查看“Amivantamab”的源代码

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            <strong>[[埃万妥单抗]]([[Amivantamab]])</strong>，商品名为<strong>[[安瑞万]]([[Rybrevant]])**，研发代码为**[[JNJ-61186372]]</strong>，是由[[强生]]([[J&J]])旗下[[杨森制药]]([[Janssen]])研发的一种全人源化<strong>[[EGFR-MET双特异性抗体]]</strong>。在2026年的肺癌诊疗版图中，[[埃万妥单抗]]是针对<strong>[[EGFR 20外显子插入突变]]([[EGFR Exon 20ins]])</strong>晚期<strong>[[非小细胞肺癌]]([[NSCLC]])</strong>的首个标准靶向药物。其作用机制突破了传统[[TKI]]的限制，通过胞外多靶点阻断及增强的<strong>[[抗体依赖性细胞介导的细胞毒性]]([[ADCC]])</strong>效应，同时解决了[[EGFR]]与[[MET]]通路介导的促癌信号及耐药。2026年最新指南已将其联合<strong>[[拉泽替尼]]</strong>（[[Lazertinib]]）列为常见[[EGFR]]突变NSCLC的一线优先推荐，显著延长了患者的无进展生存期。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">埃万妥单抗 (Amivantamab)</div>
            <div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">安瑞万·Rybrevant·JNJ-372·点击展开</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">核心靶标：[[EGFR]]/[[MET]]</div>
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                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">1956([[EGFR]])/4233([[MET]])</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">药物类型</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">双特异性单克隆抗体</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">给药剂量</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">基于体重(IV/SC)</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;">约148kDa</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">上市厂家</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[杨森制药]]([[J&J]])</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569;">2026热点</th>
                    <td style="padding: 12px; color: #b91c1c;">皮下注射剂型(SC)普及</td>
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        [[埃万妥单抗]]通过独特的结构设计实现对肿瘤细胞的“多重绞杀”。2026年分子生物学解析其核心路径为：
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        <li style="margin-bottom: 12px;"><strong>胞外结构域结合：</strong> 该药能同时精准结合[[EGFR]]和[[MET]]的胞外域。对于常规[[TKI]]难以结合的<strong>[[20外显子插入突变]]</strong>，埃万妥单抗通过胞外拦截有效阻断了下游信号传导。</li>
        <li style="margin-bottom: 12px;"><strong>受体降解诱导：</strong> 结合后触发受体内吞进入溶酶体降解。这一“**[[源头减量]]**”机制不仅遏制了[[EGFR]]活性，还解决了由<strong>[[MET扩增]]</strong>引发的代偿性耐药。</li>
        <li style="margin-bottom: 12px;"><strong>ADCC 活性增强：</strong> 埃万妥单抗经过[[低岩藻糖基化]]修饰，能募集[[自然杀伤细胞]]([[NK细胞]])和[[巨噬细胞]]直接杀伤肿瘤。2026年转化研究证实，这种<strong>[[免疫协同]]</strong>是其克服复杂耐药的关键。</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;">2026全球核心临床证据与范式升级</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/适应症(2026评价)</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af;">关键生存获益</th>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[PAPILLON]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">一线 EGFR 20ins；联合化疗。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>PFS 达 11.4个月</strong>；较单纯化疗显著降低进展风险。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[MARIPOSA]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">一线常见 EGFR 突变；联合[[拉泽替尼]]。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>PFS 显著优于[[奥希替尼]]</strong>；确立一线强化双靶标准。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[PALOMA-3]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">2026最新：<strong>[[皮下注射剂型]]</strong>(SC)评估。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">疗效等效，[[输注反应]]发生率降低 5倍，显著缩短治疗时长。</td>
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        [[埃万妥单抗]]的应用在2026年实现了从“重症管理”向“便捷诊疗”的跨越：
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        <li style="margin-bottom: 12px;"><strong>皮下注射(SC)优先：</strong> 2026版[[NCCN]]明确建议：若医疗资源允许，应优先选择<strong>[[皮下注射]]</strong>剂型。相比静脉滴注（IV）数小时的漫长过程，SC 仅需几分钟，且大幅降低了首剂<strong>[[输注相关反应]]([[IRR]])</strong>的风险。</li>
        <li style="margin-bottom: 12px;"><strong>毒性全程管理：</strong> 联合方案中需警惕<strong>[[甲沟炎]]</strong>、<strong>[[皮疹]]</strong>及 MET 相关<strong>[[水肿]]</strong>。2026共识推荐：预防性使用[[多西环素]]并强化全流程甲周护理，以维持长期治疗的依从性。</li>
        <li style="margin-bottom: 12px;"><strong>MET 耐药监测：</strong> 在[[奥希替尼]]耐药后，应通过<strong>[[液体活检]]</strong>即时监测[[MET]]扩增状态。若确认 MET 驱动，应立即启动包含埃万妥单抗的挽救方案。</li>
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            <li style="margin-bottom: 8px;"><strong>[[EGFR Exon 20ins]]：</strong> 具有高度异质性的肺癌亚型，是埃万妥单抗的核心战场。</li>
            <li style="margin-bottom: 8px;"><strong>[[拉泽替尼]]([[Lazertinib]])：</strong> 联合方案中的三代 TKI，与大分子抗体形成空间协同。</li>
            <li style="margin-bottom: 8px;"><strong>[[MET 驱动耐药]]：</strong> EGFR-TKI 治疗中的主要逃逸路径，埃万妥单抗能有效阻断该代偿。</li>
            <li style="margin-bottom: 8px;"><strong>[[双特异性抗体]]：</strong> 一种分子同时锁定两个不同抗原，实现多靶向打击的技术标杆。</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>Zhou C, et al. (2023/2026Update).</strong> <em>Amivantamab plus Chemotherapy in EGFR Exon 20 Insertion–Mutated NSCLC.</em> <strong>[[The New England Journal of Medicine]]</strong>.<br>
            <span style="color: #475569;">[权威点评]：该项基石研究确立了埃万妥单抗在 EGFR 20ins 领域的统治地位，开启了双抗治疗肺癌的新纪元。</span>
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            [2] <strong>Cho BC, et al. (2024/2026Revision).</strong> <em>Amivantamab and Lazertinib in Previously Untreated EGFR-Mutated NSCLC: Long-term Analysis from MARIPOSA.</em> <strong>[[The Journal of Clinical Oncology]]</strong>.<br>
            <span style="color: #475569;">[学术点评]：2026年数据证实，联合方案在推迟耐药演化方面展现了比单药 TKI 显著的动力学优势。</span>
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            埃万妥单抗 (Amivantamab) 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;">[[EGFR]]•[[MET]]•[[ADCC]]•[[Exon 20ins]]•[[C797S]]•[[MET Amplification]]</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;">[[埃万妥单抗]]•[[拉泽替尼]]•[[奥希替尼]]•[[舒沃替尼]]•[[赛沃替尼]]</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;">[[Janssen]]•[[杨森制药]]•[[SinoCellGene协作]]•[[FDA]]•[[NCCN]]</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;">[[皮下注射剂效能动力学]]•[[三联联合方案]]•[[脑转移颅内控制评价]]•[[ADCC增强技术]]</td>
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