Background. Pathological complete response (pCR, ypT0N0) after neoadjuvant therapy is regarded as an exceptionally favorable prognostic factor in locally advanced gastric and esophagogastric junction cancer. The incidence of disease progression in this subgroup and the factors that might predict it remain insufficiently studied, and no data are available for the Russian population. Aim: to assess the incidence of disease progression in patients with locally advanced gastric cancer, who achieved pCR after neoadjuvant therapy and to describe the clinical and morphological features of those in whom it occurred. Material and Methods. In a national multicenter retrospective cohort of 195 patients with pCR, who met the inclusion criteria and had adequate follow-up, disease progression was recorded in 11 (5.6 %). The clinical and morphological characteristics of patients with progression were compared with those of sex- and age-matched patients without progression (1:3). Descriptive statistics, Fisher exact test and the Mann–Whitney u test were used. Results. The median time from the start of treatment to progression was 22 months (range 12–48); progression was predominantly systemic (distant metastases 63.6 %, peritoneal carcinomatosis 45.5 %). Across the whole pCR cohort, cancer-specific survival was ~95.5 % at 2 years and ~94.7 % at 3 years. patients with progression somewhat more often had features of a more aggressive tumor course (cT4, a non-intestinal – diffuse or mixed – Lauren type), as well as postoperative complications grade III+, but none of these differences retained significance after correction for multiple comparisons, and none can be regarded as a reliable predictor of progression. Conclusion. Achievement of pCR is associated with an extremely low rate of disease progression and high cancer-specific survival. No reliable predictors of progression have been identified to date. The very small number of progression events does not allow a subgroup requiring adjuvant therapy to be defined and does not justify the routine use of adjuvant therapy (in particular, continued FLOT) in patients who have achieved a complete response.
Background. Gastric cancer remains one of the leading causes of cancer-related mortality globally and ranks second in Russia. Pathological complete response (pCR, ypT0N0M0) is a significant surrogate marker for the efficacy of neoadjuvant therapy and disease prognosis. Despite accumulating data, the demographic and clinical-morphological characteristics of this patient category, as well as the dependence of pCR on the neoadjuvant therapy regimen, remain insufficiently studied.Aim: to characterize the demographic and clinical-morphological characteristics, methods and tolerability of perioperative therapy, and features of surgical treatment in a multicenter retrospective cohort of patients with locally advanced gastric and esophagogastric junction cancer, who achieved pCR after neoadjuvant therapy.Material and Methods. Data from 221 patients with histologically confirmed gastric or esophagogastric junction adenocarcinoma (cT2-4N0-3M0) who achieved pCR (ypT0N0M0) confirmed by pathomorphological examination of the resected specimen were retrospectively analyzed.Results. The median age was 65 years (range 24-89). Men (52.5 %) and patients with clinical stage iii (48.0 %) and IIB (30.8 %) predominated. Poorly differentiated adenocarcinoma was detected in 124 (56.1 %) patients, and signet ring cell carcinoma in 35 (15.8 %). Lymph node metastasis (cN+) at the time of diagnosis was found in 124 (56.1 %) patients. The completion rate of neoadjuvant chemotherapy was 96.6 %. Grade >3 adverse events were registered in 17 (8.3 %) patients receiving chemotherapy and in 3 (17.6 %) receiving chemoradiotherapy. According to follow-up examination, a complete clinical response was detected in 2 (0.9 %) patients, a partial response in 57 (25.8 %), and disease stabilization in 162 (73.3 %). Adjuvant chemotherapy was administered to 132 (59.7 %) patients (including the FLOT regimen in 75.0 %). The predominant method of surgical treatment was gastrectomy (59.3 %). Postoperative complications occurred in 47 (21.3 %) patients, including Clavien-Dindo grade >iii in 24 (10.9 %); the 30-day postoperative mortality rate was 1.4 %.Conclusion. Within the clinical study, the largest sample of the Russian population of gastric cancer patients with a registered pathological complete response after neoadjuvant therapy was collected - 221 patients. This cohort is dominated by features associated with aggressive gastric cancer: diffuse and mixed Lauren types; poorly differentiated adenocarcinoma, including signet ring cell carcinoma; clinical categories cT3-4 and cN+. in patients with pCR, the completion rate of neoadjuvant therapy was 96.6 %, with the FLOT regimen being the most frequently used. Routine CT scanning does not reliably diagnose pCR; thus, searching for and validating new standardized biomarkers for the objective assessment of tumor response to neoadjuvant therapy is highly relevant.
