Новые возможности терапии метастатического HER2-позитивного рака молочной железы с лептоменингеальным поражением

Молекулярный подтип рака молочной железы, ассоциированный с гиперэкспрессией HER2/neu, характеризуется более частым и ранним метастазированием в центральную нервную систему, предопределяя неблагоприятный прогноз для больных данной категории. Пациенты с вторичным поражением головного мозга опухолями любой локализации и гистологической структуры являются наиболее сложной группой больных, демонстрирующей крайне низкий уровень качества жизни, требующей особого пристального наблюдения и выработки персонального алгоритма ведения. Развитие лептоменингеального поражения вдвойне усложняет задачу специалиста в связи с тяжестью клинического течения и резистентностью к любым терапевтическим воздействиям. Появление в практике нового лекарственного препарата – конъюгата гуманизированного антитела иммуноглобулина G1 и ингибитора топоизомеразы I, производного экзатекана трастузумаба дерукстекана (T-DXd) в качестве дополнительной терапевтической опции является новой надеждой для больных метастатическим раком молочной железы (мРМЖ), в т. ч. с поражением центральной нервной системы. В настоящей статье приведен обзор эффективности и безопасности T-DXd в регистрационных исследованиях, продемонстрирована клиническая польза терапии у пациентки с HER2-положительным (HER2+) мРМЖ с вовлечением оболочек головного мозга в условиях реальной клинической практики.

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