[Microsatellite instability and DNA mismatch repair deficiency detection in tumors of various sites]

Microsatellite instability, which is caused by a deficiency in the DNA unpaired nucleotide repair system, is an important pathogenetic event for some tumors. In addition, the detection of this molecular feature becomes an independent prognostic factor in the course of the disease and a predictor for the appointment of therapy with immune checkpoint inhibitors. Immunohistochemistry is a reliable and available method for detecting a deficiency in the DNA mismatch repair system, and it has recommended as a screening for hereditary syndromes associated with microsatellite instability. This article discusses the advantages and disadvantages of this research method from the point of view of the practitioner.

Place of durvalumab in the treatment of biliary tract cancer: A review

Biliary tract cancer (BTC) is a group of rare and aggressive types of malignancies that arise from the epithelium of the intra- and extrahepatic bile ducts (cholangiocarcinoma) and gallbladder. The prognosis of unresectable BTC is poor, and less than 5% of patients are alive at 5 years after diagnosis. Radical surgical resection remains the only potentially curative treatment for early stage BTC, and antitumor chemotherapy extends survival rates in patients with unresectable or metastatic BTC. With the emerging of monoclonal antibodies targeting immune checkpoints, the possibility of such therapy in first- and subsequent-line treatment of advanced BTC has been actively studied. The positive high-level results from the TOPAZ-1 Phase III trial showed durvalumab, in combination with standard-of-care chemotherapy (gemcitabine plus cisplatin), statistically improved overall survival versus chemotherapy alone and showed improvements versus chemotherapy alone in prespecified secondary endpoints including progression-free survival and objective response rate. Durvalumab plus chemotherapy was well tolerated, had a similar safety profile versus the comparator arm and did not increase the discontinuation rate due to adverse events compared to chemotherapy alone. The U.S. Food and Drug Administration approved the combination of durvalumab and chemotherapy (gemcitabine plus cisplatin) as the first immunotherapy regimen for patients with locally advanced or metastatic BTC. In July 2022, durvalumab plus chemotherapy (gemcitabine plus cisplatin) was added to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) as a preferred regimen category 1 in first-line therapy for Unresectable or metastatic BTC based on the data from TOPAZ-1. In addition, the durvalumab plus gemcitabine and cisplatin was recently added to the practical recommendations of the Russian Society of Clinical Oncology (RUSSCO) for the treatment of hepatobiliary cancers as an alternative to standard first-line treatment of BTC.

[Study of FGFR2 status in gastric cancer by immunohistochemistry and fluorescent in situ hybridization]

BACKGROUND

Assessment of FGFR2 status in gastric cancer is an important task, without clarification of which it is impossible to identify a cohort of patients in whom the best response to treatment with anti-FGFR2 drugs could be obtained.

OBJECTIVE

To conduct a comparative analysis of the expression and amplification of the FGFR2 gene in gastric cancer in primary tumors and metastases in the lymph nodes.

MATERIAL AND METHODS

FGFR2 status was studied in 61 patients with stage III gastric adenocarcinoma using an immunohistochemical method (Abcam clone EPR24075-418, R&D clone 98706, Santa Cruz clone C-8, Abcam clone 1G3) and FISH.

RESULTS

The antibody Abcam clone EPR24075-418 was found satisfactory for the immunohistochemical study of FGFR2. FGFR2 expression was detected in 26 (43%) cases, amplification in 5 (8%) cases. Amplification of FGFR2 in 4 cases out of 5 was accompanied by the expression of 3+, in 1 case - 2+. Discordance between FGFR2 expression in primary tumor and lymph node metastases was revealed in 13 (21%) cases.

CONCLUSION

Clone EPR24075-418 showed the best result in assessing the expression of FGFR2: the correlation with FISH results in reaction 3+ was 100%. Due to the high heterogeneity of FGFR2 expression, it is recommended to either examine the material of the primary tumor and metastasis, or evaluate a large volume of the primary tumor.

