Oncohematology: to act instead of putting off

Every year on February 4, World Cancer Day is celebrated. On this occasion, the Russian Society of Oncohematologists and the Russian Association of Oncologists held a discussion on the topic "Oncohematology: to act instead of putting off."

Oncohematology is an important field of oncology that covers malignant diseases of the blood and lymphatic tissue. This includes lymphomas. There are two types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Follicular lymphoma is the most common indolent (lethargic) form of NHL, and Diffuse large B-cell lymphoma (DLBCL) is its most common aggressive form.

"Lymphomas account for 8% of all malignant neoplasms and occupy the sixth place among the causes of cancer mortality in Russia. This indicates a high urgency of the problem and the need to find solutions to improve the situation," said Dr. Irina Poddubnaya, professor, RAS academician, Head of the Department of Oncology and Palliative Medicine named after Savitsky of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Federal State Budgetary Educational Institution for Additional Professional Education.

Until recently, these diseases had an extremely unfavorable prognosis. Today, modern therapy can significantly increase a patient's life expectancy, and some oncohematological diseases have become virtually curable.

"Analysis of the fate of patients in recent decades shows that with a modern therapeutic approach it is possible to increase overall survival by a factor of 3-4 or more. This is a consequence of the fact that we are getting new medicinal products all the time.

Oncohematology is an area where advances in fundamental medicine are being introduced very quickly. And this is where all the attention of the state should be directed, in order to provide the maximum therapeutic effect to the patients," Irina Poddubnaya said.

According to Professor Gayane Tumyan, M.D., Head of the Department of Hemoblastosis Chemotherapy at the N.N. Blokhin Oncology Research Center of the Ministry of Healthcare of the Russian Federation, only 60-70% of patients with Diffuse large B-cell lymphoma (DLBCL) respond to standard therapy. Approximately 30-40% of patients have an unfavorable prognosis. In patients with early relapses or refractory DLBCL, the survival rate is usually less than 6 months. But, fortunately, the situation is changing.

"Every year, innovative medicinal products emerge that demonstrate unprecedented efficacy rates," Irina Poddubnaya says. "For example, for the treatment of adult patients with relapsed/refractory diffuse B-cell non-Hodgkin's lymphoma, a modern drug therapy has recently emerged that significantly increases their survival rate."

This refers to immunoconjugate, a new drug for the treatment of DLBCL, which recently appeared in Russia, and it is important given the statistics of morbidity.

According to Natalia Falaleeva, Head of the Department of Anti-Tumor Drug Treatment at Medical Radiological Scientific Center named after A.F. Tsyb - a branch of Scientific Research Center of Radiology of the Russian Ministry of Healthcare, the average age of NHL patients is about 60 years, but the disease can occur at any age. Lymphoma can be sluggish or rapidly progressing, and the therapeutic tactics depend on this.

According to Falaleeva, for indolent lymphomas, there is a “watch and wait” tactic, while for aggressive lymphomas, treatment should be started as soon as possible. “Aggressive lymphoma behaves aggressively both at the initial occurrence and during the progression or recurrence of the disease. Accordingly, the patient cannot wait long for the next stage of treatment to begin,” Falaleeva emphasizes.

Professor Tumyan agrees, "There is a rule in oncology: everything that is effective must be included in the first line of therapy. Because these diseases must be "killed with the first shot". Using an effective, innovative drug in the second or third stages can bring a completely different effect than we were entitled to expect."

"It is important that we do not miss this current wave of development of modern science, especially in oncohematology," Professor Andrei Kaprin, M.D., Academician of RAS, Chief freelance specialist oncologist of the Russian Ministry of Healthcareand General Director of Scientific Research Center of Radiology of the Russian Ministry of Healthcare, believes.

This is why it is necessary to introduce new methods of treatment into practice as soon as possible. It is important to make innovative medicinal products available as quickly as possible, emphasizes Tumyan, by including them in clinical guidelines, the list of vital and essential drugs (VED) and the OMI funding model.

The expert adds that there are challenges when it comes to ensuring rapid access. When patients are counting in days, administrative "delays" can play a fatal role. Therefore, not only medical specialists, but also representatives of patient communities call for improvement of mechanisms for introducing innovative methods into practice.

"The patient should understand that the diagnosis is not a verdict," Lilia Matveeva, President of the All-Russian Society of Oncohematology "Sodeistvie", says. "Today this disease is successfully treated, but with timely prescription of therapy."

"Timely information about innovative methods is also valuable. "We need to attend Patient Schools, where high-level specialists tell everything the patient needs to know," Matveeva summarizes. "Patients need to be active and confident. And, of course, they should move forward and not despair and think that life is over. It's not, it goes on!"