Immunotherapy presents a new promising approach to the treatment of disseminated lung cancer. Pemriblisumab (Kitruda®) is one of the antiPD-1 drugs registered in Russia, which is used in both the secondand, in the event of high-level PD-L1 expression (≥50%), the first-line therapy. This paper presents a clinical observation of a highly efficient pemribrolizumab treatment of a patient with metastatic adenocarcinoma.

The survival of patients even with disseminated disease reached 7–8 years after introduction of imatinib and sunitinib for the treatment of gastrointestinal stromal tumours (GIST) into everyday clinical practice. These drugs efficacy is largely determined by the presence and any mutations of C-KIT and PDGFR genes. It was established that new mutations appear in most tumours against the background of tyrosine kinase inhibitors therapy, which causes the development of secondary resistance and the progression of the disease in most cases. The search for opportunities to overcome the newly developed or initially existing resistance caused by different gene mutations continues to be of vital importance. One of such drugs is regorafenib, which has demonstrated antitumour activity against progression on imatinib and/or sunitinib. The paper reviews the studies of the efficacy of regoraphanib in patients with disseminated GIST, taking into account the presence and any mutations of C-KIT and PDGFR genes, and presents a description of their own clinical case of prolonged use of the drug in a patient who have received earlier both imatinib and sunitinib.

A new anti-angiogenic drug aflibercept has been authorized as a second-line therapy in patients with metastatic colon cancer. The use of this drug as part of FOLFIRI regimen significantly reduces the risk of disease progression (RR = 0.758, p = 0.00007). At the same time, the additional use of aflibercept in the VELOUR study led to the development of side effects of 3-4 degrees of severity in 83.5% of patients. In this case, the use of aflibercept in combination with FOLFIRI is not only associated with complications that are typical for anti-angiogenic drugs, but also with a high percentage of cases of diarrhea and neutropenia. In this regard, the oncologist should understand the pathogenesis, the methods for prevention and treatment of complications associated with the use of aflibercept. These particular aspects are highlighted is this review.

Choice of the optimal therapy for BCLC-B hepatocellular carcinoma (HCC) is a significant clinical problem. Transarterial chemoembolisation (TACE) is considered to be the method of choice as this approach is reported to produce a direct effect and to have a significant survival rate. However, TACE is not always applicable and produce a survival benefit due to the clinical heterogeneity of BCLC-B HCC. The article includes different approaches for BCLC-B HCC patients, TACE prediction and refractory criteria as well as the results obtained. The necessity of timely sorafenib systemic therapy in BCLC-B and in advanced HCC after TACE is discussed. Practical application of regorafenib as the second line in HCC systemic treatment is discussed.

Background. Working out of the second line chemotherapy of advanced gastric adenocarcinoma is a promising approach to cancer therapy. Ramucirumab, an anti-angiogenic agent specifically targeting vascular endothelial growth factor receptor-2 (VEGFR-2). In April 2014, the FDA approved ramucirumab as a single agent or in combination with paclitaxel for treatment of advanced gastric or gastroesophageal junction adenocarcinoma that has progressed on or after prior fluoropyrimidineor platinum containing chemotherapy based on data of REGARD and RAINBOW trials.

Materials and Methods: From June 2016 to 15Jan 201837 pts with advanced GC were treated with ramucirumabin the second line treatment as single agent (11 pts) or in combination with paclitaxel (26 pts) in N.N.Blokhin National medical research center of oncology.

Results: edian PFS (MPFS) and median OS (MOS) was 1,8 and 7,6 mons for monotherapy group. For combination group MPFS was 4,0mons, MOS -10,6 mons. Ramucirumab had an acceptable safety profile

Conclusions:ur data are similar to the data of international randomized trials.

Most patients with basal cell cancer (BCC) can be cured if timely diagnosed. However approximately 1,3% of BCCs may develop into locally-advanced and sometimes even metastatic disease when local treatment options are limited and systemic therapy is warranted. Vismodegib was the first drug which demonstrated efficacy for the treatment of locally-advanced and metastatic BCC, inhibiting pathologically active Sonic Hedgehog (SHh) signaling pathway in tumor cells and preventing their uncontrolled proliferation.

Molecular and biological features of triple negative breast cancer (TN BC) determine the limited possibilities of systemic therapy and, as a consequence, the more aggressive course of the disease. Taxanes are one of the most effective chemotherapies used in breast cancer therapy. The special form of paclitaxel nab-paclitaxel makes it possible to obtain an objective and a subjective effect, which is especially important in the pre-treated patients. In addition, the drug has a favourable safety profile and a well-controlled toxicity.

