No 18 (2015)

Kadcyla (trastuzumab emtansine, T-DM1) is a conjugate of the targeted monoclonal antibody trastuzumab and the cytotoxic drug DM1 (maytansinoid). The article presents the results of two large randomized phase III trials, EMILIA and TH3RESA, including patients with HER2-positive breast cancer(BC) with progression after treatment with taxanes and trastuzumab. Compared with previous standards of treatment (a combination of lapatinib and capecitabine in the EMILIA trial and research-driven treatment in the TH3RESA trial), the application of Kadcyla led to achievement of significant increase in efficacy (progression-free survival, overall survival, objective response). Combination with a favorable range of safety allowed to consider trastuzumab emtansine as a key drug of choice in the second-line treatment of HER2-positive breast cancer.

Over the last 5 years due to the introduction of modern high-effective drugs into clinical practice, the effectiveness of the treatment of disseminated melanoma has improved significantly. Preclinical studies have demonstrated the possibility of using antibodies blocking the PD-1 or PD-L1 for the treatment of various tumors. Antitumor activity was demonstrated in melanoma, kidney cancer, bladder cancer, lung cancer and some other cancers. Based on the published results of the key clinical trials, such as KEYNOTE-001, KEYNOTE-002, and KEYNOTE-006, pembrolizumab was recommended as a high-effective drug for the treatment of disseminated skin melanoma.

Herceptin appeared in clinical practice for more than 15 years ago and firmly took the leading position in the treatment of HER2-positive breast cancer, changing our ideas about the course of this aggressive disease. During the whole period of application of this drug, indications for its use have increased considerably: today Herceptin is used successfully in the treatment of early and metastatic HER2-positive breast cancer; it is highly effective within a year in adjuvant therapy. A new dosage form of Herceptin for subcutaneous administration was recently registered. Numerous clinical studies have demonstrated the high efficacy of therapy with Herceptin in combination with other anticancer drugs. All of this determines high results of treatment of patients with HER2-positive breast cancer, increasing the duration of remission and cure rate of millions of patients worldwide.

The article presents the results of the combined treatment of 60 colorectal cancer patients with isolated liver metastases, combining surgery with perioperative chemotherapy. Proposed treatment algorithm has allowed to achieve high survival rates in patients of the study group. Clinical and morphological characteristics with the greatest prognostic value are discussed.

Currently, there are more than 1.5 billion overweight people, and 500 million obese people in the world. The negative effects of obesity are associated with an increased risk of cancer of various locations, including colorectal cancer (CRC). This was the basis for the evaluation of the effect of the degree and features of deposition of adipose tissue (AT), its metabolic activity on the course of CRC after curative surgery. The material was compiled of data of examination and treatment of 291 patients with CRC (main group) with I, II, III stages of the disease, who have received treatment in the FSBI «Russian Scientific Center of Radiology and Nuclear Medicine» in the period from 1996 to 2014. Results of the study revealed the negative impact of the increase of body mass index on the colorectal cancer prognosis. The features of AT distribution significantly affect the course of the CRC: central obesity worsens the prognosis of the disease. For patients with colorectal cancer, increasing levels of the hormone of adipose tissue - leptin, has a highest predictive value, because it is associated with increased body weight and central obesity. The increase of leptin levels above 30 ng/ml in patients with colorectal cancer dramatically affects the results of treatment and can be used as an additional factor in determining the indications for adjuvant therapy after radical surgery, regardless of the stage of disease.

Morphological examinations of the gastric mucosa with Helicobacter pylori infection testing were performed in 127 Caucasians and 132 Khakases with gastritis and in 51 newcomers and 32 Mongoloids with stomach cancer. In both populations, the incidence of atrophy and metaplasia in the gastric antrum and body was significantly higher in patients with gastric cancer compared with those with gastritis. The ethnic differences in the incidence of metaplasia between native and immigrant population with stomach cancer were determined. In Caucasians and Mongoloids H. pylori was detected more frequently in patients with distal cancer, compared to the proximal localization of the tumor. It is stressed that the concept of the Correa 's cascade of gastric carcinogenesis rationally describes the study results which confirm the feasibility of putting into practice the modern consensus on this clinical problem.

The article presents clinical data on current treatment options for metastatic colorectal cancer in the second-line therapy. The detailed analysis of the efficacy and toxicity of combinations of chemotherapeutic agents used is provided. The results of the studies of targeted drugs in the second-line therapy in combination with cytotoxic drugs and in monotherapy are concerned. The role of targeted therapy and its place in the treatment of metastatic colorectal cancer is analyzed.

The article presents a clinical case of a combined treatment of 35-year old female patient with disseminated stomach cancer and HER2/ neu hyperexpression. The combinations of cisplatin+capecitabine+trastuzumab were used. Against the background of the treatment, complete effect was achieved, the length of time to progression was 35 months, the duration of the complete effect - 27 months. Over all survival was 72 months.