Prostate cancer (PC) is a leading cause of cancer morbidity and mortality among men worldwide1 . In this regard, the issues of diagnosis and treatment of this disease are of major importance for the healthcare system. Primary and specified diagnosis of PC, tools that can be useful in stratifying patients into risk levels – these and other topical issues were addressed at the symposium: Prostate Cancer: Spot It in Time.

In recent years, approaches to the pharmacological treatment of non-small cell lung cancer (NSCLC) have significantly evolved due to a deeper understanding of tumor biology and, consequently, the active development of personalized medicine and the introduction of targeted therapies. The identification of activating mutations, including ALK gene rearrangements, enables long-term objective control, which is particularly crucial in young patients with extensive metastatic disease and brain metastases (BM). The high rate of central nervous system (CNS) metastases characteristic of ALK-positive NSCLC underscores the importance of selecting therapeutic agents with high intracranial activity. Lorlatinib, a third-generation ALK tyrosine kinase inhibitor (TKI), is capable of crossing the blood-brain barrier and effectively suppressing resistance mutations that may develop during treatment with crizotinib or second-generation TKIs. Initially, lorlatinib was used in the second-line and subsequent lines of therapy; however, updated results from the CROWN study have demonstrated its unprecedented efficacy as a first-line treatment, including in patients with BM. Currently, lorlatinib is approved in the Russian Federation for the treatment of ALK-positive advanced NSCLC in both previously treated patients and as a first-line therapy. This paper presents a clinical case of a 49-yearold patient with advanced ALK-positive NSCLC and brain metastases. Following the diagnostic phase, which included videoassisted thoracoscopy and morphological verification, the patient underwent a course of chemotherapy with cisplatin and pemetrexed. Subsequently, based on the results of molecular genetic testing, lorlatinib was initiated at a dose of 100 mg/day. Within a month, a significant regression of CNS metastases was observed. Therapy was accompanied by minimal side effects, including hypercholesterolemia and elevated liver enzymes, which were successfully managed with lipid-lowering agents and physical activity. During targeted therapy, the patient has maintained stable disease for 26 months, showing a strong clinical response without the need for dose reduction. This case report highlights the efficacy and tolerability of lorlatinib in the treatment of ALK-positive NSCLC with BM and underscores its potential in clinical practice.

Squamous cell carcinoma of the head and neck (SCCHN) is one of the causes of cancer mortality. The mortality rate of patients within a year from the moment of diagnosis reaches 27% in patients with tumors of the oral cavity and 35.2% in patients with tumors of the pharynx. Despite the visual localization of SCCHN more than 50% of patients at the time of diagnosis are not subject to radical surgical treatment. More than half of the patients develop relapses of SCCHN within 3 years after the end of radical treatment. Most patients with SCCHN receive antitumor drug therapy either when an unresectable/metastatic tumor is detected or when a relapse develops after previously performed radical treatment. Epidermal growth factor receptor (EGFR) is expressed in almost 100% SCCHN and its expression is generally associated with decreased overall survival and progression-free survival. EGFR is a target receptor for targeted drugs. Cetuximab is a monoclonal antibody that blocks EGFR. The review examines the role of cetuximab in the treatment of recurrent and/or metastatic SCCHN in combination with chemotherapy and radiation therapy. The main undesirable phenomenon of cetuximab is dermatological toxicity: acne-like rash, dry skin, paronychia. Preventive therapy, including the antibiotic doxycycline, avoids the development of dermatological toxicity of 2–3 degrees. One of the most important biological processes involved in the progression of SCCHN is tumor escape from immune response associated with the expression of programmed death receptor 1 (PD-1), which inhibits the anti-tu mor immune response. Immunotherapy with checkpoint inhibitors pembrolizumab and nivolumab has shown a significant improvement in the survival of patients with progressing SCCHN after previously performed chemotherapy with the inclusion of cisplatin. Pembrolizumab in combination with cytostatics is an effective first-line therapy regimen for SCCHN in the presence of PD-L1 expression (CPS ≥ 1). In approximately 10–20% of patients, effective therapy changes due to poor tolerability. Timely prevention and relief of adverse events, control of disease manifestations, and a multidisciplinary approach to the patient make it possible to achieve optimal treatment results.

