Иммунотерапия гастроинтестинальных стромальных опухолей: состояние вопроса и перспективы

Гастроинтестинальные стромальные опухоли (ГИСО) происходят от веретеновидных интерстициальных клеток кахаля и характеризуются наличием мутаций в генах KIT и PDGFRA, кодирующих одноименные тирозинкиназные  рецепторы. Основным принципом лекарственной терапии пациентов с данными новообразованиями (в том числе неоперабельных, рецидивирующих и метастатических форм) является назначение им таргетных препаратов, ингибирующих активность вышеуказанных рецепторных тирозинкиназ. Несмотря на высокую эффективность этих лекарственных средств, в первую очередь иматиниба мезилата (гливека), в лечении ГИСО, у подавляющего большинства пациентов спустя 1,5–2 года после начала таргетной терапии развивается резистентность опухоли к данным препаратам, что диктует необходимость пересмотра тактики лечения и последующего назначения препаратов терапии 2, 3 и 4-й линий. в обзоре рассматриваются основные молекулярно-генетические варианты ГИСО, современные принципы их лечения, а также механизмы первичной и вторичной резистентности данных новообразований к таргетным препаратам. Также описываются механизмы взаимодействия клеток иммунной системы с ГИСО, взаимосвязь мутационного и иммунного профилей опухолей, перспективные подходы к иммунотерапии этих новообразований и приводятся данные о текущих клинических испытаниях, направленных на коррекцию основных звеньев иммунной системы у пациентов с ГИСО.

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