No 8 (2013)

Several phase III clinical trials have studied the effect of trastuzumab in combination with chemotherapy on recurrence-free survival in patients with HER2-positive breast cancer, depending on the type of chemotherapy, duration of trastuzumab treatment and time of the its addition to the chemotherapy. All the major clinical studies have demonstrated the continued benefit of the one-year treatment with trastuzumab in addition to standard anthracycline/taxane-based chemotherapy.

The article is dedicated to the choice of treatment for squamous cell carcinoma of the oral mucosa. The early stages of the disease are quite successfully treated using only surgery or radiation treatment, whereas locally advanced tumors require an integrated approach. According to the literature data, modern surgery, radiotherapy and chemotherapy provide great potentials for the successful treatment of patients. The choice of the sequence of stages of the combined treatment is a difficult question. Numerous publications on the subject are inconclusive, and have not justified the use of radiation therapy in the first stage of disease, although it is conventional in Russia. A review of the introduction of targeted therapies in the schemes for the treatment of the both locally advanced and recurrent processes is presented.

The most common side effect of chemotherapy of malignant tumors is neutropenia. Neutropenia and febrile neutropenia (FN) are the major risk factors for morbidity and mortality from infectious complications. Prophylactic use of recombinant human granulocyte colonystimulating factors allows to significantly reduce the risk of FN and associated complications.

Chemotherapy for advanced ovarian cancer remains a challenge. Despite the high rate of complete remissions after maximum cyto-reduction and first-line chemotherapy, most patients experience the relapse of disease. In the last 15 years, the combination with the addition of platinum-based drugs and taxanes remains the scheme of choice. The individualization of treatment, including the determination of the optimal combination with one of the studied targeted agents for each patient, is a promising direction for the increasing the effectiveness of first-line chemotherapy. To date, the most studied group of drugs is anti-angiogenic drugs, the positive results came from studies of bevacizumab in first-line chemotherapy. This article reviews modern treatment regimens studied within the framework of the first-line treatment of ovarian cancer with the use of promising new targeted agents.

Currently, according to international expert opinion, hormone therapy (HT) is standard of treatment for patients with disseminated prostate cancer (PC). The article discusses the administration of HT for localized and locally advanced prostate cancer, including the feasibility of HT prior to surgery and radiation therapy. The article also discusses some aspects of the use of hormonal therapy in metastatic prostate cancer: a comparison of immediate and delayed HT, applicability of adding of anti-androgen therapy to castration therapy, the potentials for the use of intermittent hormonal therapy regimen.

The article considers the results of controlled clinical studies on the use of bisphosphonates (primarily zoledronate) for the prevention of bone metastases in breast cancer. In general, the use of bisphosphonates significantly reduced the incidence of bone metastases, and the most pronounced effect was observed in menopausal women. In addition, bisphosphonates have increased disease-free survival and overall survival in this group of patients.

Temozolomide is the most effective drug for the treatment of malignant gliomas. All patients included in the study and treated with temozolomide in both dosage forms have reported better tolerance of intravenous infusion in comparison with oral capsules. Advantages of intravenous infusion of the temozolomida best implemented in patients with impaired swallowing, as well as children. Limitations of use of lyophilisate include necessity for admission of patient in a medical facility. However, the low toxicity of intravenous infusion of temozolomide allowed to recommend administration of this drug in a day hospital or in outpatient settings. Thus, the presence of two formulations enhances the use of temozolomide in patients with malignant gliomas, allows to provide treatment with low toxicity and ensure the highest quality of life during treatment.

Colorectal cancer (CRC) is the third largest of cancer mortality in the world. Approximately 25 % of patients have metastases to distant organs at the time of diagnosis (synchronous metastasis), and about 50 % of patients suffer from metastatic liver lesion. The main goal of treatment of patients with liver metastases is the achievement of resectability of metastases. “Conversion therapy" in combination with surgery clearly improves the prognosis of patients with liver metastases, making the long-term outcomes comparable to those of initially resectable metastases. The choosing the optimal mode, which would allow to perform radical resection in the maximum number of patients, is still an unsolved problem. Despite the theoretical underpinnings of preoperative therapy in resectable patients (reducing the size of metastases with performing more conservative resections and increasing likelihood of complete tumor resection; exclusion of patients with early extrahepatic disease progression during chemotherapy; relevant choice of postoperative treatment by assessing the chemosensitivity of the tumor and tolerability of treatment by the patient), direct evidence for these arguments are missing.