{"id":4895,"date":"2023-04-23T22:28:17","date_gmt":"2023-04-23T14:28:17","guid":{"rendered":"http:\/\/dh.oncolab.cn\/index.php\/2023\/04\/23\/%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac20%e7%ab%a0%ef%bc%9a%e5%85%8d%e7%96%ab%e6%a3%80%e6%9f%a5%e7%82%b9%e6%8a%91%e5%88%b6%e5%9c%a8%e8%82%ba%e7%99%8c%e6%b2%bb%e7%96%97%e4%b8%ad-2\/"},"modified":"2023-04-23T22:28:17","modified_gmt":"2023-04-23T14:28:17","slug":"%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac20%e7%ab%a0%ef%bc%9a%e5%85%8d%e7%96%ab%e6%a3%80%e6%9f%a5%e7%82%b9%e6%8a%91%e5%88%b6%e5%9c%a8%e8%82%ba%e7%99%8c%e6%b2%bb%e7%96%97%e4%b8%ad-2","status":"publish","type":"post","link":"http:\/\/dh.oncolab.cn\/index.php\/2023\/04\/23\/%e8%82%bf%e7%98%a4%e5%85%8d%e7%96%ab%e5%ad%a6-%e7%ac%ac20%e7%ab%a0%ef%bc%9a%e5%85%8d%e7%96%ab%e6%a3%80%e6%9f%a5%e7%82%b9%e6%8a%91%e5%88%b6%e5%9c%a8%e8%82%ba%e7%99%8c%e6%b2%bb%e7%96%97%e4%b8%ad-2\/","title":{"rendered":"\u80bf\u7624\u514d\u75ab\u5b66-\u7b2c20\u7ae0\uff1a\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5728\u80ba\u764c\u6cbb\u7597\u4e2d\u7684\u8fd0\u7528\uff08\u4e0b)"},"content":{"rendered":"
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<\/p>\n<\/section>\n<\/section>\n

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20.5 \u4e00\u7ebf\u6cbb\u7597<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u968f\u7740\u5355\u4e00\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u5728\u5148\u524d\u6cbb\u7597\u8fc7\u7684\u60a3\u8005\u4e2d\u5b89\u5168\u6027\u548c\u7597\u6548\u7684\u786e\u7acb\uff0c\u4e00\u4e9b\u60a3\u8005\u5b9e\u73b0\u4e86\u524d\u6240\u672a\u6709\u7684\u957f\u671f\u751f\u5b58\uff0c\u4e0b\u4e00\u6b65\u5c31\u662f\u8bc4\u4f30\u8be5\u7b56\u7565\u5728\u4e00\u7ebf\u6cbb\u7597\u4e2d\u7684\u5e94\u7528\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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CHECKMate-012\u662f\u4e00\u9879I\u671f\u591a\u961f\u5217\u7814\u7a76\uff0c\u8bc4\u4f30\u4e86\u5728\u665a\u671fNSCLC\u60a3\u8005\u4e2d\u5355\u72ec\u4f7f\u7528\u7eb3\u6b66\u5355\u6297\u6216\u4e0e\u4f0a\u5339\u5355\u6297\uff08ipilimumab\uff09\u3001\u94c2\u7c7b\u5316\u7597\u3001\u5384\u6d1b\u66ff\u5c3c\uff08erlotinib\uff09\u6216\u8d1d\u4f10\u5355\u6297\uff08bevacizumab\uff09\u7684\u8054\u5408\u4f7f\u7528\u4e4b\u95f4\u7684\u6548\u679c\u5dee\u5f02\u3002\u5728\u7eb3\u6b66\u5355\u6297\u7684\u5355\u4e00\u6cbb\u7597\u7ec4\u4e2d\uff0c52\u4f8b\u60a3\u8005\u4e2d\u670912\u4f8b\u89c2\u5bdf\u5230\u660e\u663e\u7684\u53cd\u5e94\uff0c\u6574\u4f53\u53cd\u5e94\u7387\u4e3a23% (ORR, The Overall Response Rate)\uff0c\u53e6\u591614\u4f8b\u60a3\u8005\u8fbe\u5230\u75c5\u60c5\u7a33\u5b9a(SD)\uff0c\u786e\u8ba4\u75be\u75c5\u63a7\u5236\u7387(DCR)\u4e3a50%\u3002\u4e2d\u4f4dPFS\uff08\u65e0\u8fdb\u5c55\u751f\u5b58\u671f\uff09\u4e3a3.6\u4e2a\u6708\uff0cOS\uff08\u603b\u751f\u5b58\u671f\uff09\u4e3a19.4\u4e2a\u6708\u3002<\/p>\n

\u867d\u7136PD-L1<1%\u7684\u60a3\u8005\u7684\u7597\u6548\u4f4e\u4e8ePD-L1\u9633\u6027\u7684\u60a3\u8005(14% : 50%)\uff0c\u4f46\u51761\u5e74\u7684OS(79% : 83%)\u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002<\/p>\n

\u5728\u8054\u5408\u514d\u75ab\u68c0\u67e5\u70b9\u6cbb\u7597\u7684\u7814\u7a76\u4e2d\uff0c78\u4f8b\u5316\u7597\u521d\u6cbb\u7684NSCLC\u60a3\u8005\u88ab\u968f\u673a\u5206\u4e3a\u4e09\u4e2a\u6cbb\u7597\u7ec4\uff0c\u5206\u522b\u4e3a\u7eb3\u6b66\u5355\u62973 mg\/kg\u6bcf2\u5468\u4e00\u6b21\u7ec4\u3001\u4f0a\u5339\u5355\u62971 mg\/kg\u6bcf6\u5468\u4e00\u6b21\u7ec4\u548c\u4f0a\u5339\u5355\u62971 mg\/kg\u6bcf12\u5468\u4e00\u6b21\u7ec4\u3002\u4e24\u4e2a\u836f\u7269\u7684\u8010\u53d7\u6027\u826f\u597d\u3002\u6bcf12\u5468\u4e00\u6b21\u7684\u4f0a\u5339\u5355\u6297\u7ec4\u4e0e\u6bcf6\u5468\u4e00\u6b21\u7684\u4f0a\u5339\u5355\u6297\u7ec4\u76f8\u6bd4\uff0cORR(47% : 38%)\u548c\u4e2d\u4f4dPFS(8.1\u4e2a\u6708 : 3.9\u4e2a\u6708)\u6570\u503c\u8f83\u9ad8\u3002<\/p>\n

\u4f46\u5728\u5bf9\u9ed1\u8272\u7d20\u7624\u548c\u5c0f\u7ec6\u80de\u80ba\u764c\u7684\u7814\u7a76\u4e2d\uff0c\u6211\u4eec\u89c2\u5bdf\u5230\u66b4\u9732\u4e8e\u4f0a\u5339\u5355\u6297\u7684\u6b21\u6570\u8d8a\u591a\uff0c\u8054\u5408\u7597\u6cd5\u7684\u7597\u6548\u8d8a\u9ad8\uff0c\u56e0\u6b64\u9009\u62e9\u6bcf6\u5468\u4e00\u6b21\u7684\u4f0a\u5339\u5355\u6297\u65b9\u6848\u66f4\u9002\u7528\u4e8e\u6cbb\u7597NSCLC\u75be\u75c5\u3002<\/p>\n

\u4e24\u4e2a\u961f\u5217\u7684\u6c47\u603b\u7ed3\u679c\u663e\u793a\uff0c\u572813\u4f8bPD-L1\u226550%\u7684\u60a3\u8005\u4e2d\uff0c\u670912\u4f8b\u786e\u8ba4\u5e94\u7b54\uff0c1\u4f8b\u672a\u786e\u8ba4\u5e94\u7b54\u3002<\/p>\n

