Vol 31, No 7 (2024)

The article analyzes literature and own authors’ data on the use of the EU-TIRADS and Bethesda classification. Thyroid nodules are widespread in the population. Due to the unfavorable environmental situation, the spread of radiation methods for the treatment of tumors in other localizations, an increase in the incidence of thyroid cancer is noted. Having modern ultrasound machines with advanced auxiliary techniques (elastography, contrast-enhanced ultrasound, Doppler modes), the doctor often faces difficulties in interpreting the results of the study and making a decision on further patient management tactics. The TIRADS classification for thyroid nodules has been widely implemented abroad, according to which the management tactics for each group of patients are determined. In our country, doctors use various, sometimes contradictory, versions of the TIRADS classification. The purpose of the classification is to determine the risk of malignancy of the node and the choice of further tactics for patient management. According to statistics, the majority of thyroid nodes are benign. If malignancy is suspected, the patient undergo biopsy. Fine-needle aspiration biopsy (FNAB) with cytological examination is a fairly highly informative diagnostic method and allows for reliable interpretation of the ultrasound characteristics of thyroid nodes, as well as the choice of the necessary tactics for managing a specific patient. But like any interventional procedure, FNAB has complications and may have an uninformative result. The question arises about the need for a repeat biopsy and its timing. The article provides an overview of the latest clinical guidelines for the management of patients with thyroid nodules, published in August 2023 by the European Thyroid Association, from the point of view of an ultrasound diagnostic physician. It also presents data on 848 patients with thyroid nodules who underwent examination and treatment at the Chelyabinsk Regional Center for Oncology and Nuclear Medicine in 2023.

Recent studies confirm that endothelial dysfunction is an important pathogenetic mechanism in both atrial fibrillation and cancer-associated thromboses. It promotes inflammation, activation of coagulation and development of thrombosis, which requires the development of new therapeutic approaches to reduce the risk of thromboembolic complications (TEC) in such patients. The ongoing trials support the use of apixaban for the treatment of venous TEC in patients with active oncopathology in combination with atrial fibrillation, which confirms its efficacy and safety. This allows apixaban to be used both in outpatient settings and for long-term treatment with minimal risks of major bleeding, which is an important step in improving the quality of life of cancer patients.

Renal cell carcinoma (RCC) is one of the most common oncourological diseases and ranks 10th among malignant neoplasms in the world and 3rd among malignant neoplasms of the genitourinary system (EAU Guidelines, 2017). According to B.P. Matveev (2011), over the past decades, there has been a tendency to increase RCC by 2–4% per year in all population groups. This is attributable to both a true increase in a number of oncourological patients and the improvement of modern diagnostic capabilities. However, despite a significant number of patients with early identified tumor process, the mortality rate from the disease remains high. The only effective method of treating RCC is surgery, which involves nephrectomy or resection of the kidney with the tumor, but in 68.1% of patients with localized and locally advanced forms of the disease, according to B.P. Matveev (2011), tumor process progresses after radical treatment at various times. High incidence rate, large number of relapses, variability of the course of the tumor process after surgery and the lack of a single prognostic system with high accuracy determine the relevance of the problem and indicate the need to create a prognostic panel of factors that can accurately predict the course of the disease after surgery for RCC. The objective of the review is to determine the diagnostic value of CT angiography and CT perfusion in optimizing surgical treatment tactics and assessing the functional capacity of the renal parenchyma in RCC. The search results in the PubMed, Medline, Web of Science scientific databases for the queries «renal parenchyma cancer», «diagnosis of kidney tumors» were analyzed. The review provides detailed consideration and illustration of prognostic factors for the course of the disease in locally advanced renal cancer and the diagnostic value of CT angiography and CT perfusion in determining tumor invasion of intrarenal vessels.

Conclusion. Despite the long history of studying renal parenchymal cancer, there are still no reliable data on the diagnosis of kidney tumors and various prognostic factors for the course of RCC, therefore, the article analyzes and collects the results of recent studies.

Modern methods of systemic therapy of metastatic breast cancer (mBC) include the use of various combinations of chemotherapy, hormonal therapy, targeted and immunotherapy. The development and introduction of new therapeutic agents continue to change the standards of treatment and open new horizons for an individualized approach to therapy. This article considers the features of diagnostics, available treatment options for hormone-sensitive HER2-negative mBC and promising new treatment methods.

