RUDN Journal of MedicineRUDN Journal of MedicineВестник Российского университета дружбы народов. Серия: Медицина2313-02452313-0261Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University)2046810.22363/2313-0245-2018-22-4-365-386ONCOLOGYОНКОЛОГИЯReview ArticleA MODERN VIEW ON THE PROBLEM OF TREATMENT OF UROTHELIAL CANCERСОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ ЛЕЧЕНИЯ УРОТЕЛИАЛЬНОГО РАКАSalnikovaS VСальниковаС В

PhD, Associate Professor Department of Immunology & Allergology, Medical Institute of the Peoples’ Friendship University of Russia

доцент, кафедра иммунологии и аллергологии Медицинского института РУДН

drsalnikova@mail.ruSlavyanskayaT AСлавянскаяТ Аdrsalnikova@mail.ruPeoples’ Friendship University of RussiaРоссийский университет дружбы народовIstitute of ImmunophysiologyИнститут иммунофизиологии15122018224VOL 22, NO4 (2018)ТОМ 22, №4 (2018)36538606022019Copyright ©; 2018, Salnikova S.V., Slavyanskaya T.A.Copyright ©; 2018, Сальникова С.В., Славянская Т.А.2018Salnikova S.V., Slavyanskaya T.A.Сальникова С.В., Славянская Т.А.http://creativecommons.org/licenses/by/4.0https://journals.rudn.ru/medicine/article/view/20468

Urothelial cancer (UC) is one of the leading onco-urological diseases. The lack of clinical manifestations of the disease at earlier stages does not allow assigning an adequate therapy in good time. Currently they extensively use conventional methods of treatment, which are constantly improving. Nevertheless, such methods are not always sufficiently effective: they neither always avert recurring, nor ensure sufficient remission and longevity of a patient. Identification of new trends in the early diagnostics of not only cancers but also pre-cancers plays an important role in forming conceptually new approaches to medical treatments. Molecular genetic features of UC have shown a significant chromosomal mutational variability, the dependence of genetic variations on the tumor invasion level, as well as its high level of immunizing power. Successes achieved in understanding the processes taking place not only in the tumor microenvironment but also in tumors have enabled creating fundamentally new anticancer drugs and achieving a significant progress in treating UC. This article presents a new classification of UCs based on immune histochemical data and molecular genetic characteristics of tumors, presents a cluster analysis of various types of UCs, recites present-day data on the disease incidence, analyses up-to-date conventional and innovative methods of UC treatment including non-specific and specific immunotherapy, describes the underlying mechanisms preventing tumors to evade immune surveillance, shows the role of immune checkpoints and their inhibitors, target and cytokine therapies, tumor vaccines, cell-based therapies, combined and integral methods of noninvasive and metastatic UC, as well as describes the results of clinical trials when using various methods of tumor treatments.

Среди онкоурологических заболеваний одно из ведущих мест принадлежит уротелиальному раку (УР). Отсутствие клинических проявлений на ранних стадиях болезни не позволяет своевременно назначить адекватную терапию. На современном этапе широко используют традиционные методы лечения, которые постоянно совершенствуются. Тем не менее, они не всегда обладают удовлетворительной эффективностью, предотвращают рецидивирование, обеспечивают достаточную ремиссию и продолжительность жизни больного. Определение новых направлений в ранней диагностике не только рака, но и предраковых состояний играет важную роль в формировании принципиально новых подходов к лечению. Молекулярно-генетическая характеристика УР показала значительную хромосомную мутационную изменчивость, зависимость генетических изменений от степени инвазии опухоли, а также его высокую иммуногенность. Успехи, достигнутые в понимании процессов, происходящих не только в опухолевом микроокружении, но и самой опухоли, позволили создать принципиально новые противоопухолевые препараты и добиться значительного прогресса в лечении УР. В статье представлена новая классификация УР, основанная на данных иммуногистохимии и молекулярно-генетической характеристике опухоли; представлен кластерный анализ различных типов УР; изложены современные данные по распространенности УР; проведен анализ современных традиционных и инновационных методов лечения УР, включая неспецифическую и специфическую иммунотерапию; описаны основные молекулярные механизмы, препятствующие опухоли ускользать от иммунного надзора; показана роль иммунных чек-поинтов и их ингибиторов, таргетной и цитокинотерапии, противоопухолевых вакцин, клеточной терапии, комбинированных и комплексных методов в управлении неинвазивным и метастатическим УР, а также описаны результаты некоторых клинических испытаний при использовании различных методов лечения опухоли.

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