FUTURE Platform Trial - A Phase II Platform Trial of Futibatinib in Combination With (Chemo)Immunotherapy in Colorectal Cancer and Other Solid Tumor Entities

The FUTURE trial is a prospective, multicentre, exploratory, open-label phase II platform trial. Its goal is to evaluate the efficacy, feasibility and safety of futibatinib combined with immunotherapeutic, targeted or chemotherapeutic agents in colorectal and other solid tumors and to additionally identify biomarkers that correlate with clinical outcome.

开始日期2025-03-01

申办/合作机构

Institut fr Klinische Krebsforschung IKF GmbH

NCT06263153

/ Recruiting临床2期IIT

A Phase II Trial of Futibatinib in Combination with Durvalumab (MEDI4736) Administered to Cisplatin-Ineligible Patients with Muscle-Invasive Bladder Cancer Before Cystectomy

This phase II trial tests how well the combination of futibatinib and durvalumab given before cystectomy works in treating patients with muscle-invasive bladder cancer (MIBC) who are ineligible for cisplatin-based therapy. Cisplatin-based therapy is the standard of care for patients with MIBC. However, many patients cannot receive standard therapy due to poor renal function, peripheral neuropathy, poor functional status, or clinically significant heart failure. Futibatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Durvalumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. Radical cystectomy is a surgery to remove all of the bladder as well as nearby tissues and organs. Giving futibatinib in combination with durvalumab before surgery may be an effective treatment option for patients with MIBC who are ineligible for cisplatin-based therapy.

开始日期2024-12-30

申办/合作机构

Ohio State University Comprehensive Cancer Center

[+1]

NCT06506955

/ Enrolling by invitation临床2/3期

An Open-label, Rollover Study of Futibatinib in Patients Previously Enrolled in an Antecedent Futibatinib Study

This is a nonrandomized, open-label, multicenter rollover study for patients who received futibatinib as monotherapy or as combination therapy in a Taiho-sponsored futibatinib study.

开始日期2024-10-01

申办/合作机构

Taiho Oncology, Inc.

100 项与福巴替尼相关的临床结果

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100 项与福巴替尼相关的转化医学

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100 项与福巴替尼相关的专利（医药）

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项与福巴替尼相关的文献（医药）

2024-12-01·ANNALS OF ONCOLOGY

Genomic correlates of response and resistance to the irreversible FGFR1-4 inhibitor futibatinib based on biopsy and circulating tumor DNA profiling

Article

作者: Bridgewater, J A ; Meric-Bernstam, F ; Okamura, S ; Silhavy, J L ; Hollebecque, A ; Kano, A ; Halim, A ; DiToro, D ; Shimura, M ; Wacheck, V ; Goyal, L

BACKGROUND:

Futibatinib is the only covalent inhibitor of FGFR1-4 to gain regulatory approval in oncology. Here, we present genomic analyses of tissue biopsies and circulating tumor DNA (ctDNA) from patients with one of nearly 20 tumor types treated with futibatinib in the phase I/II FOENIX study.

PATIENTS AND METHODS:

Eligible patients included those with ctDNA samples collected per protocol at baseline and/or progression on futibatinib in the phase Ib portion of the study for FGF/FGFR-altered advanced solid tumors or the phase II portion of the study for FGFR2 fusion/rearrangement-positive cholangiocarcinoma. Assessments included analytical concordance between tumor and ctDNA analyses for detection of FGFR alterations, association of ctDNA-detected co-occurring genomic alterations with response to futibatinib, and determination of patterns of acquired resistance following progression on futibatinib.

RESULTS:

Among 300 patients treated with futibatinib, 226 were eligible for this analysis, including 139 (62%) with cholangiocarcinoma. Among patients with known FGFR2 fusions/rearrangements, FGFR1 fusions, FGFR3 fusions, or FGFR2 amplifications per tissue analysis, detection rates in ctDNA for these aberrations were 84%, 0%, 11%, and 59%, respectively. Objective response rates on futibatinib were not significantly different between patients with TP53 altered versus unaltered solid tumors; progression-free survival was reduced in patients with CDKN2B altered versus unaltered cholangiocarcinoma (median, 4.8 versus 11.0 months; P=0.03). Acquired resistance to futibatinib was frequently polyclonal and driven by an array of mutations within the relevant FGFR kinase domain, predominantly V565L, V565F, and N550K variants.

CONCLUSIONS:

In this largest and most systematic analysis of acquired resistance to an FGFR inhibitor from prospective clinical trials, emergence of secondary FGFR2 kinase domain mutations was observed in most patients receiving clinical benefit to futibatinib. ctDNA analysis shows clinically relevant potential as a noninvasive method for assessing genomic profiles, identifying patients who may benefit from FGFR inhibitor treatment, and exploring acquired resistance mechanisms.

2024-12-01·EXPERT OPINION ON INVESTIGATIONAL DRUGS

Fibroblast growth factor therapies in biliary tract cancers: current and future state

Review

作者: Siripoon, Teerada ; Mahipal, Amit ; Jin, Zhaohui ; O’Donnell, Conor

INTRODUCTION:

Cholangiocarcinoma is the rare and aggressive tumor with poor prognosis and limited therapeutic options. Recently, there have been promising developments in molecular targeted therapies for patients following the progression of first-line chemotherapy and immunotherapy combinations. Dysregulation of fibroblast Growth Factor Receptor (FGFR) signaling is significantly associated with tumorigenesis of intrahepatic cholangiocarcinoma and has been identified as a targetable alteration. This was possible through the discovery of crucial insights into the biochemical mechanisms and pathophysiology of the FGFR pathway.

AREAS COVERED:

This review summarizes the current state of FGFR targeted therapies, mechanisms of resistance, and future directions for FGFR-targeted therapies in patients with cholangiocarcinoma.

EXPERT OPINION:

Currently, pemigatinib and futibatinib are FDA approved FGFR-targeted therapies that have demonstrated remarkable responses. However, there is still a significant proportion of patients whose disease remains intrinsically resistant to treatment and most patients eventually develop secondary resistance after an initial response. Additionally, unique side effects of FGFR inhibitors may limit their efficacy in clinical practice and can have detrimental effects on quality of life. Several novel FGFR inhibitors are currently being investigated to overcome resistance mechanisms and reduce toxicities.

