Kenza yemapapu immunotherapy, kenza yemapapu immunotherapy, kenza yemapapu PD-1 kurapwa, uye kenza yemapapu PD-L1 kurapwa ndizvo zvese zvaunoda kuziva.
In the past two years, immune checkpoint inhibitors have undoubtedly been one of the most successful tumor immunotherapies, which has changed the treatment prospects for NSCLC. The four PD-1 / L1 currently approved for lung cancer have improved the five-year survival rate of advanced lung cancer from less than 5% to 16%, which has tripled, and many patients and even doctors are excited. Immunotherapy is gradually becoming a “special effect” drug for the treatment of advanced isina-diki kenza yemapapu kenza. Most kenza yemapapu patients still have many questions about PD-1 treatment, and today we will answer them one by one.
Chii chinonzi PD-1 / L1 kurapwa kwekenza yemapapu?
Immunotherapy is a therapy that uses the patient’s immune system to fight cancer. PD-1 / L1 treatment is called immune checkpoint inhibitor therapy and is a type of immunotherapy.
Immune checkpoint inhibitor therapy inoreva: PD-1 ipuroteni iri pamusoro peT masero anobatsira kudzora maitiro ezvirwere zvemuviri. Kana PD-1 inosunga kune imwe puroteni inonzi PDL-1 pamasero egomarara, inodzivirira T masero (immune cell) kubva pakuuraya maseru ekenza. Iyo PD-1 inhibitor inosunga kuPDL-1, nekudaro ichisunungura kudzvinyirirwa kwemasero eT uye kuwanazve kugona kuuraya cancer maseru.
Ndeapi aripo PD-1 / L1 anotenderwa neDFA yekurapa kenza yemapapu?
Iyo FDA yakabvumidza mana immune checkpoint inhibitors: Nivolumab (O mushonga), pembrolizumab (K mushonga), atezolizumab (T mushonga) uye durvalumab (I mushonga) kurapa isiri-diki cell cancer yemapapu.
| Zita reDrug | Pembrolizumab | Nivolumab | Attuzumab | Devaruzumab |
| Chirungu zita | Keytruda | Wonderful | Tecentriq | Imfinzi |
| mugadziri | Merck | Bristol-Myers | Roche | AstraZeneca |
| Dosage | 2mg / kg kamwe pavhiki nhatu | 3mg / kg kamwe pavhiki mbiri | 1200mg kamwe pamasvondo matatu | 10mg / kg kamwe pavhiki mbiri |
| Listing | Kunyorwa kweUS | Yakanyorwa mukati China | Kunyorwa kweUS | Yakanyorwa muChina |
Ndezvipi zvinoratidza zvegomarara rega rega remapapu PD-1 / L1 kubvumidzwa?
Pabolizumab (Pembrolizumab, Pambrolizumab, Pembrolizumab) | Kerui Da (Jinheide, Keytruda) | K zvinodhaka
| Zviratidzo zvinogamuchirwa (kenza yemapapu) | Kunyangwe yekuona PD-L1 |
| 1. Yakasanganiswa ne pemetrexed uye cisplatin / carboplatin yekurapa-yekutanga kurapwa kwechirwere chisingachinjike, chemberi / chakadzokororwa chisina-squamous chisiri-chidiki chemaseru kenza yemapapu (NSCLC), zvisinei nePD-L1 kutaura | kwete |
| 2. Yakasanganiswa ne carboplatin uye paclitaxel / nab-paclitaxel (Abraxane) yevarwere vane yakakwira / inowanzoitika squamous isiri-diki kenza yemapapu kenza (NSCLC) isingakwanisike nemutsara-wekutanga kurapwa, zvisinei ne PD-L1 kutaura | kwete |
| 3. Single-agent, first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC), whose metastatic non-small cell lung cancer (NSCLC) tumors have high PD-L1 expression [tumor proportion score (TPS) ≥50%], by FDA approved test confirms that there are no EGFR or ALK genome tumarara aberrations | Hongu, PD-L1-50% |
| 4. Kurapwa kwemushonga mumwechete kuvarwere vane metastatic isiri-diki cell lung cancer (NSCLC), vane bundu rinoratidza PD-L1 ((TPS) ≥ 1%), yakatemwa neFDA yakabvumidzwa miedzo, kufambira mberi kwechirwere mushure meplatinum-based chemotherapy. | Hongu, PD-L1 ≥ 1% |
Nivolumab (Navumab, Niluumab, Nivolumab) | Odivo (Odivo, Odvo, Opdivo) | O mushonga
| Zviratidzo zvinogamuchirwa (kenza yemapapu) |
