medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-27-28-35medalphabet-3409Research ArticleСтатьиРоль овариальной супрессии в адъювантной терапии рака молочной железыRole of ovarian suppression in adjuvant treatment of breast cancerhttps://orcid.org/0000-0002-1016-2009РубанМ. С.RubanM. S.

Рубан Максим Сергеевич, врач-ординатор отделения химиотерапии отдела лекарственного лечения опухолей,

Author ID: 1170985

Москва

Ruban Maksim S., resident physician at Dept of Chemotherapy, Systemic Treatment of Solid Tumors Department,

Author ID: 1170985,

Moscow.

ruban.m.s@yandex.ruhttps://orcid.org/0000-0003-3196-1368КарагодинаЮ. Б.KaragodinaYu. B.

Карагодина Юлия Борисовна, н.с. отдела лекарственного лечения опухолей,

AuthorID: 1170902

Москва.

Karagodina Yulia B., researcher at Systemic Treatment of Solid Tumors Dept.,

AuthorID: 1170902,

Moscow.

yuliaborisovnakaragodina@gmail.comhttps://orcid.org/0000-0003-4879-2687БолотинаЛ. В.BolotinaL. V.

Болотина Лариса Владимировна, д.м.н., зав. отделением химиотерапии отдела лекарственного лечения опухолей,

AuthorID: 594953

Москва.

Bolotina Larisa V., DM Sci (habil.), head of Chemotherapy Unit of Systemic Treatment of Solid Tumors Dept.,

AuthorID: 594953,

Moscow.

https://orcid.org/0000-0001-5530-3234КачмазовА. А.KachmazovA. A.

Качмазов Андрей Александрович, м.н.с. отдела лекарственного лечения опухолей,

AuthorID: 1041704

Москва.

Kachmazov Andrei A., junior researcher at Systemic Treatment of Solid Tumors Dept.,

AuthorID: 1041704,

Moscow.

https://orcid.org/0000-0003-0092-0459КорниецкаяА. Л.KornietskayaA. L.

Корниецкая Анна Леонидовна, к.м.н., в.н.с. отдела лекарственного лечения опухолей,

AuthorID: 951395

Москва.

Kornietskaya Anna L., PhD Med, leading researcher at Systemic Treatment of Solid Tumors Dept.

AuthorID: 951395,

Moscow.

https://orcid.org/0000-0002-8721-8437СавчинаВ. В.SavchinaV. V.

Савчина Виктория Владимировна, н.с. отдела лекарственного лечения опухолей

Москва.

Savchina Viktoria V., researcher at Systemic Treatment of Solid Tumors Dept.,

Moscow.

https://orcid.org/0000-0002-1993-3842ЕвдокимоваС. Ф.EvdokimovaS. F.

Евдокимова Сэвиндж Физулиевна, врач-аспирант отделения химиотерапии отдела лекарственного лечения опухолей,

AuthorID: 1160316

Москва.

Evdokimova Sevindzh F., physician, postgraduate student of Unit of Chemotherapy of Systemic Treatment of Solid Tumors Dept.,

AuthorID: 1160316

https://orcid.org/0000-0003-4927-5585ФеденкоА. А.FedenkoA. A.

Феденко Александр Александрович, д.м.н., проф., рук. отдела лекарственного лечения опухолей,

AuthorID: 823233

Москва.

Fedenko Aleksandr A., DM Sci (habil.), professor, head of Systemic Treatment of Solid Tumors Dept.,

AuthorID: 823233,

Moscow.

Московский научно-исследовательский онкологический институт имени П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияMoscow Research Institute n.a. P.A. Herzen – a Branch of the National Medical Research Centre of RadiologyRussian Federation202304122023027Диагностика и онкотерапия (3)2835Copyright © Рубан М.С., Карагодина Ю.Б., Болотина Л.В., Качмазов А.А., Корниецкая А.Л., Савчина В.В., Евдокимова С.Ф., Феденко А.А., 20232023Рубан М.С., Карагодина Ю.Б., Болотина Л.В., Качмазов А.А., Корниецкая А.Л., Савчина В.В., Евдокимова С.Ф., Феденко А.А.Ruban M.S., Karagodina Y.B., Bolotina L.V., Kachmazov A.A., Kornietskaya A.L., Savchina V.V., Evdokimova S.F., Fedenko A.A.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/3409

Адъювантная эндокринная терапия является неотъемлемым компонентом лечения резектабельного люминального рака молочной железы. Стандартом в течение многих лет было назначение монотерапии тамоксифеном или ингибиторов ароматазы, однако недавние исследования показали, что добавление овариальной супрессии статистически значимо увеличивает показатели выживаемости у пациенток с высоким риском рецидива и с факторами неблагоприятного прогноза. В данном обзоре литературы мы проанализировали последние данные, касающиеся роли овариальной супрессии в адъювантной терапии гормон-положительного рака молочной железы. Подавление функции яичников является наиболее эффективным у молодых пациенток (до 35 лет) в пременопаузе при наличии факторов неблагоприятного прогноза (показания к [нео-]адъювантной ХТ, G3 и др.) Авторами было отмечено, что использование ингибиторов ароматазы вместо тамоксифена у данной подгруппы значимо снижало риск рецидива рака молочной железы. Овариальная супрессия, в особенности в комбинации с ингибиторами ароматазы, сопровождалась увеличением частоты нежелательных побочных явлений, в частности остеопороза и переломов костей, которая может быть снижена путем назначения адекватной сопроводительной терапии ОМА. Оптимальная продолжительность подавления функции яичников также не определена, однако, учитывая результаты крупных клинических исследований, проведение двухлетнего курса представляется оптимальным. В проведенных протоколах не было отмечено значимого влияния временной овариальной супрессии на вероятность последующей беременности.

Adjuvant endocrine therapy is an integral component of treatment for resectable luminal breast cancer. Tamoxifen or aromatase inhibitors monotherapy has been the standard of practice for many years. However, recent studies have shown that the addition of ovarian suppression statistically significantly increases survival rates in patients at high risk for recurrence and with poor prognosis factors. In this literature review, we summarized recent data regarding the role of ovarian suppression in adjuvant therapy for hormone-positive breast cancer. Suppression of ovarian function was most effective in young patients (< 35 years) in the premenopausal stage when adverse prognostic factors were present (indications for (neo)adjuvant CT, G3, etc.) The authors noted that using of aromatase inhibitors instead of tamoxifen in this subgroup significantly reduced the risk of breast cancer recurrence. Ovarian suppression, especially in combination with aromatase inhibitors, was accompanied by an increase in the incidence of adverse side effects, particularly osteoporosis and bone fractures, which can be reduced by prescribing adequate accompanying therapy with OMA. The optimal duration of ovarian function suppression has also not been determined, but a two-year course seems optimal, given the results of large clinical trials. In the protocols performed, there was no significant effect of temporary ovarian suppression on the likelihood of subsequent pregnancy.

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