A. I. Nekrasov, I. Pochinka, L. Strongin, N. Orlinskaya, L. Lugovaya, E. S. Malysheva, I. N. Volovatova
Introduction. The past COVID-19 pandemic has influenced the course of many diseases including endocrine pathology. However, little is known about the clinical and pathogenetic features of thyroid pathology of the post-COVID-19 period.Aim. Evaluate the clinical and pathogenetic features of thyropathies diagnosed during the post-COVID-19 period.Materials and methods. A cross-sectional study included 250 patients with newly diagnosed thyroid diseases. 73 participants denied a history of COVID-19 and 177 suffered from it within the previous 9 months. Thyroid status and thyroid ultrasound examination were assessed. IgG SARS-Cov-2 levels were tested in 40 patients with a history of COVID-19. Fine needle aspiration biopsy was performed in 61 patients including 41 with a history of COVID-19. In the main group, all the samples were additionally investigated by immunocytochemical analysis with SARS-CoV-2 protein antibodies.Results. Among the patients with COVID-19 history higher levels of fT4 (13.6 [12.4; 15.5] vs 12.8 [11.0; 15.3] µmol/l, p = 0.046) and a lower proportion of patients with euthyroidism (122 (68.9%) vs 59 (80.8%), p = 0.037) were detected. In the main group there were more cytological samples with macrophages accumulations (16 (39.0%) vs 2 (10.0%), p = 0.017), however, immunocytochemical study did not reveal any SARS-Cov-2-positive samples. During the post-COVID-19 period, approximately 60% of patients with subclinical thyroid dysfunctions experienced spontaneous normalization. There were correlations between IgG SARS-Cov-2 levels and parameters characterizing the structural and functional state of the thyroid gland.Conclusion. The most typical clinical feature of post-COVID-19 thyropathies was a smaller proportion of individuals with euthyroidism. Mild thyroid dysfunctions identified during the post-COVID-19 period tended to develop spontaneous normalization in 60% of cases. The immunocytochemical tests indicate the absence of SARS-Cov-2 persistence in the thyroid tissue. COVID-19-associated immunopathological reactions are involved in the pathogenesis of post-COVID-19 thyropathies.
{"title":"Clinical and pathogenetic features of thyropathies diagnosed during the post-COVID-19 period","authors":"A. I. Nekrasov, I. Pochinka, L. Strongin, N. Orlinskaya, L. Lugovaya, E. S. Malysheva, I. N. Volovatova","doi":"10.21518/ms2024-242","DOIUrl":"https://doi.org/10.21518/ms2024-242","url":null,"abstract":"Introduction. The past COVID-19 pandemic has influenced the course of many diseases including endocrine pathology. However, little is known about the clinical and pathogenetic features of thyroid pathology of the post-COVID-19 period.Aim. Evaluate the clinical and pathogenetic features of thyropathies diagnosed during the post-COVID-19 period.Materials and methods. A cross-sectional study included 250 patients with newly diagnosed thyroid diseases. 73 participants denied a history of COVID-19 and 177 suffered from it within the previous 9 months. Thyroid status and thyroid ultrasound examination were assessed. IgG SARS-Cov-2 levels were tested in 40 patients with a history of COVID-19. Fine needle aspiration biopsy was performed in 61 patients including 41 with a history of COVID-19. In the main group, all the samples were additionally investigated by immunocytochemical analysis with SARS-CoV-2 protein antibodies.Results. Among the patients with COVID-19 history higher levels of fT4 (13.6 [12.4; 15.5] vs 12.8 [11.0; 15.3] µmol/l, p = 0.046) and a lower proportion of patients with euthyroidism (122 (68.9%) vs 59 (80.8%), p = 0.037) were detected. In the main group there were more cytological samples with macrophages accumulations (16 (39.0%) vs 2 (10.0%), p = 0.017), however, immunocytochemical study did not reveal any SARS-Cov-2-positive samples. During the post-COVID-19 period, approximately 60% of patients with subclinical thyroid dysfunctions experienced spontaneous normalization. There were correlations between IgG SARS-Cov-2 levels and parameters characterizing the structural and functional state of the thyroid gland.Conclusion. The most typical clinical feature of post-COVID-19 thyropathies was a smaller proportion of individuals with euthyroidism. Mild thyroid dysfunctions identified during the post-COVID-19 period tended to develop spontaneous normalization in 60% of cases. The immunocytochemical tests indicate the absence of SARS-Cov-2 persistence in the thyroid tissue. COVID-19-associated immunopathological reactions are involved in the pathogenesis of post-COVID-19 thyropathies.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"14 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141799071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. A. Kuzmina, E. Reutova, K. Laktionov, M. A. Ardzinba
In recent years, the active search and development of new therapeutic agents for a prognostically unfavourable group of patients with disseminated non-small cell lung cancer (NSCLC) has continued. Studies show that the occurrence of lung cancer can be associated with mutations of driver genes such as EGFR, ALK, ROS1, BRAF, KRAS, RET, MET, HER2, NTRK1/2/3, etc., in the normal processes of growth, proliferation, differentiation. The discovery of targeting drugs with high activity against certain mutations has led to a paradigm opening of therapeutic approaches and continued prognosis in serious disease. The presence of activating mutations predetermines the clinical and morphological profile of the patient. One of the random mutations – MET mutation with exon 14 skipping (METex14) is observed, as a rule, in patients of older age group, with disseminated tumour process, more aggressive course of the disease and poor prognosis with chemotherapy alone. This case provides an opportunity for long-term disease control while maintaining satisfactory quality of life in an elderly patient with NSCLC associated with METex14 mutations, as well as providing a major role and method for obtaining next-generation value for personalisation of therapy and new insights into the scientific targets and the future use of molecules to them.
