medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-238medsovet-8394Research ArticleТАРГЕТНАЯ ТЕРАПИЯTARGET THERAPY OF TUMORSЦеритиниб – длительный контроль за болезнью: клиническое наблюдениеCeritinib as a long-term disease control: Clinical observationhttps://orcid.org/0000-0002-2154-3376РеутоваЕ. В.ReutovaE. V.

Реутова Елена Валерьевна - к.м.н., старший научный сотрудник отделения противоопухолевой лекарственной терапии №3 отдела лекарственного лечения.

115478, Москва, Каширское шоссе, д. 23

Elena V. Reutova - Cand. Sci. (Med.), Senior Researcher of Cancer Drug Therapy Department No. 3.

23, Kashirskoye Shosse, Moscow, 115478

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

Лактионов Константин Константинович - д.м.н., заведующий отделением противоопухолевой лекарственной терапии №3 отдела лекарственного лечения, НМИЦ онкологии имени Н.Н. Блохина; профессор кафедры онкологии и лучевой терапии лечебного факультета, Российский НИМУ имени Н.И. Пирогова.

115478, Москва, Каширское шоссе, д. 23; 117997, Москва, ул. Островитянова, д. 1

Konstantin K. Laktionov - Dr. Sci. (Med.), Head of Cancer Drug Therapy Department No. 3, Blokhin National Medical Research Center of Oncology; Professor of the Department of Oncology and X-ray Therapy, General Medicine Faculty, Pirogov RNRMU.

23, Kashirskoye Shosse, Moscow, 115478; 1, Ostrovityanov St., Moscow, 117997

lkoskos@mail.ruhttps://orcid.org/0000-0002-8967-7987АрдзинбаМ. С.ArdzinbaM. A.

Ардзинба Мераб Сергеевич - к.м.н., научный сотрудник отделения противоопухолевой лекарственной терапии №3 отдела лекарственного лечения.

115478, Москва, Каширское шоссе, д. 23

Merab A. Ardzinba, Cand. Sci. (Med.), Researcher of the Cancer Drug Therapy Department No. 3.

23, Kashirskoye Shosse, Moscow, 115478

merabii@mail.ruНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationНациональный 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 Federation2024240720240106065Copyright © Реутова Е.В., Лактионов К.К., Ардзинба М.С., 20242024Реутова Е.В., Лактионов К.К., Ардзинба М.С.Reutova E.V., Laktionov K.K., Ardzinba M.A.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/8394

ALK-позитивный немелкоклеточный рак легкого – отличная модель, демонстрирующая успехи прецизионной медицины. Редкое генетическое нарушение в виде перестройки гена анапластической крупноклеточной лимфомы, встречающееся с частотой 5–7%, формирует определенный клинико-морфологический портрет пациента. При ALK-позитивном немелкоклеточном раке легкого головной мозг является частой мишенью для метастазирования. Но несмотря на этот фактор негативного прогноза, именно в данной когорте больных немелкоклеточным раком легкого достижения лекарственной противоопухолевой терапии особенно значительны: последовательное применение ингибиторов ALK нескольких поколений позволяет достичь медианы общей выживаемости около 80 мес. В РФ одобрено к применению 4 препарата для лечения ALK-позитивного немелкоклеточного рака легкого. Один из них – ингибитор ALK второго поколения церитиниб – активно применяется как в первой линии терапии, так и после прогрессирования на кризотинибе. В регистрационном исследовании ASCEND-4 медиана времени до прогрессирования на церитинибе оказалась вдвое больше, чем на стандартной полихимиотерапии. Однако первоначальная суточная доза препарата в 750 мг была сопряжена с выраженной гастроинтестинальной и гепатотоксичностью. Впоследствии доза препарата была снижена до 450 мг, что существенно улучшило переносимость лечения без снижения его эффективности. Представленный в работе клинический случай демонстрирует возможность современной таргетной терапии обеспечивать длительный контроль за болезнью при метастатическом ALK-позитивном немелкоклеточном раке легкого.

ALK-positive non-small cell lung cancer is an excellent model demonstrating the success of precision medicine. A rare genetic disorder – a rearrangement of the anaplastic large cell lymphoma gene, occurring with a frequency of 5–7%, forms a certain clinical and morphological portrait of the patient. In ALK-positive non-small cell lung cancer, the brain is a frequent target for metastasis. But despite this negative prognosis factor, it is in this cohort of non-small cell lung cancer patients that the achievements of drug antitumor therapy are especially significant – the consistent use of ALK inhibitors of several generations allows to achieve a median overall survival of about 80 months. In the Russian Federation, 4 drugs have been approved for the treatment of ALK-positive non-small cell lung cancer. One of them is a second–generation ALK inhibitor – ceritinib is actively used both in the first line of therapy and after progression on crizotinib. In the ASCEND-4 registration study, the median time to progression on ceritinib was twice as long as on standard polychemotherapy. However, the initial daily dose of the drug 750 mg was associated with severe gastrointestinal and hepatotoxicity. Subsequently, the dose of the drug was reduced to 450 mg, which significantly improved the tolerability of treatment without reducing its effectiveness. The clinical case presented below demonstrates the possibility of modern targeted therapy to provide long-term disease control in metastatic ALK-positive nonsmall cell lung cancer.

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