Head and Neck TumorsHead and Neck TumorsОпухоли головы и шеи2222-14682411-4634Publishing House ABV Press38810.17650/2222-1468-2019-9-1-51-67ORIGINAL REPORTОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕЛечение токсических побочных эффектов у пациентов с распространенным медуллярным раком щитовидной железыBroseM. S.
United States
BibleK. C.
United States
ChowL. Q. M.
United States
GilbertJ.
United States
GrandeC.
United States
WordenF.
United States
HaddadR.
United States

Robert Haddad.

robert_haddad@dfci.harvard.eduDepartment of Otorhinolaryngology, Head and Neck Surgery and the Abramson Cancer Center, University of PennsylvaniaMayo Clinic-RochesterUniversity of WashingtonVanderbilt UniversityUniversity of MichiganDana-Farber Cancer Institute030420199151670304201903042019Copyright ©; 2019, Brose M.S., Bible K.C., Chow L.Q., Gilbert J., Grande C., Worden F., Haddad R.Copyright ©; 2019, Brose M.S., Bible K.C., Chow L.Q., Gilbert J., Grande C., Worden F., Haddad R.2019Brose M.S., Bible K.C., Chow L.Q., Gilbert J., Grande C., Worden F., Haddad R.Brose M.S., Bible K.C., Chow L.Q., Gilbert J., Grande C., Worden F., Haddad R.https://creativecommons.org/licenses/by/4.0https://ogsh.abvpress.ru/jour/article/view/388

Большой прогресс в лечении распространенного медуллярного рака щитовидной железы за последние 5 лет достигнут благодаря одобрению 2 препаратов – вандетаниба и кабозантиниба. Действие этих ингибиторов протеинкиназ во многом совпадает и направлено на различные мишени, участвующие в патогенезе медуллярного рака щитовидной железы. Оба препарата имеют достаточно широкий ряд токсических побочных эффектов, таких как артериальная гипертензия, кровотечения, перфорация кишечника, диарея и другие нежелательные явления со стороны желудочно-кишечного тракта, поражения кожи и гипотиреоз. Кроме того, вандетаниб может вызывать удлинение интервала QT из-за взаимодействия с калиевыми ионными каналами клеток миокарда, а кабозантиниб – ладонно-подошвенный синдром. Связанные с лечением токсические эффекты возникают достаточно часто, могут быть очень тяжелыми и даже опасными для жизни. Следовательно, пациенты, получающие эти препараты в течение длительного времени, имеют весьма высокий риск развития побочных эффектов. В данной статье даны практические рекомендации по лечению побочных эффектов применения вандетаниба и кабозантиниба. Рекомендуемый нами подход основан на раннем выявлении побочных эффектов и их своевременном лечении на фоне прерывания терапии ингибиторами протеинкиназ или снижения их дозы, чтобы обеспечить как можно более длительное применение максимально допустимой для конкретного пациента дозы препарата и предотвратить ухудшение качества его жизни. На сегодняшний день отсутствуют рекомендации по выбору очередности применения вандетаниба и кабозантиниба, однако большинство пациентов получают оба эти препарата. Выбор терапии 1-й линии следует проводить в индивидуальном порядке после тщательной оценки потенциальных рисков и пользы. Часто этот выбор зависит от предпочтений врача и особенностей пациента, например наличия сопутствующих заболеваний. Поскольку многие специалисты могут быть незнакомы с тонкостями применения таких препаратов, как вандетаниб и кабозантиниб, мы рекомендуем проводить лечение пациентов с медуллярным раком щитовидной железы под контролем опытного, хорошо осведомленного специалиста, а также мультидисциплинарной бригады врачей.

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