Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press39310.17650/1726-9776-2014-10-4-27-36DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиПротиворечивые вопросы лечения рака почки: выбор дальнейшей стратегии в случае прогрессирования на фоне VEGF-т аргетной терапииCalvoEmiliano
Russian Federation

START Madrid, Centro Integral Oncolόgico Clara Campal, Hospital Madrid Norte Sanchinarro, Calle Oña, 10, 28050 Madrid, Spain. Телефон: +34 91 7567825; факс: +34 91 7567931

emiliano.calvo@start.stoh.comGrϋnwaldViktor
Russian Federation
BellmuntJoaquim
Russian Federation
Centro Integral Oncolόgico Clara Campal and START Madrid, Мадрид, ИспанияКлиника гематологии, гемостаза, онкологии и трансплантации стволовых клеток при медицинском факультете Ганноверского университета, ГерманияУниверситетская клиника del Mar, Барселона, Испания3012201410427360112201401122014https://oncourology.abvpress.ru/oncur/article/view/393

Эверолимус, представляющий собой ингибитор mTOR (mammalian target of rapamycin – мишень рапамицина у млекопитающих), и акситиниб, относящийся к группе ингибиторов тирозинкиназы (ИТК), в настоящее время являются единственными препаратами, официально зарегистрированными для лечения метастатического рака почки (МРП) после уже проведенной терапии первой линии. Экстраполяция достаточно убедительных результатов, полученных в исследованиях III фазы, позволяет предполагатьсхожие значения медианы выживаемости без прогрессирования (ВБП) при применении обоих этих препаратов. Таким образом, в процессе планирования схемы лечения МРП врач сталкивается с непростым вопросом: какая последовательность терапии более оптимальна – ингибитор mTOR после ИТК или 2 различных ИТК друг за другом? При этом из‑за отсутствия данных прямого сравнения акситиниба и эверолимуса клиницист не имеет ясных указаний относительно выбора терапии второй линии – какой из них будет наиболее обоснованным. В исследованиях III фазы было показано: как эверолимус, так и акситиниб предотвращали дальнейшее прогрессирование заболевания после уже проведенной терапии первой линии. Кумулятивная токсичность, характерная для последовательного применения различных ИТК, может послужить причиной более частых перерывов в терапии или снижения дозы, а также повысить вероятность нежелательных явлений. В то время как эверолимус представляется пред-почтительнее с точки зрения переносимости, акситиниб позволяет добиться более высокой частоты ответов; при этом увеличение ВБП в обоих случаях оказывается сопоставимым. Таким образом, при выборе последовательности лечения МРП доказательно обосновать превосходство одного вида терапии над другим не представляется возможным. Вместо этого в процессе планирования лечения необходимо принимать во внимание долгосрочные перспективы, включающие качество жизни, выбирая оптимальный баланс между контролем имеющихся клинических проявлений и контролем возможных нежелательных явлений, который при этом позволил бы свести к минимуму случаи перерывов в терапии или снижения доз. В отсутствие методов радикального лечения одна из основных задач подобной терапии должна заключаться в поддержании качества жизни, а приоритетным критерием для выбора препарата второй линии должна быть возможность выполнения этого условия путем сведения к минимуму вероятности нежелательных явлений.

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