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摘要
В статье обсуждается роль ингибиторов андрогенных рецепторов (ИАР) 2 поколения в лечении неметастатического кастрационно-резистентного рака предстательной железы (нмКРРПЖ). Исследования III фазы PROSPER (энзалутамид), SPARTAN (апалутамид) и ARAMIS (даролутамид) показали, что эти препараты при применении в комбинации с андрогенной депривационной терапией (АДТ) позволяют существенно по сравнению с плацебо улучшить выживаемость без метастазов и общую выживаемость пациентов с нмКРРПЖ. При выборе конкретного препарата данной группы важную роль играет профиль его безопасности, включая потенциал лекарственных взаимодействий, и влияние на качество жизни пациента. С этой точки зрения даролутамид имеет ряд преимущества перед апалутамидом и энзалутамидом. Частота центральных (когнитивных, психических, судорожных) и других нежелательных реакций, существенно ухудшающих качество жизни больных (падения, переломы, гипертензия и др.) при применении даролутамида не отличается от таковой плацебо. Кроме того, препарат сохраняет антагонистические свойства в отношении всех клинически значимых мутаций AР, которые вызывают развитие резистентности к энзалутамиду и апалутамиду.
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