| 1. Nekurapa kwepamberi (metastatic) isina-diki kenza yemapapu kenza iyo ichiri kuitiswa platinum chemotherapy |
| 2. Kurapa varwere vane advanced (metastatic) squamous non-diki maseru kenza yemapapu (NSCLC), inokodzera varwere vane platinum-based chemotherapy kana vane chirwere chakashata mushure memakemikari |
Devarizumab (Duvaluzumab, Duvalizumab, Deluzumab, Durvalumab) | Ini zvinodhaka (Imfinzi)
| Zviratidzo zvinogamuchirwa (kenza yemapapu) |
| Iyo inoshandiswa kurapa munzvimbo yemhando yepamusoro isiri-diki kenza yemapapu kenza (NSCLC) iyo isina kumboitwa resection yekuvhiya mushure mekuitwa yakajairwa platinamu-yakavakirwa panguva imwe chete radiochemotherapy |
Attuzumab (Atezolizumab, Atezolizumab) | T mushonga (Tecentriq)
| Zviratidzo zvinogamuchirwa (kenza yemapapu) |
| 1. Metastatic isiri-diki kenza yemapapu kenza iyo mamiriro ayo anoderera panguva kana mushure meplatinum ine chemotherapy. Kana kenza yemurwere isiri-diki yemukenza yemapapu ichichinja muEGFR kana ma ALK magene, mamorekuru anotarisa madhiragi anotarisa EGFR kana ALK geni shanduko inofanira kutanga yashandiswa, nezvimwewo Attuzumab |
| 2. Yakasanganiswa nekemotherapy (Abraxane [paclitaxel protein conjugate; nab-paclitaxel] uye carboplatin) semutsara wekutanga kurapwa kwevarwere vane metastatic isiri-squamous isiri-diki kenza yemapapu kenza (NSCLC) isina EGFR kana ALK |
Nzira yekusarudza PD-1 / L1 yevarwere vane kenza yemapapu
Maitiro ekusarudza iwo mana immune checkpoint inhibitors ndechimwe cheanonetsa matambudziko evarwere vegomarara remapapu. Matafura anotevera anopfupisa sarudzo yemishonga yekurapa yemunhu wese zvakadzama uye zvakajeka.
Kuchinja-kwemahara asiri madiki maseru kenza yemapapu
Chekutanga-mutsara immunotherapy yekenza yemapapu yepamberi
| Yakarohwa | Yekutanga-chikamu kurudziro | Chikamu chechitatu kurudziro |
| PD-L1-50% | Pembrolizumab monotherapy | |
| 1% ≤PD-L1≤49% | Squamous cell carcinoma: Pabolizumab
Non-squamous cell carcinoma: Pabolizumab single drug kana Pabolizumab inosanganiswa neplatinum + pemetrexed |
|
| PD-L1 ＜ 1% kana kusazivikanwa | Kwete-squamous cell carcinoma: paclizumab inosanganiswa neplatinum + pemetrexed | Non-squamous cell carcinoma: atezumab combined with bevacizumab combined with chemotherapy (carboplatin and paclitaxel) |
Yechipiri-mutsara immunotherapy yekenza yemapapu yepamberi
| Yakarohwa | Yekutanga-chikamu kurudziro | Chikamu chechitatu kurudziro |
| Hapana yapfuura PD-1 / L1 kurapwa | PD-L1 haizivikanwe kana zvisinei nemamiriro ekutaura: nivolumab monotherapy | PD-L1 haizivikanwe kana zvisinei nemamiriro ekutaura: atezumab monotherapy |
| Yapfuura PD-1 / L1 kurapwa | Yapfuura PD-1 / L1 inhibitor kurapwa: zvirimo platinamu zvinofanirwa kuve pamwe nechemotherapy (sarudza yakakodzera chemotherapy zvinoenderana neye histological mhando)
Yapfuura PD-1 / L1 inhibitor kurapa pamwe chete nekemotherapy: docetaxel kana imwe chete-mumiririri chemotherapy (yekutanga-mutsara unreceived mishonga) |
Chechitatu-mutsara immunotherapy yekenza yemapapu yepamberi: kurudziro yechipiri, nivolumab.
Matanho matatu asingarambike asiri diki kenza yemapapu: Giredhi III kurudziro, kugamuchira consolidation therapy ne dufaliolizumab mushure meradiotherapy uye chemotherapy.
Isiri-diki cel
l kenza yemapapu nekuchinja
Ye immunotherapy yeNSCLC ine yakanaka EFGR / ALK, kuchine humbowo husina kukwana. IMpower150 yekuongorora subgroup ongororo mhedzisiro inoratidza kuti inotevera chirongwa ine chimwe chiitiko: atelizumab + bevacizumab + carboplatin + taxol
Ndezvipi zviratidzo zvinoda kuyedzwa usati washandisa PD-1 / L1?
