Роль пролонгированных гранулоцитарных колониестимулирующих факторов в профилактике фебрильной нейтропении у пациентов, получающих двухнедельные режимы химиотерапии
Роль пролонгированных гранулоцитарных колониестимулирующих факторов в профилактике фебрильной нейтропении у пациентов, получающих двухнедельные режимы химиотерапии
Кононенко И.Б., Снеговой А.В., Гребенникова О.П. и др. Роль пролонгированных гранулоцитарных колониестимулирующих факторов в профилактике фебрильной нейтропении у пациентов, получающих двухнедельные режимы химиотерапии. Современная Онкология. 2020; 22 (3): 133–141. DOI: 10.26442/18151434.2020.3.200279
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Kononenko I.B., Snegovoy A.V., Grebennikova O.P. et al. Reduction of febrile neutropenia by using long-acting granulocyte colony-stimulating factors in patients with solid tumors receiving every-2-week chemotherapy. Journal of Modern Oncology. 2020; 22 (3): 133–141. DOI: 10.26442/18151434.2020.3.200279
Роль пролонгированных гранулоцитарных колониестимулирующих факторов в профилактике фебрильной нейтропении у пациентов, получающих двухнедельные режимы химиотерапии
Кононенко И.Б., Снеговой А.В., Гребенникова О.П. и др. Роль пролонгированных гранулоцитарных колониестимулирующих факторов в профилактике фебрильной нейтропении у пациентов, получающих двухнедельные режимы химиотерапии. Современная Онкология. 2020; 22 (3): 133–141. DOI: 10.26442/18151434.2020.3.200279
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Kononenko I.B., Snegovoy A.V., Grebennikova O.P. et al. Reduction of febrile neutropenia by using long-acting granulocyte colony-stimulating factors in patients with solid tumors receiving every-2-week chemotherapy. Journal of Modern Oncology. 2020; 22 (3): 133–141. DOI: 10.26442/18151434.2020.3.200279
Нейтропения – частое гематологическое осложнение химиотерапии (ХТ). Ряд исследований показал, что недовыполнение программы лечения в связи с развитием данного вида гематологической токсичности приводит к снижению эффективности терапии и увеличению онкологической смертности. Инфекции, которые возникают в результате длительной нейтропении, чрезвычайно опасны. Наиболее тяжелым проявлением нейтропении 4-й степени является фебрильная нейтропения (ФН), которая может привести к смерти от серьезных инфекций. Такие пациенты нуждаются в немедленной госпитализации и проведении эмпирической терапии антибиотиками широкого спектра действия. Затраты, связанные с госпитализацией по поводу ФН, увеличивают общую стоимость лечения онкологических больных. Внедрение в клиническую практику рекомбинантных форм природного белка гранулоцитарного колониестимулирующего фактора (Г-КСФ) позволило решить ряд важных проблем в этом направлении. В клинических исследованиях и повседневной практике показано, что первичная и вторичная профилактика с использованием рекомбинантных Г-КСФ снижает риск развития ФН и улучшает результаты лечения злокачественного новообразования. В представленном обзоре приведены современные данные о фармакологических свойствах, клинической эффективности и рациональности использования пролонгированных форм Г-КСФ для профилактики ФН у пациентов с солидными опухолями при проведении 2-недельных режимов ХТ. Уделено внимание режимам ХТ с включением 5-фторурацила, оксалиплатина, иринотекана при лечении колоректального рака (КРР). Применение неоадъювантного лечения у таких пациентов позволяет добиться резектабельности опухоли и выполнения радикальной операции. Сохранение интенсивности дозы препаратов на протяжении всех курсов ХТ играет немаловажную роль в достижении успеха лечения. Поэтому профилактика тяжелой нейтропении и ФН, индуцированной ХТ, особенно важна у пациентов, которые являются кандидатами для хирургического лечения. Результаты некоторых исследований подтверждают целесообразность использования Г-КСФ пролонгированного действия при 2-недельных схемах ХТ у пациентов с КРР.
Neutropenia is a common hematological complication of chemotherapy (СT). The number of studies showed that the underperformance of the treatment program due to the development of this type of hematological toxicity could lead to the decrease in therapy efficacy and to the increase in cancer mortality. Infections that occur as a result of prolonged neutropenia are extremely dangerous. The most severe manifestation of grade 4 neutropenia is febrile neutropenia (FN), which can lead to death from severe infections. Such patients should be immediately hospitalized and should receive empirical therapy with broad-spectrum antibiotics. The costs, associated with the hospitalization, due to FN increase total cost of cancer patients’ treatment. The application of recombinant forms of the natural protein granulocyte colony-stimulating factor (G-CSF) in clinical practice has solved the number of important problems on that front. The clinical studies and common use show that primary and secondary prevention using recombinant G-CSF reduces the risk of FN development and improves the results of the treatment of malignancies. The review provides actual data concerning pharmacological properties, clinical efficacy and reasonable use of G-CSF with prolonged action to prevent FN in patients with solid tumors during 2-week CT cycles. Special attention is paid to CH regimens with the inclusion of 5-fluorouracil, oxaliplatin, irinotecan in the treatment of colorectal cancer (CRC). The use of neoadjuvant treatment in such patients allows to achieve resectability of the tumor and to perform radical surgery. The maintenance of drugs dose intensity throughout the cycle of CT plays an important role in achieving the treatment success. Therefore, the prevention of CT-induced severe neutropenia and FN is especially important in patients who are the candidates for surgical treatment. The results of some studies confirm the necessity of using G-CSF with prolonged action during 2-week CT cycles in patients with CRC.
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1 ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*Inessa.Kononenko@mail.ru
________________________________________________
Inessa B. Kononenko*1, Anton V. Snegovoy1, Olga P. Grebennikova1,2, Vladimir Yu. Sel’chuk2, Olga V. Palchinskaia1
1 Blokhin National Medical Research Center of Oncology, Moscow, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*Inessa.Kononenko@mail.ru