Drugs最新文献

HER2 overexpression/amplification is a well-established oncogenic driver across several tumor types and has emerged as a therapeutically actionable biomarker in 3-5% of metastatic colon and rectal cancers (mCRCs). Based on increasing clinical evidence, several anti-HER2 therapeutic regimens have been incorporated into treatment guidelines. In this review, we provide a comprehensive overview of both established and emerging HER2-targeted strategies in mCRC, examining the mechanisms of action, toxicity profiles, and clinical efficacy of individual anti-HER2 drugs and their associations. As accurate and standardized HER2 testing remains critical, we also discuss current methodologies and challenges in HER2 screening for mCRC. In addition, we present an in-depth analysis of the relationship between HER2 amplification levels, co-occurring genomic alterations, and treatment outcomes across clinical trials, underscoring the importance of quantitative HER2 assessment and comprehensive tumor profiling. These data support the refinement of therapeutic strategies through more precise diagnostic approaches and improved patient selection, considering factors such as gene-dosage, toxicity, and coexisting mutations. Finally, the emerging role of anti-HER2 rechallenge strategies and the advent of novel HER2-directed therapies-including bispecific antibodies, novel tyrosine kinase inhibitors, antibody-drug conjugates, and immune-based therapies-are discussed as new opportunities to improve outcomes in this molecular subset of patients.

Imlunestrant (Inluriyo™), an oral, selective, estrogen receptor (ER) degrader (SERD), is being developed by Eli Lilly and Company for the treatment of ER-positive (ER+), human epidermal growth factor receptor 2 (HER2) negative (HER2-) breast cancer. In September 2025, imlunestrant was approved for the treatment of adults with ER+, HER2-, ESR1-mutated advanced or metastatic breast cancer with disease progression following at least one line of endocrine therapy in the USA. This article summarizes the milestones in the development of imlunestrant leading to this first approval for use in patients with ER+, HER2-, ESR1-mutated advanced or metastatic breast cancer.

An oral formulation of sepiapterin (Sephience™) is being developed by PTC Therapeutics for the treatment of phenylketonuria (PKU). Sepiapterin is a natural precursor of enzyme cofactor tetrahydrobiopterin (BH₄), which is required for phenylalanine hydroxylase (PAH)-mediated phenylalanine metabolism. Sepiapterin enhances PAH activity, which is deficient in patients with PKU. Sepiapterin received its first approval on 19 June 2025 in the European Union, for use in hyperphenylalaninaemia (HPA) in adult and paediatric patients with PKU. This was followed by approval in the USA on 28 July 2025, for the treatment of HPA in adult and paediatric patients ≥ 1 month of age with sepiapterin-responsive PKU. This article summarizes the milestones in the development of sepiapterin leading to its first approval for HPA in adult and paediatric patients with PKU.

Elinzanetant (Lynkuet™) is a non-hormonal, small-molecule neurokinin 1 (NK₁) and 3 (NK₃) antagonist being developed by Bayer for the treatment of vasomotor symptoms (VMS), which received its first approval in the UK in July 2025. As a neurokinin-targeted therapy, elinzanetant modulates the activity of hyperactive kisspeptin/neurokinin B/dynorphin neurones to reduce the frequency and severity of VMS, which was demonstrated during the OASIS clinical trials. This article summarizes the milestones in the development of elinzanetant leading to this first approval for the treatment of moderate to severe VMS associated with menopause.

Tolebrutinib (CENRIFKI^®) is an orally available, brain-penetrant small molecule inhibitor of Bruton's tyrosine kinase (BTK) being developed by Sanofi for the treatment of multiple sclerosis (MS). On 26 August 2025, tolebrutinib received its first approval in the United Arab Emirates (UAE) for the treatment of non-relapsing secondary progressive multiple sclerosis (nrSPMS) and to slow disability accumulation independent of relapse activity in adults. The drug is under regulatory review in the USA and the EU. This article summarizes the milestones in the development of tolebrutinib leading to this first approval for MS.

Zeprumetostat (), an oral, selective, small molecule inhibitor of enhancer of zeste homolog 2 (EZH2), a histone methyltransferase, is being developed by Jiangsu Hengrui Pharmaceutical Co., Ltd for the treatment of solid and haematological malignancies. In August 2025, zeprumetostat received conditional approval in China for use in adult patients with relapsed or refractory peripheral T-cell lymphoma (r/r PTCL) who have received ≥ 1 line of systemic therapy. This article summarizes the milestones in the development of zeprumetostat leading to this first approval for the treatment of r/r PTCL.

