New developments in the field of cancer treatment

Section 1: Immunotherapy – revolution in the fight against cancer

Immunotherapy, stimulating the patient’s own immune system to combat cancer, is one of the most significant achievements in oncology over the past decades. Instead of direct exposure to cancer cells, immunotherapy “teaches” the immune system to recognize and destroy them.

1.1 Inhibitors of immune control points (Immune Checkpoint Inhibitors – Icis)

ICIS is monoclonal antibodies that block proteins that prevent the activation of T cells, key players of the immune system. These proteins, known as immune control points, normally prevent an excessive immune reaction, but cancer cells often use them to “hide” from the immune system. By blocking these control points, ICIS allow T-cells to attack cancer cells.

The mechanism of action: ICIS affects such proteins as PD-1 (Programmed Cell Death Protein 1) and CTLA-4 (Cytotoxic T-Lymphocyte-SSOCIETED PROTEIN 4) located on the surface of T cells and cancer cells. Binding PD-1 with PD-L1 (Programmed Death-Ligand 1) on cancer cells and CTLA-4 with B7 on antigen-representative cells suppresses the activity of T cells. ICIS, such as Pembrolizumab (KeyTruda), Nivolumab (Opdivo) (blocking PD-1), and Ipilimumab (Yervoy) (blocking CTLA-4), prevent this suppression, allowing T-cells to effectively destroy the cancer cells.
Clinical application: ICIS demonstrated significant efficiency in the treatment of various types of cancer, including melanoma, lung cancer, kidney cancer, bladder cancer, Hodgkin lymphoma and some types of head and neck cancer. The effectiveness of ICIS depends on the expression of PD-L1 on cancer cells and on the immunogenicity of the tumor.
Side effects: ICIS can cause immuno -mediated side effects, such as colitis, pneumonitis, hepatitis, endocrinopathy (for example, hypothyroidism, hyperthyroidism, type 1 diabetes) and skin lesions. Management of these side effects often requires the use of corticosteroids or other immunosuppressive drugs.
Prospects: Research is aimed at developing new ICIS, affecting other immune control points such as LAG-3, TIM-3 and Tigit. Combined ICIS therapy with other treatment methods, such as chemotherapy, radiation therapy and targeted therapy, is also studied to increase the effectiveness of treatment.

1.2 car-T cell therapy.

CAR-T cell therapy is an innovative method of cancer treatment in which the patient T-cells are genetically modified for the expression of a chimeric antigenic receptor (CAR), which allows them to recognize and attack cancer cells.

The mechanism of action: The patient’s T cells are extracted from the blood and modified in the laboratory by introducing the gene encoding Car. CAR is a hybrid protein consisting of an extracellular domain that recognizes a specific antigen on the surface of cancer cells (for example, CD19 with B-cell lymphomas), and an intracellular domain that activates the T-cell. Modified Car-T cells breed in the laboratory, and then introduced back to the patient. Car-T cells recognize and bind to cancer cells, which leads to their activation and destruction.
Clinical application: CAR-T cell therapy has demonstrated impressive effectiveness in the treatment of recurrent and refractory B-cell lymphomas and acute lymphoblastic leukemia in children and adults. Several Car-T cell products are approved for clinical use.
Side effects: CAR-T cell therapy can cause serious side effects, such as cytokine release syndrome (CRS), characterized by fever, hypotension, respiratory failure and neurological disorders. Neurotoxicity (ICANS) is also a serious complication. Management of these side effects requires the use of toocilizumab (Actemra) (IL-6 receptor blocker) and corticosteroids.
Prospects: Studies are aimed at expanding the use of CAR-T cell therapy for the treatment of other types of cancer, including solid tumors. New Car structures are being developed that increase the effectiveness and safety of Car-T cells. Strategies for overcoming immunosuppressive microtrapery of the tumor and preventing the depletion of Car-T cells are investigated. CAR-P CALLES (natural killers) are developed, which can have greater safety and accessibility compared to CAR-T cells.

1.3 Oncolithic viruses

Oncolytic viruses are viruses that selectively infect and destroy cancer cells without damaging healthy cells.

