rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2020-7-1-6rpmj-500Research ArticleОбзорыReviewСовременные подходы в лечении трижды негативного рака молочной железыThe overview of modern approaches in treatment of triple negative breast cancerhttps://orcid.org/0000-0001-9893-5143ХаритоноваА. А.KharitonovaA. A.

Харитонова Алёна Андреевна – научный сотрудник отделения новых медицинских технологий с группой лечения заболеваний молочной железы 

Адрес: 249031, Калужская область, г. Обнинск, ул. Королёва, д. 4 

Alena A. Kharitonova – researcher of the department of new medical technologies with the group of treatment of breast diseases

a.kharitonova17@yandex.ruhttps://orcid.org/0000-0002-9172-9598СмирноваИ. А.SmirnovaI. A.

Смирнова Ия Алексеевна – д.м.н., ведущий научный сотрудник отделения новых медицинских технологий с группой лечения заболеваний молочной железы 

Researcher ID: U4570-2018(WoS)

Scopus: 13405418300

Iya A. Smirnova – Dr. Sci. (Med.), leading researcher of the department of new medical technologies with the group of treatment of breast diseases 

Researcher ID: U4570-2018(WoS)

Scopus: 13405418300

КиселеваМ. В.KiselevaM. V.

Киселева Марина Викторовна – д.м.н., заведующий отделением новых медицинских технологий с группой лечения заболеваний молочной железы

Marina V. Kiseleva – Dr. Sci. (Med.), head of the department of new medical technologies with the group of treatment of breast diseases

Медицинский радиологический научный центр им. А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской ФедерацииРоссияA. Tsyb Medical Radiological Research Centre – Branch of the National Medical Radiology Research Centre of the Russian Federation Ministry of HealthRussian Federation202012032020715565Copyright © Харитонова А.А., Смирнова И.А., Киселева М.В., 20202020Харитонова А.А., Смирнова И.А., Киселева М.В.Kharitonova A.A., Smirnova I.A., Kiseleva M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/500

На сегодняшний день наиболее агрессивным подтипом рака молочной железы (РМЖ) является трижды негативный рак. Целью данного обзора является анализ современных представлений о патогенезе, клинических характеристиках различных подтипов трижды негативного рака молочной железы, характере его метастазирования, механизмах химиорезистентности. В обзоре представлены результаты современных схем лекарственной терапии трижды негативного рака молочной железы по данным публикаций отечественных и зарубежных онкологов. На основании различных клинических исследований показана эффективность использования антрациклинов, таксанов в дозоуплотненном режиме, препаратов платины и других химиотерапевтических препаратов для лечения трижды негативного рака. Представленные схемы лечения позволяют достичь полного морфологического ответа у 85% пациентов, повысить показатели безрецидивной и общей выживаемости, сопоставимые с другими подтипами РМЖ. Обзор освещает возможности современных таргетных препаратов‑ингибиторов PARP, ингибиторов Сhk1 UCN‑01, возможности иммунотерапии для лечения данного агрессивного подтипа рака молочной железы.

By far the most aggressive subtype of breast cancer is triple negative cancer. The purpose of this review is to analyze current ideas about the pathogenesis, clinical characteristics of different subtypes of triple negative breast cancer, the nature of its metastasis, mechanisms of chemoresistance. The review presents the results of modern regimens of drug therapy of triple negative breast cancer according to the publications of domestic and foreign oncologists. On the basis of various clinical studies, the effectiveness of the use of anthracyclines, taxanes in the dose-dense regime, platinum preparations and other chemotherapy drugs for the treatment of triple-negative cancer has been shown. The presented treatment regimens allow to achieve a complete morphological response in 85% of patients, to increase the rates of relapse-free and overall survival, comparable with other subtypes of breast cancer. The review highlights the possibilities of modern targeted drugs-PARP inhibitors, chk1 inhibitors UCN‑01, immunotherapy possibilities for the treatment of this aggressive subtype of breast cancer.

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N Engl J Med. 2018 29; 379(22):2108–2121. https://doi.org/10.1056/NEJMoa1809615Протокол СО 41101 Двойное слепое плацебо-контролируемое рандомизированное исслеование III фазыдля изучения ипатасертиба в комбинации с атезолизумабом ипаклитакселом упациентов сместно-распространенным нерезектабельным или метастатическим трижды негативным раком молочной железы. Протокол СО 41101 Номер и дата РКИ: № 489 от 05.09.2019 Ф. Хоффманн-Ля Рош Лтд.Protocol CO 41101 Double-blind placebo-controlled randomized phase III trial to study ipatasertib in combination with atezolizumab and paclitaxel in patients with locally advanced unresectable or metastatic triple negative breast cancer. Protocol SO 41101 number and date of RCT: No. 489 of 05.09.2019 F. Hoffmann-La Roche Ltd.Протокол МО39196 Многоцентровое рандомизированное плацебо-контролируемое двойное слепое III фазы по изучению атезолизумаба (антитело к PD-L1) в комбинации с паклитакселом в сравнении с комбинацией плацебо с паклитакселом у пациентов с неоперабельным местно-распространенным или метастатическим трижды негативным раком молочной железы по поводу которого ранее не проводилось лечение. 01.08.2017–01.05.2021. РКИ № 292 от 30.05.2017.MO39196 Protocol a Multicenter randomized placebo-controlled phase III double-blind study of atezolizumab (PD-L1 antibody) in combination with paclitaxel compared to a combination of placebo and paclitaxel in patients with inoperable locally advanced or metastatic triple negative breast cancer for which no previous treatment has been performed. 01.08.2017– 01.05.2021. RCT #292 dated 30.05.2017.Протокол ВIG 16–05/AFT 27/WO39391 Многоцентровое рандомизированное, открытое исследование III фазы атезолизумаба (антитело к PD-L1) в комбинации с адъювантной химиотерапией у пациентов с операбельным трижды негативным раком молочной железы 06.07.2018–31.05.2022 РКИ № 318 от 06.07.2018 Ф. Хоффманн-Ля Рош Лтд.Protocol BIG 16–05/AFT 27/WO39391 Multicenter randomized, open label phase III trial of atezolizumab (antibody to PD-L1) in combination with adjuvant chemotherapy in patients with operable triple negative breast cancer 06.07.2018–31.05.2022 RCT # 318 of 06.07.2018 F. Hoffmann-La Roche Ltd.

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