medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-9-85-92medsovet-6921Research ArticleОНКОУРОЛОГИЯONCOUROLOGYЭффективность ингибитора тирозинкиназ 1-го поколения (сунитиниб) в терапии метастатического почечно-клеточного рака в альтернативных режимах дозированияEfficacy of the 1st generation tyrosine kinase inhibitor sunitinib in the treatment of metastatic renal cell carcinoma in alternative dosing regimenshttps://orcid.org/0000-0003-3734-2779МеньшиковК. В.MenshikovK. V.

Меньшиков Константин Викторович – кандидат медицинских наук, врач-онколог отдела химиотерапии, РКОД; доцент кафедры онкологии с курсами онкологии и патологической анатомии, БГМУ.

450054, Уфа, проспект Октября, д. 73/1; 450008, Уфа, ул. Ленина, д. 3.

Konstantin V. Menshikov - Cand. Sci. (Med.), Oncologist, Chemotherapy Department, Republican Clinical Oncological Dispensary; Associate Professor, Department of Oncology with Oncology and Pathological Anatomy Courses, Bashkir State Medical University.

73/1, Oktyabrya Ave., Ufa, 450054; 3, Lenin St., Ufa, 450008.

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

Султанбаев Александр Валерьевич - кандидат медицинских наук, заведующий отделом противоопухолевой лекарственной терапии.

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

Alexander V. Sultanbaev - Cand. Sci. (Med.), Head of Cancer Drug Therapy Department, Republican Clinical Oncological Dispensary.

73/1, Oktyabrya Ave., Ufa, 450054.

rkodrb@yandex.ruhttps://orcid.org/0000-0003-1185-977XМусинШ. И.MusinSh. I.

Мусин Шамиль Исмагилович - кандидат медицинских наук, заведующий хирургическим отделением №VI.

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

Shamil I. Musin - Cand. Sci. (Med.), Head of Department of Surgery No. 6, Republican Clinical Oncological Dispensary.

73/1, Oktyabrya Ave., Ufa, 450054.

https://orcid.org/0000-0002-8461-9243ИзмайловА. A.IzmailovA. A.

Измайлов Адель Альбертович – доктор медицинских наук, главный врач, РКОД; профессор кафедры урологии с курсом Института дополнительного профессионального образования, БГМУ.

450054, Уфа, проспект Октября, д. 73/1; 450008, Уфа, ул. Ленина, д. 3.

Adel A. Izmailov - Dr. Sci. (Med.), Chief Medical Officer, Republican Clinical Oncological Dispensary; Professor, Department of Urology with an Institute of Continuing Professional Education Course, Bashkir State Medical University.

73/1, Oktyabrya Ave., Ufa, 450054; 3, Lenin St., Ufa, 450008.

izmailov75@mail.ruhttps://orcid.org/0000-0001-8779-4074ЧаловВ. С.ChalovV. S.

Чалов Виталий Сергеевич - заведующий отделением радиотерапии, врач-радиотерапевт.

450000, Уфа, ул. Рихарда Зорге, д. 58, стр. 2.

Vitaliy S. Chalov - Head of Department of Radiotheraphy, Radiotherapist, Center for Nuclear Medicine “PET-Technology”.

58, Bldg. 2, Rikhard Zorge St., Ufa, 450000.

v.chalov@pet-net.ruhttps://orcid.org/0000-0002-8665-8895МеньшиковаИ. А.MenshikovaI. A.

Меньшикова Ирина Асхатовна - кандидат медицинских наук, доцент, доцент кафедры биологической химии.

450008, Уфа, ул. Ленина, д. 3.

Irina A. Menshikova - Cand. Sci. (Med.), Associate Professor, Associate Professor of Department of Biological Chemistry, Bashkir State Medical University.

3, Lenin St., Ufa, 450008.

i-menshikova@bk.ruhttps://orcid.org/0000-0001-5926-0446СултанбаеваН. И.SultanbaevaN. I.

Султанбаева Надежда Ивановна - врач-онколог отделения противоопухолевой лекарственной терапии №1.

450008, Уфа, ул. Ленина, д. 3.

Nadezda I. Sultanbaeva - Oncologist, Cancer Drug Therapy Department No. 1, Bashkir State Medical University.

3, Lenin St., Ufa, 450008.

nd.sultan@rambler.ruhttps://orcid.org/0000-0003-1242-759XПоповаЕ. В.PopovaE. V.

Попова Екатерина Владимировна - врач-онколог, заведующая отделением амбулаторной противоопухолевой лекарственной терапии.

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

Ekaterina V. Popova - Oncologist, Head of Department of Outpatient Cancer Drug Therapy, Republican Clinical Oncological Dispensary.

73/1, Oktyabrya Ave., Ufa, 450054.

https://orcid.org/0000-0002-3193-9008ЛипатовД. О.LipatovD. O.

Липатов Данила Олегович - студент лечебного факультета.

450008, Уфа, ул. Ленина, д. 3.

