02/2021

02/2021 Doc. MUDr. Tomáš Büchler, Ph.D.; MUDr. Aneta Rozsypalová; MUDr. Ludmila Boublíková, Ph.D.
Positron emission tomography using 18-fluorodeoxyglucose (FDG-PET) enables imaging based on the metabolic activity of the imaged tissue by evaluating the activity of glucose metabolism. There are numerous applications for the method in testicular germ cell neoplasms, especially for evaluation of residual tumor or for assessing treatment toxicity such as bleomycin-induced pneumonitis. The importance of FDG-PET is growing especially in advanced tumors and high-risk patients. Here we review indications and limitations of the method in testicular cancer.

02/2021 MUDr. Petra Holubová, Ph.D.; doc. MUDr. Martin Doležel, Ph.D.; MUDr. Igor Hartmann, Ph.D.
Serial evaluation of serum prostate-specific antigen is the mainstay of surveillance testing in men who have undergone definitive radiotherapy for localized prostate cancer. Based on the National Comprehensive Cancer Network guidelines serum prostate-specific antigen should be monitored every 6 to 12 months for the first five years and annually thereafter. There were created several nomograms to estimate a patienťs probability of long-term cure after radical local treatment using pathologic stage as a surrogate end point. Positron emission tomography using choline ¹⁸F-ftuciclovine and ⁶⁸Ga-labelled prostate-specific membrane antigen are an emerging radiological techniques developed to improve the characterization of relapsed prostate cancer. We can use several accepted toxicity grading scales for quantification of degree of damage of organs at risk (RTOG, FC-LENT SOMA, Common Terminology Criteria for Adverse Events).

02/2021 MUDr. Jana Katolická, Ph.D.
Non-invasive urothelial carcinoma of the bladder is commonly treated with topical therapy. Intravesical administration of the BCG vaccine has shown significant benefit in medium and high-risk patients. A new treatment option for non-BCG-responsive tumors is pembrolizumab.

02/2021 Doc. MUDr. Tomáš Büchler, Ph.D.
Cardiovascular diseases are a very important cause of morbidity and mortality in patients with prostate cancer. Androgen deprivation and androgen receptor signaling therapy (ARTA) increase the risk of cardiovascular complications. Data from randomized trials and clinical practice indicate that when ARTA is used after docetaxel chemotherapy, the cardiovascular risk is even higher than when these drugs are used in the pre-treatment indication. There is an association between prostate cancer and sinus fibrillation, which is an independent predictor of mortality in these patients. In particular, the induced hypoandrogenic state and hypokalemia associated with hormonal treatment contribute to the prolongation of the QT interval in patients with prostate cancer.

02/2021 MUDr. Martin Lukeš; MUDr. Petra Holečková; MUDr. Viktor Vik, Ph.D.; MUDr. Petr Holý, Ph.D.; MUDr. Tomáš Novotný
Radiotherapy of prostate cancer represents one of the major therapeutic options for treatment of localized or locally advanced prostate cancer. The major drawbacks represent frequency and severity of posttherapeutic side effects, same as after surgical treatment. In radiotherapy the main complications are gastrointestinal and urogenital toxicity. Despite great development in radiotherapy recently, these side effects of radiotherapy have not been eliminated. Recently published studies, describing the use of perirectal polyethylene glycol (PEG) (SpaceOAR™ Hydrogel), might offer very promising results regarding the side effects of radiotherapy. This injectable biodegradable hydrogel creates space between the prostatě and rectum before prostate radiotherapy and it is approved by Food and Drug Administration for this use since 2015. Despite the fact, that it has become a part of national guidelines in many countries and reached clear popularity and widespread abroad, it is still rare in Czech Republic. Objectives: to summarize available information and data about usage of PEG hydrogel in radiotherapy for prostate cancer, extended by our own experience with the first cohort of 81 patients after SpaceOAR™ Hydrogel application in Czech Republic.

