medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-20-47-52medsovet-6579Research ArticleТАРГЕТНАЯ ТЕРАПИЯ ОПУХОЛЕЙTarget therapy of tumorsТретья линия терапии рефрактерного метастатического колоректального рака: оптимальное решение (по материалам клинических исследований CORRECT и CONCUR)Optimal solutions in the third line therapy for refractory metastatic colorectal cancer. CORRECTness and CONCURencyhttps://orcid.org/0000-0002-6769-7194АюповР. Т.AyupovR. T.

к.м.н., заместитель главного врача по медицинской части, 

450054, Республика Башкоторстан, Уфа, проспект Октября, д. 73/1

Cand. Sci. (Med.), Deputy Chief Physician for Medical Affairs,

73/1, Oktyabrya Ave., Ufa, Republic of Bashkortostan, 450054

ru2003@bk.ruhttps://orcid.org/0000-0002-8461-9243ИзмайловА. А.IzmailovA. A.

д.м.н., главный врач, 450054, Республика Башкоторстан, Уфа, проспект Октября, д. 73/1; 

профессор кафедры урологии, 450008, Республика Башкоторстан, Уфа, ул. Ленина, д. 3

Dr. Sci. (Med.), Chief Medical Officer, 73/1, Oktyabrya Ave., Ufa, Republic of Bashkortostan, 450054;

Professor of the Department of Urology, 3, Lenin St., Ufa, Republic of Bashkortostan, 450000

UFA.RKOD@doctorrb.ruhttps://orcid.org/0000-0003-3734-2779МеньшиковК. В.MenshikovK. V.

 к.м.н., врач-онколог, отдел химиотерапии, 450054, Республика Башкоторстан, Уфа, проспект Октября, д. 73/1; 

доцент кафедры онкологии с курсами онкологии и патологической анатомии, 450008, Республика Башкоторстан, Уфа, ул. Ленина, д. 3

Cand. Sci. (Med.), Oncologist at the Chemotherapy Department, 73/1, Oktyabrya Ave., Ufa, Republic of Bashkortostan, 450054;

Associate Professor of the Department of Oncology with Oncology and Pathology Courses, 3, Lenin St., Ufa, Republic of Bashkortostan, 450000

kmenshikov80@bk.ruhttps://orcid.org/0000-0003-0996-5995СултанбаевА. В.SultanbaevA. V.

к.м.н., заведующий отделением противоопухолевой лекарственной терапии, 

450054, Республика Башкоторстан, Уфа, проспект Октября, д. 73/1

Cand. Sci. (Med.), Head of the Department of Anticancer Drug Therapy, 

73/1, Oktyabrya Ave., Ufa, Republic of Bashkortostan, 450054

rkodrb@yandex.ruhttps://orcid.org/0000-0001-8340-7962НасретдиновА. Ф.NasretdinovA. F.

врач-онколог, заведующий отделением противоопухолевой лекарственной терапии, 

450054, Республика Башкоторстан, Уфа, проспект Октября, д. 73/1

Oncologist, Head of the Department of Anticancer Drug Therapy, 

73/1, Oktyabrya Ave., Ufa, Republic of Bashkortostan, 450054

rkodrb@yandex.ruhttps://orcid.org/0000-0002-2488-597XРахимовР. Р.RakhimovR. R.

к.м.н., врач-онколог отдела противоопухолевой лекарственной терапии, 

450054, Республика Башкоторстан, Уфа, проспект Октября, д. 73/1

Cand. Sci. (Med.), Oncologist, Department of Anticancer Drug Therapy, 

73/1, Oktyabrya Ave., Ufa, Republic of Bashkortostan, 450054

radmir-rr@mail.ruhttps://orcid.org/0000-0003-1185-977XМусинШ. И.MusinSh. I.

к.м.н., заведующий хирургическим отделением №6, 450054, Республика Башкоторстан, Уфа, проспект Октября, д. 73/1;

доцент кафедры онкологии с курсами онкологии и патологической анатомии, 450008, Республика Башкоторстан, Уфа, ул. Ленина, д. 3

Cand. Sci. (Med.), Head of the Surgery Department No.6, 73/1, Oktyabrya Ave., Ufa, Republic of Bashkortostan, 450054;

Associate Professor of the Department of Oncology with courses oncology and pathological anatomy, 3, Lenin St., Ufa, Republic of Bashkortostan, 450000

musin_shamil@mail.ruhttps://orcid.org/0000-0001-5926-0446СултанбаеваН. И.SultanbaevaN. I.