2024-11-16·Future Oncology

Plain language summary of the FOENIX-CCA2 study: futibatinib for people with advanced bile duct cancer

Article

作者: Furuse, Junji ; Moehler, Markus ; Benhadji, Karim A ; Goyal, Lipika ; Meric-Bernstam, Funda ; Halim, Abdel-Baset ; Abrams, Thomas A ; Cassier, Philippe A ; Bridgewater, John A ; Komatsu, Yoshito ; Morizane, Chigusa ; Oh, Do-Youn ; Chang, Heung-Moon ; Klümpen, Heinz-Josef ; He, Yaohua ; Valle, Juan W ; Wacheck, Volker ; Liu, Mei ; Chen, Li-Tzong ; Mahipal, Amit ; Tabernero, Josep ; Epstein, Robert S ; Hollebecque, Antoine ; Karasic, Thomas B ; Ahn, Daniel H ; Kelley, Robin Katie

WHAT IS THIS SUMMARY ABOUT?:

This summary describes the results from a phase 2 study called FOENIXCCA2. The study evaluated treatment with futibatinib in people with a rare form of advanced bile duct cancer called intrahepatic cholangiocarcinoma (or iCCA), where the tumors have changes in the structure of a gene called FGFR2. These changes include FGFR2 gene fusions. Bile duct cancer often returns after surgery or cannot be treated by surgery because the tumor has spread, so it requires treatment with chemotherapy. People live for a median of 1 year after their first chemotherapy treatment and 6 months after their second treatment. This study included people whose cancer had grown/spread after one or more chemotherapy treatments. The aims of the study were to see if futibatinib could shrink the size of tumors and stop the cancer from growing/spreading and to see how long people lived when treated with futibatinib. Clinicians also looked at side effects from taking futibatinib and at how it affected people's quality of life.

WHAT WERE THE RESULTS?:

Futibatinib treatment shrank tumors in over 80% of people who received treatment. Tumors shrank by at least 30% in 42% of people. Futibatinib stopped tumors from growing/spreading for a median of 9.7 months. People who took the medicine lived for a median of 21.7 months, and 72% of people were still alive after 1 year. Side effects from taking futibatinib were like those reported for similar medicines, and clinicians considered the side effects to be manageable by adjusting the dose of futibatinib or treating the side effects. Most people reported that their quality of life stayed the same or improved during the first 9 months of taking futibatinib.

WHAT DO THE RESULTS MEAN?:

The results support the use of futibatinib for treating people with advanced bile duct cancer. Based on the results of this study, futibatinib is now approved in the US, Europe, and Japan. Futibatinib is approved for treating adults with advanced bile duct cancer who have received previous treatment for their cancer, and whose tumors have a gene fusion or other change in the FGFR2 gene.Clinical Trial Registration: NCT02052778 (FOENIX-CCA2).

项与福巴替尼相关的新闻（医药）

2025-01-02

·GlobeNewswire-Health Care

Bionano Announces Publication from Johns Hopkins School of Medicine Showing that OGM Outperformed Multiple Cytogenetic Assays in a Study of Bone and Soft Tissue Tumor Analysis

In the largest study to date of bone and soft tissue tumors, OGM detected 100% of the variants found by multiple standard techniques, including karyotyping, fluorescent in-situ hybridization (FISH) & gene fusion assays OGM was also more sensitive, including detection of diagnostic or pathogenic variants missed by karyotype in 74% (14/19) of cases that failed or were negative by karyotyping When OGM results and next-generation sequencing (NGS) results were combined, diagnostic and pathogenic structural variants (SVs), copy number variants (CNVs), and/or single nucleotide variants (SNVs) were found in ~98% of cases, a substantially greater rate than when karyotyping, FISH and NGS are used Dec. 23, 2024 -- Bionano Genomics, Inc. (Nasdaq: BNGO) today announced a publication in Modern Pathology by a group of researchers at the Johns Hopkins University School of Medicine, showing that optical genome mapping (OGM) can outperform traditional techniques in analysis of bone and soft tissue tumors. Several prior publications have shown the utility of OGM compared to traditional cytogenetics in studies of hematologic malignancies, however, data on the application of OGM in solid tumors has been relatively sparse. This study provides compelling support for extending the utility of OGM in cancer beyond hematologic malignancies to solid tumors. OGM detected all variants revealed by conventional cytogenetics: OGM showed 100% concordance, identifying all pathogenic variants detected by standard of care cytogenetic methods. The specificity of OGM was assessed to be 100%, i.e. OGM correctly identified the same pathogenic SVs and CNVs detected by standard of care/routine cytogenetics (karyotyping and FISH). OGM detected pathogenic variants missed by karyotyping: In 74% of cases with normal or failed karyotype, OGM detected diagnostic or pathogenic SVs that were missed by karyotyping. Further, in 6 cases that failed to yield any karyotyping results due to culture failure, OGM detected pathogenic SVs in all of them. Variants found by OGM but missed by standard of care included the EWSR1::ETV1 fusion, which is a key molecular hallmark of clear cell sarcoma and helps to differentiate it from other soft tissue sarcomas and melanomas. OGM resolved complex cancer genomes: Study authors found that OGM data could re-characterized and better defined complex structural rearrangements including chromoanagenesis in 27% of cases and complex 3-6-way translocations in 15% of cases when compared to traditional cytogenetic methods. OGM combined with NGS found pathogenic variants in 98% of cases, a substantially greater rate than when karyotyping, FISH and NGS are used: The integrated approach of the combination of OGM and NGS resulted in the detection of pathogenic SVs and sequence variants in ~98% of cases. OGM was 100% concordant with NGS for aneuploidy detection. OGM findings have the potential to qualify subjects for targeted therapies that otherwise would not have been possible: The authors state that several of the OGM findings could result in the potential for these cases to qualify for either targeted treatments or clinical trials. For example, cases with potential to be treated by CDK4/6 inhibitors (palbociclib, ribociclib, abemaciclib), TRK inhibitors (larotrectinib, entrectinib), pan-FGFR inhibitors (erdafitinib or futibatinib) were highlighted. Erik Holmlin, president and chief executive officer of Bionano commented, “Approximately 50% of bone and soft tissue tumor samples fail to reveal actionable information for proper classification of disease, prognosis and therapeutic management because they either fail to culture or because traditional techniques in cytogenetics lack adequate sensitivity and specificity to reliably detect relevant variants. We have seen increasing evidence for OGM as a valuable alternative to cytogenetic methods in blood cancers, and we are thrilled to see researchers at Johns Hopkins publishing this compelling case for extending OGM’s utility to bone and soft tissue tumors.” The full research publication is available at: https://doi-org.libproxy1.nus.edu.sg/10.1016/j.modpat.2024.100684 Bionano is a provider of genome analysis solutions that can enable researchers and clinicians to reveal answers to challenging questions in biology and medicine. The Company’s mission is to transform the way the world sees the genome through optical genome mapping (OGM) solutions, diagnostic services and software. The Company offers OGM solutions for applications across basic, translational and clinical research. The Company also offers an industry-leading, platform-agnostic genome analysis software solution, and nucleic acid extraction and purification solutions using proprietary isotachophoresis (ITP) technology. Through its Lineagen, Inc. d/b/a Bionano Laboratories business, the Company also offers OGM-based diagnostic testing services. The content above comes from the network. if any infringement, please contact us to modify.

