Oncology. New in cancer treatment. A combination of drugs may be the best treatment
Among the most requested medicines, a cure for cancer is considered the No. 1 panacea, over the creation of which bright heads of scientists around the world have been struggling for decades. At the moment, the problem lies also in the fact that now such a disease has become a leader in the list of the main causes of death of patients. Therefore, everyone and everyone is to some extent interested in the question of when exactly that magic pill will be created that saved a person from such an undesirable scourge.
It turns out that all this time, Russian scientists did not sit idly by and tried to produce a medicine that could overcome the most cruel ailment of the present time. And such a drug already exists! Its working name is PD-1. The action of the drug extends to the fight against such manifestations of the disease as melanoma, tumors in the kidneys, lungs, bladder, head and neck. It was about this news that not so long ago it became known from the director of the Department of Public Health of the Ministry of Health Oleg Salagay. 
Last news
A feature of the new generation of drugs is the duration or prolongation of their action, which continues even after the end of the course prescribed by the attending physician. According to the co-makers of the miracle drug, it launches the immune system to fight certain types of cancerous tumors. According to available statistics, more than 35% of patients using PD-1 were able to achieve a long-term response to treatment. Even chemotherapy cannot guarantee such an outcome. With all this, very good survival rates are achieved, demonstrated in research examples. Simply put, a very effective drug therapy has now appeared in Russia that can give a chance for recovery even to people with advanced forms of cancer.
At the moment, PD-1 is at the mandatory stage of clinical trials, which, to the delight of all cancer patients, are coming to their logical conclusion. According to forecasts of the Ministry of Health, in the fall of 2017, the drug will appear on free sale.
Another news is the emergence of another, very important drug. What is his "secret"? It is able to fight many autoimmune diseases, especially severe psoriasis. If we equate the Russian drug with its Swiss counterpart, the latter loses in terms of the final condition of the patient after treatment.
What is the essence of the new drug?
Unfortunately, now every 50th Russian suffers from such a terrible disease as cancer. According to statistics, about 500 thousand people face such a sentence every year. But if earlier it was almost impossible to get rid of such a hostile scourge, now the results of doctors give very optimistic forecasts. The number of patients who have overcome cancer through drug treatment is constantly increasing, which cannot but rejoice.
It is clear that chemotherapy is considered to be the main way by which the whole world fights against oncological problems. In fact, such treatment is recognized as the most intense of the existing ones, which is capable of so mercilessly destroying cancer cells throughout the body. True, along the way, the immune system is also destroyed. As a result, after a long course of chemotherapy, cancer patients die not from a terrible diagnosis, but because of a serious depletion of the body. 
It's time to talk about the composition of the new medicine. To be honest, it can only destroy what is needed. It is worth starting the story from the features of the cancer cell itself, which skillfully disguises itself in the human body, as a result of which its detrimental effect arises on tissues, organs or entire systems in which tumors form. The new Russian drug PD-1 removes this mask and destroys what simply should not be in a healthy person. human body. After that, the immune system begins to work, trying to point to the tumor itself. Simply put, if the enemy cannot hide, he has no chance of taking the most important thing from a person - his life.
It is very important not only the very moment of the emergence of such a drug in Russia, but also the observation of its development by the world community. For example, Japanese representatives are already ready to purchase domestic developments in order to engage in joint production of cancer drugs in the future. It turns out that so far in the world there is only one akin analogue of PD-1 in the United States. According to experts, its effect is less noticeable than the effect of the Russian drug. 
Another important feature of the drug is its high availability among ordinary citizens. That is why the release of this world panacea is eagerly awaited by thousands of patients throughout the country. I would like to hope that soon such a terrible diagnosis as cancer will no longer frighten people with its aggressiveness, because there will be an effective antidote against it.
ONCOLOGY IN NUMBERS
- According to WHO, up to 22 million new cases of cancer per year will be diagnosed in the coming decades, up from 14 million per year in 2012. During this time, cancer-related deaths will reach 70%. 7 out of 10 cancer-related deaths occur in regions with limited access to cancer screening and treatment - Africa, Asia, Central and South America.
- It is estimated that 1.7 million people were diagnosed with cancer in the United States in 2016. Due to the growth of the older population and changing demographics, cancer cases are expected to increase to 2.2 million per year by 2030.
- Today, 68% of adults and 81% of children diagnosed with cancer can survive the 5-year milestone after diagnosis. This is a big improvement compared to the 1970s, when only 50% of adults and 62% of children had a 5-year survival rate.
Investing in cancer research in the United States helps cancer patients live longer and better:
- Cancer deaths have decreased by 23% since 1991.
- Since 2006, the FDA has approved more than 90 new drugs
- The number of cancer survivors increased to 14.5 million in 2016 from 11.4 million in 2006.
Priority areas of ASCO
1. Genetic testing: integration of genetic counseling and testing into clinical practice for risk assessment, diagnosis and treatment planning, as well as the study of genetic changes in cancer cells under the influence of targeted therapy. Hereditary predisposition causes 5-10% of malignant tumors. Over the past year, some insurance companies have made it possible for oncologists to perform genetic testing on their patients. ASCO opposes any policy that interferes with the use of genetic testing or negatively impacts patient care.
2. Increasing the use of vaccination against HPV (human papillomavirus, HPV) to prevent cervical cancer. In April 2016, ASCO released a statement calling on members of the Society to help drive vaccination of all adolescents and young adults against cervical and other cancers, saving millions of lives. The Journal of Clinical Oncology, based on the research, has published a conclusion outlining the existing barriers to the use of HPV vaccination and has issued recommendations to help increase vaccination coverage.
3. Increasing access to clinical trials. ASCO is concerned that only 3% of adult cancer patients participate in clinical trials. This low participation rate not only limits access to new interventions that sometimes even cure cancer, but also limits information about the small subgroups of patients of interest to researchers. ASCO has submitted proposals to the Department of Health and Human Services and the National Institutes of Health to increase patient participation in clinical trials. In September 2016, ASCO issued a requirement for research investigators to register research to make it easier for patients and caregivers to access information about clinical trials and to determine if a patient is eligible to participate in this trial. In addition, investigators should provide more detailed information about results, including information on side effects, on the ClinicalTrials.gov website. While this is a big step forward, more efforts are needed to include low status, elderly, ethnic and racial minority patients, as they are underrepresented in treatment outcomes. ASCO also requires MedicAid to cover routine medical care costs for patients participating in clinical trials.
4. Reliable funding from the federal budget, which must be continued for progress in research. ASCO encourages legislators to invest in support of research conducted by the National Institutes of Health and the National Cancer Institute. While federal funding for biomedical research has been constant over the past decade, the inflation-adjusted budget for the National Institutes of Health was 20% lower in 2016 compared to the previous decade. This limits scientists from doing important research for millions of people.
5. Importance of data sharing in clinical science and practice. ASCO continues to promote the interoperability of electronic databases, which allows the identification, retrieval and use of data within and between electronic systems. Detailed exchange of clinical information is essential for effective care coordination. With the support of ASCO, the 21st Century Cures Act was passed, which includes provisions to improve database interoperability, including secure access, transfer, exchange, and use of all information about health with authorized access and a ban on blocking information.
