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BACKGROUND: Neoadjuvant systemic therapy for triple-negative and HER2-positive breast cancer can achieve a complete pathologic response in approximately 60% of patients. Pathological complete response to neoadjuvant systemic therapy is a predictive factor consistent with a positive prognosis which can be accurately determined by percutaneous vacuum aspiration biopsy. AIM: To evaluate the amount of surgery in the group of patients with triple-negative and HER2-positive early breast cancer whose complete pathologic response was confirmed by vacuum aspiration biopsy and who did not undergo standard surgery. MATERIALS AND METHODS: The following single-centre study has been conducted in the Russian Federation. Women aged 18 years old and older with unicentric (cT1-2N0-1M0 by classification TNM) triple-negative or HER2-positive breast cancer with complete clinical response after neoadjuvant systemic therapy according to imaging diagnostic methods. The patients underwent vacuum aspiration biopsy on the mammary gland under ultrusound control with standard amount of surgical intervention on the axillary region. In case when no invasive or in situ disease was detected, no further breast surgery was performed and the patients underwent standard radiation therapy. The survival with no tumor relapse in the ipsilateral mammary gland was assessed as the primary endpoint. The study is registered on сlinicaltrials.gov, NCT04293796. RESULTS: Between June 2020 and May 2022, twenty-seven (84.4%) patients (all women; mean age 47.5 (3268) years) were enrolled in the study and underwent visually controlled vacuum aspiration biopsy. The average initial tumor size was 20.5 (735) mm. 7 (25.9%) patients initially had metastases in the axillary lymph nodes confirmed by puncture biopsy; 15 (55.6%) patients had HER2-positive breast cancer, and 12 (44.4%) had triple-negative breast cancer. A study of vacuum aspiration biopsy samples showed that 6 (22.2%) patients had a residual tumor, and 21 (77.8%) patients achieved complete pathologic response (95% confidence interval 53.2 to 81.4). At a median follow-up of 12.4 months, there were no tumor relapses in the ipsilateral mammary gland in 21 patients with complete pathologic response confirmed by vacuum aspiration biopsy after neoadjuvant systemic therapy, as well as other relapses or progression of the disease. CONCLUSIONS: The patients with a complete pathologic response, which is confirmed by the vacuum aspiration biopsy method, who refused to perform surgery on the mammary gland do not demonstrate worse results with a short period of observation. However, additional prospective clinical studies are needed.

The narrative review addresses the evidence that physical activity can improve the results of prevention and treatment and of the conditions that feature increased risks of their development with aging. The main attention is paid to cancer and problems arising because of physical activity limitations associated with COVID-19 pandemic. To promote physical activity, which is known to reduce the risks of COVID-19 complications and of cancer, it is important to help patients and physicians in understanding the reasons why physical activity can be beneficial, more than the pharmacological means thought to reproduce some of its effects, in cancer prevention and treatment upon all differences between the locations of tumors and the pathways of carcinogenesis. Therefore, the physiological and molecular mechanisms behind the usefulness of physical activity in oncology are discussed. Based on this discussion, data on quantitative relationships between oncological risks, physical activity, and the use of its alleged pharmacological mimetics are addressed. © 2021 Izdatel'stvo Meditsina. All rights reserved.

