medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-233medsovet-8399Research ArticleОНКОУРОЛОГИЯONCOUROLOGYСобственный опыт применения комбинированной терапии в первой линии лечения метастатического светлоклеточного почечноклеточного ракаOwn experience of using combination therapy in the first line of treatment of metastatic renal cell carcinomahttps://orcid.org/0000-0002-2061-0522УстиноваТ. В.UstinovaT. V.

Устинова Татьяна Васильевна - врач-онколог отделения химиотерапии отдела лекарственного лечения опухолей. AuthorID: 951518

125834, Москва, 2-й Боткинский проезд, д. 3

Tatyana V. Ustinova - Oncologist, Department of Chemotherapy, Department of Drug Treatment of Tumors.

3, 2nd Botkinskiy Proezd, Moscow, 125834

t.v.rafeyenko@gmail.comhttps://orcid.org/0000-0001-5578-7515ЧанаеваА. Ю.ChanaevaA. Yu.

Чанаева Аминат Юсуповна - врач-ординатор отделения химиотерапии отдела лекарственного лечения опухолей.

125834, Москва, 2-й Боткинский проезд, д. 3

Aminat Yu. Chanaeva - Resident Physician, Department of Chemotherapy, Department of Drug Treatment of Tumors.

3, 2nd Botkinskiy Proezd, Moscow, 125834

chanaeva.99@mail.ruhttps://orcid.org/0000-0001-7912-8055ПайчадзеА. А.PaichadzeA. A.

Пайчадзе Анна Александровна - к.м.н., научный сотрудник отделения химиотерапии отдела лекарственного лечения опухолей; AuthorID: 936943.

125834, Москва, 2-й Боткинский проезд, д. 3

Anna A. Paichadze - Cand. Sci. (Med.), Researcher, Department of Chemotherapy, Department of Drug Treatment of Tumors.

3, 2nd Botkinskiy Proezd, Moscow, 125834

paiann@mail.ruhttps://orcid.org/0000-0002-2381-4213ЛевшаковаА. В.LevshakovaA. V.

Левшакова Антонина Валерьевна, д.м.н., заведующая отделением компьютерной и магнитно-резонансной томографии.

125834, Москва, 2-й Боткинский проезд, д. 3

Antonina V. Levshakova - Dr. Sci. (Med.), Head of the Department of Computer and Magnetic Resonance Imaging.

3, 2nd Botkinskiy Proezd, Moscow, 125834

https://orcid.org/0000-0003-4879-2687БолотинаЛ. В.BolotinaL. V.

Болотина Лариса Владимировна - д.м.н., заведующая отделением химиотерапии отдела лекарственного лечения опухолей; AuthorID: 594953

125834, Москва, 2-й Боткинский проезд, д. 3

Larisa V. Bolotina - Dr. Sci. (Med.), Head of the Chemotherapy Department, Department of Drug Treatment of Tumors.

3, 2nd Botkinskiy Proezd, Moscow, 125834

lbolotina@yandex.ruhttps://orcid.org/0009-0003-1169-102XИваныкинаВ. М.IvanykinaV. M.

Иваныкина Валентина Михайловна, врач-ординатор отделения химиотерапии отдела лекарственного лечения опухолей.

125834, Москва, 2-й Боткинский проезд, д. 3

Valentina M. Ivanykina, Resident Physician, Department of Chemotherapy, Department of Drug Treatment of Tumors.

3, 2nd Botkinskiy Proezd, Moscow, 125834

ivanykina.valya@mail.ruhttps://orcid.org/0000-0003-4927-5585ФеденкоА. А.FedenkoA. A.

Феденко Александр Александрович - д.м.н., руководитель отдела лекарственного лечения опухолей. AuthorID: 823233

125834, Москва, 2-й Боткинский проезд, д. 3

Alexander A. Fedenko - Dr. Sci. (Med.), Head of the Department of Drug Treatment of Tumors.

3, 2nd Botkinskiy Proezd, Moscow, 125834

fedenko@eesg.ruМосковский научный исследовательский онкологический институт имени П.А. Герцена – филиал Национального медицинского исследовательского центра радиологииРоссияHertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological CenterRussian Federation2024240720240109096Copyright © Устинова Т.В., Чанаева А.Ю., Пайчадзе А.А., Левшакова А.В., Болотина Л.В., Иваныкина В.М., Феденко А.А., 20242024Устинова Т.В., Чанаева А.Ю., Пайчадзе А.А., Левшакова А.В., Болотина Л.В., Иваныкина В.М., Феденко А.А.Ustinova T.V., Chanaeva A.Y., Paichadze A.A., Levshakova A.V., Bolotina L.V., Ivanykina V.M., Fedenko A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8399

Почечноклеточный рак является одним из наиболее распространенных заболеваний в онкоурологии. Ведущим морфологическим вариантом почечноклеточного рака на сегодняшний день является светлоклеточный подтип, определяемый в 80% случаев. Несмотря на интенсивность методов диагностики, практически у 1/3 больных раком почки при первичном обследовании выявляют отдаленные метастазы, что обусловливает крайне высокие показатели смертности от данной нозологии. Стандартные режимы химиотерапии с включением фторпиримидинов и противоопухолевых антибиотиков, цитокиновая терапия с применением интерлейкина-2 и интерферона-α лишь незначительно продлевали жизнь пациентам, вызывая при этом выраженные нежелательные явления. Появление ингибиторов тирозинкиназы позволило получить действительно значимые результаты в лечении метастатического почечноклеточного рака. Следующей ступенью стала регистрация FDA в апреле 2018 г. комбинации иммуноонкологических препаратов ипилимумаба и ниволумаба для лечения метастатического почечноклеточного рака. В последующем были зарегистрированы комбинации ингибиторов иммунных контрольных точек с таргетными препаратами, что не только позволило значительно увеличить продолжительность жизни пациентов, но и снизило частоту встречаемости нежелательных явлений противоопухолевой терапии. В статье приведены клинические примеры, демонстрирующие эффективность комбинации пембролизумаба и акситиниба при лечении больных метастатическим почечноклеточным раком.

Renal cell carcinoma is one of the most common diseases in oncourology. The leading morphological variation of renal cell carcinoma today is the light-cell subtype, which is determined in 80% of cases. Despite the intensity of diagnostic methods, almost 1/3 of patients with kidney cancer have distant metastases during initial examination, which causes extremely high mortality rates from this oncopathology. Standard chemotherapy schemes with the inclusion of fluoropyrimidines and antitumor antibiotics, cytokine therapy using interleukin-2 and interferon α only slightly prolonged the life of patients, while causing pronounced toxic-anemic adverse events. The appearance of tyrosine kinase inhibitors has allowed us to obtain really significant results in the treatment of metastatic renal cell carcinoma. The next step in the treatment of renal cell carcinoma was the registration by the US FDA in April 2018 of a combination of immuno-oncological drugs ipilimumab and nivolumab for the treatment of metastatic renal cell carcinoma. Afterwards, combinations of immune checkpoint inhibitors with targeted drugs were registered, which not only significantly increased the life expectancy of patients, but also reduced the incidence of adverse events of antitumor therapy. This article provides clinical examples demonstrating the effectiveness of the combination of pembrolizumab and axitinib in the treatment of patients with metastatic renal cell carcinoma.

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