Background: Due to the low efficacy of PD-L1 antibodies in second and subsequent lines of metastatic gastric cancer (mGC), the optimal treatment strategy of such patients and appropriate choice of predictive biomarkers remain challenging.

   The aim of our study is to assess the efficacy of immune checkpoint inhibitors monotherapy in patients with mGC in routine clinical practice, especially in heavily-pretreated patients.

   Materials and methods: We retrospectively analyzed data of patients treated in five oncology centers in Moscow between 2018 and 2023, who received nivolumab or pembrolizumab for advanced gastric cancer. Primary end-point of our study was 6-months PFS. Secondary end-points were overall survival (OS), objective respons e rate (ORR), and disease control rate (DCR). Toxicity was assessed using CTC AE v5.0 scale.

   Results: 122 patients with mGC who received immune checkpoint inhibitors were included between 1 January 2018 and 28 February 2023. 6-months PFS rate was 31,6 %. The median OS was 7 months (95 % CI: 2–20), the median PFS was 3 months (95 % CI: 1,5–9,5). A statistically significant difference in OS was detected in patients with MSI compared to MSS (25 months vs 6 months; 95 % CI: 0,21–0,86; HR: 0,43). A trend towards higher PFS was observed as well (10 months in MSI vs 3 months in MSS; 95 % CI:0,26–1,01; HR: 0,51). No statistical significance in PFS and OS according to PD-L1 CPS was found among patients with MSS. ORR and DCR were 36,6 % and 10,6 %, respectively. No cases of pseudoprogression or fatal immune-related AEs were observed.

   Conclusion: Our real-world data is consistent with published literature and the results from clinical trials. Further studies are needed to determine prognostic factors and to establish prognostic model of patients receiving ICIs for optimal treatment strategy of mGC.

   Introduction: Colorectal cancer is one of the leading malignancies in Russia [1]. The standard approach for selected patients (pts) with locally advanced colon cancer is surgery with adjuvant chemotherapy. Several studies have shown that colorectal cancer (CRC) with presence of a disorder in the mismatch repair (dMMR) / microsatellite instability (MSI) is characterized with high sensitivity to the immune checkpoint inhibitors. Several studies have shown that MSI / dMMR CRC patients tend to be more responsive to immune checkpoint inhibitors such as pembrolizumab, nivolumab or ipilimumab. However, there was no information about the efficacy of prolgolimab, a PD-1 receptor blocking antibody. Prolgolimab was highly effective in melanoma treatment, while the toxicity was comparable to pembrolizumab and nivolumab.

   Methods: We initiated the phase II non-randomized open-label clinical trial. Inclusion criteria were: histologically verified, MSI / dMMR, clinical stage II–III CRC. According to study protocol, prolgolimab (1 mg / kg) is administered every two weeks, then surgery should be done after 6 months of immunotherapy (12 cycles). In case of surgical treatment refusal, the systemic treatment proceeds for 1 year. The co-primary endpoint was the complete response (pCR) rate. Secondary endpoints included tumor regression grade by Mandard (TRG), major pathologic response (MPR), overall response rate (ORR) disease free survival (DFS) and overall survival (OS). Here is a presentation of safety and pathologic response data — rates of pCR / MPR, objective response rate.

   Results: A total of 26 patients began treatment with prolgolimab from April, 2022 to February, 2024. Immune-related adverse effects of grade III–IV, were recorded in 1 (3,8 %) patient (autoimmune hepatitis grade IV); 4 (15,4 %) patients had adverse effects grade I–II: autoimmune thyroiditis, diarrhea, hypothyroidism. Two patients were refused to make a surgical treatment because of clinical CR and possible volume of surgery. Nine (34,6 %) patients underwent surgical treatment within 3 months after the immunotherapy completion: 7 patients had TRG 1 and pCR, 2 — TRG 2 and MPR after the treatment. ORR was 100 %, complete clinical response rate 40 %. The study is still ongoing, DFS and OS will be announced in further publications. Median follow-up time was 5 months.

   Conclusion: The first interim analysis data suggest a strong potential for neoadjuvant immunotherapy to become standard of care and allow further exploration of organ-sparing approaches in MMR / MSI CRC patients.

