Igor Richter, Josef Dvořák, Jiří Bartoš
Jaromír Roubec, Jaromír Richter
Vladimír Červeňák, Alena Berková, Zdeněk Chovanec, Jiří Vaníček, Tomáš Hanslík, Sabina Svobodová
Zdeněk Chovanec, Michal Reška, Alena Berková, Vladimír Červeňák, Jiří Veselý, Zdeněk Dvořák, Tomáš Hanslík, Adam Peštál, Vadym Prudius, Ivan Čapov
The systemic treatment of malignant tumors has undergone significant changes in recent years. In addition to the hormonal treatment and chemotherapy, we have new therapeutic approaches as immunotherapy or targeted treatment. Many new drugs are added in the treatment of malignant tumor every year. The treatment guidelines have been updated and changed. The aim of this review is to provide summary of new drugs in treatment of solid tumors. This article presents an overview of the two groups of agents as tyrosine kinase inhibitors and monoclonal antibodies, due to extensive issues.
Epidermal growth factor receptor – its importance, diagnosis and development of treatment in non‑small cell lung cancer
The epidermal growth factor receptor (EGFR) is a transmembrane glycoprotein with a binding site for a family of extracellular protein epidermal growth factor ligands. The epidermal growth factor receptor is a member of the ErbB (erythroblastic leukemia viral oncogene) receptor family, which consists of a total of four members of closely related receptor tyrosine kinases: EGFR (ErbBI or HER1), ErbB2/neu (HER2), ErbB3 (HER3) and ErbB4 (HER4). Epidermal growth factor and its receptor were discovered by Stanley Cohen. In 1986, Cohen shared the Nobel Prize in Medicine with Rita Levi-Montalcini for his discovery of growth factors. The signal from EGFR can be transmitted by a number of intracellular transporters RAS-RAF-MAPK (leading to cell proliferation), or the singular pathways JAK-STAT3 or PI3K-AKT (affecting cell survival) are activated. Examination of the mutational status of this receptor plays a crucial role in deciding on the treatment of non-small cell lung cancer and is the goal of so-called biological treatment.
Metastatic non-small cell lung cancer represents a disease with poor prognosis. Introducing tyrosine kinase inhibitors of specific mutations into daily practice improved the prognosis of a group of patients, however for majority of the patients before the era of immunotherapy the chemotherapy was the only option. Several molecules working as immunotherapeutic agents have proven their effectivity and safety in the first and second line of palliative treatment of the lung cancer. Recently the combination of nivolumab with ipilimumab was introduced into the clinical practice based on the CheckMate 227 and CheckMate 9LA trials. Combined immunotherapy with nivolumab and ipilimumab represents a new treatment option for patients with non-small cell lung cancer without specific mutations regardless of programmed cell death-ligand 1 (PD-L1) expression. Registration in the Czech Republic as well as health care reimbursement is unfortunately missing at this moment for this new combination.
Consolidation immunotherapy with durvalumab in the treatment of locally advanced non‑small cell lung cancer
In about a quarter of cases, non-small cell lung cancer (NSCLC) is diagnosed at the stage of locally advanced disease. The standard treatment for these patients is concomitant chemotherapy and radiotherapy. Currently, immunotherapy is an integral part of the treatment of the NSCLC treatment algorithm, especially anti-PD-1 and anti-PD-L1 check-point inhibitors. Data from the PACIFIC study demonstrated a significant benefit of consolidating immunotherapy with the anti-PD-L1 monoclonal antibody durvalumab after cessation of radiotherapy, including prolongation of overall survival. Durvalumab is currently the reference molecule in this indication. Tolerance and safety profile are favorable, early diagnosis and treatment of immune-related adverse events is necessary.
In the overview the authors discuss the actual approaches in the concomitant chemoradiotherapy based on the previous results and meta-analysis and discuss the new possibilities in the combined chemoradiotherapy and immunotherapy of the locoregional advanced non-small cell lung cancer.
Non-melanoma skin cancer represents the most frequent cancer overall. Radiotherapy and surgery are the main treatment modalities; however, the best choice depends on tumor location, patient age, comorbidities and also patienťs preference. A small portion of these patients unfortunately progress into locally advanced or metastatic form when surgery and radiotherapy are not possible. Cemiplimab represents another check-point inhibitor molecule (belongs among programmed cell death protein 1 receptor inhibitors [PD-1]) which has proven effectivity and safety in clinical trials for the treatment of locally advancedor metastatic squamous cell and basal cell carcinoma where surgery and radiotherapy are not feasible. Cemiplimab is another reasonable treatment choice for this group of patients since effectivity of conventional chemotherapy is limited.