寡核苷酸

2024-12-21

·ioncology

年度盘点丨Kohei Shitara教授盘点胃肠肿瘤热门靶点研究进展和方向

点击蓝字关注我们年度盘点微专辑扫描二维码可查看更多内容年度盘点 2024 编者按：近年来胃肠道肿瘤治疗领域新药新靶点不断涌现，为患者治疗带来了新的希望。在2024年欧洲肿瘤内科学会亚洲年会（ESMO ASIA 2024）上，日本国立癌症中心医院Kohei Shitara教授针对胃肠道肿瘤的新兴靶向药物进行了精彩的报告。《肿瘤瞭望消化时讯》在会议现场邀请Kohei Shitara教授对胃肠道肿瘤治疗新靶点的研发情况以及面临的问题进行了盘点。一致癌基因相关的热门治疗靶点 1 FGFR2[1~4] 在胃癌中，大约有3%~5%患者存在FGFR2高水平扩增，其与组织学扩散和不良预后相关。FGFR2抑制剂相关研究结果如下：在Shine研究中AZD4547与PTX对比，结果显示两组的PFS无统计学差异。Futibatinib治疗FGFR2扩增（拷贝数>10）的胃癌患者，ORR为18%。Infigratinib治疗FGFR阳性胃癌患者的ORR为25%。研究人员对FGFR靶向治疗耐药问题进行探索时发现脱靶效应或旁路机制会使缓解持续时间（DoR）缩短。 2 染色体外DNA（ecDNA）[5~7] 染色体外发现的环状DNA携带有原癌基因，其产生于染色体断裂或断裂-融合-桥接循环。可通过驱动遗传异质性、快速基因组改变（使用超级增强子）和抗性基因扩增产生肿瘤耐药。一项在HER2阳性肿瘤患者的研究显示，ecDNA的HER2拷贝数增加，化疗联合HER2治疗可延长PFS。靶向ecDNA的治疗研究方向包括：氟、奥沙利铂能否增加复制压力、DNA损伤、破坏ecDNA的灵活性；NCT05827614研究正验证检测点激酶1（CHK1）抑制剂靶向复制压力的有效性；PARP/DNA-PK抑制剂能否破坏其结构完整性。 3 FGFR2b[8~11] FGFR2的剪接变异体有FGFR2b（上皮型）、FGFR2c（间质型），大约30%的胃癌中有FGFR2b表达。一项抗FGFR2b单抗Bemarituzumab研究显示，单药治疗ORR为18%；相比TKI很少有电解质异常，但存在可逆的角膜毒性。 FIGHT试验在胃/胃食管交界处腺癌对比了FOLFOX6联合Bemarituzumab或安慰剂的疗效，中位PFS（ITT人群：9.5 vs. 7.4个月，HR 0.72）、中位OS（ITT人群：19.2 vs. 13.5个月，HR 0.77）均有延长。两项Ⅲ期研究（NCT05052801、NCT05111626）和一项篮子试验正在进行中。针对Bemarituzumab耐药的研究集中于FGFR2c和上皮间质转换（EMT）。FGFR2c增高与较差的OS相关。 4 EGFR[12~16] 在食管鳞癌（ESCC）中主要为EGFR1异常（胃癌为EGFR2），EGFR-TKI与抗PD-1联合研究已显示初步疗效。化疗联合EGFR抑制剂联在MET、EGFR、HER2、融合突变富集的结直肠癌患者中显示出一定疗效，但在胃癌、食管癌中却为阴性结果，在RAS/RAF突变较少的患者或在EGFR扩增或高表达的患者亚组中提示有获益。 Amivantamab是一种EGFR、MET双特异抗体，在抗-EGFR治疗后的CRC患者中显示出初步疗效。不良事件（AE）主要有输注反应、皮肤毒性、低白蛋白血症。在胃癌、食管鳞癌中，Amivantamab与化疗联合，在靶标高表达的患者中显示出高的治疗活性。 5 MET[12~16] ABBV-400（Telisotuzumab Adizutecan）是种靶向MET的ADC，在MET扩增的胃癌患者和CRC患者两项Ⅰ期研究中观察到了初步疗效。 6 胃癌全外显子（WES）的其他基因拷贝数改变[17~20] CCNE1扩增，在研药物有CDK2抑制剂INCB123667、Wee1抑制剂Adavosertib。MYC扩增，在研药物有MYC抑制剂OMO-103。KRAS扩增，在研药物有BI 3706674。 7 MTAP缺失[21~22] MTAP缺失可增加肿瘤对MAT2A/PRMT5轴的依赖。普遍存在染色体9p21的CDKN2A共缺失。肿瘤中MTAP缺失约占10~15%，在胰腺导管腺癌（PDAC）、胆道癌（BTC）、ESCC和胃癌中均有检出。MTAP缺失患者对PRMT5、MAT2A抑制剂敏感。 8 TP53[23~24] TP53 Y220C突变位点在DNA结合域，约3%的卵巢癌患者，0.5%~1.5%的胃肠癌（胰腺导管腺癌或胃癌）患者存在此突变。在研新药Rezatapopt（PC14586）可重激活TP53的转录活性。在PYNNACLE研究中，PC14586在野生型RAS肿瘤患者中取得了30%的ORR和7个月的DOR。不良事件有恶心、呕吐、腹泻和肌酐升高。二非致癌基因相关的热门治疗靶点 1 Claudian[25~33] Claudian家族是种紧密连接的膜蛋白，有防御和调节通透性的作用。正常情况下，Claudian18.1在肺组织中高表达，Claudian18.2在胃粘膜中高表达。Claudian在胃癌、胃食管交界处肿瘤持续表达，在胰腺等恶性肿瘤中呈异位表达。首个针对Claudian18.2靶点的单克隆抗体Zolbetuximab已成功上市，该药物是一种纯IgG1单克隆抗体，本身没有显示出任何细胞阻断活性。其疗效主要依赖于抗体依赖性细胞毒性（ADCC）和补体依赖性细胞毒性（CDC），而非Claudian18.2的直接作用。在SPOTLIGHT和GLOW研究的人群中，大于75%的患者免疫组化Claudian18.2呈2+或3+，Zolbetuximab联合化疗取得了PFS和OS的显著提高。研究者正筹备开展进一步的随机对照研究。目前有大于30个靶向Claudian18.2的制剂正在进行临床试验，这些产品有增强型单抗、ADC、双特异药物、CAR-T等。 Osemitamab（TST001或ASKB589）是一种高亲和性Claudian18.2单抗。在早期实体瘤研究中与CAPOX联合用药ORR达到67%，与CAPOX、抗PD-1联合用药ORR达到80%。Osemitamab联合纳武利尤单抗和CAPOX作为晚期胃或胃食管结合部腺癌一线治疗的Ⅰ/Ⅱa期研究在开展中。 CT041（satri-cel）是种靶向Claudian18.2的CAR-T细胞，在Ⅰ期Claudian18.2阳性晚期胃肠道肿瘤研究中，总ORR为39%，胃癌ORR为55%，胰腺导管腺癌ORR为20%。97%的患者发生1~2级细胞因子释放综合征（CRS），没有3级CRS。恶心发生率67%，呕吐发生率53%。 C-CAR031是一种磷脂酰肌醇蛋白聚糖-3（GPC3）特异的、TGFβRIIDN装备的CAR-T细胞。在22例肝细胞癌患者中，ORR为50.0%（GPC3 CAR-T为15%）。中位DOR为7.4月。92%患者出现CRS，4 %（1例）患者出现3级CRS。 IM96是种靶向鸟苷酸环化酶2C（GUCY2C）的CAR-T。在19例结直肠癌中ORR为26%，常见不良事件有腹泻（55%）、皮疹（70%）、黏膜炎（35%）。 CLDN/CD3双特异性T细胞Engager（BITE），同时结合表达在肿瘤细胞上的肿瘤相关抗原Claudian18.2和表达在 T 细胞上的CD3，将癌细胞与免疫系统的T细胞连接起来，促进T细胞识别并杀死癌细胞。IBI研究中，胃癌患者ORR为31%，PDCA患者ORR为11.1%。QLS31905患者的ORR为11.1%。主要不良事件为CRS，胃肠道毒性。 