Randomized Phase III Study of Second-Line Chemotherapy With or Without Panitumumab for KRAS Wild Type, Locally Advanced or Metastatic Pancreatic Adenocarcinoma

This phase III trial compares the effect of adding panitumumab to standard chemotherapy (with nanoliposomal Irinotecan, leucovorin, and 5-fluorouracil [5-FU] or irinotecan, leucovorin, and 5-FU or nab-paclitaxel and gemcitabine) versus standard chemotherapy alone in treating patients with KRAS wild type (WT) pancreatic ductal adenocarcinoma that cannot be removed by sugery (unresectable) or that has spread to nearby tissue or lymph nodes (locally advanced) or that has spread from where it first started (primary site) to other places in the body (metastatic). Panitumumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. A monoclonal antibody is a type of protein that can bind to certain targets in the body, such as molecules that cause the body to make an immune response (antigens). Chemotherapy drugs, such as nanoliposomal irinotecan, leucovorin, 5-FU, irinotecan, nab-paclitaxel and gemcitabine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Adding panitumumab to standard chemotherapy may be effective in treating patients with unresectable, locally advanced, or metastatic KRAS WT pancreatic ductal adenocarcinoma.

开始日期2026-01-06

申办/合作机构

SWOG

[+1]

NCT07094113

/ Not yet recruiting临床1期

A Phase 1/1b Study Evaluating the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Efficacy of AMG 410 Alone and in Combination With Other Agents in Participants With KRAS Altered Advanced or Metastatic Solid Tumors

The purpose of this first-in-human study is to evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), and preliminary efficacy of AMG 410 when administered alone or in combination with other agents in participants with advanced or metastatic solid tumors harboring KRAS alterations.
This is a dose-escalation study in which participants will be assigned to multiple dose levels (DLs) of AMG 410, either as monotherapy or in combination with other agents, followed by expansion cohorts. The goal is to determine the Maximum Tolerated Dose (MTD)-the highest dose with acceptable safety and manageable side effects-or the Recommended Phase 2 Dose (RP2D) of AMG 410 in adult participants with KRAS-altered advanced or metastatic solid tumors.

开始日期2025-08-04

申办/合作机构

Amgen, Inc.

NCT07094204

/ Not yet recruiting临床1期

A Phase 1 Study of ASP5834 in Participants With Locally Advanced (Unresectable) or Metastatic Solid Tumor Malignancies With KRAS Mutations or KRAS Amplifications

Genes contain genetic code which tell the body which proteins to make. Many types of cancer are caused by changes, or mutations, in a gene called KRAS. Researchers are looking for ways to stop the actions of abnormal proteins made from the mutated KRAS gene.
ASP5834 is being studied in people with solid tumors who have certain KRAS gene mutations. Some people with solid tumors of the colon or rectum (colorectal cancer), will be given ASP5834 with panitumumab. Panitumumab is a treatment for colorectal cancer. In this study, the researchers will learn how ASP5834 is processed by and acts upon the body. This information will help find a suitable dose of ASP5834 and check for any potential medical problems from the treatment.
The main aims of this study are to check the safety of ASP5834 given by itself or given with panitumumab, and how well it is tolerated; and to find a suitable dose of ASP5834 given by itself or given with panitumumab.
People in this study will be adults with locally advanced, unresectable, or metastatic solid tumors with certain KRAS gene mutations. Locally advanced means the cancer has spread to nearby tissue. Unresectable means the cancer cannot be removed by surgery. Metastatic means the cancer has spread to other parts of the body. The key reasons people cannot take part are if they have specific uncontrollable cancers such as symptomatic or untreated cancers in nervous system, or have a specific heart condition, or infections.
In this study, ASP5834 is being given to humans for the first time. This is an open-label study. This means that people in this study and clinic staff will know that they will receive ASP5834 by itself or ASP5834 with panitumumab.
This study will be in 2 parts:
Part 1 is called Dose Escalation. Different small groups of people will receive lower to higher doses of either: ASP5834 by itself or ASP5834 with panitumumab. Only people who have colorectal cancer will receive ASP5834 with panitumumab. People with any type of solid tumor will receive ASP5834 by itself. For each dose, all medical problems will be recorded. A medical expert panel will check the results and decide if the next group can receive a higher dose of ASP5834. The panel will do this until the planned maximum number of people are treated or until suitable doses have been selected for Part 2.
Part 2 is called Dose Expansion. Other different small groups of people will receive ASP5834 or ASP5834 with panitumumab. They will receive the most suitable doses worked out from Part 1.
In both parts of the study, the study treatments ASP5834 and panitumumab will be given through a vein. This is called an infusion. Each study treatment cycle is either 21 days or 28 days long. People will continue study treatment until: they have medical problems from the study treatment they can't tolerate; their cancer gets worse; they start other cancer treatment; or they ask to stop study treatment.
People will visit the clinic on certain days during their study treatment, with extra visits during the first 2 cycles of study treatment. The study doctors will check for any medical problems from ASP5834. Also, people in the study will have a health check. On some visits they will also have scans to check for any changes in their cancer. Tumor samples will be taken at certain visits during study treatment with the option of a tumor sample being taken if people's cancer gets worse or the cancer comes back.
People will visit the clinic shortly after stopping treatment for a health check. After this, people will have health checks every couple of months to check the condition of their cancer. The number of visits and checks done will depend on the health of each person and whether they completed their study treatment or not. It is expected that people will be in this study for about 1 year.

开始日期2025-07-31

申办/合作机构

Astellas Pharma, Inc.

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100 项与帕尼单抗相关的专利（医药）

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2,471

项与帕尼单抗相关的文献（医药）

2025-12-01·Journal of Gastrointestinal Cancer

Anti-EGFR Rechallenge in Metastatic Colorectal Cancer and the Role of ctDNA: A Systematic Review and Meta-analysis

Review

作者: da Silva, Luís Felipe Leite ; Peixoto, Renata D 'Alpino ; Saldanha, Erick Figueiredo ; da Conceição, Lucas Diniz ; Noronha, Mariana Macambira ; da Silva, Marcos Vinícius Martins Grangeiro

BACKGROUND:

Metastatic colorectal cancer (mCRC) remains a significant clinical challenge. While anti-EGFR inhibitors have improved survival rates, their long-term efficacy is limited by disease progression, which is often associated with the development of acquired resistance mutations. However, some patients may regain sensitivity to anti-EGFR agents after alternative therapies, suggesting a potential benefit for rechallenge strategies. Our study aims to conduct a systematic review and meta-analysis to comprehensively evaluate the efficacy and safety of EGFR rechallenge in patients with mCRC.

METHODS:

A systematic search of the MEDLINE, EMBASE, and Cochrane databases was conducted between October 28 and December 24, 2023, to identify clinical trials investigating treatment regimens incorporating panitumumab or cetuximab as a rechallenge strategy. Pooled proportions or hazard ratios (HR) were calculated using a random effects model. Inter-study heterogeneity was assessed using the I².

RESULTS:

Among the 2105 articles identified through the search, 13 met the predetermined inclusion criteria. Of these, 12 were phase II studies, encompassing 92.3% of the patient population. Cetuximab was administered to 302 patients (75.1%), whereas panitumumab was utilized in 100 patients (24.9%).A pooled analysis of eight studies demonstrated an objective response rate of 20.50% (95% CI 7.94 to 33.07) and a disease control rate of 67.35% (95% CI 58.60 to 76.09). The median progression-free survival was estimated at 3.5 months (95% CI 2.68-6.69), with a median OS of 9.8 months (95% CI 6.71-12.89). Patients exhibiting RAS wild-type status in circulating tumor DNA (ctDNA) analysis derived enhanced benefits from anti-EGFR rechallenge (HR: 0.41; 95% CI 0.28-0.60, I² = 60%). Common grade 3 or higher treatment-related adverse events included neutropenia (22.8%) and rash (14.9%).

CONCLUSION:

This meta-analysis underscores the efficacy and safety of anti-EGFR rechallenge as a promising therapeutic approach for a subset of patients afflicted with mCRC. The observed correlation between wild-type RAS status, as determined through ctDNA analysis, and improved OS signals the prospect of precision oncology in guiding treatment decisions.

2025-12-01·Journal of Gastrointestinal Cancer

Final Results of ERBIMOX: A Randomized Phase II Study of Modified FOLFOX7 With or Without Cetuximab as First-Line Treatment for KRAS Wild-type Metastatic Colorectal Cancer

Article

作者: Zirrgiebel, Ute ; Depenbusch, Reinhard ; Müller, Lothar ; Lerchenmüller, Christian ; Boller, Emil ; Niemeier, Beate ; Marschner, Norbert ; Sahm, Stephan ; Potthoff, Karin ; Tesch, Hans

BACKGROUND:

The combination of FOLFOX/FOLFIRI with an EGFR-antibody (cetuximab/panitumumab) is a first-line standard for RAS wild-type metastatic colorectal cancer (mCRC). The OPTIMOX stop-and-go regimen, which reduces oxaliplatin-induced neuropathy, and fluorouracil/folinic acid (FU/FA) were standard maintenance-therapies in the pre-antibody era. Whether an EGFR-antibody adds value to the OPTIMOX strategy in the RAS wild-type setting remains unknown.

METHODS:

In the open-label, randomized, multicenter phase II ERBIMOX trial, patients with KRAS wild-type mCRC received either first-line induction-therapy with 8 cycles of mFOLFOX7 followed by maintenance-therapy with FU/FA (OPTIMOX arm) or mFOLFOX7 + cetuximab followed by FU/FA + cetuximab (ERBIMOX arm). Primary objective was to demonstrate superiority of additional cetuximab to mFOLFOX7 during induction/maintenance-therapy. Primary endpoint was objective response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS) and safety. The trial is registered at EudraCT (No.2006-002744-28).

RESULTS:

From 2006-2011, 138 patients with KRAS wild-type mCRC from 23 German sites were randomly assigned to either OPTIMOX (N = 63) or ERBIMOX (N = 75). ORR numerically favored the ERBIMOX arm (64.0% vs. 54.0%, P = 0.3071). Median PFS (ERBIMOX vs. OPTIMOX) was 9.6 vs. 8.8 months (P = 0.7612), median OS 25.6 vs. 30.9 months (P = 0.5821). Most common grade 3/4 adverse events (AEs) were skin reactions (21.9% vs. 2.1%) and gastrointestinal disorders (13.5% vs. 9.5%). No cetuximab-related deaths occurred.

CONCLUSION:

In treatment-naïve KRAS wild-type mCRC, adding cetuximab to mFOLFOX7 resulted in numerically higher ORR than mFOLFOX alone, but no statistically significant differences in ORR, PFS or OS; probably because of the premature stop due to poor recruitment. The safety profile was as expected, with few discontinuations.

2025-12-01·Journal of Gastrointestinal Cancer

Efficacy and Safety of Anti-EGFR Therapy Rechallenge in Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis

Review

作者: Burbano, Rommel Mario Rodríguez ; de Oliveira Rodrigues, Anna Luíza Soares ; de Moraes, Francisco Cezar Aquino ; Limachi-Choque, Jhonny ; Priantti, Jonathan N

BACKGROUND:

Colorectal cancer (CRC) represents the second leading cause of cancer-related mortality worldwide, with a significant portion of patients presenting with metastatic disease at diagnosis. Resistance to initial anti-EGFR therapy, a key treatment for RAS wild-type metastatic CRC, remains a major challenge. This study aimed to assess the efficacy and safety of rechallenge with anti-EGFR therapy in patients with metastatic CRC who have progressed after prior treatments.

