medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-9-186-192medsovet-6932Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONИнгибиторы контрольных точек в терапии немелкоклеточного рака легкого при прогрессировании в головной мозг (клиническое наблюдение)Checkpoint inhibitors in non-small cell lung carcinoma therapy for progression to the brain (clinical observation)https://orcid.org/0000-0003-4236-6476ВладимироваЛ. Ю.VladimirovaL. Yu.

Владимирова Любовь Юрьевна – доктор медицинских наук, профессор, руководитель отдела лекарственного лечения опухолей.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Lyubov Yu. Vladimirova - Dr. Sci. (Med.), Professor, Head of the Department of Drug Treatment of Tumors, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

vlu@aaanet.ruhttps://orcid.org/0000-0003-4865-8832ПоповаИ. Л.PopovaI. L.

Попова Ирина Леонидовна – кандидат медицинских наук, старший научный сотрудник отдела лекарственного лечения опухолей.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Irina L. Popova - Cand. Sci. (Med.), Senior Researcher of the Department of Drug Treatment of Tumors, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

sofira09@rambler.ruhttps://orcid.org/0000-0001-7793-9794АбрамоваН. А.AbramovaN. A.

Абрамова Наталия Александровна - кандидат медицинских наук, старший научный сотрудник отдела лекарственного лечения опухолей.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Natalia A. Abramova - Cand. Sci. (Med.), Senior Researcher of the Department of Drug Treatment of Tumors, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

pylulkin@mail.ruhttps://orcid.org/0000-0002-1957-4931ТепляковаМ. A.TeplyakovaM. A.

Теплякова Мария Андреевна - врач-онколог отделения противоопухолевой лекарственной терапии № 1.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Maria A. Teplyakova - Oncologist of the Department of Antitumor Drug Therapy No. 1, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

teplyakova0308@gmail.comhttps://orcid.org/0000-0001-5139-2639ТихановскаяН. М.TikhanovskayaN. M.

Тихановская Наталья Михайловна - врач-онколог отделения противоопухолевой лекарственной терапии № 1.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Natalia M. Tikhanovskaya - Oncologist of the Department of Antitumor Drug Therapy No. 1, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

ntihanovskaya@mail.ruhttps://orcid.org/0000-0001-8723-5897ЛьяноваА. А.LianovaA. A.

Льянова Аза Ахметовна - кандидат медицинских наук, врач-онколог отделения противоопухолевой лекарственной терапии № 1.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

SPIN-код: 5292-6017

Aza A. Lianova - Cand. Sci. (Med.), Oncologist of the Department of Antitumor Drug Therapy No. 1, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

blackswan-11@mail.ruhttps://orcid.org/0000-0003-0965-0264СторожаковаА. Э.StorozhakovaA. E.

Сторожакова Анна Эдуардовна - кандидат медицинских наук, заведующая отделением противоопухолевой лекарственной терапии № 2.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Scopus Author ID: 57045921800

Researcher ID: U-6202-2019

SPIN-код: 2804-7474

Anna E. Storozhakova - Cand. Sci. (Med.), Head of the Department of antitumor drug therapy No. 2, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

Scopus Author ID: 57045921800

Researcher ID: U-6202-2019

maymur@list.ruhttps://orcid.org/0000-0002-5964-2513РядинскаяЛ. А.RyadinskayaL. A.

Рядинская Людмила Алексеевна - кандидат медицинских наук, врач-онколог отделения противоопухолевой лекарственной терапии № 1.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Lyudmila A. Ryadinskaya - Cand. Sci. (Med.), Oncologist of the Department of Antitumor Drug Therapy No. 1, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

riadinskaya10@mail.ruhttps://orcid.org/0000-0001-8628-4240КабановС. Н.KabanovS. N.

Кабанов Сергей Николаевич - кандидат медицинских наук, врач отделения противоопухолевой лекарственной терапии № 2.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Scopus Author ID: 57045732600

Researcher ID: V-3023-2019

SPIN-код: 6369-0824

Sergey N. Kabanov - Cand. Sci. (Med.), Doctor of the Department of Antitumor Drug Therapy No. 2, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

Scopus Author ID: 57045732600

Researcher ID: V-3023-2019

introitus@mail.ruhttps://orcid.org/0000-0003-0158-3757КалабановаЕ. А.KalabanovaE. A.

