A Phase II Randomized Study of Blinatumomab With or Without Revumenib for Patients With KMT2A-Translocation B-Cell Acute Lymphoblastic Leukemia (ALL)/ Acute Leukemia With Ambiguous Lineage (ALAL) With Persistent Measurable Residual Disease (MRD)

This phase II trial tests how well adding revumenib to usual treatment (blinatumomab) compared to usual treatment alone works in treating patients with B-cell acute lymphoblastic leukemia (B-ALL) or acute leukemia with ambiguous lineage (ALAL) with KMT2A-translocation. Revumenib binds to a protein called menin and keeps it from binding to another protein called KMT2A. This stops or slows the growth of leukemia cells with changes in the KMT2A gene. Blinatumomab binds to CD19, which is found on most B cells (a type of white blood cell) and some types of leukemia cells. It also binds to a protein called CD3, which is found on T cells (another type of white blood cell). This may help the immune system kill cancer cells. In addition to blinatumomab, usual treatment also includes dexamethasone, methotrexate, cyclophosphamide, cytarabine, mercaptopurine, calaspargase pegol, doxorubicin, thioguanine, daunorubicin, vincristine and leucovorin. Dexamethasone is in a class of medications called corticosteroids. It is used to reduce inflammation and lower the body's immune response to help lessen the side effects of chemotherapy drugs. Methotrexate is in a class of medications called antimetabolites. It is also a type of antifolate. Methotrexate stops cells from using folic acid to make deoxyribonucleic acid (DNA) and may kill cancer cells. Cyclophosphamide is in a class of medications called alkylating agents. It works by damaging the cell's DNA and may kill cancer cells. It may also lower the body's immune response. Chemotherapy drugs, such as cytarabine, mercaptopurine, calaspargase pegol, doxorubicin, thioguanine, and daunorubicin, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Vincristine is in a class of medications called vinca alkaloids. It works by stopping cancer cells from growing and dividing and may kill them. Leucovorin is also being studied in the treatment of cancer. It is a type of chemoprotective agent and a type of chemosensitizing agent. Adding revumenib to usual treatment with blinatumomab may be safe, tolerable and more effective than blinatumomab alone in lowering the amount of leukemia in patients with B-ALL or ALAL with the KMT2A translocation.

开始日期2026-10-14

申办/合作机构

SWOG

[+1]

NCT07654426

/ Not yet recruiting临床2期IIT

A Randomized Study of Dexrazoxane or Liposomal Doxorubicin in Newly Diagnosed Diffuse Large B-cell Lymphoma at High Risk for Heart Failure Events: the CARDIOPROTECT Trial

This trial is to evaluate if dexrazoxane is safer and more effective than liposomal doxorubicin in preventing heart failure events in participants with diffuse large B-cell lymphoma (DLBCL) undergoing either standard of care R-CHOP or pola-R-CHP treatment regiments.
The names of the study drugs involved in this study are:
* Dexrazoxane (a type of Topoisomerase II Inhibitor)
* Liposomal Doxorubicin (a type of Topoisomerase II Inhibitor)
* Standard of care R-CHOP treatment regimen (Cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab)
* Standard of care pola-R-CHP treatment regimen: Cyclophosphamide, doxorubicin, polatuzumab vedotin-piiq, prednisone, rituximab

开始日期2026-10-02

申办/合作机构

Beth Israel Deaconess Medical Center, Inc.

NCT07649304

/ Not yet recruiting临床1期IIT

A Feasibility Study of Glofitamab Plus Chemoimmunotherapy in Newly Diagnosed HIV-Associated Large B-Cell Lymphoma

This phase I trial studies the safety and side effects of glofitamab plus a chemoimmunotherapy regimen called R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) in treating patients newly-diagnosed with HIV-associated large B-cell lymphoma. Glofitamab is a bispecific monoclonal antibody, which can bind to two different antigens that are expressed by cancer cells (CD3 and CD20) at the same time. This may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Rituximab is a monoclonal antibody. It binds to a protein called CD20, which is found on B cells (a type of white blood cell) and some types of cancer cells. This may help the immune system kill cancer cells. Cyclophosphamide is in a class of medications called alkylating agents. It works by damaging the cell's deoxyribonucleic acid (DNA) and may kill cancer cells. It may also lower the body's immune response. Doxorubicin is in a class of medications called anthracyclines. Doxorubicin damages the cell's DNA and may kill cancer cells. It also blocks a certain enzyme needed for cell division and DNA repair. Vincristine is in a class of medications called vinca alkaloids. It works by stopping cancer cells from growing and dividing and may kill them. Prednisone is in a class of medications called corticosteroids. It is used to reduce inflammation and lower the body's immune response to help lessen the side effects of chemotherapy drugs. Giving glofitamab in combination with the R-CHOP regimen may be a safe treatment for patients with newly-diagnosed with HIV-associated large B-cell lymphoma.

开始日期2026-09-11

申办/合作机构

National Cancer Institute

100 项与硫酸长春新碱相关的临床结果

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100 项与硫酸长春新碱相关的转化医学

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100 项与硫酸长春新碱相关的专利（医药）

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13,346

项与硫酸长春新碱相关的文献（医药）

2026-12-01·Blood Research

Exploring CD79b, LC3, and TERT expression in NON-GCB DLBCL: markers associated with Rituximab-Cyclophosphamide-Doxorubicin-Vincristin-Prednisone treatment response

Article

作者: Yantisetiasti, Anglita ; Trianasari, Nurvita ; Ilanur, Arnita ; Agustina, Hasrayati ; Usman, Hermin A ; Dewayani, Birgitta M ; Nuraeni, Nia ; Hernowo, Bethy S ; Primastari, Etis ; Husain, Okky ; Oehadian, Amaylia

Abstract:

Introduction:

Diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma. The non-germinal center B-cell-like (non-GCB) subtype is associated with a poor prognosis and reduced response rates to rituximab cyclophosphamide-doxorubicin-vincristin-prednisone (R-CHOP) therapy. Resistance may involve cluster of differentiation 79B (CD79B)-driven B-cell receptor (BCR)/nuclear factor kappa B activation, microtubule-associated protein 1 light chain 3 (LC3)-mediated autophagy, and telomerase reverse transcriptase (TERT)-related survival signaling. The interrelationships between these markers and their associations with therapeutic responses remain unclear. This study evaluated the association between CD79B, LC3, and TERT expression and response to R-CHOP in non-GCB DLBCL.

Methods:

This analytical case–control study included 58 paraffin-embedded samples from patients with non-GCB DLBCL diagnosed at the Dr. Hasan Sadikin General Hospital, Bandung, Indonesia (2017–2023). Tumor characteristics were assessed using immunohistochemical staining for CD79B, LC3, and TERT. Expression levels were evaluated semi-quantitatively based on staining intensity and the proportion of positive tumor cells. Treatment responses were categorized as response (complete/partial) or non-response (stable/progressive). Statistical analyses were performed using the chi-square test, Fisher’s exact test, and binary logistic regression, with significance defined as p < 0.05.

Results:

TERT, CD79B, and LC3 expression was detected in 53.4%, 55.2%, and 62.1% of the cases, respectively. Among non-responsive patients, TERT and LC3 expression rates were 62.1% and 69.0% ( p > 0.05), respectively. CD79B expression was significantly associated with non-response ( p = 0.002). Moreover, multivariate analysis identified positive CD79B expression as an independent predictor of non-response to R-CHOP therapy (OR = 9.72).

Conclusion:

CD79B expression was independently associated with a poor response to R-CHOP therapy in non-GCB DLBCL. The positive association between TERT and LC3 suggests the presence of additional metabolic adaptation mechanisms supporting tumor survival.

2026-05-14·ChemMedChem

Discovery and Evaluation of 6,7-Dimethoxy-1,2,3,4-Tetrahydroisoquinoline Derivatives as P-gp Inhibitors to Overcome Multidrug Resistance in Eca109/VCR Cells.

Article

作者: Tian, Lan ; Zeng, Rong ; Li, Hong-Wei ; Li, Yulong ; Yu, Tao ; Cao, Wen-Xuan ; Ouyang, Qin ; Xie, Ying ; Xia, Jin-Yu ; Guo, Chun-Ling ; Lai, Wen-Jing

The efficacy of chemotherapy against malignant tumors is severely limited by multidrug resistance (MDR), of which the overexpression of P-glycoprotein (P-gp) is recognized as a key mechanism. Consequently, the development of potent, low-toxicity P-gp inhibitors represents a crucial direction in anticancer drug research. Based on our group's prior work on P-gp inhibitors and supported by molecular docking analysis, 21 novel tetrahydroisoquinoline derivatives were designed and synthesized in this study. Their ability to reverse MDR was assessed in the human esophageal carcinoma multidrug-resistant cell line Eca109/VCR. The most active compound 21 demonstrated a superior reversal fold (RF = 654) compared to the third-generation P-gp inhibitor TQ, as confirmed by colony formation and flow cytometry assays. Mechanistic investigations, including chemosensitization, intracellular fluorescent substrate accumulation, and molecular docking studies, verified that the MDR reversal effect of compound 21 is mediated through P-gp inhibition. This work provides a new strategic direction for developing tetrahydroisoquinoline-based sensitizers to overcome tumor drug resistance.

2026-05-01·REPRODUCTIVE TOXICOLOGY

Vincristine induces sperm malformation and motility dysfunction in mice by downregulating Tssk4 and Ccdc159

Article

作者: Hu, Yahui ; Zhou, Chaoming ; Fu, Meng ; Chen, Suyun ; Cui, Xu ; Cao, Hua

Vincristine (VCR), a cornerstone chemotherapeutic agent in B-cell acute lymphoblastic leukemia (B-ALL) treatment, has historically been classified as exhibiting low reproductive toxicity. However, its precise impact on testicular structure and spermatogenic function remains inadequately defined. This study utilized a clinically relevant patient-derived xenograft (PDX) mouse model of B-ALL to comprehensively evaluate VCR-induced gonadal injury. Our findings demonstrate that VCR administration resulted in significant testicular atrophy, manifested by a pronounced reduction in testis weight (approximately 48% of control levels), histopathological alterations including seminiferous tubule vacuolization, and a marked impairment of spermatogenic output. Detailed computer-assisted sperm analysis (CASA) revealed a multifaceted deleterious effect, characterized by a substantial decline in sperm density, a 5.8-fold increase in sperm morphological abnormalities, and a significant compromise in key kinematic parameters indicative of motility dysfunction. Integrated transcriptomic sequencing and bioinformatic analysis identified the coordinated downregulation of Tssk4 and Ccdc159, genes critically involved in sperm morphogenesis and flagellar structural assembly, as a core molecular event. This finding was subsequently confirmed at the mRNA level. In contrast, the expression of the sperm flagellar component gene Dnah1 remained unaltered. These results establish that VCR induces considerable reproductive toxicity, predominantly mediated through the suppression of Tssk4 and Ccdc159, thereby challenging its conventional low-risk categorization and providing a mechanistic foundation for refining fertility risk assessment and protective interventions in patients undergoing VCR-containing chemotherapy regimens.

