Эффективность и безопасность применения препарата эмпэгфилграстим (Экстимия®) у пациентов с солидными опухолями, получающих цитотоксическую терапию: финальные результаты исследования DEFENDOR
Эффективность и безопасность применения препарата эмпэгфилграстим (Экстимия®) у пациентов с солидными опухолями, получающих цитотоксическую терапию: финальные результаты исследования DEFENDOR
Snegovoy AV, Kononenko IB, Radiukova IM, Orlova SA, Sultanbaev AV, Dubovichenko DM, Dergunov AS, Saidullaeva AF, Repina NN, Gronskaia IuA, Rossokha EI, Starostina TV, Akimova OV, Vasil'eva IuA, Godzhieva ZA, Garanina OIu, Gorchkhanova KhI, Machekhina IuS, Gracheva AS, Danilova AE, Dmitrakova TN, Dmitriev VN, Dmitrochenko MV, Dylinova OV, El'kova VO, Zhelezniak AV, Zubova IV, Ivanov AN, Kaleikina LP, Komoza IuV, Korolev DN, Lebedeva LN, Lebedinets AA, Mamedguseinova NN, Miagkova VS, Matiushina EI, Narovenkova KV, Nikolaeva VM, Novikov DV, Polonskaia GE, Rebrina OV, Safronova MA, Semenova AS, Semenova IA, Skotnikov RA, Solov'eva EP, Tat'ianenko AN, Teterich AA, Timin VN, Tolmacheva IA, Tiugina IaA, Khodkevich AV, Tsarakhova FV, Chapko IaS, Shegurova MM, Shakurova NR, Shalina AI, Shumilkina EA, Iakuba DV, Ibragimova TM, Feoktistova PS, Sorokina IV, Berezina AM, Kiseleva PV, Mironenko ON, Prosianikova ON. Effectiveness and safety of empegfilgrastim (Extimia®) in patients with solid tumors receiving cytotoxic therapy: final results of the DEFENDOR study. Journal of Modern Oncology. 2024;26(2):159–171. DOI: 10.26442/18151434.2024.2.202829
Эффективность и безопасность применения препарата эмпэгфилграстим (Экстимия®) у пациентов с солидными опухолями, получающих цитотоксическую терапию: финальные результаты исследования DEFENDOR
Цель. Оценка эффективности и безопасности применения препарата Экстимия® (эмпэгфилграстим, АО «БИОКАД») с целью снижения частоты, продолжительности нейтропении, частоты возникновения фебрильной нейтропении (ФН) и инфекций, развившихся по причине ФН, у пациентов с солидными опухолями, получающих миелосупрессивную терапию. Материалы и методы. В работе представлены финальные результаты многоцентрового проспективного наблюдательного пострегистрационного исследования безопасности и эффективности препарата Экстимия® (эмпэгфилграстим) у пациентов c солидными опухолями, получающих цитотоксическую терапию. Всем пациентам для первичной профилактики ФН вводили эмпэгфилграстим в дозе 7,5 мг подкожно однократно на курс химиотерапии (ХТ) через 24 ч после окончания введения химиопрепаратов. Первичная конечная точка включала оценку относительной дозоинтенсивности (ОДИ) проведенных курсов ХТ. Конечные точки, представляющие интерес, включали оценку ОДИ проведенных курсов ХТ в разбивке по нозологиям и схемам ХТ, частоту дозолимитирующей нейтропении, частоту развития всех нежелательных реакций у пациентов, получивших хотя бы одну дозу исследуемого препарата, включая серьезные НР. Результаты. С февраля 2021 по декабрь 2022 г. в 41 исследовательском центре Российской Федерации включены 3218 пациентов с различными злокачественными новообразованиями. Из них 3217 (99,97%) пациентов получили хотя бы одну дозу исследуемого препарата, 2663 (82,8%) пациента вошли в популяцию по оценке ОДИ согласно протоколу исследования. Средний возраст в данной группе больных составил 56,9 года (18–84). ОДИ≥85% достигнута у 2415 (90,7%) пациентов. Среднее значение ОДИ составило 96,2% с медианой 100%. Факторы риска развития ФН присутствовали у 1216 (45,7%) пациентов, причем возраст ≥65 лет был наиболее распространенным фактором риска – 761/2663 (28,6%). Следует отметить, что у пациентов моложе 65 лет ОДИ составляла 91,5%, а у пожилых пациентов (≥65 лет) – 88,7%. Дозолимитирующая нейтропения зафиксирована у 19 (0,7%) пациентов. Зарегистрировано 74 нежелательных явления 3–4-й степени тяжести по CTCAE v.5 у 59 (1,8%) пациентов. Наиболее частыми среди них были нейтропения, анемия и диарея у 19 (0,7%), 7 (0,2%) и 6 (0,2%) пациентов соответственно. Серьезные нежелательные явления наблюдались у 17 (0,5%) пациентов. Заключение. Первичная профилактика ФН пролонгированным гранулоцитарным колониестимулирующим фактором эмпэгфилграстимом позволяет эффективно поддерживать ОДИ в различных нозологических и терапевтических группах у больных с различными режимами ХТ в рутинной клинической практике.
