Keyword: Treatment

ABSTRACT: Cancer behaves as a dynamic evolutionary system, whereas conventional tissue biopsy and imaging provide incomplete temporal information about how a tumour is changing. This review critically examines whether longitudinal liquid-biopsy measurement, combined with artificial intelligence (AI), can move oncology from tumour monitoring toward genuine prediction of cancer evolution and treatment resistance. We synthesise mechanistic, clinical, and computational evidence on circulating tumour DNA, circulating tumour cells, extracellular vesicles, and multimodal liquid-biopsy platforms, together with AI approaches applied to longitudinal cancer data, drawing on landmark and recent studies across colorectal, lung, breast, and ovarian cancer. Current evidence distinguishes three increasingly demanding tasks: early detection, longitudinal monitoring, and genuine forecasting. Longitudinal circulating tumour DNA analysis can detect molecular progression and emerging resistance mutations months before radiographic progression, and machine-learning models can stratify survival using serial biomarker metrics; however, most published "AI prediction" studies demonstrate earlier detection or prognostic association rather than prospectively validated forecasting of a future, patient-specific event. Biological variability in tumour shedding, analytical noise, small and irregularly sampled longitudinal datasets, overfitting, data leakage, weak external validation, and limited interpretability constrain the transition from detection to actionable prediction. AI-enabled liquid biopsy has genuine potential to forecast tumour trajectories, but current evidence is considerably stronger for molecular monitoring and early detection than for prospectively validated, clinically actionable prediction. Realising this potential will require standardised assays, prospective longitudinal cohorts with predefined prediction horizons, rigorous external and temporal validation, calibrated and interpretable models, and interventional trials linking predictions to treatment decisions before AI-enabled liquid biopsy can be considered ready to guide clinical care.

ABSTRACT: Introduction: Neutrophil extracellular traps (NETs) are web-like structures composed of decondensed chromatin and neutrophil granule proteins. Accumulating evidence suggests that NETs are involved in tumor progression, invasion, and metastasis in breast cancer. Therefore, investigating changes in NET formation during anticancer therapy and their potential use as a marker of treatment efficacy is of particular interest.
Objective: To evaluate the dynamics of induced NET formation during neoadjuvant endocrine therapy (NET) in patients with hormone receptor (HR)-positive breast cancer and to determine its association with changes in primary tumor size.
Materials and Methods: The study included 50 patients with stage II–III HR-positive breast cancer who received neoadjuvant endocrine therapy for 3–6 months. Endocrine therapy included letrozole and toremifene (Fareston); in a subset of patients, toremifene was combined with ovarian suppression using triptorelin (Diphereline). Induced NET formation in peripheral blood was assessed using the method developed by I.I. Dolgushin with pyrogenal stimulation, followed by May–Grünwald azure-eosin staining and microscopy. NET-forming neutrophils were counted per 100 neutrophils. Primary tumor size was assessed by ultrasonography (US) and mammography (MMG). Statistical analysis included the Wilcoxon signed-rank test, Friedman test, and Spearman’s rank correlation.
Results: In the three-time-point analysis of patients with serial measurements (n=32), the median number of induced NETs was 2 [0; 15] at baseline, 0 [0; 1.5] after 3 months, and 2 [0; 6] after 6 months of neoadjuvant endocrine therapy; the overall change did not reach statistical significance (p=0.051). After 3 months of treatment, a reduction in primary tumor size was observed. On US, the median tumor size decreased from 25.0 [22.0; 36.25] to 21.0 [18.0; 27.25] mm (p<0.001), while on MMG it decreased from 29.0 [21.5; 36.5] to 24.0 [18.0; 30.5] mm (p=0.049). The median relative reduction was 16.0% and 11.8%, respectively. No statistically significant correlation was found between changes in NET formation and the percentage change in tumor size after 3 months: US, rₛ=0.139, p=0.351; MMG, rₛ=0.015, p=0.918.
Conclusion: Changes in induced NET formation were observed during neoadjuvant endocrine therapy, with the lowest values recorded after 3 months of treatment. However, no association was established between changes in NET formation and the degree of primary tumor size reduction. These interim findings do not support the use of induced NET dynamics as a standalone marker of radiological response to neoadjuvant endocrine therapy and warrant further evaluation in a larger cohort.

