Journal of Modern OncologyJournal of Modern OncologyСовременная онкология1815-14341815-1442LLC Obyedinennaya Redaktsiya27044ArticlesСтатьиResearch ArticleSystemic drug therapy of metastatic pancreatic cancerСистемная лекарственная терапия метастатического рака поджелудочной железыPokataevI AПокатаевИлья Анатольевич

канд. мед. наук, врач-онколог ФГБУ РОНЦ им. Н.Н.Блохина

Pokia@mail.ruTyulyandinS AТюляндинСергей Алексеевич

д-р мед. наук, проф., зав. отд-нием клинической фармакологии ФГБУ РОНЦ им. Н.Н.Блохина

N.N.Blokhin Russian Cancer Research Center of the Ministry of Health of the Russian FederationФГБУ Российский онкологический научный центр им. Н.Н.Блохина Минздрава России15032016181VOL 18, NO1 (2016)ТОМ 18, №1 (2016)202409042020Copyright ©; 2016, Consilium MedicumCopyright ©; 2016, ООО "Консилиум Медикум"2016Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc/4.0https://modernonco.orscience.ru/1815-1434/article/view/27044

The standard treatment for patients with locally advanced and metastatic pancreatic cancer was monochemotherapy using gemcitabine until 2011. For a long time the attempts to create the combinations of gemcitabine and new drugs did not lead to clinically significant increase of these patients life expectancy. Introduction of new chemotherapy regimens into clinical practice such as combination of nab-paclitaxel and FOLFIRINOX was resulted in a clinically significant increase of life expectancy. Characteristics and toxicity range of new chemotherapy regimens allow form selected mode algorithm of chemotherapy regimen for every patient based on his status, comorbidity and complications of tumor process.

До 2011 г. стандартом лечения больных местнораспространенным и метастатическим раком поджелудочной железы была монохимиотерапия гемцитабином. Попытки создания комбинаций гемцитабина с новыми лекарственными препаратами длительное время не приводили к клинически значимому увеличению продолжительности жизни этих больных. Внедрение в клиническую практику новых режимов химиотерапии - комбинации nab-паклитаксела и FOLFIRINOX - привело к клинически значимому увеличению продолжительности жизни. Особенности проведения и спектр токсичности новых режимов химиотерапии позволяют сформировать алгоритм выбора режима химиотерапии для каждого пациента на основании его состояния, сопутствующей патологии и осложнений опухолевого процесса.

