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Urothelial cancer occupies a significant place in the routine practice of cancer treatment. Systemic antitumor treatment of patients with metastatic urothelial cancer in the first line is currently well studied, has its own standards, implemented in clinical practice. However, the problem of choosing antitumor treatment for patients with metastatic urothelial cancer in the second line remains relevant. Vinflunine is one of the treatment options for such patients. This article presents the case of successful treatment of metastatic urothelial cancer in the second line with vinflunine. A 63-year-old patient with a diagnosis of C65 Urothelial cancer of the pelvis of the left kidney T3N0M1, stage IV, bone metastases. Condition after cytoreductive left-sided nephrectomy, para-aortic lymphadenectomy from 04/16/2021. Concomitant pathology: Anemia. Diabetes mellitus type 2 Hypertonic disease. As the 1st line of treatment, 6 courses of CT were performed according to the scheme: Cisplatin + Gemcitabine. The effect was evaluated according to MSCT data of 3 zones and bone scintigraphy in accordance with Recist 1.1. The best response was obtained after the 4th cycle in August 2021 in the form of stabilization. October 2021 follow-up examination revealed progression. Since October 2021, chemotherapy of the 2nd line with Vinflunin is carried out in mono mode. All AEs are well controlled and do not require discontinuation of the drug. According to the results of the control examination, stabilization was achieved. Thereby vinflunine has been shown to be effective as a second-line treatment for platinum-resistant recurrent urothelial cancer.

Prostate cancer (PC) is one of the leading causes of cancer death in the male population. Currently, the pathogenesis of prostate cancer has been studied in sufficient detail, which makes a successful radical treatment possible in most cases. However, in about 30% of patients traditional methods (e.g., radical prostatectomy, radiation therapy, androgen deprivation therapy – ADT, etc.) are ineffective, and castration- resistant (CRPC) and metastatic (mPC) types of РС are developing. Due to the advances in modern molecular oncology, various “workarounds”, genetic and epigenetic combinations, that allow РС to progress despite the absence of androgenic stimulation, are known nowadays. A personalized approach in oncology, which gradually becomes one of the standards for mCRPC therapy, allows not only to identify specific mutations, but also to select the most effective therapy for them in the most correct way. Now the most promising groups of the drugs for mCRPC treatment are poly(ADP-ribose)-polymerase (PARP) inhibitors, immune checkpoint inhibitors, and prostate- specific membrane antigen (PSMA) targeted therapy. This article attempts to summarize the current data on PARP inhibitors. The drugs of this group are especially effective for malignant neoplasms with mutations in the BRCA 1/2 genes, and successfully used in ovarian, breast and pancreatic cancer. They have been approved for the treatment of mCRPC a not so long ago. The advent of personalized companion tests has made the treatment of mCRPC more precise. Nowadays studies on the effectiveness of PARP inhibitors for mCRPC with other genetic and epigenetic changes, as well as in combination with other therapeutic agents, are notably actual.

Bone metastases often develop in patients with prostate cancer (PC) as a natural stage in the course of the disease. The skeletal system is the most typical and sometimes even the only site of metastatic prostate cancer. The involvement of bones is a cause of reduced life expectancy and a strong prognostic factor for adverse events, such as bone complications (including the pain requiring surgery or palliative radiation therapy, pathologic fractures and spinal cord compression), resulting in a significant decrease in the quality of life.The model of therapeutic decision-making in metastatic castration-resistant PC (mCRPC) is still an unsolved problem. Several therapeutic options have been developed recently, that has significantly improved the survival of patients with mCRPC. The presence of multiple active agents provides oncologists with an unprecedented opportunity to tailor their choices to the clinical characteristics of each patient and to each line of treatment, but at the same time it creates the challenge of determining the optimal therapeutic sequence for the individual patient.In Russia, radium-223 is approved for patients having bone metastases and no visceral metastases. It can be assigned to patients with lymph node metastases and patients with bulky bone metastases if other drugs are contraindicated to them. However, the use of radium-223 is most preferable if a patient has bone metastases and good bone marrow reserve.Due to the evolution of treatment strategies, the complexity of the process of assessing the dynamics of treatment and the variability of the clinical aspects of the disease, a multidisciplinary approach becomes of great importance today.