{"title":"Lung cancer associated with an activating mutation in the 14th exon of the MET gene","authors":"V. A. Kuzmina, E. Reutova, K. Laktionov, M. A. Ardzinba","doi":"10.21518/ms2024-244","DOIUrl":"https://doi.org/10.21518/ms2024-244","url":null,"abstract":"In recent years, the active search and development of new therapeutic agents for a prognostically unfavourable group of patients with disseminated non-small cell lung cancer (NSCLC) has continued. Studies show that the occurrence of lung cancer can be associated with mutations of driver genes such as EGFR, ALK, ROS1, BRAF, KRAS, RET, MET, HER2, NTRK1/2/3, etc., in the normal processes of growth, proliferation, differentiation. The discovery of targeting drugs with high activity against certain mutations has led to a paradigm opening of therapeutic approaches and continued prognosis in serious disease. The presence of activating mutations predetermines the clinical and morphological profile of the patient. One of the random mutations – MET mutation with exon 14 skipping (METex14) is observed, as a rule, in patients of older age group, with disseminated tumour process, more aggressive course of the disease and poor prognosis with chemotherapy alone. This case provides an opportunity for long-term disease control while maintaining satisfactory quality of life in an elderly patient with NSCLC associated with METex14 mutations, as well as providing a major role and method for obtaining next-generation value for personalisation of therapy and new insights into the scientific targets and the future use of molecules to them.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"23 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Antonova, I. Dzhanyan, I. V. Savchenko, E. Moroz, K. Laktionov, K. A. Romanova, R. I. Pimenov, Е. V. Sharapova, V. V. Breder
Fibrolamellar hepatocellular carcinoma is a rare primary liver tumor with no known risk factors, which occurs in 1–7% of cases of all hepatocellular carcinoma. The disease occurs mainly in adolescents, as an accidental finding or when symptoms appear already during the metastatic process. The main method of treatment with proven efficacy for localized fibrolamellar hepatocellular carcinoma is surgical. The experience of using radiation therapy and transarterial chemoembolization is contradictory and needs additional study. The option of preferred drug antitumor treatment is not fully clear, and the search for effective therapy regimens and potential targets specific to this form of hepatocellular carcinoma is relevant and requires further study. Considering the rarity of the pathology, the world literature presents data on the treatment of small groups of patients and clinical cases of successful use of a number of medicinal antitumor regimens. However, the data are contradictory. The literature describes isolated clinical cases of successful use of immunotherapy in patients with fibrolamellar hepatocellular carcinoma, requiring further detailed study. Using the example of this clinical case, we have shown the successful long-term use of combined immunotherapy in a patient with fibrolamellar liver carcinoma.
