Иммунотерапия перед трансплантацией печени: обзор литературы и клинический случай гепатоцеллюлярной карциномы с мутацией BRCA1

Гепатоцеллюлярная карцинома занимает лидирующие позиции в мировой структуре онкологической смертности. Эффективность стандартного лечения в некоторых случаях остается неудовлетворительной.

Приводим отчет о пациенте с гепатоцеллюлярной карциномой криптогенной этиологии стадии BCLC-C, достигшем продолжительности жизни 26 мес. от постановки диагноза.

Женщина, 46 лет, бывший курильщик, обратилась с повышением альфа-фетопротеина и образованием левой доли печени, диагностированным как гепатоцеллюлярная карцинома. Ранее обнаружились предположительно метастатические легочные узелки, остававшиеся стабильными. Проведена резекция левой доли печени. Спустя 1,5 мес. развился внутрипеченочный рецидив. Назначена терапия ленватиниб+пембролизумаб, позже переключенная на олапариб в связи с обнаружением соматической и герминативной мутации BRCA1. Также проведена трансплантация печени с назначением такролимуса и эверолимуса, позже дополненных экстракорпоральным фотоферезом. Лечение легочных узлов, оказавшихся метастазами, осуществлялось методами лучевой терапии. Спустя 21,3 мес. после трансплантации последовал летальный исход.

В первом обзоре литературы, относящемся к этому случаю, рассматривается проблема неоадъювантной терапии ингибиторами контрольных точек перед трансплантацией печени. В 40 работах было описано более 100 пациентов, а также 113 – в двух многоцентровых исследованиях. Несмотря на то что реакция отторжения развилась у 16,7–27,7%, этот подход может быть эффективен для снижения стадии заболевания. 

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