The article contains a review of the literature on the prospects for the use of nab-paclitaxel in breast cancer, especially in its triple negative version, and a description of the clinical case of therapy with a combination of cisplatin and nab-paclitaxel in a young patient with BRCA-1-associated TN breast cancer.

The symposium «The Role of Cytotoxic Therapy in the 21st Century» held by Veropharm was one of the events of the 21nd Russian Cancer Congress (Moscow, November 14–16, 2017). The leading Russian oncologists discussed the role of chemotherapy at the current stage, practical aspects and prospects for using cytostatics in the antitumor therapy. 

Hormonal therapy is a highly effective and well tolerable treatment of hormone-responsive breast cancer. However, it has some side effects that can affect quality of life and lead to treatment discontinuation. Common side effects of tamoxifen and aromatase inhibitors are discussed in this article: menopausal, gynecological symptoms, cardiovascular and musculoskeletal adverse events. Some of them are preventable and manageable. In order to maintain good quality of life during treatment the oncologists should pay more attention to the side effects that lead to it’s deterioration and not be too anxious about insignificant ones.

Pazopanib (Votrient®) is an oral small-molecule multi-kinase inhibitor that predominantly inhibits vascular endothelial growth factor receptor-1, -2 and -3, platelet-derived growth factor receptor-α and -β and the stem cell factor receptor c-Kit. In preliminary experiments using mouse and rabbit models of angiogenesis, pazopanib inhibited angiogenesis caused by a combined vascular endothelial growth factor and a major fibroblast growth factor. Although the drug was developed as a therapeutic multi-tumour agent, it is currently approved in many countries for the treatment of advanced soft tissue sarcoma and renal cell carcinoma (RCC). In multicentre, randomized trials of the efficacy of pazopanib as a first-line therapy in patients with metastatic RCC, progression-free survival (PFS) was significantly greater in pazopanib recipients than in cytokine recipients and pazopanib was noninferior to sunitinib with respect to time to disease progression. In addition, side effects such as liver dysfunction and hypertension can be usually managed, and pazopanib is likely to be a more preferred cost-effective option and shows better quality-of-life compared to other alternative drugs.

The development of resistance to endocrine therapy and the tumor progression in patients with prostate cancer are associated with an unfavourable prognosis. The article presents a review of clinical trials of efficacy and safety, as well as the experience in using radioisotope radium-223 chloride in clinical practice in patients with castration-resistant prostate cancer with bone metastases without visceral metastases. It was shown that radium-223 chloride therapy in this category of patients leads to an increase in overall survival and time to the development of bone complications, and is characterized by good tolerability.

Ixazomib (NINLARO, Takeda Pharmaceutical Company Limited) is the first oral proteasome inhibitor which approved in combination with lenalidomide and dexamethasone (IRd) for the treatment of patients with multiple myeloma who have received at least one prior therapy. Ixazomib is a boron-containing selective and reversible proteasome inhibitor that have high antitumor activity with excellent safety. This combination was approved based on the results from the phase 3, double-blind, placebo-controlled TOURMALINE-MM1 study, which demonstrated a 35% improvement in progression-free survival (PFS) for IRd versus placebo-Rd: median: 20.6 vs 14.7 months; hazard ratio (HR): 0.74, P = 0.012. PFS was improved in both high-and standard-risk cytogenetics subgroups with median PFS in high-risk patients 21.4 vs 9.7 months (HR 0.54; P = 0.021) and in standard-risk patients 20.6 vs

15.6 months (HR 0.64; P = 0.007). The addition of ixazomib to Rd regimen was associated with minimal additional toxicity. Common grade ≥3 adverse events with ixazomib include gastrointestinal adverse events, rash, and thrombocytopenia. No significant inhibition of neuronal cell survival protease HtrA2/Omi was noted in response on ixazomib treatment in vitro that explains its minimal clinical peripheral neuropathy. The present review addresses the current knowledge regarding the clinical use of ixazomib in relapsed myeloma patient and the prospects for further expansion of therapeutic indications.

The description of the clinical observation of the successful therapy with ibrutinib recurrent B-cell chronic lymphocytic leukemia associated with autoimmune complications is given. The reasons for occurrence the autoimmune complications of CLL, their effect on the disease prognosis as well as the tactics of conducting similar patients have been considered.

Fighting against pain is a primary and very difficult task in palliative care case management. What are the best ways we can reduce human suffering? How to achieve effective and safe anaesthesia? What needs to be done to develop a palliative care service in our country? Read up on this in an interview with the Head of the Oncology Palliative Care Center of the Herzen Moscow Oncology Research Institute of the Ministry of Health of the Russian Federation, Guzel Rafailovna Abuzarova, MD.