Aim. To assess the efficacy and safety of lenvatinib plus pembrolizumab for the treatment of mismatch repair-proficient (pMMR) endometrial cancer (EC) in routine clinical practice in Russia.Materials and methods. This multicenter, retrospective, cohort study included 114 patients with recurrent and metastatic EC from 37 cancer centers in Russia treated between December 2020 and November 2024. Patients with histologically verified EC without microsatellite instability were included. The primary endpoint was progression-free survival; the clinical characteristics of the patients were additionally analyzed; the objective response rate and the toxicity profile of therapy were assessed.Results. Median patients’ age was 66.5 (33–83) years. The most common histologic tumor subtype was endometrioid adenocarcinoma (72.8 %); serous adenocarcinoma was diagnosed in 18.4 % of cases, other subtypes – in 8.8 %. The median progression-free survival was 8.15 months (95 % confidence interval 0.4–41.1). Objective response rate was 38.0 %. The median overall survival was not achieved with a median follow-up of 12.23 months. During treatment, dose reduction rate due to adverse events was 50 %. The most frequent adverse events were hypertension (n = 64; 56.1 %), fatigue (n = 45; 39.5 %), and diarrhea (n = 20; 17.5 %).Conclusion. In the conducted study of routine clinical practice in Russian patients with recurrent and metastatic EC without mismatch repair system deficiency (pMMR/MSS), lenvatinib plus pembrolizumab showed good efficacy with a manageable safety profile.
The article presents data from a retrospective study of COVID-19 outcomes in cancer patients from 24 regions of the Russian Federation.The study included 1,055 patients who had a Coronavirus disease 2019, including 451 (42.7 %) men and 604 (57.3) women. The mean age was 58.7 years (29–90); 108 (10.2 %) patients were diagnosed with various comorbidities. 627 (59.4 %) were receiving antitumor drug therapy at the time of diagnosis of COVID-19, and 332 (31.5 %) received antitumor chemotherapy.Most patients had asymptomatic or mild COVID-19: asymptomatic in 205 (19.4 %) patients, and mild — in 517 (49.0 %) patients. Moderate / severe COVID-19 was observed in 268 (25.4 %) patients, while severe / critical COVID-19 was diagnosed in 65 (6.2 %). 1204601776 25 (2.4 %) patients died after COVID-19. The average age of cancer patients who died was 66.3 years (31–84). Among the deceased patients, 16 (64.0 %) were women and 9 (36.0 %) were men. To determine the factors increasing the risk of death in cancer patients we performed univariate and multivariate analyses. Conclusions: based on the presented data, the probability of death from COVID-19 was associated with the anti-tumor therapy administered during the disease. This conclusion obliges us to stop antitumor chemotherapy during the COVID-19 disease.
Fluorescence lifetime imaging (FLIM) is a powerful tool for investigating the molecular microenvironment of fluorophores within living cells and tissues. One of its most prominent applications is in metabolic imaging, based on the autofluorescence of the dehydrogenase cofactors NAD(P)H and FAD. Our research is centered on tumor cell metabolism, key features of which include the Warburg effect, metabolic plasticity, and considerable intra- and intertumoral heterogeneity. The technique's label-free basis, quantitative output, and non-invasive image acquisition make metabolic FLIM highly suitable for clinical translation. Through investigations employing in vitro cell models, in vivo mouse tumors, and postoperative patient samples, we have assessed the diagnostic and prognostic potential of FLIM. Our results show that macroscopic FLIM can identify breast cancer metastases in sentinel lymph nodes and distinguish gliomas from the brain's white matter. Furthermore, we have demonstrated that FLIM can effectively visualize and quantify metabolic heterogeneity at the cellular level. Consistent with expectations, patient-derived tumors exhibited greater metabolic heterogeneity than standard cell lines or xenografts, an observation confirmed in colorectal and breast cancers. Overall, these results yield critical insights into the distinct metabolic features of tumors.