Achievements in clinical oncology 2017:
ASCO annual report
Material prepared
prof. L.Yu. Vladimirova,
Rostov Research
cancer institute,
Rostov-on-Don
For 12 years, ASCO (American Society of Clinical Oncology, American Society of Clinical Oncology) has presented an annual report to highlight the most important events and trends in oncology, as well as predict future directions in research. In February 2017, Professor Daniel F. Hayes, President of ASCO 2016-2017, released the annual Presidential Address and Report on Progress in Clinical Oncology over the past year.
In his message, Dr. Hayes noted that a year ago, the government's Cancer Moonshot program began, “which contributes to progress in the fight against cancer. This initiative activated the community of scientists, determined the content of scientific cooperation, and spurred ambitions to surpass already known achievements.”
“When I started working 35 years ago,” writes Dr. D. Hayes, “I could not imagine everything that we have today. Today we detect cancer earlier, use more effective treatment manage side effects more effectively and enable patients to live better, better lives. Today, two out of three cancer patients will live at least 5 years after their diagnosis, which is higher than in the 1970s, when only one in two succeeded.” Further, the author notes that this was facilitated by advances in molecular oncology. But Dr. Hayes calls immunotherapy 2.0 the best achievement of ASCO in 2017.
According to the ASCO President, over the past year there has been a new “wave of success in immunotherapy”, which has shown its effectiveness in a wide range of oncological diseases previously considered intractable. Now scientists are looking for biological markers to find patients in whom immunotherapy will be most effective.
The success of scientists in fundamental, translational and clinical oncology would not be possible without volunteers participating in clinical research.
It further notes that approximately 30% of the studies presented in the report were at least partially funded by the federal budget allocated to the National Institutes of Health (NIH) or the National Cancer Institute (NCI). In the event of the loss of federal investment, which is "unique in duration and impact for decades," no further progress will be possible. Federal legislators can also contribute to this progress by helping to leverage big data and improve the quality of care for all patients.
The report then highlights the most significant clinical and scientific achievements 2016, which was marked by advances in the treatment of a wide range of tumors. From November 2015 to October 2016 FDA (Food and Drug Administration, food products and Medicines) approved 8 new therapies and 12 new indications for previously approved therapies (Table 1). Use Authorizations Relate to Cancer Immunotherapy Bladder and multiple myeloma, targeted therapy for difficult-to-treat lung and kidney cancers, chronic lymphocytic leukemia, and multiple myeloma. The new indications have expanded options for the treatment of patients with melanoma, sarcoma, CLL, lymphomas, neuroendocrine tumors, breast, lung, kidney, head and neck cancers. In addition, in 2016, the FDA approved the first liquid biopsy test.
The content of the report is determined by 20 experts in various fields of oncology who prepare an overview of the main events published and presented at conferences during the year (October 2015 to October 2016). The achievements highlighted in this report cover the entire spectrum of clinical research: prevention, treatment, patient care, and tumor biology.
Table 1. Anticancer therapy approved by the FDA from November 1, 2015 to October 31, 2016
| A drug | Indications | Approval date |
|---|---|---|
| New Therapy Options | ||
| Osimertinib (Tagrisso, AstraZeneca) |
Metastatic EGFR T790M-positive NSCLC (according to an FDA approved test), with progression during or after therapy with tyrosine kinase inhibitors - EGFR blockers | November 2015 |
| Daratumumab (Darzalex, Janssen Biotech) |
Multiple myeloma after three or more previous lines of therapy, including proteasome inhibitors and immunomodulatory drugs, or disease with double refractory to proteasome inhibitors and immunomodulatory drugs | November 2015 |
| Ixazomib (Ninlaro, Takeda Pharmaceuticals Company) |
In combination with lenalidomide and dexamethasone for the treatment of multiple myeloma after one or more previous lines of therapy | November 2015 |
| Necitumumab (Portrazza, Eli Lilly) |
In combination with gemcitabine and cisplatin for first-line treatment of metastatic squamous cell NSCLC | November 2015 |
| Alectinib (Alecensa, caps., Genentech) |
ALK-positive metastatic NSCLC progressing on or intolerant to crizotinib | December 2015 |
| Venetoclax (Venclexta, tablets, AbbVie Inc.) |
CLL with a 17p deletion detected by an FDA-approved test after one or more previous treatments | April 2016 |
| Cabozantinib (Cabometyx, Exelixis) |
April 2016 | |
| Atezolizumab (Tecentriq, Genentech) |
Locally advanced or metastatic urothelial cancer progressing during or after platinum-containing chemotherapy or within 12 months neoadjuvant or adjuvant therapy with platinum-containing drugs | May 2016 |
| New indications for previously approved therapy | ||
| Trametinib (Mekinist, Novartis) and Dabrafenib (Tafinlar, Novartis) |
In combination for the treatment of resectable or metastatic melanoma with a BRAF V600E or V600K mutation as determined by an FDA-approved test | November 2015 |
| Nivolumab |
Advanced RCC after prior anti-angiogenic therapy | November 2015 |
| Ofatumumab (Arzerra, injections, Novartis) |
Maintenance therapy in patients with a complete or partial response after two or more lines of therapy for relapsed and progressive CLL | January 2016 |
| Eribulin (Halaven, injections, Eisai) |
Unresectable or metastatic liposarcoma after previous anthracycline-containing regimen | January 2016 |
| Palbociclib (Ibrance, caps., Pfizer) |
In combination with fulvestrant for the treatment of hormone receptor-positive HER2-negative advanced or metastatic breast cancer progressing on endocrine therapy | February 2016 |
| Obinutuzumab (Gazyva, injections, Genentech) |
In combination with bendamustine after obinutuzumab monotherapy for the treatment of follicular lymphoma relapsed after or refractory to a retuximab-containing regimen | February 2016 |
| everolimus (Afinitor, Novartis) |
Highly differentiated progressive neuroendocrine tumor of the gastrointestinal tract or lung (unresectable, locally advanced, or metastatic) | February 2016 |
| Crizotinib (Xalkori, Pfizer) |
Metastatic NSCLC with ROS1-positive tumor | March 2016 |
| Lenvatinib (Lenvima, Eisai) |
In combination with everolimus for advanced RCC after one line of anti-angiogenic therapy | May 2016 |
| Nivolumab (Opdivo, Bristol-Myers Squibb) |
Classical Hodgkin's lymphoma with relapse or progression after autologous hematopoietic stem cell transplantation and use of brentuximab vedotin (Adcetris, Seattle Genetics) after transplantation | May 2016 |
| Test for EGFR mutation v2 (Cobas, Roche) |
Determination of mutations in the EGFR gene deletion in exon 19 or substitution in exon 21 (L858R) in order to identify patients with metastatic NSCLC suitable for treatment with erlotinib (Tartseva, Genentech) | June 2016 |
| pembrolizumb (Keytruda, Merck) |
Recurrent or metastatic head and neck squamous cell carcinoma with progression during or after platinum-containing chemotherapy | August 2016 |
| Atezolizumab (Tecentriq, Genentech) |
Metastatic NSCLC progressing during or after platinum-containing chemotherapy | October 2016 |
Immunotherapy
This year, ASCO named Immunotherapy 2.0 Achievement of the Year. This is recognition of the growing wave of progress in the use of immunotherapy in cancer treatment, which has extended and improved the lives of patients, many of whom had few other effective treatment options. For more than 100 years, scientists have tried to push the immune system to fight cancer. A large number of strategies have been tried, but only one of them - blocking immune checkpoints - has been effective in various options cancer. Immune checkpoints are special proteins that act like a brake on the immune system, allowing the immune system to work when and how much it needs to. They keep the immune system from becoming overactive, which can lead to excess inflammation or autoimmune disease.
