Immune checkpoint inhibitors have revolutionized the treatment of urothelial carcinoma. They are now part of the standard of care for locally advanced or metastatic urothelial carcinoma. Maintenance therapy with avelumab has been found to be the most effective compared to other immune checkpoint inhibitors. To date, platinum-containing chemotherapy followed by maintenance therapy with avelumab is the only regimen that has significantly improved overall survival in patients with advanced bladder cancer. The article presents the experience of maintenance therapy with avelumab on the example of 3 clinical cases of patients with inoperable forms of urothelial carcinoma. The experience of treating 3 patients who achieved stabilization with standard chemotherapy and received maintenance therapy with avelumab was retrospectively analyzed. The age of the patients ranged from 66 to 79 years, the study included two men and one woman. In two cases, muscle-invasive bladder cancer was initially verified, in one – progression 7 years after the start of treatment for non-muscle-invasive bladder cancer. Only in one of the cases, the volumetric formation of the bladder was radically removed, while distant metastases were detected 20 months after the operation, the rest of the patients did not receive radical treatment. The general condition allowed all patients to receive a full course of platinum-containing chemotherapy (gemcitabine + cisplatin or gemcitabine + carboplatin), partial remission was achieved. Maintenance immunotherapy with avelumab was started within a month of completion of chemotherapy. The duration of maintenance therapy currently ranges from 3 to 17 months; stabilization of the oncological process has been achieved in all cases. No clinically significant adverse side effects were noted in any of the cases. Our experience of maintenance immunotherapy with avelumab corresponds to world practice and illustrates the efficacy and safety of this drug.

In recent years, the approach to the treatment of advanced renal cell carcinoma (RCC) has undergone significant changes. The introduction of targeted drugs in the systemic therapy of RCC in the 2000s began with tyrosine kinase inhibitors that replaced cytokines and had a revolutionary effect. Then the therapeutic arsenal was expanded with the introduction of doublets consisting of a combination of immune checkpoint inhibitors or immune checkpoint inhibitors and tyrosine kinase inhibitors. Tyrosine kinase inhibitors continue to represent an effective treatment option for metastatic RCC (mRCC), maintaining their position as first-line therapy in patients with a favorable prognosis. According to the CheckMate study, targeted therapy is highly effective, and the incidence of complications is generally lower than with nivolumab/ipilimumab combination therapy. Unlike dual immunotherapy, sunitinib does not expose patients with a favorable prognosis to undue risk of adverse events, while leaving more options for subsequent lines of therapy, and it's also often more cost-effective. The presented clinical observation is an example of successful monotherapy with sunitinib in a previously untreated mRCC patient with a favorable prognosis. This case is of particular interest due to the lesion of a single kidney and the patient's polymorbidity. Effective targeted therapy in the postoperative period had a positive effect on the quality and life expectancy.

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.

Introduction . Nowadays the standard of care for locally advanced and metastatic urothelial carcinoma (UC) is a combination of platinum-based drugs. However, such a therapy is characterized with high toxicity and selective efficacy. So, the question of the optimal alternative to the first line of therapy and the choice of drugs for the second line of therapy is currently relevant. Immune checkpoint inhibitors have revolutionized the treatment of UC. Nevertheless, despite the fact that initially the drugs of this series showed a fairly high efficacy as a second-line therapy for metastatic UC, at present there is no unambiguous opinion about the correct tactics of their use. There is also no consensus on the predictive value of PD-L1 biomarkers and their significance in determining treatment tactics. Aim . To evaluate the efficacy and tolerability of first-line atezolizumab therapy in 22 patients with unresectable forms of UC. Materials and methods . The experience of the State Clinical Hospital named after D.D. Pletnev on the example of 22 patients with advanced UC who received first-line therapy with atezolizumab 1200 mg intravenously once every 21 days until progression or intolerable toxicity. Efficacy was assessed according to RECIST 1.1 criteria. Results and discussion . Median follow-up 16.3 months. The objective response rate (ORR) is estimated at 72.7%, 95% CI. A complete response according to RECIST 1.1 criteria was observed in 5 patients (22.7%). Median time to first response was 2.2 months (range 1.5-5.7), late responses (at 5 and 5.7 months) required space in 2 patients. Median progression-free survival was 5.2 months (95% CI) in all patients. Median overall survival (OS) 18.5 months (95% CI). Specific application-related events were required in 10 (45.4%) cases. All the side effects were managed by standard symptomatic therapy. The dosage of atezoli-zumab was reduced in 7 (32%) cases. Immune-mediated adverse events were reported in 5 (23%) patients. No patient received systemic non-corticosteroid immunomodulatory agents for immune-mediated events. 2 (9%) patients received corticosteroids. Conclusions . Atezolizumab has shown high efficacy in the first line of treatment for advanced UC.

