Mifamurtide

根据世界卫生组织（WHO）国际癌症研究所发布的数据，乳腺癌已在2020年取代肺癌成为全球第一大肿瘤，严重威胁女性健康。在中国，乳腺癌发病率同样位居女性恶性肿瘤之首；且中国乳腺癌患者的发病高峰年龄在45-54岁，比欧美国家提前10年左右。国家卫健委《乳腺癌诊疗指南（2022年版）》和中国抗癌协会《乳腺癌诊治指南与规范（2024年版）》均建议，风险人群应在40岁起接受乳腺癌筛查，高危人群可将筛查起始年龄提前到40岁之前1,2。尽管发病率较高，但乳腺癌也是众多恶性肿瘤中治疗选择较多、预后较好的癌种之一。根据2018年发布的全球癌症生存率变化趋势监测研究报告（CONCORD-3），中国乳腺癌患者在2000-2014年期间的5年生存率为83.2%，是中国5年生存率最高的癌种；但这一数据仍低于美国（90.2%）、澳大利亚（89.5%）、日本（89.4%）等发达国家3。近年来，随着分子机制研究的持续深入和新药研发的不断进展，乳腺癌诊疗领域引入了诸多新理念。以抗体偶联药物（ADC）为代表的创新疗法为广大患者提供了更为精准化、个体化的管理方案，进一步提升了乳腺癌患者的生存预后和生活质量，有望帮助更多患者实现治愈、回归社会生活。01分子分型与系统治疗根据患者是否有基因突变，激素受体和细胞分子状态，乳腺癌可分为HER2阴性（Luminal A和Luminal B）、HER2阳性（HER2+/HR-和HER2+/HR+）和三阴性乳腺癌（TNBC）。来源：CSCO乳腺癌诊疗指南HR+/HER2-的Luminal型是最普遍的乳腺癌亚型，占比高达70%。HR+/HER2-乳腺癌大多预后良好，I期5年生存率可达99%，转移性患者中位OS可达4~5年4。HR+/HER2-乳腺癌通常需接受内分泌治疗，并根据绝经状态选择不同的口服抗雌激素药物，例如：他莫昔芬等ER调节剂对绝经前和绝经后妇女均有效；来曲唑等芳香酶抑制剂仅用于绝经后患者。绝经前后的晚期患者均可考虑在内分泌治疗的基础上联合靶向治疗（CDK4/6抑制剂、HDAC抑制剂等）1。HER2阳性乳腺癌人群占比为15%-20%。I期5年生存率在94%以上，转移性患者中位OS可达5年4。以曲妥珠单抗为基础的治疗方案是HER2阳性乳腺癌的重要选择：对于符合手术指征的患者可使用为期1年的曲妥珠单抗单药或曲妥珠单抗+帕妥珠单抗的双靶治疗；对于晚期患者一线应首选紫衫类化疗联合曲帕双靶的三联方案（THP方案）1。基于PHILA研究，吡咯替尼+曲妥珠单抗+多西他赛的三联方案（PyHT）也获得了指南推荐5。HER2阳性晚期乳腺癌经曲妥珠单抗治疗病情进展后，仍应持续使用抗HER2靶向治疗。Ⅰ级推荐吡咯替尼+卡培他滨、T-DXd两种方案，Ⅱ级推荐T-DM1。对于HER2 TKI治疗失败的患者，指南推荐使用T-DXd、T-DM1两种HER2 ADC治疗，或继续使用曲帕双靶联合化疗5。TNBC占比约15%，是预后最差的乳腺癌分型。I期5年生存率约为85%，转移性患者中位OS仅10~13个月。由于缺乏作用靶点，TNBC患者通常对内分泌治疗和HER2靶向治疗不敏感，临床治疗方案仍以化疗为主，常用方案包括AC（蒽环类+环磷酰胺）、AC-T（蒽环类+环磷酰胺+紫衫类）、TC（紫衫类+环磷酰胺）等4。TROP2 ADC戈沙妥珠单抗2020年获批用于治疗TNBC，有望改善这一分型的生存结局。近年来，学界仍在持续探索乳腺癌分型的细化，以期实现更精确的患者分层。复旦大学附属肿瘤医院邵志敏教授团队提出的“复旦分型”对患者进行了更精细的划分：TNBC腔面雄激素受体型（LAR）免疫调节型（IM）基底样免疫抑制型（BLIS）间质型（MES）6Luminal型乳腺癌经典腔面型（SNF1）免疫调节型（SNF2）增殖型（SNF3）RTK驱动型（SNF4）7并根据不同亚型的分子特征确定相应分子标志物，有望为乳腺癌新药研发提供新的潜在治疗靶点。02HER2靶向治疗进展目前可选的乳腺癌HER2靶向药物包括曲妥珠单抗、帕妥珠单抗等单抗类药物，吡咯替尼、拉帕替尼等小分子酪氨酸激酶抑制剂（TKI），以及恩美曲妥珠单抗（T-DM1）、德曲妥珠单抗（T-DXd）等ADC。在研HER2靶向药还有RC-48、ARX788等ADC，以及靶向HER2不同位点的双特异性抗体ZW25等。HER2靶向ADC的问世为乳腺癌HER2靶向治疗带来了革命性的改变。针对当前已获批的两种HER2 ADC，DESTINY-Breast 03研究的头对头比较显示，T-DXd相较于T-DM1实现了更大的PFS获益8。因此，2024年的CSCO指南调整了二者的优先级，将T-DXd加入了Ⅰ级推荐；且新版指南将HER2低表达人群从HER2阴性人群中划分出来单列一组，并指出DESTINY-Breast 04研究支持HER2低表达患者也可受益于T-DXd治疗，提示HER2靶向ADC有望进一步拓展适用人群5。03CDK4/6抑制剂进展CDK4/6抑制剂联合内分泌治疗可用于绝经后HR+/HER2-局部晚期和/或转移性乳腺癌，部分药物在围术期治疗中也表现出良好疗效。目前在中国获批的CDK4/6抑制剂有哌柏西利、阿贝西利、瑞波西利3款进口药品和达尔西利1款国产药品。其中，哌柏西利已有13家本土仿制药获得批准。已获批用于肺癌的CDK4/6抑制剂曲拉西利（先声药业）也在积极拓展乳腺癌适应证，但其开展的临床研究系联合戈沙妥珠单抗治疗TNBC，更侧重于发挥骨髓保护作用、减少ADC诱发的骨髓抑制副反应9。嘉和生物在研CDK4/6抑制剂来罗西利的乳腺癌适应证上市申请已获得中国国家药监局（NMPA）受理。目前，学界对于CDK4/6抑制剂治疗的最佳时机存在争议，CDK4/6抑制剂联合治疗方案中的内分泌治疗应如何排序仍缺乏临床证据，CDK4/6抑制剂治疗后进展的患者能否换用其他CDK4/6抑制剂也尚未明确。PACE、postMONARCH等研究正在展开探索，试图解答上述问题，有望指导未来的个体化CDK4/6抑制剂治疗10,11。04其他治疗进展除了HER2靶向治疗和CDK4/6抑制剂治疗，乳腺癌领域还在不断萌生针对其他靶点或采用其他技术的新型疗法。辉瑞和Arvinas合作开发的PROTAC药物ARV-471可特异性降解ER，其在II期VERITAC研究中展现出初步疗效，临床获益率达到38%12。君实生物PD-1特瑞普利单抗联合白蛋白紫杉醇已获得TORCHLIGHT研究的积极数据，向NMPA递交了治疗TNBC的新适应证上市申请13。参考文献：[1] 国家卫健委.