Aim. To evaluate the effectiveness and safety of Extimia® (empegfilgrastim, JSC "BIOCAD") in reducing the frequency, duration of neutropenia, the incidence of febrile neutropenia (FN) and infections caused by FN in patients with solid tumors receiving myelosuppressive therapy. Materials and methods. The paper presents the final results of a multicenter prospective observational post-marketing study of the safety and effectiveness of Extimia® (empegfilgrastim) in patients with solid tumors receiving cytotoxic therapy. For the primary prevention of FN, all patients received empegfilgrastim at 7.5 mg subcutaneously once per course of chemotherapy (CT) 24 hours after the end of CT administration. The primary endpoint included an assessment of the relative dose-intensity (RDI) of the CT courses administered. The endpoints of interest included the assessment of the RDI of CT courses by nosology and CT regimen, the frequency of dose-limiting neutropenia, and the incidence of all adverse events (AEs) in patients who received at least one dose of the study medication, including serious AEs. Results. From February 2021 to December 2022, 3218 patients with various malignancies were included in 41 study centers of the Russian Federation. Of these, 3217 (99.97%) patients received at least one dose of the study drug, and 2663 (82.8%) patients were included in the RDI evaluation population according to the study protocol. The mean age in this group was 56.9 (18–84) years. RDI ≥85% was achieved in 2,415 (90.7%) patients. The mean RDI was 96.2%, with a median of 100%. FN risk factors were present in 1216 (45.7%) patients, with age ≥65 years being the most common risk factor at 761/2663 (28.6%). It should be noted that in patients younger than 65 years, the RDI was 91.5%, and in elderly patients (≥65 years) 88.7%. Dose-limiting neutropenia was reported in 19 (0.7%) patients. There were 74 cases of grade 3–4 AEs (according to CTCAE v.5) in 59 (1.8%) patients. The most common were neutropenia, anemia, and diarrhea in 19 (0.7%), 7 (0.2%), and 6 (0.2%) patients, respectively. Serious AEs were reported in 17 patients (0.5%). Conclusion. Primary prophylaxis of FN with long-acting granulocyte colony-stimulating factor empegfilgrastim effectively maintains RDI in various nosological and therapeutic groups of patients with different CT regimens in real-world clinical practice.
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3. Bosly A, Bron D, Van Hoof A, et al. Achievement of optimal average relative dose intensity and correlation with survival in diffuse large B-cell lymphoma patients treated with CHOP. Ann Hematol. 2008;87:277-83.
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DOI:10.17650/1818-8346-2022-17-1-135-142
8. Hanna RK, Poniewierski MS, Laskey RA, et al. Predictors of reduced relative dose intensity and its relationship to mortality in women receiving multi-agent chemotherapy for epithelial ovarian cancer. Gynecol Oncol. 2013;129:74-80.
9. Loibl S, Skacel T, Nekljudova V, et al. Evaluating the impact of relative total dose intensity (RTDI) on patients’ short and long-term outcome in taxane- and anthracycline-based chemotherapy of metastatic breast cancer – a pooled analysis. BMC Cancer. 2011;11:131.
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15. Naeim A, Henk HJ, Becker L, et al. Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis: a retrospective United States claims analysis of granulocyte colonystimulating factors (G-CSF). BMC Cancer. 2013;13:11.