Laboratory biomarkers of an effective antitumor immune response. Clinical significance

The modern checkpoint inhibitors block the programmed death-1 receptor and its ligand, cytotoxic T-lymphocyte-associated antigen 4 on tumor cells and lymphocytes, that induces cytotoxic reactions. Nowadays, there are no approved clinical and laboratory predictor markers of immune therapy efficacy, which would allow a more personalized approach to patient selection and treatment. The aim of this review is to analyze possible biomarkers of efficacy for treatment with checkpoint inhibitors according to the pathogenic mechanisms of drug action. The review revealed possible predictive biomarkers, that could be classified to 3 groups: biomarkers of high mutagenic potential of the tumor, biomarkers of high activity of adaptive immunity, biomarkers of low activity of the tumor microenvironment. The determination of the described markers before the start of therapy can be used to formulate a treatment regimen, in which the use of various immunomodulatory drugs, inhibitors of proinflammatory cytokines, angiogenic molecules, and probiotics can be considered.

Real-World Experience with Targeted Therapy in BRAF Mutant Advanced Melanoma Patients: Results from a Multicenter Retrospective Observational Study Advanced Melanoma in Russia (Experience) (ADMIRE)

Simple Summary

Advanced melanoma is a highly aggressive disease with a poor prognosis. Recent clinical trials have shown that targeted therapy (TT) and immunotherapy (IT) lead to significant improvements in responses to treatment and the survival of advanced melanoma patients. However, little information is available in the form of real-world data on treatment patterns and clinical outcomes for patients with advanced BRAF V600 mutant melanoma. To approach this issue, we performed a retrospective study that involved 382 patients with advanced BRAF V600 mutant melanoma, who received TT in twelve medical centers. Our objectives were to evaluate clinical outcomes in real-world settings, as well as treatment patterns, adverse events, objective response rate (ORR), progression-free survival (PFS) and overall survival (OS). Considering these parameters, the results demonstrated the effectiveness of combined TT with BRAF plus MEK inhibitors in patients with brain metastases and across all lines of therapy, which was well-tolerated and manageable and showed a high safety profile.

Abstract

Clinical trials of targeted therapy (TT) and immunotherapy (IT) for highly aggressive advanced melanoma have shown marked improvements in response and survival rates. However, real-world data on treatment patterns and clinical outcomes for patients with advanced BRAF V600 mutant melanoma are ultimately scarce. The study was designed as an observational retrospective chart review study, which included 382 patients with advanced BRAF V600 mutant melanoma, who received TT in a real-world setting and were not involved in clinical trials. The data were collected from twelve medical centers in Russia. The objective response rates (ORRs) to combined BRAFi plus MEKi and to BRAFi mono-therapy were 57.4% and 39.8%, respectively. The median progression-free survival (PFS) and median overall survival (OS) were 9.2 months and 22.6 months, respectively, for the combined first-line therapy; 9.4 months and 16.1 months, respectively, for the combined second-line therapy; and 7.4 months and 17.1 months, respectively, for the combined third- or higher-line therapy. Analysis of treatment patterns demonstrated the effectiveness of the combined TT with BRAF plus MEK inhibitors in patients with brain metastases, rare types of BRAF mutations, and across lines of therapy, as well as a well-tolerated and manageable safety profile.

Small fraction of testicular cancer cases may be causatively related to CHEK2 inactivating germ-line mutations: evidence for somatic loss of the remaining CHEK2 allele in the tumor tissue

A recent study suggested a role of CHEK2 loss-of-function germ-line pathogenic variants in the predisposition to testicular cancer (TC) (AlDubayan et al. JAMA Oncol 5:514-522, 2019). We attempted to validate this finding relying on the high population frequency of recurrent CHEK2 pathogenic variants in Slavic populations. CHEK2 pathogenic alleles (c.1100delC (p.Thr367Metfs); del5395 [del ex9-10]; IVS2 + 1G > A [c.444 + 1G > A]) were detected in 7/280 (2.5%) TC patients vs. 3/424 (0.7%) healthy men and 6/1007 (0.6%) healthy women [OR 4.0 (95% CI 1.5-11), p = 0.009 for pooled control groups]. Somatic CHEK2 loss-of-heterozygosity (LOH) was detected in 4 out of 6 tumors available for analysis; strikingly all these instances of LOH involved inactivation of the wild-type allele. The CHEK2 c.470T > C (p.Ile157Thr) variant was detected in 21/280 (7.5%) affected vs. 22/424 (5.2%) non-affected men [OR 1.5 (95% CI 0.8-2.7), p = 0.3]. Somatic CHEK2 LOH was revealed only in 6 out of 21 tumors obtained from CHEK2 c.470T > C (p.Ile157Thr) carriers, with the C-allele lost in two cases and T-allele deleted in four tumors. The results of comparison of allele frequencies in TC patients versus population controls coupled with the data on CHEK2 LOH status in tumor tissues support the association of CHEK2 pathogenic variants with TC risk.