{"title":"Experience with the use of nivolumab and ipilimumab in metastatic fibrolamellar liver carcinoma","authors":"E. Antonova, I. Dzhanyan, I. V. Savchenko, E. Moroz, K. Laktionov, K. A. Romanova, R. I. Pimenov, Е. V. Sharapova, V. V. Breder","doi":"10.21518/ms2024-225","DOIUrl":"https://doi.org/10.21518/ms2024-225","url":null,"abstract":"Fibrolamellar hepatocellular carcinoma is a rare primary liver tumor with no known risk factors, which occurs in 1–7% of cases of all hepatocellular carcinoma. The disease occurs mainly in adolescents, as an accidental finding or when symptoms appear already during the metastatic process. The main method of treatment with proven efficacy for localized fibrolamellar hepatocellular carcinoma is surgical. The experience of using radiation therapy and transarterial chemoembolization is contradictory and needs additional study. The option of preferred drug antitumor treatment is not fully clear, and the search for effective therapy regimens and potential targets specific to this form of hepatocellular carcinoma is relevant and requires further study. Considering the rarity of the pathology, the world literature presents data on the treatment of small groups of patients and clinical cases of successful use of a number of medicinal antitumor regimens. However, the data are contradictory. The literature describes isolated clinical cases of successful use of immunotherapy in patients with fibrolamellar hepatocellular carcinoma, requiring further detailed study. Using the example of this clinical case, we have shown the successful long-term use of combined immunotherapy in a patient with fibrolamellar liver carcinoma.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"3 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141804250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Yudin, К. Laktionov, V. V. Breder, K. A. Sarantseva, E. Reutova
Introduction. Although immuneand targeted therapy have become successful in recent years, platinum-based chemotherapy continues to have a place in the up-front treatment for metastatic non-small cell lung cancer (NSCLC).Aim. Tо evaluate the overall survival (OS) of patients with metastatic NSCLC who were treated with immune checkpoint inhibitors either as first-line or second-line treatment in clinical practice in Russia.Materials and methods. Using real-world database, we retrospectively selected 232 patients with metastatic NSCLC without driving mutations. Of these patients, 82 received chemoimmunotherapy as the initial treatment (group 1) and 150 patients were treated with platinum–based chemotherapy followed by immunotherapy as the second line (group 2). Multivariate subgroup analyses were performed. The median time from the start of treatment to data cut off was 38.4 months.Results. The median OS was the same in the first and second group, 21.0 months (14.4–27.6; 95% CI) and 22.4 months (17.6–27.19; 95% CI); estimated 3-year OS was 40% and 36.6%, respectively. The hazard ratio (HR) for patients in the immunochemotherapy group was 1.02 (0.72–1.44; 95% CI) compared with patients who received second-line immunotherapy. In multivariate analysis, non-compliance with basic inclusion criteria in clinical trials (ECOG 2–3, serious intercurrent illness, active infection, chronic infection, corticosteroids need) (HR = 1.71 (1.21–2.4; 95% CI), the liver metastasis (HR = 1.76 (1.09–2.84; 95% CI) and gender (male vs. female HR = 1.68 (1.04–2.71; 95% DI) were significantly associated with the shorter OS.Conclusions. The overall survival in patients who received immunotherapy in the second line of treatment did not differ from the results of treatment for the patients after immuno-chemotherapy in the first line. The crucial is the receiving of immunotherapy regardless of the line. Failure to meet the criteria of inclusion in clinical trials significantly worsens the long-term outcomes.
{"title":"Immune Checkpoint Inhibitors in first versus second line of metastatic non-small cell lung cancer: Real-World Overall Survival","authors":"D. Yudin, К. Laktionov, V. V. Breder, K. A. Sarantseva, E. Reutova","doi":"10.21518/ms2024-219","DOIUrl":"https://doi.org/10.21518/ms2024-219","url":null,"abstract":"Introduction. Although immuneand targeted therapy have become successful in recent years, platinum-based chemotherapy continues to have a place in the up-front treatment for metastatic non-small cell lung cancer (NSCLC).Aim. Tо evaluate the overall survival (OS) of patients with metastatic NSCLC who were treated with immune checkpoint inhibitors either as first-line or second-line treatment in clinical practice in Russia.Materials and methods. Using real-world database, we retrospectively selected 232 patients with metastatic NSCLC without driving mutations. Of these patients, 82 received chemoimmunotherapy as the initial treatment (group 1) and 150 patients were treated with platinum–based chemotherapy followed by immunotherapy as the second line (group 2). Multivariate subgroup analyses were performed. The median time from the start of treatment to data cut off was 38.4 months.Results. The median OS was the same in the first and second group, 21.0 months (14.4–27.6; 95% CI) and 22.4 months (17.6–27.19; 95% CI); estimated 3-year OS was 40% and 36.6%, respectively. The hazard ratio (HR) for patients in the immunochemotherapy group was 1.02 (0.72–1.44; 95% CI) compared with patients who received second-line immunotherapy. In multivariate analysis, non-compliance with basic inclusion criteria in clinical trials (ECOG 2–3, serious intercurrent illness, active infection, chronic infection, corticosteroids need) (HR = 1.71 (1.21–2.4; 95% CI), the liver metastasis (HR = 1.76 (1.09–2.84; 95% CI) and gender (male vs. female HR = 1.68 (1.04–2.71; 95% DI) were significantly associated with the shorter OS.Conclusions. The overall survival in patients who received immunotherapy in the second line of treatment did not differ from the results of treatment for the patients after immuno-chemotherapy in the first line. The crucial is the receiving of immunotherapy regardless of the line. Failure to meet the criteria of inclusion in clinical trials significantly worsens the long-term outcomes.