Treatment with immune checkpoint inhibitors forces the immune system to fight the cancer. Since immune checkpoint inhibitors showed a surprising effect in advanced melanoma in 2011, research in this area has grown remarkably rapidly. Over the past year, the FDA approved 5 new indications for the use of immune checkpoint inhibitors: lung, head and neck, bladder, kidney, and Hodgkin's lymphoma. However, many patients with these tumors do not respond at all to such therapy, or it gives only a short-term effect.
The next step is to understand why less than half of patients respond to treatment and why improvement, if it occurs, may be short-lived. In 2016, several reports showed that certain patient and tumor characteristics (such as biomarkers) can predict the outcome of immunotherapy in a particular patient. For example, it appears that certain tumors with multiple genetic mutations may respond better to currently available immunotherapy options. The results of new studies published in 2016 help to identify patients who will benefit most from immunotherapy, while at the same time saving other patients from its high costs and side effects.
In addition, studies are underway on the combination of immunotherapy with other types of treatment - radiation and chemotherapy. All this characterizes a new phase in the development of immunotherapy - Immunotherapy 2.0: expansion of use and selection of patients.
Progress in the Use of Immune Checkpoint Inhibitors
Immunotherapy increases long-term survival in advanced melanoma. In 2016, long-term outcome data were reported for 655 patients enrolled in the pembrolizumab study. Median survival was 23 months. Tumor reduction was noted in a third of patients, with a response duration of more than 1 year - in 44% of patients. Similar data were demonstrated earlier in 2014 with nivolumab, with a 2-year survival rate of 43%. In comparison, ipilimumab showed a median survival of only 11.4 months. Ongoing research on the combination of different immune checkpoint inhibitors shows that this approach gives better results, but at the same time increases their toxicity.
In addition, a large clinical study on adjuvant immunotherapy has shown that it increases the life expectancy of stage III patients who can be surgically removed from the primary tumor. Most (≈60%) of these patients have a recurrence of melanoma within 4 years after removal. The 5-year survival rate was 65% in patients treated with adjuvant ipilimumab and 54% in the placebo group. 41% of patients vs. 30% in control survived without recurrence during a 5-year follow-up period, 48% vs. 39%, respectively, without metastases. However, the dose of ipilimumab was about 3 times the FDA-approved dose (10mg/kg versus 3mg/kg). The choice of this dose was due to the fact that in previous studies it was shown to be more effective, but higher toxicity was also noted. In this study, 54% of patients had severe side effects, 5 (1%) died due to severe treatment-related toxicity. The results of this study make it necessary to carefully weigh the risks and benefits in each patient when deciding on adjuvant treatment.
PD-L1 inhibitors help increase survival in advanced lung cancer. In 2016, data from a large study of pembrolizumab versus docetaxel in pretreated patients with PD-L1 positive non-small cell lung cancer (NSCLC) were presented. In the general patient population, the median survival on pembrolizumab was 10.4 months. against 8.5 months. on docetaxel. In the group of PD-L1-positive (≥50%) patients, the median survival was even higher - 14.9 months. against 8.2 months. respectively. Toxicity with pembrolizumab treatment was less than with docetaxel chemotherapy (16% and 35%, respectively). These data allowed the approval of pembrolizumab as a new standard of care for the treatment of NSCLC, and also prompted discussion of the possibility of testing for the PD-L1 biomarker as a predictor of response to immune checkpoint inhibitors.
In addition, a study of pembrolizumab in patients with PD-L1-positive metastatic NSCLC as first-line therapy showed greater efficacy compared to chemotherapy, in contrast to nivolumab, which was not shown to be effective in a similar study. This demonstrates the need to test primary patients for PD-L1 and, when this indicator is high, give preference to immunotherapy. In October 2016, the FDA approved pembrolizumab for first-line use in patients with advanced PD-L1-positive NSCLC.
Another immune checkpoint inhibitor, atezolizumab, was approved by the FDA in 2016 as an option in patients with metastatic NSCLC after previous treatment. The approval was based on the results of two studies that demonstrated that patients treated with pembrolizumab lived longer (13.8 and 12.6 months, respectively) compared with standard docetaxel therapy (9.6 and 9.7 months, respectively).
All these studies show a change in standards in the treatment of advanced NSCLC in both first and second line.
First in 30 years new version bladder cancer treatment. For several decades, there was no progress in the treatment of advanced bladder cancer, until atezolizumab immunotherapy was approved by the FDA in May 2016. This approval was based on a study in patients with metastatic urothelial cancer after platinum-containing first-line chemotherapy. The response to atezolizumab was 15% in general group and 27% in the group of patients with PD-L1-positive status.
In addition, in 2016, scientists presented encouraging first results from two clinical trials of pembrolizumab in patients with advanced bladder cancer. Pretreated patients lived longer on immunotherapy than after chemotherapy. Another clinical study showed that pembrolizumab may also be effective as first-line therapy in patients with advanced bladder cancer who cannot be treated with cisplatin. In the entire group of patients included in the study, tumor reduction was noted in 24%, in the group with a high PD-L1 status - in 37%, of which 13% had complete regression.
Immunotherapy prolongs life for patients with recurrent head and neck cancer. For patients with advanced head and neck squamous cell carcinoma within 6 months of chemotherapy, there are no treatment options that will prolong their lives. However, in clinical trial nivolumab in these patients, it was shown that 1-year survival after treatment with nivolumab was 2 times higher compared with chemotherapy (36% vs. 17%, respectively). The median survival was 7.5 months in the nivolumab group and 5.1 months in the chemotherapy group. The benefits of nivolumab immunotherapy in terms of toxicity and quality of life have also been shown. This allowed the FDA to approve nivolumab for the treatment of patients with recurrent and metastatic head and neck squamous cell carcinoma in November 2016.
A study is ongoing on the combination of nivolumab and ipilimumab. However, pembrolizumab has already been approved for the treatment of patients with recurrent and metastatic head and neck cancer.
Ability to slow the progression of ovarian cancer. Studies published in 2015 showed that nivolumab is effective in patients who relapse after platinum therapy. In a study of 20 women, three (15%) had tumor reduction, six (30%) had stabilization after treatment with nivolumab, two women had complete regression, and one of them had a chemotherapy-resistant variant of clear cell carcinoma. These findings have allowed further research to help include immunotherapy in the treatment of ovarian cancer. Several ongoing trials are investigating the combination of nivolumab with other immunotherapy in women with recurrent ovarian cancer.
