Background. Lung cancer continues to be in the leading positions in mortality among all malignant neoplasms; 85 % of all cases are nonsmall cell lung cancer (NSCLC), and in 40 % of patients the process is diagnosed at a common unresectable stage. Chemoradiotherapy is the standard of treatment for this category of patients, which allows to improve the results of local control and overall survival. In Russia, chemoradiotherapy accounts for about 4 % of all treatment methods. Perhaps this is due to high toxicity of this method and, as a result, a deterioration in quality of life of patients.

Aim. To assess the quality of life of patients with locally advanced NSCLC during simultaneous chemoradiotherapy in combination with and without accompanying immunotherapy.

Materials and methods. The study included 60 patients with locally advanced NSCLC. The study group (n = 30) received a radical course of simultaneous chemoradiotherapy with the use of accompanying immunotherapy with azoximer bromide. Patients in the control group (n = 30) underwent a course of simultaneous chemoradiotherapy in the standard mode. We evaluated the criteria of quality of life in patients using questionnaires EORTC QLQ-LC13, EQ-5D-5L, EORTC QLQ-C30.

Results. In the study group, an improvement in most of the parameters of quality of life and a decrease in the severity of symptoms were demonstrated compared with the control group.

Conclusion. The study demonstrated a tendency to reduce hematological toxicity and improve the quality of life of patients with NSCLC. This allows us to consider the possibility of using accompanying immunotherapy in combination with chemoradiotherapy as an additional therapeutic option that improves the quality of life of patients and the tolerability of the treatment.

Aim. To study the role of progesterone receptor expression, tumor grade and Ki-67 level as possible predictors of pathological complete response (pCR) to neoadjuvant chemotherapy in patients with stage IIA–IIB (cT1–2N1, cT2–3N0M0) breast cancer of hormone-positive HER2-negative subtype.

Materials and methods. We retrospectively analysed the efficacy of neoadjuvant chemotherapy (4AC+12P/4T) in 100 patients with cancer stages IIA–IIB (cT1–2N1, cT2–3N0M0) of hormone-positive HER2-negative subtype treated at the P.A. Hertsen Moscow Oncology Research Institute from 2013 to 2022. The pathological response to neoadjuvant chemotherapy depending on the level of progesterone receptor expression, tumour grade (G) and tumour proliferation index (Ki-67) were evaluated.

Results. Pathological complete response was achieved in 12 of 100 patients. The progesterone receptor expression ≤3 Allred pCR scores were found in 16.1 % (5/31) of patients, whereas with progesterone receptor >3 scores in 10.1 % (7/69) (odds ratio 1.703; 95 % confidence interval (CI) 0.495–5.860; p = 0.507). Patients with high tumour grade (G3) achieved pCR in 12.1 % (4/33) cases and with G2 – in 11.9 % (8/67) (odds ratio 1.017; 95 % CI 0.283–3.658; p = 1.000). With the Ki-67 levels ≥50 % pCR was achieved in 14.6 % (7/48) cases compared to 9.6 % (5/52) with Ki-67 levels <50 %(odds ratio 1.605; 95 % CI 0.473–5.445; p = 0.544). The Ki-67 threshold for achieving pCR was 70 % (area under the ROC curve 0.663 ± 0.090; 95 % CI 0.486–0.840; p = 0.068) and for progesterone receptors was 3 points (area under the ROC curve 0.625 ± 0.080; 95 % CI 0.467–0.782; p = 0.156).

Conclusion. This analysis highlights the importance of considering all clinical and morphological characteristics of the tumour when planning the scope of treatment for hormone-positive HER2-negative breast cancer. The results obtained may serve as a basis for a more personalised therapeutic approach.

Retrospective analysis of the treatment results of 156 patients with locally advanced and disseminated esophageal squamous cell carcinoma was performed. The patient group included 124 (79.3 %) men (median age 64 years) and 32 (20.5 %) women (median age 63.4 years). Metastases were found primarily in the lymph nodes – 136 (87.2 %) cases, lungs – 44 (28.2 %) cases, liver – 38 (24.4 %) cases. The patients received treatment with a two-component drug combination: paclitaxel + carboplatin (ТР), or a four-component combination: docetaxel + cisplatin + leucovorin + 5-fluorouracil (mDCF). The mDCF combination showed higher rates of toxicity: hematogenic (neutropenia) and non-hematogenic (asthenia, weight loss, lower limb edema) complications. In 37 (23.7 %) patients, grade III and IV dysphagia were diagnosed. It was managed by endoscopic installation of self-expanding stents. Currently, despite toxic side symptoms, both schemes are safe and are the most commonly prescribed for locally advanced and disseminated esophageal squamous cell carcinoma.

