In Russian Federation, lung cancer is the most frequently diagnosed malignant tumor among men and the fourth in the structure of morbidity among women, also occupying a leading position in the structure of mortality [1]. Non-small cell cancer (NSCLC) accounts for about 80 % of all lung tumors. In turn, in the structure of NSCLC, the most common types are adenocarcinoma (50 %) and squamous cell lung cancer (30 %). The appearance of drugs based on blocking immune checkpoints, in particular PD-1 and PD-L1, has changed the approach to the treatment of NSCLC. Currently, the determination of the optimal tactics for treatment tumors without activated mutations is based on predicting the sensitivity of the tumor to immunotherapy. Evaluation of PD-L1 expression makes it possible to divide patients with NSCLC into several groups of the level of sensitivity to modern immune checkpoint inhibitors. Thus, three groups are distinguished: with negative (≤ 1 %), intermediate (1–49 %) and high (≥ 50 %) expression of PD-L1. The latter includes 23–28 % of patients with advanced NSCLC, regardless of the histological form of the tumor [3]. There are also reasons to believe that in the near future a subgroup of patients with ultra-high expression (> 75 %) PD-L1 will be identifid, in which it is expected to achieve the maximum advantage from treatment with monoimmunotherapy. Pembrolizumab was approved for the treatment of advanced NSCLC with high level of PD-L1 expression (≥ 50 %) with the absence of EGFR / ALK mutations in the fist line of therapy following the publication of the results of the randomized phase III clinical trial KEYNOTE-024. In this study, the median overall survival in the pembrolizumab monotherapy arm was 30.0 months compared with 14.2 months with standard platinum-containing therapy [5]. These data formed the basis for the registration of the fist cytostatic-free regimen in patients with NSCLC without activating mutations. The subsequent study KEYNOTE-042 was an attempt to assess the effect of pembrolizumab in a wider group of patients – with a positive level of PD-L1 expression (PD-L1 ≥ 1 %; ≥ 20 %; ≥ 50 %). In general, the results of the study were positive, but many authors drew attention to the fact that the greatest effect of monoimmunotherapy with pembrolizumab is obtained by patients with a high level of PD-L1 expression. Median overall survival in this study was 20.0 months in the pembrolizumab group and 12.2 months in the chemotherapy group for all patients regardless of PD-L1 status. In this article two clinical cases of the use of the PD-L1 inhibitor pembrolizumab in patients with non-small cell lung cancer and high levels of PD-L1 expression are presented.

The Kasabach–Merritt phenomenon is a rare thrombocytopenic consumption of coagulopathy that occurs against the background of such vascular anomalies as kaposiform hemangioendothelioma and giant angioma. Timely diagnosis and treatment of Kasabach–Merritt syndrome which includes therapy for vascular tumors and life‑threatening conditions are critical in resolving this rare vascular anomaly. The aim of the study is to analyze radiation therapy as salvage therapy for kaposiform hemangioendothelioma and giant angioma associated with the Kasabach–Merritt phenomenon.

he disease incidence of neuroendocrine tumors (NET) is increasing every year. Neuroendocrine tumors Grade 1 and 2 have a more favorable prognosis than Grade 3. When we are talking about NET with non-detected initial focus, the 10-year survival rate is 22 % [1]. Therefore, it is necessary to make every effort and use all technical abilities to localize the primary tumor, even in the presence of metastases, because resection of the primary tumor(s) can increase disease-free and overall survival rate. Also, the choice of chemotherapy drug or the appointment of biotherapy may depend on this. Finding tumor localization remains challenging and must involve a combination of radiological, nuclear medicine and endoscopic imaging techniques. There are many different myths about the purpose of nuclear medicine examinations and interpretation of the results in NET patients. And in this article we will try to debunk some of them, using examples from our experience in our center. We choose 111 patients with NET (histologically confimed). All patients underwent scintigraphy of neuroendocrine tumors with ^99mTc-EDDA/HYNICTOC (^99mTc-Tektrotyd) in the «whole body» mode and additional SPECT or SPECT/CT examination of the chest,abdomen and pelvis.

The relevance of the problem of screening of tumor diseases of reproductive organs is caused by high rates of incidence of tendencies to rejuvenation, unsatisfactory results of therapy. In Russia, indicators of active detection of acute respiratory disease, diagnosis in the preinvasive and early stages remain low, adversely affecting the quality and life expectancy of the patient and her reproductive function. The purpose of the study: on the basis of the analysis of literature sources to establish the reasons for the ineffectiveness of screening of tumorous diseases of the reproductive organs. The results of the bibliographic analysis of modern screening principles and methods have shown that the main reasons for unsatisfactory screening and early diagnosis of tumor diseases of reproductive organs should be considered low scoring coverage rates, inconsistency of the legislative base, inconsistency of the start time, end of examination and screening interval, lack of a single information base with the possibility of fiing and archiving results of the survey, violation of the logistics of data exchange conducted research, expressed the dissonance of diagnostic capabilities in different regions, lack of an integrated approach and a single screening program nationwide. One of the possible solutions to decide this problem should be a solution to the implementation of a comprehensive diagnostic survey with a simultaneous assessment of the condition of all organs of the reproductive system, including the mammary glands, in order to timely identify the tumor diseases of reproductive organs with the formation of risk groups for tumor pathology and to correct tactic of reference.