Hodgkin's lymphoma is partially responsive to PD-L1 inhibitor treatment. In 2016 studies, it was shown that genetic changes leading to an excess of PD-L1 and PD-L2 molecules (polysomy, copy enlargement and amplification) are common in 97% of primary patients with Hodgkin's lymphoma (HL). These genetic changes make it possible to understand why classical HL has a higher sensitivity to PD-L1 inhibitors than other types of cancer. The FDA approved nivolumab for the treatment of HL because the study showed the possibility of entering remission in 53 (66%) patients, with complete remission in 7 patients out of 80. In another study, pembrolizumab was effective in patients with resistant and recurrent HL: out of 31 patients, 20 went into remission, 5 complete, duration of response was more than 24 weeks. This allowed the FDA to approve pembrolizumab in April 2016 for the treatment of recurrent HL. Studies are ongoing on the combination of nivolumab with brentuximab vedotin and ipilimumab, as well as pembrolizumab in the treatment of other hematological diseases and multiple myeloma.
Criteria for selecting patients for immunotherapy
The high cost and side effects of immunotherapy make it necessary to determine which patients will benefit most from it. The search for biomarkers has just begun. It has been shown that in the presence of a high level of PD-L1, a response to PD-L1 inhibitors should be expected. However, in a number of tumors, such as ovarian cancer and melanoma, the relationship between PD-L1 and response to PD-L1 inhibitors is not very clear. In separate studies, including some types of lung cancer, even at low levels of the PD-L1 marker, inhibitors were effective.
A big problem is the lack of standardization of assays for PD-1 and PD-L1 markers. It is not clear which assay and reagents are optimal and whether tumor cells should be examined or whether immune cells in the surrounding stroma should be taken into account in addition to the tumor. Moreover, even when using analysis and reaction according to the same method, there are differences in sections of the tumor.
In addition, scientists are also studying the reasons why tumors that respond to treatment begin to progress again. A pilot study of melanoma patients showed that mutations in certain genes associated with the immune system may be the cause of the development of resistance to PD-L blockers.
Immune checkpoint inhibitors have a pronounced efficacy in hypermutated tumors
It is believed that tumors big amount mutations are susceptible to immune checkpoint inhibitors. The most appropriate explanation is that tumors with a large number of mutations synthesize many abnormal proteins (antigens) that are recognized by the immune system as foreign. There are various tests to assess mutation load. Tumors with a high number of mutations, so-called hypermutated cancers, are mainly caused by smoking (cancer of the lung, head and neck, bladder) or ultraviolet exposure (eg melanoma or head and neck cancer). Therefore, it is not surprising that these tumors in clinical trials turned out to be sensitive to immunotherapeutic effects. Also, scientists have shown that immunotherapy can be effective in tumors in patients with genetic disorders (for example, mismatch repair (MMR) deficiency).
colorectal cancer. A clinical study showed that 4 out of 10 MMR-deficient colorectal cancer patients responded to pembrolizumab, while none of the 18 patients without MMR deficiency responded to this treatment. Patients with MMR deficiency had an average of 1782 mutations in the tumor compared with a tumor with normal MMR function - 73 mutations per tumor.
Brain tumors in children. Another MMR-deficient tumor that is difficult to treat is glioblastoma multiforme in children. In a pilot study including patients with recurrent glioblastoma with biallelic MMR deficiency, 2 siblings were shown to respond to nivolumab therapy with tumor shrinkage and improvement. general condition. After 9 and 5 months of therapy, the sister and brother returned to school and returned to their daily activities. This is the first report of a sustained response of glioblastoma to treatment. Most children with relapses notice deterioration in the first 1-2 months and die within 3 to 6 months.
Merkel's carcinoma. Approximately 4 out of 5 cases of Merkel cell carcinoma (CM) are associated with Merkel cell infection with polyomavirus (MCPyV). In a pilot study, 56% of patients with advanced CM responded to pembrolizumab treatment. Duration of response ranged from 2.2 to 9.7 months. In another study, avelumab was effective in 32% of patients with chemotherapy-resistant CM. Polyomavirus-associated CM (MCPyV) has about 100 times fewer mutations than MCPyV-negative CM. Despite a small number of mutations, MCPyV-positive tumors had a higher response rate to pembrolizumab (62%) compared to MCPyV-negative tumors (44%). The researchers suggest that the good response to immunotherapy in MCPyV-positive tumors may be due to the fact that viral proteins (antigens) are triggers for the immune response. This may help treat other tumors associated with viruses.
Advances in Cancer Treatment Associated with Other Therapies
The selection for treatment of patients using a personalized approach allows cancer therapy to become more accurate. In addition to the growing success of immunotherapy, 2016 marked a new wave of advances in precision medicine, with new molecular targets, new treatments, and new combinations of known approaches. In 2016, this strategy led to new targeted therapies being used for advanced lung, breast, kidney, and hard-to-treat blood cancers.
Targeted Therapy
After 20 years, new treatment for patients with acute myeloid leukemia (AML) is encouraging. Since the 1990s, no new effective treatment options have been approved for patients with AML. A large clinical trial including untreated patients showed that patients treated with the FLT3 mutation-targeted drug midostaurin in combination with standard chemotherapy lived longer than those who received chemotherapy alone (median survival was 75 months). versus 26 months, respectively). The median relapse-free survival was also 2 times higher (8.0 months vs. 3.6 months).
A new treatment targeting known markers has improved outcomes in acute lymphoblastic leukemia (ALL) relapse. Inotuzumab ozogamicin belongs to a new class of anticancer drugs known as antibody-cytostatic conjugates. The antibody is directed to the CD22 molecule, which is present in 90% of patients with B-cell ALL. In a study involving elderly patients, it was randomized to treatment with inotuzumab ozogamicin or standard intensive chemotherapy. In the main group, complete regression was noted more than 2 times more often (81% vs. 29%), and the median relapse-free and overall survival was also increased. Inotuzumab ozogamicin is likely to become the new standard in the treatment of elderly patients with relapsed or refractory ALL.
Progress in the treatment of advanced ALK-positive NSCLC. A new-generation ALK inhibitor alectinib has shown encouraging results in patients with crizotinib resistance, including those with brain metastases. 48% of patients responded to alectinib, with a median duration of response of 13.5 months. In patients with brain metastases, the effect was observed in 75% of cases. In late 2015, the FDA approved the drug for the treatment of patients with ALK-positive NSCLC who are intolerant to or progressing on crizotinib. In primary patients with ALK-positive NSCLC, alectinib reduced the tumor in 92% of patients compared with 79% on crizotinib. The risk of progression was 66% less compared to crizotinib. The drug is also well tolerated.
New regimen halts progression of multiple myeloma. In a clinical study in patients with relapsed and resistant multiple myeloma, a new combination of daratumumab with standard therapy with bortezomib and dexamethasone was presented. Daratumumab targets the CD38 molecule on plasma cells. This is one of the first drugs with a bidirectional effect - the ability to directly destroy tumor cells and stimulate the immune system to attack the tumor. In the study, the three-component regimen showed a 70% reduction in the risk of progression, as well as a significant increase in response to treatment - 59% versus 29% with the two-component regimen, as well as an increase in complete responses from 9% to 19%. Other studies are ongoing with daratumumab.
A new class of targeted drugs for advanced breast cancer (BC). In 2016, researchers presented updated results of the treatment of metastatic breast cancer using a new targeted drug, palbociclib, a cyclin-dependent kinase (CDK4/6) blocker. The study included women with hormone-positive HER2-negative breast cancer who progressed on hormone therapy. Patients were randomized into 2 groups: palbociclib plus fulvestrant or placebo plus fulvestrant. As a result, the median time without progression (PST) was increased from 4.6 to 9.5 months. Two-thirds of the women had a clinical response to the palbociclib regimen, and a quarter reported tumor reduction. However, side effects were observed in 73% of patients compared with 22% in controls. Palbociclib has also been studied in combination with letrozole hormone therapy in untreated patients with advanced breast cancer. Palbociclib increased the median PFS from 14.0 to 25.0 months.
