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ПРИОБРЕТЕННАЯ РЕЗИСТЕНТНОСТЬ К ИНГИБИТОРАМ ТИРОЗИНКИНАЗЫ EGFR: ПУТИ ПРЕОДОЛЕНИЯ

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Аннотация

Успехи в лечении диссеминированных больных с немелкоклеточным раком легкого напрямую связаны с таргетной терапией. Пациенты с активирующими мутациями в гене рецептора эпидермального фактора роста (EGFR) при назначении им в первую линию ингибиторов тирозинкиназы EGFR (ТКИ  EGFR) первого и второго поколений имеют достоверное преимущество по непосредственной эффективности и времени до прогрессирования. Кроме того, у больных с делецией в 19 экзоне EGFR, получающих афатиниб, общая выживаемость достигает 30  мес., что статистически  выше по сравнению со стандартной химиотерапией. Однако в течение 10–12 мес. развивается приобретенная резистентность к таргетным препаратам, основной причиной которой в 60% случаев является мутация Т790М. Осимертиниб – ТКИ третьего поколения, оказался высокоэффективен именно у этих больных. Для уточнения механизма резистентности требуется повторное молекулярно-генетическое тестирование. Таким образом, необходима повторная биопсия опухоли, оптимально из очага прогрессирования. К сожалению, это не всегда выполнимо, и альтернативой может быть жидкостная биопсия. Только такой индивидуальный подход может обеспечить выбор оптимальной лечебной тактики и добиться улучшения выживаемости пациентов.

Об авторах

Е. В. Реутова
Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава России
Россия

Кандидат медицинских наук.

Москва



К. К. Лактионов
Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава России
Россия

Доктор медицинских наук,  профессор.

Москва



М. С. Ардзинба
Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава России
Россия

Кандидат медицинских наук.

Москва



Л. А. Нелюбина
Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава России
Россия

Кандидат медицинских наук.

Москва



А. Л. Арзуманян
Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава России
Россия

Кандидат медицинских наук.

Москва



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Для цитирования:


Реутова Е.В., Лактионов К.К., Ардзинба М.С., Нелюбина Л.А., Арзуманян А.Л. ПРИОБРЕТЕННАЯ РЕЗИСТЕНТНОСТЬ К ИНГИБИТОРАМ ТИРОЗИНКИНАЗЫ EGFR: ПУТИ ПРЕОДОЛЕНИЯ. Медицинский Совет. 2017;(14):24-28.

For citation:


., ., ., ., . . Medical Council. 2017;(14):24-28. (In Russ.)

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