METHODS:

A systematic search was conducted across PubMed, Web of Science, Cochrane, and Scopus. Studies were included if they were randomized controlled trials (RCTs) or observational studies involving patients with EGFR-mutated metastatic CRC who received anti-EGFR therapy as a rechallenge. Endpoints included objective response rate (ORR), disease control rate (DCR), and the incidence of adverse events. Statistical analyses were performed using the DerSimonian/Laird random effect model, with heterogeneity assessed via I² statistics. R, version 4.2.3, was used for statistical analyses.

RESULTS:

Fourteen studies were included with 520 patients; 50.3% were male, and the median age was 63 years old. The median progression-free survival (mPFS) ranged between 2.4 and 4.9 months, while the median overall survival (mOS) ranged from 5 to 17.8 months. Our pooled analysis demonstrated an objective response rate (ORR) of 17.70% (95% CI, 8.58-26.82%) and a disease control rate (DCR) of 61.72% (95% CI, 53.32-70.11%), both with significant heterogeneity (I², 84% and 80%, respectively; p < 0.01). In the subgroup analysis, cetuximab showed an ORR of 18.31% (95% CI, 4.67-31.94%), and panitumumab an ORR of 10.9% (95% CI, 0.00-26.82%), while the combination of both resulted in an ORR of 29.24% (95% CI, 0.00-65.84%). For DCR, cetuximab resulted in 62.1% (95% CI, 49.32-74.87%), panitumumab in 63.05% (95% CI, 52.13-73.97%), and the combination in 60.34% (95% CI, 31.92-88.77%), all with significant heterogeneity. Adverse events included anemia (15.39%), diarrhea (4.20%), hypomagnesemia (6.40%), neutropenia (22.57%), and skin rash (13.22%).

CONCLUSIONS:

Rechallenge with anti-EGFR therapy in metastatic CRC patients shows moderate efficacy with manageable safety profiles. These findings highlight the need for careful patient selection and monitoring to optimize outcomes. Further studies are warranted to refine strategies for maximizing the therapeutic benefits of anti-EGFR rechallenge.

