medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-10-27-32medsovet-2529Research ArticleТАРГЕТНАЯ ТЕРАПИЯ ОПУХОЛЕЙTarget therapy of tumorsК вопросу о лечении больных гепатоцеллюлярным раком промежуточной стадии – BCLC-B: когда нужно начинать системную терапиюBCLC-B hepatocellular carcinoma treatment or when should the systemic therapy be startedБредерВ. В.BrederV. V.

Доктор медицинских наук

Москва

ПиткевичМ. Ю.PitkevichM. U.ВиршкеЭ. Р.VirshkeE. R.

Доктор медицинских наук

Москва

КостяковаЛ. А.KostyakovaL. A.

Кандидат медицинских наук

Москва

ДжанянИ. А.DzhanyanI. A.ЛактионовК. К.LaktionovK. K.

Доктор медицинских наук, профессор

Москва

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава РоссииРоссияN.N.Blokhin National Medical Research Cancer Centre of Oncology, Federal State Budgetary Institution of the Ministry of Health of RussiaRussian Federation2018170720180102732Copyright © Бредер В.В., Питкевич М.Ю., Виршке Э.Р., Костякова Л.А., Джанян И.А., Лактионов К.К., 20182018Бредер В.В., Питкевич М.Ю., Виршке Э.Р., Костякова Л.А., Джанян И.А., Лактионов К.К.Breder V.V., Pitkevich M.U., Virshke E.R., Kostyakova L.A., Dzhanyan I.A., 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-sovet.pro/jour/article/view/2529

Выбор оптимального алгоритма лечения гепатоцеллюлярного рака промежуточной стадии по классификации BCLC – актуальная проблема современной клинической онкологии. BCLC рекомендует в первую очередь трансартериальную химиоэмболизацию (ТАХЭ) как метод лечения, обладающий хорошей непосредственной эффективностью и достоверно увеличивающий выживаемость. В связи с клинической гетерогенностью промежуточной стадии ТАХЭ не всегда применима и эффективна. В статье рассмотрены различные подходы к выбору терапии у больных ГЦР стадии BCLC-B, прогностические факторы и критерии рефрактерности ТАХЭ, результаты собственного опыта лечения ГЦР промежуточной стадии. Обсуждается необходимость своевременного начала системной терапии сорафенибом при BCLC-B в качестве самостоятельного метода лечения и при прогрессировании ГЦР после ТАХЭ. Рассматриваются практические аспекты лекарственной терапии регорафенибом во второй линии лечения.

Choice of the optimal therapy for BCLC-B hepatocellular carcinoma (HCC) is a significant clinical problem. Transarterial chemoembolisation (TACE) is considered to be the method of choice as this approach is reported to produce a direct effect and to have a significant survival rate. However, TACE is not always applicable and produce a survival benefit due to the clinical heterogeneity of BCLC-B HCC. The article includes different approaches for BCLC-B HCC patients, TACE prediction and refractory criteria as well as the results obtained. The necessity of timely sorafenib systemic therapy in BCLC-B and in advanced HCC after TACE is discussed. Practical application of regorafenib as the second line in HCC systemic treatment is discussed.

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