Комбинированная или монохимиотерапия при метастатическом раке молочной железы
https://doi.org/10.18027/2224-5057-2025-15-3s1-47-54
Аннотация
Выбор между монотерапией и комбинированной химиотерапией при метастатическом раке молочной железы (мРМЖ) остается предметом активной дискуссии. В реальной практике комбинированные варианты химиотерапии чаще применяются для достижения быстрого контроля болезни и увеличения безпрогрессивной выживаемости при агрессивном течении, тогда как монотерапия обеспечивает лучший профиль переносимости и чаще используется у более стабильных пациентов. Появление коньюгатов типа антитело-препарат (ADC — Antibody-Drug Conjugate), а также широкое применение иммунотерапии и ингибиторов CDK4/6 изменили терапевтические алгоритмы и поставили новые вопросы о последовательности назначения и эффективности классической химиотерапии. В обзоре проанализированы результаты ключевых рандомизированных исследований, мета-анализов и данных реальной практики, обсуждаются показания к комбинированной химиотерапии, оптимальные схемы, токсичность и приоритеты пациента, а также обозначены направления дальнейших исследований.
Об авторах
В. Н. Евсеев
ООО «ЛЕДИН КЛИНИК»
Россия
Конфликт интересов:
Россия
Евсеев Владислав Николаевич
119048 Москва, ул. Трубецкая, 12
Конфликт интересов:
Авторы заявляют об отсутствии возможных конфликтов интересов.
В. И. Столяров
ООО «ЛЕДИН КЛИНИК»
Россия
Конфликт интересов:
Россия
Столяров Владимир Игоревич
119048 Москва, ул. Трубецкая, 12
Конфликт интересов:
Авторы заявляют об отсутствии возможных конфликтов интересов.
Е. В. Ледин
ООО «ЛЕДИН КЛИНИК»
Россия
Конфликт интересов:
Россия
Ледин Евгений Витальевич
119048 Москва, ул. Трубецкая, 12
Конфликт интересов:
Авторы заявляют об отсутствии возможных конфликтов интересов.
Список литературы
1. Breast cancer key facts. World Health Organization. 2025. Available at: https://www.who.int/news-room/fact-sheets/ detail/breast-cancer (дата обращения: 21.10.2025).
2. Lim B., Hortobagyi G.N. Current challenges of metastatic breast cancer. Cancer Metastasis Rev 2016;35(4):495–514. https://doi.org/10.1007/s10555-016-9636-y
3. Living Beyond Breast Cancer. Breast Cancer Statistics. Available at: https://www.lbbc.org/about-breast-cancer/whatis-breast-cancer/statistics (дата обращения: 21.10.2025)
4. Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2023 году (заболеваемость и смертность). — М.: МНИОИ им. П.А. Герцена, 2024
5. Benitez Fuentes J.D., Morgan E., de Luna Aguilar A., et al. Global stage distribution of breast cancer at diagnosis: a systematic review and meta-analysis. JAMA Oncology 2023. https://doi.org/10.1001/jamaoncol.2023.4837
6. Gennari A., André F., Barrios C.H., et al; ESMO Guidelines Committee. Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol 2021;32(12):1475–1495. https://doi.org/10.1016/j.annonc.2021.09.019
7. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 4.2025. — NCCN, 2025. Available at: https://www.nccn.org/patients/guidelines/content/PDF/stage_iv_breast-patient.pdf (дата обращения: 21.10.2025).
8. Cardoso F., Paluch-Shimon S., Schumacher-Wulf E., et al. 6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7). Breast 2024;76:103756. https://doi.org/10.1016/j.breast.2024.103756
9. Тюляндин С.А., Артамонова Е.В., Жигулев А.Н. и соавт. Рак молочной железы. Практические рекомендации RUSSCO, часть 1.2. Злокачественные опухоли 2024;14(3s2):32–81. https://doi.org/10.18027/2224-5057-2024-14-3s2-1.2-01
10. Клинические рекомендации: Рак молочной железы, 2021. https://cr.minzdrav.gov.ru/preview-cr/379_4 (дата обращения: 21.10.2025)
11. Lu H., Zha S., Zhang W., et al. A systematic review and meta-analysis of nab-paclitaxel mono-chemotherapy for metastatic breast cancer. BMC Cancer 2021;21(1):830. https://doi.org/10.1186/s12885-021-08441-z
12. Blum J.L., Barrios C.H., Feldman N., et al. Pooled analysis of individual patient data from capecitabine monotherapy clinical trials in locally advanced or metastatic breast cancer. Breast Cancer Res Treat 2012;136(3):777–88. https://doi.org/10.1007/s10549-012-2288-x
13. Modi S., Currie V.E., Seidman A.D., et al. A phase II trial of gemcitabine in patients with metastatic breast cancer previously treated with an anthracycline and taxane. Clin Breast Cancer. 2005;6(1):55–60. https://doi.org/10.3816/CBC.2005.n.009
14. Cortes J., O’Shaughnessy J., Loesch D., et al; EMBRACE (Eisai Metastatic Breast Cancer Study Assessing Physician’s Choice Versus E7389) investigators. Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. Lancet 2011;377(9769):914–23. https://doi.org/10.1016/S0140-6736(11)60070-6
