Hepatocellular carcinoma (HCC) is a public health problem worldwide and is one of the most common and lethal cancers worldwide, the sixth among the most common cancers and the second mortal cancer worldwide. Viral hepatitis is the main risk factor. Growing evidence suggests that the metabolic syndrome, which includes hyperlipidemia, dyslipidemia, and hypertension, increases the risk of developing HCC. Epidemic of obesity, the proportion of HCC with non-alcoholic fatty liver disease (NAFLD) in the Russian population is 17.4 %. In clinical practice, it is often difficult to identify the leading etiological factor. In a patient with concomitant viral hepatitis, HCC may be associated with alcohol abuse or metabolic disorders. In clinical trials, investigators evaluate the most likely etiology of HCC, and studies analyze subgroup: HBV, HCV, and non-viral etiologies, which include a variety of liver diseases: alcoholic liver disease, NAFLD, autoimmune hepatitis, and others. Differences in the effectiveness of systemic therapy depend on the main etiological factor has been published recently. Pivotal studies of combinations of immuno-oncological drugs have shown mixed results in efficacy. For the combination of atezolizumab with bevacizumab and pembrolizumab with lenvatinib, there was no difference in OS in non-viral subgroups, although the difference was significant for the combination of durvalumab with tremelimumab compared with TKIs from the control group. A multivariate analysis of patient characteristics showed that lenvatinib is an independent prognostic factor for OS, reducing the risk of death by 35 % compared with atezolizumab in combination with bevacizumab in patients with non-viral HCC etiology in the A. Casadei-Gardini study. The same has been proven for the NASH/NAFLD subgroup. Currently, it is difficult to conduct prospective clinical trials to assess the efficacy and safety of treatment depending on the etiology, it is important to focus on data from real-world evidence in order to have guidelines for making decisions regarding the treatment of non-viral HCC.

The life expectancy of patients with metastatic luminal HER 2-negative breast cancer has stagnated at the level of 40 months for many years. The introduction of CDK4/6 inhibitors into practice has changed the standards of therapy, providing not only a significant increase in the time without progression while maintaining a high quality of life, but also significantly increasing overall survival. The presence of liver metastases determines an extremely unfavorable prognosis, with GH+HER 2-mBC reducing life expectancy to a median of 21 months. Endocrine therapy combined with ribociclib significantly increased overall survival rates on average per year, reaching medians of 36.1 and 46.5 months, depending on the line of treatment. This publication is devoted to liver metastases in breast cancer, in particular in the luminal HER 2-negative subtype. Epidemiological aspects are considered, the possibilities of modern systemic therapy are evaluated. A clinical case of successful therapy with ribociclib in a young patient with liver damage is presented.

Introduction. Currently, immunotropic drugs are used in the modern strategy of cancer treatment. Importance is given to immunological markers of the tumor, which may be associated with the prognosis of the disease, the effectiveness of treatment. Therefore, the study of tumor immunophenotype is one of the leading scientific directions. Of particular interest is the study of the immunophenotypic characteristics of breast cancer depending on its biological subtype.

Purpose. To evaluate the frequency of expression of HLA-I, HLA-II, CD71, MUC1, Pgp170 molecules by breast cancer cells and determine their relationship with the molecular biological subtype of the tumor.

Materials and methods. This study included 120 patients with breast cancer who received treatment at the National Medical Research Centre of Oncology n. a. N. N. Blokhin (Moscow, Russia). Tumor stages II and III prevailed: 56.7 % and 33.4 %, respectively. A moderate degree of differentiation (G2) was more often noted. The luminal subtype was 58.3 % (n = 70), non-luminal – in 41.7 % (n = 50). Immunophenotyping of the primary tumor was performed by immunofluorescence on cryostat sections. The reaction was evaluated using a Zeiss luminescent microscope (Axioskop, Germany). The frequency of expression of HLA-I and class II molecules was studied depending on the clinical and morphological characteristics of breast cancer. The frequency of expression of HLA-I, HLA-II, CD71, MUC1, Pgp170 molecules depending on the molecular subtype of breast cancer was studied.