This review is dedicated to the impact of modern achievements on the definition and diagnostics of castration-resistant prostate cancer (PCa) (CRPC), prognostic factors for its progression, and treatment strategies.It was proven with new sensitive methods of diagnostics that surgical castration (CS) decreases serum testosterone (T) levels to < 20 ng/dL, while achieving T < 20 ng/dL improves outcomes and delays the development of CRPC. Regular assessment of the T level makes it possible to understand whether this androgen is adequately suppressed in the setting of potential progression of CRPC, given that late dosing may lead to an increase in T level. Improved imaging techniques and biomarker analysis enable early detection of disease progression. Prognostically significant risk factors for CRPC progression include Gleason score, the extent of metastatic spread, hereditary characteristics such as gene mutations affecting androgen receptor (AR) amplification or DNA repair deficiency mutations, prostate-specific antigen (PSA) kinetics, and biomarker levels. Today, treatment options for CRPC have gone beyond androgen deprivation therapy (ADT) to include therapy that blocks T-synthesis and/or suppresses its activity through various mechanisms. Future directions include therapies using new biological targets, drug combinations and personalized therapies. It is necessary to assess the possible reasons for the difference in the pharmacodynamics and pharmacokinetics of androgendeprivation drugs, to study the features of the processes of destruction of drugs under the action of endogenous enzymes and resorption in the subcutaneous or muscle depot, which may cause the resistance to therapy.The aim of improved treatment and diagnostic options for PCa is to delay its progression to CRPC and to prolong patient survival. Rethinking of the castration concept and advances in understanding the biology of disease progression make it necessary to revise diagnostic and treatment strategies. ADT is a fundamental vector of treatment, and it should be continued even if some new ways of treatment for CRPC are introduced.

The standards of treatment for metastatic renal cell carcinoma (mRCC) have changed significantly from unsuccessful attempts of radiation and cytostatic therapy to the encouraging results of targeted therapy and specific immunotherapy. Sunitinib has got into the practice in 2006, and now it`s one of the most studied and approved. Sunitinib is one of the first oral targeted drugs for RCC. It affects such receptors as VEGFR1, 2, 3; PDGFR, FGFR, c-KIT, and RET, which take part in the pathologic angiogenesis, tumor growth, and metastasizing. Moreover, sunitinib stimulates the growth and development of lymphatic vessels, that deliver immunocytes to the tumor. The advantage of sunitinib over non-specific immunotherapy has been proven by Motzer et al. The randomized trials COMPARZ, RECORD-3, and SWITCH have confirmed that sunitinib is more effective than several targeted drugs (pazopanib, everolimus, and sorafenib respectively) as the first line of treatment for mRCC. The randomized trial of the 3rd phase CARMENA has demonstrated the importance of sunitinib monotherapy for mRCC of intermediate and poor prognosis. In general, sunitinib has been proven to be an effective first-line drug for mRCC, as it`s evidenced in the comprehensive metaanalysis of real-world data and randomized controlled trials published between 2000 and 2017. Nowadays, despite the success of the immunotherapeutic direction, tyrosine kinase inhibitors, and particularly sunitinib, rightfully remain the standard for mRCC of favourable prognosis, the treatment option for worse prognosis in case of contraindications for other methods of therapy, and it` s also used in subsequent therapy lines.

Prostate cancer (PC) is one of the major health problems of the male population. The most difficult is the treatment of metastatic castration-resistant prostate cancer (mCRPC), which is the main cause of mortality from PC. In the course of treatment of PC, it inevitably becomes refractory to castration, characterized by the growth of PSA and clinical signs of progression. Octreotidedepo, a representative of the synthetic analogue of somatostatin of prolonged action, has a therapeutic effect in patients with CRPC with a positive total response in the form of a decrease or stabilization of the PSA level, the drug has a favorable safety profile and is easily tolerated by patients. The economic benefit of Octreotide-depo is estimated in the article. Cost-effectiveness analysis has shown its high clinical and economic efficiency. After the establishment of CRPC, first of all, the preparation Oсtreotide-depo will allow to postpone the start of chemotherapy with docetaxel or hormonal therapy of the 2nd line by 7–8 months and save up to 17% of funds in the first year of treatment.