Oncological patients have a high risk of thrombotic complications, which worsen the outcomes of antitumor treatment and is one of the leading causes of death. Low molecular weight heparins are the main drugs for the prevention and treatment of thrombotic complications in cancer patients. Zibor (bemiparin) is a second-generation low-molecular-weight heparin (LMWH) that has the lowest molecular weight (3600 Dalton), a half-life increased to 5.3 hours and the highest anti-Factor Xa activity ratio (8:1). In clinical trials, bemiparin has demonstrated high efficacy and safety for prophylaxis and treatment of thromboembolic complications.

Taking into account the multifunctional disorders and consequences of oncological diseases and their treatment, rehabilitation in oncology has many goals and is aimed at restoring the physical, emotional, social, role and cognitive functioning of the patient, as well as returning the patient to previous labor activity. The principles of rehabilitation measures vary considerably from country to country, depending on the social security system in which they are included. In most European countries and in theUnited States of America, rehabilitation activities are mainly carried out on an outpatient basis. Whereas inGermanythere is a unique system in which rehabilitation is performed mainly in a hospital environment. This article presents an overview of rehabilitation measures in oncology practice conducted in different countries.

The randomized clinical trials showed the effectiveness of the addition of ovarian suppression to tamoxifen or to aromatase inhibitors after adjuvant chemotherapy in women younger or older than 35 years, but with at least one high-risk factor for recurrence.

However, the lack of clear criteria for evaluating the ovarian function after gonadotoxic chemotherapy, especially in women in the perimenopause, significantly complicates the choice of the right tactics for endocrine therapy. Despite proven efficacy of aromatase inhibitors as part of the adjuvant breast cancer therapy in women with preserved ovarian function in SOFT and TEXT trials, this tactic requires a more differentiated approach, according to many experts.

The relative factors (STRAW criteria, age, gonadotoxicity of chemotherapy) for determining the probability of restoration of ovarian function after the chemotherapy were determined using the characteristics of the menstrual cycle in women with hormone-sensitive breast cancer based on the international trials available in the literature. The introduction of these methods for evaluating the ovarian function after chemotherapy in premenopausal women into the clinical guidelines for the adjuvant management of early breast cancer may make the choice of ovarian suppression more appropriate not only from the clinical, but also from the physiological point of view.

The modern concept of symbiotic relationship between the macroorganism and the gut microbiota is practically assured. The microbiota composition is primarily influenced by environmental factors, genetic and immune factors of the host organism. The gut dysbiosis can lead to the dominance of certain types of bacteria that promote the activation of carcinogenesis mechanisms and the development of malignant tumours of the colon due to chronic inflammation or local immunosuppression. The role of the intestinal microbiota in forming a response to the immunotherapy of malignant neoplasms is of great interest to the medical community in the era of immunooncology. Given that the gut microbiota composition is individual for each person, its examination fits nicely into the up-and-coming concept of a personalized medical approach.

Anemia is a common hematological complication in cancer patients receiving chemotherapy. Reduction of hemoglobin level is accompanied by a significant deterioration in the patients’ life quality. A transfusion of erythrocyte mass is used to rapidly increase the hemoglobin level in case of development of a symptomatic anemia. However, a large range of risks limit the wide use of blood transfusions. Erythropoiesis-stimulating proteins are the drugs that reduce the need for blood transfusions. Treatment with erythropoietins provides a smooth and prolonged rise in the hemoglobin level, the release of fully functional red blood cells into the blood. The use of erythropoietins can significantly improve the quality of life of cancer patients without reducing the effectiveness of chemotherapy.

Achievement of complete Pathomorphologic Response (pCR) after neoadjuvant therapy of breast cancer significantly improves long-term treatment outcome. Correlation between pCR and long-term treatment outcome is strongest in HER2-positive breast cancer; this data clearly supports use of double HER2-blockade in neoadjuvant breast cancer therapy. However, the high cost of targeted drugs requires pharmacoecomomic assessments for choosing of the most optimal treatment course.

Objective: to study the breast cancer phenotype (ER/PR, FOXA1, HER2, Ki67) and the dynamics of changes in these markers in the tumour before and after neoadjuvant chemotherapy (NAT), compare them with metastases in the regional lymph nodes (LN). Materials and methods. The subject of the study was a group of patients with breast carcinomas receiving NAT according to the TAC and TC regimens, who had metastases in regional LUs in the course of the treatment (urN1,2,3). Results. Patients were divided into three groups. The first group (n = 11, primary tumour and tumour after NAT). The conversion of hormone receptor expression was both upward (37.5%) and downward (62.5%). Expression of HER2 has only changed upward by 36.4%.

