Osteosarcomas are rare tumors with aggressive biology. It is important to refer such patients to a high-volume center, where an accurate diagnosis and optimal treatment are more likely to be performed. In contrast to Ewing's sarcoma, conventional osteosarcomas are believed to be generally resistant to radiation therapy, and the main treatment modalities are surgery and chemotherapy. In this clinical case, we demonstrate the efficacy of combined treatment of osteosarcoma of the femur.Preoperative chemotherapy allowed to evaluate tumor sensitivity to systemic treatment in vivo and optimize adjuvant treatment after R0 resection which allowed to achieve complete clinical response to treatment.

Currently, treatment of patients with early primary operable BRCA mutation-associated breast cancer requires integrative approach. A mutation in BRCA1/2 genes is a prognostically unfavorable factor increasing the risk of cancer of the contralateral breast, as well as ovaries, pancreas, fallopian tubes, and primary peritoneal cancer. In this clinical observation, an integrative multidisciplinary approach to treatment of a young patient with luminal B breast cancer is described which allowed to preserve the patient’s fertility and achieve pregnancy using assisted reproductive technologies.High effectiveness of the chosen treatment tactics in the framework of integrative approach in a specialized medical facility with experience in treatment of oncological diseases and preservation of reproductive function confirmed by clinical data and results of laboratory and instrumental exams is demonstrated.

Currently, use of CDK4/6 inhibitors in combination with hormone therapy is approved for treatment of patients with advanced or metastatic breast cancer positive for estrogen and progesterone receptors and negative for human epidermal growth factor receptor 2 (HER2). In this clinical observation, analysis of the effectiveness of treatment of a patient with metastatic breast cancer of luminal A subtype is performed. The 1st line combination therapy was CDK4/6 inhibitors (ribociclib) and hormone therapy with aromatase inhibitors (letrozole) and analogues of gonadotropin-releasing hormone (goserelin) with concurrent bone-modifying denosumab therapy. Effectiveness of antitumor drug therapy administered for 7 months, and toxicity of the regimen were evaluated. Effectiveness of the selected combination treatment regimen was demonstrated and confirmed by clinical data, as well as results of laboratory and instrumental examinations. Adverse effects were controlled and managed with symptomatic therapy which allows to continue treatment using previously selected tactics.

Alveolar rhabdomyosarcoma (ARMS) is an aggressive primitive tumor with limited differentiation of rhabdomyoblasts. Primarily, it occurs in children and teens under 15 years of age in the head and neck region (in 40 % of cases). In patients older than 19-20 years, ARMS is significantly less common and is localized primarily on the limbs, while head and neck region is affected in about 24 % of all cases, involvement of the orbit in the tumor process is very rare. ARMS progression in adults is more aggressive than in children, and prognosis is more unfavorable due to development of regional and distant metastases at the time of diagnosis. Hence, selection of antitumor therapy is limited to drug treatment. Use of multimodal approach to therapy allows to improve treatment outcomes and increase quality of life in patients with ARMS.