The use of regorafenib in the treatment of patients with metastatic colorectal cancer divides Russian and foreign oncologists into two camps. Many specialists postpone its appointment until a situation where all other options for systemic therapy have been exhausted, and the physical condition is close to unsatisfactory, and the metastatic process reaches its maximum volume. The position of oncologists adhering to such positions is based on a small number of objective answers and low survival rates without signs of progression of the process, with evidence of a more effective re-prescription of chemotherapy and targeted drugs already used in the treatment of this patient. On the other hand, an analysis of the world literature on regorafenib and options for the third line of therapy for metastatic colorectal cancer shows the ambiguity of the above approach and the potential of the drug in terms of improving the patient’s prospects by overcoming the resistance of the tumor mass to already used drugs and the ability to provide the patient with the so-called chemotherapeutic holiday.

Purpose of the study: to assess the state of lipid peroxidation processes in patients with kidney cancer in relation to the clinical factors of the prognosis of the disease and against the background of surgical intervention.

Material and methods. For the study, we used blood plasma samples from 300 patients with kidney cancer T1–4N 0–1M0–1, obtained before surgery and 8–9 days after surgery. Oxidative stress was assessed by the intensity of free radical processes by the method of induced biochemiluminescence on the BKhL-07 biochemiluminometer apparatus (Medozons Co., Russia), the activity of lipid peroxidation processes was assessed by the accumulation of initial products in the blood plasma – diene conjugates (DC), triene conjugates (TC) and fial Schiff bases (OSh) according to I. A. Volchegorsky et al. method. (1989). Statistical processing of the results was carried out using Statistica 12 and Microsoft Offie Excel 2010 programs.

Results. In patients with kidney cancer, there was a decrease in the level of DC, an increase in OSh and the ratio of Osh / (DC + TC) compared with the control (p ≤ 0.05), against the background of depletion of the resources of the antioxidant defense system. The content of DC did not differ from the norm with the size of the primary tumor of the kidney pT1–pT2 and decreased (p ≤ 0.05) in the case of the presence of the tumor pT3–pT4. At the same time, there was an increase in the OSh content (p ≤ 0.05). In patients with thrombi in the inferior vena cava system, a decrease in the level of DC was observed (p ≤ 0.05), the OSh level did not differ from that of healthy individuals. In the postoperative period, there was an increase in the content of DC (p ≤ 0.05) and a decrease in the Osh / (DC + TC) coeffiient (p ≤ 0.05) compared with the initial level.

Conclusion. Kidney cancer is accompanied by the activation of free radical oxidation processes against the background of depletion of the resources of the antioxidant defense system. Changes in the pro-antioxidant homeostasis are interrelated with the size of the primary tumor and the presence of a tumor thrombus. In the postoperative period, the activity of free radical oxidation processes in the patient’s body decreases.

‘Mammographic density’ (MD) is a concept that has entered medical practice since 2017. as a marker of breast cancer risk factor (BC) according to the international classifiation of NCCN. The term reflcts the degree of severity of benign diffuse breast dysplasia in women of post-reproductive age. MD is determined by the ratio of stromal, epithelial, and adipose tissue. According to the literature, in young women, high MD limits the possibilities of X-ray mammography, reducing its effectiveness in oncomammoscreening, leading to the detection of advanced forms of breast cancer. Post-reproductive women with high MD are more likely to develop breast cancer than those with low MD. In this regard, MD is of particular interest for studying its role in oncogenesis. Recent molecular genetic studies of the differences between high and low MD explain the main biological reasons why post-reproductive women with dense breast structure are at a higher risk of developing breast cancer. The aim is to identify the factors that inflence the relationship of MD with the risk of developing breast cancer based on a comparative analysis of molecular genetic studies and radiological manifestations of MD of different severity and to identify the factors that contribute to the formation of MD variants.

