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№ 7 (2018)
- Жылы: 2018
- Мақалалар: 20
- URL: https://journals.eco-vector.com/2073-4034/issue/view/7074
Articles
VSTUPITEL'NOE SLOVO KURATORA
Pharmateca. 2018;(7):4-4
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NEWS OF MEDICINE
Pharmateca. 2018;(7):5-7
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EDINAYa INFORMATsIONNAYa SISTEMA MONITORINGA KAK INSTRUMENT SNIZhENIYa ONKOLOGIChESKOY ZABOLEVAEMOSTI I SMERTNOSTI
Pharmateca. 2018;(7):8-9
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PRINCIPLES OF MODERN IMMUNOTHERAPY
Аннотация
Currently, immunotherapy is the most promising method of treating malignant tumors. This review considers the main principles of its action: universality, inertiA., dualism, and the complexity of directed action. The original classification of immunotherapy methods according to the mechanism of their action is presented, which allows better understanding the features of individual methods of treatment. Methods for evaluating the effectiveness of immunotherapeutic agents and immuno-mediated adverse events are discussed in detail. Understanding and using the principles of immunotherapy discussed in the article will allow to optimize the use of immunooncological drugs and to maximally protect the patient from possible adverse events associated with their use.
Pharmateca. 2018;(7):10-18
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GONADOTROPIN-RELEASING HORMONE AGONISTS-INDUCED OVARIAN SUPPRESSION IN EARLY BREAST CANCER
Аннотация
The evolution of endocrine therapy for breast cancer (BC) accounts for more than 120 years (ovariectomy, use of testosterone, tamoxifen). in 1982, the use of gonadotropin-releasing hormone agonists (GnRH agonists) instead of ovariectomy in women with metastatic breast cancer and preserved menstrual function was first described. In 2017, it was proved (according to the combined analysis of SOFT/TEXT trials) that premenopausal patients with early hormone-positive BC with a persistent premenopausal estrogen levels after adjuvant chemotherapy (CT) and metastatic lesion of ≥4 lymph nodes and/or G3 malignancy degree, the addition of ovarian suppression to adjuvant hormone therapy reduces the risk of death, recurrence and contralateral BC compared with monotherapy with tamoxifen. For ovarian suppression, GnRH agonist triptorelin was used in in most patients in TEXT/SOFT trials. It should be emphasized that after completion of drug ovarian suppression in young women, the initial quality of life is restored, the menstrual cycle is normalized, and the symptoms of GnRH agonist-induced menopause disappear. Advantages of the use of GnRH agonists include not only restoration of fertility in young patients, but also an improvement of its indices, in contrast to patients who have not yet received GnRH agonists.
Pharmateca. 2018;(7):19-25
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TREATMENT OF RELAPSES AND RESISTANT FORMS OF HODGKIN'S LYMPHOMA
Аннотация
High-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDCT с autoHSCT) is a modern standard for the treatment of primary refractory forms and the first relapses of Hodgkin’s lymphoma (HL). HDCT with autoHSCT is effective for 50-60% of patients with the first late chemosensitive relapse of HL. Chemoresistance is defined as a predictive factor for an unfavorable prognosis. Allogeneic hematopoietic stem cell transplantations (alloHSCT) can be performed in case of recurrence of HL after HDCT with autoHSCT with preserved chemosensitivity, and are preferable for young patients in prospective clinical trials. Among the monoclonal antibodies studied, the greatest therapeutic activity was detected for brentuximab vedotin. Brentuximab vedotin is registered for the treatment of patients with classic HL after failure (progression or early relapse) of HDCT with autoHSCT or patients who are not candidates for high-dose CT., if two or more HT lines fail, for consolidation after HDCT with autoHSCT in HL patients with a high risk for recurrence or progression. The high activity of PD-1/PD-L1 checkpoint inhibitors, activating antitumor immunity (nivolumab, pembolizumab) was noted for patients with recurrence of HL. Promising areas of therapy for HL are associated with further study of new targets of tumor cells and their signaling pathways.