\u5728CHECKMate-012\u62a5\u544a\u7684\u7b2c\u4e09\u4e2a\u961f\u5217\u4e2d\uff0c56\u540d\u672a\u7ecf\u6cbb\u7597\u7684NSCLC\u60a3\u8005\u5148\u63a5\u53d7\u4e86\u7eb3\u6b66\u5355\u629710 mg\/kg\u8054\u5408\u94c2\u7c7b\u5316\u7597\u7684\u53cc\u8054\u6cbb\u7597\uff08\u6bcf3\u5468\u8fdb\u884c\u4e00\u6b21\uff0c\u4e3a\u671f4\u4e2a\u5468\u671f\uff09\u7136\u540e\u518d\u7ef4\u6301\u7eb3\u6b66\u5355\u6297\u7684\u5355\u4e00\u6cbb\u7597\uff0c\u76f4\u5230\u80bf\u7624\u8fdb\u5c55\u6216\u4ea7\u751f\u4e0d\u53ef\u63a5\u53d7\u7684\u6bd2\u6027\u3002\u5176\u4ed6\u7684\u7ec4\u5316\u7597\u65b9\u6848\u4e3a\u5409\u897f\u4ed6\u6ee8\uff08gemcitabine\uff09\u8054\u5408\u987a\u94c2\u6cbb\u7597\u9cde\u764c\uff0c\u57f9\u7f8e\u66f2\u585e\uff08pemetrexed\uff09\u8054\u5408\u987a\u94c2\u6cbb\u7597\u975e\u9cde\u764c\uff0c\u5361\u94c2\u8054\u5408\u7d2b\u6749\u9187\uff08paclitaxel\uff09\u6cbb\u7597\u4efb\u4f55\u7ec4\u7ec7\u5b66\u7c7b\u578b\u7684\u764c\u75c7\u3002\u53e6\u4e00\u961f\u5217\u4e3a\u7eb3\u6b66\u5355\u62975 mg\/kg\u8054\u5408\u5361\u94c2\u548c\u7d2b\u6749\u9187\u3002<\/p>\n

\u4efb\u4f55\u7b49\u7ea7\u7684TAE(treatment- related adverse events, \u6cbb\u7597\u76f8\u5173\u526f\u4f5c\u7528)\u60a3\u8005\u670935\u4f8b\uff0895\uff05\uff09\uff0c\u670925\u4f8b\uff0845\uff05\uff09\u51fa\u73b03\u62164\u7ea7\u6bd2\u6027\u3002\u67094\u540d\u60a3\u8005\uff087\uff05\uff09\u51fa\u73b03\u62164\u7ea7\u80ba\u708e\u3002\u786e\u8ba4\u7684ORR\u3001\u4e2d\u4f4dPFS\u3001\u4e2d\u4f4dOS\u30011\u5e74\u751f\u5b58\u7387\u548c2\u5e74\u751f\u5b58\u7387\u5206\u522b\u4e3a33\uff05-47\uff05\u30014.8-7.1\u4e2a\u6708\u300111.6-\u672a\u8fbe\u5230\u300150\uff05-87\uff05\u548c25\uff05-62\uff05\u3002<\/p>\n

\u5bf9\u4e8e\u63a5\u53d7\u7eb3\u6b66\u5355\u62975 mg\/kg\u8054\u5408\u5361\u94c2\u548c\u7d2b\u6749\u9187\u6cbb\u7597\u768414\u540d\u60a3\u8005\u6765\u8bf4\uff0c\u6cbb\u7597\u6548\u679c\u663e\u8457\u63d0\u5347\uff0c\u786e\u8ba4\u7684ORR\u4e3a43%\uff0c\u4f30\u8ba1\u6709\u6548\u5e94\u7b54\u65f6\u95f4\u4e3a19.6\u4e2a\u6708\uff0c\u4e2d\u4f4dOS\u672a\u8fbe\u5230\uff0c1\u5e74OS\u4e3a86\uff05\uff0c2\u5e74OS\u4e3a62\uff05\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u5728\u968f\u673a\u5f00\u653e\u6807\u7b7e\u76842\u671fKeynote-021\u4e34\u5e8a\u8bd5\u9a8c\u4e2d\uff0c123\u540d\u5316\u7597\u521d\u6cbb\u7684NSCLC\u60a3\u8005\u88ab\u968f\u673a\u5206\u6210\u5361\u94c2\u8054\u5408\u57f9\u7f8e\u66f2\u585e\uff0c\u518d\u8054\u5408\u6216\u4e0d\u8054\u5408\u6d3e\u59c6\u5355\u6297\uff08Pembrolizumab\uff09\u4e24\u7ec4\u3002<\/p>\n

\u670d\u7528\u6d3e\u59c6\u5355\u6297\u7684\u60a3\u8005\u51fa\u73b03\u7ea7\u6216\u66f4\u9ad8\u7a0b\u5ea6\u7684\u4e0d\u826f\u53cd\u5e94(40% : 26%)\u3002<\/p>\n

\u5b9e\u9a8c\u7ed3\u679c\u663e\u793a\uff0c\u4e09\u836f\u8054\u5408\u6cbb\u7597\u7ec4\u7684ORR\u663e\u8457\u589e\u52a0(55%:29%\uff0cP=0.001)\u3002\u5c3d\u7ba1\u4f7f\u7528\u6d3e\u59c6\u5355\u6297\u7ec4\u7684\u4e2d\u4f4dPFS\u8f83\u9ad8(13.0\u4e2a\u6708:8.9\u4e2a\u6708)\uff0c\u4f46\u4e24\u7ec4\u7684OS(\u603b\u751f\u5b58\u671f)\u6ca1\u6709\u5dee\u5f02\uff0c\u4e2d\u4f4d\u6570\u672a\u8fbe\u5230\uff0c\u4f30\u8ba16\u4e2a\u6708OS\u8d85\u8fc790%\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Keynote-024\u662f\u4e00\u9879\u5f00\u653e\u6807\u7b7e\u7684\u968f\u673a3\u671f\u8bd5\u9a8c\uff0c\u5728\u4ee5\u524d\u672a\u7ecf\u6cbb\u7597\u4e14\u80bf\u7624\u7ec6\u80de\u4e2dPD-L1\u8868\u8fbe\u226550%\u7684NSCLC\u60a3\u8005\u4e2d\uff0c\u6bd4\u8f83\u4e86\u6bcf3\u5468200 mg\u7684\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u4e0e\u94c2\u7c7b\u5316\u7597\u7684\u7ed3\u679c(Fig. 20.2<\/span>)\u3002\u6709EGFR\u7a81\u53d8\u6216ALK\u6613\u4f4d\u7684\u60a3\u8005\u88ab\u6392\u9664\u5728\u7814\u7a76\u4e4b\u5916\u3002<\/p>\n

\u5316\u7597\u65b9\u6848\u5206\u522b\u4e3a\u987a\u94c2\u8054\u5408\u57f9\u7f8e\u66f2\u585e\u3001\u5361\u94c2\u8054\u5408\u57f9\u7f8e\u66f2\u585e\u3001\u987a\u94c2\u8054\u5408\u5409\u897f\u4ed6\u6ee8\u3001\u5361\u94c2\u8054\u5408\u5409\u897f\u4ed6\u6ee8\u3001\u5361\u94c2\u8054\u5408\u7d2b\u6749\u9187\u3002\u5728\u7b5b\u9009\u51fa\u76841934\u4f8b\u60a3\u8005\u4e2d\uff0c\u5bf91653\u4f8b\u60a3\u8005\u8fdb\u884c\u4e86PD-L1\u8bc4\u4f30\uff0c\u5176\u4e2d500\u4f8b(30.2%)\u60a3\u8005\u7684PD-L1\u8868\u8fbe\u6bd4\u4f8b\u226550%\u3002<\/p>\n

