94%患者肿瘤缩小的靶向疗法；将化疗效果提高40%的抗癌疗法…… | 一周盘点

▎药明康德内容团队编辑

本期看点

1. 口服人类表皮生长因子受体2（HER2）酪氨酸激酶抑制剂（TKI）zongertinib治疗非小细胞肺癌（NSCLC）患者在一项早期临床试验中获积极结果，94%患者的肿瘤有缩小。

2. HER2靶向疗法BAY 2927088在一项1/2期临床试验中治疗携带HER2 YVMA插入突变的晚期NSCLC患者，客观缓解率（ORR）达90%。

3. 口服靶向抗癌化合物ibrilata zar联用化疗（紫杉醇/卡铂）在一项1/2期临床试验中使子宫内膜癌患者的无进展生存期（PFS）相比历史对照组延长了40%。

药明康德内容团队整理

Zongertinib：公布1b期临床试验的初步数据

勃林格殷格翰（Boehringer Ingelheim）公布了旗下口服HER2靶向疗法zongertinib（BI 1810631）在NSCLC患者中的最新积极。Zongertinib不与野生型表皮生长因子受体（EGFR）结合，进而相关毒性较低。Zongertinib于2023年获得美国FDA授予快速通道资格，并随后于2024年获得美国FDA和中国国家药监局药品审评中心（CDE）授予的突破性疗法认定，用于治疗曾接受过全身性疗法、携带HER2激活突变的晚期NSCLC成人患者。

此次公布的结果显示，截至2024年5月，共132例患者每天接受一次120 mg/240 mg zongertinib治疗（n=75/n=57）。经盲法独立中央审评（BICR）评估，试验达到主要终点，患者的确认ORR为66.7%（97.5% CI：53.8–77.5，p<0.0001）。在所有剂量的患者中，94%的患者观察到任何程度的肿瘤缩小。

此外，数据还显示，zongertinib具有初步的脑活性。根据BICR评估的RANO-BM（神经肿瘤脑转移瘤的疗效评估），33%（120 mg，n=27）和40%（240 mg，n=25）的无症状脑转移患者达成确认的客观缓解，疾病控制率（DCR）分别为74%和92%。Zongertinib在120 mg和240 mg剂量下的耐受性通常良好，没有因治疗导致的死亡，且导致剂量减少（11%）和停药（3%）的不良事件发生率低。

BAY 2927088：公布1/2期临床试验数据

拜耳（Bayer）公布了1/2期SOHO-01研究扩展部分的。该研究评估了其口服、可逆的HER2靶向疗法BAY 2927088在携带HER2变异的晚期NSCLC患者中的安全性和初步疗效。入组患者在接受≥1种晚期疾病全身治疗后病情出现进展，但未曾接受过HER2靶向治疗。BAY 2927088能够强效抑制突变的HER2，包括HER2外显子20插入突变和HER2点突变，同时也能抑制EGFR，对突变型EGFR具有高选择性，且不和野生型EGFR相结合。美国FDA和中国药品审评中心于2024年授予BAY 2927088突破性疗法认定，用于治疗携带HER2激活突变且曾接受过全身治疗的不可切除或转移性NSCLC成年患者。

此次公布的结果显示，43名可评估疗效患者的确认ORR为72.1%，1名（2.3%）患者实现完全缓解（CR）。中位缓解持续时间（DOR）和PFS分别为8.7个月和7.5个月。在携带HER2 YVMA插入突变（最常见的变异）的患者中，ORR为90.0%，DOR为9.7个月，PFS为9.9个月。此外，BAY 2927088的安全性是可控的，并且与之前的报告一致。

Ibrilatazar（ABTL0812）：公布1/2期临床试验数据

AbilityPharma公司公布了ibrilatazar联用化疗（紫杉醇/卡铂）治疗晚期或复发性子宫内膜癌患者的1/2期临床试验ENDOLUNG的最终数据。Ibrilatazar是一种潜在“first-in-class”、差异化的口服靶向抗癌化合物，通过诱导内质网应激和抑制PI3K/Akt/mTOR通路来引发自噬。在临床试验中，ibrilatazar对子宫内膜癌和肺癌患者显示出临床益处。此外，它在包括肺癌、子宫内膜癌、胰腺癌、神经母细胞瘤和胶质母细胞瘤等癌症类型的动物模型中展示了强有力的临床前概念验证。

