查看“阿思尼布”的源代码

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            <strong>[[阿思尼布]]</strong>（<strong>[[Asciminib]]</strong>，商品名：<strong>[[阿思尼布]]</strong>/<strong>[[Scemblix]]</strong>）是全球首个获批的<strong>[[STAMP抑制剂]]</strong>（[[ABL肉豆蔻酰口袋特异性靶向抑制剂]]），被公认为<strong>[[第四代BCR-ABL抑制剂]]</strong>。与传统的[[ATP竞争性]][[酪氨酸激酶抑制剂]]（[[TKI]]）不同，[[阿思尼布]]通过结合[[BCR-ABL1]]蛋白的[[肉豆蔻酰口袋]]发挥[[变构抑制]]作用。临床上主要用于治疗既往接受过两种或两种以上[[TKI]]治疗的[[慢性期]][[慢性髓系白血病]]（[[Ph+ CML-CP]]）成年患者，以及携带<strong>[[T315I突变]]</strong>的患者。凭借其独特的机制，[[阿思尼布]]在克服[[获得性耐药]]及降低[[脱靶毒性]]方面展现了显著优势。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">[[阿思尼布]]</div>
            <div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px;">[[Asciminib]] / [[Scemblix]] · 点击展开详情</div>
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                    <div style="width: 140px; height: 90px; background-color: #f1f5f9; display: flex; align-items: center; justify-content: center; color: #94a3b8; font-size: 0.8em; padding: 10px; text-align: center;">[[变构抑制]]：[[肉豆蔻酰口袋]]结合</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">[[STAMP]]类药物首创</div>
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                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">25([[ABL1]])</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">[[HGNC]]ID</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">76</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">[[UniProt]]</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">P00519</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;">449.8Da</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">[[药物分类]]</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">[[变构抑制剂]]</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569;">原研厂商</th>
                    <td style="padding: 12px; color: #0f172a;">[[诺华]]([[Novartis]])</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：变构口袋的精准锁定</h2>
    
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        [[阿思尼布]]的设计巧妙地利用了[[ABL1]]蛋白自带的“[[刹车]]”机制：
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        <li style="margin-bottom: 12px;"><strong>[[肉豆蔻酰口袋]]模拟：</strong>正常[[ABL1]]蛋白通过自身的[[肉豆蔻酰基]]末端插入其激酶结构域的口袋中，维持失活状态。在[[BCR-ABL1]]融合蛋白中，这一自抑制机制丧失。[[阿思尼布]]通过占据该口袋，模拟肉豆蔻酰基的作用，强行将蛋白拉回失活[[构象]]。</li>
        <li style="margin-bottom: 12px;"><strong>克服[[守门员突变]]：</strong>由于[[阿思尼布]]不与[[ATP结合口袋]]作用，它能够绕过导致一、二、三代[[TKI]]失效的[[T315I]]等[[激酶]]活性中心突变，为耐药患者提供解救手段。</li>
        <li style="margin-bottom: 12px;"><strong>极高选择性：</strong>[[肉豆蔻酰口袋]]在人体激酶组中极具独特性，这使得[[阿思尼布]]具有极佳的[[靶向选择性]]，有效减少了因误伤其他激酶（如[[KIT]]或[[PDGFR]]）而产生的副作用。</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;">核心临床研究证据矩阵</h2>

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                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #0f172a; width: 25%;">临床试验</th>
                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #475569;">研究设计/人群</th>
                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #1e40af;">关键客观数据</th>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[ASCEMBL研究]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">3线及以上[[CML-CP]] (vs [[波舒替尼]])</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">24周[[主要分子学反应]]([[MMR]])率为25% vs 13%，且不良反应导致的停药率更低。</td>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[T315I]]扩增队列</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">携带[[T315I]]突变的[[Ph+ CML-CP]]患者</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">在携带此类[[顽固耐药]]突变的群体中观察到高比例的[[分子学缓解]]。</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：服用要求与毒性管理</h2>
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        [[阿思尼布]]的精准应用需特别关注给药细节及[[血液学]]安全性：
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        <li style="margin-bottom: 12px;"><strong>[[空腹服药]]准则：</strong>食物会显著影响药物吸收。规定必须在服药前至少2小时及服药后至少1小时内禁食。</li>
        <li style="margin-bottom: 12px;"><strong>[[剂量分层]]：</strong>标准剂量通常为每日两次（40mg BID）或每日一次（80mg QD）；针对[[T315I]]突变患者，需采用更高剂量（200mg BID）。</li>
        <li style="margin-bottom: 12px;"><strong>[[实验室监测]]：</strong>需定期监测[[血常规]]及[[脂肪酶]]、[[淀粉酶]]水平。临床需警惕[[中性粒细胞减少]]、[[血小板减少]]及[[无症状性胰腺酶升高]]。</li>
        <li style="margin-bottom: 12px;"><strong>[[心血管]]保护：</strong>尽管其[[心血管毒性]]较[[普纳替尼]]小，但在有[[高血压]]或[[糖尿病]]病史的患者中仍需监测[[心血管事件]]。</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>[[STAMP]]：</strong>专门靶向ABL蛋白肉豆蔻酰口袋的新兴药物研发策略。</li>
            <li style="margin-bottom: 8px;"><strong>[[T315I突变]]：</strong>被称为“[[守门员突变]]”，是导致多种前代[[TKI]]失效的关键机制。</li>
            <li style="margin-bottom: 8px;"><strong>[[主要分子学反应]] (MMR)：</strong>[[CML]]治疗的重要里程碑，指[[BCR-ABL1]]转录本水平≤0.1%。</li>
            <li style="margin-bottom: 8px;"><strong>[[变构调节]]：</strong>通过结合非活性位点来改变蛋白构象，从而实现[[功能关闭]]。</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>Réa D, et al. (2021).</strong> <em>A Phase 3, Open-Label, Randomized Study of Asciminib, a STAMP Inhibitor, vs Bosutinib in CML after 2 or More Prior TKIs.</em> <strong>[[The New England Journal of Medicine]]</strong>.[Academic Review]<br>
            <span style="color: #475569;">[权威点评]：ASCEMBL研究确立了阿思尼布作为后线治疗新标准的地位，其安全性与疗效平衡性显著优于传统二代TKI。</span>
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            [2] <strong>Hughes TP, et al. (2019).</strong> <em>Asciminib in Chronic Myeloid Leukemia after ABL Kinase Inhibitor Failure.</em> <strong>[[NEJM]]</strong>.<br>
            <span style="color: #475569;">[临床价值]：该研究揭示了变构抑制剂在克服多种耐药突变（特别是T315I）中的强大潜力。</span>
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            [[阿思尼布]] ([[Asciminib]]) 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;">[[BCR-ABL1]]•[[ABL1]]•[[T315I]]•[[肉豆蔻酰口袋]]</td>
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                <td style="padding: 10px 15px; color: #334155;">[[波舒替尼]]•[[普纳替尼]]•[[尼洛替尼]]•[[奥雷巴替尼]]</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;">[[Novartis]]•[[FDA]]•[[NCCN]]•[[CSCO]]•[[ASH]]</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;">[[联合治疗克服复合突变]]•[[一线治疗应用探索]]•[[针对变构位点新突变的监测]]</td>
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