General data. The article presents the results of a comparative analysis of the effectiveness of integrated chemotherapy in targeted anti-EGFR therapy for patients with non-small cell lung cancer (NSCLC) with a mutation in exon 21 of the EGFR gene compared to monotherapy with firstand second-generation tyrosine kinase inhibitors (TKIs).

Material: From 2015 to 2021, the study included 45 patients with metastatic NSCLC with the L858R mutation in exon 21 for the first line of treatment, distributed into an experimental group and a control group of 23 and 22 people, respectively. Patients in the experimental group received therapy with tyrosine kinase inhibitors for the first 2 months, followed by discontinuation of targeted drugs and 3 courses of chemotherapy according to the paclitaxel and carboplatin regimen. Targeted therapy was then resumed until disease progression. Patients in the control group received only monotherapy with first- or second-generation TKIs. The median follow-up was 36 months.

Result. The objective response rate (ORR) was 59.1 % for the experimental group and 27.3 % for the control group, disease stabilization was achieved in 9 (40.9%) patients and 14 (63.6%), respectively. The median progression-free survival (PFS) for the experimental group was 23 months [95% CI: 16–36], for the control group 13 [95% CI: 11–17] (p=0.004). The median overall survival (OS) for the experimental group was statistically higher than in the control group and was 43 [lower limit of 95% CI – 38] months versus 32 [95% CI: 23–44] months (p=0.008).

Conclusion. The results of our study showed that the integration of chemotherapy into targeted treatment of this category of patients may become a new worthy option that allows for a statistically significant increase in both the median PFS and the median OS.

Cancer of the biliary tract is rare and one of the most aggressive malignancies. The main method of radical treatment is surgical. However, only 1/3 of patients can use this approach, while the rest of the patients have an unresectable, locally widespread or already metastatic process. The therapeutic tactic of this group of patients is systemic drug antitumor therapy. In this article, we present a description of a clinical case of effective treatment of a patient with advanced intrahepatic cholangiocarcinoma using not only standard cytostatics, but also modern targeted drugs.

Purpose of the study. To develop a diagnostic calculator for assessing the expression of profile microRNAs (miRNAs) that are significant for the oncogenesis of thyroid cancer, to introduce it into clinical practice and to evaluate the effectiveness of the proposed method for early diagnosis of malignant neoplasms of the thyroid gland in uncertain diagnostic situations after fine-needle aspiration biopsy (FNAB).
Material and methods. The previously developed «Method for Diagnosing Malignant Neoplasms of the Thyroid Gland» (patent RU2820815 C1) was tested on 284 patients of the dispensary group with nodular formations of the thyroid gland according to the results of ultrasound and an uncertain conclusion after FNAB. The number of patients with papillary thyroid carcinoma was 83 (29,2%), follicular carcinoma 43 (15,1%) and with benign thyroid pathology (follicular adenoma) – 158 (55,6%) people. The expression of miRNA-146b and –574–3p in cytological samples of thyroid nodules after FNAB was assessed using the real-time PCR method.
Results. In thyroid cancer patients, the expression of miRNA-146b was higher (p=0,007) compared to patients with benign pathology, while the expression activity of miRNA-574–3p was lower (p=0,013). To assess the index of reciprocal paired dysregulation of miRNA-146b and miRNA-574–3p expression in thyroid cells, it is recommended to determine the ratio of the expression values of the corresponding molecules. If the ratio index of miRNA-146b and miRNA-574–3p expression is higher than 4.5, then a conclusion is made about a malignant neoplasm of the thyroid gland. The diagnostic coefficient calculated by the developed formula using the logistic regression method also allows diagnosing malignant neoplasm of the thyroid gland when compared with the cutoff level. The proposed methods are highly informative.
Conclusion. Evaluation of the expression of miRNA-146b and miRNA-574–3p in the cells of thyroid nodules obtained by FNAB allows improving the diagnosis of malignant pathology in mutation-negative thyroid nodules with uncertain FNAB results.

In the absence of widespread access to genomic tests there is an urgent need for additional methods that influence the choice of adjuvant therapy in patients with early luminal Her2-negative subtype of breast cancer (BC). The IMPACT and POETIC trials have shown that Ki67 level decrease up to ≤10% after a “short-term” (2–4 weeks) preoperative endocrine therapy (ET) is a favorable prognostic factor. This test allows some patients to avoid adjuvant chemotherapy associated with immediate and delayed adverse events.

Aims of the study. To evaluate the impact of “short-term” preoperative endocrine therapy for guidance of further treatment for patients with primary operable luminal Her2-negative breast cancer stages T1–3 N0–1 M0.

Results. The study included 123 patients, 76 (60.8%) received tamoxifen and 47 (37.6%) – aromatase inhibitors (AI). Most patients – 69 (55.2%) were >50 years old, premenopausal – 58 (46.4%), menopausal – 67 (53.6%). The average age was 52 years (30–82). With the initial Ki67 level>10% (N= 107), Ki67 decreased in 24 (22.4%) up to ≤10% after “short-term” ET, and remained >10% in 83 (77.6%). According to the PREDICT calculator, the benefit of adjuvant chemotherapy (AChT) was assessed as high in 35 (28.5%) patients, and 10 of them (27.8%) were able to avoid Ch T. In 86 patients with a relatively low estimated AChT benefit (<5% at 10 years) there was no response to “short-term” ET, which led to the AChT prescription in 13 cases (15.1%).