Introduction. A breakthrough in the treatment of metastatic hormone-dependent (HR+) breast cancer was combination endocrine therapy with CDK4/6 inhibitors, which significantly prolonged the tumor response time to treatment and the median survival before progression. The effectiveness of combination endocrine therapy in real-life practice is of particular interest due to the wider population of patients with different somatic status and comorbidity, often not included in randomized trials.

Aim. Analyze of palbociclib using for treating patients with HR+/HER2– advanced breast cancer (mBC) at the Republican Clinical Oncology Dispensary.

Materials and methods. Data from 323 patients were analyzed. Our study examined the effectiveness of combination endocrine therapy with palbociclib in patients with metastatic HR+ HER2– breast cancer. Data on the clinicopathological characteristics of patients and disease progression during palbociclib administration were obtained by reviewing clinical data from patient records and radiological/pathological examination reports.

Results. The median age of patients included in the study was 62 years. When assessing the antitumor response, a partial response was recorded in 54 patients (16.7%), stabilization in 212 patients (65.6%), and progression in 57 patients (17.8%). The median progression-free survival was 13 months. Grade 3 adverse events were noted in 23 patients: neutropenia in 21.7% of cases, hepatotoxicity in 47.8% of cases, cardiotoxicity in 17.4% of cases, and coagulopathy in 4.3%. No patient discontinued therapy due to adverse events. The best treatment results were achieved by patients who used the combination of palbociclib with an endocrine partner as the first line of treatment for advanced stage.

Conclusion. This analysis of real-world data on the use of palbociclib in real-world clinical practice confirms the RCT data on the efficacy and safety of using CDK4/6 inhibitors for the treatment of patients with HR+ HER2- mBC.

The molecular-genetic profile of lung cancer is highly diverse, complicating the formation of a unified patient portrait and necessitating the incorporation of specific genetic testing into diagnosis. There are key mechanisms for the activation of oncogenes, including point mutations, copy number changes (amplifications), and fusions, which are observed in non-small cell lung cancer (NSCLC). Modern molecular-targeted therapy for patients with NSCLC increases the duration of disease control and, in some cases, can transform a once-fatal disease into a chronic condition. Currently, the standard testing panel includes the identification of mutations in the EGFR gene (exons 18–21), ALK translocations, ROS1 translocations, and BRAF V600E mutations. However, less common alterations such as RET and NTRK translocations also occur. The use of next-generation sequencing (NGS) allows for the identification of rarer genetic alterations. NTRK gene fusions are considered oncogenic factors for various solid tumors in both adults and children. The prevalence of NTRK gene alterations varies by tumor type. However, in lung cancer, this type of genetic alteration is rare, with an overall prevalence of less than 3%, and typically the occurrence rate is less than 1%. Currently, three drugs have been included in international clinical guidelines as potential treatment options for NTRK translocations, demonstrating their effectiveness. Several other drugs are at various stages of clinical trials. In this review, we will highlight the existing data for a better understanding of the patient profile with NTRK and present a clinical case.

Introduction. For an extended period, numerous studies have been conducted to find the optimal treatment regimen for esophageal cancer. Chemoradiotherapy has demonstrated satisfactory results in the treatment of localized and locally advanced forms of this disease. However, the search for the best chemotherapy regimen in combination with radiotherapy remains a current focus of many researchers.

Aim. To evaluate the effectiveness and safety of chemoradiotherapy (CRT) using the FOLFOX regimen in patients with esophageal cancer.

Materials and methods. A prospective study was conducted at the Ulyanovsk Regional Clinical Oncology Dispensary. The analysis included patients who received chemoradiotherapy with the FOLFOX regimen from December 1, 2022, to March 1, 2024. A total of 19 cases of esophageal cancer treatment at stages I–III were analyzed. Radical surgical treatment was subsequently performed on 5 patients (26.3%). The characteristics of the studied patients were evaluated according to a standardized protocol.