Self-assembled polypeptide nanoparticles for intracellular irinotecan delivery

In this research poly(l-lysine)-b-poly(l-leucine) (PLys-b-PLeu) polymersomes were developed. It was shown that the size of nanoparticles depended on pH of self-assembly process and varied from 180 to 650nm. The biodegradation of PLys-b-PLeu nanoparticles was evaluated using in vitro polypeptide hydrolysis in two model enzymatic systems, as well as in human blood plasma. The experiments on the visualization of cellular uptake of rhodamine 6g-loaded and fluorescein-labeled nanoparticles were carried out and the possibility of their penetration into the cells was approved. The cytotoxicity of polymersomes obtained was tested using three cell lines, namely, HEK, NIH-3T3 and A549. It was shown that tested nanoparticles did not demonstrate any cytotoxicity in the concentrations up to 2mg/mL. The encapsulation of specific to colorectal cancer anti-tumor drug irinotecan into developed nanocontainers was performed by means of pH gradient method. The dispersion of drug-loaded polymersomes in PBS was stable at 4°C for a long time (at least 1month) without considerable drug leakage. The kinetics of drug release was thoroughly studied using two model enzymatic systems, human blood serum and PBS solution. The approximation of irinotecan release profiles with different mathematical drug release models was carried out and allowed identification of the release mechanism, as well as the morphological peculiarities of developed particles. The dependence of encapsulation efficiency, as well as maximal loading capacity, on initial drug concentration was studied. The maximal drug loading was found as 320±55μg/mg of polymersomes. In vitro anti-tumoral activity of irinotecan-loaded polymersomes on a colon cancer cell line (Caco-2) was measured and compared to that for free drug.

Unusual Clinical Presentation of Gastrointestinal Clear Cell Sarcoma

BACKGROUND

Use of molecular assays is gradually becoming a mandatory part of the clinical management of soft tissue tumors, however the choice and the interpretation of these tests may present a challenge.

SUMMARY

This report demonstrates an unusual presentation of sarcoma, which was initially diagnosed as a tumor of unknown primary site. Given the presence of vimentin, Fli-1, CD99 and S100 markers, lack of immunostaining for melan A, HMB45, MITF, synaptophysin, CD56, myf4, CKAE1/3 and WT-1, as well as the presence of EWSR1 translocation determined by a break-apart FISH assay, Ewing's sarcoma (ES) diagnosis seemed to be well justified. However, polymerase chain reaction testing for ES-specific rearrangements (EWSR1/FLI1, EWSR1/ERG, EWSR1/ETV1, EWSR1/ETV4, EWS/FEV) failed to confirm the ES origin of the neoplastic tissue. We further considered clinical, morphological, immunohistochemical and molecular diagnostic features of other types of EWSR1-rearranged sarcomas and performed molecular testing for gastrointestinal clear cell sarcoma. The polymerase chain reaction assay revealed EWSR1ex7/ATF1ex5 fusion, thus confirming the latter diagnosis. Subsequent high-precision computed tomography of the abdominal cavity revealed a 5-cm tumor of the small bowel, which was subjected to surgical resection.

KEY MESSAGE

This report exemplifies that the use of anonymous cytogenetic assays, such as break-apart FISH EWSR1 testing, may not be sufficient even in case of a perfect match with relevant morphological and immunohistochemical tumor features.

PRACTICAL IMPLICATIONS

Explicit identification of the translocation gene partners is indeed important for proper sarcoma diagnosis management.

[RESULTS OF DIAGNOSTICS AND TREATMENT OF ADRENOCORTICAL CANCER]

