A Phase II, Multi-Center Study to Evaluate the Efficacy and Safety of Volrustomig as Monotherapy or in Combination With Anti-cancer Agents in Participants With Advanced/Metastatic Solid Tumors

eVOLVE-02 study will evaluate the efficacy and safety of volrustomig as monotherapy or in combination with anti-cancer agents in participants with advanced/metastatic solid tumors.

开始日期2024-08-02

申办/合作机构

AstraZeneca PLC

NCT06448754 / Not yet recruiting临床2期

A Phase II, Open-label Study to Evaluate the Safety, Tolerability, Pharmacokinetics, Immunogenicity, and Antitumor Activity of Volrustomig Priming Regimens in Combination With Other Anticancer Agents in Participants With Solid Tumors (eVOLVE-01)

Purpose of this study is to assess the safety, tolerability, pharmacokinetics, immunogenicity, and antitumor activity of volrustomig in combination with other anticancer drugs in participants with specified solid tumors.

开始日期2024-07-19

申办/合作机构

AstraZeneca PLC

NL-OMON56319 / Suspended临床3期

Clinical Performance Study Protocol for Use of VENTANA PD-L1 (SP263) CDx Assay in AstraZeneca Study D798AC00001(eVOLVE-Lung02): A Phase III, Two-Arm, Parallel, Randomized, Multi-Center, Open-Label, Global Study to Determine the Efficacy of Volrustomig (MEDI5752) Plus Chemotherapy Versus Pembrolizumab Plus Chemotherapy for First-Line Treatment of Patients with Metastatic Non-Small Cell Lung Cancer (mNSCLC) (eVOLVE-Lung02) - eVOLVE-Lung02

开始日期2024-04-15

申办/合作机构-

100 项与 Volrustomig 相关的临床结果

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100 项与 Volrustomig 相关的转化医学

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100 项与 Volrustomig 相关的专利（医药）

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项与 Volrustomig 相关的文献（医药）

2024-02-24·British journal of cancer

A phase Ib/II study of cadonilimab (PD-1/CTLA-4 bispecific antibody) plus anlotinib as first-line treatment in patients with advanced non-small cell lung cancer

Article

作者: Xia, Yu ; Lin, Jie ; Wang, Qianzhi ; Pu, Xingxiang ; Li, Baiyong ; Sun, Hong ; Wang, Huijuan ; Li, Kang ; Xu, Yan ; Duan, Huaxin ; Du, Yingying ; Xu, Li ; Li, Jia ; Li, Xingya ; Chu, Qian ; Liu, Hailong ; Liu, Liyu ; Kong, Yi ; Xu, Fang ; Wu, Lin ; Lin, Gen ; Yao, Wenxiu ; Chen, Bolin ; Xiao, Zemin

BACKGROUND:

Cadonilimab is a bispecific antibody that simultaneously targets programmed cell death receptor-1 and cytotoxic T lymphocyte-associated antigen-4. This study aimed to assess the safety and efficacy of cadonilimab plus anlotinib for the first-line treatment of advanced non-small cell lung cancer (NSCLC) without sensitizing EGFR/ALK/ROS1 mutations.

METHODS:

Patients received cadonilimab 15 mg/kg and 10 mg/kg every three weeks (Q3W) plus anlotinib at doses of 10 or 12 mg once daily for two weeks on a one-week-off schedule. The primary endpoints included safety and objective response rate (ORR).

RESULTS:

Sixty-nine treatment-naïve patients received cadonilimab 15 mg/kg Q3W combination (n = 49) and 10 mg/kg Q3W combination (n = 20). Treatment-related adverse events (TRAEs) were reported in 48 (98.0%) and 19 (95.0%) patients, with grade ≥3 TRAEs occurring in 29 (59.2%) and five (25.0%) patients, respectively. TRAEs leading to cadonilimab discontinuation occurred in eight (16.3%) and one (5.0%) patients in the cadonilimab 15 mg/kg Q3W and 10 mg/kg Q3W dosing groups. The confirmed ORRs were 51.0% (25/49) and 60.0% (12/20) accordingly.

CONCLUSIONS:

Cadonilimab 10 mg/kg Q3W plus anlotinib showed manageable safety and promising efficacy as a first-line chemo-free treatment for advanced NSCLC.

CLINICALTRIALS:

GOV IDENTIFIER:

NCT04646330.

2023-10-01·iScience

Endothelial cells are a key target of IFN-g during response to combined PD-1/CTLA-4 ICB treatment in a mouse model of bladder cancer

Article

作者: Freshour, Sharon L ; Fronick, Catrina ; Arora, Vivek K ; Griffith, Obi L ; Mosior, Matthew ; Chen, Timothy H-P ; Griffith, Malachi ; Bolzenius, Jennifer K ; Skidmore, Zachary L ; Shen, Haolin ; Fisk, Bryan

To explore mechanisms of response to combined PD-1/CTLA-4 immune checkpoint blockade (ICB) treatment in individual cell types, we generated scRNA-seq using a mouse model of invasive urothelial carcinoma with three conditions: untreated tumor, treated tumor, and tumor treated after CD4⁺ T cell depletion. After classifying tumor cells based on detection of somatic variants and assigning non-tumor cell types using SingleR, we performed differential expression analysis, overrepresentation analysis, and gene set enrichment analysis (GSEA) within each cell type. GSEA revealed that endothelial cells were enriched for upregulated IFN-g response genes when comparing treated cells to both untreated cells and cells treated after CD4⁺ T cell depletion. Functional analysis showed that knocking out IFNgR1 in endothelial cells inhibited treatment response. Together, these results indicated that IFN-g signaling in endothelial cells is a key mediator of ICB induced anti-tumor activity.

bioRxiv : the preprint server for biology

Endothelial cells are a key target of IFN-g during response to combined PD-1/CTLA-4 ICB treatment in a mouse model of bladder cancer

作者: Fronick, Catrina ; Freshour, Sharon L ; Arora, Vivek K ; Griffith, Obi L ; Mosior, Matthew ; Chen, Timothy H-P ; Bolzenius, Jennifer K ; Griffith, Malachi ; Skidmore, Zachary L ; Shen, Haolin ; Fisk, Bryan

Summary:

To explore mechanisms of response to combined PD-1/CTLA-4 immune checkpoint blockade (ICB) treatment in individual cell types, we generated scRNA-seq using a mouse model of invasive urothelial carcinoma with three conditions: untreated tumor, treated tumor, and tumor treated after CD4+ T cell depletion. After classifying tumor cells based on detection of somatic variants and assigning non-tumor cell types using SingleR, we performed differential expression analysis, overrepresentation analysis, and gene set enrichment analysis (GSEA) within each cell type. GSEA revealed that endothelial cells were enriched for upregulated IFN-g response genes when comparing treated cells to both untreated cells and cells treated after CD4+ T cell depletion. Functional analysis showed that knocking outIFNgR1in endothelial cells inhibited treatment response. Together, these results indicated that IFN-g signaling in endothelial cells is a key mediator of ICB induced anti-tumor activity.

项与 Volrustomig 相关的新闻（医药）

2024-09-06

·Insight数据库

阿斯利康将在 2024 WCLC 和 ESMO 年会上公布多项重磅临床结果

在 2024 年 9 月 7 日至 10 日由国际肺癌研究协会（IASLC）主办的 2024 年世界肺癌大会（WCLC）和 2024 年 9 月 13 日至 17 日举办的欧洲肿瘤内科学会（ESMO）年会上，阿斯利康将凭借其多元化、领先行业的产品及管线布局的全新研究数据，深化其变革癌症诊疗格局的雄心壮志。在这两场大会上，阿斯利康将公布逾 130 项摘要，其中涵盖 17 款已获得批准的药物和潜在新药，包含 5 项主席研讨会和 41 项口头报告。阿斯利康全球执行副总裁、肿瘤研发负责人 Susan Galbraith 表示：「在这两场大会上，我们的报告有力地推动了阿斯利康致力于颠覆癌症诊疗的长期战略。我们将在世界肺癌大会上展示计算病理学平台的成果，当前我们正在抗体偶联药物组合中使用该平台以研发预测生物标志物，精准提升患者筛选，并改善治疗结局。此外，我们还将分享靶向 TROP2 抗体偶联药物 datopotamab deruxtecan 联合度伐利尤单抗治疗早期肺癌的研究数据，这是我们首次公布公司自主研发的两款抗体偶联药物在相关临床试验中获取的数据，该数据令人备受鼓舞。此外，我们的下一代免疫疗法也取得了重大进展。」阿斯利康全球执行副总裁、肿瘤业务负责人 David Fredrickson 表示：「我们在世界肺癌大会和欧洲肿瘤内科学会年会上公布的数据，将展示阿斯利康在推动当下乃至可能在未来变革癌症治疗的几项重大趋势中所取得的成果。在针对治疗肌层浸润性膀胱癌的 NIAGARA 临床试验中，度伐利尤单抗取得了阳性结果，突显出在这类人群中围手术期免疫治疗的重要性。同时，datopotamab deruxtecan 和德曲妥珠单抗对各类肺癌的研究数据将着重体现，抗体偶联药物有望在多种癌症状况的治疗中替代传统化疗。关键趋势：早期干预，变革癌症早期治疗结局在 ESMO 的主席专题讨论会上，阿斯利康将展示 NIAGARA III 期试验结果，这项临床试验旨在观察肌层浸润性膀胱癌患者在接受膀胱切除术之前，先接受度伐利尤单抗联合新辅助化疗，术后接受度伐利尤单抗作为辅助单药治疗的效果。这种基于度伐利尤单抗的治疗方案取得了良好效果，在无事件生存期（EFS）和总体生存期（OS）方面表现出统计学上显著且具有临床意义的改善，使其成为首个在膀胱癌 III 期试验中显示出延长生存期的围术期免疫治疗方案。在肺癌治疗领域，两场会议中有多场报告将彰显我们在早期治疗取得的重大进展。包括： NeoCOAST-2 II 期平台型临床研究的疗效和安全性数据将在世界肺癌大会的「最新突破主席研讨会「上汇报。该研究旨在评估度伐利尤单抗在围术期的多种新型联合疗法治疗可切除的早期非小细胞肺癌（NSCLC）患者的疗效，包括与 datopotamab deruxtecan 的联合疗法。AEGEAN III 期临床研究证明了度伐利尤单抗在围手术期的疗效，且近期已在美国获批。 AEGEAN III 期临床研究的第二次中期分析结果将在 WCLC 做「最新突破的口头报告「，分析围手术期基于度伐利尤单抗的治疗方案对早期可切除（IIA-IIIB）NSCLC 患者的疗效。这些数据涵盖了亚组患者（无论是否实现病理完全缓解）的无事件生存期，以及最新的无病生存期和总生存期。在 ESMO 上的另一项口头报告中，将介绍 AEGEAN 的循环肿瘤 DNA（ctDNA）检测数据，为患者对治疗方案的应答情况提供参考。 ADRIATIC III 期临床研究将在世界肺癌大会上做简短口头报告，介绍接受同步化放疗（CRT）后未出现疾病进展的局限期小细胞肺癌患者使用度伐利尤单抗的治疗结局。此外，我们还将在 ESMO 上的口头报告中，公布主要亚组患者的治疗结局。 LAURA III 期临床研究将在世界肺癌大会上做简短口头报告，分析不可切除的 III 期 EGFR 敏感突变非小细胞肺癌患者在根治性放化疗后，使用泰瑞沙（奥希替尼）在中枢神经系统和远处转移的疗效。此外， LAURA 临床研究的安全性数据将在 WCLC 展示、中国队列的疗效和安全性将在 ESMO 上以壁报展示。关键趋势：新型抗体偶联药物（ADC）取代全身化疗在 WCLC 的「最新突破主席研讨会「上，通过应用阿斯利康专有的病理学计算平台——定量连续评分（QCS）对 TROPION-Lung01 所收集的组织样本进行探索性分析，将使得经 QCS 计算的 TROP2 有望成为用 datopotamab deruxtecan 治疗的预测生物标志物。此外，TROPION-Lung01 III 期临床研究的总生存期数据将做「最新突破的口头报告「，该研究旨在评估 datopotamab deruxtecan 治疗既往经治的局部晚期或转移性 NSCLC 患者的疗效。今年 5 月，一系列高水平阳性结果显示，相较于多西他赛（目前的标准化疗药物），datopotamab deruxtecan 在既往接受过免疫治疗或靶向治疗的晚期非鳞 NSCLC 患者中，总生存期有临床意义的改善。以及在 WCLC 上，DESTINY-Lung03 Ib 期试验第一部分的数据将做口头报告，重点介绍德曲妥珠单抗的疗效和安全性，该试验以 DESTINY-Lung01 II 期临床研究数据为基础，患者均为经治的 HER2 过表达的不可切除局部晚期或转移性 NSCLC 患者。在 ESMO 上，德曲妥珠单抗在 DESTINY-Breast12 IIIb/IV 期临床研究中治疗经治的 HER2 阳性转移性乳腺癌患者的潜在疗效将做最新突破的口头报告，部分受试患者还伴有脑转移。此外，DESTINY-Gastric03 Ib/II 临床研究的口头报告将介绍德曲妥珠单抗联合化疗和帕博利珠单抗作为一线治疗方案，在 HER2 阳性胃和胃食管结合部（GEJ）癌症中的安全性和疗效。在 ESMO 上还将发表简短口头报告，首次发布 datopotamab deruxtecan TROPION-PanTumour03 II 期临床研究在子宫内膜癌和卵巢癌的首次治疗结果。阿斯利康将在 ESMO 上发布多项报告，展示公司新兴的 ADC 专有技术实力。包括：通过优选书面报告分享 B7-H4 ADC AZD8205 在 BLUESTAR I/IIa 期临床研究治疗表达 B7-H4 的晚期实体肿瘤中的剂量递增结果。B7-H4 在多种实体肿瘤中过表达，被认为是一种有前景的 ADC 靶点。AZD8205 是首个进入临床并携带专有新型拓扑异构酶 I 抑制剂（TOP1i）的连接子载药的 ADC。此前有报道称，在多种肿瘤类型的 B7-H4 表达临床前模型中，AZD8205 具有强大的抗肿瘤活性。通过壁报首次公布 AZD5335 FONTANA I/IIa 期人体临床研究的剂量递增结果。该研究结果显示，AZD5335 在铂耐药复发性卵巢癌患者中具有良好的临床活性、药代动力学特性和可管理的安全性。这种 ADC 通过靶向 FRα抗体与专有 TOP1i 药物弹头偶联，既往已经报道它对于 FRα表达的，对另一种带有微管抑制剂药物弹头的 FRα ADC 具有耐药性的临床前模型具有强大的抗肿瘤活性。关键趋势：推动下一波免疫治疗药物浪潮几项报告将强调公司致力于推进全面的双特异性抗体计划的承诺：一项壁报首次汇报了临床 II 期试验 GEMINI-Gastric 亚研究 2 的总缓解率和安全性数据。该实验评估了 rilvegostomig（AZD2936）作为一款靶向 PD-1/TIGIT 双特异性免疫检查点抑制剂联合化疗一线治疗 HER2 阴性局部晚期不可切或转移性胃癌或胃食管结合部（GEJ）患者的疗效。此外，在 WCLC 上，两场重磅口头报告将重点介绍 rilvegostomig 治疗转移性 NSCLC 患者的 ARTEMIDE-01 I 期试验的疗效和安全性数据，以及 volrustomig（PD-1/CTLA-4）联合化疗一线治疗晚期 NSCLC 患者的 Ib/II 期试验数据。关键趋势：强大联合治疗方案，多角度攻克癌症除 DESTINY-Lung03、DESTINY-Gastric03 和 NeoCOAST-2 新型疗法外，我们还在进一步评估联合疗法手段，以改善患者的治疗结局：一项外部研究者发起的 FLOWERS II 期试验将在「最新突破主席研讨会」上做汇报，评估奥希替尼联合或不联合赛沃替尼一线治疗 EGFR 敏感突变阳性合并原发 MET 扩增或 MET 过表达的局部晚期或转移性 NSCLC 的疗效。在 WCLC 上，两项重磅简短口头报告将重点介绍评估奥希替尼联合化疗治疗晚期 EGFR 敏感突变 NSCLC 患者的疗效的 FLAURA2 III 期试验的新数据，，包括肿瘤负荷高和基线中携带 TP35 突变的患者的疗效。一项简短口头报告将介绍 HIMALAYA III 期实验的 5 年 OS 探索性分析数据，即 STRIDE 方案（Single Tremelimumab Regular Interval Durvalumab）在一线治疗既往未接受过全身治疗且不适合局部治疗的不可切除肝细胞癌（HCC）患者的疗效。该些数据是迄今为止治疗这类人群的 III 期临床研究中报告的最长生存期随访结果。科学领域的合作对于改善患者的治疗结局而言至关重要。阿斯利康正在与第一三共合作开发和商业化德曲妥珠单抗和 datopotamab deruxtecan；与默沙东合作开发和商业化奥拉帕利；与和黄医药合作开发和商业化赛沃替尼。Rilvegostomig 是一款靶向 PD-1 + TIGIT 双特异性抗体药物，是由 Compugen 在研的抗 TIGIT 抗体 COM902 开发而来。阿斯利康通过 2015 年启动的共同开发和商业化协议，于 2018 年 10 月从 Innate Pharma 获得了 monalizumab 的全部肿瘤学权利。阿斯利康在 2024 年 WCLC 期间的重要报告：阿斯利康在 2024 年 ESMO 年会期间的重要演讲：封面来源：企业 logo 免责声明：本文仅作消息分享，并不构成投资建议，也不代表 Insight 数据库的立场，文章观点仅供分享行业见解，请广大投资者谨慎。多样化功能、可溯源数据…… Insight 数据库网页版等你体验点击阅读原文，立刻解锁！

