medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-297medsovet-9251Research ArticleТАРГЕТНАЯ ТЕРАПИЯTARGET THERAPY OF TUMORSКлинический случай терапии BRCA1-ассоциированного метастатического рака поджелудочной железыClinical case of therapy for BRCA1-associated metastatic pancreatic cancerhttps://orcid.org/0000-0001-6267-8237ПоповА. Ю.PopovA. Yu.

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

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

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

27, Bolshaya Serpukhovskaya St., Moscow, 117997

popov_63@mail.ruБайтманТ. П.BaitmanT. P.

Байтман Татьяна Павловна, к.м.н., научный сотрудник отделения урологии, Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского;  ассистент кафедры урологии и оперативной нефрологии с курсом онкоурологии, Российский университет дружбы народов имени Патриса Лумумбы

117997, Москва, ул. Большая Серпуховская, д. 27; 117198, Москва, ул. Миклухо-Маклая, д. 6

Tatiana P. Baitman, Cand. Sci. (Med.), Researcher of the Urology Department, Vishnevsky National Medical Research Center of Surgery; Assistant of the Department of Urology and Operative Nephrology with Course of Oncourology, Peoples’ Friendship University of Russia named after Patrice Lumumba

27, Bolshaya Serpukhovskaya St., Moscow, 117997; 6, Miklukho-Maklai St., Moscow, 117198

 

bit.t@mail.ruhttps://orcid.org/0000-0003-3202-6873СимоновA. Д.SimonovA. D.

Симонов Антон Дмитриевич, врач-онколог

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

Anton D. Simonov, Oncologist, the Department of Chemotherapy

27, Bolshaya Serpukhovskaya St., Moscow, 117997

dr.simonov@uro-ixv.ruhttps://orcid.org/0000-0001-9838-4759МакаровВ. А.

Макаров Владислав Александрович, к.м.н., врач-онколог отделения противоопухолевой лекарственной терапии

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

https://orcid.org/0000-0002-9074-5676МарковП. В.MarkovP. V.

Марков Павел Викторович, д.м.н., заведующий отделением абдоминальной хирургии

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

Pavel V. Markov, Dr. Sci. (Med.), Head of the Department of Abdominal Surgery

27, Bolshaya Serpukhovskaya St., Moscow, 117997

https://orcid.org/0000-0002-6452-4458ГоринД. С.GorinD. S.

Горин Давид Семенович, д.м.н., заведующий хирургическим отделением №5

115446, Москва, Коломенский проезд, д. 4

David S. Gorin, Dr. Sci. (Med.), Head of the Surgical Department No. 5

4, Kolomenskiy Proezd, Moscow, 115446

https://orcid.org/0000-0002-5160-925XГрицкевичА. А.GritskevichA. A.

Грицкевич Александр Анатольевич, д.м.н., заведующий отделением урологии, Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского; профессор кафедры урологии и оперативной нефрологии с курсом онкоурологии, Российский университет дружбы народов имени Патриса Лумумбы

 117997, Москва, ул. Большая Серпуховская, д. 27; 117198, Россия, ул. Миклухо-Маклая, д. 6

Alexander A. Gritskevich, Dr. Sci. (Med.), Head of the Urology Department, Vishnevsky National Medical Research Center of Surgery; Professor of the Department of Urology and Operative Nephrology with Course of Oncourology, Peoples’ Friendship University of Russia named after Patrice Lumumba

27, Bolshaya Serpukhovskaya St., Moscow, 117997; 6, Miklukho-Maklai St., Moscow, 117198

grekaa@mail.ruhttps://orcid.org/0000-0001-7070-3391КондратьевЕ. В.KondratyevE. V.

Кондратьев Евгений Валерьевич, к.м.н., заведующий отделением рентгенологии и магнитно-резонансных исследований

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

Evgeny V. Kondratyev, Cand. Sci. (Med.), Head of the Department of Radiology and Magnetic Resonance Research

27, Bolshaya Serpukhovskaya St., Moscow, 117997

kondratev@ixv.ruhttps://orcid.org/0000-0001-6247-9481КалининД. В.KalininD. V.

Калинин Дмитрий Валерьевич, к.м.н., заведующий отделением патологической анатомии

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

Dmitry V. Kalinin, Cand. Sci. (Med.), Head of the Department of Pathological Anatomy

27, Bolshaya Serpukhovskaya St., Moscow, 117997

dmitry.v.kalinin@gmail.comhttps://orcid.org/0000-0002-9054-5068ЖуковН. В.ZhukovN. V.

