Chemotherapy Department of the P. Hertsen MORI

The department conducts clinical work on the treatment of malignant solid tumors of various localizations.

1. Preoperative (neoadjuvant) and postoperative (adjuvant) chemotherapy for breast cancer. As part of comprehensive breast cancer treatment, our department provides chemotherapy at both the preoperative and postoperative stages. The decision on the optimal treatment sequence is made collectively, in collaboration with surgeons from the breast reconstructive and plastic surgery department. Depending on the histological, immunological, and genetic variant of breast cancer, patients may be offered the most effective treatment options, including modern targeted therapies. The department is actively engaged in developing and implementing drug treatment methods for the most unfavorable morphological subtype of breast cancer (triple-negative subtype).
2. Perioperative and postoperative (adjuvant) chemotherapy for locally advanced and metastatic rectal and colon cancer.
   The department provides chemotherapy as part of the comprehensive treatment of colorectal cancer with metastatic involvement of the liver and lungs, including the use of targeted drugs both in cases of disseminated disease and when it is necessary to achieve resectability of tumor lesions (potentially allowing subsequent surgery on the liver/lung). The type of targeted drugs is chosen individually based on the molecular characteristics of the tumor, which allows for the most personalized chemotherapy regimens. The decision to use a multi-step treatment approach is made by a multidisciplinary team (in conjunction with specialists from the abdominal oncology and thoracic departments of our institute). In addition, the department administers standard postoperative chemotherapy for locally advanced cancer.
3. Induction chemotherapy for locally advanced nasopharyngeal cancer.
   This category includes the treatment of a severe group of patients with extensive tumor spread (into the cranial cavity, involving brain tissue, cranial nerves, destruction of the skull base bones, and massive metastatic involvement of cervical lymph nodes). In most medical institutions, such patients are considered untreatable, and therefore, only symptomatic therapy is recommended for them. In our department, treatment for patients begins with chemotherapy using an original chemotherapy regimen developed by the department staff. If the tumor responds to the treatment (usually in more than 80% of patients), it then becomes possible to supplement the treatment with radiotherapy. The Chemotherapy Department of the P. Hertsen MORI has the largest volume of clinical experience in the Russian Federation; since 2008, more than 130 patients with this rare pathology have been treated.
4. Induction chemotherapy within the framework of organ-preserving treatment for locally advanced cancer of the larynx, laryngopharynx, and oropharynx. The standard method of treating advanced tumors of the larynx and laryngopharynx is surgical treatment. At the same time, performing extensive surgery leads to loss of the organ and disability for the patient. A priority direction for both the chemotherapy department and the institute as a whole is the development of treatment programs that ensure organ preservation in locally advanced cancer of the larynx, laryngopharynx, and oropharynx. Successful treatment allows patients to continue breathing, speaking, and eating independently. In the first stage at the chemotherapy department, patients undergo 3 courses of high-intensity chemotherapy. If the tumor size is reduced by half or more after chemotherapy, the second stage of treatment involves radiation therapy combined with cytostatics.
5. Intraperitoneal aerosol chemotherapy (PIPAC) in combination with systemic chemotherapy in patients with gastric cancer with peritoneal involvement (in collaboration with the thoracoabdominal department). Within this scientific protocol, a combined therapy is carried out in a previously virtually incurable group of patients with a highly negative prognosis, involving the intraperitoneal administration of two antitumor drugs, which allows increasing their concentration in the area of metastatic peritoneal involvement (as the only site of distant metastases) in combination with adequate systemic control, thanks to courses of systemic chemotherapy administered between procedures. Currently, the method has been applied in more than 120 patients, who undergo up to 4–5 PIPAC sessions. After each session, usually 3 courses of systemic chemotherapy are given. In one-third of patients, peritoneal tumor metastases completely disappear, and in another 50% of patients, tumor cells almost entirely lose their viability.
6. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) combined with systemic chemotherapy in patients with gastric cancer with peritoneal involvement (in collaboration with the thoracoabdominal department). For patients with locally advanced and metastatic gastric cancer, in whom radical surgical treatment with removal of all detectable tumor lesions is possible, a high-temperature solution of two chemotherapeutic agents is administered during surgery. To prevent further tumor activity in the postoperative period, 6 courses of systemic chemotherapy are carried out. This treatment option may also be applied to a selected, very small group of patients, with the decision made by a multidisciplinary team of chemotherapists and surgeons at our institute.