免疫疗法临床2期临床3期

2024-09-05

·美通社

阿斯利康在2024年世界肺癌大会和欧洲肿瘤内科学会年会上深化其提升多癌种治疗标准的雄心壮志

主席研讨会将展示基于计算的 TROP2病理学生物标志物如何精准患者筛选，并有望预测晚期肺癌患者的治疗结局 NIAGARA研究的主席研讨会将着重展示基于英飞凡的膀胱癌围手术期治疗方案具有改变临床实践的影响上海 2024年9月5日 /美通社/ -- 在2024年9月7日至10日由国际肺癌研究协会（IASLC）主办的2024年世界肺癌大会（WCLC）和2024年9月13日至17日举办的欧洲肿瘤内科学会（ESMO）年会上，阿斯利康将凭借其多元化、领先行业的产品及管线布局的全新研究数据，深化其变革癌症诊疗格局的雄心壮志。在这两场大会上，阿斯利康将公布逾130项摘要，其中涵盖17款已获得批准的药物和潜在新药，包含5项主席研讨会和41项口头报告。阿斯利康全球执行副总裁、肿瘤研发负责人Susan Galbraith表示：“在这两场大会上，我们的报告有力地推动了阿斯利康致力于颠覆癌症诊疗的长期战略。我们将在世界肺癌大会上展示计算病理学平台的成果，当前我们正在抗体偶联药物组合中使用该平台以研发预测生物标志物，精准提升患者筛选，并改善治疗结局。此外，我们还将分享靶向TROP2抗体偶联药物datopotamab deruxtecan联合度伐利尤单抗治疗早期肺癌的研究数据，这是我们首次公布公司自主研发的两款抗体偶联药物在相关临床试验中获取的数据，该数据令人备受鼓舞。此外，我们的下一代免疫疗法也取得了重大进展。” 阿斯利康全球执行副总裁、肿瘤业务负责人David Fredrickson表示：“我们在世界肺癌大会和欧洲肿瘤内科学会年会上公布的数据，将展示阿斯利康在推动当下乃至可能在未来变革癌症治疗的几项重大趋势中所取得的成果。在针对治疗肌层浸润性膀胱癌的NIAGARA临床试验中，度伐利尤单抗取得了阳性结果，突显出在这类人群中围手术期免疫治疗的重要性。同时，datopotamab deruxtecan和德曲妥珠单抗对各类肺癌的研究数据将着重体现，抗体偶联药物有望在多种癌症状况的治疗中替代传统化疗。 ” 关键趋势：早期干预，变革癌症早期治疗结局在ESMO的主席专题讨论会上，阿斯利康将展示NIAGARA III期试验结果，这项临床试验旨在观察肌层浸润性膀胱癌患者在接受膀胱切除术之前，先接受度伐利尤单抗联合新辅助化疗，术后接受度伐利尤单抗作为辅助单药治疗的效果。这种基于度伐利尤单抗的治疗方案取得了良好效果，在无事件生存期（EFS）和总体生存期（OS）方面表现出统计学上显著且具有临床意义的改善，使其成为首个在膀胱癌III期试验中显示出延长生存期的围术期免疫治疗方案。在肺癌治疗领域，两场会议中有多场报告将彰显我们在早期治疗取得的重大进展。包括： NeoCOAST-2 II期平台型临床研究的疗效和安全性数据将在世界肺癌大会的“最新突破主席研讨会 ” 上汇报。该研究旨在评估度伐利尤单抗在围术期的多种新型联合疗法治疗可切除的早期非小细胞肺癌（NSCLC）患者的疗效，包括与datopotamab deruxtecan的联合疗法。AEGEAN III期临床研究证明了度伐利尤单抗在围手术期的疗效，且近期已在美国获批。 AEGEAN III期临床研究的第二次中期分析结果将在WCLC做“最新突破的口头报告” ，分析围手术期基于度伐利尤单抗的治疗方案对早期可切除（IIA-IIIB）NSCLC患者的疗效。这些数据涵盖了亚组患者（无论是否实现病理完全缓解）的无事件生存期，以及最新的无病生存期和总生存期。在ESMO上的另一项口头报告中，将介绍AEGEAN的循环肿瘤 DNA（ctDNA）检测数据，为患者对治疗方案的应答情况提供参考。 ADRIATIC III期临床研究将在世界肺癌大会上做简短口头报告，介绍接受同步化放疗（CRT）后未出现疾病进展的局限期小细胞肺癌患者使用度伐利尤单抗的治疗结局。此外，我们还将在ESMO上的口头报告中，公布主要亚组患者的治疗结局。 LAURA III期临床研究将在世界肺癌大会上做简短口头报告，分析不可切除的III期EGFR敏感突变非小细胞肺癌患者在根治性放化疗后，使用泰瑞沙（奥希替尼）在中枢神经系统和远处转移的疗效。此外， LAURA临床研究的安全性数据将在WCLC展示、中国队列的疗效和安全性将在ESMO上以壁报展示。关键趋势：新型抗体偶联药物（ ADC）取代全身化疗在WCLC的“最新突破主席研讨会 ” 上，通过应用阿斯利康专有的病理学计算平台——定量连续评分（QCS）对TROPION-Lung01所收集的组织样本进行探索性分析，将使得经QCS计算的TROP2有望成为用datopotamab deruxtecan治疗的预测生物标志物。此外，TROPION-Lung01 III期临床研究的总生存期数据将做“最新突破的口头报告 ” ，该研究旨在评估datopotamab deruxtecan治疗既往经治的局部晚期或转移性NSCLC患者的疗效。今年5月，一系列高水平阳性结果显示，相较于多西他赛（目前的标准化疗药物），datopotamab deruxtecan在既往接受过免疫治疗或靶向治疗的晚期非鳞NSCLC患者中，总生存期有临床意义的改善。以及在WCLC上，DESTINY-Lung03 Ib期试验第一部分的数据将做口头报告，重点介绍德曲妥珠单抗的疗效和安全性，该试验以DESTINY-Lung01 II期临床研究数据为基础，患者均为经治的HER2过表达的不可切除局部晚期或转移性NSCLC患者。在ESMO上，德曲妥珠单抗在DESTINY-Breast12 IIIb/IV期临床研究中治疗经治的HER2阳性转移性乳腺癌患者的潜在疗效将做最新突破的口头报告，部分受试患者还伴有脑转移。此外，DESTINY-Gastric03 Ib/II临床研究的口头报告将介绍德曲妥珠单抗联合化疗和帕博利珠单抗作为一线治疗方案，在HER2阳性胃和胃食管结合部（GEJ）癌症中的安全性和疗效。在ESMO上还将发表简短口头报告，首次发布datopotamab deruxtecan TROPION-PanTumour03 II期临床研究在子宫内膜癌和卵巢癌的首次治疗结果。阿斯利康将在ESMO上发布多项报告，展示公司新兴的ADC专有技术实力。包括：通过优选书面报告分享B7-H4 ADC AZD8205在BLUESTAR I/IIa期临床研究治疗表达 B7-H4的晚期实体肿瘤中的剂量递增结果。B7-H4在多种实体肿瘤中过表达，被认为是一种有前景的ADC靶点。AZD8205是首个进入临床并携带专有新型拓扑异构酶I抑制剂（TOP1i）的连接子载药的ADC。此前，在多种肿瘤类型的B7-H4表达临床前模型中，AZD8205具有强大的抗肿瘤活性。通过壁报首次公布AZD5335 FONTANA I/IIa期人体临床研究的剂量递增结果。该研究结果显示，AZD5335在铂耐药复发性卵巢癌患者中具有良好的临床活性、药代动力学特性和可管理的安全性。这种ADC通过靶向FRα抗体与专有TOP1i药物弹头偶联，既往已经报道它对于FRα表达的，对另一种带有微管抑制剂药物弹头的FRα ADC具有耐药性的临床前模型具有强大的抗肿瘤活性。关键趋势：推动下一波免疫治疗药物浪潮几项报告将强调公司致力于推进全面的双特异性抗体计划的承诺：一项壁报首次汇报了临床II期试验GEMINI-Gastric亚研究2的总缓解率和安全性数据。该实验评估了rilvegostomig（AZD2936）作为一款靶向PD-1/TIGIT双特异性免疫检查点抑制剂联合化疗一线治疗HER2阴性局部晚期不可切或转移性胃癌或胃食管结合部（GEJ）患者的疗效。此外，在WCLC上，两场重磅口头报告将重点介绍rilvegostomig治疗转移性NSCLC患者的 ARTEMIDE-01 I 期试验的疗效和安全性数据，以及volrustomig（PD-1/CTLA-4）联合化疗一线治疗晚期NSCLC患者的Ib/II期试验数据。关键趋势：强大联合治疗方案，多角度攻克癌症除DESTINY-Lung03、DESTINY-Gastric03 和 NeoCOAST-2 新型疗法外，我们还在进一步评估联合疗法手段，以改善患者的治疗结局：一项外部研究者发起的FLOWERS II期试验将在“最新突破主席研讨会”上做汇报，评估奥希替尼联合或不联合赛沃替尼一线治疗EGFR敏感突变阳性合并原发MET扩增或MET过表达的局部晚期或转移性NSCLC的疗效。在WCLC上，两项重磅简短口头报告将重点介绍评估奥希替尼联合化疗治疗晚期EGFR敏感突变NSCLC患者的疗效的FLAURA2 III 期试验的新数据，包括肿瘤负荷高和基线中携带TP35突变的患者的疗效。一项简短口头报告将介绍HIMALAYA III期实验的5年OS探索性分析数据，即STRIDE方案（Single Tremelimumab Regular Interval Durvalumab）在一线治疗既往未接受过全身治疗且不适合局部治疗的不可切除肝细胞癌（HCC）患者的疗效。该些数据是迄今为止治疗这类人群的III期临床研究中报告的最长生存期随访结果。科学领域的合作对于改善患者的治疗结局而言至关重要。阿斯利康正在与第一三共合作开发和商业化德曲妥珠单抗和datopotamab deruxtecan；与默沙东合作开发和商业化奥拉帕利；与和黄医药合作开发和商业化赛沃替尼。Rilvegostomig是一款靶向PD-1 + TIGIT双特异性抗体药物，是由Compugen在研的抗TIGIT抗体COM902开发而来。阿斯利康通过2015年启动的共同开发和商业化协议，于2018年10月从Innate Pharma获得了monalizumab 的全部肿瘤学权利。关于阿斯利康肿瘤领域的研究阿斯利康正引领着肿瘤领域的一场革命，致力提供多元化的肿瘤治疗方案，以科学探索肿瘤领域的复杂性，发现、研发并向患者提供改变生命的药物。阿斯利康专注于最具挑战性的肿瘤疾病，通过持续不断的创新，阿斯利康已经建立了领先全行业的多元化产品组合和管线，持续推动医疗实践变革，改变患者体验。阿斯利康以期重新定义癌症治疗并在未来攻克癌症。声明：本文涉及未在中国获批的产品或者适应症，阿斯利康不推荐任何未被批准的药品使用。

临床3期免疫疗法临床结果

2024-09-03

·Business Wire

AstraZeneca advances ambition to improve standards of care in multiple cancer types at WCLC and ESMO 2024

