Tumors of female reproductive system

Опухоли женской репродуктивной системы

1994-40981999-8627

Publishing House ABV Press

811

10.17650/1994-4098-2021-17-1-27-34

MAMMOLOGY. REVIEWS

МАММОЛОГИЯ. ОБЗОРНЫЕ СТАТЬИ

Current approaches to the treatment of HER2‑positive breast cancer with brain metastases

Современные подходы к лечению больных HER2-положительным раком молочной железы с метастазами в головном мозге

https://orcid.org/0000-0002-4305-6691

Semiglazova

T. Yu.

Семиглазова

Т. Ю.

Russian Federation

Tatyana Yuryevna Semiglazova

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

41 Kirochnaya St., Saint Petersburg 191015

Татьяна Юрьевна Семиглазова

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

191015 Санкт-Петербург, ул. Кирочная, 41

tsemiglazova@mail.ru

https://orcid.org/0000-0002-9842-2951

Sharashenidze

S. M.

Шарашенидзе

С. М.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-8155-2522

Kerimova

S. N.

Керимова

С. Н.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

Klimenko

V. V.

Клименко

В. В.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0003-3619-0750

Malygin

A. Yu.

Малыгин

А. Ю.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0001-6183-9764

Dashyan

G. A.

Дашян

Г. А.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-0871-9453

Paltuev

R. M.

Палтуев

Р. М.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-8825-5221

Semiglazov

V. V.

Семиглазов

В. В.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

6–8 Lva Tolstogo St., Saint Petersburg 197022

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

197022 Санкт-Петербург, ул. Льва Толстого, 6–8

https://orcid.org/0000-0002-4898-9159

Krivorotko

P. V.

Криворотько

П. В.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

41 Kirochnaya St., Saint Petersburg 191015

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

191015 Санкт-Петербург, ул. Кирочная, 41

https://orcid.org/0000-0002-7185-1967

Novikov

S. N.

Новиков

С. Н.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0003-0077-9619

Semiglazov

V. F.

Семиглазов

В. Ф.

Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

41 Kirochnaya St., Saint Petersburg 191015

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

191015 Санкт-Петербург, ул. Кирочная, 41

N.N. Petrov National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава России

I.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России

I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of RussiaФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России

16062021

171

27341606202116062021

https://ojrs.abvpress.ru/ojrs/article/view/811

The article discusses modern approaches in the treatment of HER2-positive breast cancer (BC) with brain metastases (BM).The patients are subject to multidisciplinary, comprehensive and biologically – oriented treatment, with the involvement of a neurosurgeon and a radiation therapist to make a decision considering local treatment of BM, as well as a clinical oncologist to choose systemic drug therapy. Local treatment of HER2+ BC with BM patients includes surgical treatment and/or radiotherapy. Use of targeted anti-HER2 therapy changes “biology” of the disease from aggressive to indolent.In the prospective KAMILLA trial, clinically significant antitumor activity of trastuzumab emtansine was found for the first time both in patients with HER2+ BC with BM, who were previously treated with radiotherapy, and without radiotherapy in the anamnesis, which suggests the validity of further use of trastuzumab emtansine in this category of patients.The antitumor activity of trastuzumab emtansine in patients with HER2+ BC with BM was also confirmed in preclinical models. Despite the similar drug distribution in the tissues, trastuzumab emtansine, in contrast to trastuzumab, significantly slowed the growth of metastases, causing the induction of apoptosis in HER2+ BC models with BM in mice.

В статье рассматриваются современные подходы к лечению больных HER2-положительным раком молочной железы (HER2+ РМЖ) с метастазами в головном мозге (МГМ).Пациенты с HER2+ РМЖ с МГМ подлежат мультидисциплинарному, комплексному и биологически направленному лечению: с привлечением нейрохирурга и радиотерапевта для решения вопроса о локальном лечении МГМ, а также химиотерапевта для решения вопроса о системной лекарственной терапии. Локальное лечение больных HER2+ РМЖ с МГМ включает хирургическое лечение и/или лучевую терапию. Применение же таргетной анти-HER2 терапии меняет «биологию» заболевания с агрессивной на вялотекущую (индолентную).В проспективном исследовании KAMILLA была впервые продемонстрирована клинически значимая противоопухолевая активность трастузумаба эмтанзина как у больных HER2+ РМЖ с МГМ, ранее получавших лучевую терапию, так и у пациентов без лучевой терапии в анамнезе, что позволяет предполагать обоснованность дальнейшего применения трастузумаба эмтанзина у данной категории больных. Противоопухолевая активность трастузумаба эмтанзина у больных HER2+ РМЖ c МГМ была подтверждена и на доклинических моделях. Несмотря на схожий характер распределения препарата в тканях, трастузумаб эмтанзин, в отличие от трастузумаба, значительно замедлял рост метастазов, вызывая индукцию апоптоза в моделях HER2+ РМЖ с МГМ у мышей.

HER2-positive breast cancerbrain metastasesT-DM1trastuzumab emtansineanti-HER2 therapy

HER2+ рак молочной железыметастазы в головном мозгеT-DM1трастузумаб эмтанзинанти-HER2 терапия

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