Pharmateca. 2018;(7):26-32
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INTERCELLULAR ADHESION MOLECULES (E-CADHERIN, ß-CATENIN) IN COLORECTAL CANCER: CHARACTERISTICS; ROLE IN MECHANISMS OF TUMOR INVASION, METASTASIS AND REGULATION OF TUMOR PROGRESSION; INFLUENCE ON PROGNOSIS (LITERATURE REVIEW)
Аннотация
This review of the literature is devoted to the clinical significance of intercellular adhesion molecules (e-cadherin, ß-catenin) in colorectal cancer (CRC). Their detailed characteristic is given, the role in mechanisms of tumor invasion, metastasis and regulation of tumor progression is considered, their prognostic value is estimated. Intercellular adhesion molecules play an important role in the development of the invasive-metastatic potential of CRC. E-cadherin is a protein that belongs to the homologous transmembrane Ca2+-dependent glycoprotein family and provides intercellular adhesion in epithelial tissues. Beta-catenin is an intercellular multifunctional protein interacting directly with cadherins and indirectly with the actin cytoskeleton of cells. The clinical significance of the cadherin-catenin system of intercellular interactions in CRC is associated with an increase in the invasive-metastatic potential of tumors with abnormal expression of any of the components of this complex. This is due to the prognostic significance of different models of expression of the markers in colon adenocarcinomas and their metastases. In recent years, more and more data on the disturbances in the normal expression of intercellular adhesion molecules in CRC have accumulated, but their effect on the disease prognosis has not been adequately studied
Pharmateca. 2018;(7):33-39
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EXPERIENCE OF TREATMENT with ANTI-PD-1: FROM WORLD STANDARDS TO REAL CLINICAL PRACTICE (CLINICAL OBSERVATION)
Аннотация
Background. Every fourth patient with a newly diagnosed skin melanoma has metastatic or locally advanced inoperable stage of this tumor, which determines an unfavorable prognosis of the course of the disease. This article presents the experience of SPBSBHCI CCOD in the treatment of metastatic melanoma in adult patients with an evaluation of the effectiveness of nivolumab, the PD-1 inhibitor. Methods. Twelve patients with disseminated skin melanoma who received treatment at the St. Petersburg City Clinical Oncological Dispensary from 2002 to the present day were under observation. The time from the moment of diagnosing the IV stage of the disease to the initiation of nivolumab therapy ranged from 4 to 31 months. Results. By the present moment of time (May 2018) only 3 out of 12 patients (25%) have recorded progression of the process. At the stage of this analysis, the mean time without progression is 25.75±3.13 months (95% CI, 19.61-31.89), 10 out of 12 patients (83.33%) are alive. Now, the average overall survival rate is 28.27±2.49 months (95% CI, 23.30-33.03). A clinical example of female patient with metastatic melanomA., including brain lesions, treated with nivolumab is presented. The overall survival of the patient from the moment of diagnosing the 4th stage of the disease was 3.5 years, of which, 2.5 years with nivolumab therapy. At the momenT., the patient’s condition is stable clinically and according to the results of objective examination methods. Conclusion. The provided data confirm the high efficiency of the use of immune-oncological drugs, such as the PD-1 blocker nivolumab, in the treatment of metastatic melanoma. It is important to note that the use of nivolumab in addition to achieving an objective response allows to keep the effect achieved for a long time.
Pharmateca. 2018;(7):40-44
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VNIMANIYu AVTOROV!