232

项与帕尼单抗相关的新闻（医药）

2025-08-02

·精准药物

【综述】一文带你读懂靶向KRAS的药物研发最新进展

01KRAS突变的生物学特征 No.1KRAS信号激活与突变机制◆ RAS基因家族：RAS基因家族包括HRAS、KRAS、NRAS，均为癌基因，其中KRAS是癌症中突变最频繁的亚型(占RAS突变的81%)，其次为NRAS(15%)和HRAS(4%)。◆ KRAS蛋白：是KRAS基因的产物，属于小GTP酶家族，在活性GTP结合状态(KRAS(ON))和失活GDP结合状态(KRAS(OFF))之间动态转换，调控细胞增殖、生存等信号。图1 KRAS GTPase蛋白序列和结构◆ KRAS激活：上游RTK(如EGFR)通过SOS1促进KRAS-GTP形成，下游激活RAF-MEK-ERK和PI3K-AKT等通路，驱动肿瘤发生。图2 KRAS的激活状态及其对信号通路的影响◆ KRAS突变：KRAS突变占人类癌症的20%以上，通过破坏GTP结合口袋的构象，导致GTP酶活性降低，维持KRAS持续激活状态，驱动肿瘤生长。 No.2KRAS突变类型与表达调控◆ KRAS突变类型与肿瘤分布：KRAS突变中约95%发生在G12位点，其次为G13(3–5%)和Q61(1–2%)。G12突变包括G12C、G12D、G12V、G12R、G12S等，其中G12C、G12D、G12V占所有KRAS突变的60–70%。①G12C：约13%，多见于非小细胞肺癌(12–15%)，在结直肠癌(2–3%)和胰腺癌(<1%)中罕见。②G12D：约26%，是结直肠癌(30–40%)和胰腺癌(40–50%)的最常见突变亚型。③G12V：约21%，在子宫内膜癌、卵巢癌中占比可达15–20%。图3 各种癌症类型的KRAS突变率◆ KRAS突变受非编码RNA的调控①长链非编码RNA(lncRNA)：lncRNA通过调控染色质重塑和转录因子活性，维持KRAS突变细胞的恶性表型。②微小RNA(miRNA)：miRNA通过靶向KRAS的3'UTR或下游通路组件，调节信号传导强度。 No.3KRAS突变对肿瘤微环境与代谢的影响◆ KRAS突变对肿瘤微环境与细胞行为影响①癌相关成纤维细胞(CAFs)重编程：KRAS激活TFCP2，诱导CAFs向脂质富集细胞分化，促进血管生成和肿瘤进展。②免疫微环境抑制：KRAS突变通过分泌TGF-β、IL-6等细胞因子，招募调节性T细胞(Treg)和髓系抑制细胞(MDSCs)，形成免疫抑制微环境，削弱抗肿瘤免疫应答。③癌症干细胞(CSCs)维持：KRAS突变激活CDK1，促进蛋白O-乙酰葡糖胺糖基化修饰，上调CSC标志物SOX2，增强肿瘤干细胞的自我更新和治疗耐药性。④巨胞饮作用(MP)激活：KRAS突变激活MP，增强细胞对营养物质的摄取，支持肿瘤在代谢压力下的生存。⑤细胞竞争与侵袭：KRAS突变激活NF-κB-MMP21通路，促进肿瘤细胞对邻近正常细胞的排斥和扩散浸润，增强肿瘤的侵袭性。图4 靶向致癌KRAS驱动的肿瘤中的代谢途径◆ KRAS突变促进代谢重编程①糖酵解与谷氨酰胺利用增强：KRAS突变上调己糖激酶、谷氨酰胺酶等酶活性，促进有氧糖酵解和谷氨酰胺分解，为肿瘤细胞提供能量和生物合成前体。②天冬氨酸代谢依赖：突变型KRAS激活PCK1、ASS1等酶，增强天冬氨酸和尿素循环代谢，维持核苷酸合成和氧化还原平衡，支持细胞快速增殖。图5 受致癌KRAS突变影响的KRAS蛋白和代谢途径 No.4KRAS突变的常用检测技术与局限◆ 检测方法①直接测序法(如Sanger测序)：敏感性低(需肿瘤细胞占比≥10–25%)，可检测未知突变。②BEAMing技术：敏感性高(可检测<1%突变)，但临床常规应用受成本限制。③焦磷酸测序(Pyrosequencing)：在FIRE-3试验中用于KRAS突变检测，灵敏度1–10%。④Luminex技术：敏感性约1–10%，在RASKET试验中用于KRAS突变分型◆ 临床局限性①样本质量影响：石蜡包埋样本的DNA降解可导致G>A、C>T伪突变，影响结果准确性。②异质性检测：部分KRAS突变呈亚克隆状态，突变等位基因频率低时易漏检。RenyuBio仁域生物02KRASG12C突变 No.1KRASG12C突变的分子特征该突变指KRAS蛋白第12位的甘氨酸被半胱氨酸取代，导致KRAS(OFF)状态积累。这种突变会通过空间位阻阻止GTP酶激活蛋白(GAPs)的相互作用，降低GTP酶活性，进而使活性KRASG12C-GTP蛋白(KRAS(ON))增多。图6 处于失活GDP结合状态的KRASG12C蛋白模型 No.2KRASG12C突变频率与分布◆ 肺癌方面：在非小细胞肺癌(NSCLC)中，KRASG12C突变约占13%-25%，在肺腺癌中更为常见。不同种族和性别存在差异，女性患者的突变率相对较高，且该突变与吸烟密切相关，多见于吸烟者。图7 NSCLC中的热点KRAS突变◆ 结直肠癌方面：在转移性结直肠癌(mCRC)中，KRASG12C突变发生率约为3%。在所有结直肠癌样本中，其突变频率低于G12D、G12V等突变类型，占比约3.4%。 No.3KRASG12C突变的相关临床特征◆ 肺癌临床特征：携带KRASG12C突变的NSCLC患者，肿瘤生长相对迅速，容易发生转移，常见转移部位包括脑等。患者对传统化疗和免疫疗法反应较差，预后不佳，生存期较短。◆ 结直肠癌临床特征：KRASG12C突变的结直肠癌患者，无进展生存期(PFS)较差，接受化疗时，一线化疗的中位PFS为6.4个月，二线为3.9个月，三线为3.0个月。与KRAS非G12C突变患者相比，总生存期(OS)更差。 No.4KRASG12C突变的分子机制与信号通路◆ 突变影响蛋白活性：正常情况下，KRAS蛋白通过结合GTP和GDP在激活和失活状态间转换，调控细胞生长和分化。KRASG12C突变导致第12位氨基酸由甘氨酸突变为半胱氨酸，使KRAS蛋白对GTP的亲和力增强，持续处于激活状态，无法正常调控细胞，促进肿瘤细胞的增殖和存活。◆ 激活下游信号通路：激活态的KRASG12C蛋白可激活下游的MAPK和PI3K-AKT等信号通路。如在MAPK通路中，激活RAF、MEK、ERK等，促进细胞增殖、分化和存活；在PI3K-AKT通路中，激活AKT，抑制细胞凋亡，增强细胞的生存能力。◆ 与其他基因的关系：在肺癌中，KRASG12C突变常与TP53、STK11等基因突变共存，但与EGFR突变、EML4-ALK融合等驱动突变互斥。在结直肠癌中，KRASG12C突变与其他驱动突变大多相互排斥，仅少数病例存在相关共突变。RenyuBio仁域生物03KRASG12D突变 No.1KRASG12D突变的分子特征与临床意义◆ 突变机制：KRASG12D突变指KRAS蛋白第12位甘氨酸被天冬氨酸取代，导致GTP酶活性降低，使KRAS持续处于GTP结合的激活状态，激活下游MAPK(如ERK)和PI3K-AKT信号通路，驱动细胞异常增殖。◆ 信号激活：突变蛋白通过与SOS1(鸟嘌呤核苷酸交换因子)结合，促进GDP向GTP转换，维持信号持续传导；同时，其天冬氨酸(Asp12)可与抑制剂形成盐桥，为药物设计提供靶点。◆ 与其他信号通路的交互①ERBB家族依赖：KRASG12D驱动的肿瘤依赖ERBB受体酪氨酸激酶(如EGFR)激活，抑制ERBB可增强MEK抑制剂疗效。②RhoA/Wnt信号：KRASG12D激活RhoA，抑制Wnt/β-catenin信号，减少肿瘤转移潜能。◆ 临床预后与治疗敏感性①预后争议：部分研究显示KRASG12D突变与更短的无进展生存期(PFS)和总生存期(OS)相关，但也有研究认为其预后影响与其他KRAS亚型无显著差异。②治疗响应：KRASG12D突变患者对贝伐珠单抗敏感性较低，且STK11/KEAP1共突变会削弱免疫治疗效果。 No.2KRASG12D相关信号通路与调控网络◆ 核心信号通路①ERBB-RAS-ERK轴：KRASG12D驱动的肿瘤依赖ERBB家族受体酪氨酸激酶(如EGFR)激活，抑制ERBB可增强MEK抑制剂疗效🔶4-44🔶。②SOS1-KRAS相互作用：SOS1作为鸟嘌呤核苷酸交换因子，促进KRASG12D的GTP结合，其抑制剂(如BI-3406)可阻断KRAS激活。◆ 非经典通路调控①RhoA/Wnt信号：KRASG12D通过抑制Wnt/β-catenin信号，减少肿瘤转移潜能。②NF-κB通路：KRASG12D与IKKα协同激活NF-κB，促进肿瘤生存，其抑制剂硼替佐米在侵袭性黏液腺癌中显示部分活性。RenyuBio仁域生物04不同KRAS突变亚型的差异(G12C vs G12D) No.1分子机制与信号通路差异◆ 构象与结合特性①G12C：突变产生的半胱氨酸可与抑制剂共价结合(如Sotorasib)，锁定KRAS于失活状态。②G12D：天冬氨酸(Asp12)通过盐桥与抑制剂结合(如MRTX1133)，但无法形成共价键，需依赖非共价相互作用。◆ 下游信号通路激活模式①G12C：主要激活RAF/MEK/ERK通路，对RALGDS结合影响较小。②G12D：因Asp12的空间位阻，干扰KRAS同源二聚体形成及RALGDS结合，导致RAL信号未激活。此外，G12D激活PI3K/AKT通路的能力更强，且依赖ERBB家族受体酪氨酸激酶(如EGFR)的上游信号。 No.2共突变模式差异◆ 常见共突变①G12C：常与TP53(17–50%)、KEAP1(6–23%)、STK11(10–28%)共突变。②G12D：合并STK11(15.9%)、TP53(33.6%)、KEAP1(9.4%)突变较多，其中STK11/KEAP1共突变与不良预后相关。◆ 与其他驱动突变的互斥性：均与EGFR突变、EML4-ALK融合互斥，但G12D突变与EGFR共突变率(11.6%)略高于G12C。 No.3药物开发策略差异◆ 抑制剂设计思路①G12C：利用半胱氨酸的共价结合特性开发抑制剂。②G12D：依赖非共价结合(如盐桥、氢键)，需设计与Asp12特异性作用的分子(如MRTX1133的吡啶并嘧啶骨架)。◆ 联合治疗策略：G12D因依赖ERBB信号，需联合EGFR抑制剂(如Erlotinib)增强疗效；而G12C更常与免疫治疗或SHP2抑制剂联用。RenyuBio仁域生物05KRAS靶向治疗进展与药物开发图8 KRAS的直接抑制剂 No.1KRASG12C抑制剂：从突破到局限◆ 作用机制：首款获批的KRASG12C抑制剂(如Sotorasib、Adagrasib)为“OFF状态”抑制剂，通过与KRASG12C(OFF)中突变的半胱氨酸12附近的变构结合口袋(P2口袋)共价结合，阻止GDP向GTP转换，从而抑制RAS-效应器相互作用。尽管KRASG12C突变会导致KRAS(ON)积累，但细胞中仍有25%的KRAS处于GDP结合的失活状态，这为抑制剂发挥作用提供了可能。图9 对OFF状态KRASG12C抑制剂的“靶向”和“脱靶”机制总结◆ 第一代抑制剂的突破与局限①Sotorasib(AMG510)：通过与G12C半胱氨酸共价结合，锁定其于失活状态(KRAS(OFF))。在NSCLC中ORR达33.3%，mPFS6.9个月，但在结直肠癌(CRC)中ORR仅约10%，联合Panitumumab在结直肠癌中mPFS达5.6个月。②Adagrasib(MRTX849)：选择性结合KRASG12C-GDP，II期试验显示NSCLC患者ORR为42.9%，联合Cetuximab使结直肠癌ORR提升至34%。③局限性：由于KRAS在GDP和GTP结合状态之间的动态“循环”，使得靶向GDP结合形式无法完全阻断致癌驱动。图10 KRASG12C的耐药机制◆ 第二代抑制剂的优化：提升靶点占有率、延长作用时间，克服第一代抑制剂的耐药问题(如H95D突变)①D-1553：一种新型口服强效KRASG12C抑制剂。I期研究中，NSCLC患者ORR达40.5%，DCR为91.9%，脑转移患者ORR17%(样本量6例)。安全性方面，94.9%的患者出现治疗相关不良事件，38.0%的患者发生3级或4级不良事件，多数不良事件可控。②GDC-6036(Divarasib)：亲和力比Sotorasib高5-20倍，单药ORR29.1%，联合Cetuximab在CRC中ORR达62.5%，mPFS8.1个月。③LY3537982(Olomorasib)：一种强效抑制剂，能实现持续的>90%的靶点占有率，对第一代抑制剂耐药患者仍有效。LOXO-RAS-20001试验显示安全性良好，颅内结果待公布。④FMC-376：能同时结合KRAS-GDP和GTP构象，对“ON”状态KRAS耐药突变的活性比Adagrasib高14-30倍，已进入I/II期临床试验。⑤IBI351：一种不可逆的KRASG12C共价抑制剂。II期研究确认ORR为46.6%，DCR为90.5%，脑转移患者疗效未单报。⑥D3S-001：快速靶标结合动力学，30分钟内实现>95%靶标占有率，对Sotorasib耐药模型有效，I期试验显示持久响应。表1 KRASG12 抑制剂在非小细胞肺癌中的应用◆ 联合治疗策略①EGFR抑制剂联用：Sotorasib联合EGFR抑制剂(如Erlotinib)在小鼠模型中可克服CRC中的EGFR反馈激活，使联合治疗ORR提升至43%，显著高于单药22%。②免疫治疗联合：Sotorasib可重塑肿瘤微环境为促炎状态，与PD-(L)1抑制剂联用在肺癌模型中增强疗效，但CRC中因免疫抑制微环境需进一步验证。图11 临床研究中增强KRASG12C系列抑制剂疗效的组合策略 No.2KRASG12D抑制剂：非共价结合的新探索◆ KRASG12D非共价小分子抑制剂①MRTX1133：非共价结合SwitchII口袋，抑制SOS1催化的核苷酸交换，阻断KRAS-GTP形成。