The results of examination and treatment of 96 patients with adrenocortical cancer (ACC) were analyzed. Local forms of ACC (I and II stages (T1-2N0M0) were found in 19 patients, locally advanced forms (III stage (T1-4NIM0; T3-4N0M0) - in 62 cases and metastatic forms of ACC (IV stage (TxNxM1) - in 15 patients. The diagnostic approach to ACC was optimized. It allowed identifying ACC on early stages of oncological process and staging of oncological process preoperatively in order to justify a rational treatment option. Surgical interventions were performed on 85 patients. The authors used an open access in 75 patients and endovideosurgical - in 10. The most common way of surgery was to remove an affected adrenal gland with fat of upper paranephrium and regional for adrenal lymph nodes (n=56). The adrenalectomy and nephrectomy were fulfilled on 23 patients. A removal of the right adrenal with tumor and thrombus of the interior vena cava was carried out in 2 patients. Some patients (n=4) underwent the explorative interventions. Combined treatment was applied in 28 patients with ACC of III stage. This gave a possibility to increase their life-span from 17,5±8,4 to 36,3±6 months. The overall 3-year survival rate for patients with ACC was 41,2% and 5-year survival observed in 18,7%. An application of modified treatment-and-diagnostics algorithm allowed increasing detection of patients with local and locally advanced forms of ACC in 2,5 times. Therefore, the application of rational treatment options have reduced the number of intraoperative complications from 38,8% to 10,2% and postoperative complication rates- from 61,1% to 20,4%, the lethality :rate - from 7,1% to 0% in early postoperative period. These measures have increased the life-span and life quality in 2 times.

[SUPPRESSION OF TUMOR GROWTH AFTER XENOGRAFTING OF HUMAN COLORECTAL CARCINOMA CELLS]

Previously we've described the obtainment of a subpopulation of cancer stem cells from a human colorec- tal carcinoma cell line MIP101. These cells possess elevated clonogenic and tumorigenic capacities. According to our data, depletion of stem compartment in a cancer cell population blocks its tumorigenicity. The current work is dedicated to the comparison of tumorigenic potential between cell populations with enriched or depleted stem compartment. We show that tumor growth following xenografting of enriched stem cell population can be suppressed by intramuscular injections of ganciclovir. Thus, we report a method to obtain a cell population with high Oct4 promoter expression within the MIP101 colorectal carcinoma cell line and to eliminate these cells from the population in vitro as well as in vivo.

[Chemotherapy for malignant tumors: problems and prospects]

This article is about the possibilities of increasing effectiveness and reducing toxicity in standard chemotherapy for cancer. Three possibilities are described: mechanisms of and overcoming multidrug resistance, selective transportation and drug delivery using vectors and artificial vehicles, and individualization of anticancer therapy.

[Prognostic values of the clinical, morphological and molecular biological characteristics of colon adenocarcinoma]

OBJECTIVE

to estimate the predictive and prognostic factors using morphological studies in patients with colon cancer to increase survival rates.

SUBJECTS AND METHODS

Immunohistochemical examination was made in 582 patients with colon adenocarcinoma, by determining 11 different indicators relating to the development of the tumor and its treatment.

RESULTS

The simultaneous determination of the chemokine receptor CXCR4 and proliferative activity (Ki-67 expression) can define disease prognosis in view of relapse-survival rates in patients with Stage II colon cancer after radical surgical treatment.

CONCLUSION

Thymidylate synthase and thymidine phosphorylase are of predictive value. The immunohistochemical examination of other markers, such as ALDH1, CCR10, ERCC-1, DYPD, topoisomerase II alpha, and class III beta-tubulin for the choice of treatment policy for patients with colon cancer has indicated that they are of no value.

[Immunohistochemical examination of MSH2, PMS2, MLH1, MSH6 compared with the analysis of microsatellite instability in colon adenocarcinoma]

Adenocarcinoma of the colon in 10-20% is associated with microsatellite instability, which can occur both in sporadic cancers and in hereditary nonpolyposis colon cancer. Our analysis of 195 cases of adenocarcinoma of the colon showed that microsatellite instability (MSI-H) was found only in 1.5% of patients. Subsequent choice of patients with suspected hereditary Lynch syndrome led to the identification of additional 17 patients with microsatellite instability. They passed an analysis of genes of repair system of unpaired nucleotides of DNA. The study showed that immunohistochemical staining of MSH2, MSH6, MLH1, PMS2 could effectively conduct a preliminary screening of the Lynch syndrome but was unable to divide cases of sporadic and hereditary MSI-H colon cancer.

[Morphological assessment of predictive factors in adenocarcinoma of the colon]

Immunohistochemical investigation of 15 different markers in colon adenocarcinoma was carried out. Prognostic significance showed chemokine receptor CXCR4 and Ki-67. Predictive significance was revealed for thymidylate synthase (TS) and thymidine phosphorylase (TP).

