文 | 氨基观察

guoqushiyunian，btkyizhijishichangchixubaofa。

ziyibutinizai2013nianhuopiyongyuzhiliaomanxinglinbaxibaobaixuebingyilai，btkyizhijigaogemengjin，jihuchengbaxueyeliulingyu，shichangguimoyeyichaobaiyimeiyuan。

dangran，suizheyuelaiyueduoderujuzhe，btkyizhijishichangyebiandeanliuyongdongqilai。

yibutinizoushangxiapolu，calquence、zebutiniyijipirtobrutinibdengxinshengdaililiangzoushangpolu，weilaihaihuiyougengduodexuanshouruju。

ergengduobtkyizhijidechuxian，weihuanzhetigongkongzhijibingjinzhanxinxuanzedetongshi，yejiangdailaiyigequanxindewenti：ruhezuheyijiruhepaixu？

zheihaiyoudaiyaoqimentongguotansuoquzhaodaodaan。jinniandeashnianhui，bufenyaoqijiujishichang，dailaiyixiexindaan。

01 定义耐药患者的选择

zaichuangxinyaodejingsaizhong，dingyizhenliaozhixushiyigeyonghengdehuati。

zuoweishougehuopidebtkyizhiji，yibutinidahuochenggongdegenyuanjiuzaiyu，qidingyiletaoxibaolinbaai、manxinglinbaxibaobaixuebing、xiaoxibaolinbaliu、huashijuqiudanbaixuezhengdengduozhongjibingdezhenliaoxinzhixu，bingkazhushenwei。

zaizheiyibeijingxia，houlaizheyaoxiangjushang，bukebimianxuyaosikaoyouguan“dingyi”dewenti。

baijishenzhouzebutinidechenggong，jiushiqichenggongzaifufananzhidecll/sllhuanzhezhong，touduitoulinchuangzhanshengyibutini，huodelegengjijidelinchuangshuju。dingyishilizhijiandechaju，shizebutinijueqideguanjian。

dangran，zaibtkyizhijijianghudetuwei，buzhiyouyuduishouzhengmianpk，haibaokuoquzhaodaogengduolinchuangmeiyoudaandexinjie。lilaijiujileshichangyigexinsilu：mingquechengweixianyoubtkyizhijinaiyaohuanzhedexuanze。

duiyubtkyizhijilaishuo，naiyaowentiwufabimian。liru，woyachdengrenyanjiuguji，yibutiniyongyao4nianhouyueyou19%decllhuanzhehuifashengjibingjinzhan。jiyuzheiyixuqiu，yedanshenglebaokuobcl-2yizhijivenclextadengxinjie。

lilaiyekandaolezheigeshichangdejihui。qixinyidaibtkyizhijipirtobrutinib，shejisilubuyuqianliangdaibtkyizhijidezuoyongweidianc481jiehe，kezhiliaoyiduiqianliangdaibtkyizhijinaiyaodehuanzhe。

zheizaiqilinchuangtansuozhong，dedaolechixudezhengshi。zaimingweibruindelinchuang1/2qishiyanzhong，duiyuneixieyijingjieshouguobtkzhiliaobingqiechanshengnaiyaoxingdehuanzhe，pirtobrutinibrengranyouxiao，yincihuodelejiasupizhun，yongyuzhiliaosanxianjiyishangmcl。

“zheishiyixiangzhenzhengdaibiaohuanzhequntidelinchuangshiyan......zaiguoqujinianzhongjieshoulezheixiexiandaihulibiaozhun，xianzaixuyaoqitadongxi，“lilaishouxiyiliaoguandavid hymanzaijieshoucaifangshishuo。

zaijinniandeashnianhuishang，lilaigengxindebruinyanjiushujujinyibuzhengshilezheiyidian。zaidiaozhengjiaochayongyaoyingxiangyinsuzhihou，fengxianbishuzifangmianyouliyupirtobrutinib，liangzhongbutongdetongjifenxijieguofenbiewei0.87、0.78。

yanjiurenyuanrenwei，pirtobrutinibnenggoujianghuanzhexiayicizhiliaohuosiwangtuichizhongweishuyueweiliangnian，zheituxianleqilinchuangzhiliaodiwei。

anzhaolilaizhongliuxuefuzerenjacob van naarden deshuofa，zheixieshujuyetichuleyigexindelinchuangfangxiang，jizaihuanzheshiyongdiyizhong btkyizhijihou，yishengshifoukenengxiangchangshipirtobrutiniberbushilingyizhongmingweivenclextadeyaowu。