Conclusions. “Short-term” course of preoperative endocrine therapy is a simple, accessible and reproducible method for personalizing of adjuvant therapy in patients with luminal HER2-negative breast cancer.

The aim of the study was to search for data on the effectiveness of neoadjuvant therapy hormone-positive HER2-negative breast cancer.

Material and methods. The literature search was conducted in PubMed and RISC databases. Publications from 2012 to 2024 were found. The keywords used were: “breast cancer”, “bneoadjuvant chemotherapy”, “bsurgery”, “bluminal tumors”, “bhormone-dependent tumors”, “bbreast-conserving surgery”.

Results. The indications for neoadjuvant chemotherapy in patients with hormone-positive HER2-negative breast cancer are discussed, considering the possibility of achieving clinical and pathological response with the assessment of the number of performed breast-conserving surgeries as the main task when prescribing preoperative treatment in this group of patients, as well as the influence of pathological response on survival rates.

Conclusion. Data on the effectiveness of neoadjuvant chemotherapy for hormone-positive HER2-negative breast cancer are contradictory. The rate of complete pathological response is 2.0–16.2%, with its prognostic role being ambiguous. However, most studies have shown no correlation of pCR with overall and disease-free survival. The execution of breast-conserving surgery after neoadjuvant chemotherapy is possible in 50% of cases, if other contraindications are excluded.

Background. Treatment of locally advanced breast cancer (BC) should start with systemic therapy to achieve the possibility of surgical intervention. In luminal HER2-negative BC, 2 options for neoadjuvant systemic therapy are possible – chemotherapy and hormonal therapy. To date, there are no clear criteria for choosing the most optimal treatment option for a particular patient.

Objective. To evaluate the efficacy of neoadjuvant hormone therapy (NHT) and chemotherapy (NCT) for patients with intermediate expected hormone sensitivity (high levels of ER/RP and Ki67>30% or low levels of ER/RP and Ki67<30%)

Materials and methods. The study involved 75 pre- and postmenopausal patients with locally advanced luminal HER2-negative breast cancer who received NHT (tamoxifen/aromatase inhibitors) or NCT (4 cycles of AC and taxanes) in the preoperative period. The primary endpoint was a decrease in Ki67 levels by 50% or more.

Results. The NGT group included 39 patients, the NCT group – 36 patients. Taking into account differences in patient characteristics between the groups, pseudorandomization (propensity matching analysis) was performed for correct comparison, after which 23 patients remained in each group. Operability was achieved in 87% of patients in the NHT group and 91.3% in the NCT group (p = 0.25). A decrease in Ki67 by 50% or more was noted in 47.1% of cases in the NHT group and in 57.1% in the NCT group (p = 0.284), and a decrease to <10% – in 42.9% and 35.3% of cases, respectively (p = 0.66). The frequency of achieving complete pathomorphological regression (pCR) was 10% with NHT and 14.3% with NCT. The 4-year disease-free survival (DFS) with a median follow-up of 46 months in the NHT group was 89.1%, in the NCT group – 84.8% (p = 0.693).

Conclusions. Neoadjuvant chemotherapy and hormonal therapy demonstrate similar efficacy in patients with intermediate hormone sensitivity in terms of the frequency of significant decrease in Ki67, achievement of pCR, DFS rates.

Breast cancer currently occupies the first place in the structure of cancer morbidity in the female population worldwide. Approximately 15–20% of breast cancer patients have overexpression and/or amplification of human epidermal growth factor receptor type 2 (HER2), which causes aggressive biological behavior of the tumor and is associated with poor prognosis. Anti-HER2 therapies have significantly improved the prognosis of patients with HER2-positive breast cancer. Starting from the earliest stages (T2 and/or N+), patients should be treated with neoadjuvant drug therapy, which allows direct assessment of treatment efficacy, increases the chances of organ-preserving surgery, and helps to tailor postneoadjuvant therapy. Anthracycline-based chemotherapy regimens have historically been the first treatment option for HER2-positive breast cancer, as HER2 status is a predictor of anthracycline efficacy. However, the development of new agents and the resulting emergence of novel combinations with multiple anti-HER2 agents have provided an opportunity to explore anthracycline-free regimens aimed at reducing adverse events and improving patient quality of life. The results of the BCIRG-006 trial investigating the adjuvant use of such regimens and, later, neoadjuvant assignment in the TRAIN-2 protocol marked a turning point in the use of non-anthracycline regimens. One important open question is the appropriateness of adding carboplatin, as direct comparisons of non-anthracycline combinations with or without carboplatin are lacking. There is now strong evidence of the impact of achieving a complete pathomorphological response (pCR) after the neoadjuvant phase of treatment on long-term oncologic outcomes. The development and validation of possible biomarkers that predict achievement of pCR is extremely promising.

