medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-22-130-135medsovet-7247Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHОптимальный выбор лекарственного противоопухолевого лечения у пациентов с фиброламеллярной карциномой печениOptimal choice of drug antitumor treatment in patients with Fibrolamellar liver carcinomahttps://orcid.org/0000-0002-9740-3839АнтоноваЕ. Ю.AntonovaE. Yu.

Антонова Елена Юрьевна - врач-онколог отделения лекарственных методов лечения (химиотерапевтическое) №17 Научно-исследовательского института клинической онкологии имени Н.Н. Трапезникова.

115478, Москва, Каширское шоссе, д. 24

SPIN-код: 6335-7053

Elena Yu. Antonova - Oncologist of the Department of Medicinal Treatment (Chemotherapy No. 17 Department), Blokhin National Medical Research Center of Oncology.

24, Kashirskoe Shosse, Moscow, 115478

elenaantonova5@mail.ruhttps://orcid.org/0000-0002-6775-3678МорозЕ. А.MorozE. A.

Мороз Екатерина Александровна - кандидат медицинских наук, врач-патологоанатом патологоанатомического отделения Научно-исследовательского института клинической онкологии имени Н.Н. Трапезникова.

115478, Москва, Каширское шоссе, д. 24

Ekaterina A. Moroz - Cand. Sci. (Med.), Pathologist of the Pathology Department, Blokhin National Medical Research Center of Oncology.

24, Kashirskoe Shosse, Moscow, 115478

moroz-kate@yandex.ruhttps://orcid.org/0000-0002-6323-511XДжанянИ. А.DzhanyanI. A.

Джанян Ирина Анатольевна - врач-хирург онкологического отделения лекарственных методов лечения (химиотерапевтическое) №17 Научно-исследовательского института клинической онкологии имени Н.Н. Трапезникова.

115478, Москва, Каширское шоссе, д. 24

Irina A. Dzhanyan - Surgeon, Department of Medicinal Treatment (Chemotherapy No. 17 Department), Blokhin National Medical Research Center of Oncology.

24, Kashirskoe Shosse, Moscow, 115478

i-dzhanyan@mail.ruhttps://orcid.org/0000-0003-4412-2256ВолковА. Ю.VolkovA. Yu.

Волков Александр Юрьевич – кандидат медицинских наук, врач-онколог, хирург.

115191, Москва, Духовской пер., д. 22б

РИНЦ Author ID: 1036201; SPIN-код: 3013-4392

Alexander Yu. Volkov - Cand. Sci. (Med.), Oncologist, Surgeon of the Federal Clinic of Expert Oncology “Euroonco”.

22b, Dukhovskoy Lane, Moscow, 115191

79164577128@yandex.ruhttps://orcid.org/0000-0003-4469-502XЛактионовК. К.LaktionovK. K.

Лактионов Константин Константинович - доктор медицинских наук, профессор, профессор кафедры онкологии и лучевой терапии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

РИНЦ Author ID: 160970; SPIN-код: 7404-5133

Konstantin K. Laktionov - Dr. Sci. (Med.), Professor, Professor of the Department of Oncology and Radiation Therapy, Faculty of Medicine.

1, Ostrovityanov St., Moscow, 117997

lkoskos@mail.ruhttps://orcid.org/0000-0002-6244-4294БредерВ. В.BrederV. V.

Бредер Валерий Владимирович – доктор медицинских наук, ведущий научный сотрудник онкологического отделения лекарственных методов лечения (химиотерапевтическое) №17 Научно-исследовательского института клинической онкологии имени Н.Н. Трапезникова.

115478, Москва, Каширское шоссе, д. 24

РИНЦ Author ID: 280121; SPIN-код: 9846-4360

Valeriy V. Breder - Dr. Sci. (Med.), Leading Researcher, Department of Medicinal Treatment (Chemotherapy No. 17 Department), Blokhin National Medical Research Center of Oncology.

24, Kashirskoe Shosse, Moscow, 115478

vbreder@yandex.ruНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationФедеральная клиника экспертной онкологии «Евроонко»РоссияFederal Clinic of Expert Oncology “Euroonco”Russian FederationНациональный медицинский исследовательский центр онкологии имени Н.Н. Блохина; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202206122022022130135Copyright © Антонова Е.Ю., Мороз Е.А., Джанян И.А., Волков А.Ю., Лактионов К.К., Бредер В.В., 20222022Антонова Е.Ю., Мороз Е.А., Джанян И.А., Волков А.Ю., Лактионов К.К., Бредер В.В.Antonova E.Y., Moroz E.A., Dzhanyan I.A., Volkov A.Y., Laktionov K.K., Breder V.V.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/7247Введение

Введение. Фиброламеллярная гепатоцеллюлярная карцинома (ФлК) представляет собой редкий подтип гепатоцеллюлярного рака (ГЦР). Лекарственное противоопухолевое лечение ФлК изучено недостаточно ввиду редкости патологии и требует дальнейших исследований для выбора эффективного лечения.