593

项与硫酸长春新碱相关的新闻（医药）

2026-06-15

·BioSpace

Results from Incyte’s Pivotal Phase 3 frontMIND Trial of Tafasitamab (Monjuvi®/Minjuvi®) Combination Presented at the 2026 European Hematology Association (EHA) Congress Plenary Showed Prolonged Progression Free Survival

- frontMIND study evaluating tafasitamab (Monjuvi ® /Minjuvi ® ) in patients with previously untreated high-risk diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma (HGBL) selected for the prestigious Plenary Abstracts Session at EHA 2026 - Results showed tafasitamab and lenalidomide plus R-CHOP (Tafa-Len-R-CHOP) significantly prolonged progression-free survival (PFS), reducing risk of disease progression or death by 25% - Positive trends toward PFS benefit with Tafa-Len-R-CHOP were observed across prespecified subgroups, including in patients with centrally confirmed lymphoma subtypes and both cell-of-origin (COO) molecular subtypes - The frontMIND data support global regulatory applications for tafasitamab and lenalidomide in addition to R-CHOP for previously untreated DLBCL and HGBL WILMINGTON, Del.--(BUSINESS WIRE)-- $INCY #EHA2026 --Incyte (Nasdaq:INCY) today announced positive results from the pivotal Phase 3 frontMIND trial evaluating the efficacy and safety of tafasitamab (Monjuvi ® /Minjuvi ® ), a humanized Fc-modified cytolytic CD19-targeting monoclonal antibody, and lenalidomide added to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone; Tafa-Len-R-CHOP) versus R-CHOP, the current standard of care, as a first-line treatment for adults with previously untreated diffuse large B-cell lymphoma (DLBCL) or high-grade B-cell lymphoma (HGBL). Eligible patients had an International Prognostic Index (IPI) score of 3-5, or, for patients ≤60 years of age, an age-adjusted IPI (aaIPI) of 2-3. These data are being highlighted in a prestigious Plenary Abstracts Session at the European Hematology Association (EHA) 2026 Congress, being held June 11 - 14, 2026, in Stockholm, Sweden (Abstract # S101. Plenary Abstract Session. June 13, 6:00 - 7:30 a.m. ET [12:00-1:30 p.m. CEST]). frontMIND results were also recently published in The Lancet . “These frontMIND data reinforce the potential of Tafa-Len-R-CHOP to meaningfully change the first-line treatment landscape for patients with high-risk DLBCL or HGBL, for which outcomes have remained unchanged for decades,” said Steven Stein, M.D., Executive Vice President, Chief Medical Officer and Head of Late-stage Development, Incyte. “With encouraging efficacy observed across prespecified subgroups regardless of cell-of-origin (COO) molecular subtype, we believe these findings position this therapy as a compelling potential new standard of care and support our continued efforts to bring it to patients who are in need of other efficacious treatment options.” The results, which build on previously reported topline data and also recently announced at the 2026 American Society of Clinical Oncology Annual Meeting, showed Tafa-Len-R-CHOP resulted in statistically significant and clinically meaningful improvements in progression-free survival (PFS). Efficacy Data A 25% reduction in risk of disease progression or death demonstrated with Tafa-Len-R-CHOP compared with R-CHOP (HR 0.75 [ P =0.0194]; 95% CI: 0.59, 0.96; median follow-up of 35.2 months). PFS increase of 8.2% at 2 years (71.1% with Tafa-Len-R-CHOP vs. 62.9% with R-CHOP) and a PFS increase of 6.6% at 3 years (67.3% with Tafa-Len-R-CHOP vs. 60.7% with R-CHOP). Tafa-Len-R-CHOP trends toward PFS advantage were broadly consistent across prespecified subgroups, including patients with centrally confirmed lymphoma subtypes and across COO molecular subtypes (ABC [Activated B-cell-like] and GCB [Germinal Center B-cell-like]). Tafa-Len-R-CHOP significantly improved event-free survival (EFS) compared to R-CHOP (HR 0.79 [ P =0.0260] 95% CI: 0.64, 0.97; median follow-up of 35.4 months). Interim overall survival (OS) analysis demonstrated a positive trend toward improvement (HR=0.85 [ P =0.2703] 95% CI: 0.63, 1.14, median follow-up of 35.9 months). Minimal residual disease (MRD)-negativity rate was 81.3% with Tafa-Len-R-CHOP and 66.7% with R-CHOP. “A key goal in frontline treatment is to potentially prevent relapse, and spare patients from requiring additional therapies later. This is particularly meaningful for high-risk DLBCL and HGBL patients, where new treatment approaches are needed,” said Dr. Georg Lenz, University Hospital Münster and principal investigator of the frontMIND study. “The frontMIND results are especially encouraging because the addition of tafasitamab and lenalidomide improved outcomes without compromising delivery of the R-CHOP backbone, which remains fundamental to achieving better outcomes for patients.” Safety Data Tafa-Len-R-CHOP was generally well tolerated, and safety was consistent with the expected safety pro adding Tafa-Len to R-CHOP. Safety findings included: The most common treatment-emergent adverse events (TEAEs) for Tafa-Len-R-CHOP were neutropenia (70.7%), anemia (46.3%) and peripheral neuropathy (40.6%). Any grade TEAEs were similar in both treatment arms (98.6% vs 97.1%). More Grade ≥3 TEAEs occurred with Tafa-Len-R-CHOP (86.7%) vs R-CHOP (76.1%). The most common Grade 3 TEAEs for Tafa-Len-R-CHOP group were anemia (22.8%), thrombocytopenia (13.1%) and neutropenia (12.4%) vs. anemia (15.9%), febrile neutropenia (8.7%) and thrombocytopenia (6.7%) for R-CHOP. Incremental safety events observed with Tafa-Len-R-CHOP were well managed and did not interfere with the delivery of the R-CHOP backbone. Rates of TEAEs leading to discontinuation of all study treatment were similar between the two groups (5.2% for Tafa-Len-R-CHOP and 5.4% for R‑CHOP) - a higher rate of fatal TEAEs was observed with Tafa-Len-R-CHOP (5.9% vs 3.8% with R-CHOP), however there were fewer overall deaths with Tafa-Len-R-CHOP (82 [18.5%]) compared to R-CHOP (97 [21.7%]), consistent with the positive trend observed in overall survival. The frontMIND data support global regulatory applications for tafasitamab and lenalidomide in addition to R-CHOP for previously untreated DLBCL and HGBL. About DLBCL Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) in adults worldwide, representing 40% of all cases. 1 It is characterized as an aggressive, fast-growing type of lymphoma that can emerge in lymph nodes or extranodal sites such as the gastrointestinal tract, skin and brain. 2 Each year, approximately 24,000 people in the U.S. and up to 36,000 people in Europe are diagnosed with DLBCL. 3,4 With about 40% of these patients not responding to initial therapy or relapsing thereafter 5,6 , there is a high medical need for new, effective therapies, particularly for high-risk patients. About frontMIND The frontMIND trial (NCT04824092) is a randomized, double-blind, placebo-controlled, global Phase 3 study in patients with previously untreated high-risk diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma (HGBL). The study enrolled 899 adults (≥18 to ≤80 years) and is evaluating the efficacy and safety of tafasitamab and lenalidomide added to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) compared with R-CHOP. The primary endpoint of the study is investigator-assessed progression-free survival (PFS) using the Lugano 2014 criteria. Key secondary endpoints include event-free survival (EFS) by investigator assessment and overall survival (OS). For more information about the frontMIND trial, please visit . About Tafasitamab (Monjuvi ® /Minjuvi ® ) Tafasitamab (Monjuvi ® /Minjuvi ® ) is a humanized Fc-modified cytolytic CD19-targeting monoclonal antibody. Tafasitamab incorporates an XmAb ® engineered Fc domain, which mediates B-cell lysis through apoptosis and immune effector mechanism including Antibody-Dependent Cell-Mediated Cytotoxicity (ADCC) and Antibody-Dependent Cellular Phagocytosis (ADCP). Incyte licenses exclusive worldwide rights to develop and commercialize tafasitamab from Xencor, Inc. In the U.S., Monjuvi ® (tafasitamab-cxix) is approved by the U.S. Food and Drug Administration in combination with lenalidomide and rituximab for the treatment of adult patients with relapsed or refractory follicular lymphoma (FL). Additionally, Monjuvi received accelerated approval in the United States in combination with lenalidomide for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified, including DLBCL arising from low grade lymphoma, and who are not eligible for autologous stem cell transplant (ASCT). Monjuvi is not indicated and is not recommended for the treatment of patients with relapsed or refractory marginal zone lymphoma outside of controlled clinical trials. In Europe, Minjuvi ® (tafasitamab) received conditional Marketing Authorization from the European Medicines Agency in combination with lenalidomide, followed by Minjuvi monotherapy, for the treatment of adult patients with relapsed or refractory DLBCL who are not eligible for ASCT. In addition, in December 2025, the EMA approved Minjuvi, in combination with lenalidomide and rituximab, for the treatment of adult patients with relapsed or refractory FL (Grade 1-3a) after at least one line of systemic therapy. In Japan, Minjuvi is approved in combination with rituximab and lenalidomide for adult patients with relapsed or refractory follicular lymphoma (2L+ FL). XmAb ® is a registered trademark of Xencor, Inc. Monjuvi and Minjuvi are registered trademarks of Incyte. IMPORTANT SAFETY INFORMATION What are the possible side effects of MONJUVI? MONJUVI may cause serious side effects, including: Infusion reactions. Your healthcare provider will monitor you for infusion reactions during your infusion of MONJUVI. Tell your healthcare provider right away if you get fever, chills, flushing, headache, or shortness of breath during an infusion of MONJUVI. Low blood cell counts (platelets, red blood cells, and white blood cells). Low blood cell counts are common with MONJUVI, but can also be serious or severe. Your healthcare provider will monitor your blood counts during treatment with MONJUVI. Tell your healthcare provider right away if you get a fever of 100.4°F (38°C) or above, or any bruising or bleeding. Infections. Serious infections, including infections that can cause death, have happened in people during treatment with MONJUVI and after the last dose. Tell your healthcare provider right away if you get a fever of 100.4°F (38°C) or above, or develop any signs and symptoms of an infection. The most common side effects of MONJUVI include: Feeling tired or weak Diarrhea Cough Fever Swelling of lower legs or hands Respiratory tract infection Decreased appetite These are not all the possible side effects of MONJUVI. Your healthcare provider will give you medicines before each infusion to decrease your chance of infusion reactions. If you do not have any reactions, your healthcare provider may decide that you do not need these medicines with later infusions. Your healthcare provider may need to delay or completely stop treatment with MONJUVI if you have severe side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Before you receive MONJUVI, tell your healthcare provider about all of your medical conditions, including if you: Have an active infection or have had one recently. Are pregnant or plan to become pregnant. MONJUVI may harm your unborn baby. You should not become pregnant during treatment with MONJUVI. Do not receive treatment with MONJUVI in combination with lenalidomide if you are pregnant because lenalidomide can cause birth defects and death of your unborn baby. You should use an effective method of birth control (contraception) during treatment and for at least 3 months after your final dose of MONJUVI. Tell your healthcare provider right away if you become pregnant or think that you may be pregnant during treatment with MONJUVI. Are breastfeeding or plan to breastfeed. It is not known if MONJUVI passes into your breastmilk. Do not breastfeed during treatment for at least 3 months after your last dose of MONJUVI. You should also read the lenalidomide Medication Guide for important information about pregnancy, contraception, and blood and sperm donation. Tell your healthcare provider about all the medications you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Please see the full Prescribing Information for Monjuvi, including Patient Information, for additional Important Safety Information. About Incyte ® Incyte is redefining what’s possible in biopharmaceutical innovation. Through deep scientific expertise and a relentless focus on patients, we have built an established portfolio of first-in-class medicines and an extensive portfolio of next-generation medicines across our key franchises: Hematology, Oncology and Inflammation & Autoimmunity. To learn more, visit Incyte.com and Investor.Incyte.com . Follow us on social media: LinkedIn , X and Instagram . Incyte Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 and other federal securities laws, including statements regarding whether and when tafasitamab may provide a successful treatment option for patients with DLBCL and HGBL, the potential and promise suggested by the Phase 3 frontMIND results, the potential for Tafa-Len-R-CHOP to become a new standard of care option in the first-line treatment of DLBCL, Incyte’s plans to advance its global regulatory filings for tafasitamab and Incyte’s aspirations and goals as set forth under the heading “About Incyte”. Actual results may differ materially from those indicated in the forward-looking statements as a result of various important factors, including Incyte’s ability to demonstrate the efficacy and safety of its products and product candidates; the sufficiency of clinical trial data to meet applicable regulatory standards or warrant continued development; the ability to enroll sufficient numbers of subjects in clinical trials; actions of regulatory agencies, which may affect the initiation, timing and progress of clinical trials and marketing approval; Incyte’s ability to achieve commercial success for its marketed products and product candidates, if approved; Incyte’s ability to obtain and maintain protection of intellectual property for its products and technology; Incyte’s reliance on third parties and partners; the acceptance of Incyte’s products in the marketplace; market competition, sales, marketing, manufacturing and distribution requirements; and those risks and uncertainties discussed in greater detail in Incyte’s reports filed with the U.S. Securities and Exchange Commission, including its annual report on Form 10-K and its quarterly report on Form 10-Q for the quarter ended March 31, 2026. Incyte disclaims any intent or obligation to update these forward-looking statements. Wang S. Epidemiology and etiology of diffuse large B-cell lymphoma. Semin Hematol. 2023 Nov;60(5):255-266. Skrabek, P., et al. (2019). Emerging Therapies for the Treatment of Relapsed or Refractory Diffuse Large B Cell Lymphoma. Current Oncology , 26(4), 253-265. Chihara D, et al . Clin Lymphoma Myeloma Leuk . 2022;22(12):e1092-e1099. GLOBOCAN 2020 Cancer Today. Swerdlow SH, et al. Blood . 2016;127(20):2375-2390. Kanas G, et al. Leuk Lymphoma . 2021;63:54-63. Contacts Media media@incyte.com Investors ir@incyte.com

