Vol 27, No 5 (2022)

In this article, we reviewed the works devoted to one of the promising areas in the immunotherapy of oncological diseases — tumor-specific vaccines based on immunocompetent cells. The most promising, effective and safe methods of cellular vaccination against cancer are presented based on data from clinical trials for the period 2016–2023, which are sorted in the article by the origin of the active component into non-cellular (vaccines based on oncolytic viruses, bacteria, nucleic acids, peptides and in-situ) and cellular (dendritic, T-effector, natural killer cells) immunotherapeutic approaches. Cancer vaccines based on personalized neo-antigenic dendritic cells have promising anti-tumor effects in clinical practice. Dendritic-based vaccines have a number of advantages, one example being the ability to activate both innate and adaptive immunity, as well as to develop long-term immunological memory against recurrence of tumors. DCs are the most professional and consistent antigens and are more effective in activating resting T cells. The review provides the most up-to-date information on cancer vaccines, as well as an analysis of the types of cancer vaccines, using both local and international sources. The conclusion of this brief review is the wide variety of types of tumor-specific vaccines and their rapid improvement.

BACKGROUND: People, living with HIV, have a greater chance of malignancies especially with the success of antiretroviral therapy, and non-AIDS-defining cancers have become the most common cause of death after AIDS and the most common of them is the lung cancer in developed countries.

AIM: To research nosological characteristics of lung cancer in the context of HIV infection, HIV-associated risk factors during antiretroviral therapy and compare with global trends of this problem.

MATERIALS AND METHODS: Retrospectively were analyzed the medical documentation of 98 patients with lung cancer and HIV-infection, who were in database and received specialized treatment in Saint Petersburg from 2008 to 2018 years.

RESULTS: The population was dominated by patients of young (1844 years old) and middle (4559 years old) ages, 45.9% and 42.9%, respectively, and 11.2% of elderly patients (6074 years old), p <0.001, which satisfies the global data of earlier incidence of lung cancer in people living with HIV.

Adenocarcinomas were more common histological subtype of lung cancer as in the general population (p <0.001).

There was no static significance between high viral load and lung cancer, which can indicate the absence of a direct mechanism of HIV-carcinogenesis (90.8% of patients with low and medium viral load, p <0.001). Nevertheless, the prevalence of 4-stage of HIV infection among lung cancer patients (p <0.001) indicates a history of inflammatory diseases, including pulmonary diseases, as a result of induced immunosuppression due to CD8⁺-lymphocyte dysfunction and the formation of a micro-tumor environment, which can be a prognostic unfavorable factor in the occurrence of lung cancer in this group of patients , as well as indirect mechanism of viral carcinogenesis.

The presence of elderly patients (11.2%, MAX71 years) indirectly indicates an increasing of period of life expectancy among this category of patients in Russia.

CONCLUSION: The mechanisms of increased risk of lung cancer among HIV-infected people remain largely unclear and can be the area for active research. HIV-infected patients with lung cancer are younger than HIV-negative patients and have more advanced stages of cancer with a prevalence of adenocarcinoma type of cancer. The lung cancer prognosis of survival in HIV-infected people is much worse than that of persons without HIV-infection, but it is not fully known whether this is due to a more aggressive course of the disease, disparities in treatment, treatment resistance, or a greater risk and toxicity of therapy.

BACKGROUND: The study reported clinical results of patients with cervical cancer, who were treated with different methodological approaches of radiation therapy (RT), switching from conventional to conformal irradiation, as well as different brachytherapy (BT) techniques.

AIM: To evaluate long-term results of treatment, locoregional and distant control.

METHODS: 137 patients having stage IIB–IIIB cervical cancer in 2013–2016 were analyzed retrospectively. 70 patients (51%), divided in two groups of n=35, were treated with conventional RT and two-dimensional (2D) planning of intracavitary BT with ⁶⁰Сo alone or in combination with cisplatin (40 mg/m²). The total dose (TD) for point A was 75.08±0.57 Gy, for point B — 57.9±0.43 Gy. 67 patients (49%), divided in two groups of n=35 and n=32, were treated with conformal external-beam RT following three-dimensional (3D) planning of intracavitary BT with ¹⁹²Ir alone or in combination with cisplatin (40 mg/m²), respectively. Total D90 of high-risk clinical target volume was 95.0±0.67 Gy EQD2 (Equivalent Total Dose in 2 Gy fraction).

RESULTS: 3- and 5-year overall survival rate with 3D-RT versus 2D-RT was 84.6±4.5% vs 63.1±6.0% and 84.6±4.5% vs 56.1±6.0%, respectively (p=0.030). It was revealed that modern technologies are also important in improving overall survival with image-guided RT: 3-year overall survival rate was higher in the group of image-guided RT combined with 3D-BT — 88.2±6.6% versus 59.0±8.4%, respectively (p=0.027). The use of chemoradiotherapy showed an advantage for 3-year event-free survival in groups with 2D RT — 67.9±8.4% versus 55.2±8.6% (p=0.042). Between the groups where 3D RT was used, no statistically significant differences were recorded. Locoregional control was higher in the 3D RT groups at 3 years of follow-up: 97.0±2.9% versus 82.9±5.3%, p=0.050. Chemoradiotherapy allows to reduce the number of local failures in the pelvis in the follow-up period up to 6 months, regardless of the RT technologies. The number of relapses and metastases in pelvis is lower when using 3D RT (3.0±2.1%) compared with 2D (15.7±4.4%), p=0.05. There was no statistically significant difference in the frequency of detection of metastases: with 2D RT — 5.7±2.8%, and with 3D RT — 9.0±3.5% (p >0.05).

CONCLUSIONS: The study proves the improvement of local control when using conformal RT and 3D-BT, which is an important component in the RT program for cervical cancer.

BACKGROUND: Treatment of pancreatic cancer presents significant difficulties due to the aggressive course of the disease and the extremely low sensitivity of the tumor to standard chemotherapy. In recent years, researchers have increasingly considered the possibility of using immunotherapeutic drugs capable of potentiating the effectiveness of cytostatic therapy as part of antitumor treatment of such patients. They draw particular attention to the combination of interferon-γ and recombinant tumor necrosis factor thymosin-α-1, capable of activating an antitumor immune response, stimulating apoptosis of tumor cells, having a direct antiproliferative effect, causing destruction of neoplasm vessels, stimulating necrosis of tumor tissue.

DESCRIPTION: The patient with stage IV pancreatic head cancer underwent 13 courses of FOLFIRINOX therapy. Treatment was terminated because of increasing toxicity. According to computed tomography, disease progression was detected. The patient referred to cytokinogenetic therapy. After completion of the fourth treatment course, the partial response was seen on computed tomography scan. The TNFα level and the Karnofsky score both grew during the therapy.

CONCLUSION: Cytokinogenetic therapy made it possible to improve the patient’s quality of life, to stabilize his general condition and functional activity, to achieve partial regression of the tumor, and to increase the chances of survival.