medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-515medsovet-9699Research ArticleТАРГЕТНАЯ ТЕРАПИЯTARGET THERAPY OF TUMORSМутация BRCA как предиктор эффективности системного лечения у пациентки с первично-множественным синхронным раком (молочной железы, яичников и желудка)BRCA mutation as a predictor of systemic therapy response in a patient with synchronous multiple primary cancer (breast, ovarian, and gastric cancer)https://orcid.org/0000-0002-6244-9159ПризоваН. С.PrizovaN. S.

Призова Наталия Сергеевна - к.м.н., врач-онколог отделения химиотерапии.

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

Natalia S. Prizova - Cand. Sci. (Med.), Oncologist, Department of Chemotherapy, Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Center.

3, 2nd Botkinskiy Proezd, Moscow, 125834

sonrisa3n@mail.ruhttps://orcid.org/0000-0003-4879-2687БолотинаЛ. В.BolotinaL. V.

Болотина Лариса Владимировна - д.м.н., заведующая отделением химиотерапии.

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

Larisa V. Bolotina - Dr. Sci. (Med.), Head of Chemotherapy Department, Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Center.

3, 2nd Botkinskiy Proezd, Moscow, 125834

lbolotina@yandex.ruhttps://orcid.org/0000-0003-0092-0459КорниецкаяА. Л.KornietskayaA. L.

Корниецкая Анна Леонидовна - к.м.н., ведущий научный сотрудник отдела лекарственного лечения опухолей.

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

Аnna L. Kornietskaya - Cand. Sci. (Med.), Senior Researcher, Department of Chemotherapy, Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Center.

3, 2nd Botkinskiy Proezd, Moscow, 125834

kornietskaya@mail.ruhttps://orcid.org/0000-0002-1993-3842ЕвдокимоваС. Ф.EvdokimovaS. F.

Евдокимова Сэвиндж Физулиевна - врач-онколог.

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

Sevindzh F. Evdokimova - Oncologist, Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Center.

3, 2nd Botkinskiy Proezd, Moscow, 125834

evdokimova.sevindzh@gmail.comМосковский 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 Federation2025010120260217380Copyright © Призова Н.С., Болотина Л.В., Корниецкая А.Л., Евдокимова С.Ф., 20262026Призова Н.С., Болотина Л.В., Корниецкая А.Л., Евдокимова С.Ф.Prizova N.S., Bolotina L.V., Kornietskaya A.L., Evdokimova S.F.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/9699

Первично-множественные злокачественные новообразования (ПМЗНО) становятся все более актуальной проблемой в онкологии из-за роста заболеваемости и сложности подбора оптимальной терапии. Герминальные мутации в генах BRCA1/2 повышают риск развития рака молочной железы и яичников и могут служить предикторами чувствительности к системной терапии препаратами платины и PARP-ингибиторами, которые являются универсальными агентами для лечения этих ЗНО. В статье представлен клинический случай пациентки 63 лет с ПМЗНО: серозной карциномы яичников IV стадии с метастатическим поражением внутригрудных лимфатических узлов, раком молочной железы IIА стадии и перстневидно-клеточным раком желудка IIB стадии. При проведении молекулярно-генетического исследования методом NGS была выявлена герминальная мутация BRCA1 (с.5382_5383insC). Пациентке проведено 6 курсов химиотерапии по схеме паклитаксел + карбоплатин, что привело к значительному уменьшению опухолевых очагов яичников и молочной железы, а также стабилизации опухолевого процесса в желудке по данным инструментальных методов обследования. После достижения частичного ответа выполнено радикальное хирургическое вмешательство в объеме дистальной субтотальной резекции желудка с лимфодиссекцией Д2, экстирпации матки с придатками и радикальной мастэктомии справа. С учетом выявленной BRCA1-мутации пациентке в качестве поддерживающей терапии назначен PARP-ингибитор олапариб в течение 24 мес. в сочетании с ингибиторами ароматазы. На протяжении 2 лет наблюдения отсутствуют признаки прогрессирования какого-либо из выявленных ЗНО, терапия переносилась удовлетворительно, токсичность ограничивалась анемией 1-й степени. Данный клинический случай демонстрирует значение молекулярно-генетического тестирования и мультидисциплинарного подхода при ПМЗНО. Наличие герминальной мутации BRCA1 позволило подобрать эффективную системную терапию, включающую платиносодержащую схему химиотерапии и PARP-ингибитор, и достичь стойкой ремиссии при множественной первично-синхронной опухолевой патологии. Приведенное наблюдение подчеркивает важность персонализированного подхода к лечению пациентов с множественными синхронными опухолями.

Synchronous multiple primary malignancies (MPM) represent an increasingly relevant challenge in oncology due to rising the incidence and complexity of selecting optimal therapy. Germline mutations in BRCA1/2 genes are associated with a higher risk of breast and ovarian cancers and may serve as predictors of sensitivity to systemic therapies, including platinum-based chemotherapy and PARP inhibitors. We present a case of a 63-year-old female patient with MPM, including stage IV serous ovarian carcinoma with metastases in mediastinal lymph nodes, stage IIA breast carcinoma, and signet-ring cell gastric carcinoma stage IIB. Next-generation sequencing (NGS) identified a germline BRCA1 mutation (c.5382_5383insC). The patient received six cycles of paclitaxel plus carboplatin chemotherapy, resulting in a significant reduction of ovarian and breast tumor lesions by more than threefold and stabilization of the gastric tumor as assessed by imaging. Following partial response, radical surgical treatment was performed, including distal subtotal gastrectomy with D2 lymphadenectomy, hysterectomy with bilateral salpingo-oophorectomy, and right mastectomy. Considering the detected BRCA1 mutation, maintenance therapy with the PARP inhibitor olaparib was administered for 24 months in combination with aromatase inhibitors. During two years of follow-up, no disease progression was observed, the therapy was well tolerated, and adverse effects were limited to grade 1 anemia. This case highlights the clinical value of molecular genetic testing and a multidisciplinary approach in patients with MPM. Identification of a germline BRCA1 mutation allowed for selection of an effective systemic therapy, including platinum-based agents and a PARP inhibitor, achieving durable remission in the context of multiple synchronous primary tumors. The report underscores the importance of personalized treatment strategies for patients with synchronous multiple malignancies.

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