medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-20-32-38medsovet-5932Research ArticleТАРГЕТНАЯ ТЕРАПИЯ ОПУХОЛЕЙTarget therapy of tumorsЭффективность и переносимость абемациклиба у пожилых больныхEfficiency and tolerability of abemaciclib in elderly patientshttps://orcid.org/0000-0003-4763-7992КоваленкоЕ. И.KovalenkoE. I.

Коваленко Елена Игоревна, кандидат медицинских наук, старший научный сотрудник отделения химиотерапии №1

115478, Россия, Москва, Каширское шоссе, д. 24

Elena I. Kovalenko, Cand. of Sci. (Med.), Senior Researcher of the Department of Chemotherapy No. 1

24, Kashirskoye Shosse, Moscow, 115478, Russia

eikovalenko@mail.ruhttps://orcid.org/0000-0002-3770-5173ХорошиловМ. В.KhoroshilovM. V.

Хорошилов Максим Викторович, аспирант отделения химиотерапии №1

115478, Россия, Москва, Каширское шоссе, д. 24

Maxim V. Khoroshilov, Postgraduate Student of the Department of Chemotherapy No. 1

24, Kashirskoye Shosse, Moscow, 115478, Russia

fair815@mail.ruhttps://orcid.org/0000-0001-7728-9533АртамоноваЕ. В.ArtamonovaE. V.

Артамонова Елена Владимировна, доктор медицинских наук, профессор, заведующая отделением химиотерапии №1, Национальный медицинский исследовательский центр онкологии имени Н.Н. Блохина; кафедра онкологии, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова

115478, Россия, Москва, Каширское шоссе, д. 24; 117997, Россия, Москва, ул. Островитянова, д. 1

Elena V. Artamonova, Dr. of Sci. (Med.), Professor, Head of the Department of Chemotherapy No. 1, Blokhin National Medical Research Center of Oncology; Department of Oncology, Pirogov Russian National Research Medical University

24, Kashirskoye Shosse, Moscow, 115478, Russia; 1, Ostrovityanov St., Moscow, 117997, Russia

Национальный медицинский исследовательский центр онкологии им. Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationНациональный медицинский исследовательский центр онкологии им. Н.Н. Блохина; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияBlokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical UniversityRussian Federation2020181220200203238Copyright © Коваленко Е.И., Хорошилов М.В., Артамонова Е.В., 20202020Коваленко Е.И., Хорошилов М.В., Артамонова Е.В.Kovalenko E.I., Khoroshilov M.V., 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-sovet.pro/jour/article/view/5932

Пожилые онкологические пациенты представляют собой гетерогенную популяцию не только по хронологическому возрасту, но и по функциональному статусу, сопутствующим заболеваниям и терапии, гериатрическим синдромам и, как следствие, по переносимости онкологического лечения. Выбор лечения метастатического рака молочной железы (мРМЖ) у этой категории пациентов зачастую является сложной задачей для онкологов. Появление нового класса препаратов – ингибиторов циклинзависимых киназ 4/6 (CDK4/6) – изменило парадигму лечения пациентов с люминальным HER2-негативным мРМЖ (ЭР+ HER2мРМЖ), однако данные по эффективности и переносимости этих препаратов у пожилых больных ограниченны. Как показали объединенные подгрупповые анализы исследований с CDK4/6, пожилые пациентки с ЭР+ HER2РМЖ имеют несомненный выигрыш в ВБП от добавления таргетных препаратов к гормонотерапии. Нежелательные явления наблюдаются чаще на комбинированной терапии с увеличением возраста, что требует модификации доз и соответствующей терапии. В этом плане весьма привлекателен препарат абемациклиб, характеризующийся более низкой по сравнению с другими CDK4/6ингибиторами частотой нейтропении, но более высокой диареей, которая может контролироваться приемом соответствующих препаратов и не является поводом для полной отмены лечения. Безусловно, при принятии решения о назначении любой терапии пожилым онкологическим пациентам необходим их тщательный отбор. Только комплексный мультидисциплинарный подход позволит максимально индивидуализировать лечение этой непростой категории пациентов и минимизировать вероятность получения ими избыточного или недостаточного онкологического лечения.

Elderly cancer patients represent a very heterogeneous population not only in chronological age, but also in functional status, concomitant diseases and therapy, geriatric syndromes, and, as a consequence, in the tolerability of cancer treatment. The choice of treatment for metastatic breast cancer (mBC) in this category of patients is often a difficult task for oncologists. The emergence of a new class of drugs, inhibitors of cyclin-dependent kinases 4/6 (CDK4/6), has changed the paradigm of treatment of patients with luminal HER2 negative mBC (ER + HER2mBC); however, data on the efficacy and tolerability of these drugs in elderly patients are limited. Pooled subgroup analyzes of studies with CDK4/6 have shown that elderly patients with ER + HER2breast cancer have a clear PFS benefit from the addition of targeted drugs to hormonal therapy. Adverse events are observed more often in combination therapy with increasing age, which requires dose modification and appropriate therapy. In this regard, the drug abemaciclib is very attractive, which is characterized by a lower frequency of neutropenia compared to other CDK4/6 inhibitors, but a higher incidence of diarrhea, which can be controlled by taking appropriate drugs and is not a reason for treatment discontinuation. Careful selection of patients is necessary when deciding on the appointment of any therapy to geriatric cancer patients. Only a comprehensive multidisciplinary approach will make it possible to maximally individualize the approach to the treatment of this difficult category of patients and minimize the likelihood that they will receive excessive or insufficient oncological treatment.

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