Danila O. Lipatov - Student, Faculty of General Medicine, Bashkir State Medical University.

3, Lenin St., Ufa, 450008.

lipatov911@gmail.comРеспубликанский клинический онкологический диспансер; Башкирский государственный медицинский университетРоссияRepublican Clinical Oncological Dispensary; Bashkir State Medical UniversityRussian FederationРеспубликанский клинический онкологический диспансерРоссияRepublican Clinical Oncological DispensaryRussian FederationЦентр ядерной медицины «ПЭТ-Технолоджи»РоссияCenter for Nuclear Medicine “PET-Technology”Russian FederationБашкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian Federation202218062022098592Copyright © Меньшиков К.В., Султанбаев А.В., Мусин Ш.И., Измайлов А.A., Чалов В.С., Меньшикова И.А., Султанбаева Н.И., Попова Е.В., Липатов Д.О., 20222022Меньшиков К.В., Султанбаев А.В., Мусин Ш.И., Измайлов А.A., Чалов В.С., Меньшикова И.А., Султанбаева Н.И., Попова Е.В., Липатов Д.О.Menshikov K.V., Sultanbaev A.V., Musin S.I., Izmailov A.A., Chalov V.S., Menshikova I.A., Sultanbaeva N.I., Popova E.V., Lipatov D.O.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6921

Метастатический почечно-клеточный рак составляет почти 85% всех случаев злокачественных новообразований почки. Одним из показаний к применению сунитиниба (антиангиогенный ингибитор тирозинкиназы) является метастатический почечно-клеточный рак (мПКР) у взрослых. Сунитиниб - пероральный ингибитор тирозинкиназ, включающий рецептор фактора роста эндотелия сосудов (VEGFR) и рецептор тромбоцитарного фактора роста (PDGFR). В основном он используется в качестве препарата первой линии при начальной дозе 50 мг 1 раз в сутки в течение 4 нед. с последующим 2-недельным перерывом. Рекомендации в случае необходимости модификации дозы сводятся к снижению дозы до 37,5 мг/сут, при необходимости - к дальнейшему уменьшению до 25 мг/сут. Другим многообещающим режимом терапии является продолжение приема суточной дозы в 50 мг с более частыми перерывами: 2 нед. лечения с последующей паузой в 1 нед. Приведенный в статье анализ показывает, что пациенты с мПКР, перешедшие из-за нежелательных явлений с терапии по стандартной схеме 4/2 на режим 2/1 сунитиниба, действительно демонстрируют лучший профиль безопасности. Имеются данные о значительном снижении общей токсичности 3-4-й степени, а также о снижении частоты специфической лекарственной токсичности, такой как утомляемость, артериальная гипертензия, ладонно-подошвенный синдром и тромбоцитопения. В статье приведено клиническое наблюдение пациентки с распространенным ПКР, имеющей противопоказание для проведения иммунотерапии. Пациентке была произведена циторедуктивная лапароскопическая резекция левой почки. С учетом имеющихся противопоказаний к иммунотерапии пациентке в первой линии был назначен сунитиниб в монорежиме в стандартной дозировке. После 2 курсов терапии ввиду нежелательных явлений была произведена замена режима терапии 4/2 на 2/1. Проводимая терапия в режиме 2/1 продемонстрировала удовлетворительный профиль безопасности при адекватной клинической эффективности.

Metastatic renal cell carcinoma accounts for almost 85% of all cases of malignant neoplasms of the kidney. Sunitinib is an anti-angiogenic tyrosine kinase inhibitor, one of the indications is the treatment of mRCC in adults. Sunitinib is an oral tyrosine kinase inhibitor that includes the vascular endothelial growth factor receptor (VEGFR) and the platelet-derived growth factor receptor (PDGFR). Sunitinib is primarily used as a first-line drug at an initial dose of 50 mg. 1 time per day for 4 weeks followed by a 2-week break. Recommendations, if dose modification is necessary, indicate a dose reduction to 37.5 mg per day and, if necessary, a further dose reduction to 25 mg per day. Another promising regimen is to continue the daily dose of 50 mg with more frequent breaks: 2 weeks of treatment followed by a pause of 1 week. The analysis presented in the article shows that patients with mRCC who switched to sunitinib 2/1 regimen due to adverse events from the standard 4/2 regimen do show an improved safety profile. There is evidence of a significant reduction in overall grade 3-4 toxicity, as well as a reduction in the incidence of specific drug toxicity such as fatigue, hypertension, hand and foot syndrome, and thrombocytopenia. The article presents a clinical observation of a patient with advanced renal cell carcinoma who has a contraindication for immunotherapy. The patient underwent cytoreductive laparoscopic resection of the left kidney. Taking into account the existing contraindications to immunotherapy, the patient was prescribed sunitinib monotherapy at the standard dosage in the first line. After two courses of therapy, due to adverse events, the therapy regimen was changed from 4/2 to 2/1. The ongoing therapy in the 2/1 regimen demonstrated a satisfactory safety profile with adequate clinical efficacy.

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