The fundamental parameters of professional communication between an oncologist and a patient are quality contact and the presence of trust. Their absence can cause the physician stress in the doctor and become a source of unpleasant experiences. Disruption of the communication process intensifies patients' psychological distress, reduce treatment satisfaction, and even affect the effectiveness of the conducted treatment due to the patient's understanding of the information. This can lead to conflicts and complaints.

For five years, as part of the Russian Oncology Congress, medical psychologists with experience in cancer clinics have been conducting master classes, during which various aspects of psychologically competent professional com munications between a doctor and a patient are considered. The article discusses the questions asked during the last master class (11–13 December, 2025) and the answers of psychologists, which offer some principles and specific ways to resolve difficult situations that arise at the recep tion of oncologists.

Objective: To evaluate the efficacy and safety of avelumab maintenance therapy in patients with metastatic urothelial carcinoma (UC) in real-world practice.

Methods: This ambispective study included patients with metastatic UC and measurable tumor lesions, without progression during and after first-line platinum-based chemotherapy (CHT), who received avelumab maintenance therapy (800 mg IV every 2 weeks). The primary endpoint of the study was overall survival (OS).

Results: The study included 110 patients, with a predominance of men (81 %). The median age of all patients was 65 (range, 36–84) years. With a median follow-up of 11.9 months, the median OS was not reached; the one-year OS was 78.7 %. The median progression-free survival (PFS) was 9.5 months (95 % CI, 7.8–11.2 months). The objective response rate (ORR) to first-line chemotherapy was 48.2 %. Of the 97 patients with an evaluated objective response, 38 (39.2 %) demonstrated additional objective responses to avelumab therapy (16 complete and 22 partial responses). Grade 3 adverse events during avelumab therapy were observed in 11.8 % of patients.

Conclusions: The efficacy and safety of avelumab maintenance therapy in real-world practice are comparable to those in the pivotal study.

Introduction: Hereditary cancer syndromes (HCS) represent a group of genetically determined diseases where the risk of developing various types of tumors is significantly higher compared to the general population. Iden tifying germline pathogenic variants (PVs) associated with an increased risk of tumor formation is crucial for prevention, diagnosis, and treatment of patients. Scientific studies conducted on Russian patients with malignant neoplasms (MNs) will help to identify genetic markers of HCS that are specific to different ethnic groups and patient samples.

Aim: To analyze the results of whole-genome sequencing (WGS) of 500 patients with MNs from the Yamalo-Nenets Autonomous Okrug (YNAO) and to identify germline variants associated with the development of HCS in oncology patients, along with a description of the structure and frequency of the genetic variants obtained.

Methods: Since 2021, unique scientific projects aimed at identifying genetic variants associated with HCS have been implemented in YNAO using WGS. This study included 500 patients with MNs meeting at least one of the following criteria: 1) early age at onset of MN; 2) multiple primary MNs; 3) certain histological and immunohisto chemical characteristics of MNs; 4) a significant family cancer history. Whole-genome sequencing of DNA isolated from peripheral blood lymphocytes was performed.

Results: WGS results demonstrated that 83 out of 500 patients with MNs were found to have PVs in genes associ ated with carcinogenesis, accounting for 16.6 %. This article presents the structure of the identified PVs in groups of patients with breast and ovarian cancers, patients with colorectal cancer and endometrial cancer, as well as in a heterogeneous group of patients with various tumor types.

Conclusion: We have published the WGS results from YNAO for the first time and analyzed the structure of the obtained genetic variants in oncology patients. Research on the genetic characteristics of the patients from YNAO not only helps to identify patients at increased risk of developing cancer, providing them with preventive measures and effective treatment but also generates unique scientific information necessary for the development and adap tation of molecular genetic tests considering the sample’s peculiarities and international experience.

Introduction: Treatment options in the third line for patients with metastatic colorectal cancer are limited in the Russian Federation to the multikinase inhibitor regorafenib and the strategy of re-administering previously effective chemo-targeted therapy (hereinafter referred to as chemotherapy re-challenge).

Aim: To evaluate the efficacy and safety of regorafenib and chemotherapy re-challenge in later lines of therapy for metastatic colorectal cancer, and to identify patient subgroups deriving the greatest clinical benefit from the upfront choice of each approach.

Materials and methods: A multicenter retrospective study was conducted (four oncology institutions in the Russian Federation, 2010–2021). A total of 218 patients with metastatic colorectal cancer after progression on fluoropyrimidines, oxaliplatin, and irinotecan were included; they received regorafenib or chemotherapy re-challenge in the 3rd and / or 4th line. All patients had 4‑th line of treatment. The primary endpoint was median progression-free survival in the 3rd line; secondary endpoints included median progression-free survival in the 4th line, median overall survival, and toxicity (CTCAE v5.0). Survival was analyzed using the Kaplan — Meier method with the logrank test; subgroup analyses were performed according to clinical and prognostic factors.