临床结果上市批准临床3期ASCO会议加速审批

2026-06-14

·手机新浪网

《原发性肺癌化疗规范化应用中国指南(2024版)》

肺癌是我国及世界范围内发病率和死亡率较高的恶性肿瘤之一。在我国,肺癌的发病率和死亡率呈上升趋势,据国家癌症中心统计,2022 年我国肺癌发病率和死亡率均居恶性肿瘤首位,其中新发病例约 106.06 万,死亡病例约 73.33 万[1]。近年来,肺癌的治疗实现了飞跃式的发展,尤其是针对表皮生长因子受体(epidermal growth factor receptor, EGFR)和间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)等靶点的药物研发及临床应用,显著改善了驱动基因阳性肺癌患者的预后。此外,免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)的研发和临床应用,使肺癌的治疗进入免疫治疗时代,部分晚期肺癌患者也可实现长期生存。然而,不可否认的是针对围手术期肺癌、小细胞肺癌(small cell lung cancer, SCLC)、驱动基因阴性的晚期非小细胞肺癌(non-small-cell lung cancer, NSCLC)以及驱动基因阳性 NSCLC 靶向治疗耐药后的治疗仍是以化疗为基础,化疗依然是目前不可或缺且应用较为广泛的治疗手段。一、指南制定方法学为规范我国肺癌化疗以及为各级临床医师提供专业的循证医学意见,中国医师协会肿瘤多学科诊疗专业委员会在国内外最新指南与专家共识的基础上,结合肺癌治疗领域新发表的临床研究证据和实践经验,由专家组组长与执笔作者整理出初稿,设定了 11 个涉及 SCLC 化疗方案、NSCLC 围手术期化疗方案、晚期 NSCLC 化疗方案等相关问题,发给 42 位国家肿瘤质控中心肺癌质控专家委员会及中国医师协会肿瘤多学科诊疗专业委员会专家代表进行投票,收集投票结果及修改意见,并请每位专家提供支持问题答案的证据和相关材料。在随后进行的共识研讨会上,参会专家对上述问题和循证医学证据进行了充分讨论,对指导意见进行推荐等级、证据级别分类,并进行第二轮投票,制定出《原发性肺癌化疗规范化应用中国指南(2024 版)》,以期为肺癌领域各级临床医师提供具有循证依据的专业性、指导性意见。通过 Pubmed、EMBASE 和 Web of Science 3 个国际文献数据库以及万方医学中文数据库、中国知网进行文献检索,检索出版物截至时间为 2024 年 3 月 23 日。在 Pubmed、EMBASE 和 Web of Science 数据库中检索关键词为“lung cancer” AND “chemotherapy”,时间限制范围为“1981/1/1”:“2024/3/23”。在万方医学中文数据库、中国知网检索策略关键词为“=(化疗) AND 关键词=(肺癌 OR 小细胞肺癌 OR 非小细胞肺癌 OR NSCLC OR SCLC)”。检索文献类型限制为系统综述、荟萃分析、临床研究,除外重复文献、述评、来信、新闻报道、编辑点评等文献。基于上述检索策略,获得英文文献 5 798 篇,中文文献 294 篇,总计 6 092 篇。指南推荐证据级别及推荐等级见表 1、2。二、SCLC(一)局限期 SCLC1.术后辅助化疗方案指南推荐:SCLC 术后推荐行含铂辅助化疗,辅助化疗推荐依托泊苷联合顺铂(EP)方案或依托泊苷联合卡铂(EC)方案(证据等级:2 类;推荐级别:强),具体方案见表 3。证据:SCLC 患者术后辅助治疗探索的研究相对较少,日本开展的多中心单臂Ⅱ期研究JCOG9101中纳入62例I～ⅢA期根治术后的SCLC患者,其中42例接受EP方案化疗4个周期,I期、Ⅱ期、Ⅲ期患者的3年生存率分别为68%、56%和13%[2]。美国国家癌症数据库对2003年至2011年进行手术的1 574例pT1～2N0M0期SCLC患者数据进行分析,有566例患者接受术后辅助治疗,其中辅助化疗354例,结果显示,与单纯手术比较,术后接受辅助化疗联合或不联合放疗能够显著提高患者的远期生存(HR=0.78, 95%CI:0.63～0.95)[3]。2. 同步放化疗中的化疗方案指南推荐:不可手术的局限期SCLC同步放化疗是标准治疗,放疗应在化疗的第1～3个周期内尽早介入,不能耐受同步放化疗的患者,可行序贯化放疗。推荐EP或EC方案化疗(证据等级:1类;推荐级别:强)。证据:JCOG9104研究纳入231例局限期SCLC,随机接受同步放化疗或序贯化放疗,化疗方案采用EP方案,结果显示,同步放化疗组患者的中位总生存时间(overall survival, OS)为27.2个月,5年生存率为23.7%,序贯化放疗组患者的中位OS为19.7个月,5年生存率为18.3%[4]。荟萃分析结果显示,相比放疗晚期介入(化疗3个周期后开始同步放化疗),尽早接受同步放化疗(不晚于第3个周期)能进一步提高患者的2年生存率[5]。一项荟萃分析纳入 4 项临床研究共 663 例 SCLC,评估 EP 或 EC 方案在 SCLC 中的疗效,结果显示,EP 或 EC 方案患者的中位 OS、客观缓解率 (objective response, ORR ) 和中位无进展生存时间 (progression-free survival, PFS) 差异均无统计学意义 (分别为 9.6 和 9.4 个月、67% 和 66%、5.5 和 5.3 个月,均 P>0.05),表明 EP 和 EC 方案疗效相似,EC 方案也是同步放化疗期间的可选方案,但 EC 方案血液学不良反应相对较高[6]。(二)广泛期 SCLC1.一线化疗方案指南推荐:ICIs(阿替利珠单抗、度伐利尤单抗、阿得贝利单抗、斯鲁利单抗,证据等级: 1 类,推荐级别: 强; 替雷利珠单抗、特瑞普利单抗、贝莫苏拜单抗+安罗替尼,证据等级: 1 类,推荐级别: 中)联合 EP 或 EC 方案推荐用于广泛期 SCLC 一线治疗。对于 ICIs 不适用的患者,EP 或 EC 方案仍是标准一线化疗方案(证据等级: 1 类; 推荐级别: 强); 此外,伊立替康联合顺铂(IP)或伊立替康联合卡铂(IC)方案也是一线可选方案(证据等级: 1 类; 推荐级别: 强); 对于不适用顺铂的患者,也可以选择依托泊苷联合洛铂(EL)方案(证据等级: 2 类; 推荐级别: 中)。具体方案见表 4。证据:(1)IMpower133 研究纳入 403 例广泛期 SCLC,评估阿替利珠单抗联合 EC 方案对比安慰剂联合 EC 方案用于广泛期 SCLC 一线治疗的疗效,结果显示,阿替利珠单抗联合 EC 方案可显著延长患者的中位 OS (分别为 12.3 和 10.3 个月; HR=0.70,P=0.007) 和中位 PFS (分别为 5.2 和 4.3 个月; HR=0.77,P=0.02),基于上述研究结果,推荐阿替利珠单抗联合 EC 方案用于广泛期 SCLC 患者的一线治疗[7]。(2) CASPIAN 研究纳入 805 例广泛期 SCLC,评估度伐利尤单抗+tremelimumab 联合依托泊苷+铂类(顺铂或卡铂)及度伐利尤单抗联合依托泊苷+铂类对比单纯依托泊苷+铂类一线治疗广泛期 SCLC 的疗效,免疫联合治疗组化疗最多 4 个周期,之后进入免疫维持阶段,单纯化疗最多 6 个周期且允许预防性脑照射治疗,结果显示,度伐利尤单抗联合 EP 对比 EP 方案可显著延长患者的中位 OS(分别为 13.0 和 10.3 个月; HR=0.73,P=0.004 7),基于上述研究结果,推荐度伐利尤单抗联合 EP 方案用于广泛期 SCLC 患者的一线治疗[8]。(3) CAPSTONE-1 研究纳入 462 例广泛期 SCLC,评估阿得贝利单抗联合 EC 方案对比安慰剂联合 EC 方案一线治疗广泛期 SCLC 的疗效,结果显示,在 EC 方案基础上联合阿得贝利单抗可显著改善患者的中位 OS(分别为 15.3 和 12.8 个月; HR=0.72,P=0.001 7)和中位 PFS (分别为 5.8 和 5.6 个月; HR=0.67,P0.000 1),基于上述研究结果,推荐阿得贝利单抗联合 EC 方案用于广泛期 SCLC 患者的一线治疗[9]。(4) ASTRUM-005 研究纳入 585 例广泛期 SCLC,评估斯鲁利单抗联合 EC 方案对比安慰剂联合 EC 方案的疗效,结果显示,斯鲁利单抗联合 EC 方案较 EC 方案可显著延长患者的中位 OS(分别为 15.4 和 10.9 个月; HR=0.63,P0.001) 和中位 PFS (分别为 5.7 和 4.3 个月;HR=0.48,95%CI:0.38～0.59),基于上述研究结果,推荐斯鲁利单抗联合 EC 方案用于广泛期 SCLC 患者的一线治疗[10]。(5) RATIONALE-312 研究纳入 457 例广泛期 SCLC,评估替雷利珠单抗联合依托泊苷+铂类对比安慰剂联合依托泊苷+铂类一线治疗广泛期 SCLC 的疗效,结果显示,替雷利珠单抗联合化疗较化疗可显著延长患者的中位 OS(分别为 15.5 和 13.5 个月; HR=0.75,P=0.004) 和中位 PFS(分别为 4.7 和 4.3 个月;HR=0.64,P0.000 1),基于上述研究结果,推荐替雷利珠单抗联合 EC 方案用于广泛期 SCLC 患者的一线治疗[11]。(6) EXTENTORCH 研究纳入 442 例广泛期 SCLC,评估特瑞普利单抗联合依托泊苷+铂类对比安慰剂联合依托泊苷+铂类的疗效,结果显示,特瑞普利单抗联合化疗较单纯化疗可显著延长患者的中位 OS(分别为 14.6 和 13.3 个月;HR=0.798,P=0.032)和中位 PFS(分别为 5.8 和 5.6 个月;HR=0.667,P=0.000 2),基于上述研究结果,推荐特瑞普利单抗联合依托泊苷+铂类方案用于广泛期 SCLC 患者的一线治疗[12]。(7) ENTER 701 研究纳入 738 例广泛期 SCLC,随机分为 3 组,分别接受 EC+安罗替尼+贝莫苏拜单抗、EC+安罗替尼+安慰剂或安慰剂+EC 方案治疗,研究结果显示,EC+安罗替尼+贝莫苏拜单抗较 EC 方案可显著延长患者的中位 OS(分别为 19.32 和 11.8 个月;HR=0.61,P=0.000 2)和中位 PFS(分别为 6.93 和 4.21 个月;HR=0.32,P0.000 1),基于上述研究结果,推荐贝莫苏拜单抗+安罗替尼+EC 方案用于广泛期 SCLC 患者一线治疗[13]。(8) 对于合并有活动性自身免疫性疾病或正在持续使用免疫抑制剂存在 ICIs 不适用的情况,EP 或 EC 方案仍是广泛期 SCLC 的标准一线化疗方案[14]。荟萃分析提示,EC 方案与 EP 方案疗效相当,但 EC 方案骨髓不良反应相对高,EP 方案非血液学不良反应如消化系统不良反应更为显著[6]。(9) 在日本开展的一项广泛期 SCLC 研究中,比较伊立替康联合顺铂(IP)与 EP 方案的疗效,结果显示,IP 方案较 EP 方案可延长患者的中位 OS(分别为 12.8 和 9.4 个月,P=0.002),并提高患者的 2 年总生存率(分别为 19.5% 和 5.2%)[15]。