Parizvino, varapi vanoreva kutaura kweTMB uye PD-L1 sezviratidzo zvemapapu immunotherapy uye chemotherapy. Rossy akaronga chinyorwa kuti iwe ududzire mabhiomarker mashanu ayo anofanotaura kushanda kwePD-1 Unogona kureva: Ungafungidzira sei kushanda kwePD-1 pamberi? Kuongorora kwakazara kweanofungidzira makuru mashanu!
1) PD-L1
Parizvino, zvinofungidzirwa kuti kutaura kwePD-L1 mumatumbu maturusi ndiko kunzwisisika kwekusarudza huwandu hwevanhu pamberi pekurapwa-PD-1 / PD-L1 kurapwa. Asi panguva imwecheteyo, kune matambudziko mazhinji mukutsvaga kwePD-L1, senge nzvimbo yekusiyana, chikamu chidiki chebundu chingamiririra nyika yese yebundu? Iko kune zvakare kweyepasi heterogeneity, nekuti mushure mekurapwa, PD-L1's Izwi rekutaura richachinja. Iko hakuna kuisirwa kwema immunohistochemical kuona. Kune akawanda ma antibodies ePD-L1 immunohistochemical stain. Chiyero chibvumirano chema antibodies akasiyana 73% -76% chete, zvinova zvinokanganisa mhedzisiro yekuonekwa.
2) TMB
Tsvagurudzo yazvino inoratidza kuti TMB / bTMB seyakafanofungidzira chiratidzo chekurapa maitiro eICI ichiri kukakavara.
Kune avo varwere vepamba vachangobva kuongororwa kuti vane epamberi isiri diki kenza yemapapu kenza, indasitiri yekurapa kenza yemapapu indasitiri inowanzo kurudzira bvunzo dzePD-L1. Kana PD-L1- 50%, ingave squamous cell carcinoma kana isiri-squamous cell carcinoma, ichangobva kurapwa, isiri-geni mutation isiri-diki sero kenza yemapapu varwere vanogona kurapwa naK madhiragi kuwana mukana mukuru wekurarama parizvino.
Ehezve, kune iyo kiriniki yekushandisa ye immune checkpoint inhibitors, United States ndiyo yakanyanya kuongororwa uye ine hupfumi hwekiriniki. Nyanzvi dzemapapu dzemapapu muUnited States dzinoenderana neruzivo rwazvino paTMB uye PD-L1 ye chemotherapy uye / kana immunotherapy yekenza yemapapu Varwere vakasungwa.
1. Anti-PD-1 monotherapy inopihwa kuvarwere vane "inopisa" kana mapundu anopisa ane akanyanya PD-L1 expression uye TMB.
2. Kune varwere vane yakakwira PD-L1 kutaura asi yakaderera TMB, ipai chemoimmunotherapy.
3. Kune avo varwere vane yakakwira TMB asi yakaderera kana isina kunaka PD-L1 kutaura, ipai chemoimmunotherapy kana anti-PD-1 / CTLA-4 kurapa.
4. Mukuwedzera, kune varwere vane "kutonhora" kana kuti kwete-anogumbura mamota ane yakaderera TMB uye yakaderera kana yakaipa PD-L1 kutaura, chemotherapy inoitwa pamwe kana isina immunotherapy kana inogoneka cellular immunotherapy.
Rossy anoyeuchidza ruzhinji rwevarwere vegomarara remapapu kuti vasati vashandisa PD-1, vanofanirwa kusarudza ine simba yekuyedza kambani yekuyedza biomarker, vobva vabvunza Bei Shangguang kana kunyangwe nyanzvi inozivikanwa yekenza yemapapu muUnited States kuti vagadzire chirongwa chaicho chemishonga , kana ivo vanogona kubvunza kune wepasi rose oncologist. Dhipatimendi reWebhu Mishonga.
Vanogona PD-1 varwere vane yakaderera kutaura vanoshandisa PD-1?
Kune avo varwere vane epamberi isiri-diki cell carcinoma avo vachangobva kuongororwa, chero bedzi PD-L1 expression iri yakanaka, ingave squamous cell carcinoma kana isiri-squamous cell carcinoma, zvinogona kuita kuti vawane kupona mabhenefiti kubva pakutanga kurapwa kweK-drug monotherapy, nokudaro kuwedzera hupenyu. Dzimwe nyanzvi zvakare dzinoratidza kuti varwere vane PD-L1 kutaura pakati pe 1-49% vanogona zvakare kushandisa K pamwe nekemotherapy kana vachigona kutsungirira chemotherapy.