\u7b2c\u4e00\u4e2a\u89c2\u5bdf\u7ec8\u70b9\u4e3aPFS(\u65e0\u8fdb\u5c55\u751f\u5b58\u671f)\uff0c\u6211\u4eec\u5728\u7b26\u5408\u6761\u4ef6\u7684305\u540d\u60a3\u8005\u4e2d\u968f\u673a\u9009\u62e9154\u4eba\u63a5\u53d7\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\uff0c151\u4eba\u63a5\u53d7\u5316\u7597\u3002\u6700\u5e38\u89c1\u7684\u5316\u7597\u662f\u5361\u94c2\u8054\u5408\u57f9\u7f8e\u66f2\u585e\u3002<\/p>\n

\u6d3e\u59c6\u5355\u6297\u53ef\u4ee5\u964d\u4f4e\u4efb\u4f55\u7ea7\u522b(73.4% : 90%)\u4ee5\u53ca3\u7ea7\u6216\u66f4\u9ad8\u7ea7\u522b(26.6% : 53.3%)\u7684\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u3002\u5728\u63a5\u53d7\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c\u670945\u4f8b(29.2%)\u51fa\u73b0\u514d\u75ab\u4ecb\u5bfc\u7684\u4e0d\u826f\u4e8b\u4ef6\uff0c\u6700\u5e38\u89c1\u7684\u662f\u7532\u72b6\u817a\u529f\u80fd\u51cf\u9000(9.2%)\u3001\u7532\u72b6\u817a\u529f\u80fd\u4ea2\u8fdb(7.8%)\u548c\u80ba\u708e(5.8%)\u3002<\/p>\n

\u6b64\u5916\uff0c\u5728\u56e0\u6cbb\u7597\u5bfc\u81f4\u7684\u6b7b\u4ea1\u4e8b\u4ef6\u4e2d\uff0c\u63a5\u53d7\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u7684\u53601\u4f8b(0.6%)\uff0c\u63a5\u53d7\u5316\u7597\u7684\u53603\u4f8b(2%)\u3002\u63a5\u53d7\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u7684\u60a3\u8005ORR\u8f83\u9ad8(44.8%:27.8%)\u3002<\/p>\n

\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u7ec4\u7684\u4e2d\u4f4dFPS\u660e\u663e\u957f\u4e8e\u5316\u7597\u7ec4(10.3 vs 6\u4e2a\u6708\uff0cHR 0.50\uff0cP<0.01)\u3002\u5c3d\u7ba1\u4e24\u7ec4\u5747\u672a\u8fbe\u5230\u4e2d\u4f4d\u6570OS\uff0c\u4f46\u63a5\u53d7\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u7684\u60a3\u8005\u57286\u4e2a\u6708\u65f6\u7684\u4f30\u8ba1\u5b58\u6d3b\u767e\u5206\u6bd4\u4e5f\u66f4\u9ad8(80.2%:72.4%)\u3002<\/p>\n

\u6765\u81eaKeynote-024\u7684\u7ed3\u679c\u4e3a\u672a\u7ecf\u6cbb\u7597\u7684NSCLC(\u6392\u9664EGFR\u7a81\u53d8\u6216ALK\u6613\u4f4d)\u4e14\u80bf\u7624\u7ec6\u80dePD-L1\u8868\u8fbe\u6c34\u5e73\u226550%\u7684\u60a3\u8005\u5efa\u7acb\u4e86\u65b0\u7684\u6cbb\u7597\u6807\u51c6\uff0c\u4e0e\u6807\u51c6\u5316\u7597\u76f8\u6bd4\uff0c\u5176\u5177\u6709\u66f4\u5c11\u7684\u6bd2\u6027\u6548\u5e94\u4ee5\u53ca\u6539\u5584\u7684ORR\u548cPFS (Fig. 20.3<\/span>)\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig 20.2 <\/span>Keynote-024\u7684\u8bbe\u8ba1\u3002\u672a\u7ecf\u6cbb\u7597\u7684IV\u671fNSCLC\u60a3\u8005\u968f\u673a\u63a5\u53d7\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u6216\u5316\u7597\u3002\u5316\u7597\u65b9\u6848\u5206\u522b\u4e3a\u987a\u94c2\u8054\u5408\u57f9\u7f8e\u66f2\u585e\u3001\u5361\u94c2\u8054\u5408\u57f9\u7f8e\u66f2\u585e\u3001\u987a\u94c2\u8054\u5408\u5409\u897f\u4ed6\u6ee8\u3001\u5361\u94c2\u8054\u5408\u5409\u897f\u4ed6\u6ee8\u3001\u5361\u94c2\u8054\u5408\u7d2b\u6749\u9187\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig 20.3<\/span> \u6839\u636ePD-L1\u7684\u8868\u8fbe\uff0c\u6cbb\u7597\u975e\u764c\u57fa\u56e0\u9a71\u52a8\u7684\u665a\u671fNSCLC\u7684\u65b0\u7b97\u6cd5<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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20.6 \u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u7597\u6548\u7684\u9884\u6d4b\u56e0\u5b50<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u7531\u4e8e\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u5bf9\u80bf\u7624\u7684\u957f\u671f\u63a7\u5236\u53ea\u5728\u4e00\u5c0f\u90e8\u5206\u60a3\u8005\u4e2d\u4f53\u73b0\uff0c\u56e0\u6b64\u627e\u5230\u4e0e\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u7597\u6548\u76f8\u5173\u7684\u9884\u6d4b\u56e0\u5b50\u4e00\u76f4\u662f\u4eba\u4eec\u975e\u5e38\u611f\u5174\u8da3\u7684\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u7814\u7a76\u6700\u591a\u7684\u751f\u7269\u6807\u5fd7\u7269\u662fPD-L1\uff0c\u5b83\u53ef\u4ee5\u901a\u8fc7\u514d\u75ab\u7ec4\u7ec7\u5316\u5b66(IHC)\u68c0\u6d4b\u5230\uff0c\u901a\u5e38\u5728\u80bf\u7624\u7ec6\u80de\u8868\u9762\u4e0a\u8c03\u3002\u591a\u9879\u7814\u7a76\u8868\u660e\uff0c\u80bf\u7624\u7f13\u89e3\u7387\u4e0ePD-L1\u8868\u8fbe\u4e4b\u95f4\u5b58\u5728\u5173\u8054\uff0c\u4f46\u6ca1\u6709PD-L1\u8868\u8fbe\u7684\u60a3\u8005\u4e5f\u80fd\u53d7\u76ca\u3002<\/p>\n

\u5728\u4e00\u9879\u5305\u62ec1567\u4f8b\u63a5\u53d7\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u7684NSCLC\u60a3\u8005\u7684\u5206\u6790\u4e2d\uff0c652\u4f8bPD-L1\u9633\u6027\u80bf\u7624\u60a3\u8005\u7684\u5ba2\u89c2\u7f13\u89e3\u7387ORR\u4e3a29%\uff0c\u800cPD-L1\u9634\u6027\u80bf\u7624\u60a3\u8005\u7684ORR\u4e3a13%(\u76f8\u5bf9\u6bd4[RR]\u4e3a2.08\uff0c95%CI\u4e3a1.49-2.91\uff0cP<0.01)\u3002<\/p>\n

\u8fd9\u79cd\u4e0ePD-L1\u8868\u8fbe\u76f8\u5173\u7684ORR\u7684\u533a\u522b\u5728\u9cde\u764c\u548c\u975e\u9cde\u764c\u4e2d\u90fd\u5b58\u5728\uff0c\u4e0ePD-L1\u9634\u6027\u80bf\u7624\u76f8\u6bd4\uff0c\u9cde\u764c\u7684ORR\u5206\u522b\u4e3a29%\u548c14%\uff0cRR\u4e3a2.12\uff1b95%CI\u4e3a1.37-3.29\uff0cP<0.01\uff1b\u975e\u9cde\u764c\u7684ORR\u4e3a32%\u548c11%\uff0cRR\u4e3a3.14\uff1b95%CI\u4e3a2.15-4.54\uff0cP<0.01\u3002<\/p>\n

