异性抗体有望成为初治FL患者潜在的无化疗治疗[25]。 2.2.2  R/R FL R/R FL患者治疗原则为延长PFS时间，尽可能降低治疗相关不良反应，改善患者生活质量。复发时除需再次评估分期、治疗指征及是否发生转化等疾病因素外，还包括体能状况、合并症及既往治疗效果等。首次复发时的治疗对患者的预后至关重要。首次复发患者的治疗原则建议采用与一线治疗方案非交叉耐药的药物；多次复发的患者鼓励优先参加临床试验。末次治疗方案疗效维持＞2年的患者，再复发时仍可考虑采用原方案。难治或短期内进展的患者，优先考虑选择作用机制不同的药物。 一项Ⅰb/Ⅱ期研究结果显示，固定周期mosunetuzumab治疗既往≥2线治疗的R/R FL患者90例，中位随访18.3个月时疗效显著，总缓解率为80%，CR率达60%，远高于历史对照的14%；54例达到CR患者中，49例在治疗结束时仍保持CR；中位完全缓解持续时间未达到，30个月CR率为72.4%。36个月OS率为82.4%，中位OS未达到；中位PFS为24.0个月，36个月PFS率为43.2%；中位至下次治疗时间（time to next treatmen，TTNT）为37.3个月，36个月TTNT率为51.8%。安全性方面，未报告新致命、严重或≥3级不良事件，CRS发生率为44.4%，多发于第1周期，3～4级CRS发生率为2.2%。以上结果表明，mosunetuzumab单药治疗具有高缓解率、持久缓解及可管理安全性优势，有望成为3L＋FL标准治疗选择[26]。另一项全球多中心单臂Ⅱ期研究提示，127例R/R FL患者接受axicabtagene ciloleucel（Axi-cel）治疗后ORR和CR率分别为94%，79%，中位随访41.7个月，中位OS时间未达到，36个月估计OS率为76%，36个月淋巴瘤特异性死亡累积发生率为13%，显示出持久缓解效果及可控安全性[27]。 2.3 套细胞淋巴瘤（mantle cell lymphoma，MCL） 对于少部分不伴高危因素的Ⅰ期或连续型Ⅱ期（可放一个靶区放疗）MCL患者，一线治疗可采取类似于FL的治疗策略，单纯受累野放疗（involved-site radiotherapy，ISRT）、免疫化疗联合或不联合IRST，放疗剂量30～36 Gy。而对于非连续型Ⅱ期且不伴高危因素患者，推荐进行常规免疫化疗（非强化方案）。对于伴有高危因素的Ⅰ～Ⅱ期患者，建议按照晚期（Ⅲ～Ⅳ期）进行治疗。对于年龄≤65岁且一般状况较好、适合ASCT的MCL患者，应选择R联合含中大剂量阿糖胞苷的方案诱导治疗，缓解后进行ASCT巩固，但目前在临床实践中仅少部分最终完成ASCT[28]。欧洲MCL协作组发起了一项随机、开放标签、国际多中心的Ⅲ期临床研究（TRIANGLE），共纳入870例MCL患者，并按照1∶1∶1随机分为A组（n=288，标准强化诱导方案序贯ASCT）、I组[n＝290，标准强化诱导方案＋伊布替尼（包括诱导+维持）但不接受ASCT]和A＋I组[n＝292，标准强化诱导方案序贯ASCT＋伊布替尼（包括诱导+维持）]。主要研究终点为无失败生存（failure-free survival，FFS）时间，中位随访时间31个月。结果表明，A组患者的3年FFS率与I组无显著差异（72%∶86%，P＝0.997 9，HR＝1.77）；A＋I组3年FFS率显著优于A组（88%∶72%，P＝0.000 8，HR＝0.52）；同时高p53表达患者和高危生物学[高危MIPI-c（MCL国际预后指数）或p53高表达＞50%]患者中，A＋I组患者的FFS优于A组（HR=0.31）。以上数据提示，与免疫化疗联合ASCT巩固这一标准疗法相比，联合伊布替尼的免疫化疗疗效更优，但在维持治疗或随访期间，与单纯用伊布替尼相比，ASCT＋伊布替尼治疗后3~5级不良事件发生率显著升高，其中中性粒细胞减少症发生率分别为44%、23%[29]。另一项针对适合移植的18～65岁初治MCL患者的匹配性研究（NCT02896582）结果证实，奥妥珠单抗（obinutuzumab，O）组（基于O的免疫化疗方案序贯ASCT）预后优于R组，其中诱导治疗结束时O组接受治疗的患者骨髓微小残留病变阴性率显著高于R组（骨髓为83.1%∶63.4%，P＝0.007；外周血为95.3%：72.9%，P<0.001)，且O组预估5年PFS率和OS率均高于R组（82.8%：66.6%，HR=1.99，P=0.029），同时维持治疗期间，两组患者3～4级中性粒细胞减少发生率相近，故对于适合移植MCL患者O与R相比疾病控制更优，可延长PFS时间和OS时间，且未增加不良反应发生风险[30]。 一线治疗后复发MCL患者首选参加临床试验，无临床试验时依据患者是否具有高危因素进行选择，非高危患者首选布鲁顿酪氨酸激酶（Bruton tyrosine kinase，BTK）抑制剂[31]或来那度胺＋R治疗（特别是24个月内复发患者）；24个月后复发患者可首选以苯达莫司汀为主的联合化疗，如R-BAC方案（苯达莫司汀＋阿糖胞苷）或BR方案（苯达莫司汀＋R）。一线复发后伴高危因素或二线治疗未达CR或BTK抑制剂治疗失败患者应尽早考虑靶向CD19的CAR-T治疗或异基因造血干细胞移植[32]。 2.4 外周T细胞淋巴瘤（peripheral T-cell lymphomas，PTCL） PTCL的生物学行为和临床表现呈现高度异质性和侵袭性，亚型种类繁多，不同亚型具有不同的临床特征、遗传学改变及治疗反应。含蒽环类药物的化疗方案如CHOP方案或CHOP样方案是PTCL最常使用的一线方案，但CR率和3年OS率仅分别为39%和26%。目前对于初治PTCL患者化疗联合新药仍然是临床探索重要方向，ECHELON-2研究证实，中位随访时间66.8个月，靶向CD30 ADC（BV）＋CHP方案较CHOP方案5年PFS率显著改善（51.4%∶43.0%，HR＝0.70，P=0.008）[33]。但罗米地辛＋CHOP方案对比CHOP方案治疗初治PTCL的全球多中心随机Ⅲ期研究未获得阳性结果，中位随访时间为6年，罗米地辛＋CHOP方案和患者CHOP方案中位PFS时间分别为12.0、10.2个月，但在滤泡辅助性T细胞（follicular helper T cell，TFH）亚组中罗米地辛＋CHOP方案显示出生存获益趋势，中位PFS时间分别为19.5、10.6个月[34]。 对于R/R PTCL患者应优先推荐参加临床试验，无临床试验时则可接受后线挽救治疗，目前已获批药物包括西达本胺、贝利司他、罗米地辛、普拉曲沙、BV（针对CD30+PTCL患者人群）、克唑替尼（针对ALK+PTCL患者人群）、吉西他滨、PD-1抑制剂、苯达莫司汀、来那度胺、硼替佐米、度维利塞等，但CR率和缓解持续时间均不理想。一项单臂国际多中心Ⅱ期研究（JACKPOT8 Part B）证实，高选择性JAK1抑制剂戈利昔替尼单药治疗R/R PTCL患者114例ORR为44.3%，CR率达23.9%，不同亚型PTCL中均观察到肿瘤缓解，自然杀伤细胞/T淋巴细胞淋巴瘤、血管免疫母细胞性T淋巴细胞淋巴瘤及外周T淋巴细胞淋巴瘤非特指型亚组ORR分别达66.7%、56.3%、46%，中位缓解持续时间和中位OS时间分别为20.7、24.3个月，最常见的≥3级治疗相关不良事件为血液学毒性，且安全性可控[35]。VALENTINE-PTCL01研究是一项开放标签、多中心、单臂Ⅱ期临床试验，旨在评估EZH 1/2抑制剂valemetostat单药治疗R/R PTCL的疗效及安全性，主要研究终点为CT评估ORR。结果显示，119例可评价疗效患者ORR和CR率分别为43.7%和14.3%，中位缓解持续时间为11.9个月，在所有PTCL亚型中均观察到缓解，但TFH淋巴瘤疗效获益更佳，ORR达54%；最常见的治疗相关不良事件（任何等级/≥3级）为血小板减少（49.6%/23.3%）、贫血（35.3%/18.8%）、腹泻（29.3%/3.8%）、消化不良（28.6%/0）及中性粒细胞减少（26.3%/17.3%）[36]。 3. 总结与展望 随着小分子抑制剂、单克隆抗体、双特异性抗体、ADC、CAR-T等新型疗法不断涌现，淋巴瘤治疗格局正在发生翻天覆地改变，为患者提供更多临床治疗选择。淋巴瘤的治疗应遵循个体化及精准化原则，结合患者的具体情况和治疗反应，综合权衡传统治疗方法与新型药物的应用，以实现最佳的治疗效果和患者生活质量，同时期待后续临床研究及药物研发助力改善淋巴瘤患者预后。 参考文献 [1] SIEGEL R L, GIAQUINTO A N, JEMAL A. 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Lancet Oncol, 2024. Epub ahead of print. 推荐阅读 ●   盘点2023 | 李志铭教授：2023年度淋巴瘤诊断和治疗进展 ●   2023年度肿瘤学科盘点集锦(共17个) 声明：本文由“肿瘤界”整理与汇编，欢迎分享转载，如需使用本文内容，请务必注明出处。 排版：lagertha 校对：松月