临床前模型中抑制胰腺癌和结直肠癌细胞增殖，I/II期试验正在评估，但因药代动力学问题已终止。②TH-Z816/TH-Z827/TH-Z835：以G12C抑制剂MRTX22为骨架，引入烷基胺基团与Asp12形成盐桥，选择性结合KRASG12D-GDP/GTP，阻断KRAS-RAF相互作用，抑制MAPK和PI3K/mTOR通路。◆ KRASG12D抑制性肽类(KS-58、NKTP-3)①NKTP-3：双靶点环肽，先结合癌细胞膜NRP1，再进入细胞与KRASG12D结合，抑制AKT和ERK磷酸化，在A427细胞异种移植模型中显著抗肿瘤，无明显毒性。②KS-58：KRpep-2d衍生物，通过双环结构阻断KRAS-SOS1和KRAS-BRAF相互作用，选择性抑制KRASG12D阳性细胞(如A427、PANC-1)增殖，体内模型中肿瘤缩小但药代动力学需优化。表2 KRASG12D抑制剂临床试验◆ 联合EGFR抑制剂的协同效应：CRC中KRASG12D突变依赖EGFR上游信号，MRTX1133联合西妥昔单抗可阻断反馈激活，在细胞模型中抑制PI3K/AKT和ERK磷酸化，延缓耐药发生。 No.3泛KRAS与通路靶向药物：突破突变亚型限制◆ 泛KRAS抑制剂①BI-2865：非共价结合KRAS非激活态，抑制G12D/V突变细胞增殖，通过阻止核苷酸交换发挥作用，但可能因激活其他RAS亚型(如HRAS/NRAS)导致耐药，对抑制作用较弱。②ADT-007：新型泛RAS抑制剂，在CRC小鼠模型中诱导肿瘤凋亡，机制为靶向RAS效应器结构域，对G12C/D/V突变均有效。 No.4新型疗法：从降解剂到免疫干预◆ KRAS(ON)抑制剂：靶向激活态KRAS通过“分子胶水”技术结合KRAS激活态(GTP-bound)，诱导其与免疫亲和素CyclophilinA(CYPA)形成稳定三元复合物，阻断KRAS与下游效应蛋白(如RAF)的相互作用，抑制下游信号传导。区别于KRAS(OFF)抑制剂(如Sotorasib)，KRAS(ON)抑制剂可靶向多种突变亚型(如G12D、G12V)，且不依赖KRAS的GDP结合状态。代表药物RMC-6236(G12C/D/V等突变)、RMC-9805(G12D)、RMC-6291、BBO-8520等。◆ PROTAC降解剂：诱导KRAS蛋白降解双功能分子通过E3泛素连接酶配体(如VHL)与KRAS结合域连接，招募E3酶标记KRAS蛋白，经蛋白酶体降解，实现靶向敲低。代表药物ASP3082(G12D)、XX4–88、ACBI3、LC-2等。◆ 抗RAS疫苗(GI-4000、TG02)①GI-4000：热灭活重组酵母表达KRAS突变肽，PhaseI试验显示可诱导T细胞应答，与PD-1抑制剂联用治疗KRAS突变型CRC的安全性已验证。②mRNA疫苗(mRNA-5671)：编码KRAS突变新抗原，刺激CD8+T细胞应答，正进行PhaseI试验评估联合pembrolizumab的疗效。◆ 核酸药物：剪接调控与ASO利用反义寡核苷酸(ASO)靶向KRAS突变转录本，或通过剪接调控诱导突变型KRAS降解。例如，针对KRASQ61K突变的剪接调节剂可选择性杀伤突变细胞，避免野生型KRAS抑制毒性。图12 KRAS抑制剂目前临床试验总结 No.5靶向KRAS信号通路的间接策略图13 靶向KRAS信号通路的间接策略◆ SOS1抑制剂①BI-3406：结合SOS1催化域，阻止其与KRAS相互作用，减少GTP-KRAS形成，对G12D/E/V突变肿瘤有效，与MEK抑制剂联用可增强疗效。②BAY-293：靶向SOS1表面口袋，阻断KRAS-SOS1复合物形成，与KRASG12D共价抑制剂联用有协同效应。◆ MEK抑制剂：单药疗效有限，但与免疫治疗(如抗PD-L1)联合可增强肿瘤微环境T细胞浸润。图14 RAS抑制剂表现出不同的作用机制◆ SHP2抑制剂①RMC-4550/SHP099：变构抑制SHP2，阻断SOS1介导的KRAS激活，降低RAS-ERK信号，对KRASG12D突变细胞敏感。②RMC-4630/TN0155：变构抑制SHP2，阻断RTK介导的KRAS激活，与KRASG12C抑制剂联用可降低RAS-ERK信号，克服反馈耐药，PhaseI/II试验正在进行中。◆ GRP78/HSP90抑制剂①HA15/YuW70：靶向ER分子伴侣GRP78，减少KRASG12D蛋白成熟，同时抑制PI3K、TGF-β等通路，诱导ER应激和细胞凋亡，对KRAS突变型CRC细胞具选择性毒性。图15 RAS抑制剂的临床阶段表3 靶向KRAS信号通路的间接策略RenyuBio仁域生物06KRAS耐药机制分类与联合治疗 No.1原发性耐药与KEAP1、SMARCA4、CDKN2A等基因突变相关，这些突变会导致患者对KRAS抑制剂治疗的临床结局更差，疾病早期进展风险升高。 No.2获得性耐药◆ “靶向”耐药机制(KRAS自身突变)①KRAS基因二次突变：KRASG12基因发生二次突变(如G12D、G12V)，或KRAS其他位点突变(如R68S、H95D)，阻止抑制剂结合或激活下游通路。②KRAS拷贝数扩增：突变型KRAS基因扩增或拷贝数增加，会增强信号输出，降低抑制剂的相对作用效率。◆ “非靶向”机制(旁路激活)①上游受体酪氨酸激酶(RTK)基因：如EGFR、MET，扩增或突变，激活KRAS非依赖的信号通路。②下游通路基因：如NRAS、BRAF、PI3KCA，激活突变，或抑癌基因(如PTEN)失活突变，绕过KRAS调控。③其他：基因融合(如EML4-ALK)或MET扩增，通过HGF/MET通路激活AKT和ERK。图16 KRAS抑制期间结直肠癌的耐药机制 No.3非遗传机制耐药◆ 生长因子受体(GFR)上游再激活：EGFR、HER2等RTK快速激活，增加KRAS突变型蛋白输出并激活野生型KRAS/NRAS，恢复MAPK信号。如Sotorasib治疗后48小时内可观察到ERK和RSK磷酸化升高。◆ 上皮-间质转化(EMT)：KRAS抑制剂诱导EMT，通过TGF-β信号增强肿瘤细胞迁移能力，同时激活PI3K/AKT通路，形成耐药微环境。◆ Wnt/β-catenin通路：Wnt/β-catenin通路与KRAS突变协同激活，促进肿瘤细胞存活。例如，β-catenin与突变KRAS结合可增强其稳定性，削弱抑制剂效果。◆ 血脑屏障(BBB)：BBB限制药物进入中枢神经系统(CNS)，导致脑转移灶药物浓度不足，形成局部耐药。◆ 肿瘤微环境(TME)：KRAS突变肿瘤的TME具有免疫抑制性，RAS抑制可短暂降低免疫抑制，增强免疫治疗敏感性，但具体耐药机制尚不明确。 No.4联合治疗策略为应对耐药问题，联合治疗策略不断发展，包括RTK抑制(如联合EGFR抑制剂)、SHP2抑制(联合SHP2抑制剂阻断RTK-RAS信号)、免疫与代谢靶向联合(如联合PD-1抑制剂重塑肿瘤微环境，或联合代谢调节剂诱导突变细胞能量危机)等。表4 临床试验中当前RAS抑制剂的单一和联合疗法RenyuBio仁域生物07挑战与未来方向 No.1当前瓶颈◆ 耐药机制复杂：KRAS抑制剂治疗后可出现H95/Y96突变、PI3K通路激活或YAP/TEAD核转位，需联合多靶点抑制。◆ 器官特异性差异：CRC中KRAS突变依赖EGFR反馈激活，而肺癌更依赖免疫微环境，需开发适配CRC生物学特征的联合方案。 No.2未来策略◆ 共价KRASG12D抑制剂开发：借鉴G12C抑制剂思路，设计与Asp12共价结合的分子，提升结合稳定性。◆ 液体活检动态监测：通过ctDNA追踪KRAS突变克隆演变，如治疗中出现G12D二次突变，及时切换至MRTX1133联合方案。◆ 代谢靶向联合：针对KRAS突变细胞的谷氨酰胺依赖，联用谷氨酰胺酶抑制剂(如CB-839)与KRAS抑制剂，诱导能量危机。RenyuBio仁域生物抗体发现服务 & 产品01羊驼免疫&骆驼免疫—自建现代化养殖农场02万亿级天然抗体库产品—轻松DIY科研抗体03配套产品—助您轻松搭建基因工程抗体平台参考文献Jiang M, Ma S, Xuan Y, Chen K. Synthetic approaches and clinical application of KRAS inhibitors for cancer therapy. Eur J Med Chem. 2025 Jul 5;291:117626.Dong P, Ni J, Zheng X, Wang M, Yang M, Han H. Small molecules for Kirsten rat sarcoma viral oncogene homolog mutant cancers: Past, present, and future. Eur J Pharmacol. 2025 Jun 5;996:177428. Isermann T, Sers C, Der CJ, Papke B. KRAS inhibitors: resistance drivers and combinatorial strategies. Trends Cancer. 2025 Feb;11(2):91-116. Takeda M, Yoshida S, Inoue T, Sekido Y, Hata T, Hamabe A, Ogino T, Miyoshi N, Uemura M, Yamamoto H, Doki Y, Eguchi H. The Role of KRAS Mutations in Colorectal Cancer: Biological Insights, Clinical Implications, and Future Therapeutic Perspectives. Cancers (Basel). 2025 Jan 27;17(3):428. Shi Y, Zheng H, Wang T, Zhou S, Zhao S, Li M, Cao B. Targeting KRAS: from metabolic regulation to cancer treatment. Mol Cancer. 2025 Jan 11;24(1):9. Liguori L, Salomone F, Viggiano A, Sabbatino F, Pepe S, Formisano L, Bianco R, Servetto A. KRAS mutations in advanced non-small cell lung cancer: From biology to novel therapeutic strategies. Crit Rev Oncol Hematol. 2025 Jan;205:104554. Cox AD, Der CJ. "Undruggable KRAS": druggable after all. Genes Dev. 2025 Jan 7;39(1-2):132-162.Deming DA. Development of KRAS Inhibitors and Their Role for Metastatic Colorectal Cancer. J Natl Compr Canc Netw. 2025 Jan 3;23(1):e247067. Zhao R, Shu Y, Xu W, Jiang F, Ran P, Pan L, Wang J, Wang W, Zhao J, Wang Y, Fu G. The efficacy of immunotherapy in non-small cell lung cancer with KRAS mutation: a systematic review and meta-analysis. Cancer Cell Int. 2024 Nov 1;24(1):361. Chour A, Toffart AC, Berton E, Duruisseaux M. Mechanisms of resistance to KRASG12C inhibitors in KRASG12C-mutated non-small cell lung cancer. Front Oncol. 2024 Sep 5;14:1328728.Tang Y, Pu X, Yuan X, Pang Z, Li F, Wang X. Targeting KRASG12D mutation in non-small cell lung cancer: molecular mechanisms and therapeutic potential. Cancer Gene Ther. 2024 Jul;31(7):961-969. Piazza GA, Chandrasekaran P, Maxuitenko YY, Budhwani KI. Assessment of KRASG12C inhibitors for colorectal cancer. Front Oncol. 2024 Jun 24;14:1412435.Tang M, Wu Y, Bai X, Lu Y. KRASG12C Inhibitors in Non-Small Cell Lung Cancer: A Review. Onco Targets Ther. 2024 Aug 24;17:683-695. 声明：发表/转载本文仅仅是出于传播信息的需要，并不意味着代表本公众号观点或证实其内容的真实性。据此内容作出的任何判断，后果自负。若有侵权，告知必删！长按关注本公众号粉丝群/投稿/授权/广告等请联系公众号助手觉得本文好看，请点这里↓

