medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-436medsovet-7992Research ArticleТАРГЕТНАЯ ТЕРАПИЯTARGET THERAPY OF TUMORSМесто тирозинкиназных ингибиторов в первой линии лечения гепатоцеллюлярной карциномыPlace of tyrosine kinase inhibitors in the first line of treatment of hepatocellular carcinomahttps://orcid.org/0009-0000-2673-4932СергееваА. В.SergeevaA. V.

Сергеева Анастасия Владимировна - врач-ординатор отделения противоопухолевой лекарственной терапии №2, НМИЦ онкологии им. Н.Н. Блохина; ординатор кафедры онкологии института клинической медицины, ПМГМУ им. И.М. Сеченова (Сеченовский Университет).

115478, Москва, Каширское шоссе, д. 23; 119991, Москва, ул. Трубецкая, д. 8, стр. 2

Anastasia V. Sergeeva - Resident Physician, Department of Antitumor Drug Therapy No. 2, Blokhin National Medical Research Center of Oncology; Resident, Department of Oncology, Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University).

23, Kashirskoye Shosse, Moscow, 115478; 8, Bldg. 2, Trubetskaya St., Moscow, 119991

a.sergeeva1919@gmail.comhttps://orcid.org/0000-0002-5084-4872МанукянМ. Ш.ManukyanM. Sh.

Манукян Мариам Шираковна - врач-онколог отделения противоопухолевой лекарственной терапии №2.

115478, Москва, Каширское шоссе, д. 23

Mariam Sh. Manukyan - Oncologist, Department of Antitumor Drug Therapy No. 2, Blokhin National Medical Research Center of Oncology.

23, Kashirskoye Shosse, Moscow, 115478

manukyanmariam6@gmail.comhttps://orcid.org/0000-0001-5348-5011ПоляковА. Н.PolyakovA. N.

Поляков Александр Николаевич - к.м.н., старший научный сотрудник отделения абдоминальной онкологии №2 (опухолей гепатопанкреатобиллиарной зоны).

115478, Москва, Каширское шоссе, д. 23

Alexander N. Polyakov - Cand. Sci. (Med.), Senior Researcher at the Department of Abdominal Oncology No. 2 (Tumors of the Hepatopancreatobiliary Zone), Blokhin National Medical Research Center of Oncology.

23, Kashirskoye Shosse, Moscow, 115478

Dr.alexp@gmail.comhttps://orcid.org/0000-0003-2624-9341БазинИ. С.BazinI. S.

Базин Игорь Сергеевич - д.м.н., ведущий научный сотрудник отделения противоопухолевой лекарственной терапии №2, НМИЦ онкологии им. Н.Н. Блохина; доцент кафедры онкологии, хирургии и паллиативной медицины, ТГМУ.

115478, Москва, Каширское шоссе, д. 23; 170100, Тверь, ул. Советская, д. 4

Igor S. Bazin - Dr. Sci. (Med.), Leading Researcher, Department of Antitumor Drug Therapy No. 2, Blokhin National Medical Research Center of Oncology; Associate Professor, Department of Oncology, Surgery and Palliative Medicine, Tver State Medical University.

23, Kashirskoye Shosse, Moscow, 115478; 4, Sovetskaya St., Tver, 170100

bazin_onk@mail.ruНациональный медицинский исследовательский центр онкологии имени Н.Н. Блохина; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияBlokhin National Medical Research Center of Oncology; Sechenov First Moscow State Medical University (Sechenov University)Russian FederationНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationНациональный медицинский исследовательский центр онкологии имени Н.Н. Блохина; Тверской государственный медицинский университетРоссияBlokhin National Medical Research Center of Oncology; Tver State Medical UniversityRussian Federation2023180120240226472Copyright © Сергеева А.В., Манукян М.Ш., Поляков А.Н., Базин И.С., 20242024Сергеева А.В., Манукян М.Ш., Поляков А.Н., Базин И.С.Sergeeva A.V., Manukyan M.S., Polyakov A.N., Bazin I.S.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/7992

Заболеваемость гепатоцеллюлярной карциномой (ГЦК) в России и мире со временем увеличивается. У большинства пациентов с ГЦК диагностируется поздняя стадия заболевания, не подходящая для потенциально излечивающих методов терапии. До появления новых режимов лечения медиана общей выживаемости при данном заболевании была чуть больше 1 года. Изучение комбинаций иммунотерапии и таргетной терапии позволило улучшить клинические результаты по сравнению с монотерапией тирозинкиназными ингибиторами, но новые режимы лечения не могут быть назначены всем пациентам с распространенной ГЦК. Применение комбинации атезолизумаба с бевацизумабом может быть назначено сохранным пациентам с распространенной ГЦК без варикозно расширенных вен, с гипертоническими кризами в анамнезе. В реальной клинической практике крайне трудно отобрать пациентов, подходящих под критерии включения в клинические исследования. Также монотерапия тирозинкиназными ингибиторами эффективна независимо от этиологии развития ГЦК и может быть назначена пациентам с признаками печеночной недостаточности (класс В Чайлд – Пью) в отличие от комбинированной терапии. Применение двойной иммунотерапии показало свою эффективность во второй линии лечения ГЦК, но, возможно, в будущем данные комбинации покажут свою эффективность и в первой линии. Нет убедительных данных об эффективности иммунотерапии у пациентов, ожидающих пересадку донорской печени. У данной категории препаратами выбора являются ленватиниб, сорафениб. В статье приведены особенности выбора режима терапии в зависимости от этиологии процесса, целей терапии, сопутствующих заболеваний пациента и наличия/степени печеночной недостаточности.

The incidence of hepatocellular carcinoma (HCC) in Russia and worldwide is steadily increasing over time. The majority of HCC patients are diagnosed at a late stage of the disease, which is not suitable for potentially curative treatment methods. Before the emergence of new treatment regimens, the median overall survival for this condition was just over one year. Studying combinations of immunotherapy and targeted therapy has improved clinical outcomes compared to monotherapy with tyrosine kinase inhibitors, but the new treatment regimens cannot be prescribed to all patients with advanced HCC. The combination of atezolizumab with bevacizumab may be prescribed to eligible patients with advanced hepatocellular carcinoma who do not have varicose veins and have no history of hypertensive crises. In real clinical practice, it is extremely difficult to select patients who meet the inclusion criteria for clinical trials. Monotherapy with tyrosine kinase inhibitors is also effective regardless of the etiology of HCC development and can be prescribed to patients with signs of liver insufficiency (Child-Pugh B) as opposed to combined therapy. Double immunotherapy has shown its efficacy in second-line treatment, and in the future, these combinations may also demonstrate their effectiveness in first-line treatment of hepatocellular carcinoma. There is insufficient evidence on the effectiveness of immunotherapy in patients awaiting liver transplantation. For this category of patients, the drugs of choice are lenvatinib and sorafenib. The article highlights the specific considerations in choosing the treatment regimen based on the etiology of the disease, treatment goals, concomitant patient conditions, and the presence/severity of liver insufficiency.

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