medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-10-16-21medalphabet-2055Research ArticleДИАГНОСТИКА И ОНКОТЕРАПИЯDIAGNOSTICS AND ONCOTHERAPYКомбинированная иммунотерапия колоректального рака у молодой пациентки с микросаттелитной нестабильностью (клинический случай)Combined immunotherapy of colorectal cancer in young patient with microsatellite instability (clinical case)https://orcid.org/0000-0002-9558-5579ЛядоваМ. А.LyadovaM. A.

Лядова Марина Александровна, к.м.н., зав. отделением химиотерапии

Москва

Lyadova Marina A., PhD Med, head of Chemotherapy Dept.

Moscow

dr.lyadova@gmail.comhttps://orcid.org/0000-0002-7853-0349НерсесоваТ. А.NersesovaT. A.

Нерсесова Татьяна Александровна, врач-онколог

Nersesova Tatiana A., oncologist

Moscow

https://orcid.org/0000-0001-5615-7806ФедянинМ. Ю.FedyaninM. Yu.

Федянин Михаил Юрьевич, д.м.н.; с.н.с.; доцент кафедры онкологии и гематологии

SPIN-code: 4381-5628

Москва

Fedyanin Mikhail Yu., DM Sci, chief researcher; associate prof. at Oncology and Hematology Dept.

Moscow

ГБУЗ «Городская клиническая онкологическая больница № 1 Департамента здравоохранения Москвы»РоссияCity Clinical Oncology Hospital No. 1Russian FederationФГБУ «Национальный медицинский исследовательский центр онкологии имени Н. Н. Блохина» Минздрава России; ФГАОУ ВО «Российский университет дружбы народов»РоссияNational Medical Research Centre of Oncology n.a. N. N. Blokhin; Peoples’ Friendship University of RussiaRussian Federation202128062021010«Диагностика и онкотерапия» (1)1621Copyright © Лядова М.А., Нерсесова Т.А., Федянин М.Ю., 20212021Лядова М.А., Нерсесова Т.А., Федянин М.Ю.Lyadova M.A., Nersesova T.A., Fedyanin M.Y.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/2055

В настоящее время комбинированное использование нескольких ингибиторов контрольных точек для лечения колоректального рака (КРР) демонстрирует хорошие результаты, однако исследований проведено недостаточно, особенно у пациентов с микросателлитной нестабильностью (MSI).

Цель

Цель. Описание эффективности комбинированной иммунотерапии у пациентки с КРР и MSI-H.

Результаты

Результаты. Приведен клинический случай молодой пациентки с раком поперечно-ободочной кишки cT4N 2M1 IV стадии. Пациентка прошла курс химиотаргетной терапии. После прогрессирования проводился курс иммунотерапии ниволумабом и ипилимумабом (четыре курса) и в дальнейшем 21 курс ниволумаба, на фоне которых отмечена положительная динамика. Среди иммуноопосредованных нежелательных явлений отмечались переферическая полинейропатия II степени, иммуноопосредованный гипотиреоз, а также иммуноопосредованный артрит.

Выводы

Выводы. Требуется проведение дальнейших исследований подгруппы пациентов с метастатическим КРР с MSI-H с целью разработки максимально эффективных подходов с использованием иммунотерапевтических препаратов и дополнительных методов лечения.

At present administration of a combination of several immune checkpoint inhibitors (ICT) for the treatment of colorectal cancer (CRC) demonstrates promising results, but clinical trials of that approach are lacking, especially in patients with high microsatellite instability (MSI-H).

Aim

Aim. To describe the efficacy of combination of ICT therapy in a female patient with CRC and MSI-H.

Results

Results. A clinical case of a young female patient with transverse colon cancer with T4N 2M1 IV stage is presented. Patient underwent a course of chemotherapy. After disease progression a course of ICT therapy with nivolumab and ipilimumab (four courses) with subsequent 21 course of nivolumab were performed, with positive clinical dynamics. Immune-mediated adverse events included peripheral polyneuropathy (2nd grade), immune-mediated hypothyreosis and immune-mediated arthritis.

Conclusions

Conclusions. Further studies are needed in a subgroup of patients with metastatic CRC with MSI-H to develop treatment approaches utilizing ICT and additional treatment modalities with maximal efficacy.

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