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2025-08-02

·靶点圈

一文带你读懂KRAS从“不可成药”到靶向突破的成功奥秘

01KRAS突变的生物学特征 No.1KRAS信号激活与突变机制◆ RAS基因家族：RAS基因家族包括HRAS、KRAS、NRAS，均为癌基因，其中KRAS是癌症中突变最频繁的亚型(占RAS突变的81%)，其次为NRAS(15%)和HRAS(4%)。◆ KRAS蛋白：是KRAS基因的产物，属于小GTP酶家族，在活性GTP结合状态(KRAS(ON))和失活GDP结合状态(KRAS(OFF))之间动态转换，调控细胞增殖、生存等信号。图1 KRAS GTPase蛋白序列和结构◆ KRAS激活：上游RTK(如EGFR)通过SOS1促进KRAS-GTP形成，下游激活RAF-MEK-ERK和PI3K-AKT等通路，驱动肿瘤发生。图2 KRAS的激活状态及其对信号通路的影响◆ KRAS突变：KRAS突变占人类癌症的20%以上，通过破坏GTP结合口袋的构象，导致GTP酶活性降低，维持KRAS持续激活状态，驱动肿瘤生长。 No.2KRAS突变类型与表达调控◆ KRAS突变类型与肿瘤分布：KRAS突变中约95%发生在G12位点，其次为G13(3–5%)和Q61(1–2%)。G12突变包括G12C、G12D、G12V、G12R、G12S等，其中G12C、G12D、G12V占所有KRAS突变的60–70%。①G12C：约13%，多见于非小细胞肺癌(12–15%)，在结直肠癌(2–3%)和胰腺癌(<1%)中罕见。②G12D：约26%，是结直肠癌(30–40%)和胰腺癌(40–50%)的最常见突变亚型。③G12V：约21%，在子宫内膜癌、卵巢癌中占比可达15–20%。图3 各种癌症类型的KRAS突变率◆ KRAS突变受非编码RNA的调控①长链非编码RNA(lncRNA)：lncRNA通过调控染色质重塑和转录因子活性，维持KRAS突变细胞的恶性表型。②微小RNA(miRNA)：miRNA通过靶向KRAS的3'UTR或下游通路组件，调节信号传导强度。 No.3KRAS突变对肿瘤微环境与代谢的影响◆ KRAS突变对肿瘤微环境与细胞行为影响①癌相关成纤维细胞(CAFs)重编程：KRAS激活TFCP2，诱导CAFs向脂质富集细胞分化，促进血管生成和肿瘤进展。②免疫微环境抑制：KRAS突变通过分泌TGF-β、IL-6等细胞因子，招募调节性T细胞(Treg)和髓系抑制细胞(MDSCs)，形成免疫抑制微环境，削弱抗肿瘤免疫应答。③癌症干细胞(CSCs)维持：KRAS突变激活CDK1，促进蛋白O-乙酰葡糖胺糖基化修饰，上调CSC标志物SOX2，增强肿瘤干细胞的自我更新和治疗耐药性。④巨胞饮作用(MP)激活：KRAS突变激活MP，增强细胞对营养物质的摄取，支持肿瘤在代谢压力下的生存。⑤细胞竞争与侵袭：KRAS突变激活NF-κB-MMP21通路，促进肿瘤细胞对邻近正常细胞的排斥和扩散浸润，增强肿瘤的侵袭性。图4 靶向致癌KRAS驱动的肿瘤中的代谢途径◆ KRAS突变促进代谢重编程①糖酵解与谷氨酰胺利用增强：KRAS突变上调己糖激酶、谷氨酰胺酶等酶活性，促进有氧糖酵解和谷氨酰胺分解，为肿瘤细胞提供能量和生物合成前体。②天冬氨酸代谢依赖：突变型KRAS激活PCK1、ASS1等酶，增强天冬氨酸和尿素循环代谢，维持核苷酸合成和氧化还原平衡，支持细胞快速增殖。图5 受致癌KRAS突变影响的KRAS蛋白和代谢途径 No.4KRAS突变的常用检测技术与局限◆ 检测方法①直接测序法(如Sanger测序)：敏感性低(需肿瘤细胞占比≥10–25%)，可检测未知突变。②BEAMing技术：敏感性高(可检测<1%突变)，但临床常规应用受成本限制。③焦磷酸测序(Pyrosequencing)：在FIRE-3试验中用于KRAS突变检测，灵敏度1–10%。④Luminex技术：敏感性约1–10%，在RASKET试验中用于KRAS突变分型◆ 临床局限性①样本质量影响：石蜡包埋样本的DNA降解可导致G>A、C>T伪突变，影响结果准确性。②异质性检测：部分KRAS突变呈亚克隆状态，突变等位基因频率低时易漏检。RenyuBio仁域生物02KRASG12C突变 No.1KRASG12C突变的分子特征该突变指KRAS蛋白第12位的甘氨酸被半胱氨酸取代，导致KRAS(OFF)状态积累。这种突变会通过空间位阻阻止GTP酶激活蛋白(GAPs)的相互作用，降低GTP酶活性，进而使活性KRASG12C-GTP蛋白(KRAS(ON))增多。图6 处于失活GDP结合状态的KRASG12C蛋白模型 No.2KRASG12C突变频率与分布◆ 肺癌方面：在非小细胞肺癌(NSCLC)中，KRASG12C突变约占13%-25%，在肺腺癌中更为常见。不同种族和性别存在差异，女性患者的突变率相对较高，且该突变与吸烟密切相关，多见于吸烟者。图7 NSCLC中的热点KRAS突变◆ 结直肠癌方面：在转移性结直肠癌(mCRC)中，KRASG12C突变发生率约为3%。在所有结直肠癌样本中，其突变频率低于G12D、G12V等突变类型，占比约3.4%。 No.3KRASG12C突变的相关临床特征◆ 肺癌临床特征：携带KRASG12C突变的NSCLC患者，肿瘤生长相对迅速，容易发生转移，常见转移部位包括脑等。患者对传统化疗和免疫疗法反应较差，预后不佳，生存期较短。◆ 结直肠癌临床特征：KRASG12C突变的结直肠癌患者，无进展生存期(PFS)较差，接受化疗时，一线化疗的中位PFS为6.4个月，二线为3.9个月，三线为3.0个月。与KRAS非G12C突变患者相比，总生存期(OS)更差。 No.4KRASG12C突变的分子机制与信号通路◆ 突变影响蛋白活性：正常情况下，KRAS蛋白通过结合GTP和GDP在激活和失活状态间转换，调控细胞生长和分化。KRASG12C突变导致第12位氨基酸由甘氨酸突变为半胱氨酸，使KRAS蛋白对GTP的亲和力增强，持续处于激活状态，无法正常调控细胞，促进肿瘤细胞的增殖和存活。◆ 激活下游信号通路：激活态的KRASG12C蛋白可激活下游的MAPK和PI3K-AKT等信号通路。如在MAPK通路中，激活RAF、MEK、ERK等，促进细胞增殖、分化和存活；在PI3K-AKT通路中，激活AKT，抑制细胞凋亡，增强细胞的生存能力。◆ 与其他基因的关系：在肺癌中，KRASG12C突变常与TP53、STK11等基因突变共存，但与EGFR突变、EML4-ALK融合等驱动突变互斥。在结直肠癌中，KRASG12C突变与其他驱动突变大多相互排斥，仅少数病例存在相关共突变。RenyuBio仁域生物03KRASG12D突变 No.1KRASG12D突变的分子特征与临床意义◆ 突变机制：KRASG12D突变指KRAS蛋白第12位甘氨酸被天冬氨酸取代，导致GTP酶活性降低，使KRAS持续处于GTP结合的激活状态，激活下游MAPK(如ERK)和PI3K-AKT信号通路，驱动细胞异常增殖。◆ 信号激活：突变蛋白通过与SOS1(鸟嘌呤核苷酸交换因子)结合，促进GDP向GTP转换，维持信号持续传导；同时，其天冬氨酸(Asp12)可与抑制剂形成盐桥，为药物设计提供靶点。◆ 与其他信号通路的交互①ERBB家族依赖：KRASG12D驱动的肿瘤依赖ERBB受体酪氨酸激酶(如EGFR)激活，抑制ERBB可增强MEK抑制剂疗效。②RhoA/Wnt信号：KRASG12D激活RhoA，抑制Wnt/β-catenin信号，减少肿瘤转移潜能。◆ 临床预后与治疗敏感性①预后争议：部分研究显示KRASG12D突变与更短的无进展生存期(PFS)和总生存期(OS)相关，但也有研究认为其预后影响与其他KRAS亚型无显著差异。②治疗响应：KRASG12D突变患者对贝伐珠单抗敏感性较低，且STK11/KEAP1共突变会削弱免疫治疗效果。 No.2KRASG12D相关信号通路与调控网络◆ 核心信号通路①ERBB-RAS-ERK轴：KRASG12D驱动的肿瘤依赖ERBB家族受体酪氨酸激酶(如EGFR)激活，抑制ERBB可增强MEK抑制剂疗效🔶4-44🔶。②SOS1-KRAS相互作用：SOS1作为鸟嘌呤核苷酸交换因子，促进KRASG12D的GTP结合，其抑制剂(如BI-3406)可阻断KRAS激活。◆ 非经典通路调控①RhoA/Wnt信号：KRASG12D通过抑制Wnt/β-catenin信号，减少肿瘤转移潜能。②NF-κB通路：KRASG12D与IKKα协同激活NF-κB，促进肿瘤生存，其抑制剂硼替佐米在侵袭性黏液腺癌中显示部分活性。RenyuBio仁域生物04不同KRAS突变亚型的差异(G12C vs G12D) No.1分子机制与信号通路差异◆ 构象与结合特性①G12C：突变产生的半胱氨酸可与抑制剂共价结合(如Sotorasib)，锁定KRAS于失活状态。②G12D：天冬氨酸(Asp12)通过盐桥与抑制剂结合(如MRTX1133)，但无法形成共价键，需依赖非共价相互作用。◆ 下游信号通路激活模式①G12C：主要激活RAF/MEK/ERK通路，对RALGDS结合影响较小。②G12D：因Asp12的空间位阻，干扰KRAS同源二聚体形成及RALGDS结合，导致RAL信号未激活。此外，G12D激活PI3K/AKT通路的能力更强，且依赖ERBB家族受体酪氨酸激酶(如EGFR)的上游信号。 No.2共突变模式差异◆ 常见共突变①G12C：常与TP53(17–50%)、KEAP1(6–23%)、STK11(10–28%)共突变。②G12D：合并STK11(15.9%)、TP53(33.6%)、KEAP1(9.4%)突变较多，其中STK11/KEAP1共突变与不良预后相关。◆ 与其他驱动突变的互斥性：均与EGFR突变、EML4-ALK融合互斥，但G12D突变与EGFR共突变率(11.6%)略高于G12C。 No.3药物开发策略差异◆ 抑制剂设计思路①G12C：利用半胱氨酸的共价结合特性开发抑制剂。②G12D：依赖非共价结合(如盐桥、氢键)，需设计与Asp12特异性作用的分子(如MRTX1133的吡啶并嘧啶骨架)。◆ 联合治疗策略：G12D因依赖ERBB信号，需联合EGFR抑制剂(如Erlotinib)增强疗效；而G12C更常与免疫治疗或SHP2抑制剂联用。RenyuBio仁域生物05KRAS靶向治疗进展与药物开发图8 KRAS的直接抑制剂 No.1KRASG12C抑制剂：从突破到局限◆ 作用机制：首款获批的KRASG12C抑制剂(如Sotorasib、Adagrasib)为“OFF状态”抑制剂，通过与KRASG12C(OFF)中突变的半胱氨酸12附近的变构结合口袋(P2口袋)共价结合，阻止GDP向GTP转换，从而抑制RAS-效应器相互作用。尽管KRASG12C突变会导致KRAS(ON)积累，但细胞中仍有25%的KRAS处于GDP结合的失活状态，这为抑制剂发挥作用提供了可能。图9 对OFF状态KRASG12C抑制剂的“靶向”和“脱靶”机制总结◆ 第一代抑制剂的突破与局限①Sotorasib(AMG510)：通过与G12C半胱氨酸共价结合，锁定其于失活状态(KRAS(OFF))。在NSCLC中ORR达33.3%，mPFS6.9个月，但在结直肠癌(CRC)中ORR仅约10%，联合Panitumumab在结直肠癌中mPFS达5.6个月。