Igor Richter, Josef Dvořák
Jana Katolická, Petr Filipenský
Jiří Kubeš, Vladimír Vondráček
Jakub Cvek, Lukáš Knybel
Jindřich Kopecký, Ondřej Kubeček
Renata Soumarová, Pavel Dvořák, Eva Kindlová, Martina Kubecová
Zuzana Střížová, Michal Podrazil, Jiřina Bartůňková
The most particular histological type of bladder cancer is urothelial carcinoma. The chemotherapeutic schedules for metastatic disease are based on derivatives of platinum. The imunotherapy is novel therapeutic possibility for patients with local advanced and metastatic disease.
Two new molecules, nivolumab (anti-PD-1) and cabozantinib (a multikinase inhibitor of the VEGF, AXL and MET pathway), are coming into the treatment of metastatic clear cell carcinoma of the kidneys. In the second treatment line, both offer an identical survival extension of five months compared to everolimus. Cabozantinib appears to be more appropriate in patients with bone metastases and when rapid onset of action is required. In contrast, nivolumab has an advantage in patients with high tumor burden.
Axitinib is an oral, selective inhibitor of vascular endothelial cell growth factor receptor (VEGFR)-1, -2, -3. It is currently registered for the treatment of metastatic renal cell carcinoma progressing on sunitinib or cytokine therapy. The AXIS phase III registration trial was the first study to directly compare two different targeted agents for metastatic renal cell carcinoma. The study also validated hypertension as a clinical biomarker of axitinib efficacy. The main benefits of axitinib include a relatively favorable toxicity profile, with relatively uncommon, predictable and usually manageable side effects.
Prostate cancer is the most common male malignant neoplasm in men worldwide and second cause of cancer related death. In castrate-resistance prostate cancer (CRPC) we can see the development of the new therapeutic options. The chemotherapy is an important part of the CRPC treatment. Cabazitaxel, a new generation taxane, demonstrates the overall survival prolongation as first substances in patients with metastatic CRPC after previous treatment by docetaxel. The discussed issues are to find the optimal treatment sequences. The aim of this presented article is to define the status of cabazitaxel in CRPC.
Bone metastases in prostate cancer are a major cause of pain and bone complications. Radium-223 treatment of patients with bone metastasis in castration-resistant prostate cancer proved to be beneficial in prolonging overall survival. Administration of 5-6 doses of radium-223 compared to 1-4 doses is associated with a significantly longer overall survival. The most common haematological adverse event induced treatment is anemia and thrombocytopenia.
External radiotherapy is used in the treatment of all stages of prostate cancer and generally has a high rate of success and low toxicity. It is applied in all its forms - conformal 3D radiotherapy, intensity modulated radiotherapy, intensity modulated proton therapy, and carbon ion radiotherapy.
Brachytherapy is one of the basic standard options for the treatment of localized prostate cancer. Long-term data confirm efficiency and safety of using brachytherapy for treating a prostate cancer and make it an adequate choice of treatment along with benefits, which this procedure provides. It is suitable for all risk groups either as a single treatment or in combination with external radiotherapy.
Extracranial stereotactic radiotherapy is one of the rapid developing fields in oncology. Article deals with important aspects of precise quality assurance as well as results of prostate cancer treatment from different institutions.
Thanks to gradually improving understanding of complex interactions between the immune system and cancer and thanks to deeper understanding of molecular interactions between tumour and immune cells at the level of so-called checkpoint inhibitors, there has been a renaissance of immunotherapy as a therapeutic modality in oncology in recent years. The following article focuses on the current status of checkpoint inhibitors for therapy of malignant melanoma and other possibilities for their use in the future.
Metastatic melanoma was still relatively recently considered as a malignant tumor with a very poor prognosis, with only limited response to the available treatment methods. However, over the last five years, at least in part of the patients, metastatic melanoma has been slowly changing from being a disease with poor prognosis to disease with long-term survival. It is mostly due to new therapeutic options. Ten years ago, five-year survival rate was no more than 10% of patients. Nowadays, using the latest therapeutic options, the number is approximately 30%.
