Background. Breast cancer is the most common cancer among women. Triple negative breast cancer (TNBC) is the most aggressive subtype of breast cancer, in which there are no special targets for therapy. Therefore chemotherapy is still leading treatment for TNBC including the regiments with platinum drugs.Aim. To study the association of polymorphic markers of the genes XRCC1 (rs25487), ERCC5 (rs17655), TP53 (rs1042522), CDKN1A1 (rs1801270) with progression-free survival (PFS) and overall survival (OS) of TNBC patients after platinum-based neoadjuvant chemotherapy.Materials and methods. Polymorphic markers of the XRCC1, ERCC5, CDKN1A and TP53 genes were studied in blood samples of 67 patients with stage II–III TNBC by real-time polymerase chain reaction with fluorescent allele-specific probes. The results of determining the markers were compared with PFS and OS using the Kaplan–Meyer method and the log-rank-test.Results. The association was found for the polymorphic marker rs25487 of the XRCC1 gene with PFS (carrying the T/T genotype was associated with a decrease of median PFS: 15.6 months versus 34.3 months, p = 0.013) and OS (carrying the T allele was associated with a decrease of median OS: 24.3 months versus 34.6 months, p = 0.041) without depending on the BRCA status. For the polymorphic marker rs17655 of the ERCC5 gene, significant difference in PFS was obtained in the period from 15.4 to 60.0 months of follow-up (the carrier of the C allele was associated with a decrease of median PFS: 20.0 months versus 35.2 months, p = 0.035). When considering the genotypes of the polymorphic marker of the ERCC5 gene differences were revealed between patients with the C/C genotype (M = 15.9 months) and two other genotypes (M = 33.6 months), p = 0.039. For the polymorphic marker rs1801270 of the CDKN1A gene significant differences in PFS were obtained in the period from 15.4 to 60.0 months of follow-up (for carriers of allele A, a decrease in median PFS was observed: 16.6 months versus 32.0 months, p = 0.046). For the polymorphic marker of the TP53 gene (rs1042522) a tendency to decrease OS for carriers of the C/C genotype was found seems promising for further study.Conclusion. The association of the studied polymorphic markers of the genes XRCC1 (rs25487), ERCC5 (rs17655) and CDKN1A (rs1801270) with PFS was revealed in patients with TNBC. Association with OS was obtained for the polymorphic marker of the XRCC1 gene (rs25487). These data may allow for further validation to individualize the treatment of this category of patients.

Взаимосвязь маркеров ранней и поздней активации лимфоцитов с эффективностью неоадъювантной химиотерапии больных трижды негативным раком молочной железыФедеральное государственное бюджетное учреждение «Национальный медицинский

Triple-negative breast cancer (TNBC) remains the most aggressive subtype of breast cancer. In the presence of distant metastases, the median overall survival does not exceed 14 months. TNBC is an extremely heterogeneous group of tumors, it includes both tumors extremely sensitive to chemotherapy and tumors that require targeted or immunotherapy for the best treatment outcomes. Such subtype features make it difficult to develop a single treatment strategy for all patients. Current perceptions of resistance mechanisms and molecular drivers progression have increased therapeutic opportunities for metastatic TNBC (mTNBC). For example, in the last few years, checkpoint inhibitors and PARP inhibitors have entered into clinical practice in the Russian Federation. This review presents clinical trial data, as well as an algorithm for choosing therapy for patients with TNBC, based on the results of recent clinical studies. The review focuses mainly on drugs registered at the territory of the Russian Federation, that allows to apply these options in everyday clinical practice. Promising directions therapy of mTNBC not registered at the territory of the Russian Federation yet will be showed in a separate review in the next issue in the Journal of Modern Oncology.

Clear-cell carcinoma (CCC) of the uterus is an aggressive disease. Current international guidelines on the treatment of uterine carcinomas predominantly cover cancer with endometrioid histology, and clinicians tend to use the same approach for patients with non-endometrioid histology due to the absence of separate guidelines for these rare tumor types. At present, molecular analysis enables the assessment of novel and non-standard treatment options based on the individual characteristics of a tumor. The present report presents a clinical case of successful treatment of a patient with clear cell uterine carcinoma with HER2 and ER expression. Non-toxic targeted treatment was used based on immunohistochemistry (IHC) data. The patient received anti-HER2 and hormonal treatment and demonstrated an excellent response. The follow-up period was 47 months and the patient remained stable during treatment without significant toxicity. Therefore, this approach demonstrated the potential for selecting highly-specific therapy for rare tumors, which lack distinct recommendations for their treatment.

