Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press64610.17650/2949-5857-2023-13-3-49-56CASE REPORTКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕComplete radiological response when using pembrolizumab in the mono mode in the 2nd-line drug therapy of MSI-h / dMMR-positive advanced endometrial cancer. A clinical caseПолный радиологический ответ при использовании пембролизумаба в монорежиме во 2-й линии лекарственной терапии MSI-h / dMMR-положительного распространенного рака эндометрия. Клинический случайhttps://orcid.org/0000-0002-6505-2202DarenskayaA. D.ДаренскаяА. Д.
Russian Federation

Anna Dmitrievna Darenskaya

24 Kashirskoe shosse, Moscow 115522

Анна Дмитриевна Даренская

115522 Москва, Каширское шоссе, 24

darenskaya@bk.ruhttps://orcid.org/0000-0003-1779-003XMedvedevaB. M.МедведеваБ. М.
Russian Federation

24 Kashirskoe shosse, Moscow 115522

115522 Москва, Каширское шоссе, 24

https://orcid.org/0000-0003-4443-9974RumyantsevA. A.РумянцевА. А.
Russian Federation

24 Kashirskoe shosse, Moscow 115522

115522 Москва, Каширское шоссе, 24

https://orcid.org/0000-0002-6104-7473TyulyandinaA. S.ТюляндинаА. С.
Russian Federation

24 Kashirskoe shosse, Moscow 115522

Build. 2, 8 Trubetskaya St., Moscow 119991

115522 Москва, Каширское шоссе, 24

119991 Москва, ул. Трубецкая, 8, стр. 2

Blokhin National Medical Research Center of Oncology of the Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава РоссииI. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)ФГАОУ ВО «Первый Московский государственный медицинский университет им. И. М. Сеченова» Минздрава России (Сеченовский Университет)2112202313349562112202321122023Copyright ©; 2023, Darenskaya A.D., Medvedeva B.M., Rumyantsev A.A., Tyulyandina A.S.Copyright ©; 2023, Даренская А.Д., Медведева Б.М., Румянцев А.А., Тюляндина А.С.2023Darenskaya A.D., Medvedeva B.M., Rumyantsev A.A., Tyulyandina A.S.Даренская А.Д., Медведева Б.М., Румянцев А.А., Тюляндина А.С.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/646

Until recently, the prognosis of patients with advanced endometrial cancer remained disappointing despite the standard treatment methods. None of the drugs in the arsenal of oncologists-chemotherapists provided long-term disease control and long-term survival of patients who received standard platinum-containing first-line chemotherapy. It is obvious that the poor results of treatment in patients with advanced endometrial cancer required a change in treatment approaches and indicated the need to develop more effective treatment regimens. A deeper understanding of the mechanisms of carcinogenesis, the emergence of new molecular classification of endometrial cancer and division of treatment approaches depending on the tumor biological potential has led to significant breakthrough in the treatment of advanced endometrial cancer. One of the most significant achievements is discovery of the function of microsatellite instability (MSI) and disorders in the repair system of unpaired bases of deoxyribonucleic acid (MMR) as a predictor of high efficient immunotherapy – a new direction of systemic drug therapy for the advanced endometrial cancer. The paper presents a clinical case of successful treatment of MSI-h / dMMR-positive advanced endometrial cancer using pembrolizumab as a second-line therapy (in the presence of refractoriness to standard platinum-based chemotherapy of the 1st line) in a mono mode with a complete radiological response of the tumor to treatment.

До недавнего времени прогноз больных распространенным раком эндометрия, несмотря на проводимые стандартные методы лечения, оставался неутешительным. Ни один из препаратов в арсенале онкологов-химиотерапевтов не обеспечивал долговременного контроля болезни и длительной выживаемости пациенток, получивших стандартную платиносодержащую химиотерапию 1-й линии. Очевидно, что неудовлетворительные результаты лечения больных распространенным раком эндометрия требовали изменения подходов к терапии и указывали на необходимость разработки более эффективных режимов лечения. Углубленное понимание механизмов канцерогенеза, появление новой молекулярной классификации рака эндометрия и разделение лечебных подходов в зависимости от биологического потенциала опухоли привели к значительному прорыву в лечении распространенного рака эндометрия. Одним из наиболее важных достижений следует считать открытие роли микросателлитной нестабильности (MSI) и нарушений в системе репарации неспаренных оснований дезоксирибонуклеиновой кислоты (MMR) как предиктора высокой эффективности иммунотерапии – нового направления системной лекарственной терапии распространенного рака эндометрия. В статье представлен клинический случай успешного лечения MSI-h / dMMR-положительного распространенного рака эндометрия с использованием в качестве лекарственной терапии 2-й линии (при наличии рефрактерности к стандартной платиносодержащей химиотерапии 1-й линии) пембролизумаба в монорежиме с достижением полного радиологического ответа опухоли на лечение.

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