此次公布的结果显示，ibrilatazar联用化疗的总缓解率为65.8%，其中13.2%的患者达到CR，52.6%的患者达到部分缓解（PR），中位DOR为7.4个月。中位PFS为9.8个月，相比历史对照组延长了40%。中位总生存期（OS）为23.6个月。这些结果表明，接受ibrilatazar联用化疗治疗的患者的ORR、PFS和OS相较于历史对照组（分别为51%、7.1个月和20.4个月）均有所提高。

安全性方面，ibrilatazar联用化疗治疗显示出良好的安全性，未引入与化疗相关的重大不良事件，其安全性与历史对照组一致。药代动力学参数与临床前试验中观察到的靶点作用相符，血液药效学生物标志物表明治疗开始后至少28天内靶点调节持续存在。

RLY-2608：公布首个人体试验数据

Relay Therapeutics公司公布了其在研疗法RLY-2608的首个人体试验的积极。RLY-2608是Relay Therapeutics开发针对PI3Kα突变体的选择性抑制剂。该激酶是所有癌症中最常出现突变的激酶之一，约在14%的实体瘤患者检测出PI3Kα的致癌突变。传统上，PI3Kα抑制剂的开发聚焦于蛋白的活性位点。然而，这些抑制剂缺乏对突变型PI3Kα的选择性，导致治疗效果欠佳。为了增强PI3Kα抑制剂的选择性，Relay Therapeutics解析了PI3Kα的全长蛋白冷冻电镜结构，以阐明野生型和突变型PI3Kα的构象差异，并利用这些见解支持RLY-2608的设计。

此次公布的数据显示，此前接受过大量治疗，携带PI3Kα突变的HR阳性、HER2阴性局部晚期或转移性乳腺癌患者在接受RLY-2608（600 mg）联合fulvestrant治疗后，表现出具有临床意义的PFS。中位随访时间为7.5个月时，所有携带PI3Kα突变患者的中位PFS为9.2个月。在30名具有可测量疾病的患者中，1/3的患者达到PR，ORR为33%。新闻稿指出，RLY-2608是首个针对PI3Kα，具有突变体和异构体（isoform）选择性的别构抑制剂。

▲RLY-2608让73%患者的肿瘤缩小（图片来源：Relay Therapeutics公司官网）

Mosliciguat：公布1b期临床试验数据

Roivant公司公布了其肺动脉高压（PH）疗法mosliciguat的1b期概念验证试验的。Mosliciguat是一种每日给药一次、潜在"first-in-class"和“best-in-class”的吸入性可溶性鸟苷酸环化酶（sGC）激动剂，可靶向递送至肺部。sGC是一种一氧化氮（NO）/环磷酸鸟苷（cGMP）信号通路中的关键酶，可催化cGMP生成，从而增加血管扩张、减少炎症和细胞凋亡、逆转血管重塑和抗纤维化作用。与需要减少血红素和NO才能对sGC产生作用的sGC激动剂不同，mosliciguat是一种独立于血红素和NO的sGC激活剂。这使mosliciguat可能在典型PH患者体内高氧化环境中保持有效性。该疗法目前正在开发用于治疗与间质性肺病（PH-ILD）相关的肺动脉高压。

此次公布的结果显示，1.0、2.0和4.0毫克mosliciguat分别使患者的肺血管阻力（PVR）相对于基线的平均最大峰值降低达25.9%、38.1%和36.3%，超过预定主要结果≥20%降幅的阈值。此外，该疗法的耐受性良好，治疗引起的不良事件发生率低。根据新闻稿，这是迄今为止PH相关试验中观察到PVR的最大降低幅度之一。Mosliciguat的全球2期PHocus研究即将启动。

CT-996：公布1期临床试验数据

罗氏（Roche）公布了其每日一次的口服胰高血糖素样肽-1（GLP-1）受体小分子激动剂CT-996的。罗氏在去年12月与Carmot Therapeutics达成合并协议，斥资约31亿美元收购了Carmot公司，囊获包括CT-996在内的多款处于临床开发阶段的皮下和口服肠促胰岛素疗法。