Triple-negative breast cancer is 1024% of all cases of breast cancer and is characterized by the absence of estrogen, progesterone, and HER-2 receptors in the tumor. The therapy of this illness is a difficult clinical case. In contrast to hormone-positive and HER-2-positive phenotypes, in which we successfully use targeted drugs (antiestrogens and anti-HER-2 drugs), for triple-negative breast cancer we have not had such targets for a long time. Thus, despite the impressive results of immunotherapy of triple-negative breast cancer, there remains a fairly large group of patients with negative PD-L1 status, for whom it is necessary to develop other treatment strategies. One of the approaches in the treatment of malignant tumors includes not the impact on tumor cells, but the process of angiogenesis. Antiangiogenic drugs have positively proven themselves in the treatment of a large number of malignant tumors but are underestimated for breast cancer (including triple-negative phenotype). The use of bevacizumab in combinations with cytostatic drugs in breast cancer therapy (including triple-negative breast cancer) has been studied in a large number of clinical trials but was undeservedly forgotten in some countries due to the revoked FDA registration. This review presents the role of bevacizumab in the treatment of patients with triple-negative breast cancer and suggests the conditions when the administration of this drug is justified and leads to better results.

Metastatic triple negative breast cancer (mTNBC) is a difficult task for the chemotherapist in view of the disease aggressiveness, biological heterogeneity of the tumor, as well as the limit of therapy options. The approved modern drugs, such as immunotherapy and PARP inhibitors, have improved the treatment results in women with mTNBC. However, not all women are the candidates for this kind of therapy due to the lack of suitable points of application. In this context, high hopes are placed on the new treatment options currently being studied in clinical trials. The review summarizes data on advanced drugs that have demonstrated their efficacy in this multiplex group of women, but not yet registered at the territory of the Russian Federation Russian Federation, and will allow us to form an idea of the future algorithm of treatment of women with mTNBC.

Метастатический трижды негативный рак молочной железы (мТНРМЖ) представляет собой сложную задачу для химиотерапевта ввиду агрессивности заболевания, биологической гетерогенности опухоли, а также лимита опций терапии. Одобренные на сегодняшний момент препараты, в частности иммунотерапия и PARP-ингибиторы, позволили улучшить результаты лечения пациенток с мТНРМЖ. Тем не менее далеко не все пациентки являются кандидатами для этой терапии ввиду отсутствия подходящих точек приложения. В связи с этим большие надежды возлагаются на новые опции лечения, изучаемые в настоящий момент в клинических исследованиях. Представленный обзор суммирует данные по перспективным препаратам, продемонстрировавшим свою эффективность для этой сложной когорты пациенток, но еще не зарегистрированным в Российской Федерации, и позволяет сформировать представление о будущем алгоритме лечения пациенток с мТНРМЖ.

Трижды негативный рак молочной железы (ТНРМЖ) составляет 10–24% всех случаев рака молочной железы (РМЖ), характеризуется отсутствием в опухоли рецепторов к эстрогенам, прогестерону и HER-2. Терапия данного заболевания является трудной клинической задачей. В отличие от гормонопозитивного и HER-2-позитивного РМЖ, при которых мы успешно применяем таргетные препараты (антиэстрогены и анти-HER-2-препараты), при ТНРМЖ мы долгое время не имели таких мишеней. Так, несмотря на впечатляющие результаты иммунотерапии метастатического ТНРМЖ, остается достаточно большая группа пациенток с отрицательным PD-L1-статусом, для которых необходимо разрабатывать иные стратегии лечения. Один из подходов в лечении злокачественных опухолей предусматривает воздействие не на опухолевые клетки, а на процесс новообразования сосудов в опухоли – ангиогенез. Антиангиогенные препараты положительно зарекомендовали себя при лечении большого количества злокачественных опухолей, но являются недооцененными для РМЖ (в том числе для тройного негативного фенотипа). Применение бевацизумаба в комбинации с цитостатиками на различных этапах лечения пациенток с РМЖ изучалось в многочисленных клинических исследованиях и продемонстрировало обнадеживающие результаты, в том числе и для ТНРМЖ, однако из-за отозванной регистрации Управлением по контролю пищевых продуктов и лекарств в США было незаслуженно забыто в ряде стран. В данном обзоре представлена роль бевацизумаба в терапии пациенток с ТНРМЖ и предложены условия, при которых назначение этого препарата было бы оправданным и приводило к лучшим результатам.