7. Combined intra-arterial and systemic chemotherapy for inoperable head and neck tumors (in collaboration with the Department of Interventional Treatment Methods). This treatment option is offered to patients for whom the only treatment method is palliative chemotherapy (not eligible for standard treatment). According to the developed treatment protocol, 2 chemotherapeutic drugs included in the standard treatment regimen are administered traditionally (intravenously); an additional chemotherapeutic drug (cisplatin) is administered intra-arterially to achieve maximum drug concentration in the tumor tissue. This method can be used for cancers of the tongue, floor of the mouth, and oropharynx. Thanks to this method, many patients experience increased survival and stabilization of the tumor process. Currently, the group of patients using this drug delivery method has been expanded.
8. Induction chemotherapy for locally advanced pancreatic cancer (in collaboration with the Department of Abdominal Oncology). Pancreatic cancer is an oncological disease with a highly unfavorable prognosis. In many cases, even with the earliest possible detection, tumor invasion into vital arteries and veins is noted, which prevents surgery from being performed as the first stage of treatment. The decision on the feasibility of using this method is made by a consortium of surgeons and chemotherapists. Administering chemotherapy, if effective, allows for surgical intervention at the second stage. In our department, a comparison of the two most advanced and highly effective preoperative chemotherapy regimens has been conducted, and criteria have been developed that allow predicting which regimen is most suitable for each individual patient.
9. Chemotherapy in combination with the high-intensity focused ultrasound (HIFU) method for generalized forms of cancer of various localizations (in collaboration with the ultrasound diagnostics and therapy group). The aim of this treatment option is to enhance the therapeutic effect on individual tumor lesions accompanied by pain syndrome (which is most commonly observed in pancreatic cancer). Patients undergo systemic chemotherapy, with the regimen chosen depending on the structure of the primary tumor. Simultaneously with systemic treatment, HIFU therapy is applied to specific tumor lesions. Currently, this method is used in patients with pancreatic cancer, gallbladder cancer, lung cancer, cancer of the major duodenal papilla, stomach cancer, breast cancer, colon cancer with metastatic liver involvement, and retroperitoneal liposarcomas.
10.  Predicting the effectiveness of immunotherapy (in collaboration with the tumor therapy efficacy prediction laboratory).
    Studying the level of PD-L1 ligand in blood serum as a prognostic model for the effectiveness of immunotherapy of malignant tumors (in collaboration with the tumor therapy efficacy prediction laboratory). Examining the ligand level before the start of treatment and at subsequent stages, in comparison with the objective response to therapy, will allow for more accurate prediction of a positive response to the ongoing immunotherapy.
11. Prediction of nephrotoxicity risk in patients receiving chemotherapy with platinum-based drugs (in collaboration with the Laboratory for Predicting Tumor Therapy Effectiveness and Sechenov University).
    Studying the level of the KIM marker in urine will allow earlier detection of toxic kidney damage when using certain chemotherapy drugs and enable timely modification of treatment regimens.
12. Chemohormonal therapy for prostate cancer with metastases in lymph nodes and the skeletal system. Drug therapy is offered to patients with unfavorable prognostic factors in hormonally-sensitive prostate cancer. Within the framework of the department’s research work, chemohormonal therapy is administered to some patients before surgery, while others receive it after the surgical stage of treatment. For patients undergoing preoperative chemotherapy, radical prostatectomy is performed in the second stage of treatment, followed by dynamic observation. This approach allows delaying the loss of tumor sensitivity to hormone therapy, which can be re-administered as a highly effective treatment option in case of subsequent tumor progression.
13. Treatment within the framework of international clinical protocols. In the chemotherapy department, cancer treatments for various localizations have been conducted for 20 years within the framework of international clinical protocols. If the characteristics of the disease meet the efficacy criteria of the investigational drugs, patients may receive therapy with the most modern innovative medications (often targeted therapies and immunotherapies) not yet registered in the Russian Federation. The decision on the possibility of treatment within these protocols is made based on a consultation with the chemotherapists of our department.

