Ингибиторы тирозинкиназ второго поколения при хроническом миелоидном лейкозе сегодня: эффективность и безопасность

Прогноз хронического миелолейкоза (ХМЛ) за последние два с лишним десятилетия существенно изменился: заболевание с общей выживаемостью всего 5 лет превратилось в болезнь, при которой продолжительность жизни пациентов может быть близка к популяционной. Такое значительное улучшение результатов терапии в основном связано с введением в клинику иматиниба – первого одобренного к лечению ХМЛ ингибитора тирозинкиназ (ИТК), а также ИТК последующих генераций. Несмотря на то что около 20–25% больных после достижения глубокой молекулярной ремиссии смогут успешно прекратить прием ИТК, большинству из них потребуется продолжение лечения в течение неопределенного срока и различных сценариев развития ХМЛ. В статье рассматриваются эффективность и безопасность лишь ИТК 2-го поколения, каждый из которых имеет свой спектр как нежелательных явлений, так и преимущества при назначении в первой или последующих линиях терапии ХМЛ. При этом чрезвычайно важно учитывать наличие и степень выраженности сопутствующих заболеваний, знать, какие ИТК и в каких дозировках приемлемы для каждой конкретной клинической ситуации, что можно ожидать в случае назначения того или иного ИТК и как предупреждать их потенциальные побочные эффекты. Многим из пациентов потребуется третья и, возможно, последующие линии терапии. При отборе таких пациентов важно проводить различие между неэффективностью и непереносимостью предыдущих ИТК, что влияет на принятие решения об изменении дозы препарата или его замене. Все эти вопросы рассматриваются в настоящей статье с практической точки зрения.

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