Another clinical study of the combination of letrozole with another drug in this class, ribociclib, showed similar results with the ability to control the progression of the disease and similar toxicity. There are no results yet to assess the effect of these drugs on overall survival, and there are no biomarkers that predict response to cyclin-dependent kinases. However, these results have changed the standard of care for patients with hormone-positive metastatic breast cancer. The FDA approved the combination of palbociclib with fulvestrant in women progressing on hormone therapy in February 2016. Palbociclib was tentatively approved for use with letrozole as first-line hormone therapy in ER-positive, HER2-negative patients with advanced breast cancer.
More effective treatment in patients with advanced kidney cancer. In 2016, data from a large clinical trial in patients with recurrent renal cell carcinoma (RCC) treated with cabozantinib were published. Cabozantinib is an oral drug that blocks several targets in tumor cells, the tyrosine kinases MET, VEGFR2, and AXL. The median overall survival was 21.4 months. on cabozantinib and 16.5 months. on everolimus. Patients treated with cabozantinib had a 49% lower risk of tumor progression and a significantly better rate of tumor regression (17% versus 3%). On this basis, the FDA approved cabozantinib for the treatment of patients with advanced RCC after progression on VEGFR inhibitors.
In addition, two other large clinical trials were presented in patients with advanced non-metastatic RCC with a high risk of recurrence after surgical treatment. Despite the fact that up to 40% of patients with stage III RCC have recurrence and metastases after surgical treatment, observation is currently the standard for them.
The S-TRAC (Sunitinib Treatment of Renal Adjuvant Cancer) study involved treatment with sunitinib or placebo after surgical removal of the tumor in stage III RCC. Time to progression on sunitinib was 6.8 years on average and 5.6 years on placebo. However, continued follow-up is needed to demonstrate an increase in survival with sunitinib.
In contrast, another large ASSURE study (Adjuvant Sorafenib or Sunitinib for Unfavorable Renal Carcinoma; ECOG-ACRIN E2805) showed no statistical difference in relapse-free survival (RFS) in patients receiving placebo (median 6.6 years), sunitinib (median 5, 8 years) or sorafenib (median 6.1 years) after surgery. There were 5 treatment-related deaths. The authors concluded that none of these drugs should be used as an adjuvant in patients with high-risk RCC. The use of VEGFR inhibitors in an adjuvant should not be carried out until additional information, which will explain the differences in the results of the S-TRAC and ASSURE studies.
Promising results in ovarian cancer treatment. A first phase study in patients with platinum-resistant folate-receptor-alpha-positive ovarian cancer showed tumor shrinkage in 4 out of 10 patients treated with IMGN853 (mirvetuximab soravtansine). The most common side effects were diarrhea, ocular pathology, cough, fatigue, and decreased appetite. IMGN853 belongs to a new class of anticancer drugs - antibody-cytostatic conjugates. It includes an antibody that targets the alpha folate receptor (a marker found in most ovarian cancer patients) and the anticancer drug DM4, which blocks cell division and growth. Studies of this drug in patients with ovarian cancer are ongoing.
Expanding Targeted Therapy for Ovarian Cancer Patients. A study of the novel PARP inhibitor niraparib in platinum-sensitive patients with BRCA mutations was presented. The use of the drug was compared with placebo. In the niraparib group, the median time to progression was 21 months. against 5.5 months. on placebo, in the presence of BRCA mutations - 9.3 months. against 3.9 months. respectively. In the subgroup of patients with insufficient repair of homologous DNA recombination (Homologous Recombination Deficiency, HRD) - 12.9 months. against 3.8 months. respectively. Toxicity was predominantly hematological. This study significantly expands the possibilities of PARP inhibitors in the treatment of ovarian cancer.
Combination Therapy Options
Addition of chemotherapy to radiotherapy increases glioma survival. In 2016, the results of a study of patients with glioma were presented, in which patients were randomized into 2 groups: radiation therapy and radiation therapy with previous chemotherapy according to the PCV regimen (procarbazine, CCN4, vincristine). The median survival for combined treatment was higher, 13.3 years versus 7.8 years. With a follow-up period of 10 years, progression was noted in only 21% versus 51% in the radiotherapy group. It changed the standard of glioma care high risk: PCV chemotherapy was added to radiation therapy.
A more effective regimen in children with high-risk neuroblastoma. Repeat autologous stem cell transplantation in combination with standard therapy may improve outcomes in patients with neuroblastoma. At a three-year follow-up period, disease recurrence was not observed in 61% of patients compared with 48% of patients who underwent only one transplant. However, no significant differences were found in the results of 3-year overall survival. However, the study did not aim to improve this indicator. It is also required to track the late complications of this therapy.
Location of the tumor in the colon: an important factor in the treatment decision. According to an analysis of data from a large clinical trial, patients with advanced colon cancer had a longer life expectancy when it affected the left side of the colon compared to the right side. Patients received combinations of FOLFOX or FOLFIRI with one of the standard targeted drugs, cetuximab or bevacizumab. Previously, both regimens showed similar survival rates. This analysis demonstrated that the median survival of patients with left-sided tumor lesions is higher (33 months) compared with right-sided (19 months). An analysis of two other clinical studies also showed that patients with lesions on the left side of the colon live longer than those with lesions on the right side. Among patients with left-sided tumors, the combination of FOLFIRI and cetuximab was more effective than FOLFIRI and bevacizumab, while both combinations had little effect on the right side. The data obtained make it possible to take into account the location of the primary tumor for making decisions when prescribing treatment, as well as for the design of clinical trials in the future.
Chemotherapy
Pancreatic cancer: two-component regimen increases survival. After surgical removal of the tumor, the addition of a second drug capecitabine to gemcitabine increases the median survival from 25.5 months to 25.5 months. (on monotherapy with gemcitabine) up to 28 months. (per combination). The addition of capecitabine significantly increases the ability to live 5 years - from 16% to 29%. This combination was well tolerated. This has set a new standard of care in the adjuvant treatment of pancreatic cancer after surgery.
High-Risk AML: New Form of Known Drug Increases Survival. The new drug CPX-351, which is a liposomal-coated cytarabine and daunorubicin, allows them to enter leukemia cells. CPX-351 has been investigated in elderly patients with a newly diagnosed secondary AML that develops as a result of treatment for another tumor or exposure to radiation or a chemical agent. environment. In this study, patients receiving CPX-351 lived 4 months longer (median survival 10 months) than those receiving standard combination chemotherapy with the same drugs (median survival 6 months). At a two-year follow-up in the CPX-351 group, 31% of patients were alive versus 12%. There was no difference in side effects between groups.