Цель

Цель. Выбрать эффективное лекарственное противоопухолевое лечение у пациентов с фиброламеллярной карциномой печени. Материалы и методы. В ретроспективное исследование включены 31 пациент с ФлК, получивших лекарственную противоопухолевую терапию в ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России в период с 2005 по 2020 г. Пациенты были разделены на группы сравнения: «таргетная терапия» (преимущественно сорафениб), «химиотерапия» (преимущественно гемцитабин + цисплатин). Проводился сравнительный межгрупповой анализ эффективности лекарственного противоопухолевого лечения в 1-й и 2-й линиях терапии. Произведена оценка адъювантной химиотерапии на БРВ. Также оценивалась корреляция количества линий лечения в анамнезе с прогнозом заболевания.

Результаты

Результаты. ВБП таргетной терапии (преимущественно сорафениб) достоверно выше по сравнению с химиотерапией, преимущественно гемцитабин + цисплатин/оксалиплатин (p = 0,000; log-rank test), у пациентов в 1-й линии лечения. Во 2-й линии также ВБП у пациентов, получающих таргетную терапию (p = 0,042; log-rank test), выше по сравнению с пациентами, получавшими во 2-ю линию лечения химиотерапию. Более длительная ОВ была зафиксирована в группах пациентов, которым проводилась 2-я линия лекарственного противоопухолевого лечения, и в группе 3 и более линий по сравнению с применением только 1-й линии лечения (p = 0,024 и p = 0,003 соответственно).

Выводы

Выводы. Результаты работы демонстрируют преимущество в назначении таргетной терапии в качестве 1-й и 2-й линий лекарственного противоопухолевого лечения, тогда как назначение химиотерапии остается менее прогностически благоприятной опцией. Назначение адъювантной терапии не продемонстрировало статистически значимой разницы в БРВ.

Introduction

Introduction. Fibrolamellar hepatocellular carcinoma (FlC) is a rare subtype of hepatocellular carcinoma (HCC). Drug antitumor treatment of FlC has not been studied sufficiently due to the rarity of the pathology and requires further research to choose an effective treatment.

Aim

Aim. The choice of effective drug antitumor treatment in patients with fibrolamellar liver carcinoma.

Materials and methods

Materials and methods. The retrospective study included 31 patients with FlC who received drug antitumor therapy at the N.N. Blokhin National Research Center of Oncology of the Ministry of Health of the Russian Federation in the period from 2005 to 2020. The patients were divided into comparison groups: “targeted therapy” (mainly sorafenib), “chemotherapy” (mainly gemcitabine + cisplatin). A comparative intergroup analysis of the effectiveness of drug antitumor treatment in the 1st and 2nd lines of therapy was carried out. Adjuvant chemotherapy was evaluated for time without progression. The correlation of the number of treatment lines in the anamnesis with the prognosis of the disease was also evaluated.

Results

Results. Analysis of the effect of adjuvant therapy on relapse-free survival did not prove significant differences between the comparison groups (p = 0.112; log-rank test). Therapy with multikinase inhibitors (mainly sorafenib) allows to achieve a better time without progression compared to chemotherapy (mainly gemcitabine + cisplatin / oxaliplatin) (p = 0.000; log-rank test) in patients in the 1st line of FlC treatment. OS did not significantly differ between the groups (p = 0.417; log-rank test). In line 2, time without progression in patients receiving targeted therapy (p = 0.042; log-rank test) is higher compared to patients receiving chemotherapy in line 2. A longer duration of OV was recorded in the groups of patients who underwent 2 lines of drug antitumor treatment and in the group of 3 or more lines compared with the use of only 1st line of treatment (p = 0.024) and (p = 0.003), respectively.

Conclusion

Conclusion. The results of the work demonstrate an advantage in the appointment of targeted therapy as the 1st and 2nd lines of drug antitumor treatment, while the appointment of chemotherapy remains a less prognostically favorable option. Adjuvant therapy administration did not demonstrate a statistically significant difference in relapse-free survival.

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