Soquelitinib Atopic Dermatitis Phase 1 Clinical Trial Enrolling Patients in Second Dosing Cohort Interim Data from Atopic Dermatitis Trial Expected to be Announced December 2024 Registration Phase 3 Clinical Trial of Soquelitinib in Peripheral T Cell Lymphoma (PTCL) Enrolling with Multiple Clinical Sites Open Conference call today at 4:30 p.m. ET / 1:30 p.m. PT BURLINGAME, Calif., Nov. 12, 2024 (GLOBE NEWSWIRE) -- Corvus Pharmaceuticals, Inc. (Corvus or the Company) (Nasdaq: CRVS), a clinical-stage biopharmaceutical company, today provided a business update and reported financial results for the third quarter ended September 30, 2024. “There is strong interest from clinicians and patients in both of our clinical programs for soquelitinib – the registration Phase 3 clinical trial in PTCL and the Phase 1 clinical trial in atopic dermatitis – and we are pleased with ongoing enrollment in these trials,” said Richard A. Miller, M.D., co-founder, president and chief executive officer of Corvus. “ITK inhibition offers a novel mechanism of action that inhibits multiple parallel signaling pathways that modulate T cell function and immunity, giving it broad potential across a range of indications in oncology and immune disease. Its clinical potential has already been demonstrated in PTCL and we look forward to presenting interim data from our Phase 1 clinical trial in atopic dermatitis in December. We are excited for the potential of ITK inhibition to provide a new oral treatment option for atopic dermatitis, with the potential for improved efficacy, and with a more convenient and tolerable profile than biologics.” Business Update and Strategy Prioritized Program: Soquelitinib (Corvus’ selective ITK inhibitor) Soquelitinib for Immune Diseases Corvus continues to enroll patients at multiple clinical sites in its randomized, placebo-controlled Phase 1 clinical trial of soquelitinib in patients with moderate to severe atopic dermatitis. The trial is planned to enroll 64 patients that have failed at least one prior therapy across four different 28-day dosing regimens of soquelitinib compared to a placebo group. Patients are followed for an additional 30 days after completing the 28 day course of therapy. The endpoints include safety and improvement in the Eczema Area and Severity Index. Patients and physicians are blinded to the treatment assignment. Enrollment in the first cohort (100 mg, twice per day) has been completed and the data review committee has met and found no safety signals. The second cohort (200 mg, once-daily) is now enrolling patients. Corvus plans to announce interim data from the Phase 1 clinical trial in December 2024. In November, Corvus plans to present new preclinical data highlighting the potential of soquelitinib to prevent lung damage, inflammation and pulmonary hypertension caused by systemic sclerosis at ACR Convergence 2024, the annual meeting of the American College of Rheumatology.Corvus continues to advance its next-generation ITK inhibitor preclinical product candidates, which were designed to deliver precise T-cell modulation that is optimized for specific immunology indications. Soquelitinib for T Cell Lymphoma Corvus continues to enroll patients in a registrational Phase 3 clinical trial of soquelitinib in patients with relapsed PTCL at multiple sites. This randomized controlled trial is