Givastomig是种Claudian18.2 / 41BB双特异抗体，Q1802是种CLDN18.2 / PD-L1双特异抗体，已开展首次人体试验。 Claudian18.2 ADC主要有：CMG901或AZD0901是Claudian18.2单抗与微管抑制剂MMAE的偶联物；SHR-A1904是Claudian18.2单抗与拓扑异构酶Ⅰ抑制剂（topo1）的偶联物；IBI343是Claudian18.2单抗与拓扑异构酶Ⅰ抑制剂exatecan的偶联物，已进入Ⅱ期或Ⅲ期临床试验。以上研究Claudian18.2表达使用了不同的cut-off水平，并使用多种分层标志物，如肿瘤相关标志物MMR、HER2、CLDN18.2、FGFR2b、CPS等；免疫相关生物标志物包括PD-1、CD3、CD4、CD8、CD163、FOXP3、CCR8、CTLA4、TIGIT等。 2 TROP-2[34-36] Trop-2是一种在多种肿瘤中异常表达的糖蛋白。目前针对这一靶标的ADC有sacituzumab tirumotecan (sac-TMT)，已完成Ⅰ期研究。在TROP-2 ADC治疗中，Trop2表达可作为生物标志物。在TROP-2 ADC药物Dato-DXd研究中，自动成像分析标准化膜比例[膜Trop2 /总Trop2（膜+细胞浆）]可反映其表达，比例降低（细胞浆染色更多）者预后较好。 3 CEA[37~39] CEACAM5是一种与细胞粘附分化相关的细胞表面糖蛋白。在结直肠癌、胃癌、非小细胞肺癌中高表达。针对这一靶标的ADC有Tusamitamab ravtansine (SAR408701)、M9140。 4 B7-H3[40~41] B7-H3是种I型跨膜糖蛋白，和免疫检测点抑制分子同属B7家族。针对这一靶标的ADC有DS7300 (I-DXd)、YL201。 5 组织因子（TF）[42] TF在宫颈癌中高表达，针对这一靶标的ADC药物Tisotumab已经上市。ADC产品的研发也产生了新的问题，如耐药性。目前的研究主要集中于联合用药，如与免疫检查点抑制剂或CD47抑制剂联合用药、与受体酪氨酸激酶（RTK）治疗联合用药、与Weel或EZH1/2抑制剂联合用药、制备双特异ADC、ADC与ADC联合。研究者说目前在胃癌、结直肠癌、胆管癌等消化道肿瘤领域有许多新兴靶点以及相对应的靶向药物，例如，HER2靶点，当前靶向其治疗的ADC药物德曲妥珠单抗（T-DXd），其在抗肿瘤活性已经明确。KRAS和组织因子（TF）也是令人惊喜的靶点，不仅针对结直肠癌有效，对其他类型的肿瘤也显示出潜力。当前TF和其他靶点的联合用药已经在结直肠癌等临床试验中得到了验证。对于p53突变型结直肠癌，KRAS和Trop靶点的检出推动了化疗与靶向治疗的联合用药研究。此外，在胰腺癌中，KRAS抑制剂也展现出显著的疗效。除了述药物外，还有许多针对新靶标的药物正处于研发阶段，这标志着该领域正在蓬勃发展。同时，上消化道肿瘤的其他靶点，如靶向Claudian18.2的药物——Zolbetuximab已上市，针对该靶点的CAR-T、高特异性药物、ADC药物等也正在各类患者中进行研究。对于HER2扩增，即使不是过表达，也可以作为靶标，目前已有多个相关试验正在进行。此外，肿瘤中MTAP缺失约占10%~15%，在PDAC、BTC、ESCC和胃癌中均有检出，这也是一个令人惊喜的靶标，其对PRMT5、MAT2A抑制剂表现出高度敏感。最后，TROP-2、CCR家族、B7-H3及组织因子等许多分子也被确认为新的治疗靶标。总之，我们期望针对上消化道靶标的创新疗法能够显著提升患者的治疗效果，为患者带来更佳的预后。参考文献（上下滑动可查看） [1]JOGO T ,et al.CCR 2020 [2]Calenacci DVT et al. ASCO 2021 [3]Gastric Cancer 2021; [4]an Clsem E, etal Arnab of0nel2017; DoiT, et al. Cancer Science 2022 [5]Huang Q, et al Heliyon 2024 [6]Tang J, et al. Nature 2024 [7]Tshai C, et al ASCO 2024 [8]Tumer N, et al Nat Rev Cancer, 2010 [9]Powers J, et al.AACR 2016 [10]Kaloh M, et al, Nature Revie Clinical Oncol 2024 [11]Wainberg ZA, et al Lancet Oncol 2022,ESMO-G1 2023 [12]Nakamura Y ,Shitara K JCO PO 2020 [13]Oberstein PE, et al ASC0-G1 2024 [14]Kotani D, et al. ASCO-G1 2024 [15]Shama MR, et al ASCO 2024 [16]Strickler JH, et al.ESMO 2024 [17]Garralda E, et al. EORTC-NCI-AACR 2022 [18]Wee S,et al. EORTC-NCI-AACR 2022 [19]Garralda E, et al. Nature Med 2024 [20]Simoneli M, et al. ESMO 2024 [21]Rodon J, et al. EORTC-NCI-AACR 2023 [22]Seguchi K et al. ESMO 2024 [23]Dumbrava EE, et al ASCO 2022 [24]Schram A, et aL AACR-NCLEORTC 2023 [25]Nakayama l, Shitara K et al Nature Revise Clinical Oncol. 2024 [26]Shitara K, et al. N EnglJ Med 202 [27]Nakayama l, Shitara K. et al. Nature Revise Clinical Oncol 2024 [28]Guo W et al.ASCO GI2023 [29]Zhang M et al.ASCO GI 2023; [30]chare Q et al.ASCO 2023 [31]Shen et al. ASCO 2023 [32]PengZ,et al. ASCO GI 2024 [33]zhang X, et al. ASCO 2024 [34]Bardia A, et al. Annals of Oncol 2021 [35]Kobitzsch B, et al. ESMO Gastroinestinal Oncol 2024 [36]Wainberg ZA, et al. AACR 2024 [37]Decary S, et al. CCR2020 [38]Gazzah A, et al. Annals of Oncol 2022 [39]Kopetz S, et al. ASCO 2024 [40]Doi T. et al. ESMO 2023 [41]Zhao H, et al. ESMO 2024 [42]Park W, et al. ASCO 2024 （来源：肿瘤瞭望消化时讯）声明凡署名原创的文章版权属《肿瘤瞭望》所有，欢迎分享、转载。本文仅供医疗卫生专业人士了解最新医药资讯参考使用，不代表本平台观点。该等信息不能以任何方式取代专业的医疗指导，也不应被视为诊疗建议，如果该信息被用于资讯以外的目的，本站及作者不承担相关责任。