②Adagrasib(MRTX849)：选择性结合KRASG12C-GDP，II期试验显示NSCLC患者ORR为42.9%，联合Cetuximab使结直肠癌ORR提升至34%。③局限性：由于KRAS在GDP和GTP结合状态之间的动态“循环”，使得靶向GDP结合形式无法完全阻断致癌驱动。图10 KRASG12C的耐药机制◆ 第二代抑制剂的优化：提升靶点占有率、延长作用时间，克服第一代抑制剂的耐药问题(如H95D突变)①D-1553：一种新型口服强效KRASG12C抑制剂。I期研究中，NSCLC患者ORR达40.5%，DCR为91.9%，脑转移患者ORR17%(样本量6例)。安全性方面，94.9%的患者出现治疗相关不良事件，38.0%的患者发生3级或4级不良事件，多数不良事件可控。②GDC-6036(Divarasib)：亲和力比Sotorasib高5-20倍，单药ORR29.1%，联合Cetuximab在CRC中ORR达62.5%，mPFS8.1个月。③LY3537982(Olomorasib)：一种强效抑制剂，能实现持续的>90%的靶点占有率，对第一代抑制剂耐药患者仍有效。LOXO-RAS-20001试验显示安全性良好，颅内结果待公布。④FMC-376：能同时结合KRAS-GDP和GTP构象，对“ON”状态KRAS耐药突变的活性比Adagrasib高14-30倍，已进入I/II期临床试验。⑤IBI351：一种不可逆的KRASG12C共价抑制剂。II期研究确认ORR为46.6%，DCR为90.5%，脑转移患者疗效未单报。⑥D3S-001：快速靶标结合动力学，30分钟内实现>95%靶标占有率，对Sotorasib耐药模型有效，I期试验显示持久响应。表1 KRASG12 抑制剂在非小细胞肺癌中的应用◆ 联合治疗策略①EGFR抑制剂联用：Sotorasib联合EGFR抑制剂(如Erlotinib)在小鼠模型中可克服CRC中的EGFR反馈激活，使联合治疗ORR提升至43%，显著高于单药22%。②免疫治疗联合：Sotorasib可重塑肿瘤微环境为促炎状态，与PD-(L)1抑制剂联用在肺癌模型中增强疗效，但CRC中因免疫抑制微环境需进一步验证。图11 临床研究中增强KRASG12C系列抑制剂疗效的组合策略 No.2KRASG12D抑制剂：非共价结合的新探索◆ KRASG12D非共价小分子抑制剂①MRTX1133：非共价结合SwitchII口袋，抑制SOS1催化的核苷酸交换，阻断KRAS-GTP形成。临床前模型中抑制胰腺癌和结直肠癌细胞增殖，I/II期试验正在评估，但因药代动力学问题已终止。②TH-Z816/TH-Z827/TH-Z835：以G12C抑制剂MRTX22为骨架，引入烷基胺基团与Asp12形成盐桥，选择性结合KRASG12D-GDP/GTP，阻断KRAS-RAF相互作用，抑制MAPK和PI3K/mTOR通路。◆ KRASG12D抑制性肽类(KS-58、NKTP-3)①NKTP-3：双靶点环肽，先结合癌细胞膜NRP1，再进入细胞与KRASG12D结合，抑制AKT和ERK磷酸化，在A427细胞异种移植模型中显著抗肿瘤，无明显毒性。②KS-58：KRpep-2d衍生物，通过双环结构阻断KRAS-SOS1和KRAS-BRAF相互作用，选择性抑制KRASG12D阳性细胞(如A427、PANC-1)增殖，体内模型中肿瘤缩小但药代动力学需优化。表2 KRASG12D抑制剂临床试验◆ 联合EGFR抑制剂的协同效应：CRC中KRASG12D突变依赖EGFR上游信号，MRTX1133联合西妥昔单抗可阻断反馈激活，在细胞模型中抑制PI3K/AKT和ERK磷酸化，延缓耐药发生。 No.3泛KRAS与通路靶向药物：突破突变亚型限制◆ 泛KRAS抑制剂①BI-2865：非共价结合KRAS非激活态，抑制G12D/V突变细胞增殖，通过阻止核苷酸交换发挥作用，但可能因激活其他RAS亚型(如HRAS/NRAS)导致耐药，对抑制作用较弱。②ADT-007：新型泛RAS抑制剂，在CRC小鼠模型中诱导肿瘤凋亡，机制为靶向RAS效应器结构域，对G12C/D/V突变均有效。 No.4新型疗法：从降解剂到免疫干预◆ KRAS(ON)抑制剂：靶向激活态KRAS通过“分子胶水”技术结合KRAS激活态(GTP-bound)，诱导其与免疫亲和素CyclophilinA(CYPA)形成稳定三元复合物，阻断KRAS与下游效应蛋白(如RAF)的相互作用，抑制下游信号传导。区别于KRAS(OFF)抑制剂(如Sotorasib)，KRAS(ON)抑制剂可靶向多种突变亚型(如G12D、G12V)，且不依赖KRAS的GDP结合状态。代表药物RMC-6236(G12C/D/V等突变)、RMC-9805(G12D)、RMC-6291、BBO-8520等。◆ PROTAC降解剂：诱导KRAS蛋白降解双功能分子通过E3泛素连接酶配体(如VHL)与KRAS结合域连接，招募E3酶标记KRAS蛋白，经蛋白酶体降解，实现靶向敲低。代表药物ASP3082(G12D)、XX4–88、ACBI3、LC-2等。◆ 抗RAS疫苗(GI-4000、TG02)①GI-4000：热灭活重组酵母表达KRAS突变肽，PhaseI试验显示可诱导T细胞应答，与PD-1抑制剂联用治疗KRAS突变型CRC的安全性已验证。②mRNA疫苗(mRNA-5671)：编码KRAS突变新抗原，刺激CD8+T细胞应答，正进行PhaseI试验评估联合pembrolizumab的疗效。◆ 核酸药物：剪接调控与ASO利用反义寡核苷酸(ASO)靶向KRAS突变转录本，或通过剪接调控诱导突变型KRAS降解。例如，针对KRASQ61K突变的剪接调节剂可选择性杀伤突变细胞，避免野生型KRAS抑制毒性。图12 KRAS抑制剂目前临床试验总结 No.5靶向KRAS信号通路的间接策略图13 靶向KRAS信号通路的间接策略◆ SOS1抑制剂①BI-3406：结合SOS1催化域，阻止其与KRAS相互作用，减少GTP-KRAS形成，对G12D/E/V突变肿瘤有效，与MEK抑制剂联用可增强疗效。②BAY-293：靶向SOS1表面口袋，阻断KRAS-SOS1复合物形成，与KRASG12D共价抑制剂联用有协同效应。◆ MEK抑制剂：单药疗效有限，但与免疫治疗(如抗PD-L1)联合可增强肿瘤微环境T细胞浸润。图14 RAS抑制剂表现出不同的作用机制◆ SHP2抑制剂①RMC-4550/SHP099：变构抑制SHP2，阻断SOS1介导的KRAS激活，降低RAS-ERK信号，对KRASG12D突变细胞敏感。②RMC-4630/TN0155：变构抑制SHP2，阻断RTK介导的KRAS激活，与KRASG12C抑制剂联用可降低RAS-ERK信号，克服反馈耐药，PhaseI/II试验正在进行中。◆ GRP78/HSP90抑制剂①HA15/YuW70：靶向ER分子伴侣GRP78，减少KRASG12D蛋白成熟，同时抑制PI3K、TGF-β等通路，诱导ER应激和细胞凋亡，对KRAS突变型CRC细胞具选择性毒性。图15 RAS抑制剂的临床阶段表3 靶向KRAS信号通路的间接策略RenyuBio仁域生物06KRAS耐药机制分类与联合治疗 No.1原发性耐药与KEAP1、SMARCA4、CDKN2A等基因突变相关，这些突变会导致患者对KRAS抑制剂治疗的临床结局更差，疾病早期进展风险升高。 No.2获得性耐药◆ “靶向”耐药机制(KRAS自身突变)①KRAS基因二次突变：KRASG12基因发生二次突变(如G12D、G12V)，或KRAS其他位点突变(如R68S、H95D)，阻止抑制剂结合或激活下游通路。②KRAS拷贝数扩增：突变型KRAS基因扩增或拷贝数增加，会增强信号输出，降低抑制剂的相对作用效率。◆ “非靶向”机制(旁路激活)①上游受体酪氨酸激酶(RTK)基因：如EGFR、MET，扩增或突变，激活KRAS非依赖的信号通路。②下游通路基因：如NRAS、BRAF、PI3KCA，激活突变，或抑癌基因(如PTEN)失活突变，绕过KRAS调控。③其他：基因融合(如EML4-ALK)或MET扩增，通过HGF/MET通路激活AKT和ERK。图16 KRAS抑制期间结直肠癌的耐药机制 No.3非遗传机制耐药◆ 生长因子受体(GFR)上游再激活：EGFR、HER2等RTK快速激活，增加KRAS突变型蛋白输出并激活野生型KRAS/NRAS，恢复MAPK信号。如Sotorasib治疗后48小时内可观察到ERK和RSK磷酸化升高。◆ 上皮-间质转化(EMT)：KRAS抑制剂诱导EMT，通过TGF-β信号增强肿瘤细胞迁移能力，同时激活PI3K/AKT通路，形成耐药微环境。◆ Wnt/β-catenin通路：Wnt/β-catenin通路与KRAS突变协同激活，促进肿瘤细胞存活。例如，β-catenin与突变KRAS结合可增强其稳定性，削弱抑制剂效果。◆ 血脑屏障(BBB)：BBB限制药物进入中枢神经系统(CNS)，导致脑转移灶药物浓度不足，形成局部耐药。◆ 肿瘤微环境(TME)：KRAS突变肿瘤的TME具有免疫抑制性，RAS抑制可短暂降低免疫抑制，增强免疫治疗敏感性，但具体耐药机制尚不明确。 No.4联合治疗策略为应对耐药问题，联合治疗策略不断发展，包括RTK抑制(如联合EGFR抑制剂)、SHP2抑制(联合SHP2抑制剂阻断RTK-RAS信号)、免疫与代谢靶向联合(如联合PD-1抑制剂重塑肿瘤微环境，或联合代谢调节剂诱导突变细胞能量危机)等。表4 临床试验中当前RAS抑制剂的单一和联合疗法RenyuBio仁域生物07挑战与未来方向 No.1当前瓶颈◆ 耐药机制复杂：KRAS抑制剂治疗后可出现H95/Y96突变、PI3K通路激活或YAP/TEAD核转位，需联合多靶点抑制。◆ 器官特异性差异：CRC中KRAS突变依赖EGFR反馈激活，而肺癌更依赖免疫微环境，需开发适配CRC生物学特征的联合方案。 No.2未来策略◆ 共价KRASG12D抑制剂开发：借鉴G12C抑制剂思路，设计与Asp12共价结合的分子，提升结合稳定性。◆ 液体活检动态监测：通过ctDNA追踪KRAS突变克隆演变，如治疗中出现G12D二次突变，及时切换至MRTX1133联合方案。◆ 代谢靶向联合：针对KRAS突变细胞的谷氨酰胺依赖，联用谷氨酰胺酶抑制剂(如CB-839)与KRAS抑制剂，诱导能量危机。RenyuBio仁域生物抗体发现服务 & 产品01羊驼免疫&骆驼免疫—自建现代化养殖农场02万亿级天然抗体库产品—轻松DIY科研抗体03配套产品—助您轻松搭建基因工程抗体平台仁域生物成都仁域生物成立于2019年1月，是一家专注基因工程抗体技术和天然抗体库开发的公司，拥有优化的噬菌体展示抗体库技术和现代化的骆驼/羊驼养殖免疫基地。可为客户提供14天、100%成功率的先导抗体分子发现服务，彻底解决传统抗体定制的周期长、失败率高、成本高三大难题。目前已经成功完成300+靶点抗体筛选项目！protocol 获取 / 产品咨询邮箱｜find@renyubio.com电话｜19136178673地址｜成都市经开区科技产业孵化园关注我们，持续更新相关内容参考文献Jiang M, Ma S, Xuan Y, Chen K. 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2025-07-29

