Introduction: Belarus, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Republic of Moldova, Romania, Russian Federation, Serbia, Slovakia, Slovenia and the Ukraine represent a collection of Central and Eastern European (CEE) countries in which the epidemiology and treatment of cancer varies greatly between and within countries. Current challenges include non-adherence to current treatment guidelines, restrictions in access and reimbursement for new therapies, and a lack of basic oncology programs. Metastatic renal cell carcinoma (mRCC) is a malignancy with historically poor prognosis. In CEE countries, the incidence and mortality rates of mRCC are among the highest in the world. Fortunately, mRCC represents a cancer for which a number of new targeted therapies have recently demonstrated benefit, resulting in new evidence-based treatment guidelines. Incorporating these mRCC treatment recommendations into the routine care of patients with mRCC in CEE countries would represent a major step forward for cancer care in this region.
e20027 Background: Despite the quite low melanoma incidence in Russia (approx. 5 per 100 000) mortality rate is very similar to countries with higher incidence (approx. 2 per 100 000). We believe this is a consequence of poor early detection. Methods: We performed a continuous retrospective observational study which covered all primary melanoma patients referred to our institution from 01Jan2009 to 31Dec2009 and from 01Jan2013 to 31Dec2013. Only patients with cutaneous melanoma stage I or II were included in the analysis. We analyze morphological and clinical features for all cases to reveal any improvements in early detection during last 5 years. Results: In total 83 patients with primary cutaneous melanoma were identified in 2009 and 77 in 2013. 21 and 17 pts were excluded due to simultaneous regional lymph nodes metastases (in 2009 and 2013 respectively). From 61 and 60 pts 23 (38%) and 24 (40%) were male in 2009 and 2013 respectively (p>.5). Mean age was 52.05±14.8y and 57.83±13.7y in 2009 and 2013 respectively (p=0.26). Melanoma of the trunk, upper limbs lower limbs, head and neck was detected in 47.5% pts, in 9.8% pts, 34.4% pts, and 8.2% pts (all pts). Superficial-spreading melanoma (SSM), nodular melanoma (NM), SSM+NM and lentigo maligna melanoma were identified in 23%, 55.7%, 18.0% and 3.3% pts respectively (all pts). Mean Breslow thickness was 4.48±3.87 mm (median 3.00 mm) in 2009 and 4.55±4.89 mm (median 3.00 mm) in 2013 (p>.5). Ulcerated tumors were detected in 38 (62,3%) pts and in 36 (60%) pts in 2013 (p>.5). AJCC stage IA, IB, IIA, IIB, IIC was established for 11 (18%), 8 (13.1%), 5 (8.2%), 14 (23.0%), 22 (36.1%) respectively in 2009 and 12 (20%), 5 (8.3%), 8(13.3%), 11(18.4%), 24 (40%) respectively in 2013 (p>.5). Conclusions: According to our single institution experience extremely high proportion of patients in Russia at diagnosis had very thick and ulcerated melanoma which may leads to higher mortality rates. Nothing had been changed in 2013 since 2009. National program for melanoma early detection is required.
Активное применение ингибиторов контрольных точек иммунного ответа (ИКТИО) в качестве стандарта
лечения различных злокачественных новообразований приводит к увеличению числа наблюдаемых различных иммуноопосредованных нежелательных явлений (ИОНЯ), обусловленных активацией иммунной
системы. Эндокринные ИОНЯ по частоте выявления занимают 3-е место, уступая лишь поражениям кожи
и желудочно-кишечного тракта.
ЦЕЛЬ: оценить частоту развития эндокринных ИОНЯ на фоне терапии ИКТИО.