Laparoscopic rectal cancer surgery: problems in use
The choice between open and laparoscopic surgery in patients with rectal cancer is one of the important issues. Experts expressed concern that laparoscopic surgery for rectal cancer does not completely remove tumor tissue. open method. As a result, after laparoscopic surgery, the number of relapses may increase, which reduces survival rates. In one study, the surgical success rate (i.e., complete removal of the tumor) was significantly lower among rectal cancer patients who had their tumor removed laparoscopically (82%) compared with those who underwent open surgery (87%). Similarly, in another large study, successful tumor removal by laparoscopy was 82% of patients, and by open surgery, 89%. These data indicate that the use of laparoscopic surgery is not recommended in patients with stage II and III rectal cancer. Conversely, for colon cancer, laparoscopy is the accepted approach.
Longer hormone therapy reduces the number of breast cancer recurrences
In 2016, it was shown that continuing aromatase inhibitor therapy for up to 10 years after the standard period of 5 years reduces the risk of breast cancer recurrence. The study included postmenopausal women with early breast cancer who received 5 years of aromatase inhibitors as first line or after tamoxifen. The women were randomized into 2 groups: continued aromatase inhibitors for another 5 years or placebo. In the letrozole group, the chance of recurrence or development of a second tumor in the other breast was 34% lower than in the placebo group. At a follow-up period of 5 years, 95% of patients on letrozole and 91% of patients on placebo remained disease-free. The incidence of second breast cancer was lower in the letrozole group (0.2% vs. 0.5%). However, 5-year survival was not significantly different (letrozole 94%, placebo 93%).
In addition, another analysis of more than 45,000 patients who were followed up for 15 years after hormonal therapy for 5 years allowed a more accurate calculation of the risk of breast cancer recurrence according to the stage of the primary tumor, the degree of differentiation and the state of the lymph nodes. These data will help to make a decision regarding the continuation of hormone therapy for more than 5 years.
The ASCO President's report also focuses on risk factor research, cancer prevention and screening. Two more genes have been found that are associated with an increased risk of ovarian cancer - RAD51C and RAD51D. Women with mutations in these genes have a 5 to 12 times higher risk of developing ovarian cancer than the general population. The data from this study led to a change in national recommendations for genetic testing. Recommendations have been amended to allow consideration of surgery (salpingo-oophrectomy) to reduce the risk of ovarian cancer in women with RAD51 mutations. And in women with ovarian cancer, the presence of these mutations may also affect the choice of treatment, in particular, treatment with PARP inhibitors should be considered. In addition, the issues of genetic testing of patients with a family history of aggravated in order to search for pancreatic cancer on early stages, as well as patients with Lynch syndrome. The possibility of screening children for hereditary genetic mutations is discussed separately. Also in this section are the results of a study that showed that daily intake of vitamin B helps reduce the risk of developing skin cancer.
One of the most interesting is the section on achievements in study of tumor biology. The results of studies of genetic evolution, from precancerous changes to the formation of invasive melanoma, the so-called mutational signatures that occur under the influence of UV radiation, are presented. These data will help improve not only the diagnosis, but also the prognosis of this disease.
Advantages are discussed separately. liquid biopsy, which helps to personalize anticancer treatment. Currently, new molecular technologies can quickly detect molecular changes in a tumor or free-circulating tumor DNA. All more patients with such changes may receive targeted therapy or may be included in clinical trials.
This is of particular importance in determining the EGFR T790M mutation in the treatment of lung cancer. The possibility of studying other genes, such as BRAF, KRAS, ALK, RET, and ROS1, has been suggested, which makes it possible to determine the choice of therapy in two-thirds of patients with an insufficient amount of tumor tissue for biopsy.
In addition, in 2016 researchers proposed using liquid biopsy for a very different approach. In stage II colon cancer, after surgical treatment, its use can predict recurrence. It was detected in approximately 80% of patients in whom circulating tumor DNA was determined in the blood. In contrast, among patients in whom circulating DNA was not found in the blood, only 10% of patients had a relapse.
Taking care of the patient as a whole
The report emphasizes that every cancer patient deserves the best possible care. It is necessary not only to prolong, but also to improve the quality of life of patients. Although the treatment of a physical illness remains a priority, more and more attention is paid to caring for the patient as a whole, taking into account the emotional and psychosomatic component.
Increasing access to health information can make the patient an active partner in caring for their health. Among the tools that help in this are the Internet, which can be used for self-management of symptoms, educational projects and navigation programs for underserved segments of the population.
The report also talks about new approaches to the prevention of nausea caused by chemotherapy. A new regimen for its prevention was proposed. In a large clinical trial, patients received olanzapine or placebo in combination with standard antiemetic therapy (aprepitant or fosaprepitant and one of the 5-hydroxytryptamine type 3 receptor antagonists - 5HT3) during chemotherapy and for several days after it. Patients received highly emetic chemotherapy with cisplatin or cyclophosphamide and doxorubicin. There were significantly more patients without nausea and vomiting in the study group with olanzapine: in the first 24 hours - 74% versus 45%; within the next 5 days after chemotherapy - 37% versus 22%. Of the side effects of olanzapine in the study, drowsiness was noted on the 2nd day after using the drug and disappearing in the following days. No serious side effects were noted.
Federal Funding Supports Groundbreaking Research
Cancer research in the US has been made possible by funding from the public and private sectors. The federal funding that has continued for decades since the end of World War II has become indispensable for risky, groundbreaking, prevention, screening, and treatment comparison studies. A third of the top achievements highlighted in the report were supported by funding from the National Institutes of Health and the National Cancer Institute (USA).
“There is a lot of work ahead. Many questions remain about how cancer develops and spreads and how to treat it most effectively. I hope that you, like me, will be inspired as you read the report by the achievements that the scientific community has made over the past year and that promise new era achievements that are still beyond the horizon,” says ASCO President.
* In 2016, the US government launched the Cancer Moonshot program to accelerate research into cancer detection, treatment, and prevention, with a planned investment of $1 billion. The name of the project appeared after the speech of J. Biden, in which he called for a breakthrough in the fight against cancer, similar to the national achievement - the flight to the moon. Cancer Moonshot's ambitious goal is to double the current rate of innovation in the medical industry, complete the 10-year journey of cancer research in 5 years, and "eradicate cancer as we know it." To achieve this goal, a group of 150 prominent scientists and doctors formulated directions significant achievements in which they must change the existing situation. Among them are active research into immunotherapeutic approaches, the study of resistance mechanisms, etc. Moreover, this government initiative does not involve large expenditures for the construction of new cancer treatment centers or the start of new scientific developments. Instead, it was proposed to simplify bureaucratic procedures and find ways to bring together regulators, industry, researchers, patient groups and charities. It is assumed that by joint efforts to collect large volumes of data and organize their exchange, results will be achieved that exceed the capabilities of individual participants in the process.
Perhaps scientists have come close to the moment when about half of the deadly cancers will be curable. About the flagships of the "anti-cancer revolution" - in our review.
Oncology today
Ahead of all types of cancer treatment are approaches such as immunotherapy (restoration of antitumor immunity with vaccines or antibody proteins) and targeted therapy (impact on a target cell that does not affect healthy tissues).
Experiments with light, nanomaterials and genetic engineering technologies are interesting.
In addition, the success of modern oncology is largely the success of diagnosis and prevention, and as treatment becomes more individualized, there is a direct link between breakthroughs in therapy and personalized medicine in general.
Spot preparations
In the 21st century, the first drugs for targeted effects on the immune system (ipilimumab, rituximab, pembrolizumab) gained world fame. All of them, not surprisingly, are imported. At the end of 2016, the leaders of the international pharmaceutical industry signed a memorandum on cooperation and development of immuno-oncology in Russia.