·ioncology

ESMO 2025丨标题公布！消化道肿瘤领域口头报告一文速览

点击蓝字关注我们编者按2025年欧洲肿瘤内科学会年会（ESMO 2025）将于10月17~21日在德国柏林盛大举行。作为全球肿瘤学领域最具影响力的学术盛会之一，本届大会将集中呈现肿瘤诊疗领域的突破性研究进展。目前，大会官网已公布除LBA（Late-breaking Abstract）摘要外的全部入选研究标题。本文系统梳理了消化系统肿瘤领域Proffered Paper session和Mini oral session部分前沿成果，涵盖结直肠癌、胃癌、肝癌、胰腺癌、神经内分泌肿瘤等主要癌种，旨在为临床工作者和研究人员构建完整的研究进展图谱。期待ESMO 2025正式召开时，更多重磅数据的发布有望为全球消化系统肿瘤诊疗实践带来革命性突破。上消化道肿瘤Proffered Paper session 摘要号：2094O英文标题：SKYSCRAPER-07: A phase Ⅲ, randomised study of atezolizumab (atezo) with or without tiragolumab (tira) in patients (pts) with unresectable esophageal squamous cell carcinoma (ESCC) that has not progressed following definitive concurrent chemoradiotherapy (dCRT)中文标题：SKYSCRAPER-07：阿替利珠单抗（Atezo）联合或不联合Tiragolumab（Tira）治疗接受过根治性同步放化疗（dCRT）后未进展的不可切除食管鳞癌（ESCC）患者的Ⅲ期随机研究讲者：Ian Chau (Sutton, United Kingdom)Mini oral session 摘要号：2095MO 英文标题：Pembrolizumab and trastuzumab in combination with FLOT in the perioperative treatment of HER2-positive localized esophagogastric adenocarcinoma – Interim Analysis of the phase Ⅱ PHERFLOT/IKF-053 trial of the AIO study group (AIO STO 0321)中文标题：帕博利珠单抗联合曲妥珠单抗及FLOT方案用于HER2阳性局部食管胃腺癌围手术期治疗——AIO研究组Ⅱ期PHERFLOT/IKF-053试验的阶段性分析（AIO STO 0321）讲者：Eray Goekkurt (Hamburg, Germany)***************************************************************摘要号：2096MO英文标题：Systemic Therapy, Gastrectomy and CRS/HIPEC vs Systemic Therapy Alone for Gastric Cancer with Limited Peritoneal Dissemination: Results of the Randomised PERISCOPE Ⅱ Trial.中文标题：系统治疗、胃切除术联合CRS/HIPEC对比单纯系统治疗用于局限性腹膜播散胃癌：随机化PERISCOPE Ⅱ试验结果讲者：Judith S. Quik (Amsterdam, Netherlands)***************************************************************摘要号：1469MO英文标题：Liver resection versus continued atezolizumab plus bevacizumab (atezo/bev) in locally advanced hepatocellular carcinoma (HCC) after atezo/bev treatment (TALENTop): a multicenter, open-label, randomized phase Ⅲ trial.中文标题：局部晚期肝细胞癌（HCC）患者接受Atezo/Bev治疗后，肝切除术对比继续Atezo/Bev治疗（TALENTop）：多中心、开放标签、随机Ⅲ期试验讲者：Hui-Chuan Sun (Shanghai, China)讲者：复旦大学附属中山医院孙惠川***************************************************************摘要号：1470MO英文标题：Perioperative Camrelizumab plus Rivoceranib in Resectable Hepatocellular Carcinoma (CARES-009): A Randomized, Multicenter, Phase 3 Trial中文标题：围手术期卡瑞利珠单抗联合瑞戈非尼治疗可切除肝细胞癌（CARES-009）：随机、多中心、Ⅲ期试验讲者：复旦大学附属中山医院周俭***************************************************************摘要号：1471MO英文标题：Adding Ipilimumab (IPI) to Atezolizumab (ATEZO) plus Bevacizumab (BEV) in patients (pts) with unresectable hepatocellular carcinoma (uHCC) in first-line systemic therapy (1L): PRODIGE 81/FFCD 2101 - TRIPLET HCC中文标题：伊匹木单抗（IPI）联合阿替利珠单抗（ATEZO）和贝伐珠单抗（BEV）用于不可切除肝细胞癌（uHCC）的一线系统治疗（1L）：PRODIGE 81/FFCD 2101 - TRIPLET HCC试验讲者：Philippe Merle (LYON, France)***************************************************************摘要号：2214MO 英文标题：Phase 1 basket study of telisotuzumab adizutecan (ABBV-400; Temab-A), a c-Met protein–targeting antibody-drug conjugate: Results from patients (pts) with pancreatic ductal adenocarcinoma (PDAC)中文标题：针对c-Met蛋白的抗体药物偶联物Telisotuzumab Adizutecan（ABBV-400; Temab-A）的Ⅰ期篮式研究：胰腺导管腺癌（PDAC）患者的结果讲者：James J. Harding (New York, United States of America)***************************************************************摘要号：2215MO英文标题：HRS-4642 Combined with Gemcitabine and Nab-paclitaxel in KRAS-G12D Mutant Advanced Pancreatic Cancer: A Phase 1b/2 Study中文标题：HRS-4642联合吉西他滨和白蛋白结合型紫杉醇治疗KRAS-G12D突变晚期胰腺癌：1b/2期研究讲者：上海交通大学医学院附属仁济医院王理伟教授***************************************************************摘要号：2216MO英文标题：VIRAGE trial: randomized Phase Ⅱb, open-label, study of Nab-Paclitaxel and Gemcitabine with/without intravenous VCN-01 in Patients with Metastatic Pancreatic Cancer (mPDAC)中文标题：VIRAGE试验：随机Ⅱb期、开放标签研究，评估白蛋白结合型紫杉醇联合吉西他滨±静脉VCN-01治疗转移性胰腺癌（mPDAC）讲者：Rocio Garcia-Carbonero (Madrid, Spain)下消化道肿瘤Proffered paper session摘要号：726O英文标题：Prognostic value of the Combined Analysis of Pathologists and Artificial Intelligence (CAPAI) in high-risk stage Ⅱ-Ⅲ colon cancer treated without chemotherapy: interim report from a nationwide validation中文标题：病理学家与人工智能联合分析（CAPAI）对未接受化疗的高危Ⅱ-Ⅲ期结肠癌的预后价值：全国验证的阶段性报告讲者：Marie-Christine E. Bakker (Utrecht, Netherlands)***************************************************************摘要号：723O英文标题：Post-surgical liquid biopsy-guided treatment of stage Ⅲ and high-risk stage Ⅱ colon cancer patients: final results of the PEGASUS trial.中文标题：术后液体活检指导的Ⅲ期及高危Ⅱ期结肠癌治疗：PEGASUS试验最终结果讲者：Silvia Marsoni (Milan, Italy, (TO))***************************************************************摘要号：724O英文标题：Comparison of outcomes in clinical trials of locally advanced dMMR colon cancer: FOxTROT and NICHE-2中文标题：局部晚期dMMR结肠癌临床试验结果比较：FOxTROT与NICHE-2讲者：Jenny Seligmann (Leeds, United Kingdom, Yorkshire)***************************************************************摘要号：725O英文标题：Leveraging Artificial Intelligence to predict immune checkpoint inhibitor (ICI) efficacy in proficient MMR mCRC: translational analyses of AtezoTRIBE and AVETRIC trials中文标题：利用人工智能预测免疫检查点抑制剂（ICI）在MMR熟练型转移性结直肠癌（mCRC）中的疗效：AtezoTRIBE和AVETRIC试验的转化分析讲者：Martina Carullo (Pisa, Italy)Mini oral session摘要号：1MO英文标题：Placental features overexpression reveals hidden facets of early-onset colorectal cancer中文标题：胎盘特征过度表达揭示早发性结直肠癌的隐藏面讲者：Gianluca Mauri (Milan, Italy)***************************************************************摘要号：727MO英文标题：FOLFOX plus PANITUMUMAB (Pmab) according to a “stop-and-go” strategy in first-line in patients (pts) with non-mutated RAS/BRAF metastatic colorectal cancer (mCRC). Results of the FFCD 1605 – OPTIPRIME phase Ⅱ trial.中文标题： FOLFOX联合帕尼单抗（Pmab）"stop-and-go"策略治疗RAS/BRAF野生型转移性结直肠癌（mCRC）患者的一线治疗：FFCD 1605-OPTIPRIME Ⅱ期试验结果讲者：Jean-Baptiste Bachet (Paris, France)***************************************************************摘要号：728MO英文标题：Predictive Value of Low-Frequency Resistance Mutations and Relative Mutant Allele Frequencies (rMAFs) in Anti-EGFR Rechallenge for RAS/BRAF Wild-Type (wt) Metastatic Colorectal Cancer (mCRC)中文标题：低频耐药突变及相对突变等位基因频率（rMAFs）在RAS/BRAF野生型转移性结直肠癌（mCRC）抗EGFR再挑战中的预测价值讲者：Pau Mascaró Baselga (Barcelona, Spain)***************************************************************摘要号：729MO英文标题：Circulating tumor (ct) DNA analysis of BRAF V600E dynamics and changes in genomic landscape in patients (pts) with first-line (1L) BRAF V600E-mutant metastatic colorectal cancer (mCRC) treated in BREAKWATER中文标题：循环肿瘤（ct）DNA分析BRAF V600E动态及基因组图谱变化：BREAKWATER试验中一线（1L）BRAF V600E突变转移性结直肠癌（mCRC）患者讲者：Scott Kopetz (Houston, United States of America)***************************************************************摘要号：730MO英文标题：Trifluridine/Tipiracil in combination with Capecitabine and Bevacizumab as upfront treatment for metastatic colorectal cancer: first results of the phase Ⅱ TriComB study by GONO中文标题：曲氟尿苷/替匹嘧啶联合卡培他滨和贝伐珠单抗作为转移性结直肠癌的初始治疗：GONO Ⅱ期TriComB研究的初步结果讲者：Veronica Conca (Pisa, Italy)***************************************************************摘要号：731MO英文标题：Telisotuzumab adizutecan (ABBV-400; Temab-A) in combination with bevacizumab (Bev) vs standard of care (SOC) in patients (pts) with 3L+ colorectal cancer (CRC): Dose expansion results of a phase 1 study中文标题：Telisotuzumab Adizutecan（ABBV-400; Temab-A）联合贝伐珠单抗（Bev）对比标准治疗（SOC）用于3线及以上结直肠癌（CRC）：Ⅰ期研究剂量扩展结果讲者：Michael Cecchini (New Haven, United States of America)神经内分泌肿瘤与内分泌肿瘤Proffered Paper session摘要号：1705O英文标题：LITESPARK-015: Belzutifan in advanced pheochromocytoma and paraganglioma中文标题：LITESPARK-015：Belzutifan治疗晚期嗜铬细胞瘤和副神经节瘤讲者：Camilo Jimenez (Houston, United States of America)***************************************************************摘要号：1706O英文标题：Efficacy, safety and subgroup analysis of 177Lu-edotreotide vs everolimus in patients with Grade 1 or Grade 2 GEP-NETs: Phase 3 COMPETE trial中文标题：177Lu-edotreotide对比依维莫司治疗1~2级胃肠胰神经内分泌肿瘤（GEP-NETs）的疗效、安全性及亚组分析：Ⅲ期COMPETE试验讲者：Jaume Capdevila (Barcelona, Spain)***************************************************************摘要号：2987O英文标题：Efficacy and Safety of Dabrafenib Plus Trametinib (D+T) in Patients With Radioactive Iodine (RAI)-Refractory BRAF V600-Mutant Differentiated Thyroid Cancer (DTC)中文标题：达拉非尼联合曲美替尼（D+T）治疗放射性碘（RAI）难治性BRAF V600突变分化型甲状腺癌（DTC）的疗效与安全性讲者：津市人民医院高明教授Mini oral session摘要号：1707MO英文标题：A Phase 2 Dose Expansion Study of ZG006, a Trispecific T Cell Engager Targeting DLL3/DLL3/CD3, as Monotherapy in Patients with Refractoy Neuroendocrine Carcinoma中文标题：ZG006（靶向DLL3/DLL3/CD3的三特异性T细胞衔接器）单药治疗难治性神经内分泌癌的Ⅱ期剂量扩展研究讲者：中国人民解放军总医院赵传华***************************************************************摘要号：1708MO英文标题：ZG005 in combination with etoposide and cisplatin for the first-line treatment of advanced neuroendocrine carcinoma中文标题：ZG005联合依托泊苷和顺铂用于晚期神经内分泌癌的一线治疗讲者：Sisi Ye (Beijing, China)***************************************************************摘要号：1709MO英文标题：Multi-center NCI-sponsored phase 1 study of triapine in combination with 177Lu-dotatate in patients with well-differentiated gastroenteropancreatic neuroendocrine tumours (GEP-NETs)中文标题：多中心NCI资助的Ⅰ期研究：Triapine联合177Lu-dotatate治疗分化良好的胃肠胰神经内分泌肿瘤（GEP-NETs）讲者：Aman Chauhan (Deerfield Beach, United States of America)***************************************************************摘要号：1033MO英文标题：[212Pb]VMT-α-NET targeted alpha-particle therapy (TAT) for advanced somatostatin receptor 2 positive (SSTR2+) neuroendocrine tumours (NETs): mature safety and preliminary efficacy for enrollment from dose-finding cohorts 1 and 2 (n=44)中文标题：[212Pb]VMT-α-NET靶向α粒子治疗（TAT）用于晚期生长抑素受体2阳性（SSTR2+）神经内分泌肿瘤（NETs）：剂量探索队列1和2（n=44）的成熟安全性和初步疗效讲者：Thorvardur R. Halfdanarson (Rochester, United States of America)***************************************************************摘要号：1034MO英文标题：Long-term Follow-up of Peptide Receptor Radionuclide Therapy (PRRT)-Naïve Patients with Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs) Treated with Targeted Alpha Therapy 212Pb-DOTAMTATE in the Phase 2 ALPHAMEDIX 02 Trial中文标题：212Pb-DOTAMTATE靶向α治疗在未接受过肽受体放射性核素治疗（PRRT）的胃肠胰腺神经内分泌肿瘤（GEP-NETs）患者中的长期随访：一项Ⅱ期ALPHAMEDIX 02临床试验结果讲者：Jonathan R. Strosberg (Tampa, United States of America)***************************************************************摘要号：1035MO英文标题：A Prediction Tool for Malnutrition and Sarcopenia in Patients with Gastroenteropancreatic (GEP) Neuroendocrine Neoplasms (NENs): Results from NUTRIGETNE (GETNE-S2109) Study中文标题：胃肠胰神经内分泌肿瘤（NENs）患者营养不良和肌肉减少症的预测工具：NUTRIGETNE（GETNE-S2109）研究结果讲者：Maribel Del Olmo (Valencia, Spain)***************************************************************摘要号：1710MO英文标题：Belzutifan for Advanced Pancreatic Neuroendocrine Tumors (panNETs): Results From Cohort A2 of the Phase 2 LITESPARK-015 Study中文标题：Belzutifan治疗晚期胰腺神经内分泌肿瘤（panNETs）：Ⅱ期LITESPARK-015研究A2队列结果讲者：Jaume Capdevila (Barcelona, Spain)***************************************************************摘要号：2988MO英文标题：Patient-Derived Organoids Predict Clinical Response and Guide Personalized Therapy in Advanced Thyroid Cancer中文标题：患者来源的类器官预测晚期甲状腺癌临床反应并指导个性化治疗讲者：Jiaye Liu (Chengdu, China)（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2期临床3期临床结果临床成功