Интервью с вице-президентом Российского общества онкоурологов (РООУ), врачом-онкологом Московской городской клинической больницы № 57, доктором медицинских наук, профессором Игорем Георгиевичем РУСАКОВЫМ и заведующим отделением онкоурологии ГБУЗ «ГКБ им. Д.Д. Плетнева», кандидатом медицинских наук Сергеем Владимировичем МИШУГИНЫМ.

Therapy of CRPC is one of the most difficult problems in oncourology. Until now the optimal consequence of use of drugs in CRPC is not determined.Study objective: evaluation of effectiveness of sequential therapeutic schemes in progression of m-CRPC: cytotoxic (Docetaxel) or second-line hormonal therapy (Abiraterone) after previous treatment by an analogue of prolonged action somatostatin (Octreotide-depo) and without it.Materials and methods: the study design included 4 groups of patients (170 subjects). The first two groups included patients who received initial therapy by Octreotide-Depo 30 mg before chemotherapy and second line hormone therapy, compared to two groups of primary chemical and hormone therapy indicated after progression of m-CRPC.Results: the number of patients in whom the reduction of PSA concentration, process stabilization, tolerability profile were analogous in groups receiving Docetaxel as the first-line therapy and in the group after administration of Octreotide-depo. Analogous data were registered in groups who administered Abiraterone.Conclusion: the analysis of the therapeutic results didn’t demonstrate any significant differences in groups that received Docetaxel or Abiraterone as the second-line therapy after administration of Octreotide-Depo with groups of patients with received first-line cytotoxic or hormone therapy, which means lack of resistance after application of the prolonged action somatropin analogue to subsequent schemes of anti-tumour therapy, which allows delaying the dates of the second line chemical or hormonal therapy of CRPC.

This article provides a critical overview of the methods of optical diagnosis of muscular and non-invasive bladder cancer (BC), describes the technologies available so far, their advantages and disadvantages, and reviews the assessment of their effectiveness, both clinical and economic. The results are based on the work of leading scientific societies, such as the European Association of Urology (EAU), the European Organization for Research and Treatment of cancer (EORTC), Сlinical Research Office of the Endourological Society (Croes), etc.

Our surveillance was performed for 358 patients with locally advanced and disseminated prostate gland cancer who were treated by analogues of LHRH. Patients in group 1 (n = 222) received treatment with a LHRH analogue, and patients in group 2 (n = 136) received treatment with 75 mg Buserelin-depo 3. Experience has shown that the use of the Buserelin-Depot drug results in a regression of the average PSA value: Up to 36.05 ng/ml in 2 months, up to 12.35 ng/ml - in four months, up to 3.3 ng/ml - in six months. The drug ensures a steady decrease in the level of testosterone in the blood serum to the castration level already in a month after the start of treatment, a decrease in prostate gland volume (from 57.3 to 40.45 cc 3 by month 6 of treatment (-29.4%)). A number of patients have experienced a decrease in the need for analgesics and thus an increase in the activity status. The obtained data are comparable to those in the group of patients receiving other analogues of LHRH.

Prostate cancer initially responds to androgen-deprivation therapy, but most patients eventually develop a castration-resistant form of disease. Enzalutamid is the superselective inhibitor of the androgen receptor (AR), which blocks several stages of the AR signal path. The drug showed significant effectiveness in the treatment of metastatic castration-resistant prostate cancer (MCRPC) in both the first line therapy and the second line therapy after the previous cytotoxic therapy of Docetaxel. To ensure optimum treatment, it is important to understand the impact of Enzalutamide in the context of other therapies, as recent studies have shown that cross-resistance occurs between and within classes of drugs. Mutations and AR splice-variants also affect prostate cancer. Future treatment strategies, including enzalutamide, should take into account the previous level of exposure to taxanes or anti-androgen therapy and the existence of variants of AR that may affect efficiency.