Results: Chemotherapy re-challenge was administered to 121 patients (55.5 %) and regorafenib to 97 (44.5 %); median age was 63 and 62 years, respectively (p = 0.41). Median overall survival was higher with chemotherapy re-challenge: 19.05 months versus 13.6 months (HR = 0.60; 95 % CI 0.43–0.83; p < 0.01). Median progression-free survival in the 3rd line was also higher in the chemotherapy re-challenge group: 6.06 versus 3.02 months (HR = 0.58; 95 % CI 0.44–0.76; p < 0.01). In the 4th line, no statistically significant differences in median progression-free survival were observed: 3.7 vs 2.87 months (HR = 0.78; 95 % CI 0.59–1.04; p = 0.09). Subgroup analyses showed an overall survival and / or progression-free survival advantage for chemotherapy re-challenge across all prognostic groups. Chemotherapy re-challenge was associated with a more favorable toxicity profile. Dose reduction of regorafenib was required in approximately 40 % of patients, and treatment discontinuation due to toxicity occurred in 8–10 %.

Conclusion: In a selected cohort of patients able to receive subsequent lines of therapy, third-line chemotherapy re-challenge was associated with longer overall survival and progression-free survival compared with regorafenib.

Objective: To evaluate the effectiveness and safety of ¹⁷⁷Lu-PSMA radioligand therapy (RLT) in patients with disseminated prostate cancer who were followed up in healthcare institutions of the Moscow Department of Health and received treatment outside of clinical trials.

Materials and methods: This retrospective study included patients with disseminated prostate cancer treated with ¹⁷⁷Lu-PSMA RLT and followed up at outpatient oncology centers in Moscow between January 1, 2022, and December 1, 2025. Inclusion criteria: histologically verified prostate adenocarcinoma, radiological signs of metastatic disease, and treatment with at least 1 cycle of ¹⁷⁷Lu-PSMA RLT. Exclusion criteria: absence of data on ≥ 1 ¹⁷⁷Lu-PSMA administration and ≥ 1 follow-up examination after treatment initiation. The primary endpoint was radiologic progression-free survival (rPFS). The secondary endpoints included the PSA50 response rate (defined as a ≥ 50 % decline in prostate-specific antigen from baseline), PSA progression-free survival (PSA-PFS), progression-free survival according to the Prostate Cancer Working Group 3 criteria (PFSPCWG3), overall survival (OS), time to clinical deterioration, safety, and toxicity.

Results: A total of 41 patients were included in the analysis. The median age was 72 years (range: 53–85). At RLT initiation (baseline), 9 patients (21.9 %) had ECOG PS scores of 2–3. Twenty-nine patients (70.7 %) had been previously treated with ≥ 1 taxane and ≥ 1 androgen receptor signaling inhibitor (ARSI). Castration resistance prior to RLT initiation was observed in 40 patients (97.6 %). The median baseline PSA level was 121.7 ng / mL (range: 0.6–4987.7). All patients had PSMA-positive metastases; in 3 cases (7.3 %), these were accompanied by clinically significant PSMA-negative metastases. All patients received ¹⁷⁷Lu-PSMA RLT (median of 4 cycles [range, 1–8]). Forty patients (97.6 %) received RLT concomitantly with continuous androgen deprivation therapy (ADT); 11 patients (26.8 %) received RLT during ADT in combination with an ARSI; 3 patients (7.3 %) underwent combined systemic radiopharmaceutical therapy (2 patients [4.9 %] with ¹⁷⁷Lu-PSMA / ¹⁵³Sm, and 1 patient [2.4 %] with ¹⁷⁷Lu-PSMA / ²²⁵Ac-PSMA). The median follow-up duration was 10 months (range: 0.4–30). The PSA50 response rate was 46.3 %, median rPFS was 6.2 months (95 % confidence interval [CI], 4.7–7.7), median PSA-PFS was 5.2 months (95 % CI, 2.7–7.7), median PFSPCWG3 was 5.7 months (95 % CI, 4.8–6.5), median OS was 11.4 months (95 % CI, 6.2–16.6), and median time to clinical deterioration was 5.8 months (95 % CI, 3.9–7.8). Serious AEs were reported in 18 patients (43.9 %), AE-related RLT discontinuation was required in 8 cases (19.5 %), and AE-related death was reported in 3 cases (7.3 %). Grade 3–4 anemia developed in 15 patients (36.6 %), grade 3–4 thrombocytopenia in 14 patients (34.1 %), and neutropenia in 17 patients (41.5 %).

Conclusion: Data from real-world clinical practice confirm the effectiveness of ¹⁷⁷Lu-PSMA RLT in patients with disseminated prostate cancer. However, the safety profile raises significant concern. These findings highlight the need for a more balanced approach to patient selection for RLT.

Introduction: Radiation therapy (RT) is the standard of care for radical treatment of early prostate cancer (PCa). The use of stereotactic radiotherapy (SBRT) in the treatment of localized PCa is currently being studied. Most researchers believe that SBRT is a highly effective RT method, comparable in oncologic outcomes to conventional radiation techniques. The efficacy and safety of SBRT without the use of additional imaging techniques (gold fiducials) and anatomical protectors (biodegradable perirectal spacers) remain controversial. Therefore, the development and testing of SBRT for PCa using a modern “standard” linear accelerator is relevant and has significant scientific and practical significance.

