medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-8-6-11medalphabet-1501Research ArticleСтатьиСовременные режимы применения винорелбина при метастатическом раке молочной железы: роль и место пероральной лекарственной формы, метрономная терапия, комбинации с анти-HER 2-препаратамиCurrent regimens for use of vinorelbine in metastatic breast cancer: role and place of oral dosage form, metronome therapy, combinations with anti-HER 2 drugsАртамоноваЕ. В.ArtamonovaE. V.

д. м. н., зав. отделением химиотерапии; проф. кафедры онкологии и лучевой терапии

г. Москва

Moscow

ФГБУ «Национальный медицинский исследовательский центр онкологии имени Н. Н. Блохина» Минздрава России; ФГБОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава РоссииРоссияNational Medical Research Centre of Oncology n. a. N. N. Blokhin; Russian National Research Medical University n. a. N. I. PirogovRussian Federation20201606202008Диагностика и онкотерапия611Copyright © Артамонова Е.В., 20202020Артамонова Е.В.Artamonova E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1501

Основной целью лечения мРМЖ является не только увеличение продолжительности жизни, но и сохранение и улучшение ее качества, поэтому особое значение приобретает поиск режимов ХТ с наилучшим соотношением эффективности и переносимости. С этих позиций особое внимание клиницистов привлекают пероральные цитостатики, в частности винорелбин в капсулах, который характеризуется высокой эффективностью, благоприятным профилем токсичности, позволяет избежать внутривенных введений и может комфортно использоваться в амбулаторной практике у пациенток различных возрастных категорий. По мнению экспертов, винорелбин является возможным и эффективным вариантом выбора первой линии терапии мРМЖ наряду с антрациклинами и таксанами и предпочтительной опцией у больных, которые имеют сопутствующую патологию или желают избежать алопеции. Так как пролонгированная ХТ первой линии достоверно увеливает ВБП и ОВ у больных мРМЖ, пероральные цитостатики, в том числе винорелбин в капсулах, приобретают значительные преимущества, потому что их прием может быть продолжен в течение значительно большего периода времени, чем введение антрациклинов или таксанов. Комбинация перорального винорелбина с трастузумабом является высокоактивным вариантом лечения HER 2-позитивного подтипа заболевания. Кроме того, винорелбин является одним из вариантов выбора для антрациклин-таксан-резистентного мРМЖ. Новые метрономные режимы дозирования винорелбина в капсулах представляют серьезную альтернативу традиционной ХТ, предусматривающей назначение максимально переносимых доз цитостатиков. Таким образом, результаты применения перорального винорелбина как в монотерапии, так и в различных комбинациях (в зависимости от клинической ситуации), благоприятный профиль безопасности, а также возможность гибкого дозирования, включая и метрономные режимы, ставит препарат в ряд важнейших опций лечения мРМЖ.

The purpose of the treatment of metastatic breast cancer is overall survival improvement, thus the search for new effective regimes of chemotherapy with low toxicity is especially important. Therefore chemotherapy is one of the options for the treatment of metastatic breast cancer, for instance oral vinorelbine has shown consistant efficacy with a low toxicity profile. In this framework, an active and well tolerated oral CT option provides additional benefits for patients such as the possibilty of intake of the treatment at home and allows avoiding an intravenous infusion and alopecia if that is a priority for the patients. According to experts’ opinions vinorelbine is an efficient choice for first line of chemotherapy of metastatic breast cancer along with anthracyclines and taxanes. A meta-analysis of published trials concluded that longer first-line CT duration is associated with a marginally longer OS and a substantially longer PFS. In this context oral vinorelbine may be chosen as a preferable treatment since treament with oral vinorelbine can go on substantianaly longer than treatment with many other drugs. Vinorelbine yielded equal or superiour results to both paclitaxel and docetaxel, when combined with trastuzumab in the HER-2-positive ABC in the HERNATA and TRAVIOTA trials. And finally oral vinorelbine can be used in new metronomic regimens in which drugs are adminstered frequently or continuously. This kind of treatment maintains low, prolonged and pharmacologically active plama concentrations of drugs to avoid toxicity associated with traditional chemotherapy regimens, while achieveing tumor responce. Thus vinorelbine can be used as one of the options of metastatic breast cancer treatment.

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The authors declare that there are no conflicts of interest present.