College of Pharmacy, Union University, Jackson, TN, USA.
Ann Pharmacother. 2024 Jun;58(6):622-635. doi: 10.1177/10600280231197459. Epub 2023 Sep 12.
OBJECTIVE: To evaluate the safety and efficacy of the novel KRAS-targeting agents, sotorasib and adagrasib, in treating -mutated non-small cell lung cancer (NSCLC). DATA SOURCES: A comprehensive English-based literature search of PubMed and Clinicaltrials.gov between January 2000 and July 2023 was conducted using the terms , , , , , and . STUDY SELECTION AND DATA EXTRACTION: Relevant prescribing information, clinical trials, and treatment guidelines were evaluated. DATA SYNTHESIS: Sotorasib and adagrasib received accelerated US Food and Drug Administration (FDA) approval following pivotal phase I/II clinical trials. Sotorasib, a first-in-class KRAS inhibitor, demonstrated an overall response rate (ORR) of 41% and a progression-free survival (PFS) of 6.3 months. In a phase III confirmatory trial, sotorasib showed significantly longer PFS compared with docetaxel (5.6 vs. 4.5 months; = 0.0017). Adagrasib produced an ORR of 42.9% and a PFS of 6.5 months. Both drugs present unique safety profiles, with common toxicities, including diarrhea, musculoskeletal pain, fatigue, and hepatotoxicity. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: With mutations being among the most common oncogenic alterations in NSCLC, sotorasib and adagrasib offer new therapeutic avenues for this previously "undruggable" target. Current treatment guidelines list sotorasib and adagrasib as second-line options in patients with confirmed -mutated NSCLC. Additional studies are required to further differentiate the safety and efficacy profiles of these 2 agents and identify their optimal place in therapy. CONCLUSION: Sotorasib and adagrasib demonstrated promising outcomes in targeting the constitutively active KRAS G12C oncogenic driver, underscoring the need for further research to optimize their therapeutic application in this high-risk population.
目的:评估新型 KRAS 靶向药物,索托拉西布和阿达格拉西布,在治疗 - 突变型非小细胞肺癌(NSCLC)中的安全性和疗效。
资料来源:通过使用术语 、 、 、 、 ,对 2000 年 1 月至 2023 年 7 月期间的 PubMed 和 Clinicaltrials.gov 进行了全面的基于英语的文献检索。
研究选择和数据提取:评估了相关的处方信息、临床试验和治疗指南。
数据综合:索托拉西布和阿达格拉西布在关键性的 I/II 期临床试验后获得了美国食品和药物管理局(FDA)的加速批准。索托拉西布,一种首创的 KRAS 抑制剂,总缓解率(ORR)为 41%,无进展生存期(PFS)为 6.3 个月。在一项 III 期确证性试验中,与多西他赛相比,索托拉西布显著延长了 PFS(5.6 个月 vs. 4.5 个月;=0.0017)。阿达格拉西布的 ORR 为 42.9%,PFS 为 6.5 个月。两种药物均具有独特的安全性特征,常见的毒性包括腹泻、肌肉骨骼疼痛、疲劳和肝毒性。
与患者护理和临床实践的相关性:由于 突变是 NSCLC 中最常见的致癌改变之一,索托拉西布和阿达格拉西布为这个以前“不可用药”的靶点提供了新的治疗途径。目前的治疗指南将索托拉西布和阿达格拉西布列为经证实的 突变型 NSCLC 患者的二线治疗选择。需要进一步的研究来进一步区分这两种药物的安全性和疗效特征,并确定它们在治疗中的最佳位置。
结论:索托拉西布和阿达格拉西布在靶向组成性激活的 KRAS G12C 致癌驱动因素方面显示出了有希望的结果,强调需要进一步研究以优化它们在这一高危人群中的治疗应用。
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