PharmatecaPharmatecaФарматека2073-40342414-9128Bionika Media36821210.18565/pharmateca.2025.9.207-216АлгоритмыResearch ArticleCurrent approaches to the diagnosis and treatment of metastatic triple-negative breast cancerСовременные подходы к диагностике и терапии метастатического трижды-негативного рака молочной железыhttps://orcid.org/0009-0007-3112-8081LazakovichAlina A.ЛазаковичАлина Алексеевна
Russian Federation

Oncologist, Oncology Department No. 1, Pirogov Clinic of High Medical Technologies

врач-онколог онкологического отделения № 1, Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0000-0001-6183-9764DashyanGarik A.ДашянГарик Альбертович
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0000-0002-2571-243XDzhelyalovErnest S.ДжеляловЭрнест Серверович
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0000-0001-7553-2026SeredaOlga A.СередаОльга Андреевна
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0009-0000-0450-0166VatsAnna B.ВацАнна Борисовна
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0000-0001-9623-3877ShaykhelislamovaLaysan F.ШайхелисламоваЛяйсан Фидагиевна
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0009-0004-7511-2952ZhurovAleksandr S.ЖуровАлександр Сергеевич
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0000-0003-3348-4251AkhmedovRuslan M.АхмедовРуслан Мерзиалиевич
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0000-0001-5706-250XSemiletovaYulia V.СемилетоваЮлия Вадимовна
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comhttps://orcid.org/0000-0002-2274-8170BelousovAleksandr M.БелоусовАлександр Михайлович
Russian Federation

Pirogov Clinic of High Medical Technologies

Клиника высоких медицинских технологий им. Н.И. Пирогова

dr.lazakovich@gmail.comPirogov Clinic of High Medical Technologies, Saint Petersburg State UniversityСанкт-Петербургский государственный университет2912202532920721618012026Copyright ©; 2025, Bionika MediaCopyright ©; 2025, ООО «Бионика Медиа»2025Bionika MediaООО «Бионика Медиа»https://journals.rcsi.science/2073-4034/article/view/368212

Metastatic triple-negative breast cancer (mTNBC) is characterized by an aggressive course and previously limited treatment options. However, in recent years, the treatment paradigm has undergone revolutionary changes, shifting from non-specific chemotherapy to a personalized, biomarker-based approach. This review provides a detailed analysis of current strategies for the diagnosis and treatment of mTNBC. The critical importance of comprehensive molecular testing, including determination of PD-L1 status, germline mutations in the BRCA1/2 genes, and HER2 expression (including HER2-low status) for choosing the optimal strategy is emphasized. This article puts focus on the strategic sequencing of different classes of targeted agents, taking into account their mechanisms of action and application sites. The article provides not only information on available options but also a practical algorithm for decision-making based on the latest evidence-based medicine and a clear hierarchy of biomarkers.

Метастатический трижды-негативный рак молочной железы (мТНРМЖ) характеризуется агрессивным течением и ранее ограниченными вариантами лечения. Однако в последние годы парадигма его терапии претерпела революционные изменения, сместившись от неспецифической химиотерапии к персонализированному подходу, основанному на биомаркерах. В данном обзоре подробно анализируются современные стратегии диагностики и лечения мТНРМЖ. Подчёркивается критическая важность всестороннего молекулярного тестирования, включая определение статуса PD-L1, герминальных мутаций в генах BRCA1/2 и экспрессии HER2 (включая HER2-низкий статус), для выбора оптимальной тактики. В данной статье акцент делается на стратегической последовательности назначения различных классов таргетных препаратов с учётом механизмов их действия и точек приложения. Статья предоставляет не только информацию о доступных опциях, но и практический алгоритм для принятия решений, основанный на последних данных доказательной медицины и четкой иерархии биомаркеров.

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