Таргетные препараты и лучевая терапия в лечении местнораспространенного рака легкого

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Аннотация

Рак легкого является самой распространенной формой злокачественных опухолей в мире. Большинство больных с вновь установленным диагнозом имеют местнораспространенную или метастатическую форму заболевания, не подлежащую хирургическому лечению, дающему наилучшие результаты. В настоящее время при неоперабельном местнораспространенном немелкоклеточном раке легкого (НМРЛ) химиолучевая терапия является стандартным подходом у больных с удовлетворительным соматическим статусом. Несмотря на улучшение результатов лечения, показатели местного контроля заболевания не достигают желаемых значений, а развитие отдаленных метастазов остается основным путем прогрессирования. Разнообразие молекулярных и генетических нарушений при НМРЛ может отчасти являться причиной его устойчивости к проводимой терапии. Поэтому вполне обоснованно, что основной перспективой повышения результатов лечения является использование разнонаправленных противоопухолевых воздействий, которые могут проявлять положительные синергетические эффекты. Умение определять и воздействовать на конкретные молекулярные механизмы при лечении злокачественных опухолей, в том числе рака легкого, является целью исследователей и клиницистов, занимающихся данной проблемой. Несмотря на большое число диагностических тестов, широкий спектр групп изучаемых препаратов и внушительную доказательную базу доклинических исследований, для большинства препаратов до настоящего времени не удалось выявить статистически значимых преимуществ их совместного назначения с уже имеющимися методами лечебного воздействия. Наиболее часто при комбинации с лучевой и химиолучевой терапией используются блокаторы сигнального пути EGFR (ингибиторы TKI и моноклональные антитела) и ингибиторы ангиогенеза. Рациональное включение препаратов данных групп в схемы комбинированного лечения является сегодня реальной возможностью повышения результатов лечения больных НМРЛ. В клинических исследованиях таргетные препараты широко применяются при различных методиках, однако пока отсутствует достаточная доказательная база для их использования как стандарта.

Ключевые слова: местнораспространенный НМРЛ, лучевая терапия, таргетная терапия, химиотерапия.

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Lung cancer is the most common cancer and leading cause of cancer-related death in the world. More than two thirds of patients with newly diagnosed lung cancer have locally advanced or metastatic disease and cannot be candidates for surgery. Currently, in locally advanced non-small cell lung cancer (NSCLC) chemoradiotherapy is the standard approach in patients with good performance status. Despite improvement of results of treatment, indicators of local control of disease are unsatisfactory, and the distant metastases remain the main way of progression. A variety of molecular and genetic abnormalities in NSCLC may partly be the reason for his aggressive course and resistance to the therapy. Therefore use of methods of treatment with various mechanisms of action is justified. Despite the large number of diagnostic tests, a wide range of groups studied drugs and an impressive evidence base for pre-clinical studies, the majority of drugs so far failed to identify statistically significant benefits of a joint appointment with the existing methods of therapeutic effects. Two of the most attractive pathways where new agents have been developed and assessed in combination with thoracic radiotherapy or radiochemotherapy are the EGFR pathway (either with the use of monoclonal antibodies or tyrosine kinase inhibitors) and the angiogenesis inhibition. The clinical using of targeted agents in the combined treatment to date is a real opportunity to improve the treatment results of NSCLC patients. In clinical trials targeted therapies are widely used in various techniques, but as yet there is insufficient evidence base for use as a standard.

Key words: locally advanced NSCLC, radiotherapy, targeted therapy, chemotherapy.

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Авторы

Ю.А.Рагулин

ФГБУ Медицинский радиологический научный центр Минздравсоцразвития РФ, Обнинск

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Y.A.Ragulin

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