The mechanism of action: Oncolytic viruses can be both natural and genetically modified. They penetrate into cancer cells, multiply inside them and cause their lysis (destruction). With the destruction of cancer cells, viral particles are released that infect other cancer cells, as well as antigens that stimulate the immune system.
Clinical application: Talimogen Lagerpacco (T-VEC) is a genetically modified herpes virus approved for the treatment of melanoma. Oncolytic viruses are also studied for the treatment of other types of cancer, including brain cancer, pancreatic cancer and liver cancer.
Side effects: Oncolytic viruses usually cause light side effects, such as flu -like symptoms. In rare cases, more serious side effects can occur, such as inflammation.
Prospects: Research is aimed at developing more effective and safe oncolytic viruses. Combined therapy with oncolytic viruses with other methods of treatment, such as immunotherapy and chemotherapy, is also studied to increase the effectiveness of treatment.

1.4 vaccines against cancer

Cancer vaccines are designed to stimulate the immune system to recognize and destroy cancer cells.

The mechanism of action: Cancer vaccines contain antigens specific to cancer cells. These antigens can be proteins, peptides, DNA or RNA. When the vaccine is introduced, the immune system recognizes antigens and activates T cells and B cells that attack cancer cells expressing these antigens.
Clinical application: Sipuleusel-T is a vaccine against prostate cancer, approved for the treatment of metastatic castration and resolution cancer of the prostate. Cancer vaccines are also developed to treat other types of cancer, including melanoma, lung cancer and pancreatic cancer.
Side effects: Cancer vaccines usually cause light side effects, such as pain in the injection site and flu -like symptoms.
Prospects: Research is aimed at developing more effective cancer vaccines, which induce a stronger and long -term immune response. Personalized cancer vaccines are being developed, which are aimed at mutations that are unique to cancer of each patient.

Section 2: Targeted therapy – an accurate blow to cancer cells

Targeted therapy is a method of treating cancer aimed at specific molecules involved in growth, progression and spread of cancer cells. Unlike chemotherapy, which affects all rapidly dividing cells, targeted therapy more selectively affects cancer cells, minimizing damage to healthy cells.

2.1 Tyrosinkinaz inhibitors (Tyrosine Kinase Inhibitors – Tkis)

TKIS is small molecules that block the activity of thyrosinkinase, enzymes that play a key role in transmitting signals inside cells and regulation of cellular growth, differentiation and apoptosis. Many cancer cells have abnormally active tyrosinkinase, which contributes to their uncontrolled growth and survival.

The mechanism of action: TKIS bind to the active center of tyrosinkinase, blocking its phosphorizing activity and thereby interrupting the transmission of signals. Various TKIS are aimed at different tyrosinkinase, such as EGFR (epidermal growth factor), VEGFR (vascular endothelium factor), BCR-BL (mergers characteristic of chronic myelocosis) and ALK (kinase of anaplastic lymphoma).
Clinical application: TKIS are widely used for the treatment of various types of cancer, including chronic myelolecosis (imatinib), lung cancer (hefitinib, Erlotinib, Osimertinib), kidney cancer (Sorafenibanib, Sunitinib) and melanoma (Vemorafenib, Dubrafenib). The effectiveness of TKIS often depends on the presence of specific mutations in the gene encoding tyrosyankinase.
Side effects: TKIS can cause various side effects, such as skin rash, diarrhea, fatigue, hypertension and thyroid function.
Prospects: Research is aimed at developing new TKIS with improved selectivity and less toxicity. TKIS are developed, aimed at new tyrosinkinase, as well as strategies for overcoming resistance to TKIS.

2.2 MTOR inhibitors (Mammalian Target of Rapamycin Inhibitors)

Mtor is Serin/Treoninkinase, which plays a central role in the regulation of cellular growth, proliferation, metabolism and angiogenesis. The MTOR path is often activated in cancer cells, contributing to their growth and survival.

The mechanism of action: MTOR inhibitors, such as Everolymus and Temsirolymus, contact MTOR and block its activity, which leads to inhibiting cell growth and proliferation, as well as the suppression of angiogenesis.
Clinical application: MTOR inhibitors are used to treat kidney cancer, breast cancer, neuroendocrine tumors and tuberous sclerosis.
Side effects: MTOR inhibitors can cause various side effects, such as stomatitis, rash, fatigue, hyperglycemia, hyperlipidemia and pneumonitis.
Prospects: Research is aimed at developing new MTOR inhibitors with improved selectivity and less toxicity. Combined therapy of MTOR inhibitors with other treatment methods, such as chemotherapy and hormonal therapy, is also studied to increase the effectiveness of treatment.