《乳腺癌诊疗指南（2022年版）》[2] 中国抗癌协会乳腺癌诊治指南与规范（2024年版）[3] Global surveillance of trends in cancer survival 2000–14 (CONCORD-3)[4] Waks, Adrienne G, and Eric P Winer. Breast Cancer Treatment: A Review. JAMA vol. 321,3 (2019): 288-300.[5] 中国临床肿瘤学会（CSCO）乳腺癌诊疗指南（2024版）[6] Jiang, Yi-Zhou et al. Genomic and Transcriptomic Landscape of Triple-Negative Breast Cancers: Subtypes and Treatment Strategies. Cancer cell vol. 35,3 (2019): 428-440.e5.[7] Jin, Xi et al. Molecular classification of hormone receptor-positive HER2-negative breast cancer. Nature genetics vol. 55,10 (2023): 1696-1708.[8] Hurvitz, Sara A et al. Trastuzumab deruxtecan versus trastuzumab emtansine in patients with HER2-positive metastatic breast cancer: updated results from DESTINY-Breast03, a randomised, open-label, phase 3 trial. Lancet (London, England) vol. 401,10371 (2023): 105-117.[9] Trilaciclib combined with sacituzumab govitecan (SG) in metastatic triple-negative breast cancer (mTNBC): Preliminary phase 2 results. ESMO BC 2023[10] Palbociclib after CDK and endocrine therapy (PACE): A randomized phase II study of fulvestrant, palbociclib, and avelumab for endocrine pre-treated ER+/HER2- metastatic breast cancer. SABCS 2022[11] postMONARCH: A phase 3 study of abemaciclib plus fulvestrant versus placebo plus fulvestrant in patients with HR+, HER2-, metastatic breast cancer following progression on a CDK4 & 6 inhibitor and endocrine therapy. ASCO 2022[12] ARV-471: Phase 2 VERITAC Trial Results. https://ir.arvinas.com/static-files/e0d56eb4-13c4-43e9-935d-f24a18d2fe6e [13] Jiang, Zefei et al. Toripalimab plus nab-paclitaxel in metastatic or recurrent triple-negative breast cancer: a randomized phase 3 trial. Nature medicine vol. 30,1 (2024): 249-256.\ | /★联 系 我 们投稿 | 发稿 | 媒体合作▶ sylvia.hua@generalbiologic.com数据库 | 咨询服务 | 资讯追踪▶ 点击左下“阅读原文”完成表单填写点击 阅读原文 订阅全球行业新闻

IRVINE, Calif. & AMSTERDAM--( BUSINESS WIRE )-- Agendia ® , Inc. , announced today it will share new data from the ongoing prospective, observational FLEX Trial ( NCT03053193 ) in two poster presentations at the 41 st Annual Miami Breast Cancer Conference (MBCC), taking place March 7 – 10 th , 2024. The first poster, titled MammaPrint ® and BluePrint ® predict anthracycline chemosensitivity in patients with HR+HER2-early-stage breast cancer enrolled in FLEX, (Audeh, W., et al.), investigates the associations between MammaPrint and BluePrint classifications, therapy regimen, and the likelihood of achieving a pathologic Complete Response (pCR). Researchers looked at patients who had hormone receptor-positive (HR+), Human Epidermal Growth Factor Receptor (HER) 2-negative early-stage breast cancer – categorized as MammaPrint High Risk – who had been treated with either a combination of two (taxane and cyclophosphamide, TC) or three (TC with anthracycline, AC-T) types of neoadjuvant chemotherapy. Patients were then further stratified into MP High 1 and High 2 categories, and further