\u7136\u800c\uff0c\u867d\u7136PD-L1\u9633\u6027\u80bf\u7624\u60a3\u800524\u5468\u7684PFS\u663e\u8457\u9ad8\u4e8ePD-L1\u9634\u6027\u80bf\u7624\u60a3\u8005(35% : 26%\uff0cP<0.01)\uff0c\u4f46\u4e24\u80051\u5e74\u7684OS\u65e0\u5dee\u5f02 (28% : 27%\uff0cP=0.39)\u3002<\/p>\n

\u57287\u9879\u5bf9\u63a5\u53d7\u6cbb\u7597\u7684511\u540dNSCLC\u60a3\u8005\u7684\u7814\u7a76\u5206\u6790\u4e2d\u4e5f\u89c2\u5bdf\u5230\u4e86\u7c7b\u4f3c\u7684\u7ed3\u679c\uff0c\u5176\u4e2dPD-L1\u9633\u6027\u80bf\u7624\u60a3\u8005\u7684ORR\u66f4\u9ad8(23.2% : 14.5%)\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u9884\u6d4b\u9488\u5bf9PD-1\u6216PD-L1\u7684\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u4f5c\u7528\u6548\u679c\u7684\u6700\u5408\u7406\u548c\u6700\u76f4\u63a5\u7684\u751f\u7269\u6807\u5fd7\u7269\u662f\u76f4\u63a5\u8bc4\u4f30\u80bf\u7624\u7ec6\u80de\u4e0aPD-L1\u7684\u8868\u8fbe\u91cf\u3002\u7136\u800c\uff0c\u4e3a\u4e86\u51c6\u786e\u8bf4\u660ePD-L1\u7684\u8868\u8fbe\u91cf\uff0c\u6709\u51e0\u4e2a\u56e0\u7d20\u9700\u8981\u8003\u8651\uff0c\u5305\u62ecPD-L1\u4e0a\u8c03\u7684\u673a\u5236\u3001\u80bf\u7624\u6d78\u6da6\u6027\u6dcb\u5df4\u7ec6\u80de(TILs)\u7684\u6570\u91cf\u548cIHC\u68c0\u6d4b\u7684\u65b9\u6cd5\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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PD-L1\u5728\u80bf\u7624\u7ec6\u80de\u4e2d\u7684\u8868\u8fbe\u53ef\u80fd\u662f\u7ec4\u6210\u6027\u7684\uff0c\u4e5f\u53ef\u80fd\u662f\u9002\u5e94\u6027\u7684(\u53ef\u8bf1\u5bfc\u7684)\u3002\u8fd9\u4e9b\u673a\u5236\u4e0d\u662f\u76f8\u4e92\u6392\u65a5\u7684\uff0c\u53ef\u4ee5\u5171\u5b58\u4e8e\u540c\u4e00\u80bf\u7624\u5fae\u73af\u5883(TME)\u4e2d\u3002<\/p>\n

PD-L1\u7684\u7ec4\u6210\u6027\u8868\u8fbe\u662f\u7531\u4e8e\u81f4\u764c\u9014\u5f84\u7684\u6539\u53d8\uff0c\u5305\u62ec9q24\u7684\u6269\u589e\uff0c\u5176\u4e2d\u5305\u542bPD-L1\u3001PD-L2\u548cJAK-2(PDJ\u6269\u589e\u5b50)\uff0cPTEN\u7f3a\u5931\uff0cPI3K\u6216AKT\u7a81\u53d8\uff0c\u4ee5\u53caMYC\u8fc7\u8868\u8fbe\u3002<\/p>\n

\u5e72\u6270\u7d20(INF)\u4e5f\u53ef\u4ee5\u8bf1\u5bfcPD-L1\u7684\u8868\u8fbe\uff0c\u5c24\u5176\u662f\u7531\u6fc0\u6d3b\u7684CD4\u8f85\u52a9Th1\u7ec6\u80de\u3001\u6fc0\u6d3b\u7684CD8\u7ec6\u80de\u548c\u81ea\u7136\u6740\u4f24(NK)\u7ec6\u80de\u4ea7\u751f\u7684INF\u03b3\u3002INF\u03b3\u5bfc\u81f4\u5e72\u6270\u7d20\u53d7\u4f53\u5468\u56f4\u7ec6\u80de\u4e2dPD-L1\u8868\u8fbe\u4e0a\u5347\uff0c\u5305\u62ec\u80bf\u7624\u7ec6\u80de\u548cTME\u5185\u7684\u7ec6\u80de\uff0c\u5982\u9ad3\u7cfb\u7ec6\u80de\u3001\u57fa\u8d28\u7ec6\u80de\u548cT\u7ec6\u80de(Fig. 20.4<\/span>)\u3002<\/p>\n

\u8bf1\u5bfc\u6027\u8868\u8fbe\u6bd4\u7ec4\u6210\u6027\u8868\u8fbe\u66f4\u5e38\u89c1\uff0c\u5176\u7279\u5f81\u662f\u80bf\u7624\u7ec6\u80de\u548cTILs\u7ed3\u5408\u5904\u7684PD-L1\u5448\u6591\u5757\u72b6\u3002\u76f8\u53cd\uff0c\u5728\u5927\u591a\u6570\u7ec6\u80de\u4e2d\uff0c\u7ec4\u6210\u6027PD-L1\u8868\u8fbe\u66f4\u5747\u5300\uff0c\u5176PD-L1\u67d3\u8272\u4e5f\u56e0\u6b64\u66f4\u5747\u5300\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig 20.4<\/span> \u9002\u5e94\u6027\u514d\u75ab\u62b5\u6297\u3002INF\u03b3\u7ed3\u5408\u5e72\u6270\u7d20\u53d7\u4f53(IR)\u5bfc\u81f4PD-L1\u8868\u8fbe\u589e\u52a0\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u6839\u636ePD-L1\u8868\u8fbe\u7684\u72b6\u6001\u548cTILs\u7684\u5b58\u5728\uff0c\u80bf\u7624\u53ef\u4ee5\u5206\u4e3a\u56db\u4e2a\u4e0d\u540c\u7684\u7ec4(Fig. 20.5<\/span>)\u3002I\u578b\u80bf\u7624\u5177\u6709TILs\uff0c\u4e14PD-L1\u5448\u9633\u6027\uff0c\u800cIII\u578b\u80bf\u7624\u6709PD-L1\u8868\u8fbe\uff0c\u4f46\u6ca1\u6709TILs\u3002II\u578b\u548cIV\u578b\u80bf\u7624PD-L1\u5448\u9634\u6027\uff0c\u524d\u8005\u65e0TILs\uff0c\u540e\u8005\u6709TILs\u3002<\/p>\n

\u6d78\u6da6\u6027\u514d\u75ab\u7ec6\u80de\u5206\u6ccc\u7684INF\u03b3\u53ef\u4ee5\u8bf1\u5bfc\u80bf\u7624\u7ec6\u80de\u8868\u8fbePD-L1\uff0cI\u578b\u80bf\u7624\u8868\u73b0\u4e86\u80bf\u7624\u7ec6\u80de\u5bf9\u6d78\u6da6\u7684\u514d\u75ab\u7ec6\u80de\u5206\u6ccc\u7684INF\u03b3\u4f5c\u51fa\u7684\u9002\u5e94\u6027PD-L1\u8bf1\u5bfc\u8868\u8fbe\u3002\u800cIII\u578b\u80bf\u7624\u8868\u73b0\u4e3a\u7ec4\u6210\u6027PD-L1\u8868\u8fbe\uff0c\u8fd9\u79cd\u8868\u8fbe\u4e0e\u80bf\u7624\u7ec6\u80de\u548cINF\u03b3\u5206\u6ccc\u7ec6\u80de\u4e4b\u95f4\u7684\u76f8\u4e92\u4f5c\u7528\u65e0\u5173\u3002<\/p>\n

