No 17 (2017)

On March 15, 2017, the 15th St. Gallen International Breast Cancer Conference (Vienna) examined controversial clinical issues with the goal of reaching agreement among the 50 most influential panel world leaders. Also, the results of randomized trials were examined in order to narrow or, conversely, expand the standards for local and systemic treatment. The introduction of trastuzumab in combination chemotherapy has significantly improved the results of treatment of HER2-positive breast cancer. Double inhibition of HER2 appears to be a promising strategy to improve the frequency of pCR and the survival rates in patients with breast cancer.

The prospects for clinical use of palbociclib, a new oral selective cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor, in patients with hormone-positive advanced breast cancer (BC) are discussed. The article presents the results of clinical studies, which show that the palbociclib-based combinations significantly increase the progression-free survival rates in this category of patients. The main candidates for palbociclib-based combination therapy can be patients with hormone-positive, HER2-negative breast cancer who had previously been recommended for chemotherapy due to the spread of the disease and the threat of a visceral crisis. Strong arguments in favor of the appointment of this treatment regimen are manageable safety profile of the palbociclib-based combination and a higher progression-free survival rate in comparison with chemotherapy.

The tactics of treatment of the pulmonary adenocarcinoma is based on the identification of molecular genetic disorders. Over the past 10 years, a number of subtypes of this disease associated with various disorders have been identified. Activating BRAF gene mutations determine the pathogenesis of 1-4% of cases of pulmonary adenocarcinoma. The presence of these molecular disorders correlates with history of smoking. The use of BRAF inhibitors in combination with MEK inhibitors in this group of patients makes it possible to achieve a clinical effect in 75% of patients and 13-15 months without progression of the disease. Development of the optimal algorithm for screening of glandular lung tumors, including for the presence of BRAF mutations, will significantly improve the results of drug therapy for this group of patients.

Breast cancer (BC) is a biologically heterogeneous disease, and approximately 15-20% of the cases is accounted for by triple negative variant (ER/PR/HER2-negative), which is characterized by a relatively high frequency of progression and mortality. The place of eribulin mesylate in the treatment of this form of cancer is discussed. The target of eribulin action is tubulin. Currently, possibility of combination of eribulin with capecitabine is studied. It was concluded that the appearance of new drug with the original mechanism of action, eribulin mesylate, in the clinical oncology expands the possibilities of effective therapeutic effects not only in metastatic ER-negative and triple-negative forms of breast cancer resistant to standard therapeutic interventions, but also in the earlier stages of the disease.

This article discusses in detail the possibilities of combined therapy with vemurafenib+cobimetinib (V+C) in patients with metastatic skin melanoma. In the coBRIM study, about 50% of patients in the group of combination therapy V+C had an unfavorable prognosis factor - an elevated lactate dehydrogenase (LDH) level. Despite this, the median progression-free survival and median overall survival rates were high, which points out the possibility of the use of combined targeted V+C therapy in patients with elevated LDH levels. The article also discusses the results of the BRIM7 study, which are of great interest due to the presence of a group of patients previously treated with BRAF inhibitors.

Dermatologist can meet skin melanoma (SM) in 4.5-6.6% of cases in patients who have seek medical attention for skin lesions. The article contains data on external manifestations, incl. early forms, comparative characteristics of the dermatoscopic picture of SM, depending on the size of the tumor, as well as in different clinical observation groups. The melanomas actively detected by the dermatologist, regardless of the diameter, were characterized by more superficial tumor growth (non-invasive and minimally invasive), which points out the importance and necessity of preventive screening examinations. Based on personal experience, the authors suggest that in most cases, the fact of the «metamorphosis of the mole» described by patients is nothing more than the transition of the tumor from the stage of horizontal growth into the stage of vertical growth. New data on clinico-dermatoscopic characteristics of the early stage of melanoma have been obtained, which makes it possible to increase the accuracy of non-invasive diagnostics. A significant (85.7%) incidence of discrepancy between dermatoscopic and histological diagnoses of this category of tumors was identified, requiring revision and additional consultation of histological preparations.

Oncological diseases are the second most frequent cause of death both in the world and in Russia. Annually up to 14 million new cases of oncological diseases are registered in the world. The number of patients receiving chemotherapy increased significantly due to an increase in the survival period for breast cancer, colorectal cancer, bronchopulmonary cancer, bladder cancer, melanoma, leukemia, and non-Hodgkin’s lymphoma. Among patients receiving chemotherapeutic treatment, 30-40% will suffer from polyneuropathy of varying severity. Some patients will not be able to continue the main treatment due to the development of dose-limiting neurological complications. The problem of study of chemotherapy-induced polyneuropathy concerns all its aspects, including epidemiology, the phenomenology of standardization of approaches to prevention, effective treatment and specific approaches to rehabilitation, taking into account the main diagnosis. In the absence of neuroprotective therapy, particular attention should be paid to the timely diagnosis and adequate prevention of the development of polyneuropathy taking into account the individual patient characteristics. In the context of the accumulation of data on the safety of the use of certain physical and physiotherapeutic methods, the development of rehabilitation strategies, along with rational psychotherapy, is necessary to overcome the complications of life-saving treatment of the oncological process.

The article presents a clinical case of successful complex treatment of a patient with HER2-negative disseminated gastric cancer with the presence of disseminated tumor cells (DTCs) in the bone marrow. The life expectancy of the patient from the start of treatment is 32+ months. The mentioned observation demonstrates: 1) the possibility of performing surgical treatment in selected patients with disseminated gastric cancer; 2) the need to re-determine HER2-status in metastases of gastric cancer due to the possibility of its change in the treatment process; 3) high efficacy of trastuzumab in HER2-positive stomach cancer; and 4) prognostic role of the presence of DTCs in the bone marrow and their dynamics during the treatment.