Journal of Modern OncologyJournal of Modern OncologyСовременная онкология1815-14341815-1442LLC Obyedinennaya Redaktsiya26933ArticlesСтатьиResearch ArticleNew aspects of the first-line chemotherapy in colorectal cancerНовые аспекты первой линии химиотерапии метастатического колоректального ракаArtamonovaE VАртамоноваЕлена Владимировна

д-р мед. наук, вед. науч. сотр.

ФГБУ Российский онкологический научный центр им. Н.Н.Блохина РАМН15032014161VOL 16, NO1 (2014)ТОМ 16, №1 (2014)303509042020Copyright ©; 2014, Consilium MedicumCopyright ©; 2014, ООО "Консилиум Медикум"2014Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc/4.0https://modernonco.orscience.ru/1815-1434/article/view/26933

Colorectal cancer (CRC) steadily occupies the third position in the morbidity and mortality in the world. Due to advance in chemotherapy,surgery and the use of multidisciplinary approach in patients with metastatic colorectal cancer (mCRC) the CRC treatment algorithms have changed recently. Depending on the clinical situation there are 4 groups of patients with CRC: resectable group, potentially resectable group, unresectable group of patients who could undergo the intensive treatment, unresectable group of patients with concomitant diseases. It was found, that besides mutations in 2 exone KRAS there is a scope of rare mutations (exons 3 and 4 in KRAS gene and mutation in NRAS gene) which determines the resistance to EGFR inhibitors as well. The PRIME study found that 17% of patients, who were included in to the group without mutations (KRAS WT), according to the old type of test, could have these rare mutations. The target choice in first line therapy in mCRC patients RAS mutant is only bevacizumab. In RAS WT patients as EGFR inhibitors, so bevacizumab can be used. The presence of BRAF mutation is a factor of the negative prognosis in patients with mCRC and is correlated with a reduction in life expectancy. Further research in the field of molecular genetic characteristics of the tumor will help to solve the remaining points and to optimize treatment in different patients` groups.

Колоректальный рак (КРР) устойчиво занимает 3-е место в мире в структуре заболеваемости и смертности. В последнее времяблагодаря прогрессу в химиотерапии и хирургическом лечении метастатического колоректального рака (мКРР) и использованию мультидисциплинарного подхода алгоритмы лечения больных изменились. В зависимости от клинической ситуации выделяют 4 группы больных мКРР: с исходно резектабельными метастазами, с потенциально операбельными метастазами, с неоперабельными метастазами с симптомным течением болезни или быстрым прогрессированием, которые могут перенести интенсивное лечение, а также группу больных с неоперабельными метастазами и выраженной сопутствующей патологией. Оказалось, что помимо мутаций в экзоне 2 гена KRAS есть еще целый ряд более редких мутаций (в экзонах 3 и 4 гена KRAS, а также мутации в гене NRAS), также определяющих резистентность к анти-EGFR-терапии. В исследовании PRIME 17% больных, отнесенных в соответствии со старым тестом в группу без мутации (KRAS wt), имеют эти редкие мутации. Выбор таргетного препарата в 1-й линии лечения больных мКРР с мутацией RAS ограничен только бевацизумабом, а у пациентов без мутации можно использовать как анти-EGFR моноклональные антитела, так и бевацизумаб. Наличие мутации BRAF является фактором негативного прогноза больных мКРР и коррелируется с уменьшением продолжительности жизни. Дальнейшие исследования в этой области помогут разрешить оставшиеся вопросы и оптимизировать лечебные подходы в отношении разных групп пациентов.

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