medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-17-7-14medalphabet-3833Research ArticleДИАГНОСТИКА И ОНКОТЕРАПИЯDIAGNOSTICS AND ONCOTHERAPY«Прометей» – выбор оптимальной терапии ЭР+HER2-метастатического РМЖ: общероссийский анализ предпочтений врачей (обновленные результаты исследования)The choice of optimal therapy for ER+ HER2-metastatic breast cancer (PROMETHEUS): all-Russian analysis of physicians’ preferences – updated survey resultshttps://orcid.org/0000-0003-4763-7992КоваленкоЕ. И.KovalenkoE. I.

Коваленко Елена Игоревна - к.м.н., с.н.с. отделения химиотерапии № 1.

 Москва

Kovalenko Elena I. - PhD Med, senior researcher at Dept of Chemotherapy No. 1

Moscow

eikovalenko@mail.ruhttps://orcid.org/0000-0001-7728-9533АртамоноваЕ. В.ArtamonovaE. V.

Артамонова Елена Владимировна - д.м.н., профессор; зав. отделением лекарственных методов лечения № 1; профессор кафедры онкологии и лучевой терапии; зав. кафедрой онкологии и торакальной хирургии

 Москва

 

Artamonova Elena V. - DM Sci (habil.), head of Dept of Antitumor Drug Therapy No.1 Dept of Drug Treatment; professor at Dept of Oncology and Radiation Therapy; head of Dept of Oncology and Thoracic Surgery

Moscow

artamonovae@mail.ruФГБУ «Национальный медицинский исследовательский центр онкологии имени Н.Н. Блохина» Минздрава РоссииРоссияN.N. Blokhin National Medical Investigation Centre of OncologyRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии имени Н.Н. Блохина»; Кафедра онкологии и лучевой терапии ФГАОУ ВО «Российский Национальный Исследовательский Медицинский Университет имени Н.И. Пирогова» Минздрава России; Кафедра онкологии и торакальной хирургии ФДО ГБУЗ Московской области «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»РоссияN.N. Blokhin National Medical Investigation Centre of Oncology; Dept of Oncology and Radiation Therapy at N.I. Pirogov Russian National Research Medical University; Dept of Oncology and Thoracic Surgery at M. F. Vladimirsky Moscow Regional Research Clinical InstituteRussian Federation202405092024017«Диагностика и онкотерапия» (2)714Copyright © Коваленко Е.И., Артамонова Е.В., 20242024Коваленко Е.И., Артамонова Е.В.Kovalenko E.I., 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/3833

Ингибиторы циклин-зависимых киназ 4/6 (иCDK4/6) являются общепризнанным стандартом лечения люминального HER2-негативного метастатического рака молочной железы (ЭР+HER2- мРМЖ). Данные рандомизированных и наблюдательных исследований доказали высокую эффективность комбинации иCDK4/6 с гормонотерапией (ГТ) как в 1-й, так и в последующих линиях. Интеграция новых препаратов в реальную клиническую практику определяется целым рядом факторов, включая информированность врачей, их личный опыт и субъективные предпочтения, а также финансовое обеспечение и доступность лекарства в конкретном регионе. Для оценки частоты назначения иCDK4/6, а также других видов лечения в 1–2-й линиях терапии ЭР+ HER2- мРМЖ в реальной клинической практике в России, а также определения факторов и предпочтений врачей, влияющих на их выбор, Национальным обществом онкомаммологов (НАОМ) был проведен опрос специалистов-онкологов «Прометей». На сайте anketolog.ru с 15 февраля по 30 августа 2023 года проводилось веб-анкетирование специалистов здравоохранения, которые занимаются лечением пациенток с мРМЖ. Приглашение к анкетированию разослали по базе данных НАОМ, получено и обработано 112 анкет. Ранее, в 2020 г., с такой же целью на территории Российской Федерации проводился подобный опрос. В данной работе мы представляем результаты обновленного и расширенного опроса и оцениваем изменения, произошедшие за последние 3 года в реальной клинической практике.

Результаты проведенного опроса 2023 года показали, что за последние 3 года среди практикующих врачей повысился уровень «доверия» к иCDK4/6, расширились показания к их применению, в том числе при висцеральных метастазах (и даже при угрожающем висцеральном кризе), сузились показания к назначению ХТ в 1-й линии. При прогрессировании заболевания на фоне моноГТ в 1-й линии большинство опрошенных назначают иCDK4/6 во 2-й. Очевидно, что более широкое применение иCDK4/6 связано не только с накоплением клинических знаний и опыта, но и с улучшением лекарственного обеспечения. Тем не менее по-прежнему основными ограничениями к назначению иCDK4/6 остаются недостаточное финансирование и организационные сложности. Необходимо отметить, что 1/5 часть опрошенных не сталкивается с какими-либо ограничениями и широко назначает комбинированную терапию

Cyclin-dependent kinase 4/6 inhibitors (iCDK4/6) are the generally accepted standard of care for the treatment of luminal HER2-negative metastatic breast cancer (ER+HER2- mBC). Data from randomized and observational studies have proven the high effectiveness of the combination of iCDK4/6 and endocrine therapy (ET) both in the 1st and in subsequent lines. The use of new drugs in real clinical practice is determined by a number of factors, including the awareness of doctors, their personal experience and subjective preferences, as well as financial support and availability in a particular region. To assess the frequency of prescription of CDK4/6, as well as other types of treatment in the 1st‑2nd line of therapy for ER+ HER2- mBC in real clinical practice in Russia, as well as to determine the factors and preferences of doctors influencing their choice, the National Association of Oncomammologists (NAOM) conducted a survey “Prometheus” of oncology specialists. From February 15 to August 30, 2023, a web survey of healthcare professionals who treat patients with mBC was conducted on the website anketolog.ru. An invitation to survey was sent out through the NAOM database, 112 questionnaires were received and processed. Earlier, in 2020, the “Prometheus” survey was conducted on the territory of the Russian Federation for a similar purpose. In this paper, we present the results of an updated and expanded survey and evaluate changes that have occurred over the past 3 years in actual clinical practice. The results of a 2023 survey conducted in the Russian Federation on the choice of early-line therapy for ER+HER2- mBC showed that, compared with the 2020 survey, the level of “trust” in iCDK4/6 has increased among practicing physicians, and the indications for their use have expanded, including visceral metastases (and even pending visceral crisis), the indications for prescribing chemotherapy in the 1st line have narrowed. When using monoET in the 1st line, the majority of respondents prescribe iCDK4/6 in the 2nd line. Obviously, the wider use of iCDK4/6 is associated not only with the accumulation of clinical knowledge and experience in the use of drugs, but also with improved drug supply. However, the main limitations to the use of iCDK4/6 are still insufficient funding and organizational difficulties. However, it should be noted that 1/5 of the respondents do not face any restrictions and widely prescribe combination therapy.

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