临床结果临床3期

2024-10-03

·药渡

浅谈：FGFR靶向治疗的临床进展

前言成纤维细胞生长因子（FGF）通过FGF受体（FGFR1-4）发出信号，协调胎儿发育，有助于组织和全身稳态，但FGFR基因的融合、重排或突变也可能促进肿瘤发生。FGFR融合可分为I型（非受体型，由融合伴侣的N端置换引起，如BCR-FGFR1和ZYM2-FGFR1）、IIa型（受体型，也由融合伴侣N端置换产生；如FN1-FGFR1、KLK2-FGFR2）或IIb型（受体型，由融合伴侣C端置换产生；如FGFR2-BICC1、FGFR3-TACC3）。在实体瘤中检测到的FGFR变化包括非小细胞肺癌中的FGFR1扩增（20%）、乳腺癌中的FGFR 1/2扩增（7-23%）、尿路上皮癌中的FGFR3突变（10-60%）或FGFR3融合（6%）、肝内胆管癌中的FGFR2融合（10-20%）、子宫内膜癌中的FGFR2突变（12%）和胃癌中FGFR2的扩增（5-10%）。在约7.0%的未经选择的癌症患者中可以检测到FGFR基因的改变。目前，已经开发出了多种FGFR靶向药物，包括泛FGFR抑制剂（erdafitinib和futibatinib）、FGFR1/2/3抑制剂（infigratinib和pemigatinib），以及一系列更具特异性的药物，其中一些已进入临床使用。Erdafitinib已被批准用于携带FGFR2/3突变的尿路上皮癌患者，futibatinib和pemigatinib被批准治疗携带FGFR2融合或重排的胆管癌患者。这些药物的临床益处在一定程度上受到高磷血症的限制，这是由于FGFR1的脱靶抑制以及FGFR基因中耐药性突变的出现。下一代小分子抑制剂，如lirafugratinib和LOXO-435，以及FGFR2特异性抗体bemarituzumab，有望降低高磷血症的风险，并有能力克服某些耐药性突变。 FGFR的结构和信号通路 FGFs由具有球状或非典型β三叶结构的保守核心结构域组成，可分为典型FGFs（FGF1-10、FGF16-18、FGF20和FGF22）、内分泌型FGF（FGF19/FGF15、FGF21和FGF23）以及FGF同源因子（FGF11-14）。全长FGF受体（FGFR1-4）是I型跨膜蛋白，具有三个细胞外免疫球蛋白样结构域和一个胞内酪氨酸激酶结构域。典型的FGF与硫酸乙酰肝素辅因子一起通过FGFR传递信号，而内分泌型FGF与klotho共受体（KLA和KLB）和硫酸乙酰肝素辅助因子一起通过FGFR传递信号。FGF–FGFR信号传导参与细胞存活、增殖、代谢、迁移和分化，包括生理作用，如协调胎儿发育和维持组织和/或全身稳态。这些受体也可以驱动肿瘤的发展。 FGFR中配体依赖性二聚化或病理改变通过自身抑制机制释放而导致内源性激酶激活。FGFR激活导致FRS2依赖性激活PI3K–AKT、RAS–ERK和磷脂酶Cγ（PLCγ）依赖性二酰基甘油（DAG）–PKC和IP3–Ca2+信号。癌症患者的FGFR改变通过异常的FGFR信号传导促进肿瘤发生：FGFR扩增导致FGFR过度表达和下游信号通路过度激活；FGFR融合或重排导致融合伴侣介导的FGFR二聚化、磷酸化改变和异常的下游信号传导；细胞外区或跨膜结构域中的FGFR突变通过改变对FGF配体的特异性或亲和力，以及配体非依赖性二聚化来激活FGFR；酪氨酸激酶结构域中的FGFR突变由于自身抑制机制的破坏而结构性性地激活FGFR。小分子FGFR抑制剂几种小分子FGFR抑制剂已被开发用于治疗具有FGFR改变的癌症患者，如尿路上皮癌、乳腺癌、胃癌、肝癌、肺癌、卵巢癌和宫颈癌。能够与酪氨酸激酶结构域的ATP结合位点结合的FGFR抑制剂通常分为多激酶FGFR抑制剂或选择性FGFR抑制剂。Derazatinib、dovitinib、tasurgratinib、lenvatinib、lucitanib、nintedanib和ponatinib都是多激酶FGFR抑制剂，对FGFR以外的多种RTK具有活性。然而，由于其广泛的活性，与选择性FGFR抑制剂相比，多激酶FGFR抑制剂的作用机制和不良反应都很复杂。选择性FGFR抑制剂包括泛FGFR、FGFR1/2/3和FGFR2/3抑制剂以及选择性FGFR2、FGFR3或FGFR4抑制剂。泛FGFR抑制剂包括 erdafitinib, futibatinib, rogaratinib和resigratinib；FGFR1/2/3抑制剂包括pemigatinib, infigratinib, fexagratinib和zoligratinib；Lirafugratinib是一种选择性FGFR2抑制剂，LOXO-435是一种选择FGFR3抑制剂，roblitinib和fissotioninib是选择性FGFR4抑制剂。目前，根据在II期试验中观察到的疗效和耐受性，美国食品药品监督管理局（FDA）在这些适应症的二线或更后线的治疗中加速批准erdafitinib、futibatinib、infigratinib和pemiginib。在erdafitinib的临床研究（BLC2001）中，根据FGFR3或FGFR2/FGFR3融合物中至少一种突变的存在，选择局部晚期和/或不可切除的尿路上皮癌患者。整体队列的ORR为40%，中位无进展生存期（mPFS）和中位总生存期（mOS）分别为5.5个月和13.8个月。46%的患者出现≥3级不良事件，在初步分析中包括低钠血症（11%）、口腔炎（10%）和乏力（7%），以及长期随访的指甲（15%）、口炎（14%）和皮肤事件（8%）。在FIGHT-203的II期研究中，在携带I型FGFR1融合（如ZMYM2–FGFR1或BCR–FGFR2）的MLN患者中测试了pemiginib的药效和安全性。其中77%（24/31）的患者对pemiginib有完全响应。常见的≥3级不良事件包括贫血（18%）、口腔炎和四肢疼痛（均为12%）。2022年8月，FDA批准了pemiginib用于携带FGFR1融合的复发性和/或难治性MLN患者。任何级别的高磷血症都发生在大多数接受泛FGFR抑制剂或FGFR1/2/3抑制剂的患者中。这种不良反应很可能反映了泛FGFR或FGFR1/2/3抑制剂对FGF23信号传导的抑制，因为这种分泌蛋白依赖于与近端小管上皮细胞膜上的FGFR1和klotho的结合。