社團法人臺灣臨床藥學會

已出刊文章

【綜合評述】頑固/復發型瀰漫性大B細胞淋巴瘤新藥—Polatuzumab Vedotin
Polatuzumab Vedotin: New Medication of Refractory/Relapsed Diffuse Large B-Cell Lymphoma
Polatuzumab Vedotin, Refractory/Relapsed Diffuse Large B-Cell Lymphoma, Antibody-Drug Conjugate、Polatuzumab Vedotin、頑固/復發型瀰漫性大B 細胞淋巴瘤、抗體藥物複合體
方瑄蔚Hsuan-Wei Fang1,* 、童郁琇Yu-Siou Tong1 、劉淑貞Shu-Chen Liu1
1高雄長庚紀念醫院臨床藥學科
瀰漫性大B 細胞淋巴瘤 (diffuse large B-cell lymphoma, DLBCL) 是屬於非何杰金氏淋巴瘤 (non-Hodgkin’s lymphoma) 分類之一,大約30 ~ 40% DLBCL 病人接受了第一線療法之後,結果無效或復發,因此適當的後續治療是延長存活期的關鍵,現今已知有特定生物標記的亞型預後較差,這類病人可能需要更積極的初始治療。新藥polatuzumab vedotin 藥理分類為抗體藥物複合體 (antibody-drug conjugate, ADC),顧名思義,其結構包含與標靶蛋白結合的單株抗體,以及藥物抗有絲分裂劑monomethyl auristatin (MMAE)。Polatuzumab vedotin 的標的為B 細胞特異性表面蛋白CD79b,透過單株抗體選擇特定標的,從而減少MMAE 的毒性。另外在細胞株實驗以及臨床試驗中,發現polatuzumab vedotin 療效不受已知前述生物標記與標靶蛋白表現量的影響,對於預後不佳的病人是一大福音,也暗示或許有其他標記可以預測ADC 的療效。Polatuzumab vedotin 目前核准適應症只有與bendamustine 和rituximab 併用,治療復發或頑固型,先前已接受過兩種治療,且不適合接受造血幹細胞移植的DLBCL 病人。目前已有許多臨床試驗正在進行中,探討polatuzumab vedotin 與其他藥品併用的效益,以期能發揮最大的潛能。
 
Diffuse large B-cell lymphoma (DLBCL) is classified as non-Hodgkin’s lymphoma. after receiving first-line therapy, approximately 30-40% of patients with DLBCL failed or relapsed; therefore, appropriate subsequent therapy is the key to prolong survival. Nowadays, subtypes with specific biomarkers are known to have a poor prognosis. Those patients with poor prognosis may require more aggressive initial treatment. The new medication polatuzumab vedotin is pharmacologically classified as an antibodydrug conjugate (ADC), as the name suggests, its structure contains a monoclonal antibody, and the anti-mitotic agent monomethyl auristatin (MMAE). The target of polatuzumab vedotin is the B cell-specific surface protein CD79b, and the specific target is selected through the monoclonal antibody to reduce the toxicity of MMAE. In addition, in cell line experiments and clinical trials, it was found that the efficacy of polatuzumab vedotin was not affected by the known expression of the aforementioned biomarkers and the amount of target protein. This is a great boon for patients with poor prognosis, and it also implies that there may be other markers that can predict the efficacy of ADC. Currently, polatuzumab vedotin is approved of only combined use with bendamustine and rituximab to treat patients with refractory/relapsed DLBCL, who have previously received two treatments and are not candidates for autologous stem-cell transplantation. There are many clinical trials underway to explore the benefits of polatuzumab vedotin in combination with other drugs in order to maximize its potential.

 
Summited for publication: 2021.6.3; Accepted for publication: 2021.8.17
操作進行中,請稍候~~~~
×
加载中...