medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-244medsovet-7668Research ArticleОНКОУРОЛОГИЯONCOUROLOGYИнгибиторы иммунных контрольных точек в терапии рака мочевого пузыря: опыт применения авелумабаImmune checkpoint inhibitors in bladder cancer therapy: the experience with avelumabhttps://orcid.org/0000-0002-5160-925XГрицкевичА. А.GritskevichA. A.

Грицкевич Александр Анатольевич, д.м.н.,  заведующий отделением хирургического лечения урологических заболеваний; профессор кафедры урологии и оперативной нефрологии с курсом онкоурологии Медицинского института

117997, Россия, Москва, ул. Большая Серпуховская, д. 27

117198, Россия, Москва, ул. Миклухо-Маклая, д. 6 

Alexander A. Gritskevich, Dr. Sci. (Med.), Head of the Department of Surgical treatment of urological Diseases; Professor of the Department of Urology and Operative Nephrology with the course of Oncourology of the Medical Institute

27, Bolshaya Serpukhovskaya St., Moscow, 117997, Russia

6, Miklukho-Maklai St., Moscow, 117198, Russia

grekaa@mail.ruhttps://orcid.org/0000-0002-3646-1664БайтманТ. П.BaitmanT. P.

Байтман Татьяна Павловна, научный сотрудник отделения хирургического лечения урологических заболеваний; ассистент кафедры урологии и оперативной нефрологии с курсом онкоурологии Медицинского института

117997, Россия, Москва, ул. Большая Серпуховская, д. 27

117198, Россия, Москва, ул. Миклухо-Маклая, д. 6 

Tatiana P. Baitman, Researcher of the Department of Surgical treatment of urological Diseases; Assistant of the Department of Urology and Operative Nephrology with the course of Oncourology of the Medical Institute 

27, Bolshaya Serpukhovskaya St., Moscow, 117997, Russia

6, Miklukho-Maklai St., Moscow, 117198, Russia

bit.t@mail.ruhttps://orcid.org/0000-0002-6751-2399МишугинС. В.MishuginS. V.

Мишугин Сергей Владимирович, к.м.н., заведующий онкоурологическим отделением

111123, Россия, Москва, шоссе Энтузиастов, д. 86 

Sergei V. Mishugin, Cand. Sci. (Med.), Head of the Oncourological Department

86, Entuziastov Shosse, Moscow, 111123, Russia 

sergeymishugin@yandex.ruhttps://orcid.org/0000-0001-6267-8237ПоповА. Ю.PopovA. Yu.

Попов Анатолий Юрьевич, к.м.н., заведующий отделением химиотерапии

117997, Россия, Москва, ул. Большая Серпуховская, д. 27

Anatoly Yu. Popov, Cand. Sci. (Med.), Head of the Chemotherapy Department

27, Bolshaya Serpukhovskaya St., Moscow, 117997, Russia 

popov_63@mail.ruhttps://orcid.org/0000-0002-5949-6915ЯгудаевД. М.YagudaevD. M.

Ягудаев Даниэль Меерович, д.м.н., профессор кафедры эндоскопической урологии и ультразвуковой диагностики; заведующий отделением онкоурологии

117198, Россия, Москва, ул. Миклухо-Маклая, д. 6 

129128, Россия, Москва, ул. Будайская, д. 2

Daniel M. Yagudaev, Dr. Sci. (Med.), Professor of the Department of Endoscopic Urology and Ultrasound Diagnostics; Head of the Oncourology Department

6, Miklukho-Maklai St., Moscow, 117198, Russia

2, Budaiskaya St., Moscow, 129128, Russia 

https://orcid.org/0000-0003-2315-6457ФалалееваЛ. А.FalaleevaL. A.

Фалалеева Лидия Александровна, врач-онколог

115682, Россия, Москва, Ореховый бульвар, д. 28 

Lidiуa A. Falaleeva, Oncologist

28, Orekhovy Boulevard, Moscow, 115682, Russia 

lidochka924@yandex.ruhttps://orcid.org/0000-0002-0945-2498РусаковИ. Г.RusakovI. G.

