在2025年欧洲肺癌大会（ELCC）上，巴黎居里研究所肿瘤内科主任Nicolas Girard教授重磅发布SOHO-01和COCOON试验数据，并作题为"胸腺上皮肿瘤全身治疗最新进展"的专题报告。应《肿瘤瞭望》邀请，Girard教授对SOHO-01和COCOON研究结果以及胸腺上皮肿瘤治疗进展进行了深度解读。

 

Dr.Girard：HER2突变型NSCLC是NSCLC的一小部分，占2-4%。BAY 2927088是一种口服酪氨酸激酶抑制剂，可以抑制HER2。SOHO-01研究评估了BAY 2927088在HER2突变型NSCLC患者中的疗效。在剂量扩展阶段采用每日两次，每次20 mg的剂量。

 

我在2025年ELCC大会上展示了两组患者的研究结果。第一组患者是未接受过HER2靶向治疗但之前接受过全身治疗的患者（n=44）；第二组患者是之前接受过HER2靶向抗体药物偶联物（ADC）治疗的患者（n=34）。第一组患者中，研究者评估的客观缓解率（ORR）高达70.5%，疾病控制率（DCR）为81.8%，中位缓解持续时间（DOR）长达8.7个月，意味着患者在接受化疗±免疫治疗后，BAY 2927088疗法仍具有很高的疗效。第二组患者中（超过一半的患者之前接受过≥三线治疗），ORR为35.3%，DCR为52.9%，中位DOR为9.5个月，在接受化疗、免疫检查点抑制剂和ADC治疗后别无选择的情况下，这个数字相当高。

 

 

BAY 2927088的安全性主要体现在腹泻（1/2级），目前没有患者因腹泻而停药。腹泻是最常见的副作用，我们可能需要对腹泻进行预防性治疗。我们正在进行一项III期临床试验SOHO-02，该试验旨在对比HER2突变型NSCLC患者接受一线BAY 2927088和化疗+免疫治疗。

 

Dr.Girard:I am Nicolas Girard.I am Head of Medical Oncology at Institut Curie in Paris.HER2 NSCLC is a small subset of NSCLC，2-4%.We have BAY 2927088(BAY 88)，which is an oral tyrosine kinase inhibitor that is inhibiting HER2.The SOHO-01 study assessed this compound in patients with EGFR HER2-mutated NSCLC.After dose expansions，dosing of 20mg twice daily was chosen for expansion.At ELCC 2025，I presented the results of two cohorts.The first one being a cohort of patients who were HER2-targeted therapy naïve，but who had previously received systemic therapy，The second was patients who had received prior treatment with HER2-targeting antibody-drug conjugates.Forty-four patients and 34 patients were treated respectively.What we see from the SOHO-01 trial is a high response rate in HER2-targeted treatment naïve patients–72%，which is quite high.There was a duration of efficacy of 9 months in this cohort of patients is quite long.It means that after treatment with chemotherapy plus or minus immunotherapy，BAY 88 has a high efficacy.The second cohort were previously treated patients with three or more lines of therapy in more than half the patients.We see a response rate of 35%and a control rate of 53%.This is quite high in the setting of having no more option after treatment with chemotherapy，IO and ADCs.The safety of BAY 88 was mostly diarrhea(grade 1/2)，with no discontinuation due to diarrhea.We probably need to implement prophylactic management for diarrhea，which was the most frequent side effect.We have an ongoing phase III trial，SOHO-02，in the first-line setting，versus chemotherapy and immunotherapy for patients with EGFR-mutated NSCLC.

 

Dr.Girard：COCOON试验的主要目的是评估预防性治疗能否降低EGFR突变型局部晚期/转移性NSCLC患者接受埃万妥单抗+兰泽替尼治疗前12周出现的≥2级皮肤病副作用。EGFR突变NSCLC的标准治疗方案是奥希替尼，在中国和亚洲还有其他第三代TKI可选。随着MARIPOSA研究证明埃万妥单抗联合兰泽替尼相比奥希替尼显著改善总生存期（两组中位总生存差异超过1年），该疗法将成为此类患者一线治疗的新标准。然而，埃万妥单抗联合兰泽替尼的皮肤不良反应发生率较高，尤其是在治疗的前四个月。

 

