Перспективы в терапии метастатического трижды негативного рака молочной железы

Ганьшина И.П., Гордеева О.О., Манукян М.Ш. Перспективы в терапии метастатического трижды негативного рака молочной железы. Современная Онкология. 2021; 23 (1): 78–81.
DOI: 10.26442/18151434.2021.1.200761

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Ganshina IP, Gordeeva OO, Manukian MSh. Opportunities for metastatic triple negative breast cancer therapy. Journal of Modern Oncology. 2021; 23 (1): 78–81. DOI: 10.26442/18151434.2021.1.200761

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Аннотация

Метастатический трижды негативный рак молочной железы (мТНРМЖ) представляет собой сложную задачу для химиотерапевта ввиду агрессивности заболевания, биологической гетерогенности опухоли, а также лимита опций терапии. Одобренные на сегодняшний момент препараты, в частности иммунотерапия и PARP-ингибиторы, позволили улучшить результаты лечения пациенток с мТНРМЖ. Тем не менее далеко не все пациентки являются кандидатами для этой терапии ввиду отсутствия подходящих точек приложения. В связи с этим большие надежды возлагаются на новые опции лечения, изучаемые в настоящий момент в клинических исследованиях. Представленный обзор суммирует данные по перспективным препаратам, продемонстрировавшим свою эффективность для этой сложной когорты пациенток, но еще не зарегистрированным в Российской Федерации, и позволяет сформировать представление о будущем алгоритме лечения пациенток с мТНРМЖ.

Ключевые слова: трижды негативный рак молочной железы, иммунотерапия, конъюгированные препараты, AKT-ингибиторы, атезолизумаб, лекарственная терапия

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Metastatic triple negative breast cancer (mTNBC) is a difficult task for the chemotherapist in view of the disease aggressiveness, biological heterogeneity of the tumor, as well as the limit of therapy options. The approved modern drugs, such as immunotherapy and PARP inhibitors, have improved the treatment results in women with mTNBC. However, not all women are the candidates for this kind of therapy due to the lack of suitable points of application. In this context, high hopes are placed on the new treatment options currently being studied in clinical trials. The review summarizes data on advanced drugs that have demonstrated their efficacy in this multiplex group of women, but not yet registered at the territory of the Russian Federation Russian Federation, and will allow us to form an idea of the future algorithm of treatment of women with mTNBC.

Keywords: triple negative breast cancer, immunotherapy, conjugated drugs, AKT inhibitors, atezolizumab, drug therapy

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________________________________________________

1. Sørlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A 2001; 98 (19): 10869–874.
2. Lehmann BD, Bauer JA, Chen X, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest 2011; 121 (7): 2750–67.
3. Jézéquel P, Loussouarn D, Guérin-Charbonnel C, et al. Gene-expression molecular subtyping of triple-negative breast cancer tumours: importance of immune response. Breast Cancer Res 2015; 17: 43.
4. Bustein MD, Tsimelzon A, Poage GM, et al. Comprehensive Genomic Analysis Identifies Novel Subtypes and Targets of Triple-negative Breast Cancer. Clin Cancer Res 2015; 21 (7): 1688–98.
5. Masuda H, Baggerly KA, Wang Y, et al. Differential response to neoadjuvant chemotherapy among 7 triple-negative breast cancer molecular subtypes. Clin Cancer Res 2013; 19: 5533–40.
6. Gradishar WJ, Anderson BO, Abraham J, et al. Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18 (4): 452–78.
7. Cardoso F, Paluch-Shimon S, Senkus E, et al. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). Ann Oncol 2020; 31 (12): 1623–49.
8. Stenina MB, Zhukova LG, Koroleva IA, et al. Prakticheskie rekomendatsii po lekarstvennomu lecheniiu invazivnogo raka molochnoi zhelezy. Zlokachestvennye opukholi. Prakticheskie rekomendatsii RUSSCO. 2019; 9 (3s2): 128–63 (in Russian)
9. Ganshina IP, Gordeeva OO, Manukian MSh. Novel therapeutic strategies for patients with metastatic triple-negative breast cancer. Journal of Modern Oncology. 2020; 22 (4): 56–61 (in Russian) DOI: 10.26442/18151434.2020.4.200495
10. Schmid P, Rugo HS, Adams S, et al. Atezolizumab plus nab-paclitaxel as first-line treatment for unresectable, locally advanced or metastatic triple-negative breast cancer (IMpassion130): updated efficacy results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2020; 21 (1): 44–59.
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12. Cortes J, Cescon DW, Rugo H, et al. KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. J Clin Oncol 2020; 38 (Suppl. 15): 1000.
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14. Von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med 2019; 380 (7): 617–28.
15. Modi S, Saura C, Yamashita T, et al. DESTINY-Breast01 Investigators. Trastuzumab Deruxtecan in Previously Treated HER2-Positive Breast Cancer. N Engl J Med 2020; 382 (7): 610–621.
16. Keam SJ. Trastuzumab Deruxtecan: First Approval. Drugs 2020; 80 (5): 501–8.
17. Zhao W, Kuai X, Zhou X, et al. Trop2 is a potential biomarker for the promotion of EMT in human breast cancer. Oncol Rep 2018; 40 (2): 759–66.
18. Bardia A, Mayer IA, Vahdat LT, et al. Sacituzumab govitecan-hziy in refractory metastatic triple-negative breast cancer. N Engl J Med 2019; 380: 741–51.
19. U.S. Food and Drug Administration: FDA grants accelerated approval to sacituzumab govitecan-hziy for metastatic triple negative breast cancer. Available at: https://www.fda.gov/drugs/drug-approvals-and-databases/fda-grants-accelerated-approval-sacituzumab-g.... Accessed: 06.05.2020.
20. Bardia A, Tolaney SM, Loirat D, et al. ASCENT: A randomized phase 3 study of sacituzumab govitecan (SG) vs treatment of physician’s choice (TPC) in patients (pts) with previously treated metastatic triple-negative breast cancer (mTNBC). ESMO Virtual Congress 2020, LBA17. Presented September 19, 2020.
21. Guerrero-Zotano A, Mayer IA, Arteaga CL. PI3K/AKT/mTOR: role in breast cancer progression, drug resistance, and treatment. Cancer Metastasis Rev 2016; 35 (4): 515–24.
22. Schmid P, Abraham J, Chan S, et al. Capivasertib Plus Paclitaxel Versus Placebo Plus Paclitaxel As First-Line Therapy for Metastatic Triple-Negative Breast Cancer: The PAKT Trial. J Clin Oncol 2020; 38 (5): 423–33.
23. Schmid P, Cortes J, Robson M, et al. Abstract OT2-08-02: Capivasertib and paclitaxel in first-line treatment of patients with metastatic triple-negative breast cancer: A phase III trial (CAPItello-290). Cancer Res 2020; 80 (Suppl. 4): OT2-08-02.
24. Dent R, Antunes De Melo e Oliveira M, Isakoff SJ, et al. Final results of the double-blind placebo-controlled randomized phase II LOTUS trial of first-line ipatasertib plus paclitaxel for inoperable locally advanced/metastatic triple-negative breast cancer. 2020 ESMO Breast Cancer Virtual Meeting. Abstract 139O.
25. Dent R, Kim SB, Oliveira M, et al. Double-blind placebo-controlled randomized phase III trial evaluating first-line ipatasertib combined with paclitaxel for PIK3CA/AKT1/PTEN-altered locally advanced unresectable or metastatic triple-negative breast cancer: Primary results from IPATunity130 Cohort A. 2020 San Antonio Breast Cancer Symposium.
26. Lyons TG. Targeted Therapies for Triple-Negative Breast Cancer. Curr Treat Options Oncol 2019; 20 (11): 82. DOI: 10.1007/s11864-019-0682-x

Авторы

И.П. Ганьшина*, О.О. Гордеева, М.Ш. Манукян

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия
*ganshinainna77@mail.ru

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Inna P. Ganshina*, Olga O. Gordeeva, Mariam Sh. Manukian

Blokhin National Medical Research Center of Oncology, Moscow, Russia
*ganshinainna77@mail.ru

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