Abstract Background. Triple negative breast cancer (TNBC) is the most aggressive molecular subtype. It is mostly observed in younger patients, however, substantial proportion of patients are above age of 60. Despite that, this group of patients was not studied and analyzed separately in previous studies. Objectives. To establish efficacy of neoadjuvant chemotherapy in elderly patients with stage II-III TNBC and patterns of progression for this group of patients. Methods. Since 2014 we treated 92 patients with histologically confirmed stage II-III TNBC. Neoadjuvant therapy included 6 cycles of Cisplatin 75mg/m2 day 1 and Paclitaxel 80mg/m2 days 1, 8, 15, every 4 weeks according to local protocol. After neoadjuvant chemotherapy patients proceeded to radical breast surgery with assessing pathological response. Then we analyzed clinical characteristics of patients and their survival according to the pathological response achieved. Results. In our analysis were included 92 patients, 22 of them were elderly patients (above 60). Pathological complete response was achieved in 57,6% of all patients. In the elderly group we observed significantly higher proportion of tumors with advanced stages (N3: 40,9% vs 20,0%, p<0.05, locally advanced: 77,3% vs 51,4%, p<0.05). Although not clinically significant, elderly patients less frequently achieved complete clinical response (28,6% vs 41,4%). Pathologic complete response was achieved in 52,6% of elderly patients and in 71,7% of younger patients (p<0.05). Higher proportion of patients above 60 experienced nephrotoxicity (54,5% vs 17,1%, p<0.05) and peripheral polyneuropathy (22,7% vs 17,1%, p=0.054). In this group of patients only 22,7% completed all 6 cycles as opposed to 65,7% of younger patients (p<0.05). Higher proportion of elderly patients had local recurrence: 45,5% vs 22,9% (p<0.05), visceral metastases: 36,4% vs 17,1% (p<0.05). We observed tendency for this group of patients to have liver and lungs as first sites of metastases (80%), as opposed to younger patients, for whom CNS was the most frequent first metastatic site (50%). To the date of cut-off (June 2019) 17 patients died, all of them due to the progression of the disease (31,8% in elderly group, 14,3% in younger group). Survival outcomes are presented in table below. Table 1. Survival outcomes.SurvivalBelow 60 y.o.Above 60 y.o.Recurrence-free survival<0.053 years73,7%61,9%5 years69,6%51,6%Survival without distant metastases<0.053 years78,9%68,6%5 years74,6%57,2%Overall survival0,0573 years81,8%72,4%5 years77%54,3% Conclusion. In our analysis elderly patients with early and locally advanced TNBC demonstrate decreased response, another safety profile and lower survival rates. Different efficacy could be explained with lower number of cycles of neoadjuvant chemotherapy administered and more advanced stages upon presentation. Different metastatic patterns which we observed in younger and elderly patients should be further studied. Citation Format: Olga Gordeeva, Irina Kolyadina, Lyudmila Zhukova, Inna Ganshina, Dmitry Komov, Andrey Meshcheryakov. Patterns of survival and efficacy of chemotherapy in elderly patients with triple-negative breast cancer treated in the neoadjuvant setting [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-16-34.

This study is the first stage of prospective study of NGS-based testing of ctDNA in pts with various types of cancer and it's utility in routine oncological practice. This prospective, single-center, sample collection study; pts with various cancers were included. For the detection of сtDNA, an assay based on a combination of targeted NGS and ddPCR was developed. Tumor somatic mutations were determined by target sequencing of DNA from FFPE tumor. Sequencing was performed using the small (96 amplicon) NGS panel covering regions of frequent cancer somatic mutations. Tumor-specific mutations were monitored in plasma samples. Mutations of plasma ctDNA were determined by ddPCR. The plasma sample was considered "positive" if the content of ctDNA was more than 0.5 copies of mutant DNA in ml plasma. The study comprised 599 pts, including pts with gastric cancer (62, 10%), pancreatic cancer (62, 10%), colorectal cancer (197, 33%), ovarian cancer (102, 17%), breast cancer (75, 12%), renal cancer (11, 2%), bladder cancer (6, 1%), and lung cancer (84, 14%). Distribution of cases by the stage was: I stage, 12%; II stage, 28%; III stage, 38%; and IV stage, 22%. Tumor-derived mutations were found in plasma with sensitivity of 60% for gastric cancer, 64% for pancreatic cancer, 89% for colorectal cancer, 74% for ovarian cancer, 73.6% for breast cancer, 36.4% for renal cancer, 66.6% for bladder cancer and 67.8% for lung cancer. A robust and economical assay of ctDNA detection is sensitive (relative to the values founded in recent studies) for all examined types of tumors, except for renal cancer.

