Оптимизация второй линии лечения метастатического колоректального рака: новые возможности таргетной терапии

Артамонова Е.В., Манзюк Л.В. Оптимизация второй линии лечения метастатического колоректального рака: новые возможности таргетной терапии. Современная Онкология. 2016; 18 (1): 25–31.

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Artamonova E.V., Manzyuk L.V. The optimization of second-line therapy for metastatic colorectal cancer: new targeted therapy options. Journal of Modern Oncology. 2016; 18 (1): 25–31.

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Аннотация

Успехи в лечении метастатического колоректального рака (мКРР), достигнутые за последние годы, во многом связаны с широким применением таргетных препаратов и высокоэффективных химиотерапевтических режимов в повседневной клинической практике, а также с внедрением концепции длительного лечения – «continuum of care». Данная концепция предполагает четкое планирование последовательности назначения различных режимов и выбора оптимальной комбинации режима химиотерапии (ХТ) и таргетного препарата на каждом этапе лечения. При таком подходе возрастает роль 2-й линии терапии, и в настоящем обзоре затронуты основные вопросы, касающиеся выбора наилучшей комбинации для лечения больных мКРР на данном этапе. Оптимальным вариантом последовательной терапии для большинства больных с нерезектабельными метастазами является применение оксалиплатинсодержащего режима в 1-й линии и переход на схему FOLFIRI (инфузионный дуплет иринотекана и 5-фторурацила) во 2-й линии. Поэтому выбор наиболее эффективного таргетного препарата для назначения вместе с комбинацией FOLFIRI представляется сегодня чрезвычайно актуальной задачей. Таргетные биологические препараты, такие как анти-EGFR антитела и ингибиторы ангиогенеза бевацизумаб и афлиберцепт, были изучены в различных комбинациях во 2-й линии терапии мКРР. Применение анти-EGFR антител во 2-й линии терапии обеспечило увеличение выживаемости без прогрессирования (ВБП) заболевания, но не привело к достоверному увеличению продолжительности жизни, в то время как блокада ангиогенеза оказалась эффективной не только в отношении ВБП, но и продолжительности жизни, как у бевацизумаб-наивных пациентов, так и у пациентов, получавших бевацизумаб в 1-й линии терапии. Афлиберцепт стал первым таргетным препаратом, который при использовании во 2-й линии терапии в комбинации с режимом FOLFIRI достоверно увеличил все показатели эффективности, включая продолжительность жизни, ВБП и частоту объективного ответа, в широкой популяции больных мКРР.

Ключевые слова: метастатический колоректальный рак, афлиберцепт, терапия второй линии.

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Advances in the treatment of metastatic colorectal cancer (mCRC) during the past years, largely associated with the wide use of targeted agents and effective chemotherapy regimens in routine clinical practice, as well as with the introduction of the "continuum of care" concept. This concept means a clear planning of the treatment sequence and identifying the optimal combination of the chemotherapy regimen and targeted agent at each setting. Following this approach the role of the 2-nd line setting is dramatically icreasing, and this review aimed to identify the best treatment combination for the mCRC patients at this setting. The optimal treatment sequence for most patients with unresectable metastases is the use of oxaliplatin containing regimen the in 1-st line and switch to FOLFIRI (duplet containing irinotecan and infusion of 5-fluorouracil) in the 2-nd line treatment for metastatic colorectal cancer. Therefore, the choice of the most effective targeted agent in combination with FOLFIRI seems extremely actual. Various targeted biological agents including as anti-EGFR antibodies as well as antiangiogenic agents such as bevacizumab and aflibercept have been studied in various combinations in the 2-nd line setting for mCRC treatment. Anti-EGFR antibodies in 2-nd line treatment increased progression-free survival, but didn’t result in the overall survival increase, while angiogenesis inhibitors were effective in terms of PFS and OS in bevacizumab-naive patients as well as in bevacizumab pretreated patients. Aflibercept was the first targeted agent showed the increase of overall survival as well as progression-free survival and objective response rate in 2-line setting when combined with FOLFIRI in a broad population of mCRC patients.

Key words: metastatic colorectal cancer, aflibercept, second-line therapy.

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Авторы

Е.В.Артамонова*, Л.В.Манзюк

ФГБУ Российский онкологический научный центр им. Н.Н.Блохина Минздрава России. 115478, Россия, Москва, Каширское ш., д. 23
*artamonovae@mail.ru

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E.V.Artamonova*, L.V.Manzyuk

N.N.Blokhin Russian Cancer Research Center of the Ministry of Health of the Russian Federation. 115478, Russian Federation, Moscow, Kashirskoe sh., d. 23
*artamonovae@mail.ru

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