Results. In the study group, 18 patients (94.7%) completed the planned course of treatment. One patient received an incomplete course of radiotherapy but completed the entire planned chemotherapy. The most common hematologic complication was leukopenia, observed in 9 patients (47.3%) after the full course of chemoradiotherapy. No cases of febrile neutropenia were reported. The hematologic complications were manageable and did not lead to the discontinuation of treatment. Among non-hematologic complications, the most frequently reported were grade 1–2 nausea in 11 patients (58%) and grade 1–2 vomiting in only 2 cases (10%), which was effectively controlled with antiemetic therapy. Overall and relapse-free survival were assessed. The reason for discontinuing radiotherapy in 1 patient (5.3%) was ulcerative stomatitis. Surgery was performed on 5 patients, with tumor regression (TRG) grades 1–2 according to the Mandard scale observed in 4 of them (80%). One patient (20%) had a TRG 3 response.

Conclusions. After chemoradiotherapy with the FOLFOX regime in patients with squamous cell carcinoma of the esophagus, the rate of therapeutic tumor regression (TRG1–2) in operated patients reached 80%. One-year relapse-free survival was 58%, one-year overall survival was 73%, indicating the effectiveness and safety of this chemotherapy regimen as part of the comprehensive treatment of esophageal cancer.

Gastric cancer is an important medical and social problem all over the world. The aggressiveness of the course of this disease is reflected by the high figures of one-year mortality, which is due to both high neglect at the time of diagnosis and unsatisfactory results of surgical treatment of even a localized tumor process, which from a biological point of view casts doubt on the possibility of performing a “radical” operation for this type of malignant tumor. Currently, the “gold standard” has become the conduct of perioperative chemotherapy according to the FLOT scheme for locally advanced stages of gastric cancer, esophagogastric junction and esophagogastric junction and lower esophagus. A further promising direction for improving perioperative chemotherapy is the investigation of immune checkpoint inhibitors (pembrolizumab, atezolizumab and durvalumab) in combination with cytostatics. Today, there are still a number of unresolved issues, including the need to continue such aggressive treatment in the postoperative period with an unsatisfactory pathomorphological response from the tumor. Performing the entire volume of chemotherapy is a difficult task, due to the toxicity of this type of treatment and the weakened condition of the patient after extensive surgery. The significance of the pathomorphological regression of the tumor after neoadjuvant chemotherapy is also unclear. Only 10–15% of patients achieve a complete pathomorphological response. The standard postoperative practice is to carry out the same preoperative chemotherapy regimen, regardless of sensitivity to it. The search for prognostic markers will help to individualize the treatment strategy of such patients and protect patients from excessive toxicity with unjustified continuation of chemotherapy.

The incidence of early-stage breast cancer among young patients has shown a significant increase over the past twenty years, with a substantial portion of these patients requiring chemotherapy. Most treatment regimens used in both neo-adjuvant and adjuvant settings are characterized as moderately or highly emetogenic. Young patients typically lead socially active lives, balancing work and childcare, and strive to remain indistinguishable from healthy women. However, one of the most pronounced adverse effects of chemotherapy is nausea and vomiting, which significantly impair quality of life. One modern method for the prevention of nausea and vomiting involves the use of a combined NK1-receptor and 5-HT3-receptor antagonist, comprising the drugs netupitant and palonosetron (NEPA). This medication is administered as a single dose on the first day in conjunction with dexamethasone, without the need for additional medication on subsequent days. This review discusses the mechanisms of action of NEPA and pres ents studies focused on the effectiveness of the combination of netupitant and palonosetron in patients undergoing moderately and highly emetogenic therapy. According to literature the efficacy of NEPA in combination with dexamethasone reached 70.5% for complete response in the first cycle of treatment. A retrospective analysis involving 2,173 patients confirmed the high efficacy of NEPA, particularly in patients under 60 years of age. Data from real clinical practice further support the results of studies on the effectiveness of NEPA, demonstrating a complete control rate of nausea and vomiting ranging from 74 to 90%.