anticipated to enroll a total of 150 patients with relapsed PTCL and is evaluating soquelitinib versus physicians’ choice of either belinostat or pralatrexate. The primary endpoint of the trial is progression free survival.There are no FDA fully approved agents for the treatment of relapsed PTCL and the FDA has granted soquelitinib Orphan Drug Designation for the treatment of T cell lymphoma and Fast Track designation for treatment of adult patients with relapsed or refractory peripheral T cell lymphoma after at least 2 lines of systemic therapy. Collaboration with Kidney Cancer Research Consortium: Ciforadenant (adenosine A2a receptor inhibitor) Corvus is collaborating with the Kidney Cancer Research Consortium in a Phase 1b/2 clinical trial evaluating ciforadenant as a potential first line therapy for metastatic renal cell cancer (RCC) in combination with ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1). The efficacy endpoint for the trial is deep response rate, defined as CR plus PRs of greater than 50% tumor volume reduction. The clinical trial is expected to enroll up to 60 patients and as of September 30, 2024, a total of 46 patients were enrolled in the trial. The protocol defined, interim pre-specified statistical threshold for efficacy is a 50% increase above the 32% deep response rate seen with previous ipilimumab/nivolumab combination trials in RCC conducted by investigators at the Kidney Cancer Research Consortium. The analysis of the clinical trial continues to meet the threshold for efficacy and therefore enrollment continues. Along with our partners at the Kidney Cancer Research Consortium, we have decided to continue our follow-up of patients on the trial before presenting the data. Therefore, we will not be presenting this data at the GU Malignancy conference taking place in late November and will instead target a presentation sometime in 2025.The Phase 1b/2 clinical trial in patients with metastatic RCC is supported by data presented in November at the Society for Immunotherapy of Cancer (SITC) 39th Annual Meeting highlighting the potential of ciforadenant to overcome immunotherapy resistance in metastatic castration resistant prostate cancer. Financial Results As of September 30, 2024, Corvus had cash, cash equivalents and marketable securities of $41.7 million as compared to $27.1 million as of December 31, 2023. In October 2024, a holder of 1,677,220 common stock warrants early exercised all of their warrants resulting in cash proceeds of approximately $5.9 million. Corvus expects full year 2024 net cash used in operating activities to be between approximately $25 million and $26 million, resulting in a projected cash balance of between approximately $38 million and $39 million at December 31, 2024. Based on its current plans, Corvus expects its cash to fund operations into 2026. Research and development expenses for the three months ended September 30, 2024 totaled $5.2 million compared to $4.0 million for the same period in 2023. The increase of approximately $1.2 million was primarily due to higher clinical trial costs associated with the development of soquelitinib. The net loss for the three months ended September 30, 2024 was $40.2 million compared to a net loss of $6.0 million for the same period in 2023. Total stock compensation expense for the three months ended September 30, 2024 was $0.7 million compared to $0.5 million for the same period in 2023 and the non-cash loss from Corvus’ equity method investment in Angel Pharmaceuticals was $0.7 million for the three months ended September 30, 2024 compared to a loss