   Introduction: Despite the fact that highly differentiated thyroid cancer is included in the group of malignant neoplasms with a favorable prognosis, data on the high frequency and recurrence of relapses are reported. The presence of metastatic lymph nodes in HDTC increases the risk of regional relapse by up to 27 %. According to the literature, the factors that increase the risk of recurrence are: histological type, stage, depth of extrathyroid invasion, the presence of metastatic lymph nodes, age, and the volume of primary surgical intervention. Lateral neck dissection should be performed in patients with morphologically verified metastatic thyroid cancer, but there is still no clear consensus on the volume of dissection.

   Aim: Assessment of factors affecting the risk of regional recurrence in the lateral neck tissue and the localization of recurrence.

   Materials and methods: The study included 56 patients with HDTC, in whom metastatic lateral neck nodes were identified and verified. All patients previously underwent unilateral or bilateral neck lymph node dissection in various institutions. During the period of dynamic follow-up, these patients revealed regional recurrences in the lateral tissue of the neck. The patients were observed and treated for recurrence at the N. N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia.

   Results: Age over 55 years is a prognostically significant factor affecting the frequency of regional relapse in the lateral neck tissue (p = 0.002). The presence of metastatic nodes in the lateral tissue of the neck at the initial treatment is a prognostically significant factor that increases the risk of regional recurrence in the lateral tissue of the neck (p = 0.017). According to the results of a single-factor analysis, a statistically significant effect of the stage on the risk of regional relapses in the lateral neck tissue was noted (p = 0.014). In 35.7 % of cases, recurrent nodes were localized in the level V.

   Conclusion: Main risk factors for relapse are clinico-morphological, such as age, aggressive type of HDTC, stage of the disease, N1b status after primary surgery, as well as technical defects during primary surgical treatment.

   Aim: analysis of the influence of demographic and clinicopathologic factors on the lymph nodes yield in complicated colon cancer.

   Materials and methods: The cohort retrospective study included data on 227 patients with complicated colon cancer, including: group 1 — n = 76 cancer of the right colon cohort; group 2 — n = 151 cancer of the left colon cohort. Inclusion criteria: patients aged 18 years and older with colon adenocarcinoma of varying degrees of differentiation complicated by obstructive obstruction or perforation. These patients underwent operations within 24 hours from the moment of admission for the period: September 2016 to December 2022 in the hospitals of the Smolensk. Not included in the study: patients with emergency interventions for obstructive obstruction and perforation complicating the course of rectal cancer, non-epithelial malignant tumors, colon carcinoid, appendix adenocarcinoma; patients with stage IV disease.

   Results: The median age at the time of complication was 72 years for right colon cancer and 74 for left colon cancer. Most patients had local tumor status pT3, pT4a and pN+(1b–2b) status in regional lymph nodes. The average tumor size in complicated cancer of the right colon cohort was 55.4 ± 23.5 mm, the left colon cohort — 49.3 ± 18.0 mm. The median number of lymph nodes examined was 11 (5–15) for right colon cancer and 7 (3–15) for left colon cancer. Statistically significant factors that had a substantial impact on the number of removed lymph nodes were: age at the time of diagnosis — up to 70 years, local tumor status pT3 and pT4a, tumor localization in the right half of the colon, the presence of metastases in regional lymph nodes, low differentiation of adenocarcinoma.

   Conclusion: The results obtained confirm that the lymph nodes yield is affected by demographic factors (age) and clinical and pathomorphological factors, such as tumor localization, local status and size of the tumor, and the degree of differentiation of adenocarcinoma.

   Purpose of the study: To conduct a comparative assessment of the results of surgical and radiation treatment of patients with stage I renal cell carcinoma (RCC) in terms of overall survival (OS), progression-free survival (PFS), local control and changes in renal function.

