Russian Journal of Oncology

BACKGROUND: A key challenge in modern oncology is the development and implementation of more effective therapies aimed that would improve prognosis and quality of life in patients with cancer. Most anticancer drugs are dosed based on body weight and body surface area. In many cases, however, patients’ actual body weight and body surface area differ from standardized average values, which may hinder access to modern and high-quality anticancer therapy.

AIM: This work aimed to analyze approaches to reimbursement of anticancer drug therapy in day-care and inpatient settings based on the use of average patient body weight.

METHODS: A database extracted from the qMS medical information system of the Krasnoyarsk Regional Clinical Oncology Center named after A.I. Kryzhanovsky included data on 30,866 hospitalizations dating 2023 for anticancer drug therapy. Statistica 12.0 was used for the statistical analysis. Differences were considered significant at p < 0.05.

RESULTS: The mean body weight of patients receiving anticancer drug therapy was 75.23 ± 17.05 kg, and the mean body surface area was 1.86 ± 0.23 m². Additionally, patient parameters were calculated for individual anticancer drugs whose dilution and dosing directly depend on patient body weight. Among the selected agents, only ramucirumab was administered to patients whose mean body weight fell within the established standard values.

CONCLUSION: When forming clinical–statistical groups, reimbursement calculations are based on standardized costs of injectable drug regimens that, in routine practice, are not fully covered by existing tariffs (for 2024, standardized values of 72.3 kg for body weight and 1.83 m² for body surface area are used). The obtained results indicate an additional financial burden on medical institutions. Therefore, cost of treatment regimens should be calculated based on actual patient anthropometric parameters.

This review analyzes treatment outcomes in patients with locally advanced oropharyngeal squamous cell carcinoma. Despite the use of modern high-technology treatment modalities, management of this patient population remains a challenging clinical problem. As with other malignant tumors of the head and neck, the effectiveness of therapeutic approaches depends on multiple factors, including disease stage, tumor localization, treatment modality, HIV status, and other clinical variables. Surgical and reconstructive procedures are not indicated for most patients, which is attributable to the complex anatomical structure of the oropharyngeal region and the severe general condition of patients due to advanced disease. Therefore, conservative treatment modalities are preferable in the majority of cases, including radiotherapy in combination with chemotherapy (or without it) or targeted therapy. However, many conservative treatment modalities are accompanied by pronounced local or systemic toxic effects, which hinder completion of the planned therapy and, in some cases, result in patient death. Thus, the search for strategies to improve treatment outcomes in patients with advanced oropharyngeal cancer remains a relevant issue in oncology. Particular attention is given to the effectiveness of antitumor therapy in patients with human papillomavirus–associated oropharyngeal cancer.

Osteosarcoma is one of the most common primary bone cancers, predominantly affecting children and young adults, and is characterized by aggressive behavior and a high risk of metastasis. Despite the introduction of modern therapeutic methods into clinical practice, overall survival rates remain low, and traditional diagnostic and monitoring approaches, including imaging modalities and invasive tissue biopsy, are associated with a number of limitations. In this context, the development of noninvasive diagnostic strategies is of particular relevance. One of the most promising approaches is liquid biopsy, which enables the analysis of tumor-derived biomarkers circulating in the bloodstream. This narrative review analyzes current scientific data on the application of liquid biopsy for the diagnosis and monitoring of osteosarcoma. The review focuses on three key biological substrates: circulating tumor DNA, circulating tumor cells, and extracellular vesicles. The available evidence indicates that circulating tumor DNA harboring osteosarcoma-specific chromosomal aberrations enables assessment of tumor burden, prediction of treatment response, and detection of minimal residual disease. Circulating tumor cells, particularly those of mesenchymal origin, are associated with a high metastatic potential and an unfavorable prognosis. Extracellular vesicles contain a wide range of biomolecules (including microRNAs, proteins, and messenger RNAs) that are involved in intercellular communication, formation of the premetastatic niche, and development of therapy resistance. The review also summarizes contemporary analytical platforms, such as digital polymerase chain reaction, next-generation sequencing, mass cytometry, and proteomic analysis, which provide high analytical sensitivity and specificity for the detection of tumor activity biomarkers. Despite existing methodological and economic limitations, including the lack of standardization of preanalytical procedures and high costs, liquid biopsy demonstrates significant potential for the implementation of a personalized approach in the management of patients with osteosarcoma.

INTRODUCTION: Activation of inflammatory cascades by the tumor microenvironment and tumor cells is crucial to the progression and metastasis of breast cancer. Interleukin-6, as one of the major mediators of tumor-associated inflammation, represents a promising therapeutic target in metastatic breast cancer, particularly in cases with bone and bone marrow involvement.

CASE DESCRIPTION: A 54-year-old woman with disseminated recurrent triple-negative breast cancer and diffuse bone marrow carcinomatosis associated with severe pancytopenia received cyclic therapy with eribulin 1.4 mg/m² on days 1 and 8 in combination with tocilizumab 80 mg on day 1 and lenalidomide 0.5 mg/day. The treatment cycle interval was 21 days. At treatment initiation, the patient had an Eastern Cooperative Oncology Group (ECOG) performance status of 3, persistent fever >38 °C, grade 4 thrombocytopenia, and refractory grade 3 anemia. Baseline laboratory findings included an interleukin-6 level of 64.15 pg/mL, ferritin >2025 μg/L, lactate dehydrogenase 1474 U/L, and alkaline phosphatase 498 IU/L. On therapy, clinical improvement was observed, including normalization of performance status (ECOG 1), resolution of the inflammatory syndrome, normalization of interleukin-6 levels and other inflammatory markers, and achievement of transfusion independence. After six treatment cycles, a reduction in tumor marker levels and regression of metabolic activity in previously identified bone lesions were documented, along with normalization of alkaline phosphatase, parathyroid hormone, and lactate dehydrogenase levels. Treatment-related toxicity did not exceed grade 1. At 6-month follow-up, the patient maintained an ECOG performance status of 1, remained independent of blood product transfusions, and showed no evidence of tumor progression.

CONCLUSION: Combination therapy incorporating interleukin-6 blockade together with chemotherapy, immunotherapy, or targeted agents represents a promising therapeutic approach for patients with aggressive forms of breast cancer and may serve as a basis for the development of new personalized treatment strategies.