[Proliferation of cancer stem cells in colorectal adenocarcinoma]

Correlation between level of ALDH1 expression and metastases development in patients with colorectal adenocarcinoma was not revealed. Proliferation of stem cancer cells (ALDH1-positive) was significantly lower comparatively ALDH-1 negative tumor cells (p < 0.001). Proliferation of stem cancer cells vary from 0,1% to 10%.

[Use of liquid-based endometrial cytology in breast cancer patients receiving tamoxifen]

Fifty-four (54) breast cancer patients, receiving tamoxifen, were enrolled into an evaluation of the status of the endometrium. Liquid-based cytology and immuno-cytochemical analysis were used for assessment. Our method proved viable in selective screening for differential diagnosis of endometrial pathology and cancer detection.

[Results of chemotherapy for gynecologic cancer patients in ambulatory care]

Russian Academy for Further Medical Education, St. Petersburg A clinical-statistical analysis of chemotherapeutic treatment of 198 gynecological cancer patients in an outpatient clinic and 226 ones in a hospital. It was concluded that was no difference in the treatment effectiveness, as well as in the incidence of hematological and non-hematological complications.

[Possibilities of palliative operations in patients with intrapulmonary metastases of renal cancer]

Results of treatment of 51 patients with intrapulmonary metastases of renal cancer were analyzed. Surgical interventions in volume of complete cytoreduction were made in 31 of them. All the patients were followed-up after operations at the period from 3 through 68 months. A multi-factor analysis has shown that surgical metastasectomy gives reliably better results of treatment of patients with disseminated renal cancer. Regressive analysis in the group of operated patients has shown that involvement of the lymph nodes of the bronchopulmonary group and mediastinum gave reliably worse results of treatment of this group of patients.

[Cytoreductive operations in complex treatment of patients with intrapulmonary metastases of colorectal carcinoma]

An analysis of results of treatment of 112 patients with metastases of intrapulmonary colorectal carcinoma (CRC) for the period from 1990 to 2006 has shown that cytoreductive opera tions for excision of the metastases are an effective method of treatment of this category of patients which allows a two times increased survival median as compared with analogous index in the group of patients exposed to palliative chemotherapy. Palliative chemotherapy fails to have statistically significant influence to survival of patients who have ablated intrapulmonary CRC metastases in the volume of complete cytoreduction.

[Quality of life of patients with breast cancer receiving hormonal therapy, depending on age and marital status]

Our study involved 247 patients with histologically verified breast tumors, aged 48-89, who had received hormones - tamoxifen as first-line therapy, exemestan (second-line) for 12 months. FACT-B and FACT-G questionnaires were used to assess quality of life. Worse results were reported in tamoxifen-treated patients older than 60 years. Indices of emotional and social security in the two groups: 60-70 year-olds (10.8+/-0.96% and 14.3+/-1.27% vis-à-vis 14.8+/-1.31% and 15.6+/-1.42%, respectively) and over 70 year-olds (15.2+/-1.46% and 15.8+/-1.48%, respectively). Our evidence suggested that a large-seale complex of effective psychological rehabilitation be given, particularly, to those under 60, married andlor with minors, right from the very beginning of treatment.

[Comparison of efficacy of combined use of liquid cytology and immunohistochemical assay of p16ink4 and standard procedure and high risk evaluation by polymerase chain reaction of human papillomavirus infection in diagnosing cervical dysplasia and carcinoma]

Efficacy of liquid cytology, on the one hand, and those of standard one, appraisal of high risk of cancer by polymerase chain reaction (PCR) of human papillomavirus infection and immunohistochemical assay of p16ink4 high risk in cervical carcinoma diagnosis, on the other, was evaluated PCR of high risk of cancer (dysplasia-free) was detected in 73% (n = 73), CIN I-II--78%, CIN II-III--89%, CIN III and carcinoma--100%. p16ink4 was not detected in dysplasia-free cases and it was--(16%) in CIN I-II, (89%) CIN II-III, (90%) CIN III and (100%)--in carcinoma. Hence, unlike p16ink4 expression (p < or = 0.001), a correlation between the increase in the number of those infected with papillomavirus was not significantly higher than that of dysplasia grade (p < or = 0.05). It is suggested that combined use of liquid cytology and immunohistochemical assay of p16ink4 is more effective.