   Material and methods: From 2011 to 2022 170 patients with stage I RCC were treated at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine. We conducted a retrospective study of their treatment results. The first group — 115 patients who underwent surgical treatment of T1N0M0 kidney cancer (mainly in the amount of kidney resection — 85 people), the second group — 55 patients with verified T1N0M0 renal cell carcinoma who underwent stereotactic radiation therapy (SBRT) up to 30–45 Gy in 3 fractions using CyberKnife. SBRT was performed mainly for the treatment of a primary kidney tumor, in 7 cases — for a recurrence of kidney cancer, including 1 patient with recurrent tumors in both kidneys. The average age of patients in the surgery group was 73 years, in the SBRT group — 69.9 years. The average tumor diameter in the operation group was 4.3 cm, in the SBRT group it was 3.5 cm.

   Results: The median OS in the surgery group was 121 months, but it was not achieved in the SBRT group, since most patients are alive at the time of the study. 1‑year OS in the surgery group and SBRT was comparable (98.9 % and 95.1 %, respectively), but 5‑year OS in the surgery group was significantly higher — 90.2 % vs. 70 % in the SBRT group (p < 0.05). The same trend was noted in the assessment of PFS. In the surgery group, 4 patients out of 115 (3.5 %) had a recurrence in the tumor bed, in all cases after kidney resection, after 28 months in average. In the SBRT group, 42 patients (75 %) according to RECIST 1.1 criteria 6 months after SBRT showed stabilization of the process, in 20 % of cases (11 patients) — a partial response, in 5 % (3 patients) — progressed disease. 1‑year local control was 96.4 %, 1‑year cancer‑specific survival in both groups was 100 %. Renal toxicity was recorded in 38 patients (33 %) in the surgery group and in 10 patients (18 %) in the radiotherapy group 6 months after treatment. On average, glomerular filtration rate decreased by 25 % in the surgery group and by 18 % in the radiotherapy group. We have not noted a single case of a pronounced decrease in GFR, which would require dialysis.

   Conclusion: Surgery remains the main treatment option for T1N0M0 kidney cancer, but if there are contraindications to surgery, SBRT may be the best option for inoperable patients.

   Luminal HER2‑negative breast cancer accounts for about 60–70 % of all cases of this disease. The choice of adjuvant systemic therapy for patients with operable luminal HER2‑negative breast cancer, especially the prescription of adjuvant chemotherapy and ovarian suppression, is one of the most complex and controversial issues. The reasons for this are the pronounced heterogeneity of luminal breast cancer, the absence of clear markers of chemosensitivity, as well as hormone resistance of the tumor in some patients. Genetic tests have become a great help in resolving this issue in a number of foreign countries, allowing in each specific case to assess the risk of relapse of the disease and the need to prescribe more aggressive adjuvant drug therapy, however, they are not yet available to Russian oncologists. However, even in the absence of the ability to use such tests, we have tools that can significantly facilitate decision‑making on the choice of adjuvant treatment for operable luminal HER2‑negative breast cancer. As alternative tools, the article discusses a calculator for estimating the risk of recurrence based on clinicopathological tumor characteristics, preoperative test hormonal therapy with aromatase inhibitors for postmenopausal patients, and the composite progression risk index for premenopausal patients. All of these tools are available and can be used to guide adjuvant systemic treatment.

   Positive surgical margin is observed in approximately 10 % of specimens after radical surgery for locally advanced urothelial carcinoma, and is associated with an increased risk of locoregional recurrence, metastases, and death. R+ patients are a heterogeneous group of patients requiring individual treatment approaches. There is no standard of care for R+ patients; acceptable options include observation, removal of residual tumor, postoperative chemotherapy (CT), immunotherapy (IT), radiation therapy (RT), and chemoradiotherapy (CRT). The choice of treatment plan depends on the location and characteristics of the primary tumor, use of neoadjuvant chemotherapy (NACT) before surgery and the response to it, the pathological response, the presence of detectable residual tumor, as well as the potential tolerability of immediate postoperative treatment.