然而,后续在美国开展的 2 项Ⅲ期临床试验中并未观察到 IP 较EP 方案可改善患者生存[16-17]。一项荟萃分析结果提示,在广泛期 SCLC 中 IP 较 EP 方案能够给患者带来 OS 的获益,但 IP 方案组腹泻的发生率略高[18]。因此 IP 或 IC 方案也是一线治疗的可选方案。(10) 顺铂有剂量限制性肾不良反应、耳不良反应、神经系统不良反应和严重的消化系统不良反应,由我国学者开展的依托泊苷联合洛铂(EL)对比 EP 方案一线治疗广泛期 SCLC 的Ⅲ期临床研究结果显示,两组在中位 PFS(分别为 5.1 和 5.3 个月,P=0.786)和中位 OS(分别为 10.6 和 9.7 个月,P=0.701)方面疗效相当,而 EL 组的肾不良反应、恶心和呕吐发生的频率显著降低,对于不适用顺铂的患者,也可以选择 EL 方案[19]。2.二线及以上化疗方案尽管 SCLC 对于初始治疗非常敏感,但大多数 SCLC 患者在初始治疗后会出现疾病复发及耐药,这些患者在接受进一步治疗后中位 OS 仅为 4～5 个月。二线治疗的有效率很大程度上取决于初始治疗结束至复发的时间间隔。指南推荐:(1)距离一线治疗结束≤6 个月内复发进展的患者,二线推荐治疗方案拓扑替康(证据等级:1 类;推荐级别:强)。具体方案见表 5。 (2)距离一线治疗结束>6 个月复发或进展者,可选择初始 EP 或 EC 方案治疗(证据等级:2 类;推荐级别:强)。(3)其他可选方案:伊立替康、吉西他滨、多西他赛、紫杉醇、长春瑞滨、替莫唑胺、口服依托泊苷及 CAV(环磷酰胺+多柔比星+长春新碱)方案(证据等级:2 类;推荐级别:中)。具体方案见表 5。P=0.795),而拓扑替康组患者的症状改善比例显著高于 CAV 组[20]。拓扑替康口服给药与静脉给药对比的研究显示出相似的临床疗效和耐受性,为患者提供了更为便捷的给药方式[21]。标准剂量的拓扑替康 3～4 级血液学不良反应及治疗相关死亡率高,一项单臂研究显示,拓扑替康 1.25 mg/m2,第 1～5 天,每 21 天为 1 个周期,静脉给药后的中位 OS 约为 20 周,3～4 级血液学不良反应较既往数据略低,拓扑替康静脉给药可选择 1.25 mg/m2,第 1～5 天,每 21 天为 1 个周期[22]。(2)多个小样本Ⅱ期临床研究数据显示,伊立替康、吉西他滨、多西他赛、紫杉醇、长春瑞滨、替莫唑胺、CAV 在复发转移 SCLC 中均显示出一定临床疗效,也是可选策略[23-27]。(3) 在一项单臂Ⅱ期篮子临床试验(NCT02454972)中纳入 105 例化疗失败后的 SCLC 患者,ORR 为 35%,中位 PFS 为 3.5 个月,中位 OS 为 9.3 个月,1 年总生存率为 34.2%,在耐药复发的 SCLC 中 ORR 为 22%,敏感复发的 SCLC 中 ORR 为 45%,治疗相关3～4 级不良反应主要包括贫血、中性粒细胞减少和血小板减少[28]。基于上述研究,美国食品药品监督管理局附条件批准了芦比替定在 SCLC 二线治疗中的适应证。我国开展的一项桥接试验中剂量递增阶段纳入 10 例晚期实体瘤,剂量扩展阶段纳入 22 例复发进展期 SCLC,确定了芦比替定 3.2 mg/m2为推荐剂量,在 21 例进行疗效评估的 SCLC 患者中,ORR 为 45.5%,中位 PFS 和中位 OS 分别为 5.6 个月和 11 个月,安全性主要是骨髓抑制和肝损伤,与篮子研究的疗效和安全性相似[29]。在 ATLANTIS Ⅲ期随机对照研究中,纳入 613 例复发进展的 SCLC,芦比替定联合多柔比星对比 CAV 或拓扑替康,中位 OS 分别为 8.6 和 7.6 个月,两组治疗中 3 级以上治疗相关不良反应的发生率分别为 66% 和 86.5%。在 ATLANTIS 研究中考虑联合治疗的不良反应,芦比替定的剂量由 3.2 mg/m2,第 1 天,每 21 天为 1 个治疗周期,降低至 2.0 mg/m2,第 1 天,每 21 天为 1 个治疗周期,多柔比星剂量也下调至 40 mg/m2,每 21 天为 1 个周期,两种药物均选择相对低的剂量可能影响联合治疗的疗效[30]。芦证据:(1)拓扑替康对比 CAV 方案治疗复发难治 SCLC 的Ⅲ期临床试验显示,拓扑替康单药治疗的临床疗效不劣于三药联合方案(中位 OS 分别为 25.0 和 24.7 周,比替定治疗相关的骨髓相关不良反应在临床应用中需要关注。3.老年SCLC老年SCLC患者需综合患者体能状态、器官功能储备状态、合并基础疾病等因素制定个体化治疗方案。对于体能状态良好、器官功能相对较好,建议给予标准联合化疗,如果有指征也可以联合放疗,联合治疗方案首选依托泊苷联合铂类。对于无法接受标准化疗,可进行单药方案或减量联合方案。对于体弱患者或不愿意接受静脉用药的患者,可考虑口服依托泊苷。对于一般情况差的患者,应以对症支持治疗为主。三、NSCLC(一)围手术期治疗1.新辅助治疗推荐:ⅡA～ⅢB期潜在可切除的NSCLC患者,新辅助治疗推荐纳武利尤单抗联合化疗(证据等级:1类;推荐级别:强),帕博利珠单抗、替雷利珠单抗、度伐利尤单抗、特瑞普利单抗联合化疗(证据等级:1类;推荐级别:中)。对于不适用ICIs的患者,新辅助治疗推荐含铂双药化疗(证据等级:1类;推荐级别:强)。证据:(1)Checkmate 816研究评估新辅助纳武利尤单抗联合化疗对比单纯化疗在可切除的ⅠB(>4cm)～ⅢA期NSCLC患者中的疗效,排除EGFR突变和ALK融合的患者,主要研究终点为无事件生存时间(event free survival,EFS)和病理完全缓解率(pathological complete response,pCR),结果显示,纳武利尤单抗联合化疗较单纯化疗可显著提高术后pCR率(分别为24.0%和2.2%),并延长中位EFS(分别为31.6和20.8个月;HR=0.63,P=0.005)。基于上述研究结果,纳武利尤单抗联合化疗推荐用于ⅠB～ⅢA期NSCLC的术前新辅助治疗。上述研究中化疗方案非鳞癌选择培美曲塞+顺铂或紫杉醇+卡铂;鳞癌选择吉西他滨+顺铂或紫杉醇+卡铂;长春瑞滨+顺铂或多西他赛+顺铂也是可选方案,术前诱导治疗3个周期[31]。(2)Keynote 671研究评估帕博利珠单抗+化疗术前新辅助-手术-术后帕博利珠单抗辅助治疗对比术前新辅助化疗在Ⅱ～ⅢB(N2)期NSCLC患者中的疗效,主要研究终点为研究者评估EFS和OS,结果显示,帕博利珠单抗联合化疗组和单纯化疗组患者的2年无事件生存率分别为62.4%和40.6%,中位EFS(分别为未达到和17个月;HR=0.58,P0.001)、pCR率(分别为18.1%和4.0%)和主要病理缓解率(major pathological response,MPR;分别为30.2%和11.0%)均为联合治疗组优于单纯化疗组。基于上述研究结果,帕博利珠单抗联合化疗推荐用于Ⅱ～ⅢB(N2)期NSCLC新辅助治疗-术后帕博利珠单抗辅助治疗。上述研究中鳞癌化疗选择吉西他滨+顺铂,非鳞癌选择培美曲塞+顺铂,术前诱导治疗4个周期[32]。(3)RATIONALE 315研究评估替雷利珠单抗+化疗术前新辅助-手术-术后替雷利珠单抗辅助治疗对比新辅助化疗在Ⅱ～ⅢA期NSCLC中的疗效,研究排除EGFR突变和ALK融合的患者,主要研究终点为术后MPR率和EFS,结果显示,替雷利珠单抗联合化疗较单纯化疗可显著提高患者的术后MPR率(分别为56%和15%,P0.0001)和pCR率(分别为41%和6%,P上述研究中非鳞癌选择培美曲塞+顺铂或卡铂化疗,鳞癌选择紫杉醇+顺铂或卡铂方案,术前诱导治疗3～4个周期,术后替雷利珠单抗400mg,每6周为1个治疗周期,治疗8个周期[33]。(4) AEGEAN 研究评估度伐利尤单抗+化疗术前新辅助-手术-度伐利尤单抗术后辅助治疗对比新辅助化疗在 II A～ III B(N2)期 NSCLC 中的疗效,研究排除 EGFR 突变和 ALK 融合的患者,主要研究终点为 pCR 率和 EFS,结果显示,化疗联合度伐利尤单抗可显著提高患者的术后 pCR 率(分别为 17.2% 和 4.3%, P=0.000 036)和 MPR 率(分别为 33.3% 和 12.3%, P=0.000 002),中位 EFS(分别为未达到和 25.9 个月;HR=0.68,P=0.003 902)和 2 年无事件生存率(分别为 73.4% 和 64.5%)有提升。基于上述研究结果,度伐利尤单抗联合化疗推荐用于 II A～ III B 期 NSCLC 术前新辅助治疗-术后度伐利尤单抗辅助治疗。该研究中鳞癌化疗选择紫杉醇或吉西他滨+卡铂或顺铂,非鳞癌选择培美曲塞+卡铂或顺铂,术前诱导治疗 4 个周期,术后度伐利尤单抗 1 500 mg,每 28 天为 1 个治疗周期,治疗 12 个周期[34]。(5) Neotorch 研究评估了特瑞普利单抗+化疗围手术期治疗联合特瑞普利单抗术后辅助治疗对比化疗在 II ～ III 期 NSCLC 患者中的疗效,研究采用“3+1+13”的围手术期治疗模式,排除 EGFR 突变和 ALK 融合的患者,主要研究终点为术后 MPR 率和 EFS,2023 年美国临床肿瘤学会(American Society of Clinical Oncology, ASCO)会议公布了 404 例 III 期患者的结果,结果显示,中位随访 18.25 个月,特瑞普利单抗联合化疗围手术期治疗对比化疗提高了术后 MPR 率(分别为 48.5% 和 8.4%, P 0.000 1)和 pCR 率(分别为 28.2% 和 1.0%, PHR=0.40,P 0.000 1),并提高了 2 年无事件生存率(分别为 64.7% 和 38.7%)。基于上述研究结果,特瑞普利单抗推荐用于 III 期 NSCLC 围手术期治疗。上述研究中鳞癌化疗选择紫杉醇或多西他赛+卡铂或顺铂,非鳞癌选择培美曲塞+卡铂或顺铂,术前化疗免疫联合治疗 3 个周期,术后继续化疗免疫治疗 1 个周期后进行特瑞普利单抗维持治疗 13 个周期[35]。(6) CheckMate-77T 研究评估纳武利尤单抗+化疗术前新辅助-手术-术后纳武利尤单抗辅助治疗对比单纯化疗在 II A～ III B(N2)期 NSCLC 患者中的疗效,研究排除 EGFR 突变和 ALK 融合的患者,主要研究终点为 EFS,研究共纳入 461 例患者,中位随访 25.4 个月,纳武利尤单抗联合化疗显著延长了 EFS(分别为未达到和 18.4 个月;HR=0.5,P=0.000 25),提高了 pCR 率(分别为 25.3% 和 4.7%)和 MPR 率(分别为 35.4% 和 12.1%)。基于上述研究结果,纳武利尤单抗推荐用于 II A～ III B(N2)期 NSCLC 患者的围手术期治疗。上述研究中鳞癌化疗选择紫杉醇或多西他赛+卡铂或顺铂,非鳞癌选择培美曲塞+卡铂或顺铂,术前化疗免疫联合治疗 4 个周期,术后纳武利尤单抗 480 mg,每 28 天为 1 个治疗周期,治疗 1 年[36]。(7) 一项纳入 15 项随机对照临床试验共计 2 385 例 NSCLC 患者的 Meta 分析显示,相比单纯手术,新辅助化疗组患者的 5 年生存率由 40% 提高到 45%(HR=0.87,P=0.007)。