stratified by BluePrint subtype of Luminal and Basal. Results showed that patients with MP High 2 tumors, including Luminal B and Basal subtypes, are more likely to achieve a pCR in response to AC-T, while the addition of anthracycline to the therapy regimen does not appear to improve pCR rates for patients with MP High 1, Luminal B-type tumors. The second poster, titled Prediction of chemotherapy benefit by MammaPrint ® in patients with HR+HER2-early-stage breast cancer from real-world evidence studies (Audeh, W., et al.), used data from patients with HR+ HER2-negative early-stage breast cancer enrolled in the FLEX and NBRST trials to generate a prediction of the magnitude of chemotherapy benefit based upon a patient’s genomic risk, looking at the MammaPrint index more closely as a continuous variable. Researchers examined the association of the MammaPrint index with benefit from chemotherapy by evaluating two clinical endpoints, the likelihood of pCR in response to neoadjuvant chemotherapy, and the five-year outcome among patients who received chemotherapy and endocrine therapy or endocrine therapy alone. Consistent with results found in the landmark MINDACT trial, this study showed that the MammaPrint index demonstrates strong efficacy in predicting low chemosensitivity in Low Risk and Ultra Low Risk tumors, reinforcing that these groups do not derive significant chemotherapy benefit. However, it was also observed that chemotherapy effectiveness increased as MammaPrint risk increased in High 1 and High 2 tumors, as evidenced by both pCR rates and 5-year outcomes, demonstrating that the overall benefit of chemotherapy increases as MammaPrint risk increases. Taken together, these findings indicate the utility of MammaPrint to predict neoadjuvant and adjuvant chemotherapy benefit in this patient population. “In this unique real world evidence FLEX study, we were able to look at chemosensitivity for patients who had received neoadjuvant treatment and the chemo benefit for patients who are treated with systemic therapy after surgery, showing that MammaPrint is predictive of chemotherapy benefit in both cases. The FLEX Trial, with over 16,000 women enrolled, is now allowing us to look at clinical outcomes as well as analyzing whole transcriptome data,” said William Audeh, MD, MS, Chief Medical Officer of Agendia. “The data we’re sharing at the Miami Breast Cancer Conference confirms that gene expression profiling with these assays identify who may benefit from chemotherapy, and may prove helpful in regimen selection as well. We look forward to further exploring the capabilities of MammaPrint and BluePrint for women across the entire spectrum of breast cancer risk and subtype.” The goal of Agendia’s research is to increase the likelihood of managing each individual’s cancer diagnosis by