medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-535medsovet-9693Research ArticleТАРГЕТНАЯ ТЕРАПИЯTARGET THERAPY OF TUMORSКлинический случай применения трастузумаба дерукстекана в лечении HER2-позитивного рака молочной железы, резистентного к стандартной терапииClinical case of trastuzumab deruxtecan use in treatment of patient with metastatic HER2-positive breast cancer and failure to standard therapyhttps://orcid.org/0000-0002-8149-0085ФроловаМ. А.FrolovaM. A.

Фролова Мона Александровна - д.м.н., ведущий научный сотрудник отделения противоопухолевой лекарственной терапии №1.

115478, Москва, Каширское шоссе, д. 23

Mona A. Frolova - Dr. Sci. (Med.), Leading Researcher of the Department of Antitumor Drug Therapy No. 1, Blokhin National Medical Research Center of Oncology.

23, Kashirskoye Shosse, Moscow, 115478

drfrolova@yandex.ruhttps://orcid.org/0009-0003-4878-9303ТрусиловаЕ. В.TrusilovaE. V.

Трусилова Елена Владимировна - к.м.н., научный сотрудник отделения противоопухолевой лекарственной терапии №1.

115478, Москва, Каширское шоссе, д. 23

Elena V. Trusilova - Cand. Sci. (Med.), Researcher of the Department of Antitumor Drug Therapy No. 1, Blokhin National Medical Research Center of Oncology.

23, Kashirskoye Shosse, Moscow, 115478

tev_86@mail.ruНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian Federation2025010120260216772Copyright © Фролова М.А., Трусилова Е.В., 20262026Фролова М.А., Трусилова Е.В.Frolova M.A., Trusilova E.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/9693

В настоящее время в арсенале онкологов имеются многочисленные препараты анти-HER2-направленного действия, последовательное применение которых обеспечивает длительный контроль болезни при метастатическом HER2-позитивном раке молочной железы. Данные препараты относятся к различным классам: моноклональные антитела, ингибиторы тирозинкиназ, а также конъюгаты «антитело – цитостатик», отличающиеся принципиально новым механизмом действия. В них цитостатик соединен с моноклональным антителом специальным линкером. Благодаря такому строению моноклональное антитело (трастузумаб) распознает таргетные опухолевые клетки (HER2-позитивные), соединяется с HER2-рецептором, после чего комплекс «антитело – рецептор» интернализуется в клетку, а затем активный цитостатик высвобождается и оказывает свое действие непосредственно в опухолевой клетке. Одним из наиболее эффективных конъюгатов на сегодняшний день является трастузумаб дерукстекан (T-DXd), который изучался в большом количестве исследований и продемонстрировал высокую частоту объективных ответов, при этом выживаемость без прогрессирования и общая выживаемость были существенно выше, чем при использовании стандартных вариантов лечения. В настоящей статье представлен клинический случай применения T-DXd в качестве 6-й линии терапии у пациентки с метастатическим HER2-позитивным раком молочной железы с поражением легких и головного мозга, а также отсутствием ответа на предшествующие линии лечения, что встречается крайне редко. В процессе прогрессирования при проведении стандартных вариантов лечения у пациентки нарастали кашель и одышка, что заставило ее оставить работу и существенно ухудшило качество жизни. При выявлении метастазов в головном мозге ей был назначен T-DXd, и впервые за все линии лечения была зафиксирована положительная динамика со стороны опухолевого процесса в легких, что привело к выраженному улучшению самочувствия.

Currently oncologists have numerous anti-HER2 drugs available, the sequential use of which ensures long-term disease control in metastatic HER2-positive breast cancer. These drugs belong to various classes, including monoclonal antibodies, tyrosine kinase inhibitors, and antibody–drug conjugates, which feature a fundamentally new mechanism of action. In these conjugates, the cytostatic agent is linked to the monoclonal antibody via a special linker. This structure allows the monoclonal antibody (trastuzumab) to recognize targeted tumor cells (HER2-positive), bind to the HER2 receptor, and the antibody–receptor complex is then internalized into the cell. The active cytostatic agent is then released and exerts its effect directly on the tumor cell. One of the most effective conjugates to date is trastuzumab deruxtecan (T-DXd). It has been studied in numerous trials and demonstrated high objective response rates, with progression-free survival and overall survival significantly higher than with standard treatment options. This article presents a clinical case of the use of T-DXd as a sixth-line therapy in a patient with metastatic HER2-positive breast cancer involving the lungs and brain, who had failed to respond to previous treatments, a rare occurrence. As the disease progressed, the patient’s cough and shortness of breath worsened with standard treatments, forcing her to leave work and significantly impairing her quality of life. When brain metastases were detected, she was prescribed T-DXd, and for the first time after all treatments, positive dynamics in the lung tumor process were observed, leading to a significant improvement in her well-being.

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