16. Снеговой А.В., Кононенко И.Б., Сорокина И.В., и др. Частота встречаемости схем с высоким риском развития фебрильной нейтропении и частота развития дозолимитирующей нейтропении среди пациентов, получающих цитотоксическую терапию по поводу злокачественных новообразований: результаты исследования FLAME. Современная Онкология. 2023;25(3):378-84 [Snegovoy AV, Kononenko IB, Sorokina IV, et al. The frequency of regimens associated with high risk of febrile neutropenia and the incidence of dose-limiting neutropenia among patients receiving cytotoxic therapy for malignancies: the FLAME study results. Journal of Modern Oncology. 2023;25(3):378-4 (in Russian)]. DOI:10.26442/18151434.2023.3.202452
17. Cornes P, Gascon P, Chan S, et al. Systematic Review and Meta-analysis of Shortversus Long-Acting Granulocyte Colony-Stimulating Factors for Reduction of Chemotherapy-Induced Febrile Neutropenia. Adv Ther. 2018;35(11):1816-29. DOI:10.1007/s12325-018-0798-6
18. Wang Y, Chen L, Liu F, et al. Efficacy and tolerability of granulocyte colony-stimulating factors in cancer patients after chemotherapy: A systematic review and Bayesian network meta-analysis. Sci Rep. 2019;9(1):15374. DOI:10.1038/s41598-019-51982-4
19. Криворотько П.В., Бурдаева О.Н., Ничаева М.Н., и др. Эффективность и безопасность препарата ЭКСТИМИЯ® (эмпэгфилграстим) у пациентов с диагнозом «рак молочной железы», получающих миелосупрессивную химиотерапию: результаты двойного слепого сравнительного клинического исследования III фазы. Современная Онкология. 2015;17(2):45-5 [Krivorotko PV, Burdaeva ON, Nechaeva MN, et al. Efficacy and safety of Extimia® (empegfilgrastim): results of a double-blind controlled phase III study in patients with diagnosis «breast cancer» receiving myelosuppressive chemotherapy. Journal of Modern Oncology. 2015;17(2):45-52 (in Russian)].
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21. Madry R, Poplawska L, Haslbauer F, et al. Results of a prospective dose intensity and neutropenia prophylaxis evaluation programme (DIEPP) in cancer patients at risk of febrile neutropenia due to myelosuppressive chemotherapy. Wien Klin Wochenschr. 2016;128:238-2.
22. National Comprehensive Cancer Network. Practice Guidelines in Oncology (NCCN Guidelines®) V.3.2024. January 30, 2024.
23. Green MD, Koelbl H, Baselga J, et al. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol. 2003;14:29-35.
24. Holmes FA, Jones SE, O’Shaughnessy, et al. Comparable efficacy and safety profiles of once-per-cycle pegfilgrastim and daily injection filgrastim in chemotherapy-induced neutropenia: a multicenter dose-finding study in women with breast cancer. Ann Oncol. 2002;13:903-9.
25. Green MD, Koelbl H, Baselga J, et al. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol. 2003;14:29-35.
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1. Lyman GH. Impact of chemotherapy dose intensity on cancer patient outcomes. J Natl Compr Canc Netw. 2009;7:99-108.
2. Bonadonna G, Valagussa P, Moliterni A, et al. Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: the results of 20 years of follow-up. N Engl J Med. 1995;332:901-6.
3. Bosly A, Bron D, Van Hoof A, et al. Achievement of optimal average relative dose intensity and correlation with survival in diffuse large B-cell lymphoma patients treated with CHOP. Ann Hematol. 2008;87:277-83.
4. Budman DR, Berry DA, Cirrincione CT, et al. Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. Cancer and Leukemia Group B. J Natl Cancer Inst. 1998;90:1205-11.
5. Chirivella I, Bermejo B, Insa A, et al. Optimal delivery of anthracycline-based chemotherapy in the adjuvant setting improves outcome of breast cancer patients. Breast Cancer Res Treat. 2009;114:479-84.
6. Wildiers H, Reiser M. Relative dose intensity of chemotherapy and its impact on outcomes in patients with early breast cancer or aggressive lymphoma. Crit Rev Oncol Hematol. 2011;77:221-40.
7. Kononenko IB, Snegovoy AV, Larionova VB. Chemotherapy limiting neutropenia. Is prevention required? Oncohematology. 2022;17(1):135-42 (in Russian).
DOI:10.17650/1818-8346-2022-17-1-135-142
8. Hanna RK, Poniewierski MS, Laskey RA, et al. Predictors of reduced relative dose intensity and its relationship to mortality in women receiving multi-agent chemotherapy for epithelial ovarian cancer. Gynecol Oncol. 2013;129:74-80.