ABSTRACT: Background: Adjuvant chemotherapy is the standard of care after radical resection of stage III colon cancer. Key process quality indicators include the use of standard regimens, timely treatment initiation, treatment completion, and documentation of reasons for deviations. In Kazakhstan, data on these indicators and regional patient pathways remain limited.
Objective: To assess process quality indicators of adjuvant chemotherapy after radical surgery, taking into account subsequent treatment provided at the patients’ place of residence.
Materials and Methods: This single-center retrospective cohort study included 45 patients aged ≥18 years with morphologically confirmed stage III colon cancer who underwent radical resection at the National Scientific Oncology Center between January 9, 2021, and December 5, 2023. Patients with distant metastases at surgery, prior neoadjuvant chemotherapy, or rectal cancer were excluded. Subsequent treatment was mainly provided at the patients’ place of residence, and data were retrieved from medical records. We assessed treatment administration, reasons for non-initiation, use of standard regimens, time to treatment initiation, proportion of planned cycles completed, and reasons for non-completion. Descriptive statistics were performed using IBM SPSS Statistics. Interregional comparisons were not performed due to small and uneven subgroup sizes.
Results: Adjuvant chemotherapy was administered to 36/45 patients (80.0%). Among nine untreated patients, one had medical contraindications, one refused treatment, and the reason was undocumented in seven. Standard regimens were used in 34/36 patients (94.4%). Among 34 patients with available timing data, median time to treatment initiation was 5.4 weeks (range, 1.0–11.7), and 31 (91.2%) started within 8 weeks. Among 34 patients with data on planned cycles, the median proportion of completed cycles was 70.8% (range, 25.0–100.0%); 15 (44.1%) completed the full course and 17 (50.0%) received ≥75% of planned cycles. Among 19 patients who did not complete treatment, reasons included progression in seven, toxicity in three, and coronavirus infection, drug unavailability, and death due to stroke in one case each; the reason was undocumented in six. Patients represented 12 regions, with subgroup sizes of 1–18 patients.
Conclusions: Most patients received standard adjuvant chemotherapy and initiated treatment within the recommended timeframe; however, fewer than half completed the full planned course. Reasons for non-completion were heterogeneous and should not be interpreted as a single marker of inadequate quality of care. Incomplete documentation and interregional patient pathways limited the assessment. Expansion of the registry and standardized data exchange are required for further analysis.

ABSTRACT: Introduction: Colorectal cancer remains one of the leading causes of cancer morbidity and mortality. Timely detection of metastases and assessment of treatment efficacy are important tasks in modern oncology. PET/CT with 18F-FDG has limitations related to physiological uptake of the radiopharmaceutical in the intestine and variable sensitivity across different histological tumor types. The use of 68Ga-FAPI, which has high affinity for tumor stroma and low background uptake, is a promising alternative. 
Objective: To evaluate the diagnostic value of PET/CT with 68Ga-FAPI in detecting colorectal cancer metastases and monitoring treatment efficacy.
Materials and Methods: The study included 311 patients with histologically verified colorectal cancer examined between January 2024 and January 2026. The study had a retrospective-prospective design. All patients underwent PET/CT using 68Ga-FAPI. Radiopharmaceutical distribution, the presence of metastatic and additional suspicious lesions, as well as dynamic changes during treatment were assessed. Statistical analysis was performed in Microsoft Excel, calculating mean, median, and SUVmax range. The study was approved by the Local Bioethics Committee of the "Astana Medical University" NJSC (Decision No. 11 dated 27.02.2026).
Results: The mean age of patients was 58.5 years (range 17–87 years); 171 (55.0%) were women and 140 (45.0%) were men. Adenocarcinoma predominated (87%), predominantly G2; the majority of patients had stage II–III disease. Metastases were detected in 31.2% of patients, most frequently in the liver and lymph nodes; recurrence was observed in 13.0%. Additional suspicious lesions requiring verification were identified in 40% of patients. The mean SUVmax of metastatic lesions was 6.46 (range 1.1–13.8), for recurrence – 5.78 (range 2.6–9.5), and for suspicious lesions – 4.02.
Conclusions: PET/CT using 68Ga-FAPI is a promising imaging modality for colorectal cancer, allowing detection of metastatic and additional suspicious lesions and assessment of dynamic changes during antitumor treatment.

ABSTRACT: Castleman disease (CD) is a rare lymphoproliferative disorder with heterogeneous clinical manifestations. This article presents a clinical case of HHV-8–associated multicentric Castleman disease (MCD) in an HIV-negative patient treated at the National Scientific Oncology Center. Diagnostic methods included histological and immunohistochemical evaluation, laboratory investigations, and imaging studies. The choice of therapy is discussed. The patient demonstrated resistance to rituximab monotherapy but achieved a favorable response to R-CHOP chemotherapy. This case highlights the importance of early assessment of HHV-8 status and an individualized approach to treatment selection.