Renata Soumarová, Lenka Rušínová
Dagmar Brančíková, Markéta Protivánková
Markéta Protivánková, Dagmar Brančíková, Jiří Vašina
Lenka Rušinová, Renata Soumarová, Marián Liberko
Jana Krejčí, Petr Opálka
Adjuvant radiotherapy after both radical and partial mastectomy has an effect on local disease control as well as overall survival, as evidenced by large studies with long-term follow-up. However, postoperative radiotherapy indications for patients after neoadjuvant chemotherapy are controversial. This is due to a different tumor response to neoadjuvant treatment and a lack of prospective studies. Currently, when considering post-operative radiotherapy after neoadjuvant treatment, both the very accurate pre-treatment classification and the tumor characteristics including molecular subtypes and the definitive pathological classification must be taken into account. The most difficult decision is especially in the group of patients who have achieved a pathological complete response.
Triple-negative breast cancer is associated with poor outcomes compared to other breast cancer subtypes. It is known to have an aggressive behaviour but on the other hand it is exceptionally chemosensitive. Currently, the only standard treatment modality that is used in both early and advanced triple-negative breast cancer is conventional chemotherapy. When anthracyclines, alkylating agents, and taxanes are administered, 30-40 % of patients treated with neoadjuvant chemotherapy achieve pathological complete remission associated with excellent prognosis. The prognosis of patients with a residual disease after neoadjuvant chemotherapy is poor. In clinical trials, the addition of platinum to standard chemotherapy was attempted to achieve more complete pathological responses. Importance of platinum remains unclear, controversial are the data on their effectiveness especially in patients with germline mutation in the BRCA (breast cancer) genes.
Hormonal therapy is an integral part of a multidisciplinary approach to the treatment of breast cancer with positive estrogen and/or progesteron receptors. While neoadjuvant chemotherapy is well established as a part of therapeutic regimes based on outcomes of clinical trials even in operable tumors, neoadjuvant hormonotherapy is generally used only in the treatment of locally advanced tumors, particularly in elderly population. There are a number of clinical trials comparing the efficacy of aromatase inhibitors with tamoxifen in the neoadjuvant setting, but there is a lack of comparison studies of neoadjuvant and adjuvant hormonal therapies. In addition to the effectiveness of neoadjuvant hormonotherapy in primary inoperable tumors, this treatment also leads to a reduction of mastectomies compared to breast conservation surgery. It is necessary to specify the optimal length of neoadjuvant hormonotherapy.
Adjuvant chemotherapy in hormonal‑dependent breast cancer patients – options in using of multigene assays
The time before 2000, when adjuvant chemotherapy was a standard part of the treatment of almost all breast cancers, including hormonal-dependent, is long gone. Multigene assays help us to clarify the biological behavior of estrogen/progesterone-positive tumors and thus the prognosis of patients. In the past, chemotherapy was indicated in the majority of patients without lymph node involvement, now is shown that even tumors with 1-3 metastatic lymph nodes may be those with a good prognosis that does not require chemotherapy. The challenge of the upcoming period is prognostic stratification of the disease according to the risk of relapse and predictive administration of systemic therapy. The more prognostic groups we create, the more targeted will be the treatment and the smaller group of patients will be exposed to its side effects.
Immunotherapy is an emerging new modality in the treatment of many tumors. In the treatment of breast carcinomas, there is already the first experience with this treatment, which gradually defines the subgroups of patients and stages of breast malignancies that receive the highest profits from immunotherapy alone or in combinations with chemotherapy and target therapy. We present a review of the literature on clinical (age, weight, gender) and laboratory parameters that predict the response to immunotherapy and an overview of suitable combinations with chemotherapy or targeted agents in the treatment of metastatic breast cancer. Monotherapy checkpoint inhibitors do not yet appear to be effective but combinations atezolizumab or pembrolizumab with nab-paclitaxel and eribulin mesylate in neoadjuvant and in the first line of palliation are very promising in the treatment of triple-negative breast cancer locally advanced. So far, in the treatment of HER (epidermal growth factor receptor) positive tumors and ER (estrogen receptor) positive, a subset of patients with significant immunotherapy benefit cannot be unequivocally established.
The primary goal of neoadjuvant systemic therapy in patients with early breast cancer is the down-staging of the disease and achieving operability of the primarily inoperable tumor or achieving less radical surgery. Achieving complete pathological remission affects the long-term prognosis of patients, mainly in triple negative breast cancer and non-luminal HER2 (human epidermal receptor 2, positive for breast epidermal growth factor 2). In the case report we present a case of a patient with locally advanced HER2-positive breast cancer who achieved complete remission by intensive neoadjuvant systemic treatment using dual HER2 receptor blockade, which could significantly reduce subsequent surgical treatment.
Treatment of metastatic HER2 positive breast cancer in young patient with very advanced disease – case report
Although the percentage of patients diagnosed in the early stage of the disease is increasing after the introduction of breast cancer screening, a large group of patients still have metastatic breast cancer. Advanced HER2 positive breast cancer has been therapeutically difficult to treat with adverse prognosis until the introduction of targeted anti-HER2 therapy, and its therapy has been complicated by a number of possible side effects and considerable toxicity. Our case report describes a case of a 42-year-old patient who had HER2 positive breast cancer diagnosed at a very advanced stage of the disease. After the use of dual-block treatment with concomitant administration of trastuzumab and pertuzumab, a high-quality and long-term response of the disease was achieved in which the quality of life of the patient significantly increased. At the same time, this treatment was very well tolerated.