Русаков Игорь Георгиевич, д.м.н., профессор, заместитель главного врача по онкологии

105077, Россия, Москва, ул. 11-я Парковая, д. 32

Igor G. Rusakov, Dr. Sci. (Med.), Professor, Deputy Chief Physician for Oncology

32, 11th Parkovaya St., Moscow, 105077, Russia 

igorrusakov@mail.ruНациональный медицинский исследовательский центр хирургии имени А.В. Вишневского; Российский университет дружбы народовРоссияVishnevsky National Medical Research Center of Surgery; RUDN UniversityRussian FederationМосковский клинический научный центр имени А.С. ЛогиноваРоссияLoginov Moscow Clinical Scientific CenterRussian FederationНациональный медицинский исследовательский центр хирургии имени А.В. ВишневскогоРоссияVishnevsky National Medical Research Center of SurgeryRussian FederationРоссийский университет дружбы народов; Центральная клиническая больница «РЖД-Медицина»РоссияRUDN University; Сentral Clinical Hospital “RZD-Medicine”Russian FederationФедеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий Федерального медико-биологического агентстваРоссияFederal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical Biological AgencyRussian FederationГородская клиническая больница имени Д.Д. ПлетневаРоссияPletnev City Clinical HospitalRussian Federation2023270720230114855Copyright © Грицкевич А.А., Байтман Т.П., Мишугин С.В., Попов А.Ю., Ягудаев Д.М., Фалалеева Л.А., Русаков И.Г., 20232023Грицкевич А.А., Байтман Т.П., Мишугин С.В., Попов А.Ю., Ягудаев Д.М., Фалалеева Л.А., Русаков И.Г.Gritskevich A.A., Baitman T.P., Mishugin S.V., Popov A.Y., Yagudaev D.M., Falaleeva L.A., Rusakov I.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7668

Ингибиторы иммунных контрольных точек произвели революцию в лечении уротелиальной карциномы. В настоящее время они входят в стандарты лечения местнораспространенной или метастатической уротелиальной карциномы. Поддерживающая терапия авелумабом признана наиболее эффективной по сравнению с другими ингибиторами иммунных контрольных точек. На данный момент платиносодержащая химиотерапия с последующей поддерживающей терапией авелумабом – единственный режим, достоверно увеличивший общую выживаемость больных распространенным раком мочевого пузыря. В статье представлен опыт поддерживающей терапии авелумабом на примере 3 клинических наблюдений пациентов с неоперабельными формами уротелиальной карциномы. Ретроспективно проанализирован опыт лечения 3 пациентов, достигших стабилизации при стандартной химиотерапии и получивших поддерживающую терапию авелумабом. Возраст пациентов составил от 66 до 79 лет, в исследование вошли двое мужчин и одна женщина. В двух случаях первично верифицирован мышечно-инвазивный рак мочевого пузыря, в одном – прогрессирование через 7 лет после начала лечения немышечно-инвазивного рака мочевого пузыря. Лишь в одном из случаев объемное образование мочевого пузыря было радикально удалено, при этом отдаленные метастазы выявлены через 20 мес. после операции, остальные пациенты не получали радикального лечения. Общее состояние позволило всем пациентам получить полный курс платиносодержащей химиотерапии (по схеме «гемцитабин + цисплатин» или «гемцитабин + карбоплатин»), достигнута частичная ремиссия. Поддерживающая иммунотерапия авелумабом была начата в течение месяца после завершения химиотерапии. Продолжительность поддерживающей терапии в настоящее время составляет от 3 до 17 мес., во всех случаях достигнута стабилизация онкологического процесса. Ни в одном из случаев не отмечено клинически значимых нежелательных побочных эффектов. Представленный нами опыт поддерживающей иммунотерапии авелумабом соответствует мировой практике и иллюстрирует эффективность и безопасность данного препарата.

Immune checkpoint inhibitors have revolutionized the treatment of urothelial carcinoma. They are now part of the standard of care for locally advanced or metastatic urothelial carcinoma. Maintenance therapy with avelumab has been found to be the most effective compared to other immune checkpoint inhibitors. To date, platinum-containing chemotherapy followed by maintenance therapy with avelumab is the only regimen that has significantly improved overall survival in patients with advanced bladder cancer. The article presents the experience of maintenance therapy with avelumab on the example of 3 clinical cases of patients with inoperable forms of urothelial carcinoma. The experience of treating 3 patients who achieved stabilization with standard chemotherapy and received maintenance therapy with avelumab was retrospectively analyzed. The age of the patients ranged from 66 to 79 years, the study included two men and one woman. In two cases, muscle-invasive bladder cancer was initially verified, in one – progression 7 years after the start of treatment for non-muscle-invasive bladder cancer. Only in one of the cases, the volumetric formation of the bladder was radically removed, while distant metastases were detected 20 months after the operation, the rest of the patients did not receive radical treatment. The general condition allowed all patients to receive a full course of platinum-containing chemotherapy (gemcitabine + cisplatin or gemcitabine + carboplatin), partial remission was achieved. Maintenance immunotherapy with avelumab was started within a month of completion of chemotherapy. The duration of maintenance therapy currently ranges from 3 to 17 months; stabilization of the oncological process has been achieved in all cases. No clinically significant adverse side effects were noted in any of the cases. Our experience of maintenance immunotherapy with avelumab corresponds to world practice and illustrates the efficacy and safety of this drug.

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