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"16 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141803000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prognosis of chronic myeloid leukemia (CML) has changed during the past two decades from a disease with an overall survival of 5 years only to one in which patients can enjoy a near normal life-expectancy. Such remarkable improvement in the patients’ outcome is mainly due to the introduction of imatinib into the clinic (the first approved tyrosine kinase inhibitor [TKI]), but also to the approvals of others TKIs. Currently, there are six TKIs available for CML treatment in clinical practice. The article discusses the effectiveness and safety of only the 2nd generation of ITCs, each of which has its own range of both adverse events and advantages when prescribed in the first or subsequent lines of CML therapy. Although a proportion of patients (around 25%) will be able to successfully discontinue TKI treatment after achieving a deep molecular remission, most of them will require to keep on treatment indefinitely. In such a situation, it is crucial for doctors caring for CML patients to be aware of which TKIs are available for each particular clinical situation, what can be expected from them, and how to manage their potential side effects. In the present review, we will briefly address these issues from a practical point of view.
{"title":"Second-generation tyrosine kinase inhibitors in chronic myeloid leukemia today: efficacy and safety","authors":"N. N. Tsyba, A. Turkina","doi":"10.21518/ms2024-222","DOIUrl":"https://doi.org/10.21518/ms2024-222","url":null,"abstract":"The prognosis of chronic myeloid leukemia (CML) has changed during the past two decades from a disease with an overall survival of 5 years only to one in which patients can enjoy a near normal life-expectancy. Such remarkable improvement in the patients’ outcome is mainly due to the introduction of imatinib into the clinic (the first approved tyrosine kinase inhibitor [TKI]), but also to the approvals of others TKIs. Currently, there are six TKIs available for CML treatment in clinical practice. The article discusses the effectiveness and safety of only the 2nd generation of ITCs, each of which has its own range of both adverse events and advantages when prescribed in the first or subsequent lines of CML therapy. Although a proportion of patients (around 25%) will be able to successfully discontinue TKI treatment after achieving a deep molecular remission, most of them will require to keep on treatment indefinitely. In such a situation, it is crucial for doctors caring for CML patients to be aware of which TKIs are available for each particular clinical situation, what can be expected from them, and how to manage their potential side effects. In the present review, we will briefly address these issues from a practical point of view.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"14 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141803784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. R. Volkova, K. Vakhitov, E. K. Rashitova, A. M. Zakirova
Among the childhood cancers, neuroblastoma ranks fourth. This tumour is considered the most common extracranial malignant neoplasm in children and was first described in 1865 by the German scientist Rudolf Virchow. Neuroblastoma has the unique ability to undergo increased cell differentiation and transform into ganglioneuroma. In some cases, the disease can be asymptomatic and may undergo spontaneous regression or maturation into a benign tumour. However, neuroblastoma often has an aggressive course with early metastasis. Due to the ambiguity of clinical symptoms, the primary diagnosis of neuroblastoma in children requires pediatricians to be acutely aware of oncological emergencies and initial signs such as increased abdominal size and asymmetry, neurological symptoms, pain, and dysuria. In low-risk patients, minimal therapy, including surgery alone, achieves long-term survival in more than 90% of cases. Achieving similarly high survival rates in the intermediate-risk group is possible only with the use of modern polychemotherapy regimens in combination with surgical treatment and, in some cases, radiation therapy. High-risk patients require a combination of the aforementioned methods together with autologous or allogeneic hematopoietic stem cell transplantation, with long-term overall survival rates not exceeding 50%. The most favorable prognosis is seen in patients with localised disease under the age of one year. This article describes the features of tumour development, the course of the disease, and the evolution of diagnostic and therapeutic strategies from the past to the present.