Complete and long‑term response of HER2 positive locally highly advanced metastatic breast cancer – case report
Unfortunately, we are currently encountering locally very advanced and generalized breast cancers. However, due to systemic therapy and especially targeted therapy, we can see excellent long-term responses in patients with HER2 positive tumors. The discovery of novel products targeting the extracellular domain of the human epidermal growth factor receptor 2 (HER2) and the combination of this monoclonal antibody with the microtubule inhibitor T-DM1 (trastuzumab emtansine) has resulted in a statistically significant increase in overall survival and has changed metastatic HER2 positive breast cancer to chronic disease.
Ovarian cancer is beyond the usual behavior of other solid tumors due to its biological behavior, spreading to serous surfaces, high metabolic demands and high recurrence rates. Although not the most common malignancy, it is a gynecological cancer with the highest mortality. Early or earlier diagnosis, proper therapeutic management, and metabolic care are crucial for the quality of life of patients and their survival. In the diagnosis and other care of a woman with ovarian cancer, experts from other medical specializations should be involved. Therefore, it is essential that they are informed about special characteristics of this type of cancer.
Borderline ovarian tumors represent 10-20 % of all epithelial tumors of ovary. Borderline ovarian tumors are characterized by cellular proliferation and nuclear atypia, but they usually do not show infiltrative growth pattern. They differ from epithelial ovarian cancer by their low incidence, early stage diagnosis, different percentages of the most common histological types, and high survival rate even when associated with advanced stage of the disease. They occur in young women, which is why one of the objectives in these patients will be preservation of fertility. The management of these tumors is still controversial and widely discussed. Due to higher risk of recurrence in patients undergoing a conservative surgical treatment, the long-time follow-up is needed.
Menopause hormone therapy is the best therapy for acute climacteric syndrome, osteoporosis' prevention and urogenital atrophy. It is absolutely safety in personal history of cervical cancer, endometrial cancer, hematologic malignancies, local malignant melanoma, colorectal cancer and liver cancer. It is strictly contraindicated in cases history of breast cancer, endometrial stromal sarcoma, meningioma and estrogen receptor positive gastric and bladder cancer.
Poly(ADP-ribose) polymerase inhibitors (PARP) represent the most modern approach to ovarian cancer treatment. This treatment is exclusive for individuals harbouring germline or somatic BRCA1 or BRCA2 gene mutations. This case report presents a patient with recurrent ovarian cancer treated with oral PARP inhibitor olaparib as a part of third line treatment. Well tolerated treatment led to excellent long-term survival and quality of life.
This article reviews the efficacy panitumumab in the 1st line systemic treatment of metastatic colorectal carcinoma (mCRC). First study published was PRIME in which panitumumab plus FOLFOX compared to chemotherapy alone prolonged overall survival in patients with nonresectable mCRC, furthermore it showed trend towards higher resection rate in patients with liver limited disease. The PEAK trial was comparing panitumumab and bevacizumab with chemotherapy backbone. Both overall survival and progression-free survival favored panitumumab compared to bevacizumab. PLANET trial was exploring potential of panitumumab to enhance overall response rate and allow for more curative resections in LLD population of mCRC patients. PLANET trial provided evidence high resectability and long overall survival. VOLFI trial represents a reasoned step in searching for more potent combination therapy. In randomized manner it compared FOLFOXIRI alone to FOLFOXIRI plus panitumumab. This study met its primary point, which was objective response rate, furthermore it showed greatly increased resectability in panitumumab arm and suggested better overall survival. Panitumumab plus FOLFOXIRI pose viable and efficient option for patients with mCRC, where deep tumor response could open way to surgical resection.
Optimal procedure in treatments of advanced ALK‑positive and ROS1‑positive non‑small cell lung cancers
Lung cancer is one of the most common and most dangerous diseases. Currently, various treatments for non-small cell lung cancers are used, not only by histology but also by molecular genetic properties. A pre-treatment normative procedure should be performed with regard to the fact that ALK (anaplastic lymphoma kinase) translocation in all patients without magnificent histologies prior to treatment. ROS1 (ROS proto-oncogene 1) translocation and PD-L1 (programmed cell death 1 ligand 1) expression are also recommended. If you resort to being an ALK positivity that could be compromised. If ROS1 positive patients do not yet have any drugs in the Czech Republic, they will need to be covered by the rules that apply to ALK-positive patients, and there should also be an exception to the revision doctor.
The treatment of colorectal cancer in the first two lines is based on a combination of chemotherapy (FOLFOX and FOLFIRI, also in variations) and biological therapy in the form of vascular endothelial growth factor (VEGF) and epidermal growth factor (EGFR) inhibitors. Although this therapy is challenging and brings a lot of side effects, many patients are in good condition after progression. Especially for these patients the treatment with trifluridine/tipiracil is appropriate. This preparation contains a nucleoside analogue trifluridine and a thymidine phosporylase inhibitor tipiracil - inhibitor of the enzyme metabolizing just that nucleoside analogue. Trifluridine/tipiracil demonstrated efficacy in phase 3 clinical trial RECOURSE.1 Based on that the treatment was approved as well in the Czech Republic.