ORIENT-31 / ATTLAS：EGFR-TKI 后免疫 + 抗血管 + 化疗组合
类型: III期临床试验 / 免疫治疗 + 抗血管 发表日期: 2023-10-20 入库日期: 2026-05-21 来源: PubMed / Lancet Respiratory Medicine / Journal of Clinical Oncology 标签: EGFR L858R, 免疫治疗, Sintilimab, Atezolizumab, Bevacizumab, ORIENT-31, ATTLAS, 奥希替尼后, 抗血管
Citations
Lu S, et al. Sintilimab plus chemotherapy for EGFR-mutated non-squamous NSCLC after EGFR-TKI progression (ORIENT-31): second interim analysis. Lancet Respiratory Medicine. 2023. PMID: 37156249. DOI: 10.1016/S2213-2600(23)00135-2
First interim ORIENT-31 report: PMID: 35908558. DOI: 10.1016/S1470-2045(22)00382-5
Park S, et al. Atezolizumab Plus Bevacizumab and Chemotherapy in EGFR- or ALK-Mutated NSCLC (ATTLAS, KCSG-LU19-04). Journal of Clinical Oncology. 2024. PMID: 37861993. DOI: 10.1200/JCO.23.01891
Why it matters for mom
These trials are the reason immunotherapy cannot be dismissed with one sentence in EGFR-mutant NSCLC. The more plausible immune-based strategy after EGFR-TKI progression appears to be immunotherapy plus chemotherapy plus anti-VEGF/antiangiogenic therapy, not PD-1/PD-L1 plus chemo alone.
Applicability still depends heavily on treatment line, prior drugs, geography, blood counts, bleeding/thrombosis risk, proteinuria, hypertension, and whether a more targeted resistance option exists.
Practical takeaways
- ORIENT-31 is especially relevant to China/Asia availability because it studied sintilimab with chemotherapy and bevacizumab biosimilar IBI305.
- ATTLAS supports the same general concept with atezolizumab + bevacizumab + chemotherapy after targeted therapy failure in EGFR/ALK-altered NSCLC.
- Anti-VEGF combinations add practical screening issues: bleeding risk, thrombosis risk, blood pressure, urine protein, wound healing, and tumor location.
- These are not first-choice substitutes for molecularly targeted options if repeat biopsy finds MET amplification, EGFR C797S/T790M, HER2, BRAF, RET/NTRK/ALK fusion, or transformation.
Questions for doctors
- If immunotherapy is discussed, is the proposed regimen a chemo-antiangiogenic-immunotherapy regimen similar to ORIENT-31/ATTLAS, or PD-1/PD-L1 plus chemo alone?
- Is bevacizumab/anti-VEGF safe with her current lesions, bleeding history, platelet counts, blood pressure, and procedures?
- Would a repeat biopsy/NGS result change the recommendation away from immunotherapy?