№82. The most important events in Oncology in 2019

This paper describes the most remarkable advances in fundamental and translational oncology occurred within the year 2019. The discussion includes various aspects of acquired tumor drug resistance, breakthrough in the treatment of RAS-mutated tumors, use of CRISPR-Cas9 technology for genome editing, results of genome profiling-driven clinical trials, progress in the metastasis research etc. The article is aimed at clinical oncologists, various professionals working in medicine and biology, students etc.

Keywords: oncology, genome, resistance to therapy, genomic profiling of neoplasms, clinical trials.

Microbiome is a now thought to be a unique isolated ecosystem, that tightly interact with host organism. Among functions that are influenced by microbiome we can mention energetic homeostasis, central nervous system functioning, activity of innate and diversity of adaptive immunity. As a consequence of such interaction the qualitative and quantitative composition of microbiome might influence many pathologic and physiologic processes, among which are malignant solid tumors. In this article we try to summarize up-to-date information on the role of microbiome in the appearance, clinical course and treatment of various solid tumors.

Keywords: drug therapy, cancer, microbiome, immunotherapy.

The article focused on the changes in the treatment approaches in patients with the gastrointestinal malignances in 2019–2020. How to treat a patient with operable gastric cancer, what is more effective – perioperative or postoperative chemotherapy? What is the true effectiveness of immunotherapy and is it possible to reduce the intensity of treatment for patients with advanced gastric cancer. Did we achieve a personification of treatment for pancreatic cancer? What is the new standard of the first-line for advanced hepatocellular cancer? We critically examine studies in early and advanced colon cancer.

Keywords: cancer, chemotherapy, immunotherapy, targeted therapy.

Introduction: patients with advanced ovarian cancer have unfavorable prognosis after primary debulking surgery if the size of residual tumor exceeds 1 cm. The optimal approaches to systemic treatment of these patients remain unknown. We evaluated the efficacy and safety of dose-dense chemotherapy in frontline treatment of ovarian cancer patients after upfront non-optimal debulking surgery.

Patients and methods: this was a non-randomized single-arm phase II trial. We enrolled patients with advanced (FIGO
III–IV) epithelial ovarian who underwent non-optimal upfront debulking surgery with residual tumor size >10 mm. All patients were treated with dose-dense chemotherapy (i.e., paclitaxel 80 mg/m2 day 1, 8, 15 + carboplatin AUC6 day 1, cycled every 21 days – 6 cycles). The primary end point of the trial was progression-free survival (PFS).

Statistical hypothesis: according to the historical data of our department, 1-year PFS in this category of patients equals to 51%. To increase 1-year PFS to 70%, 39 patients should be enrolled with α=0,05 and β=0,20 and estimated data loss for 10% of patients.

Results: the study included 39 patients, median age was 56,9 years, 23% of patients had stage IV disease. Median followup was 24,0 months. The 1-year PFS was 76,9%, the median PFS was 19,8 months. The 1-year overall survival rate was 92,3% with median OS not reached with specified follow-up period. Severe neutropenia, anemia, thrombocytopenia was observed in 82,1%, 53,8%, 15,3% of patients, respectively.

Conclusion: the results of the study showed high efficacy of dose-dense chemotherapy as front line of treatment for advanced ovarian cancer patients after non-optimal upfront debulking surgery

Keywords: ovarian cancer, dose-dense chemotherapy, dose-intensive chemotherapy, suboptimal debulking, non-optimal debulking.

This article describes the potential uses of liquid biopsy for non-small cell lung cancer as a method for determining the mutational profile, as well as minimal residual disease after radical surgical treatment. This paper describes the advantages and disadvantages of this method compared to tissue biopsy. Presented potential applications of liquid biopsy to personalize treatment.

Keywords: non-small cell lung cancer, fluid biopsy, mutation profile, minimal residual disease

The purpose of this report is to analyze your own clinical data on the usefulness of apathinib in the second line of therapy for pulmonary adenocarcinoma. On the basis of MONIKI medical institutions, material was accumulated for 12 patients with lung adenocarcinoma who received the second line of therapy with Afatinib.

Keywords: lung cancer, adenocarcinoma, non-small cell lung cancer, EGFR mutation, chemotherapy, targeted therapy, efficacy, elderly, side effects

Aim: to demonstrate the features of the examination of the quality of medical care for patients with metastatic kidney cancer.

Materials and methods: the incidence of kidney cancer is increasing both in Russia and around the world. Despite the improvement of the methods of special diagnostics and in the absence of clinical manifestations of the disease in the early stages of the oncological process, it is sometimes difficult to detect kidney neoplasms, and the clinical picture of metastatic kidney cancer may resemble other various diseases. A case of a patient with a metastatic kidney cancer is presented.

Results: peculiarities of patient routing to various medical institutions of St. Petersburg with the assessment of the quality of medical care in a patient with advanced form of cancer of the renal origin were demonstrated. Indicators of laboratory and instrumental examination methods are reviewed in dynamics. The course of the disease and its outcome are analyzed in the light of modern clinical recommendations for urology, oncology and the assessment of the quality and safety of medical activity.

Conclusion. With proper organization of medical care, which is provided by health managers, technological problems that arise directly during the examination and treatment are eliminated as soon as possible, without defects. In the absence of opportunities for proper medical and diagnostic measures in medical organizations, the leadership of a healthcare institution together with specialists should be able to route patients to specialized medical centers where examination and treatment can be guaranteed to be carried out at the highest possible level of medical knowledge.

Keywords: malignant neoplasms, kidney tumors, metastatic kidney cancer, quality of care.