Rilzabrutinib (WAYRILZ™) is a small-molecule, reversible, highly specific, covalent BTK inhibitor being developed by Sanofi for the treatment of multiple immune-related and inflammatory disorders, including immune thrombocytopenia, warm autoimmune haemolytic anaemia, sickle cell disease, IgG4-related disease, asthma, chronic spontaneous urticaria, among others. As a BTK inhibitor, rilzabrutinib demonstrates multiple immunomodulatory effects, including reduced B cell activation and autoantibody production, inhibition of macrophage activity, and anti-inflammatory effects. In clinical trials, rilzabrutinib was associated with durable platelet responses in patients with previously treated immune thrombocytopenia. This article summarizes the milestones in the development of rilzabrutinib leading to its first approval for the treatment of adults with persistent or chronic immune thrombocytopenia who have had an insufficient response to previous treatment.

Elamipretide (Forzinity™) is a mitochondrial cardiolipin binder being developed by Stealth BioTherapeutics for the treatment of a range of disorders featuring mitochondrial dysfunction. In September 2025, elamipretide was granted accelerated approval in the USA for use to improve muscle strength in adult and pediatric patients with Barth syndrome weighing ≥ 30 kg. With this accelerated approval, elamipretide became the first disease-specific treatment approved for Barth syndrome, an ultra-rare X-linked recessive genetic disorder. Elamipretide is also under phase III clinical development for use in the treatment of dry age-related macular degeneration and mitochondrial myopathies. This article summarizes the milestones in the development of elamipretide leading to this first approval for Barth syndrome.

Vitiligo is a common, chronic, immune-mediated disorder characterized by progressive skin depigmentation, often associated with significant psychosocial burden and impaired quality of life. Therapeutic management remains challenging, with limited effective options available. Although topical corticosteroids, calcineurin inhibitors, and narrowband ultraviolet B (NB-UVB) phototherapy constitute the mainstays of treatment, many patients, particularly those with extensive or refractory disease, fail to achieve satisfactory or durable repigmentation. The clinical course is further complicated by high relapse rates and heterogeneous treatment responses across different anatomical sites. Recent advances in the understanding of vitiligo pathogenesis have identified the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway as a central driver of immune-mediated melanocyte destruction. This pathway is activated by key cytokines involved in vitiligo, including interferon gamma (IFN-γ), interleukin 15 (IL-15), among others, which sustain cytotoxic T cell infiltration and melanocyte apoptosis. As a result, JAK inhibitors have emerged as promising targeted therapies for vitiligo. Several topical and JAK inhibitors are currently under clinical investigation, with one topical agent, ruxolitinib cream, already approved for the treatment of vitiligo. Topical ruxolitinib, a JAK1/2 inhibitor, has demonstrated consistent and clinically meaningful repigmentation, particularly in facial lesions, and is already approved for use in both adolescents and adults. Among oral agents, ritlecitinib (a JAK3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) inhibitor), upadacitinib and povorcitinib (JAK1 inhibitors) have shown the most promising efficacy, either as monotherapy or in combination with NB-UVB phototherapy. Ongoing phase III trials are expected to further define their role in clinical practice. Other agents, including tofacitinib, baricitinib, abrocitinib, among others, are currently under investigation or being used off-label in clinical practice. JAK inhibitors exhibit variable safety profiles depending on selectivity, formulation, and dose. Topical agents are generally well tolerated with minimal systemic absorption, whereas oral JAK inhibitors require monitoring owing to potential risks of infection, hematologic abnormalities, and cardiovascular events. In this article, we review the current evidence on the efficacy and safety of topical and oral JAK inhibitors for vitiligo and contextualize their role within the broader landscape of emerging therapeutic strategies.

Acid sphingomyelinase deficiency is an ultra-rare disease characterised by generalised storage of sphingomyelin, caused by deficiency of the lysosomal enzyme acid sphingomyelinase, owing to the presence of biallelic pathogenic variants in the SMPD1 gene. The main disease manifestations are in the liver, spleen, lung and bone - with some patients having also involvement of the central nervous system. Patients show variable degrees of anaemia, thrombocytopenia and lipid abnormalities, among other findings. Clinically, acid sphingomyelinase deficiency spans from an acute neurovisceral form, with neurological involvement and early death (type A), to a chronic visceral disease, with no or minimal neurological manifestations (type B). An intermediate form, with chronic neurovisceral involvement, is presented by some patients (type A/B). Diagnosis involves the measurement of biomarkers, an assay of enzyme activity and genetic testing. Until a few years ago, treatment was mainly dependent on symptomatic management and bone marrow or solid organ (liver and/or lung) transplantation. In 2022, a specific enzyme replacement therapy with olipudase alfa was approved, and the results available indicate that it changed the therapeutic landscape for patients with acid sphingomyelinase deficiency type B and A/B. Research is being developed to address the needs of patients with acid sphingomyelinase deficiency type A, with gene therapy remaining as a promising approach.