上述研究确立了新辅助化疗在可切除非小细胞肺癌中的治疗地位[37]。2. 辅助治疗推荐: I B～ III A 期根治术后 NSCLC 患者推荐行术后辅助治疗,EGFR 敏感突变推荐辅助奥希替尼或埃克替尼治疗(证据等级: 1 类;推荐级别:强),ALK 融合推荐辅助阿来替尼治疗(证据等级:1 类;推荐级别:强);未行新辅助治疗,术后推荐辅助化疗后序贯阿替利珠单抗辅助治疗(证据等级:1 类;推荐级别:强)或帕博利珠单抗辅助治疗(证据等级:1 类;推荐级别:中);术前采用新辅助化疗联合免疫治疗,术后推荐行免疫巩固治疗(帕博利珠单抗,替雷利珠单抗,度伐利尤单抗,纳武利尤单抗,特瑞普利单抗,证据等级:1类;推荐级别:中)。辅助化疗推荐方案包括长春瑞滨或多西他赛或培美曲塞(非鳞癌)或吉西他滨+顺铂或卡铂(证据等级:1类;推荐级别:强)。具体方案见表6。证据:(1)ⅠB期(pT2aNOMO)术后NSCLC,由于缺乏高级别证据的支持,不推荐辅助化疗。ⅡA期(pT2bNOMO)患者根治术后如伴有高危因素,推荐行辅助化疗,高危因素包括分化差、血管侵犯、楔形切除、脏层胸膜侵犯和淋巴结状态未知(Nx)。CALGB9633研究评估了紫杉醇+卡铂辅助化疗对比观察在ⅠB期(美国癌症联合委员会第6版分期)患者术后辅助治疗中的疗效,共纳入144例患者,中位随访74个月,紫杉醇+卡铂辅助化疗相比观察组未改善ⅠB期患者生存(HR=0.83,P=0.12);亚组分析显示,肿物>4cm的患者能够从紫杉醇+卡铂辅助化疗中获益(HR=0.69,P=0.043)[38]。ⅡB～ⅢB(N2)期术后患者,推荐行辅助化疗,LACE荟萃分析显示,术后辅助化疗能够提升5年生存率5.4%,因此对于Ⅱ～Ⅲ期根治术后的NSCLC患者,建议行含铂双药辅助化疗[39]。(2)IMpower 010研究对于Ⅱ～ⅢA期NSCLC患者,根治性手术和含铂双药化疗后,阿替利珠单抗1年辅助治疗对比最佳支持治疗可显著延长程序性死亡配体1(programmed cell death 1 ligand 1,PD-L1)>1%患者的无病生存时间(disease free survival,DFS),分别为未达到和35.3个月(HR=0.66,P=0.004)。基于上述研究结果,推荐Ⅱ～ⅢA期NSCLC术后,PD-L1>1%,辅助化疗后序贯阿替利珠单抗辅助治疗1年[40]。(3)Keynote 091研究对于ⅠB(>4cm)～ⅢA期患者,根治手术及含铂双药化疗后,帕博利珠单抗 1 年辅助治疗对比安慰剂可显著延长患者的 DFS (分别为 53.6 和 40.2 个月; HR=0.76, P=0.001 4)。基于上述研究结果, 推荐帕博利珠单抗用于 I B (> 4 cm) ～ III A 期 NSCLC 术后含铂辅助化疗后治疗[41]。(4)多项围手术期免疫“夹心饼”式治疗在早期 NSCLC 患者中展示出良好疗效,基于此类研究的阳性结果,推荐帕博利珠单抗 (Keynote 671)、替雷利珠单抗 (RATIONALE 315)、度伐利尤单抗(AEGEAN)、特瑞普利单抗(Neotorch)及纳武利尤单抗(CheckMate-77T)用于术后辅助治疗。(二)局部晚期 NSCLC 化疗推荐: 对于不可手术的局部晚期 NSCLC 患者,推荐同步放化疗后度伐利尤单抗巩固治疗(证据等级: 1类;推荐级别: 强),同步或序贯放化疗后舒格利单抗巩固治疗(证据等级: 1类;推荐级别: 强)。推荐 EP 方案、卡铂+紫杉醇、顺铂或卡铂+培美曲塞(非鳞癌)以及多西他赛+顺铂为同步放化疗方案(证据等级: 1类;推荐级别: 强);推荐紫杉醇+卡铂、顺铂或卡铂+培美曲塞(非鳞癌)为序贯放化疗方案(证据等级: 1类;推荐级别: 强)。具体方案见表 7。证据:(1) PACIFIC 研究中不可手术切除的局部晚期 NSCLC 根治性同步放化疗后未进展的患者,接受度伐利尤单抗 1 年的巩固治疗较安慰剂组可显著延长患者的中位 PFS (分别为 16.8 和 5.6 个月; HR=0.52, P 0.001 )和中位 OS (分别为 47.5 和 29.1 个月; HR=0.68, P=0.002 51)。基于上述研究结果,局部晚期 NSCLC 患者,同步放化疗后疾病稳定的患者,推荐度伐利尤单抗巩固治疗 1 年[42]。(2) GEMSTONE-301 研究对于同步或序贯放化疗后未进展的患者,接受舒格利单抗 1 年的巩固治疗较安慰剂组可延长中位 PFS (分别为 10.5 和 6.2 个月, HR=0.65),其中同步放化疗组(分别为 15.7 和 8.3 个月, HR=0.71),序贯放化疗组(分别为 8.1 和 4.1 个月, HR=0.57)。基于上述研究结果,对于局部晚期 NSCLC 同步或者序贯放化疗后未进展的患者,推荐舒格利单抗巩固治疗 1 年[43]。(3)一项纳入6项随机对照研究共1 205例患者的Meta分析结果显示,同步放化疗相比序贯放化疗提高了无进展生存率及总生存率,3年生存率提高5.7%,5年生存率提高4.5%[44]。多项研究显示,放疗期间同步EP方案化疗可显著改善患者总生存,紫杉醇联合铂类方案显示出相似的临床疗效和安全性[45]。PROCLAIM研究在同步放化疗期间采用培美曲塞+顺铂的方案对比EP方案,研究显示,培美曲塞+顺铂方案虽未显示出明显的总生存改善,但培美曲塞+顺铂组3～4级药物相关不良反应明显低于EP方案组,因此培美曲塞+顺铂的方案也推荐为同步放化疗期间的联合治疗方案[46]。(三)晚期 NSCLC 化疗1.EGFR 敏感突变晚期 NSCLC推荐:一线首选EGFR-酪氨酸激酶抑制剂(tyrosine kinase inhibitors, TKI)治疗(证据等级:1类;推荐级别:强),吉非替尼或厄洛替尼或奥希替尼联合化疗为可选策略(证据等级:1类;推荐级别:中)。一或二代药物耐药后T90M阴性或三代耐药后,推荐含铂双药化疗±贝伐珠单抗(证据等级:1类;推荐级别:中),培美曲塞+顺铂+贝伐珠单抗+信迪利单抗(证据等级:1类;推荐级别:中)。证据:(1)Ⅱ期随机对照JMIT研究、Ⅲ期随机对照NEJ009研究以及FLAURA2研究评估了靶向联合化疗对比靶向单药均可显著延长PFS。基于此类研究,吉非替尼或厄洛替尼或奥希替尼联合化疗为EGFR敏感突变NSCLC患者的可选策略[47-49]。(2)IMPRESS研究在一线吉非替尼耐药后患者中继续靶向联合化疗相比化疗并未改善患者PFS,联合治疗OS反而低于化疗组(分别为13.4和19.5个月,HR=1.44,P=0.016)。基于上述研究结果针对一、二代药物耐药后T90M阴性或三代耐药后耐药机制未明的患者,推荐含铂双药化疗±贝伐珠单抗[50]。(3)ORIENT-31研究评估了培美曲塞+顺铂+贝伐珠单抗联合信迪利单抗对比安慰剂联合化疗治疗EGFR敏感突变NSCLC患者靶向耐药后的疗效,结果显示,四药联合组显著延长了PFS(分别为6.9和4.3个月;HR=0.464,P0.000 1),但四药联合同时增加了治疗相关不良反应。基于上述研究结果,推荐培美曲塞+顺铂+贝伐珠单抗联合信迪利单抗用于靶向耐药后治疗[51]。IMpower150研究纳入部分EGFR敏感突变靶向耐药后患者,结果显示,紫杉醇+卡铂+贝伐珠单抗联合阿替利珠单抗相比化疗联合贝伐珠单抗显著延长了PFS[52],然而在中国人群中开展的相似设计的IMpower151研究并未复制出IMpower150阳性结果,四药联合相比含铂双药化疗在EGFR敏感突变靶向耐药的中国患者中,并未显示出生存获益(中位PFS分别为8.5和8.3个月,HR=0.86)[53]。(4)MARIPOSA-2研究评估了埃万妥单抗+拉泽替尼+化疗或埃万妥单抗+化疗对比化疗(培美曲塞+铂类)在奥希替尼耐药的NSCLC中的疗效,结果显示,埃万妥单抗联合化疗或埃万妥单抗+拉泽替尼+化疗对比化疗显著提高了ORR(分别为64%、63%和36%,P0.001),并延长了中位PFS(分别为6.3、8.3和4.2个月,P[54]。2.EGFR 20 插入突变 NSCLC推荐:参考晚期驱动基因阴性NSCLC(证据等级:1类;推荐级别:强),后线治疗可选择舒沃替尼(证据等级:1类;推荐级别:弱)。证据:PAPILLON研究评估了埃万妥单抗联合培美曲塞+卡铂对比培美曲塞+卡铂在初治晚期EGFR 20插入突变NSCLC患者中的疗效,共纳入308例患者,中位随访14.9 个月,埃万妥单抗联合化疗组较化疗组显著延长了患者的中位 PFS (分别为 11.4 和 6.7 个月,P0.001),联合治疗组的安全性可耐受[55]。3. 驱动基因 (非 EGFR 突变) 阳性 NSCLC推荐: ALK 融合、ROS-1 融合、BRAF V600E 突变、NTRK 融合、RET 融合、MET 14 跳跃突变患者靶向治疗失败后,推荐含铂双药土贝伐珠单抗。4. 驱动基因阴性的非鳞 NSCLC推荐:培美曲塞+铂类联合帕博利珠单抗或卡瑞利珠单抗或信迪利单抗或替雷利珠单抗或舒格利单抗或阿替利珠单抗或特瑞普利单抗(证据等级:1 类;推荐级别:强)。对于不适用 ICIs 的患者,可用含铂双药联合贝伐珠单抗-贝伐珠单抗维持治疗(证据等级:1 类;推荐级别:强)。对于伴有 ICIs 及贝伐珠单抗治疗相对或绝对禁忌证的患者,可行含铂双药治疗(证据等级:1 类;推荐级别:强)。四药联合即紫杉醇+卡铂+贝伐珠单抗联合阿替利珠单抗、白蛋白紫杉醇+卡铂联合阿替利珠单抗、恩度联合长春瑞滨+顺铂及纳武利尤单抗+伊匹木单抗+两周期培美曲塞+铂类也是可选策略(证据等级:1 类;推荐级别:中)。具体方案见表 8。证据:(1)KEYNOTE-189 研究纳入 616 例驱动基因阴性的晚期非鳞 NSCLC 患者,无论 PD-L1 表达情况,帕博利珠单抗联合化疗较安慰剂联合化疗组可显著延长患者的中位 PFS (分别为 9.0 和 4.9 个月,HR=0.50)和中位 OS(分别为 22.0 和 10.6 个月,HR=0.6)[56]。基于上述研究结果,推荐帕博利珠单抗联合培美曲塞+铂类一线用于 EGFR 和 ALK 野生型晚期非鳞 NSCLC 患者。(2)ORIENT-11 研究评估了信迪利单抗或安慰剂联合培美曲塞+铂类治疗晚期非鳞 NSCLC 一线治疗的疗效,结果显示,信迪利单抗联合治疗组可显著延长患者的中位 PFS (分别为 9.2 和 5.0 个月;HR=0.49,P0.000 1)和中位 OS (分别为 24.2 和 16.8 个月,HR=0.65)[57-58]。基于上述研究结果,推荐信迪利单抗联合培美曲塞+铂类一线用于 EGFR 和 ALK 野生型晚期非鳞 NSCLC 患者。(3)CameL 研究评估了卡瑞利珠单抗联合培美曲塞+卡铂对比培美曲塞+卡铂在晚期非鳞 NSCLC 一线治疗中的疗效,结果显示,卡瑞利珠单抗联合化疗可显著延长患者的中位 PFS (分别为 11.3 和 8.3 个月;HR=0.6,P=0.000 1)[59]。基于上述研究结果,推荐卡瑞利珠单抗联合培美曲塞+卡铂一线用于 EGFR 和 ALK 野生型晚期非鳞 NSCLC 患者。(4)RATIONALE 304 研究纳入ⅢB、Ⅳ期非鳞 NSCLC 患者,比较替雷利珠单抗联合培美曲塞+卡铂和单纯培美曲塞+卡铂的临床疗效,研究显示,替雷利珠单抗联合化疗可显著延长患者的中位 PFS (分别为 9.8 和 7.7 个月,HR=0.63)[60]。