[Role of cytoreductive surgery in complex treatment for lung metastases from solid tumors]

The report evaluates prognostic factors derived from the data on survival of 123 patients with isolated lung metastases from solid tumors after performing full-scale cytoreductive surgery. Colorectal carcinoma was diagnosed in 43 patients (35%), renal carcinoma--26 (21%), non small cell lung cancer--25 (20%), melanoma--11 (9%), endometrial carcinoma--9 (7.5%) and breast cancer--9 (7.5 a%). All patients were followed up for 3--150 months (median--16 months). Fifty-eight patients (48%) had died by the time the study started. Median of survival for colorectal carcinoma was 29 mos, renal carcinoma--23 mos, non small cell lung cancer--18 mos, melanoma--13 mos, endometrial carcinoma--70 mos and breast cancer--38 mos. According to the findings on regression results, of prognostic value for such patients are both intraoperative and histologically confirmed evidence of secondary metastases to the lymph nodes as well as relapse-free survival. Median of survival for secondary metastases to the lymph nodes was 21 mos and 67 mos without them (p = 0.04). Three cohorts were identified relating to relapse-free survival: 0-12, 12-24 and more than 24 mos. Median of survival for those groups was 19, 23 and 38 mos, respectively (p = 0.03). Such parameters as tumor site, gender, age or postoperative antitumor pharmaceutical therapy appeared irrelevant as far as survival was concerned.

[The possibility and prognostic value of secondary lymphatic cancer spread in intrapulmonic metastases of solid tumors]

In the period from 1996 to 2007 operations were fulfilled in 120 patients with isolated pulmonary metastases of solid tumors (68 men and 52 women aged from 22 through 77 years): 46 patients with metastases of colorectal cancer, 28 - with cancer of the kidney, 23 - with non-small cell carcinoma of lung, 7 - with breast cancer, 9 - with endometrium cancer, 7 - with melanoma. Altogether there were 128 operations. The operations have revealed lesion of intrathoracic lymph nodes in 29 patients (24%). In most cases (21 patients) they were lesions of lymph nodes of the lung root and intrapulmonary lymph nodes. In 93% of cases (27 patients) localization of the lesion coincided with anatomical pathways of lymph outflow from the affected part of the lung. The survival rate median of the operated patients who had alterations in the lymph nodes was 21 months, in cases with intact lymphatic system it was 37 months. A conclusion is made of possible secondary lymphatic cancer spread from intrapulmonary metastases of solid tumors and its negative influence on results of treatment that allows recommendation of revision of the lymphatic system of the lungs and mediastinum in all cases of surgical treatment of intrapulmonary metastases, and in a number of cases recommendation of anatomical resections of the lung tissue as operation of choice.

[Effect of systemic chemotherapy on clinical status and biological and immunologic markers in patients with breast cancer]

Complex examination of breast cancer patients (102, aged 35-63) receiving systemic polychemotherapy was carried out to make a case for a course of immunotherapy. Cycles of chemotherapy were given to all patients. Basal immunological status revealed T-cell and non-specific immunity suppression, disordered cytokine regulation, lowered nitrite concentration and enhanced SOD and catalase levels. Chemotherapy was followed by more frequent immunopathological syndromes and graver immunosuppression. The dynamics of biochemical parameters was characterized by decreasing antioxidant system activity.

[Role of palliative surgery in complex treatment for disseminated breast cancer]

An assessment was undertaken of survival and prognosis in 30 patients with primary disseminated breast tumors which disintegrated following palliative mastectomy carried out for sanitary purposes. That resulted in significant improvement in general condition, higher hemoglobulin and lowered intoxication which in turn made medication and radiotherapy possible: chemotherapy (4-6 cycles) followed by hormonal therapy (22-73.3%), hormonal therapy (8-26.7%), and radiotherapy for surgical scar (16-53.3%). All patients were followed up for 18 months (median--3.8 years). Tumor progression at different stages was detected in 12 (40%); local recurrences--8 out of them (26.7%). By the time of investigation, 9 (20%) out of 30, had died of tumor progression while 21 (80%) continued their treatment at the Institute's Clinic. Mean survival was 21.5 +/-2.2 months (median--19 (8-60+)). Our method proved effective due to high survival (median--18 months) and significant improvement in quality of life. However, visceral metastases (p = 0.02) and tumor growth duration (p = 0.05) were of prognostic significance. Such characteristics as presence or absence of estrogen and progesterone receptors of tumor, histological pattern, and anemia appeared insignificant, as far as prognosis was concerned. Function chi2 difference was highly significant (Cox) (p = 0.00013).

