medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-20-194-198medsovet-5956Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONКлинический случай применения осимертиниба у пациентки с диссеминированным немелкоклеточным раком легкого с мутацией гена EGFR в первой линии терапииClinical case of use of osimertinib in a patient with disseminated EGFR-mutated non-small cell lung cancer in the first-line therapyhttps://orcid.org/0000-0002-7817-8429СаранцеваК. А.SarantsevaK. A.

Саранцева Ксения Андреевна, кандидат медицинских наук, врач-онколог

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

Ksenia A. Sarantseva, Cand. of Sci. (Med.), Oncologist

24, Kashirskoye Shosse, Moscow, 115478, Russia

sarantsevaka@gmail.comhttps://orcid.org/0000-0003-4469-502XЛактионовК. К.LaktionovK. K.

Лактионов Константин Константинович, доктор медицинских наук, профессор, заведующий онкологическим отделением лекарственных методов лечения (химиотерапевтическое) №17

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

Konstantin K. Laktionov, Dr. of Sci. (Med.), Professor, Head of Drug Therapy (Chemotherapeutic) Department No.17

24, Kashirskoye Shosse, Moscow, 115478, Russia

lkoskos@mail.ruhttps://orcid.org/0000-0002-2154-3376РеутоваЕ. В.ReutovaE. V.

Реутова Елена Валерьевна, кандидат медицинских наук, старший научный сотрудник

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

Elena V. Reutova, Cand. of Sci. (Med.), Senior Researcher

24, Kashirskoye Shosse, Moscow, 115478, Russia

evreutova@rambler.ruhttps://orcid.org/0000-0002-0620-2696ЮдинД. И.YudinD. I.

Юдин Денис Иванович, кандидат медицинских наук, старший научный сотрудник

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

Denis I. Yudin, Cand. of Sci. (Med.), Senior Researcher

24, Kashirskoye Shosse, Moscow, 115478, Russia

yudinden@mail.ruhttps://orcid.org/0000-0002-6244-4294БредерВ. В.BrederV. V.

Бредер Валерий Владимирович, доктор медицинских наук, ведущий научный сотрудник

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

Valeriy V. Breder, Dr. of Sci. (Med.), Lead Researcher

24, Kashirskoye Shosse, Moscow, 115478, Russia

vbreder@yandex.ruНациональный медицинский онкологический центр им. Н.Н. БлохинаРоссияBlokhin Russian Cancer Research CenterRussian Federation202021122020020194198Copyright © Саранцева К.А., Лактионов К.К., Реутова Е.В., Юдин Д.И., Бредер В.В., 20202020Саранцева К.А., Лактионов К.К., Реутова Е.В., Юдин Д.И., Бредер В.В.Sarantseva K.A., Laktionov K.K., Reutova E.V., Yudin D.I., Breder V.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/5956

Осимертиниб был первым ингибитором тирозинкиназы (TKI) рецептора эпидермального фактора роста третьего поколения (EGFR), получившим одобрение для лечения пациентов с метастатическим EGFR-мутированным немелкоклеточным раком легкого (НМРЛ), а также пациентов с мутацией резистентности T790M. Метастатическое поражение центральной нервной системы (ЦНС) является частым осложнением у пациентов с мутацией гена EGFR и одним из неблагоприятных факторов прогноза, существенно ограничивающим возможности терапии. Почти у 25% пациентов на момент постановки диагноза обнаруживается метастатическое поражение ЦНС. Лечение метастазов в ЦНС требует мультидисциплинарного подхода, но оптимальная последовательность этапов терапии пока не определена и в каждом конкретном случае подбирается индивидуально. Многие системные методы лечения имеют низкую эффективность в отношении ЦНС из-за проблем с преодолением гематоэнцефалического барьера (ГЭБ), что заставляет исследователей искать новые агенты, способные решить эту проблему. В целом ряде клинических исследований осимертиниб продемонстрировал высокую способность проникновения через ГЭБ и высокую концентрацию в спинномозговой жидкости. Совокупность этих факторов позволяет не только достигнуть клинического контроля над уже развившимися метастазами в головной мозг, но и предотвратить появление новых. Это является еще одним серьезным аргументом в пользу назначения осимертиниба в качестве первой линии лечения.

Osimertinib is a third-generation tyrosine kinase inhibitor (TKI) of the epidermal growth factor receptor (EGFR) that has been approved for the treatment of metastatic non-small cell lung cancer (NSCLC) positive for the secondary T790M mutation of EGFR. Central nervous system (CNS) metastases are a common complication in patients with epidermal growth factor receptor (EGFR)‐mutated non‐small cell lung cancer (NSCLC), resulting in a poor prognosis and limited treatment options. Almost 25% of patients present with accompanying central nervous system (CNS) metastases at the first diagnosis. Treatment of CNS metastases requires a multidisciplinary approach, and the optimal treatment options and sequence of therapies are yet to be established. Many systemic therapies have poor efficacy in the CNS due to the challenges of crossing the blood‐brain barrier (BBB), creating a major unmet need for the development of agents with good BBB‐penetrating biopharmaceutical properties. Although the CNS penetration of first‐ and second‐generation EGFR tyrosine kinase inhibitors (TKIs) is generally low, EGFR‐TKI treatment has been shown to delay time to CNS progression in patients with both in preventing or delaying the onset of CNS metastases, and in leading to intracranial response of preexisting CNS lesions. This is one of the arguments in favor of starting osimertinib upfront rather than initiating treatment with firstor second-generation EGFR-TKIs.

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