medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-189medsovet-7667Research ArticleГОРМОНОТЕРАПИЯHormonotherapyМесто фулвестранта в лечении больных метастатическим люминальным Her2-негативным раком молочной железыPlace of fulvestrant in the treatment of patients with metastatic luminal Her2-negative breast cancerhttps://orcid.org/0000-0002-8149-0085ФроловаМ. А.FrolovaM. A.

Фролова Мона Александровна, д.м.н., ведущий научный сотрудник онкологического отделения лекарственных методов лечения  (химиотерапевтического) №1 

115478, Россия, Москва, Каширское шоссе, д. 24 

Mona А. Frolova, Dr. Sci. (Med.), Leading Researcher of the Oncological Department of Medicinal Methods of Treatment (Chemotherapeutic) No. 1

24, Kashirskoye Shosse, Moscow, 115478, Russia 

drfrolova@yandex.ruhttps://orcid.org/0000-0001-5304-9682СтенинаМ. Б.SteninaM. B.

Стенина Марина Борисовна, д.м.н., ведущий научный сотрудник онкологического отделения лекарственных методов лечения (химиотерапевтического) №1 

115478, Россия, Москва, Каширское шоссе, д. 24 

Marina В. Stenina, Dr. Sci. (Med.), Leading Researcher of the Oncological  Department of Medicinal Methods of Treatment (Chemotherapeutic) No. 1 

24, Kashirskoye Shosse, Moscow, 115478, Russia 

mstenina@mail.ruНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian Federation2023270720230114147Copyright © Фролова М.А., Стенина М.Б., 20232023Фролова М.А., Стенина М.Б.Frolova M.A., Stenina M.B.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7667

Гормонотерапия в монорежиме или в комбинации с таргетными агентами (ингибиторы CDK4/6, алпелисиб, эверолимус) является на сегодняшний день стандартом лечения метастатического люминального Her2-отрицательного рака молочной железы. Ингибиторы ароматазы и фулвестрант – основные препараты гормонотерапии. Фулвестрант относится к особому классу антиэстрогенов – селективным дегрейдерам рецепторов эстрогена (SERD), и не обладает агонистической активностью в отношении рецепторов эстрогенов в отличие от тамоксифена. Кроме того, эффективность фулвестранта не зависит от наличия ESR1 мутации в опухоли. Комбинация ингибиторов ароматазы с ингибиторами CDK4/6 является стандартом первой линии лечения у больных с гормоночувствительными опухолями, т. е. при прогрессировании более 1 года после окончания адъювантной гормонотерапии. В то время как фулвестрант ± ингибиторы CDK4/6 применяется при прогрессировании болезни на фоне адъювантной гормонотерапии в первой линии или в качестве второй линии при прогрессировании на терапии ингибиторами ароматазы по поводу метастатического рака. Сложным является вопрос выбора тактики лечения для больных с мутацией PIK3CА при прогрессировании на первой линии терапии фулвестрантом с ингибитором CDK4/6. В данной статье приведен клинический пример использования комбинации фулвестранта и алпелисиба у больной с вторичной гормонорезистентностью (прогрессирование на фоне адъювантной терапии ингибиторами ароматазы) и прогрессированием на фоне терапии первой линии фулвестрантом и палбоциклибом. Проведение терапии фулвестрантом и алпелисибом в качестве второй линии обеспечило длительную, в течение 14 месяцев, стабилизацию опухолевого процесса.

Hormone therapy alone or in combination with targeted agents (CDK4/6 inhibitors, alpelisib, everolimus) is currently the standard treatment of metastatic luminal Her2-negative breast cancer. Aromatase inhibitors and fulvestrant are the main hormone therapy agents. Fulvestrant belongs to a special class of antiestrogens – selective estrogen receptor degraders (SERD) and does not have estrogen receptor agonist activity, unlike tamoxifen. In addition, the efficacy of fulvestrant does not depend on the presence of ESR1 mutations in the tumor. The combination of aromatase inhibitors with CDK4/6 inhibitors is the standard first-line treatment in patients with hormone-sensitive tumors, that is, with progression of more than 1 year after the end of adjuvant hormone therapy. Whereas fulvestrant ± CDK4/6 inhibitors are used for disease progression on adjuvant hormonal therapy in the 1st line or as 2nd line for progression on aromatase inhibitor therapy for metastatic cancer. The choice of treatment for patients with a PIK3CA mutation with progression on the 1st line of fulvestrant with a CDK4/6 inhibitor is difficult. This article presents a clinical example of the use of a combination of fulvestrant and alpelisib in a patient with secondary hormone resistance (progression on the adjuvant therapy with aromatase inhibitors) and progression on the first-line therapy with fulvestrant and palbociclib. Carrying out therapy with fulvestrant and alpelisib as the 2nd line provided a long-term (for 14 months) stabilization of the tumor process.

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