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Aim. To increase the effectiveness of neoadjuvant chemotherapy in patients with locally advanced gastric cancer by correcting nutritional deficiency. Materials and methods. Of 200 patients with locally advanced gastric cancer (mean age 57.2 years (46.168.3), 100 patients received neoadjuvant chemotherapy with nutritional support from 2018 to 2020. One hundred patients received neoadjuvant chemotherapy without nutritional support from 2013 to 2018 (historical control). The incidence of nutritional deficiency before treatment in the neoadjuvant chemotherapy + nutritional support group was 54%, and in the neoadjuvant chemotherapy only group it was 47%. Nutritional status was assessed using anthropometry, questionnaires (NRS-2002, MUST, GLIM), dynamometry, blood tests, bioimpedance. Complications according to NCI CTCAE v5.0; оbjective response rate according to RECIST 1.1; pathomorphological regression according to the JGCA classification (2017); 2-year event-free survival were assessed. Results. The frequency of nutritional deficiency before the start of treatment in the neoadjuvant chemotherapy + nutritional support group was 54%, in the neoadjuvant chemotherapy only group 47%. After the completion of neoadjuvant chemotherapy in the group neoadjuvant chemotherapy + nutritional support the frequency of nutritional deficiency was 1%, in the group neoadjuvant chemotherapy only without nutritional support 62%. In patients with nutritional deficiency in the neoadjuvant chemotherapy + nutritional support group, partial regression was registered in 51.9% of cases, in the neoadjuvant chemotherapy only group it was 27.6% (p0.05). There were no differences in the frequency of pathological response. 2-year event-free survival in patients without nutritional deficiency in the group neoadjuvant chemotherapy + nutritional support was 100%, in the neoadjuvant chemotherapy only group it was 68.5% (p0.001); in patients with nutritional deficiency 72,5 and 60.6% respectively (p0.05). Conclusion. Nutritional deficiency is an important predictive and prognostic marker of the efficacy of neoadjuvant chemotherapy in the treatment of locally advanced gastric cancer. Comprehensive diagnosis of nutritional status and nutritional support can improve the results of neoadjuvant chemotherapy in patients with locally advanced gastric cancer.

Cervical cancer (CC) ranks fourth for cancer incidences in women after breast cancer, colorectal cancer and lung cancer. There is a steady increase in the incidence of invasive forms of CC in Russia. Over the past quarter of a century, the mortality rate of reproductive age group women with cervical cancer has increased by 2 times. The standard treatment options for cervical cancer progression were the regime of paclitaxel plus cisplatin (carboplatin). The addition of an antiangiogenic therapy (bevacizumab) to the standard chemotherapy regimen increases overall survival of only 4%. The response to other lines of chemotherapy does not exceed 10% after the therapy using the combination of paclitaxel + carboplatin + bevacizumab. The results of KEYNOTE-158 trial demonstrated objective responses in 91% of CC patients lasting for more than 6 months in case of application of pembrolizumab 200 mg every 3 weeks in cases of PD-L1 expression (CPS1) with acceptable toxicity. The presented clinical case of successful treatment using pembrolizumab in women with PD-L1 expression in metastatic CC has a beneficial effect on further accumulation of experience and could help to choose the right treatment options in order to increase the efficacy of the therapy and to increase the survival rates for this category of patients.