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.

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 paper presents the results of using Vero-Mitomycin in patients with superficial bladder carcinoma (SBC). The study included 23 SBC patients over 18 years of age, with invasion levels of pTa, pT1, and differentiation grades of G1—2, ECOG 0 or 1, who were treated at the Department of Oncourology, P.A. Herzen Moscow Research Oncological Institute. The patients were given 6 intravesicular instillations of Vero-Mitomycin in a single dose of 40 mg. During a follow-up, a recurrence developed in 9 (39.1%) patients, a tumorous process progressed in none patient. There were recurrences at 12—16 months. The acute cystitis syndrome was revealed in 2 patients (after 4 and 6 instillations of the drug). Hematological toxicity was not observed. Thus, Vero-Mitomycin is one of the drugs of choice for the first-line intravesicular chemotherapy in patients with low and moderate risk SBC. Intravesicular chemotherapy with Vero-Mitomycin is an effective and low-toxic preventive method against recurrent SBC.

Purpose of the study. To determine the association of individual biomolecular markers of oncogenesis MMP-2, MMP-9 and the inhibitor of metalloproteinases TIMP-1 with the risk of tumor invasion and metastasis in the early and late postoperative period in various types of methods The study prospectively included medical data of 60 patients with kidney cancer with T 1-3 N 0 M 0 who from 2019. The patients were divided into 3 groups: 1 st group included 20 patients who underwent kidney resection for elective indications, with tumors of the renal parenchyma; 2 nd group – 20 patients who underwent radical nephrectomy by laparoscopic approach; Group 3-20 patients who underwent radical nephrectomy with lumbotomy access. All patients being in the early (7-10 th day) and long-term postoperative period (after 1 and 2 years) by solid- phase ELISA, on a StatFax 4200 analyzer using eBiosence and Cloud- Clone Corp reagent kits, a study was made on the basis of the concentration in the blood serum of markers of oncogenesis MMP-2, MMP-9 and TIMP-1 metalloproteinase inhibitor Results . In all groups of patients with RCC, an initial increase in the concentration of MMP-9 was revealed compared to the control ( p ≤0.05). According to the results of the ROC analysis, this indicator has a high specificity and sensitivity in terms of predicting RCC at the preoperative stage. The highest sensitivity and specificity for detecting tumor progression was demonstrated by matrix metalloproteinases: MMP-2 – sensitivity 96 %, specificity 67 % (cut-off point 357.5 pg/ml) and MMP-9 – sensitivity 87.5 % and specificity 62 % (cut-off point 958 ng/ml). At the same time, TIMP-1 showed less significant indicators – sensitivity and specificity (74 % and 60 %, respectively) with a cut-off point of 0.49 ng/ml. of a poor prognosis for the progression of RCC. RCC individual process. in patients with RCC allows a personalized approach to the choice of the scope and method of surgical treatment of RCC

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.

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.

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.

Рак предстательной железы (РПЖ) является одним из наиболее распространенных онкологических заболеваний у мужчин. Ежегодно в мире регистрируют более 600 тыс. новых случаев, а в ряде стран, где его встречаемость наиболее высока (США, Канада, Северная Европа), он вышел на первое место в структуре онкологической заболеваемости мужского населения [1, 2].

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.

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.

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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.

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.

The article presents the results of the meeting of the Advisory board “Modern treatment approaches for advanced renal cell carcinoma”, held on Apr 24, 2017, with the aim to discuss current approaches to inoperable, locally advanced and advanced renal cell carcinoma. To discuss the Russian experience with lenvatinib in the routine clinical practice and get the experts’ opinion on the perspectives directions of lenvatinib study in renal cell carcinoma landscape.