Калабанова Елена Александровна - кандидат медицинских наук, старший научный сотрудник отдела лекарственного лечения опухолей.

344037, Ростов-на-Дону, ул. 14-я линия, д. 63.

Scopus Author ID: 57046062200

Researcher ID: V-2943-2019

SPIN-код: 9090-3007

Elena A. Kalabanova - Cand. Sci. (Med.), Senior Researcher of the Department of Drug Treatment of Tumors, National Medical Research Center of Oncology.

63, 14th Liniya St., Rostov-on-Don, 344037.

Scopus Author ID: 57046062200

Researcher ID: V-2943-2019

alenakalabanova@mail.ruНациональный медицинский исследовательский центр онкологииРоссияNational Medical Research Center of OncologyRussian Federation20221906202209186192Copyright © Владимирова Л.Ю., Попова И.Л., Абрамова Н.А., Теплякова М.A., Тихановская Н.М., Льянова А.А., Сторожакова А.Э., Рядинская Л.А., Кабанов С.Н., Калабанова Е.А., 20222022Владимирова Л.Ю., Попова И.Л., Абрамова Н.А., Теплякова М.A., Тихановская Н.М., Льянова А.А., Сторожакова А.Э., Рядинская Л.А., Кабанов С.Н., Калабанова Е.А.Vladimirova L.Y., Popova I.L., Abramova N.A., Teplyakova M.A., Tikhanovskaya N.M., Lianova A.A., Storozhakova A.E., Ryadinskaya L.A., Kabanov S.N., Kalabanova E.A.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/6932

Развитие нового направления противоопухолевой лекарственной терапии - иммунотерапии с использованием ингибиторов иммунных контрольных точек, нацеленных на PD-1/PD-L1, - в значительной степени изменило подходы к лечению распространенного немелкоклеточного рака легкого (НМРЛ). Многие клинические исследования показали клиническую пользу, а также длительный эффект этих препаратов. В настоящее время актуальна проблема лечения пациентов после прогрессирования заболевания на фоне применения ингибиторов контрольных точек. Не меньшим по актуальности является вопрос выбора правильной и максимально эффективной тактики лечения больных НМРЛ при олигопрогрессировании, а также абскопальном эффекте. В данной работе приведено описание клинического случая пациентки с аденокарциномой легкого без драйверных мутаций с PD-L1-позитивным статусом, которой после химиотерапии второй линии лечения по поводу прогрессирования заболевания проведено лечение ниволумабом, а также после олигопрогрессирования заболевания в головной мозг проведена стереотаксическая лучевая терапия метастатического поражения и продолжена терапия ниволумабом. Достигнут частичный регресс метастазов с длительным сохранением эффекта на фоне продолжающегося лечения ниволумабом в течение 24 мес. Отмечается удовлетворительная переносимость терапии: нежелательных явлений не наблюдалось. Пациентка сохраняет полученный результат в течение 1,5 лет.

The development of a new area of antitumor drug therapy, immunotherapy using immune checkpoint inhibitors targeting PD-1/PD-L1, has significantly changed approaches to the treatment of advanced non-small cell lung cancer (NSCLC). Many clinical trials have demonstrated the clinical benefit as well as the long-term effect of these drugs. Currently, the problem of treatment of patients after disease progression against the background of the use of checkpoint inhibitors is relevant. Equally relevant is the issue of choosing the correct and most effective treatment tactics for NSCLC patients with oligoprogression, as well as with abscopal effect. This paper describes a clinical case of a patient with lung adenocarcinoma without driver mutations with PD-L1-positive status, who was treated with nivolumab after second-line chemotherapy for disease progression, and after oligoprogression of the disease into the brain was given stereotactic radiotherapy of metastatic lesion and continued therapy with nivolumab. Partial regression of metastases was achieved with a prolonged effect on the background of continued treatment with nivolumab for 24 months. Tolerability of therapy was satisfactory: no adverse events were observed. The patient retained the result for 1.5 years.

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