该复合物通过抑制磷酸钠协同转运蛋白（NPT2a/c）调节肾脏中的磷酸盐吸收。FGFR1在这一过程中的作用得到证实，因此，开发FGFR2特异性和FGFR3特异性抑制剂有望避免或降低这种不良反应的发生率。 FGFR抑制性单克隆抗体在靶向FGF/FGFR信号的生物制剂中，bemarituzumab是目前正在III期试验中评估的唯一药物。bemarituzumab是一种人源化抗FGFR2b抗体，其抑制FGF7、FGF10和FGF22的结合，从而抑制癌细胞中配体诱导的FGFR2b信号传导，并且由于修饰的Fc结构域对自然杀伤细胞上的人FcγRIIIA受体的亲和力增加，因此具有诱导抗体依赖性细胞介导的细胞毒性（ADCC）的能力。在一项涉及晚期FGFR2b过表达胃和胃食管交界腺癌（GEA）患者的I期试验中，bemarituzumab单药治疗显示出可接受的耐受性，ORR为18%（5/28）。随后，在携带FGFR2扩增或FGFR2过表达的GEA患者的II期FIGHT试验中，将bemarituzumab与mFOLFOX6（包括氟嘧啶、亚叶酸和奥沙利铂）联合测试。bemarituzumab联合化疗组和安慰剂联合化疗组患者的ORR分别为53%和40%，mPFS分别为9.5个月和7.4个月（P=0.073)。bemarituzumab的其他几项试验，包括评估bemarituzumab联合mFOLFOX6加(NCT0511626) 或不加(NCT050252801) nivolumab在先前未经治疗的晚期GEA患者中的研究正在进行中。新型FGFR靶向疗法蛋白水解靶向嵌合体（PROTAC）、嵌合抗原受体（CAR）T细胞、抗体偶联药物（ADC）、放射免疫偶联物（RICs）和可溶性受体是能够靶向FGF–FGFR信号级联的潜在新治疗模式，其中一些已经或正在临床试验中进行测试。 PROTAC PROTAC具有双重部分，使其能够与靶蛋白和E3泛素连接酶相互作用，从而诱导靶蛋白的泛素化介导的蛋白酶体降解。LC-MB12是一种基于infigratinib的PROTAC，能够优先降解FGFR2，并抑制表达TEL–FGFR2融合的Ba/F3细胞和FGFR2扩增的SNU16癌细胞的增殖。相比之下，DGY-09-192是另一种基于 infigratinib的PROTAC，旨在募集von Hippel–Lindau蛋白（VHL），从而优先降解FGFR1和FGFR2。这些药物目前仍处于临床前开发阶段。 CAR-T细胞由于PAX3–FOXO1的下游作用，FGFR4在儿科横纹肌肉瘤中普遍过表达。然而，N535K和V550L等耐药性突变通常在治疗前出现，这可能会限制小分子抑制剂的有效性。因此，研究人员开发了靶向FGFR4的CAR-T细胞，如RJ154-HL和3A11，具有不同的靶向FGFR4的scFv。目前，靶向FGFR的CAR-T细胞也仍处于临床前开发阶段。基于抗体的药物 Aprutumab是一种全人源抗FGFR2抗体，它识别FGFR2b和FGFR2c亚型共同N末端区域P23、L27和E29周围的表位，并已被证明能诱导这些变体的内化和运输至溶酶体降解。Aprutumab和bemarituzumab在I期临床试验中均显示出良好的安全性和耐受性。目前，bemarituzumab已作为联合疗法进行II期和III期临床试验，而Aprutumab用于开发ADCs和RICs。 Aprutumab ixadotin（前身为BAY-1187982）是具有不可裂解连接子的抗FGFR2 ADC，LY3076226是具有可裂解连接子的抗FGFR3 ADC。然而，测试这两种药物的第一阶段试验(nct22368951)由于耐受性差和活性有限而终止。此外，Aprutumab和抗FGFR3抗体vofatamab分别用于FGFR2靶向的RIC（227Th-Aprutumab，BAY 2304058）和FGFR3靶向的RIC，225Ac-vofatamab（FPI-1966）和111In vofatamab（FPI-1967）。BAY 2304058仍处于临床前开发阶段，而FPI-1966（用于放射免疫疗法）和FPI-1967（用于放射成像）目前正在I/II期试验(NCT05363605)中进行测试，用于表达FGFR3的晚期实体瘤患者。可溶性FGFR受体可溶性FGFR受体，如衍生自FGFR1c的细胞外结构域的FP-1039和衍生自FGFR 3c的细胞外区域的Recifecept，是另一类通过充当诱饵受体来捕获FGFR配体的重组蛋白药物。FP-1039已显示对促有丝分裂FGF配体具有高亲和力，并且在FGFR1扩增的肺癌和FGFR2突变的子宫内膜癌的小鼠异种移植模型中具有抗肿瘤作用。FP-1039在一期试验中具有可接受的耐受性。测试FP-1039与各种化疗联合用药的Ib期试验(NCT01868022) 显示同时接受紫杉醇和卡铂治疗的鳞状非小细胞肺癌患者的ORR为47%，同时接受培美曲塞和顺铂治疗的恶性胸膜间皮瘤患者的ORR为39%。小结目前，小分子FGFR抑制剂和FGFR靶向抗体药物已在临床后期试验中进行开发和测试，其中几种小分子FGFR抑制剂已被批准用于FGFR改变的癌症患者。尽管如此，某些不良事件，如FGFR1脱靶抑制引起的高磷血症和获得性耐药性，仍然限制了这些药物的临床益处。选择性第三代抑制剂，如特异性靶向FGFR2或FGFR3的抑制剂，正在临床开发中，这些药物可能避免或显著降低高磷血症的风险，并可能克服突变介导的耐药性。参考文献： 1.FGFR-targeted therapeutics: clinical activity, mechanisms of resistance and new directions. Nat Rev Clin Oncol.2024 Feb 29 药渡媒体商务合作媒体公关 | 新闻&会议发稿张经理：18600036371（微信同号）点击下方“药渡“，关注更多精彩内容免责声明 “药渡”公众号所转载该篇文章来源于其他公众号平台，主要目的在于分享行业相关知识，传递当前最新资讯。图片、文章版权均属于原作者所有，如有侵权，请及时告知，我们会在24小时内删除相关信息。微信公众号的推送规则又双叒叕改啦，如果您不点个“在看”或者没设为"星标"，我们可能就消散在茫茫文海之中~点这里，千万不要错过药渡的最新消息哦！👇👇👇