WILMINGTON, Del.--( BUSINESS WIRE )--AstraZeneca advances its ambition to revolutionize cancer care with new data across its diverse, industry-leading portfolio and pipeline at the IASLC 2024 World Conference on Lung Cancer (WCLC) hosted by the International Association for the Study of Lung Cancer, September 7 to 10, 2024 and the European Society for Medical Oncology (ESMO) Congress, September 13 to 17, 2024. Across the two meetings, more than 130 abstracts will feature 17 approved and potential new medicines from AstraZeneca including five Presidential Symposia and 41 oral presentations. Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca, said: “ The presentations across these two congresses advance our long-term strategy to revolutionize cancer care. We will show results from our computational pathology platform at WCLC which we are using across our antibody drug conjugate portfolio to develop predictive biomarkers to enhance patient selection and improve outcomes for patients. We will also share data on the use of our TROP2 antibody drug conjugate datopotamab deruxtecan in combination with IMFINZI in early-stage lung cancer, a promising first look at clinical activity from two of our own pipeline antibody drug conjugates and important progress for our next-generation immunotherapies.” Dave Fredrickson, Executive Vice President, Oncology Business Unit, AstraZeneca, said: “ Our data featured at WCLC and ESMO will exhibit AstraZeneca’s progress in advancing several of the biggest trends transforming cancer treatment today and potentially in the future. Positive results for IMFINZI from the NIAGARA trial in muscle-invasive bladder cancer will show the importance of integrating perioperative immunotherapy in this setting, and data for datopotamab deruxtecan and ENHERTU in several lung cancer settings will highlight how antibody drug conjugates have the potential to replace traditional chemotherapy approaches in many cancer settings.” Key trend: early intervention and transforming outcomes in early-stage disease A Presidential Symposium at ESMO will showcase the results from the NIAGARA Phase III trial of IMFINZI ® (durvalumab) in combination with neoadjuvant chemotherapy before cystectomy (surgery to remove the bladder) followed by IMFINZI as adjuvant monotherapy in patients with muscle-invasive bladder cancer. High-level results for this IMFINZI-based regimen showed a statistically significant and clinically meaningful event-free survival (EFS) and overall survival (OS) benefit, making it the first perioperative immunotherapy regimen to show extended survival in bladder cancer in a Phase III trial. In lung cancer, several presentations at both meetings will reinforce the Company’s progress toward moving treatment to earlier stages of disease. These include: A late-breaking Presidential Symposium at WCLC that will feature efficacy and safety data from the NeoCOAST-2 Phase II platform trial. This trial evaluates IMFINZI in multiple novel combinations, before and after surgery, in patients with resectable, early-stage non-small cell lung cancer (NSCLC), including a combination with datopotamab deruxtecan (Dato-DXd). Results will build on the proven efficacy of perioperative IMFINZI as demonstrated in the AEGEAN Phase III trial, which was recently approved in the US. A late-breaking oral presentation at WCLC sharing results from the second interim analysis of the AEGEAN Phase III trial of perioperative IMFINZI-based treatment in patients with resectable early-stage (IIA-IIIB) NSCLC. The data include EFS in subgroups of patients who did or did not achieve pathologic complete response, as well as new disease-free survival and OS results. An additional late-breaking oral presentation at ESMO sharing AEGEAN circulating tumor DNA (ctDNA) data will provide insights on how patients respond to treatment. A late-breaking mini-oral presentation at WCLC highlighting patient-reported outcomes from the ADRIATIC Phase III trial of IMFINZI in patients with limited-stage small cell lung cancer whose disease did not progress on concurrent chemoradiotherapy (CRT). Additionally, an oral presentation at ESMO will share outcomes in key patient subgroups. A mini-oral presentation at ESMO of results from the LAURA Phase III trial including analyses of central nervous system metastases and distant progression with TAGRISSO ® (osimertinib) in unresectable, Stage III EGFRm NSCLC after CRT. Additional data from LAURA will include a safety analysis at WCLC and a poster presentation at ESMO of efficacy and safety results in a cohort of patients in China. Key trend: novel ADCs replacing systemic chemotherapy A late-breaking Presidential Symposium at WCLC of exploratory results from the application of AstraZeneca’s proprietary computational pathology platform, quantitative continuous scoring (QCS), to tissue samples collected in TROPION-Lung01 will demonstrate the potential of TROP2, as measured by QCS, as a predictive biomarker for datopotamab deruxtecan. Additionally, a late-breaking oral presentation will showcase OS data from the TROPION-Lung01 Phase III trial evaluating datopotamab deruxtecan in patients with previously treated locally advanced or metastatic NSCLC. In May , high-level results showed that datopotamab deruxtecan demonstrated a clinically meaningful OS improvement versus docetaxel, the current standard-of-care chemotherapy, in patients with advanced nonsquamous NSCLC previously treated with immunotherapy or targeted therapy. Also, at WCLC, an oral presentation will highlight efficacy and safety data from Part 1 of the DESTINY-Lung03 Phase Ib trial of ENHERTU ® (fam-trastuzumab deruxtecan-nxki) in patients with previously treated HER2-overexpressing unresectable, locally advanced or metastatic NSCLC, building on data from the DESTINY-Lung01 Phase II trial. At ESMO, a late-breaking oral presentation from the DESTINY-Breast12 Phase IIIb/IV trial of ENHERTU in patients with previously treated metastatic HER2-positive breast cancer with and without brain metastases will showcase the potential benefits of this important medicine in this patient population. Additionally, an oral presentation of the DESTINY-Gastric03 Phase Ib/II trial will feature safety and efficacy data for the combination of ENHERTU, chemotherapy and pembrolizumab as a 1st-line treatment in HER2-positive gastric and gastroesophageal junction (GEJ) cancers. A mini-oral presentation at ESMO will highlight first results from the endometrial and ovarian cancer cohorts of the TROPION-PanTumor03 Phase II trial of datopotamab deruxtecan. Several presentations at ESMO will showcase the strength of the Company’s emerging proprietary antibody drug conjugate (ADC) technology. These include: A proffered paper presentation sharing dose escalation results from the BLUESTAR Phase I/IIa trial of B7-H4 ADC AZD8205 in patients with B7-H4-expressing advanced solid tumors. B7-H4 is a promising ADC target which is highly expressed in several solid tumors. AZD8205 is the first ADC bearing a novel proprietary topoisomerase I inhibitor (TOP1i) linker payload to enter the clinic. Robust AZD8205 anti-tumor response has previously been reported in B7-H4-expressing preclinical models across multiple tumor types. A poster presentation sharing dose escalation results from the FONTANA Phase I/IIa first-in-human trial of AZD5335 demonstrating clinical activity, favorable pharmacokinetic and manageable safety profiles in patients with platinum-resistant recurrent ovarian cancer. This ADC has a FRα-targeting antibody linked to a proprietary TOP1i warhead. A robust anti-tumor response has previously been reported in FRα-expressing preclinical models that are resistant to another FRα ADC with a microtubule inhibitor warhead. Key trend: advancing next wave of immunotherapy agents Several presentations will underscore the Company’s commitment to advancing its comprehensive bispecific antibody program: A poster presentation sharing the first report of overall response rate and safety data from Substudy 2 of the GEMINI-Gastric Phase II trial, testing rilvegostomig (AZD2936), a PD-1/TIGIT bispecific immune checkpoint inhibitor, plus chemotherapy as a 1st-line treatment in patients with HER2-negative, locally advanced unresectable or metastatic GEJ cancers. Additionally, two late-breaking oral presentations at WCLC will highlight efficacy and safety results from the ARTEMIDE-01 Phase I trial of rilvegostomig in patients with metastatic NSCLC, as well as from a Phase Ib/II trial of volrustomig (PD-1/CTLA-4) in combination with chemotherapy in the 1st-line for patients with advanced NSCLC. Key trend: powerful combinations to attack cancer from multiple angles In addition to the novel regimens evaluated in DESTINY-Lung03, DESTINY-Gastric03 and NeoCOAST-2, we are assessing further combination treatment approaches below to improve outcomes for patients: A late-breaking, Presidential Symposium presentation for TAGRISSO from the externally sponsored FLOWERS Phase II trial of TAGRISSO with or without savolitinib in patients with EGFRm advanced NSCLC with MET aberrations will evaluate the potential of this novel combination to overcome mechanisms of resistance in the 1st-line setting. Two late-breaking mini-oral presentations at WCLC will highlight new data from the FLAURA2 Phase III trial of TAGRISSO plus chemotherapy in advanced EGFRm NSCLC, including efficacy in patients with high tumor burden and those whose cancers harbour TP53 mutations at baseline. A mini-oral presentation featuring five-year OS data from an exploratory analysis of the HIMALAYA Phase III trial of STRIDE (Single Tremelimumab-actl Regular Interval Durvalumab) in patients with unresectable liver cancer who have not received prior systemic therapy and are not eligible for localized treatment. These data represent the longest survival follow-up reported to date for a Phase III trial in this setting. Collaboration in the scientific community is critical to improving outcomes for patients. AstraZeneca is collaborating with Daiichi Sankyo Company Limited to develop and commercialize ENHERTU and datopotamab deruxtecan, collaborating with Merck & Co., Inc. (known as MSD outside the US and Canada) to develop and commercialize LYNPARZA ® (olaparib), and collaborating with HUTCHMED to develop and commercialize savolitinib . Rilvegostomig is a PD-1/TIGIT bispecific antibody where the TIGIT component is derived from Compugen’s clinical stage anti-TIGIT antibody, COM902. AstraZeneca obtained full oncology rights to monalizumab from Innate Pharma in October 2018 through a co-development and commercialisation agreement initiated in 2015. Key AstraZeneca presentations during IASLC WCLC 2024 1 Lead Author Abstract Title Presentation details (PDT) Antibody drug conjugates Garassino, MC Normalized membrane ratio of TROP2 by quantitative continuous scoring is predictive of clinical outcomes in TROPION-Lung 01 Abstract #PL02.11 Presidential 1 September 8, 2024 9:22 AM Sands, J Datopotamab deruxtecan vs docetaxel in patients with non-small cell lung cancer: final overall survival from TROPION-Lung01 Abstract #OA08.03 Oral Session September 9, 2024 10:47 AM Planchard, D Fam-trastuzumab deruxtecan-nxki monotherapy in pretreated HER2-overexpressing nonsquamous non-small cell lung cancer: DESTINY-Lung03 part 1 Abstract #OA16.05 Oral Session September 10, 2024 1:52 PM Immuno-oncology Cascone, T Neocoast-2: Efficacy and safety of neoadjuvant durvalumab (D) + novel anticancer agents + CT and adjuvant D ± novel agents in resectable NSCLC Abstract #PL02.07 Presidential 1 September 8, 2024 8:56 AM Hiltermann, TJN Efficacy and safety of rilvegostomig, an anti-PD-1/TIGIT bispecific, for CPI-naïve metastatic NSCLC with PD-L1 1-49% or ≥50% Abstract #OA11.03 Oral Session September 9, 2024 2:02 PM Heymach, JV Perioperative durvalumab for resectable NSCLC (R-NSCLC): updated outcomes from the phase 3 AEGEAN trial Abstract #OA13.03 Oral Session September 9, 2024 3:32 PM Spigel, DR Volrustomig + platinum doublet chemotherapy (CTx) in first-line non-small cell lung cancer (NSCLC): phase 1b trial update Abstract #OA11.04 Oral Session September 9, 2024 2:12 PM Novello, S Patient-reported outcomes (PROs) with consolidation durvalumab versus placebo following cCRT in limited-stage SCLC: ADRIATIC Abstract #MA17.04 Mini Oral Session September 10, 2024 3:07 PM Skoulidis, F TRITON: Tremelimumab-actl + durvalumab + chemotherapy (CT) vs pembrolizumab + CT in mNSCLC with STK11, KEAP1 and/or KRAS mutations Abstract #P4.11D.01 Poster Session September 9, 2024 6:30 PM Tumor drivers and resistance Yang, J Osimertinib with or without savolitinib as 1L in de novo MET aberrant, EGFRm advanced NSCLC (CTONG 2008): a phase II trial Abstract #PL04.10 Presidential 2 September 9, 2024 9:17 AM Kato, T Osimertinib after definitive CRT in unresectable stage III EGFR-mutated NSCLC: safety outcomes from the phase 3 LAURA study Abstract #OA12.03 Oral Session September 9, 2024 2:02 PM Yang, JC FLAURA2: Resistance, and impact of baseline TP53 alterations in patients treated with 1L osimertinib ± platinum-pemetrexed Abstract #MA12.03 Mini Oral Session September 10, 2024 1:32 PM Valdiviezo, N FLAURA2: Impact of tumor burden on outcomes of 1L osimertinib ± chemotherapy in patients with EGFR-mutated advanced NSCLC Abstract #MA12.04 Mini Oral Session September 10, 2024 1:37 PM 1 59 abstracts at IASLC WCLC 2024 will feature AstraZeneca medicines and pipeline molecules Key AstraZeneca presentations during ESMO Congress 2024 2 Lead Author Abstract Title Presentation details (CEST) Antibody drug conjugates Datopotamab deruxtecan Oaknin, A Datopotamab deruxtecan (Dato-DXd) in patients with endometrial (EC) or ovarian cancer (OC): results from the phase 2 TROPION-PanTumor03 study Abstract #714MO Mini Oral Session September 15, 2024 2:45 PM Trivedi, MS Rates of pathologic complete response (pCR) after datopotamab deruxtecan (dato) plus durvalumab (durva) treatment strategy in the neoadjuvant setting: results from the I-SPY 2.2 trial Abstract #LBA15 Mini Oral Session September 14, 2024 11:20 AM Khoury, K Rates of pathologic complete response (pCR) after datopotamab deruxtecan (dato) in the neoadjuvant setting: results from the I-SPY 2.2 trial Abstract #LBA16 Mini Oral Session September 14, 2024 11:25 AM Rugo, HS Exposure-adjusted incidence rates (EAIRs) of adverse events (AEs) from the TROPION-Breast01 study of datopotamab deruxtecan (Dato-DXd) vs investigator’s choice of chemotherapy (ICC) in patients (pts) with pretreated, inoperable/metastatic HR+/HER2– breast cancer (BC) Abstract #431P Poster Session September 16, 2024 Pons-Tostivint, E Datopotamab deruxtecan (Dato-DXd) vs docetaxel (DTX) in patients (pts) with advanced nonsquamous (NSQ) non-small cell lung cancer (NSCLC) with brain metastases (mets): results from TROPION-Lung01 Abstract #1312P Poster Session September 14, 2024 Enhertu Lin, N Fam-trastuzumab deruxtecan-nxki (T-DXd) in patients (pts) with HER2+ advanced/metastatic breast cancer (mBC) with or without brain metastases (BM): DESTINYBreast-12 primary results Abstract #LBA18 Proffered Paper Session September 13, 2024 4:00 PM Janjigian, YY Fam-trastuzumab deruxtecan-nxki (T-DXd) monotherapy and combinations in patients (pts) with advanced/metastatic HER2-positive (HER2+) esophageal, gastric or gastroesophageal junction adenocarcinoma (GEJA): DESTINY-Gastric03 (DG-03) Abstract #1401O Proffered Paper Session September 14, 2024 9:25 AM Hu, X Effects of fam-trastuzumab deruxtecan-nxki (T-DXd) vs choice of chemotherapy (TPC) on patient-reported outcomes (PROs) in hormone receptor–positive, HER2-low or HER2-ultralow metastatic breast cancer (mBC): results from DESTINY-Breast06 Abstract #LBA22 Mini Oral Session September 15, 2024 9:10 AM Ueno, NT Exploratory biomarker analysis of fam-trastuzumab deruxtecan-nxki versus treatment of physician’s choice in HER2-low, hormone receptor–positive metastatic breast cancer in DESTINY-Breast04 Abstract #432P Poster Session September 16, 2024 AZD8205 Meric-Bernstam, F Initial results from a first-in-human study of the B7-H4–directed antibody-drug conjugate (ADC) AZD8205 (puxitatug samrotecan) in patients with advanced/metastatic solid tumors Abstract #606O Proffered Paper Session September 13, 2024 4:50 PM AZD5335 Shapira-Frommer, R Initial results from a first-in-human study of AZD5335, a folate receptor α (FRα)-targeted antibody-drug conjugate, in patients (pts) with platinum-resistant recurrent ovarian cancer (PRROC) Abstract #754P Poster Session September 14, 2024 Immuno-oncology Powles, TB A randomized phase 3 trial of neoadjuvant durvalumab plus chemotherapy followed by radical cystectomy and adjuvant durvalumab in muscle-invasive bladder cancer (NIAGARA) Abstract #LBA5 Presidential 2 September 15, 2024 5:14 PM Tomasini, P Precision immuno-oncology for advanced non-small cell lung cancer (NSCLC) patients with PD-(L)1 inhibitors resistance (PIONeeR): a phase Ib/IIa clinical trial targeting identified resistance pathways Abstract #LBA8 Presidential 3 September 16, 2024 5:24 PM Senan, S Durvalumab (D) as consolidation therapy in limited-stage SCLC (LS-SCLC): outcomes by prior concurrent chemoradiotherapy (cCRT) regimen and prophylactic cranial irradiation (PCI) use in the ADRIATIC trial Abstract #LBA81 Proffered Paper Session September 13, 2024 2:25 PM Reck, M Associations of ctDNA clearance (CL) during neoadjuvant Tx with pathological response and event-free survival (EFS) in pts with resectable NSCLC (R-NSCLC): expanded analyses from AEGEAN Abstract #LBA49 Mini Oral Session September 15, 2024 10:40 AM Riccardo Filippi, A Circulating tumor DNA (ctDNA) dynamics and treatment responses in chemotherapy-ineligible patients (pts) with unresectable Stage III NSCLC from the phase 2 DUART trial Abstract #LBA51 Mini Oral Session September 15, 2024 10:45 AM Rimassa, L Five-year overall survival (OS) and OS by tumor response measures from the phase 3 HIMALAYA study of tremelimumab-actl plus durvalumab in unresectable hepatocellular carcinoma (uHCC) Abstract #947MO Mini Oral Session September 16, 2024 9:25 AM Rivera Herrero, F First-line rilvegostomig (rilve) + chemotherapy (CTx) in patients (pts) with HER2-negative (HER2–) locally advanced unresectable or metastatic gastric cancers: first report of GEMINI-Gastric substudy 2 Abstract #1422P Poster Session September 16, 2024 Blank, SV Durvalumab + carboplatin/paclitaxel (CP) followed by durvalumab ± olaparib as a first-line treatment for endometrial cancer (EC): progression-free survival (PFS) by clinical factors in DUO-E Abstract #732P Poster Session September 14, 2024 Tumor drivers and resistance Lu, S Osimertinib (osi) after definitive chemoradiotherapy (CRT) in unresectable (UR) stg III EGFRm NSCLC: analyses of CNS and distant progression from the phase 3 LAURA study Abstract #1241MO Mini Oral Session September 16, 2024 2:45 PM Dong, X Osimertinib (osi) after definitive chemoradiotherapy (CRT) in unresectable stage III epidermal growth factor receptor-mutated (EGFRm) NSCLC: LAURA China cohort analysis Abstract #1248P Poster Session September 14, 2024 2 79 abstracts at ESMO Congress 2024 will feature AstraZeneca medicines and pipeline molecules IMPORTANT SAFETY INFORMATION FOR IMFINZI ® and IMJUDO ® There are no contraindications for IMFINZI ® (durvalumab) or IMJUDO ® (tremelimumab-actl). Severe and Fatal Immune-Mediated Adverse Reactions Important immune-mediated adverse reactions listed under Warnings and Precautions may not include all possible severe and fatal immune-mediated reactions. Immune-mediated adverse reactions, which may be severe or fatal, can occur in any organ system or tissue. Immune-mediated adverse reactions can occur at any time after starting treatment or after discontinuation. Monitor patients closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate clinical chemistries including liver enzymes, creatinine, adrenocorticotropic hormone (ACTH) level, and thyroid function at baseline and before each dose. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate. Withhold or permanently discontinue IMFINZI and IMJUDO depending on severity. See USPI Dosing and Administration for specific details. In general, if IMFINZI and IMJUDO requires interruption or discontinuation, administer systemic corticosteroid therapy (1 mg to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reactions are not controlled with corticosteroid therapy. Immune-Mediated Pneumonitis IMFINZI and IMJUDO can cause immune-mediated pneumonitis, which may be fatal. The incidence of pneumonitis is higher in patients who have received prior thoracic radiation. IMFINZI as a Single Agent In patients who did not receive recent prior radiation, the incidence of immune-mediated pneumonitis was 2.4% (34/1414), including fatal (<0.1%), and Grade 3-4 (0.4%) adverse reactions. In patients who received recent prior radiation, the incidence of pneumonitis (including radiation pneumonitis) in patients with unresectable Stage III NSCLC following definitive chemoradiation within 42 days prior to initiation of IMFINZI in PACIFIC was 18.3% (87/475) in patients receiving IMFINZI and 12.8% (30/234) in patients receiving placebo. Of the patients who received IMFINZI (475), 1.1% were fatal and 2.7% were Grade 3 adverse reactions. The frequency and severity of immune-mediated pneumonitis in patients who did not receive definitive chemoradiation prior to IMFINZI were similar in patients who received IMFINZI as a single agent or with ES-SCLC or BTC when given in combination with chemotherapy. IMFINZI with IMJUDO Immune‑mediated pneumonitis occurred in 1.3% (5/388) of patients receiving IMFINZI and IMJUDO, including fatal (0.3%) and Grade 3 (0.2%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated pneumonitis occurred in 3.5% (21/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including fatal (0.5%), and Grade 3 (1%) adverse reactions. Immune-Mediated Colitis IMFINZI with IMJUDO and platinum-based chemotherapy can cause immune-mediated colitis, which may be fatal. IMFINZI and IMJUDO can cause immune-mediated colitis that is frequently associated with diarrhea. Cytomegalovirus (CMV) infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis. In cases of corticosteroid-refractory colitis, consider repeating infectious workup to exclude alternative etiologies. IMFINZI as a Single Agent Immune-mediated colitis occurred in 2% (37/1889) of patients receiving IMFINZI, including Grade 4 (<0.1%) and Grade 3 (0.4%) adverse reactions. IMFINZI with IMJUDO Immune‑mediated colitis or diarrhea occurred in 6% (23/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (3.6%) adverse reactions. Intestinal perforation has been observed in other studies of IMFINZI and IMJUDO. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated colitis occurred in 6.5% (39/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy including fatal (0.2%) and Grade 3 (2.5%) adverse reactions. Intestinal perforation and large intestine perforation were reported in 0.1% of patients. Immune-Mediated Hepatitis IMFINZI and IMJUDO can cause immune-mediated hepatitis, which may be fatal. IMFINZI as a Single Agent Immune-mediated hepatitis occurred in 2.8% (52/1889) of patients receiving IMFINZI, including fatal (0.2%), Grade 4 (0.3%) and Grade 3 (1.4%) adverse reactions. IMFINZI with IMJUDO Immune‑mediated hepatitis occurred in 7.5% (29/388) of patients receiving IMFINZI and IMJUDO, including fatal (0.8%), Grade 4 (0.3%) and Grade 3 (4.1%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated hepatitis occurred in 3.9% (23/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including fatal (0.3%), Grade 4 (0.5%), and Grade 3 (2%) adverse reactions. Immune-Mediated Endocrinopathies Adrenal Insufficiency : IMFINZI and IMJUDO can cause primary or secondary adrenal insufficiency. For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment, including hormone replacement as clinically indicated. IMFINZI as a Single Agent Immune-mediated adrenal insufficiency occurred in 0.5% (9/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions. IMFINZI with IMJUDO Immune-mediated adrenal insufficiency occurred in 1.5% (6/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.3%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated adrenal insufficiency occurred in 2.2% (13/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.8%) adverse reactions. Hypophysitis : IMFINZI and IMJUDO can cause immune-mediated hypophysitis. Hypophysitis can present with acute symptoms associated with mass effect such as headache, photophobia, or visual field cuts. Hypophysitis can cause hypopituitarism. Initiate symptomatic treatment including hormone replacement as clinically indicated. IMFINZI as a Single Agent Grade 3 hypophysitis/hypopituitarism occurred in <0.1% (1/1889) of patients who received IMFINZI. IMFINZI with IMJUDO Immune-mediated hypophysitis/hypopituitarism occurred in 1% (4/388) of patients receiving IMFINZI and IMJUDO. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated hypophysitis occurred in 1.3% (8/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.5%) adverse reactions. Thyroid Disorders (Thyroiditis, Hyperthyroidism, and Hypothyroidism) : IMFINZI and IMJUDO can cause immune-mediated thyroid disorders. Thyroiditis can present with or without endocrinopathy. Hypothyroidism can follow hyperthyroidism. Initiate hormone replacement therapy for hypothyroidism or institute medical management of hyperthyroidism as clinically indicated. IMFINZI as a Single Agent Immune-mediated thyroiditis occurred in 0.5% (9/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions. Immune-mediated hyperthyroidism occurred in 2.1% (39/1889) of patients receiving IMFINZI. Immune-mediated hypothyroidism occurred in 8.3% (156/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions. IMFINZI with IMJUDO Immune-mediated thyroiditis occurred in 1.5% (6/388) of patients receiving IMFINZI and IMJUDO. Immune-mediated hyperthyroidism occurred in 4.6% (18/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.3%) adverse reactions. Immune-mediated hypothyroidism occurred in 11% (42/388) of patients receiving IMFINZI and IMJUDO. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated thyroiditis occurred in 1.2% (7/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy. Immune-mediated hyperthyroidism occurred in 5% (30/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.2%) adverse reactions. Immune-mediated hypothyroidism occurred in 8.6% (51/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.5%) adverse reactions. IMFINZI with Carboplatin and Paclitaxel Immune-mediated hypothyroidism occurred in 14% (34/235) of patients receiving IMFINZI in combination with carboplatin and paclitaxel. Type 1 Diabetes Mellitus, which can present with diabetic ketoacidosis : Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Initiate treatment with insulin as clinically indicated. IMFINZI as a Single Agent Grade 3 immune-mediated Type 1 diabetes mellitus occurred in <0.1% (1/1889) of patients receiving IMFINZI. IMFINZI with IMJUDO Two patients (0.5%, 2/388) had events of hyperglycemia requiring insulin therapy that had not resolved at last follow-up. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated Type 1 diabetes mellitus occurred in 0.5% (3/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy including Grade 3 (0.3%) adverse reactions. Immune-Mediated Nephritis with Renal Dysfunction IMFINZI and IMJUDO can cause immune-mediated nephritis. IMFINZI as a Single Agent Immune-mediated nephritis occurred in 0.5% (10/1889) of patients receiving IMFINZI, including Grade 3 (<0.1%) adverse reactions. IMFINZI with IMJUDO Immune-mediated nephritis occurred in 1% (4/388) of patients receiving IMFINZI and IMJUDO, including Grade 3 (0.5%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated nephritis occurred in 0.7% (4/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.2%) adverse reactions. Immune-Mediated Dermatology Reactions IMFINZI and IMJUDO can cause immune-mediated rash or dermatitis. Exfoliative dermatitis, including Stevens-Johnson Syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS), and toxic epidermal necrolysis (TEN), has occurred with PD-1/L-1 and CTLA-4 blocking antibodies. Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-exfoliative rashes. IMFINZI as a Single Agent Immune-mediated rash or dermatitis occurred in 1.8% (34/1889) of patients receiving IMFINZI, including Grade 3 (0.4%) adverse reactions. IMFINZI with IMJUDO Immune-mediated rash or dermatitis occurred in 4.9% (19/388) of patients receiving IMFINZI and IMJUDO, including Grade 4 (0.3%) and Grade 3 (1.5%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated rash or dermatitis occurred in 7.2% (43/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.3%) adverse reactions. Immune-Mediated Pancreatitis IMFINZI in combination with IMJUDO can cause immune-mediated pancreatitis. Immune-mediated pancreatitis occurred in 2.3% (9/388) of patients receiving IMFINZI and IMJUDO, including Grade 4 (0.3%) and Grade 3 (1.5%) adverse reactions. Other Immune-Mediated Adverse Reactions The following clinically significant, immune-mediated adverse reactions occurred at an incidence of less than 1% each in patients who received IMFINZI and IMJUDO or were reported with the use of other immune-checkpoint inhibitors. Cardiac/vascular : Myocarditis, pericarditis, vasculitis. Nervous system : Meningitis, encephalitis, myelitis and demyelination, myasthenic syndrome/myasthenia gravis (including exacerbation), Guillain-Barré syndrome, nerve paresis, autoimmune neuropathy. Ocular : Uveitis, iritis, and other ocular inflammatory toxicities can occur. Some cases can be associated with retinal detachment. Various grades of visual impairment to include blindness can occur. If uveitis occurs in combination with other immune-mediated adverse reactions, consider a Vogt-Koyanagi-Harada-like syndrome, as this may require treatment with systemic steroids to reduce the risk of permanent vision loss. Gastrointestinal : Pancreatitis including increases in serum amylase and lipase levels, gastritis, duodenitis. Musculoskeletal and connective tissue disorders : Myositis/polymyositis, rhabdomyolysis and associated sequelae including renal failure, arthritis, polymyalgia rheumatic. Endocrine : Hypoparathyroidism. Other (hematologic/immune) : Hemolytic anemia, aplastic anemia, hemophagocytic lymphohistiocytosis, systemic inflammatory response syndrome, histiocytic necrotizing lymphadenitis (Kikuchi lymphadenitis), sarcoidosis, immune thrombocytopenia, solid organ transplant rejection, other transplant (including corneal graft) rejection. Infusion-Related Reactions IMFINZI and IMJUDO can cause severe or life-threatening infusion-related reactions. Monitor for signs and symptoms of infusion-related reactions. Interrupt, slow the rate of, or permanently discontinue IMFINZI and IMJUDO based on the severity. See USPI Dosing and Administration for specific details. For Grade 1 or 2 infusion-related reactions, consider using pre-medications with subsequent doses. IMFINZI as a Single Agent Infusion-related reactions occurred in 2.2% (42/1889) of patients receiving IMFINZI, including Grade 3 (0.3%) adverse reactions. IMFINZI with IMJUDO Infusion-related reactions occurred in 10 (2.6%) patients receiving IMFINZI and IMJUDO. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Infusion-related reactions occurred in 2.9% (17/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including Grade 3 (0.3%) adverse reactions. Complications of Allogeneic HSCT after IMFINZI Fatal and other serious complications can occur in patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after being treated with a PD-1/L-1 blocking antibody. Transplant-related complications include hyperacute graft-versus-host disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease (VOD) after reduced intensity conditioning, and steroid-requiring febrile syndrome (without an identified infectious cause). These complications may occur despite intervening therapy between PD-1/L-1 blockade and allogeneic HSCT. Follow patients closely for evidence of transplant-related complications and intervene promptly. Consider the benefit versus risks of treatment with a PD-1/L-1 blocking antibody prior to or after an allogeneic HSCT. Embryo-Fetal Toxicity Based on their mechanism of action and data from animal studies, IMFINZI and IMJUDO can cause fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. In females of reproductive potential, verify pregnancy status prior to initiating IMFINZI and IMJUDO and advise them to use effective contraception during treatment with IMFINZI and IMJUDO and for 3 months after the last dose of IMFINZI and IMJUDO. Lactation There is no information regarding the presence of IMFINZI and IMJUDO in human milk; however, because of the potential for serious adverse reactions in breastfed infants from IMFINZI and IMJUDO, advise women not to breastfeed during treatment and for 3 months after the last dose. Adverse Reactions Unresectable Stage III NSCLC In patients with Stage III NSCLC in the PACIFIC study receiving IMFINZI (n=475), the most common adverse reactions (≥20%) were cough (40%), fatigue (34%), pneumonitis or radiation pneumonitis (34%), upper respiratory tract infections (26%), dyspnea (25%), and rash (23%). The most common Grade 3 or 4 adverse reactions (≥3%) were pneumonia (7%) and pneumonitis/radiation pneumonitis (3.4%). In patients with Stage III NSCLC in the PACIFIC study receiving IMFINZI (n=475), discontinuation due to adverse reactions occurred in 15% of patients in the IMFINZI arm. Serious adverse reactions occurred in 29% of patients receiving IMFINZI. The most frequent serious adverse reactions (≥2%) were pneumonitis or radiation pneumonitis (7%) and pneumonia (6%). Fatal pneumonitis or radiation pneumonitis and fatal pneumonia occurred in <2% of patients and were similar across arms. Resectable NSCLC In patients with resectable NSCLC in the AEGEAN study, the most common adverse reactions (occurring in ≥20% of patients) were anemia, nausea, constipation, fatigue, musculoskeletal pain, and rash. In patients with resectable NSCLC in the neoadjuvant phase of the AEGEAN study receiving IMFINZI in combination with platinum-containing chemotherapy (n=401), permanent discontinuation of IMFINZI due to an adverse reaction occurred in 6.7% of patients. Serious adverse reactions occurred in 21% of patients. The most frequent (≥1%) serious adverse reactions were pneumonia (2.7%), anemia (1.5%), myelosuppression (1.5%), vomiting (1.2%), neutropenia (1%), and acute kidney injury (1%). Fatal adverse reactions occurred in 2% of patients, including death due to COVID-19 pneumonia (0.5%), sepsis (0.5%), myocarditis (0.2%), decreased appetite (0.2%), hemoptysis (0.2%), and death not otherwise specified (0.2%). Of the 401 IMFINZI treated patients who received neoadjuvant treatment and 398 placebo-treated patients who received neoadjuvant treatment, 1.7% (n=7) and 1% (n=4), respectively, did not receive surgery due to adverse reactions. In patients with resectable NSCLC in the adjuvant phase of the AEGEAN study receiving IMFINZI as a single agent (n=265), permanent discontinuation of IMFINZI due to an adverse reaction occurred in 8% of patients. Serious adverse reactions occurred in 13% of patients. The most frequent serious adverse reactions reported in >1% of patients were pneumonia (1.9%), pneumonitis (1.1%), and COVID-19 (1.1%). Four fatal adverse reactions occurred during the adjuvant phase of the study, including COVID-19 pneumonia, pneumonia aspiration, interstitial lung disease and aortic aneurysm. Metastatic NSCLC In patients with mNSCLC