Organization clinical decision-making programs in the local practice of the region: problematic issues that determine the choice of therapy in the progression of endometrial cancer

Abstract

Introduction. For the treatment of uterine body cancer (UBC), modern oncologists have at their disposal clinical recommendations of scientific communities, the set of drug options in which is represented by a limited range of drugs that have not been studied enough (phase II studies, no more than 52 patients in each). There is an obvious lack of information about clinical routine data systematization algorithms that describe the molecular biological features of the tumor, its prevalence, patient characteristics, existing treatment models, and form a decision-making program when planning the treatment of UBC patients.Aim. Тo develop an algorithm for routing patients with UBC on the territory of the Krasnodar Region in the existing conditions for organizing medical care and human resources.Materials and methods. Local observational retrospective study. Sources – medical records. The data were collected by the co-authors of the article in the course of daily clinical activities. Information from the medical records of 72 patients with endometrial cancer who were referred for microsatellite instability (MSI) testing at the Oncological Dispensary of Krasnodar from 01/01/2021 to 11/16/2022 was analyzed to determine the possibility of receiving immuno/immuno-targeted therapy in the second and subsequent lines medicinal treatment.Results. In the Krasnodar Oncological Dispensary all the therapy options specified in the clinical guidelines were used. One line of systemic therapy for a common disease was received by 61 patients out of 72, only 41 patients received the second line, and only 19 patients received the third line. Five patients received the immunotargeted combination in the second line and 3 in the third. One patient received immunotherapy with pembrolizumab in the third line. One patient received immunotherapy with pembrolizumab in the third line. An analysis of the factors influencing the possibility of receiving this therapy showed the importance of timely genetic testing of MSI, as well as related organizational issues, such as the ability to quickly receive treatment and ensure appropriate follow-up of patients.Conclusions. Based on the study, low awareness of clinicians about the possibility and necessity of early testing for the presence of MSI in an endometrial tumor was revealed. The organization of delivery of material from clinics that have a territorial remoteness, insufficient access to patient consultations by related specialists, and low patient compliance limit the introduction of modern methods of therapy for UBC patients. Establishing a system of close professional interaction between physicians will contribute to a wider introduction of new methods of diagnosis and treatment of UBC patients.