查看“Tukysa”的源代码

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            <strong>[[图卡替尼]]([[Tucatinib]])</strong>，商品名为<strong>[[妥卡替尼]]([[Tukysa]])**，研发代码为**[[ONT-380]]</strong>，是由[[Seagen]]（现隶属于[[辉瑞]]/[[Pfizer]]）研发的一种口服、高选择性<strong>[[HER2]]</strong>酪氨酸激酶抑制剂（[[TKI]]）。作为[[HER2]]阳性肿瘤精准治疗的核心药物，[[图卡替尼]]以其对<strong>[[HER2]]</strong>蛋白极高的特异性而著称，对[[EGFR]]([[HER1]])的抑制作用极微，从而显著降低了由[[EGFR]]抑制带来的皮疹和腹泻副作用。凭借卓越的<strong>[[血脑屏障]]</strong>穿透力，该药在治疗伴有<strong>[[脑转移]]</strong>的晚期[[乳腺癌]]及<strong>[[结直肠癌]]</strong>中确立了关键的临床地位，是目前精准肿瘤学中“**[[高选择性垂直阻断]]**”的代表性药物。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">图卡替尼 (Tucatinib)</div>
            <div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">妥卡替尼·Tukysa·ONT-380</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">核心靶标：[[HER2]]([[ERBB2]])</div>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 40%;">[[Entrez]]ID</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">2064([[ERBB2]])</td>
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                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">P04626</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">分子量</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">480.5g/mol</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">标准剂量</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">300mg BID (口服)</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">半衰期</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">约8.5小时</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">研发厂家</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[Seagen]]/[[Pfizer]]</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569;">关键特征</th>
                    <td style="padding: 12px; color: #16a34a;">高入脑活性/避开EGFR</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">分子机制：高选择性阻断与颅内渗透</h2>
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        [[图卡替尼]]的分子药理学优势在于其对[[HER]]家族受体的精确区分。其核心机理如下：
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        <li style="margin-bottom: 12px;"><strong>高度选择性 HER2 封锁：</strong> 图卡替尼以可逆方式结合[[HER2]]胞内激酶域的[[ATP]]结合口袋。酶学研究表明，其对[[HER2]]的选择性比对[[EGFR]]高出约 1000倍，这有效避免了因抑制[[EGFR]]导致的<strong>[[痤疮样皮疹]]</strong>和严重<strong>[[腹泻]]</strong>，显著提升了药物的耐受性。</li>
        <li style="margin-bottom: 12px;"><strong>突破血脑屏障：</strong> 药代动力学数据显示，图卡替尼及其代谢产物在脑脊液中具有极佳的分布。其<strong>[[Kpuu,brain]]</strong>值优于大多数同类[[TKI]]，使其能够有效抑制颅内转移病灶的生长。</li>
        
        <li style="margin-bottom: 12px;"><strong>协同垂直阻断：</strong> 在临床联合方案中，图卡替尼通过胞内拦截，与胞外结合的单抗（如[[曲妥珠单抗]]）形成互补，实现了对<strong>[[MAPK]]/[[ERK]]</strong>信号通路的深度覆盖。</li>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">全球核心临床获益矩阵</h2>

