2024_CSCO晚期非小细胞肺癌指南更新（英）_6页_632kb

2024 CSCO Advanced NSCLC Guidelines Updates Summary

1. Driver Gene Mutations

• ALK Fusion Mutations:
  • Envoalkib: Approved as first-line treatment, showing significantly longer PFS (24.9 months vs. 11.6 months, HR=0.47, P<0.0001) and ORR (89.4%).
  • Repotrectinib: High ORR (79%) and PFS (35.7 months) as first-line, and ORR (38%) and PFS (9.0 months) as second-line for ROS1 fusion NSCLC.
  • Unecritinib: Approved as first-line treatment with ORR (80.2%) and PFS (16.5 months).
• RET Fusion Mutations:
  • Pralsetinib: Approved as first-line treatment with ORR (84.2%) and RECIST confirmed ORR (77.3%).
  • Selpercatinib: Recommended as grade I for first-line treatment with ORR (84%) and PFS (28.9 months).
• BRAF V600 Mutation:
  • Encorafenib + Binimetinib: ORR (74.3%) and approved for first-line treatment.
• MET Ex14 Skipping Mutation:
  • Tepotinib, Gumarontinib, Vebreltinib, and Savolitinib: Showed ORR exceedings 50%, extending PFS and OS compared to chemotherapy.
  • Garsorasib and JDQ443: Demonstrated ORR (40.5%) and disease control rate (91.9%) in second-line treatment.
• KRAS G12C Mutation:
  • Fosfomycin: ORR (61.2%) and disease control rate (92.5%) as second-line treatment.
• HER2 Mutation:
  • Trastuzumab Deruxtecan (T-DXd): ORR (50.8% to 73.3%) as first-line treatment, with PFS (10.8 to 15.4 months).

2. Immunotherapy

• Anti-PD-1/PD-L1 Monotherapy:
  • Atezolizumab: Recommended for patients with PS ≥ 2, showing doubled 2-year survival rate (24.3%) compared to chemotherapy.
  • Immunotherapy is now integrated into first-line treatment for PD-L1 positive patients.
• Immunotherapy + Chemotherapy:
  • Recommended for all-comer population, including drugs like Pembrolizumab, Camrelizumab, etc.
• Immunotherapy Combination:
  • Atezolizumab-based combinations show efficacy in specific subgroups.

3. Targeted Therapy

• ADCs (Antibody-Drug Conjugates):
  • Dato-DXd: TROP2-targeting ADC, effective in overcoming resistance to prior treatments, with PFS (5.6 months vs. chemotherapy).
  • Trastuzumab Deruxtecan: Approved for HER2-positive NSCLC, showing ORR (50.8%-73.3%) and PFS (10.8-15.4 months).
• Second-Generation Inhibitors:
  • Drugs like Repotrectinib and Unecritinib have shown superior efficacy in ROS1, ALK, and RET mutations.

4. Emerging Trends

• The guidelines emphasize targeted therapies and ADCs, providing more personalized options.
• Immunotherapy combinations and first-line targeted treatments are becoming integral to NSCLC management.

Overall, the 2024 CSCO guidelines reflect rapid advancements in targeted and immunotherapy, offering improved treatment options for NSCLC patients with various driver mutations.