Introduction. Palliative care is an approach aimed at improving the quality of life of patients and their families. Palliative patients, including oncological ones, have pronounced manifestations of intoxication, body weight deficiency, loss of muscle mass, which leads to weakness, asthenization, decreased motor activity, and the inability to maintain a habitual lifestyle.

Aim. To evaluate the effectiveness and safety of the impact of nutritional support for palliative patients by including in the diet a specialized product of dietary therapeutic and dietary preventive nutrition Protein detoxification cocktail of domestic production.

Materials and methods. The study involved 60 palliative patients of both sexes, the data from questionnaires on the organoleptic properties and parameters of the functional activity of patients, as well as clinical and biochemical studies of blood, liver functions after a 30-day intake of a detoxifying food product were examined.

Results. The studies showed good tolerability, safety and excellent organoleptic properties of the therapeutic Protein Detoxifying Cocktail. Patients noted an improvement in their general condition, a decrease in weakness, an increase in physical activity, mobility and the ability to move, the ability to take care of themselves, engage in normal activities, an improvement in appetite and a decrease in bowel disorders, a decrease in pain and discomfort, anxiety and depression, and an improvement in sleep. Analysis of laboratory data showed that in the main group of palliative patients, there was an increase in the level of hemoglobin, hematocrit, total protein and albumin, as well as a decrease in such indicators as: CRP, creatinine, urea, bilirubin.

Conclusions. The study demonstrates the effectiveness of detoxifying therapeutic enteral nutrition in oncological palliative patients. Detoxifying therapeutic enteral nutrition not only improves metabolism and protein-energy status of patients, but also improves the quality of life and overall survival due to detoxifying, antioxidant, restorative, anti-inflammatory, analgesic and general tonic effects.

Breast cancer remains the leading cause of death in the female population. Screening studies are conducted in order to detect the disease at an early stage. At the same time, domestic authors emphasize the lack of alternatives to preventive mammography in breast cancer screening and the prospects of using mobile mammographs for early diagnosis of breast cancer and precancerous breast diseases.

Aim. To evaluat the results of the use of mobile mammography units for active and early detection of breast cancer.

Materials and methods. The research uses methods of content analysis, information and analytical materials of Russian and foreign researchers, and forms of federal statistical observation. Statistical research methods were used to analyze the data obtained.

Results. Regression analysis with a very low probability of error (p = 0.001) showed that the larger the total volume of mammographic studies with preventive purposes in the subjects of the Russian Federation, the higher the proportion of cases of active detection of breast cancer, although this relationship is rather weak. Taking into account the obtained value of R2 (0.192), only 19.2% of the increase in the proportion of breast cancer cases detected actively can be explained by an increase in the volume of preventive mammograms. The correlation analysis showed that the volumes of preventive mammograms performed using mobile devices in the subjects of the Russian Federation were not associated with either the proportion of breast cancer cases detected actively or with the proportion of breast cancer cases detected in the early stages. At the same time, it is worth noting that the obtained value of p ≥ 0.5 indicates a statistically insignificant result of evaluating the relationship between variables, the interpretation of which should be performed with caution.

Conclusion. Despite the high cost of mobile mammography units, the increase in their number in the subjects of the Russian Federation and the growth in their activities, the contribution of these diagnostic devices to solving the problem of early and active diagnosis of breast cancer remains uncertain. More promising are personalized approaches to the timely detection of cancers, including breast cancer, based on an assessment of the individual risk of their occurrence.

Introduction. Next-generation sequencing (NGS) is a molecular approach that can provide clinicians with comprehensive information about a patient’s molecular profile, which is an important aspect of the effective application of targeted therapy.

Aim. To assess the frequency of tumor somatic mutations in non-small cell lung cancer (NSCLC) in a cohort of Russian patients to subsequently optimize diagnostics and personalize treatment strategies.

Materials and methods. The study included the results of NGS testing from a cohort of 1.400 NSCLC patients between March 17, 2023, and July 22, 2024. Several other clinics across the country participated in this multicenter study. Panels with various options for identifying potential genetic alterations were used. An analysis of the frequency of various alterations was conducted based on the panel used, clinical characteristics of the patients, considering the geographical and ethnographic diversity of the regions in the country.