МАТЕРИАЛЫ И МЕТОДЫ: в многоцентровое исследование были включены 172 пациента, проходящих
противоопухолевое лечение в ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России или ГБУЗ «МГОБ
№ 62 ДЗМ». Медиана возраста пациентов на момент обследования составила 60 лет [24; 87], соотношение мужчин/женщин (%) – 52,7/47,3. Используемые препараты из группы ИКТИО в исследуемой выборке
пациентов: ниволумаб – 60,9% (n = 103); атезолизумаб – 16,6% (n = 28); пембролизумаб – 14,8% (n = 25);
пролголимаб – 5,9% (n = 10); комбинированная терапия ипилимумаб + ниволумаб – 1,8% (n = 3). По данным
нозологической классификации основного онкологического заболевания (Международная статистическая
классификация болезней 10-го пересмотра, МКБ-10) среди исследуемой выборки встречались следующие
патологии: злокачественная меланома кожи (С43) – 50,9% (n = 86); злокачественное новообразование
бронхов и легкого (С34) – 35,5% (n = 60); злокачественное новообразование самостоятельных (первичных)
множественных локализаций (С97) – 8,3% (n = 14); злокачественное новообразование печени и внутрипеченочных желчных протоков (С22) – 3,6% (n = 6); злокачественное новообразование ободочной кишки
(С18) – 0,6% (n = 1); злокачественное новообразование шейки матки (С53) – 0,6% (n = 1); злокачественное
новообразование тела матки (С54) – 0,6% (n = 1). В исследуемой выборке пациентов осуществлялась оценка: ТТГ, своб. Т4, своб. Т3, АКТГ, кортизола, глюкозы, натрия и калия сыворотки (или плазмы) крови.
РЕЗУЛЬТАТЫ: развитие эндокринных иммуноопосредованных нежелательных явлений на фоне терапии ИКТИО выявлено у 15,2% испытуемых. Среди них наиболее часто диагностирована дисфункция
щитовидной железы (n = 20).
ВЫВОДЫ: развитие поражений органов эндокринной системы на фоне ИКТИО остается неясным
и не зависит от выбранного лекарственного препарата, типа опухоли и возраста пациента. При этом эндокринные ИОНЯ не рассматривались как показание для прекращения противоопухолевого лечения. Лишь
при выраженных клинических проявлениях на время подбора гормональной терапии осуществление
инфузий препаратом ИКТИО было приостановлено.
The results of treatment of 448 patients with disseminated malignant melanoma using new Russian nitrosourea aranoza in phase IIII clinical trials in monoregime, combinations, intravenously and intraarterially, were analysed. Aranoza appeared to be quantitive effective against malignant melanoma with moderate toxicity, easy for prognosis and management.
Most case reports of paraneoplastic vasculitis have been associated with hematologic malignancies rather than with solid tumors. Various treatment principles of paraneoplastic vasculitis have been proposed for tumor-associated vasculitis, including prednisolone and cytostatic drugs. Interleukin-2 (IL-2) monotherapy provides superior objective response rates and survival benefits as compared with chemo-, hormonotherapy in renal cell carcinoma. We describe a 55-year-old man with an advanced renal cell carcinoma (RCC) and paraneoplastic vasculitis who was treated with high doses of recombinant IL-2 (Roncoleukni1). Despite RCC progression, skin manifestations of vasculitis resolved after first infusion. Deep venous thrombosis regressed in a middle of immunotherapy course. We suppose that IL-2 activated suppressor system of control including antigen-specific immunosuppression.
This paper represents the results of N.N. Blokhin Russian Cancer Research Center research on two novel promising Russian nitrosoureas Aranoza and Lysomustine. It was shown that single drug effectiveness in metastatic melanoma is 20 % for Aranoza and 18,8 % for Lysomustine that is comparable with DTIC standard chemotherapy. The drugs are associated with moderate myelosuppression. Their clinical efficacy could be encouraged in combination with Cisplatin, Vincristine and Dactinomycin. Based on these results Aranoza and Lysomustine containing regimens were approved for the treatment of metastatic melanoma.
Vaccinotherapy with gene-modified tumor cells was shown to be a promising treatment method for malignant tumors. The treatment method using autologous tumor cells transferred by tag-7 gene was developed. Pre-clinical investigations demonstrated specificity in vitro and in vivo and low toxicity of this method. Phase I clinical trials performed on 9 patients with disseminated melanoma and kidney cancer detected no side effects. The activated influence of this vaccine on immune system was found.
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