delivering a customized treatment plan to the patients most likely to benefit based on the unique features of their tumor. About Agendia Agendia is a leading provider of innovative solutions in the field of precision oncology. With a focus on early-stage breast cancer, Agendia offers reliable biological insights that inform personalized treatment decisions for patients and their care teams. Their advanced genomic assays, MammaPrint ® + BluePrint ® , enable clinicians to quickly identify the most effective treatment plan, minimizing the risk of both under- and over-treatment. Founded in 2003 in Amsterdam, Agendia is headquartered in Irvine, California with a state-of-the-art laboratory facility. Led by world-renowned scientists and oncologists, Agendia is committed to advancing genomic insights through ongoing research. This includes the notable FLEX Study– the world's largest whole transcriptome Real-World Evidence-based Breast Cancer database which aims to revolutionize precision in breast cancer management. With cutting-edge technology, research and innovation, Agendia strives to shape the future of precision oncology and make a significant impact in the fight against breast cancer. About MammaPrint MammaPrint ® is a gene expression profiling test that reveals the distinct underlying biology of an early-stage tumor to determine its risk of spreading. As the only FDA-cleared gene expression profiling test to assess a woman's risk of distant metastasis, MammaPrint ® provides critical answers that help inform the future of her treatment plan at the point of diagnosis, including the timing and benefit to chemotherapy and endocrine therapy. MammaPrint® listens to the signals from 70 key genes in a woman’s tumor to stratify her risk within four distinct categories - ranging from UltraLow, Low, High 1, and High 2– to fuel a right-sized care plan tailored to her biology and her life's plans. About BluePrint BluePrint ® is a gene expression profiling test that reveals the driving forces behind a tumor’s growth at the earliest stage possible in a woman’s breast cancer care journey to help optimize and personalize treatment planning. As the only molecular subtyping test available in the U.S., BluePrint® goes where pathology cannot, offers critical insights that providers may otherwise have not known to act on, and gives women the best chance to return to a life not defined by cancer. BluePrint® measures the activity of 80 key genes that are involved in a tumor's growth to classify a tumor as Luminal-type, HER2-type, or Basal-type, each of which warrant distinct treatment pathways. By revealing the distinct underlying biology of a woman's tumor, BluePrint® can catch often misclassified, yet highly aggressive, Basal tumors, so women can be prescribed the most appropriate treatment from the start.