Pharmateca. 2018;(7):44-44
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CYCLIN-DEPENDENT KINASE INHIBITORS - NEW THERAPEUTIC OPTION FOR PATIENTS WITH HORMONE-DEPENDENT HER2-NEGATIVE BREAST CANCER: CLINICAL EXPERIENCE
Аннотация
Background. In the vast majority of patients with suspected metastasis of breast cancer (BC), the luminal type of tumor - hormone sensitive (HR+) with no significant expression of the epidermal growth factor receptor (HER2-) is diagnosed at presentation. The sequential application of various variants of endocrine therapy provides a significant increase in the overall and disease-free survival in such patients, while maintaining a sufficiently high quality of life. Over time, however, the disease progresses due to the development of resistance to the treatment. The appearance of drugs with direct effect on the cell cycle regulators has given rise to a new stage in the treatment of patients with advanced HR+ HER2-BC. Ribociclib (Kisqaly, LEE001) is an oral, highly selective cyclin-dependent kinase inhibitor (CDK4/6), which stops the progression of the cell cycle at the G1/S phase. Description of the clinical case. Postmenopausal woman with BC was diagnosed with generalization of the process with the presence of bone metastases and visceral lesions 3 years after the end of adjuvant therapy with letrozole. In this clinical experience, we confirmed the rapid response to ribociclib therapy in combination with letrozole. A partial response was recorded after 3 months (tumor reduction by 31%) with further reduction of the tumor by 42% after 6 month of treatment. Clinically significant improvement in the quality of life and relief of pain in the bones was noted already at 8th week of therapy. The tolerability of therapy was satisfactory. Conclusion. Oral high selective CDK4/6 inhibitor ribociclib is an excellent therapeutic option for patients with hormone-dependent HER2-negative advanced breast cancer in real clinical practice.
Pharmateca. 2018;(7):45-49
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MODERN APPROACHES TO THE CHOICE OF THERAPY OF LOCALLY ADVANCED AND RECURRENT/ METASTATIC HEAD AND NECK SQUAMOUS CELL CARCINOMA: WHAT IS THE BASIS FOR THE CHOICE OF THERAPY IN CLINICAL PRACTICE?
Аннотация
This article presents the main approaches to the choice of treatment tactics for locally advanced and recurrent/metastatic head and neck squamous cell carcinoma. The potentials for the use of the targeted drug - epidermal growth factor inhibitor, cetuximab, in clinical practice are discussed.
Pharmateca. 2018;(7):50-56
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SYSTEMIC THERAPY FOR ADVANCED OVARIAN CANCER IN BRCA1 MUTATION CARRIERS -NEW THERAPEUTIC APPROACHES: RESULTS OF A PROSPECTIVE NON-RANDOMIZED MULTI-CENTER STUDY
Аннотация
Background. BRCA1-associated tumors demonstrate a unique sensitivity to platinum-based drugs, but the overall effectiveness of treatment remains limited. Despite the pronounced regression of the tumor, standard therapy with platinum-based drugs rarely leads to complete pathomorphological response. Objective: to evaluate the clinical efficacy, safety, frequency of complete pathomorphological responses of the new scheme of neoadjuvant therapy for patients with BRCA1-associated ovarian cancer (OC) using combination of mitomycin C and cisplatin. Methods. The study included 217 patients with OC who were treated during 2015-2017. Three oncological centers participated in the study. All patients with OC were subjected to polymerase chain reaction testing for mutations: BRCA1 c.5266dupC [5382insC], c.4034delA [4153delA], c.181T>G [C61G], c.68_69delAG [185delAG] prior to initiation of treatment. Of the 217 patients, 21 (10%) mutation carriers were identified; 12 (57%) patients received a combination of mitomycin C 10 mg/m2 and cisplatin 100 mg/m2 every 4 weeks in the neoadjuvant regimen. The results of a prospective study of the NACT of BRCAI-associated OC using combination of mitomycin C and cisplatin were compared to the retrospective data (n=62) of NACT of BRCA1-associated OC treated with standard neoadjuvant therapy. Results. All 12 OC patients demonstrated an objective clinical response to treatment. Complete cytoreductive surgery was achieved in all patients included in the study. The pathological evaluation of tissues removed during surgery established a complete pathomorphological response (pCR) in 2 (17%) of 12 cases. In addition, one patient had a complete pathomorphological r esponse in the ovaries and an almost complete response in the omentum. In general, 5 (42%) patients had a pronounced pathomorphological response (score 3, according to [12]). Conclusion. The combination of platinum doublets in combination with other drugs, whose activity is not limited to cells with BRCA1 deficiency, can be a promising chemotherapeutic approach. The use of platinum-taxane regimens, which are the current «gold» standard, apparently does not exceed other regimens in effectiveness for BRCA1 gene mutations carriers.
