medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2022-13-18-21medalphabet-2698Research ArticleСтатьиЕсть ли место химиотерапии в первой линии лечения метастатического НМРЛ в эпоху иммунотерапии?Is there a place for chemotherapy in first line of treatment for metastatic NSCLC in era of immunotherapy?https://orcid.org/0000-0002-0620-2696ЮдинД. И.YudinD. I.

Юдин Денис Иванович, к. м. н., с. н. с.

Москва

Yudin Denis I., PhD Med, senior researcher

Moscow

yudinden@mail.ruhttps://orcid.org/0000-0003-4469-502XЛактионовК. К.LaktionovK. K.

Лактионов Константин Константинович, д. м. н., проф. кафедры, Кафедра онкологии и лучевой терапии лечебного факультета ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России; зав. отделением онкологическим лекарственных методов лечения (химиотерапевтическое) № 17, ФГБУ «Национальный медицинский исследовательский центр онкологии имени Н. Н. Блохина» Минздрава России

Москва

Laktionov Konstantin K., DM Sci (habil.), professor at Dept of Oncology and Radiation Therapy of Therapeutical Faculty, Russian National Research Medical University n. a. N. I. Pirogov; head of Dept of Oncological Medicinal Methods of Treatment (Chemotherapeutic) No. 17, National Medical Research Centre of Oncology n. a. N. N. Blokhin

Moscow

lkoskos@mail.ruФГБУ «Национальный медицинский исследовательский центр онкологии имени Н. Н. Блохина» Минздрава РоссииРоссияNational Medical Research Centre of Oncology n. a. N. N. BlokhinRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии имени Н. Н. Блохина» Минздрава России; Кафедра онкологии и лучевой терапии лечебного факультета ФГАОУ 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 Federation202226072022013Диагностика и онкотерапия (2)1821Copyright © Юдин Д.И., Лактионов К.К., 20222022Юдин Д.И., Лактионов К.К.Yudin D.I., Laktionov K.K.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/2698

В настоящее время наблюдается значительное улучшение результатов лечения пациентов с диагнозом «рак легкого». Постоянно вносятся изменения в рекомендации по лечению, публикуются результаты успешных исследований, появляются новые схемы и препараты в клинической практике. Однако за пределами существующих рекомендаций остаются сложные случаи: пациенты в тяжелом состоянии, ECOG‑2, клинически быстро прогрессирующие, с выраженной тревогой, малым количеством опухолевого материала. Такие пациенты не включаются в клинические исследования и формально переносить на них современные стандартные решения неверно. В данном обзоре рассматриваются различные аспекты, связанные с выбором первой линии лечения у пациентов с метастатическим немелкоклеточным раком легкого в условиях нехватки времени для полноценного молекулярно-генетического исследования в реальной клинической практике. Рассматриваются варианты начала лечения с химиотерапии или иммунохимиотерапии ингибиторами контрольных точек, перехода на таргетную терапию или иммунотерапию по мере получения дополнительной информации.

Nowadays we can see a significant improvement and changes in the treatment of the patients with lung cancer. The current recommendations for the treatment are constantly being changed. New schemes and medicines are coming to the clinical practice. However, there are a group of patients outside of guidelines: patients with ECOG‑2 status, clinically rapidly progressing, with severe anxiety. Such patients are not including in clinical trials. Apparently, it is not quite right to transfer the current standard recommendations for the treatment to this group of patients. This review discusses various aspects related to the choice of a first line treatment in patients with metastatic non-small cell lung cancer in the situation of time absence and luck of molecular status of the patient. Is there a place for the starting with chemotherapy or immunochemotherapy, switching to targeted therapy or immunotherapy in the process of treatment.

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