После завершения трех позитивных РКИ подходы к лечению нмКРРПЖ группы высокого риска существенно изменились и включили назначение антиандрогенов второго поколения (АА2) в дополнение к продолжающейся андроген-депривационной терапии у пациентов с ВУПСА ≤10 месяцев. Все изученные АА2 (апалутамид, энзалутамид и даролутамид) продемонстрировали сопоставимую эффективность в отношении БМВ и ОВ, благоприятный профиль безопасности и отсутствие негативного влияния на качество жизни пациентов. Однако уникальная структура молекулы даролутамида обеспечивает возможность снижения риска развития специфичных для данной группы препаратов НЯ, прежде всего – неврологических. Потенциально наиболее безопасным АА2 у пациентов, получающих комедикацию для коррекции сопутствующих заболеваний, является даролутамид. Upon completion of three positive randomized clinical trials (RCTs), the treatment strategies in high-risk patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have changed significantly and now include administration of second- generation antiandrogens (SGAAs) in addition to continued androgen deprivation therapy (ADT) in patients with (PSADT) ≤ 10 months. All studied SGAAs (apalutamide, enzalutamide and darolutamide) have shown comparable efficacy in terms of metastasis- free survival (MFS) and overall survival (OS), favorable safety profile and no negative effect on patients’ quality of life. However the unique molecular structure of darolutamide makes it possible to decrease the risk of adverse events (AEs) specific for this group of drugs, primarily neurological AEs. Darolutamide is potentially the safest SGAA in patients receiving concomitant treatment for their comorbidities.
This article deals with the rare clinical observation of the patient with recurrent desmoid-type fibromatosis, who have achieved long-term stability after surgical treatment. A 24-year-old patient was diagnosed with retroperitoneal tumor which size was 8.85.613 cm in 2013, infiltrating the left psoas muscle, left kidney, left common and left external iliac arteries, descending colon and sigmoid colon. The patient underwent surgery in the volume of the tumor removal, resection of the left common iliac artery and prosthetics using GORE-TEX prosthesis, left hemicolectomy, left nephrectomy at Blokhin National Medical Research Center of Oncology. The first recurrence of the tumor was detected nine months after the surgery. Due to the subsequent growth of tumor mass, located along the left external iliac artery and in the inguinal canal, the repeated surgery was performed. Then the patient had a second relapse, and underwent surgery again. The third recurrence was detected seven months after the last surgery. During the multidisciplinary discussion, according to the absence of complaints and the small size of the recurrent tumor, as well as the absence of the risk of life-threatening complications, it was decided to stop on the observation. The patient was examined once every six months there were no data concerning recurrent tumor growth. Today, the patient is alive, does not have any complaints and is able-bodied. Our clinical observation demonstrates that active surgical tactics in case of the retroperitoneal fibromatosis recurrence not always can lead to long-term progression-free survival time and several patients can stay under the observation, using Look and Stay tactic.
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