引进/卖出临床结果

100 项与福巴替尼相关的药物交易

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外链

KEGG	Wiki	ATC	Drug Bank
D11725	-	-	DB15149

研发状态

批准上市

10 条最早获批的记录,

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适应症	国家/地区	公司	日期
FGFR2融合或重排的胆管癌	日本	Taiho Pharmaceutical Co., Ltd.	2023-06-26
肝内胆管癌	美国	Taiho Oncology, Inc.	2022-09-30

未上市

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适应症	最高研发状态	国家/地区	公司	日期
胆道癌	申请上市	日本	Taiho Pharmaceutical Co., Ltd.	2022-01-30
肿瘤转移	临床3期	美国	Taiho Oncology, Inc.	2024-10-01
肿瘤转移	临床3期	法国	Taiho Oncology, Inc.	2024-10-01
肿瘤转移	临床3期	韩国	Taiho Oncology, Inc.	2024-10-01
肿瘤转移	临床3期	西班牙	Taiho Oncology, Inc.	2024-10-01
肿瘤转移	临床3期	英国	Taiho Oncology, Inc.	2024-10-01
食管腺癌	临床2期	美国	Taiho Oncology, Inc.	2023-07-13
食管腺癌	临床2期	法国	Taiho Oncology, Inc.	2023-07-13
食管腺癌	临床2期	德国	Taiho Oncology, Inc.	2023-07-13
食管腺癌	临床2期	西班牙	Taiho Oncology, Inc.	2023-07-13

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临床结果

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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