In recent years several therapeutic options have been developed that significantly improve the survival of patients with metastatic treatment-resistant prostate gland cancer (mCRPC). The presence of several active agents gives oncologists an unprecedented opportunity to adapt their choices to the clinical characteristics of each patient, to each treatment line, but at the same time raises the problem of determining the optimal therapeutic sequence for the individual. Due to evolution of the therapeutic strategy, difficulty of the process of the therapy dynamics evaluation and variability of the clinical disease aspects the multi-disciplinary approach currently acquires the primary importance. This article presents the views and recommendations of the expert of the Interdisciplinary Group (Milan, Italy) on the use of Radium-223 in men with mCRPC.

Androgen deprivation therapy (ADT) is used in the treatment of prostate cancer metastatic cancer (PC) since the first description of its hormone dependence in 1941. After receiving the results of a TAX 327 study in 2004, the drug from the taxanes - docetaxel became the main cytostatic agent in the treatment of the castration resistant prostate cancer (CRPC). In a recently publishedstudy CHAARTED it was shown for the first time that the combination of ADT with docetaxel in men with hormone-sensitive metastatic prostate cancer (HSMPC) showed the advantage in the total survival rate by 13.6 months compared to the independent ADT. Similar results were obtained in the STAMPEDE study of men with local-distrubuted and metastatic PC with initial long ADT. A combination of six docetaxel courses with ADT in men starting long-term ADT demonstrated the same advantage by the survival rate parameter compared to the standard ADT by 10 months. Based on the reliability of the treatment results obtained by a new combination of a cytostatic and hormonal product, docetaxel in addition to ADT should be regarded as the basic initial therapy for men with the first identified hormone-sensitive PC, as reflected in the practical recommendations on the treatment of malignant tumours (RUSSCO) 2016 and the recommendations of the European Association of Urologists, 2017.

The role of the level of prostate specific antigen ( PSA) before initial therapy discusses widely as a prognostic factor in the treatment of prostate cancer (PC ). Despite the fact that many of the questions on the diagnostic and prognostic value of PSA unclear, and new markers of prostate diseases are being introduced with increasing frequency , we assume that the PSA will continue to be one of the main methods of screening and monitoring of patients with prostate cancer, because of its high diagnostic value due to tissue specificity. Using the initial PSA level and Gleason score improves the predictive value significantly. This article presents the results of a retrospective analysis of 307 patients completed the treatment of PC. The effect of baseline PSA level and Gleason score on the choice of treatment , the effectiveness of hormone deprivation and overall survival are evaluated.

Currently, the study of mechanisms of development and introduction of the most effective treatment for castration-resistant prostate cancer (CRPC) – one of the most highlighted problems concerning facing oncologists and urologists worldwide. Several large randomized trials recently (TAX 327 , SWOG 9916) shows high possibilities of combinations based on docetaxel. Results of different treatment schemes on the basis of docetaxel and cabazitaxel in hormone-refractory prostate cancer treatment are presented in this study. The favorable effect is received and justifies further research of efficacy of drug combination.

Prostate cancer (PCa) is a hormonsensitive tumor. Due to the discovery of the androgen receptor (AR) it became possible to implement the antiandrogens as drugs blocking testosterone Binding to the AR into routine clinical practice. There have been discovered several generations of the antiandrogens over the years and the possibility of using these drugs in clinical practice has significantly changed. First generations of the antiandrogens (cyproterone, flutamid, bicalutamid) are used mainly for the treatment of advanced hormonsensitive PCa in combination with castration therapy. However these drugs do not increase survival in patients with PCa and are not indicated in terms of castration resistant PCa. Discovery of the enzalutamide (antiandrogen of 2’d generation), acting on the nuclear level of the tumor cell, allowed to increase significantly survival in patients with metastatic castration-resistant prostate cancer (mCRPC) and improve treatment results in patients with mCRPC. At the moment enzalutamide is being studied in combination with castration therapy in patients with hormonsensitive PCa.

The article tells about the current problems in the treatment of castrate-resistant prostate cancer. An extensive search for more effective treatments resulted in the development of a number of novel drugs which affect the quality of life of patients as well as increase the overall survival rate and time to PSA progression. The article studied the clinical efficacy of first-line cytotoxic chemotherapy with docetaxel. Satisfactory tolerance of docetaxel monotherapy was demonstrated. PSA levels declined > 50% in 43.7% of patients with overall survival up to 16 months.

