№74. The most important events in Oncology in 2017

This review summarizes the most interesting findings in experimental oncology made within the year 2017. Recent data on the role of host microbiome in pathogenesis of human tumours are discussed. Overview on novel approaches to cancer treatment is provided. Advances in high-throughput investigations in oncology are summarized.

Keywords: oncology, microbiome, tumor, cancer treatment methods, medical and biological technologies.

Main principles of drug therapy were formulated more than 50 years ago but still are used in clinical practice. Undoubtedly at that time they were revolutionizing and allowed to achieve cure for some tumors. Besides this the vast majority of patients with solid tumors though live significantly longer still cannot saved from the disease. Not much optimism might be drawn from the newer concepts of cancer evolution that clearly defines impossibility of cure with conventional modern approaches. The newer drugs less toxic and some times more efficacious still would hardly defeat the diversity of cancer phenotypes. From the registered remedies only half influences overall survival positively. In this article authors try to summarize potential directions for drug therapy evolution.

Keywords: cancer, treatment, tumor kinetics, modeling, adaptive regimens.

Presented and published in 2017 data led to the registration of new drugs or new indications for already registered drugs. Some amendments were made in clinical recommendations of professional oncology societies. The most important changes happened in 2017 in drug treatment of solid tumors are presented in this overview. The new options of adjuvant treatment of melanoma showing good results were introduced in clinical practice. First time median progression free survival after the first line of palliative treatment of non-small cell lung cancer and first line of endocrine treatment of metastatic breast cancer (in combination with CDK4/6 inhibitors) reach 2 years. The results of following clinical trials are briefly presented: FLAURA, ASCEND 4 и 5, ALEX, MONALEESA 2 и 3, MONARCH 2 и 3, ExteNET, OlympiAD.

Keywords: non-small cell lung cancer, breast cancer, Osimertinib, Alectinib, Ribociclib, Abemaciclib, Neratinib, Olaparib.

During past few years new developments in cancer immunotherapy are steadily regarded as major advances in oncology. In 2017 two paradigm changing immunotherapeutic approaches were approved. Adoptive therapies with CAR T-cells targeting CD19 were first approved for the treatment of acute lymphoblastic leukemia and diffuse large B-cell lymphoma. Further for the first time ever tissue-agnostic treatment was approved for use on the basis of the genetic feature of a tumor, rather than the histologic type of cancer or its origin. Namely pembrolizumab therapy was approved for any tumor type harboring microsatellite instability. New options emerged in 2017 for the treatment of urothelial carcinoma, gastroesophageal cancer, non-small cell lung cancer, liver cancer and Merkel cell carcinoma. Research is continued in other tumor types which is expected to broaden the potential of improving cancer treatment.

Keywords: cancer immunotherapy, immune check-point inhibitors, chimeric antigen receptor, clinical trials.

The paper covers specific demographic determinants related to malignant neoplasms throughout the world including morbidity, mortality, and their changes in time. The paper presents data on economic damage and global burden of disease related to oncological diseases. The important part of the review includes the presentation of main threats that influence the development of malignant neoplasms (MN). The paper also gives a review of international practices aimed at implementation, analysis, and efficiency estimation of screening methods for particular types of malignant neoplasms.

Keywords: malignant neoplasms, cancer, demography, threats, screening.

Objectives. The study aims to analyze the results of Gamma Knife radiosurgery for patients with brain metastases from gastrointestinal cancer taking into consideration prognostic factors.

• Material and methods. The study includes 96 patients with GI metastases in the brain, who underwent radiosurgical treatment with Leksell Gamma Knife from 2009 to 2016. Overall survival, local control and the appearance of new metastases in the brain were studied by the Kaplan-Meier method based on follow-up data and control MRI.
• Results. Median overall survival after Gamma Knife radiosurgery was 8,0 months for the entire cohort and differed significantly depending on the RPA class: RPA III – 4,5 months, RPA II – 9,7 months and RPA I – 18,5 months. Local control (stabilization or reduction in tumor volume) was achieved in 94% of cases. The appearance of new metastases in the brain was observed in 47% of patients; the median time to detect new metastatic lesions was 5,8 months. Favorable prognostic factors were a solitary metastasis in the brain and the absence of extra cranial disease.
• Conclusion. Radiosurgical treatment allows one to achieve effective local control of gastrointestinal metastases in the brain and significantly prolong the patients’ life, especially in prognostically favorable classes.

Keywords: brain metastases, gastrointestinal cancer, Gamma-Knife, prognostic factors, RPA classes.

Aim. To evaluate the possibilities of intra-arterial contrast material injection for visualization, navigation, monitoring and evaluation of treatment response during percutaneous cryoablation (PC) of hypovascular liver metastases under the control of flat-detector computed tomography (FDCT).

• Material and methods. In 2017 for treatment of 54 patients with unresectable colorectal liver metastases (n=45) and other hypovascular liver metastases (n=9) 86 procedures of angiographically-assisted FDCT-controlled PC were performed. During PC, various protocols of FDCT hepatic arteriography (FDCT-HA), which were combined with the use of iGuide Needle Guidance and 3D/3D Fusion technologies on the angiographic system Artis Zee Floor (Siemens, Germany), were applied.
• Results. The two methods of intra-arterial contrasting were the most useful during PC: 1) FDCT during capillary phase of infusion hepatic arteriography (FDCT-CPHIHA) – injection of 40 ml contrast material at a rate of 2 ml/second and scanning delay 22 seconds; 2) FDCT during interstitial phase of diffusion hepatic arteriography (FDCT-IPHDHA) – injection of 40 ml contrast material at a rate of 20 ml/minute and scanning delay 300 seconds. The FDCT-CPHIHA allowed detecting and performing PC of metastases with a diameter of less than 10 mm, including those that were not detected by any other diagnostic methods, such as ultrasound, MDCT and/or PET-CT. FDCT-IPHDHA immediately after the end of PC allowed to visualize not only the ablation zone, but also the ablated metastasis contained within it. This made it possible to accurately measure the ablation margin to assess the technical effectiveness of the procedure. FDCT-CPHIHA was also highly effective for early diagnosis of local tumor progression and local tumor recurrence in the liver during dynamic observation of patients.
• Conclusion. The use of intra-arterial contrasting fundamentally improves visualization, navigation, monitoring and evaluation of treatment response during PC of hypovascular liver metastases. The use of FDCT-HA allows not only to detect hypovascular liver metastases with a diameter of less than 10 mm, but also to carry out their PC with reliable control of the efficiency of the procedure according to the magnitude of the ablation margin.

Keywords: ablation, percutaneous cryoablation, diagnosis of liver metastases, treatment of liver metastases, flat-detector computed tomography, FDCT hepatic arteriography.