Background: Incorporation of molecular analysis of the epidermal growth factor receptor (EGFR) gene into routine clinical practice has shown great promise to provide personalized therapy of the non-small cell lung cancer (NSCLC) in the developed world. However, the genetic testing of EGFR mutations has not yet become routine clinical practice in territories remote from the central regions of Russia. Therefore, we aimed to study the frequency of major types of activating mutations of the EGFR gene in NSCLC patients residing in West Siberia. Materials and Methods: We examined EGFR mutations in exons 19 and 21 in 147 NSCLC patients (excluding squamous cell lung carcinomas) by real time polymerase chain reaction. Results: EGFR mutations were detected in 28 of the 147 (19%) patients. There were 19 (13%) cases with mutations in exon 19 and 9 cases (6%) in exon 21. Mutations were more frequently observed in women (42%, p=0.000) than in men (1%). A significantly higher incidence of EGFR mutations was observed in bronchioloalveolar carcinomas (28%, p=0.019) and in adenocarcinomas (21%, p=0.024) than in large cell carcinomas, mixed adenocarcinomas, and NOS (4%). The EGFR mutation rate was much higher in never-smokers than in smokers: 38% vs. 3% (p=0.000). The frequency of EGFR mutations in the Kemerovo and Tomsk regions was 19%. Conclusions: The incorporation of molecular analysis of the EGFR gene into routine clinical practice will allow clinicians to provide personalised therapy, resulting in a significant increase in survival rates and improvement in life quality of advanced NSCLC patients.
Immune checkpoint inhibitors (ICT) therapy is a successful immunotherapy (IT) strategy that is quite effective in a number of patients with non-small cell lung cancer, melanoma, bladder cancer, breast cancer and others. Nevertheless, there is a need in predictive markers for ICT therapy for personalized IT as far as there is a large group of patients, the proportion of which varies depending on the tumor, who do not have a clinical response to such therapy. The review summarizes the theoretical aspects and results of clinical trials dedicated to various clinical efficiency predictor using modern databases. As a result of the analysis it is established that the main candidates for the role of such markers are tumor infiltrating lymphocytes and their subpopulations, peripheral blood lymphocytes (PBL) and their subpopulations. PD1 (programmed death receptor 1) and PDL1 (programmed death receptor ligand 1) expression in tumor tissue can also be important for predicting IT efficiency. The most promising predictive biomarker meaning the most clinically relevant is a combination of the PBL subpopulations study and PD1 and PDL1 expression on the tumor cells.PubMed, Scopus, Web of Science, eLibrary, Russian Science Citation Index databases were searched for the available appropriate literature reports. The authors included 82 in the given review.
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.
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