COCOON研究评估了预防性皮肤病治疗（口服多西环素或米诺环素12周，随后头皮涂抹克林霉素乳液；指甲涂抹氯己定手液；身体和面部涂抹神经酰胺保湿霜）与标准治疗相比，能否改善埃万妥单抗+兰泽替尼的皮肤毒性。在中位随访期约4个月早期时间点进行的首次中期分析中，预防性方案带来获益，前12周≥2级皮肤不良事件（AE）（76.5%vs.38.6%）和3级皮肤AE（8.8%vs.4.3%）发生率仅为标准治疗组的50%，因不良事件导致的停药率降低了50%。

 

 

显然，根据MARIPOSA试验进行埃万妥单抗联合兰泽替尼治疗时，必须同时采用COCOON预防性方案，同时配合静脉血栓栓塞症（VTE）预防以及输液相关反应的预防。

 

Dr.Girard:The COCOON trial had the objective of assessing whether prophylactic dermatologic management could prevent Grade 2 or higher dermatological side effects that are associated with the administration of amivantamab plus lazertinib in patients with EGFR-mutated NSCLC.For EGFR-mutated NSCLC，the historic standard-of-care is osimertinib，and there are other third-generation TKIs available in China and Asia.Amivantamab plus lazertinib demonstrate an overall survival benefit versus osimertinib.This is a significant benefit with>1 year difference in median overall survival.So，it is a new standard-of-care for first-line treatment in these patients.But this combination has been associated with high rates of dermatologic adverse effects，especially in the first four months.COCOON assessed whether prophylactic dermatologic management versus standard-of-care could improve this situation.COCOON is doxycycline，clindamycin lotion，chlorhexidine wash for hands and feet，and a ceramide-based moisturizer on the body and face.At the first interim analysis at the early timepoint of four months median follow-up，we see a benefit with COCOON regimen from 77%of patients presenting with Grade 2 or higher dermatologic adverse events after 12 weeks of follow-up to 40%of patients.So，it is a two-fold decrease in the incidence of dermatological adverse events–a two-fold decrease in Grade 3 events，a two-fold decrease in dose modification of amivantamab plus lazertinib.Clearly，this goes with MARIPOSA with amivantamab and lazertinib.COCOON has to be implemented as part of this treatment together with along with venous thromboembolism(VTE)prophylaxis，and prophylaxis for infusion-related reactions.

 

Dr.Girard：晚期或转移性胸腺上皮肿瘤领域近期取得多项进展。在一线治疗中，除了历史悠久的细胞毒性化疗外，一些临床试验探索了新方案，例如化疗（卡铂-紫杉醇）联合抗血管生成药物（包括雷莫芦单抗和贝伐珠单抗）。近期研究显示，化疗联合抗血管生成药物的三联方案（卡铂+紫杉醇+雷莫芦单抗）可显著延长无进展生存期（相比传统化疗的数据），可能成为这类患者的优选方案。当前治疗模式正从单纯化疗向“化疗+抗血管生成药物±免疫疗法”转变。

 

 

二线治疗选择包括化疗药物、抗血管生成药物（例如舒尼替尼和仑伐替尼）以及免疫检查点抑制剂（单药或联合抗血管生成药物）。同样，联合策略和用药顺序正在发生变化。好消息是，胸腺上皮肿瘤的治疗有了更多选择。

 

Dr Girard:A lot is coming in thymic epithelial tumors.We have the historic cytotoxic chemotherapy regimens for the first-line treatment of patients with advanced metastatic thymic tumors.We have some new trials combining chemotherapy(carboplatin-paclitaxel)with antiangiogenic agents，including ramucirumab，and bevacizumab.This may be one option for those patients.We have also seen data with combination of chemotherapy plus antiangiogenic agents，a triad of carboplatin plus paclitaxel plus ramucirumab，reporting quite prolonged progression-free survival，which is probably the best endpoint in these patients.There is movement away from chemotherapy alone to combinations of chemotherapy plus antiangiogenic agents plus immunotherapy.In the second-line setting，we have chemotherapy，we have antiangiogenic agents，sunitinib for thymoma，lenvatinib for thymic carcinoma，immune checkpoint inhibitors as single agent or combined with antiangiogenic agents.Again，the combinations and sequence are moving.What is good is that we have more options for the management of those patients.

 

《肿瘤瞭望》在ELCC现场报道