of $0.9 million for the same period in 2023. In addition, the Company recorded a non-cash loss of $32.8 million related to an increase in the fair value of its warrant liability during the three months ended September 30, 2024 due an increase in the Company’s stock price from $1.82 at June 30, 2024 to $5.28 at September 30, 2024. The Company issued approximately 17.1 million common stock warrants in its May 2024 registered direct offering with an exercise price of $3.50 per common stock warrant. After the October 2024 early exercise of 1,677,220 common stock warrants, approximately 15.4 million common stock warrants remain outstanding. The common stock warrants expire on June 30, 2025. Conference Call DetailsCorvus will host a conference call and webcast today, Tuesday, November 12, 2024, at 4:30 p.m. ET (1:30 p.m. PT), during which time management will provide a business update and discuss the third quarter 2024 financial results. The conference call can be accessed by dialing 1- 800-717-1738 (toll-free domestic) or 1- 646-307-1865 (international) or by clicking on this link for instant telephone access to the event. The live webcast may be accessed via the investor relations section of the Corvus website. A replay of the webcast will be available on Corvus’ website for 90 days. About Corvus PharmaceuticalsCorvus Pharmaceuticals is a clinical-stage biopharmaceutical company pioneering the development of ITK inhibition as a new approach to immunotherapy for a broad range of cancer and immune diseases. The Company’s lead product candidate is soquelitinib, an investigational, oral, small molecule drug that selectively inhibits ITK. Its other clinical-stage candidates are being developed for a variety of cancer indications. For more information, visit www.corvuspharma.com. About SoquelitinibSoquelitinib (formerly CPI-818) is an investigational small molecule drug given orally designed to selectively inhibit ITK (interleukin-2-inducible T cell kinase), an enzyme that is expressed predominantly in T cells and plays a role in T cell and natural killer (NK) cell immune function. Based on interim results from a Phase 1/1b clinical trial in patients with refractory T cell lymphomas, which demonstrated tumor responses in very advanced, refractory, difficult to treat T cell malignancies, the Company initiated a registrational Phase 3 clinical trial of soquelitinib in patients with relapsed PTCL. Soquelitinib also is now being investigated in a randomized placebo controlled phase 1 clinical trial in patients with atopic dermatitis. The immunologic effects of soquelitinib lead to what is known as Th1 skewing and inhibition of Th2 and Th17 cells. Research on soquelitinib’s mechanism of action suggests that it has the potential to control differentiation of normal T helper cells and enhance immune responses to tumors by augmenting the generation of cytotoxic killer T cells and the production of cytokines that inhibit cancer cell survival. Soquelitinib has also been shown to prevent T cell exhaustion, a major limitation of current immunotherapy and CAR-T therapies. Soquelitinib has been shown to affect T cell differentiation and induce the generation of Th1 helper cells while blocking the development of both Th2 and Th17 cells and production of their secreted cytokines. Th1 T cells are required for immunity to tumors, viral infections and other infectious diseases. Th2 and Th17 helper T cells are involved in the pathogenesis of many autoimmune and allergic diseases. The Company believes the inhibition of specific molecular targets in T cells may be of therapeutic benefit