Inogona PD-1 kushandiswa kune vachangobva kurapwa varwere vasina kunaka PD-L1 bvunzo?
Zvichangoburwa zve multiple PD-1 monoclonal antibody yakasanganiswa chemotherapy zvidzidzo zvakaratidza kuti kunyangwe PD-L1 bvunzo isina kunaka, kana PD-L1 isina kuyedzwa zvine mamiriro, PD-1 monoclonal antibody inosanganiswa ne chemotherapy inogona kurapa squamous cell carcinoma kana isiri-squamous sero carcinoma. Maseru emukenza emapapu varwere vanounza zvakakosha kupona mabhenefiti ne chemotherapy chete.
Kune varwere vane PD-L1-isina-isiri-diki kenza yemapapu kenza, zvisinei kuti vane squamous kana isiri-squamous isiri-diki kenza yemapapu kenza, kana vasati vagamuchira chemotherapy pamberi, mushure mekugamuchira K yakabatana chemotherapy, ichienzaniswa nekemotherapy chete Vese varwere vanogona kuwana yakareba kupona kubatsirwa. Dhata dzakadai inhau dzakanaka kune avo varwere vane yakaipa PD-L1 kutaura kana vasina mamiriro ekuona PD-L1.
Varwere vanogona kurapwa chemotherapy switch kana kuwedzera PD-1?
Kunyangwe iri squamous kana isiri-squamous isiri-diki kenza yemapapu kenza, mhedzisiro yeK inosangana nekemotherapy iri nani pane chemotherapy chete, asi varwere vari kugamuchira chemotherapy vanogona here kuwana PD-1 monoclonal antibody? Chii chiri nani mhedzisiro yekemotherapy?
Mushure meradiotherapy uye chemotherapy, inozouraya mamwe maseru emota, nokudaro ichisunungura tumarara maantigen uye ichikurudzira hutachiona hwevanhu. Panguva ino, kana PD-1 monoclonal antibody kurapwa ikapihwa, zvinofungidzirwa, iyo inorwisa-bundu mhedzisiro inosimba. Parizvino, kune ekutanga mhedzisiro mhedzisiro inoratidza kuti immune immune kurapwa kwePD-1 monoclonal antibody kana PD-L1 monoclonal antibody mushure meimwe nguva radiotherapy uye chemotherapy ine zvainoita zvakanaka uye zvakanyanya kuwedzera hupenyu.
Varwere vachangobva kuongororwa vanofanira kutanga chemotherapy kutanga, vobva vasarudza PD-1 kana kushandisa PD-1 chaiko mushure mekuramba kwemishonga
Kune avo varwere vane yakakwira isiri-diki kenza yemaseru avo vachangobva kuongororwa, kushandiswa kwekutanga kwePD-1 monoclonal antibody kunounza zvirinani kupona mabhenefiti pane kunonoka kushandiswa.
Chii chekuita mushure mekudzvinyirira PD-1?
Varwere vane PD-1 inhibitors inoshanda vanowanzo kuve nemhedzisiro inogara; zvisinei, vangangoita makumi matatu muzana evarwere vakaonekwa vachiramba zvirwere Kiyi yekukunda kusagadzikana kwemishonga inonyanya kuve mapoinzi maviri:
Kutanga, kana zvichikwanisika, biopsy uye-yakadzika kuongororwa kwehutachiona kunogona kuitwa pane dzichangowedzerwa kana kuwedzera nzvimbo dzekumirisana nemishonga kutsvaga chikonzero chekurwisa zvinodhaka uye kurapa zvinoenderana nechikonzero. Semuenzaniso, vamwe varwere vanokonzerwa nekubhadhara kwakakwira kutaura kweTIM-3, LAG-3 kana IDO; wobva wasarudza, PD-1 inhibitor inosanganiswa neTIM-3 inhibitor, LAG-3 antibody, IDO inhibitor ndiyo yakanakisa yekurapa mhinduro.
Chechipiri, kune varwere vasingakwanise kuona chinokonzera kushorwa nemishonga, vanogona kusanganisa iwo chaiwo mamiriro kuti asarudze akanakisa mubatanidzwa wepamoyo kudzora kusagadzikana kwezvinodhaka uye kuwedzera kupona; kana, chinja kurapa kwetsika senge radiotherapy uye chemotherapy, kupindira, redhiyo frequency, uye kudzoreredzwa kwetunhu.
Chekupedzisira, uye zvakanyanya kukosha, hwakawanda uye hwakawanda humbowo hunotsigira kuti immunotherapy yakadai sePD-1 inhibitors inofanira kushandiswa nekukurumidza sezvinobvira kana mamiriro ezvinhu emurwere ave nani uye bundu mutoro uri mudiki.
