medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-247medsovet-7700Research ArticleПРАКТИКАPRACTICEОпыт применения талазопариба при агрессивном течении BRCA2-ассоциированного трижды негативного рака молочной железы: клиническое наблюдениеExperience of using talazoparib in the aggressive course of BRCA2-associated triple-negative breast cancer: a clinical observationhttps://orcid.org/0000-0002-0635-9343ЦареваА. С.TsarevaA. S.

Царева Анастасия Сергеевна, врач-ординатор отделения лекарственных методов лечения №1; ординатор кафедры онкологии факультета дополнительного профессионального образования 

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

117997, Россия, Москва, ул. Островитянова, д. 1 

Anastasia S. Tsareva, Resident Oncologist, Department of Medicinal Methods of Treatment No. 1; Resident Physician, Department of Oncology, Faculty of Additional Professional Education 

24, Kashirskoye Shosse, Moscow, 115478, Russia

1, Ostrovityanov St., Moscow, 117997, Russia 

tsarevaas1997@yandex.ruhttps://orcid.org/0000-0001-5289-7866ЛубенниковаЕ. В.LubennikovaE. V.

Лубенникова Елена Владимировна, к.м.н., старший научный сотрудник отделения лекарственных  методов лечения №1 

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

Elena V. Lubennikova, Cand. Sci. (Med.), Senior Researcher of Department of Medicinal Methods of Treatment No. 1 

24, Kashirskoye Shosse, Moscow, 115478, Russia

lubennikova@yandex.ruhttps://orcid.org/0000-0003-4443-9974РумянцевА. А.RumyantsevA. A.

Румянцев Алексей Александрович, к.м.н., старший научный сотрудник онкологического отделения лекарственных методов лечения (химиотерапевтическое) №4 отдела лекарственного  лечения Научно-исследовательского института  клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова 

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

Alexey A. Rumyantsev, Cand. Sci. (Med.), Senior Research Associate, Department of Chemotherapy No. 4, Research Institute of Clinical Oncologynamed after Academician of RAS and RAMS N.N. Trapeznikova 

24, Kashirskoye Shosse, Moscow, 115478, Russia

alexeymma@gmail.comhttps://orcid.org/0000-0002-1459-2292ГлазковаЕ. В.GlazkovaE. V.

Глазкова Елена Владимировна, к.м.н., заведующая онкологическим отделением противоопухолевой лекарственной терапии 

108814, Россия, Москва, пос. Коммунарка, ул. Сосенский Стан, д. 8, стр. 2 

Elena V. Glazkova, Cand. Sci. (Med.), Chief of Oncology Department of Medicinal Methods of Treatment 

8, Bldg. 2, Sosensky Stan St., Kommunarka Settlement, Moscow, 108814, Russia 

mdglazkova@gmail.comhttps://orcid.org/0000-0002-0105-9376ГаньшинаИ. П.GanshinaI. P.

Ганьшина Инна Петровна, к.м.н., ведущий научный сотрудник онкологического отделения лекарственных методов лечения (химиотерапевтического) №1 Научно-исследовательского института клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова 

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

Inna P. Ganshina, Cand. Sci. (Med.), Senior Researcher of Department of Medicinal Methods of Treatment No. 1, Research Institute of Clinical Oncology named after Academician of RAS and RAMS N.N. Trapeznikova 

24, Kashirskoye Shosse, Moscow, 115478, Russia

ganshinainna77@mail.ruНациональный медицинский исследовательский центр онкологии имени Н.Н. Блохина; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияBlokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical UniversityRussian FederationНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationМосковский многопрофильный клинический центр «Коммунарка»РоссияMoscow Multidisciplinary Clinical Center “Kommunarka”Russian Federation202331072023011158165Copyright © Царева А.С., Лубенникова Е.В., Румянцев А.А., Глазкова Е.В., Ганьшина И.П., 20232023Царева А.С., Лубенникова Е.В., Румянцев А.А., Глазкова Е.В., Ганьшина И.П.Tsareva A.S., Lubennikova E.V., Rumyantsev A.A., Glazkova E.V., Ganshina I.P.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/7700

Медиана общей выживаемости при метастатическом трижды негативном РМЖ составляет около 12–14 мес. Долгое время единственной опцией лечения данного подтипа опухоли, вне зависимости от иммунологических и генетических характеристик, оставалась химиотерапия. Не определены однозначные алгоритмы терапии, последовательность использования химиотерапевтических режимов остается на усмотрении лечащего врача. В настоящее время впечатляющие данные клинических исследований по использованию иммунотерапии и таргетной терапии ингибиторами PARP находят отражение в современных рекомендациях, повышая шансы больных на продление жизни и сохранение ее высокого качества. Так, использование иммунотерапии в первой линии лечения PD-L1-позитивных опухолей позволила впервые за долгие годы значимо повысить общую выживаемость пациентов. А использование ингибиторов PARP у носителей герминальных мутаций BRCA1/2 не только достоверно продлевает выживаемость без прогрессирования, но и улучшает показатели качества жизни в сравнении со стандартными режимами химиотерапии. Выигрыш отмечается в т. ч. и у пациентов с агрессивным течением болезни: с поражением висцеральных органов и ЦНС. Наличие герминальных мутаций в генах BRCA1/2, поражение ЦНС и висцеральных органов ассоциировано с крайне неблагоприятным прогнозом и значимым сокращением продолжительности жизни. Однако полноценная диагностика до начала лечения, правильное планирование терапии и использование современных возможностей позволяет улучшить результаты лечения. В статье рассмотрены возможные опции терапии метастатического ТНРМЖ, отражены современные рекомендации по использованию иммуно- и таргетной терапии. Приведено клиническое наблюдение лечения пациентки со значимо отягощенным анамнезом и агрессивным течением ТНРМЖ. При наличии висцеральных метастазов, поражении головного мозга и раннем прогрессировании после первичного лечения пациентка получает терапию уже в течение двух лет, сохраняя при этом удовлетворительное качество жизни.

The median overall survival for patients with metastatic triple-negative breast cancer is about 12-14 months. Chemotherapy has been the only treatment option for this tumour subtype for a long time, irrespective of immunological and genetic characteristics. Straightforward therapy algorithms have not been defined, and the optimum sequencing of chemotherapy regimens is left to the discretion of the attending physician. Today, impressive findings from clinical studies on the use of immunotherapy and targeted therapy for cancer using PARP inhibitors reflect in current guidelines, raising the chances of patients to prolong life and maintain its high quality. Thus, the use of immunotherapy as first-line treatment of PD-L1-positive tumours allowed to significantly increase the overall survival of patients for the first time in many years. And the use of PARP inhibitors in carriers of BRCA1/2 germline mutations not only significantly prolongs progression-free survival, but also improves quality of life versus standard chemotherapy regimens. The benefit is also observed in patients with an aggressive course of the disease such as damage to the visceral organs and the central nervous system. The presence of BRCA1/2 germline mutations in the genes, damage to the CNS and visceral organs is associated with an extremely unfavourable prognosis and a significant decline in life expectancy. However, a high-quality diagnosis before initiation of treatment, creating proper treatment plans and the use of modern opportunities can improve the outcomes of treatment. The article discusses possible treatment options for metastatic TNBC, reflects current guidelines on the use of immuno- and targeted therapy. A clinical case report of the treatment of a patient with a significantly aggravated history and an aggressive course of TNBC is presented. The patient with visceral metastases, brain damage and early progression after primary treatment has been receiving therapy for two years, while maintaining a satisfactory quality of life.

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