NCT04601857 (ESMO2024) 人工标引	临床2期	尿路上皮癌一线 FGFR alteration	43	Futibatinib 20 mg PO QD Pembrolizumabzumab 200 mg IV Q3W	艱艱繭衊願蓋觸憲鏇繭(網製艱廠繭夢鏇齋願觸) = 襯觸衊鹹艱積鹹觸觸鬱鹽鑰壓艱壓鬱餘簾鏇願 (餘醖襯糧鹹膚窪積遞築, 23 ~ 72) 更多	积极	2024-09-15
NCT04601857 (ESMO2024) 人工标引	临床2期	尿路上皮癌一线 FGFR alteration	43	Futibatinib 20 mg PO QD+PembrolizumabPembrolizumab 200 mg IV Q3W (without FGFR3 mutations or FGFR1–4 fusion/rearrangements)	艱艱繭衊願蓋觸憲鏇繭(網製艱廠繭夢鏇齋願觸) = 醖餘製顧餘觸繭衊膚鹹鹽鑰壓艱壓鬱餘簾鏇願 (餘醖襯糧鹹膚窪積遞築, 14 ~ 52) 更多	积极	2024-09-15
NCT02052778 (FOENIX-CCA2, Pubmed \| Future Oncol) 人工标引	临床2期	晚期胆管癌 FGFR2 Fusion	-	Futibatinib	鏇築觸築醖築選繭餘鑰(醖鹽壓構獵獵糧鹹觸夢) = 鬱繭顧製鏇顧齋顧餘糧鹽窪鑰鬱繭醖範繭簾壓 (願鏇壓襯遞齋遞餘積築 ) 更多	积极	2024-06-17
JPRN-jRCT2080224975 (ASCO2024) 人工标引	临床1期	食管癌	-	Futibatinib 2Pembrolizumabembrolizumab 200mg/q3w with chemotherapy	築鬱衊醖簾餘鹹觸蓋糧(廠製鹽醖築簾觸觸積願) = 繭繭鬱繭壓鏇觸壓壓廠鹽選鏇窪糧襯襯膚築繭 (糧簾顧鹹憲鏇襯鑰網衊, 43.4 ~ 87.4) 更多	积极	2024-05-24
JPRN-jRCT2080224975 (ASCO2024) 人工标引	临床1期	食管癌	-	Futibatinib 20Pembrolizumabmbrolizumab 200mg/q3w without chemotherapy	築鬱衊醖簾餘鹹觸蓋糧(廠製鹽醖築簾觸觸積願) = 醖夢窪繭窪衊觸廠鬱憲鹽選鏇窪糧襯襯膚築繭 (糧簾顧鹹憲鏇襯鑰網衊, 26.3 ~ 60.6) 更多	积极	2024-05-24
JPRN-jRCT2080224975 (ESMO 12023 \| ESMO 22023) 人工标引	临床1期	食管癌	92	Futibatinib + pembrolizumab (ICI naïve)	遞壓網齋齋獵簾築積廠(願鹽壓壓鹽夢蓋窪膚顧) = 鑰壓壓艱築艱願願衊鹽餘築衊鹽築範鬱網艱鑰 (夢廠顧襯淵遞積顧製艱 ) 更多	积极	2023-10-23
JPRN-jRCT2080224975 (ESMO 12023 \| ESMO 22023) 人工标引	临床1期	食管癌	92	Futibatinib + pembrolizumab (ICI refractory)	遞壓網齋齋獵簾築積廠(願鹽壓壓鹽夢蓋窪膚顧) = 選構廠鑰鬱構艱餘壓簾餘築衊鹽築範鬱網艱鑰 (夢廠顧襯淵遞積顧製艱 ) 更多	积极	2023-10-23
TAS-120-101 (EMA) 人工标引	N/A	FGFR2融合或重排的胆管癌	103	futibatinib	網壓鹽壓築獵壓夢窪衊(觸顧網鬱齋壓築膚築獵) = 遞糧網艱襯顧壓簾積繭鑰襯廠鹽衊選餘糧鏇範 (鬱築網艱夢壓夢範願餘, 32 ~ 52) 更多	积极	2023-07-18
NCT04189445 (SO-10, ESMO_GI2023)	临床2期	FGFR2阳性胃食管交界处腺癌 FGFR2 amplification	28	Futibatinib 20 mg	淵艱膚襯鹹廠製蓋簾鏇(鏇餘簾鬱醖簾鹹廠艱觸) = 壓鏇廠艱觸窪積網壓範獵選觸獵積網窪觸蓋觸 (構願餘鹹製鏇餘衊廠壓, 6.1 ~ 36.9) 更多	积极	2023-07-01
NCT02052778 (FOENIX-CCA2, ESMO_GI2023)	临床2期	FGFR2阳性肝内胆管癌 FGFR2	103	Futibatinib	選觸壓糧鹽襯製艱憲鹹(構糧構觸繭繭壓蓋鏇窪) = 壓膚遞鹽醖鬱壓簾淵壓蓋蓋鏇齋窪網鏇簾觸範 (繭觸夢繭衊艱襯簾獵鏇 ) 更多	积极	2023-07-01
TiFFANY (ASCO2023)	临床2期	FGFR突变肿瘤	26	Futibatinib 20 mg	築齋醖願鹹襯壓範憲膚(艱獵蓋積製壓鹹範遞醖) = 鑰膚鬱艱糧廠製積窪餘餘繭繭鹹齋願艱網顧構 (鹹網鹽積遞壓鏇鏇醖繭, 6.6–39.4) 更多	积极	2023-05-31
AACR2023 人工标引	临床1期	-	38	futibatinib (mild HI)	蓋簾顧顧窪鑰選醖鏇醖(蓋獵築獵壓鹽廠鹹淵製) = 膚繭製淵鑰襯廠網蓋築築網夢夢鬱顧夢簾淵蓋 (鑰範遞衊夢積鬱範糧鏇 ) 更多	积极	2023-04-14
AACR2023 人工标引	临床1期	-	38	futibatinib (moderate HI)	蓋簾顧顧窪鑰選醖鏇醖(蓋獵築獵壓鹽廠鹹淵製) = 衊簾廠醖選網鏇餘膚鏇築網夢夢鬱顧夢簾淵蓋 (鑰範遞衊夢積鬱範糧鏇 ) 更多	积极	2023-04-14
NCT02052778 (FOENIX-CCA2, Pubmed \| N Engl J Med)	临床2期	肝内胆管癌 \| 肿瘤转移 \| 晚期恶性实体瘤 ... 更多	103	Futibatinib 20 mg	繭構鏇餘繭鬱鹽襯選鏇(製製蓋鏇廠膚鏇艱範齋) = 鏇繭廠餘遞網壓願夢觸齋淵淵衊廠餘壓鏇鑰壓 (壓艱齋範衊齋願齋觸網 ) 更多	积极	2023-01-19