Significant progress has been made in the treatment of multiple myeloma (MM), leading to improved clinical outcomes. However, despite the success of traditional methods such as surgery, radiotherapy, and chemotherapy, the challenge of fully curing patients with relapsed and refractory MM remains pressing. A promising therapeutic approach is the use of chimeric antigen receptor T-cells (CAR-T), which has demonstrated efficacy in patients with resistant B-cell malignancies and is actively being studied for the treatment of MM. Special attention is being given to B-cell maturation antigen (BCMA) as a potential target for CAR-T therapy in MM.

The objective is to analyze the current state of anti-BCMA CAR-T therapy in ММ, covering aspects of production, preclinical and clinical trials, as well as examining therapy-related toxicity and relapses.

Data analysis was conducted using specialized medical databases such as PubMed, Scopus, Web of Science, Frontiers, and Google Scholar from 1974 to 2024. The article reviews latest achievements in CAR-T therapy for MM, current advances in the production and application of BCMA CAR T-cells, along with key challenges faced by this technology. The data obtained confirm significant progress in optimizing CAR T-cell structures and improving manufacturing processes, making the therapy more accessible for clinical use.

Although early-phase trials of anti-BCMA CAR-T therapy show promising results, challenges remain, such as toxicity and insufficient response in some patients. Optimization of CAR structure and manufacturing technologies may improve the efficacy and accessibility of CAR T-cell therapy, making it a key direction for future research.

Background. Anemia is the main symptom of multiple myeloma (MM) both at the time of disease onset and during tumor progression. Previously, the main method of anemia treatment was blood transfusion therapy. Currently, blood transfusions are supplemented by erythropoietin (EPO) administration. Safety and effectiveness of the drug have been proven in multiple trials including trials involving oncohematological patients.

Aim. To present the results of using epoetin alpha (Eralfon) in patients with MM complicated by dialysis-dependent myeloma cast nephropathy in real clinical practice; to analyze the literature data on the use of EPO for the treatment of anemia in MM patients.

Materials and methods. A retrospective analysis of a series of clinical observations was carried out: 4 patients with newly diagnosed MM at the ages between 52 and 60 years who underwent treatment at the Department of Hematology and Chemotherapy of Paraproteinemic Hemablastoses with a Bone Marrow and Hematopoietic Stem Cell Transplantation Block. All patients were diagnosed with myeloma cast nephropathy with significantly decreased glomerular filtration rate of 7–15 mL/min requiring renal replacement therapy. At the time of disease diagnosis, median hemoglobin level was 75 g/L, median creatinine level was 517.5 µmole/L. Endogenous EPO level was measured in all patients prior to epoetin alpha prescription: it varied between 2.31 and 149.6 IU/mL. Epoetin alpha (Eralfon) was prescribed at dose 12 000 IU – 0.3 mL subcutaneously 3 times a week. A review of the literature data on the use of EPO in patients with MM was conducted.

Results. All patients at MM onset were dependent on renal replacement therapy and blood transfusion, therefore epoetin alpha was prescribed immediately. In case of renal function recovery and end of dialysis at target hemoglobin levels, administration of the drug was ceased. If dependence on renal replacement therapy persisted, epoetin alpha treatment continued as synthetic function of EPO-producing cells was compromised. In all clinical cases, epoetin alpha therapy was effective.

Conclusion. Clot formation prevention should be kept in mind during epoetin alpha therapy. Decreased requirement for blood transfusions, improved quality of life with favorable safety profile of the drug make epoetin alpha an indispensable part of accompanying therapy in patients with MM and anemia.

Background. Chemoimmunotherapy, including cytotoxic drugs and anti-CD20 monoclonal antibodies have significantly improved outcomes in patients with newly diagnosed follicular lymphoma (FL) compared with chemotherapy. A number of clinical studies have compared the effectiveness of the two most popular treatment regimens, rituximab plus bendamustine (RB) and rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP), with conflicting results.

Aim. To conduct a retrospective analysis of the treatment results of a large cohort of patients with grade 1–2 FL who received RB or R-CHOP regimens in the first line therapy in real-life clinical practice, to analyze the impact of individual prognostic factors, as well as rituximab maintenance therapy on survival, the incidence of secondary malignancies and causes of mortality.

Materials and methods. Data were collected on patients with grade 1–2 FL who were treated at the Botkin Hospital from November 2006 to November 2022. The inclusion criteria for the study were newly diagnosed histologically confirmed FL of grade 1–2, age ≥18 years, RB or R-CHOP therapy as first line. No radiation therapy was allowed. Response assessment was performed according to the 2007 International Working Group criteria.