[Immunohistochemical assay of cellular cycle markers: an alternative to chip-diagnosis of breast cancer]

A new method of evaluation of immunohistochemical markers of cellular cycle (K-67, topoisomerase-II-alpha, P21/wafl), adhesion molecules (E-cadherin, CD33v6), oncoprotein HER-2, and estrogen and progesterone receptors of tumor is presented. High-precision count of tumor cells, which express each marker, was carried out using serial paraffin sections and Leica CTR5000 morphometric station and Leica Quin Plus program, to identify tumor sensitivity to anthracyclines and taxanes. Proliferative potential, tumor sensitivity to key chemical drugs and prognosis were evaluated on the basis of the evidence obtained and, in particular, the role of the proteins under study played in cellular cycle.

Phase I/II trial of gene therapy with autologous tumor cells modified with tag7/PGRP-S gene in patients with disseminated solid tumors: miscellaneous tumors

BACKGROUND

The use of genetically modified autologous tumor cells appears to be a promising approach for cancer therapy. A phase I/II trial was undertaken to define the feasibility, safety and antitumor effects of the autologous vaccine prepared by transferring tag7/PGRP-S gene into malignant melanoma and renal cell carcinoma cells.

PATIENTS AND METHODS

Twenty-one patients (17 with disseminated malignant melanoma and four with metastatic renal cell carcinoma) were enrolled in this study. Cytoreduction was performed in all cases prior to therapy. Autologous tumor cells were transfected with the tag7/PGRP-S gene, irradiated and injected intradermally every 3 weeks.

RESULTS

Vaccinations were well tolerated by all patients, without clinically significant signs of toxicity. Delayed-type hypersensitivity was observed in 48% of cases. Antitumor immune response was observed in 95% of patients. There were no complete or partial responses; however, a minor response was achieved in one patient with renal cell carcinoma. The stabilization of neoplastic disease was observed in eight patients (seven with malignant melanoma and one with renal cell carcinoma). Median time to tumor progression was 3 months.

CONCLUSIONS

The approach suggested here appears to be well tolerated and produces a number of durable clinical effects. Further studies are required to determine whether promising effects on immune activation will result in an actual clinical benefit for patients with malignant melanoma and renal cell carcinoma.

[Assessment of influence of dose variation on the effectiveness and toxicity of cytostatic therapy of disseminated breast cancer]

Main indices of efficacy such as objective response and stabilization frequency, objective response median and survival rate were evaluated in 84 patients with disseminated breast cancer receiving different doses of cytostatics: high-dose chemotherapy (HDC) plus transplantation of peripheral blood stem cells, standard-dose (SDC), dose reduced by 20% (RDC20) or by 50% (RDC50). There was an inverse correlation between complete+partial response frequency, on the one hand, and dosage, on the other: highest dose--70% and lowest dose--11.1%. Objective response median in both groups was pretty close--8.5 +/- 5.5 and 5 +/- 0.4% months, respectively. The lowering of dose involved a higher risk of tumor progression from 15% after HDC, 46.6%--SDC and 44.4%--RDC20 to 61.1% after RDC50, with likelihood of objective response decreasing. Nether median nor mean survival rates depended on dosage, nor the difference was significant (p = 0.72). Hence, adequate dose proved to be an important factor, as far as treatment efficacy is concerned. Escalation to high dose was followed by an increase in objective response rates to 70%, SDC - 35.7%, RDC20--33.4% and RDC50--11.1%. Yet, nether dose escalation nor dose reduction involved significant variation in survival (p = 0.72).

[High-dose Roncoleukin in patients with disseminated cutaneous melanoma: a phase 1 study]

High doses of recombinant interleukin-2 (rlL-2) have been shown to provide clinical effect and long-term survival in patients with malignant melanoma. We have performed a phase 1 study of rIL-2 "Roncoleukin", produced in Saccharomyces cerevisiae. Twenty six patients with disseminated malignant melanoma received from 12 up to 108 millions international units (MIU) of IL-2 as 3-hour i.v. infusions days 1-5 of the 21-day cycle. From 2 to 6 patients were included on each dose level. Response was assessed according to RECIST criteria. Twenty two patients were available for response and 26 for toxicity; 68 cycles of therapy performed. No grade 4 toxicity or toxic death occurred. Main dose limiting toxicity was cardiologic, skin and constitutional (fever) symptoms. One hundred and eight MIU of "Roncoleukin" was considered the highest tolerable dose because of grade 3 toxicity in 2/2 patients, receiving this dose. One complete response (CR) and 2 partial responses (PR) were observed at dose levels of 72 MIU (1 CR and 1 PR) and 84 MIU (1 PR). 3/4 objective responses were in patients with metastases in soft tissues and lymph nodes. Overall response rate was 13.7%. "Roncoleukin" provide certain efficiency in patients with malignant melanoma. This drug has acceptable toxicity; the maximum tolerable dose is 108 MIU. Recommended dose for phase 2 clinical trails is 72 MIU.