The second group (n = 32, residual tumour and regional metastases). The conversion of hormonal receptors was reported in 12.5%. Expression of HER2 has changed by 21.87%. In the third group (n = 11, the primary tumour before the onset of NAT and metastasis in LN after treatment). Conversion of ER in 18.2% in the form of a total loss, PR in 54.5%. Expression of HER2 increased by 45.5%. Expression of FOXA1 remained stable in all cases after NAT, where expression of hormonal receptors decreased or disappeared. Conclusions. In the era of personalized therapy and NAT, it is required to conduct a pathomorphological study of the immunohistochemical status of metastases in LN, since the hormone receptor status changes in almost 20% of cases, with the signal pathway for steroid hormone receptors remaining unchanged. The HER-2 oncoprotein expression status changes in almost half of cases when comparing the primary biopsy and metastasis after NAT.

Ramucirumab is a monoclonal antibody targeting vascular endothelial growth factor receptor 2. In two randomised clinical trials Ramucirumab either alone or in combination with paclitaxel has been found to be safe and effective for patients with previously treated advanced gastric cancer. One of the serious adverse events associated with ramucirumab is bleeding.

We report the case of a 56-year-old man with advanced gastric cancer located at the gastroesophageal junction with liver, pulmonary and multiple lymph node metastases, plevritis was treated with a paclitaxel plus Ramucirumab regimen. We demonstrate a case of a cardioesophageal junction bleeding due to the high efficiency of treatment. He was successfully treated with by applying only hemostatical therapy, but after stop the bleeding chemotherapy was not reintroduced. The partial response was maintained for approximately 10 months. The patient died on 28 November 2017.

Chemotherapy with best supportive care for metastatic gastric cancer shown the improvement the performance status, help keep the cancer under control and help relieve symptoms during the time.

The article describes the onset of acute lymphoblastic leucosis, which has a mask of kidney pathology in children. The presented cases are characterized by early manifestation of the disease against the absence of classical markers of oncological diseases. The diagnosis was successfully verified only on the basis of immunohistochemical tests. This paper may be of interest for pediatricians, children’s oncologists and hematologists, children’s nephrologists.

According with the present-day ideas, sequential lines of hormone therapy including those in patients with visceral metastases and multiple lesions form the basis of the treatment of HER2-negative metastatic hormone-dependent breast cancer. These measures make it possible to exercise the long-term control of the disease and maintain a good quality of life. In recent years, the clinical practice comprises the next-generation drugs that potentiate the effect of hormone therapy. These include cyclindependent kinases 4/6 inhibitors. Palbociclib (Ibransa, Pfizer) is the first representative of this class approved in Russia for the treatment of disseminated hormone-dependent breast cancer. The PALOMA-2 study demonstrated the high efficacy of the palbociclib combined with letrozole as a first-line hormone therapy. In the palbociclib and letrozole combination arm, the median time to progression was 27,6 months compared to 14,5 months in the letrozole monotherapy arm (p <0,001). The presented clinical case demonstrates the possibility of long-term successful control of the disease using palbociclib combined with letrozole hormone therapy.

Over the past 40 years, the incidence of skin melanoma in the world has increased approximately 3-fold.

To study the current epidemiological situation of skin melanoma in the Russian Federation, data on the absolute, coarse and standardized incidence rates of melanoma (S43) in the male and female populations were analyzed. The specific gravity of the melanoma patients detected actively was analyzed at different stages of the tumor process who died within the first year since the diagnosis was established between 2006–2016.

The incidence of skin melanoma in the Russian population is characterized by a constant increase of indexes, the average annual rate of increase in the incidence of the Russian Federation’s population of melanoma is 2 times higher than that of the general oncological morbidity. A higher average annual rate and a general increase in the incidence of SM is recorded in the male population. Only every 4th patient in the RF is detected actively, despite the fact that melanoma is a tumor of visual localization. In general, only one third of patients with skin melanoma (32.8%) are diagnosed in the first stage of the tumor process in the Russian Federation. Over the period from 2006 to 2016 in Russia, the indicators of neglect on skin melanoma significantly decreased by 40.6%, however they remain at an unacceptably high level. The index of the first-year lethality from skin melanoma in Russia for the period from 2006 to 2016 decreased by 26.01%.