Results. The inclusion criteria for the study were met by 277 patients; 164 patients received R-CHOP and 113 patients received RB. Overall response rate was comparable between groups (96 % vs 94 % in the RB and R-CHOP groups, respectively, p = 0.3396). The median followup period was 35 (3–117) months in the RB group and 50 (3–200) months in R-CHOP group. The median progression-free survival (PFS) in the R-CHOP group was 86 months, while the median of PFS in the RB group was not reached, the differences did not reach statistical significance (hazard ratio (HR) 0.65; 95 % confidential interval (CI) 0.42–1.004; p = 0.0665). Three-year PFS was 81 and 72 %, and five-year PFS was 66 and 57 % in the RB and R-CHOP groups, respectively. Progression within 24 months of initiation of therapy was more common in R-CHOP group (20 % vs 11 %, p = 0.0466). The median time to next therapy in R-CHOP group was 90 months and was not reached in RB group (HR 0.75; 95 % CI 0.48–1.18; p = 0.2277). Unifactor analysis of individual prognostic factors showed superior PFS in most subgroups receiving RB regimen. R-CHOP regimen showed a trend towards improved PFS only in patients with maximum standardized uptake value (SUVmax) >14 (HR 2.46; 95 % CI 0.52–11.62; p = 0.2211). The use of rituximab maintenance therapy improved PFS in both treatment groups: in R-CHOP group, the differences reached the level of significance (HR 0.22; 95 % CI 0.05–1.01; p<0.0001) , in RB group they did not reach the level of significance (HR 0.41; 95 % CI 0.02–8.67; p = 0.3605). There were no significant differences in overall survival. The 5-year cumulative incidence of secondary malignancies as well as the incidence of grade 5 infections were comparable between groups.

Conclusion. In summary, our study shows that RB regimen generally has comparable long-term efficacy to R-CHOP regimen in first-line therapy in patients with grade 1–2 FL. Unifactor analysis of individual prognostic factors showed better PFS in most subgroups using the RB regimen. The use of rituximab maintenance therapy significantly improved PFS in R-CHOP group compared with RB regimen. Our study with a significant median follow-up did not find differences in the incidence of secondary malignancies or non-lymphoma related mortality.

Stent migration is an important problem in stenting of the biliary and pancreatic ducts. It can lead to severe consequences including pancreatitis, cholangitis, duct perforation, sepsis, fistula formation. Removal of proximally migrated stents is complicated by duct diameter, their tortuosity, possible strictures.

The article presents 2 clinical cases of proximal migration of plastic stents from the common bile duct with successful use of the SpyGlass system to remove the migrated stents.

In the clinical practice of an oncologist, primary multiple tumors are one of the most difficult and poorly understood problems. The treatment of patients with multiple malignancies often involves а combined treatment methods. Taking into account the possibility of detecting tumors at different stages and localizations, the doctor needs to determine such a therapeutic approach that will be directed at several oncological processes at once. The article describes a clinical case of a male patient, born in 1948, with metachronous bladder cancer, both lungs and multifocal basal cell skin cancer.

The presented experience reflects the patient’s long-term observation from 2002 to 2024, during which the patient repeatedly underwent surgical and radiation treatment of tumors of various localizations. The presented clinical case shows the importance of dynamic monitoring and regular examinations by an oncologist, which allows timely verification of a recurrence of the disease or a new malignant neoplasm and achieve the best therapeutic results.

Hemophagocytic lymphohistiocytosis is a severe hyperinflammatory syndrome induced by aberrantly activated macrophages and cytotoxic.

T cells, the cause of which is most often infection. The article presents a clinical case of hemophagocytic lymphohistiocytosis in a 34-year-old patient with a history of follicular lymphoma, who was treated at the A.F. Tsyba Medical Radiological Research Center. Six courses of R-CHOP were performed for follicular lymphoma with a complete response and further supportive therapy with rituximab. A month after the end of therapy, the patient complained of pain in his right side. According to morpho-immunohistochemical examination, the diagnosis of B-lymphoblastic lymphoma was established. Treatment according to the ALL-2016 protocol at the stage of consolidation III was complicated by a long period of three-stage cytopenia with the addition of sepsis. According to the results of an additional examination and assessment according to risk scales, the diagnosis of hemophagocytic lymphohistiocytosis was confirmed. After a few days of therapy with ruxolitinib, the general somatic status of the patient improved, blood parameters were restored and hematopoiesis was normalized according to myelogram data.

A generalized infectious process can be assumed as the cause of the development of hemophagocytic lymphohistiocytosis in this patient.

Malignant endometrioid-associated neoplasias are malignant tumors wich develop as a result of malignant transformation of endometrioid heterotopias outside the uterus. The mechanisms of their transformation are diverse, and oncological risks are known only for ovarian and breast cancer.

The article presents a rare clinical case of malignant endometrioid-associated neoplasia of a postoperative scar in a 67-year-old woman. Differential criteria and prognostic factors of the disease course are considered. The literature data on this issue were analyzed. Literature search was carried out in PubMed, eLIBRARY.RU databases over the past 5 years was performed for the search words: malignant endometrioid-associated neoplasia, endometrioid cancer of postoperative scar.