The article presents the results of a study of the biopsychosocial principle in the rehabilitation of patients with breast cancer. Aim. to assess the need for patients with operable breast cancer in rehabilitation measures at various stages of treatment. Results. when assessing the need for rehabilitation of patients with operable breast cancer, it was found that the need for rehabilitation measures in all patients increases in the postoperative period and persists for 12 months after the end of treatment. Special attention should be paid to the indicators of physical and social functioning in subgroups of patients who received neoadjuvant chemotherapy: increased fatigue, weight gain, unstable emotional background impose significant restrictions on the socio-role functioning of patients, reducing the quality of life and increasing the risks associated with the progression of the underlying disease, exacerbation of chronic diseases. Thus, patients who participated in the program of rehabilitation measures in the framework of the biopsychosocial approach showed the best performance after the end of treatment during the observation period: in the subgroup of patients receiving chemotherapy and rehabilitation in the framework of the biopsychosocial model, the dynamics of the recovery needs of the operation sought to average indicators by domain “b4552 Fatigue” – 21%, “b4551 Aerobic capacity “ – 18%, “d240 Handling stress and other psychological demands » – 39%, “b710 Mobility of joint functions “ – 29%, self-service (“d510 Washing”; “ d540 Dressing») – 21%, “b455 Exercise tolerance functions “ – 22%. In the subgroup of patients who received on-demand rehabilitation, there was an increase in the need for rehabilitation by domain: “d240 Handling stress and other psychological demands “ – 45%, “b4552 Fatigue” – 28%, self-service (“d510 Washing”; “ d540 Dressing») – 32%, b455 Exercise tolerance functions – 30%. Conclusion: The results of the study suggest a positive effect of rehabilitation measures on the functioning of patients with operable breast cancer.

Relevance: early breast cancer is detected in more than 60% of cases. Maintaining the quality of life of patients with early breast cancer at the highest possible level is a priority, along with the treatment of patients. Under a complex antitumor treatment as well as after its completion, more than 60% of patients with early breast cancer report the occurrence of functional disorders.An important aspect is to improve the effectiveness of the rehabilitation process of patients with early breast cancer taking into account scientifically-based and proven recommendations.Objective: to evaluate the event-free survival rate (EFS) of patients with EBC undergoing rehabilitation within a biopsychosocial approach.Materials and methods: 228 patients with breast cancer who received complex treatment from 2015 to 2019 were included in the study. The prospective part of the study included 114 patients with early breast cancer undergoing rehabilitation measures within the biopsychosocial approach. The control group which was selected retrospectively, using the method of "pairwise selection", included 114 patients with early breast cancer comparable in age, stage of the disease, volume of surgical treatment and menopausal status, undergoing physical and psychological rehabilitation prescribed by a doctor. Patients in both groups were stratified depending on preoperative chemotherapy. EFS was calculated over a 2-year follow-up period. Events that were censored were a disease progression, the appearance of metastases, the occurrence of another cancer, a new concomitant disease, an exacerbation of the concomitant pathology and death.Results: Rehabilitation measures within the biopsychosocial model improve the indicators of EFS in the group of patients with EBC: EFS was 18.3 months against 14.5 months in the control group (HR=0.91, 95% CI [0.83; 0.99]; p=0.0034). In a multi-factor analysis the key factors affecting EFS were neoadjuvant chemotherapy (HR=0.79, 95% CI [0.69; 0.94]; p=0.0025), age (HR=0.87, 95% CI [0.71;1.09]; p=0.0027) and menopausal status (HR=0.85, 95% CI [0.84; 0.95]; p=0.0022) (table 1). Conclusions: Rehabilitation measures within the biopsychosocial model improve the indicators of EFS in the group of patients with early breast cancer, the key factors affecting EFS were neoadjuvant chemotherapy, age and menopausal status. Table 1 Multi-factor analysis of event-free survival of patients with early breast cancer in the group of biopsychosocial model of rehabilitation versus control group.CharacteristicNumber of patientsHR (95% CI)Preoperative chemotherapyyes1520,84 (0,77; 1,1)no760,79 (0,69; 0,94)Menopauseyes1300,84 (0,77; 1,04)no980,85 (0,84; 0,95)Age group25-44610,87 (0,71; 1,09)45-601030,89 (0,74; 1,1)61-75641,01 (0,82; 1,24)EventDisease progression281,11 (0,86; 1,26)Exacerbation of the concomitant pathology160,83 (0,74; 0,96) Citation Format: Valeria Kluge, Tatiana Semiglazova, Petr Krivorotko, Elena Melnikova, Vladislav Semiglazov, Kristina Kondrateva, Svetlana Nazarova, Margarita Tynkasova, Bahtiyar Adhamov, Roman Pesotsky, Konstantin Zernov, Valentina Chulkova, Boris Kasparov, Denis Kovlen, Vladimir Semiglazov, Alexey Belyaev. Biopsychosocial approach in the rehabilitation of patients with early breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-62.