The article presents the results of the study of the diffusion capacity of the lungs (DSL) for carbon monoxide by single inhalation (DLco) in children with acute leukemia (AL) and acquired idiopathic aplastic anemia (AIAA) after allogeneic hematopoietic stem cell transplantation (HSCT). A comparative analysis of the DLco indicator before the HSCT and on the 30th, 90th, 180th, 360th days after it was carried out. Its significant irreversible decrease was revealed starting from 30 days after HSCT during the year of follow-up in most patients with AL. In children with AIAA, a significant decrease in DSL was also registered after a month of follow-up, however, by a year of dynamic control, the changes were less pronounced than in AL group, and the average DLco value was restored to indicators before transplantation. This method is important to use in a comprehensive assessment of the functional state of the respiratory system for the timely diagnosis of pulmonary complications after HSCT.

Relevance. Improving the diagnosis and treatment of children with lymphoid tumors (LT) contributes to an increase in the number of cured patients. Antitumor therapy has a side effect on the nervous system, and can lead to neurotoxic consequences. Due to the increased life expectancy of children cured of LT, the assessment of the long-term neurotoxic effects of antitumor therapy is relevant.

Objective: based on the literature data, to study the long-term neurotoxic side effects of antitumor therapy in children cured of LT.

Material and methods. When writing a literature review, data were analyzed in specialized medical databases Pubmed, Scopus, Web of Science on research in children cured of lymphoid tumors from 1993 to 2023.

Results. In cured children from lymphoid tumors, the long-term neurotoxic effects of therapy containing methotrexate in high doses are manifested by neurocognitive decline and structural changes in the brain. Late peripheral neuropathy caused by vincristine affects the quality of life of patients in physical and social aspects. However, the prognostic parameters of long-term neurotoxic effects in children cured of LT have not been determined. The issues of monitoring patients in the long term have not been sufficiently studied. This will contribute to the rehabilitation and long-term follow-up of patients with oncohematological diseases, and improve their quality of life.

Background. Currently, after subcutaneous/skin-preserving mastectomies with simultaneous reconstruction in cancer of stages I–II, the need for radiation therapy is debatable, especially in the presence of favorable subtypes or when complete clinical regression is achieved after neoadjuvant polychemotherapy.

Materials and methods. A retrospective non-randomized study was conducted, which included 1135 breast cancer patients who received treatment at the P.A. Herzen Moscow State Medical Institute from 2014 to 2023, in all patients the surgical stage included subcutaneous/skinpreserving mastectomies with simultaneous reconstruction. The patients were divided into 2 groups – with and without radiation therapy.

Results. Relapses were analyzed by groups depending on the clinical and morphological features of tumors, with a detailed analysis of the data obtained.

Conclusion. Among patients I–IIA, In the stages of breast cancer after PME/CME with reconstruction included in the study, the risk of recurrence over 5 years was 4.3± 0.1% of cases. The recurrence in the group with radiation therapy was 2.5±0.6%, without radiation therapy 6.9±1.2% (p0.05), thus radiation therapy reduces the risk of recurrence by 4.4%. In our study, the following criteria were identified for the appointment of radiation therapy in the postoperative period: resection margin R1, luminal/non-luminal NONR2 positive type, rN1.

In accordance with the International Classification of Diseases 10th Revision (ICD-10), malignant tumors (MT) of the nasal cavity and paranasal sinuses include diagnosis codes with sub-codes C30 and C31. In world and state statistics, summary data on morbidity is summarized under two diagnosis codes, C30 and C31. Our PCR database of the North-West Federal District of the Russian Federation contains more than 1.5 million cases, which allows us to consider the peculiarities of the prevalence of cancer in rare groups of malignant neoplasms. The population of the Northwestern Federal District of the Russian Federation is 13.9 million people, which is more than the population of Belarus, Latvia and Estonia combined.

Objective. To study the prevalence and survival patterns of patients with malignant neoplasms of the nasal cavity, middle ear and paranasal sinuses using the database of the newly created NMR of the Northwestern Federal District of the Russian Federation, taking into account the detailed localization structure by subheadings: C30.0.1 and C31 with subheadings C31.0.1–3.8.9.

Materials and methods. The study material is the data of the International Agency for Research on Cancer (IARC), reference books of the P.A. Herzen Moscow Oncology Research Institute and the N.N. Petrov National Medical Research Center of Oncology. Data processing was carried out using licensed programs MS Excel 2013–2016 and STATISTICA 6.1. A modified EUROCARE program was used to calculate survival. The calculations are based on the NMR of St. Petersburg and the Northwestern Federal District of the Russian Federation.

Results and discussion. The conducted study with the analysis of prevalence, assessment of the quality of registration and survival of cancer patients with malignant neoplasms of the nasal cavity, middle ear and paranasal sinuses, confirmed the rarity of this pathology in the world and Russia. In general, a decrease in standardized morbidity rates, including age-related ones, was established. Improvement in the quality of registration of primary patients and provision of medical care was noted. An increase in the one-year survival of patients with malignant neoplasms of the nasal cavity, middle ear over three observation periods by 20.5% and paranasal sinuses by 15.4% was revealed. Five-year survival has remained virtually unchanged.