surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2022-12-3-205-216surgonco-715Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSИнгибиторы иммунных контрольных точек при уротелиальной карциноме (обзор литературы)Immune Checkpoint Inhibitors in Urothelial Carcinoma (Literature Review)https://orcid.org/0000-0003-3734-2779МеньшиковК. В.MenshikovK. V.

к.м.н., доцент, кафедра онкологии с курсами онкологии и патологической анатомии ИДПО, отдел химиотерапии

Уфа

Cand. Sci. (Med.), Assoc. Prof., Department of Oncology with courses of Oncology and Pathological Anatomy for Advanced Professional Education, Chemotherapy Unit

Ufa

kmenshikov80@bk.ruhttps://orcid.org/0000-0003-0996-5995СултанбаевА. В.SultanbaevA. V.

к.м.н., отдел противоопухолевой лекарственной терапии

Уфа

Cand. Sci. (Med.), Oncology Drug Therapy Unit

Ufa

https://orcid.org/0000-0003-1185-977XМусинШ. И.MusinSh. I.

к.м.н., хирургическое отделение № 6

Уфа

Cand. Sci. (Med.), Surgery Unit № 6

Ufa

https://orcid.org/0000-0002-8461-9243ИзмайловА. А.IzmailovA. A.

д.м.н., доцент, кафедра урологии с курсом ИДПО

Уфа

 

Dr. Sci. (Med.), Assoc. Prof., Department of Urology with a courseof Advanced Professional

Ufa

https://orcid.org/0000-0002-8867-504XЛипатовО. Н.LipatovO. N.

д.м.н., профессор, кафедра онкологии с курсами онкологии и патологической анатомии ИДПО

Уфа

Dr. Sci. (Med.), Prof., Department of Oncology with courses ofOncology and Pathological Anatomy for Advanced Professional Education

Ufa

https://orcid.org/0000-0002-8665-8895МеньшиковаИ. А.MenshikovaI. A.

к.м.н., доцент, кафедра биологической химии

Уфа

Cand. Sci. (Med.), Assoc. Prof., Department of Biological Chemistry

Ufa

https://orcid.org/0000-0001-5926-0446СултанбаеваН. И.SultanbaevaN. I.

отделение противоопухолевой лекарственной терапии № 1

Уфа

Oncology Drug Therapy Unit № 1

Ufa

https://orcid.org/0000-0003-1242-759XПоповаЕ. В.PopovaE. V.

отделение амбулаторной противоопухолевой лекарственнойтерапии

Уфа

Outpatient Oncology Drug Therapy

Ufa

Республиканский клинический онкологический диспансер; Башкирский государственный медицинский университетРоссияRepublican Clinical Oncology Dispensary; Bashkir State Medical UniversityRussian FederationРеспубликанский клинический онкологический диспансерРоссияRepublican Clinical Oncology DispensaryRussian FederationБашкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian Federation202224102022123205216Copyright © Меньшиков К.В., Султанбаев А.В., Мусин Ш.И., Измайлов А.А., Липатов О.Н., Меньшикова И.А., Султанбаева Н.И., Попова Е.В., 20222022Меньшиков К.В., Султанбаев А.В., Мусин Ш.И., Измайлов А.А., Липатов О.Н., Меньшикова И.А., Султанбаева Н.И., Попова Е.В.Menshikov K.V., Sultanbaev A.V., Musin S.I., Izmailov A.A., Lipatov O.N., Menshikova I.A., Sultanbaeva N.I., Popova E.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.surgonco.ru/jour/article/view/715

Рак мочевого пузыря считается одним из самых агрессивных новообразований во всем мире. Терапия первой линии метастатической уротелиальной карциномы оставалась неизменной на протяжении последних десятилетий и основывалась на комбинациях цисплатина. К сожалению, почти все пациенты в конечном счете прогрессируют и умирают от рака мочевого пузыря, несмотря на первоначальный ответ, связанный с комбинациями на основе цисплатина. Ингибиторы иммунных контрольных точек становятся все более широко используемым терапевтическим вариантом при многих солидных опухолях. При раке мочевого пузыря высокий уровень лиганда запрограммированной смерти связан с быстро прогрессирующими и агрессивными опухолями с неудовлетворительными показателями выживаемости. Хотя ингибиторы контрольных точек эффективны при метастатическом уротелиальном раке мочевого пузыря, лишь небольшая часть пролеченных пациентов получает явную пользу, в то время как большое число пациентов получают значительные побочные эффекты и токсичность без улучшения качества жизни или выживаемости. Ни один имеющийся биомаркер на этот момент не был связан с частотой ответов. Имеются данные о связи между экспрессией PD-L1, эффективностью ингибиторов иммунных контрольных точек и результатами лечения пациентов с раком мочевого пузыря. Серьезный сдвиг парадигмы в медицине рака мочевого пузыря был связан с одобрением FDA авелумаба, пембролизумаба, дурвалумаба, атезолизумаба и ниволумаба для лечения пациентов с метастатической уротелиальной карциномой, ранее получавших химиотерапию. Сочетание классических клинико-патологических параметров с данными, полученными с помощью информационных технологий, вместе с геномным профилированием может стать будущим персонализированной терапии рака мочевого пузыря.

Bladder cancer is globally considered as one of the most aggressive neoplasms. Traditionally, first-line therapy for metastatic urothelial carcinoma has remained unchanged over the past decades and has been based on combinations of cisplatin. Unfortunately, almost all patients eventually progress and die from bladder cancer, despite the initial response associated with cisplatin-based combinations. Immune checkpoint inhibitors are becoming an increasingly widely used therapeutic option in many solid tumors. In bladder cancer, a high level of programmed death-ligand is determined by rapidly progressive and aggressive tumors and unsatisfactory survival rates. Although checkpoint inhibitors are effective in metastatic urothelial bladder cancer, only a small proportion of treated patients receive a clear benefit, while a large number of patients experience significant side effects and toxicity without improving quality of life or surviving. None of the available biomarkers at this point was associated with response rates. There is evidence of an correlation between PD-L1 expression, the efficacy of immune checkpoint inhibitors, and treatment outcomes in patients with bladder cancer. A major paradigm shift in bladder cancer medicine has followed the FDA approval of avelumab, pembrolizumab, durvalumab, atezolizumab, and nivolumab for the treatment of patients with metastatic urothelial carcinoma previously treated with chemotherapy. Combining classical clinicopathological parameters with data obtained via information technology, together with genomic profiling, could be the future of personalized therapy for bladder cancer.

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