cancerspЮжно-Российский онкологический журнал/ South Russian Journal of CancerSouth Russian Journal of Cancer2686-9039АНО "Перспективы онкологии"10.37748/2686-9039-2021-2-4-5cancersp-138Research ArticleОбзорREVIEWМолекулярные мишени немелколеточного рака легкого (НМРЛ) вне «главной тройки»Клинический случай легочной формы мукормикоза у ребенка с острым лимфобластным лейкозомhttps://orcid.org/0000-0003-0640-2994ХарагезовД. А.KharagezovD. A.

Харагезов Дмитрий Акимович – к.м.н., хирург, заведующий отделением торакальной хирургии

SPIN: 5120-0561

AuthorID: 733789ResearcherID: AAZ-3638-2021

Scopus Author ID: 56626499300

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Dmitriy A. Kharagezov – Cand. Sci. (Med.), surgeon, head of department of thoracic surgery

SPIN: 5120-0561

AuthorID: 733789

ResearcherID: AAZ-3638-2021

Scopus Author ID: 56626499300

63 14 line str., Rostov-on-Don 344037

dmitr8@mail.ruhttps://orcid.org/0000-0002-6655-7632ЛазутинЮ. Н.LazutinYu. N.

Лазутин Юрий Николаевич – к.м.н., доцент, ведущий научный сотрудник отдела торакальной хирургии

SPIN: 5098-7887

AuthorID: 364457

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Yuriy N. Lazutin – Cand. Sci. (Med.), associate professor, leading Researcher of the Department of Thoracic Surgery

SPIN: 5098-7887

AuthorID: 364457

63 14 line str., Rostov-on-Don 344037

lazutin.jurij@yandex.ruhttps://orcid.org/0000-0002-0328-9714МирзоянЭ. А.MirzoyanE. A.

Мирзоян Эллада Арменовна – аспирант

SPIN: 2506-8605

AuthorID: 1002948

ResearcherID: AAZ-2780-2021

Scopus Author ID: 57221118516

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Ellada A. Mirzoyan – PhD student

SPIN: 2506-8605

AuthorID: 1002948

ResearcherID: AAZ-2780-2021

Scopus Author ID: 57221118516

63 14 line str., Rostov-on-Don 344037

ellada.mirzoyan@yandex.ruhttps://orcid.org/0000-0002-2589-7606МилакинА. Г.MilakinA. G.

Милакин Антон Григорьевич – онколог отделения торакальной хирургии

SPIN: 7737-4737

AuthorID: 794734

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Anton G. Milakin – oncologist at the Department of Thoracic Surgery

SPIN: 7737-4737

AuthorID: 794734

63 14 line str., Rostov-on-Don 344037

ellada.mirzoyan@yandex.ruСтатешныйО. Н.StateshnyO. N.

Статешный Олег Николаевич – онколог отделения торакальной хирургии

SPIN: 9917-1975

AuthorID: 1067071

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Oleg N. Stateshny – oncologist at the Department of Thoracic Surgery

SPIN: 9917-1975

AuthorID: 1067071

63 14 line str., Rostov-on-Don 344037

ellada.mirzoyan@yandex.ruhttps://orcid.org/0000-0003-2572-1624ЛейманИ. А.LeimanI. A.

Лейман Игорь Александрович – к.м.н., врач-онколог отделения торакальной хирургии

SPIN: 2551-0999

AuthorID: 735699

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Igor A. Leiman – Cand. Sci. (Med.), oncologist at the Department of Thoracic Surgery

SPIN: 2551-0999

AuthorID: 735699

63 14 line str., Rostov-on-Don 344037

toraxrnioi@yandex.ruЧубарянА. В.ChubaryanA. V.

Чубарян Анна Васильевна – к.м.н., старший научный сотрудник, врач-онколог отделения торакальной хирургии

SPIN: 7307-0670

AuthorID: 842662

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Anna V. Chubaryan – Cand. Sci. (Med.), senior Researcher, oncologist of the Department of Thoracic Surgery

SPIN: 7307-0670

AuthorID: 842662

63 14 line str., Rostov-on-Don 344037

ellada.mirzoyan@yandex.ruhttps://orcid.org/0000-0002-5351-3251ИозефиК. Д.IozefiK. D.