Results. The absence of molecules of the major histocompatibility complex of class I and II on breast cancer cells was found in 89.6 % of the samples. The monomorphic expression was observed in 23.4 % of cases. In the luminal subtype, HLA-II class molecules were expressed more often: in total, mosaic and monomorphic types of reactions were observed in 30.5 % (20/65) of cases. With non-luminal – 20.0 % (10/47) of cases. The frequency of expression of the transferrin receptor is significantly higher in the luminal subtype than in the non-luminal subtype: 85.9 % (n = 5) and 65.2 % (n = 30), p = 0.011. Luminal breast cancer cells express transferrin receptors predominantly monomorphically: 75.4 % (n = 49) vs 43.5 % (n = 20) in the non-luminal subtype, p = 0.003. The MUC 1 expressing monomorphically tumors is higher in luminal cancer: 83.3 % (n = 35) versus 65 % (n = 26) in the non-luminal subtype. Monomorphic expression of Pgp170 is more often observed in luminal breast cancer.

Conclusion. Luminal breast cancer is characterized by unfavorable prognostic immunophenotypic features. In the luminal subtype, expression of CD71 is more often observed, predominantly monomorphic. In the non-luminal subtype, expression of Pgp170 is observed less frequently. No statistically significant differences between the molecular subtypes in terms of the level of expression of HLA-I and class II molecules were found.

For a long time, cytostatic therapy practically does not increase life expectancy than up to 18 months. The article describes the latest advances in the development of drug treatment of pleural mesothelioma and the results of the CheckMate‑743 trial, which are a turning point in the development of drug treatment for malignant unresectable pleural mesothelioma.

Minimal residual disease (MRD) assessment in patients with acute lymphoblastic leukemia (ALL) became an integral part of total evaluation of chemotherapy efficacy. No doubt, that it is necessary to evaluate MRD at remission induction and before allogenic stem cell transplantation, but MRD prognostic role at post-induction treatment is on-study.

Aim. To evaluate a prognostic significance of MRD at post-induction treatment in pediatric patients with ALL.

Materials and methods. From October 2010 to September 2022, there were 142 pediatric patients with primary diagnosed B-precursor ALL enrolled the study. All the patients were treated by ALL–IC BFM 2009 protocol.

Results. 6-year overall survival (OS) for patients with MRD-positive status at post-induction treatment (78th day of therapy) was 90.8 ± 4.0 %, with MRD-negative – 91,1 ± 3.9 % (р = 0,8). Relapse-free survival (RFS) for MRD-positive – 67.4 ± 11.6 %, MRD-negative – 88.9 ± 4.3 % (р = 0,03). Event-free survival for MRD-positive – 67.4 ± 11.6 %, MRD-negative – 87,5 ± 4.5 % (р = 0,06).

Conclusion. MRD level at induction remission treatment is an important risk-stratified factor in pediatric patients with ALL, but prognostic significance of MRD at post-induction therapy is under investigation. Presented our data showed increased relapse incidence on 21.5 % in patients with MRDpositive status at 78th day of therapy. OS was the same and not depended on post-induction MRD-level.

Although melanoma is one of the most immunogenic tumors, it has an ability to evade anti-tumor immune responses by exploiting tolerance mechanisms. The most extensively studied checkpoints represent cytotoxic T lymphocyte-associated protein‑4 (CTLA‑4) and programmed cell death protein‑1 (PD‑1). Immune checkpoint inhibitors (ICI), which were broadly applied for melanoma treatment in the past decade, can unleash anti-tumor immune responses and result in melanoma regression. Patients responding to the ICI treatment showed long-lasting remission or disease control status. However, a large group of patients failed to respond to this therapy, indicating the development of resistance mechanisms. Among them are intrinsic tumor properties, the dysfunction of effector cells, and the generation of immunosuppressive tumor microenvironment (TME). This review discusses achievements of ICI treatment in melanoma, reasons for its failure, and promising approaches for overcoming the resistance. These methods include combinations of different ICI with each other, strategies for neutralizing the immunosuppressive TME and combining ICI with other anti-cancer therapies such as radiation, oncolytic viral, or targeted therapy. New therapeutic approaches targeting other immune checkpoint molecules are also discussed.