02/2021 Doc. MUDr. Milada Zemanová, Ph.D.
Lung cancer in the Czech Republic is the cause of almost 5 and a half thousand deaths per year, the median survival of metastatic and recurrent tumors with standard chemotherapy is approximately one year. For several years, the exception has been about 10% of patients with targeted treatment according to epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) translocation. Progress has been made with third-generation tyrosine kinase inhibitors (TKI) such as the anti-EGFR TKI osimertinib or the anti-ALK TKI alectinib, brigatinib and lorlatinib, which have made it possible to prolong median survival to 3 to 5 years. To administer effective molecularly targeted treatment in other rare molecular aberrations, such as ROS1, BRAF, KRAS, NTRK, cMET, HER2/neu, would allow the identification of this mutation using the next generation sequencing method and the subsequent reimbursement of the registered product. For most patients without driver mutations, the chance of greater treatment success is the possibility of including anti-tumor immunotherapy in the treatment algorithm as soon as possible after diagnosis. The reimbursed standard is durvalumab as consolidation therapy after concomitant chemoradiotherapy of inoperable non-small cell lung cancer (NSCLC) with programmed death-ligand 1 (PD-L1) ≥ 1%, with a median prolongation of survival to almost four years. In the first line of NSCLC treatment we have pembrolizumab monotherapy for PD-L1 ≥ 50% tumours and in combination with chemotherapy for PD-L1 ≥ 1%, in the second line nivolumab or atezolizumab is indicated regardless of PD-L1 expression. Other combinations for the first-line treatment of NSCLC with atezolizumab, nivolumab and pembrolizumab are registered. Overall, the use of anti-tumor immunotherapy in NSCLC reduces the risk of death by approximately 20-40%, with a median prolongation of survival between 16-30 months. Immunochemotherapy with durvalumab or atezolizumab is also significantly effective in extensive disease small cell lung cancer.

01/2021 Doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Tereza Kohlová
The aim of the article is to provide an overview of studies published in 2020 that change and have changed clinical practice in radiation oncology. The list of studies does not have the ambition to be complete, it will certainly not include all the interesting, but most of the most important randomized phase III studies. Radiotherapy, like other fields in 2020, was affected by the Covid-19 pandemic, and therefore shorter hypofractionation regimens were introduced more quickly into practice. On the other hand, it is important to realize how important the time factor is for the results of our patienťs treatment. In the first place in every situation are mainly oncological results and procedures based mainly on the data of large randomized studies.

02/2021 MUDr. Nikol Rušarová; MUDr. Hana Študentová, Ph.D.
Prostate cancer is one of the most common cancers in men worldwide. Many patients have and advanced disease despite of early diagnosis. Finding the optimal treatment sequencing in advanced prostate cancer is currently one of the most common question.

02/2021 MUDr. Igor Richter, Ph.D.; doc. MUDr. Josef Dvořák, Ph.D.; MUDr. Vladimír Šámal, Ph.D.; MUDr. Jiří Bartoš, MBA
Targeted therapy and immunotherapy have improved survival outcomes for patients with metastatic renal cell carcinoma. ESMO, NCCN and Czech society for oncology provide some guidelines for the most appropriate first-, secondand third-line treatment. With the growing number of available therapeutic agents and improved survival, the optimal treatment patterns in fourth-line therapy need to be examined. No robust evidence exists to optimize treatment selection in this setting. The fourth-line therapy varies significantly amongst different centers and jurisdictions.

02/2021 Doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Tereza Kohlová
Oligometastatic disease is a separate category of metastatic prostate cancer. In recent years, more and more attention has been focused on its optimal definition and treatment. Central to the identification of oligometastatic prostate cancer is not only the number and location of metastases, but also the use of new imaging methods in their identification. Treatment of oligometastatic prostate cancer may have curative potential. It includes systemic and radical local treatment, which can be targeted at both primary tumors and metastases. Radiotherapy, especially the technique of stereotactic radiotherapy, is more widely used as a locally ablative treatment. In this case, topical treatment not only prevents local disease progression, but also improves overall survival. The boundaries between curative and palliative treatment are thus constantly shifting. Better identification of patients who will benefit from topical treatment and better classification of oligometastatic prostate cancer subgroups based on biomolecular markers is the task of further studies.