Pharmateca. 2018;(7):57-63
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EXPERIENCE OF PERSONALIZED APPOINTMENT OF NEOADJUVANT CHEMOTHERAPY FOR PATIENT WITH BREAST CANCER: A PROSPECTIVE STUDY
Аннотация
Background. One of the most significant reasons for the low effectiveness of neoadjuvant chemotherapy (NACT) of breast cancer (BC) is the lack of a personalized approach to the choice of conventional chemotherapy regimens. Objective. Development and prospective clinical testing of the algorithm for personalized administration of NACT for BC patients using molecular-genetic tumor markers. Methods. All patients participating in the study were divided into two groups. The first (study) group included 37 patients with breast cancer. In these patients, before the start of the treatmenT., DNA and RNA were isolated from the tumor tissue from the biopsy; representation and expression levels of ABC transporter genes and the BRCA1, Top2A., TYMS and TUBB3 sensitivity genes were determined using the CytoScan HD Array microarray (Affymetrix, USA) and quantitative PCR. Based on the results of molecular genetic analysis, the treatment tactics were personalized for patients. The second group (historical control) included 71 patients with luminal B HER2(-) breast cancer, who received NACT without taking into account the molecular genetic characteristics of the tumor. Results. The study included 108 patients with luminal HER2(-) - BC. A two-stage algorithm for the personalized assignment of NACT was developed. At the first stage, the reasonability of preoperative treatment was determined based on the markers of the ABC genes and regions 18p11.1-32; 11q21- 25 and 1q21.3-44 representation; and in the second stage, in the case of a positive results, a personalized choice of the regimen was made based on the markers of the representation and the expression of sensitivity genes. Personalized NACT was assigned to 26 of 37 patients; 11 patients started treatment with surgery, as they had no indication for chemotherapy in the preoperative period. The immediate efficacy of NACT in the study group was 88.5% (23 of 26), stabilization was observed in 5 (11.5%) patients. In the control grouР., the immediate efficacy of NACT was 53.5% (38 of 71), stabilization and progression were observed in 46.5% (33 of 71) patients. Differences between the groups were statistically significant (p=0.002). Conclusion. New informative predictive criteria have been determined; their use has significantly increased the efficacy of NACT in comparison with standard approaches to prescribing preoperative treatment.
Pharmateca. 2018;(7):64-70
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ANALYSIS OF INFLUENCE ON THE BUDGET OF THE RUSSIAN FEDERATION OF THE USE OF ORAL VINORELBINE FOR THE TREATMENT OF METASTATIC BREAST CANCER
Аннотация
Background. Breast cancer (BC) is a serious medical and social problem for society. Treatment of metastatic breast cancer (MBC) involves the appointment of several lines of chemotherapy. Clinical recommendations contain a lot of options for choosing a treatment regimen. Existing limited resources, however, do not always allow using the most effective regimen for treatment of MBC. Objective. Evaluation of the effect of the oral vinorelbine (capsules) on the budget of the Russian Federation in comparison with the most frequently used and comparable in clinical effectiveness parenteral pharmacotherapy regimens for advanced MBC in patients previously treated with anthracyclines and taxanes. Methods. In order to select the optimal therapy for advanced BC, a cost analysis and «budget impact» analysis for oral vinorelbine were performed as compared with intravenous eribulin and ixabepilone. Results. The cost analysis and «budget impact» analysis have shown a positive economic effect from the use of oral vinorelbine as an alternative therapy for advanced BC. As a result of the «budget impact» analysis, suspected budget savings with the replacement of eribulin and ixabepilone on oral vinorelbine is 860,870.2 rubles per patient in a year in comparison with eribulin and 137,615.8 rubles for ixabepilone. Conclusion. The use of oral vinorelbine in the 2nd-3rd line therapy of advanced MBC is reasonable from the position of the healthcare economics.
