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Современная стратегия лечения метастатического колоректального рака – ключ к увеличению продолжительности жизни пациентов с метастатическим колоректальным раком без мутаций в генах RAS
Аннотация
Обзор посвящен месту цетуксимаба в лечении метастатического колоректального рака (мКРР) без мутаций в генах RAS (RAS wt) и BRAF (BRAF wt) в зависимости от целей терапии, а также анализу влияния различных факторов, включая локализацию первичной опухоли, на эффективность лечения. Рандомизированные клинические исследования и проведенные на их основе метаанализы позволяют сделать вывод о том, что цетуксимаб в комбинации с инфузионным дуплетом или триплетом обеспечивает максимальную частоту глубоких и ранних объективных ответов независимо от локализации первичной опухоли. Препарат превосходит по этому показателю как одну химиотерапию (ХТ), так и комбинацию ХТ с бевацизумабом, что важно в плане достижения резектабельности у пациентов с потенциально резектабельными метастазами. Для пациентов с левосторонней локализацией первичной опухоли и RAS wt цетуксимаб, назначенный в первой линии, обеспечивает достоверное и клинически значимое увеличение продолжительности жизни. Отсрочка начала его применения до 2–4-го цикла ХТ (до получения результата молекулярно-генетического исследования) не оказывает негативного влияния на эффективность первой линии терапии мКРР RAS wt, а при левосторонней локализации первичной опухоли ХТ с отсроченным цетуксимабом превосходит немедленное назначение ХТ с бевацизумабом по ЧОО, ОВ и ВБП. Оптимальная продолжительность индукционной химио-таргетной терапии составляет 3–4 месяца (6–8 курсов), после чего целесообразно переходить на поддерживающее лечение одним цетуксимабом. Новый режим введения цетуксимаба раз в 2 недели в дозировке 500 мг/м2 внутривенной инфузии обеспечивает максимальное удобство его применения.
Об авторе
Е. В. Артамонова
ФГБУ «Национальный медицинский исследовательский центр онкологии имени Н. Н. Блохина» Минздрава России; ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России
Россия
Россия
Артамонова Елена Владимировна, д. м. н., зав. онкологическим отделением лекарственных методов лечения (химиотерапевтическим № 1) , проф. кафедры онкологии и лучевой терапии лечебного факультета
SPIN: 2483–6309. Author ID: 707707
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Рецензия
Для цитирования:
Артамонова Е.В. Современная стратегия лечения метастатического колоректального рака – ключ к увеличению продолжительности жизни пациентов с метастатическим колоректальным раком без мутаций в генах RAS. Медицинский алфавит. 2021;(19):54-63. https://doi.org/10.33667/2078-5631-2021-19-54-63
For citation:
Artamonova E.V. Modern strategy for treatment of metastatic colorectal cancer as key to increasing life expectancy of patients with metastatic colorectal cancer without mutations in RAS genes. Medical alphabet. 2021;(19):54-63. (In Russ.) https://doi.org/10.33667/2078-5631-2021-19-54-63
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