in the POSEIDON study receiving IMFINZI and IMJUDO plus platinum-based chemotherapy (n=330), the most common adverse reactions (occurring in ≥20% of patients) were nausea (42%), fatigue (36%), musculoskeletal pain (29%), decreased appetite (28%), rash (27%), and diarrhea (22%). In patients with mNSCLC in the POSEIDON study receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy (n=330), permanent discontinuation of IMFINZI or IMJUDO due to an adverse reaction occurred in 17% of patients. Serious adverse reactions occurred in 44% of patients, with the most frequent serious adverse reactions reported in at least 2% of patients being pneumonia (11%), anemia (5%), diarrhea (2.4%), thrombocytopenia (2.4%), pyrexia (2.4%), and febrile neutropenia (2.1%). Fatal adverse reactions occurred in a total of 4.2% of patients. Extensive-stage Small Cell Lung Cancer In patients with extensive-stage SCLC in the CASPIAN study receiving IMFINZI plus chemotherapy (n=265), the most common adverse reactions (≥20%) were nausea (34%), fatigue/asthenia (32%), and alopecia (31%). The most common Grade 3 or 4 adverse reaction (≥3%) was fatigue/asthenia (3.4%). In patients with extensive-stage SCLC in the CASPIAN study receiving IMFINZI plus chemotherapy (n=265), IMFINZI was discontinued due to adverse reactions in 7% of the patients receiving IMFINZI plus chemotherapy. Serious adverse reactions occurred in 31% of patients receiving IMFINZI plus chemotherapy. The most frequent serious adverse reactions reported in at least 1% of patients were febrile neutropenia (4.5%), pneumonia (2.3%), anemia (1.9%), pancytopenia (1.5%), pneumonitis (1.1%), and COPD (1.1%). Fatal adverse reactions occurred in 4.9% of patients receiving IMFINZI plus chemotherapy. Locally Advanced or Metastatic Biliary Tract Cancers In patients with locally advanced or metastatic BTC in the TOPAZ-1 study receiving IMFINZI (n=338), the most common adverse reactions (occurring in ≥20% of patients) were fatigue (42%), nausea (40%), constipation (32%), decreased appetite (26%), abdominal pain (24%), rash (23%), and pyrexia (20%). In patients with locally advanced or metastatic BTC in the TOPAZ-1 study receiving IMFINZI (n=338), discontinuation due to adverse reactions occurred in 6% of the patients receiving IMFINZI plus chemotherapy. Serious adverse reactions occurred in 47% of patients receiving IMFINZI plus chemotherapy. The most frequent serious adverse reactions reported in at least 2% of patients were cholangitis (7%), pyrexia (3.8%), anemia (3.6%), sepsis (3.3%) and acute kidney injury (2.4%). Fatal adverse reactions occurred in 3.6% of patients receiving IMFINZI plus chemotherapy. These include ischemic or hemorrhagic stroke (4 patients), sepsis (2 patients), and upper gastrointestinal hemorrhage (2 patients). Unresectable Hepatocellular Carcinoma In patients with unresectable HCC in the HIMALAYA study receiving IMFINZI and IMJUDO (n=388), the most common adverse reactions (occurring in ≥20% of patients) were rash (32%), diarrhea (27%), fatigue (26%), pruritus (23%), musculoskeletal pain (22%), and abdominal pain (20%). In patients with unresectable HCC in the HIMALAYA study receiving IMFINZI and IMJUDO (n=388), serious adverse reactions occurred in 41% of patients. Serious adverse reactions in >1% of patients included hemorrhage (6%), diarrhea (4%), sepsis (2.1%), pneumonia (2.1%), rash (1.5%), vomiting (1.3%), acute kidney injury (1.3%), and anemia (1.3%). Fatal adverse reactions occurred in 8% of patients who received IMFINZI and IMJUDO, including death (1%), hemorrhage intracranial (0.5%), cardiac arrest (0.5%), pneumonitis (0.5%), hepatic failure (0.5%), and immune-mediated hepatitis (0.5%). Permanent discontinuation of treatment regimen due to an adverse reaction occurred in 14% of patients. Primary advanced or Recurrent dMMR Endometrial Cancer In patients with advanced or recurrent dMMR endometrial cancer in the DUO-E study receiving IMFINZI in combination with carboplatin and paclitaxel followed by IMFINZI as a single-agent (n=44), the most common adverse reactions, including laboratory abnormalities (occurring in >20% of patients) were peripheral neuropathy (61%), musculoskeletal pain (59%), nausea (59%), alopecia (52%), fatigue (41%), abdominal pain (39%), constipation (39%), rash (39%), decreased magnesium (36%), increased ALT (32%), increased AST (30%), diarrhea (27%), vomiting (27%), cough (27%), decreased potassium (25%), dyspnea (25%), headache (23%), increased alkaline phosphatase (20%), and decreased appetite (18%). The most common Grade 3 or 4 adverse reactions (≥3%) were constipation (4.5%) and fatigue (4.5%). In patients with advanced or recurrent dMMR endometrial cancer in the DUO-E study receiving IMFINZI in combination with carboplatin and paclitaxel followed by IMFINZI as a single-agent (n=44), permanent discontinuation of IMFINZI due to adverse reactions occurred in 11% of patients. Serious adverse reactions occurred in 30% of patients who received IMFINZI with carboplatin and paclitaxel; the most common serious adverse reactions (≥4%) were constipation (4.5%) and rash (4.5%). The safety and effectiveness of IMFINZI and IMJUDO have not been established in pediatric patients. Indications: IMFINZI, as a single agent, is indicated for the treatment of adult patients with unresectable Stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy. IMFINZI in combination with platinum-containing chemotherapy as neoadjuvant treatment, followed by IMFINZI continued as a single agent as adjuvant treatment after surgery, is indicated for the treatment of adult patients with resectable (tumors ≥4 cm and/or node positive) NSCLC and no known epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements. IMFINZI, in combination with IMJUDO and platinum-based chemotherapy, is indicated for the treatment of adult patients with metastatic NSCLC with no sensitizing EGFR mutations or ALK genomic tumor aberrations. IMFINZI, in combination with etoposide and either carboplatin or cisplatin, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC). IMFINZI, in combination with gemcitabine and cisplatin, is indicated for the treatment of adult patients with locally advanced or metastatic biliary tract cancer (BTC). IMFINZI in combination with IMJUDO is indicated for the treatment of adult patients with unresectable hepatocellular carcinoma (uHCC). IMFINZI in combination with carboplatin and paclitaxel followed by IMFINZI as a single agent is indicated for the treatment of adult patients with primary advanced or recurrent endometrial cancer that is mismatch repair deficient (dMMR). Please see Full Prescribing Information including Medication Guide for IMFINZI and IMJUDO . IMPORTANT SAFETY INFORMATION FOR ENHERTU ® Indications: ENHERTU is a HER2-directed antibody and topoisomerase inhibitor conjugate indicated for the treatment of adult patients with: Unresectable or metastatic HER2-positive (IHC 3+ or ISH positive) breast cancer who have received a prior anti-HER2-based regimen either: – In the metastatic setting, or – In the neoadjuvant or adjuvant setting and have developed disease recurrence during or within six months of completing therapy Unresectable or metastatic HER2-low (IHC 1+ or IHC 2+/ISH-) breast cancer, as determined by an FDA-approved test, who have received a prior chemotherapy in the metastatic setting or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy Unresectable or metastatic non-small cell lung cancer (NSCLC) whose tumors have activating HER2 (ERBB2) mutations, as detected by an FDA-approved test, and who have received a prior systemic therapy This indication is approved under accelerated approval based on objective response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. Locally advanced or metastatic HER2-positive (IHC 3+ or IHC 2+/ISH positive) gastric or gastroesophageal junction (GEJ) adenocarcinoma who have received a prior trastuzumab-based regimen Unresectable or metastatic HER2-positive (IHC3+) solid tumors who have received prior systemic treatment and have no satisfactory alternative treatment options This indication is approved under accelerated approval based on objective response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. WARNING: INTERSTITIAL LUNG DISEASE and EMBRYO-FETAL TOXICITY Interstitial lung disease (ILD) and pneumonitis, including fatal cases, have been reported with ENHERTU. Monitor for and promptly investigate signs and symptoms including cough, dyspnea, fever, and other new or worsening respiratory symptoms. Permanently discontinue ENHERTU in all patients with Grade 2 or higher ILD/pneumonitis. Advise patients of the risk and to immediately report symptoms. Exposure to ENHERTU during pregnancy can cause embryo-fetal harm. Advise patients of these risks and the need for effective contraception. Contraindications None. Warnings and Precautions Interstitial Lung Disease / Pneumonitis Severe, life-threatening, or fatal interstitial lung disease (ILD), including pneumonitis, can occur in patients treated with ENHERTU. A higher incidence of Grade 1 and 2 ILD/pneumonitis has been observed in patients with moderate renal impairment. Advise patients to immediately report cough, dyspnea, fever, and/or any new or worsening respiratory symptoms. Monitor patients for signs and symptoms of ILD. Promptly investigate evidence of ILD. Evaluate patients with suspected ILD by radiographic imaging. Consider consultation with a pulmonologist. For asymptomatic ILD/pneumonitis (Grade 1), interrupt ENHERTU until resolved to Grade 0, then if resolved in ≤28 days from date of onset, maintain dose. If resolved in >28 days from date of onset, reduce dose one level. Consider corticosteroid treatment as soon as ILD/pneumonitis is suspected (e.g., ≥0.5 mg/kg/day prednisolone or equivalent). For symptomatic ILD/pneumonitis (Grade 2 or greater), permanently discontinue ENHERTU. Promptly initiate systemic corticosteroid treatment as soon as ILD/pneumonitis is suspected (e.g., ≥1 mg/kg/day prednisolone or equivalent) and continue for at least 14 days followed by gradual taper for at least 4 weeks. HER2-Positive or HER2-Low Metastatic Breast Cancer, HER2-Mutant NSCLC, and Solid Tumors (Including IHC 3+) (5.4 mg/kg) In patients with metastatic breast cancer, HER2-mutant NSCLC, and other solid tumors treated with ENHERTU 5.4 mg/kg, ILD occurred in 12% of patients. Median time to first onset was 5.5 months (range: 0.9 to 31.5). Fatal outcomes due to ILD and/or pneumonitis occurred in 1.0% of patients treated with ENHERTU. HER2-Positive Locally Advanced or Metastatic Gastric Cancer (6.4 mg/kg) In patients with locally advanced or metastatic HER2-positive gastric or GEJ adenocarcinoma treated with ENHERTU 6.4 mg/kg, ILD occurred in 10% of patients. Median time to first onset was 2.8 months (range: 1.2 to 21). Neutropenia Severe neutropenia, including febrile neutropenia, can occur in patients treated with ENHERTU. Monitor complete blood counts prior to initiation of ENHERTU and prior to each dose, and as clinically indicated. For Grade 3 neutropenia (Absolute Neutrophil Count [ANC] <1.0 to 0.5 x 10 9 /L), interrupt ENHERTU until resolved to Grade 2 or less, then maintain dose. For Grade 4 neutropenia (ANC <0.5 x 10 9 /L), interrupt ENHERTU until resolved to Grade 2 or less, then reduce dose by one level. For febrile neutropenia (ANC <1.0 x 10 9 /L and temperature >38.3º C or a sustained temperature of ≥38º C for more than 1 hour), interrupt ENHERTU until resolved, then reduce dose by one level. HER2-Positive or HER2-Low Metastatic Breast Cancer, HER2-Mutant NSCLC, and Solid Tumors (Including IHC 3+) (5.4 mg/kg) In patients with metastatic breast cancer, HER2-mutant NSCLC, and other solid tumors treated with ENHERTU 5.4 mg/kg, a decrease in neutrophil count was reported in 63% of patients. Seventeen percent had Grade 3 or 4 decreased neutrophil count. Median time to first onset of decreased neutrophil count was 22 days (range: 2 to 939). Febrile neutropenia was reported in 1% of patients. HER2-Positive Locally Advanced or Metastatic Gastric Cancer (6.4 mg/kg) In patients with locally advanced or metastatic HER2-positive gastric or GEJ adenocarcinoma treated with ENHERTU 6.4 mg/kg, a decrease in neutrophil count was reported in 72% of patients. Fifty-one percent had Grade 3 or 4 decreased neutrophil count. Median time to first onset of decreased neutrophil count was 16 days (range: 4 to 187). Febrile neutropenia was reported in 4.8% of patients. Left Ventricular Dysfunction Patients treated with ENHERTU may be at increased risk of developing left ventricular dysfunction. Left ventricular ejection fraction (LVEF) decrease has been observed with anti-HER2 therapies, including ENHERTU. Assess LVEF prior to initiation of ENHERTU and at regular intervals during treatment as clinically indicated. Manage LVEF decrease through treatment interruption. When LVEF is >45% and absolute decrease from baseline is 10-20%, continue treatment with ENHERTU. When LVEF is 40-45% and absolute decrease from baseline is <10%, continue treatment with ENHERTU and repeat LVEF assessment within 3 weeks. When LVEF is 40-45% and absolute decrease from baseline is 10-20%, interrupt ENHERTU and repeat LVEF assessment within 3 weeks. If LVEF has not recovered to within 10% from baseline, permanently discontinue ENHERTU. If LVEF recovers to within 10% from baseline, resume treatment with ENHERTU at the same dose. When LVEF is <40% or absolute decrease from baseline is >20%, interrupt ENHERTU and repeat LVEF assessment within 3 weeks. If LVEF of <40% or absolute decrease from baseline of >20% is confirmed, permanently discontinue ENHERTU. Permanently discontinue ENHERTU in patients with symptomatic congestive heart failure. Treatment with ENHERTU has not been studied in patients with a history of clinically significant cardiac disease or LVEF <50% prior to initiation of treatment. HER2-Positive or HER2-Low Metastatic Breast Cancer, HER2-Mutant NSCLC, and Solid Tumors (Including IHC 3+) (5.4 mg/kg) In patients with metastatic breast cancer, HER2-mutant NSCLC, and other solid tumors treated with ENHERTU 5.4 mg/kg, LVEF decrease was reported in 3.8% of patients, of which 0.6% were Grade 3. HER2-Positive Locally Advanced or Metastatic Gastric Cancer (6.4 mg/kg) In patients with locally advanced or metastatic HER2-positive gastric or GEJ adenocarcinoma treated with ENHERTU 6.4 mg/kg, no clinical adverse events of heart failure were reported; however, on echocardiography, 8% were found to have asymptomatic Grade 2 decrease in LVEF. Embryo-Fetal Toxicity ENHERTU can cause fetal harm when administered to a pregnant woman. Advise patients of the potential risks to a fetus. Verify the pregnancy status of females of reproductive potential prior to the initiation of ENHERTU. Advise females of reproductive potential to use effective contraception during treatment and for 7 months after the last dose of ENHERTU. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with ENHERTU and for 4 months after the last dose of ENHERTU. Additional Dose Modifications Thrombocytopenia For Grade 3 thrombocytopenia (platelets <50 to 25 x 10 9 /L) interrupt ENHERTU until resolved to Grade 1 or less, then maintain dose. For Grade 4 thrombocytopenia (platelets <25 x 10 9 /L) interrupt ENHERTU until resolved to Grade 1 or less, then reduce dose by one level. Adverse Reactions HER2-Positive and HER2-Low Metastatic Breast Cancer, HER2-Mutant NSCLC, and Solid Tumors (Including IHC 3+) (5.4 mg/kg) The pooled safety population reflects exposure to ENHERTU 5.4 mg/kg intravenously every 3 weeks in 1799 patients in Study DS8201-A-J101 (NCT02564900), DESTINY-Breast01, DESTINY-Breast02, DESTINY-Breast03, DESTINY-Breast04, DESTINY-Lung01, DESTINY-Lung02, DESTINY-CRC02, and DESTINY-PanTumor02. Among these patients, 65% were exposed for >6 months and 38% were exposed for >1 year. In this pooled safety population, the most common (≥20%) adverse reactions, including laboratory abnormalities, were nausea (73%), decreased white blood cell count (70%), decreased hemoglobin (66%), decreased neutrophil count (63%), decreased lymphocyte count (58%), fatigue (56%), decreased platelet count (48%), increased aspartate aminotransferase (47%), increased alanine aminotransferase (43%), vomiting (40%), increased blood alkaline phosphatase (38%), alopecia (34%), constipation (33%), decreased appetite (32%), decreased blood potassium (31%), diarrhea (29%), musculoskeletal pain (24%), and abdominal pain (20%). HER2-Positive Metastatic Breast Cancer DESTINY-Breast03 The safety of ENHERTU was evaluated in 257 patients with unresectable or metastatic HER2-positive breast cancer who received at least one dose of ENHERTU 5.4 mg/kg intravenously once every three weeks in DESTINY-Breast03. The median duration of treatment was 14 months (range: 0.7 to 30). Serious adverse reactions occurred in 19% of patients receiving ENHERTU. Serious adverse reactions in >1% of patients who received ENHERTU were vomiting, interstitial lung disease, pneumonia, pyrexia, and urinary tract infection. Fatalities due to adverse reactions occurred in 0.8% of patients including COVID-19 and sudden death (one patient each). ENHERTU was permanently discontinued in 14% of patients, of which ILD/pneumonitis accounted for 8%. Dose interruptions due to adverse reactions occurred in 44% of patients treated with ENHERTU. The most frequent adverse reactions (>2%) associated with dose interruption were neutropenia, leukopenia, anemia, thrombocytopenia, pneumonia, nausea, fatigue, and ILD/pneumonitis. Dose reductions occurred in 21% of patients treated with ENHERTU. The most frequent adverse reactions (>2%) associated with dose reduction were nausea, neutropenia, and fatigue. The most common (≥20%) adverse reactions, including laboratory abnormalities, were nausea (76%), decreased white