Vol 26, No 12 (2019)

Stomach cancer (SC) is one of the oncological diseases characterized by an extremely unfavorable prognosis. The disease is accompanied by a number of serious complications, including various disorders of metabolic processes, which undoubtedly leads to a deterioration of the general somatic status of patient, adversely affect the tolerability of specialized treatment, quality of life and longevity. Correction and/ or maintenance of nutritional status (NS) in cancer patients is an important factor, which plays a significant role in increasing the effectiveness of antitumor treatment. The evaluation of NS and the programs for correcting its disorders in oncological patients are associated with a number of unresolved issues: in many countries, the protocols for diagnosing and correcting nutritional deficiencies have significant differences; possession of skills and methods for evaluating NS in patients are not mandatory for oncologists; not all of the standards for assessing NS are available for use in routine clinical ractice; there are some difficulties in the implementation of programs for providing formulas necessary for the correction of malnutrition in cancer patients not only in outpatient settings, but often also in the hospital.

Background. BRCA1-associated ovarian cancer (OC) demonstrates a high sensitivity to DNA-damaging agents, but the most effective drug regimen for disease recurrence has not been determined. Objective. Evaluation of the efficacy of platinum-containing chemotherapy with mitomycin for the recurrence of OC with BRCA1 gene mutation. Methods. The study included 12 patients with relapse of a BRCA-associated OC who were treated in the N.N. Petrov NMRCO of the Ministry of Health of the Russian Federation from 2015 to 2017. Mitomycin (10 mg/m2) and cisplatin (100 mg/m2) or carboplatin (AUC6) preparations were administered intravenously every 3-4 weeks. Results. Complete clinical regression was recorded in 5/12 (41.67%) patients, partial regression - in 5/12 (41.67%), stabilization of the disease - in 2/12 (16.67%). A decrease in Ca-125 level was observed in all patients during treatment. Median progression-free survival was 11.5 months. Grade 3-4 toxicity, according to NCI CTC criteria, was detected in 4/12 (33.33%) patients. Conclusion The results of the trial can serve as a basis for planning a randomized study on the efficacy and toxicity of combined platinum-containing chemotherapy with mitomycin for relapses of BRCA1-associated OC.

Background. Cervical cancer is the most common malignant tumor of the female reproductive system in the reproductive period. The age of patients at the initial detection of cervical cancer is becoming more and more young. The search for the optimal modality of neoadjuvant treatment of patients with locally advanced cervical cancer is a promising area of research. Systemic chemotherapy as a stage of neoadjuvant treatment of patients with locally advanced cervical cancer is currently considered as the therapy of choice, being a competitive alternative to chemoradiotherapy. Objective. Evaluation of the results of using neoadjuvant dose-intensive platinum-containing chemotherapy in patients with FIGOIB2 -IIB locally advanced cervical cancer. Methods. The efficacy and toxicity of three cycles of intravenous dose-intensive neoadjuvant chemotherapy according to the AP scheme (cisplatin 75 mg/m2, doxorubicin 35 mg/m2) and TP scheme (cisplatin 60 mg/m2 and paclitaxel at a dosage of 60 mg/m2) were studied in the patients participating in the study. Results. The study included 105 primary patients (75 in the AP group and 30 in the TP group) at the age of27-68 years (mean age, 44 years) with verified cervical cancer (cT1B2Nx, 0M0 - cT2BNx, 0M0). In the AP group, surgical treatment was performed in 88% (66 patients), in the TP group - in 80% (24 patients). Disease progression was detected in 8.0% (6 cases) in the AP group and in 3.3% (1 case) in the TP group. In 4 patients (2.8%) in the AP group, a relapse of the disease was diagnosed, and no relapses were recorded in the TP group. Dose-dense chemotherapy regimen did not lead to significant complications at the medicinal and surgical stages. Conclusion. Analysis of the research results showed that dose-intensive neoadjuvant chemotherapy is an effective method with an objective response rate of 84% (63 cases) in the AP group and 56.7% in the TP group (17 cases). The pathological tumor response in the AP group was 89.4% (66 cases), and complete tumor regression (CTR) was confirmed in 10.6% (7 cases); in the TP group - 79.2% (24 cases), in 16,7% (4 cases) tumor regression was confirmed by a complete pathologic response. Dose-intensive neoadjuvant chemotherapy may be considered as an alternative to the standard treatment for locally advanced cervical cancer, but requires further research due to the small number of observations.

Background. Stomach cancer (SC) occupies a leading position in the structure of oncological morbidity and mortality. Violation of the regulation of the processes of lipid peroxidation (LP) - antioxidant defence (AOD) causes a decrease in the body’s resistance and contributes to the development and progression of diseases. Objective. Evaluation of the patterns of LP- AOD in SC. Methods. The parameters of the immune system and LP-AOD in chronic atrophic gastritis (CAG) and SC were evaluated for one year after the detection of pathology. The study included 50 patients with CAG and 50 patients with SC. The control group consisted of 85 healthy donors. The study material was venous blood, which was taken from patients upon admission before the start of the pathogenetic treatment. The study was conducted from June to September 2019, venous blood was taken from patients one time. LP-AOD indicators were determined by spectrophotometric methods. For testing statistical hypotheses, the critical level of significance was taken equal to p<0.05. Results. Compared to the control group, patients with SC has increased blood plasma malondialdehyde, catalase, glutathione-S-transferase, glutathione peroxidase, and ceruloplasmin levels, and prooxidant processes prevailed over antioxidant ones. The highest values of indicators were detected at stage III disease. Compared to patients with CAG, patients with SC had more pronounced increase in the malondialdehyde levels. A decrease in the activity of the superoxide dismutase enzyme indicates inhibition of the leading enzyme in the enzymatic link of AOD. An increase in ceruloplasmin protein proves its compensatory activation in oxidative stress. Conclusion. High malondialdehyde and ceruloplasmin levels, low activity of superoxide dismutase are pathogenetic mechanisms in the transformation of CAG into SC.