15. Jones S.E., Erban J., Overmoyer B., et al. Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. J Clin Oncol 2005;23(24):5542–51. https://doi.org/10.1200/JCO.2005.02.027
16. Isakoff S.J. Triple-negative breast cancer: role of specific chemotherapy agents. Cancer J 2010;16(1):53–61. https://doi.org/10.1097/PPO.0b013e3181d24ff7
17. Robson M., Im S.A., Senkus E., et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med 2017;377(6):523–533. https://doi.org/10.1056/NEJMoa1706450. Erratum in: N Engl J Med 2017;377(17):1700. https://doi.org/10.1056/NEJMx170012
18. Jia X., Wang K., Xu L., et al. A systematic review and meta-analysis of BRCA1/2 mutation for predicting the effect of platinum-based chemotherapy in triple-negative breast cancer. Breast 2022;66:31–39. https://doi.org/10.1016/j.breast.2022.08.012
19. Carrick S., Parker S., Thornton C.E., et al. Single agent versus combination chemotherapy for metastatic breast cancer. Cochrane Database Syst Rev 2009;2009(2):CD003372. https://doi.org/10.1002/14651858.CD003372.pub3
20. Albain K.S., Nag S.M., Calderillo-Ruiz G., et al. Gemcitabine plus Paclitaxel versus Paclitaxel monotherapy in patients with metastatic breast cancer and prior anthracycline treatment. J Clin Oncol 2008;26(24):3950–7. https://doi.org/10.1200/JCO.2007.11.9362
21. Belfiglio M., Fanizza C., Tinari N., et al.; Consorzio Interuniversitario Nazionale per la Bio-Oncologia. Meta-analysis of phase III trials of docetaxel alone or in combination with chemotherapy in metastatic breast cancer. 2012. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews Internet. York (UK): Centre for Reviews and Dissemination (UK); 1995. Available at: https://www.ncbi.nlm.nih.gov/books/NBK97888/
22. Truong J., Lee E.K., Trudeau M.E., Chan K.K. Interpreting febrile neutropenia rates from randomized, controlled trials for consideration of primary prophylaxis in the real world: a systematic review and meta-analysis. Ann Oncol 2016;27(4):608–18. https://doi.org/10.1093/annonc/mdv619
23. Lobo F., Virizuela J.A., Dorta F.J., et al; Spanish Group for Research in Breast Cancer. Gemcitabine/vinorelbine in metastatic breast cancer patients previously treated with anthracyclines: results of a phase II trial. Clin Breast Cancer 2003;4(1):46–50. https://doi.org/10.3816/cbc.2003.n.011
24. Abdayem P., Ghosn M., Valero V., et al. Phase I and II study of gemcitabine and vinorelbine in heavily pretreated patients with metastatic breast cancer and review of the literature. J Cancer 2014;5(5):351–9. https://doi.org/10.7150/jca.8304
25. Yardley D.A., Coleman R., Conte P., et al; tnAcity investigators. nab-Paclitaxel plus carboplatin or gemcitabine versus gemcitabine plus carboplatin as first-line treatment of patients with triple-negative metastatic breast cancer: results from the tnAcity trial. Ann Oncol 2018;29(8):1763–1770. https://doi.org/10.1093/annonc/mdy201
26. Lobefaro R., Mariani L., Peverelli G., et al. Efficacy and safety of first-line carboplatin-paclitaxel and carboplatin-gemcitabine in patients with advanced triple-negative breast cancer: a monocentric, retrospective comparison. Clin Breast Cancer 2023;23(3):e151-e162. https://doi.org/10.1016/j.clbc.2022.12.008
27. Brezden-Masley C., Fathers K.E., Coombes M.E., et al. A population-based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with triple-negative breast cancer. Cancer Med 2020;9(20):7548–7557. https://doi.org/10.1002/cam4.3038
28. Ciruelos E.M., Cortés J., Cortés-Funes H., et al. Gemcitabine and capecitabine in previously anthracycline-treated metastatic breast cancer: a multicenter phase II study (SOLTI 0301 trial). Ann Oncol 2010;21(7):1442–1447. https://doi.org/10.1093/annonc/mdp536
29. Cortes J., O’Shaughnessy J., Loesch D., et al; EMBRACE (Eisai Metastatic Breast Cancer Study Assessing Physician’s Choice Versus E7389) investigators. Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. Lancet 2011;377(9769):914–23. https://doi.org/10.1016/S0140-6736(11)60070-6
30. Perez E.A., Hillman D.W., Stella P.J., et al. A phase II study of paclitaxel plus carboplatin as first-line chemotherapy for women with metastatic breast carcinoma. Cancer 2000;88(1):124–31. https://doi.org/10.1002/(sici)1097-0142(20000101)88:1<124::aid-cncr17>3.3.co;2-6