Жуков Николай Владимирович, д.м.н., профессор, руководитель отдела междисциплинарной онкологии

117997, Россия, Москва, ул. Саморы Машела, д. 1

Nikolay V. Zhukov, Dr. Sci. (Med.), Professor, Head of the Department of Interdisciplinary Oncology

1, Samora Mashel St., Moscow, 117997

Национальный медицинский исследовательский центр хирургии имени А.В. ВишневскогоРоссияVishnevsky National Medical Research Center of SurgeryRussian FederationНациональный медицинский исследовательский центр хирургии имени А.В. Вишневского; Российский университет дружбы народов имени Патриса ЛумумбыРоссияVishnevsky National Medical Research Center of Surgery; Peoples’ Friendship University of Russia named after Patrice LumumbaRussian FederationНациональный медицинский исследовательский центр хирургии имени А.В. ВишневскогоRussian FederationГородская клиническая больница имени С.С. ЮдинаРоссияCity Clinical Hospital named after S.S. YudinRussian FederationНациональный медицинский исследовательский центр детской гематологии, онкологии и иммунологии имени Дмитрия РогачеваРоссияNational Medical Research Center for Children’s Hematology, Oncology and Immunology named after Dmitry RogachevRussian Federation2025300720250105664Copyright © Попов А.Ю., Байтман Т.П., Симонов A.Д., Макаров В.А., Марков П.В., Горин Д.С., Грицкевич А.А., Кондратьев Е.В., Калинин Д.В., Жуков Н.В., 20252025Попов А.Ю., Байтман Т.П., Симонов A.Д., Макаров В.А., Марков П.В., Горин Д.С., Грицкевич А.А., Кондратьев Е.В., Калинин Д.В., Жуков Н.В.Popov A.Y., Baitman T.P., Simonov A.D., Макаров В.А., Markov P.V., Gorin D.S., Gritskevich A.A., Kondratyev E.V., Kalinin D.V., Zhukov N.V.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/9251

Представлено клиническое наблюдение пациентки с BRCA1-ассоциированным метастатическим раком поджелудочной железы (мРПЖ), получавшей первую линию химиотерапии (ХТ) mFOLFIRINOX с последующим переходом на поддерживающую терапию олапарибом (300 мг 2 раза в сутки). На фоне лечения достигнута значимая регрессия опухоли и метастазов в печени, нормализация уровня СА-19-9 (с 952 до 7 Ед/мл). Пациентка была условно радикально оперирована в объеме удаления первичной опухоли, продолжена терапия олапарибом. Клинический случай иллюстрирует эффективность таргетной терапии PARP-ингибиторами у пациентов с BRCA1/2-мутациями и подчеркивает важность генетического тестирования при РПЖ и дает повод задуматься о месте ингибиторов PARP в адъювантной терапии. В настоящее время олапариб является стандартом поддерживающей терапии для пациентов с gBRCA-мутированным (включая BRCA1) мРПЖ, достигших контроля заболевания на первой линии ХТ платиной. Отдаленные результаты обнадеживают, демонстрируя потенциал для длительного контроля заболевания у значительной части пациентов. Данные по ответу на терапию и выживаемости свидетельствуют о значительном расхождении в эффективности лечения пациентов с наличием или отсутствием мутаций. Так, медиана общей выживаемости (ОВ) при BRCA-положительном мРПЖ без терапии составляет 8–12 мес. (что сопоставимо со спорадическим мРПЖ), а с ХТ (FOLFIRINOX/гемцитабин + цисплатин) достигает 18–22 мес. Поддерживающая терапия олапарибом после лечения препаратами платины повышает выживаемость без прогрессирования (ВБП): 7,4 мес. против 3,8 мес. без терапии. Это свидетельствует о высокой значимости тестирования на BRCA1/2 при РПЖ. Вопрос о хирургическом лечении больных мРПЖ, давших положительный ответ на терапию, остается крайне дискутабельным и требует дальнейшего изучения. Данных по адъювантному (после радикальной операции) режиму терапии пока недостаточно, однако ведутся  исследования  (APOLLO, NCT04858334).

The article presents a clinical case of a patient with BRCA1-associated metastatic pancreatic cancer (mPC) who received first-line chemotherapy with mFOLFIRINOX followed by a transition to maintenance therapy with olaparib (300 mg 2 times a day). During the treatment, significant regression of the tumor and liver metastases, normalization of the CA-19-9 level (from 952 to 7 U/ml) were achieved. The patient underwent conditional radical surgery to remove the primary tumor, and olaparib therapy was continued. The clinical case illustrates the effectiveness of targeted therapy with PARP inhibitors in patients with BRCA1/2 mutations and emphasizes the importance of genetic testing in PCa and gives reason to think about the place of PARP inhibitors in adjuvant therapy. Nowadays olaparib is the standard of care for patients with gBRCA-mutated (including BRCA1) mPCa who have achieved disease control on first-line platinum-based chemotherapy. Long-term results are encouraging, demonstrating the potential for long-term disease control in a significant proportion of patients. Data on response to therapy and survival indicate a significant discrepancy in the effectiveness of treatment for patients with or without mutations. Thus, the median overall survival (OS) in BRCA-positive mPC without therapy is 8–12 months (which is comparable to sporadic mPC), and with chemotherapy (FOLFIRINOX/gemcitabine + cisplatin) it reaches 18–22 months. Maintenance therapy with olaparib after treatment with platinum drugs increases progression-free survival (PFS): 7.4 months versus 3.8 months without therapy. This indicates the high significance of BRCA1/2 testing in PC. The issue of surgical treatment of patients with mPCa who have responded positively to therapy remains highly controversial and requires further study. There is insufficient data on the adjuvant (after radical surgery) therapy regimen, but studies are underway (APOLLO, NCT04858334).

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