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胶质母细胞瘤中分子匹配的靶向治疗联合放疗:1/2a期NM伞式试验

Molecularly matched targeted therapies plus radiotherapy in glioblastoma: the phase 1/2a NM umbrella trial.

作者信息

Wick Wolfgang, Lanz Lisa-Marie, Wick Antje, Harting Inga, Dettmer Susan, Suwala Abigail K, Ketter Ralf, Tabatabai Ghazaleh, Seliger Corinna, Glas Martin, Burger Michael C, Timmer Marco, Ringel Florian A, Mildenberger Iris, Schulz-Schaeffer Walter J, Winkler Frank, König Laila, Herold-Mende Christel, Eisenmenger Andreas, Pfister Stefan M, Renovanz Mirjam, Bendszus Martin, Sahm Felix, Platten Michael, Kessler Tobias

机构信息

Neurology, University Clinic Heidelberg, Heidelberg University & German Cancer Consortium (DKTK) and CCU Neurooncology, German Cancer Research Center, Heidelberg, Germany.

NCT Trial Center, University Clinic Heidelberg, Heidelberg University & German Cancer Research Center, Heidelberg, Germany.

出版信息

Nat Med. 2025 Sep 5. doi: 10.1038/s41591-025-03928-9.

Abstract

Advances in molecular understanding and diagnostic precision of glioblastoma enable the identification of key genetic alterations in a timely manner and, in principle, allow treatments with targeted compounds based on molecular markers. Here we report the results of the phase 1/2 umbrella trial NCT Neuro Master Match (NM), which evaluated targeted treatments in 228 patients with newly diagnosed glioblastoma without O6-methylguanine DNA-methyltransferase promoter hypermethylation. Stratification for treatment was conducted by a trial-specific molecular tumor board across five subtrials, each evaluating a targeted therapy-alectinib, idasanutlin, palbociclib, vismodegib or temsirolimus-selected according to the best-matching molecular alteration. Patients without matching alterations were randomized between subtrials without strong biomarkers using atezolizumab and asunercept, and the standard of care (SOC), temozolomide. All received radiotherapy. The primary endpoints were dose-limiting toxicities (phase 1) and progression-free survival at 6 months (PFS-6; phase 2). Secondary endpoints included safety and tolerability, as well as overall survival (OS). The subtrials for alectinib and vismodegib did not open as they did not have matching patients. The idasanutlin subtrial (n = 9) was terminated early at the discretion of the manufacturing company. The temsirolimus subtrial (n = 46) demonstrated a PFS-6 of 39.1% and median OS of 15.4 months in patients with activated mammalian target of rapamycin (mTOR) signaling compared to a PFS-6 at 18.5% in the SOC group (n = 54), meeting the primary endpoint. The atezolizumab (n = 42), asunercept (n = 26) and palbociclib (n = 41) subtrials did not meet the primary endpoint for efficacy. The safety signals of NM match prior experiences with the drugs in quality and quantity; no relevant negative interaction with the parallel radiotherapy was noted. The results of the NM trial support further investigation of temsirolimus in addition to radiotherapy in patients with newly diagnosed glioblastoma with activated mTOR signaling. ClinicalTrials.gov registration: NCT03158389 .

摘要

胶质母细胞瘤在分子认识和诊断精度方面的进展能够及时识别关键基因改变,原则上允许基于分子标志物使用靶向化合物进行治疗。在此,我们报告1/2期伞式试验NCT神经主匹配(NM)的结果,该试验评估了228例新诊断的无O6-甲基鸟嘌呤DNA甲基转移酶启动子高甲基化的胶质母细胞瘤患者的靶向治疗。治疗分层由一个特定试验的分子肿瘤委员会在五个子试验中进行,每个子试验评估一种根据最佳匹配分子改变选择的靶向治疗——阿来替尼、idasanutlin、帕博西尼、维莫德吉或替西罗莫司。没有匹配改变的患者在没有强生物标志物的子试验之间随机分组,使用阿特珠单抗和阿苏单抗,以及标准治疗(SOC)替莫唑胺。所有患者均接受放疗。主要终点为剂量限制性毒性(1期)和6个月无进展生存期(PFS-6;2期)。次要终点包括安全性和耐受性以及总生存期(OS)。阿来替尼和维莫德吉的子试验未开启,因为没有匹配的患者。idasanutlin子试验(n = 9)由生产公司自行决定提前终止。替西罗莫司子试验(n = 46)显示,与SOC组(n = 54)18.5%的PFS-6相比,哺乳动物雷帕霉素靶蛋白(mTOR)信号激活的患者PFS-6为39.1%,总生存期中位数为15.4个月,达到主要终点。阿特珠单抗(n = 42)、阿苏单抗(n = 26)和帕博西尼(n = 41)子试验未达到疗效主要终点。NM试验的安全信号在质量和数量上与药物先前的经验相符;未发现与同期放疗有相关负面相互作用。NM试验结果支持对新诊断的mTOR信号激活的胶质母细胞瘤患者,除放疗外进一步研究替西罗莫司。ClinicalTrials.gov注册号:NCT031583‌89 。

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