2.3 CDK4/6 inhibitors (Cyclin-Dependent Kinase 4/6 Inhibitors)

CDK4/6 is Serin/Treoninkinase, playing a key role in the regulation of the cell cycle. They control the transition from the phase G1 to the phase S of the cell cycle, which is necessary for the proliferation of cells. In cancer cells, CDK4/6 activity is often increased, which contributes to their uncontrolled growth.

The mechanism of action: CDK4/6 inhibitors, such as Palbocyclib, Ribocyclib and Abemaclicclib, bind to CDK4/6 and block their activity, which leads to the stopping of the cell cycle in the G1 phase and inhibiting the proliferation of cancer cells.
Clinical application: CDK4/6 inhibitors are used to treat hormone-positive (HR+), Her2-Negative metastatic cancer of the mammary gland in combination with hormonal therapy.
Side effects: CDK4/6 inhibitors can cause various side effects, such as neutropenia, leukopenia, anemia, fatigue, nausea and diarrhea.
Prospects: Research is aimed at studying the effectiveness of CDK4/6 inhibitors in the treatment of other types of cancer, as well as the development of new CDK4/6 inhibitors with improved pharmacological properties.

2.4 PARP inhibitors (Poly Adp-Ribose Polymerase Inhibitors)

PARP is enzymes involved in DNA reparations. PARP inhibitors block the activity of these enzymes, which leads to the accumulation of DNA damage and the death of cancer cells, especially in patients with DNA recar, for example, with mutations in BRCA1 and BRCA2 genes.

The mechanism of action: PARP inhibitors, such as Olaparib, Rhparib and Talazoparib, bind to PARP and block their activity. In cells with defects in DNA reparation, such as BRCA1/2-mutant cells, PARP inhibiting leads to the accumulation of dual-band DNA tears that cannot be effectively restored, which leads to the death of cells.
Clinical application: PARP inhibitors are used to treat ovarian cancer, breast cancer, prostate cancer and pancreatic cancer in patients with mutations in BRCA1 and BRCA2 genes.
Side effects: PARP inhibitors can cause various side effects, such as nausea, fatigue, anemia, thrombocytopenia and leukopenia.
Prospects: Research is aimed at expanding the use of PARP inhibitors for the treatment of other types of cancer, as well as at the development of combined therapeutic strategies using PARP inhibitors and other antitumor drugs.

2.5 monoclonal antibodies (Monoclonal Antibodies – Mabs)

Monoclonal antibodies are antibodies that specifically associate with a certain antigen on the surface of cancer cells. They can be used to deliver cytotoxic drugs or radioactive isotopes directly to cancer cells, as well as to block signal tracts necessary for the growth and survival of cancer cells.

The mechanism of action: Mabs can act in various ways. Some MABS, such as Trustuzumab (Herceptin), associate with receptors of growth factors such as HER2 and block their activation, which leads to inhibiting cell growth and proliferation. Other MABS, such as Rituximab (Rituxan), bind to antigens such as CD20 on the surface of cancer cells and cause their death through a complement-dependent cytotoxicity (CDC) or antibody-dependent cellular cytotoxicity (ADCC). MABS can also be used to deliver cytotoxic drugs (antibody-levaric conjugates, ADCS) or radioactive isotopes directly to cancer cells.
Clinical application: MABS are widely used for the treatment of various types of cancer, including breast cancer (trastuzumab, pertuzumab), lymphoma (rituximab), lung cancer (Bevacizumab), colon cancer (cetuximab, panitumab) and melanoma (Ipylymumab, pembroralizumab, nivolumab).
Side effects: Side effects of MABS depend on a specific antibodies and may include infusion reactions, allergic reactions and specific toxicities associated with the target of antibodies.
Prospects: New MABS with improved affinity and specificity, as well as new ADCS with more effective cytotoxic drugs, are developed. Strategies for increasing the efficiency of MABS by combining them with other treatment methods such as chemotherapy, radiation therapy and immunotherapy are investigated.

