ГОРМОНОЧУВСТВИТЕЛЬНЫЙ РАК МОЛОЧНОЙ ЖЕЛЕЗЫ: МОЛЕКУЛЯРНОБИОЛОГИЧЕСКИЕ И КЛИНИЧЕСКИЕ АСПЕКТЫ ПРЕДОПЕРАЦИОННОЙ ПРОТИВООПУХОЛЕВОЙ ГОРМОНОТЕРАПИИ
Ключові слова:
рак молочной железы, неоадъювантное лечение, гормонотерапия, резистентность, таргетная терапия.Анотація
В обзоре проанализированы современные представления о молекулярных
механизмах участия гормонов (эстрогенов), ростовых факторов, внутриклеточных белковых продуктов онкогенов и генов-супрессоров в патогенезе и клиническом течении рака молочной железы (РМЖ). На основе информации о молекулярной биологии РМЖ в настоящее время активно разрабатываются терапевтические алгоритмы пред- и послеоперационного
лечения с заменой традиционной химиотерапии гормонотерапией (ГТ) без
риска ухудшения отдаленных результатов. Наиболее изучаемая сейчас опция терапии РМЖ — неоадъювантное лечение. Активно разрабатываются вопросы показаний к проведению тех или иных режимов неоадъювантной ГТ, текущей оценки ее эффективности, продолжительности такого
лечения, механизмов резистентности опухолевых клеток к ГТ. Показано,
что резистентность к антиэстрогенной терапии связана с двунаправленными перекрестными связями между рецепторами эстрогенов, рецепторами факторов роста и нисходящими киназами сигнальных путей. Для оптимизации результатов ГТ активно исследуются различные комбинации
препаратов ГТ и целевых ингибиторов внутриклеточных сигнальных молекул (рецепторных и нерецепторных тирозинкиназ, молекул-звеньев сигнального пути PI3K/Akt/mTOR).
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