medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-9-130-136medsovet-6258Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONКлиническое наблюдение достижения частичного эффекта на второй линии лекарственной терапии рамуцирумабом с FOLFIRI у 74-летнего пациента HER2-негативной аденокарциномой желудкаCase report of partial response on second line with Ramucirumab and FOLFIRI in treatment of 74 year old male with metastatic HER2-negative gastric adenocarcinomahttps://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.ruhttps://orcid.org/0000-0002-5039-6360ТитоваТ. А.TitovaT. A.

Титова Татьяна Александровна, кандидат медицинских наук, врач-онколог онкологического отделения лекарственных методов лечения (химиотерапевтического) №  1  Научно-исследовательского института клинической онкологии имени академика РАН и  РАМН Н.Н. Трапезникова

115478, Москва, Каширское шоссе, д. 24

Tatiana A. Titova, Cand. Sci. (Med.), Oncologist of the Oncology Department of Medicinal Methods of Treatment (Chemotherapy) No. 1, Trapeznikov Scientific Research Institute of Clinical Oncology

24, Kashirskoye Shosse, Moscow, 115478

tatiana.titovadoc@gmail.comhttps://orcid.org/0000-0001-7457-3889КалининА. Е.KalininA. E.

Калинин Алексей Евгеньевич, кандидат медицинских наук, старший научный сотрудник отделения хирургических методов лечения № 6 (абдоминальной онкологии) Научно-исследовательского института клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова

115478, Москва, Каширское шоссе, д. 24

Aleksey E. Kalinin, Cand. Sci. (Med.), Senior Researcher, Department of Surgical Treatment Methods No. 6 (Abdominal Oncology), Trapeznikov Scientific Research Institute of Clinical Oncology

24, Kashirskoye Shosse, Moscow, 115478

main2001@inbox.ruhttps://orcid.org/0000-0002-0884-561XШаленковВ. А.ShalenkovV. A.

Шаленков Василий Александрович, кандидат медицинских наук, врач-онколог отделения хирургических методов лечения №  6  (абдоминальной онкологии) Научно-исследовательского института клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова

115478, Москва, Каширское шоссе, д. 24

Vaslily A. Shalenkov, Dr. Sci. (Med.), Oncologist, Department of Surgical Treatment Methods No. 6 (Abdominal Oncology), Trapeznikov Scientific Research Institute of Clinical Oncology

24, Kashirskoye Shosse, Moscow, 115478

do71@yandex.ruhttps://orcid.org/0000-0002-0493-1166СтилидиИ. С.StilidiI. S.

Стилиди Иван Сократович, академик РАН, доктор медицинских наук, профессор, директор, Национальный медицинский исследовательский центр онкологии имени Н.Н. Блохина; заведующий кафедрой онкологии и лучевой терапии лечебного факультета, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова; профессор кафедры онкологии и паллиативной медицины хирургического факультета, Российская медицинская академия непрерывного профессионального образования

115478, Москва, Каширское шоссе, д. 24,

117997, Москва, ул. Островитянова, д. 1,

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Ivan S. Stilidi, Acad. RAS, Dr. Sci. (Med.), Professor, Director, Blokhin National Medical Research Center of Oncology; Head of the Department of Oncology and Radiation Therapy, Faculty of General Medicine, Pirogov Russian National Research Medical University; Professor of the Department of Oncology and Palliative Medicine of the Surgical Faculty, Russian Medical Academy of Continuous Professional Education

24, Kashirskoye Shosse, Moscow, 115478,

1, Ostrovityanov St., Moscow, 117997,

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

stylidi@yandex.ruНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationНациональный медицинский исследовательский центр онкологии имени Н.Н. Блохина; Российский национальный исследовательский медицинский университет имени Н.И. Пирогова; Российская медицинская академия непрерывного профессионального образованияРоссияBlokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical University; Russian Medical Academy of Continuous Professional EducationRussian Federation20210708202109130136Copyright © Бесова Н.С., Титова Т.А., Калинин А.Е., Шаленков В.А., Стилиди И.С., 20212021Бесова Н.С., Титова Т.А., Калинин А.Е., Шаленков В.А., Стилиди И.С.Besova N.S., Titova T.A., Kalinin A.E., Shalenkov V.A., Stilidi I.S.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/6258

По данным мировой статистики, рак желудка (РЖ) среди злокачественных новообразований занимает 5-е место по заболеваемости и 3-е – по смертности. Значительную часть больных составляют пациенты пожилого возраста, доля которых в реальной клинической практике может достигать 60%. Рамуцирумаб входит в число стандартов лекарственной терапии второй линии как в монотерапии, так и в комбинации с паклитакселом. Целесообразность назначения рамуцирумаба пациентам с диссеминированным РЖ пожилого возраста и его удовлетворительная переносимость показаны при подгрупповом анализе исследований REGARD и  RAINBOW. Применение паклитаксела, входящего в  стандартные режимы 1-й линии лечения, может быть ограничено персистирующей нейротоксичностью – побочным эффектом производных платины. В связи с этим в качестве терапии 2-й линии начато изучение эффективности комбинации рамуцирумаба с режимом FOLFIRI. В статье представлен клинический случай достижения частичного эффекта на 2-й линии лечения рамуцирумабом с режимом FOLFIRI у 74-летнего пациента HER2-негативной аденокарциномой желудка при регистрации бурного прогрессирования после 4 курсов химиотерапии 1-й линии в режиме XELOX. Переносимость 2-й линии была приемлемой: наблюдались астения 1-й ст., стоматит 1–2-й ст., нейтропения 3-й ст., в  связи с  чем доза иринотекана была редуцирована до  165  мг/м2. К  июню 2021  г. проведено 10 28-дневных циклов лечения, которое продолжается. Длительность контроля заболевания на 2-й линии лечения составила 11+ мес., из них 9+ мес. – на фоне лекарственной терапии в режиме FOLFIRI с рамуцирумабом.

According to the data of the world statistics, gastric cancer (GC) occupies the 5th place by morbidity and the 3rd one by mortality among malignant neoplasms. A significant proportion of patients are elderly patients, the proportion of which in real clinical practice can reach up to 60%. Ramucirumab is among the standards of second-line drug therapy both in monotherapy and in combination with paclitaxel. The feasibility of prescribing ramucirumab to patients with disseminated cancer of the elderly and its satisfactory tolerability is shown in a subgroup analysis of the REGARD and RAINBOW studies. The use of paclitaxel, included in the standard first-line regimens, may be limited by persistent neurotoxicity, a side effect of platinum derivatives. In this regard, the effectiveness of the combination of ramucirumab with the FOLFIRI regimen as a second-line therapy began to be studied. The article presents a clinical case of achieving a partial effect on the second-line therapy with ramucirumab with FOLFIRI regimen in a 74-year-old patient with HER2-negative gastric adenocarcinoma while registering rapid progression after 4 courses of first-line chemotherapy in XELOX regimen. Tolerability of the second line was acceptable: asthenia grade 1, stomatitis grade 1-2, neutropenia grade 3 were observed, so the irinotecan dose was reduced to 165 mg/m2. By June 2021, there were 10 28-day cycles of treatment, which is ongoing. The duration of disease control in the second line therapy was 11+ months, of which 9+ months – on the background of FOLFIRI regimen drug therapy with ramucirumab.

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