for patients with cancers, including solid tumors, and in patients with autoimmune and allergic diseases. About Peripheral T Cell LymphomaPeripheral T cell lymphoma is a heterogeneous group of malignancies accounting for about 10% of non-Hodgkin’s lymphomas (NHL) in Western populations, reaching 20% to 25% of NHL in some parts of Asia and South America. The most common subtypes are PTCL-not otherwise specified (PTCL-NOS) and T follicular helper cell lymphoma. First line treatment for these diseases is typically combination chemotherapy, however, approximately 75% of patients either do not respond or relapse within the first two years. Patients in relapse are treated with various chemotherapy agents but have poor overall outcomes with median progression-free survival in the three to four month range and overall median survival of six to 12 months. There are no approved drugs in relapsed PTCL based on randomized trials. PTCL is a disease of mature helper T cells that express ITK, often containing numerous genetic mutations and frequently associated with viral infection. Most often the malignant cells of PTCL express a Th2 phenotype. About Atopic DermatitisAtopic dermatitis, also called eczema, is a chronic disease that can cause inflammation, redness, scaly patches, blisters and irritation of the skin. It affects up to 20% of children and up to 10% of adults, and treatments include topical therapies, oral therapies and systemic injectable biologic therapies. It is frequently associated with other allergic disorders such as food allergies and asthma. Atopic dermatitis, like asthma and allergy, involves the participation of Th2 lymphocytes which secrete cytokines that result in inflammation. Soquelitinib has been shown in preclinical studies to inhibit cytokine production from Th2 lymphocytes. About CiforadenantCiforadenant (CPI-444) is an investigational small molecule, oral, checkpoint inhibitor designed to disable a tumor’s ability to subvert attack by the immune system by blocking the binding of adenosine to immune cells present in the tumor microenvironment. Adenosine, a metabolite of ATP (adenosine tri-phosphate), is produced within the tumor microenvironment where it may bind to the adenosine A2a receptor present on immune cells and block their activity. Ciforadenant has been shown to block the immunosuppressive effects of myeloid cells present in tumors and preclinical studies published in 2018 demonstrated synergy with combinations of anti PD1 and anti-CTLA4 antibodies. About MupadolimabMupadolimab (CPI-006) is an investigational, potent humanized monoclonal antibody that is designed to react with a specific site on CD73. In preclinical studies, it has demonstrated immunomodulatory activity resulting in activation of lymphocytes, induction of antibody production from B cells and effects on lymphocyte trafficking. While there are other anti-CD73 antibodies and small molecules in development for treatment of cancer, such agents react with a different region of CD73. Mupadolimab is designed to react with a region of the molecule that acts to stimulate B cells and block production of immunosuppressive adenosine. Mupadolimab is being studied in combination with pembrolizumab in a Phase 1b/2 clinical trial in patients with advanced head and neck cancers and in patients with NSCLC that have failed chemotherapy and anti-PD(L)1 therapy. It is postulated that the activation of B cells will enhance immunity within the tumors of these patients, leading to improved clinical outcomes. About Angel PharmaceuticalsAngel Pharmaceuticals is a privately held biopharmaceutical company developing a pipeline of precisely targeted investigational medicines for cancer, autoimmune, infectious and other serious diseases in China. Angel Pharmaceuticals was launched through a collaboration with U.S.