Monitoring of the presence of EGFR-mutated DNA during EGFR-targeted therapy may assist in the prediction of treatment outcome

The aim of our trial was to evaluate the prognostic significance of qualitative ctDNA analysis on different stages of EGFR mutated non-small cell lung cancer (NSCLC) treatment. We included 99 patients amendable for the first line treatment with either gefitinib/erlotinib (n = 87), afatinib (n = 10) or osimertinib (n = 2). Sequential qualitative analysis of ctDNA with cobas® EGFR Mutation Test v2 were performed before first dose, after 2 and 4 months of treatment, and on progression. Our analysis showed clinically significant heterogeneity of EGFR-mutated NSCLC treated with 1st line tyrosine kinase inhibitors (TKIs) in terms of progression-free and overall survival. When treated with conventional approach, i.e. monotherapy with TKIs, the patients falls into three subgroups based on ctDNA analysis before and after 2 months of treatment. Patients without detectable ctDNA at baseline (N = 32) possess the best prognosis on duration of treatment (PFS: 24.07 [16.8-31.3] and OS: 56.2 [21.8-90.7] months). Those who achieve clearance after two months of TKI (N = 42) have indistinguishably good PFS (19.0 [13.7 - 24.2]). Individuals who retain ctDNA after 2 months (N = 25) have the worst prognosis (PFS: 10.3 [7.0 - 13.5], p = 0.000). 9/25 patients did not develop ctDNA clearance at 4 months with no statistical difference in PFS from those without clearance at 2 months. Prognostic heterogeneity of EGFR-mutated NSCLC should be taken into consideration in planning further clinical trials and optimizing the outcome of patients.

[The risk-adaptive strategies of Hodgkin's lymphoma therapy]

Using of radiochemotherapy improves short-term and long-term results of treatment in patients with primary Hodgkin’s lymphoma (HL) comparing with treatment by chemotherapy alone. The rates of 5-year, 10-year OS and DFS are 88%, 83% and 90%, 86% in case of radiochemotherapy, versus 73%, 66% and 72%, 68% using chemotherapy alone. The 5-year and 10-year OS, DFS estimates in treatment with ABVD are 84% and 83%, 75% and 74%; BEACOPP-baseline - 83% and 82%, 82% and 81% (p<0.05). At the same time ABVD chemotherapy develops less toxicity (p<0.001). The treatment with 6 cycles of ABVD is considered as the most appropriate in primary Hodgkin’s lymphoma patients with extranodal lesions. Comparison of complications rate during chemotherapy with MOPP, ABVD, BEACOPP-baseline, BEACOPP-escalated reveals major hematologic toxicity and infectious complications rate in BEACOPP-escalated program (p<0,05). The age ≥45 years, hemoglobin <105g/l, B symptoms, fibrinogen >5g/l, involvement of 3 and more areas of lymph nodes, liver involvement, inguinal lymph nodes are defined by the multiple-factor analysis as adverse prognostic factors of patients with primary Hodgkin’s lymphoma (HL) with extranodal lesions (p<0.05). Allocation of group of high risk is proved by correlation between survival and the Prognostic Score (PS). The 5-year and 10-year DFS, OS for patients with PS-0-2 estimates are 88% and 86%, 89% and 83%, for patients with PS-3-4 - 78% and 69%, 80% and 77%, for patients with PS-5-6 - 43% and 42%, 60% and 38% respectively (p<0.001).

[Role of bone-density-conserving agents in the treatment for pain in patients with bone metastases]

Bones are the fourth area of metastases of malignant tumors that significantly burden the disease reducing the quality of life of a patient as cause pain, threat pathological fracture, deteriorate limb function, and develop hypercalcemia. Treatment of patients should be comprehensive and base on the rational use of systemic therapy and local impacts. The use of bisphosphonates inhibits bone resorption and progression of bone metastases, reduces the risk of complications due to metastatic bone disease including pain. Bisphosphonates significantly reduce the incidence of SRE in patients with bone metastases, diminish the need for analgesic radiotherapy, postpone terms of SRE occurrence, reduce pain syndrome as well as the need for analgetics. They also easily tolerated by patients.

[Phase II clinical trial of autologous dendritic cell vaccine with immunologic adjuvant in cutaneous melanoma patients]

This paper describes the clinical results and immunologic changes in cutaneous melanoma patients receiving active specific immunotherapy with autologous dendritic cell vaccine (DCV) in combination with cyclophosphamide used as immunologic adjuvant. Twenty eight patients with morphologically verified stage III-IV cutaneous melanoma receiving therapy in N. N. Petrov Research Institute of Oncology between 2008 and 2011 were included in the study. All patients signed an informed consent form. Nineteen patients (67,9%) received DCV in therapeutic setting, 9 (32,1%) received it in adjuvant setting. DCV therapy was well tolerated. No serious adverse events were registered. Frequent adverse events included Grade 1-2 unspecific symptoms (fever, fatigue, flu-like symptoms) observed in 22% patients after 3,5% of vaccinations. In therapeutic settings the use DCV lead to clinical effect (PR+SD) in 36,6% of patients. PR was observed in 5% of (95% CI 0-15%) patients, SD in 31,6% (95% CI 13-56%). Duration of the objective responses was 168-965+days. Addition of immunologic adjuvant (cyclophosphamide 300 mg/m2 IV 2 hours) 3 days before vaccination increased its efficacy. In this patients group (n=12) the therapy lead to clinical benefit in 42% (95% CI 17-69%) of cases, median time to progression was 91 (95% CI 55-126) days. This regimen was selected for adjuvant therapy. In the adjuvant therapy group (n=9) the median time to progression was 112 (95% CI 58-166) days. Immunologic monitoring showed correlation ofT- and B-cell immune response with DCV clinical efficacy (p<0,05), no correlation with delayed hypersensivity reaction was observed (p>0,1). DCV is well tolerated and shows immunological and clinical response in stage III-IV skin melanoma patients.

[Role of computerized tomography in the diagnosis of gastrointestinal stromal tumors]

In this study we present an analysis of our own data on computerized tomography (CT) employment in patients with gastrointestinal stromal tumors (GIST) and the review of the literature. The CT data for 21 patients with GIST was compared with operation and morphology data. Difficulties of GIST timely diagnostic are described.

[Frequency of expression of markers predictive of sensitivity to cytostatics in skin melanoma]

At present, choice of treatment for skin melanoma depends on empirical data on efficacy of medication. Individual treatment may be promoted if certain markers of sensitivity to chemotherapy are evaluated. We studied frequencies of expression of marker sensitivity to fluoropyrimidin [(FPd) (-1)], TS(-)0 and TS(-). TS(-/+) was reported in 36.1%. Sensitivity to platinum drugs [EPCC1(-) - 64.4%], taxotere drugs- [beta = tubulin(-) -72.7%], cyclooxygenase inhibitors [COX2(+)] - 8.9%, mutant tyrosokinase inhibitors [c = kit(+)] - 21.4%, PDGFR = beta(+) -35.5%. Marker expression in tumor tissue was heterogenous. Data on molecular-genetic characteristics of tumor may be used to individualize choice of drugs, dosage and to lower risk of toxicity. Use of cytostatics should be evaluated in clinic for their efficacy in skin melanoma with due consideration of prognostic markers.