surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2022-12-3-199-204surgonco-714Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSРоль неоадъювантной гормонотерапии в лечении рака молочной железы: что мы знаем на данный момент?Preoperative Hormone Therapy in the Treatment of Breast Cancer: What Do We Know So Far?ВоротниковВ. В.VorotnikovV. V.

к.м.н., отделение онкохирургии

Москва

Cand. Sci. (Med.), Department of Oncosurgery

Moscow

ПахомоваР. А.PakhomovaR. A.

д.м.н., доцент, кафедра пластической хирургии

Москва

Dr. Sci. (Med.), Assoc. Prof., Department of Plastic Surgery

Moscow

https://orcid.org/0000-0003-3739-5344СойновА. В.SoinovA. V.

отделение онкохирургии

Москва

Department of Oncosurgery

Moscow

aleksandersoinov@yandex.ruГунинаА. С.GuninaA. S.

отделение онкохирургии

Москва

Department of Oncosurgery

Moscow

КопытичИ. В.KopytichI. V.

отделение онкохирургии

Москва

Department of Oncosurgery

Moscow

ЦойМ. Г.TsoiM. G.

кафедра онкологии

Москва

Department of Oncology

Moscow

АбдугаффоровС. А.AbdugafforovS. A.

кафедра пластической хирургии

Москва

Department of Plastic Surgery

Moscow

Центральная клиническая больница «РЖД-Медицина»РоссияCentral Clinical Hospital «RZD-Medicine»Russian FederationМосковский государственный медико-стоматологический университет им. А.И. ЕвдокимоваРоссияA.I. Yevdokimov Moscow State University of Medicine and DentistryRussian Federation202224102022123199204Copyright © Воротников В.В., Пахомова Р.А., Сойнов А.В., Гунина А.С., Копытич И.В., Цой М.Г., Абдугаффоров С.А., 20222022Воротников В.В., Пахомова Р.А., Сойнов А.В., Гунина А.С., Копытич И.В., Цой М.Г., Абдугаффоров С.А.Vorotnikov V.V., Pakhomova R.A., Soinov A.V., Gunina A.S., Kopytich I.V., Tsoi M.G., Abdugafforov S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/714

Рак молочной железы – самое распространенное злокачественное заболевание в мире. Один из методов лечения рака молочной железы – неоадъювантная химиотерапия. В настоящее время неоадъювантная химиотерапия (НХТ) – это стандарт лечения местнораспространенного рака молочной железы. Наибольшие преимущества от НХТ получают пациентки с HER2-положительным и трижды негативным подтипами рака молочной железы, у которых вероятность достижения pCR равна 50–60 %, в то время как вероятность достижения pCR у гормончувствительных, HER2-негативных подтипов рака молочной железы равна в среднем 10–20 %. Для пациенток с местнораспространенным гормончувствительным Her2neu-негативным раком молочной железы неоадъювантная гормонотерапия терапия способствует уменьшению стадии опухоли и увеличению частоты органосохраняющих операций. Однако неоадъювантная гормонотерапия по-прежнему не используется рутинно. Существует ограниченное количество клинических рекомендаций, в которых описан выбор оптимальной группы лекарственных препаратов, оптимальная продолжительность гормонотерапии и критерии отбора пациентов для предоперационной гормонотерапии. Это первый литературный обзор в России, который включает в себя систематизацию фактических данных, касающихся эффективности неоадъювантной гормонотерапии, сравнения гормонотерапии с химиотерапией в неоадъювантном режиме, сравнения групп гормональных препаратов, оптимальной длительности гормонотерапии, попыток комбинации гормонотерапии с препаратами группы селективных ингибиторов циклинзависимых киназ CDK4/6 и ингибиторов фосфатидилинозитол-3-киназы для женщин с местнораспространенным гормончувствительным Her2neu-негативным раком молочной железы. Также рассмотрены возможности применения современных коммерческих мультигенных панелей для оценки возможности определения когорты пациентов, для которой неоадъювантная гормонотерапия будет наиболее эффективна.

Breast cancer is the most common malignant disease in the world. One of the methods of treating breast cancer is neoadjuvant chemotherapy. Neoadjuvant chemotherapy (NCT) is now the standard of care for locally advanced breast cancer. Patients with HER2-positive and triple-negative breast cancer subtypes benefi t the most from NCT, with a 50–60 % chance of achieving pCR, while patients with hormone-sensitive, HER2-negative breast cancer subtypes have an average chance of achieving pCR of 10–20 %. For patients with locally advanced, hormone-sensitive Her2neu-negative breast cancer, neoadjuvant hormone therapy contributes to a tumor downstaging and an increasing rate of organ-preserving surgery. However, neoadjuvant hormone therapy is still not used routinely. There are a limited number of clinical guidelines that describe the choice of the optimal drugs, the optimal duration of hormone therapy and the criteria for selecting patients for preoperative hormone therapy. This is the first literature review in Russia that includes a systematization of the evidence regarding the effectiveness of neoadjuvant hormone therapy, a comparison of hormone therapy with neoadjuvant chemotherapy, comparison of hormonal drug groups, optimal duration of hormone therapy, attempts to combine hormone therapy with drugs of the group of selective CDK4/6 cyclin-dependent kinase inhibitors and phosphatidylinositol 3-kinase inhibitors for women with locally advanced hormone-sensitive Her2neu-negative breast cancer. The possibilities of using modern commercial multigene panels to assess the feasibility of identifying the cohort of patients for whom neoadjuvant hormone therapy would be most effective are also considered.

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