Background: Patients with germ cell tumors (GCTs) and poor-prognosis demonstrate unsatisfactory oncological outcomes, with a one-year progression-free survival (PFS) rate of approximately 50 %. We hypothesized that switching the chemotherapy regimen to TIP (paclitaxel, ifosfamide (mesna), cisplatin) in cases of unfavorable decline of serum tumor markers (STMs) after the first cycle of BEP (bleomycin, etoposide, cisplatin) could improve treatment outcomes in this subgroup of patients.

Materials and methods: A multicenter, prospective, non-randomized phase II study included patients with nonseminomatous GCTs and poor-prognosis according to IGCCCG. All patients received the first cycle of chemotherapy in BEP regimen. Patients with an unfavorable decline of STMs subsequently received 4 cycles of TIP regimen (paclitaxel 120 mg / m² on days 1 and 2 + ifosfamide 1500 mg / m² on days 2–5 (+ mesna) + cisplatin 25 mg / m² on days 2–5 + G-CSF). In the presence of residual tumors larger than 1 cm and the technical feasibility of removal, surgical treatment was performed. The primary endpoint was one-year PFS.

Results: From 2017 to 2023, 34 patients were included in the study. Enrollment was prematurely closed due to an extremely low likelihood of achieving the primary endpoint. One-year PFS and overall survival (OS) were 57.1 % and 74.4 %, respectively. The favorable response rate (complete response + partial response with normalization STM) was observed in 55,8 % of patients. Disease progression was observed in 21 patients, with the central nervous system being the first site of progression in 8 (37 %) of them. Surgical treatment was performed in 16 patients, with viable tumor obtained in 4 patients. Conducting the first cycle in a “stabilization» mode for ultra-high-risk patients did not affect PFS (p = 0.28) or OS (p = 0.434). The toxicity profile of the TIP regimen was acceptable.

Conclusion: Switching from BEP to TIP for patients with nonseminomatous GCTs and an unfavorable decline of STMs did not demonstrate efficacy. Further exploration of alternative therapeutic approaches is needed to improve treatment outcomes.

Background: Over 10 years from 2013 to 2023, the number of new cases of breast cancer (BC) among women under the age of 40 increased in the Krasnoyarsk region. The increase in new cases was 63.9 % (from 83 cases in 2013 to 136 cases in 2023).

Aim: The analysis of clinical and morphological parameters and assessment of the prognosis of the disease in young women under 40 years old with breast cancer in the Krasnoyarsk region.

Materials and methods: We performed a retrospective analysis of data from the Population Cancer Registry, the TFOMS Oncology Registry and MIS qMS on breast cancer patients under 40 years diagnosed in the Krasnoyarsk region for the period of 2013–2023. Statistical analysis was carried out using Microsoft Excel, Statistica 12 and StatTech 4.0.6 software products. Survival analysis was performed using Kaplan-Meier curves, and the log-rank test was used to evaluate differences in survival. Outcomes of interest were event-free survival (EFS) and overall survival (OS). EFS was defined as the time period from diagnosis to disease relapse, disease progression, or death, whichever occurred first. OS was defined as the time period from diagnosis until final analysis (3 / 31 / 2024) or death, whichever occurred first. The significance level of the test was considered statistically significant at p < 0.05.

Results: In the region, women with breast cancer were detected in the early stages predominately (73.0 %), mostly invasive carcinomas by morphological type (89.6 %) and HR(+) Her2(–) molecular genetic subtype (50.6) %. Five-year survival rate during the study period increased by 48.1 %, one-year mortality decreased by 81.7 %. OS and EFS for patients with advanced breast cancer are statistically significantly lower. There was no correlation between OS and EFS by tumor subtype. Lower OS rates in patients with HR(–) Her2(–). Lower EFS rates in patients with HR(+) Her2(–).

Conclusions: The results of the analysis to identify the clinical features of the course and assess the prognosis of the disease in patients with breast cancer under the age of 40 years indicate the need to revise the age for starting screening studies aimed at detecting breast cancer in the early stages.

