Gyula Nyárs, David Vrána
Juraj Ďuraš, Michal Kaščák, Roman Hájek
Prostate cancer represents a most frequent tumor among men. Despite high success rate of iocoregionai treatment some patients will finally relapse and develop castration resistant disease even without metastases. Apalutamid represents a new treatment modality in the treatment of this stage of prostate cancer. Apalutamid has shown statistically significant prolongation of the median of the metastasis-free survival as well as time to symptomatic progression. Apalutamid represents new possibility in the treatment of castration resistant prostate cancer without distant metastases.
In this overview are presented data and results of the combination check-point inhibitor atezolizumab and chemotherapy from the clinical trial IMpower133 in the extensive-stage small cell lung cancer. This data new support introducing of this therapeutic modality into clinical praxis based on the prolonged progression free survival and overall survival. Discussed is the problem of the therapy of the small cell lung cancer and next possibilities with using of the immunotherapy in the combination in this time used therapies and next perspectives in this area.
Atezolizumab is a modified humanized IgG1 monoclonal antibody that inhibits programmed death-ligand 1 (PD-L1). It is the one of few check-point inhibitors which can be used to treat patients with non-small cell lung cancer. Although it is currently registered in the Czech Republic only for the second and higher lines of palliative treatment after progression on chemotherapy or targeted therapy, unfortunately health insurance still does not reimburse it. The goal of this article is to summarize outcomes of the most important studies which proved the efficacy and safety of atezolizumab in the first and second line of palliative treatment.
Better therapeutic results that are observed in many different tumor types in the last years are primarily caused by the better understanding of principles of tumor growth and tumor progression. When we focus on breast cancer, the knowledge of these crucial events has led to the development new classes of antineoplastic drugs that attack different signaling pathways including mTOR, PI3K, HER2/Neu as well as G1 checkpoint. Until now there are registered three drugs in the letter mentioned group also called CDK4/6 inhibitors - abemaciclib, palbociclib and ribociclib. In this article, we focus on abemaciclib in the context of other two drugs.
LATITUDE study and current perspectives in the treatment of metastatic, hormone-sensitive prostate cancer
Therapy of prostate cancer has improved significantly over the past 10 years. In the treatment of localized stages, the emphasis is on the quality of life of patients after radical treatment and the effort to minimize late adverse effects of treatment. Patients achieve very good treatment results and their overall and cancer-specific survival is significantly better compared to other malignancies. A similar trend is seen in patients with metastatic disease. Advances in palliative systemic therapy noticeably changed and improved overall and cancer-specific survival. The new generation of antiandrogens offers patients with metastatic prostate cancer new perspectives not only in terms of survival but especially in the quality of life during treatment. The aim of this article is to provide an overview of current treatment options for metastatic, hormone-sensitive prostate cancer.
Chemotherapy-induced neutropenia, and in particular febrile neutropenia, is a serious complication of antitumor systemic therapy. It is possible to indicate the growth factors of myelopoiesis in prophylaxis of neutropenia in specific situations. In addition to filgrastim and pegfilgrastim, a number of biosimillar products have recently been developed with a similar therapeutic and safety profile as compared to the original products. Biosimillar drugs are subject to the same approval processes and the same standards of pharmaceutical quality, safety and efficacy that apply to all biological drugs approved in the European Union. Reducing the cost of biosimilar preparations could optimize the use of growth factors with better availability for indicated patients.
Recent demographic trends with increasing proportion of elderly people are associated with the higher incidence of hematological malignancies including non-Hodgkin's lymphomas. Higher age is associated with a significantly worse prognosis because of physiological decline of organ functions and increasing incidence of comorbidities that both limit treatment options.
Staging procedures in elderly patients do not differ significantly from younger patients. The standard imaging method is computed tomography (CT), positron emission tomography (PET) / CT is recommended in patients with aggressive lymphoma treated with curative intent. In follicular lymphoma, PET/CT is recommended especially before local radiotherapy to confirm localized disease.
A Geriatric 8 (G8) questionnaire is recommended as a screening tool for geriatric assessment. In the case of score ≤14, a comprehensive geriatric assessment including assessment of performance status, activities of daily life, mental status, possible sensory impairment and comorbidities is recommended.
Treatment of elderly patients with lymphoma requires personalized approach. In fit patients who are able to tolerate standard treatment, the outcomes are similar to outcomes in young patients. In vulnerable patients treatment should be conducted with the aim of prolonging life with respect to its quality while avoiding intensive treatment procedures with risk of toxicity. In terminal patients who won't profit from oncological therapy, only symptomatic supportive treatment is recommended. Treatment options for most common lymphoma subtypes are discussed in second part of the article.
Patient with NSCLC and brain metastases and positive reassortment ALK treated with alectinib - case report
A better understanding of the molecular biology of tumors and the expanding possibilities of their genotyping lead to the enhancement of precise medicine, which is based on the pursuit of individualized treatment. It is primarily the genetic changes of the tumor that help us to predict the response to molecularly targeted treatment. These also include rearrangement of the ALK (anaplastic lymphoma kinase) gene in NSCLC (non-small cell lung cancer), which predicts the efficacy of ALK inhibitors, which significantly improve treatment outcomes in patients with this severe disease. Alectinib, the current standard for the first line ALK-positive NSCLC treatment, is a highly selective and potent inhibitor of ALK and RET (rearranged during transfection) tyrosine kinase and has been set to be reimbursed in the 1st line of treatment in the Czech Republic from 1st November 2019.
A case of a patient who has been treated for metastatic colorectal cancer for six years will be presented. Patient was treated with six lines of systemic treatment and two local liver treatments. All available cytostatics indicated for the diagnosis except for capecitabine, targeted therapies except bevacizumab were used in systemic treatment, and the rechallenge of the EGFR inhibitor was used.
We present a case report of a 75-year-old woman who has been treated for 4.5 years for metastatic colorectal cancer and emphasizes out-patient treatment, which should not significantly affect her life.