Section 3: New technologies in radiation therapy

Radiation therapy is a method of cancer treatment using high -energy radiation to destroy cancer cells. Modern technologies of radiation therapy allow you to more accurately aim to radiation on the tumor, minimizing damage to surrounding healthy tissues.

3.1 Intensively modulated radiation therapy

IMRT is an advanced form of radiation therapy, which allows you to modulate the intensity of the radial beam to deliver a higher dose of radiation to the tumor and a lower dose of surrounding healthy fabrics.

The mechanism of action: IMRT uses computer planning to create a three -dimensional treatment plan that optimizes the radiation dose delivered to the tumor and minimizes the dose delivered to surrounding healthy tissues. IMRT uses a multi -petal collimator (MLC), which consists of many independently controlled petals, which form a radial bundle and modulate its intensity.
Clinical application: IMRT is used to treat various types of cancer, including prostate cancer, head and neck cancer, breast cancer and lung cancer.
Advantages: IMRT allows you to deliver a higher dose of radiation to the tumor, which can improve control over the tumor. IMRT also can minimize the radiation dose delivered to the surrounding healthy tissues, which can reduce the risk of side effects.

3.2 volumetric-modulated arc therapy (Volumetric Modulated Arc Therapy-VMAT)

VMAT is a variety of IMRT, in which the radiation beam revolves around the patient, simultaneously modulating the radiation intensity and the speed of rotation of the gentri.

The mechanism of action: VMAT uses computer planning to create a treatment plan that optimizes the radiation dose delivered to the tumor and minimizes the dose delivered to the surrounding healthy tissues. VMAT uses MLC and a rotating gent to deliver a radial beam to a tumor from different angles.
Clinical application: VMAT is used to treat various types of cancer, including prostate cancer, cancer of the head and neck, breast cancer and lung cancer.
Advantages: VMAT allows you to deliver a higher dose of radiation to the tumor than ordinary radiation therapy, and at the same time minimize the dose of radiation delivered to the surrounding healthy tissues. VMAT can also reduce treatment time compared to IMRT.

3.3 stereotactic radiation therapy (stereotactic radiation therapy – SRT)

SRT is a radiation therapy method that uses very accurate guidance methods and a high dose of radiation delivered for a small number of fractions (usually from 1 to 5). SRT can be used to treat small tumors in the brain, lungs, liver and other organs.

The mechanism of action: SRT uses computer planning and accurate guidance methods to deliver a high dose of radiation to the tumor, minimizing damage to surrounding healthy tissues. SRT can be used using various types of radiation equipment, such as gamma-knife, cyber knife and linear accelerators.
Clinical application: SRT is used to treat various types of cancer, including brain cancer, lung cancer, liver cancer and spine cancer.
Advantages: SRT allows you to deliver a high dose of radiation to the tumor for a small number of fractions, which can improve control over the tumor and reduce treatment time. SRT also minimizes damage to surrounding healthy tissues.

3.4 Proton therapy

Proton therapy is a form of radiation therapy using protons (positively charged particles) instead of x -rays to destroy cancer cells. Protons have unique physical properties that allow you to deliver most of the dose of radiation directly to the tumor and minimize the dose delivered to the surrounding healthy tissues.

The mechanism of action: Protons have the property of the Bragg Peak, which means that they give most of their energy at the end of their path. This allows you to deliver a high dose of radiation to the tumor and minimize the dose delivered to the surrounding healthy tissues.
Clinical application: Proton therapy is used to treat various types of cancer, especially in children where it is important to minimize the dose of radiation delivered to growing tissues. Proton therapy is also used to treat prostate cancer, brain cancer, lung cancer and head and neck cancer.
Advantages: Proton therapy allows you to deliver a higher dose of radiation to the tumor than ordinary radiation therapy, and at the same time minimize the dose of radiation delivered to the surrounding healthy tissues. This can lead to an improvement in control over the tumor and reducing the risk of side effects.

Section 4: Surgical Innovation in Cancer Treatment

Surgery remains an important component of the treatment of many types of cancer. New surgical methods and technologies allow surgeons to more accurately remove tumors, minimize damage to surrounding healthy tissues and improve treatment results.

