Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press64610.17650/1994-4098-2019-15-2-30-41MAMMOLOGY. ORIGINAL REPORTSМАММОЛОГИЯ. ОРИГИНАЛЬНЫЕ СТАТЬИHormone therapy for premenopausal women with metastatic breast cancer: combinations with cyclin-dependent kinase inhibitorsГормонотерапия больных метастатическим раком молочной железы в пременопаузе: комбинации с ингибиторами циклинзависимых киназhttps://orcid.org/0000-0001-7728-9533ArtamonovaE. V.АртамоноваЕ. В.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

Елена Владимировна Артамонова 

115478 Москва, Каширское шоссе, 24

artamonovae@mail.ruKovalenkoE. I.КоваленкоЕ. И.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России0609201915230410609201906092019https://ojrs.abvpress.ru/ojrs/article/view/646

This article discusses the problems associated with the search of the most effective treatment strategies for HER2-negative metastatic breast cancer in premenopausal women. Until recently, ovarian suppression and hormone therapy had been the main treatments used in this group of patients. The development of palbociclib, called a “breakthrough therapy”, as well as promising results of trials evaluating the efficacy of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors added to hormone therapy in postmenopausal women suggested a need for the assessment of this treatment regimen in combination with ovarian suppression in younger patients.

According to the results of randomized trials and subgroup analysis, the addition of a CDK4/6 inhibitor to ovarian suppression and hormonal therapy significantly increases survival. The safety profile is similar to that of older patients. Randomized trials comparing the efficacy of palbociclib + ovarian suppression + aromatase inhibitor vs. chemotherapy in premenopausal women demonstrated significant benefits of a new treatment strategy: a CDK4/6 inhibitor as a part of combination therapy reduced the risk of progression by 36 % compared to capecitabine.

В статье обсуждаются вопросы поиска наиболее эффективных стратегий терапии гормонозависимого HER2-отрицательного метастатического рака молочной железы в пременопаузе. До недавнего времени выключение яичников и последовательная гормонотерапия были основным видом лечения пациенток этой подгруппы. Появление палбоциклиба, названного «терапией прорыва», и впечатляющие результаты добавления ингибиторов циклинзависимых киназ 4 и 6 (CDK4/6) к режимам гормонотерапии у больных в менопаузе привели к необходимости оценки эффективности и безопасности данной стратегии в комбинации с овариальной супрессией у молодых пациенток.

Как показали результаты рандомизированных исследований и подгрупповых анализов, добавление ингибитора CDK4/6 к овариальной супрессии и гормональному препарату в соответствующей линии терапии приводит к существенному увеличению показателей выживаемости. Данные по безопасности соответствуют таковым у пациенток старшей возрастной группы. Рандомизированное исследование по сравнению комбинации палбоциклиб + овариальная супрессия + ингибитор ароматазы с химиотерапией у больных в пременопаузе показало достоверное превосходство новой стратегии: назначение ингибитора CDK4/6 в составе комплексного режима на 36 % снизило риск прогрессирования по сравнению с капецитабином.

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