Оптимальная последовательность применения ингибиторов рецептора эпидермального фактора роста у пациентов с распространенным немелкоклеточным раком легкого, имеющих в опухоли активирующие мутации гена EGFR

Автор: Коломейцева Алина Андреевна, Феденко Александр Александрович

Журнал: Сибирский онкологический журнал @siboncoj

Статья в выпуске: 6 т.19, 2020 года.

Бесплатный доступ

Актуальность. Успехи лечения больных EGFR-позитивным немелкоклеточным раком легкого (НМРЛ) напрямую связаны с применением ингибиторов рецептора эпидермального фактора роста (EGFR). В настоящее время для лечения этой группы пациентов применяются три поколения ингибиторов EGFR. Актуальным представляется вопрос о том, какой препарат или какая последовательность их применения будет оптимальным вариантом лечения для конкретного пациента. Цель исследования -проанализировать современные данные о применении ингибиторов EGFR в терапии больных распространенным EGFR-позитивным НМРЛ, а также оценить возможные механизмы резистентности к ним и определить оптимальную терапевтическую последовательность ингибиторов EGFR различных поколений. Материал и методы. В обзор включены данные рандомизированных клинических исследований, а также результаты исследования, проведенного в условиях реальной клинической практики, изучающих эффективность ингибиторов EGFR и варианты последующей терапии в случае развития лекарственной резистентности к ним. Результаты. Выбор оптимального варианта терапии первой линии больных EGFR-позитивным НМРЛ зависит от множества факторов но, на наш взгляд, терапия афатинибом с последующим переходом на осимертиниб при появлении мутации Т790М в опухоли позволяет максимально продлить малотоксичную таргетную терапию и отсрочить применение цитостатических препаратов. Заключение. Учитывая доминирующий механизм развития резистентности - появление мутации Т790М гена EGFR, именно последовательное применение ингибиторов EGFR второго и третьего поколений, на наш взгляд, представляется оптимальным вариантом лечения больных EGFR-позитивным НМРЛ.

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Нмрл, ингибиторы egfr, мутация t790m, гефитиниб, эрлотиниб, афатиниб, осимертиниб, резистентность

Короткий адрес: https://sciup.org/140254388

IDR: 140254388 | DOI: 10.21294/1814-4861-2020-19-6-119-125

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