Results. Mutations were most frequently found in the KRAS (17.9%) and EGFR (15.8%) genes, particularly among never-smoker women. The frequency of rare mutations such as RET, MET, and NTRK corresponds to literature data and underscores the need to expand the group of patients being tested for these alterations. However, deletions in exon 19 of EGFR (12.7%) and KRAS G12C (16.4%) were also found among smokers. The results highlight the inadequate scope of existing testing, partly due to the lack of co-mutation assessment and primary resistance mutations, while also demonstrating possible differences when using various diagnostic panels.

Conclusion. The implementation of NGS in public health systems allows for a more personalized approach to selecting treatment strategies for patients. The data obtained can be used in predictive models to optimize drug distribution.

Introduction. Hepatocellular cancer (HCC) ranks 3rd in the structure of cancer mortality, remaining a social and economic problem. Surgical treatment is the main radical treatment for HCC in the early stages. Russian data on approaches to selecting patients for surgery and on long-term results of treatment of patients with HCC are not sufficiently presented.

Aim. To evaluate the long-term results of surgical treatment of patients with HCC in routine clinical practice in the Russian population.

Materials and methods. A multicenter (7 centers) retrospective observational study included 178 patients with a confirmed diagnosis of HCC who underwent surgical treatment. Before treatment, the general condition was assessed according to the ECOG scale, the functional state of the liver according to the Child – Pugh scale, and the prevalence of the tumor process according to the Barcelona classification (BCLC). The end points of the study were overall survival (OS), relapse-free survival (RFS).

Results. Resection of various volumes of the liver was performed in 178 patients with HCC: 139 has BCLC 0/A, 29 – BCLC B, 10 – BCLC C. The median RFS was 20.6 months (95% CI 16.7–31.5), median OS – 55.7 months (95% CI 42.4–76.4). RFS significantly depended on the stage of the disease (median RFS at stage BCLC 0/A – 25.6, at B – 10.1, at C – 3.3 months), on the presence of macro- and microvascular invasion (median RFS 7.6 and 13.7 months), from viral or non-viral etiology of HCC (median RFS 18.0 and 22.6 months). OS was negatively affected by disease stage BCLC B and C according to the Barcelona classification (median OS 34.2 versus 5.2 months), viral etiology (median OS 42.4 versus 69.9 months), and occurrence of relapse (median OS 43.3 months).

Conclusion. Data from the largest multicenter study on surgical treatment of HCC in Russian clinical practice were obtained. Liver resections of various volumes are also performed outside the scope of clinical recommendations. 3 out of 4 patients have risk factors for relapse. The data obtained are consistent with international experience in the treatment of patients with HCC.

Introduction. The article considers approaches to the treatment of patients with stage III non-small-cell lung cancer (NSCLC). Particular attention is paid to neoadjuvant and adjuvant drug therapy.

Aim. To evaluate the efficacy of neoadjuvant treatments, such as neoadjuvant chemotherapy and immunochemotherapy, and adjuvant approaches to the stage III NSCLC treatment.

Materials and methods. The results were obtained during the study: Clinical Testing of Lung Cancer (“CARL-001”). A total of 186 untreated patients with stage IIIA-IIIC NSCLC (160 patients with stage IIIA, 25 patients with IIIB and 1 with IIIC) were enrolled in the study. The study included 108 patients with adenocarcinoma and 78 with squamous cell carcinoma. 118 patients underwent surgery with adjuvant polychemotherapy (aPCT), 49 patients underwent neoadjuvant polychemotherapy (neoPCT) followed by surgery, and 19 patients had neoadjuvant immunotherapy combined with chemotherapy (neoICT). The median follow-up was 40 months.

Results. Both adjuvant and neoadjuvant chemotherapy shared equivalent efficacy. The median relapse-free survival (RFS) in the aPCT and neoPCT groups was 30.4 and 32.6 months, respectively (differences between groups were not statistically significant). There was no significant difference in overall survival (OS) either. The use of neoICT showed better results as compared to neoPCT. The median RFS was not reached in the neoICT group, the median RFS in the neoPCT group was 32.6 months. OS was numerically higher in the neoICT group as compared to the neoPCT group, and accounted for 78.9% and 59.18% over a 36-month follow-up period, respectively.