The aim of this work was to evaluate the results of treatment of patients with progression of primary cerebral medulloblastomas in adults. The study included 10 patients with progression of brain medulloblastomas, who had been treated since 2016 to 2021 treatment was carried out on the basis of the Chelyabinsk Regional Centre for Oncology and Nuclear Medicine. The mean age of patients with relapse of brain medulloblastoma was 27.14 ± 4.30 years (from 23 to 35 years). Males predominated (n = 9) and in one case a relapse was recorded in a woman. The median time to relapse was 56 months (12 to 144 months). According to the method of recurrence treatment, in 3 cases, for recurrence, repeated stereotaxic radiation therapy was performed using the CyberKnife device with ROD = 7 Gy in three fractions up to SOD = 24 Gy, the remaining 7 patients underwent chemotherapy according to the PCV scheme. The median overall survival was 130 months (CI: 59.6–200.3), 1-year overall survival rates were 100 %; 5-year-old – 76.7 %; 7-year-old – 53.7 %. When analyzing the relationship between the size of the residual tumor and survival rates, we found that with a residual tumor size of more than 1.5 cm, the 5-year overall survival rate was significantly lower compared to a small residual tumor – 54 % and 77 % respectively (p = 0.005). The best indicators of method-specific survival were observed during polychemotherapy: 27 months compared to 21 months when performing stereotactic radiation therapy (p = 0.782).

Relevance. Giant cell tumor of the bone is most common in people of working age, which determines the high social significance of successful treatment of this category of patients. The main method of treatment is surgical. Currently, the targeted drug denosumab has appeared, the criteria for evaluating the effectiveness of therapy for which, according to the data of radiation methods, are not clearly defined.

Target. To analyze and compare the possibilities of CT and MRI in evaluating the effectiveness of denosumab therapy for giant cell tumors.

Materials and methods. The data of CT and MRI of 19 patients with giant cell tumor of tubular bones on the background of denosumab therapy were analyzed.

Results. Before treatment, the extraosseous component was determined in 57.9 % (n = 11), after – 31.6 % (n = 6). The decrease occurred in 100 %, the disappearance – in 45 % (n = 11) of cases. The thickness of the extraosseous component before treatment ranged from 4 to 43 mm (Me = 15 mm), after treatment it ranged from 0 to 30 mm (Me = 8 mm). The decrease occurred in the range from 4 to 14 mm (M ± SD = 7 ± 4 mm). In 100 % of cases, a sclerotic rim appeared, the thickness of which after treatment ranged from 1 to 5 mm (Me = 3 mm). In the structure of the tumor, fibrosis occurred in 95 % (n = 18), a decrease in the cystic component occurred in 82 % (n = 9) of cases. Perifocal changes decreased in 100 % of cases. In 100 %, the average tumor density increased. The mean tumor density before treatment ranged from 27 to 65 HU (M ± SD = 42 ± 11 HU), after treatment it ranged from 69 to 500 HU (Me = 150 HU). The increase in density occurred in the range from 41 to 454 HU (Me = 101 HU). All differences are statistically significant (p < 0.05).

Conclusions. Evaluation of effectiveness with the definition of quantitative and qualitative indicators is possible according to the data of both CT and MRI; with CT, changes are recorded longer, and more indicators available for quantitative measurement are determined.

In developed countries, there is a steady increase in the incidence of malignant neoplasms. The health care system of St. Petersburg is tasked with improving the rates of treatment of malignant neoplasms. The main tasks for achieving the goals are to increase the availability of personnel at different levels of the health care system, as well as the staffing of specialized medical institutions that provide care to patients with malignant neoplasms. The purpose of this study is to assess the resource base of medical organizations in St. Petersburg as part of the provision of specialized inpatient care for patients suffering from malignant neoplasms. The data of the resource base of the system for the provision of specialized oncological care in St. Petersburg were studied for the period from 2014 to 2019. The indicator of the staffing of oncologist posts in the inpatient link with individuals had a significant increase over the analyzed period, a decrease in the number of employees was also noted, and an increase in the number of oncological beds in St. Petersburg.

Due to the promising results of recent trials in the treatment of metastatic renal cell cancer (mRCC) multi-drug regimens combining immunotherapy and targeted therapy in the first line are increasingly recognized. The combinations are already included in international clinical guidelines as preferred treatment options for patients with mRCC. In particular, combination of lenvatinib and pembrolizumab demonstrated high efficacy in terms of achieving a complete response, progression-free survival with a manageable toxicity profile. All adverse events on this therapy are predictable and quite well controlled. We report on our own experience of using lenvatinib plus pembrolizumab combination therapy on the example of two clinical cases of patients with intermediate prognosis mRCC.