4.1 Robotized surgery

Robotized surgery is a surgical technique that uses a robotic system to perform surgical operations. The surgeon controls the robotic system from the console, which provides a three -dimensional image of the operating field and allows the surgeon to perform complex surgical manipulations with greater accuracy and control.

The mechanism of action: The robotic system consists of a surgical console, a robotic platform with several manipulators and an endoscopic chamber. The surgeon controls the manipulators from the console, and the robotic system exactly performs the movements of the surgeon. The robotic system provides an increased three -dimensional image of the operating field, which allows the surgeon to see and work with greater accuracy.
Clinical application: Robotized surgery is used to treat various types of cancer, including prostate cancer, kidney cancer, bladder cancer, colon cancer and uterine cancer.
Advantages: Robotized surgery can provide smaller cuts, less blood loss, less pain, a shorter stay in the hospital and a faster recovery compared to traditional open surgery. Robotized surgery can also allow surgeons to perform complex surgical operations that would be difficult or impossible to perform using traditional surgery.

4.2 Laparoscopic surgery

Laparoscopic surgery is a minimum invasive surgical technique that uses small cuts and specialized tools to perform surgical operations.

The mechanism of action: Laparoscopic surgery uses a small incision to introduce a laparoscope, a thin tube with a camera at the end, into the abdominal cavity. The surgeon uses a laparoscope to visualize the operating field and introduces other tools through small incisions to perform surgical manipulations.
Clinical application: Laparoscopic surgery is used to treat various types of cancer, including colon cancer, kidney cancer, liver cancer, stomach cancer and uterine cancer.
Advantages: Laparoscopic surgery can provide smaller cuts, less blood loss, less pain, a shorter time in the hospital and a faster recovery compared to traditional open surgery.

4.3 Intraoperative radiation therapy

It is a radiation therapy method in which a high dose of radiation is delivered directly to the operating field during a surgical operation.

The mechanism of action: It is delivered directly to the tumor after its removal, which allows you to destroy residual cancer cells and minimize damage to the surrounding healthy tissues.
Clinical application: IRT is used to treat various types of cancer, including breast cancer, pancreatic cancer, colon cancer and sarcoma cancer.
Advantages: IRT allows you to deliver a high dose of radiation directly to the tumor, which can improve control over the tumor. IRT can also reduce the total treatment time.

4.4 Navigation surgery

Navigation surgery is a surgical technique that uses computer technologies to instill a surgeon during surgery.

The mechanism of action: Navigation surgery uses preoperative images, such as CT or MRI, to create a three -dimensional model of the operating field. During the operation, the surgeon uses the navigation system to track the position of the tools and for orientation in the operating field.
Clinical application: Navigation surgery is used to treat brain cancer, cancer of the spine and liver cancer.
Advantages: Navigation surgery can provide a more accurate removal of the tumor and minimize damage to the surrounding healthy tissues.

Section 5: New approaches to cancer diagnosis

Early and accurate diagnosis of cancer is crucial for improving the results of treatment. New technologies and diagnostic methods allow you to identify cancer in earlier stages, determine the molecular characteristics of the tumor and choose the most effective treatment methods.

5.1 Liquid biopsy (Liquid Biopsy)

Liquid biopsy is a non -invasive method of cancer diagnosis that uses blood and other body fluids to analyze cancer, DNA, RNA and other molecules circulating in the blood.

The mechanism of action: Liquid biopsy allows you to detect circulating tumor cells (CTCS), circulating tumor DNA (CTDNA), exosomes and other molecules released by cancer cells into the blood. The analysis of these molecules can provide information about the presence of cancer, genetic mutations in the tumor, a response to the treatment and progression of the disease.
Clinical application: Liquid biopsy is used for various purposes, including cancer screening, diagnosis, treatment monitoring and predicting treatment results.
Advantages: Liquid biopsy is a non -invasive diagnostic method that can be repeated several times to monitor the treatment and progression of the disease. Liquid biopsy can also provide information about genetic mutations in the tumor, which can be used to select the most effective treatment methods.

5.2 molecular tumor profiling

Molecular tumor profiling is a cancer diagnosis method that analyzes the genetic composition of the tumor to detect mutations, expression of genes and other molecular characteristics.