Conclusions. Preoperative chemotherapy is proven to be equal to the postoperative chemotherapy in the treatment of patients with stage III NSCLC. The use of neoICT demonstrated better results as compared to neoPCT. Further study of these treatments will allow a more personalized approach to the treatment of patients with stage III NSCLC.

Introduction. Lung cancer remains one of the main causes of death for a long period of time. The existing screening methods are ambiguous. The presence of patients with metastatic stage of lung cancer justifies the creation of an optimal program for more accurate formation of risk groups. It is of interest to determine the intensity of the impact on the incidence rate from the point of view of both clarifying the parameters of urban pollution, but also a detailed analysis of other factors at the regional level.

Aim. To identify the main potential risk factors in Saratov patients diagnosed with lung cancer, taking into account the ecological and geographical features of their place of residence in order to further create a model of active disease search by risk groups.

Materials and methods. The complex of factors influencing the development of lung cancer among the population of Saratov has been studied. A group of 1049 patients was analyzed. The distribution of patients across urban landscape areas of the city has been determined depending on the impact of certain adverse environmental factors. To detail the remaining factors, the main group included 200 patients with the specified diagnosis who underwent outpatient and inpatient treatment in oncological institutions. All data was collected using official statistical documents and a medical information system.

Results. When conducting a subgroup analysis by parameters (gender, age, localization and clinical form of the cancer process, stage of the disease, the patient’s attitude to smoking, body mass index, occupational hazards, the presence of oncopathology in the history of the patient and his relatives, the presence of chronic lung disease), the main patterns and features were identified depending on the histological variant. Given the complexity of the interaction of risk factors in the development of lung cancer, it becomes necessary to conduct further research to form a model questionnaire for lung cancer risk based on multifactorial analysis.

Conclusion. The formation of a more precise risk group will increase the percentage of detection of early stages of lung cancer.

 Melanoma of the skin is one of the most aggressive cancers. Until recently, metastatic melanoma was associated with an extremely negative prognosis: the median overall survival for this category of patients was no more than 7–8 months. Thanks to the improvement of therapeutic approaches, it was possible to achieve a significant increase in the life expectancy of patients with an unresectable and metastatic process. Currently, several targeted and immunotherapy options are available for the treatment of metastatic or unresectable skin melanoma. These therapeutic approaches have thoroughly taken a leading place in everyday clinical practice and have made it possible to change the natural history of this disease: today about 30–60% of patients can survive 5 years or more. There are 3 immune response checkpoint inhibitors related to PD-1 receptor blockers registered in our country: pembrolizumab, nivolumab and the Russian-made prolgolimab. In this article, we describe a clinical case of effective treatment of a patient with generalized melanoma of the skin using the domestic drug prolgolimab. The article also provides a brief description of the main studies on domestic immunotherapy molecules and their indirect comparison with foreign analogues.

The MET gene encodes cell surface receptors that have tyrosine kinase activity and mediates embryonic development, organogenesis, and wound healing. Overexpression of MET is observed in some human cancers, including non-small cell lung cancer. Capmatinib is a selective type Ib inhibitor of MET. A total of 151 patients with MET exon 14 skipping mutations were enrolled in the GEOMETRY-mono 1 study. ORR achieved was 51% in patients receiving second-line chemotherapy, the median PFS was 6.9 months. We present a clinical case of NSCLC treatment in a pretreated patient aged 50 years with MET exon 14 skipping mutations. The MET mutation was detected by next-generation sequencing. Initially, the patient presented with metastatic disease, underwent surgical treatment due to lung cancer complications. She received a platinum-containing chemotherapy regimen as the first-line therapy, and in case of progression, targeted therapy was considered. Currently, progression-free survival is 9 months. This clinical observation shows the efficacy of targeted capmatinib therapy in a pretreated patient with advanced NSCLC and MET exon 14 skipping mutations. Testing of patients with advanced non-squamous non-small cell lung cancer for rare mutations such as MET, RET is clearly needed.