Nº 17 (2013)

The present review is dedicated to the effectiveness of modern therapy of bone metastases. Bisphosphonates, zoledronic acid and denosumab are compared. Results of clinical studies in patients with breast cancer, lung cancer and prostate cancer are presented. A number of large studies that confirmed efficacy of denosumab in many malignant tumors and its advantage over zoledronic acid in the prevention of bone complications and improving the quality of life of patients with breast cancer, lung cancer and prostate cancer are described.

Therapeutic approach in nasopharyngeal carcinoma (NPC) depends on the extent of the process. Radiation therapy is the main method for treatment of localized forms of NPC. For the treatment of stage I, radiation therapy is used alone; in stage II, optimal treatment option includes simultaneous chemoradiation therapy with the addition of cisplatin. In locally advanced cases (III, IV A-, B-stages), radiation/concurrent chemoradiation therapy is limited by involvement or close proximity of vital structures with low tolerance to radiotherapy. In these situations, the application of induction chemotherapy (IHT) at 1st phase of treatment can be considered as optimal treatment approach. We have developed two IHT regimens (anthracycline - containing an no anthracycline - containing) and evaluated their efficacy and toxicity.

The article describes the first experience of testing methodology of chronic intrathecal therapy with implantable programmable pumps in Russia. The study was aimed to development of method for the therapy of severe chronic pain syndrome (CPS) for the improvement of quality of life of patients receiving high doses of opioid analgesics by prolonged intrathecal administration of micro-doses of morphine using programmable implantable pump. The study included 10 patients, 9 of them - with HBS of cancer genesis, and 1 patient - with non-tumor pathology. The first step included morphine test; positive test was the indication for the pump implantation. The pain intensity was assessed by standard rating scales. All patients have reported better pain relief, no systemic opioid-related side effects and improvement of quality of life after the selection of the individual mode of morphine administration using pump.

The article is dedicated to the prevention and treatment of neutropenia associated with myelosuppressive chemotherapy in patients with malignant tumors, particularly breast cancer. For the prevention and treatment of neutropenia, recombinant drugs of human granulocyte colony stimulating factor are used for the last 20 years. The implementation of Extimia®, unique domestic drug of pegylated filgrastim (empegfilgrastim) in clinical practice would provide more available modern drug against neutropenia, with advantages over other pegylated filgrastim, for the target population of patients with cancer receiving myelosuppressive chemotherapy.

The randomized study «The role of taxanes in combination with anthracyclines (TAC) and without anthracyclines (TC) in the neoadjuvant treatment of patients with locally advanced breast cancer (BC)» (2010 to 2013) was performed; 120 patients were randomized in a ratio of 1:1 to receive chemotherapy according to the TAC or TC schemes. Patients with operable breast cancer forms, in accordance with the randomization in the first group, have received 4 to 8 (average 4,6) cycles of chemotherapy TAC scheme (docetaxel 75 mg/m 2, doxorubicin 60 mg/m 2, cyclophosphamide 600 mg/m 2) once a 3 weeks; second group of patients - 4 to 8 (mean 4,9) cycles of chemotherapy TC scheme (docetaxel 75 mg/m 2, cyclophosphamide 600 mg/m 2) once a 3 weeks against the background of standard pre- and postmedikation using dexamethasone. The treatment groups have shown a significant difference between the rate of objective clinical response (89.8 vs. 74.5 %; p < 0,05) and indicators of pathomorphological complete response (22.0 vs. 10.6 %, p < 0.05 ), respectively. Patients with HER2 + breast cancer have received targeted therapy with trastuzumab at standard doses in addition to the polychemotherapy. In different biological subtypes of breast cancer, significant differences in the rates of pathomorphological complete response of the tumor and regional lymph nodes (pCR) after neoadjuvant taxane - containing chemotherapy ( TAC and TC schemes) were revealed. In luminal subtype A. pCR rate was 7.3 %, luminal B - 16.7 %, triplenegative - 24 %, HER2 + breast cancer - 27.3 % (p < 0.05). BRCA1 mutation was found in 9 % of patients: triple-negative breast cancer was diagnosed in 5 (55%) patients with mutation in the gene BRCA1 5382insC, and luminal A subtype of breast cancer - 4 (45 %) patients. The high efficiency of TAC and TC schemes in patients with BRCA 1 - associated breast cancer was determined: overall objective response rate (complete + partial regression) was observed in 8 (88.9 %) patients, pathomorphological complete response (pCR) - in 4 (44.4 %) patients. Low level of в-tubulin III type breast cancer gene expression is reliable predictive factor for pathomorphological complete response (pCR) to taxane-containing chemotherapy in 23.8 % of patients vs 12.5 and 15.4 % with an average and high expression of markers (p < 0,05). High and medium level of TOR2a gene expression increases by 2.6 and 2.8 times the frequency of significant drug pathomorphism (4 + 5 stages by Miller-Payne) compared with its low level (p <0,05), which allows to consider TOR2a as a predictive marker of sensitivity to anthracycline antibiotics.

The incidence of colorectal cancer (CRC) occupies the third place in most developed countries and the second place in the structure of mortality from cancer. Geriatric patient has the largest proportion of advanced forms of the disease, emergency surgeries and poor outcomes. The problem of adequate bowel preparation prior to intervention for colorectal cancer in senile patients is extremely important, but underinvestigated. The relatively high frequency of comorbidities and age-related decline in the functional reserve of senile organism significantly complicate the perioperative management of these patients. The article presents a protocol of preoperative assessment and preparation of senile patients. Preoperative bowel preparation for surgery is described in detail.