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徐卫教授:泽布替尼在复发/难治CLL中疗效及安全性均优,有望成为“Best in-class”BTK抑制剂

2019-06-27 佚名 肿瘤资讯

2019年6月18日~22日,第15届国际淋巴瘤大会(ICML)在风光旖旎的瑞士·卢加诺(Lugano)隆重举行。目前ICML已成为全球淋巴瘤领域最具影响力的盛会,数千名来自世界各地的淋巴瘤领域专家参加了这次学术盛会。泽布替尼(zanubrutinib)是一种选择性不可逆BTK抑制剂,既往研究已证实可有效抑制BTK,对其他激酶的脱靶抑制作用很小。本次ICML期间,来自江苏省人民医院的徐卫教授受邀针

2019年6月18日~22日,第15届国际淋巴瘤大会(ICML)在风光旖旎的瑞士·卢加诺(Lugano)隆重举行。目前ICML已成为全球淋巴瘤领域最具影响力的盛会,数千名来自世界各地的淋巴瘤领域专家参加了这次学术盛会。泽布替尼(zanubrutinib)是一种选择性不可逆BTK抑制剂,既往研究已证实可有效抑制BTK,对其他激酶的脱靶抑制作用很小。本次ICML期间,来自江苏省人民医院的徐卫教授受邀针对泽布替尼治疗复发/难治慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(R/R CLL/SLL)的BGB-3111-205研究进行了口头发言。

BGB-3111 205研究:泽布替尼在CLL/SLL患者中疗效及安全性均优

BGB-3111-205是一项多中心、开放标签、单臂II期临床研究,共纳入91例R/R-CLL/SLL患者(82例为CLL,9例为SLL),均接受泽布替尼单药治疗,研究的主要终点为IRC判断的总体有效率(ORR),而次要终点为研究者评估的ORR。

截至2018年12月14日,75例患者仍在接受泽布替尼治疗,16例患者退出治疗(7例因疾病进展,8例因毒副反应,1例患者自己撤除同意书退出研究)。经过中位15个月的泽布替尼治疗,研究结果显示:①IRC判断的ORR为84%, 其中部分缓解率(PR)以上的CLL/SLL患者达62%;②中位起效时间为2.7个月,达到≥PR疗效的中位时间为5.5个月;③研究者评估的ORR高达91%,这与IRC判断的ORR结果高度一致;④经过13个月随访,中位无进展生存(PFS)尚未达到,12月PFS率为87%。安全性方面,泽布替尼的不良反应(AEs)发生率较低,较之其他BTK抑制剂具有优势。本研究中,泽布替尼的最常见AEs为血细胞减少症,但需要指出,本研究采用CTCAE标准进行AEs评估,而基于该标准,很多CLL/SLL患者在入组时便已出现血细胞减少。此外,本研究中无任何CLL/SLL患者出现房颤,这显示了泽布替尼的安全性优势。

优化的药物结构造就良好的疗效及安全性

目前,泽布替尼主要针对于R/R-CLL/SLL患者的治疗,具有两大主要特点:①相较于其他BTK抑制剂,泽布替尼在外周血及淋巴结当中具有更高的BTK占有率,并且BTK占有的持续时间很长,该优势在很大程度上保证了泽布替尼的良好疗效;②泽布替尼对于BTK具有高度的选择性,因此与一代BTK抑制剂相比,泽布替尼因脱靶导致的AEs发生率很低,保证了安全性。接下来,在R/R CLL/SLL患者中,泽布替尼将继续进行III期临床研究、与伊布替尼的头对头研究等。此外,泽布替尼还将开展前瞻性、随机对照研究,以探讨在CLL/SLL一线治疗中的价值。

泽布替尼向NMPA递交获批申请,期待惠及更多患者

基于BGB-3111-205研究的结果,百济神州目前已经向国家药品监督管理局(NMPA)递交了泽布替尼的获批申请,以用于R/R CLL/SLL患者的治疗。除了具有良好的疗效,泽布替尼良好的安全性对高龄CLL/SLL患者也是显着的临床优势之一,可惠及更多的CLL/SLL患者。

深耕细作,力求探索出更优化的治疗方案

目前,泽布替尼有两项前瞻性、随机对照研究正在开展,分别为BGB-3111-305和BGB-3111-304研究。其中,BGB-3111-305研究将泽布替尼与伊布替尼进行头对头比较,以评估两种BTK抑制剂对R/R CLL/SLL患者的疗效差异。BGB-3111-304研究则是在初治CLL/SLL患者中将泽布替尼与伊布替尼进行了疗效比较。这体现了泽布替尼在CLL/SLL患者治疗中的地位。

需要指出的是,现有的研究显示,由于泽布替尼具有高度的BTK选择性、脱靶率低,因此作用于ITK等靶点的可能性很小。这一特点可能意味着泽布替尼与CD20单抗联合治疗时,对CD20单抗的干扰性小,进而可能会产生更好的疗效,这也是泽布替尼未来的研究方向之一。

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    2020-04-11 jklm09
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    2019-06-29 fengting7
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    2019-06-27 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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