Selected articles
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Current indications and possibilities of immunooncological treatment
05/2020 MUDr. Libor Havel
Immunotherapy in the form of immune checkpoint inhibitors targeting PD-1/PD-L1 or CTLA-4 has become an integral part of lung cancer treatment algorithms. The dynamics of progress in this field can undoubtedly be called unbelievable. In the conditions of the Czech Republic, there is a certain delay towards the world in the availability of individual treatments. However, there are a number of patients who intend to make the most of all available treatment options, even if they are not covered by general health insurance. The following text is therefore conceived as an overview of available and in some parts of the world registered treatment methods, not what is currently covered in the Czech Republic by health insurance.
ENTIRE ARTICLE
Immunotherapy in the form of immune checkpoint inhibitors targeting PD-1/PD-L1 or CTLA-4 has become an integral part of lung cancer treatment algorithms. The dynamics of progress in this field can undoubtedly be called unbelievable. In the conditions of the Czech Republic, there is a certain delay towards the world in the availability of individual treatments. However, there are a number of patients who intend to make the most of all available treatment options, even if they are not covered by general health insurance. The following text is therefore conceived as an overview of available and in some parts of the world registered treatment methods, not what is currently covered in the Czech Republic by health insurance.
KRAS mutations in non‑small cell lung cancer and options of treatment
02/2020 MUDr. Marie Drösslerová; MUDr. Libor Havel
KRAS (Kirsten rat sarcoma viral oncogene homolog) mutations are the most frequently oncogene aberrations in non-small cell lung cancer (NSCLC). KRAS-mutated NSCLC represents a heterogeneous subgroup because there are different KRAS subtypes, mutations and comutations. It results in different biological behavior of the tumor and its response to treatment. A large majority of patients with KRAS mutations have short-term survival. Trials for targeted treatment have failed. Immunotherapy is the most promising treatment for some patients with KRAS-mutated NSCLC. A very hopeful is an experimental cancer drug AMG 510 which is tested in phase 1/2 clinical trial.
ENTIRE ARTICLE
KRAS (Kirsten rat sarcoma viral oncogene homolog) mutations are the most frequently oncogene aberrations in non-small cell lung cancer (NSCLC). KRAS-mutated NSCLC represents a heterogeneous subgroup because there are different KRAS subtypes, mutations and comutations. It results in different biological behavior of the tumor and its response to treatment. A large majority of patients with KRAS mutations have short-term survival. Trials for targeted treatment have failed. Immunotherapy is the most promising treatment for some patients with KRAS-mutated NSCLC. A very hopeful is an experimental cancer drug AMG 510 which is tested in phase 1/2 clinical trial.
A rare case of choroidal metastasis in ALK‑positive NSCLC that responds to crizotinib
05/2019 MUDr. Marie Drosslerová, MUDr. Libor Havel
Targeted therapy enables patients with non-small cell lung cancer (NSCLC) with driver mutations prolongation of overall survival and improvement quality of life compared to chemotherapy. Crizotinib is one of biological drugs. It is a tyrosine kinase inhibitor targeting ALK (anaplastic lymphoma kinase) gene rearrangement. Crizotinib is indicated for the first-line treatment of adults with ALK positive advanced NSCLC and for the treatment of adults with previously treated ALK positive advanced NSCLC. It is also indicated for the treatment of ROS1 positive advanced NSCLC. Crizotinib has a good safety profile and tolerability. Our article describes a clinical case report of ALK positive advanced NSCLC patient with rare choroidal metastasis that responds to crizotinib. Vision of our patient improved with crizotinib. The quality of life was definitely better.
ENTIRE ARTICLE
Targeted therapy enables patients with non-small cell lung cancer (NSCLC) with driver mutations prolongation of overall survival and improvement quality of life compared to chemotherapy. Crizotinib is one of biological drugs. It is a tyrosine kinase inhibitor targeting ALK (anaplastic lymphoma kinase) gene rearrangement. Crizotinib is indicated for the first-line treatment of adults with ALK positive advanced NSCLC and for the treatment of adults with previously treated ALK positive advanced NSCLC. It is also indicated for the treatment of ROS1 positive advanced NSCLC. Crizotinib has a good safety profile and tolerability. Our article describes a clinical case report of ALK positive advanced NSCLC patient with rare choroidal metastasis that responds to crizotinib. Vision of our patient improved with crizotinib. The quality of life was definitely better.
Osimertinib in locally advanced or metastatic non‑small cell lung cancer therapy
05/2019 MUDr. Libor Havel
Epidermal growth factor receptor (EGFR) mutations are found in 10-14 % lung cancer patients in Central Europe. Therapeutic standard for these patients are EGFR-tyrosinkinase inhibitors (TKI). Screening for these mutations became a diagnostic standard in adenocarcinoma histology. Majority of these mutations are sensitizing mutations (Del 19, exon 21 point mutations). Main resistance mechanism after prior EGFR tyrosinkinase inhibitors therapy is exon 20 mutation T790M. Osimertinib is third generation EGFR tyrosinkinase inhibitors that selectively inhibits both EGFR-TKI sensitizing and EGFR T790M resistance mutations.