II\u578b\u80bf\u7624\u65e2\u4e0d\u8868\u8fbeTILs\uff0c\u4e5f\u4e0d\u8868\u8fbePD-L1\uff0c\u53ef\u80fd\u4ee3\u8868\u514d\u75ab\u5ffd\u89c6\uff0c\u800c\u5728IV\u578b\u80bf\u7624\u4e2d\uff0c\u80bf\u7624\u7ec6\u80de\u4e2d\u5b58\u5728TILs\u800c\u6ca1\u6709\u8bf1\u5bfcPD-L1\u8868\u8fbe\uff0c\u53ef\u80fd\u8868\u660e\u5b58\u5728\u514d\u75ab\u8010\u53d7\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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Fig 20.5<\/span> \u57fa\u4e8ePD-L1\u8868\u8fbe\u548cTILs\u7684\u80bf\u7624\u5206\u7c7b<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\u7531\u4e8e\u53ea\u6709\u4e24\u4e2a\u5c0f\u7684\u4eb2\u6c34\u6027\u533a\u57df\u53ef\u7528\u4f5cIHC\u68c0\u6d4bPD-L1\u7684\u6297\u4f53\u7684\u7ed3\u5408\u4f4d\u70b9\uff0c\u4e0e\u6cbb\u7597\u6027\u6297PD-L1\u7684\u6297\u4f53\u76f8\u6bd4\uff0c\u8fd9\u4e9b\u68c0\u6d4bPD-L1\u7684\u6297\u4f53\u4f1a\u7ed3\u5408\u5230PD-L1\u4e0a\u7684\u4e00\u4e2a\u7279\u6b8a\u4f4d\u70b9\u3002<\/p>\n

\u6b64\u5916\uff0c\u4eba\u4eec\u4f7f\u7528\u4e0d\u540c\u7684IHC\u4e34\u754c\u503c\u6765\u5b9a\u4e49PD-L1\u9633\u6027\uff0c\u5e76\u63d0\u4f9b\u591a\u79cd\u68c0\u6d4b\u65b9\u6cd5\uff0c\u800c\u6ca1\u6709\u4e00\u4e2a\u6807\u51c6\u5316\u7684\u6846\u67b6\u6765\u6bd4\u8f83\u8fd9\u4e9b\u65b9\u6cd5\uff0c\u8fd9\u4f7f\u5f97\u89e3\u91ca\u7ed3\u679c\u548c\u63a8\u65ad\u4e2a\u522b\u7814\u7a76\u7684\u7ed3\u679c\u53d8\u5f97\u56f0\u96be\u3002<\/p>\n

\u7a0b\u5e8f\u6027\u6b7b\u4ea1\u914d\u4f531\uff08PD-L1\uff09IHC\u68c0\u6d4b\u6bd4\u8f83\u9879\u76ee\u662f\u4e3a\u4e86\u89e3\u51b3\u6297\u4f53\u68c0\u6d4b\u7684\u6807\u51c6\u5316\u95ee\u9898\u800c\u542f\u52a8\u7684\u3002\u5728\u8be5\u9879\u76ee\u7684\u7b2c\u4e00\u9636\u6bb5\uff0c\u5bf938\u4f8bNSCLC\u8fdb\u884c\u4e864\u79cd\u6700\u5e38\u7528\u6297\u4f53\u7684\u67d3\u8272\uff0c\u5305\u62ecDAKO 28-8\u3001DAKO 22C3\u3001Ventana SP142\u548cVentana SP263\uff0c\u5b83\u4eec\u5206\u522b\u7528\u4e8e\u7eb3\u6b66\u5355\u6297\u3001\u6d3e\u59c6\u5355\u6297\u3001\u963f\u7279\u73e0\u5355\u6297\uff08atezolizumab\uff09\u548c\u5fb7\u74e6\u9c81\u5355\u6297\uff08duvalumab\uff09\u7684\u7814\u7a76\u3002<\/p>\n

\u7528DAKO\u548cVentana\u5bf9\u80bf\u7624\u5207\u7247\u7684\u6297\u4f53\u8fdb\u884c\u67d3\u8272\uff0c\u7136\u540e\u5bf9\u514d\u75ab\u67d3\u8272\u73bb\u7247\u8fdb\u884c\u8bc4\u4f30\uff0c\u7531\u4e09\u540d\u75c5\u7406\u5b66\u4e13\u5bb6\u5bf9\u73bb\u7247\u4e0a\u7684PD-L1\u5728TCs\u548cICs\u4e2d\u7684\u767e\u5206\u6bd4\u8fdb\u884c\u72ec\u7acb\u8bc4\u5206\u3002PD-L1\u67d3\u8272\u7684\u80bf\u7624\u7ec6\u80de\u767e\u5206\u6bd4\u572822C3\u300128-8\u548cSP263\u68c0\u6d4b\u4e2d\u76f8\u5f53\uff0c\u800cSP142\u68c0\u6d4b\u7684\u603b\u4f53\u67d3\u8272\u8f83\u4f4e\u3002<\/p>\n

\u5728\u4ee5\u4e0a\u56db\u79cd\u68c0\u6d4b\u65b9\u6cd5\u4e2d\uff0c\u670919\u4f8b(50%)PD-L1\u67d3\u8272\u5747\u9ad8\u4e8e\u4e34\u754c\u503c\uff0c\u65e0\u8bba\u662f\u54ea\u79cd\u65b9\u6cd5\uff0c\u90fd\u663e\u793a\u9633\u6027\u7ed3\u679c\uff1b\u800c5\u4f8b(13%)\u5747\u4f4e\u4e8e\u4e34\u754c\u503c\u3002\u7136\u800c\uff0c14\u4f8b(37%)PD-L1\u8868\u8fbe\u6c34\u5e73\u4e0d\u4e00\u81f4\uff0c\u5bfc\u81f4\u90e8\u5206\u60a3\u8005\u7684PD-L1\u72b6\u6001\u5206\u7c7b\u4e0d\u540c\u3002\u514d\u75ab\u7ec6\u80de\u4e0a\u7684PD-L1\u5728\u56db\u79cd\u68c0\u6d4b\u65b9\u6cd5\u4e2d\u5747\u6709\u8868\u8fbe\uff0c\u4f46\u4e0eTC\u8868\u8fbe\u76f8\u6bd4\uff0c\u5404\u68c0\u6d4b\u65b9\u6cd5\u4e4b\u95f4\u7684\u5dee\u5f02\u5f88\u5927\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

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\n

PD-L1\u68c0\u6d4b\u7684\u53e6\u4e00\u4e2a\u95ee\u9898\u662f\u80bf\u7624\u7684\u5f02\u8d28\u6027\u3002<\/p>\n

\u5728\u4e00\u9879\u4f7f\u752849\u4f8bNSCLC\u6d3b\u68c0\u7ec4\u7ec7\u6807\u672c\u7684\u7814\u7a76\u4e2d\uff0c\u901a\u8fc7\u663e\u8272IHC\u548c\u4f7f\u7528\u6297\u4f53E1L3N\u548cSP142\u7684\u81ea\u52a8\u5b9a\u91cf\u514d\u75ab\u8367\u5149\u6765\u8bc4\u4f30PD-L1\u5728\u80bf\u7624\u7ec6\u80de\u548c\u95f4\u8d28\u4e2d\u7684\u8868\u8fbe\u3002\u7ed3\u679c\u663e\u793a\u5728\u4e0d\u540c\u7684\u6d3b\u68c0\u90e8\u4f4d\u4e2d\uff0c\u4e00\u4e9b\u80bf\u7624\u7684PD-L1\u8868\u8fbe\u7ed3\u679c\u4e0d\u4e00\u81f4\uff0c\u6709\u9633\u6027\u533a\u57df\uff0c\u4e5f\u6709\u9634\u6027\u533a\u57df\u3002<\/p>\n