врач-онколог, отделениe противоопухолевой лекарственной терапии №1, 

450054, Республика Башкоторстан, Уфа, проспект Октября, д. 73/1

Oncologist, Department of  Anticancer Drug Therapy No.1, 

73/1, Oktyabrya Ave., Ufa, Republic of Bashkortostan, 450054

nd.sultan@rambler.ruРеспубликанский клинический онкологический диспансерРоссияRepublican Clinical Oncology DispensaryRussian FederationРеспубликанский клинический онкологический диспансер; Башкирский государственный медицинский университетРоссияRepublican Clinical Oncology Dispensary; Bashkir State Medical UniversityRussian FederationРеспубликанский клинический онкологический диспансер Башкирский государственный медицинский университетРоссияRepublican Clinical Oncology Dispensary; Bashkir State Medical UniversityRussian Federation2021091220210204752Copyright © Аюпов Р.Т., Измайлов А.А., Меньшиков К.В., Султанбаев А.В., Насретдинов А.Ф., Рахимов Р.Р., Мусин Ш.И., Султанбаева Н.И., 20212021Аюпов Р.Т., Измайлов А.А., Меньшиков К.В., Султанбаев А.В., Насретдинов А.Ф., Рахимов Р.Р., Мусин Ш.И., Султанбаева Н.И.Ayupov R.T., Izmailov A.A., Menshikov K.V., Sultanbaev A.V., Nasretdinov A.F., Rakhimov R.R., Musin S.I., Sultanbaeva N.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6579

Терапия рака толстой кишки в настоящее время насчитывает как минимум 3 цитостатических агента и 6 таргетных препаратов, комбинации которых составляют множество различных схем лечения. Тем не менее, как показывают клинические исследования, основным остается применение оксалиплатин-, иринотекан- и фторпиримидин-содержащих режимов совместно с моноклональными таргетными препаратами. После прогрессирования на основных линиях терапии и регистрации рефрактерного заболевания остается не так много стандартных опций, имеющих статистическую достоверность в плане улучшения показателей выживаемости, для 3-й линии лечения. Были сделаны попытки поиска генетических аббераций для таргетной терапии, предикторов эффективности иммунотерапии, применения режимов re-introduction (повторное применение схемы, которую пациент прекратил принимать из-за явлений непереносимости) и re-challenge (применение предыдущих схем, на которые сначала был зарегистрирован противоопухолевый ответ, а только затем развилось прогрессирование), а изобилие решений могло ограничиваться лишь воображением исследователя. Однако с появлением нового мультикиназного ингибитора регорафениба рекомендации по лечению претерпели изменения. Препарат получил показание для применения в 3-й линии терапии рефрактерного колоректального рака. Проведен обзор существующих вариантов таргетной терапии и анализ исследований разных режимов в 3-й линии терапии в сравнении с регорафенибом. Установлено, что регорафениб в настоящее время является оптимальной опцией в  3-й линии терапии метастатического колоректального рака, независимо от  предшествующих линий и мутационного статуса, и имеет удовлетворительный спектр побочных явлений, многие из которых могут служить предикторами эффективности терапии. 

Colon cancer therapy currently includes at least 3 cytostatic agents and 6 targeted drugs, combinations of which constitute many different treatment regimens. Nevertheless, as shown by various clinical studies, the use of oxaliplatin, irinotecan and fluoropyrimidine regimens in conjunction with monoclonal targeted drugs remains the main one. After progression on the main lines of therapy and registration of refractory disease, there are not many standard options for treatment in the 3rd line that have statistical confidence in terms of improving survival rates. There have been attempts to search for genetic aberrations for targeted therapy, predictors of the effectiveness of immunotherapy, the use of re-introduction regimens (re-application of a regimen that the patient stopped taking due to intolerance phenomena) and re-challenge (use of previous regimens, with response at first time, and then developed progression), and the abundance of solutions could only be limited by the imagination of the researcher. However, with the advent of the new multi-kinase inhibitor regorafenib, recommendations for the treatment of colorectal cancer have changed. The  drug has received indications for  use in  the  third line of  therapy for  refractory colorectal cancer. A review of the existing options for targeted therapy and an analysis of studies of different regimens in the 3rd line of therapy in  comparison with regorafenib was carried out. It has been established that regorafenib is currently the  optimal option for the treatment of metastatic colorectal cancer in the third line of therapy, regardless of previous lines of therapy and mutational status, and has a satisfactory spectrum of side effects, many of which may be predictors of therapy efficacy. 

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