Introduction: the use of immunotherapy agents in combination with chemotherapy has shown its effectiveness in randomized trials for the first-line treatment of metastatic gastric cancer. The paper considers the experience of the Moscow oncological service in evaluating the effectiveness of pembrolizumab and nivolumab in patients with metastatic gastric cancer, depending on morphological (CPS, MSI) characteristics.

Aim of the study: to compare progression-free survival (PFS) and overall survival (OS) in patients with advanced gastric cancer who underwent immunotherapy (as monotherapy or in combination with chemotherapy) or standard chemotherapy with oxaliplatin and fluoropyrimidines.

Patients and methods: 194 patients met the inclusion criteria. Of these, 52 patients received checkpoint inhibitors (ICI) (18-immunotherapy alone; 31-in combination with chemotherapy, 15 patients received pembrolizumab and 37 patients received nivolumab); 142 patients received chemotherapy CAPOX or FOLFOX without ICI. The median follow-up was 29.5 months (17.4–62 months). Males were 55.8 % and 57.7 % with average age of 64.5 and 65.9 years, ECOG 2 was detected in 15.4 % and 8.5 % of patients. Other characteristics were also comparable: CPS > 10 69.2 % and 19.7 % (p = 0.0001), MSI 26.2 % and 4.9 % (p = 0.009), 2nd lines and further treatment were received by 36.5 % and 69.3 % (p = 0.0001), respectively.

Results: in the entire population PFS was 7.9 months and 6.4 months (HR 0.46; 95 % CI 0.32–0.67, p = 0.0001), and OS was 17.3 months and 14.6 months (HR 0.71; 95 % CI 0.49–1.04, p = 0.076), respectively. The univariate analysis showed that only 1 prognostic factor for survival — the number of organs with metastases. In accordance with this, in case of the presence of metastases in 1–2 organs the use of ICI had an advantage in terms of PFS (p = 0.051 and p = 0.001), while in case of 3 or more organs involved there was no advantage (p = 0.62). Assessing the effect of the CPS level in patients with MSS phenotype, it was shown that at CPS0–9 there was no advantage in PFS (6.1 months and 6.9 months, p = 0.7) and OS (8.8 months and 14.9 months, p = 0.39). With CPS > 10, an advantage was noted when adding ICI for PFS (9.9 months and 4.4 months, p = 0.0001), and OS 18.2 months and 12.1 months (p = 0.23). However, the results did not differ at the CPS level > 50. When evaluating patients with MSI, we demonstrated that with a median PFS of 6.6 months and 5.2 months, respectively (HR 0.48; 95 % CI 0.17–1.4; p = 0.165), the median OS in patients who received ICI with or without CT was significantly higher — 24.3 months and 11.1 months, respectively (HR 0.4; 95 % CI 0.13–1.21; p = 0.11).

Conclusions: the use of ICI in the first line therapy for metastatic gastric cancer (compared with CT alone) increases the proportion of patients living without progression for 12 months or more, and the overall survival rate was also increased by more than 2 times. The threshold level of CPS for ICI assignment needs to be > 10. The relationship between the effectiveness of immunotherapy and PD-L1 expression in gastric cancer with MSI tumors requires further study in a larger sample of patients. Information at the CPS level, the presence of MSI and HER2 / neu should be presented at the time of discussion of treatment tactics at the onset of metastatic disease.

Objective: to compare the results of approaches used in real clinical practice to the treatment of elderly patients with primary non-metastatic prostate cancer (PCa).

Material: a retrospective study based on the EMIAS database included medical information on patients aged 75 years and older with verified non-metastatic PCa who were under observation at the Central Administrative District Clinical Hospital of the Moscow Health Department from July 31, 2000 to January 18, 2024. Patients were included in the study if there was available information on concomitant diseases, the prevalence of the tumor process, treatment tactics, the chronology of the course and outcome of PCa, the date of the last observation or death, as well as the cause of death if it was registered.