31. Vernieri C., Milano M., Mennitto A., et al. Antitumor activity and safety profile of weekly carboplatin plus paclitaxel in metastatic breast cancer: a ten-year, monocentric, retrospective study. Breast Cancer Res Treat 2017;165(2):365–373. https://doi.org/10.1007/s10549-017-4336-z
32. Gehl J., Boesgaard M., Paaske T., et al. Combined doxorubicin and paclitaxel in advanced breast cancer: effective and cardiotoxic. Ann Oncol 1996;7(7):687–93. https://doi.org/10.1093/oxfordjournals.annonc.a010717
33. Mavroudis D., Papakotoulas P., Ardavanis A., et al; Breast Cancer Investigators of the Hellenic Oncology Research Group. Randomized phase III trial comparing docetaxel plus epirubicin versus docetaxel plus capecitabine as firstline treatment in women with advanced breast cancer. Ann Oncol 2010;21(1):48–54. https://doi.org/10.1093/annonc/mdp498
34. Nabholtz J.M., Falkson C., Campos D., et al; TAX 306 Study Group. Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first-line chemotherapy for metastatic breast cancer: results of a randomized, multicenter, phase III trial. J Clin Oncol 2003;21(6):968–75. https://doi.org/10.1200/JCO.2003.04.040. Erratum in: J Clin Oncol 2003;21(10):2048
35. Choong G.M., Liddell S., Ferre R.A. L, et al. Clinical management of metastatic hormone receptor-positive, HER2-negative breast cancer (MBC) after CDK 4/6 inhibitors: a retrospective single-institution study. Breast Cancer Res Treat 2022;196(1):229–237. https://doi.org/10.1007/s10549-022-06713-1
36. Munzone E., Pagan E., Bagnardi V., et al. Systematic review and meta-analysis of post-progression outcomes in ER +/ HER2metastatic breast cancer after CDK4/6 inhibitors within randomized clinical trials. ESMO Open 2021;6(6):100332. https://doi.org/10.1016/j.esmoop.2021.100332
37. Ettorre V.M., Greenman M., Palmieri L., et al. Successful sequential use of the antibody-drug conjugate trastuzumab deruxtecan after progression on sacituzumab govitecan in a recurrent treatment-resistant ovarian cancer patient: a case report. Cureus 2025;17(10):e94784. https://doi.org/10.7759/cureus.94784
38. Tutt A., Tovey H., Cheang M.C.U., et al. Carboplatin in BRCA1/2-mutated and triple-negative breast cancer BRCAness subgroups: the TNT Trial. Nat Med 2018;24(5):628–637. https://doi.org/10.1038/s41591-018-0009-7
39. Miller K.D., Chap L.I., Holmes F.A., et al. Randomized phase III trial of capecitabine compared with bevacizumab plus capecitabine in patients with previously treated metastatic breast cancer. J Clin Oncol 2005;23(4):792–9. https://doi.org/10.1200/JCO.2005.05.098
40. Miles D., Cameron D., Bondarenko I., et al. Bevacizumab plus paclitaxel versus placebo plus paclitaxel as first-line therapy for HER2-negative metastatic breast cancer (MERiDiAN): A double-blind placebo-controlled randomised phase III trial with prospective biomarker evaluation. Eur J Cancer 2017;70:146–155. https://doi.org/10.1016/j.ejca.2016.09.024
41. Miles D.W., de Haas S.L., Dirix L.Y., et al. Biomarker results from the AVADO phase 3 trial of first-line bevacizumab plus docetaxel for HER2-negative metastatic breast cancer. Br J Cancer 2013;108(5):1052–60. https://doi.org/10.1038/bjc.2013.69
42. Kimura T., Takami T., Piao Y., et al. Treatment patterns and clinical outcomes in patients with metastatic triple-negative breast cancer: a large-scale data analysis using the Japanese claims database. Breast Cancer Res Treat 2024;206(1):91–103. https://doi.org/10.1007/s10549-024-07273-2
43. Bland K.A., Mustafa R., McTaggart-Cowan H. Patient preferences in metastatic breast cancer care: a scoping review. Cancers (Basel) 2023;15(17):4331. https://doi.org/10.3390/cancers15174331
44. Sparano J.A., Vrdoljak E., Rixe O., et al. Randomized phase III trial of ixabepilone plus capecitabine versus capecitabine in patients with metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol 2010;28(20):3256–63. https://doi.org/10.1200/JCO.2009.24.4244
45. Miller K., Wang M., Gralow J., et al. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 2007;357(26):2666–76. https://doi.org/10.1056/NEJMoa072113
46. Hesketh P.J., Kris M.G., Basch E., et al. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017;35(28):3240–3261. https://doi.org/10.1200/JCO.2017.74.4789
Рецензия
Для цитирования:
Евсеев В.Н., Столяров В.И., Ледин Е.В. Комбинированная или монохимиотерапия при метастатическом раке молочной железы. Malignant tumours. 2025;15(3s1):47-54. https://doi.org/10.18027/2224-5057-2025-15-3s1-47-54
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