Nasopharyngeal cancer (NPC) belongs to the group of orphan malignant neoplasms. This nosology is characterized by a modest arsenal of treatment options for both localized and widespread forms. The above facts explain the extremely unsatisfactory results of treatment of patients with nasopharyngeal carcinoma. Major recent international conferences have not presented breakthrough studies in this area beyond the Chinese protocols using chemo-immunotherapy for recurrent/metastatic forms of the disease. The exception was the latest congress of the European Society of Medical Oncology (ESMO), which was held from September 13 to 17 in Barcelona, Spain. In this review article, we discuss the most significant studies on the treatment of patients with nasopharyngeal carcinoma that were reported at ESMO 2024 and may change the routine practice of an oncologist in the near future.

Background. Currently, ramucirumab, an inhibitor of type 2 vascular endothelial growth factor receptors, in combination with paclitaxel is the most effective second-line treatment regimen for disseminated gastric cancer (DGC). The experience of successful use of ramucirumab in real clinical practice in various countries of the world is widely presented in the literature.

Objective. Evaluation of the effectiveness of ramucirumab as monotherapy or in combination with chemotherapy as a second-line treatment for patients with DGC in routine clinical practice in Russia.

Methods. The analysis included data from 163 patients with GC from 11 oncology institutions in Russia who received ramucirumab as part of the second-line treatment: 17 patients were prescribed ramucirumab as a monotherapy, 104 – in combination with paclitaxel, 42 – in combination with irinotecan-based regimens. The treatment efficacy was assessed.

Results. The efficacy of ramucirumab as a monotherapy was: disease stabilization – 47.1%, median progression-free survival (mPFS) – 2.2 months, median overall survival (mOS) – 5.6 months. When treating with ramucirumab in combination with paclitaxel, the objective response rate (ORR) was 24.0% (3,8% complete response), disease control – 76.9%. The median PFS and OS were 6.1 and 10.6 months, respectively. As a result of treatment with ramucirumab in combination with irinotecan-based regimens, the ORR was 26.2% (4.8% complete response), disease control was 88.1%. The median PFS and OS were 7.5 and 13.3 months, respectively.

Conclusion. According to the obtained results, ramucirumab in combination with paclitaxel or the FOLFIRI regimen is an effective option for second-line therapy in DGC. The results of using ramucirumab alone or in combinations in real clinical practice in Russia are not inferior to and even numerically surpass the data from international studies and are comparable with the practical experience of other countries.

Background. The most common type of breast cancer (BC) is hormone receptor-positive HER2-negative (HR+ HER2-) tumors, approximately 40% of which have mutations in the PIK3CA oncogene encoding the catalytic subunit of the PI3K protein. The most effective pharmacotherapy for such neoplasms is the use of a combination of PI3Kα-specific inhibitors alpelisib and fulvestrant. However, in real clinical practice, the use of this combination did not become available immediately.

Objective. Retrospective analysis of the efficacy of various drug therapy options in the study cohort of patients in real clinical practice.

Methods. The study included 34 patients with HR+/HER2- metastatic breast cancer with PIK3CA mutation, who received treatment at the Primorsky Regional Oncology Dispensary.

Results. The median EFS in the group receiving CDk4/6 inhibitors was 27.00 months (95% CI: 18.00–78.00), and in the group not receiving CDk4/6 inhibitors it was 8.00 months (95% CI: 3.00–39.00), P=0.020. The median EFS in the alpelisib group was 65.00 months (95% CI: 19.00–78.00), the median EFS in the other therapy group (not receiving alpelisib) was 9.00 months (95% CI: 7.00–27.00). The differences in EFS were statistically significant (P=0.025).

Conclusion. Effective pharmacotherapy options for the study group of patients include the use of both CDk4/6 inhibitors and the PIK3 inhibitor alpelisib in combination with fulvestrant. Despite a number of limitations, the RWD study demonstrated improved survival outcomes for patients who were prescribed any CDk4/6 inhibitor and alpelisib.

Background. Long-term consequences of polychemotherapy (PCT) for acute lymphoblastic leukemia (ALL), adversely affecting the kidneys, require study in pediatric practice.

Objective. Evaluation of the markers of kidney damage in children with acute lymphoblastic leukemia after completion of polychemotherapy.