{"title":"Neuroblastoma in children: What has changed in the 21st century","authors":"A. R. Volkova, K. Vakhitov, E. K. Rashitova, A. M. Zakirova","doi":"10.21518/ms2024-255","DOIUrl":"https://doi.org/10.21518/ms2024-255","url":null,"abstract":"Among the childhood cancers, neuroblastoma ranks fourth. This tumour is considered the most common extracranial malignant neoplasm in children and was first described in 1865 by the German scientist Rudolf Virchow. Neuroblastoma has the unique ability to undergo increased cell differentiation and transform into ganglioneuroma. In some cases, the disease can be asymptomatic and may undergo spontaneous regression or maturation into a benign tumour. However, neuroblastoma often has an aggressive course with early metastasis. Due to the ambiguity of clinical symptoms, the primary diagnosis of neuroblastoma in children requires pediatricians to be acutely aware of oncological emergencies and initial signs such as increased abdominal size and asymmetry, neurological symptoms, pain, and dysuria. In low-risk patients, minimal therapy, including surgery alone, achieves long-term survival in more than 90% of cases. Achieving similarly high survival rates in the intermediate-risk group is possible only with the use of modern polychemotherapy regimens in combination with surgical treatment and, in some cases, radiation therapy. High-risk patients require a combination of the aforementioned methods together with autologous or allogeneic hematopoietic stem cell transplantation, with long-term overall survival rates not exceeding 50%. The most favorable prognosis is seen in patients with localised disease under the age of one year. This article describes the features of tumour development, the course of the disease, and the evolution of diagnostic and therapeutic strategies from the past to the present.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"50 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141805061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Menshikov, A. Nasretdinov, N. Sultanbaeva, O. Lipatov, S. Musin, I. Menshikova, A. A. Volkov, S. Galimov, A. V. Sultanbaev
In the middle of the last century, the discovery of a number of cytotoxic agents was an incredible achievement in the treatment of malignant tumors. However, their use was limited by adverse events, primarily the development of myelosuppression. The occurrence of neutropenia is associated with frequent and extremely dangerous events that do not allow timely initiation of a new cycle of therapy and increases risk of infectious complications. Over the years, many attempts have been made to develop optimal management tactics for patients receiving cytotoxic therapy, including antibiotic therapy, the use of nonspecific myelopoiesis modulators, and even blood transfusions. With the advent of granulocyte precursor maturation stimulators in 1983, the situation has improved greatly. Filgrastim and its bioanalogues, registered later, made it possible to reconsider approaches to the use of intensified chemotherapy regimens. It has become possible to control the incidence of neutropenia using only subcutaneous forms of granulocyte colony-stimulating factors (GCSF). The article presents a clinical observation of the use of filgrastim in neoadjuvant therapy of early breast cancer. Filgrastim not only helped to cope with the development of newly diagnosed febrile neutropenia, but during continued treatment it prevented the development of adverse events. The administration of GCSF allowed timely completion of treatment with a complete pathological response, providing the patient with better survival prognosis.
{"title":"The role of G-CSF in the prevention of cytostaticassociated adverse events during antitumor drug therapy","authors":"K. Menshikov, A. Nasretdinov, N. Sultanbaeva, O. Lipatov, S. Musin, I. Menshikova, A. A. Volkov, S. Galimov, A. V. Sultanbaev","doi":"10.21518/ms2024-257","DOIUrl":"https://doi.org/10.21518/ms2024-257","url":null,"abstract":"In the middle of the last century, the discovery of a number of cytotoxic agents was an incredible achievement in the treatment of malignant tumors. However, their use was limited by adverse events, primarily the development of myelosuppression. The occurrence of neutropenia is associated with frequent and extremely dangerous events that do not allow timely initiation of a new cycle of therapy and increases risk of infectious complications. Over the years, many attempts have been made to develop optimal management tactics for patients receiving cytotoxic therapy, including antibiotic therapy, the use of nonspecific myelopoiesis modulators, and even blood transfusions. With the advent of granulocyte precursor maturation stimulators in 1983, the situation has improved greatly. Filgrastim and its bioanalogues, registered later, made it possible to reconsider approaches to the use of intensified chemotherapy regimens. It has become possible to control the incidence of neutropenia using only subcutaneous forms of granulocyte colony-stimulating factors (GCSF). The article presents a clinical observation of the use of filgrastim in neoadjuvant therapy of early breast cancer. Filgrastim not only helped to cope with the development of newly diagnosed febrile neutropenia, but during continued treatment it prevented the development of adverse events. The administration of GCSF allowed timely completion of treatment with a complete pathological response, providing the patient with better survival prognosis.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"51 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141805046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. L. Kornietskaya, S. Evdokimova, L. V. Bolotina, A. A. Fedenko
Gastric cancer (GC) is one of the most aggressive and unfavorably ongoing malignant neoplasms, occupying the fifth and fourth places in the structure of oncological morbidity and mortality, respectively. Overexpression of the human epidermal growth factor receptor 2 (HER2-neu) is detected in about 20% of patients with advanced GC, which made it possible to successfully use trastuzumab in combination with chemotherapy (CT) in this cohort of patients. The development of resistance to trastuzumab is a serious problem that requires research and development of new therapy targeted to blockHER2-neu. Trastuzumab deruxtecan is an antibody–drug conjugate consisting of an antibody to the HER2-neu receptor and a topoisomerase inhibitor linked by a cleavable tetrapeptide-based linker. The drug has proven its effectiveness as a monotherapy for the treatment of patients with metastatic or locally advanced HER2-positive gastric adenocarcinoma or cardio esophageal junction in the 2nd and subsequent lines of treatment. In the above clinical case a 57-year-old patient with CEС adenocarcinoma with metastatic liver damage, distant lymphnodes and the presence of HER2-neu overexpression is presented. After the standard first-line drug treatment according to the XELOX scheme with trastuzumab, the patient underwent surgical treatment followed by postoperative chemotherapy according to the FOLFOX scheme in combination with trastuzumab. Given the negative dynamics, the next step was 3 injections of nivolumab immunotherapy, which eventually led to the development of autoimmune hepatitis and rapid progression of the disease. Almost the last hope for the patient was the introduction of trastuzumab deruxtecan, which allowed for an objective response, as well as an improvement in the patient’s clinical condition, which led to the achievement of the longest possible progression-free survival (PFS).