Трижды негативный рак молочной железы (ТНРМЖ) остается наиболее агрессивным подтипом рака молочной железы. При наличии отдаленных метастазов медиана общей выживаемости не превышает 14 мес. ТНРМЖ – чрезвычайно гетерогенная группа опухолей, она включает в себя как высокочувствительные к химиотерапии опухоли, так и те, что требуют назначения таргетной или иммунотерапии для достижения наилучших результатов лечения. Такие особенности подтипа обусловливают трудности разработки единой стратегии лечения для всех пациентов. Существующие на данный момент представления о механизмах резистентности и молекулярных драйверах прогрессии позволили расширить терапевтические возможности для метастатического ТНРМЖ (мТНРМЖ). Так, за последние несколько лет в клиническую практику в Российской Федерации вошли ингибиторы контрольных точек и PARP-ингибиторы. В настоящем обзоре представлены данные клинических исследований, а также алгоритм выбора терапии для пациентов с мТНРМЖ, основанный на результатах последних клинических исследований. Обзор посвящен препаратам, зарегистрированным на территории РФ, что позволяет применить перечисленные опции в повседневной клинической практике. Перспективные направления в терапии мТНРМЖ, еще не зарегистрированные в РФ, будут рассмотрены в отдельном обзоре в следующем номере журнала «Современная онкология».

Background. Treatment results for the patients with stage II–III triple negative breast cancer (TN BC) have to be improved. Not only the new treatment regimens, but new predictive and prognostic factors should to be developed.Materials and methods. We included 98 patients with stage II–III TN BC in our study. We studied efficacy and safety of PlaTax regimen (cisplatin 75 mg / m2 day 1 + paclitaxel 80 mg / m2 days 1, 8, 15, course every 4 weeks) in this cohort of patients. We assessed pathologic response, survival and factors, which were relevant for predicting response and prognose survival.Results. PlaTax regimen is characterized by high efficacy and tolerable toxicity. Clinical efficacy was 85.8 %, pCR achievement was 60.5 %, tpCR achievement was 58.1 %. The regimen has low haematological toxicity (neutropenia III–IV grades – 4.1 %); the most frequent adverse events were polyneuropathy (18.5 %) and decreased renal function (24.5 %). 3-year progression-free survival was 68.4 %, most of the relapses (92 %) occurred during first 2 years. 3 year overall survival was 77.6 %. The most relevant predictive factor was level of Ki-67 ≥50 % (pCR 38.5 % vs. 68.7 %, p = 0.038). pCR achievement was the most important prognostic factor, resulting in improved 3-year progressionfree survival (44.3 % vs. 89.1 %, p <0.0001), and 3-year overall survival (61.5 % vs. 91.6 %, p = 0.001). Not only the residual disease, but also the size of residual tumor was important from prognostic point of view. Other important prognostic factors were size of the tumor, status of regional lymph nodes, grade. Delay in surgical treatment more than a month lead to decreased 3-year progression-free survival: 87.1 % vs. 62.5 % (p = 0.047).Conclusions. Our data suggest that studied regimen could be an option for patients with stage II–III TN BC. The assessment of the predictive and prognostic factors will help improve the treatment results for patients with stage II–III TN BC.

