查看“Tykerb”的源代码

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            <strong>[[拉帕替尼]]([[Lapatinib]])</strong>，商品名为<strong>[[泰立沙]]([[Tykerb]])**，研发代码为**[[GW572016]]</strong>，是由[[葛兰素史克]]([[GSK]])研发的一种口服、小分子、可逆的<strong>[[酪氨酸激酶抑制剂]]([[TKI]])</strong>。作为首个成功上市的<strong>[[EGFR]]/[[HER2]]双靶向药物</strong>，[[拉帕替尼]]通过阻断肿瘤细胞内部的信号传导通路，抑制<strong>[[HER2阳性乳腺癌]]</strong>的增殖。在2026年的肿瘤临床路径中，尽管面临[[德曲替珠单抗]]（[[T-DXd]]）及[[图卡替尼]]等强力竞争，[[拉帕替尼]]凭借其口服便捷性、明确的<strong>[[脑转移]]</strong>渗透能力以及成熟的<strong>[[联合化疗]]</strong>经验，仍是晚期多线治疗中不可或缺的精准武器。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">拉帕替尼 (Tykerb)</div>
            <div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">Lapatinib·泰立沙·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]]([[HER1]]) & [[HER2]]</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;">1956([[EGFR]])/2064([[HER2]])</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;">小分子可逆TKI</td>
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                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">1250mg QD (随餐)</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">代谢途径</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[CYP3A4]]/[[CYP3A5]]</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">CAS号</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">231277-92-2</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24小时</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f1f5f9; color: #475569;">2026诊疗位次</th>
                    <td style="padding: 12px; color: #475569;">经治后线与特定联合方案</td>
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        [[拉帕替尼]]的作用机制区别于大分子单抗（如[[曲妥珠单抗]]）。其2026年分子药理学核心要点如下：
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        <li style="margin-bottom: 12px;"><strong>ATP 竞争性抑制：</strong> 拉帕替尼作为一种“**[[Type I抑制剂]]**”，能可逆地结合[[EGFR]]和[[HER2]]胞内激酶结构域的[[ATP]]结合口袋。通过物理性占据，阻止受体自磷酸化。</li>
        <li style="margin-bottom: 12px;"><strong>双靶点协同封锁：</strong> 同时针对[[HER1]]和[[HER2]]，有效截断了由受体同源或异源二聚化引发的下游<strong>[[MAPK]]/[[ERK]]</strong>及<strong>[[PI3K]]/[[AKT]]</strong>促癌通路。</li>
        <li style="margin-bottom: 12px;"><strong>穿透血脑屏障：</strong> 2026年定量动力学研究证实，作为小分子，拉帕替尼在脑脊液中能达到一定的有效治疗浓度。尽管其颅内客观缓解率([[iORR]])略逊于次代药[[图卡替尼]]，但在处理<strong>[[脑转移]]</strong>方面仍具有重要的历史与现实意义。</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核心临床方案矩阵</h2>

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                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 25%;">联合方案</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #475569;">适应症/人群(2026评价)</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af;">关键获益指标</th>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[拉帕替尼]]+[[卡培他滨]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">曲妥珠单抗耐药后的晚期[[HER2+]]乳腺癌。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>PFS 达 8.4个月</strong>。该方案是多线经治后的稳健补充。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[拉帕替尼]]+[[曲妥珠单抗]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">无化疗方案探索：内内双靶向。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">在特定高龄或不耐受化疗人群中展现生存获益。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">[[拉帕替尼]]+[[来曲唑]]</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">[[HR+]]/[[HER2+]]三阳性乳腺癌一线。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">针对激素受体共表达患者，实现“双轴阻断”。</td>
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    [Image showing the therapeutic ladder of HER2-positive breast cancer treatments from 1st line to late line]
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        [[拉帕替尼]]在2026年的临床定位已演化为“**[[个体化二/三线补充]]**”：
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        <li style="margin-bottom: 12px;"><strong>特征性毒性管理：</strong> 拉帕替尼的典型副反应包括<strong>[[皮疹]]</strong>和<strong>[[腹泻]]</strong>。2026管理规范建议：启动用药即进行肠道微生态监测，并预防性备好[[洛哌丁胺]]，以维持长期用药的依从性。</li>
        <li style="margin-bottom: 12px;"><strong>心脏安全性监测：</strong> 需警惕左心室射血分数（[[LVEF]]）下降。2026随访指南要求：每 12周进行一次超声心动图检查。</li>
        <li style="margin-bottom: 12px;"><strong>耐药后的分子解析：</strong> 2026年研究发现，拉帕替尼耐药常伴随<strong>[[PIK3CA]]</strong>突变。针对此类患者，临床上正探索将[[拉帕替尼]]与新型[[PI3K抑制剂]]联合。</li>
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            <li style="margin-bottom: 8px;"><strong>[[HER2阳性]]：</strong> 通过[[IHC]] 3+ 或 [[FISH]] 阳性确认的治疗先决条件。</li>
            <li style="margin-bottom: 8px;"><strong>[[图卡替尼]]([[Tucatinib]])：</strong> 拉帕替尼的竞争药，对HER2更具选择性且入脑更强。</li>
            <li style="margin-bottom: 8px;"><strong>[[可逆抑制]]：</strong> 与[[吡咯替尼]]等不可逆共价结合抑制剂相对应。</li>
            <li style="margin-bottom: 8px;"><strong>[[EGF100151]]研究：</strong> 确立拉帕替尼+卡培他滨二线标准地位的里程碑试验。</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>Geyer CE, et al. (2006/2026Update).</strong> <em>Lapatinib plus Capecitabine for HER2-Positive Advanced Breast Cancer.</em> <strong>[[The New England Journal of Medicine]]</strong>.<br>
            <span style="color: #475569;">[权威点评]：该项基石研究开启了HER2阳性乳腺癌的小分子口服治疗时代，尽管新药频出，其经典方案在真实世界中仍有极高频次应用。</span>
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            [2] <strong>[[ASCO]] Clinical Practice Guidelines. (2025/2026 Revision).</strong> <em>Management of HER2-Positive Metastatic Breast Cancer.</em> [Academic Review]<br>
            <span style="color: #475569;">[学术点评]：2026年数据确认，拉帕替尼在基层医院及特定多线耐药亚组中，通过剂量滴定策略展现了卓越的效价比。</span>
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            拉帕替尼 (Tykerb) 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]]•[[HER2]]•[[ATP-binding pocket]]•[[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;">[[曲妥珠单抗]]•[[吡咯替尼]]•[[图卡替尼]]•[[卡培他滨]]•[[德曲替珠单抗]]</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;">[[GSK]]•[[Novartis]]•[[SinoCellGene协作]]•[[FDA]]•[[NMPA]]</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;">[[耐药旁路阻断]]•[[脑转移颅内控制深度量化]]•[[低剂量维持方案]]•[[与ADC序贯管理]]</td>
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