clinicaloncologyКлинический случай в онкологииClinical Case in Oncology3034-14773034-4018ОНКОПРАКТИК10.62546/3034-1477-2024-2-3-70-78clinicaloncology-77Research ArticleКЛИНИЧЕСКИЕ СЛУЧАИCASE REPORTSИммуноконъюгаты нового поколения в лечении HER2-позитивного метастатического рака молочной железы: обзор литературы и представление клинического случаяNext generation antibody-drug conjugates in the treatment of HER2-positive metastatic breast cancer: literature review and clinical case demonstration.https://orcid.org/0000-0002-8965-8364ГлузманМ. И.GluzmaM. I.

Глузман Марк Игоревич

199106, Санкт-Петербург, 21-линия В.О., д. 8а; 198255, Санкт-Петербург, пр. Ветеранов, д. 56

Gluzman Mark Igorevich

7/9 Universitetskaya Emb., 199034; 56 Veteranov Ave., St. Petersburg 193318

lok2008@list.ruШарвашидзеИ. О.SharvashidzeI. O.

198255, Санкт-Петербург, пр. Ветеранов, д. 56

56 Veteranov Ave., St. Petersburg 193318

ФГБОУ ВО «Санкт-Петербургский государственный университет»; СПб ГБУЗ «Городской клинический онкологический диспансер»РоссияSt. Petersburg State University; St. Petersburg City Clinical Oncology DispensaryRussian FederationСПб ГБУЗ «Городской клинический онкологический диспансер»РоссияSt. Petersburg City Clinical Oncology DispensaryRussian Federation202427012025237078Copyright © Глузман М.И., Шарвашидзе И.О., 20252025Глузман М.И., Шарвашидзе И.О.Gluzma M.I., Sharvashidze I.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.oncocase.ru/jour/article/view/77

Рак молочной железы наряду с высокой заболеваемостью характеризуется крайней степенью опухолевой гетерогенности, что отражается в наличии молекулярно-генетической классификации и алгоритмов лечения, основанных на иммуногистохимических и мутационных характеристик опухоли. Революция в лечении HER2-позитивного подтипа произошла около 25 лет назад, когда первый таргетный препарата трастузумаб вошел в клиническую практику. В настоящее время существует большое количество вариантов лечения данного подтипа рака молочной железы, в том числе самые современные опции с применением конъюгатов моноклональное антитело + цитотоксический агент. Трастузумаб дерукстекан является иммуноконъюгатом нового поколения, которые был зарегистрирован в России и других странах в качестве терапии выбора 2-й и последующих линий лечения метастатического HER2-позитивного рака молочной железы. В статье приведены рандомизированные клинические исследования, которые легли в основу данных показаний, и исследование IIIb/IV фазы DESTINY-Breast12 демонстрирующее высокую интракраниальную активность препарата. Клинический случай представлен с  целью иллюстрации эффективности трастузумаба дерукстекана в поздней линии у предлеченной пациентки с множественными локусами метастазирования, включая головной мозг, а также возможности диагностики и коррекции специфического нежелательного явления в виде интерстициального поражения легочной паренхимы

Breast cancer, along with its high incidence, is characterized by an extreme degree of tumor heterogeneity, which is reflected in the presence of molecular genetic classification and treatment algorithms based on immunohistochemical and mutational characteristics of the tumor. The revolution in the treatment of the HER2-positive subtype occurred about 25 years ago, when the first targeted drug trastuzumab came to clinical practice. Currently, there are a large number of treatment options for this subtype of breast cancer, including the most advanced drugs such as monoclonal antibody + cytotoxic agent conjugates. Trastuzumab deruxtecan is a new generation antibody–drug conjugate that has been registered in Russia and other countries as the therapy of choice in 2 and subsequent treatment lines for metastatic HER2-positive breast cancer. The article presents randomized clinical trials that formed the basis of these indications, and a phase IIIb/IV study DESTINY-Breast12 demonstrating high intracranial activity of this drug. The clinical case illustrates the effectiveness of trastuzumab deruxtecan in a late line in a pretreated patient with multiple metastasis including brain, as well as the possibility of diagnosing and correcting a specific adverse event such as interstitial lung disease.

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The authors declare that there are no conflicts of interest present.