02 如何卡住前线位次

dangran，duiyuzhongliuyaowulaishuo，zaimanzunaiyaohuanzhedetongshi，zuidadexiwangshiwangqianxiantingjin，manzugengduohuanzhedexuqiu，jinerhuodegengdadeshangyehuibao。

btkyizhijijianghudefuzaxing，yezaiyuci。liru，zebutinizaifufananzhidecll/sllhuanzhezhongtouduitoulinchuangzhanshengyibutinidehudiexiaoying，yuanbixiangxiangzhongda。

hexinyuanyinzaiyu，zailingyixiangtouduitouyibutinidelinchuangzhong，asilikangdecalquencezhishizhanxianlefeiliexingdejieguo。

zheiyedaozhi，suirancalquenceyijinghuopiyixiancll，qiexiaoshouerengzaigaosuzengzhang，dancalquenceshifoushizuiyouxuanzedeyihuo，rengrancunzai。bijing，zebutiniyeyijinghuopiyongyuyixiancll。

duici，asilikangyexuanzeyongzhanxianjiroudefangshi，laijiejueshichangdeyilv。zaijinniandeashnianhuishang，asilikangzhanxianlecalquenceyuvenclextaxiangjiehezaixianqianweizhiliaodecllhuanzhezhong3qiamplifyyanjiujieguo。

shujuxianshi，yubiaozhunhuaxuemianyiliaofaxiangbi，zheizhongzuhejiangjibingjinzhanhuosiwangdefengxianjiangdile35%。tianjiadisanzhongbutongdeyaowugazyvajinyibujiangdilefengxian。

zheiyeyiweizhe，calquencedelianheliaofashiyan，nenggourangcllhuanzheshengcunqijinyibuyanzhang。zaiashshangzhanshide3qiamplifyshiyanshuju，wuyijianggongguqidiwei。

dangran，chuangxinyaodemeilizaiyu，jingzhengyongyuanbuhuitingzhi。muqian，zebutinirengzaikaiqigengduodehaodu，liruqiziyanbcl-2yizhijisonrotoclaxlianhezebutini，touduitouvenclextalianheliaofade3qilinchuangyijingjiasutuijin。

zheiyeyiweizhe，cllyixianliaofadefenzheng，rengranhuijixu。

03 永不休止的纷争

lazhangzhouqilaikan，btkyizhijidezhengduobiranhuiyuelaiyuejingcai。

qifuzaxingzaiyu，yimianshi，baokuozebutini、akatinizaineidedierdaibtkyizhijidezhengduo，suirantamenzaiyudiyidaibtkyizhijiyibutinidejingzhengzhong，yijingzhanwenjiaogen，danshuyutamenzhijiandejingzhengcaiganggangkaishi，qiaruasilikanghebaijishenzhouyiyang。

lingyimianshi，disandaibtkyizhijikaishidengtai，weijumianzengjialegengfuzadebianshu。zhengrushangwensuoshuo，fenzishejidebutong，rangdisandaibtkyizhijizainaiyaohuanzhequntifangmiandeliaoxiaoyijingfeichangmingque，weilai，sandaibtkyizhijibiranyehuijiangmuguangkanxianggengduoshiyingzhengdeqianxianliaofa。

zheibingbuyiweizhe，pirtobrutinibyidinghuishishenglizhe。yixieyanjiuxianshi，pirtobrutinibzhiliaohoujibingjinzhanxiangduiyibutinijiaozao，tishijieshoupirtobrutinibzhiliaodehuanzhehuoyoukenenggengzaofashengnaiyao，zheiyiqianzaichayihuoduiweilaiqikaifayixianshiyingzhengchanshengyidingyingxiang。

danbuguanzenmeshuo，btkyizhijidediedaibuhuitingzhi，suoyibtkyizhijidejianghuzhixuzhongpai，huishiyigechixuxingdehuati。

jinguandabufenxuanshoudounantao“paohui”demingyun，dantongguozaishibaidejichushangbuduanfupan，zhongyouxuanshounenggouhuodezuizhongshengli，weihuanzhetigonggenghaodezhiliaoxuanze。

zheijiushichuangxinyaodeshijie，cankuqueyourucimeili。