ENTIRE ARTICLE
Epidermal growth factor receptor (EGFR) mutations are found in 10-14 % lung cancer patients in Central Europe. Therapeutic standard for these patients are EGFR-tyrosinkinase inhibitors (TKI). Screening for these mutations became a diagnostic standard in adenocarcinoma histology. Majority of these mutations are sensitizing mutations (Del 19, exon 21 point mutations). Main resistance mechanism after prior EGFR tyrosinkinase inhibitors therapy is exon 20 mutation T790M. Osimertinib is third generation EGFR tyrosinkinase inhibitors that selectively inhibits both EGFR-TKI sensitizing and EGFR T790M resistance mutations.
Is age limiting factor for nivolumab treatment?
05/2018 MUDr. Libor Havel
Immunotherapy as a new treatment modality is currently widely accepted and perceived as a modality in NSCLC treatment, which is changing the prognosis of patients in the long term. But it is not entirely clear how immunotherapy is suitable for patients of advanced age.
ENTIRE ARTICLE
Immunotherapy as a new treatment modality is currently widely accepted and perceived as a modality in NSCLC treatment, which is changing the prognosis of patients in the long term. But it is not entirely clear how immunotherapy is suitable for patients of advanced age.
Erlotinib in the treatment of advanced non‑small cell lung cancer – present experience and results in the Czech Republic
04/2018 MUDr. Helena Čoupková, Mgr. Renata Chloupková, Marek Konečný, Mgr. Magda Bařinová, prof. MUDr. Jana Skřičková, CSc., prof. MUDr. Miloš Pešek, CSc., prof. MUDr. Vítězslav Kolek, DrSc., doc. MUDr. František Salajka, CSc., doc. MUDr. Milada Zemanová, CSc., MUDr. Leona Koubková, MUDr. Libor Havel, MUDr. Kateřina Košatová
Erlotinib is an inhibitor of epidermal growth factor receptor (EGFR) tyrosine-kinase activity, a potent drug in non-small-cell lung cancer (NSCLC) treatment. In this paper, we report a population of patients suffering from advanced NSCLC who are being treated with erlotinib in the Czech Republic under the terms of the TULUNG drug registry (excluding the patients from the University Hospital of Ostrava). By October 2nd 2017, 3763 patients were treated with erlotinib in this cohort. The overall response rate (ORR) in the entire group was 8,7 %, the disease control rate was 58,5 %. Survival data were updated on May 21st 2018. Progression-free survival and overall survival were 3,1 months and 7,7 months, respectively. In our evaluation, we noticed a statistically significant difference both in overall survival (OS) and progression free survival (PFS) in patients grouped according to status of EGFR mutation, performance status, gender and smoking habits. Moreover, there was a statistically significant difference in PFS among patients grouped according to treatment line. Based on our results, skin toxicity appears to be a prognostic factor. The efficacy difference in squamous and non-squamous carcinomas was not statistically significant. From the 3763 patients included in the safety analysis, 1592 (42,3 %) experienced therapy-related adverse events, the most common was rash (35,3 %) and diarrhea (16,3 %). Serious adverse events (G3/4) were reported in 13,6 % patients, the most common was rash (9 %) and diarrhea (3 %). Our results confirm the efficacy and safety of the erlotinib therapy in the first and in the following lines of advanced NSCLC.
ENTIRE ARTICLE
Erlotinib is an inhibitor of epidermal growth factor receptor (EGFR) tyrosine-kinase activity, a potent drug in non-small-cell lung cancer (NSCLC) treatment. In this paper, we report a population of patients suffering from advanced NSCLC who are being treated with erlotinib in the Czech Republic under the terms of the TULUNG drug registry (excluding the patients from the University Hospital of Ostrava). By October 2nd 2017, 3763 patients were treated with erlotinib in this cohort. The overall response rate (ORR) in the entire group was 8,7 %, the disease control rate was 58,5 %. Survival data were updated on May 21st 2018. Progression-free survival and overall survival were 3,1 months and 7,7 months, respectively. In our evaluation, we noticed a statistically significant difference both in overall survival (OS) and progression free survival (PFS) in patients grouped according to status of EGFR mutation, performance status, gender and smoking habits. Moreover, there was a statistically significant difference in PFS among patients grouped according to treatment line. Based on our results, skin toxicity appears to be a prognostic factor. The efficacy difference in squamous and non-squamous carcinomas was not statistically significant. From the 3763 patients included in the safety analysis, 1592 (42,3 %) experienced therapy-related adverse events, the most common was rash (35,3 %) and diarrhea (16,3 %). Serious adverse events (G3/4) were reported in 13,6 % patients, the most common was rash (9 %) and diarrhea (3 %). Our results confirm the efficacy and safety of the erlotinib therapy in the first and in the following lines of advanced NSCLC.
