Supportive Therapy in Oncology

Background. Cytoreductive partial nephrectomy (CPN) for metastatic renal cell cancer (mRCC) is currently used infrequently and prognostic factors affecting survival rates for this cytoreductive surgery are currently undefined.

Aim. To determine the prognostic factors influencing the survival rates in mRCC patients when performing CPN in real clinical practice.

Materials and methods. The retrospective study included 32 patients who underwent CPN at the Municipal Oncologic Hospital No. 62 in Moscow and the Municipal Oncologic Dispensary in St. Petersburg from 2014 to 2022. Clinical data from medical records were obtained and analyzed retrospectively, all patients underwent clinical, laboratory, and pathomorphological examination. Patients' survival rates were evaluated using the statistical method of Survival Analysis with calculation of descriptive characteristics of life time in the form of a life table and construction of Kaplan–Meier curves.

Results. In the present study, clear-cell variant of CPN occurred in 84.4 %, low-differentiated tumors – 21.9 %; synchronous metastases – 21.9 % and multiple metastases 59.4 %. A favorable prognosis according to IMDC was noted in 34.4 % of patients. Lung metastases were detected most often (53,1 %), the predominant number of patients (96.9 %) were treated with systemic therapy with targeted drugs. The length of hospital stay was 3.8 ± 6.2 % days, 30-day mortality – 3.1 %. The 3- and 5-year overall survival rates were 74 % and 62 %, respectively.

Conclusion. The tactics for cytoreductive partial nephrectomy in mRCC are currently undefined. Multivariate analysis revealed an independent negative effect of gender (p = 0.041), bone (p = 0.003) and lung (p = 0.022) metastases, and ECOG status (p = 0.03) on overall survival rates.

The study aims to assess the impact of restrictions on the purchases of pharmaceuticals that are outside the list of vital and essential drugs (VED) on the availability and quality of medical care for cancer patients in the system of compulsory medical insurance (CMI).

Materials and methods. A sociological study was conducted in 2024–2025 using a telephone and online survey of 502 patients with cancer from various regions of the Russian Federation. In addition, it analyzed appeals to the hotline of the Interregional public movement (IPM) “Movement against cancer” and the purchase of drugs that are not included in the VED list for 2024 and 2025.

Results. 34.5 % of patients had problems with receiving anticancer therapy, 24.1% - with receiving drugs in the hospital. 70 % of respondents had a need to purchase drugs at their own expense. Among patients who were prescribed therapy with drugs outside the VED list (n = 73), 80 % experienced problems receiving it. During 9 months of 2025, the number of requests for drugs outside the VED list increased by 5 % as compared with the same period in 2024. It was established that individual purchases are associated with long approval periods (from several weeks to months), which is critical for cancer patients. The use of innovative analgesics outside the VED list (for example, tyrosyl-D-arginyl-phenylalanyl-glycine amide) can increase the effectiveness of treatment and reduce the costs of CMI.

Conclusion. The current mechanism for purchasing drugs outside the VED list does not provide timely access for patients to the necessary therapy. It is recommended to develop a system of predicted provision of such drugs to improve the quality and accessibility of cancer care.

Neuroendocrine neoplasms have heterogeneous morphological features and varying clinical manifestations, which in turn influences their therapeutic approach. Histologically, based on cell morphology, they can be divided into neuroendocrine tumors and neuroendocrine carcinomas. Clinically, they are subdivided into functioning (in the presence of a specific tumor syndrome) and nonfunctioning (in cases where only general, nonspecific symptoms are observed). One of the most common clinical manifestations of functioning neuroendocrine tumors is carcinoid syndrome, caused by the tumor’s secretion of multiple hormonal amines and peptides, primarily serotonin. In most cases, these tumors are relatively indolent. However, as the disease slowly progresses, patients may experience delayed complications such as carcinoid heart disease, mesenteric fibrosis, malnutrition, and vitamin deficiencies. Carcinoid syndrome can also rapidly worsen to a life-threatening complication known as a carcinoid crisis. Given the multifaceted and insidious nature of carcinoid syndrome, effective treatment relies on the indispensable role of a multidisciplinary team consisting of gastroenterologists, endocrinologists, radiologists, oncologists, nuclear medicine physicians, surgeons, cardiologists, and nutritionists.

The review is devoted to the problem of opioid-induced hyperalgesia – a paradoxical effect in which therapy with narcotic analgesics can increase existing pain. The review considers the epidemiology, risk factors, mechanisms of development, differential diagnostics, recommendations for assessment and measures aimed at stopping the phenomenon of opioid-induced hyperalgesia.

Immunotherapy is one of the most effective methods of cancer therapy. There are five main groups of immunotherapy, including treatment with chimeric antigen receptor T cells, checkpoint inhibitors, anticancer vaccines, antibody-based targeted therapies, and oncolytic viruses. On the adult cohort of patients, immunotherapy has been proven to increase the survival rate of patients with cancer. At the same time, in some patients, it can cause an immune-mediated damage and contribute to unfavorable heart immune modulation and heart failure. Immunotherapy can target many components of the cardiovascular system, including the myocardium, blood vessels, electrical wiring, and the pericardium. Activated T lymphocytes (CD4 + and CD8 + T cells) penetrate the heart tissue and skeletal targets, which leads to local inflammation and damage. Additional theoretical mechanisms for side effects include autoantibody recognition of self-antigens and T cell-mediated damage to cardiomyocytes and stressed endothelial cells. After treatment with T cells, the level of proinflammatory cytokines may increase, which is often the cause of cytokine release syndrome, the occurrence of which is considered a “targeted, non-neoplastic” effect. Proinflammatory cytokines can have negative cytotoxic effects on cardiomyocytes, resulting in reduced myocardial contractility, cardiomyopathy, and hypotension. This review presents a clinical case of cardiotoxicity due to the use of antiGD2 monoclonal antibodies in a child with a refractory form of osteosarcoma.