{"title":"Fourth-line Trastuzumab deruxtecan in HER2-positive metastatic gastric cancer","authors":"A. L. Kornietskaya, S. Evdokimova, L. V. Bolotina, A. A. Fedenko","doi":"10.21518/ms2024-250","DOIUrl":"https://doi.org/10.21518/ms2024-250","url":null,"abstract":"Gastric cancer (GC) is one of the most aggressive and unfavorably ongoing malignant neoplasms, occupying the fifth and fourth places in the structure of oncological morbidity and mortality, respectively. Overexpression of the human epidermal growth factor receptor 2 (HER2-neu) is detected in about 20% of patients with advanced GC, which made it possible to successfully use trastuzumab in combination with chemotherapy (CT) in this cohort of patients. The development of resistance to trastuzumab is a serious problem that requires research and development of new therapy targeted to blockHER2-neu. Trastuzumab deruxtecan is an antibody–drug conjugate consisting of an antibody to the HER2-neu receptor and a topoisomerase inhibitor linked by a cleavable tetrapeptide-based linker. The drug has proven its effectiveness as a monotherapy for the treatment of patients with metastatic or locally advanced HER2-positive gastric adenocarcinoma or cardio esophageal junction in the 2nd and subsequent lines of treatment. In the above clinical case a 57-year-old patient with CEС adenocarcinoma with metastatic liver damage, distant lymphnodes and the presence of HER2-neu overexpression is presented. After the standard first-line drug treatment according to the XELOX scheme with trastuzumab, the patient underwent surgical treatment followed by postoperative chemotherapy according to the FOLFOX scheme in combination with trastuzumab. Given the negative dynamics, the next step was 3 injections of nivolumab immunotherapy, which eventually led to the development of autoimmune hepatitis and rapid progression of the disease. Almost the last hope for the patient was the introduction of trastuzumab deruxtecan, which allowed for an objective response, as well as an improvement in the patient’s clinical condition, which led to the achievement of the longest possible progression-free survival (PFS).","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"33 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141805263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. V. Petkau, E. Bessonova, A. Tarkhanov, M. V. Kartashov, M. A. Anashkina
Introduction. An increase in the life expectancy of patients with HCC can be achieved both by improving treatment methods and by implementing early examination through screening programs.Aim. Evaluation of the impact of screening in risk groups on early detection of HCC, on the possibility of specialized treatment, on one-year overall survival of patients with HCC.Materials and methods. The clinical records of 148 patients with HCC and liver cirrhosis (LC) who received medical care at the Sverdlovsk Regional Oncology Center in 2022 with the follow-up period exceeding 12 months were retrospectively studied. HCC was diagnosed as a result of screening carried out on the basis of the Regional Hepatological Center in 34 patients. 114 patients were referred to the oncological hospital due to the detection of a malignant tumor in liver during examination in cause of complaints. The compared groups of patients did not differ in age and sex composition, in the frequency of smoking, alcohol consumption, drug addiction, viral hepatitis B, obesity, diabetes mellitus, arterial hypertension, oncological heredity, in the distribution of LC by class. Patients with HCC detected at screening had a better general somatic status (p < 0.001), more often had viral hepatitis C (82.4% vs. 35.1%, p < 0.001) and AFP above normal (64.7% vs. 43.0%, p = 0.027).Results. Screening influenced the staging of newly diagnosed patients with HCC. If the proportion of stages B and C according to the Barcelona system remained the same, then stage A accounted for 32.4% versus 12.3% (OR = 3.42; 95% CI 1.37–8.49; p = 0.007). Stage D, on the contrary, was less: 8.8% vs. 36.8% (OR = 0.17; 95% CI 0.05–0.58; p = 0.002). Identification at earlier stages and better general condition of patients influenced the possibilities and results of treatment. In the HCC group after screening more patients received treatment: 88.2% versus 56.1% (OR = 5.86; 95% CI 1.94–17.73; p < 0.001). There was a higher one-year overall survival: 79.4% vs 39.5% (OR = 5.91; 95% CI 2.38–14.73; p < 0.001).Conclusion. Screening for HCC in risk groups improves early diagnosis, increases the likelihood of patients receiving specialized anticancer treatment and increases the one-year overall survival rate.