Results: The data of 401 patients aged ≥ 75 years with verified non-metastatic prostate cancer were included. The median age was 84.0 (75.0–99.0) years. The median Charlson comorbidity index was 7 (4–12). The median baseline prostate-specific antigen (PSA) level was 12.0 (0.3–182.1) ng / ml. All patients had verified prostate adenocarcinoma (ISUP grade 4–5–87 (21.7 %)). The cT category was assessed as cT3–4 in 91 (22.7 %), the cN1 category was diagnosed in 22 (5.5 %) patients. Patients were classified into intermediate unfavorable, high and very high risk groups in 235 (58.6 %) cases. In 113 (28.2 %) cases, radical treatment was performed (external beam radiotherapy (EBRT) — 113 (28.2 %), radical prostatectomy — 37 (9.2 %), brachytherapy — 14 (3.5 %), ablation — 2 (0.5 %)), in 202 (50.4 %) cases — immediate antitumor therapy, 33 (8.2 %) patients received deferred treatment within the framework of active observation (10 (2.5 %)) or expectant tactics (23 (5.7 %)). The deferred treatment group was incomparable with the immediate radical and drug treatment groups in sample size and had a smaller proportion of patients in the intermediate unfavorable, high and very high risk groups (p < 0.05 for all). For other characteristics, the treatment groups were balanced. The median follow-up for all patients was 54.1 (1.1–275.7) months. In the entire study population, 4-year overall survival (OS) was 95.0 %, specific survival (SS) was 99.4 %, and cardiospecific survival (CSS) was 95.3 %; relapse-free survival (RFS) of radically treated patients was 74.4 %, progression-free survival (PFS) with first-line systemic therapy was 78.3 %, and PFS in patients who did not receive immediate treatment was 46.6 %. No effect of treatment approach was found on OS and CSS in the entire patient population, including those adjusted for risk group (p > 0.05 for all). A decrease in 4-year DFS was noted in the deferred treatment group compared with the radical treatment group (83.1 % vs. 95.2 %, p = 0.036) due to the subgroup with the Charlson comorbidity index ≥ 8 (72.5 % vs. 94.8 %, p = 0.060). RFS in operated patients was lower than in irradiated patients (p = 0.032), which did not affect the DFS and OS indicators (p > 0.05 for all). In the watchful waiting subgroup, DFS was lower than in patients under active surveillance (p = 0.015), but DFS and OS in these cohorts were similar.

Conclusion: in elderly patients with non-metastatic prostate cancer, immediate radical and drug treatment does not lead to an increase in SV and OS compared with delayed treatment.

Background: Serous endometrial carcinoma (SEC) and clear cell endometrial carcinoma (CCC) are rare forms of endometrial cancer (EC) characterized by an aggressive clinical course.

Purpose of the study: Evaluation of differences in the content of vascular endothelial growth factors (VEGF) and their soluble receptors (sVEGF-R) in endometrial tumor tissue and blood of patients with various types of EC.

Materials and methods: The study included 21 patients with CCC (71.5 % with stage I–II, 28.5 % with stage III–IV), as well as 20 patients with SEC (80 % with stage I–II, 20 % with stage III–IV). All had high grade G3 tumors. The control group included patients with endometrioid endometrial carcinoma G3 (EEC): 75 with stage I–II, 25 % with stage III–IV. Samples of intact endometrium obtained from patients who underwent surgical procedures for uterine fibroids (n = 20) and blood samples from conditionally healthy women (n = 20) served as the normal parameters. The levels of VEGF-A, VEGF-C, sVEGF-R1, and sVEGF-R2 were determined by ELISA in 10 % of homogenates of tumor samples, intact endometrium, and blood samples. Statistical processing of the obtained results was performed using the Statistica 10.0 program.

