No 17 (2014)

Treatment of disseminated melanoma many years remained challenging. Standard chemotherapy had no fundamentally effect on overall survival of patients. Given the high immunogenicity of the tumor, immunotherapy of melanoma was always the center of attention of researchers. However, the first real success of immunotherapy for metastatic melanoma is associated with the emergence of a new generation of immunotherapeutic drugs - inhibitors of regulatory molecules of key stages of the immune response. The article describes the main drugs of this group, and the latest results from clinical studies conducted in disseminated melanoma are presented.

The article considers the characteristics of lobular invasive carcinoma (LIC) compared with ductal invasive carcinoma in breast cancer. Despite more frequent incidence of ductal carcinoma, LIC occurs in older patients and is characterized by several more favorable prognostic features (positive estrogen and/or progesterone receptors, negative HER2 status, low Ki 67 levels, and a low degree of malignancy. On the other hand, the pattern of growth of the primary tumor in LIC and complexity of radiological diagnosis determine relatively late detection of the disease. In some cases, the problem includes a quite unusual for breast cancer localization of metastases in ovaries, peritoneum and gastrointestinal tract. The clinical observation of the patient 57 years old with LIC illustrating features of the course of this form of cancer is presented. Based on the results of large clinical trials, approaches to the treatment of LIC are discussed. It is stated that the best option of adjuvant endocrine therapy for menopausal patients with luminal, HER2 negative LIC is the use of aromatase inhibitors, in particular - letrozole.

However, there is obvious fact that not all patients with HER2-positive respond to trastuzumab-containing therapy. The use of combination of pertuzumab, trastazumab and docetaxel in the first-line therapy of metastatic breast cancer has allowed to significantly increase the effectiveness of treatment. The CLEOPATRA study showed an unprecedented increase in overall survival of patients receiving combination of pertuzumab, trastuzumab and docetaxel as first-line treatment compared with the group receiving placebo, trastuzumab, and docetaxel (56.5 months vs 40.8 months). In addition, the use of pertuzumab in combination with trastuzumab and docetaxel can increase the time to detection of brain metastases. The article also describes a clinical case of patient treated more than 60 months within the framework of the study.