Pharmateca. 2018;(7):71-75
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DENOSUMAB IN TREATMENT OF BONE METASTASES FROM SOLID TUMORS
Аннотация
Background. Denosumab is the first osteomodifier of the new class - RANK ligand blocker; the mechanism of action of this class differs from bisphosphonates, and according to the results of clinical studies their effectiveness in bone metastases exceeds bisphosphonates. Objective: clinical evaluation of the effectiveness and safety of the use of denosumab. Цель исследования: клиническая оценка эффективности и безопасности применения деносумаба. Methods. The data of 28 patients with bone metastases from solid tumors treated with denosumab were analyzed. The drug was administered subcutaneously at a dose of 120 mg once every 28 days. As the 1st line therapy, 6 (21.5%) patients received denosumab (21.5%); 22 (78.5%) patients were pretreated with bisphosphonates and had bisphosphonate resistance; 7 (24.9%) patients received radiation therapy and/or treatment with radioactive isotopes before the initiation of therapy with denosumab. Time to the first bone event (pathological fracture, radiation therapy for bone for any reasons, surgical intervention for bone metastases, spinal cord compression, hypercalcemia), the incidence of bone events, the dynamics of pain syndrome (according to the MS scale) were assessed. Results. The duration of therapy with denosumab was 3 to 24 months, the median was 16.8±2.3 months, the time to the first bone event against the background of therapy with denosumab was 8 to 18 months, the median was not achieved. Bone events were observed in 7 (25%) patients: pathological fracture in 2 (7.1%), surgical intervention in 1 (3.6%), spinal cord compression in 2 (7.1%), hypercalcemia - in 2 (7.1%) patients. The pain syndrome decreased by 50% at 6th month of therapy, and by by 77% at 12th month of therapy. Conclusion. Thus, denosumab showed high efficacy without clinically significant manifestations of toxicity in long-term use in patients with bone metastases from solid tumors.
Pharmateca. 2018;(7):76-81
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PROSPECTIVE II PHASE STUDY ON THE EVALUATION OF THE EFFICACY OF MONOTHERAPY WITH CETUXIMAB AS THE FIRST-LINE TREATMENT FOR PATIENTS WITH METASTATIC COLORECTAL CANCER WITH WILD-TYPE KRAS, NRAS, AND BRAF GENES
Аннотация
Background. The use of a consistent approach to cytostatic therapy in the form of monotherapy as a first-line treatment for 20-25% of patients with metastatic colorectal cancer (mCRC) makes it possible to achieve a similar survival rate, as with polychemotherapy. The list of standard regimens of drug therapy for mCRC for various treatment lines includes monotherapy with fluoropyrimidines and cetuximab. The efficacy of cetuximab and panitumumab is indicated in patients with tumors that do not have KRas, NRas, and BRAF gene mutations. Currently, there is no evidence of the effectiveness of monotherapy with cetuximab as the first-line of therapy for patients selected by molecular factors. Methods. A prospective II phase study of monotherapy with cetuximab in patients with unresectable mCRC without KRas, NRas and BRAF gene mutations and without symptomatic manifestations of the tumor was conducted. After molecular analysis, the study included patients who had not previously received drug therapy for a advanced tumor and without mutation changes in any of the listed tumor genes. Patients received monotherapy with cetuximab in standard mode: loading dose of400 mg/m2, then - 250 mg/m2 once a week intravenously until progression or intolerable toxicity. The primary endpoint of the study was a 6-month progressionfree survival (PFS). For the independent validation of the results, retrospective data on the efficacy of standard monochemotherapy with fluoropyrimidines in a similar population of patients with wild type KRas, NRas and BRAF genes in tumor tissue were used. Results. Samples of tumor tissue of 73 patients were analyzed for mutations in the KRas, NRas and BRAF genes. In 33 of 73 tumors, no mutations were found in all 3 genes. Cetuximab therapy was initiated in 21 of 33 patients. Data for assessing the effect of treatment and survival were obtained for 19 patients. The median duration of cetuximab therapy was 3.9 months (95% CI, 2.18-5.69). Six months after the start of therapy, 11 (57.9%) of 19 patients had no progression of the disease. Median PFS was 