Along with the rapid development of molecular genetic testing, immunotherapy and targeted antitumor therapy in Oncology, the risk of cardiotoxicity associated with chemotherapy remains a keystone that directly affects the survival and quality of life of patients after therapy. Elevated levels of troponin, BNP/NT-proBNP, myeloperoxidase, and D-dimer have been associated with increased all-cause mortality in cancer patients and have been shown in numerous studies to predict the risk of heart failure and myocardial damage associated with chemotherapy. Specifi diagnostic algorithms are particularly important for risk stratifiation, monitoring, and long-term follow-up of cancer patients receiving chemotherapy. Biomarkers are the basis for diagnosing acute and chronic heart diseases. However, their role in the timely detection and monitoring of cardiotoxicity is not well understood. Thus, clinicians should identify adverse effects at an early stage, seeking to take appropriate preventive measures before the occurrence of a permanent or irreversible dysfunction of the heart. In dynamic cardiology, biomarkers are a key tool for risk assessment, diagnosis, and monitoring of cancer-related cardiotoxicity and cancer therapy. The complex interaction of such branches of medicine as oncology, oncotherapy and cardiology indicates the need for a multi-disciplinary cardio-oncological approach to ensure optimal quality of treatment

The review is devoted to the place of cetuximab in the treatment of metastatic colorectal cancer (mCRC) without mutations in the RAS (RAS wt) and BRAF (BRAF wt) genes, depending on the goals of therapy, as well as to the analysis of the inflence of various factors, including the localization of the primary tumor, on the effectiveness of treatment. Randomized clinical trials and meta-analyses conducted on their basis allow us to conclude that cetuximab in combination with an infusion doublet or triplet provides the maximum frequency of deep and early objective responses, regardless of the location of the primary tumor. The drug is superior in this parameter to both a single chemotherapy (CT) and a combination of CT with bevacizumab which is important in terms of achieving resectability in patients with potentially resectable metastases. For patients with left-sided localization of the primary tumor and RAS wt, cetuximab, prescribed in the 1st line, provides a reliable and clinically signifiant increase in life expectancy. Postponing the start of its use until 2–4 cycles of CT (until the result of a molecular genetic study is obtained) does not negatively affect the effectiveness of the 1st line of therapy for mCRC RAS wt, and with left-sided localization of the primary tumor, CT with delayed cetuximab exceeds the usage of CT with bevacizumab from the fist cycle for ORR, OS and PFS. The optimal duration of induction chemo-targeted therapy is 3–4 months (6–8 courses), after which it is advisable to switch to maintenance treatment with one cetuximab. The new mode of administration of cetuximab once every 2 weeks at a dosage of 500 mg/m 2 IV provides maximum convenience of its use.

Relevance. When selecting the components of parenteral nutrition (PN) for oncology patients, it is necessary to take into account not only the composition optimization but also its potential positive effect on the surgical treatment outcome. Therefore, the use of pharmaconutrients in PN, in particular, omega-3 fatty acids, is of great theoretical and practical interest and has determined the aim of this study.

The aim. To assess the effiacy of postoperative PN using the 3-in-1 system with omega-3 fatty acids (FA) (SMOFKabiven central and peripheral) in the treatment of metabolic disorders in patients undergoing gastrointestinal cancer surgery.

Materials and methods. A prospective, randomized, controlled, comparative study included the patients undergoing gastrointestinal cancer surgery. Group 1 (comparison group) consisted of 29 patients, postoperative PN was performed using a 3-in-1 system without omega-3 fatty acids.

Group 2 (main group) consisted of 20 patients treated with 3-in-1 system with omega-3 FA (SMOFKabiven central) and 9 patients recieved PN with omega-3 FA through peripheral vein access FA (SMOFKabiven peripheral).

Main results. A complete range of amino acids in SMOFKabiven (50 g/L) and an increased content of nitrogen (8 g/L) have a pronounced effect on protein metabolism and anabolic processes. The long-term PN showed that the liver enzyme (alanine transaminase [ALT], aspartate transaminase [AST], and total bilirubin) levels were signifiantly lower compared to the patients who received traditional lipid emulsions without fih oil. The analysis of the corrective effect of PN containing omega-3 fatty acids showed that at day 6–7 after surgery the group 2 patients had a signifiant decrease in the concentration of pro-inflmmatory cytokines: IL-6 down to 79.5±19.2 pg/mL, TNF-α down to 12.9±3.3 pg/mL (p < 0.05) compared to group 1. Clinical signs of gastrointestinal dysfunction were mainly resolved at day 4–5. Full recovery of the GIT functions was seen in more than 80 % of patients. The anti-inflmmatory properties of omega-3 fatty acids, as well as their effect on the cytokine balance recovery, have been confimed in our studies by signifiant reductions in the synthesis of IL-6, TNF.

Conclusion. The high content of omega-3 fatty acids in PN promotes early management of metabolic disorders after surgery, can have a signifiant effect on the ability to adequately tolerate the maintenance chemotherapy and radiation therapy, and can signifiantly improve the quality of life under the conditions of progressive disease.