medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-32-40-45medalphabet-4109Research ArticleСтатьиСовременные подходы к неоадъювантной лекарственной терапии первично операбельного HER2-положительного рака молочной железыCurrent approaches to neoadjuvant drug therapy for primary operable HER2-positive breast cancerhttps://orcid.org/0000-0002-1016-2009РубанМ. С.RubanM. S.

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

Author ID: 1170985 

Москва 

Ruban Maxim S., physician-postgraduate student at Dept of Chemotherapy, Systemic Treatment of Solid Tumors Dept

Author ID: 1170985 

Moscow 

ruban.m.s@yandex.ruhttps://orcid.org/0000-0003-4879-2687БолотинаЛ. В.BolotinaL. V.

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

AuthorID: 594953

Москва 

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

AuthorID: 594953 

Moscow 

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

Карагодина Юлия Борисовна, научный сотрудник отдела лекарственного лечения опухолей 

AuthorID: 1170902 

Москва 

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

AuthorID: 1170902 

Moscow 

yuliaborisovnakaragodina@gmail.comМосковский научно-исследовательский онкологический институт им. 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 Federation202421012025032Диагностика и онкотерапия (4)4045Copyright © Рубан М.С., Болотина Л.В., Карагодина Ю.Б., 20252025Рубан М.С., Болотина Л.В., Карагодина Ю.Б.Ruban M.S., Bolotina L.V., Karagodina Y.B.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/4109

Рак молочной железы в настоящее время занимает первое место в структуре онкологической заболеваемости женского населения во всем мире. Примерно у 15–20 % больных РМЖ наблюдается гиперэкспрессия и/или амплификация рецептора эпидермального фактора роста человека 2 типа (HER2), что обуславливает агрессивное биологическое поведение опухоли и сопряжено с плохим прогнозом. Направленные на HER2 таргетные препараты значительно улучшили прогноз пациентов с HER2-позитивным раком молочной железы. Начиная с самых ранних стадий (T2 и/или N+) пациентам необходимо проведение неоадъювантной лекарственной терапии, которая позволяет непосредственно оценить эффективность лечения, повышает шансы выполнения органосохраняющей операции, а также помогает адаптировать постнеоадъювантную терапию. Схемы химиотерапии на основе антрациклинов исторически были первым вариантом лечения HER2-позитивного РМЖ, поскольку статус HER2 является предиктором эффективности антрациклинов. Однако разработка новых агентов и, как результат, появление новых комбинаций с несколькими анти-HER2-агентами предоставили возможность изучения безантрациклиновых схем, направленных на уменьшение нежелательных явлений и улучшение качества жизни пациентов. Результаты исследования BCIRG-006 по изучению адъювантного применения таких режимов и, позднее, неоадъювантного назначения в протоколе TRAIN-2 ознаменовали поворотный момент в использовании безантрациклиновых схем. Одним из важных открытых вопросов является целесообразность добавления карбоплатина, так как прямые сравнения неантрациклиновых комбинаций с карбоплатином или без него отсутствуют. В настоящее время имеются убедительные доказательства влияния достижения полного патоморфологического ответа (pCR) после неоадъювантного этапа лечения на долгосрочные онкологические результаты. Крайне перспективными являются разработка и валидизация возможных биомаркеров, прогнозирующих достижение pCR.

Breast cancer currently occupies the first place in the structure of cancer morbidity in the female population worldwide. Approximately 15–20% of breast cancer patients have overexpression and/or amplification of human epidermal growth factor receptor type 2 (HER2), which causes aggressive biological behavior of the tumor and is associated with poor prognosis. Anti-HER2 therapies have significantly improved the prognosis of patients with HER2-positive breast cancer. Starting from the earliest stages (T2 and/or N+), patients should be treated with neoadjuvant drug therapy, which allows direct assessment of treatment efficacy, increases the chances of organ-preserving surgery, and helps to tailor postneoadjuvant therapy. Anthracycline-based chemotherapy regimens have historically been the first treatment option for HER2-positive breast cancer, as HER2 status is a predictor of anthracycline efficacy. However, the development of new agents and the resulting emergence of novel combinations with multiple anti-HER2 agents have provided an opportunity to explore anthracycline-free regimens aimed at reducing adverse events and improving patient quality of life. The results of the BCIRG-006 trial investigating the adjuvant use of such regimens and, later, neoadjuvant assignment in the TRAIN-2 protocol marked a turning point in the use of non-anthracycline regimens. One important open question is the appropriateness of adding carboplatin, as direct comparisons of non-anthracycline combinations with or without carboplatin are lacking. There is now strong evidence of the impact of achieving a complete pathomorphological response (pCR) after the neoadjuvant phase of treatment on long-term oncologic outcomes. The development and validation of possible biomarkers that predict achievement of pCR is extremely promising.

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