No 17 (2010)

The article presents a clinical observation of patient with cancer of medium and lower thoracic portion of esophagus with extention to the forestomach and liver metastases, who underwent combined surgery, including one-stage extirpation of the esophagus, proximal gastric resection and an extended right hemihepatectomy. As adjuvant treatment, the patient receives Gleevec at dose 400 mg/day. At 6 months after surgery, the patient has no complaints.

Therapeutic agents targeting tyrosine kinase of vascular endothelial growth factor receptors (VEGFR) or their's ligands allowed to archieve the significant results in treatment of patients with advanced renal cell carcinoma. Investigations of rapamycin and it's cell target wre the first step to new class of drug development, they have been called as mTOR inhibitors. Currently mTOR inhibitors are the agents of investigations in a big number of phase II-III clinical trials in multiple tumor types. mTOR inhibitor everolimus acts through key pathways and targets key pathogenetic mechanisms of renal cell carcinoma. mTOR inhibitor everolimus (Afinitor®) has proven clinical efficacy in renal cancer and well-tolerated by almost patients. Today this drug is successfully used in more than 50 countries worlwide for treatment of patients with advanced and/or metastatic renal cell carcinoma after failure on or after any other antiangiogenic therapy.

HER2-positive status of patients with breast cancer (BC) is a reliable predictive factor for the brain metastases developed in one third of patients with disseminated HER2 + BC. Lapatinib and Trastuzumab (Bevacizumab, less frequently) are investigated in the treatment of brain metastases of BC. After detection of brain metastases, continuation of therapy with trastuzumab significantly improves overall survival primarily due to effective control of extracranial metastases. It is proved that Trastuzumab and Lapatinib cross the blood-brain barrier in some settings. Combinations of Lapatinib + Capecitabine, Capecitabine + Trastuzumab and Trastuzumab + Lapatinib are promising in the treatment of HER2-positive breast cancer with brain metastases.

The article is dedicated to the modern features of maintenance therapy in patients with IIIB-IV stages non-small-cell lung cancer. As a supportive treatment, use of drugs included in regimen of induction therapy may be continued, and administration of new drug with other mechanisms of action and spectrum of side effects is feasible. After a standard induction treatment (4 to 6 courses of chemotherapy, doublet regimen with the inclusion of platinum derivatives), maintenance therapy can be performed in the absence of disease progression. This treatment is particularly effective against the background of achieving stabilization of disease. Maintenance therapy can be appointed until disease progression or development of unacceptable toxicity. Currently, pemetrexed or erlotinib can be applied in non-small-cell lung cancer; docetaxel, gemcitabine, and erlotinib in squamous cell cancer. In the case of use of bevacizumab in the induction treatment, it is reasonable to continue maintenance treatment with this drug, possibly in combination with erlotinib (bevacizumab in combination of with chemotherapy as a maintenance treatment is studied).

Currently, treatment of malignant (poorly differentiated) glial brain tumors in children is most demanding task in pediatric neurooncology. Used in the present study for treatment of 17 children with glioblastomas and anaplastic astrocytomas of the central nervous system Bevacizumab (Avastin) in combination with cytotoxic drugs showed good tolerability and relatively high efficacy, reflected in increasing overall survival compared with published data.

Bisphosphonates have long been used successfully for the prevention of complications associated with tumors of skeletal system. Currently, however, there are increasing evidences that at least one of them - zoledronic acid - has direct antitumor activity and the ability to increase patients' survival. The Congress of the American Society of Clinical Oncology presented multicenter randomized trial Myeloma IX, confirming the ability of zoledronic acid to significantly increase overall survival of patients with multiple myeloma as compared to clodronic acid (50.0 vs 44.5 months, respectively, P = 0.0118 ). Reported at the Congress ABCSG-12 study (Austrian Breast and Colorectal Cancer Study Group-12) indicated the antitumor activity of zoledronic acid at other tumors (breast cancer).

The article presents results of study involving 32 patients with malignant gliomas, which has evaluated two regimen of chemotherapy: fotemustin (Mustophoran) as monotherapy in patients with anaplastic gliomas, and Mustophoran in combination with carboplatin and etoposide in patients with glioblastoma; hematological and other toxicity of chemotherapy regimens were also assessed. Based on these results, Mustophoran as monotherapy can be recommended as a priority regimen in the adjuvant treatment of patients with anaplastic gliomas III malignance grade.

The article is dedicated to the results of study which was aimed to evaluation the efficacy and safety of combination of pemetrexed and cisplatin (700 mg/m2 and 75 mg/m2, respectively) as the first-line therapy, and analysis of progression-free survival (PFS), overall survival (OS) and duration of effect in 53 patients with generalized gastric adenocarcinoma (IV stage) or recurrent gastric cancer. Objective response rate was 32.1% and the rate of disease control - 58.5%. The median duration of effect was 3.8 months, median PFS - 3.7 and the median OS - 8.8 months. The most frequent III-IV grade drug-induced hematologic toxicity was neutropenia (54.7%); in other cases hematologic toxicity led to anemia, thrombocytopenia, alopecia and rash. Study has demonstrated moderate effectiveness and satisfactory safety profile of this treatment regimen. Rate of disease control, equal to 58.5%, indicates the effectiveness of combination at this stage of the disease in this patient population

A review presents the main materials of The Conference Of Renal cancer Experts (CORE) (Turkey, Istanbul, March 12-13, 2010), which reflect the current status of the treatment in advanced renal cell carcinoma (RCC). Sunitinib, bevacizumab with interferon-α and pazopanib are considered the standard of care for the first-line treatment of good- and intermediate-risk metastatic clear cell RCC. Temsirolimus is recommended for the first-line treatment in poor-risk clear cell RCC. Sorafenib should be administered in cytokine-refractory tumors. The only agent showed efficacy in RCC after tyrosine-kinase inhibitors in phase III trial is everolimus.