This study aimed to analyze clinical and regional factors influencing the distribution of actionable genetic alterations in a large consecutive series of colorectal carcinomas (CRCs). KRAS, NRAS and BRAF mutations, HER2 amplification and overexpression, and microsatellite instability (MSI) were tested in 8355 CRC samples. KRAS mutations were detected in 4137/8355 (49.5%) CRCs, with 3913 belonging to 10 common substitutions affecting codons 12/13/61/146, 174 being represented by 21 rare hot-spot variants, and 35 located outside the “hot” codons. KRAS Q61K substitution, which leads to the aberrant splicing of the gene, was accompanied by the second function-rescuing mutation in all 19 tumors analyzed. NRAS mutations were detected in 389/8355 (4.7%) CRCs (379 hot-spot and 10 non-hot-spot substitutions). BRAF mutations were identified in 556/8355 (6.7%) CRCs (codon 600: 510; codons 594–596: 38; codons 597–602: 8). The frequency of HER2 activation and MSI was 99/8008 (1.2%) and 432/8355 (5.2%), respectively. Some of the above events demonstrated differences in distribution according to patients’ age and gender. In contrast to other genetic alterations, BRAF mutation frequencies were subject to geographic variation, with a relatively low incidence in areas with an apparently warmer climate (83/1726 (4.8%) in Southern Russia and North Caucasus vs. 473/6629 (7.1%) in other regions of Russia, p = 0.0007). The simultaneous presence of two drug targets, BRAF mutation and MSI, was observed in 117/8355 cases (1.4%). Combined alterations of two driver genes were detected in 28/8355 (0.3%) tumors (KRAS/NRAS: 8; KRAS/BRAF: 4; KRAS/HER2: 12; NRAS/HER2: 4). This study demonstrates that a substantial portion of RAS alterations is represented by atypical mutations, KRAS Q61K substitution is always accompanied by the second gene-rescuing mutation, BRAF mutation frequency is a subject to geographical variations, and a small fraction of CRCs has simultaneous alterations in more than one driver gene.

Relevance: The strategy of finding evidence on the use of rehabilitation technologies in patients with lung cancer is based on scientometric analysis. Methods: For the period from 1991 to 2018. Using PICO (T) technology in electronic databases (PEDro, PubMed, Elibrary, Cochrane Library), full-text analysis of 249682 studies was performed. MeSH bibliographic descriptors: «lung cancer», «rehabilitation», «physical therapy». Studies were evaluated on a PEDro scale, which includes 10 parameters of the level of evidence: randomization, endpoint evaluation, blinding, etc. Results: The verified distribution profile of research on the quality of evidence showed that 55.9% of studies had a quality level of 4 to 8 on the PEDro scale. One study had a quality level of 9 points (0.8%). The bulk of research (69%) is devoted to the study of the effectiveness of exercise. Evaluation of the effectiveness of respiratory gymnastics, traditional health practices (Tai Chi, gypsy, yoga, etc.) are devoted to 7.5% of the studies. 6.5% of works are devoted to studying the effectiveness of acupuncture. Analysis of the effectiveness of non-invasive ventilation technology (mainly CPAP), the effects of artificially modified air (aerosol therapy, aerophytotherapy), and therapeutic physical factors of mechanical nature (massage, vibrotherapy) is devoted to 10.8% of studies. The use of technologies of physical rehabilitation measures using electromagnetic factors is devoted to 3.2%. In 2% of the studies, an assessment of the effectiveness of respiratory gymnastics was presented, and in a number of works, such technologies of physical rehabilitation, which are gaining popularity in the rehabilitation of patients with lung cancer, have been studied as kinesio-taping and audio-visual relaxation (1% each). Conclusion: Clinical recommendations developed on the basis of the obtained results will form the basis of a new, evidence-based stage in the development of the rehabilitation of patients with lung cancer in Russia.

