Журнал "Медицинский совет" №9/2020

DOI: 10.21518/2079-701X-2020-9-16-24

¹ Национальный медицинский онкологический центр им. Н.Н. Блохина; ² Российский национальный исследовательский медицинский университет им. Н.И. Пирогова

В последнее время ингибиторы иммунных контрольных точек существенно изменили возможности терапии рака во всем мире. Постоянно увеличивается количество препаратов этой группы и показаний к их применению. В настоящий момент в Российской Федерации зарегистрированы и используется целый ряд ингибиторов иммунных контрольных точек: анти-PD1 (ниволумаб, пембролизумаб), анти-PD-L1 (атезолизумаб, дурвалумаб), анти-CTLA-4-моноклональные антитела (ипилимумаб). Одним из наиболее распространенных осложнений иммунотерапии является иммуноопосредованная эндокринопатия. По данным клинических исследований частота развития серьезных эндокринных иммуноопосредованных нежелательных явлений в целом при монотерапии анти-PD1-моноклональными антителами невелика и составляет 3,5–8%. Однако применение анти-CTLA4-препаратов, комбинированных режимов, проведение иммунотерапии после химиолучевой терапии значительно повышают частоту развития серьезных нежелательных явлений до 30%. В реальной клинической практике иммуноопосредованная эндокринопатия была выявлена у 22 из 245 пациентов (8,9%), получавших иммунотерапию в химиотерапевтическом отделении №17 НМИЦ онкологии им. Н.Н. Блохина по поводу немелкоклеточного рака легкого и гепатоцеллюлярного рака. У большинства пациентов развились нежелательные явления 1–2-й степени, у двух – 3-й степени, что потребовало прекращения лечения. Данная статья имеет своей целью предоставить полезную информацию и дать рекомендации практическим онкологам относительно коррекции часто встречающихся вариантов иммуноопосредованной эндокринопатии (в том числе гипотиреоза, гипертиреоза, гипофизита, надпочечниковой недостаточности).

Юдин Д.И., Лактионов К.К., Саранцева К.А., Борисова О.И., Бредер В.В., Реутова Е.В., Белоярцева М.Ф., Крутелева С.Ю., Джанян И.А. Иммуноопосредованная эндокринопатия у пациентов на фоне лечения ингибиторами контрольных точек. Медицинский Совет. 2020;(9):16-24. https://doi.org/10.21518/2079-701X-2020-9-16-24

Конфликт интересов: авторы заявляют об отсутствии конфликта интересов.

Immuno-related endocrinopathy in patients treated with immune checkpoint inhibitors

¹ N.N. Blokhin National Medical Research Center of Oncology; ² Pirogov Russian National Research Medical University

Recently immune checkpoint inhibitors amazingly changed the landscape of cancer therapy worldwide. The number of immune checkpoint molecules in clinical practice is constantly increasing. There are some monoclonal antibodies recently registered in the Russian Federation: anti-PD1 antibodies (nivolumab, pembrolizumab), anti-PD-L1 (atezolizumab, durvalumab), anti-CTLA-4 (ipilimumab). Immune-mediated endocrinopathies are some of the most common complications of immunotherapy. According to the results of clinical studies, the incidence of serious endocrine immuno-mediated adverse events with anti-PD1 monoclonal antibodies is low (3.5–8%). The use of anti-CTLA4 antibodies, combined regimens, and the use of immunotherapy after chemoradiotherapy significantly increase the incidence of serious adverse events to 30%. In clinical practice of N.N. Blokhin Cancer Research Center among 245 non-small cell lung cancer and hepatocellular carcinoma patients treated with immunotherapy, 22 (8,9%) developed an immune-mediated endocrinopathy. Most patients developed adverse events of 1–2 degrees, in two patients – 3 degrees, requiring discontinuation of treatment. The aim of this article was to provide useful information and recommendations regarding the management of common immuno-related endocrine adverse events (including hypothyroidism, hyperthyroidism, pituitary, adrenal insufficiency) for clinical oncologists.

Yudin D.I., Laktionov K.K., Sarantseva K.A., Borisova O.I., Breder V.V., Reutova E.V., Beloyartseva M.F., Kruteleva S.Yu., Dzhanyan I.A. Immuno-related endocrinopathy in patients treated with immune checkpoint inhibitors. Meditsinskiy sovet = Medical Council. 2020;(9):16-24. (In Russ.) https://doi.org/10.21518/2079-701X-2020-9-16-24

Conflict of interest: the authors declare that there is no conflict of interest.

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