-based Corvus and investments from investors in China. Angel Pharmaceuticals licensed the rights to develop and commercialize Corvus’ three clinical-stage candidates – soquelitinib, ciforadenant and mupadolimab – in greater China and obtained global rights to Corvus’ BTK inhibitor preclinical programs. Under the collaboration, Corvus currently has a 49.7% equity stake in Angel Pharmaceuticals excluding 7% of Angel’s equity reserved for issuance under the Angel ESOP, and Corvus has designated three individuals on Angel’s five-person Board of Directors. For more information, visit www.angelpharma.com. Forward-Looking StatementsThis press release contains forward-looking statements, including statements related to the potential safety and efficacy of the Company’s product candidates including soquelitinib, ciforadenant and mupadolimab; the potential use of soquelitinib to treat a variety of hematological cancers and autoimmune diseases; the potential of ciforadenant to overcome immunotherapy resistance in metastatic castration resistant prostate cancer; the potential of ITK inhibition to provide a new oral treatment option for atopic dermatitis; the Company’s ability and its partners’ ability, as well as the timing thereof, to develop and advance product candidates into and successfully complete preclinical studies and clinical trials, including the Company’s registrational Phase 3 clinical trial for PTCL with soquelitinib and its Phase 1 clinical trial for atopic dermatitis with soquelitinib; the timing of and the Company’s ability to launch clinical trials, including the soquelitinib Phase 1 clinical trial for solid tumors; the design of clinical trials, including the timeline for initiation, target or expected number of patients to be enrolled, expected number of sites and certain other product development milestones, including in regards to the Phase 1 clinical trial for atopic dermatitis with soquelitinib and the registrational Phase 3 clinical trial for PTCL with soquelitinib; the availability and timing of clinical and preclinical data announcements and clinical readouts, including interim data from the Phase 1 clinical trial for atopic dermatitis with soquelitinib and preclinical data highlighting the potential of soquelitinib to prevent lung damage, inflammation and pulmonary hypertension caused by systemic sclerosis; the estimated amount of net cash used in operating activities for 2024 and its ability to fund operations into 2026. All statements other than statements of historical fact contained in this press release are forward-looking statements. These statements often include words such as “believe,” “expect,” “anticipate,” “intend,” “plan,” “estimate,” “seek,” “will,” “may” or similar expressions. Forward-looking statements are subject to a number of risks and uncertainties, many of which involve factors or circumstances that are beyond the Company’s control. The Company’s actual results could differ materially from those stated or implied in forward-looking statements due to a number of factors, including but not limited to, risks detailed in the Company’s Quarterly Report on Form 10-Q for the three months ended September 30, 2024, filed with the Securities and Exchange Commission on or about the date hereof, as well as other documents that may be filed by the Company from time to time with the Securities and