恩曲替尼治疗 ROS1 阳性晚期非小细胞肺癌:一项 2/3 期 BFAST 试验。

Entrectinib in ROS1-positive advanced non-small cell lung cancer: the phase 2/3 BFAST trial.

机构信息

Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.

Henry Ford Cancer Institute/Henry Ford Health System, Detroit, MI, USA.

出版信息

Nat Med. 2024 Jul;30(7):1923-1932. doi: 10.1038/s41591-024-03008-4. Epub 2024 Jun 19.

Abstract

Although comprehensive biomarker testing is recommended for all patients with advanced/metastatic non-small cell lung cancer (NSCLC) before initiation of first-line treatment, tissue availability can limit testing. Genomic testing in liquid biopsies can be utilized to overcome the inherent limitations of tissue sampling and identify the most appropriate biomarker-informed treatment option for patients. The Blood First Assay Screening Trial is a global, open-label, multicohort trial that evaluates the efficacy and safety of multiple therapies in patients with advanced/metastatic NSCLC and targetable alterations identified by liquid biopsy. We present data from Cohort D (ROS1-positive). Patients ≥18 years of age with stage IIIB/IV, ROS1-positive NSCLC detected by liquid biopsies received entrectinib 600 mg daily. At data cutoff (November 2021), 55 patients were enrolled and 54 had measurable disease. Cohort D met its primary endpoint: the confirmed objective response rate (ORR) by investigator was 81.5%, which was consistent with the ORR from the integrated analysis of entrectinib (investigator-assessed ORR, 73.4%; data cutoff May 2019, ≥12 months of follow-up). The safety profile of entrectinib was consistent with previous reports. These results demonstrate consistency with those from the integrated analysis of entrectinib in patients with ROS1-positive NSCLC identified by tissue-based testing, and support the clinical value of liquid biopsies to inform clinical decision-making. The integration of liquid biopsies into clinical practice provides patients with a less invasive diagnostic method than tissue-based testing and has faster turnaround times that may expedite the reaching of clinical decisions in the advanced/metastatic NSCLC setting. ClinicalTrials.gov registration: NCT03178552 .

摘要

虽然在开始一线治疗前建议所有晚期/转移性非小细胞肺癌(NSCLC)患者进行全面的生物标志物检测,但组织的可获得性可能会限制检测。液体活检中的基因组检测可用于克服组织采样的固有局限性,并为患者确定最合适的基于生物标志物的治疗选择。Blood First Assay Screening Trial 是一项全球性、开放性、多队列试验,评估了多种疗法在液体活检中确定的晚期/转移性 NSCLC 和可靶向改变的患者中的疗效和安全性。我们展示了队列 D(ROS1 阳性)的数据。通过液体活检检测到 ROS1 阳性、IIIB/IV 期的年龄≥18 岁的患者,接受恩曲替尼 600mg 每日治疗。截至数据截止日期(2021 年 11 月),共入组 55 例患者,54 例患者可测量疾病。队列 D 达到了主要终点:研究者确认的客观缓解率(ORR)为 81.5%,与恩曲替尼的综合分析结果一致(研究者评估的 ORR,73.4%;数据截止日期 2019 年 5 月,随访时间≥12 个月)。恩曲替尼的安全性特征与之前的报告一致。这些结果与通过组织检测确定的 ROS1 阳性 NSCLC 患者的恩曲替尼综合分析结果一致,支持液体活检在指导临床决策方面的临床价值。液体活检纳入临床实践为患者提供了一种比组织检测侵入性更小的诊断方法,并且具有更快的周转时间,可能会加快晚期/转移性 NSCLC 临床决策的制定。临床试验注册:NCT03178552。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5902/11271410/0bcfd2a1859c/41591_2024_3008_Fig1_HTML.jpg

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