Modern Oncology: Innovations in Cancer Diagnosis and Targeted Therapy

Introduction: Evolution of Approaches in Oncology

Oncological diseases remain one of the leading causes of death worldwide, requiring the continuous development of diagnostic and therapeutic strategies. Modern oncology strives for a personalized approach based on a deep understanding of tumor biology and individual patient characteristics. This includes the development of high-precision imaging methods, innovative pharmaceuticals, and targeted radionuclide therapies that allow for more effective cancer combat while minimizing side effects.

Accurate Diagnostics: From Biopsy to Molecular Imaging

A key stage in the fight against cancer is timely and accurate diagnosis. The choice of optimal treatment tactics depends on the correct determination of the tumor type and its stage.

• The importance of adequate tissue sampling: In some cases, especially in rare forms of cancer, an initial biopsy may be insufficient for a definitive diagnosis. For example, in one clinical case of primary gastric squamous cell carcinoma in an elderly female patient, the initial biopsy with a limited tissue sample indicated adenocarcinoma. However, a subsequent deep biopsy with a full immunohistochemical study (CK5/6+, P40+, P63+) definitively confirmed the diagnosis of gastric squamous cell carcinoma. This example highlights the critical importance of obtaining a sufficient and high-quality tissue sample for accurate diagnosis and treatment selection [3].
• PET/CT in the search for recurrences: Positron emission tomography combined with computed tomography (PET/CT) plays an increasingly significant role in oncology. A study showed that [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT demonstrates high diagnostic accuracy in detecting recurrences of medullary thyroid carcinoma, outperforming [¹⁸F]F-FDG and [⁶⁸Ga]Ga-DOTATATE PET/CT in certain parameters. This method is also promising for assessing prognosis and selecting patients for targeted radionuclide therapy [2].
• Optimal timing for scintigraphy: Following radioiodine therapy for differentiated thyroid cancer, post-therapeutic whole-body scintigraphy with [¹³¹I]NaI is mandatory. The study showed that scans obtained 24 hours after therapy have the highest interpretability compared to other time points (6, 48, 72, and 168 hours), which is important for accurate assessment of disease spread [6].

Targeted Radionuclide Therapy: A Personalized Approach

Targeted radionuclide therapy (TRT) represents an innovative field using radioactive isotopes delivered directly to tumor cells.

• [¹⁷⁷Lu]Lu-PSMA-617 in prostate cancer: Therapy with [¹⁷⁷Lu]Lu-PSMA-617 is an established treatment method for metastatic castration-resistant prostate cancer. Because the radiopharmaceutical is excreted by the kidneys, the kidneys receive measurable radiation exposure. This requires routine monitoring of renal function (assessment of glomerular filtration rate and creatinine levels) prior to each treatment cycle and after therapy to ensure patient safety, especially in the presence of comorbidities such as hypertension and diabetes mellitus [1].
• FAP-targeted therapy in medullary thyroid carcinoma: Fibroblast activation protein (FAP) is a promising target for radionuclide therapy. A study of long-term outcomes showed that therapy with [¹⁷⁷Lu]/[²²⁵Ac]-DOTAGA.Glu.(FAPi)₂ in patients with progressive medullary thyroid carcinoma resulted in a partial response in 33% and disease stabilization in 47%, achieving an overall disease control rate of 80%. This highlights the potential of FAP-targeted therapy as an effective approach [8].

Challenges in Treatment and Monitoring of Cancer Patients

The treatment of oncological diseases is often complicated by comorbid pathologies and individual features of the disease course.

• Prognostic value of disease localization: In radioiodine-refractory differentiated thyroid cancer requiring systemic therapy, disease localization (predominantly locoregional involvement or distant metastases) is an independent predictor of survival. This indicates the need to account for this factor when planning treatment with tyrosine kinase inhibitors [7].
• Cardiovascular complications: Cancer patients are at an increased risk of cardiovascular events. The study showed that ST-segment elevation myocardial infarction (STEMI) halves expected survival in cancer patients, even after successful revascularization. This underscores the importance of timely diagnosis and management of cardiac risks in this patient group [5].
• The role of ECG: For patients with non-ST-segment elevation myocardial infarction (NSTEMI), a right-sided electrocardiogram (ECG) can be an effective tool for detecting ischemia or right ventricular infarction, thereby improving diagnosis and risk stratification [4].

Conclusion

Modern oncology is a dynamically developing field where advancements in diagnostics and therapy are constantly changing approaches to cancer treatment. From precise morphological and molecular diagnostics to the introduction of targeted radiopharmaceuticals and the management of comorbidities, every step is aimed at improving treatment outcomes and patients' quality of life. A comprehensive, multidisciplinary approach and the continuous integration of innovations are the key to progress in the fight against oncological diseases.

Sources

1. Renal Function During and After ¹⁷⁷Lu-PSMA-617 Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer. https://pubmed.ncbi.nlm.nih.gov/42481178/
2. Clinical performance of [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT in detecting recurrent disease in medullary thyroid carcinoma: a comparative analysis with [¹⁸F]F-FDG and [⁶⁸Ga]Ga-DOTATATE PET/CT, alongside identification of suitable candidates for targeted radionuclide therapy. https://pubmed.ncbi.nlm.nih.gov/42384206/
3. Overcoming diagnostic pitfalls in primary gastric squamous cell carcinoma: the imperative of adequate sampling in an elderly female patient, case report. https://pubmed.ncbi.nlm.nih.gov/41333217/
4. The effectiveness of right-sided electrocardiogram in non-ST-segment elevation myocardial infarction. https://pubmed.ncbi.nlm.nih.gov/42036709/
5. ST-elevation myocardial infarction halves expected survival in cancer patients even after effective revascularization. https://pubmed.ncbi.nlm.nih.gov/41526974/
6. Optimal timing of post-therapeutic [¹³¹I]NaI whole-body scintigraphy in predominantly low- and intermediate-risk differentiated thyroid cancer: a secondary analysis of prospectively acquired data and a structured literature review. https://pubmed.ncbi.nlm.nih.gov/42572024/
7. Disease site as an independent predictor of survival in radioiodine-refractory thyroid cancer. https://pubmed.ncbi.nlm.nih.gov/42369055/
8. Long-term outcomes in medullary thyroid cancer patients treated with [¹⁷⁷Lu]Lu-DOTAGA.FAPi dimer therapy. https://pubmed.ncbi.nlm.nih.gov/42348144/

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