Exchange Commission. In particular, the following factors, among others, could cause results to differ materially from those expressed or implied by such forward-looking statements: the Company’s ability to demonstrate sufficient evidence of efficacy and safety in its clinical trials of soquelitinib and its other product candidates; the accuracy of the Company’s estimates relating to its ability to initiate and/or complete preclinical studies and clinical trials and release data from such studies and clinical trials; the results of preclinical studies and interim data from clinical trials not being predictive of future results; the Company’s ability to enroll sufficient numbers of patients in its clinical trials; the unpredictability of the regulatory process; regulatory developments in the United States, and other foreign countries; the costs of clinical trials may exceed expectations; the Company’s ability to accurately estimate the amount of net cash used in operating activities for 2024 and cash on hand providing funding into 2026 and the Company’s ability to raise additional capital. Although the Company believes that the expectations reflected in the forward-looking statements are reasonable, it cannot guarantee that the events and circumstances reflected in the forward-looking statements will be achieved or occur, and the timing of events and circumstances and actual results could differ materially from those projected in the forward-looking statements. Accordingly, you should not place undue reliance on these forward-looking statements. All such statements speak only as of the date made, and the Company undertakes no obligation to update or revise publicly any forward-looking statements, whether as a result of new information, future events or otherwise. The Company’s results for the quarter ended September 30, 2024 are not necessarily indicative of its operating results for any future periods. CORVUS PHARMACEUTICALS, INC.CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (in thousands, except share and per share data) Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 (unaudited) (unaudited)Operating expenses: Research and development $5,222 $3,965 $13,411 $12,527 General and administrative 2,033 1,595 6,032 5,229 Total operating expenses 7,255 5,560 19,443 17,756 Loss from operations (7,255) (5,560) (19,443) (17,756)Interest income and other expense, net 566 425 1,316 1,204 Change in fair value of warrant liability (32,846) — (31,030) — Sublease income - related party — — — 56 Loss from equity method investment (682) (865) (1,023) (3,880)Net loss $(40,217) $(6,000) $(50,180) $(20,376)Net loss per share, basic and diluted$(0.60) $(0.12) $(0.86) $(0.43)Shares used to compute net loss per share, basic and diluted 66,701,086 48,971,246 58,513,303 47,683,792 CORVUS PHARMACEUTICALS, INC.CONDENSED CONSOLIDATED BALANCE SHEETS (in thousands) September 30,December 31, 2024 2023 (unaudited) Assets Cash, cash equivalents and marketable securities$41,651 $27,149Operating lease right-of-use asset 284 1,149Other assets 1,693 1,132Investment in Angel Pharmaceuticals 15,187 16,123Total assets$58,815 $45,553Liabilities and stockholders' equity Accounts payable and accrued liabilities and other liabilities$6,088 $5,495Operating lease liability 354 1,374Warrant liability 39,964 —Stockholders' equity 12,409 38,684Total liabilities and stockholders' equity$58,815 $45,553 INVESTOR CONTACT:Leiv LeaChief Financial OfficerCorvus Pharmaceuticals, Inc.+1-650-900-4522llea@corvuspharma.com MEDIA CONTACT:Sheryl SeapyReal Chemistry+1-949-903-4750sseapy@realchemistry.com