Drug therapy for advanced endometrial cancer (EC) has remained a challenging task for practical oncology for many years. Despite the effectiveness of standard platinum chemotherapy, most patients develop resistance to the treatment and further disease progression. Chemotherapy drugs used in the 2^nd line of therapy show unsatisfactory results in terms of effectiveness. The situation has radically changed after the discovery of the role of microsatellite instability as a predictive marker of the effectiveness of immunotherapy. EC is the leading nosology in terms of the frequency of deficient mismatch repair system (dMMR) and demonstrates a high incidence of tumors with the phenomenon of high microsatellite instability (MSI-H). For such patients, the standard of treatment has become the use of immunotherapy, in monotherapy and in combination with platinum drugs. However, 70% of patients with EC show no signs of microsatellite instability in tumor tissue (MSS/pMMR), and for many years the introduction of immunotherapy into this subgroup has been associated with very low results, not exceeding the effectiveness of standard chemotherapy regimens. Only the use of a combined approach, a combination of immunotherapy and targeted therapy demonstrated an improvement in long-term treatment outcomes, disease-free survival (DFS) and overall survival (OS) in the MSS/pMMR group of endometrial cancer. In this article, we present the literature review on the effectiveness of this regimen, demonstrate the practical experience of St. Petersburg GBUZ «City Clinical Oncology Dispensary» in using a combined regimen, and also illustrate statistical data with a real clinical case effectiveness of this treatment tactic.

Carcinoid heart disease (CHD) is one of the complications that occurs in patients with widespread neuroendocrine tumors as a consequence of the course of carcinoid syndrome. CHD most often develops when the primary tumor is localized in the small intestine, as well as in the lungs, colon, pancreas, appendix and ovaries. Carcinoid syndrome is a paraneoplastic manifestation that develops as a result of the release of serotonin and other vasoactive substances by the tumor into the bloodstream. It is accompanied by a spectrum of symptoms such as diarrhea, flushes, bronchospasm and symptoms of congestive heart failure. Without specific therapy, patients with severe heart failure against the background of CHD have an extremely negative prognosis for life, with an expected overall survival of no more than one year. Treatment of this pathology is often difficult, since patients usually seek treatment late, while the disease can progress rapidly. Thus, optimal management of this group of patients requires close collaboration between physicians from various specialties, including hepatobiliary and cardiovascular surgeons, endocrinologists, anesthesiologists and gastroenterologists, to select the most effective treatment strategies depending on the severity of heart failure in order to improve quality of life and reduce mortality.

Breast cancer (BC) is the most common malignant tumour and the leading cause of cancer death in women worldwide [1, 2]. Significant progress has been made in the treatment of this disease over the last decade [3], largely due to the introduction of new drug treatment options, of which CDK4/6 inhibitors are one of the most important.

CDK4/6 inhibitors in combination with hormonal therapy (aromatase inhibitors, fulvestrant) have shown in a number of trials a convincing increase in progression-free survival, objective response rate [4–12] and in some cases — an advantage in overall survival compared to hormonal therapy as monotherapy [6, 8, 11, 12], making the combination of CDK4/6 and hormonal therapy the unquestioned standard in first-line treatment of metastatic breast cancer [6, 8, 11–However, for a long time the possibility of using CDK4/6 inhibitors in the first-line setting of visceral crisis and aggressive disease was controversial and not considered an acceptable treatment option because of the lack of prospective data supporting the use of CDK4/6 inhibitors in the described clinical setting and their advantages over chemotherapy, which seemed to be an alternative treatment option.

The following case describes the outcome of treatment with ribociclib and anastrozole in a patient with metastatic luminal breast cancer complicated by visceral crisis.

Immunotherapy (IT) is one of the main ways to treat solid tumors. Indications for IT become more extensive every year, and data on monitoring and treating autoimmune adverse events are accumulating. Rare complications become more common. In this clinical case, we show experience of using chemoimmunotherapy in the neoadjuvant setting of locally advanced gastric cancer with the presence of microsatellite instability and autoimmune adverse event — ocular myasthenia gravis.

Pancreatic neuroendocrine tumors (PNETs) are frequently asymptomatic (in >50% of patients) and are diagnosed at stage IV, typically with synchronous liver metastases. Patients with initially unresectable PNETs presenting with massive liver involvement, systemic intoxication, and multiorgan failure face poor prognosis and often have contraindications to antitumor therapy. We present a clinical case of a female patient followed in St. Petersburg medical institutions since 2009 for multifocal liver lesions initially diagnosed as «hepatic hemangiomatosis». Since January 2016, she has been managed at the A. M. Granov Russian Research Center with diagnosis: PNET G2 T3N1M1 (>80% liver involvement). At initial diagnosis, her condition was graded as severe (ECOG 3) with rapid deterioration due to progressive hepatic failure. The clinical complexity was compounded by contraindications to systemic therapy. The patient received a center-developed treatment algorithm incorporating locoregional approaches. Following treatment, partial response was achieved, allowing treatment-free interval from October 2021 to July 2024, after which systemic therapy was initiated. Currently, the patient is asymptomatic with satisfactory performance status (ECOG 0–1).

A clinical case of ineffectiveness of four-fold transarterial chemoembolization of hepatocellular carcinoma is presented, which was caused by the formation of parasitic blood supply to the tumor from extrahepatic sources.