   The problem of locally advanced rectal cancer (LARC) treatment has not lost its importance and relevance over the past decades, due to the steady increase in the incidence. For a long time, neoadjuvant chemoradiotherapy (nCRT) before total mesorectal excision (TME) and followed systemic chemotherapy was widely accepted as the standard therapy for locally advanced rectal cancer. Although local control is more than satisfactory using this approach, the same cannot be said of distant metastases, which rate reaches 30 % or more and is mainly the cause of death of this category of patients. One of the reasons for this lack of improvement may be the rate of patients who complete the planned adjuvant chemotherapy, which is approximately 50 %. The reasons for that may be postoperative complications, long-term recovery after extensive surgical procedures, etc. Total Neoadjuvant Therapy (TNT) is an emerging approach for the treatment of LARC aimed at improving distant metastasis. This review will outline the main steps in the evolution of LARC treatment and the formation of the stages of total neoadjuvant therapy.

   Unlike many other malignancies, the incidence and mortality of endometrial cancer continues to rise. This unfortunate trend is in no small part the result of the worldwide obesity epidemic, which is caused by reduced physical activity, poor diet and chronic stress. Currently, more than 50 % of endometrial cancer cases are associated with obesity, which is recognized as an independent risk factor for the development of this disease. Adipose tissue is not only the main place of storage of excess energy, but also a full-fledged endocrine organ that affects the metabolism, immune response and production of biologically active substances involved in cell growth and differentiation, angiogenesis, apoptosis and carcinogenesis. In this review, we assess the impact of obesity as a key component of metabolic syndrome on the development and progression of endometrial cancer. There are several mechanisms by which obesity enlarges the risk of endometrial cancer, including increased endogenous sex steroid hormones, hyperglycemia, insulin resistance, adipokine secretion, and chronic inflammation.

   The purpose of this review is to analyze publications, reflecting the already known aspects of the biological effect of obesity, as well as new data from recent years.

   About 400 thousand of new cases of endometrial cancer is registered in the world every year. Previously uncommon (for this type of malignancy) metastatic sites, such as brain or skin, have been observed over the past 15 years. Skin metastases of endometrial cancer are extremely rare and occur in less than 1 % of cases. We present a clinical case of atypical metastasis of endometrial cancer to the skin of the pubic region in a patient who underwent combined treatment.

   Introduction: Gastric cancer is one of the most common oncological diseases in the world, occupying the 5th place of morbidity and the 3rd place in the structure of mortality from oncological diseases. For a long time, issues affecting the risk of developing cancer after bariatric surgery remain relevant. Our observation is devoted to the diagnosis and treatment of a patient with gastric cancer after gastric bypass.

   Description of the clinical case: A 62‑year‑old patient was operated on 13. 07. 2016 – laparoscopic Roux gastric bypass for morbid obesity, 11.  09.  2019 – laparoscopic installation of the Cardioplant plate on a small stomach due to recurrent weight gain. Since 2020 the patient had the phenomena of anastomositis, dysphagia and gastroesophageal reflux. Courses of conservative therapy, sessions of balloon dilation of gastroenteroanastomosis and anastomosis resection failed to show a significant effect. The patient underwent comprehensive examinations at each treatment, including abdominal MSCT, cancer markers and studies of biopsy material of the gastric mucosa and gastroenteroanastomosis. As a result of histological studies, no signs of cancer were found. After applying to the Avicenna Medical Center in 2022 a molecular genetic analysis was carried out, in which the mRNA panel most corresponded to a malignant neoplasm. 20. 12. 2022 extirpation of the stomach stump with resection of the esophagus was performed. The cancer diagnosis was confirmed by histological and immunohistochemical studies: low‑grade adenocarcinoma of the stomach with a cricoid component with germination into the esophagus and small intestine, with spread beyond the muscle layer.

   Conclusion: This clinical case highlights the complexity of oncological verification in patients after bariatric surgery. Prolonged dysphagia, anastomositis and recurrent GERD in such patients determine the need for a more detailed examination, including the latest achievements of molecular genetic analysis.

   The article contains a review of the educational publication “Oncology 2.0”, prepared by a group of authors edited by Gantsev Sh. Kh. This work is intended to train doctors in the specialty of oncology, as well as improve the skills of practicing specialists in the field of cancer treatment. The publication represents an up-to-date and comprehensive presentation of the authors on oncology as a science, its place in medicine, as well as the discussion of the prerequisites for modern methods of treating malignant tumors and the ways of their development.