晚期NSCLC一线治疗新进展

1、精选课件晚期晚期NSCLCNSCLC一线治疗进展一线治疗进展 陆军军医大学新桥医院 徐 瑜 The power of teamwork 精选课件选择少：选择少： 放疗，放疗，化疗化疗 肺癌：肺癌：培美曲塞培美曲塞治疗非鳞治疗非鳞非小细胞肺癌非小细胞肺癌靶向靶向驱动基因变异驱动基因变异以病理为指导以病理为指导的治疗的治疗以疾病为指导以疾病为指导的治疗的治疗以分子检测为以分子检测为指导的治疗指导的治疗临床肿瘤学临床肿瘤学 分子肿瘤学分子肿瘤学病理肿瘤学病理肿瘤学肿瘤免疫学肿瘤免疫学精准医学精准医学重建免疫监视重建免疫监视晚期NSCLC一线治疗模式演变过程以肿瘤免疫微环以肿瘤免疫微环境指导的治疗境指

2、导的治疗精选课件Evading growth suppressor can-thanosSustaining proliferative signalAvoiding immuneDestruction Inducing angiogenesisEGFRALKROS-1Captain TKIChemo-hulkDestroyeverythingCheckpoint thorAngio-man精选课件Part1 Part1 驱动基因阳性驱动基因阳性NSCLCNSCLC治疗进展治疗进展精选课件驱动基因检测成为晚期NSCLC一线治疗前的关键步骤NCCN Clinical Practice Guide

3、lines in Oncology (NCCN Guidelines) Non-Small Cell Lung Cancer version1.2018.精选课件研究研究患者患者人群人群TKI病例数病例数PFS (月月)OS (月月)TKI化疗化疗HR(95%CI)TKI化疗化疗HR(95%CI)III期临床中期临床中EGFR突变亚组人群突变亚组人群IPASS亚裔、亚裔、不吸烟不吸烟G2619.56.30.48(0.36-0.64)21.621.90.78(0.50-1.20)First Signal韩裔、韩裔、不吸烟不吸烟G428.06.30.61(0.31-1.22)27.225.60.8

4、2(0.352-1.922)EGFR突变人群中进行的突变人群中进行的III期临床期临床NEJ002日本日本G22810.85.40.322(0.236-0.438)27.726.60.88(0.634-1.241)WJTOG3405日本日本G1729.66.60.52(0.378-0.715)35.538.81.185(0.767-1.829)OPTIMAL中国中国E15413.14.60.16(0.10-0.26)32.137.51.065ENSURE亚裔亚裔E21711.05.50.34(0.22-0.51)26.325.50.91（0.63-1.31）EURTAC高加索裔高加索裔E173

5、9.75.20.37(0.25-0.54)19.319.50.80(0.47-1.37)Lux-lung 3高加索裔、高加索裔、亚裔亚裔A34511.16.90.58(0.43-0.78)28.228.20.88（0.66-1.17）Lux-lung 6亚裔亚裔A36411.05.60.29(0.20-0.33)23.123.50.93（0.72-1.22）EGFR突变型晚期非鳞患者一线突变型晚期非鳞患者一线TKI治疗治疗PFS更长更长1.Mok, et al. NEJM 2009; 2. Han et al. JCO 2012. 30(10). 3,Maemondo, et al. NEJM

6、 2010; 4. Mitsudomi, et al. Lancet Oncol 2010; 5. Zhou, et al. Lancet Oncol 2011;6.Wu YL, et al. Ann Oncol. 2015. 7. Rosell et al. Lancet Oncol 2012.8.CH Yang, et al. Lancet Oncol. 2015.9.Wu YL,et al.Lancet Oncol 2014,15. 10. BJ. Solomon,et al. NEJM 2014精选课件驱动基因的发现推进了晚期驱动基因的发现推进了晚期NSCLC OS的延长的延长0123

7、4500.20.40.60.81.0Log-rank p 1 gene, 3%MET, 1%NRAS, 1%MEK1, 1%Keynote 407Prombro +CP（nab）vs placebo+CP（nab）鳞癌anyKeynote 189Prombro+pem+ 铂 vs palcebo+pem+ 铂 腺癌anyNivolumabBMScheckmate227Nivo+ipilimu and Nivo+chemo vs chemoNSCLCany（50%1,50%1,50%totalPD-L1HR=0.81NAHR=1.07 (NS)HR=0.69HR=0.92HR=0.81Keyno

8、te 407HR=0.5658.4% vs 35%HR=0.64PD-L1Keynote 189HR=0.5247.6% vs 18.9%HR=0.49PD-L1CM227PD-L11%A vs BTMB high HR=0.48NAimmatureTMB，PD-L1TMB low HR=1.17C vs BHR=0.7436.7% vs 23.1%immatureIP150ANA40% vs 41% HR=0.88 (NS)Teff，PD-L1B vs CHR=0.5956% vs 41% HR=0.78IMpower131HR=0.7149% vs 41% immature(HR= 0.96)PD-L1精选课件精选课件PD-L1 50%PD-L1 1%50%PD-L1 1%pembrolizumabIO+chemoIO+chemo+bevpembrolizumabIO+chemo+bevIO+chemoIO+chemo+bevIO+chemo TMB10IO+IO非鳞非鳞NSCLCNSCLC一线免疫一线免疫治疗选择方案治疗选择方案鳞癌一线免疫治疗选鳞癌一线免疫治疗选择方案择方案pembrolizumabIO+chemopembrolizumabIO+chemoIO+