To plan anti-cancer measures and to correctly manage its condition, it is necessary to use only reliable sources of its formation. For this purpose, a system of Population-based or territorial Cancer Registries (PCR) has been created in Russia. The first Registry was the St. Petersburg PCR, created by us in 1993, which became the school of methodological preparation of the system in the administrative territories of Russia. The corresponding Order No. 420 of April, 19, 1996 issued by the Ministry of Public Health of the Russian Federation has legitimized a new organizational structure and entrusted it with the supervision of the P. Hertsen Moscow Oncology Research Institute. Unfortunately, to date, the PCR databases are not used, when creating state reports, analytical developments on the PCR database are either not conducted, or are used extremely rarely. The only exception was the St. Petersburg PCR, and now the entire Northwestern Federal District of the Russian Federation (NWFD RF) and 6 more administrative territories operating under our programs. The materials of the real state of the oncological service, prepared on the basis of the St. Petersburg PCR database, have been published by us in more than 20 monographs in St. Petersburg and the Northwestern Federal District of Russia. In this paper, we present the dynamics of analytical indicators calculated according to the PCR database, which sharply differ from the data of the Form No. 7 Annual Reports. The calculated indicators are close to the European average and have a positive trend.

The first part of the study includes a brief historical outline on the creation of an objective system for assessing the activities of the oncological service in Russia and the Northwestern Federal District of the Russian Federation.Dynamic series of all types of indicators of the populations morbidity and mortality have been presented, an increasing process of reliability and improvement of the quality of registration of primary patients with malignant tumors has been shown.In Russia, aswell as in the Northwestern Federal District of the Russian Federation, standardized indicators of the malignant tumorsincidence remain at a relatively low level. In the world ranking of Cancer Registries, the Russian Federation is on 300th place among 450 others.The mortality rate of the population in most localizations isrecorded above the average European indicators.

The conference "Results and prospects of development of new polyphenolic drugs for cancer patients" took place at the N.N. Petrov National Medical Research Center of Oncology (PNMRCO) on May 31, 2017, and gathered researchers involved in development and evaluation of medicinal products based on the novel lignin-derived soluble polyphenolic polymer BP-Cx-1. BP-Cx-1 is the platform for a portfolio of innovative pharmacological products such as BP-C1, BP-C2 and BP-C3.

Distribution of cancer-predisposing mutations demonstrates significant interethnic variations. This study aimed to evaluate patterns of APC and MUTYH germ-line mutations in Russian patients with colorectal malignancies. APC gene defects were identified in 26/38 (68%) subjects with colon polyposis; 8/26 (31%) APC mutations were associated with 2 known mutational hotspots (p.E1309Dfs*4 [n = 5] and p.Q1062fs* [n = 3]), while 6/26 (23%) mutations were novel (p.K73Nfs*6, p.S254Hfs*12, p.S1072Kfs*9, p.E1547Kfs*11, p.L1564X and p.C1263Wfs*22). Biallelic mutations in MUTYH gene were detected in 3/12 (25%) remaining subjects with polyposis and in 6/90 (6.7%) patients with colorectal cancer (CRC) carrying KRAS p.G12C substitution, but not in 231 early-onset CRC cases negative for KRAS p.G12C allele. In addition to known European founder alleles p.Y179C and p.G396D, this study revealed a recurrent character of MUTYH p.R245H germ-line mutation. Besides that, 3 novel pathogenic MUTYH alleles (p.L111P, p.R245S and p.Q293X) were found. Targeted next-generation sequencing of 7 APC/MUTYH mutation-negative DNA samples identified novel potentially pathogenic POLD1 variant (p.L460R) in 1 patient and known low-penetrant cancer-associated allele CHEK2 p.I157T in 3 patients. The analysis of 1120 healthy subjects revealed 15 heterozygous carriers of recurrent MUTYH mutations, thus the expected incidence of MUTYH-associated polyposis in Russia is likely to be 1:23 000.