简介通过改进治疗方法和实施筛查计划进行早期检查，可以延长 HCC 患者的预期寿命。评估高危人群筛查对早期发现 HCC、专业治疗的可能性以及 HCC 患者一年总生存率的影响。回顾性研究了 2022 年在斯维尔德洛夫斯克地区肿瘤中心接受治疗的 148 名 HCC 和肝硬化（LC）患者的临床记录，随访时间超过 12 个月。34名患者在地区肝病中心的筛查中被确诊为HCC。114名患者因主诉检查发现肝脏中存在恶性肿瘤而被转诊至肿瘤医院。两组患者在年龄和性别组成、吸烟频率、饮酒、吸毒、乙型病毒性肝炎、肥胖、糖尿病、动脉高血压、肿瘤遗传以及肝癌等级分布方面均无差异。筛查发现的 HCC 患者一般体质较好（P < 0.001），更常患有丙型病毒性肝炎（82.4% 对 35.1%，P < 0.001）和甲胎蛋白高于正常值（64.7% 对 43.0%，P = 0.027）。筛查对新诊断的 HCC 患者的分期有影响。如果根据巴塞罗那系统进行的 B 期和 C 期比例保持不变，那么 A 期患者占 32.4%，而 C 期患者占 12.3%（OR = 3.42；95% CI 1.37-8.49；p = 0.007）。相反，D 阶段的比例较低：8.8% 对 36.8%（OR = 0.17；95% CI 0.05-0.58；p = 0.002）。在较早阶段进行识别以及患者的一般状况较好，都会影响治疗的可能性和效果。在筛查后的 HCC 组中，更多患者接受了治疗：88.2% 对 56.1%（OR = 5.86；95% CI 1.94-17.73；p < 0.001）。一年总生存率更高：79.4% 对 39.5%（OR = 5.91；95% CI 2.38-14.73；P < 0.001）。对高危人群进行 HCC 筛查可提高早期诊断率，增加患者接受专业抗癌治疗的可能性，并提高一年总生存率。
{"title":"Impact of hepatocellular cancer screening on early diagnostics and overall survival: own data","authors":"V. V. Petkau, E. Bessonova, A. Tarkhanov, M. V. Kartashov, M. A. Anashkina","doi":"10.21518/ms2024-231","DOIUrl":"https://doi.org/10.21518/ms2024-231","url":null,"abstract":"Introduction. An increase in the life expectancy of patients with HCC can be achieved both by improving treatment methods and by implementing early examination through screening programs.Aim. Evaluation of the impact of screening in risk groups on early detection of HCC, on the possibility of specialized treatment, on one-year overall survival of patients with HCC.Materials and methods. The clinical records of 148 patients with HCC and liver cirrhosis (LC) who received medical care at the Sverdlovsk Regional Oncology Center in 2022 with the follow-up period exceeding 12 months were retrospectively studied. HCC was diagnosed as a result of screening carried out on the basis of the Regional Hepatological Center in 34 patients. 114 patients were referred to the oncological hospital due to the detection of a malignant tumor in liver during examination in cause of complaints. The compared groups of patients did not differ in age and sex composition, in the frequency of smoking, alcohol consumption, drug addiction, viral hepatitis B, obesity, diabetes mellitus, arterial hypertension, oncological heredity, in the distribution of LC by class. Patients with HCC detected at screening had a better general somatic status (p < 0.001), more often had viral hepatitis C (82.4% vs. 35.1%, p < 0.001) and AFP above normal (64.7% vs. 43.0%, p = 0.027).Results. Screening influenced the staging of newly diagnosed patients with HCC. If the proportion of stages B and C according to the Barcelona system remained the same, then stage A accounted for 32.4% versus 12.3% (OR = 3.42; 95% CI 1.37–8.49; p = 0.007). Stage D, on the contrary, was less: 8.8% vs. 36.8% (OR = 0.17; 95% CI 0.05–0.58; p = 0.002). Identification at earlier stages and better general condition of patients influenced the possibilities and results of treatment. In the HCC group after screening more patients received treatment: 88.2% versus 56.1% (OR = 5.86; 95% CI 1.94–17.73; p < 0.001). There was a higher one-year overall survival: 79.4% vs 39.5% (OR = 5.91; 95% CI 2.38–14.73; p < 0.001).Conclusion. Screening for HCC in risk groups improves early diagnosis, increases the likelihood of patients receiving specialized anticancer treatment and increases the one-year overall survival rate.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"50 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141805565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anticancer drug therapy has made significant progress in the last two decades. However, the correction of adverse events and complications that arise during treatment requires special attention. Most often, special antitumor therapy can cause side effects from the gastrointestinal tract. Chemo-induced nausea and vomiting is the most common adverse event associated with drug therapy of cancer. It significantly worsens the well-being and quality of life of patients. With multiple cycles of