The very next day, MSD (the creator of pembrolizumab) registered the first drug in Russia from the class of PD-1/PD-L1 inhibitors. This is a specific antibody (so-called "monoclonal antibody") that inhibits the programmed cell death protein that hides metastases from the immune system.
Pembrolizumab is unique in that it eliminates advanced or recurrent tumors, inoperable melanoma, or lung cancer. It is expected to reach patients by mid-2017.
The end of 2016 brought another big event to domestic oncology. RAS scientists have synthesized a new compound of sulfur, hydrocarbons and nitrogen. It will help where chemotherapy is powerless (for example, ovarian carcinoma). The synthesis method itself makes it possible to quickly obtain anti-cancer drugs at low costs: the creators brought out several dozen drugs at once.
Another, international, success is the full development of viruses. By the beginning of the year, the United States approved the first anticancer agent based on the herpes virus. Since then, the drug has firmly established itself both in the market and at the top of the ranking of medical innovations according to Popular Science.
Finally, American scientists have made a "hormonal breakthrough": prostate cancer was cured for the first time by injection of testosterone. In the blood of volunteers, the level of “prostate specific antigen” (by the way, an effective tumor marker) has dropped significantly. One patient completely got rid of this antigen - thus, completely cured of cancer in just three months.
Despite the results, the method has not yet passed a number of clinical trials and remains “experimental”: however, for patients this means rather indirect problems (for example, with paperwork), but not a direct danger or illegality of treatment.
Robots and bacteria as advanced experimental methods
Promising areas are work with nanoparticles that deliver drugs inside a cancer cell.
Another option is the point-to-point injection of nanorobots, which are equally suitable for monitoring the state and for delivering drugs, and even for direct attack on the tumor and its metastases.
Last summer at Moscow State University the therapeutic value of silicon nanoparticles. The reason was their ability to decompose quickly, without accumulating excess cargo inside the body: this makes them remarkable in terms of medical transportation.
Another well-known university, Stanford, studied iron nanoparticles: the substance ferumoxytol they form also charges the immune system to fight metastases.
Meanwhile, scientists in Canada have turned flagellar bacteria into high-fidelity nanocyborgs.
Therapy with anaerobic bacteria is developing no less actively: they easily destroy the central part of the tumor and are perfectly complemented by chemotherapy.
It is also worth mentioning the prospects for emitters in domestic science. Thus, the Research Institute of Oncology began to use stereotactic radiation therapy. The focus is on an electron accelerator that brings the radiation to submillimeter accuracy. This treatment is especially recommended for patients with cancer of the lung or various glands. At the same time, for citizens of the Russian Federation, it is available free of charge - according to the quotas of the Ministry of Health.
Diagnosis and Prevention: Cancer vs. Cancer
Today, science has turned against the cancer diagnosis of real crustaceans (namely mantis shrimp): more precisely, their unique eyes. At the University of Illinois, a highly sensitive polarizing camera, similar to the visual apparatus of these arthropods. Since cancer cells specifically reflect polarized light, such a camera can easily capture them at a very early stage. Testing on mice has already been completed, human studies are just around the corner.
Other aliens from the marine world are also interesting: jellyfish, the night glow of which brought researchers the Nobel Prize. Based on the protein of jellyfish, scientists have developed green fluorescent biomarkers, and now they have also created a state-of-the-art polariton laser. Markers are effective wherever X-rays are blind, and the method itself is associated not only with a revolution in oncology, but also with the future of quantum physics.
In addition, a special status for modern diagnostics in lung cancer. Now The best way to detect it preventively - tomography of groups of active smokers with a long history. And here, a recent study showed that the risk of death from lung cancer is almost halved by taking ibuprofen. This is a statistical argument in favor of appropriate prevention.
In third place is cancer of the trachea, bronchi and lungs: in 2017, 62.2 thousand cases were diagnosed.
Is it possible to avoid
Skin cancer is a global problem, the director of the National Medical Research Center of Oncology named after V.I. N.N. Petrov Alexey Belyaev. But this disease is quite easily treated and does not cause metastases, the main thing is to detect it at an early stage, the expert noted. Melanoma is more difficult to treat and causes metastases. To prevent these diseases, Belyaev recommends avoiding long exposure to the sun and refraining from using a solarium.
“Unfortunately, in the 1970s, tanning was popularized, a lot was said about the benefits of tanning, children were quartzed. All this continues to affect the incidence of this type of cancer, ”the expert noted.
The main reasons for the appearance of breast cancer and cancer of the respiratory organs are the same - a hereditary predisposition and a violation of the information characteristics of DNA, Andrey Korzhikov, Honored Doctor of Russia, head of the oncology department of the Scandinavian Health Center, noted in a conversation with RBC. Among the factors influencing the occurrence of the disease, he also names climatic conditions and the level of radiation load. “When these factors are summed up in one organism, they are aimed at the same target - the violation of the structure of DNA, the violation of its informational characteristics. A prerequisite for transient forms of cancer is stressful situations, then all these mechanisms become aggravated against the background of stress, ”the expert added.
Among the reasons for the prevalence of breast cancer, Korzhikov names hormonal changes, abortions and the use of hormonal drugs. Breast cancer, if detected early, is also curable, says Belyaev. “Now there are about 30 types of breast cancer. And they all react differently to therapy, develop differently. In general, over the past 25 years, this cancer has become much better treated, ”he said.
Belyaev believes that the increase in the number of diagnosed oncological diseases cannot mean that the Russians began to get sick more. “I, as an oncologist, can say: no, people don’t get cancer anymore, but it’s better to find it. In addition, those elderly people who, thanks to the development of medicine, were able to avoid a heart attack or stroke, began to live up to their oncology, ”he said.
death statistics
Oncology is less and less often indicated as the cause of death of people who had a malignant tumor, follows from the data of the collection of the Ministry of Health. In 2017, in 30% of cases when a person with cancer died, cancer was not indicated as the cause of death, in 2013 this figure was 23.6%, in 1993 - 11.6%. In other words, 25 years ago, 88% of those who died with a malignant neoplasm died from it, and in 2017, cancer turned out to be the cause of death for 70% of the dead.
“Earlier, if there was a diagnosis of cancer, no matter what a person was sick with, he was given the cause of death as oncology. Now they are tracking malignant tumors, trying to figure out the cause of death and exclude unfounded conclusions about cancer as the cause of death, ”explained the director of the National Medical Research Center for Oncology. N.N. Petrov Alexey Belyaev.
Detection and mortality
The number of Russians who died from malignant neoplasms in 2017 amounted to 274.2 thousand people - almost the same as in 2015, when Russia set a record for cancer deaths over an 11-year period. 22.5% of patients who were first diagnosed with a malignant neoplasm died in the first year after diagnosis. The proportion of such patients is decreasing: ten years ago they were almost 30%, 20 years ago - more than 36%. Malignant neoplasms at the first and second stages began to be detected 1.5% more often than in 2016.
Compared to 2016, testicular cancer has become more common in Russia — 13.2% more cases in 2017, and penis cancer — 7.4% more.
Detectability in the regions
The largest increase in the number of new patients with oncological diseases was recorded in the Khabarovsk Territory - 6.2 thousand newly diagnosed malignant neoplasms. This is 14% more than a year earlier.
