#ESMO26 | 我们的荟萃分析
我们与 Rohit 和 Rahul（@OncBrothers）合作开展的另一项研究！
BRAF/MEK 抑制 vs 基于 ICI 的治疗，用于一线 BRAF V600E 突变型转移性 NSCLC。
我们的荟萃分析纳入了 4 项回顾性研究，共涉及 589 例患者。
🔹PFS: HR 1.22 (95% CI 0.89–1.68; p=0.22)
🔹OS: HR 1.01 (95% CI 0.59–1.73; p=0.97)
🔹ORR: 65.3% vs 48.0%，BRAF/MEK 抑制更优 (p=0.04)。
BRAF/MEK 抑制实现了更高的缓解率，但未显示出具有统计学意义的生存优势。
我猜大多数临床医生仍会优先考虑 BRAF/MEK 抑制，尤其是鉴于 PHAROS 研究结果令人印象深刻。
然而，最佳一线策略仍是一个悬而未决的问题，我们的发现凸显了对前瞻性比较证据的必要性。
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NRG-GY020: Phase III randomized trial of radiation +/- MK-3475 (pembrolizumab) for newly diagnosed early-stage high intermediate risk (HIR) mismatch repair deficient (dMMR) endometrioid endometrial cancer
https://esmocongress.esmo.orgSacituzumab tirumotecan (Sac-TMT) + pembrolizumab (Pembro) in post-platinum advanced mismatch repair proficient (pMMR) endometrial cancer (EC)
https://esmocongress.esmo.orgSTARBOARD phase 3: A randomized, double-blind study of first-line (1L) encorafenib (enco), binimetinib (bini), and pembrolizumab (pembro) vs placebo (pbo) and pembro for unresectable locally advanced or metastatic BRAF V600-mutant melanoma
https://esmocongress.esmo.orgEfficacy and safety of lifileucel and pembrolizumab in patients with immune check point inhibitor-naïve advanced melanoma: Final results from IOV-COM-202 study
https://esmocongress.esmo.orgUpdated results from the phase 1b/2 KEYNOTE-365 cohort I: Pembrolizumab (pembro) + carboplatin and etoposide chemotherapy (chemo) or chemo alone for neuroendocrine prostate cancer (NEPC)
https://esmocongress.esmo.orgFirst-line (1L) olomorasib + pembrolizumab in KRAS G12C-mutant NSCLC: Updated results from LOXO-RAS-20001 and SUNRAY-01
https://esmocongress.esmo.org- Yakup Ergün@dr_yakupergun
I don't consider TMB alone a reliable predictive biomarker in MSS colorectal cancer. Particularly after treatment, an increase in TMB may reflect the accumulation of subclonal mutations rather than sensitivity to immunotherapy. Outside specific molecular subgroups such as POLE/POLD1 proofreading-deficient tumors, we lack convincing evidence to support immunotherapy based solely on high TMB. However, when standard treatment options have been exhausted, immunotherapy may be considered, particularly in patients with markedly elevated TMB, while acknowledging the limited evidence.
- Asil0707@asill7007
Hi Doctor, regarding the recent October 2026 FDA approval update for Keytruda in TMB-High solid tumors: For a heavily pretreated metastatic colorectal cancer patient (MSS/MSI-negative, prior therapies, Pembrolizumab-naive) with a TMB of 16, would you consider Keytruda a viable option? What would be your clinical approach if this were your patient? Thanks!
来源：Yakup Ergün · x.com