Контроль нежелательных явлений – путь к достижению оптимальных результатов у пациентов с плоскоклеточным раком головы и шеи: клинический случай

Саникович В.Д., Секачева М.И., Орлова Е.В., Габриелян Г.А., Борода А.М., Агакина Ю.С., Решетов И.В. Контроль нежелательных явлений – путь к достижению оптимальных результатов у пациентов с плоскоклеточным раком головы и шеи: клинический случай. Consilium Medicum. 2024;26(6):386–395.
DOI: 10.26442/20751753.2024.6.202912

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Sanikovich VD, Sekacheva MI, Orlova EV, Gabrielian GA, Boroda AM, Agakina JS, Reshetov IV. Adverse event management as a pathway to optimal outcomes in head and neck squamous cell carcinoma patients: A clinical case. Consilium Medicum. 2024;26(6):386–395. DOI: 10.26442/20751753.2024.6.202912

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Аннотация

Плоскоклеточный рак головы и шеи является шестым по распространенности раком во всем мире. При этом злокачественные опухоли среднего уха крайне редки. Плоскоклеточная карцинома – наиболее распространенный гистологический тип в этой области, который встречается более чем в 50% случаев. Сложные анатомо-топографические особенности внутреннего уха и стертая клиническая картина объясняют позднюю диагностику данного заболевания. Представлен клинический случай пациентки с высокодифференцированной плоскоклеточной карциномой среднего уха. Пациентка получила комплексное лечение, включающее в том числе лекарственную противоопухолевую терапию по протоколу TPEx: доцетаксел + цисплатин + цетуксимаб. Являясь высокоэффективным, данный протокол требует мультидисциплинарного подхода с целью обеспечения максимальной безопасности терапии. Клинический случай иллюстрирует классический «портрет» пациента с рецидивным или метастатическим плоскоклеточным раком головы и шеи, а также дает практически исчерпывающее представление о спектре нежелательных явлений, с которыми сталкиваются такие пациенты и их лечащие врачи-онкологи. На клиническом примере разобраны особенности коррекции таких нежелательных явлений.

Ключевые слова: плоскоклеточный рак головы и шеи, злокачественная опухоль среднего уха, системная противоопухолевая терапия, химиотерапия, ингибиторы рецептора эпидермального фактора роста, нежелательные явления противоопухолевой терапии, цетуксимаб

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Squamous cell carcinoma of the head and neck is the sixth most common cancer worldwide. However, malignant tumors of the middle ear are extremely rare. Squamous cell carcinoma is the most common histologic type of tumor in this area, accounting for more than 50% of cases. Complex anatomical and topographic features of the inner ear and inapparent clinical symptoms result in delayed diagnosis of this disease. A case of a patient with highly differentiated middle ear squamous cell carcinoma is presented. The patient received complex treatment, including drug antitumor therapy according to the TPEx protocol: docetaxel + cisplatin + cetuximab. Being highly effective, this protocol requires a multidisciplinary approach in order to ensure maximum safety of therapy. The case illustrates the classic “portrait” of a patient with recurrent or metastatic squamous cell carcinoma of the head and neck and also provides a comprehensive description of the spectrum of adverse events faced by such patients and their oncologists. Based on this clinical case, the features of management of such adverse events are analyzed.

Keywords: head and neck squamous cell carcinoma, middle ear malignancy, systemic antitumor therapy, chemotherapy, epidermal growth factor receptor inhibitors, antitumor therapy adverse events, cetuximab

