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多腺苷二磷酸核糖聚合酶(PARP)对脱氧核糖核酸(DNA)修复发挥至关重要的作用,当可遗传抑癌基因BRCA发生致病突变,损坏癌细胞DNA修复机制时,PARP抑制剂能够抑制PARP活性,有效增强BRCA缺陷癌细胞对化疗的敏感性,导致癌细胞死亡。不过,现有PARP抑制剂治疗期间贫血和中性粒细胞减少等血液学毒性发生率较高。因此,在不影响疗效的前提下,最大程度降低PARP抑制剂血液学毒性具有重要临床价值。β葡萄糖醛酸糖苷酶能够水解葡萄糖醛酸与其他化合物之间的葡萄糖醛酸糖苷键,主要由炎症细胞和肿瘤组织细胞释放,乳腺癌组织与邻近组织相比,β葡萄糖醛酸糖苷酶活性高出近6倍。中国原研新药TSL-1502是PARP抑制剂TSL-1502M的葡萄糖醛酸前药,可被癌细胞释放的β葡萄糖醛酸糖苷酶水解,临床前研究表明,在远低于现有PARP抑制剂所需浓度下,即可抑制PARP,对BRCA缺陷肿瘤的活性优于现有PARP抑制剂。一期临床研究表明,每天口服350毫克和500毫克TSL-1502胶囊对乳腺癌等晚期实体肿瘤患者的有效性和安全性良好,故有必要开展二期临床研究进行验证。
2026年8月10日,英国《自然》旗下《信号转导与靶向治疗》在线发表中国工程院徐兵河、中国医学科学院肿瘤医院兰波、重庆大学附属肿瘤医院徐发良、辽宁省肿瘤医院孙涛、浙江大学医学院附属第二医院邱福铭、山东第一医科大学附属肿瘤医院王永胜、中南大学湘雅医院王守满、吉林大学第一医院李薇、武汉大学中南医院钟亚华、湖北省肿瘤医院吴新红、湖南省肿瘤医院欧阳取长、天津市肿瘤医院王珂、天士力米晓兰和刘锐等学者的二期临床研究报告,首次对TSL-1502或化疗用于遗传BRCA突变HER2阴性乳腺癌局部晚期或远处转移患者的有效性和安全性进行随机分组比较,并确定进一步研究最佳剂量。
TSL-CM-TSL1502-II (NCT05420779): A Study to Evaluate the Efficacy and Safety of TSL-1502 Capsules in Breast Cancer Patients With Germline BRCA Mutations
Official Title: A Randomized, Parallel, Open-label, Positive Controlled Phase II Clinical Study to Evaluate the Efficacy and Safety of TSL-1502 Capsules in HER2-negative Locally Advanced or Metastatic Breast Cancer Patients With Germline BRCA Mutations
该全国多中心非盲随机对照二期临床研究于2022年8月18日至2024年3月5日从中国28家医院入组年龄18至75岁HER2阴性乳腺癌局部晚期或远处转移且遗传BRCA突变女性患者63例,按2比2比1随机分为3组,分别给予TSL-1502胶囊(每天1次口服350毫克或500毫克)或研究者选择单药化疗方案(艾立布林、卡培他滨或长春瑞滨),每3周为1个周期。
结果,根据独立评审委员会的评定,350毫克组、500毫克组、化疗组相比:
客观缓解率:36.0%、55.6%、40.0%(95%置信区间:18.0-57.5、35.3-74.5、12.2-73.8)
中位无进展生存:5.6个月、8.8个月、9.2个月(95%置信区间:4.0-8.2、5.7-未达上限、1.38-未达上限)
中位总生存:17.4个月、未达中位、19.8个月(95%置信区间:9.1-未达上限、16.9-未达上限、9.2-未达上限)
≥3级治疗相关不良事件发生率:60.0%、59.3%、80.0%
其中,TSL-1502组最常见不良事件为贫血,化疗组最常见不良事件为中性粒细胞减少,未发生治疗相关死亡。
因此,该小样本二期临床研究结果表明,TSL-1502每天1次口服500毫克与350毫克或研究者选择单药化疗方案相比,抗肿瘤活性良好且安全性可控,支持进一步开展大样本三期临床研究与现有PARP抑制剂进行随机分组比较。
Signal Transduct Target Ther. 2026 Aug 10;11:316. IF: 81.2
Randomized phase 2 trial of a PARP inhibitor TSL-1502 in germline BRCA-mutated, HER2-negative locally advanced/metastatic breast cancer.
Lan B, Xu F, Sun T, Qiu F, Wang Y, Wang S, Li W, Zhong Y, Wu X, Ouyang Q, Wang K, Mi X, Liu R, Xu B.
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Chongqing University Affiliated Cancer Hospital, Chongqing, China; Liaoning Cancer Hospital, Shenyang, China; The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; Shandong Cancer Prevention and Treatment Institute, Shandong Cancer Hospital, Shandong First Medical University Affiliated Tumor Hospital, Jinan, China; Xiangya Hospital Central South University, Changsha, China; The First Hospital of Jilin University, Changchun, China; Zhongnan Hospital of Wuhan University, Wuhan, China; Hubei Provincial Cancer Hospital, Wuhan, China; Hunan Cancer Hospital, Changsha, China; Tianjin Medical University Cancer Institute & Hospital, Tianjin, China; Tasly Pharmaceutical Group Co. Ltd., Tianjin, China.
Glucuronide prodrug strategies may enhance target specificity and reduce the toxicity of PARP inhibitors, but no clinical evaluation has been performed. We evaluated TSL-1502, a novel glucuronide prodrug of a PARP inhibitor, in a randomized, open-label, phase 2 study at 28 sites in China (NCT05420779). Eligible patients were women aged 18-75 years with HER2-negative locally advanced or metastatic breast cancer and germline BRCA mutations. Patients were assigned randomly (2:2:1) to receive TSL-1502 at 350 mg or 500 mg once daily or the investigator's choice of chemotherapy (eribulin, capecitabine, or vinorelbine) in 3-week cycles. Sixty-three patients were enrolled between August 18, 2022, and March 5, 2024. According to the Independent Review Committee assessment, the objective response rates were 36.0% (95% CI, 18.0-57.5) in the 350 mg group, 55.6% (95% CI, 35.3-74.5) in the 500 mg group, and 40.0% (95% CI, 12.2-73.8) in the chemotherapy group. The median progression-free survival times were 5.6 (95% CI, 4.0-8.2), 8.8 (95% CI, 5.7-not assessable [NA]), and 9.2 (95% CI, 1.38-NA) months, respectively, and the overall survival times were 17.4 months (95% CI, 9.1-NA), not reached (95% CI, 16.9-NA), and 19.8 months (95% CI, 9.2-NA), respectively. Grade ≥3 treatment-related adverse events occurred in 60.0%, 59.3%, and 80.0% of patients, with anemia most common in the TSL-1502 group and neutropenia most common with chemotherapy. No treatment-related deaths occurred. TSL-1502 at 500 mg showed promising antitumor activity and a manageable safety profile, supporting further clinical development.
PMID: 42572030
DOI: 10.1038/s41392-026-02771-9
(来源:SIBCS)
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