基于上述研究结果,推荐替雷利珠单抗联合培美曲塞+卡铂一线用于 EGFR 和 ALK 野生型ⅢB、Ⅳ期非鳞 NSCLC 患者。(5)GEMSTONE-302 研究评估了舒格利单抗或安慰剂联合化疗一线治疗晚期鳞状和非鳞状 NSCLC 患者的疗效,研究显示,舒格利单抗联合化疗可显著延长患者的中位 PFS (分别为 9.0 和 4.9 个月;HR=0.49,P0.000 1)和中位 OS (分别为 25.4 和 16.9 个月,HR=0.65,P=0.000 8)[61]。基于上述研究结果,推荐舒格利单抗联合化疗一线用于驱动基因阴性的晚期鳞状和非鳞 NSCLC 患者。(6)IMpower 132 研究评估了阿替利珠单抗联合培美曲塞+铂类对比培美曲塞+铂类一线治疗 EGFR 和 ALK 阴性的晚期非鳞 NSCLC 的疗效,结果显示,阿替利珠单抗联合化疗可以带来中位 PFS 显著获益(分别为 7.7 和 5.2 个月 ; HR=0.56, P0.000 1), 且中位 OS 有获益趋势 (分别为 17.5 和 13.6 月 ; HR=0.86, P=0.154 6), 亚组分析显示, 亚裔人群从阿替利珠单抗联合组中取得获益, 可更加显著延长中位 PFS (分别为 10.7 和 5.3 月, HR=0.41)[62] 。基于上述研究结果, 推荐阿替利珠单抗联合培美曲塞+铂类一线用于 EGFR 和 ALK 野生型晚期非鳞 NSCLC 患者。(7) CHOICE-01 研究评估了特瑞普利单抗或安慰剂联合化疗一线治疗 III B、IV 期鳞状和非鳞状 NSCLC 患者的疗效, 研究显示, 特瑞普利单抗联合化疗可显著延长患者的中位 PFS (分别为 8.4 和 5.6 个月 ; HR=0.49, P 0.000 1) 和中位 OS (分别为 23.8 和 17.0 个月 ; HR=0.73, P=0.010 8), 非鳞癌亚组接受特瑞普利单抗联合化疗后 OS 获益更为突出 (分别为 27.8 和 15.9 个月, HR=0.49, P[63] 。基于上述研究结果, 推荐特瑞普利单抗联合培美曲塞+铂类一线用于 EGFR 和 ALK 野生型晚期非鳞 NSCLC 患者。(8) BEYOND 研究显示, 贝伐珠单抗联合紫杉醇+卡铂对比安慰剂联合紫杉醇+卡铂可显著延长患者的中位 PFS (分别为 9.2 和 6.5 个月 ; HR=0.40, P0.001 ) 和中位 OS (分别为 24.3 和 17.7 个月 ; HR=0.68, P=0.015 4), 与全球性研究 E4599 和 AVAiL 在亚洲人群中的结果相一致 [64] 。基于上述研究结果, 推荐贝伐珠单抗联合化疗一线用于晚期非鳞 NSCLC 患者。(9) 在 Impowere150 研究中, 紫杉醇+卡铂+贝伐珠单抗联合阿替利珠单抗相比于紫杉醇+卡铂+贝伐珠单抗可显著延长患者的中位 PFS (分别为 8.3 和 6.8 个月 ; HR=0.62, P0.001 ) 和中位 OS (分别为 19.2 和 14.7 个月 ; HR=0.78, P=0.02), 四药联合治疗相关不良反应增加 [65], 相较化疗联合 PD-1 单抗模式是否增加临床疗效尚未明确, 然而上述研究为 EGFR-TKI 治疗进展或伴有肝转移的患者提供了治疗策略。(10) Impowere130 研究证实了白蛋白紫杉醇+卡铂联合阿替利珠单抗相对于白蛋白紫杉醇+卡铂可显著延长患者的中位 PFS (分别为 7.0 和 5.5 个月 ; HR=0.64, P0.000 1) 和中位 OS (分别为 18.6 和 13.9 个月 ; HR=0.79, P=0.033)[66] 。基于上述研究结果, 推荐阿替利珠单抗联合白蛋白紫杉醇+卡铂一线用于晚期非鳞 NSCLC 患者。(11) Checkmate-9LA 研究评估了纳武利尤单抗+伊匹木单抗+2 个周期化疗对比 4 个周期含铂双药化疗治疗晚期驱动基因阴性 NSCLC 的疗效, 研究显示, 双免联合 2 个周期化疗相比 4 个周期含铂双药化疗可延长患者的中位 PFS (分别为 6.4 和 5.3 个月, HR=0.70 ) 和中位 OS (分别为 15.8 和 11.0 个月, HR= 0.72)[67] 。基于上述研究结果, 推荐纳武利尤单抗+伊匹木单抗+2 个周期培美曲塞+铂类一线用于晚期驱动基因阴性非鳞 NSCLC 患者。(12) 在中国人群中开展的恩度联合长春瑞滨+顺铂对比长春瑞滨+顺铂治疗晚期 NSCLC 的随机对照研究显示, 恩度联合长春瑞滨+顺铂提高了患者的客观缓解率 (分别为 35.4% 和 9.5%), 并延长了中位 PFS (分别为 6.3 和 3.6 个月) 和中位 OS (分别为 14.87 和 9.9 个月)[68] 。基于上述研究结果, 推荐恩度联合长春瑞滨+顺铂一线用于晚期 NSCLC。5. 晚期肺鳞癌推荐: 对于 PD-L1 表达肿瘤阳性细胞比率 ≥50%, 可选择单药帕博利珠单抗或阿替利珠单抗; 对于 PD-L1 低表达或未知状态的患者, 推荐免疫联合化疗, 可选择的治疗方案包括紫杉醇或白蛋白紫杉醇+铂类联合帕博利珠单抗或替雷利珠单抗 (证据等级: 1 类; 推荐级别: 强), 紫杉醇+铂类联合卡瑞利珠单抗或舒格利单抗或派安普利单抗(证据等级: 1 类; 推荐级别: 强)、白蛋白紫杉醇+铂类联合斯鲁利单抗(证据等级: 1 类;推荐级别: 强)以及吉西他滨+铂类联合信迪单抗(证据等级: 1 类; 推荐级别: 强)。对于不适宜行 ICIs 治疗的患者, 推荐行顺铂或卡铂联合吉西他滨或多西他赛或紫杉醇或脂质体紫杉醇或紫杉醇聚合物胶束的方案 (证据等级: 1 类;推荐级别: 强), 其他可选方案包括奈达铂联合多西他赛(证据等级: 1 类; 推荐级别: 强)、白蛋白紫杉醇+卡铂 (证据等级: 1 类; 推荐级别: 中), 纳武利尤单抗+伊匹木单抗+2 个周期紫杉醇+铂类也是可选策略 (证据等级: 1 类; 推荐级别: 中)。具体方案见表 8 。证据:(1) KEYNOTE-407 研究评估了帕博利珠单抗联合紫杉醇或白蛋白紫杉醇+卡铂对比安慰剂联合化疗在Ⅳ期肺鳞癌患者中的疗效, 结果显示, 帕博利珠单抗联合治疗可显著延长患者的中位 PFS (分别为 8.0 和 5.1 个月, HR=0.57) 和中位 OS (分别为 17.1 和 11.6 月, HR=0.71)[69] 。基于上述研究结果, 推荐帕博利珠单抗联合紫杉醇或白蛋白紫杉醇+卡铂一线用于晚期肺鳞癌。(2) RATIONAL 307 研究评估了替雷利珠单抗联合紫杉醇+卡铂或白蛋白紫杉醇+卡铂对比紫杉醇+卡铂在ⅢB、Ⅳ期肺鳞癌患者中的疗效, 结果显示, 替雷利珠单抗联合紫杉醇+卡铂(A 组)或替雷利珠单抗联合白蛋白紫杉醇+卡铂(B 组)对比紫杉醇+卡铂(C 组)显著延长了中位 PFS (分别为 7.7、9.6 和 5.5 个月, HR=0.45 和 0.43), 同时中位 OS 也有延长 (分别为 26.1、23.3 和 19.4 个月)[70] 。基于上述研究结果, 推荐替雷利珠单抗联合紫杉醇或白蛋白紫杉醇+卡铂一线用于晚期肺鳞癌。(3) CameL-sq 研究评估了卡瑞利珠单抗联合紫杉醇+卡铂对比安慰剂联合紫杉醇+卡铂在ⅢB、Ⅳ期肺鳞癌患者中的疗效, 结果显示, 卡瑞利珠单抗联合化疗相比化疗可显著延长患者的中位 PFS (分别为 8.5 和 4.9 个月; HR=0.37, P0.000 1) 和中位 OS (分别为 27.4 和 15.5 个月; HR=0.57, P[71] 。基于上述研究结果, 推荐卡瑞利珠单抗联合紫杉醇+卡铂一线用于晚期肺鳞癌。(4) AK105-302 研究评估了派安普利单抗联合紫杉醇+卡铂对比安慰剂联合紫杉醇+卡铂在ⅢB、Ⅳ期肺鳞癌患者中的疗效, 结果显示, 派安普利单抗联合化疗较化疗相比, 可显著延长患者的中位 PFS (分别为 7.6 和 4.2 个月; HR=0.44, P0.000 01) 和中位 OS (分别为未达到和 19.8 个月; HR=0.55, P=0.000 2)[72] 。基于上述研究结果, 推荐派安普利单抗联合紫杉醇+卡铂一线用于晚期肺鳞癌。(5) ASTRUM-004 研究评估了斯鲁利单抗联合白蛋白紫杉醇+卡铂对比安慰剂联合白蛋白紫杉醇+卡铂在ⅢB、Ⅳ期肺鳞癌患者中的疗效, 结果显示, 斯鲁利单抗联合化疗较化疗相比, 可显著延长患者的中位 PFS (分别为 8.28 和 5.72 个月; HR=0.55, P0.000 1), OS 也有获益趋势 (HR=0.60)[73] 。基于上述研究结果, 推荐斯鲁利单抗联合白蛋白紫杉醇+卡铂一线用于晚期肺鳞癌。(6) ORIENT-12 研究评估了信迪利单抗联合吉西他滨+铂类对比安慰剂联合吉西他滨+铂类在ⅢB、Ⅳ期肺鳞癌患者中的疗效, 结果显示, 信迪利单抗联合化疗与化疗相比, 可显著延长患者的中位 PFS (分别为 5.5 和 4.9 个月; HR=0.536, P0.000 1), OS 也有获益趋势 (HR=0.567)[74] 。基于上述研究结果, 推荐信迪利单抗联合吉西他滨+铂类一线用于晚期肺鳞癌。(7) 顺铂有剂量限制性肾脏不良反应、耳不良反应、神经系统不良反应和严重的消化系统不良反应,由我国学者牵头开展的在中国晚期肺鳞癌中对比多西他赛联合奈达铂及多西他赛联合顺铂两种治疗方式的疗效及安全性的研究,结果显示,两组临床疗效差异无统计学意义,多西他赛联合奈达铂组耐受性更佳[75],因此,多西他赛联合奈达铂方案也可作为晚期肺鳞癌的一线化疗策略。(8) CTONG1002研究证实了白蛋白紫杉醇+卡铂与吉西他滨+卡铂的方案疗效相近,白蛋白紫杉醇+卡铂组后续减量比例相对低,可显著改善患者的生活质量,因此白蛋白紫杉醇联合卡铂也推荐作为一线治疗可选方案[76]。(9) 紫杉醇聚合物胶束联合顺铂对比溶剂型紫杉醇联合顺铂在 EGFR 和 ALK 野生型ⅢB、Ⅳ期 NSCLC 中的疗效研究显示,可显著提升 ORR(分别为 50.33% 和 26.4%, P0.001),并可延长中位 PFS(分别为 6.4 和 5.3 个月;HR=0.63,P=0.000 1)。基于上述研究结果,紫杉醇聚合物胶束联合顺铂或卡铂可一线用于晚期 NSCLC[77]。6. 特殊人群对于 PS 评分 2 分的晚期肺癌患者,单药化疗较最佳支持治疗能延长患者生存时间并提高生活质量,可选择单药化疗方案包括吉西他滨、紫杉醇、长春瑞滨、多西他赛、培美曲塞(非鳞癌)。PS 评分≥3 分的患者建议最佳支持治疗。对于一线化疗进展后,PS 评分 0～2 分的患者,二线推荐的化疗方案包括多西他赛、培美曲塞(证据等级:1 类;推荐级别:强)、吉西他滨(证据等级:2 类;推荐级别:中)、长春瑞滨(证据等级:2 类;推荐级别:中)。四、总结与展望肺癌的治疗走向精准化、多样化,化疗依旧是肺癌内科治疗至关重要的组成部分,规范化疗药物的使用是提高我国肺癌患者化疗效果、改善患者预后的重要环节,国家肿瘤质控中心肺癌质控专家委员会、中国医师协会肿瘤多学科诊疗专业委员会在综合国内外指南、专家共识及相关研究进展的基础上制定出本指南,将为各级临床医师提供专业的循证医学意见并规范化疗药物的临床应用。