[Phase I-II trial of gene therapy with tag-7 modified autologous tumor cells in patients with metastatic solid tumors]

A prospective (phase I-II) trial was undertaken to study the efficacy and toxicity of gene therapy with tag 70-modified autologous tumor cells in 32 patients with metastatic renal cell carcinoma (RC) (5) and melanoma (MBL) (27) treated at the Institute's Clinic (2001-2003). Resected material was reduced to cell culture, which was transfected with tag 70 gene and devitalized by irradiation. Immune blotting was used for gene expression. Clinical and immunological effectiveness was evaluated in 22 patients (MBL--17 and RC--5) who received 1-6 injections (3 on the average). Full course of vaccination was given to 8 (MBL--6 and RC--2). No complete or partial response was reported while least regression (50%) was registered in a case of RC metastatic to the lung. According to CT and ultrasound evidence, stabilization was achieved in 5 (23.8%) (MBL--4 and RC--1). Relapse-free period was 6.5+/-3.5 months beginning from the start of treatment. The vaccine was well tolerated while DHT reaction was observed in 47.6% (10 out of 17) of primary immunized patients. A trend of increased content of T- and B-cells in peripheral blood and intensified functional activity was established.

[Treatment with Miltex for metastatic skin lesions in breast cancer]

Miltex (miltefosine) is a new antiproliferation drug comprising phospholipid ingredients. It is used for topical treatment of metastatic skin lesions in breast cancer. Clinical trials of the drug were conducted in 11 breast cancer patients resistant to standard therapy. Apparent therapeutic effect (partial regression) was registered in 27.3% (3/11). Moderate toxic effects were generally confined to skin itching (36.4%) and scaling (18.2%), erythema (18.2%), and paper skin (45.5%).

[Effectiveness of current chemotherapy in metastatic breast cancer resistant to anthracycline antibiotics]

The efficacy of different antitumor therapies was evaluated in a study involving 53 patients with metastatic breast cancer resistant to anthracyclin antibiotics. Complete and partial regression of tumor was recorded following combined administration of vinorelbin and doxorubicin (27.3%) and taxanes (21.3%). Median therapeutic benefit duration was 22 and 28 weeks, respectively. Response frequency for mitomicin C + mitoxantron + methotrexate regimen was 11.1%. However, no objective therapeutic effects were observed in patients on ifosfamide + mitoxantron and regular 5-fluorouracil infusins.

[Subchondral endoprosthesis in combined treatment of patients with primary and metastatic tumors of long tubular bones]

The report deals with the results of organ-saving surgery for subchondral endoprosthesis carried out in 31 patients with primary tumors and pathological fracture of bones caused by metastasis. An original procedure using the anatomo-physiological peculiarities of cartilage permits to preserve the physiological status of the joint. Lysis of tumor cells in subchondral bone is caused by methyl acrylate used as bone cement. Administration of adaptogen-immunomodulators promotes postoperative healing processes and lowers the risk of infection-related complications.

[Prevention of cardiotoxicity of doxorubicin (Adriamycin) using cardioxane (ICRF-187, dexrazoxane) in the combination chemotherapy of disseminated breast cancer]

Clinical, ultrasound and ECG studies of the left ventricle ejection fraction (LVEF) carried out in 25 patients with extensive breast cancer in the course of 148 cycles of standard CAF combination therapy established a protective effect of cardioxane (ICRF-187, dexrazoxane) treatment against the cardiotoxicity of doxorubicin, administered in the maximal cumulative dose of 850 mg/sq. m (decrease in LVEF over 20% as compared with basal level, without clinical symptoms of cardiomyopathy or ECG-revealed disturbances in 0.6% of cycles). 1000 mg/sq.m cardioxane, administered in conjunction with doxorubicin in the ratio of 20:1, neither inhibited the antitumor activity of chemotherapy nor contributed to untoward side-effects which are not associated with cardiotoxicity.