此次公布的结果显示，CT-996在未患有2型糖尿病的肥胖人群中，在4周内将受试者体重减轻7.3%（约7公斤），安慰剂同期将体重降低1.2%。与安慰剂相比，CT-996提供了具有临床意义的体重减轻。安全性方面，所有的治疗伴发不良事件（TEAE）均为轻度或中度，没有发现3级以上TEAE。没有出现与在研药物相关的停止用药。最常见的TEAE为胃肠道相关不良事件，与其它肠促胰岛素疗法类似。接受更高剂量治疗的参与者TEAE更多，不过更缓慢的剂量滴定可能改善耐受性。基于这些积极结果，该公司计划在2025年启动2期临床试验。

▲CT-996的减重效果（图片来源：参考资料[5]）

Radiprodil：公布1b期临床试验数据

GRIN Therapeutics公司公布了其正在进行的全球1b期开放标签临床试验的初步结果。该试验的两个部分正在评估radiprodil的安全性、耐受性、药代动力学以及疗效。Radiprodil是一种在研选择性强效N-甲基-D-天冬氨酸受体亚基2B（GluN2B）的负变构调节剂，用于治疗GRIN相关神经发育障碍。GRIN相关神经发育障碍是一组由GRIN基因突变引起的罕见儿科神经发育障碍，目前尚无批准的疗法。

此次公布的结果显示，radiprodil在具有GRIN基因功能增加突变的患者中，无论基线时是否存在可数的运动性癫痫发作（CMS），均表现出良好的耐受性。具有CMS患者的中位癫痫发作频率与基线相比降低了86%，超过了背景抗癫痫药物，其中71%的患者癫痫发作频率降低了50%以上。这些结果预计将支持GRIN Therapeutics与监管机构的讨论，以推动radiprodil进入3期关键性试验。

Elraglusib：公布1/2期临床试验的新数据

Actuate Therapeutics公司更新了elraglusib用于治疗复发/难治性尤文氏肉瘤（r/r EWS）的1/2期临床试验进展。该研究旨在评估elraglusib在复发/难治性恶性肿瘤儿科患者中的安全性和疗效，涵盖EWS及EWS相关的小圆细胞肉瘤。所有患者均接受了elraglusib与环磷酰胺/拓扑替康的联合治疗。

此次公布的结果显示，在首批8名复发/难治性EWS及相关肉瘤患者中，两名患者正在经历持续的CR，两名患者实现疾病稳定（SD），1名患者取得了PR，肿瘤缩小了52%。Elraglusib展现了抗肿瘤活性，DCR为62.5%。该研究招募正在进行，预计2025年上半年有望公布顶线数据。

▲Elraglusib联用环磷酰胺/拓扑替康的1/2期临床试验结果（图片来源：参考资料[6]）

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参考资料（可上下滑动查看）

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[24] NKGen Biotech’s Positive Phase 1 Clinical Data in Moderate Alzheimer’s Disease Advances Troculeucel into Phase 2 with First Patient Dosed in Phase 1/2a Trial. Retrieved September 12, 2024, from https://www.globenewswire.com/news-release/2024/09/12/2945163/0/en/NKGen-Biotech-s-Positive-Phase-1-Clinical-Data-in-Moderate-Alzheimer-s-Disease-Advances-Troculeucel-into-Phase-2-with-First-Patient-Dosed-in-Phase-1-2a-Trial.html

[25] HotSpot Therapeutics Presents First-in-Human Phase 1 Clinical Data on its Novel CBL-B Inhibitor, HST-1011, at ESMO Congress 2024. Retrieved September 13, 2024, from https://www.prnewswire.com/news-releases/hotspot-therapeutics-presents-first-in-human-phase-1-clinical-data-on-its-novel-cbl-b-inhibitor-hst-1011-at-esmo-congress-2024-302246957.html

[26] Sernova Announces New Positive Data from Phase I/II Trial Regarding Islet Survival and Function. Retrieved September 13, 2024, from https://www.globenewswire.com/news-release/2024/09/12/2945121/0/en/Sernova-Announces-New-Positive-Data-from-Phase-I-II-Trial-Regarding-Islet-Survival-and-Function.html

[27] VYNE Therapeutics Announces Positive Phase 1a SAD Data for VYN202, a Novel BD2-Selective BET Inhibitor. Retrieved September 13, 2024, from https://www.globenewswire.com/news-release/2024/09/12/2945109/0/en/VYNE-Therapeutics-Announces-Positive-Phase-1a-SAD-Data-for-VYN202-a-Novel-BD2-Selective-BET-Inhibitor.html

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