1. Silver medal of the XXIII Moscow International Salon of Inventions and Innovative Technologies “Archimedes 2020” for the project “Technology for the Use of High-Intensity Focused Ultrasound Therapy in Palliative Care for Cancer Patients” (see appendix).
2. Diploma from the Federal Service for Intellectual Property in the category “100 Best Inventions of Russia for 2019 and the First Half of 2020” for the development “Method of Combined Treatment for Patients with Unresectable Extrahepatic Bile Duct Cancer” (see appendix).

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2. Возможности таргетной терапии метастатического колоректального рака с гиперэкспрессией HER2: клинический случай //Медицинский совет. – 2019. – №. 19.
3. «Влияние результатов международных исследований на выбор лечебной тактики при нерезектабельных формах плоскоклеточного рака головы и шеи» // Опухоли головы и шеи, 2’2020, том №10, стр. 10-21
4. «Влияние пандемии COVID-19 на онкологическую практику» // Сибирский онкологический журнал 2020; 19(3):5-22
5. «Рак мочевого пузыря: лечение после прогрессирования Результаты 2-го ретроспективного анализа данных по применению винфлунина у пациентов с метастатическим уротелиальным раком в условиях реальной клинической практики в России» // Онкоурология 3’2020 том 16, стр. 17-24.
6. «Внутрибрюшная аэрозольная химиотерапия под давлением в сочетании с системной химиотерапией – новый подход в лечении больных раком желудка с перитонеальным карциноматозом» // Сибирский онкологический журнал. 2020; 19(4): 49–58
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8. «Breast cancer organoid model allowed to reveal potentially beneficial combinations of 3,30 -diindolylmethane and chemotherapy drugs» // Biochimie (179) 2020, pp 217-227
9. «Ленватиниб как ключевой компонент эффективной 1-й линии терапии пациентов с нерезектабельным гепатоцеллюлярным раком» // Современная Онкология. 2020; 22 (3): 142–148.
10. «Эффективность таргетной терапии ALK-позитивных опухолей на примере использования препарата кризотиниб у больного распространенным раком желудка» // Сибирский онкологический журнал. 2020;19(1):141-146.
11. «Сравнение 2D- и 3D-культур аденокарциномы прямой кишки как моделей для тестирования лекарственных препаратов» // Известия Академии наук. Серия химическая, 2019, № 12, стр. 2377-2380
12. «Эффективность ниволумаба в процессе второй или последующей линии терапии и качество жизни у больных с распространенным рефрактерным немелкоклеточным раком легкого: промежуточные результаты проспективного наблюдательного исследования» // Вопросы онкологии, том 65, №1, стр. 99-105, 2019 год
13. Systemic treatments in MDM2 positive intimal sarcoma: A multicentre experience with anthracycline, gemcitabine, and pazopanib within the World Sarcoma Network // Cancer. 2020. Том:126. №:1 С 98-104
14. «Проведение высокоинтенсивной сфокусированной ультразвуковой терапии в рамках комбинированного лечения неоперабельной больной раком поджелудочной железы» Онкология. Журнал им. П,А. Герцена 2020, Т. 9, N9′], с. 50-54
15. Three-modality therapy for advanced squamous maxillary sinus cancer Case report Biomedical Journal of Scientific & Technical Research (BJSTR) Volume 26- Issue 1 19657-19659 DOI: 10.26717/BJSTR

The original methods for treating malignant neoplasms of various localizations developed at the P. Hertsen MORI  with the participation of the staff of the chemotherapy department are protected by patents. Examples include:

1. A method of combined drug treatment for patients with primarily unresectable locally advanced squamous cell carcinoma of the cervix IB2-IIIB 2017109567, 22.03.2017, Published 10.05.2017, Bulletin 13 (Decision on issuance 21.09.2018)
2. Method of combined treatment for patients with primarily operable and locally advanced inoperable breast cancer 2017143432 (filed on 12.12.17), patent grant decision on 24.07.2018
3. Method for treating squamous cell carcinoma of the oropharynx, Application No. 2018127510. Date of state registration in the State Register of Inventions of the Russian Federation: May 29, 2019. The term of the exclusive right to the invention expires on July 26, 2038.
4. Method of treating patients with metastases in lymph nodes and oligometastases in the bones of the skeleton for prostate cancer. Application No. 2018115744. Invention priority date: April 26, 2018. Date of state registration in the State Register of Inventions of the Russian Federation: July 23, 2019.
5. The term of the exclusive right to the invention expires on April 26, 2038.Method of combined treatment of patients with unresectable extrahepatic bile duct cancer No. 2703330, state registration date: 16.10.2019
6. Method of treating squamous cell carcinoma of the oral cavity and pharynx in combination with radiation and drug therapy
7. Method of combined treatment of muscle-invasive bladder cancer T3-T4N0-+M0 No. 2713443, state registration date: 05.02.2020