To improve the index of active detection of patients with SM, especially in the early stages, it is necessary to create a system for interaction of primary contact physicians with the patient (dermatovenerologists, cosmetologists, therapists) with the oncological service, the formation of on-alertness among physicians of all specialties, and among the population.

Objective. Improve the method for concentrating the cellular material of serous cavities exudates for cytological investigation.

Materials and methods. The optimal time of accumulation of cell samples in effusion liquids was determined on the basis of the sedimentation method using a dropping funnel by examining 28 samples of exudates (pleural and abdominal) obtained from 24 patients with ovarian cancer. The two methods for concentrating the cellular material of exudate were compared: the method using a dropping funnel and the method using a cylinder.

Results. It was found that the 60-minute exposure time was optimal in using a dropping funnel to concentrate the cellular material of exudates.

Conclusion. Using a dropping funnel to concentrate the cellular material of the exudates is optimal. In this case, the investigational preparations contain a sufficient amount of cellular material for the cytological study and the cell complexes are larger than those in using the cylinder.

Gastric cancer is the third leading cause of cancer-related deaths worldwide. The prognosis of advanced gastric cancer remains poor despite therapeutic advances in recent decades. Several recent positive phase III trials established the efficacy of second-line chemotherapy for metastatic gastric cancer in prolonging overall survival. Many targeted-therapies failed to show a significant survival benefit in GC, only 2 of them are approved FDA: trastuzumab in the 1-st line treatment of HER2-positive gastric cancer and ramucirumab with or without paclitaxel as second line chemotherapy. The article presents the case of effective treatment of patient with Her2-negative advanced gastric cancer. A 76-year-old man had a moderately differentiated adenocarcinoma of gastric with synchronous multiple liver metastases. He received ramucirumab with paclitaxel as second -line chemotherapy. The size of the liver metastases was reduced and he maintained a partial response for one year. This clinical case report demonstrates that new option in the treatment of advanced gastric cancer can to allow our patients to live longer without losing the quality of life.

The aim of this study is to analyse the efficacy of efferent therapy (hemosorption) as part of drug treatment in patients with metastatic colorectal cancer (mCRC) based on the use of standard first-line chemotherapy combined with the bevacizumab biosimilar. The study included 54 patients with histologically verified mCRC who received the first-line FOLFOX + bevacizumab therapy in combination with and without hemosorption. All patients of the FOLFOX + bevacizumab (+) hemosorption group (n = 32) received the hemosorption using Hemophoenix apparatus on Day 4 of the cycle during the first 6 cycles. A total of 182 hemosorption procedures were performed. The control group included 22 patients receiving the FOLFOX + bevacizumab regimen without hemosorption. The bevacizumab biosimilar was introduced in both groups throughout the treatment at standard doses once every 2 weeks. There was no statistically significant difference between the study groups in the main clinical, pathomorphological, molecular genetic characteristics (sex, age, ECOG status, localization of primary tumor, tumor differentiation, RAS, BRAF mutations, microsatellite instability, etc.).

Blood sampling to evaluate the effect of hemosorption on the pharmacokinetics (PK) of bevacizumab biosimilar was performed during the 2nd cycle before (PK1) and after (PK2) hemosorption procedures. The bevacizumab biosimilar concentration in the blood of patients before and after hemosorption showed no statistically significant difference (p = 0,423).

The use of pharmaceutical treatment in the FOLFOX + bevacizumab (+) hemosorption group contributed to the achievement of an objective response (OR) in 62% of patients (p = 0.001). Median progression-free survival (PFS) was 10 ± 0.9 months [95% CI 8.3-11.7] in the FOLFOX + bevacizumab (+) hemosorption group, and 7 ± 0.5 months [95% CI 4.4-11.6] in the FOLFOX + bevacizumab (-) hemosorption group. There was no significant difference in PFS between the groups of patients treated with FOLFOX + bevacizumab regimen with and without hemosorption (p = 0.445).

There were statistically significant differences in the frequency of nausea, diarrhoea and asthenia in the FOLFOX + bevacizumab (+) hemosorption group. The analysis of the dynamics of the quality of life (QoL) level before and after treatment showed that QoL level related to health (p = 0.0001) as well as the emotional (p = 0.0001) and social (p = 0,04) functioning increased in patients receiving the FOLFOX + bevacizumab regimen in combination with hemosorption, 0,039).

Thus, the addition of hemosorption to the first-line drug treatment according to the FOLFOX + bevacizumab regimen does not affect bevacizumab pharmacokinetics, increases the frequency of objective response, reduces toxicity of the therapy and improves the quality of patients’ life indicators.