Purpose. Pharmacoeconomic rationale for the use of sorafenib in malignant tumors in comparison with drugs that are included in the list of pharmaceuticals to provide to certain categories of citizens.Method of the study. Pharmacoeconomic rationale for the use of sorafenib in this study is made by analyzing the impact on the budget. The calculated costs of treatment with sorafenib at a hypothetical group of 100 patients with metastatic renal cell carcinoma (MRCC), hepatocellular carcinoma (HCC) and differentiated thyroid cancer resistant to radioactive iodine (DCT). These costs were compared with costs of treatment of a similar group of 100 patients, with treatment of MRCC applied bevacizumab (original or generic) in combination with interferon α, and patients with HCC and DCT were excluded from receiving drugs from a program of providing with necessary medicines (PNM). As a result the potential economic effect of the inclusion of sorafenib in the list of PNM was calculated.Results. Treatment of MRCC is cheaper with the use of sorafenib compared to bevacizumab in combination with interferon α: savings is 592 878 rubles in the original use of bevacizumab and 274 976 rubles in the use of generic bevacizumab for one patient-year. If we use sorafenib in a group of 100 people with MRCC, HCC and DCT suitable for treatment with sorafenib, the overall expenses are more than 175 million rubles, while using the original combination of bevacizumab with interferon α – more than 204 million rubles, and in the application of the generic combination of bevacizumab with interferon α – more than 176 million rubles, while in the two last cases the treatment of patients with HCC and DCT is not carried out. The total amount of annual budget savings in the treatment of 100 patients is more than 28.5 million rubles at the account of original of bevacizumab or more than 1 million rubles in accounting of generic bevacizumab.Conclusion. The inclusion of the targeted drug sorafenib in the list of pharmaceuticals to provide certain categories of citizens is economically justified. The use of sorafenib, instead of the combination of bevacizumab + interferon-α in patients with MRCC gives us the opportunity to release the funds and provide a systemic treatment of patients with other malignancies (HCC, DCT) while reducing the burden on the budget.

Androgen suppression strategy has become the key treatment of advanced prostate cancer. Historically, testosterone level below 1.73 nmol/l (50 ng/dl) was regarded as the castrate level. The current data shows that in an attempt to improve the therapeutic outcome, the new target for chemical castration is testosterone level below 0.69 nmol/l (20 ng/dl). Testosterone surges and suboptimal castrate level due to LHRH analogue therapy result in a porrer control for prostate cancer. Obese men have higher levels of testosterone during treatment with LHRH analogues than patients with a normal body mass index. The study of androgen ablation consists in identifying those agents which would allow to achieve and maintain the lowest possible levels of testosterone.

The main challenge of treating non-muscle invasive bladder cancer is multifocal tumors. Current methods of diagnosis are failed to detect all superficial flat tumor lesions in bladder mucosa. The use of fluorescence imaging with 5-aminolevulinic acid (5-ALA) allows to improve the sensibility of routine cystoscopy, but low specificity decreases its diagnostic accuracy. The method of fluorescence imaging combined with local fluorescence spectroscopy developed in P.A. Herzen MCRI has been shown to increase the specificity from 71% to 84%. Thus, local fluorescence spectroscopy in visible fluorescence of 5-ALA-induced protoporphyrin allows to perform guided biopsy and decrease the rate of diagnostic mistakes.

The main challenge of treating non-muscle invasive bladder cancer is multifocal tumors. Current methods of diagnosis are failed to detect all superficial flat tumor lesions in bladder mucosa. The use of fluorescence imaging with 5-aminolevulinic acid (5-ALA) allows to improve the sensibility of routine cystoscopy, but low specificity decreases its diagnostic accuracy. The method of fluorescence imaging combined with local fluorescence spectroscopy developed in P.A. Herzen MCRI has been shown to increase the specificity from 71% to 84%. Thus, local fluorescence spectroscopy in visible fluorescence of 5-ALA-induced protoporphyrin allows to perform guided biopsy and decrease the rate of diagnostic mistakes.