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1. Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. 2024. Available at: https://gco.iarc.who.int/today. Accessed: 15.05.2024.
2. Srivani N, Joyce TM. Clinicopathology of Middle Ear Tumours: A Retrospective Study from a Tertiary Care Hospital, Hyderabad, India. J Clin Diagn Res. 2022;16(7):EC27-31. DOI:10.7860/JCDR/2022/52936/16646
3. Gurgel RK, Karnell LH, Hansen MR. Middle ear cancer: a population-based study. Laryngoscope. 2009;119(10):1913-7. DOI:10.1002/lary.20202
4. Hu XD, Wu TT, Zhou SH. Squamous cell carcinoma of the middle ear: report of three cases. Int J Clin Exp Med. 2015;8(2):2979-84.
5. Attakkil A, Thorawade V, Jagade M, et al. Squamous Cell Carcinoma of the Middle Ear Mimicking CSOM with Intracranial Complications: A Diagnostic Dilemma. International Journal of Otolaryngology and Head & Neck Surgery. 2014;3:376-81. DOI:10.4236/ijohns.2014.36067
6. Pontes F, Garcia AR, Domingues I, et al. Survival predictors and outcomes of patients with recurrent and/or metastatic head and neck cancer treated with chemotherapy plus cetuximab as first-line therapy: A real-world retrospective study. Cancer Treat Res Commun. 2021;27:100375. DOI:10.1016/j.ctarc.2021.100375
7. Burtness B, Harrington KJ, Greil R, et al.; KEYNOTE-048 Investigators. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet. 2019;394(10212):1915-28. DOI:10.1016/S0140-6736(19)32591-7. Erratum in: Lancet. 2020;395(10220):272. DOI:10.1016/S0140-6736(20)30116-1. Erratum in: Lancet. 2020;395(10224):564. DOI:10.1016/S0140-6736(20)30254-3. Erratum in: Lancet. 2021;397(10291):2252. DOI:10.1016/S0140-6736(21)01119-3
8. Rettig EM, D'Souza G, Thompson CB, et al. Health-related quality of life before and after head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage. Cancer. 2016;122(12):1861-70. DOI:10.1002/cncr.30005
9. Quinten C, Coens C, Mauer M, et al.; EORTC Clinical Groups. Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol. 2009;10(9):865-71. DOI:10.1016/S1470-2045(09)70200-1
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12. Lop J, Venegas MDP, Pujol A, et al. Causes of long-term mortality in patients with head and neck squamous cell carcinomas. Eur Arch Otorhinolaryngol. 2022;279(7):3657-64. DOI:10.1007/s00405-021-07211-8
13. Zapata I, Alvarez M, Hidalgo R, et al. Causes of death in patients with locally advanced head and neck cancer treated with radiotherapy and systemic therapy. BMC Cancer. 2019;19(1):1241. DOI:10.1186/s12885-019-6427-1
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16. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Head and Neck Cancers. Version 4.2024 – May 1, 2024.
17. Black MD, Yoo J, Fung K, et al. Personalized Treatment of Recurrent, Metastatic Head and Neck Cancer Guided by Patient-Derived Xenograft Models. Cureus. 2024;16(2):e53645. DOI:10.7759/cureus.53645
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23. Fallon M, Giusti R, Aielli F, et al.; ESMO Guidelines Committee. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol.
2018;29(Suppl. 4):iv166-91. DOI:10.1093/annonc/mdy152
24. Katopodis P, Karteris E, Katopodis KP. Pathophysiology of Drug-Induced Hypomagnesaemia. Drug Saf. 2020;43(9):867-80. DOI:10.1007/s40264-020-00947-y
25. Huang CL, Kuo E. Mechanism of hypokalemia in magnesium deficiency. J Am Soc Nephrol. 2007;18(10):2649-52. DOI:10.1681/ASN.2007070792
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27. Ostroumova OD, Kochetkov AI, Klepikova MV. Drug-induced electrolyte disorder. Part 2. Drug-induced hypomagnesemia. RMJ. 2020;12:36-48 (in Russian).
28. Workeneh BT, Uppal NN, Jhaveri KD, Rondon-Berrios H. Hypomagnesemia in the Cancer Patient. Kidney360. 2020;2(1):154-66. DOI:10.34067/KID.0005622020
29. Sakaeva DD, Borisov KE, Bulavina IS, et al. Prakticheskie rekomendatsii po diagnostike i lecheniiu febril'noĭ neĭtropenii. Prakticheskie Rekomendatsii RUSSCO, Chast' 2. Zlokachestvennye Opukholi. 2023;13(#3s2):62-71 (in Russian).
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32. Polonskaia AS, Shatokhina EA, Kruglova LS. Dermatologic adverse events associated with epidermal growth factor receptor inhibitors: current concepts of interdisciplinary problem. Head and Neck Tumor. 2021;11(4):97-109 (in Russian). DOI:10.17650/2222-1468-2021-11-4-97-109
33. Bozzetti F, Cotogni P. Nutritional Issues in Head and Neck Cancer Patients. Healthcare (Basel). 2020;8(2):102. DOI:10.3390/healthcare8020102
34. Kristensen MB, Isenring E, Brown B. Nutrition and swallowing therapy strategies for patients with head and neck cancer. Nutrition. 2020;69:110548. DOI:10.1016/j.nut.2019.06.028
35. Sytov AV, Zuzov SA, Kukosh MIu, et al. Prakticheskie rekomendatsii po nutritivnoi podderzhke onkologicheskikh bol'nykh. Prakticheskie Rekomendatsii RUSSCO, Chast' 2. Zlokachestvennye Opukholi. 2023;13(#3s2):131-41 (in Russian).
36. Martinovic D, Tokic D, Puizina Mladinic E, et al. Nutritional Management of Patients with Head and Neck Cancer-A Comprehensive Review. Nutrients. 2023;15(8):1864. DOI:10.3390/nu15081864

Авторы

В.Д. Саникович*¹, М.И. Секачева¹, Е.В. Орлова¹, Г.А. Габриелян¹, А.М. Борода¹, Ю.С. Агакина^1,2, И.В. Решетов¹

¹ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
²ФГБУ «Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий Федерального медико-биологического агентства», Москва, Россия
*sanikovich_v_d@staff.sechenov.ru

________________________________________________

Varvara D. Sanikovich*¹, Marina I. Sekacheva¹, Ekaterina V. Orlova¹, Gaiane A. Gabrielian¹, Alexander M. Boroda¹, Juliya S. Agakina^1,2, Igor V. Reshetov¹

¹Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
²Federal Research and Clinical Center of specialized types of health care and medical technology of the Federal Medical and Biological Agency, Moscow, Russia
*sanikovich_v_d@staff.sechenov.ru

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