Background. Ramucirumab is a monoclonal antibody that inhibits the vascular endothelial growth factor receptor-2 (VEGFR2). The study is aimed to analyse prognostic factors for survival in patients with disseminated gastric cancer who received ramucirumab in the second-line therapy in ’real-life’ clinical setting of Russia (RAMSELGA). Methods. We retrospectively analysed the outcome of 163 patients aged 20–78 years from 11 oncological centres in Russia. Survival analysis was performed using the Kaplan – Meier model, and regression analysis was performed using the Cox model. Results. In a univariate analysis of overall survival, 5 factors were identified as independent factors of an unfavourable prognosis: 1) age <65 years (RR 0.542; 95% CI 0.302–0.971; p = 0.039); 2) time to tumour progression on the first-line therapy is not more than four months. (RR 0.161; 95% CI 0.105–0.246; p = 0.0000); 3) a low grade tumour or colloid cancer (RR 1,868; 95% CI 1,063–3,284; p = 0,030); 4) peritoneal metastasis (RR 1.549; 95% CI 1.026–2.339; p = 0.037); 5) ascites or pleurisy (RR 0.624; 95% CI 0.424–0.920; p = 0.017). In a multivariate analysis, favourable prognostic factors of overall survival of patients included age – 65 years or older (OS 2.288; 95% CI 1.240–4.220; p = 0.008) and time to tumour progression on the first-line therapy – more than 4 months (OS 6.650; 95% CI 4.221–10.477; p = 0.000). Conclusion. Despite an active search, prognostic factors for survival in patients that are universal for dGC have not yet been found. To build a universal prognostic model, a very thoughtful analysis considering not only clinical and laboratory, but also pathomorphological and molecular genetic characteristics is required.

Популяция CD8 + -лимфоцитов периферической крови и ее значение для непосредственных и отдаленных результатов лечения больных трижды негативным раком молочной железы Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр онкологии имени Н

Background. We previously found that a decrease in the number of NKT cells and activated CD 25+ peripheral blood lymphocytes (PBLs) before neoadjuvant chemotherapy was associated with an increased likelihood of disease progression in patients with locally advanced triple-negative breast cancer (TN BC).The purpose of this study was to determine the relationship between the initial number of NKT-and CD 25+ PBLs and relapsefree survival (RFS)/overall survival (OS ) in patients with TN BC who received neoadjuvant chemotherapy with cisplatin and paclitaxel followed by surgery.Material and Methods. The study included patients with stage II and III TN BC. The follow-up time was 36 and 66.9 months. Immediately before chemotherapy, the percentage of CD 3+CD 16+CD 56+ (NKT) -, CD 25+- and CD 8+ PBLs was determined by flow cytometry. Statistical analysis of the data was carried out using the Statistics 7 software package. The Kaplan-Meier method was used to determine the relationship between immunological parameters and RFS/ OS .Results. The decreased level of NKT cells before treatment was associated with a decrease in the 3-year RFS [Me: 20.1 (0.533 and 39.7) months] compared to that observed in patients with higher percentage of these cells than in the control (Me was not achieved). There were no statistically significant differences in the 3-year OS between the groups. The initially reduced number of CD 25+ lymphocytes in comparison with the control was associated with decreased rates of both RFS and OS . The difference in DFS and OS was more significant between the groups of patients who simultaneously had an increased initial number of both NKT and CD 25+ cells and patients in whom both cell populations were below normal levels.Conclusion. The initial (prior to chemotherapy) number of NKT and activated CD 25+ PBLs can apparently be a predictive factor in TN BC patients, who received neoadjuvant chemotherapy with cisplatin and paclitaxel.