6.4 months (95% CI, 4.31-8.39). In 2 of 19 patients partial regress of tumor foci was noted, complete responses to therapy were not noted. Control of the disease (partial regression or stabilization) was achieved in 68% of patients. The median overall survival was 14.9 months (95% CI, 13.1-16.7). Subgroup analysis showed no significant correlations of PFS or disease control with any of the clinical characteristics of patients. Compared with retrospective data on the efficacy of monotherapy with fluoropyrimidines as the first-line therapy in 19 patients with wild type KRas, NRas and BRAF genes in tumor tissue, PFS and overall survival of patients treated with cetuximab did not significantly differ in this study. Conclusion. This study showed the efficacy of monotherapy with cetuximab as the 1st-line therapy in patients with unresectable mCRR selected according to known molecular factors and not requiring urgent aggressive chemotherapy. Further research on the factors for the selection of patients with colorectal cancer to increase the effectiveness of therapy with epidermal growth factor receptor antibodies in patients of the selected subgroup is needed.
Pharmateca. 2018;(7):82-88
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PROGNOSTIC SIGNIFICANCE OF THE E-CADHERIN EXPRESSION LEVEL IN PRIMARY TUMORS OF THE COLON IN PATIENTS WITH METASTATIC COLORECTAL CANCER, RECEIVED NEW CHEMOTHERAPY REGIMEN BASED ON TRIPLE COMBINATION: IRINOTECAN+OXALIPLATIN+CONTINUOUS-INFUSION 5-FLUOROURACIL AS A FIRST-LINE TREATMENT
Аннотация
Background. The use of clinical and morphological characteristics is not enough to predict the prognosis of the disease in patients with metastatic colorectal cancer (mCRC). Aggressiveness of the tumor process can be significantly different in patients with similar clinical and morphological signs of the disease. It is assumed that these differences are due to the molecular biological features of the tumor and are additional factors predicting the survival of patients. Objective. Evaluation of the prognostic significance of the e-cadherin expression level in the primary tumors of the colon in mCRC patients who received a new chemotherapy regimen (CT) based on the triple combination: irin otecan+oxaliplatin+continuous-infusion 5-fluorouracil as 1st line treatment. Methods. The study included mCRC patients who received a new CT regimen based on the triple combination: irinotecan+oxaliplatin+continuous-infusion 5-fluorouracil as the first-line treatment. The evaluation of immediate and long-term results of treatment was carried out. In the tissue of the primary tumor of the colon (biopsic or surgical material) obtained before the start of the first-line therapy, the expression level of molecular-biological marker e-cadherin was estimated using immunohistochemical method. The obtained data on the e-cadherin expression were compared with immediate and long-term results of treatment. Results. In 18 of the 20 patients included in the study the immunohistochemical method was used to analyze the expression of e-cadherin in the tissue of the primary colon tumor, the Association of this marker with the prognosis of the disease, was analyzed. When analyzing the effect of e-cadherin expression in the tumor on the time-to-progression (TTP) in mCRC patients against the background of the first-line CT using a triple combination, it was found that high expression of this marker is a favorable factor predicting an increase in the TTP: median TTP in patients with overexpression e-cadherin of the tumor was significantly higher than in patients with low/no e-cadherin expression - 12.1±3.23 vs. 7.8 months. When analyzing the effect of e-cadherin expression in the tumor on the overall survival (OS) in mCRC patients, a statistically significant increase in OS was observed in the group of patients with overexpression e-cadherin (with median follow-up period 17.3 months, median OS was not achieved [75% of patients are alive], mean OS - 27, 85±3,23 months) compared with the group of patients with low/no e-cadherin expression of the tumor (median OS - 9.0 months). Conclusion. E-cadherin overexpression in the primary tumor tissue is a factor for favorable prognosis of TTP and OS in mCRC patients who received a triple combination CT as the first- line treatment. This marker can already be used today in real clinical practice for individual prognosis of the disease course in mCRC patients.