There are also many new patients in the Amur Region, where the increase in the number of detected cases was 11%. Less often than in 2016, malignant neoplasms began to be detected in Leningrad region(by 9.7%) and in Adygea (by 9.6%).
Most high level oncological diseases in 2017 was in the Kursk region. There are 32.4 thousand people per million, that is, more than 3% of the population, under dispensary observation in oncology centers there. The same situation was in 2016. More than 3% of the population is registered in oncology dispensaries in Krasnodar Territory and Mordovia. In Ingushetia, the number of people under dispensary observation in cancer centers increased by almost 11% compared to 2016.
In Sevastopol, the most significant decrease in the proportion of the population under observation in oncology dispensaries in Russia was recorded - from 3.2% in 2016 to 2.8% in 2017.
The death rate from cancer has fallen 23% since its peak in 1991. Currently, America's biopharmaceutical companies are working on more than 800 cancer drugs.
Reader's Digest magazine partners with Stand Up to Cancer, an organization that funds innovative research projects that will help to introduce new treatments faster.
Perform genetic screening
“One of my ovarian cancer patients told me that her mother and grandmother died of the same disease,” recalls Elizabeth Swisher, MD, an oncologist at the University of Washington. By the time she came to me, it was already too late. I tested it to determine the mutation that caused the cancer. After that, I suggested that her daughter undergo a genetic test and remove her ovaries as a preventive measure. She will probably be the first person in four generations of women in her family not to die of cancer."
Individual Cancer Treatment Programs Work
By deciphering thousands of genes, scientists can find out which mutations they carry, and then, based on the type of mutations, find the right drugs. Today, targeted therapies are used for many types of disease, including lung, breast, colon, and melanoma.
Study of the type of cancer cells
“We had an 11-year-old patient with a rare form of leukemia who went through chemotherapy four times, but her cancer kept coming back,” says Arul Chinnayan, MD, a pathologist from the University of Michigan “Finally, we examined her tumor cells and found a genetic mutation that was sensitive to a particular compound. We gave her this drug and the disease was in remission for 18 months.”
Blood test to replace needle biopsy
Scientists have developed a blood test that can identify biomarkers of stage 1 cancers in the bloodstream. Cancer centers are already exploring the use of tests, but scientists hope that one day a routine blood test will help detect cancer.
May help the immune system fight cancer
Cancer cells use a type of "brake" to turn off your immune system's response. Immunomodulators release this brake, allowing the immune system's T cells to attack cancer cells.
The test results were stunning. Three immunotherapies were offered to 5,000 patients with stage IV melanoma. Three years later, 20% of them were still alive. “Many patients have gone more than a decade without signs of illness,” says Tak Wak Mak, Ph.D., an immunologist and molecular biologist at the Princess Margaret Cancer Center in Toronto, Ontario.
A combination of drugs may be the best treatment
“If we take only one drug, the cancer can mutate or become resistant,” says Dr. Chinnayan. “But we find that using a drug cocktail can be more effective.”
Viruses are our most secret weapon
“When a virus invades a tumor, it makes the cancer cells think they are infected, so they start to self-destruct or produce new antigens that can also fight them,” says Peter Jones, Ph.D., chief scientist at the Van Andel Research Institute at Grand -Rapids, Michigan. The FDA recently approved a genetically modified form of the herpes virus for the treatment of melanoma. And at Duke University in Durham, North Carolina, scientists are treating brain cancer by injecting tumors with a genetically engineered polio virus.
Pap smear, which can detect ovarian cancer
“A test has been developed that can detect genetic markers for ovarian and endometrial cancer in cervical fluid collected during a routine cancer test,” says Dr. Nelson. The research is in its early stages, but it's important because the disease kills 14,000 women a year because it's diagnosed too late.
Creating a chip that can detect runaway tumor cells
Malignant cancerous tumors send free cells into the bloodstream. They provoke the appearance of new tumors in other parts of the body. But due to the fact that there is one such cell for every one billion blood cells, scientists have not yet been able to detect them. Finding them is important because the reason people die of cancer is because the cells spread to other places.
Visit an oncologist as well as a surgeon
During the last decade, the surgical treatment of oncology has come to the fore, while such mild methods of treatment as lumpectomy have receded into the background.
An oncologist can talk to you about the advantages and disadvantages of surgery and may suggest alternative treatments.
Keep track of your nutrition
Many researchers believe that eating too much sugar and fast-release carbohydrates is particularly dangerous. Sugar raises insulin levels, and insulin activates P13K, an enzyme that causes many cancers.
For many of us, it's personal.
“I decided to become an oncologist when I was 16 after I lost both of my parents to cancer,” says Patricia LoRusso, director of innovative medicine at Yale Cancer Center in Connecticut. “I wanted to understand thoroughly what ruined my childhood.”
Clinical trials are the best way to access the latest treatments
If you're not in the placebo group, you get the standard treatment plus whatever is currently being tested. And when doctors find that a therapy is particularly effective, they often move on to a study that allows each patient to receive the study drug.
Naturopathic remedies do not cure
Evidence suggests that naturopathic remedies do not cure cancer. Doctors warn against buying such drugs, as they can only aggravate an already too difficult situation.
Look for a cancer center
“It's important to have access to the latest technologies, treatments, trials and drugs, and cancer centers are where you can find these things,” says Dr. Cantley. — Look for an institution that has great experience work with a specific type of cancer or, even better, one that is doing research on the subject.
Cancer is no longer a death sentence
“My father had lymphoma when he was 76,” says Daniel von Hoff, MD, chief medical officer and director of translational research at the Translational Genomics Research Institute in Phoenix, Arizona. The father said: "I know that most people with this diagnosis die." Daniel von Hoff replied that he was not, but his father did not want to listen to him. The oncologist exclaimed, “Dad, I am a cancer researcher. If you die, I will look bad." The father underwent a course of treatment, and this stopped the disease. He is now 94 years old and doing well.
Little money is spent on the fight against cancer
“Federal investment in cancer research (adjusted for inflation) has stagnated for decades. At the same time, the cost of doing research has increased,” says Dr. Haber. So much good projects not funded.
Cancer has many varieties
“In fact, there are over 100 unique diseases, each with dozens of genetic subsets,” says Dr. Chinnayan. “Even cancers that occur in the same part of the body can have different genetic backgrounds.”
Knowing your family's cancer history is important, especially if you have more than one relative with cancer.
“Genetic tests can show you every known hereditary cancer gene,” says Dr. Swisher. “Finding out if you have a mutation is not a death sentence, but a call to action.”
Too little focus on prevention
The vast majority of available research funds are spent on developing treatments, with only a fraction focused on prevention. However, at least 21% of cancer deaths in the US can be attributed to preventable causes such as smoking and obesity. This is evidenced by a study by the CDC. Other studies show that this figure is closer to 50%.
Fighting cancer is everyone's business
The Stand Up To Cancer Program is asking the public for donations for cutting edge cancer research. Stand Up To Cancer has partnered with a scientific partner, the prestigious American Association for Cancer Research, to present the latest scientific information.
Created by Bradley Kuuded, the program includes the famous telephone and multimedia banks. One hundred percent of the donations received from the general public go to support cancer centers.
