Зрительные нарушения при лечении злокачественных новообразований женской репродуктивной системы: обзор литературы и практические рекомендации для онкогинекологов

С внедрением в клиническую практику новых противоопухолевых агентов – таргетной терапии, иммунотерапии, эндокринных препаратов офтальмологическая токсичность приобретает все большее значение. Женщины с опухолями репродуктивной системы, включая рак яичников, эндометрия и шейки матки, все чаще получают терапию, ассоциированную с потенциальными зрительными нарушениями. В настоящем обзоре систематизированы данные о глазных побочных эффектах, связанных с основными классами противоопухолевых средств, применяемых в онкогинекологии: ингибиторами BRAF (англ. B-Rafproto-oncogene, serine/threoninekinase; прототоонкоген B-раф, серин/треонин-киназа), MEK (англ. mitogen-activated protein kinase kinase; митоген-активируемая протеинкиназа киназа), ингибиторами иммунных контрольных точек (англ. immune check point inhibitors; ICIs), включая PD-1 (англ. programmed cell death protein 1; белок программируемой клеточной гибели 1), PD-L1 (англ. programmed cell death-ligand 1; лиганд программируемой клеточной гибели 1), CTLA-4 (англ. cytotoxic T-lymphocyte-associated protein 4; цитотоксический антиген-4 Т-лимфоцитов), антиангиогенными средствами, воздействующими на VEGF (англ. vascular endothelial growth factor; фактор роста эндотелия сосудов) и VEGFR (англ. vascular endothelial growth factor receptor; рецептор фактора роста эндотелия сосудов), а также с использованием SERM (англ. selective estrogen receptor modulators; селективные модуляторы рецепторов эстрогена), ингибиторов ароматазы и PARP (англ. poly(ADP-ribose) polymerase; поли(АДФ-рибоза)полимераза)-ингибиторов. Особое внимание уделено наиболее распространенным и клинически значимым нарушениям, таким как увеит, кератит, синдром сухого глаза, макулярный отек, ретинопатия, неврит зрительного нерва, а также редким, но тяжелым осложнениям, включая окклюзию вен сетчатки и отслойку сетчатки. Представлены дифференцированные подходы к диагностике и ведению офтальмотоксичности в зависимости от конкретного класса препаратов. Подчеркнута необходимость междисциплинарного взаимодействия между онкологом, акушером-гинекологом и офтальмологом для своевременного выявления и коррекции зрительных нарушений. Предложены практические рекомендации по скринингу, мониторингу и ведению пациенток с риском офтальмологических осложнений. Статья направлена на повышение осведомленности онкогинекологов о значении офтальмотоксичности и оптимизацию клинического маршрута пациенток.

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