Role of targeted therapy in the treatment of HER-2-positive breast cancer brain metastases

Brain metastases are detectable in 25–35 % of patients with progressive HER-2-positve breast cancer. Even after spreading metastases into the brain, chemotherapy in combination with anti-HER- 2 therapy improves survival due to better control of the systemic disease. The paper presents the results of investigations substantiating the use of anti-HER-2 targeting agents, as well as the innovative agent T-DM1 to treat brain metastases

Overcoming resistance to therapy HER2 - overexpressing breast cancer (Review)

Despite the efficacy of trastuzumab in the adjuvant setting, there is a group of patients who develop recurrent disease. The presence of distant metastases resistance develops inevitable. Currently, many of HER2- targeted agents, is under clinical trials of monoclonal antibodies , and small molecule - konyugatyantitelo medicament. The concept of dual anti -HER2 blockade has already been introduced into clinical practice, with pertuzumab in combination with trastuzumab and dotsetakselomutverzhden as first-line therapy for metastatic breast cancer. Trastuzumab -DM1, anti -HER2 - konyugatantitelo medicament active agent is currently in the process of clinical testing. Several molecular mechanisms of resistance to HER2 blockers are considered as therapeutic targets, and conducted experimental development compounds.Несмотря на эффективность трастузумаба в адъювантной терапии, существует группа пациентов, у которых развивается рецидив заболевания. При наличии отдалённых метастазов резистентность развивается неизбежно. В настоящее время множество НЕЯ2-таргетных агентов находится в стадии клинического исследования: моноклональные антитела, малые молекулы и конъюгатыантитело-лекарственное средство. Концепция двойной анти-НЕВ2 блокады уже внедрена в клиническую практику, при этом пертузумаб в комбинации с трастузумабом и доцетакселомутверждён в качестве терапии первой линии метастатического РМЖ. Трастузумаб-DMI, анти-НЕР2 конъюгатантитело-лекарственное средство, является активным агентом, в настоящее время находящимся в стадии клинических испытаний. Некоторые молекулярные механизмы резистентности к блокаторам HER2 рассматриваются как терапевтические мишени, и проводится разработка экспериментальных соединений

Реконструкция молочной железы и лучевая терапия

In recent years there were significant advances in auto- and heterological breast reconstruction. Reconstruction with implants after mastectomy is being used more of ten. A recent study conducted by Albronoz et al, based on Nationwide Inpatient Sample data, found an increasing rate of immediate breast reconstruction with implants af ter mastectomy up to 11%, compared to autological methods of reconstruction [Barreau-Pouhaer L., 1992]. A possible reason for this increase is the growing number of young patients who need a mastectomy, but have not enough fat tissue for autological reconstruction. The purpose of reconstruction is to reach a long-term, oncologically safe and aesthetically pleasing result with reasonable operation expenses. Radiation therapy after mastectomy, as part of a complex treatment, is needed for an increasing amount of patients with breast cancer. Radiation therapy is a vital par t of cancer treatment, but often causes complications. Patients should be informed and consulted about potential complications so they can make reasonable decisions about their treatment.В последние годы отмечаются значительные продвижения в области ауто- и гетерологических реконструкций молочных желез. Реконструкция с помощью имплантатов при мастэктомии используется все чаще. Недавнее исследование, проведенное Albronoz с соавторами, на основе данных Nationwide Inpatient Sample с 1998 по 2008 год, выявило увеличение частоты одномоментных реконструкций имплантатами в среднем на 11% в год, по сравнению с аутологичными методами реконструкции [Barreau-Pouhaer L., 1992]. Возможной причиной для этого увеличения является растущее число молодых, нуждающихся в мастэктомии и не располагающих достаточной жировой клетчаткой для аутологичной реконструкции. Цель реконструкции – достичь долгосрочного, безопасного с онкологических позиций и эстетически удовлетворительного результата с рациональными затратами на операцию. Лучевая терапия после мастэктомии, как часть комплексного лечения, требуется все большему числу больных при раке молочной железы. Она, хотя и  является важнейшим  компонентом в лечении рака молочной железы, связана с высокой частотой возникновения осложнений. Следует надлежащим образом консультировать пациентово возможности этих потенциальных осложнений, с тем, чтобы они могли принимать обоснованные решения

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment

БИОПСИЯ СИГНАЛЬНЫХ ЛИМФАТИЧЕСКИХ УЗЛОВ ПРИ РАКЕ МОЛОЧНОЙ ЖЕЛЕЗЫ

За последние десятилетия в хирургическом лечении рака молочной железы появилась тенденция к органосохраняющему и все менее травматичному и калечащему этапу в многоступенчатой терапии этого заболевания. Выполнение подмышечной лимфодиссекции часто сопровождается такими осложнениями, как лимфостаз верхних конечностей, ограничение подвижности и болевые ощущения плечевого сустава, что, в ряде случаев, ведет к инвалидизации, при излечении от рака