\u5728\u4e00\u9879\u5bf9109\u4f8b\u80ba\u817a\u764c\u60a3\u8005\u8fdb\u884c\u7684E1L3N\u6297\u4f53\u67d3\u8272\u7684\u7814\u7a76\u4e2d\uff0cPD-L1\u5728\u539f\u53d1\u80bf\u7624\u548cN1\u8f6c\u79fb\u7684\u6dcb\u5df4\u7ed3\u4e4b\u95f4\u670915-18%\u7684\u8868\u8fbe\u5dee\u5f02\uff0c\u5728\u539f\u53d1\u80bf\u7624\u548cN2\u8f6c\u79fb\u7684\u6dcb\u5df4\u7ed3\u4e4b\u95f4\u67099.4-38%\u7684\u8868\u8fbe\u5dee\u5f02\uff0c\u5176\u5dee\u5f02\u7684\u5927\u5c0f\u53d6\u51b3\u4e8e\u9633\u6027\u7684\u5206\u754c\u503c\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u5176\u4ed6\u6f5c\u5728\u7684\u751f\u7269\u6807\u5fd7\u7269\u5305\u62ec\u7a81\u53d8\u8d1f\u8377\u548c\u9a71\u52a8\u7a81\u53d8\u7684\u56e0\u7d20\u7684\u5b58\u5728\u3002\u7531\u4e8e\u7a81\u53d8\u540e\u65b0\u80bd\u7684\u6297\u539f\u6027\u4e0e\u5176\u529f\u80fd\u65e0\u5173\uff0c\u6ca1\u6709\u529f\u80fd\u4f5c\u7528\u7684\u5076\u7136\u7a81\u53d8\u53ef\u80fd\u4f1a\u52a0\u5f3a\u80bf\u7624\u6297\u539f\u7684\u6297\u539f\u6027\uff0c\u8fd9\u8868\u660e\u66f4\u9ad8\u7684\u7a81\u53d8\u8d1f\u8377\u53ef\u80fd\u4f1a\u4ea7\u751f\u66f4\u591a\u7684\u65b0\u6297\u539f\uff0c\u5e76\u589e\u52a0\u60a3\u8005\u4ece\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u53d7\u76ca\u7684\u53ef\u80fd\u6027\u3002<\/p>\n

\u4e8b\u5b9e\u4e0a\uff0c\u9ed1\u8272\u7d20\u7624\u3001NSCLC\u548c\u8180\u80f1\u764c\u7b49\u4f53\u7ec6\u80de\u7a81\u53d8\u9891\u7387\u6700\u9ad8\u7684\u80bf\u7624\u5bf9\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u7684\u53cd\u5e94\u7684\u6982\u7387\u66f4\u9ad8\u3002<\/p>\n

\u5728\u4e00\u9879\u8bc4\u4f3034\u4f8bNSCLC\u60a3\u8005\u7684\u7814\u7a76\u4e2d\uff0c\u5c06\u60a3\u8005\u5206\u4e3a\u53d1\u73b0\u961f\u5217\u548c\u9a8c\u8bc1\u961f\u5217\u3002\u4f7f\u7528\u5b8c\u6574\u5916\u663e\u5b50\u7ec4\u6d4b\u5e8f\u7684\u7a81\u53d8\u8d1f\u8377\u88ab\u8bc4\u4f30\u53ef\u4f5c\u4e3a\u6d3e\u59c6\u5355\u6297\u6cbb\u7597\u7684\u83b7\u76ca\u7684\u9884\u6d4b\u56e0\u5b50\u3002\u53d1\u73b0\u961f\u5217\u4e2d\u768416\u4f4d\u60a3\u8005\u548c\u9a8c\u8bc1\u961f\u5217\u4e2d\u768418\u4f4d\u60a3\u8005\u7684\u4f53\u7ec6\u80de\u975e\u540c\u4e49\u7a81\u53d8\u7684\u4e2d\u4f4d\u6570\u5206\u522b\u4e3a209\u548c200\u3002<\/p>\n

\u5728\u4e24\u4e2a\u961f\u5217\u4e2d\uff0c\u7a81\u53d8\u8d1f\u8377\u9ad8\u4e8e\u4e2d\u4f4d\u6570\u7684\u60a3\u8005\u7684\u6301\u4e45\u4e34\u5e8a\u53d7\u76ca\u6982\u7387(DCB)\uff08\u7528\u90e8\u5206\u7f13\u89e3PR\u6216\u7a33\u5b9a\u75c5\u60c5SD\u8d85\u8fc76\u4e2a\u6708\u6765\u5b9a\u4e49\uff09\u548c\u4e2d\u4f4dPFS\u663e\u8457\u5347\u9ad8\u3002PD-L1\u9633\u6027\u4e14\u975e\u540c\u4e49\u7a81\u53d8\u8d1f\u8377\u9ad8(200\u4ee5\u4e0a)\u7684\u80bf\u7624\u60a3\u8005\uff0cDCB\u9ad8\u4e8e\u4f4e\u7a81\u53d8\u8d1f\u8377\u7684\u60a3\u8005(91% : 10%)\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

EGFR\u7a81\u53d8\u6216ALK\u6613\u4f4d\u7684\u60a3\u8005\u901a\u5e38\u4e0d\u5438\u70df\u6216\u8f7b\u5ea6\u5438\u70df\u3002\u7531\u4e8e\u4e0d\u5438\u70df\u8005\u7684\u5e73\u5747\u7a81\u53d8\u9891\u7387\u6bd4\u5438\u70df\u8005\u4f4e\u5341\u500d\uff0c\u56e0\u6b64\u63a8\u6d4b\u4e0d\u5438\u70df\u6216\u8f7b\u5ea6\u5438\u70df\u7684\u60a3\u8005\u4ece\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u4e2d\u53d7\u76ca\u7684\u6982\u7387\u8f83\u4f4e\u3002<\/p>\n

\u5728\u4e00\u9879\u5bf958\u540d\u63a5\u53d7\u6297PD-1\u6216PD-L1\u6291\u5236\u5242\u6cbb\u7597\u7684\u60a3\u8005\u7684\u7814\u7a76\u4e2d\uff0c\u91ce\u751f\u578bEGFR\u548cALK\u60a3\u8005\u7684ORR(23.3% : 3.6%\uff0cP=0.05)\u548c\u4e2d\u4f4dPFS(2.58\u4e2a\u6708 : 2.07\u4e2a\u6708\uff0cHR=0.5\uff0cP=0.01)\u9ad8\u4e8eEGFR\u7a81\u53d8\u6216ALK\u6613\u4f4d\u60a3\u8005\u3002<\/p>\n

\u4e00\u79cd\u89e3\u91ca\u662f\u7531\u4e8e\u5728EGFR\u6216ALK\u6539\u53d8\u7684\u60a3\u8005\u4e2d\uff0cTME\u5185PD-L1\u8868\u8fbe\u548cCD8\u9633\u6027TILs\u7684\u5e76\u5b58\u6bd4\u7387\u8f83\u4f4e\u3002<\/p>\n