FOLFIRINOXpancreatic cancerchemotherapyabraksanNAB-paclitaxelFOLFIRINOXрак поджелудочной железыхимиотерапияабраксанNAB-паклитакселСостояние онкологической помощи населению России в 2014 году. Под ред. А.Д.Каприна, В.В.Старинского, Г.В.Петровой. М.: МНИОИ им. П.А.Герцена, 2015.Burris A.H, Moore M.J, Andersen J et al. Improvements in survival and clinical benefit with gemcitabine as first - line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997; 15: 2403-13.Berlin J.D, Catalano P, Thomas J.P et al. Phase III study of gemcitabine in combination with fluorouracil versus gemcitabine alone in patients with advanced pancreatic carcinoma: Eastern Cooperative Oncology Group Trial E2297. J Clin Oncol 2002; 20: 3270-5.Bernhard J, Dietrich D, Scheithauer W et al. Clinical benefit and quality of life in patients with advanced pancreatic cancer receiving gemcitabine plus capecitabine versus gemcitabine alone: a randomized multicenter phase III clinical trial--SAKK 44/00-CECOG/PAN.1.3.001. J Clin Oncol 2008; 26: 3695-701.Louvet C, Labianca R, Hammel P et al. Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol 2005; 23: 3509-16.Colucci G, Labianca R, Di Costanzo F et al. Randomized phase III trial of gemcitabine plus cisplatin compared with single - agent gemcitabine as first - line treatment of patients with advanced pancreatic cancer: the GIP-1 study. J Clin Oncol 2010; 28: 1645-5.Rocha Lima C.M, Green M.R, Rotche R et al. Irinotecan plus gemcitabine results in no survival advantage compared with gemcitabine monotherapy in patients with locally advanced or metastatic pancreatic cancer despite increased tumor response rate. J Clin Oncol 2004; 22: 3776-83.Oettle H, Richards D, Ramanathan R.K et al. A phase III trial of pemetrexed plus gemcitabine versus gemcitabine in patients with unresectable or metastatic pancreatic cancer. Ann Oncol 2005; 16: 1639-45.Philip P.A, Benedetti J, Corless C.L et al. Phase III study comparing gemcitabine plus cetuximab versus gemcitabine in patients with advanced pancreatic adenocarcinoma: Southwest Oncology Group - directed intergroup trial S0205. J Clin Oncol 2010; 28: 3605-10.Kindler H.L, Niedzwiecki D, Hollis D et al. Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the Cancer and Leukemia Group B (CALGB 80303). J Clin Oncol 2010; 28: 3617-22.Moore M.J, Goldstein D, Hamm J et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 2007; 25: 1960-6.Rougier P, Riess H, Manges R et al. Randomised, placebo - controlled, double - blind, parallelgroup phase III study evaluating aflibercept in patients receiving first - line treatment with gemcitabine for metastatic pancreatic cancer. Eur J Cancer 2013; 49: 2633-42.Kindler H.L, Richards D.A, Garbo L.E et al. A randomized, placebo - controlled phase 2 study of ganitumab (AMG 479) or conatumumab (AMG 655) in combination with gemcitabine in patients with metastatic pancreatic cancer. Ann Oncol 2012; 23: 2834-42.Bodoky G, Timcheva C, Spigel D.R et al. A phase II open - label randomized study to assess the efficacy and safety of selumetinib (AZD6244 [ARRY-142886]) versus capecitabine in patients with advanced or metastatic pancreatic cancer who have failed first - line gemcitabine therapy. Invest New Drugs 2012; 30: 1216-23.Wolpin B.M, Hezel A.F, Abrams T et al. Oral mTOR inhibitor everolimus in patients with gemcitabine - refractory metastatic pancreatic cancer. J Clin Oncol 2009; 27: 193-8.Royal R.E, Levy C, Turner K et al. Phase 2 trial of single agent Ipilimumab (anti-CTLA-4) for locally advanced or metastatic pancreatic adenocarcinoma. J Immunother 2010; 33: 828-33.Wolpin B.M, O’Reilly E.M, Ko Y.J et al. Global, multicenter, randomized, phase II trial of gemcitabine and gemcitabine plus AGS-1C4D4 in patients with previously untreated, metastatic pancreatic cancer. Ann Oncol 2013; 24: 1792-801Grubbs S.S, Grusenmeyer P.A, Petrelli N.J, Gralla R.J. Is it cost - effective to add erlotinib to gemcitabine in advanced pancreatic cancer? J Clin Oncol 2006; 24 (18S): 6048.Conroy T, Desseigne F, Ychou M et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364 (19): 1817-25.Marsh Rde W, Talamonti M.S, Katz M.H, Herman J.M. Pancreatic cancer and FOLFIRINOX: a new era and new questions. Cancer Med 2015; 4 (6): 853-63.Desai N, Trieu V et al. Increased antitumor activity, intratumor paclitaxel concentrations, and endothelial cell transport of cremophor - free, albumin - bound paclitaxel, ABI-007, compared with cremophor - based paclitaxel. Clin Cancer Res 2006; 12: 1317-24.Von Hoff, D, Ramanathan R, Borad M et al. Gemcitabine Plus nab-Paclitaxel Is an Active Regimen in Patients With Advanced Pancreatic Cancer: A Phase I/II Trial. J Clin Oncol 2011; 36: 5742.Von Hoff D.D, Ramanathan R, Borad M et al. SPARC correlation with response to gemcitabine (G) plus nab - paclitaxel (nab-P) in patients with advanced metastatic pancreatic cancer: A phase I/II study.J Clin Oncol 2009; 27 (Suppl.): 4525.Von Hoff D.D, Ervin T, Arena F.P et al. Increased survival in pancreatic cancer with nab - paclitaxel plus gemcitabine. N Engl J Med 2013; 369 (18): 1691-703.Goldstein D, El-Maraghi R.H, Hammel P et al. nab-Paclitaxel plus gemcitabine for metastatic pancreatic cancer: long - term survival from a phase III trial. J Natl Cancer Inst 2015; 107 (2).