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Ниволумаб как представитель ингибиторов контрольных точек иммунного ответа в поздних линиях лечения при диссеминированном раке желудка

https://doi.org/10.21518/2079-701X-2021-9-96-107

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Аннотация

Рак желудка (РЖ) является одной из наиболее распространенных злокачественных опухолей как в мире, так и в России. Основным методом лечения является лекарственная терапия с последовательным применением нескольких линий. Число химиопрепаратов, эффективных при данном виде злокачественных опухолей, ограничено, спектр таргетных препаратов также узок и включает трастузумаб в 1-й линии лечения HER2-позитивного РЖ и рамуцирумаб – во 2-й линии. Ингибиторы контрольных точек иммунного ответа произвели революцию в лечении многих злокачественных опухолей. При диссеминированном РЖ доказана эффективность ингибитора рецепторов PD-1, расположенных на T-лимфоцитах, – ниволумаба – в 3-й линии лечения. Согласно результатам рандомизированного исследования ATTRACTION-2, ниволумаб по сравнению с оптимальной симптоматической терапией значимо увеличил медиану общей выживаемости (с 4,14 до 5,26 мес., p < 0,0001), выживаемости без прогрессирования (с 1,45 до 1,61 мес., p < 0,0001); объективный ответ с медианой длительности 9,5 мес. был достигнут у 11,2% пациентов, стабилизация болезни – у 29,1%. Медиана времени до ответа на терапию ниволумабом составила 1,61 мес. Токсичность лечения была довольно низкой и привела к прекращению лечения только у 1% (n = 4) больных, ранее получивших массивную химиотерапию. В исследовании ATTRACTION-2 принимали участие только пациенты из стран Азии. Однако его результаты были подтверждены в исследовании CheckMate-032 на неазиатской популяции больных: частота объективного ответа составила 12%, медиана длительности ответа – 7,1 мес., медиана выживаемости без прогрессирования – 1,4 мес., медиана общей выживаемости – 6,1 мес. Ниволумаб был эффективен при MSI-H и MSS, при PD-L1-позитивных и PD-L1-негативных опухолях. Ниволумаб является общепризнанным и хорошо переносимым стандартом терапии поздних линий при диссеминированном РЖ. Спектр показаний для его назначения в ближайшее время будет расширяться.

Об авторе

Н. С. Бесова
Национальный медицинский исследовательский центр онкологии имени Н.Н. Блохина
Россия

Бесова Наталия Сергеевна, кандидат медицинских наук, ведущий научный сотрудник онкологического отделения лекарственных методов лечения (химиотерапевтического) №2 Научно-исследовательского института клинической онкологии имени академика РАН и РАМН Н.Н. Трапезникова

115478, Москва, Каширское шоссе, д. 24



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Для цитирования:


Бесова Н.С. Ниволумаб как представитель ингибиторов контрольных точек иммунного ответа в поздних линиях лечения при диссеминированном раке желудка. Медицинский Совет. 2021;(9):96-107. https://doi.org/10.21518/2079-701X-2021-9-96-107

For citation:


Besova N.S. Nivolumab as a representative of immune checkpoint inhibitors in late-line treatment for disseminated gastric cancer. Meditsinskiy sovet = Medical Council. 2021;(9):96-107. (In Russ.) https://doi.org/10.21518/2079-701X-2021-9-96-107

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