06/2020
Content
Patient with non‑small cell lung cancer treated with osimertinib – case report
Leona Koubková
Gabriela Krákorová, Jan Baxa, Miloš Pešek
Atypical manifestation of non‑small cell lung carcinoma – case report
Tomáš Hanslík, Zdeněk Chovanec, Alena Berková, Stanislav Špelda, Michal Benej, Adam Peštál, Vadim Prudius Ivan Čapov, Vladimír Červeňák, Tetiana Shatokhina
Věra Benešová
Michaela Miškovičová
Martina Kubecová, Klaudia Regináčová
BRCA‑positive ovarian cancer – case report
Klaudia Regináčová, Martina Kubecová
Ivo Kocák, Ilona Kocáková, Zdeněk Řehák
Neuroendocrine carcinoma of the liver – case report
Andrea Jurečková
Mucinous neoplasms of the appendix – case report
Alena Berková, Petr Vlček, Ilona Krejčová, Tamara Vystrčilová, Vladimír Červeňák, Zdeněk Chovanec, Sabina Svobodová
Long‑term survival of a patient with primarily metastatic prostate cancer – case report
Jana Katolická
Mature teratoma of the thymus, random diagnosis in patient with ebrieta
Zdeněk Chovanec, Alena Berková, Vladimír Červeňák, Tomáš Hanslík, Adam Peštál, Vadym Prudius, Ivan Čapov
Petra Bělohlávková
Kateřina Benková, Zdeněk Kořístek, Petra Richterová, Jana Mihályová, Dagmar Zámoravcová, Karel Lach, Roman Hájek
Eugen Kubala
Denosumab – an important part of the treatment of patients with skeletal metastatic disease
Samuel Vokurka
RECOMMENDED ARTICLES
Patient with non‑small cell lung cancer treated with osimertinib – case report
06/2020 MUDr. Leona Koubková
We know that non-small cell lung cancer (NSCLC) is a genetically inhomogeneous group of tumors. Demonstration of genetic aberrations then allows us to predict the effectiveness of targeted treatment. Mutations in the epidermal growth factor receptor (EGFR) gene have been investigated for many years. We already have three generations of EGFR tyrosine kinase inhibitors available. Osimertinib is a third-generation EGFR tyrosine kinase inhibitor that was first approved for the treatment of patients with locally advanced or metastatic NSCLC with a proven T790M EGFR mutation (FDA 11/2015 and EMA 2/2016). Osimertinib is also currently approved for first-line treatment in patients with a proven activating mutation in the EGFR gene (FDA 4/2018 and EMA 6/18).
ENTIRE ARTICLE
We know that non-small cell lung cancer (NSCLC) is a genetically inhomogeneous group of tumors. Demonstration of genetic aberrations then allows us to predict the effectiveness of targeted treatment. Mutations in the epidermal growth factor receptor (EGFR) gene have been investigated for many years. We already have three generations of EGFR tyrosine kinase inhibitors available. Osimertinib is a third-generation EGFR tyrosine kinase inhibitor that was first approved for the treatment of patients with locally advanced or metastatic NSCLC with a proven T790M EGFR mutation (FDA 11/2015 and EMA 2/2016). Osimertinib is also currently approved for first-line treatment in patients with a proven activating mutation in the EGFR gene (FDA 4/2018 and EMA 6/18).
Long‑term surviving patient with EGFR mutation – deletion on exon 19 and acquired resistant mutation T790 – case report
06/2020 MUDr. Gabriela Krákorová, Ph.D.; doc. MUDr. Jan Baxa, Ph.D.; prof. MUDr. Miloš Pešek, CSc.
Metastatic lung cancer has a very poor prognosis, with a 5-year survival of about 5%. Pulmonary malignancies with a control mutation for which biologically targeted drugs are available have a better prognosis, as shown by a case report of a patient with a sensitive control EGFR mutation. Tumor biopsy and peripheral blood sampling, liquid biopsy, were performed repeatedly during treatment to detect the acquired T790 resistance mutation, among other things. The patient survives with metastatic lung adenocarcinoma for eight years, still with a good quality of life. The case report shows that due to a suitably selected treatment sequence according to the presumed or known genetic profile of the tumor, even metastatic lung cancer can change from such a serious disease to a chronic one.
