medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-9-96-107medsovet-6252Research ArticleОБЗОРЫREVIEWSНиволумаб как представитель ингибиторов контрольных точек иммунного ответа в поздних линиях лечения при диссеминированном раке желудкаNivolumab as a representative of immune checkpoint inhibitors in late-line treatment for disseminated gastric cancerhttps://orcid.org/0000-0002-1693-0523БесоваН. С.BesovaN. S.

Бесова Наталия Сергеевна, кандидат медицинских наук, ведущий научный сотрудник онкологического отделения лекарственных методов лечения (химиотерапевтического) №2 Научно-исследовательского института клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова

115478, Москва, Каширское шоссе, д. 24

Natalia S. Besova, Cand. Sci. (Med.), Leading Researcher of the Oncological Department of Medicinal Methods of Treatment (Chemotherapeutic) No. 2, Trapeznikov Scientific Research Institute of Clinical Oncology

24, Kashirskoye Shosse, Moscow, 115478

besovans@mail.ruНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian Federation2021070820210996107Copyright © Бесова Н.С., 20212021Бесова Н.С.Besova N.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6252

Рак желудка (РЖ) является одной из наиболее распространенных злокачественных опухолей как в мире, так и в России. Основным методом лечения является лекарственная терапия с последовательным применением нескольких линий. Число химиопрепаратов, эффективных при данном виде злокачественных опухолей, ограничено, спектр таргетных препаратов также узок и включает трастузумаб в 1-й линии лечения HER2-позитивного РЖ и рамуцирумаб – во 2-й линии. Ингибиторы контрольных точек иммунного ответа произвели революцию в лечении многих злокачественных опухолей. При диссеминированном РЖ доказана эффективность ингибитора рецепторов PD-1, расположенных на T-лимфоцитах, – ниволумаба – в 3-й линии лечения. Согласно результатам рандомизированного исследования ATTRACTION-2, ниволумаб по сравнению с оптимальной симптоматической терапией значимо увеличил медиану общей выживаемости (с 4,14 до 5,26 мес., p < 0,0001), выживаемости без прогрессирования (с 1,45 до 1,61 мес., p < 0,0001); объективный ответ с медианой длительности 9,5 мес. был достигнут у 11,2% пациентов, стабилизация болезни – у 29,1%. Медиана времени до ответа на терапию ниволумабом составила 1,61 мес. Токсичность лечения была довольно низкой и привела к прекращению лечения только у 1% (n = 4) больных, ранее получивших массивную химиотерапию. В исследовании ATTRACTION-2 принимали участие только пациенты из стран Азии. Однако его результаты были подтверждены в исследовании CheckMate-032 на неазиатской популяции больных: частота объективного ответа составила 12%, медиана длительности ответа – 7,1 мес., медиана выживаемости без прогрессирования – 1,4 мес., медиана общей выживаемости – 6,1 мес. Ниволумаб был эффективен при MSI-H и MSS, при PD-L1-позитивных и PD-L1-негативных опухолях. Ниволумаб является общепризнанным и хорошо переносимым стандартом терапии поздних линий при диссеминированном РЖ. Спектр показаний для его назначения в ближайшее время будет расширяться.

Gastric cancer (GC) is one of the most common malignant tumours both in Russia and in the world. The drug therapy with consistent use of several therapy lines is the main method for treatment. The number of chemotherapy drugs, which are effective for the treatment of this type of malignant tumours, is limited; the range of targeted drugs is also narrow and includes trastuzumab in the first-line regimen for the treatment of HER2-positive gastric cancer and ramucirumab in the second-line regimen. Immune checkpoint inhibitors made a revolution in the treatment of many cancers. The efficacy of nivolumab, T cell inhibitory receptor of PD-L1, has been proven in the third-line regimen in disseminated gastric cancer. The ATTRACTION-2 randomized study showed that nivolumab significantly increased the median overall survival (from 4.14 to 5.26 months, p < 0.0001), progression-free survival (from 1.45 to 1.61 months, p < 0.0001); objective response with a median duration of 9.5 months was achieved in 11.2% of patients, stable disease in 29.1%. The median time to progression was 1.61 months. The toxicity of the treatment was quite low and led to discontinuation of treatment in only 1% (n = 4) of patients, who had previously received massive chemotherapy. Only patients from Asia took part in the ATTRACTION-2 study. However, its results were confirmed in the CheckMate-032 study in the non-Asian patient population: the objective response rate was 12%, the median DOR was 7.1 months, the median progressionfree survival was 1.4 months, and the median overall survival was 6.1 months. Nivolumab was effective for the treatment of MSI-H and MSS, PD-L1-positive and PD-L1-negative tumours. Nivolumab is a recognized and well-tolerated standard of late-line therapy in disseminated gastric cancer. The range of indications for its prescription will be expanded in the nearest future.

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