The aim of the study: improving the results of radical radiation treatment for patients with localized prostate cancer by developing a method of SBRT without using of gold fiducials and biodegradable perirectal spacers on a linear accelerator in a regional oncology center.

Materials and methods: A single-center, prospective, non-randomized study of the use of SBRT in patients with localized PCa was conducted. The study group included 80 patients with histologically confirmed low or intermediate risk PCa who underwent SBRT (36.25 Gy / 5 fractions, 3 times per week) at the Vladimir Regional Clinical Oncology Dispensary from December 2021 to March 2023.

Results: The two-year biochemical relapse-free survival was 97.5 %. No grade 3 acute genitourinary or rectal toxicity was recorded. Grade 2 acute genitourinary toxicity according to CTCAE v5.0 was 6.2 %. Late genitourinary toxicity of grade ≥ 2 at 2 years was 15 %. Grade 2 acute rectal toxicity was 1.2 %. Late rectal toxicity grade ≥ 2 at 2 years was 3.7 %.

Conclusion: Developed and tested on a linear accelerator, SBRT should be recognized as an effective method for the radical treatment of localized PCa. A high level of biochemical control with a tolerable safety profile was achieved without the use of gold fiducials or biodegradable perirectal spacers.

Cyclin-dependent kinase 4 / 6 inhibitors (CDK4 / 6i) have become a standard component of therapy for hormone receptor — positive (HR+) / HER2‑negative (HER2–) breast cancer (BC). However, in most patients, their clinical benefit is only temporary. Acquired resistance is not the exception but the rule, representing a major barrier to achieving durable disease control. To summarize current knowledge on resistance mechanisms, we conducted a literature search and analysis in the PubMed / MEDLINE, Scopus, and Web of Science databases covering the period 2015–2024, supplemented by seminal publications from earlier years.

This review summarizes current evidence on the molecular mechanisms underlying resistance to CDK4 / 6 inhibitors. It highlights alterations in cell-cycle regulation and activation of compensatory intracellular signaling cascades that enable tumor cells to circumvent the effects of these agents.

The principal mechanisms of resistance to CDK4 / 6i include altered expression of the kinases themselves (CDK6 overexpression or CDK4 downregulation), loss or reduced expression of the estrogen receptor (ER), dysfunction of the retinoblastoma protein (Rb), and loss of the APC / C co-activator FZR1, leading to APC / C^MR1 complex dysfunction and CDK hyperactivation. Of particular interest is amplification of the CDKN2A tumor-suppressor gene, which alters the functional properties of its product, p16^INK4a, endowing it with noncanonical oncogenic activity. Alternative signaling pathways also play key roles in resistance development, including hyperactivation of PI3K — AKT — mTOR, activation of FGFR, and dysregulation of the Hippo kinase pathway. PI3K — AKT — mTOR hyperactivation, often associated with loss of the tumor suppressor PTEN, correlates not only with resistance to CDK4 / 6i but also with reduced sensitivity to PI3K inhibitors. FGFR activation stimulates MAPK and PI3K signaling cascades and promotes ligand-independent ER activation through protein phosphorylation. Dysregulation of the Hippo pathway drives nuclear translocation of YAP / TAZ and enhances expression of proliferation-related genes, including CDK6. The diversity of these resistance mechanisms turns therapy into a “whack-a-mole” scenario: inhibition of one pathway inevitably triggers activation of another. Overcoming resistance therefore requires the development of rational combination strategies that synergistically target both the canonical proliferation pathway and critical compensatory cascades. Such an approach holds promise for the development of truly personalized therapies for patients with HR+ / (HER2–) breast cancer.

Aim: to analyze global scientific publications dedicated to the “watch and wait” strategy and the prospects for its application in a g roup of patients with locally advanced non-small cell lung cancer (NSCLC).

Material and Methods: a literature search was conducted using medical databases: PubMed, Web of Science, RSCI (Russian Science Citation Index), and Scopus. Publications were selected based on the following criteria: randomized and cohort studies, systematic reviews, and meta-analyses.

Conclusion: the “watch and wait” strategy is a promising option in the therapy of patients with NSCLC and requires more in-depth study. The conduct of prospective studies is necessary to determine key parameters (patient selection criteria, follow-up regimens). Furthermore, the development of effective methods for assessing the degree of pathological response is required.

Objective: to present and analyze the clinical treatment outcomes of patients with RAS-mutated metastatic colorectal cancer based on two case reports, assessing the efficacy of systemic therapy regimens, and demonstrating factors influencing treatment strategy and tumor response. These cases demonstrate the need for new markers and a personalized approach to therapy in patients with colorectal cancer. These observations were compared with current literature data, demonstrating the practical value of an individualized approach to treating patients with RAS-mutated metastatic colorectal cancer.