Иозефи Кристиан Дмитриевич – ординатор 2 года по специальности торакальная хирургия

SPIN: 1232-3097

AuthorID: 1122592

ResearcherID: AAZ-3632-2021

г. Ростов-на-Дону

Kristian D. Iozefi – 2nd year thoracic surgery resident

SPIN: 1232-3097

AuthorID: 1122592

ResearcherID: AAZ-3632-2021

Rostov-on-Don

K.iozeffi@gmail.comФГБУ «НМИЦ онкологии» Минздрава РоссииРоссияNational Medical Research Centre for Oncology of the Ministry of Health of RussiaRussian FederationФГБУ «НМИЦ онкологии» Минздрава России, г. Ростов-на-ДонуРоссияNational Medical Research Centre for Oncology of the Ministry of Health of RussiaRussian FederationФГБОУ ВО «РостГМУ» Минздрава РоссииРоссияRostov State Medical UniversityRussian Federation202112112021243847Copyright © Харагезов Д.А., Лазутин Ю.Н., Мирзоян Э.А., Милакин А.Г., Статешный О.Н., Лейман И.А., Чубарян А.В., Иозефи К.Д., 20212021Харагезов Д.А., Лазутин Ю.Н., Мирзоян Э.А., Милакин А.Г., Статешный О.Н., Лейман И.А., Чубарян А.В., Иозефи К.Д.Kharagezov D.A., Lazutin Y.N., Mirzoyan E.A., Milakin A.G., Stateshny O.N., Leiman I.A., Chubaryan A.V., Iozefi K.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cancersp.com/jour/article/view/138

Рак легкого (РЛ) занимает первое место в структуре общей онкологической заболеваемости и смертности у мужчин как в России, так и в зарубежных странах. Большинство новых случаев РЛ диагностируется у пациентов старше 65 лет, и в последние годы наблюдается тенденция к увеличению данного показателя. РЛ представляет собой гетерогенную группу злокачественных опухолей с различными генетическими и биологическими характеристиками. Несмотря на то, что курение считается основной причиной немелкоклеточного рака легкого (НМРЛ), генетическая предрасположенность и воздействие окружающей являются причиной развития 10–15 % случаев заболевания. Тактика лечения пациентов с одним НМРЛ давно отработана и, как правило, не вызывает никаких трудностей. Хирургическое вмешательство является основным методом лечения ранних стадий НМРЛ. Однако, по мере прогрессирования заболевания возрастает риск метастазирования, и в этом случае эффективность хирургического метода лечения резко снижается. Разработка новых схем лекарственной терапии, использование таргетных препаратов улучшила выживаемость больных с РЛ, несущими онкогенные драйверные мутации. Персонифицированное лечение становится все более доступным по мере развития технологии секвенирования. Таргетная терапия несомненно улучшает исходы больных НМРЛ, опухоли которых несут онкогенные драйверные мутации EGFR, слияние АLK и реаранжировки ROS1. Однако, помимо основных молекулярных мишеней, выявлены и изучаются другие генетические альтерации, такие как: вирусный онкоген Kirsten RAS (КРАS), МЕТ, RЕТ, HER2 и NRG. Некоторые из таких мутаций (BRAF и NTRK) уже доступны для таргетной терапии. Перечень генетических альтераций растет и расширяется молекулярное профилирование больных НМРЛ, что имеет весьма важное значение при прогрессировании заболевания. Молекулярно-генетический отбор идентифицирует конкретные группы пациентов, которые получают пользу от таргетной терапии и дает представление о потенциальных механизмах резистентности. Несмотря на достигнутый прогресс, необходимы дальнейшие исследования для выяснения взаимодействий с иммунными клетками в микроокружении опухоли как факторов, влияющих на выживаемость. Кроме того, становится все более важным изучение таргетной терапии в контексте мультимодального лечения. Настоящий обзор посвящен пониманию генетических изменений, поиску новых генетических мишеней, проблемам и будущим направлениям развития таргетной терапии в лечении пациентов с опухолями легких.

The article presents a clinical case of pulmonary mucormycosis in a 12‑year-old child at the stage of diagnosis of acute lymphoblastic leukemia. The first symptoms of the disease (headaches, malaise and weakness, pallor), changes in the general blood count (hyperleukocytosis up to 200 thousand cells/μl, single platelets). Based on the results of the examination, the main diagnosis was verified for acute lymphoblastic leukemia L2, IFT T-II, CD1a-. At the stage of diagnosis of acute lymphoblastic leukemia, the underlying disease was complicated by the development of right-sided pneumonia according to X-ray examination. To verify the etiology of infiltration of lung tissue, broncho-alveolar lavage was directed to microbiological diagnostics, which included studies: enzyme immunoassay, microscopic and cultural. On the aggregate of all the results obtained, invasive mucormycosis was diagnosed and antifungal therapy was started immediately.

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