Journal of Clinical PracticeJournal of Clinical PracticeКлиническая практика2220-30952618-8627Eco-Vector68882010.17816/clinpract688820VBIHKPCase reportsКлинические случаиResearch ArticleOsteonecrosis of the femoral head: a rare complication of combination therapy with bevacizumab and atezolizumab in a patient with non-small cell lung cancerОстеонекроз головки бедренной кости как редкое осложнение комбинированной терапии бевацизумабом и атезолизумабом у пациента с немелкоклеточным раком лёгкогоhttps://orcid.org/0000-0002-4548-10263940-0321BarbolinaTatyana D.БарболинаТатьяна Дмитриевна
Russian Federation

MD, PhD

канд. мед. наук

katan4ik@list.ruhttps://orcid.org/0000-0003-2981-76663642-5948BagrovaSvetlana G.БагроваСветлана Геннадьевна
Russian Federation

MD, PhD

канд. мед. наук

s.bagrova@mail.ruhttps://orcid.org/0000-0002-4516-32551198-9039FedorovaAleksandra V.ФедороваАлександра Владимировна
Russian Federation

MD, PhD

канд. мед. наук

fedorova.ronc@gmail.comNational Medical Research Center of Oncology named after N.N. BlokhinНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаRussian University of MedicineРоссийский университет медициныYaroslavl State Medical UniversityЯрославский государственный медицинский университет08042026060820261721571670708202529032026Copyright ©; 2026, Eco-VectorCopyright ©; 2026, Эко-Вектор2026Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://clinpractice.ru/clinpractice/article/view/688820

BACKGROUND: Anti-angiogenic therapy is used in the treatment of many solid malignant neoplasms, both alone and in combination with immunotherapy, targeted therapy, and chemotherapy. Complications of drug therapy for malignant neoplasms may necessitate the permanent discontinuation of antitumor therapy, resulting in disability. These complications include bone disorders. Osteonecrosis of the jaw is most commonly associated with bone-modifying agents (bisphosphonates); however, it is extremely rare with other drugs. Necrosis of the femur is even less common. CLINICAL CASE DESCRIPTION: This article presents a clinical case of bilateral avascular necrosis of the femoral head in a patient with disseminated non-small cell lung cancer who was receiving long-term combination immunotherapy and targeted therapy. CONCLUSION: Avascular necrosis of the femoral head is a major concern, considering the expanding range of drug therapies for various malignant neoplasms and novel combination therapy options. The lack of a clear algorithm for managing patients with this serious complication of antitumor drug therapy highlights the relevance of this issue.

Обоснование. Антиангиогенная терапия применяется в лечении многих солидных злокачественных новообразований как самостоятельно, так и в комбинации с иммунотаргетной и химиотерапией. Развитие осложнений лекарственной терапии злокачественных новообразований, одним из которых является патология костной ткани, может приводить к полному прекращению противоопухолевого лечения и инвалидизации пациента. Чаще всего при этом развивается остеонекроз челюсти как осложнение применения остеомодифицирующих агентов, бисфосфонатов и крайне редко каких-либо других препаратов. Ещё реже встречается некроз бедренных костей. Описание клинического случая. Представлено клиническое наблюдение асептического аваскулярного некроза головок бедренных костей с двух сторон у пациента с диссеминированным немелкоклеточным раком лёгкого, длительно получающего комбинированную иммунотаргетную терапию. Заключение. Настороженность в отношении аваскулярного некроза головок бедренных костей обусловлена расширением спектра лекарственных агентов, применяемых для лечения различных злокачественных новообразований и создания новых комбинаций. Отсутствие чёткого алгоритма ведения пациентов с таким грозным осложнением противоопухолевой лекарственной терапии требует привлечения внимания к этой проблеме.

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