Роль иммунотерапии в лечении метастатических и рецидивирующих новообразований женской репродуктивной системы

В 2019 г. такие злокачественные новообразования женской репродуктивной системы, как рак яичников (РЯ), рак тела (РТМ) и шейки матки (РШМ) были диагностированы у 58 860 пациенток, что составляет 17,6% от всех злокачественных опухолей у женщин. Показатели заболеваемости и смертности от этих новообразований в течение последних 10 лет остаются на стабильно высоком уровне. В данной статье проведен подробный обзор текущей доказательной базы по применению различных иммунотерапевтических агентов при таких злокачественных новообразованиях женской репродуктивной системы, как рак тела матки, рак шейки матки и рак яичников. Продемонстрировано, что при рецидивах РЯ единственной нишей для применения иммунотерапии является категория пациенток с наличием в опухоли доказанной микросателлитной нестабильности (MSI), а такой распространенный маркер, как PD-L1, не имеет самостоятельной роли при данном заболевании. При этом MSI встречается приблизительно у 8% пациенток с метастатическим РЯ. Значительно бо́льшая частота встречаемости этого биомаркера – до 25% отмечается при диссеминированном РТМ, MSI-позитивный подтип заболевания характеризуется крайне высокой чувствительностью к иммунотерапии – частота объективного ответа при применении пембролизумаба превышает 50%. При MSI-негативном РТМ доказанной эффективностью обладает комбинация пембролизумаба и ленватиниба. При диссеминированном РШМ, с другой стороны, PD-L1 обладает предиктивной ролью в отношении эффективности иммунотерапии: исследование KEYNOTE-158 продемонстрировало, что около 15% пациенток с предлеченным метастатическим PD-L1-позитивным РШМ достигают длительной ремиссии на фоне иммунотерапии пембролизумабом по сравнению с 0% при PD-L1-негативных опухолях. Одновременно с этим анализ литературных данных показывает, что экспрессия PD-L1 отмечается у ≥ 30% пациенток с распространенным РШМ, что делает целесообразным широкое тестирование пациенток на наличие данного биомаркера.

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