Malignant endometrioid-associated neoplasia of the postoperative scar is a rare malignant tumor that develops from endometrioid heterotopia in women who have undergone surgery on the pelvic organs. Oncological look-out and timely routing of such patients to a specialized level can increase the effectiveness of treatment and improve the prognosis of such patients.

Disease stage and especially condition of the sentinel lymph node (SLN) assessed in patients with breast cancer prior to treatment are among the most important prognostic factors. SLN is the first lymph node in the regional lymph node system receiving lymph outflow from the primary tumor. SLN biopsy with blue dye gradually replaced traditional axillary lymph node dissection as the standard of treatment of early breast cancer. In the recent years, technique of contrast-enhanced sonography with microbubble contrast agents for examination of the lymph system has been studied both in animal and human trials.

Aim of the review is to investigate the effectiveness of transcutaneous contrast-enhanced sonography of the SLN for biopsy and for diagnosis of metastatic SLNs using methylene blue as the standard in patients with early breast cancer.

Background. Metabolic tumor volume (MTV) is an insufficiently studied parameter of positron emission tomography, combined with computer tomography (PET/CT), which has been gaining increasing interest in modern oncology in recent years. It is important to use MTV as a prognostic marker in diffuse large B-cell lymphoma (DLBCL).

Aim. To analyze the results of therapy in patients with DLBCL and to identify their relationship with MTV, determined by PET/CT data before the start of treatment, after 2 and 6 courses of therapy.

Materials and methods. The prospective study included 80 patients with a morphologically verified diagnosis of DLBCL who were treated at the A.F. Tsyba Medical Radiological Research Center from 2021 to 2024. All patients underwent therapy using R-CHOP regimens (66.25 %) and R-CHOP-like regimens (33.75 %). Each of the patients underwent 3 PET/CT studies with MTV registration – at the staging stage, after 2 and after 6 treatment courses. The median follow-up was 19.5 (4.97–45.53) months. The survival rate was calculated using the Kaplan–Mayer technique, the MTV threshold values were calculated using ROC analysis taking into account the Yuden index.

Results. On the initial PET/CT, the threshold value of MTV was 37.12 cm3 (p = 0.006). In patients with a value above the threshold, failures of classical first-line therapy were statistically significantly more common. The threshold value of MTV in PET/CT after 2 courses of treatment was 19.15 cm3 (p = 0.032), in PET/CT after 6 courses – 8.73 cm3 (p = 0.028). In patients with an MTV value above the threshold, according to the results of PET/CT performed after the 2nd and 6th courses, cases of disease progression were also statistically significantly more frequent.

Conclusion. MTV is a new prognostic factor in modern oncological practice and should be evaluated in all patients with DLBCL and taken into account when making decisions regarding therapy tactics.

Thanks to modern approaches to the treatment of children with oncohematological diseases, an increase in overall and relapse-free survival is noted. However, in the process of therapy of a malignant disease, a number of complications may arise, leading to the development of concomitant pathology with various functional disorders.

The article presents a broad spectrum of morphologic and functional disorders in 52 patients completed an oncohematological disease treatment. It is justified the use of physical and psychological methods of rehabilitation for the most effective prophylaxis and treatment.

Background. Combination of 5-HT3-receptor inhibitors and NK1-inhibitors with dexamethasone and olanzapine is the standard-of-care measure for prevention of chemotherapy-induced nausea and vomiting in autologous hematopoietic stem cell transplant (auto-HCT) recipients.

Aim. To assess the efficacy and toxicity of netupitant/palonosetron (NEPA) as monotherapy in the prevention of nausea and vomiting induced by pretransplant conditioning.

Materials and methods. This prospective study included patients (n = 21) who underwent auto-HCT at the P.A. Herzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre. Patients with multiple myeloma were administered 1 capsule of NEPA 1 hour before conditioning, patients with lymphoma – 2 capsules: 1 hour before conditioning and 72 hours after the first dose of the drug. The primary endpoint was the complete response rate defined as no emesis and no rescue medication during the acute and delayed phases.

Results. Complete response in the overall cohort was achieved in 81 % of patients both in the acute and delayed phases. In the high-dose melphalan group and LEAM-conditioning group (lomustine, etoposide, cytarabine, melphalan), the rates were also identical in the acute and delayed phases and were 75 and 88.9 %, respectively. Complete control in the entire cohort was achieved in 66.7 % during acute phase and 76.2 % during delayed phase. Corresponding rates in high-dose melphalan group were 66.7 and 75 %, respectively, and in LEAM-conditioning group – 66.7 and 77.8 %, respectively.

Conclusion. NEPA monotherapy demonstrates high efficacy in auto-HCT recipients receiving highly-emetogenic pretransplant conditioning, while simplifying the antiemetic prophylaxis protocol as compared to four-drug-based regimens.