\u5728\u4e00\u9879\u5bf91903\u540d\u60a3\u8005\u7684Meta\u5206\u6790\u4e2d\uff0c\u5c06\u7eb3\u6b66\u5355\u6297\u3001\u6d3e\u59c6\u5355\u6297\u6216\u963f\u7279\u73e0\u5355\u6297\u4e0e\u591a\u70ef\u7d2b\u6749\u9187\u4e09\u9879\u7814\u7a76\u8fdb\u884c\u6bd4\u8f83\uff0c\u6839\u636eEGFR\u72b6\u6001\u5bf9\u7ed3\u679c\u8fdb\u884c\u8bc4\u4f30\u3002\u5728\u91ce\u751f\u578bEGFR\u60a3\u8005\u4e2d\uff0c\u4f7f\u7528\u6297PD-1\u6216PD-L1\u6291\u5236\u5242\u7684\u514d\u75ab\u68c0\u67e5\u70b9\u963b\u65ad\u4e0eOS\u663e\u8457\u6539\u5584\u76f8\u5173(HR\u4e3a0.66\uff1b95%CI\u4e3a0.58-0.76)\u3002\u76f8\u6bd4\u4e4b\u4e0b\uff0c\u5728EGFR\u7a81\u53d8\u80bf\u7624\u60a3\u8005\u4e2d\uff0c\u514d\u75ab\u6cbb\u7597\u6ca1\u6709\u660e\u663e\u7684\u6548\u679c(HR \u4e3a1.05\uff1b95%CI \u4e3a0.70-1.55)\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n


<\/p>\n<\/section>\n<\/section>\n

\n
\n

20.7\u603b\u7ed3<\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u9488\u5bf9PD-1\u6216PD-L1\u7684\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u662f\u6cbb\u7597\u665a\u671fNSCLC\u60a3\u8005\u7684\u91cd\u8981\u6b65\u9aa4\uff0c\u5728\u65e2\u5f80\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u8be5\u7597\u6548\u660e\u663e\u4f18\u4e8e\u591a\u70ef\u7d2b\u6749\u9187\u3002\u6700\u8fd1\uff0c\u5728\u65e2\u5f80\u672a\u7ecf\u6cbb\u7597\u7684\u5e76\u4e14TC PD-L1\u67d3\u8272\u81f3\u5c11\u8fbe\u523050%\u7684\u80bf\u7624\u60a3\u8005\u4e2d\u53d1\u73b0\uff0c\u4e0e\u4e00\u7ebf\u94c2\u57fa\u53cc\u8054\u5242\u76f8\u6bd4\uff0cPD-1\u6216PD-L1\u7684\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u53ef\u4ee5\u4f7f\u60a3\u8005\u5b58\u6d3b\u7387\u63d0\u9ad8\u3002<\/p>\n

\u6b64\u5916\uff0c\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u663e\u793a\uff0c\u4e0e\u6807\u51c6\u5316\u7597\u76f8\u6bd4\uff0c\u6297PD-1\u6216PD-L1\u6297\u4f53\u7684\u8010\u53d7\u6027\u66f4\u597d\uff0c\u8fd9\u8fdb\u4e00\u6b65\u63d0\u9ad8\u4e86\u5176\u88ab\u6279\u51c6\u4f7f\u7528\u7684\u53ef\u80fd\u6027\u3002\u7136\u800c\uff0c\u53ea\u80fd\u5728\u4e00\u5c0f\u90e8\u5206\u60a3\u8005\u4e2d\u89c2\u5bdf\u5230\u8fd9\u4e9b\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u7684\u76ca\u5904\uff0c\u79d1\u7814\u4eba\u5458\u4e5f\u4e00\u76f4\u5728\u52aa\u529b\u5bfb\u627e\u53ef\u4ee5\u9884\u6d4b\u6cbb\u7597\u6548\u679c\u7684\u56e0\u7d20\u3002\u5728TCs\u4e2d\u8fdb\u884cPD-L1 IHC\u67d3\u8272\u662f\u4e00\u4e2a\u4e0d\u5b8c\u7f8e\u7684\u751f\u7269\u6807\u5fd7\u7269\uff0c\u56e0\u4e3a\u5728PD-L1\u9633\u6027\u548c\u9634\u6027\u80bf\u7624\u4e2d\u90fd\u80fd\u89c2\u5bdf\u5230\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u7684\u6cbb\u7597\u6548\u679c\u3002<\/p>\n

\u5f71\u54cdPD-L1\u67d3\u8272\u51c6\u786e\u6027\u7684\u53ef\u80fd\u56e0\u7d20\u5305\u62ec\uff0cTILs\u5bf9PD-L1\u8868\u8fbe\u7684\u5f71\u54cd\u3001\u73b0\u6709\u6297\u4f53\u68c0\u9a8c\u65b9\u6cd5\u5b66\u4e4b\u95f4\u7684\u5dee\u5f02\u3001\u9633\u6027\u4e34\u754c\u503c\u4ee5\u53ca\u80bf\u7624\u7684\u5f02\u8d28\u6027\u3002\u4f8b\u5982\uff0c\u9884\u8ba1PD-L1\u9633\u6027\u4e14\u5177\u6709TILs\u7684(I\u578b\u80bf\u7624)\u60a3\u8005\u6709\u9002\u5e94\u6027PD-L1\u8868\u8fbe\uff0c\u5e76\u4e14\u6bd4PD-L1\u9633\u6027\u4f46TILs\u5f88\u5c11\u6216\u6ca1\u6709TILs\u7684(III\u578b\u80bf\u7624)\u60a3\u8005\u66f4\u6709\u53ef\u80fd\u4ece\u514d\u75ab\u68c0\u67e5\u70b9\u963b\u65ad\u4e2d\u53d7\u76ca\uff0c\u4f46\u76ee\u524d\u5c1a\u4e0d\u6e05\u695a\u8fd9\u4e9bIII\u578b\u80bf\u7624\u60a3\u8005\u7684\u7ec4\u6210\u6027PD-L1\u8868\u8fbe\u662f\u5426\u9884\u793a\u7740\u4ed6\u4eec\u80fd\u4ece\u514d\u75ab\u6cbb\u7597\u4e2d\u53d7\u76ca\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u867d\u7136\u4e0e\u9633\u6027\u67d3\u8272\u76f8\u6bd4\uff0c\u4f7f\u7528\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u6cbb\u7597\u7684PD-L1\u9634\u6027IHC\u67d3\u8272\u7684NSCLC\u60a3\u8005ORR\u8f83\u4f4e\uff0c\u4f46\u5373\u4f7f\u662fPD-L1\u9634\u6027\u60a3\u8005\uff0c\u5176\u7ed3\u679c\u4ecd\u4e0e\u591a\u70ef\u7d2b\u6749\u9187\u7684\u6807\u51c6\u5316\u7597\u76f8\u4f3c\uff0c\u4e14\u6ca1\u6709\u4e00\u9879\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u663e\u793a\u5728\u4e8c\u7ebf\u5316\u7597\u524d\u7ed9\u4e0e\u514d\u75ab\u6cbb\u7597\u4f1a\u5bf9\u751f\u5b58\u9020\u6210\u4e0d\u5229\u5f71\u54cd\u3002<\/p>\n

\u6b64\u5916\uff0c\u5728EGFR\u7a81\u53d8\u7684\u60a3\u8005\u4e2d\uff0c\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u4e0e\u591a\u70ef\u7d2b\u6749\u9187\u76f8\u6bd4\uff0c\u5bf9PFS\u7684\u5f71\u54cd\u65e2\u6ca1\u6709\u597d\u5904\u4e5f\u6ca1\u6709\u574f\u5904\uff0c\u8fd9\u8868\u660e\u8fd9\u4e9b\u60a3\u8005\u4e5f\u9002\u4e8e\u63a5\u53d7\u6297PD-1\u6216PD-L1\u6297\u4f53\u6cbb\u7597\u3002<\/p>\n