Hormonal therapy is the key method in the treatment of locally advanced and metastatic APC. 142 patients with APC treated with LHRH analogues were followed up from December 2011 till December 2014. The efficacy and tolerability of Buserelin-depo was compared with other LHRH analogues. Both Buserelin and such expensive foreign drugs as goserelin, leuprorelin and triptorelin demonstrated high efficacy and tolerability in the treatment of hormone-dependent APC.

429 patients with histologically confirmed prostate cancer undergoing various treatment from 1995 till 2014 were studied retrospectively. Overall survival with the baseline PSA less than 30 ng/ml averaged 50.5 months; with higher rates of PSA, the lifespan was reduced to 28 months regardless of treatment. The cause of death of 150 (35%) patients with PSA below 30ng/ml was not an oncological disease. Even with the initial PSA more than 30 ng/ml, 39 patients (9.1%) died from comorbidities. PSA above 30 ng/ml is a poor prognostic factor requiring a more aggressive approach to the treatment of these patients. Gleason score above 7 points is associated with a worse life expectancy forecast as well as a considerable decrease in the quality of life. PSA level determination continues to play a key role in the early detection of prostate cancer.

Рак предстательной железы (РПЖ) является в настоящее время одним из наиболее распространенных видов злокачественных новообразований в мире. Дальнейшее прогрессирование болезни приводит к потере чувствительности к андрогенным воздействиям, после чего развивается гормонорефрактерная стадия опухолевого процесса (гормонорефрактерный рак предстательной железы - ГРРПЖ). Средняя продолжительность жизни больных РПЖ на этом этапе не превышает 6-12 мес. Лечение ГРРПЖ является сложным и многоэтапным процессом. Эстрацит, сочетая в своем механизме действия цитостатический противоопухолевый эффект и гормональный эффект, с успехом может применяться на всех этапах терапии ГРРПЖ, общий объективный ответ на лечение составляет 40-50%. Благодаря незначительной миелосупрессивной токсичности и синергизму с различными противоопухолевыми агентами эстрамустин является базисным препаратом для проведения различных схем полихимиотерапии. Таким образом, терапия Эстрацитом и комбинированная терапия с его применением являются методами выбора лечения ГРРПЖ.

Рак предстательной железы (РПЖ) - одно из наиболее распространенных заболеваний у мужчин пожилого возраста. При наличии костных метастазов, а также при развитии резистентности к гормональной терапии, вероятность осложнений со стороны скелета возрастает.В связи с актуальностью проблемы в 2002 г. было решено провести Российское многоцентровое исследование по оценке эффективности зометы у больных РПЖ с костными метастазами.В исследовании участвовало 9 исследовательских центров. Урологи, онкологи в настоящее время имеют в своем арсенале эффективный препарат "Зомета", который позволяет длительное время стабилизировать состояние костной системы и снижать число патологических осложнений со стороны скелета. Зомета одобрена Фармкомитетом МЗ РФ для лечения больных с литическими, бластическими и смешанными метастазами в кости. Все указанное подтверждает необходимость широкого использования зометы в лечении больных РПЖ.

Рак предстательной железы (РПЖ) в настоящее время является одним из наиболее широко распространенных злокачественных новообразований у мужчин.Гормонотерапия является основным методом лечения генерализованного РПЖ.Наибольший интерес привлекает монотерапия с использованием нестероидного антиандрогена бикалутамида (касодекс).При анализе результатов лечения 480 больных с местнораспространенным РПЖ отмечены одинаковые показатели выживаемости и продолжительности ремиссии в группе пациентов, получавших касодекс, и в группе больных, перенесших кастрацию. Риск умереть во время лечения у больных, получавших касодекс, оказался на 7% меньше, чем у больных после двусторонней орхидэктомии или лечения агонистами ЛГРГ, качество жизни больных в группе монотерапии бикалутамидом также оказалось значительно более высоким. Таким образом, монотерапия касодексом в дозе 150 мг может быть выбрана в качестве метода лечения больных местнораспространенным и метастатическим РПЖ, желающих сохранить потенцию, но при этом пациенты должны быть хорошо информированы о всех применяемых способах гормонотерапии и их эффективности.