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Triple negative breast cancer
04/2021 MUDr. Michaela Miškovičová, Ph.D.
Triple negative breast cancer (TNBC) represents a heterogeneous group of breast cancers, histologically, molecularly biologically and immunologically. A common molecular feature is that they do not express alpha estrogen, progesterone, and HER2 receptors.1 They appear to be the most aggressive subtype of breast cancer and are usually associated with a serious prognosis and increased mortality worldwide. Their extremely high proliferation and tendency to hematogenous metastasis are typical.2 The severity of this disease is primarily observed in younger women but can occur in all age groups. Epidemiologically, they represent about 15-20 % of newly diagnosed breast cancers.3 Young patients often suffer from worse clinical outcomes, such as early relapse and the appearance of visceral metastases. Current clinical treatment of TNBC is generally challenging, with chemoresistance and recurrent tumor recurrence being common barriers.4
We have seen little therapeutic progress in recent decades, and chemotherapy remains the standard of care. Although the incorporation of targeting agents such as poly (ADP ribose polymerase (PARP) inhibitors and immune checkpoint inhibitors in clinical practice appears promising, TNBC responses to these therapies still vary widely. However, despite enriched chemosensitivity and immunogenicity, most patients with TNBC do not achieve satisfactory clinical responses. The lack of specific effective therapeutic targets is one of the key factors preventing a significant improvement in the effect of targeted treatment.5 Incorporating immunomolecular targets into combination and improving standard chemotherapy, especially in the early stages of the disease, may be key to unlocking the promising future of management of TNBC.4
ENTIRE ARTICLE
Triple negative breast cancer (TNBC) represents a heterogeneous group of breast cancers, histologically, molecularly biologically and immunologically. A common molecular feature is that they do not express alpha estrogen, progesterone, and HER2 receptors.1 They appear to be the most aggressive subtype of breast cancer and are usually associated with a serious prognosis and increased mortality worldwide. Their extremely high proliferation and tendency to hematogenous metastasis are typical.2 The severity of this disease is primarily observed in younger women but can occur in all age groups. Epidemiologically, they represent about 15-20 % of newly diagnosed breast cancers.3 Young patients often suffer from worse clinical outcomes, such as early relapse and the appearance of visceral metastases. Current clinical treatment of TNBC is generally challenging, with chemoresistance and recurrent tumor recurrence being common barriers.4
We have seen little therapeutic progress in recent decades, and chemotherapy remains the standard of care. Although the incorporation of targeting agents such as poly (ADP ribose polymerase (PARP) inhibitors and immune checkpoint inhibitors in clinical practice appears promising, TNBC responses to these therapies still vary widely. However, despite enriched chemosensitivity and immunogenicity, most patients with TNBC do not achieve satisfactory clinical responses. The lack of specific effective therapeutic targets is one of the key factors preventing a significant improvement in the effect of targeted treatment.5 Incorporating immunomolecular targets into combination and improving standard chemotherapy, especially in the early stages of the disease, may be key to unlocking the promising future of management of TNBC.4
Ribociclib in the first‑line therapy of hormone‑dependent generalized breast cancer in a young patient with liver toxicity – case report
06/2020 MUDr. Michaela Miškovičová
The case report describes the case of a young premenopausal patient with hormone-dependent, HER2-negative breast cancer diagnosed in the stage of generalization to the skeleton and lymph nodes. Due to the extent of disease, no risk of visceral crisis and histopathological characteristics of the tumor, a combination of the cyclin-dependent kinase 4/6 (CDK4/6) inhibitor ribociclib with the aromatase inhibitor letrozole and a luteinizing hormone-releasing hormone (LHRH) agonist was selected for first line palliative therapy. This treatment has very promising results from randomized trials in which the ribociclib arms show significant long-term superiority over hormonal treatment alone. The effectiveness and benefit of treatment is evident in our patient, the use of therapy is initially complicated by severe hepatotoxicity, but the etiology in this case is very suspiciously multifactorial. After a slight adjustment of the dosage and careful monitoring of liver parameters, she continues the therapy with very good tolerance, now for the tenth cycle.
ENTIRE ARTICLE
The case report describes the case of a young premenopausal patient with hormone-dependent, HER2-negative breast cancer diagnosed in the stage of generalization to the skeleton and lymph nodes. Due to the extent of disease, no risk of visceral crisis and histopathological characteristics of the tumor, a combination of the cyclin-dependent kinase 4/6 (CDK4/6) inhibitor ribociclib with the aromatase inhibitor letrozole and a luteinizing hormone-releasing hormone (LHRH) agonist was selected for first line palliative therapy. This treatment has very promising results from randomized trials in which the ribociclib arms show significant long-term superiority over hormonal treatment alone. The effectiveness and benefit of treatment is evident in our patient, the use of therapy is initially complicated by severe hepatotoxicity, but the etiology in this case is very suspiciously multifactorial. After a slight adjustment of the dosage and careful monitoring of liver parameters, she continues the therapy with very good tolerance, now for the tenth cycle.
Gastric neuroendocrine neoplasms
05/2019 MUDr. Michaela Miškovičová
Gastric neuroendocrine neoplasms are rare lesions consisting of a heterogenous group of neoplasms. The majority of them arise from ECL (enterochromaffin-like) cells - neuroendocrine cells of gastric mucosa, which produce histamin and have the impact on the regulation of gastric secretion. This is why we can call them “ECLomas”. Their incidence is increasing, due to the widespread use of upper digestive endoscopy and the technical refinement of endoscopists. Gastric neuroendocrine neoplasms comprise tumor types of varying pathogenesis, histomorphologic characteristic, biological behavior and prognosis. They can present with clinical symptoms, or can be asymptomatic, carcinoid syndrome is extremely rare. The correct management of patients with gastric neuroendocrine neoplasms can only be proposed when the tumor has been classified by an accurate pathological and clinical evaluation of the patient.
ENTIRE ARTICLE
Gastric neuroendocrine neoplasms are rare lesions consisting of a heterogenous group of neoplasms. The majority of them arise from ECL (enterochromaffin-like) cells - neuroendocrine cells of gastric mucosa, which produce histamin and have the impact on the regulation of gastric secretion. This is why we can call them “ECLomas”. Their incidence is increasing, due to the widespread use of upper digestive endoscopy and the technical refinement of endoscopists. Gastric neuroendocrine neoplasms comprise tumor types of varying pathogenesis, histomorphologic characteristic, biological behavior and prognosis. They can present with clinical symptoms, or can be asymptomatic, carcinoid syndrome is extremely rare. The correct management of patients with gastric neuroendocrine neoplasms can only be proposed when the tumor has been classified by an accurate pathological and clinical evaluation of the patient.