PharmatecaPharmatecaФарматека2073-40342414-9128Bionika Media31271610.18565/pharmateca.2020.7.46-52ArticlesСтатьиResearch ArticleTreatment of residual breast cancerЛечение резидуального рака молочной железыEreschenkoS. SЕрещенкоС. СSemiglazovV. FСемиглазовВ. Ф

Dr. Sci. (Med.), Corr. Member of RAS, Professor, Head of the Scientific Department, Chief Researcher at the Scientific Department of Breast Tumors

д.м.н., чл.-корр. РАН, профессор, зав. научным отделением, главный науч. сотр. научного отделения опухолей молочной железы

vsemiglazov@mail.ruKrivorotkoP. VКриворотькоП. ВDashyanG. AДашянГ. АSmirnovaV. OСмирноваВ. ОKomyakhovA. VКомяховА. ВGigolaevaL. PГиголаеваЛ. ПZhiltsovaE. KЖильцоваЕ. КN.N. Petrov National Medical Research Center for OncologyНациональный медицинский исследовательский центр онкологии им. Н.Н. Петрова15072020277VOL 27, NO7 (2020)ТОМ 27, №7 (2020)465203032023Copyright ©; 2020, Bionika MediaCopyright ©; 2020, ООО «Бионика Медиа»2020Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/2073-4034/article/view/312716

Background. Patients with residual tumors after neoadjuvant systemic therapy (NST) are at greater risk of relapse compared with those who have achieved complete pathomorphological tumor regression (pCR). Objective: to improve treatment outcomes for residual breast cancer after neoadjuvant systemic therapy. Methods. The study included information on 339 patients with breast cancer (BC) who received NST at the N.N. Petrov National Research Center of Oncology. Results. Residual tumor was detected in 212 (62.5%) patients. The presence of a residual tumor worsens the 3-year survival rate for all BC subtypes, especially with a triple negative phenotype (TNBC; 48.8 versus 91.8%; p=0.01). In TNBC, the risk of disease recurrence is 2 higher than that in patients with HER2-positive and luminal B BC subtypes (51.2 versus 23.9 and 25.6%; p=0.02). In patients with TNBC with a residual tumor after NST (anthracyclines and taxanes), the administration of adjuvant therapy with capecitabine improves the relapse-free survival rate. Conclusion. Further progress in the treatment of the most aggressive types of breast cancer (triply negative and HER2-positive phenotypes) is associated with immunotherapy. Randomized clinical trials are evaluating the contribution of anti-PD-L1 immunotherapy (atesolizumab) in combination with chemotherapy (TNBC) or targeted therapy (HER2+) in the treatment of patients with metastatic or locally advanced breast cancer.

Обоснование. Пациенты с остаточной (резидуальной) опухолью после неоадъювантной системной терапии (НСТ) подвержены большему риску рецидива заболевания по сравнению с теми, кто достиг полного патоморфологического регресса опухоли (pCR). Цель исследования: улучшение результатов лечения резидуального рака молочной железы после неоадъювантной системной терапии. Методы. В исследование включены сведения о 339 пациентах с раком молочной железы (РМЖ), получавших НСТ в ФГБУ «НМИЦ онкологии им. Н.Н. Петрова» Минздрава России. Результаты. Резидуальная опухоль выявлена у 212 (62,5%) больных. Наличие резидуальной опухоли ухудшает показатели 3-летней выживаемости при всех подтипах РМЖ, особенно при трижды негативном фенотипе (ТНРМЖ; 48,8 против 91,8%; p=0,01). При ТНРМЖ риск рецидива заболевания в 2 раза превышает таковой у пациентов с HER2-позитивным и люминальным В-подтипами РМЖ (51,2 против 23,9 и 25,6%; p=0,02). Назначение адъювантной терапии капецитабином пациентам с ТНРМЖ с резидуальной опухолью после НСТ (антрациклины и таксаны) улучшает их показатели безрецидивной выживаемости. Заключение. Дальнейший прогресс в лечении наиболее агрессивных типов РМЖ (трижды негативного и HER2-позитивного фенотипов) связывается с иммунотерапией. В рамках рандомизированных клинических испытаний оценивается вклад анти-PD-L1 иммунотерапии (атезолизумаб) в комбинации с химио- (ТНРМЖ) или с таргетной терапией (HER2+) при лечении пациентов с метастатическим или местнораспространенным РМЖ.

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