Summary.-The study group (1977); an increased frequency of Type IV hyperlipoproteinaemia proved to be the most characteristic feature of tumour patients. The results are discussed in terms of the concept of the importance of lipid metabolic disturbances, primarily those due to ageing, in the genesis of the syndrome of "cancerophilia" (predisposition to cancer).
The paper presents the results of a survey of 254 patients of reproductive and menopausal age who after the completion of the surgical, in some patients also chemo-radiotherapY., received tamoxifen for breast cancer for different lengths of time. All patients underwent ultrasound examination of pelvic organs and determination of the content of estradiol, follicle-stimulating and luteinizing hormones in the serum. It was showed that with tamoxifen therapy ovarian cysts were diagnosed in 50 women with preserved menstrual cycle (73.5%) and 31 - in menopause (16.6%). Detection of cysts in 72% of patients of reproductive age and 19.3% of menopausal age was accompanied by increased production of estradiol. Cyst formation and hyperproduction of estradiol appeared mainly during the first year of tamoxifen; in the future they could disappear, which made it possible to observe such patients and not immediately made a decision about the need for pharmacological or surgical suppression of ovarian function.
Materials and methods. The effect of melatonin (MLT) and metformin (MTF) on the efficacy of neoadjuvant hormone therapy with toremifene was investigated in 54 patients with estrogen receptor-positive, locally advanced breast cancer (ER + BC). The average age of women was 67 years. The patients had no diabetes mellitus. The first group of patients (n = 19) received toremifene 120 mg per day, the second group (n = 16) - toremifene in combination with MLT 3 mg orally every night, the third group (n = 19) - toremifene in combination with MTF 850 mg twice daily. Randomization was performed - 1: 1: 1. The duration of therapy in all study groups was 4 months. After the end of treatment, all patients were undergone surgery. Further adjuvant treatment depended on the results of the postoperative pathomorphological conclusion. The primary endpoint was a decrease in the Ki-67% level (a surrogate marker for the effectiveness of hormone therapy), the secondary endpoints were the objective response, a pathological response in the tumor and lymph nodes, and the quality of life. Results. In all patients (n = 54), the frequency of decrease Ki-67 level and the frequency of objective response were 57% and 50%, respectively. At the same time, the incidence of Ki-67% level decrease in the «toremifene» group was 42%, in the «toremifene+MLT» group - 56%, in the «toremifene+MTF» group - 74%. Multifactor analysis showed that the addition of MTF to toremifene increases the chances of reducing Ki-67 compared with control 4.2 times (RR 4.23 [95% CI 1,04417,139], p = 0.043). It is important that only in the patients of the «toremifene+MTF» group a significant correlation was found between the Ki-67 index decrease in the tumor and the BMI value above the norm (p = 0.015). A complete pathomorphological response in the tumor and lymph nodes was not achieved in any patient. The objective response in the study groups was 31.6%, 86.7% and 47.3%, respectively. The addition of MLT to hormone therapy with toremifene significantly increased the frequency of the objective response from 31.6% to 86.7% (x2 = 10.32, p = 0.001). The inclusion into neoadjuvant hormone therapy with toremifene of MLT or MTF did not reduce the quality of life of patients, while in 50% of patients in the «toremifene+MLT» group there was an improvement in sleep.
Neoadjuvant systemic treatment of patients with breast cancer (BC) may include neoadjuvant chemotherapy (NHT), neoadjuvant hormone therapy (NGT), neoadjuvant targeted therapy. The type of systemic therapy is determined by the level of expression of estrogen/progesterone receptors, HER2, i.e. immunohistochemical characteristic of the disease. In this article, we evaluated the predictive value of the profile of plasma exosomal microRNA, assessing the immediate efficacy of NHT, which included taxanes. Obtained results revealed a correlation between the level of concentration of several miRNA molecules in circulating exosomes and the effect of NHT. Furthermore, the index calculated as the ratio of miR-34a and miR-451 concentrations, allowеd to predict the effect of taxanecontaining NHT. The results confirm the assumption on the predictive significance of exosomal miRNA. Further research is needed to confirm the validity of a new method of prediction of the NHT efficacy in breast cancer.
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