Pharmateca. 2018;(7):89-96
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POSTOPERATIVE ADYNAMIC ILEUS: PREVENTION AND TREATMENT
Аннотация
In modern health care, the problem of correction of motor-evacuation disorders of the digestive tracT., developing in the postoperative period, is extremely topical and relevant. Despite the possibility of developing enteroparesis after any surgical intervention, most often the latter results from an increase in the extent of the operation, multivisceral resections with multiple anastomoses, and extended variants of lymphadenectomy during oncosurgical interventions. It should be recognized that to date there is no universally recognized, adequate scheme for the prevention and treatment of postoperative paresis of the gastrointestinal tracT., and further in-depth studies with the development of action algorithms and clinical recommendations are required.
Pharmateca. 2018;(7):97-101
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RAMUCIRUMAB IN A COMBINATION WITH IRINOTECAN-BASED TWO-COMPONENT THERAPY REGIMEN AS THE SECOND LINE FOR THE TREATMENT OF DISSEMINATED GASTRIC CANCER. CASE REPORT
Аннотация
Background. Gastric cancer is one of the most widespread malignant tumors in the world, the treatment of which is receiving increasing attention every year. Description of the clinical case. The article presents a clinical case of successful use of ramucirumab in combination with FOLFIRI as the 2nd line of therapy for a patient with disseminated gastric adenocarcinoma.
Pharmateca. 2018;(7):102-104
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SUCCESSFUL TREATMENT OF THE COMPLICATED FORM OF NON-HODGKIN'S LYMPHOMA OF THE CECUM. CASE REPORT
Аннотация
Background. Non-Hodgkin’s lymphomas (NHL) as oncopathology have long been known to oncologists. Good results have been achieved in the complicated course of NHL of the digestive tracT., but a lethal outcome is still often recorded because NHL of the digestive tract is diagnosed almost at the stage of development of complications. Description of the clinical case. A clinical case of NHL in a patient of 34 years is presented. Based on clinical, instrumental, laboratory, intraoperative and morphological datA., the diagnosis of «non-Hodgkin’s lymphoma of the cecum» was determined. Complications: hollow viscus perforation, diffuse fecal purulent peritonitis. Despite the presence of such a terrible, up to a fatal complication, as hollow viscus perforation with secondary diffuse fecal purulent peritonitis in the patienT., the life-saving medicinal treatment according to the R CHOP-21 scheme was carried out. After four courses of the 1st-line chemotherapy with complete regression of the tumor process, patient with the formed enteric fistula was hospitalized in the surgical thoracoabdominal unit where an combined-expanded right-sided hemicolectomy with extensive enterectomy with the formation of an end-to-side ileotransversostomy was performed. Currently, the patient is alive, and signs of recurrence and disease progression were not recorded during follow-up examination. Conclusion. The described clinical case proves that treatment of a complicated course of NHL of the digestive tract is not futile; complication is not a sign of neglect of the oncological process.
Pharmateca. 2018;(7):105-111
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