9. Loibl S, Skacel T, Nekljudova V, et al. Evaluating the impact of relative total dose intensity (RTDI) on patients’ short and long-term outcome in taxane- and anthracycline-based chemotherapy of metastatic breast cancer – a pooled analysis. BMC Cancer. 2011;11:131.
10. Nielson CM, Bylsma LC, Fryzek JP, et al. Relative Dose Intensity of Chemotherapy and Survival in Patients with Advanced Stage Solid Tumor Cancer: A Systematic Review and Meta-Analysis. Oncologist. 2021;26(9):e1609-18. DOI:10.1002/onco.13822
11. Seebacher V, Reinthaller A, Koelbl H, et al. The Impact of the Duration of Adjuvant Chemotherapy on Survival in Patients with Epithelial Ovarian Cancer – A Retrospective Study. PloS One. 2017;12(1):e0169272. DOI:10.1371/journal.pone.0169272
12. Li L, Ma S, Wu M, et al. The prophylactic effects of long-acting granulocyte colony-stimulating factor for febrile neutropenia in newly diagnosed patients with epithelial ovarian cancer: a randomized controlled study. BMJ Support Palliat Care. 2019;9(4):373-80. DOI:10.1136/bmjspcare-2019-001862
13. Canton C, Boussari O, Boulin M, et al. Impact of G-CSF Prophylaxis on Chemotherapy Dose-Intensity, Link Between Dose-Intensity and Survival in Patients with Metastatic Pancreatic Adenocarcinoma. Oncologist. 2022;27(7):e571-9. DOI:10.1093/oncolo/oyac055
14. Holmes FA, Jones SE, O’Shaughnessy J, et al. Comparable efficacy and safety profiles of once-per-cycle pegfilgrastim and daily injection filgrastim in chemotherapy induced neutropenia: a multicenter dose-finding study in women with breast cancer. Ann Oncol. 2002;13:903-9.
15. Naeim A, Henk HJ, Becker L, et al. Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis: a retrospective United States claims analysis of granulocyte colonystimulating factors (G-CSF). BMC Cancer. 2013;13:11.
16. Snegovoy AV, Kononenko IB, Sorokina IV, et al. The frequency of regimens associated with high risk of febrile neutropenia and the incidence of dose-limiting neutropenia among patients receiving cytotoxic therapy for malignancies: the FLAME study results. Journal of Modern Oncology. 2023;25(3):378-4 (in Russian). DOI:10.26442/18151434.2023.3.202452
17. Cornes P, Gascon P, Chan S, et al. Systematic Review and Meta-analysis of Shortversus Long-Acting Granulocyte Colony-Stimulating Factors for Reduction of Chemotherapy-Induced Febrile Neutropenia. Adv Ther. 2018;35(11):1816-29. DOI:10.1007/s12325-018-0798-6
18. Wang Y, Chen L, Liu F, et al. Efficacy and tolerability of granulocyte colony-stimulating factors in cancer patients after chemotherapy: A systematic review and Bayesian network meta-analysis. Sci Rep. 2019;9(1):15374. DOI:10.1038/s41598-019-51982-4
19. Krivorotko PV, Burdaeva ON, Nechaeva MN, et al. Efficacy and safety of Extimia® (empegfilgrastim): results of a double-blind controlled phase III study in patients with diagnosis «breast cancer» receiving myelosuppressive chemotherapy. Journal of Modern Oncology. 2015;17(2):45-52 (in Russian).
20. Chu E, DeVita VT Jr. Principles of Cancer Management. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005; pp. 295-306.
21. Madry R, Poplawska L, Haslbauer F, et al. Results of a prospective dose intensity and neutropenia prophylaxis evaluation programme (DIEPP) in cancer patients at risk of febrile neutropenia due to myelosuppressive chemotherapy. Wien Klin Wochenschr. 2016;128:238-2.
22. National Comprehensive Cancer Network. Practice Guidelines in Oncology (NCCN Guidelines®) V.3.2024. January 30, 2024.
23. Green MD, Koelbl H, Baselga J, et al. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol. 2003;14:29-35.
24. Holmes FA, Jones SE, O’Shaughnessy, et al. Comparable efficacy and safety profiles of once-per-cycle pegfilgrastim and daily injection filgrastim in chemotherapy-induced neutropenia: a multicenter dose-finding study in women with breast cancer. Ann Oncol. 2002;13:903-9.