blood cell count (74%), decreased neutrophil count (70%), increased aspartate aminotransferase (67%), decreased hemoglobin (64%), decreased lymphocyte count (55%), increased alanine aminotransferase (53%), decreased platelet count (52%), fatigue (49%), vomiting (49%), increased blood alkaline phosphatase (49%), alopecia (37%), decreased blood potassium (35%), constipation (34%), musculoskeletal pain (31%), diarrhea (29%), decreased appetite (29%), headache (22%), respiratory infection (22%), abdominal pain (21%), increased blood bilirubin (20%), and stomatitis (20%). HER2-Low Metastatic Breast Cancer DESTINY-Breast04 The safety of ENHERTU was evaluated in 371 patients with unresectable or metastatic HER2-low (IHC 1+ or IHC 2+/ISH-) breast cancer who received ENHERTU 5.4 mg/kg intravenously once every 3 weeks in DESTINY-Breast04. The median duration of treatment was 8 months (range: 0.2 to 33) for patients who received ENHERTU. Serious adverse reactions occurred in 28% of patients receiving ENHERTU. Serious adverse reactions in >1% of patients who received ENHERTU were ILD/pneumonitis, pneumonia, dyspnea, musculoskeletal pain, sepsis, anemia, febrile neutropenia, hypercalcemia, nausea, pyrexia, and vomiting. Fatalities due to adverse reactions occurred in 4% of patients including ILD/pneumonitis (3 patients); sepsis (2 patients); and ischemic colitis, disseminated intravascular coagulation, dyspnea, febrile neutropenia, general physical health deterioration, pleural effusion, and respiratory failure (1 patient each). ENHERTU was permanently discontinued in 16% of patients, of which ILD/pneumonitis accounted for 8%. Dose interruptions due to adverse reactions occurred in 39% of patients treated with ENHERTU. The most frequent adverse reactions (>2%) associated with dose interruption were neutropenia, fatigue, anemia, leukopenia, COVID-19, ILD/pneumonitis, increased transaminases, and hyperbilirubinemia. Dose reductions occurred in 23% of patients treated with ENHERTU. The most frequent adverse reactions (>2%) associated with dose reduction were fatigue, nausea, thrombocytopenia, and neutropenia. The most common (≥20%) adverse reactions, including laboratory abnormalities, were nausea (76%), decreased white blood cell count (70%), decreased hemoglobin (64%), decreased neutrophil count (64%), decreased lymphocyte count (55%), fatigue (54%), decreased platelet count (44%), alopecia (40%), vomiting (40%), increased aspartate aminotransferase (38%), increased alanine aminotransferase (36%), constipation (34%), increased blood alkaline phosphatase (34%), decreased appetite (32%), musculoskeletal pain (32%), diarrhea (27%), and decreased blood potassium (25%). HER2-Mutant Unresectable or Metastatic NSCLC (5.4 mg/kg) DESTINY-Lung02 evaluated two dose levels (5.4 mg/kg [n=101] and 6.4 mg/kg [n=50]); however, only the results for the recommended dose of 5.4 mg/kg intravenously every 3 weeks are described below due to increased toxicity observed with the higher dose in patients with NSCLC, including ILD/pneumonitis. The safety of ENHERTU was evaluated in 101 patients with HER2-mutant unresectable or metastatic NSCLC who received ENHERTU 5.4 mg/kg intravenously once every three weeks until disease progression or unacceptable toxicity in DESTINY‑Lung02. Nineteen percent of patients were exposed for >6 months. Serious adverse reactions occurred in 30% of patients receiving ENHERTU. Serious adverse reactions in >1% of patients who received ENHERTU were ILD/pneumonitis, thrombocytopenia, dyspnea, nausea, pleural effusion, and increased troponin I. Fatality occurred in 1 patient with suspected ILD/pneumonitis (1%). ENHERTU was permanently discontinued in 8% of patients. Adverse reactions which resulted in permanent discontinuation of ENHERTU were ILD/pneumonitis, diarrhea, decreased blood potassium, hypomagnesemia, myocarditis, and vomiting. Dose interruptions of ENHERTU due to adverse reactions occurred in 23% of patients. Adverse reactions which required dose interruption (>2%) included neutropenia and ILD/pneumonitis. Dose reductions due to an adverse reaction occurred in 11% of patients. The most common (≥20%) adverse reactions, including laboratory abnormalities, were nausea (61%), decreased white blood cell count (60%), decreased hemoglobin (58%), decreased neutrophil count (52%), decreased lymphocyte count (43%), decreased platelet count (40%), decreased albumin (39%), increased aspartate aminotransferase (35%), increased alanine aminotransferase (34%), fatigue (32%), constipation (31%), decreased appetite (30%), vomiting (26%), increased alkaline phosphatase (22%), and alopecia (21%). HER2-Positive Locally Advanced or Metastatic Gastric Cancer (6.4 mg/kg) The safety of ENHERTU was evaluated in 187 patients with locally advanced or metastatic HER2-positive gastric or GEJ adenocarcinoma in DESTINY-Gastric01. Patients intravenously received at least one dose of either ENHERTU (N=125) 6.4 mg/kg every 3 weeks or either irinotecan (N=55) 150 mg/m 2 biweekly or paclitaxel (N=7) 80 mg/m 2 weekly for 3 weeks. The median duration of treatment was 4.6 months (range: 0.7 to 22.3) for patients who received ENHERTU. Serious adverse reactions occurred in 44% of patients receiving ENHERTU 6.4 mg/kg. Serious adverse reactions in >2% of patients who received ENHERTU were decreased appetite, ILD, anemia, dehydration, pneumonia, cholestatic jaundice, pyrexia, and tumor hemorrhage. Fatalities due to adverse reactions occurred in 2.4% of patients: disseminated intravascular coagulation, large intestine perforation, and pneumonia occurred in one patient each (0.8%). ENHERTU was permanently discontinued in 15% of patients, of which ILD accounted for 6%. Dose interruptions due to adverse reactions occurred in 62% of patients treated with ENHERTU. The most frequent adverse reactions (>2%) associated with dose interruption were neutropenia, anemia, decreased appetite, leukopenia, fatigue, thrombocytopenia, ILD, pneumonia, lymphopenia, upper respiratory tract infection, diarrhea, and decreased blood potassium. Dose reductions occurred in 32% of patients treated with ENHERTU. The most frequent adverse reactions (>2%) associated with dose reduction were neutropenia, decreased appetite, fatigue, nausea, and febrile neutropenia. The most common (≥20%) adverse reactions, including laboratory abnormalities, were decreased hemoglobin (75%), decreased white blood cell count (74%), decreased neutrophil count (72%), decreased lymphocyte count (70%), decreased platelet count (68%), nausea (63%), decreased appetite (60%), increased aspartate aminotransferase (58%), fatigue (55%), increased blood alkaline phosphatase (54%), increased alanine aminotransferase (47%), diarrhea (32%), decreased blood potassium (30%), vomiting (26%), constipation (24%), increased blood bilirubin (24%), pyrexia (24%), and alopecia (22%). HER2-Positive (IHC3+) Unresectable or Metastatic Solid Tumors The safety of ENHERTU was evaluated in 347 adult patients with unresectable or metastatic HER2-positive (IHC3+) solid tumors who received ENHERTU 5.4 mg/kg intravenously once every 3 weeks in DESTINY-Breast01, DESTINY-PanTumor02, DESTINY-Lung01, and DESTINY-CRC02. The median duration of treatment was 8.3 months (range 0.7 to 30.2). Serious adverse reactions occurred in 34% of patients receiving ENHERTU. Serious adverse reactions in >1% of patients who received ENHERTU were sepsis, pneumonia, vomiting, urinary tract infection, abdominal pain, nausea, pneumonitis, pleural effusion, hemorrhage, COVID-19, fatigue, acute kidney injury, anemia, cellulitis, and dyspnea. Fatalities due to adverse reactions occurred in 6.3% of patients including ILD/pneumonitis (2.3%), cardiac arrest (0.6%), COVID-19 (0.6%), and sepsis (0.6%). The following events occurred in one patient each (0.3%): acute kidney injury, cerebrovascular accident, general physical health deterioration, pneumonia, and hemorrhagic shock. ENHERTU was permanently discontinued in 15% of patients, of which ILD/pneumonitis accounted for 10%. Dose interruptions due to adverse reactions occurred in 48% of patients. The most frequent adverse reactions (>2%) associated with dose interruption were decreased neutrophil count, anemia, COVID-19, fatigue, decreased white blood cell count, and ILD/pneumonitis. Dose reductions occurred in 27% of patients treated with ENHERTU. The most frequent adverse reactions (>2%) associated with dose reduction were fatigue, nausea, decreased neutrophil count, ILD/pneumonitis, and diarrhea. The most common (≥20%) adverse reactions, including laboratory abnormalities, were decreased white blood cell count (75%), nausea (69%), decreased hemoglobin (67%), decreased neutrophil count (66%), fatigue (59%), decreased lymphocyte count (58%), decreased platelet count (51%), increased aspartate aminotransferase (45%), increased alanine aminotransferase (44%), increased blood alkaline phosphatase (36%), vomiting (35%), decreased appetite (34%), alopecia (34%), diarrhea (31%), decreased blood potassium (29%), constipation (28%), decreased sodium (22%), stomatitis (20%), and upper respiratory tract infection (20%). Use in Specific Populations Pregnancy: ENHERTU can cause fetal harm when administered to a pregnant woman. Advise patients of the potential risks to a fetus. There are clinical considerations if ENHERTU is used in pregnant women, or if a patient becomes pregnant within 7 months after the last dose of ENHERTU. Lactation: There are no data regarding the presence of ENHERTU in human milk, the effects on the breastfed child, or the effects on milk production. Because of the potential for serious adverse reactions in a breastfed child, advise women not to breastfeed during treatment with ENHERTU and for 7 months after the last dose. Females and Males of Reproductive Potential: Pregnancy testing : Verify pregnancy status of females of reproductive potential prior to initiation of ENHERTU. Contraception : Females : ENHERTU can cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential to use effective contraception during treatment with ENHERTU and for 7 months after the last dose. Males : Advise male patients with female partners of reproductive potential to use effective contraception during treatment with ENHERTU and for 4 months after the last dose. Infertility : ENHERTU may impair male reproductive function and fertility. Pediatric Use: Safety and effectiveness of ENHERTU have not been established in pediatric patients. Geriatric Use: Of the 1287 patients with HER2-positive or HER2-low breast cancer treated with ENHERTU 5.4 mg/kg, 22% were ≥65 years and 3.8% were ≥75 years. No overall differences in efficacy within clinical studies were observed between patients ≥65 years of age compared to younger patients. There was a higher incidence of Grade 3-4 adverse reactions observed in patients aged ≥65 years (59%) as compared to younger patients (49%). Of the 101 patients with HER2-mutant unresectable or metastatic NSCLC treated with ENHERTU 5.4 mg/kg, 40% were ≥65 years and 8% were ≥75 years. No overall differences in efficacy or safety were observed between patients ≥65 years of age compared to younger patients. Of the 125 patients with HER2-positive locally advanced or metastatic gastric or GEJ adenocarcinoma treated with ENHERTU 6.4 mg/kg in DESTINY-Gastric01, 56% were ≥65 years and 14% were ≥75 years. No overall differences in efficacy or safety were observed between patients ≥65 years of age compared to younger patients. Of the 192 patients with HER2-positive (IHC 3+) unresectable or metastatic solid tumors treated with ENHERTU 5.4 mg/kg in DESTINY-PanTumor02, DESTINY-Lung01, or DESTINY-CRC02, 39% were 65 years or older and 9% were 75 years or older. No overall differences in efficacy or safety were observed between patients ≥65 years of age compared to younger patients. Renal Impairment: A higher incidence of Grade 1 and 2 ILD/pneumonitis has been observed in patients with moderate renal impairment. Monitor patients with moderate renal impairment more frequently. The recommended dosage of ENHERTU has not been established for patients with severe renal impairment (CLcr <30 mL/min). Hepatic Impairment: In patients with moderate hepatic impairment, due to potentially increased exposure, closely monitor for increased toxicities related to the topoisomerase inhibitor, DXd. The recommended dosage of ENHERTU has not been established for patients with severe hepatic impairment (total bilirubin >3 times ULN and any AST). To report SUSPECTED ADVERSE REACTIONS, contact Daiichi Sankyo, Inc. at 1-877-437-7763 or FDA at 1-800-FDA-1088 or fda.gov/medwatch. Please see accompanying full Prescribing Information , including Boxed WARNINGS, and Medication Guide . IMPORTANT SAFETY INFORMATION FOR TAGRISSO ® There are no contraindications for TAGRISSO ® (osimertinib). Interstitial lung disease (ILD)/pneumonitis occurred in 4% of the 1813 TAGRISSO-treated patients; 0.4% of cases were fatal. In the FLAURA2 study, ILD/pneumonitis occurred in 3.3% of the 276 patients who received TAGRISSO in combination with pemetrexed and platinum-based chemotherapy; 0.4% of cases were fatal. Withhold TAGRISSO and promptly investigate for ILD in patients who present with worsening of respiratory symptoms which may be indicative of ILD (eg, dyspnea, cough and fever). Permanently discontinue TAGRISSO if ILD/pneumonitis is confirmed Heart rate-corrected QT (QTc) interval prolongation occurs in TAGRISSO-treated patients. Of the 1813 TAGRISSO monotherapy-treated patients in clinical trials, 1.1% were found to have a QTc >500 msec, and 4.3% of patients had an increase from baseline QTc >60 msec. Of the 276 patients treated with TAGRISSO in combination with pemetrexed and platinum-based chemotherapy in the FLAURA2 study, 1.8% were found to have a QTc >500 msec, and 10.5% of patients had an increase from baseline QTc >60 msec. No QTc-related arrhythmias were reported. Conduct periodic monitoring with ECGs and electrolytes in patients with congenital long QTc syndrome, congestive heart failure, electrolyte abnormalities, or those who are taking medications known to prolong the QTc interval. Permanently discontinue TAGRISSO in patients who develop QTc interval prolongation with signs/symptoms of life-threatening arrhythmia Cardiomyopathy occurred in 3.8% of the 1813 TAGRISSO-treated patients; 0.1% of cardiomyopathy cases were fatal. In the FLAURA2 study, cardiomyopathy occurred in 9% of the 276 patients who received TAGRISSO in combination with pemetrexed and platinum-based chemotherapy; 1.1% of cardiomyopathy cases were fatal. A decline in left ventricular ejection fraction (LVEF) ≥10% from baseline and to <50% LVEF occurred in 4.2% of 1557 patients who had baseline and at least one follow-up LVEF assessment. In the ADAURA study, 1.5% (5/325) of TAGRISSO-treated patients experienced LVEF decreases ≥10% from baseline and a drop to <50%. In the FLAURA2 study, 8% (21/262) of patients treated with TAGRISSO in combination with pemetrexed and platinum-based chemotherapy, who had baseline and at least one follow-up LVEF assessment, experienced LVEF decreases ≥10% and a drop to less than 50%. For patients receiving TAGRISSO monotherapy, conduct cardiac monitoring in patients with cardiac risk factors, including assessment of LVEF at baseline and during treatment. For patients receiving TAGRISSO in combination with pemetrexed and platinum-based chemotherapy, conduct cardiac monitoring in all patients, including assessment of LVEF at baseline and during treatment. Assess LVEF in patients who develop relevant cardiac signs or symptoms during treatment. For symptomatic congestive heart failure, permanently discontinue TAGRISSO Keratitis was reported in 0.6% of 1813 patients treated with TAGRISSO monotherapy in clinical trials. Promptly refer patients with signs and symptoms suggestive of keratitis (such as eye inflammation, lacrimation, light sensitivity, blurred vision, eye pain and/or red eye) to an ophthalmologist Postmarketing cases consistent with erythema multiforme major (EMM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in patients receiving TAGRISSO. Withhold TAGRISSO if EMM, SJS, or TEN is suspected and permanently discontinue if confirmed Postmarketing cases of cutaneous vasculitis including leukocytoclastic vasculitis, urticarial vasculitis, and IgA vasculitis have been reported in patients receiving TAGRISSO. Withhold TAGRISSO if cutaneous vasculitis is suspected, evaluate for systemic involvement, and consider dermatology consultation. If no other etiology can be identified, consider permanent discontinuation of TAGRISSO based on severity Aplastic anemia has been reported in patients treated with TAGRISSO in clinical trials (0.06% of 1813) and postmarketing. Some cases had a fatal outcome. Inform patients of the signs and symptoms of aplastic anemia including but not limited to, new or persistent fevers, bruising, bleeding, and pallor. If aplastic anemia is suspected, withhold TAGRISSO and obtain a hematology consultation. If aplastic anemia is confirmed, permanently discontinue TAGRISSO. Perform complete blood count with differential before starting TAGRISSO, periodically throughout treatment, and more frequently if indicated Verify pregnancy status of females of reproductive potential prior to initiating TAGRISSO. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with TAGRISSO and for 6 weeks after the final dose. Advise males with female partners of reproductive potential to use effective contraception for 4 months after the final dose Because of the potential for serious adverse reactions in breastfed infants from TAGRISSO, women should not breastfeed during treatment with TAGRISSO and for 2 weeks after the final dose Most common (≥20%) adverse reactions, including laboratory abnormalities, were: TAGRISSO monotherapy: leukopenia, lymphopenia, thrombocytopenia, anemia, diarrhea, rash, musculoskeletal pain, neutropenia, nail toxicity, dry skin, stomatitis, and fatigue TAGRISSO in combination with pemetrexed and platinum-based chemotherapy: leukopenia, thrombocytopenia, neutropenia, lymphopenia, rash, diarrhea, stomatitis, nail toxicity, dry skin, and increased blood creatinine Indications: TAGRISSO is indicated as adjuvant therapy after tumor resection in adult patients with non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test TAGRISSO is indicated for the first-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test TAGRISSO is indicated in combination with pemetrexed and platinum-based chemotherapy, for the first-line treatment of adult patients with locally advanced or metastatic NSCLC whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test TAGRISSO is indicated for the treatment of adult patients with metastatic epidermal growth factor receptor (EGFR) T790M mutation-positive NSCLC, as detected by an FDA-approved test, whose disease has progressed on or after EGFR tyrosine kinase inhibitor (TKI) therapy Please see complete Prescribing Information , including Patient Information for TAGRISSO. IMPORTANT SAFETY INFORMATION FOR LYNPARZA® (olaparib) CONTRAINDICATIONS There are no contraindications for LYNPARZA. WARNINGS AND PRECAUTIONS Myelodysplastic Syndrome/Acute Myeloid Leukemia (MDS/AML): Occurred in approximately 1.2% of patients with various BRCA m, g BRCA m, HRR gene-mutated or HRD-positive cancers who received LYNPARZA as a single agent or as part of a combination regimen, consistent with the approved indications, and the majority of events had a fatal outcome. The median duration of therapy in patients who developed MDS/AML was approximately 2 years (range: <6 months to >4 years). All of these patients had previous chemotherapy with platinum agents and/or other DNA-damaging agents, including radiotherapy. In SOLO-1, patients with newly diagnosed advanced BRCA m ovarian cancer, the incidence of MDS/AML was 1.9% (5/260) in patients who received LYNPARZA and 0.8% (1/130) in patients who received placebo based on an updated analysis. In PAOLA-1, of patients with newly diagnosed advanced ovarian cancer with HRD-positive status, the incidence of MDS/AML was 1.6% (4/255) in patients who received LYNPARZA and 2.3% (3/131) in the control arm. In SOLO-2, patients with BRCA m platinum-sensitive relapsed ovarian cancer, the incidence of MDS/AML was 8% (15/195) in patients who received LYNPARZA and 4% (4/99) in patients who received placebo. The duration of LYNPARZA treatment prior to the diagnosis of MDS/AML ranged from 0.6 years to 4.5 years. Do not start LYNPARZA until patients have recovered from hematological toxicity caused by previous chemotherapy (≤Grade 1). Monitor complete blood count for cytopenia at baseline and monthly thereafter for clinically significant changes during treatment. For prolonged hematological toxicities, interrupt LYNPARZA and monitor blood count weekly until recovery. If the levels have not recovered to Grade 1 or less after 4 weeks, refer the patient to a hematologist for further investigations, including bone marrow analysis and blood sample for cytogenetics. Discontinue LYNPARZA if MDS/AML is confirmed. Pneumonitis: Occurred in 0.8% of patients exposed to LYNPARZA monotherapy, and some cases were fatal. If patients present with new or worsening respiratory symptoms such as dyspnea, cough, and fever, or a radiological abnormality occurs, interrupt LYNPARZA treatment and initiate prompt investigation. Discontinue LYNPARZA if pneumonitis is confirmed and treat patient appropriately. Venous Thromboembolism (VTE): Including severe or fatal pulmonary embolism (PE) occurred in patients treated with LYNPARZA. In the combined data of two randomized, placebo-controlled clinical studies (PROfound and PROpel) in patients with metastatic castration-resistant prostate cancer (N=1180), VTE occurred in 8% of patients who received LYNPARZA, including pulmonary embolism in 6%. In the control arms, VTE occurred in 2.5%, including pulmonary embolism in 1.5%. Monitor patients for signs and symptoms of venous thrombosis and pulmonary embolism, and treat as medically appropriate, which may include long-term anticoagulation as clinically indicated. Embryo-Fetal Toxicity: Based on its mechanism of action and findings in animals, LYNPARZA can cause fetal harm. Verify pregnancy status in females of reproductive potential prior to initiating treatment. Females Advise females of reproductive potential of the potential risk to a fetus and to use effective contraception during treatment and for 6 months following the last dose. Males Advise male patients with female partners of reproductive potential or who are pregnant to use effective contraception during treatment and for 3 months following the last dose of LYNPARZA and to not donate sperm during this time. ADVERSE REACTIONS—First-Line Maintenance BRCA m Advanced Ovarian Cancer Most common adverse reactions (Grades 1-4) in ≥10% of patients who received LYNPARZA in the first-line maintenance setting for SOLO-1 were: nausea (77%), fatigue (67%), abdominal pain (45%), vomiting (40%), anemia (38%), diarrhea (37%), constipation (28%), upper respiratory tract infection/influenza/nasopharyngitis/bronchitis (28%), dysgeusia (26%), decreased appetite (20%), dizziness (20%), neutropenia (17%), dyspepsia (17%), dyspnea (15%), leukopenia (13%), urinary tract infection (13%), thrombocytopenia (11%), and stomatitis (11%). Most common laboratory abnormalities (Grades 1-4) in ≥25% of patients who received LYNPARZA in the first-line maintenance setting for SOLO-1 were: decrease in hemoglobin (87%), increase in mean corpuscular volume (87%), decrease in leukocytes (70%), decrease in lymphocytes (67%), decrease in absolute neutrophil count (51%), decrease in platelets (35%), and increase in serum creatinine (34%). ADVERSE REACTIONS—First-Line Maintenance Advanced Ovarian Cancer in Combination with Bevacizumab Most common adverse reactions (Grades 1-4) in ≥10% of patients treated with LYNPARZA/bevacizumab and at a ≥5% frequency compared to placebo/bevacizumab in the first-line maintenance setting for PAOLA-1 were: nausea (53%), fatigue (including asthenia) (53%), anemia (41%), lymphopenia (24%), vomiting (22%), and leukopenia (18%). In addition, the most common adverse reactions (≥10%) for patients receiving LYNPARZA/bevacizumab irrespective of the frequency compared with the placebo/bevacizumab arm were: diarrhea (18%), neutropenia (18%), urinary tract infection (15%), and headache (14%). In addition, venous thromboembolism occurred more commonly in patients receiving LYNPARZA/bevacizumab (5%) than in those receiving placebo/bevacizumab (1.9%). Most common laboratory abnormalities (Grades 1-4) in ≥25% of patients for LYNPARZA in combination with bevacizumab in the first-line maintenance setting for PAOLA-1 were: decrease in hemoglobin (79%), decrease in lymphocytes (63%), increase in serum creatinine (61%), decrease in leukocytes (59%), decrease in absolute neutrophil count (35%), and decrease in platelets (35%). ADVERSE REACTIONS—Maintenance g BRCA m Recurrent Ovarian Cancer Most common adverse reactions (Grades 1-4) in ≥20% of patients who received LYNPARZA in the maintenance setting for SOLO-2 were: nausea (76%), fatigue (including asthenia) (66%), anemia (44%), vomiting (37%), nasopharyngitis/upper respiratory tract infection (URI)/influenza (36%), diarrhea (33%), arthralgia/myalgia (30%), dysgeusia (27%), headache (26%), decreased appetite (22%), and stomatitis (20%). Most common laboratory abnormalities (Grades 1-4) in ≥25% of patients who received LYNPARZA in the maintenance setting for SOLO-2 were: increase in mean corpuscular volume (89%), decrease in hemoglobin (83%), decrease in leukocytes (69%), decrease in lymphocytes (67%), decrease in absolute neutrophil count (51%), increase in serum creatinine (44%), and decrease in platelets (42%). ADVERSE REACTIONS—Adjuvant Treatment of g BRCA m, HER2-Negative, High-Risk Early Breast Cancer Most common adverse reactions (Grades 1-4) in ≥10% of patients who received LYNPARZA in the adjuvant setting for OlympiA were: nausea (57%), fatigue (including asthenia) (42%), anemia (24%), vomiting (23%), headache (20%), diarrhea (18%), leukopenia (17%), neutropenia (16%), decreased appetite (13%), dysgeusia (12%), dizziness (11%), and stomatitis (10%). Most common laboratory abnormalities (Grades 1-4) in ≥25% of patients who received LYNPARZA in the adjuvant setting for OlympiA were: decrease in lymphocytes (77%), increase in mean corpuscular volume (67%), decrease in hemoglobin (65%), decrease in leukocytes (64%), and decrease in absolute neutrophil count (39%). ADVERSE REACTIONS—g BRCA m, HER2-Negative Metastatic Breast Cancer Most common adverse reactions (Grades 1-4) in ≥20% of patients who received LYNPARZA in the metastatic setting for OlympiAD were: nausea (58%), anemia (40%), fatigue (including asthenia) (37%), vomiting (30%), neutropenia (27%), respiratory tract infection (27%), leukopenia (25%), diarrhea (21%), and headache (20%). Most common laboratory abnormalities (Grades 1-4) in ≥25% of patients who received LYNPARZA in the metastatic setting for OlympiAD were: decrease in hemoglobin (82%), decrease in lymphocytes (73%), decrease in leukocytes (71%), increase in mean corpuscular volume (71%), decrease in absolute neutrophil count (46%), and decrease in platelets (33%). ADVERSE REACTIONS—First-Line Maintenance g BRCA m Metastatic Pancreatic Adenocarcinoma Most common adverse reactions (Grades 1-4) in ≥10% of patients who received LYNPARZA in the first-line maintenance setting for POLO were: fatigue (60%), nausea (45%), abdominal pain (34%), diarrhea (29%), anemia (27%), decreased appetite (25%), constipation (23%), vomiting (20%), back pain (19%), arthralgia (15%), rash (15%), thrombocytopenia (14%), dyspnea (13%), neutropenia (12%), nasopharyngitis (12%), dysgeusia (11%), and stomatitis (10%). Most common laboratory abnormalities (Grades 1-4) in ≥25% of patients who received LYNPARZA in the first-line maintenance setting for POLO were: increase in serum creatinine (99%), decrease in hemoglobin (86%), increase in mean corpuscular volume (71%), decrease in lymphocytes (61%), decrease in platelets (56%), decrease in leukocytes (50%), and decrease in absolute neutrophil count (25%). ADVERSE REACTIONS—HRR Gene-mutated Metastatic Castration-Resistant Prostate Cancer Most common adverse reactions (Grades 1-4) in ≥10% of patients who received LYNPARZA for PROfound were: anemia (46%), fatigue (including asthenia) (41%), nausea (41%), decreased appetite (30%), diarrhea (21%), vomiting (18%), thrombocytopenia (12%), cough (11%), and dyspnea (10%). Most common laboratory abnormalities (Grades 1-4) in ≥25% of patients who received LYNPARZA for PROfound were: decrease in hemoglobin (98%), decrease in lymphocytes (62%), decrease in leukocytes (53%), and decrease in absolute neutrophil count (34%). ADVERSE REACTIONS—Metastatic Castration-Resistant Prostate Cancer in Combination with Abiraterone and Prednisone or Prednisolone Most common adverse reactions (Grades 1-4) in ≥10% of patients who received LYNPARZA/abiraterone with a difference of ≥5% compared to placebo for PROpel were: anemia (48%), fatigue (including asthenia) (38%), nausea (30%), diarrhea (19%), decreased appetite (16%), lymphopenia (14%), dizziness (14%), and abdominal pain (13%). Most common laboratory abnormalities (Grades 1-4) in ≥20% of patients who received LYNPARZA/abiraterone for PROpel were: decrease in hemoglobin (97%), decrease in lymphocytes (70%), decrease in platelets (23%), and decrease in absolute neutrophil count (23%). DRUG INTERACTIONS Anticancer Agents: Clinical studies of LYNPARZA with other myelosuppressive anticancer agents, including DNA-damaging agents, indicate a potentiation and prolongation of myelosuppressive toxicity. CYP3A Inhibitors: Avoid coadministration of strong or moderate CYP3A inhibitors when using LYNPARZA. If a strong or moderate CYP3A inhibitor must be coadministered, reduce the dose of LYNPARZA. Advise patients to avoid grapefruit, grapefruit juice, Seville oranges, and Seville orange juice during LYNPARZA treatment. CYP3A Inducers: Avoid coadministration of strong or moderate CYP3A inducers when using LYNPARZA. USE IN SPECIFIC POPULATIONS Lactation: No data are available regarding the presence of olaparib in human milk, its effects on the breastfed infant or on milk production. Because of the potential for serious adverse reactions in the breastfed infant, advise a lactating woman not to breastfeed during treatment with LYNPARZA and for 1 month after receiving the final dose. Pediatric Use: The safety and efficacy of LYNPARZA have not been established in pediatric patients. Hepatic Impairment: No adjustment to the starting dose is required in patients with mild or moderate hepatic impairment (Child-Pugh classification A and B). There are no data in patients with severe hepatic impairment (Child-Pugh classification C). Renal Impairment: No dosage modification is recommended in patients with mild renal impairment (CLcr 51-80 mL/min estimated by Cockcroft-Gault). In patients with moderate renal impairment (CLcr 31-50 mL/min), reduce the dose of LYNPARZA to 200 mg twice daily. There are no data in patients with severe renal impairment or end-stage renal disease (CLcr ≤30 mL/min). INDICATIONS LYNPARZA is a poly (ADP-ribose) polymerase (PARP) inhibitor indicated: First-Line Maintenance BRCA m Advanced Ovarian Cancer For the maintenance treatment of adult patients with deleterious or suspected deleterious germline or somatic BRCA -mutated (g BRCA m or s BRCA m) advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to first-line platinum-based chemotherapy. Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. First-Line Maintenance HRD-Positive Advanced Ovarian Cancer in Combination with Bevacizumab In combination with bevacizumab for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube or primary peritoneal cancer who are in complete or partial response to first-line platinum-based chemotherapy and whose cancer is associated with homologous recombination deficiency (HRD)-positive status defined by either: a deleterious or suspected deleterious BRCA mutation, and/or genomic instability Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. Maintenance BRCA -mutated Recurrent Ovarian Cancer For the maintenance treatment of adult patients with deleterious or suspected deleterious germline or somatic BRCA -mutated (g BRCA m or s BRCA m) recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer, who are in complete or partial response to platinum-based chemotherapy. Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. Adjuvant Treatment of g BRCA m, HER2-Negative, High-Risk Early Breast Cancer For the adjuvant treatment of adult patients with deleterious or suspected deleterious g BRCA m, human epidermal growth factor receptor 2 (HER2)-negative, high-risk early breast cancer who have been treated with neoadjuvant or adjuvant chemotherapy. Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. g BRCA m, HER2-Negative Metastatic Breast Cancer For the treatment of adult patients with deleterious or suspected deleterious g BRCA m, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer who have been treated with chemotherapy in the neoadjuvant, adjuvant, or metastatic setting. Patients with hormone receptor (HR)-positive breast cancer should have been treated with a prior endocrine therapy or be considered inappropriate for endocrine therapy. Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. First-Line Maintenance g BRCA m Metastatic Pancreatic Cancer For the maintenance treatment of adult patients with deleterious or suspected deleterious g BRCA m metastatic pancreatic adenocarcinoma whose disease has not progressed on at least 16 weeks of a first-line platinum-based chemotherapy regimen. Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. HRR Gene-mutated Metastatic Castration-Resistant Prostate Cancer For the treatment of adult patients with deleterious or suspected deleterious germline or somatic homologous recombination repair (HRR) gene-mutated metastatic castration-resistant prostate cancer (mCRPC) who have progressed following prior treatment with enzalutamide or abiraterone. Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. BRCA m Metastatic Castration-Resistant Prostate Cancer in Combination with Abiraterone and Prednisone or Prednisolone In combination with abiraterone and prednisone or prednisolone (abi/pred) for the treatment of adult patients with deleterious or suspected deleterious BRCA -mutated ( BRCA m) metastatic castration-resistant prostate cancer (mCRPC). Select patients for therapy based on an FDA-approved companion diagnostic for LYNPARZA. Please see complete Prescribing Information , including Medication Guide . Notes AstraZeneca in oncology AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all its complexities to discover, develop and deliver life-changing medicines to patients. The Company’s focus is on some of the most challenging cancers. It is through persistent innovation that AstraZeneca has built one of the most diverse portfolios and pipelines in the industry, with the potential to catalyze changes in the practice of medicine and transform the patient experience. AstraZeneca has the vision to redefine cancer care and, one day, eliminate cancer as a cause of death. About AstraZeneca AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines in Oncology, Rare Diseases and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 125 countries, and its innovative medicines are used by millions of patients worldwide. For more information, please visit www.astrazeneca-us.com and follow us on social media @AstraZeneca. US-93392 Last Updated 9/24