Methods. A cross-sectional study of kidney damage markers in the serum (creatinine and cystatin C) and urine (neutrophil gelatinase-associated lipocalin (NGAL), β2-microglobulin, kidney injury molecule-1 (KIM-1), and interleukin 18 (IL-18)) was conducted in 38 children aged 3–18 years with ALL in the period from 2 weeks to 6.5 years after the end of chemotherapy. The control group included 50 children of the corresponding age and sex, II health group. The data are presented as median and interquartiles (Me [25; 75]), comparison of groups – according to the Mann-Whitney criterion.

Results. A higher serum cystatin C level was found in children with ALL, regardless of the renal filtration function in all studied periods after the end of chemotherapy (p < 0.001). In the first two years after the end of chemotherapy, children with ALL had an increased urine KIM-1 level compared to the control group (p =0.009). In children with ALL after chemotherapy, who have a decrease in eGFR <90 ml/min/1.73 m² based on the CKiD U25 formula for serum cystatin C using an age-dependent coefficient, an increased urine KIM-1 level (p=0.005) and its normalized value – urine KIM-1/ creatinine ratio (p=0.016) were observed.

Conclusion. An increase in the serum cystatin C levels for 6.5 years after chemotherapy and urine KIM-1 levels in the first two years after the end of therapy may indicate persistent changes in the glomeruli and tubules of the kidneys and serve as predictors of the development of CKD in children.

Bone scintigraphy is a highly sensitive but low-specific diagnostic method. It is noted that single-photon emission computed tomography combined with computed tomography (SPECT/CT) has greater sensitivity and accuracy compared to planar scintigraphy. The article presents differential diagnostics of focal bone changes detected by planar bone scintigraphy using clinical cases, carried out using the hybrid diagnostic method SPECT/CT, due to which benign changes in the skeletal system were detected. Thus, SPECT/CT examination allows to detect not only foci of malignant neoplasms, but also changes of benign nature, which is especially important in differential diagnostics of malignant and benign neoplasms.

Mutations in the epidermal growth factor receptor (EGFR) gene are present in more than 15–20% of patients with non-small cell lung cancer (NSCLC). These are mostly classical activating mutations – deletions in exon 19 and L858R point mutations in exon 21. Both mutations are sensitive to EGFR tyrosine kinase inhibitors (TKIs), which have become the accepted standard of first-line treatment for advanced EGFR-mutated NSCLC. However, 10 to 20% of EGFR-positive NSCLC cases have less common mutations, including exon 20 mutations, for which the response to EGFR TKI therapy can vary significantly depending on the type of mutation, and the choice of optimal therapy remains a challenge. Here, we present a description of a clinical case of successful and durable response to first-generation (within a year) and then third-generation (more than 7 years) TKI therapy in metastatic NSCLC with a rare EGFR exon 20 mutation. Treatment is still ongoing.

Background. Patients with chronic kidney disease (CKD) on hemodialysis (HD) often face difficulties in the use of chemotherapy (CT), since most antitumor drugs have nephrotoxicity, which can worsen the condition of the kidneys. At the same time, there are no clear recommendations for the management of patients in this category. The article presents current information on the management of patients receiving CT against the background of HD, assesses the possibility of CT in patients with gastrointestinal tract (GIT) tumors against the background of the end-stage CKD receiving HD, and gives recommendations for individual treatment adjustment using the example of two clinical cases of patients with end-stage CKD receiving HD and CT.

Results. Both patients showed positive dynamics: the first patient had a partial tumor response to treatment, the second patient had stabilization of the process. However, the treatment was accompanied by various manifestations of toxicity, including stomatitis, asthenia and diarrhea, which required further dose adjustment. An important role was played by the pharmacokinetics of antitumor drugs, which was taken into account when prescribing CT in the conditions of program HD.

Discussion. CT in patients with CKD on HD can be successful if the pharmacokinetics of the drugs, regular monitoring and dose adjustment are taken into account. Platinum derivatives and 5-fluorouracil, used in the treatment of gastrointestinal tumors, require special attention in conditions of renal failure. Nevertheless, dose adjustment and HD before and after drug administration provide achieving therapeutic efficacy while minimizing side effects.

Conclusion. The end-stage CKD and the need for program HD are not an absolute contraindication to CT in patients with gastrointestinal tumors. An individual approach to each patient, dose adjustment and careful monitoring of the patient’s condition provide achieving positive results in antitumor treatment.