tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2024-003tumors-1309Research ArticleОБЗОРЫ И АНАЛИТИКАREVIEWS AND ANALYSISПрактические инструменты, облегчающие выбор адъювантной лекарственной терапии у больных операбельным люминальным HER2‑негативным раком молочной железыPractical tools to facilitate the choice of adjuvant systemic therapy for resectable luminal HER2‑negative breast cancerhttps://orcid.org/0000-0001-9807-2229ТюляндинС. А.TjulandinS. A.

Сергей Алексеевич Тюляндин

115478; Каширское шоссе, 23; Москва

Sergey Alekseevich Tjulandin

115478; 23 Kashirskoe Shosse; Moscow

stjulandin@gmail.comhttps://orcid.org/0000-0001-5304-9682СтенинаМ. Б.SteninaM. B.

Марина Борисовна Стенина

115478; Каширское шоссе, 23; Москва

Marina Borisovna Stenina

115478; 23 Kashirskoe Shosse; Moscow

https://orcid.org/0000-0002-8149-0085ФроловаМ. А.FrolovaM. A.

Мона Александровна Фролова

115478; Каширское шоссе, 23; Москва

Mona Aleksandrovna Frolova

115478; 23 Kashirskoe Shosse; Moscow

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава РоссииРоссияN. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaRussian Federation2024150520241425157Copyright © Тюляндин С.А., Стенина М.Б., Фролова М.А., 20242024Тюляндин С.А., Стенина М.Б., Фролова М.А.Tjulandin S.A., Stenina M.B., Frolova M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/1309

   Люминальный HER2‑негативный рак молочной железы составляет около 60–70 % всех случаев этого заболевания. Выбор тактики адъювантной лекарственной терапии при лечении больных первично‑операбельным люминальным HER2‑негативным раком молочной железы, особенно назначение адъювантной химиотерапии и овариальной супрессии, является одним из наиболее сложных и дискутабельных вопросов. Причинами этого являются выраженная гетерогенность люминального рака молочной железы, отсутствие четких маркеров химиочувствительности, а также гормонорезистентности опухоли у части больных. За рубежом большим подспорьем при решении данного вопроса стали генетические тесты, позволяющие в каждом конкретном случае оценить риск рецидива заболевания и необходимость назначения более агрессивной адъювантной лекарственной терапии, однако пока они не доступны для российских онкологов. Вместе с тем, даже в отсутствие возможности пользоваться подобными тестами, у нас имеются инструменты, которые могут существенно облегчить принятие решения об объеме адъювантной лекарственной терапии первично операбельного люминального HER2‑негативного рака молочной железы. В качестве альтернативных инструментов в статье обсуждаются калькулятор для оценки риска рецидива на основании клинико‑патологических характеристик опухоли, предоперационная тестовая гормонотерапия ингибиторами ароматазы для больных в постменопаузе и композитный индекс риска прогрессирования для больных в пременопаузе. Все эти инструменты доступны и могут быть использованы для определения тактики адъювантного лечения.

   Luminal HER2‑negative breast cancer accounts for about 60–70 % of all cases of this disease. The choice of adjuvant systemic therapy for patients with operable luminal HER2‑negative breast cancer, especially the prescription of adjuvant chemotherapy and ovarian suppression, is one of the most complex and controversial issues. The reasons for this are the pronounced heterogeneity of luminal breast cancer, the absence of clear markers of chemosensitivity, as well as hormone resistance of the tumor in some patients. Genetic tests have become a great help in resolving this issue in a number of foreign countries, allowing in each specific case to assess the risk of relapse of the disease and the need to prescribe more aggressive adjuvant drug therapy, however, they are not yet available to Russian oncologists. However, even in the absence of the ability to use such tests, we have tools that can significantly facilitate decision‑making on the choice of adjuvant treatment for operable luminal HER2‑negative breast cancer. As alternative tools, the article discusses a calculator for estimating the risk of recurrence based on clinicopathological tumor characteristics, preoperative test hormonal therapy with aromatase inhibitors for postmenopausal patients, and the composite progression risk index for premenopausal patients. All of these tools are available and can be used to guide adjuvant systemic treatment.

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The authors declare that there are no conflicts of interest present.