25. Green MD, Koelbl H, Baselga J, et al. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol. 2003;14:29-35.
26. Holmes FA, Jones SE, O’Shaughnessy J, et al. Comparable efficacy and safety profiles of once-per-cycle pegfilgrastim and daily injection filgrastim in chemotherapy-induced neutropenia: a multicenter dose-finding study in women with breast cancer. Ann Oncol. 2002;13:903-9.
27. Siena S, Piccart MJ, Holmes FA, et al. A combined analysis of two pivotal randomized trials of a single dose of pegfilgrastim per chemotherapy cycle and daily filgrastim in patients with stage II–IV breast cancer. Oncol Rep. 2003;10:715-24.
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31. Morita S, Kikumori T, Tsunoda N, et al. Feasibility of dose-dense epirubicin and cyclophosphamide with subcutaneous pegfilgrastim 3.6 mg support: a single-center prospective study in Japan. Int J Clin Oncol. 2018;23(1):195-200.
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1Научно-исследовательский институт урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, Москва, Россия; 2БУЗ Омской области «Клинический онкологический диспансер», Омск, Россия; 3АУ «Республиканский клинический онкологический диспансер» Минздрава Чувашии, Чебоксары, Россия; 4ГАУЗ «Республиканский клинический онкологический диспансер» Минздрава Республики Башкортостан, Уфа, Россия; 5ГБУЗ Архангельской области «Архангельский клинический онкологический диспансер», Архангельск, Россия; 6ГБУЗ «Тверской областной клинический онкологический диспансер», Тверь, Россия; 7ГУЗ «Тульский областной клинический онкологический диспансер», Тула, Россия; 8ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург, Россия; 9КГБУЗ «Алтайский краевой онкологический диспансер», Барнаул, Россия; 10БУЗ Воронежской области «Воронежский областной клинический онкологический диспансер», Воронеж, Россия; 11ОБУЗ «Курский онкологический научно-клинический центр им. Г.Е. Островерхова», Курск, Россия; 12ГБУЗ Псковской области «Псковский областной клинический онкологический диспансер», Псков, Россия; 13ГБУЗ «Республиканский онкологический диспансер» Минздрава Республики Северной Осетии – Алании, Владикавказ, Россия; 14ГАУЗ «Брянский областной онкологический диспансер», Брянск, Россия; 15ГБУ «Республиканский онкологический диспансер» Республики Ингушетии, Назрань, Россия; 16ГБУЗ «Городская клиническая больница им. С.П. Боткина» Департамента здравоохранения г. Москвы, Москва, Россия; 17СПб ГБУЗ «Городская поликлиника №106», Санкт-Петербург, Россия; 18ОГБУЗ «Белгородский областной онкологический диспансер», Белгород, Россия; 19ОГБУЗ «Смоленский областной онкологический клинический диспансер», Смоленск, Россия; 20ГБУЗ Ярославской области «Областная клиническая онкологическая больница», Ярославль, Россия; 21ГАУЗ НО НИИКО «Нижегородский областной клинический онкологический диспансер», Нижний Новгород, Россия; 22ГБУЗ Республики Мордовии «Республиканский онкологический диспансер», Саранск, Россия; 23ГБУЗ «Приморский краевой онкологический диспансер», Владивосток, Россия; 24ГБУЗ «Ленинградская областная клиническая больница», Санкт-Петербург, Россия; 25ГБУ Ростовской области «Онкологический диспансер», Ростов-на-Дону, Россия; 26ГУ «Коми республиканский онкологический диспансер», Сыктывкар, Россия; 27ГБУ Республики Саха (Якутия) «Якутский республиканский онкологический диспансер», Якутск, Россия; 28ОБУЗ «Ивановский областной онкологический диспансер», Иваново, Россия; 29ОГАУЗ ТО «Томский областной онкологический диспансер», Томск, Россия; 30ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия; 31АО «Биокад», Санкт-Петербург, Россия; 32ФГБОУ ВО «Российская академия народного хозяйства и государственной службы при Президенте Российской Федерации», Москва, Россия