02/2021 Doc. MUDr. David Vrána, Ph.D.
The treatment of the metastatic colorectal cancer is unfortunately mostly palliative. There are new molecules which have entered the treatment algorithm of the colorectal cancer. From the immunotherapy pembrolizumab, nivolumab or combination of nivolumab with ipilimumab have been approved by the Food and Drug Administration (FDA) for the previously treated colorectal cancer with mismatch repair deficiency / high microsatellite instability (dMMR/MSI-H) and also pembrolizumab has gained approval FDA in the first line palliative treatment. In the Czech Republic unfortunately there are all these molecules in the diagnosis of colorectal cancer without registration and without reimbursement. At the same time there is new combination of cetuximab with encorafenib in previously treated patients with BRAF V600E mutation unfortunately without reimbursement.

02/2021 MUDr. Jana Katolická, Ph.D.
Metastatic bone disease is commonly seen with urogenital cancer types - notably those with prostate (85%) and kidney (40%). Bone-targeted agents - bisphosphonates and denosumab - are potent inhibitors of bone resorption for prevention of skeletal-related events in patients with solid tumors. In a phase III study, denosumab significantly delayed skeletal-related events compared with zoledronic acid in patients with metastatic castration resistant prostate cancer and renal cancer. In addition, denosumab showed superior effects on pain and health-related quality of life in these patients.

02/2021 MUDr. Leona Koubková
In recent years, we have witnessed the expanding possibilities of genotyping tumors, which allows us to strengthen precision medicine, the essence of which is the pursuit of individualized treatment. There is also an increase in the number of drugs that enable molecularly targeted therapy of tumors with proven genetic aberrations. These include entrectinib, which is effective in patients with non-small cell lung cancer who have been shown to rebuild the ROS1 gene or fuse the NTRK gene, even with metastatic central nervous system involvement.

02//2021 MUDr. Lukáš Chlachula
Monoclonal antibodies to various structures represent an important milestone in oncological treatment and form a clearly established group of anticancer therapy. However, we find their application in practically all fields of medicine. Bevacizumab is one of the first mass-established in oncology practice. However, there are also biosimilar drugs that are not identical generic copies of the reference drugs, but nevertheless have the same properties as the reference product. Mvasi® is the first FDA and EMA approved biosimilar for bevacizumab to treat a large group of cancers. Through a specific approval process (totality of evidence, TOE), it demonstrated the same properties, including efficacy, as the reference product (bevacizumab).

02/2021 MUDr. Daniel Krejčí; MUDr. Lukáš Hruška
Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune, presynaptic disorder of neuromuscular transmission characterized by fluctuating muscle weakness, autonomic dysfunction and depressed tendon reflexes.¹ The coappearance with small cell lung cancer happens to be typical and sometimes the symptoms may precede the radiological cancer confirmation. There is a symptomatic therapy of LEMS as a complement of the causal cancer treatment. This case report presents patient with Lambert-Eaton myasthenic syndrome and concurrent atypical long small cell lung cancer survival.

02/2021 MUDr. Jana Krejčí; MUDr. Petr Opálka, CSc., MBA; MUDr. Bc. Petr Zůna; MUDr. Daniel Krejčí; MUDr. Ferdinand Třebický; doc. MUDr. Norbert Pauk, Ph.D.
Multiple tumors are not common in oncology, but their proportion is increasing and they need attention. Our patient with tetraplicity (kidney cancer, laryngeal cancer and two bronchogenic carcinomas) is a demonstration of struggle and determination. Although all these diagnoses are serious and the patient has been treated since 2018, among other things, for the generalization of bronchogenic carcinoma to the brain, he has a zest for life and does not give up. He underwent operations, tracheostomy, gastrostomy, chemotherapy and radiotherapy. In the near future, we will have to decide which treatment path to take next.

02/2021 MUDr. Igor Richter, Ph.D.; doc. MUDr. Josef Dvořák, Ph.D.; MUDr. Vladimír Šámal, Ph.D.; MUDr. Jiří Bartoš, MBA
The treatment landscape for metastatic castration-resistant prostate cancer (mCRPC) has rapidly evolved over the past 10 years. The addition chemotherapy (docetaxel, cabazitaxel), androgen receptor targeted agents (ARTA - abiraterone, enzalutamide) and radium 223 has improved outcomes for patients with mCRPC. Abiraterone in our clinical practice is applied most often before the docetaxel-based chemotherapy. We present a case study of patient with mCRPC treated by abirateron (before chemotherapy) for four years.