2026-06-14

·中山大学肿瘤防治中心儿童肿瘤科

祝贺！儿童肿瘤科多项研究成果精彩亮相 2026 ASCO 年会

5月29日到6月2日，2026 年美国临床肿瘤学会（ASCO）年会如期举行，本届会议以“科学和实践的转化：改善全球癌症的预后”为主题，汇聚全球顶尖的医生和科学家，共同探讨肿瘤诊疗领域的最新突破。中山大学肿瘤防治中心儿童肿瘤团队的两项快速口头报告、一项壁报交流共三项研究成果亮相国际顶级学术舞台，全方位展示团队在儿童实体肿瘤新药临床研究、精准监测等方向的探索。两项 Rapid Oral Presentation 双靶向新药联合治疗的临床研究研究探索 APG-115单药，以及联合利沙托克拉，在儿童实体瘤肿瘤中的抗肿瘤活性与安全性。数据显示：APG-115单药治疗儿童难治性横纹肌肉瘤初显疗效，1例患儿获得完全缓解（CR）;联合利沙托克拉展现出显著抗肿瘤活性，17例可评估疗效的患者客观缓解率（ORR）为23.5%，其中1例尤文肉瘤获得完全缓解。在安全性方面，APG-115单药或联合利沙托克拉在儿童实体瘤人群中安全可控。APG-115是亚盛医药自主研发的口服、高选择性MDM2-P53抑制剂，是首个在中国进入临床阶段的同类靶点品种，具有First-in-class潜力。日前，APG-115已被国家药品监督管理局药品审评中心（CDE）正式纳入“儿童抗肿瘤药物研发鼓励试点计划”，即“星光计划”，拟开发用于儿童和青少年横纹肌肉瘤、尤文肉瘤、神经母细胞瘤等实体肿瘤。中山大学肿瘤防治中心张翼鷟教授、首都医科大学附属北京儿童医院张谊教授、亚盛医药首席执行官翟一帆博士等为该报告的重要作者，中山大学肿瘤防治中心孙斐斐副教授代表多中心团队汇报该研究进展。横纹肌肉瘤 ctDNA 动态监测：STRIDE 研究中肿儿童肿瘤团队依托143例初治儿童横纹肌肉瘤患者的血浆、肿瘤组织、脑脊液等500余份标本开展基因组动态监测分析，数据显示治疗第 5 周期第 1 天（C5D1）的 ctDNA 状态，可作为早期预判治疗失败与远期生存的核心标志物；DDR、TP53 通路突变富集是肿瘤耐药的关键机制；针对中枢侵犯的患者，脑脊液 ctDNA 能检出血浆无法发现的特异性突变，证实中枢病灶存在独立的基因组进化规律，为横纹肌肉瘤的精准监测、个体化干预提供了重要依据。路素英副教授是该报告的第一作者，张翼鷟教授为通讯作者，孙斐斐副教授代表团队进行现场报告。一项 Poster 壁报交流本次壁报发布了LiViT 方案（脂质体伊立替康 + 长春新碱 + 替莫唑胺）用于 2-18 岁复发 / 难治性儿童实体瘤的 I 期临床研究（NCT06710821）的初步数据。研究采用经典 3+3 剂量递增设计，共入组 29 例患儿，病种以神经母细胞瘤、横纹肌肉瘤为主。安全性数据显示：各剂量组整体耐受性良好，仅 80mg/m² 剂量组出现了 1 例剂量限制性毒性，未达到最大耐受剂量，确定脂质体伊立替康 100mg/m² 为 II 期推荐剂量（RP2D）。疗效方面，27 例可评估患者客观缓解率（ORR）达 18.5%，疾病控制率（DCR）为63.0%，初步结果显示该方案安全性良好、具有明显的抗肿瘤活性，值得开展 II 期临床研究进一步验证。目前该研究仍在继续招募患者中。三项临床研究聚焦临床痛点，从创新性靶向药物、液体活检精准诊疗、传统化疗方案优化三大维度持续探索。未来团队将继续深耕儿童肿瘤领域，把前沿研究成果转化为临床诊疗策略，守护孩子们的健康。撰稿：孙斐斐编辑：张莉审核：孙斐斐路素英