临床结果临床3期临床1期免疫疗法临床2期

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适应症	最高研发状态	国家/地区	公司	日期
局部晚期头颈部鳞状细胞癌	临床3期	美国	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	日本	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	奥地利	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	比利时	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	巴西	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	加拿大	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	法国	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	德国	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	匈牙利	AstraZeneca PLC	2023-12-14
局部晚期头颈部鳞状细胞癌	临床3期	印度	AstraZeneca PLC	2023-12-14

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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


NCT03530397 (ESMO2022) 人工标引	临床1/2期	非鳞状非小细胞肺癌一线 PD-L1	91	MEDI5752+chemotherapy (R cohort)	夢觸範艱鬱獵餘願鏇襯(憲繭製顧獵選壓觸築膚) = 鏇鹹糧淵願壓膚淵範積繭構壓選鑰襯範艱廠願 (膚鏇鹽選築網醖淵窪壓, 27.2 ~ 72.8) 更多	积极	2022-09-11
				Pembrolizumab+chemotherapy (R cohort)	夢觸範艱鬱獵餘願鏇襯(憲繭製顧獵選壓觸築膚) = 範觸蓋積糧壓積膚衊窪繭構壓選鑰襯範艱廠願 (膚鏇鹽選築網醖淵窪壓, 25.7 ~ 70.2) 更多
NCT03530397 (AACR2022)	临床1期	HR阳性/HER2低表达实体瘤	86	MEDI5752	衊醖衊憲蓋鹹範鹽繭糧(餘鏇範積觸簾糧鹽獵遞) = 憲糧鏇鹹製構艱鑰鹹獵鏇鏇繭鏇鑰製顧繭齋遞 (獵糧獵齋範餘構夢築壓 ) 更多	-	2022-06-15
NCT03530397 (ASCO2022) 人工标引	临床1期	晚期肾细胞癌一线	46	MEDI 5752 (escalation)	獵艱簾蓋網淵壓築衊壓(積鏇糧壓製鹽糧夢窪遞) = 壓繭鹽顧窪鹽艱範觸艱膚簾糧遞餘艱衊選製憲 (簾鹹願齋積願艱繭鏇選, 16.3 ~ 61.6) 更多	积极	2022-06-02
				MEDI 5752 (expansion total)	獵艱簾蓋網淵壓築衊壓(積鏇糧壓製鹽糧夢窪遞) = 鏇膚獵簾廠範衊鏇構簾膚簾糧遞餘艱衊選製憲 (簾鹹願齋積願艱繭鏇選, 20.2 ~ 59.4) 更多