Vol 21, No 1 (2019)

Aim. The aim of the study is to examine the efficacy and safety of eribulin in HER2-negative metastatic breast cancer (BC) in Russian clinical practice. Materials and methods. The analysis included 459 patients with advanced BC from 44 federal and municipal medical clinics in Russia and received at least 2 courses of treatment with eribulin in accordance with the registered indications for drug. The average age of women was 56 years (between 29 and 81 years), 83% of patients had HER2-negative tumor subtype (49.9% - luminal BC and 33.1% - triple-negative BC) HER2-positive biological tumor subtype was registered in 17% of patients. Visceral metastases were diagnosed in 73% of patients and three-zone and multiple zone metastases were diagnosed in 41.6% of cases. The median number of prior lines of therapy in patients with disseminated disease was 2; anthracycline and taxane chemotherapy was applied in 94.3% of patients, and 38.1% of patients were recived CT plus capecitabine. Standard treatment regimen with eribulin was cotinuing (1.4 mg/m² as a 2-5-minute intravenous infusion administrated on days 1, 8 of a 21-day cycle) until disease progression, unacceptable toxic effects, or impossibility of the drug administration for any other reason. We estimated the efficacy and safety of treatment with eribulin in Russian patients with HER2-negative BC. Results. Objective response rate was achieved in 20.5% of cases, complete response rate was in 3.2%, partial - 17.3%, and the stable disease rate was marked in 52.7% of women, and in 19.7% of these cases was prolonged more than 6 months. The frequency of objective response was higher in luminal BC group compared with triple-negative BC: 23.5% vs 15.8%; tumor growth control 76.9% vs. 67.8%, respectively; p<0.05. Median progression-free survival was 4.83 months (5.17 months - luminal BC and 4.0 months - triple-negative BC). On application of eribulin in first-, second- and third-line treatment we achived maximum efficiency: the frequency of objective response rate was 24.2%, tumor growth control - 82.2%, median progression-free survival - 5.07 months; any data were achived on drug application in fourth-line and further lines of treatment: 15.4%, 58.6% and 4.27 months, respectively; p<0.05. We showed the group of women with "special response" to eribulin (72 cases, 19%) associated with the high efficacy of therapy, regardless of biological subtypes and metastases localization: objective response rate - 48.6%, long-term stable disease rate - 51.4%. The safety profile of eribulin was acceptable; the dose reduction to 1.1 mg/m² was required only in 14.2% of patients and after the reduction eribulin therapy was continued without moderate adverse events. Conclusions. Efficacy and safety of eribulin therapy in Russian patients completely confirm the results of earlier randomized studies. The combination of efficiency in tumors with different biological subtypes and a safety profile makes eribulin the therapeutic option of appling in patients with advanced anthracycline-and taxan-resistant BC.

Viral oncolysis, an approach to cancer therapy that emerged in the XX century and based on the natural ability of viruses to kill (lyse) cells in which it multiplies, has been developed in recent years by identifying viruses or their engineering variants with selective tumor replication. Over the past decades, a number of specific interactions of oncolytic viruses (both RNA and IDNA-containing) with malignant tumor cells have been described, individual candidate viruses and the types of tumors that they lase have been detected. The therapeutic efficacy of oncolytic viruses is achieved through a combination of selective destruction of tumor cells through a direct cytotoxic effect and activation of antitumor immunity; In addition, oncolytic viruses can affect abberant signaling pathways followed by blockade of tumor cell apoptosis, which gives the virus more time to complete its life cycle. A number of oncolytic viruses have shown promising therapeutic efficacy in preclinical studies in breast cancer; thus, the herpes simplex virus has a high selectivity for replication in tumor cells, which contributes to the death and the formation of infiltration of CD8+ and CD4+ T cells around tumor islands. The ability of reoviruses to enhance the expression of PD-L1 protein in cells was found, and the measles virus armed with the BNiP3 proapoptosis gene is more active in the cell lines of triple negative breast cancer. Improved viruses, from the point of view of the effectiveness and selectivity of effects on the tumor, as well as optimized combinations with other "standard" types of systemic therapy, are very promising, especially in patients with developed drug resistance.

Verification of volumetric peripheral neoplasms of the lung is quite a challenge for the modern minimally invasive methods of diagnosis. Aim. Application of transthoracic trepan biopsy of the thoracic cavity organs under the control of computed tomography to obtain morphological material with high accuracy and to make a correct diagnosis. Materials and methods. From January 2017 to December 2017 103 patients underwent a transthoracic biopsy of lung tumors and mediastinum under the control of computer tomography. Results. The effectiveness of the study was 96.2%. Complications in the form of post manipulation pneumothorax developed in 8.5% of cases. This technique is safe and effective and should be used in the daily diagnosis of tumors of the cavity chest.

Background. Many studies concerning molecular-biological markers in colorectal cancer (CRC) were performed over the past decade. Вcl-2 protein (B-cell lymphoma 2) was one of the most studied molecular-biological markers and attracted the attention of different specialties as on studying carcinogenesis and the relationship with prognosis. Aim. To study in details the characteristics of Bcl-2; to study Bcl-2 role in the mechanisms regulating apoptosis; to show update data concerning the prognostic significance of this protein in CRC. Materials and methods. To write this literature review we have studied domestic and foreign publications from Russian and international systems of search (PubMed, eLibrary, etc.) over the past 2-30 years. Results. The evaluation of the expression of antiapoptopic protein Вcl-2 in tumor can give additional information about the course of malignant process independently of therapeutic effects, the biological behaviour of the tumor: the rapidity of growth, the ability of invasion and metastasis (i.e. the prognosis of a disease). Conclusion. The results concerning the impact of abnormal expression of apoptosis inhibitor Вcl-2 on the course and prognosis of CRC have been accumulated in the scientific literature, but there have been only several studies, analyzing the relationship between Вcl-2 and metastasis of CRC and factors influencing the invasive potential of tumor cells. Nowadays, there is no consensus about the prognostic significance of protein Вcl-2 in patients with CRC. In some studies, concerning CRC, have been shown the correlation between Bcl-2 overexpression in tumor cells and a favorable course of disease and good survival in patients. Other authors have been shown that tumors with Bcl-2 overexpression, by contrast, are more aggressive in comparison with tumors without Bcl-2 expression. There are a number of studies in which the prognostic significance of Bcl-2 protein is not proved. Many issues, concerning the correlation between this molecular-biological marker and clinico-morphological characteristics of tumor, might also need to be itemized. All shown in the article is a subject to further research.