Basal cell carcinoma is the most common carcinoma with low malignant potential and mortality, and in early diagnosis with high curability. It occurs in different clinical forms, histological variants with different risk. Early diagnostics, based on experience, good clinical knowledge and histological variants, is a prerequisite for choosing the optimal modal treatment of both primary and recurrent treatment. Dominant surgery is the only surgical procedure in which contraindication can be done with non-surgical methods, radiation therapy, cryodestruction, photodynamic therapy or topical treatment. For advanced or metastatic basal cell carcinoma, vismodegib the first inhibitor hedgehog signaling pathway is used.
Patient with brain metastases of malignant melanoma a long‑term surviving with BRAF and MEK inhibitor in combination therapy
In recent years, there has been a significant shift in the treatment of generalized malignant melanoma due to the introduction of targeted BRAF and MEK inhibitors in patients with BRAF mutation in tumor cells and modern immunotherapy using antibodies against immune response checkpoints. The results of clinical trials have confirmed a significantly higher response rate and an increase in overall survival in patients treated with both types of medication.
Tomotherapy is a radiotherapy procedure providing a highly conformal dose distribution that allows critical organs to be investigated and/or a local dose increase in the target volume. The principle of the technique is to place a small megavoltage linear accelerator on a rotating gantry, including the acquisition of a CT verification before each fraction. A similar technology is volumetric modulated arc therapy (so-called VMAT) on a conventional linear accelerator. There are several studies that directly compare volumetric radiotherapy and tomotherapy. The results indicate a generally faster delivery of the dose by VMAT technique, tomotherapy provides a relatively more consistent and homogeneous dose distribution. Tomotherapy is used in the adjuvant, neoadjuvant, radical and palliative treatment of a wide range of diagnoses.
The present review summarizes current treatment approaches for head and neck tumors. The basic therapeutic modalities for squamous cell carcinomas are surgery and radiotherapy. Systemic treatment is a part of concurrent chemoradiotherapy or it is indicated with a palliative intent alone. A new approach to palliative treatment is the use of immunotherapy. A partly different approach compared to other head and neck tumors is taken into consideration in nasopharyngeal cancer and salivary gland tumors.
In the Czech Republic bortezomib and lenalidomide-based regimens (VD, CVD, VTD, RD) are the most commonly used second- and third-line therapies for patients with multiple myeloma (MM). Now is new combination - carfilzomib-lenalidomid-dexamethason (KRd) approved for the treatment for patients with relapse of MM. The approvals for the combination KRd were based on results of randomized ASPIRE trial, phase 3, which evaluated KRd versus Rd in patients with relapsed or refractory MM (1-3 previous lines of therapy). Treatment with KRd led to a significant reduction in the risk of disease progression or death. Progression-free survival was significantly improved with carfilzomib (median 26.3 months for KRd versus 17.6 months for Rd). Median overall survival was 48.3 months for KRd versus 40.4 months for Rd. Selected grade > 3 adverse events of interest included cardiac failure (4.3 % vs 2.1 %), ischemic heart disease (3.8 % vs 2.3 %) and arterial hypertension (6.4 % vs 2.3 %).
Immunotherapy has accomplished an impressive success within the past several years and therefore is widely accepted as a breakthrough therapy in the field of oncology. The rapid development of modern methods has led to generation of highly personalized biological and cellular therapy. In the solid tumor treatment, checkpoint inhibitors turned to be a very perspective therapeutic modality however, the prevention of undesired autoimmune events should be targeted in ongoing clinical trials. In hematological malignancies, application of CAR T cells showed significant results and combining CAR T cells with oncolytic viruses might be a promising approach in the future. Here we provide the systematic review of the modern immune-oncologic approaches and present the course of basic research in the field of cancer immunotherapy.