OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press87110.17650/1818-8346-2023-18-4-90-103RARE AND COMPLEX CLINICAL SITUATIONS: DIAGNOSIS AND TREATMENT CHOICEРЕДКИЕ И СЛОЖНЫЕ КЛИНИЧЕСКИЕ СИТУАЦИИ: ДИАГНОСТИКА И ВЫБОР ТАКТИКИ ЛЕЧЕНИЯIsatuximab in the treatment of refractory and relapsed multiple myeloma: literature review and case reportИзатуксимаб в терапии рефрактерной и рецидивирующей множественной миеломы: обзор литературы и клиническое наблюдениеhttps://orcid.org/0000-0001-8443-8816RyabukhinaYu. E.РябухинаЮ. Е.
Russian Federation

Yuliya E. Ryabukhina

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

Юлия Евгеньевна Рябухина 

143081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111

gemonk.yur@mail.ruhttps://orcid.org/0000-0003-1564-424XZeynalovaP. A.ЗейналоваП. А.
Russian Federation

Department of Oncology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Build. 2, 8 Trubetskaya St., Moscow 119991,

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

Кафедра онкологии ФГАОУ ВО Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский Университет

143081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111,

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

https://orcid.org/0000-0002-2359-0547AbbasbeyliF. M.АббасбейлиФ. М.
Russian Federation

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

143081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111

https://orcid.org/0000-0002-6229-7300TimofeevaO. L.ТимофееваО. Л.
Russian Federation

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

143081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111

https://orcid.org/0000-0002-1469-2365ValievT. T.ВалиевТ. Т.
Russian Federation

Department of Oncology

Build. 2, 8 Trubetskaya St., Moscow 119991

Кафедра онкологии 

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

https://orcid.org/0000-0001-8509-0954KupryshinaN. A.КупрышинаН. А.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

https://orcid.org/0000-0001-5353-8857ZhukovA. G.ЖуковА. Г.
Russian Federation

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

143081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111

Clinical Hospital “Lapino” of the “Mother and Child” Group of companiesКлинический госпиталь «Лапино» группы компаний «Мать и дитя»I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)ФГАОУ ВО Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский Университет)N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России09122023184901030812202308122023https://oncohematology.abvpress.ru/ongm/article/view/871

Multiple myeloma is a malignant tumor characterized by the proliferation of clonal plasma cells and currently remains an incurable disease, despite advances in therapy. Resistance and development of double refractoriness represent a significant problem, worsening the prognosis. To overcome double refractoriness, new proteasome inhibitors carfilzomib and ixazomib, the 3rd generation immunomodulator pomalidomide and monoclonal antibodies daratumumab, elotuzumab and isatuximab are used. Based on randomized phase III ICARIA-MM and IKEMA studies results, which demonstrated, along with a manageable safety profile, advantages in increasing the antitumor response depth, the rate of achieving negative minimal residual disease status and survival in all subgroups of patients with refractory/relapsed multiple myeloma, isatuximab is used in IsaPd (isatuximab, pomalidomide, dexamethasone) and IsaKd (isatuximab, carfilzomib, dexamethasone) combination. This article discusses the clinical pharmacology of isatuximab. The results of studies demonstrating the effectiveness and safety of antitumor therapy regimens including isatuximab, which made it possible to use it in clinical practice, are presented. We present a case report of a patient with refractory/relapsed multiple myeloma who received 3 lines of antitumor treatment, including class 2 proteasome inhibitors, lenalidomide and the monoclonal antibody elotuzumab. After 3 cycles of IsaPd (8 injections of isatuximab), partial remission and pain relief were recorded. The achieved antitumor effect, along with the absence of significant adverse events, facilitated the continuation of therapy at recommended doses.

Множественная миелома – злокачественная опухоль, характеризующаяся пролиферацией клональных плазматических клеток и остающаяся в настоящее время неизлечимым заболеванием, несмотря на достигнутые успехи в терапии. Резистентное течение и развитие двойной рефрактерности представляют значимую проблему, ухудшая прогноз. Для преодоления двойной рефрактерности используют новые ингибиторы протеасом карфилзомиб и иксазомиб, иммуномодулятор 3-го поколения помалидомид и моноклональные антитела даратумумаб, элотузумаб и изатуксимаб. благодаря результатам рандомизированных исследований III фазы ICARIA-MM и IKEMA, продемонстрировавших наряду с управляемым профилем безопасности преимущества в увеличении глубины противоопухолевого ответа, частоты достижения отрицательного статуса по минимальной остаточной болезни и выживаемости во всех подгруппах пациентов с рефрактерной/ рецидивирующей множественной миеломой, изатуксимаб используется в составе триплетов IsaPd (изатуксимаб, помалидомид, дексаметазон) и IsaKd (изатуксимаб, карфилзомиб, дексаметазон).

В настоящей статье освещены вопросы клинической фармакологии изатуксимаба. приведены результаты исследований, продемонстрировавшие эффективность и безопасность режимов противоопухолевой лекарственной терапии с включением изатуксимаба, позволившие применять его в клинической практике. представлено наблюдение пациента с рефрактерной/рецидивирующей множественной миеломой, получившего 3 линии противоопухолевого лекарственного лечения, включая ингибиторы протеасомы 2 классов, леналидомид и моноклональное антитело элотузумаб. после 3 циклов терапии в режиме IsaPd (8 введений изатуксимаба) были зафиксированы частичная ремиссия, купирование болевого синдрома. Достигнутый противоопухолевый эффект, наряду с отсутствием значимых нежелательных явлений, способствовал продолжению терапии в рекомендованных дозах.

 

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