Biological rationale for patient-specific treatment of breast cancer. Analysis of new data for breast cancer

Breast cancer is the most common malignancy in females. More than 1.7 million of cases are detected annually worldwide. The incidence of breast cancer in Russia has increased by 64 % over the last 20 years. There was a 1.43-fold increase in the prevalence of breast cancer (from 297 to 457cases per 100,000) between 2005 and 2017. A total of59,538 new cases were registered in the Russian Federation in 2012. In Russia, breast cancer is the most common malignancy among women aged 40—85years and the second most common cancer among women aged 15—39 (after cervical cancer). The disease is primarily detected in women aged between 40 and 54 years (29.5 %). More than 66,000 of new cases of breast cancer are registered in the Russian Federation annually. In 2017, there were 70,293 new cases of breast cancer; of them, 49,134 patients (69.9 %) hade stage I—II breast cancer. There was a 0.02 % increase in the proportion of new cases of stage I—II breast cancer in 2016—2017. For this reason, it is important to study in depth the markers of breast cancer used in everyday practice in order to personalize the treatment of patients with breast cancer

Biological rationale for a patient-specific approach in the treatment of breast cancer. Clinical value of novel biomarkers of breast cancer

Breast cancer, being the most common type of malignant diseases, remains a significant challenge for both clinicians and fundamental researchers. The implementation of screening mammography, as well as adjuvant and neoadjuvant systemic therapy has made a significant progress in tackling the disease. The studies aimed at the assessment of novel biomarkers of breast cancer, alternative to standard ones, are becoming increasingly relevant. A number of new markers, such as p53, CK5/6, SMA, p63, PHH3, E-cadherin, EGFR, FOXA1, androgen receptors, TILs etc., have demonstrated their high predictive and/or prognostic value in multiple studies. New findings suggest that evaluation of novel biomarkers in breast cancer requires further thorough analysis.Recent studies have identified the role of biomarkers in choosing an optimal treatment strategy for breast cancer, estimated the prognostic value of biomarkers associated with tumor proliferative activity (including cyclin D1, G1-cyclin-dependent kinases 4 and 6, and cyclin-dependent kinases 8/19), specified the role of phospho-histone H3 (which is a proliferation marker that can be used to determine tumor grade), and evaluated the prognostic value of androgen receptors and other biomarkers. Multiple studies have also analyzed the expression of various biomarkers and their impact on overall and relapse-free survival

General recommendations for the management of breast cancer (St. Gallen Expert Consensus developed at the 16^thth International Breast Cancer Conference)

This article summarizes the results of the 16th St. Gallen International Breast Cancer Conference (March 2019), which traditionally resulted in the development of a new guideline for local/regional and systemic treatment of breast cancer

AUTOMATED ANALYSIS OF CELL DENSITY IN BREAST CANCER AS AN ADDITIONAL METHOD OF INCREASING OBJECTIVITY AND ACCURACY OF BREAST CANCER PROGNOSIS

Introduction. In the last ten years, it became obvious that on the molecular level breast cancer is a group of heterogenous tumors. The current objective of routine clinical practice of treatment prescription includes accurate disease prognosis for every individual patient and conviction that the risk of breast cancer recurrence after adjuvant hormone therapy without adjuvant chemotherapy doesn’t increase.The study objective is to evaluate how clinical use of risk associated with cell density can in practice improve prognosis of recurrence risk in patients with breast cancer after standard clinical and pathomorphological examinations.Materials and methods. The article analyzes therapy results using data from the cumulative cancer registry of breast cancer diagnosis and treatment of the N.N. Petrov National Medical Research Oncology Center in 2000–2009. The database includes information on diagnosis, treatment, and survival of 5106 patients with breast cancer. Archived material (from 2000 to 2009) from paraffin blocks of the “targeted group” for methods of molecular and genetic profiling was poured into recipient blocks, stained with corresponding antibodies such as widely used ER, PR, HER2/neu, Ki-67 markers as well as poorly studied markers: cell density, р53, CK5/6, CK14, CD4/CD8, p63, EGFR, FOXP3, AR, FOX1.Results. The study of 1118 patients with stage T1–2N0M0 breast cancer has shown that analysis of risk associated with cell density allows to predict disease outcome. Correlation between the marker and the grade of histological malignancy is more rare than for Ki-67 determined in this patient group. As a result, determination of cell density is an additional method to increase objectivity and accuracy of breast cancer prognosis.Conclusions. Automated cell density analysis for breast cancer is almost fully operator-independent which increases accuracy and objectivity of the results. Cell density in breast cancer lower than 3000 cells/mm2 is a favorable prognostic factor