The analysis of the results of studies on the efficacy of ribocyclib as the first-line treatment in pre- and perimenopausal patients with HR+ HER2-advanced breast cancer (BC) was carried out. It was concluded that the combination therapy with ribocyclic and aromatase inhibitors is highly effective for pre- and perimenopausal BC patients against the background of ovarian suppression. Available data allow to conclude that this combination helps not only to delay the onset of further progression, but also to increase the life expectancy of patients while maintaining its quality, regardless of the location of metastases.

On March 23, 2019, the 16th St. Gallen International Breast Cancer Conference (Vienna) has examined the contraversial issues on the clinical approaches to the treatment of breast cancer in order to reach agreement among the 52 most influential world leaders in this field. The results of randomized trials were discussed to narrow or, conversely, expand the standards of local and systemic treatment of breast cancer. The use of trastuzumab in combination with pertuzumab in combination with neoadjuvant and adjuvant chemotherapy has significantly improved the results of treatment of HER2-positive breast cancer. An expert panel has recommended therapy with trastuzumab emtansine (T-DM1) for the treatment of residual invasive HER2-positive breast cancer. Patients with triple negative breast cancer with a pathological invasive residual disease previously treated with neoadjuvant systemic therapy with anthracyclines or taxane-containing chemotherapy regimens may be offered adjuvant therapy with capecitabine (6 to 8 cycles). Most (80%) experts have recommended neoadjuvant endocrine therapy for postmenopausal women with luminal A breast cancer stage II-III.

Prostate cancer (PC) is an actual disease and a frequent oncological pathology in men. The detection rate of locally advanced and lymphogenic disseminated forms of prostate cancer in Russia remains high. Therapeutic tactics in PC patients is determined by the prevalence of the tumor process, the stage of the disease, and belonging to a risk group. In patients with a high and extremely high risk of disease progression, a multimodal approach can be considered. To date, there are many studies on neoadjuvant therapy, and there are also a number of works on adjuvant drug treatment. Neoadjuvant chemohormonotherapy at the first stage as part of a conditionally combined treatment demonstrates the advantage of this approach. Regarding the use of adjuvant chemotherapy, the data are contradictory. Further research is required to understand the appropriateness of this treatment approach. In the near future, probably, a multimodal approach to the treatment of patients of this cohort will be included in the standards of antitumor therapy.

Background. This article presents a clinical case describing the own authors’ experience of the effective use of pembrolizumab in a patient with non-small cell lung cancer (NSCLC) with metastatic brain lesion. Description of the clinical case. A patient with peripheral cancer of the right lung T3N3M1 (stage IV), metastasis to the left parietal region, the condition after removal of metastasis in the left parietal region and the treatment with pembrolizumab. The size of the tumor foci according to computed tomography of the chest before treatment: the tumor node size at the S1/S2 border was 20x20 mm, aortopulmonary lymph node - 17x15 mm, bronchopulmonary lymph node - 15x15 mm. According to the results of the control examination at 12th week therapy with pembrolizumab, partial regression of the tumor was achieved. According to this CT scan of the chest: tumor node size at the border S1/S2 - 10x9 mm, aortopulmonary lymph node - 10x5 mm, bronchopulmonary lymph node - 10x12 mm. At the time of the description of the clinical case (October 2019), therapy with pembrolizumab is continued, partial regression remains. During therapy, adverse reactions were not observed. Conclusion. The results allow to conclude that therapy with pembrolizumab is the effective and safe options for the treatment of patients with NSCLC and brain metastasis.

Background. Platinum-containing combinations of drugs remain the drug of choice both for the 1st-line therapy and the therapy of platinum-sensitive relapses for patients with ovarian cancer. In some cases, it is necessary to select alternative approaches to reduce the effects of toxicity, allergic reactions, as well as in the case of relapses that develop in the interval without treatment for less than 1 year. Description of the clinical case. A patient with a diagnosis of T3CN0M0, grade III, was admitted with complaints of ascites, an increase in the volume of the abdomen, weakness, shortness of breath during physical exertion. An additional examination revealed cystic and solid components in both ovaries, metastases along the peritoneum, forming confluent dissemination along the peritoneum of the pelvis, with extension to the greater omentum. Due to the stage of the disease and the moderately grave condition of the patient, it was decided to start with neoadjuvant chemotherapy (CT) according to the scheme: paclitaxel + carboplatin with a partial effect according to ultrasound examination and a decrease in the CA marker level. Extirpation of the uterus with appendages, removal of a large omentum in a non-optimal volume was performed. Due to the treatment, it was possible to increase the time to the third chemotherapy by 20 months, which allowed the patient to recover after the previous taxane-platinum therapy. A further strategy for choosing CT taking into account factors such as residual polyneuropathy stage 1, the presence of a BRCA1 mutation, the patient’s desire to use drugs that do not cause alopecia, is described. Subsequently, the patient received olaparib in a maintenance regimen for 16 months; good tolerability of treatment was noted. Conclusion. The case described indicates the importance of competent sequential alternation of treatment of patients with ovarian cancer, which allows achieving significant stabilization of the patients’ condition, regression of the oncological process, without deterioration in the quality of their life.