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

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.

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