Results: The level of VEGF-A was found to be elevated in tumor samples by 1.8–2 times compared to intact endometrium, and in the blood by 3.8–12 times compared to donor values. The VEGF-A level in the endometrial tissue of cancer patients did not demonstrate a dependence on histology, while in the blood it exhibited a statistically significant increase in patients with rare forms of EC compared to EEC. The sVEGF-R1 levels in the blood and tumor samples were found to exceed standard values, with the highest levels observed in rare forms of EC. The VEGF-A / sVEGF-R1 ratio in EEC did not differ from the normal values, whereas in patients with CCC and SEC, the ratio decreased in tumor samples and increased in the blood compared to donors. The analysis further revealed that the concentration of VEGF-C in the tumor samples was higher than the values observed in the intact endometrium in all cancer patients. However, a statistically significant increase in the level of VEGF-C was observed in CCC and SEC compared to EEC. Conversely, the level of sVEGF-R2 in rare forms of cancer in the tumor was reduced. The level of VEGF-C in the blood of patients with EEC, CCC, and SEC was 1.5–1.6 times higher than that of healthy donors, regardless of the histological structure of endometrial cancer, while sVEGF-R2 did not have reliable differences from healthy donors.

Conclusion: The pronounced activation of sVEGF-R1 and inhibition of sVEGF-R2, as detected in CCC and SEC, suggests that in tumors of rare histological forms of endometrial cancer, along with angiogenesis processes, vasculogenic mimicry occurs, contributing to the aggressiveness of these cancers.

Background: Radical cystectomy (RC) is effectively used for urothelial bladder cancer, however, the risk of recurrence remains high necessitating the search for the new treatment approaches. The aim of this study is to analyze the impact of pre- and postoperative treatments on 10-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) in patients diagnosed with bladder cancer (BC).

Materials and methods: This retrospective single-center cohort study included the surgical treatment outcomes of 484 patients with confirmed BC diagnosis (cTis-4N0–3) who underwent cystectomy between 2012 and 2021. The final analysis included 455 cases, with a median age of 65 years, and the majority being male (82.6 %). Prior radiation therapy (RT) was administered to 6.4 % of patients, BCG therapy to 5.9 %, and neoadjuvant therapy (NT) to 23.5 %. Among postoperative treatments, only adjuvant systemic therapy (AT) in 49 patients (10.8 %) was considered. The study protocol was approved by the Biomedical Ethics Committee (No. 32 / 355, dated December 23, 2020).

Results: Three key trends were identified over the past 10 years. First, the number of NT prescriptions increased by more than 50 %, mainly due to platinum-based regimens and immuno-oncological agents; however, such regimens were rarely used in patients over 75 years old. Second, prior definitive RT was found to be a significant risk factor for recurrence (OR 2.84, p < 0.001), while NT and AT did not impact survival due to the limited number of cases. Third, surgical treatment after RT was not limited to laparoscopic access and did not lead to an increase in positive surgical margins (detected in only one case, 3.4 %).

Conclusions: Our study revealed that definitive radiation therapy negatively affects oncological outcomes and increases the risk of recurrence after radical cystectomy, emphasizing the need for a cautious approach when selecting treatment for such patients.

Molecular genetic profiling of solid tumors by next generation sequencing (NGS) is widely used to select targeted therapy. At the same time, with rare exceptions, NGS has not proven to be a reliable tool for differential diagnosis of diseases. However, some types of tumors have specific somatic mutations, and their detection can serve as a reason for clarifying the diagnosis using standard methods. An example of such mutations are specific abnormalities in the EGFR gene, which occur exclusively in lung cancer. In the described clinical case, the patient was diagnosed with skin adenocarcinoma. Molecular genetic profiling revealed an EGFR exon 19 deletion mutation, which served as a reason for additional histological studies and revision of the diagnosis in favor of lung adenocarcinoma, and demonstrates the possibility of using the results of molecular profiling as an auxiliary method for differentiating cancer subtypes.

The Russian consensus on prevention, diagnostic and treatment of gastric cancer was prepared on the initiative of the Moscow clinical scientific center named after A. S. Loginov on the Delphi method. Its aim was to clarify and consolidate the opinions of specialists on the most relevant issues of prevention, diagnosis and treatment of gastric cancer. An interdisciplinary approach was provided by the participation of leading gastroenterologists, oncologists and surgeons.