In the context of the COVID-19 pandemic, the multikinase inhibitor regorafenib is an important option for systemic treatment of metastatic colorectal cancer (mCRC) after oxaliplatin, irinotecan, and fluoropyrimidine ± biologics. Regorafenib inhibits various protein kinases implicated in oncogenesis, angiogenesis, and the tumour microenvironment. In two placebo-controlled, randomized, phase III trials treatment with regorafenib was associated with prolonged overall survival and progression-free survival in heavily pretreated patients and clinical benefit was consistent across various patient subgroups. The benefit provided by regorafenib was confirmed in observational studies designed to characterize safety and effectiveness in an unselected, real-world population of patients with mCRC. Both immunotherapy (atesolizumab) or combination of target plus immunotherapy (cobimetinib plus atezolizumab) did not prolong overall survival compared to regorafenib in phase III trial IMblaze, where regorafenib was used as the standart of care in the control arm because it is approved globally in the treatment setting tested in the study. New data show that regorafenib can positively interfere with the immunosuppressive state, increasing the immunosensitivity of the tumor or the tumor microenvironment. Regorafenib has increased activity in earlier lines of therapy vs later lines of therapy (when patients tend to benefit to a lesser degree) and clinical date provide evidence for the use of regorafenib before chemotherapy rechallenge or anti-EGFR monotherapy.

Accurate determination of the tumor with the use of modern diagnostic methods which make the maximum exposure to the tumor and the identified affected lymph nodes possible lead to careful attitude to healthy tissues and critical structures. During the period 2000-2015 301 patients with squamous cell carcinoma of the anal canal stage T1-4N0-3M0-1 completed complex treatment which consisted of radiation therapy in a conventional or conformal mode, including the use of modern technologies - radiation therapy with intensity modulation - IMRT and arch volume-modulated radiation therapy - VMAT. The use of IMRT andVMAT in comparison with conformal radiation therapy allowed to reduce the frequency of unplanned interruptions up to 48 % (p = 0.005), which led to increase in 5-year rates of local regional control - 83.7 % compared with the group where the interruption was applied - 74.2 % (p = 0.049); also increased the frequency of complete responses in the range of the total dose of 50-54 Gy to 28.5 %, 56-58 Gy to 44.3 % and 60-64 Gy to 26.1 %. The achievement of a complete response led to a significant increase in the 92.1 % 5-year locoregional control compared to the group with the absence of a complete response - 76.5 % (p = 0.001). Modern conservative treatment is based on continuous radiation exposure with the absence of intervals between courses, which is the radiobiologically considered the most effective treatment regimen.

Liver metastases of gastric cancer determine the poor prognosis. Until now The expediency of their surgical removal has been controversial. However, according to a number of studies, the removal of potentially operable isolated liver metastases allows a significant increase of overall and relapse-free survival in some cases. The review is dedicated to the analysis of prognostic factors that allow selecting patients for surgical removal of liver metastases of gastric cancer. The main criteria are: effective perioperative chemotherapy; stage under T4, N0, absence of lymphovascular invasion, absence of peritoneal dissemination, number less than 3, size up to 4 cm, localization of metastases in one lobe, low level of cancer markers CA 19-9 and CEA.

The rate of detection of breast cancer by MRI, while other methods of radiological diagnosis are not sufficiently informative, ranges from 5.2 to 26.3 per cent. Suspicious breast tumors of category BI-RADS 4, 5 show morphological image-guided biopsy verification, in particular MRI with contrast. Purpose. To show the possibilities and features of carrying out MRI-guided vacuum breast biopsy, including after aesthetic breast augmentation. Material and methods. A comprehensive X-ray, ultrasound and MRI examination of 54 women aged between 28 and 70 years with different breast tumors was conducted. Of these, five were detected only by breast MRI with contrast, and were morphologically verified by MRI-guided vacuum aspiration biopsy. Results. 14 of the 54 patients with breast mass were diagnosed with breast cancer and 26 were diagnosed with benign diseases. The effectiveness of comprehensive examination and low-invasive high-tech MRI-guided procedures in early refined screening for breast cancer, including after aesthetic breast augmentation, has been demonstrated. MRI-guided vacuum-assisted breast biopsy is a fast, safe and accurate diagnostic method of morphological verification of suspicious breast tumors that do not have X-ray and ultrasound.

Tumor-infiltrating lymphocytes (TILs) play a key role in the formation of anti-tumor immunity and, as studies have shown, can be one of the markers of treatment effectiveness and cancer prognosis. The aim was to study the subpopulation composition of the lymphoid infiltrate in early luminal breast cancer in patients receiving neoadjuvant chemotherapy (NACT) and its effect on achieving a pathological complete response (pCR). Materials and methods. We included 24 patients who received anthracycline-taxane-contain-ing preoperative chemotherapy. The subpopulation composition of TIL was assessed in core-biopsy samples before starting NACT in all patients; after treatment, the assessment was made on postoperative material. The analysis was carried out by flow cytometry. Clinical and immunological assessment was carried out for the following seven subpopulations of lymphocytes: CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺, CD4⁺CD127⁺CD25⁺, CD3 CD19⁺ CD3CD16⁺CD56⁺, CD3⁺CD16⁺CD56⁺. Results. The incidence pCR was 16.7 %. It was revealed that the initial level before treatment of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺, CD4⁺C-D127⁺CD25⁺, CD3-CD19⁺, CD3 CD16⁺CD56⁺, CD3⁺CD16⁺CD56⁺ lymphocytes did not differ depending on the stage of the disease (II or III), tumor subtype (luminal A/B) and Ki-67 level (up to 20, 20-39, 40 and more). No correlations were found between Ki-67 and TIL content. When conducting regression analysis, it was revealed that only the level of CD3⁺, CD3⁺CD8⁺ and CD19⁺ was a significant factor in achieving a pCR (p = 0.005). When an empirical subgroup was identified, which was characterized by a high content (above or equal to the median) of CD3⁺, CD3⁺CD8⁺ and low (below the median) CD19⁺ (four observations), the frequency of pCR reached 75 %. Conclusion. Thus, the initial level of T-lymphocytes (CD3⁺, CD3⁺CD8⁺) and B-lymphocytes (CD19⁺) in the tumor, regardless of the stage of the disease, tumor subtype, ki-67 index, was a predictor of high sensitivity to neoadjuvant chemotherapy of luminal breast cancer and was associated with higher frequency of pCR.

