oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2020-19-6-119-125oncotomsk-1649Research ArticleОБЗОРЫREVIEWSОПТИМАЛЬНАЯ ПОСЛЕДОВАТЕЛЬНОСТЬ ПРИМЕНЕНИЯ ИНГИБИТОРОВ РЕЦЕПТОРА ЭПИДЕРМАЛЬНОГО ФАКТОРА РОСТА У ПАЦИЕНТОВ С РАСПРОСТРАНЕННЫМ НЕМЕЛКОКЛЕТОЧНЫМ РАКОМ ЛЕГКОГО, ИМЕЮЩИХ В ОПУХОЛИ АКТИВИРУЮЩИЕ МУТАЦИИ ГЕНА EGFROPTIMAL SEQUENCE OF APPLICATION OF EPIDERMAL GROWTH FACTOR RECEPTOR INHIBITORS IN ADVANCED NON-SMALL CELL LUNG CANCER PATIENTS WITH ACTIVATING EGFR MUTATIONShttps://orcid.org/0000-0002-6762-9511КоломейцеваА. А.KolomeytsevaA. A.

кандидат медицинских наук, заведующая дневным стационаром поликлиники

SPIN-код: 1899-8316

Россия, 125284, г. Москва, 2-й Боткинский пр., 3

MD, PhD, Head of Day Hospital

3, 2-nd Botkinsky proezd, Moscow-125284, Russia

almed2002@mail.ruhttps://orcid.org/0000-0003-4927-5585ФеденкоА. А.FedenkoA. A.

доктор медицинских наук, заведующий отделом лекарственного лечения опухолей

SPIN-код: 9847-7668

Россия, 125284, г. Москва, 2-й Боткинский пр., 3

 

3, 2-nd Botkinsky proezd, Moscow-125284, Russia

МНИОИ им. П.А. Герцена – филиала ФГБУ «НМИЦ радиологии» Минздрава РоссииРоссияP.A. Herzen Moscow Research Oncology Institution – branch of National Medical Research Center of Radiology of Ministry of Healthcare of the Russian FederationRussian Federation202030122020196119125Copyright © Коломейцева А.А., Феденко А.А., 20202020Коломейцева А.А., Феденко А.А.Kolomeytseva A.A., Fedenko A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/1649Актуальность

Актуальность. Успехи лечения больных EG FR-позитивным немелкоклеточным раком легкого (НМРЛ) напрямую связаны с применением ингибиторов рецептора эпидермального фактора роста (EG FR). В настоящее время для лечения этой группы пациентов применяются три поколения ингибиторов EG FR. 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 EG FR в терапии больных распространенным EG FR-позитивным НМРЛ, а также оценить возможные механизмы резистентности к ним и определить оптимальную терапевтическую последовательность ингибиторов EG FR различных поколений.

Материал и методы

Материал и методы. В обзор включены данные рандомизированных клинических исследований, а также результаты исследования, проведенного в условиях реальной клинической практики, изучающих эффективность ингибиторов EG FR и варианты последующей терапии в случае развития лекарственной резистентности к ним.

Результаты

Результаты. Выбор оптимального варианта терапии первой линии больных EG FR-позитивным НМРЛ зависит от множества факторов но, на наш взгляд, терапия афатинибом с последующим переходом на осимертиниб при появлении мутации T790M в опухоли позволяет максимально продлить малотоксичную таргетную терапию и отсрочить применение цитостатических препаратов.

Заключение

Заключение. Учитывая доминирующий механизм развития резистентности – появление мутации T790M гена EGFR, именно последовательное применение ингибиторов EG FR второго и третьего поколений, на наш взгляд, представляется оптимальным вариантом  лечения больных EG FR-позитивным НМРЛ. 

Background

Background. Successful treatment of patients with EG FR-positive non-small cell lung cancer (NSCLC ) is directly related to epidermal growth factor receptor (EG FR) tyrosine kinase inhibitors (TKIs). Currently, three generations of EG FR TKIs are used for treatment of EG FR-positive NSCLC . The issue of what drug or what sequence of its administration will be the optimal treatment option for a particular patient seems relevant.

Purpose

Purpose: To analyze available data on the use of TKIs for the treatment of advanced EG FR-positive NSCLC patients, as well as to assess the possible mechanisms of resistance to them and determine the optimal sequence of EG FR TKI therapy.

Material and Methods

Material and Methods. The review includes data from randomized controlled trials, as well as data from real-world studies on the efficacy of EG FR TKIs and subsequent therapy options in cases of drug resistance.

Results

Results. The choice of the optimal first-line treatment option for patients with EG FR-positive NSCLC depends on many factors. To our opinion, afatinib therapy with subsequent osimertinib therapy allows maximal prolongation of low-toxic targeted therapy and delayed administration of cytostatic drugs in patients with T790M mutation.

Conclusion

Conclusion. Considering the dominant mechanism of resistance development (presence of EG FR -T790M mutation), the use of the second- and third-generation EG FR inhibitors seems to be an optimal treatment option for patients with activating EG FR mutations.

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The authors declare that there are no conflicts of interest present.