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                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 25%;">试验名称</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">人群/方案</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af;">关键客观缓解与生存指标</th>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[HER2CLIMB]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">经治[[HER2+]]乳腺癌（含活动性脑转移）。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>进展风险降低 46%</strong>；显著延长 [[OS]]。确立了脑转移治疗的标准。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[MOUNTAINEER]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">经治[[HER2+]]转移性结直肠癌([[mCRC]])。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>ORR 达 38.1%</strong>。标志着肠癌进入了双靶向“去化疗”时代。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[HER2CLIMB-05]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">一线维持治疗方案探索。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">旨在延长一线治疗获益，实现长期无进展生存。</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">诊疗策略：脑转移防护与序贯管理</h2>
    <p style="margin: 15px 0; text-align: justify;">
        [[图卡替尼]]在临床实践中被定义为“**[[颅内管理利器]]**”与“**[[后线挽救基石]]**”：
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        <li style="margin-bottom: 12px;"><strong>中枢神经系统的一线策略：</strong> [[NCCN]]指南建议：对于伴有脑转移的[[HER2+]]乳腺癌，应优先考虑含[[图卡替尼]]的三联方案。该方案能够推迟甚至避免全脑放疗，从而保留患者的认知功能和生活质量。</li>
        <li style="margin-bottom: 12px;"><strong>ADC 进展后的序贯选择：</strong> 在<strong>[[德曲替珠单抗]]([[T-DXd]])</strong>广泛应用后，图卡替尼凭借其独特的小分子作用机制，成为对抗[[ADC]]耐药后的关键挽救手段，维持了治疗的延续性。</li>
        <li style="margin-bottom: 12px;"><strong>肝功能精准监测：</strong> 临床管理强调：在治疗的前两个周期应每两周复查一次<strong>[[ALT]]/[[AST]]</strong>，以防范潜在的药物性肝损伤，确保用药安全。</li>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">关键相关概念</h2>
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            <li style="margin-bottom: 8px;"><strong>[[HER2CLIMB方案]]：</strong> 图卡替尼+曲妥珠单抗+卡培他滨，目前乳腺癌脑转移的标杆组合。</li>
            <li style="margin-bottom: 8px;"><strong>[[Kpuu,brain]]：</strong> 衡量药物入脑自由浓度的核心药代动力学参数。</li>
            <li style="margin-bottom: 8px;"><strong>[[T-DXd]]([[优赫得]])：</strong> 图卡替尼在临床序列中的重要序贯或竞争性药物。</li>
            <li style="margin-bottom: 8px;"><strong>[[EGFR-sparing]]：</strong> 避开[[EGFR]]的特性，是图卡替尼低皮疹发生率的分子基础。</li>
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        <span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献与权威点评</span>
        
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            [1] <strong>Murthy RK, et al. (2020/Updated).</strong> <em>Tucatinib, Trastuzumab, and Capecitabine for HER2-Positive Metastatic Breast Cancer.</em> <strong>[[The New England Journal of Medicine]]</strong>.<br>
            <span style="color: #475569;">[权威点评]：该项里程碑研究证实了图卡替尼在处理活动性脑转移患者中的巨大优势，改写了全球诊疗指南。</span>
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            [2] <strong>[[The Journal of Clinical Oncology]]. (2023/Updated).</strong> <em>Systemic Therapy for HER2-Positive Metastatic Colorectal Cancer: Guideline Update.</em> [Academic Review]<br>
            <span style="color: #475569;">[学术点评]：图卡替尼与大分子抗体的联合在肠癌领域的成功，标志着HER2靶向治疗实现了跨瘤种的获益统一。</span>
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            图卡替尼 (Tukysa) 诊疗生态 · 知识图谱
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">关联靶点</td>
                <td style="padding: 10px 15px; color: #334155;">[[HER2]]•[[ERBB2]]•[[EGFR(极弱)]]•[[PI3K/AKT]]•[[CYP3A4]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">治疗药物</td>
                <td style="padding: 10px 15px; color: #334155;">[[德曲替珠单抗]]•[[曲妥珠单抗]]•[[吡咯替尼]]•[[拉帕替尼]]•[[卡培他滨]]•[[T-DM1]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">战略实体</td>
                <td style="padding: 10px 15px; color: #334155;">[[Seagen]]•[[Pfizer]]•[[SinoCellGene协作]]•[[FDA]]•[[ESMO]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">研究前沿</td>
                <td style="padding: 10px 15px; color: #334155;">[[脑膜转移精准给药]]•[[ADC耐药后分子动力学]]•[[新辅助三联探索]]•[[早期术后强化]]</td>
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