Third‑generation inhibitors targeting EGFR T790M mutation in non‑small cell lung cancer
01/2018 MUDr. Libor Havel
EGFR tyrosinkinase inhibitors became a cornerstone of therapy patients with advanced non-small cell lung cancer harbouring mutations in the EGFR kinase domain. EGFR TKI therapy is characterized by high response rate and prolonged progression free survival when compared with standard platinum-based chemotherapy dublets. Despite this, vast majority of patients develope during first 12 months of therapy resistence to TKI and tumor progression. The most common mechanism of this resistence is a secondary T790M mutation. EGFR TKI of third generation are deginged to overcome this type of resistence. Osimertinib became only one of these 3rd generation tyrosinkinase inhibitors adopted for clinical use. This paper will summarize data about 3rd generation EGFR TKI in the treatment of patients with non-small cell lung cancer.
ENTIRE ARTICLE
EGFR tyrosinkinase inhibitors became a cornerstone of therapy patients with advanced non-small cell lung cancer harbouring mutations in the EGFR kinase domain. EGFR TKI therapy is characterized by high response rate and prolonged progression free survival when compared with standard platinum-based chemotherapy dublets. Despite this, vast majority of patients develope during first 12 months of therapy resistence to TKI and tumor progression. The most common mechanism of this resistence is a secondary T790M mutation. EGFR TKI of third generation are deginged to overcome this type of resistence. Osimertinib became only one of these 3rd generation tyrosinkinase inhibitors adopted for clinical use. This paper will summarize data about 3rd generation EGFR TKI in the treatment of patients with non-small cell lung cancer.
Giotrif in non‑small cell lung cancer therapy – case report
04/2017 MUDr. Libor Havel
The activating epidermal growth factor receptor mutation is present in almost 50% of patients with advanced non-small cell lung cancer, who are of Asian ethnicity1 compared with only 12% in the Caucasian population.2 These molecular alterations predict sensitivity to first and second generation epidermal growth factor receptor tyrosine kinase inhibitors such as erlotinib, gefitinib, afatinib. Response rate and progression-free survival with epidermal growth factor receptor tyrosine kinase inhibitors are superior to standard first-line platinum doublet chemotherapy, making them the standard of care.
ENTIRE ARTICLE
The activating epidermal growth factor receptor mutation is present in almost 50% of patients with advanced non-small cell lung cancer, who are of Asian ethnicity1 compared with only 12% in the Caucasian population.2 These molecular alterations predict sensitivity to first and second generation epidermal growth factor receptor tyrosine kinase inhibitors such as erlotinib, gefitinib, afatinib. Response rate and progression-free survival with epidermal growth factor receptor tyrosine kinase inhibitors are superior to standard first-line platinum doublet chemotherapy, making them the standard of care.
Is there any difference in treatment strategy between squamous and non‑squamous lung cancer?
03/2017 MUDr. Libor Havel
Lung cancer is one of the most common cancer worldwide. There is approximately 1.8 million of new lung cancer cases, and 1,6 million deaths by lung cancer. There are changes is in frequency of histologic subtypes during past two decades. Predominant histology became non-squamous non-small cell lung cancer, and majority of new therapies are related to this histologic subtype. Is there any fundamental difference in treatment strategy between squamous and non-squamous lung cancer?
ENTIRE ARTICLE
Lung cancer is one of the most common cancer worldwide. There is approximately 1.8 million of new lung cancer cases, and 1,6 million deaths by lung cancer. There are changes is in frequency of histologic subtypes during past two decades. Predominant histology became non-squamous non-small cell lung cancer, and majority of new therapies are related to this histologic subtype. Is there any fundamental difference in treatment strategy between squamous and non-squamous lung cancer?
ALK inhibitors in the treatment of patients with NSCLC
01/2017 Libor Havel
Patients with EML4-ALK translocation represent small, but clinically interesting subgroup of patients with non-small cell lung cancer. Since this genetic alteration revealing we are witness of rapid progress in therapy of these patients. ALK (anaplastic lymphoma kinase) inhibitors became a standard therapy in first line treatment, second generation ALK inhibitors are available in clinical practice and higher lines are tested. This article would be a summarisation of recent attitude to ALK inhibitors in NSCLC.
ENTIRE ARTICLE
Patients with EML4-ALK translocation represent small, but clinically interesting subgroup of patients with non-small cell lung cancer. Since this genetic alteration revealing we are witness of rapid progress in therapy of these patients. ALK (anaplastic lymphoma kinase) inhibitors became a standard therapy in first line treatment, second generation ALK inhibitors are available in clinical practice and higher lines are tested. This article would be a summarisation of recent attitude to ALK inhibitors in NSCLC.