e12581 Background: Triple negative breast cancer (TNBC) is the most aggressive subtype of breast cancer. Pathologic complete response (pCR) achievement during neoadjuvant chemotherapy (NACT) is very important for these pts as it correlates with long-term outcome. Predictive and prognostic factors for this group of pts are needed. Methods: Since 2014 we treated 98 pts with histologically confirmed stage II-III TNBC with following regimen of NACT: 6 cycles of Cisplatin 75mg/m2 day 1 and Paclitaxel 80mg/m2 days 1, 8, 15, every 4 weeks according to local protocol. After NACT pts proceeded to radical breast surgery with assessing of pathological response. Before the treatment we assessed TILs in biopsy samples of all patients. We also conducted subpopulation analysis of lymphocytes in peripheral blood before treatment. We analyzed CD8+, CD25+, NK and NKT cells as they were reported to be significant earlier. We compared results with median value in reference group (mRG) of healthy women. Results: Among all 98 pts 86 (87%) were operated, pCR was achieved in 60,5% of operated pts. pCR strongly correlated with TILs level: 38,5% for pts with TILs < 5% and 69,8% for pts with TILs > 5% (p = 0,05). We also found that NKT population was associated with pCR: 77,8% vs 45,8% among patients with NKT above mRG and up to mRG, respectively (p = 0,01). It correlated also with tpCR: 22,2% vs 70,6% (p = 0,01). When both CD25+ and NKT population were above mRG pCR rate achieved in 85,7% pts vs 50,0% pts if it was up to mRG (p = 0,049). NK, CD8+ and CD25+ did not show any correlation with pCR. Survival results are presented in table below. NK, NKT and TILs did not show any correlation with survival. Interestingly, CD8+ were also associated with lower incidence of visceral metastases: 42,1% in pts with normal CD8+ and 15,7% in pts with CD8+ above normal (p = 0,19). Conclusions: Not only TILs, but also NKT and CD25+/NKT population in the peripheral blood could be possible predictive factors for patients with stage II-III TNBC receiving NACT. CD8+, CD25+ and NKT populations could be further studied as prognostic markers for this group of patients. [Table: see text]

Nowadays there are several effective drugs to treat castration-resistant prostate cancer. However, treatment options are still limited. In this regard, overcoming the resistance to the prescribed treatment remains extremely important. One possible way is to replace prednisone with dexamethasone when using abiraterone acetate. There are several studies, including randomized ones, which confirm the rationality of this method. We present a literature review and our own clinical observation, which demonstrates the possibility of repeated long-term (3 years) use of abiraterone acetate after replacing a steroid drug in an intensively pre-treated patient with castration-resistant prostate cancer.

Luminal metastatic HER2-negative breast cancer remains one of the most common cancers in oncological practice. This disease still remains incurable. Endocrine therapy remained the standard therapy of choice for disseminated patients for a long time. The search for new effective drugs, development of strategies that can overcome primary and secondary resistance to endocrinotherapy has shown that the CDK4/6-inhibitors group can improve not only the short-term treatment outcomes, but also affect the overall survival of patients, which has been demonstrated in a number of phase III studies. Along with that, the use of CDK4/6 inhibitors maintains a good quality of life, allows patients to maintain professional and social activities, which is of great importance for long-term prospects. Given that the endocrine therapy combined with CDK4/6-inhibitors today is the new standard of therapy in patients with luminal HER2- negative breast cancer, knowing how to use this therapy in daily clinical practice is crucial. Know and apply innovative drugs in clinical practice and the management of regimen toxicity always my work demands close application. This article provides an overview of the data on the efficacy of ribociclib based on phase III registration studies. It also presents its own clinical experience demonstrating the feasibility of using a new group of drugs in patients both in pre- and postmenopausal women. The authors discussed the issues related to the modification of the regimen due to the toxicity of therapy, in particular, neutropenia and hepatotoxicity. They also showed the possibility of managing adverse events with the preservation of a long-term effect with no loss in quality of life.

Background. Assessment of hormone receptor status plays a crucial role in treatment of patients with breast cancer. currently, clinicians are limited to determining the expression status of estrogen receptor (ER), progesterone receptor (pR) and HER2 only in primary breast cancer tissues, even in the presence of regional metastases.The purpose of the study was to review available data on heterogeneity of ER, pR and HER2/neu expressions in primary breast cancer and regional metastases.Material and methods. We analyzed publications available from pubmed, medline etc. using the keywords «discordance», «breast cancer», «locally advanced», «regional lymph nodes», «ER», «pR», and «HER2».Results. The clinical and prognostic role in assessing the heterogeneity of the receptor status of primary tumors and synchronous regional metastases, as well as the effect of detected discordance on treatment tactics was assessed.Conclusion. Data on the frequency of discordance in hormone receptor status between primary and metastatic breast cancer tumors and its effect on the further prognosis in breast cancer are still contradictory. However, the fact of the presence of such heterogeneity suggests that some patients with affected lymph nodes will have significant benefits from determining the status of steroid hormones and HER2 not only in the primary tumor, but also in the lymph nodes, since it will open up new opportunities for subsequent targeted therapy.

In this article we demonstrate a clinical case of young patient with non-small lung cancer with ALK-translocation treated with crizotinib in the first line of therapy. This approach was associated with complete response and acceptable toxicity.