According to the analyzed literature, the use of botulinum toxin type A is promising as an auxiliary method for simultaneous or delayed breast reconstruction using a subpectoral silicone implant or tissue expander. This method is safe and simple. Relaxation of the large pectoral muscle both intraoperatively and in the postoperative period reduces the intensity of pain, accelerates the rehabilitation of patients. Botulinum toxin therapy prevents the animation and deformation of the reconstructed breast. The effect after injection of botulinum toxin persists for 6-8 months and for a long time there is no need for analgesic therapy. According to the literature, this technique for reconstructive plastic surgery in patients with breast cancer significantly improves the quality of life of patients by reducing pain, preventing deformation and contraction of the large pectoral muscle. Conclusion. The literature analysis evaluates the effectiveness of botulinum toxin preparations for pain after reconstructive plastic surgery on the breast using a subpectoral space. The possibilities of therapeutic use of botulinum toxin preparations as an analgesic are known, but are little used in practice. This direction is promising. Given the small number of literary publications on this subject, it is necessary to conduct further research in this direction.

Pancreatic cancer is the 12th most common malignant neoplasm and the 7th most common cancer related death worldwide. Early diagnosis of pancreatic cancer is complicated, since the disease proceeds for a long time without pronounced clinical symptoms, and the identification and screening of the so-called risk groups of patients is difficult, since the etiology of pancreatic cancer is currently a matter of scientific debate. Early diagnosis of pancreatic cancer can be based on the anamnestic analysis of the psychoemotional status of patients. Back in the early 20th century, based on an analysis of the results of a survey of patients with pancreatic cancer, researchers described a triad of affective signs, including depression, anxiety and a sense of impending death, which worried patients in the early stages of development of the disease. According to literature, the psychiatric symptoms of pancreatic cancer can appear 43 months before the somatic symptoms and occur in more than 50 % of patients. To date, there are a number of concepts in the literature that point to a significant contribution of affective disorders to the development of pancreatic cancer. The aim of this review is to analyze the literature data on the relationship between affective disorders and the development of pancreatic cancer.

The article describes the main histological types of tumors of the appendix, epidemiological, prognostic, and clinical features, as well as current recommendations for the diagnosis and treatment of these tumors.

Currently, neuroendocrine neoplasms (NENs) of the gastroenteropancreat-ic and bronchopulmonary systems are well studied and the most common, the share of which is 73 and 25 % of cases, respectively. The remaining 2 % of cases are attributed to NEN of more rare localizations, the static registration of which is difficult due to their rarity, and clinical cases are presented by episodic descriptions of single observations. Such tumors include NEN of the prostate gland from 0.5 to 1.0 %, NEN of ovaries 0.5 %, NEN of the mammary gland from 0.3 to 0.5 %, NEN of the kidney (practically devoid of static data), bladder 0.48-1.00 %. The retrospective study included 92 patients with NEN of rare localizations who were examined and treated of the N. N. Blochin National Medical Research Center of Oncology from 1990 to 2019. Currently, there are no generally accepted methods of treatment for this group of patients due to the rarity of the pathology, and it is carried out according to the NEN of other localizations. NEN of rare localizations have high survival rates (the observation period was from a month to 14 years), both general and without progression and require long-term monitoring and observation. At the time of assessment of long-term results, 20 (21.8 %) patients died of progression, 12 (13.1 %) patients dropped out of observation. The rest were alive at the date of the last control.

The analysis of the current strategy for the treatment of advanced HR+/HER2-negative metastatic breast cancer (mBC) was carried out, the criteria for hormone sensitivity and hormone resistance were given, and the changes in the classification of tumors were reflected taking into account the level of expression of estrogen receptors. A detailed characterization of a new potential marker of acquired hormone resistance - activating somatic mutation of the estrogen receptor gene ESR1, leading to constitutive ligand-independent activity of the estrogen receptor is given; describes the predictive and prognostic role of ESR1 mutation, its association with the clinical course of the disease and response to endocrine therapy. The paper presents studies to find the optimal treatment regimen after progression to CDK4/6 inhibitors, including the emergence of ESR1 mutations. The characteristics and key advantages of eribulin chemotherapy in patients with hormone-resistant mBC are presented, and preliminary results of the EMPOWER study on the potential for eribulin use after progression to CDK4/6 inhibitors are presented. This review will help form the concept of a personalized approach to the choice of a treatment strategy for hormone-resistant mBC.