\u7f3a\u4e4fPD-L1\u548cTILs\u7684(II\u578b)\u80bf\u7624\u60a3\u8005\u4e0d\u592a\u53ef\u80fd\u5bf9\u5355\u5242\u514d\u75ab\u68c0\u67e5\u70b9\u963b\u65ad\u6709\u53cd\u5e94\uff0c\u8fd9\u4e9b\u60a3\u8005\u53ef\u80fd\u662f\u75ab\u82d7\u3001\u6297CTLA-4\u6216\u5176\u4ed6\u68c0\u67e5\u70b9\u6291\u5236\u5242\u7b49\u8054\u5408\u6cbb\u7597\u7684\u6700\u4f73\u9002\u7528\u7fa4\u4f53\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n

\u76ee\u524d\uff0c\u9488\u5bf9PD-1\u6216PD-L1\u7684\u5355\u5242\u5355\u514b\u9686\u6297\u4f53\u514d\u75ab\u6cbb\u7597\u5df2\u6210\u4e3a\u665a\u671fNSCLC\u60a3\u8005\u7684\u4e00\u79cd\u516c\u8ba4\u6cbb\u7597\u65b9\u6cd5\uff0c\u5176\u5e2e\u52a9\u4e86\u8bb8\u591a\u60a3\u8005\u51cf\u8f7b\u75db\u82e6\uff0c\u5ef6\u957f\u5bff\u547d\u3002\u5c3d\u7ba1\u5982\u6b64\uff0c\u8be5\u7597\u6cd5\u4ecd\u6709\u6539\u8fdb\u7684\u7a7a\u95f4\uff0c\u672a\u6765\u7684\u7814\u7a76\u53ef\u80fd\u4f1a\u9488\u5bf9\u5bfb\u627e\u786e\u5b9a\u8fd9\u79cd\u7597\u6cd5\u7684\u6700\u4f73\u9002\u7528\u7fa4\u4f53\u4ee5\u53ca\u5408\u7406\u4f18\u5316\u8054\u5408\u6cbb\u7597\u7684\u65b9\u6848\u3002<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

\n
\n
\n
\n

\u672c\u6587\u7531Oncolab\u5fae\u4fe1\u516c\u4f17\u53f7\u7ffb\u8bd1\u6574\u7406\u81eaOncoimmunology: A Practical Guide for Cancer Immunotherapy\uff0c\u4ec5\u7528\u4e8e\u5b66\u4e60\u4ea4\u6d41\u4f7f\u7528\uff0c\u5982\u9700\u8d2d\u4e70\u539f\u7248\u4e66\u7c4d\u53ef\u70b9\u51fb\u9605\u8bfb\u539f\u6587\u8d2d\u4e70\u3002<\/span>
<\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n


<\/p>\n

\u2014<\/span> <\/span>T<\/span>H<\/span>E<\/span> <\/span> <\/span>E<\/span>N<\/span>D<\/span> <\/span>\u2014<\/span><\/span><\/p>\n


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\u6765<\/span>\u6e90<\/span> <\/span>|<\/span> <\/span>O<\/span>n<\/span>c<\/span>o<\/span>i<\/span>m<\/span>m<\/span>u<\/span>n<\/span>o<\/span>l<\/span>o<\/span>g<\/span>y<\/span>:<\/span> <\/span>A<\/span> <\/span>P<\/span>r<\/span>a<\/span>c<\/span>t<\/span>i<\/span>c<\/span>a<\/span>l<\/span> <\/span>G<\/span>u<\/span>i<\/span>d<\/span>e<\/span> <\/span><\/span><\/section>\n
f<\/span>o<\/span>r<\/span> <\/span>C<\/span>a<\/span>n<\/span>c<\/span>e<\/span>r<\/span> <\/span>I<\/span>m<\/span>m<\/span>u<\/span>n<\/span>o<\/span>t<\/span>h<\/span>e<\/span>r<\/span>a<\/span>p<\/span>y<\/span><\/span><\/section>\n
\u4f5c<\/span>\u8005<\/span> <\/span>|<\/span> <\/span><\/span><\/span>Daniel Morgensztern and Roy S. Herbst<\/span><\/span><\/section>\n
\u521d\u7a3f\u7ffb<\/span>\u8bd1<\/span> <\/span>|<\/span> <\/span>\u7ae0\u9707 \u8d75\u6db5 \u5415\u601d\u8d24 \u7f57\u4f73\u4f73<\/span><\/span><\/span><\/span><\/section>\n
\u7f16<\/span>\u8f91<\/span>\u6392<\/span>\u7248<\/span> <\/span>| \u674e\u5b89\u742a \u5e94\u6b63<\/span><\/span><\/span><\/span><\/section>\n
\u5ba1\u6838\u4fee\u6539 <\/span>|<\/span> \u738b\u5764<\/span> \u80e1\u73ca<\/span><\/span><\/section>\n
\uff08<\/span>\u8f6c<\/span>\u8f7d<\/span>\u8bf7<\/span>\u4fdd<\/span>\u7559<\/span>\u6b64<\/span>\u90e8<\/span>\u5206<\/span>\u5185<\/span>\u5bb9<\/span>\uff09<\/span><\/span><\/strong><\/section>\n


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\u7f51\u7ad9\u81ea\u5e26\u68c0\u7d22\u529f\u80fd\uff0c\u53ef\u4ee5\u6839\u636e\u5173\u952e\u8bcd\u8fdb\u884c\u68c0\u7d22<\/span>\uff0c\u5e76\u4e14\u53ef\u4ee5\u6839\u636e\u65e5\u671f\u53ca\u5185\u5bb9\u5206\u7c7b<\/span>\u8fdb\u884c\u67e5\u770b ,\u5927\u5bb6\u53ef\u4ee5\u6536\u85cf\u65b9\u4fbf\u5728\u7535\u8111\u4e0a\u67e5\u770b\u3002<\/p>\n

\u7f51\u5740\u662f\uff1aoncolab.cn<\/span><\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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\u7f51\u5740\u662f\uff1adh.<\/strong><\/span>oncolab.cn<\/span><\/strong><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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\u8be5\u661f\u7403\u7528\u4e8eOncoLab\u516c\u4f17\u53f7\u8bfb\u8005\u4ea4\u6d41\u5b66\u4e60\u4f7f\u7528\uff0c\u6c38\u4e45\u514d\u8d39<\/span>\u3002<\/span><\/span><\/p>\n<\/section>\n<\/section>\n<\/section>\n<\/section>\n

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\u70b9\u4eae\u8d5e\u4e0e\u5728\u770b <\/span><\/section>\n
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\u672c\u7bc7\u6587\u7ae0\u6765\u6e90\u4e8e\u5fae\u4fe1\u516c\u4f17\u53f7:OncoLab<\/p>\n<\/blockquote>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

20.5 \u4e00\u7ebf\u6cbb\u7597 \u968f\u7740\u5355\u4e00\u514d\u75ab\u68c0\u67e5\u70b9\u6291\u5236\u5242\u5728\u5148\u524d\u6cbb\u7597\u8fc7\u7684\u60a3\u8005\u4e2d\u5b89\u5168\u6027\u548c\u7597\u6548\u7684\u786e\u7acb\uff0c\u4e00\u4e9b\u60a3\u8005\u5b9e\u73b0\u4e86\u524d\u6240\u672a\u6709\u7684\u957f\u671f\u751f\u5b58\uff0c\u4e0b\u4e00\u6b65\u5c31\u662f\u8bc4\u4f30\u8be5\u7b56\u7565\u5728\u4e00\u7ebf\u6cbb\u7597\u4e2d\u7684\u5e94\u7528\u3002 CHECKMate-…<\/p>\n","protected":false},"author":1,"featured_media":4889,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[59],"tags":[],"_links":{"self":[{"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/posts\/4895"}],"collection":[{"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/comments?post=4895"}],"version-history":[{"count":0,"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/posts\/4895\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/media\/4889"}],"wp:attachment":[{"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/media?parent=4895"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/categories?post=4895"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/dh.oncolab.cn\/index.php\/wp-json\/wp\/v2\/tags?post=4895"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}