100 项与硫酸长春新碱相关的药物交易

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外链

KEGG	Wiki	ATC	Drug Bank
D02197	硫酸长春新碱	L01CA02	DB00541

研发状态

批准上市

10 条最早获批的记录,

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适应症	国家/地区	公司	日期
嗜铬细胞瘤	日本	Nippon Kayaku Co., Ltd.	2013-03-26
广泛期小细胞肺癌	巴西	Libbs Farmacêutica Ltda.	2006-11-20
女性生殖器官肿瘤	巴西	Libbs Farmacêutica Ltda.	2006-11-20
蕈样真菌病	巴西	Libbs Farmacêutica Ltda.	2006-11-20
骨肉瘤	巴西	Libbs Farmacêutica Ltda.	2006-11-20
横纹肌肉瘤	巴西	Libbs Farmacêutica Ltda.	2006-11-20
宫颈癌	巴西	Libbs Farmacêutica Ltda.	2006-11-20
星形细胞瘤	日本	Nippon Kayaku Co., Ltd.	2005-02-14
胶质瘤	日本	Nippon Kayaku Co., Ltd.	2005-02-14
尤文肉瘤	中国	江苏省勤奋药业有限公司	1982-01-01
白血病	中国	江苏省勤奋药业有限公司	1982-01-01
白血病	中国	扬州制药有限公司	1982-01-01
黑色素瘤	中国	江苏省勤奋药业有限公司	1982-01-01
神经母细胞瘤	中国	江苏省勤奋药业有限公司	1982-01-01
神经母细胞瘤	中国	扬州制药有限公司	1982-01-01
小细胞肺癌	中国	江苏省勤奋药业有限公司	1982-01-01
肾母细胞瘤	中国	江苏省勤奋药业有限公司	1982-01-01
急性白血病	日本	Eli Lilly Japan KK	1968-04-18
慢性白血病	日本	Eli Lilly Japan KK	1968-04-18
急性淋巴细胞白血病	美国	Eli Lilly & Co.	1963-07-10

未上市

10 条进展最快的记录,

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适应症	最高研发状态	国家/地区	公司	日期
淋巴母细胞淋巴瘤	临床2期	美国	Amgen, Inc.	2025-01-23
淋巴母细胞淋巴瘤	临床2期	美国	Pfizer Inc.	2025-01-23
前体B细胞成淋巴细胞白血病淋巴瘤	临床2期	美国	Amgen, Inc.	2025-01-23
前体B细胞成淋巴细胞白血病淋巴瘤	临床2期	美国	Pfizer Inc.	2025-01-23
典型霍奇金淋巴瘤	临床2期	美国	Teva Pharmaceuticals USA, Inc.	2018-12-12
典型霍奇金淋巴瘤	临床2期	美国	Seagen, Inc.	2018-12-12
Ph样急性淋巴细胞白血病	临床2期	美国	Spectrum Pharmaceuticals, Inc.	2013-03-05
骨癌	临床2期	美国	Amgen, Inc.	2011-05-01
侵袭性 B 细胞非霍奇金淋巴瘤	临床2期	法国	Cephalon Ltd.	2002-10-01
侵袭性 B 细胞非霍奇金淋巴瘤	临床2期	德国	Cephalon Ltd.	2002-10-01

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临床结果

适应症

分期

评价

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研究	分期	人群特征	评价人数	分组	结果	评价	发布日期


NCT00690560 (CTgov)	临床2期	CD20阳性大B细胞淋巴瘤	30	yttrium Y 90 ibritumomab tiuxetan+cyclophosphamide+prednisone+doxorubicin hydrochloride+vincristine sulfate+rituximab	簾廠艱鏇觸網窪顧築蓋 = 選範襯積糧鑰構壓膚鏇鏇網獵蓋醖構廠憲襯襯 (淵糧膚壓壓製鹹製壓鬱, 築膚遞餘築餘構夢窪壓 ~ 醖觸餘夢蓋壓築願構構) 更多	-	2026-05-22
ESGO2026	N/A	妊娠滋养细胞疾病	106	Methotrexate	醖構窪鹽廠願夢遞簾鏇(繭鹹齋鏇鹽簾願築壓積) = 繭艱蓋鹹積衊網廠夢積餘鏇鏇獵製膚糧糧鹹憲 (獵積艱選餘壓選糧鹹蓋 ) 更多	积极	2026-02-28
				EMA-CO regimen - Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide and Vincristine	廠糧糧廠築獵獵廠膚鏇(壓鏇獵網獵艱淵襯願窪) = 積襯膚製積網壓鹹繭壓憲遞壓齋窪齋壓餘鏇選 (願蓋膚選顧願壓餘製窪, 12 ~ 66)
NCT03504644 (EA9152, CTgov)	临床1/2期	复发性 B 细胞急性淋巴细胞白血病 \| 前体B淋巴细胞淋巴瘤/难治性白血病 \| 复发性T淋巴母细胞淋巴瘤 ... 更多	40	Computed Tomography+Venetoclax+Vincristine Sulfate+Vincristine Liposomal	鏇餘衊範鹽夢糧築獵簾(衊積襯齋艱構製顧選廠) = 鬱衊鬱夢艱築選繭鏇餘鑰製觸網鹹網壓襯範鬱 (願鑰窪獵鹹夢齋製蓋壓, 遞鹹壓鹽觸鹽鏇鑰壓淵 ~ 觸蓋糧鹹網網觸蓋鬱遞) 更多	-	2026-02-25
NCT01777152 (ECHELON-2, Pubmed \| Blood Adv)	临床3期	外周T细胞淋巴瘤	452	BV-CHP	餘鏇顧顧齋憲糧艱膚鹹(顧積艱壓顧觸夢淵獵餘): HR = 0.38 (95.0% CI, 0.16 ~ 0.94) 更多	积极	2025-12-09
				CHOP
NCT03023046 (ASH2025)	临床2期	急性淋巴细胞白血病一线	53	DA-EPOCH±R±TKI (Ph+)	範築淵蓋鏇鏇壓鹹襯艱(願鬱襯鏇淵網淵繭簾鏇) = 蓋簾顧構夢窪鹽構蓋糧壓壓襯襯繭顧廠廠遞願 (醖淵築簾簾窪糧繭網構, 22 ~ 59) 更多	积极	2025-12-06
				DA-EPOCH±R±TKI (Ph-)	範築淵蓋鏇鏇壓鹹襯艱(願鬱襯鏇淵網淵繭簾鏇) = 鬱製糧築窪艱醖積壓鬱壓壓襯襯繭顧廠廠遞願 (醖淵築簾簾窪糧繭網構, 12 ~ 48) 更多
NCT06207123 (ASH2025)	临床1/2期	T细胞急性淋巴细胞白血病/淋巴瘤	21	LP-118+Ponatinib+Vincristine+Dexamethasone	獵範鹹構願積簾構願淵(顧壓簾廠窪網艱窪鹽遞) = 觸鑰淵窪淵製鏇選繭淵構遞網廠願襯鹹築構壓 (衊糧蓋願醖鹹鬱範選築 )	积极	2025-12-06
ASH2025	N/A	弥漫性大B细胞淋巴瘤	428	Rituximab+Cyclophosphamide+Doxorubicin+Vincristine+Prednisone	獵網艱鹽鹹糧齋製糧壓(糧製蓋積蓋醖網簾鏇鹽) = 餘淵鑰顧餘鏇範構範廠選醖獵遞築製壓積夢蓋 (遞壓獵鬱鏇鬱壓襯鑰繭 ) 更多	积极	2025-12-06
ASH2025	N/A	弥漫性大B细胞淋巴瘤	46	R-CHOP therapy (R-CHOP with XRT)	願蓋網積膚簾遞顧鹽壓(鬱顧構膚壓襯築鏇選鹽) = 壓廠鹹糧夢鏇顧觸膚夢艱構餘淵糧製壓齋襯壓 (積齋醖觸鑰艱襯鹽網範 ) 更多	积极	2025-12-06
				R-CHOP therapy (without XRT)	願蓋網積膚簾遞顧鹽壓(鬱顧構膚壓襯築鏇選鹽) = 製獵繭鹽網淵醖蓋淵網艱構餘淵糧製壓齋襯壓 (積齋醖觸鑰艱襯鹽網範 ) 更多
NCT00136435 (CTgov)	临床2期	急性淋巴细胞白血病	100	L-asparaginase	簾構醖鏇鹽鬱餘製積觸 = 糧餘顧鹽淵繭夢觸憲遞蓋糧網範餘構淵齋鑰餘 (餘築廠蓋夢糧網築繭夢, 襯壓壓鹽鏇夢獵範廠鹽 ~ 膚餘鹽製積襯鏇構夢觸) 更多	-	2025-10-20
ESMO2025	N/A	肠病相关的T细胞淋巴瘤	56	mNewcastle regimen	鑰顧獵鑰艱範憲鏇鏇積(鹽築鏇鬱艱獵衊築製襯) = 夢鏇繭構觸鬱獵餘鹽獵鏇膚網積憲築廠積顧網 (鹹選膚膚網選壓蓋構範 ) 更多	积极	2025-10-17
				CHOP-like regimens	鑰顧獵鑰艱範憲鏇鏇積(鹽築鏇鬱艱獵衊築製襯) = 鹽夢齋壓齋襯製鹽淵淵鏇膚網積憲築廠積顧網 (鹹選膚膚網選壓蓋構範 ) 更多