Вторая линия терапии распространенного рака эндометрия. Обзор литературы и клинический случай

Abstract

Currently, endometrial cancer (EC) remains a socially significant and urgent problem in oncology. In the structure of malignant neoplasms of the uterus, endometrial carcinoma remains the most common type of cancer. According to GLOBOCAN, in 2018, there were 382 069 new cases of uterine cancer worldwide and 89 929 deaths associated with this pathology. Unlike the first line of chemotherapy for advanced EC, the second shows worse results. The overall response rate to second-line chemotherapy is much lower than first-line chemotherapy. Drugs such as oxaliplatin, topotecan, liposomal doxorubicin, etoposide, cyclophosphamide, pemetrexed, gemcitabine, and ifosfamide have shown worse results in studies compared to paclitaxel alone as second-line therapy for advanced endometrial cancer. The clinical efficacy of pembrolizumab monotherapy was a breakthrough in the treatment of EC, as evidenced by a Phase II study published in 2017. The results of molecular genetic studies allow the development and personalization of anticancer drug therapy. The FDA recently approved the use of the tyrosine kinase inhibitor lenvatinib (VEGFR1-3, FGFR 1-4, KIT, RET, PDGFRa) and pembrolizumab as a second-line EC without MSI-H or dMMR. The above clinical observation demonstrates the experience of treating a patient with advanced endometrial cancer in the second line. The combination of lenvatinib with pembrolizumab resulted in a partial response from the first months of therapy. Combination therapy showed a satisfactory tolerability profile in a patient with comorbid pathology; adverse events did not require discontinuation or dose reduction of pembrolizumab and lenvatinib.