Vol 22, No 5 (2017)

The incidence rate of thyroid cancer is increasing, especially among young and middle-aged people. In most cases a malignant tumor can be diagnosed at the background of multinodular goiter. Differential diagnosis of malignant and benign tumors of the thyroid presents considerable difficulties. In this situation the decision on the extent of the surgical intervention seems to be important. In the article there are described features of the diagnosis and the choice of the surgical intervention for thyroid cancer associated with multinodular goiter. The morphological examination is the decisive method of diagnosis. The decision on the extent of the operative measure should be both individualized for each particular patient and proceed from the principles of oncological radicalism and functional effect.

Patients with advanced small cell lung cancer (SCLC) have an extremely poor prognosis against a background of standard therapy with a combination of etoposide with platinum drugs. In a randomized, double-blind of the CA184-156 phase 3, the efficacy and safety of ipilimumab or placebo in combination with etoposide and platinum preparations was evaluated as the first line treatment for disseminated SCLC. Material and methods. Randomization of patients was carried out in a ratio of 1:1 in the group of therapy: etoposide + platinum drug (carboplatin or cisplatin) + ipilimumab and etoposide + platinum preparation + placebo. Ipilimumab/placebo was administered at a dose of 10 mg/kg every 3 weeks, starting from the 3rd course of chemotherapy to the 6th course of chemotherapy. Further, in the absence of progression, maintenance therapy with ipilimumab/placebo was performed every 12 weeks. The main end point of the study was the assessment of overall survival (OS). Results. Out of 1,132 randomized patients, 954 received at least 1 administration of ipilimumab/placebo in combination with chemotherapy: ipilimumab, n = 478; placebo, n = 476. Median OS was 11.0 months in the chemotherapy group with ipilimumab and 10.9 months, in the chemotherapy group with placebo (RR, 0.94, 95% CI, 0.81-1.09, p =0,3775). The median progression-free survival was 4.6 months in the chemotherapy group with ipilimumab and 4.4 months in the chemotherapy group with placebo. (RR, 0.85, 95% CI, 0.75-0.97). The frequency and severity of side effects in the compared groups was similar, with the exception of diarrhea, rash, and colitis, which occurred significantly more frequent in the chemotherapy group with ipilimumab. The frequency of the discontinuation of therapy due to toxicity was higher in the chemotherapy group with ipilimumab (18% vs. 2%). Treatment-related deaths accounted for 5 in the chemotherapy group with ipilimumab and 2 - in the chemotherapy group with placebo. Conclusion. The addition of ipilimumab to chemotherapy did not contribute to an increase in OS in comparison with only chemotherapy in advanced SCLC patients. Unexpected adverse events in the chemotherapy group with ipilimumab were not noted. The study of the efficacy of ipilimumab in patients with disseminated SCLC in combination with PD1 inhibitors is ongoing. The results obtained in the analysis of data in a subset of 33 patients who participated in this study on the basis of the Department chemotherapy of N.N. Blokhin Russian Cancer Research Center, correspond to data obtained in the entire multicenter study CA184-156.

In recent years there has been strong progress in the treatment of metastatic colorectal cancer (mCRC) patients. The gain of the median of the overall survival (mOS) rate was more than doubled due to the introduction in the clinical practice of new compounds, the work of a multidisciplinary team, the timely registration of the disease progress, prescription of combined chemotherapy in the second line. The article presents the immediate and long-term results of a comparative study carried out on the basis of Oncology Centers, 122 mCRC patients were included, most of these patients - 87(71,3%) had surgery firstly, after that all patients were treated with standard chemotherapy FOLFOX-4 in the first-line treatment and FOLFIRI in the second line treatment, two groups of patients in the first and second lines of treatment received a combination of chemotherapy and targeted agents (bevacizumab, cetuximab), depending on the biological properties of the tumor (RAS-gene mutation status). The following results: metastatic progression-free survival (mPFS) for FOLFOX-4 group accounted for 12.0(±1.2) months; FOLFOX-4 + Bevacizumab - 20.3(±1.2) months, FOLFOX-4 + cetuximab - 22.0(± 2.0) months; mPFS for second-line therapy for FOLFIRI + bevacizumab group amounted to 24.0(± 3.1) months, FOLFIRI + cetuximab 22.5(±2.5) months, FOLFIRI-1 8.0(±2.4) months, FOLFIRI-2 6.4(±2.6) months; mOS for FOLFOX-4 group was 49.5(±2.5) months; FOLFOX-4 + Bevacizumab - 45.8(±2.1) months; FOLFOX-4 + cetuximab - 37.4(± 2.0) months; mOS for second-line therapy for FOLFIRI + bevacizumab group was 37.8(± 2.1) months, FOLFIRI + cetuximab - 31.5(± 2.3) months, FOLFIRI-1 - 26.3(± 1.8) months, FOLFIRI-2 - 26.2(± 1.9) months. The adverse events during the treatment of patients are reported.

The research is devoted to the study of the contrasting properties of new iodinated oil drug Linoyodol (100% solution) by in vitro (monitoring: well-known contracter Omnipak and saline) and in vivo under intraarterial injection of 0.1-1.0 ml to a. femoralis of rats with a intramuscular tumor (n = 18) with the aid of X-ray and СT. In vitro contrasting was shown to be less intensive, than in Omnipak, and in vivo is manifested in a lethal dose of 1.0 ml of highly viscid solution. The conclusion was drawn concerning low contrasting of Linoyodol in vitro with the limitation of its administration of the viscid solution to rats into artery of rather small size. The last demands the use of larger laboratory animals with an artery of sufficient size and decrease of the viscosity of the injection solution.

Experimental studies were carried out with non-covalent complex AIMPILA targeting on AFP receptors (ReCAF). The human subcutaneous xenografts were used with different ReCAF containing transplanted to immunodeficient mice Balb/c nude: colon cancer SW620/ReCAF +, liver cancer HepG2/ReCAF + + and breast cancer T47D/ReCAF + + +. IMPILA was administrated per os under beginning on 4th day after tumor transplantation daily for 5 or 10 days in the total doses of 0.5-2.0 mg/kg or 1.0-4.0 mg/kg, accordingly. The inhibiting effect (T/C < 42%) of AIMPILA was shown to increase in dependence on ReCAF containing on tumor cells: T/C = 70% (SW620/ReCAF +); T/C = 51% (HepG2/ReCAF + +) and T/C = 22% (T47D/ReCAF+++). On the more sensitive model in a series of experiences 10-times course for the treatment with the total dose of 4.0 mg/kg was detected and revealed to T/C = 15-37% (p < 0.05). In the pathomorphological investigation of the T47D/ReCAF+++ tumor there was verified the death of the majority of tumor cells under the treatment of AIMPILA via the apoptosis pathway.