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Supportive Therapy in Oncology

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Vol 1, No 2 (2024)
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ORIGINAL REPORTS

14-22 152
Abstract

Risks of adverse effects during therapy increase along with progress in oncology and development of new treatment methods. Thus, radiotherapy, one of the main methods of treatment of malignant tumors of various locations, can cause radiodermatitis: an adverse side effect manifesting on the skin in the irradiated area or near it. Clinical manifestations vary from stage to stage and negatively affect patients’ willingness to undergo or continue treatment due to fear of esthetic defects of the skin. Additionally, development of advanced stage radiodermatitis carries the risk of infectious complications in this area. One of the goals of radiation therapists is management of radiation-induced dermatitis and search for techniques aimed at its treatment and prevention.

This study evaluates the effects of several products and their components on clinical manifestations of radiodermatitis caused by radiation therapy.

23-31 211
Abstract

Background. Granulocyte colony-stimulating factors (G-CSFs) are used in oncology practice for prevention of febrile neutropenia caused by cytotoxic chemotherapy. Despite the proven safety of G-CSFs use in randomized clinical trials and in real clinical practice, clinicians have questions about the tolerability of this group of drugs.

Aim. To demonstrate the safety profile of a long-acting G-CSF produced in Russia which was used to prevent febrile neutropenia and maintain dose intensity of drug therapy in patients with various solid tumors undergoing chemotherapy at the Arkhangelsk Clinical Oncological Dispensary.

Materials and methods. The retrospective analysis included patients with a confirmed diagnosis of malignant neoplasm who received various chemotherapy regimens that required the inclusion of G-CSF. For primary prevention of febrile neutropenia, patients were prescribed empegfilgrastim (Extimia®) at a dose of 7.5 mg subcutaneously once per course of chemotherapy.

Results. Data of 151 patients were analyzed for the period from July 2021 to April 2023. The average age was 57 years (28–75). The group of elderly patients (over 65 years) consisted of 38 (25 %) patients. The majority of patients were diagnosed with breast cancer (56 (37 %) patients) and gastric cancer (37 (25 %) patients). The number of empegfilgrastim injections over the entire observation period was 773. Adverse reactions associated with the use of empegfilgrastim were registered in 13 (8.6 %) patients, the most common of which was grade 1–2 leukocytosis according to the CTCAE v.5 classification. One patient developed a serious adverse reaction: grade 4 neutropenia according to the CTCAE v.5 classification. A subgroup of patients with metastatic pancreatic cancer treated with FOLFIRINOX was analyzed separately to assess the relative dose intensity of the chemotherapy courses. Nine patients with metastatic pancreatic cancer received FOLFIRINOX therapy with a median of 8 (5–12) courses. A total of 69 chemotherapy cycles were administered to 9 patients with a median of 7.5 (2–13) cycles. The relative dose intensity of the chemotherapy courses was 83.71 ± 19.33.

Conclusion. Empegfilgrastim has shown a favorable safety and tolerability profile in patients with various solid tumors in real-world clinical practice including the highly toxic FOLFIRINOX regimen.

REVIEWS

32-44 193
Abstract

In patients with malignant neoplasms, the incidence of symptomatic venous thromboembolism (VTE) is 4–7 times higher than in the general population. The presence of distant metastases of solid tumors increases the risk of VTE. Most often, VTE develops in pancreatic and stomach cancers. Chemotherapy increases the risk of VTE development. Low-molecular-weight heparin and direct oral anticoagulants are used for the treatment of VTE in patients receiving chemotherapy.

Prior to the start of chemotherapy, it is necessary to assess the risk of VTE development using the Khorana risk score. Outpatient patients with high-risk cancer (Khorana score >3 before the start of a new systemic chemotherapy regimen) may be prescribed thromboprophylaxis.

45-54 145
Abstract

Neuropathic pain component occurs in every second patient with pain syndrome caused by a malignant tumor. Detection of the neuropathic component of pain syndrome is crucial for selection of effective analgesia.

The review presents an application algorithm for an updated system of neuropathic pain component assessment in oncological patients.

55-59 128
Abstract

According to the World Health Organization, 12.6 million new cases of cancer were identified in 2008. In 2022, this number reached 18.1 million cases, and it is projected to increase to 26 million in 2040. Chronic pain is defined by the International Association for the Study of Pain as pain that persists or recurs for 3 months. A similar definition is given in the International Classification of Diseases, 11th revision, which for the first time includes chronic pain as an independent category with a unique code MG30. The incidence of pain syndrome in advanced terminal or metastatic stages of cancer is 64 %, during antitumor therapy – 59 %, after successful treatment – 33 %. However, side effects from opioids significantly worsen the quality of life of patients.

A new type of peptide drugs can reduce the toxic effects of drug pain therapy.

60-64 130
Abstract

Accompanying therapy (AT) is vital for oncological patients as it allows to alleviate complications associated with both cancer and antitumor therapy. These complications include anemia, febrile neutropenia, nausea, and chronic pain syndrome. The problem is that many patients do not receive sufficient AT because of the lack of clinical guidelines and regulations. Currently, clinical guidelines only for anemia are approved and none for the other complications. The main barriers are the absence of legislative funding of AT and impossibility to obtain medications on the outpatient basis. The system of clinical-statistical disease groups also causes difficulties with payment for medical treatment. Low cost ratios and impossibility to combine AT payment with payment for the main therapy also limit its availability.

To solve these problems, separate clinical guidelines for AT should be developed, tariffs for the clinical-statistical disease groups should be revised, and coefficients of treatment complexity should be increased for wider medication coverage.



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ISSN 3034-2473 (Print)
ISSN 3034-3178 (Online)