chemotherapy, episodes of both acute and delayed nausea/vomiting may occur. There are several pharmacological groups of antiemetics. The most effective regimen for the prevention of chemotherapy-induced nausea and vomiting is a combination of serotonin receptor (5-HT3) and neurokinin receptor (NK-1) antagonists. It provides high symptom control in both the acute and delayed phases of nausea/vomiting. Palonosetron, a new-generation serotonin receptor antagonist, differs from firstgeneration 5-HT3 receptor antagonists in its stronger and longer-lasting antiemetic effect with a comparable safety profile. Oral administration of palonosetron is not inferior in effectiveness to its intravenous administration. An oral combination drug containing the NK-1 antagonist netupitant and the 5-HT3 antagonist palonosetron is highly effective in preventing nausea and vomiting in moderately and highly emetogenic drug regimens. The long half-life of both drugs and their high affinity to their receptors provide a long-lasting and persistent effect even with a single dose. This combination is particularly effective in relieving symptoms of delayed nausea/vomiting. A number of clinical studies have demonstrated that a single oral dose of netupitant/palonosetron combination is significantly more effective than 3-day aprepitant-based regimens in preventing delayed chemotherapy-induced nausea and vomiting. In addition, the netupitant/palonosetron combination may be cost-effective by reducing the cost of managing of complications of poorly controlled nausea and vomiting.
{"title":"Real hopes in antiemetic therapy","authors":"L. Kogoniya","doi":"10.21518/ms2024-194","DOIUrl":"https://doi.org/10.21518/ms2024-194","url":null,"abstract":"Anticancer drug therapy has made significant progress in the last two decades. However, the correction of adverse events and complications that arise during treatment requires special attention. Most often, special antitumor therapy can cause side effects from the gastrointestinal tract. Chemo-induced nausea and vomiting is the most common adverse event associated with drug therapy of cancer. It significantly worsens the well-being and quality of life of patients. With multiple cycles of chemotherapy, episodes of both acute and delayed nausea/vomiting may occur. There are several pharmacological groups of antiemetics. The most effective regimen for the prevention of chemotherapy-induced nausea and vomiting is a combination of serotonin receptor (5-HT3) and neurokinin receptor (NK-1) antagonists. It provides high symptom control in both the acute and delayed phases of nausea/vomiting. Palonosetron, a new-generation serotonin receptor antagonist, differs from firstgeneration 5-HT3 receptor antagonists in its stronger and longer-lasting antiemetic effect with a comparable safety profile. Oral administration of palonosetron is not inferior in effectiveness to its intravenous administration. An oral combination drug containing the NK-1 antagonist netupitant and the 5-HT3 antagonist palonosetron is highly effective in preventing nausea and vomiting in moderately and highly emetogenic drug regimens. The long half-life of both drugs and their high affinity to their receptors provide a long-lasting and persistent effect even with a single dose. This combination is particularly effective in relieving symptoms of delayed nausea/vomiting. A number of clinical studies have demonstrated that a single oral dose of netupitant/palonosetron combination is significantly more effective than 3-day aprepitant-based regimens in preventing delayed chemotherapy-induced nausea and vomiting. In addition, the netupitant/palonosetron combination may be cost-effective by reducing the cost of managing of complications of poorly controlled nausea and vomiting.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"48 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141805004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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