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外链

KEGG	Wiki	ATC	Drug Bank
D05350	帕尼单抗	L01XC08	DB01269

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
KRAS G12C突变结直肠癌	美国	Amgen, Inc.	2025-01-16
KRAS 野生型结直肠癌	美国	Amgen, Inc.	2014-05-23
结直肠癌	日本	Takeda Pharmaceutical Co., Ltd.	2010-04-16
RAS 野生型结直肠癌	澳大利亚	Amgen Australia Pty Ltd.	2008-05-14
转移性结直肠癌	美国	Amgen, Inc.	2006-09-27

未上市

10 条进展最快的记录,

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适应症	最高研发状态	国家/地区	公司	日期
大肠腺癌	临床3期	美国	Amgen, Inc.	2018-02-27
遗传性非息肉病性结直肠癌1型	临床3期	美国	Amgen, Inc.	2018-02-27
NRAS 野生型结直肠癌	临床3期	日本	Takeda Pharmaceutical Co., Ltd.	2015-05-29
转移性食管鳞状细胞癌	临床3期	德国	Amgen, Inc.	2012-05-01
KRAS 突变结直肠癌	临床3期	美国	Amgen, Inc.	2010-02-02
KRAS 突变结直肠癌	临床3期	澳大利亚	Amgen, Inc.	2010-02-02
KRAS 突变结直肠癌	临床3期	比利时	Amgen, Inc.	2010-02-02
KRAS 突变结直肠癌	临床3期	加拿大	Amgen, Inc.	2010-02-02
KRAS 突变结直肠癌	临床3期	捷克	Amgen, Inc.	2010-02-02
KRAS 突变结直肠癌	临床3期	法国	Amgen, Inc.	2010-02-02

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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


EUCTR2016-001490-33-FR (PANIRINOX-UCGI28, ESMO_GI2025)	临床2期	RAS/BRAF wild-type \| circulating DNA (cirDNA)	-	Panitumumab + FOLFIRINOX	壓鏇簾壓遞壓積餘鏇壓(壓窪夢憲網願簾顧顧齋) = 糧築夢顧積範壓鹹遞獵範構窪繭糧遞築鑰簾鹽 (網夢製鑰壓繭鏇範襯蓋 ) 更多	不佳	2025-07-05
EUCTR2016-001490-33-FR (PANIRINOX-UCGI28, ESMO_GI2025)	临床2期	RAS/BRAF wild-type \| circulating DNA (cirDNA)	-	Panitumumab + mFOLFOX6	壓鏇簾壓遞壓積餘鏇壓(壓窪夢憲網願簾顧顧齋) = 觸鏇鹹艱簾襯襯糧窪膚範構窪繭糧遞築鑰簾鹽 (網夢製鑰壓繭鏇範襯蓋 ) 更多	不佳	2025-07-05
BEACON and BREAKWATER (ESMO_GI2025)	N/A	BRAF V600E突变结直肠癌二线 \| 三线 BRAF V600E	43	Panitumumab plus Encorafenib	鬱顧艱製鏇廠糧艱蓋鬱(願鹹餘艱製築鹽製鹹壓) = 7% 糧範夢壓膚鹽鹹艱鏇繭 (膚襯壓製製齋願壓構觸 ) 更多	积极	2025-07-03
AGEO group (ESMO_GI2025)	N/A	BRAF V600E突变结直肠癌	20	Cetuximab (CET)	製醖鹽繭艱糧衊壓簾鏇(鹽醖積獵廠獵衊鑰齋衊) = 5% 積壓鏇淵餘獵製憲構築 (願顧鏇艱觸齋鏇壓築餘 ) 更多	积极	2025-07-03
NCT05198934 (CodeBreaK 300 \| CodeBreak300, NEWS \| Pubmed) 人工标引	临床3期	KRAS G12C突变结直肠癌 KRAS G12C	160	960 mg索托拉西布联合帕尼单抗	積襯鏇膚鹹夢廠選鹹構(觸鑰觸壓築齋醖製願蓋) = 醖鹹範鬱餘築範衊獵顧選艱網網淵觸繭淵繭鬱 (鑰窪繭憲構構鹽鏇淵願 ) 更多	积极	2025-05-07
	临床3期	KRAS G12C突变结直肠癌 KRAS G12C	160	240 mg索托拉西布联合帕尼单抗	積襯鏇膚鹹夢廠選鹹構(觸鑰觸壓築齋醖製願蓋) = 蓋顧蓋觸餘鹹積製製鏇選艱網網淵觸繭淵繭鬱 (鑰窪繭憲構構鹽鏇淵願 ) 更多	积极	2025-05-07
NCT01814501 (CTgov)	临床2期	印戒细胞癌 \| 粘液腺癌 \| 复发性结肠癌 ... 更多	16	Leucovorin Calcium+irinotecan hydrochloride+fluorouracil+panitumumab	鹹鹽廠網鑰製壓鑰壓網(膚窪齋鬱製襯繭願糧選) = 窪醖遞鏇壓觸齋襯簾齋繭廠鏇鏇壓壓糧願糧艱 (淵夢淵願窪憲繭餘鬱壓, 艱顧夢壓構糧築醖鹽齋 ~ 構夢願餘繭鑰顧鑰窪顧) 更多	-	2025-02-05
NCT04117945 (CTgov)	临床2期	遗传性非息肉病性结直肠癌1型 \| 转移性结直肠癌	22	Regorafenib (Arm A (Regorafenib))	遞顧鏇築窪願網艱構獵(夢簾衊構齋遞窪憲餘蓋) = 憲鏇觸蓋願齋蓋醖夢觸艱夢選憲淵蓋窪醖糧願 (觸鹹醖製齋齋廠觸鬱夢, 淵遞鹽願廠膚窪觸鬱選 ~ 選簾範鹹艱鏇蓋艱襯齋) 更多	-	2024-09-27
NCT04117945 (CTgov)	临床2期	遗传性非息肉病性结直肠癌1型 \| 转移性结直肠癌	22	Cetuximab+Irinotecan+Panitumumab (Arm B (Cetuximab, Panitumumab, Irinotecan))	遞顧鏇築窪願網艱構獵(夢簾衊構齋遞窪憲餘蓋) = 願顧壓簾觸遞憲鑰鹽網艱夢選憲淵蓋窪醖糧願 (觸鹹醖製齋齋廠觸鬱夢, 鏇夢艱壓網網醖淵顧範 ~ 夢鏇襯醖遞願遞遞襯憲) 更多	-	2024-09-27
NCT03043950 (VALIDATE, ESMO2024) 人工标引	N/A	RAS 野生型结直肠癌一线	611	Panitumumab plus FOLFIRI/FOLFOX	齋選鏇鑰鏇艱艱膚願夢(顧範膚壓蓋選糧蓋餘鹹) = 繭艱齋壓醖糧壓網夢壓醖獵蓋簾鏇夢製鏇鏇襯 (獵顧夢構膚積遞構窪窪, 24.8 ~ 29.2) 更多	积极	2024-09-16
NCT04185883 (CodeBreaK 101, ESMO2024) 人工标引	临床1期	KRAS G12C突变结直肠癌一线 KRAS G12C–mutated	40	Sotorasib (soto) + Panitumumab (pani) + FOLFIRI	衊網顧膚顧淵餘鬱醖廠(觸積簾醖鏇襯襯壓淵夢) = 網鹽簾鬱顧願遞積構夢鏇窪淵鏇蓋構構鹽遞糧 (夢鹽鏇鏇齋選衊膚構遞 ) 更多	积极	2024-09-15
NCT01581840 (FFCD 0904, CTgov)	临床1/2期	肛门鳞状细胞癌 \| 肛门上皮内瘤变	45	radiochemotherapy+Panitumumab	鑰製淵築積製壓醖鹽醖 = 鏇夢醖淵憲鹹夢齋齋鹽願夢淵積廠壓鑰鏇壓繭 (願鹽鏇獵積膚鬱獵獵艱, 繭製憲廠鑰顧憲製淵鬱 ~ 廠淵簾鏇鏇膚觸襯製築) 更多	-	2024-07-01
NCT04737187 \| NCT05198934 \| NCT04185883 (SUNLIGHT, ESMO_GI2024) 人工标引	N/A	转移性结直肠癌	-	Sotorasib 960mg (soto960) Plus Panitumumab (pani)	選壓網鑰壓鏇鑰築醖鹽(齋鏇醖艱鹽壓淵蓋獵壓) = 鏇艱廠鹹衊壓壓範積淵積夢齋壓築醖醖蓋鏇糧 (獵艱淵鑰選蓋鏇構艱鹹 ) 更多	积极	2024-06-27
	N/A	转移性结直肠癌	-	Trifluridine/Tipiracil(T/T) PlusBevacizumab (bev)	選壓網鑰壓鏇鑰築醖鹽(齋鏇醖艱鹽壓淵蓋獵壓) = 衊築壓構製鬱膚夢鑰夢積夢齋壓築醖醖蓋鏇糧 (獵艱淵鑰選蓋鏇構艱鹹 ) 更多	积极	2024-06-27