*drsneg@gmail.com
________________________________________________
Anton V. Snegovoy*1, Inessa B. Kononenko1, Irina M. Radiukova2, Svetlana A. Orlova3, Alexander V. Sultanbaev4, Daria M. Dubovichenko5, Aleksandr S. Dergunov6, Aleksandra F. Saidullaeva6, Nadezhda N. Repina7, Iuliia A. Gronskaia8, Elena I. Rossokha9, Tatiana V. Starostina10, Oksana V. Akimova11, Iuliia A. Vasil'eva12, Zarina A. Godzhieva13, Ol'ga Iu. Garanina14, Khava I. Gorchkhanova15, Iuliia S. Machekhina16, Aleksandra S. Gracheva6, Anastasiia E. Danilova17, Tat'iana N. Dmitrakova14, Vadim N. Dmitriev18, Marina V. Dmitrochenko19, Olga V. Dylinova20, Viktoriia O. El'kova10, Alla V. Zhelezniak21, Irina V. Zubova19, Aleksandr N. Ivanov3, Liliia P. Kaleikina22, Iuliia V. Komoza14, Dmitrii N. Korolev23, Liudmila N. Lebedeva5, Andrei A. Lebedinets24, Naira N. Mamedguseinova25, Valeriia S. Miagkova25, Elena I. Matiushina26, Kristina V. Narovenkova14, Valentina M. Nikolaeva27, Denis V. Novikov6, Galina E. Polonskaia6, Olesia V. Rebrina19, Mariia A. Safronova19, Anna S. Semenova27, Inessa A. Semenova14, Roman A. Skotnikov7, Ekaterina P. Solov'eva5, Anna N. Tat'ianenko6, Antonina A. Teterich18, Vladimir N. Timin26, Irina A. Tolmacheva14, Iana A. Tiugina28, Aleksandra V. Khodkevich14, Fatima V. Tsarakhova13, Iana S. Chapko5, Margarita M. Shegurova21, Nadezhda R. Shakurova29, Anna I. Shalina20, Elena A. Shumilkina3, Daria V. Iakuba6, Tansylu M. Ibragimova30, Polina S. Feoktistova30, Irina V. Sorokina30,31, Anna M. Berezina32, Polina V. Kiseleva31, Olga N. Mironenko32, Oxana N. Prosianikova31
1Lopatkin Scientific Research Institute of Urology – branch of the National Medical Research Radiological Centre, Moscow, Russia; 2Clinical Oncology Dispensary, Omsk, Russia; 3Republican Clinical Oncology Dispensary, Cheboksary, Russia; 4Republican Clinical Oncology Dispensary, Ufa, Russia; 5Arkhangelsk Clinical Oncology Dispensary, Arkhangelsk, Russia; 6Tver Regional Clinical Oncology Dispensary, Tver, Russia; 7Tula Regional Clinical Oncology Dispensary, Tula, Russia; 8Saint Petersburg State University, Saint Petersburg, Russia; 9Altai Regional Oncology Dispensary, Barnaul, Russia; 10Voronezh Regional Clinical Oncology Dispensary, Voronezh, Russia; 11Ostoverkhov Kursk Oncology Scientific and Clinical Center, Kursk, Russia; 12Pskov Regional Clinical Oncology Dispensary, Pskov, Russia; 13Regional Oncology Dispensary, Vladikavkaz, Russia; 14Briansk Regional Oncology Dispensary, Briansk, Russia; 15Republican Oncology Dispensary, Nazran, Russia; 16Botkin Hospital, Moscow, Russia; 17City Clinic No. 106, Saint Petersburg, Russia; 18Belgorod Oncology Dispensary, Belgorod, Russia; 19Smolensk Regional Oncology Clinical Dispensary, Smolensk, Russia; 20Regional Clinical Oncology Hospital, Yaroslavl, Russia; 21Nizhniy Novgorod Regional Clinical Oncology Dispensary, Nizhniy Novgorod, Russia; 22Republican Oncology Dispensary, Saransk, Russia; 23Primorsky Regional Oncology Dispensary, Vladivostok, Russia; 24Leningrad Regional Clinical Hospital, Saint Petersburg, Russia; 25Oncology Dispensary, Rostov-on-Don, Russia; 26Komi Republican Oncology Dispensary, Syktyvkar, Russia; 27Yakutsk Republican Oncology Dispensary, Yakutsk, Russia; 28Ivanovo Regional Oncology Dispensary, Ivanovo, Russia; 29Tomsk Regional Oncology Dispensary, Tomsk, Russia; 30Loginov Moscow Clinical Scientific Center, Moscow, Russia; 31JSC "Biocad", Saint Petersburg, Russia; 32Russian Academy of National Economy and Public Administration of the President of the Russian Federation, Moscow, Russia
*drsneg@gmail.com