The mechanism of action: The molecular profiling of the tumor uses samples of tumor tissue for the analysis of DNA, RNA and proteins. The analysis of these molecules can provide information about genetic mutations, tumor growth drivers and potential targets for targeted therapy.
Clinical application: Molecular tumor profiling is used to select the most effective methods of treatment, predicting the results of treatment and determining patients who can be candidates for clinical trials.
Advantages: Molecular tumor profiling can provide information about the genetic composition of the tumor, which can be used to select the most effective treatment methods.

5.3 PET-KT (Positron emission tomography-computed tomography)

PET CT is a visualization method that uses a radioactive drug (tracer) to detect cancer cells in the body.

The mechanism of action: PET-KT uses a radioactive tracer that is inserted into the patient’s body. The tracer accumulates in cancer cells, which have a higher level of metabolic activity. PET scanner detects the radioactivity of the tracer and creates a three-dimensional image of the distribution of the tracer in the body. CT scanner provides anatomical images that are used to localize cancer cells.
Clinical application: PET CT is used for diagnosis, stadium and monitoring of treatment of various types of cancer.
Advantages: PET-kt can identify cancer cells in the early stages, when they are not yet visible on other visualization methods. PET-KT can also provide information about the metabolic activity of the tumor, which can be used to monitor the response to treatment.

5.4 MRI (magnetic resonance imaging)

MRI is a visualization method that uses a magnetic field and radio waves to create images of organs and tissues in the body.

The mechanism of action: MRI uses a strong magnetic field to align the nuclei of hydrogen atoms in the body. Then radio waves are used to arouse these nuclei, and when the nuclei return to their original state, they emit radio signals that are detected by an MRI scanner. The computer processes these signals to create images of organs and tissues.
Clinical application: MRI is used to diagnose and monitor the treatment of various types of cancer, especially brain cancer, breast cancer, prostate cancer and liver cancer.
Advantages: MRI provides high detail of images of organs and tissues and does not use ionizing radiation.

Section 6: Modern Strategies for Management Effects of Cancer Treatment

Management of side effects of cancer is an important aspect of complex oncological assistance. Modern strategies are aimed at mitigating side effects, improving the quality of life of patients and ensuring the possibility of continuing treatment.

6.1 supporting therapy

Supporting therapy includes a wide range of measures aimed at facilitating side effects of cancer and improving the quality of life of patients.

Medicines: Supporting therapy may include the use of drugs to facilitate nausea, vomiting, pain, fatigue, diarrhea, constipation, mucositis and other side effects.
Nourishing support: Nourishing support may include recommendations for proper nutrition, food additives and intravenous nutrition to maintain adequate nutrition and prevent weight loss.
Physiotherapy and rehab: Physiotherapy and rehabilitation can help patients restore strength, mobility and functionality after cancer treatment.
Psychological support: Psychological support can help patients cope with the emotional and psychological consequences of cancer treatment.
Alternative and additional treatment methods: Alternative and additional methods of treatment, such as acupuncture, massage and meditation, can help patients cope with side effects and improve the quality of life.

6.2 preventive measures

Preventive measures can help prevent or soften the side effects of cancer treatment.

Preventive drugs: Preventive drugs can be prescribed to prevent nausea, vomiting, infections and other side effects.
Radiation therapy using modern technologies: Radiation therapy using modern technologies, such as IMRT and proton therapy, can minimize damage to surrounding healthy tissues and reduce the risk of side effects.
Surgical methods with minimal invasiveness: Surgical methods with minimal invasiveness, such as laparoscopic surgery and robotic surgery, can reduce blood loss, pain and recovery time.

6.3 Individual approach to treatment

An individual approach to treatment involves the adaptation of cancer treatment to the needs and characteristics of each patient.

Molecular tumor profiling: Molecular tumor profiling can provide information about genetic mutations in the tumor, which can be used to select the most effective treatment methods and to predict the risk of side effects.
Assessment of the general state of health of the patient: Assessment of the general state of health of the patient can help determine the risk factors of side effects and choose the most suitable methods of treatment and maintenance therapy.
Careful monitoring of side effects: Careful monitoring of side effects during treatment can allow it early to identify

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