ENTIRE ARTICLE
Metastatic lung cancer has a very poor prognosis, with a 5-year survival of about 5%. Pulmonary malignancies with a control mutation for which biologically targeted drugs are available have a better prognosis, as shown by a case report of a patient with a sensitive control EGFR mutation. Tumor biopsy and peripheral blood sampling, liquid biopsy, were performed repeatedly during treatment to detect the acquired T790 resistance mutation, among other things. The patient survives with metastatic lung adenocarcinoma for eight years, still with a good quality of life. The case report shows that due to a suitably selected treatment sequence according to the presumed or known genetic profile of the tumor, even metastatic lung cancer can change from such a serious disease to a chronic one.
Atypical manifestation of non‑small cell lung carcinoma – case report
06/2020 MUDr. Tomáš Hanslík; MUDr. Zdeněk Chovanec, Ph.D.; MUDr. Alena Berková, Ph.D.; MUDr. Stanislav Špelda; MUDr. Michal Benej, Ph.D.; MUDr. Adam Peštál, Ph.D.; MUDr. Vadim Prudius, Ph.D.; prof. MUDr. Ivan Čapov, CSc.; MUDr. Vladimír Červeňák; MUDr. Tetiana Shatokhina
The authors acquaint the readers through a case report with a patient in whom non-small cell lung cancer manifested itself in an atypically bulky arching of the chest wall. Initially, it acted clinically and radiologically as chest wall sarcoma, as no tumorous infiltration of the lung parenchyma was evident. There was also a deposit of the right thyroid lobe of uncertain origin. Finally a number of immunohistochemical tests have brought about the resolution and diagnosis. According to genetic examination, the presence of a programmed cell death-ligand 1 (PD-L1) mutation was demonstrated in the cancer, and subsequently immunological therapy was used, which led to a significant regression of the tumor mass of the chest wall.
ENTIRE ARTICLE
The authors acquaint the readers through a case report with a patient in whom non-small cell lung cancer manifested itself in an atypically bulky arching of the chest wall. Initially, it acted clinically and radiologically as chest wall sarcoma, as no tumorous infiltration of the lung parenchyma was evident. There was also a deposit of the right thyroid lobe of uncertain origin. Finally a number of immunohistochemical tests have brought about the resolution and diagnosis. According to genetic examination, the presence of a programmed cell death-ligand 1 (PD-L1) mutation was demonstrated in the cancer, and subsequently immunological therapy was used, which led to a significant regression of the tumor mass of the chest wall.
Treatment of metastatic hormone‑dependent breast cancer with a combination of palbociclib and letrozole – case report
06/2020 MUDr. Věra Benešová
The antitumor effect of cyclin-dependent kinase 4/6 (CDK4 / 6) inhibitors in combination with hormonal therapy significantly prolongs progression-free survival with prolonged lifespan. The use of this combination therapy in routine clinical practice is fundamentally changing the treatment options of our patients.
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The antitumor effect of cyclin-dependent kinase 4/6 (CDK4 / 6) inhibitors in combination with hormonal therapy significantly prolongs progression-free survival with prolonged lifespan. The use of this combination therapy in routine clinical practice is fundamentally changing the treatment options of our patients.
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.
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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.
The importance of a multidisciplinary approach to the treatment of ovarian cancer and its effect on prolonging overall survival – case reports
06/2020 Doc. MUDr. Martina Kubecová, Ph.D.; MUDr. Klaudia Regináčová
Using the example of patients with advanced ovarian cancer, we try to demonstrate the importance of a multidisciplinary approach to this disease and its effect on prolonging survival.
ENTIRE ARTICLE
Using the example of patients with advanced ovarian cancer, we try to demonstrate the importance of a multidisciplinary approach to this disease and its effect on prolonging survival.
BRCA‑positive ovarian cancer – case report
06/2020 MUDr. Klaudia Regináčová; doc. MUDr. Martina Kubecová, Ph.D.
In our case report we present a patient with BRCA-positive ovarian cancer, who was diagnosed with stage IV and underwent treatment modalities which were accessible. In the case report, we wanted to emphasize the importance of a multidisciplinary team, the need for genetic testing in treatment decisions, as well as the impact of antiangiogenic and targeted treatment on the patienťs survival in a good quality of life.
ENTIRE ARTICLE
In our case report we present a patient with BRCA-positive ovarian cancer, who was diagnosed with stage IV and underwent treatment modalities which were accessible. In the case report, we wanted to emphasize the importance of a multidisciplinary team, the need for genetic testing in treatment decisions, as well as the impact of antiangiogenic and targeted treatment on the patienťs survival in a good quality of life.
Concomitant administration of nivolumab and targeted radiotherapy with a significant clinical effect on metastatic melanoma in an elderly patient – ca
06/2020 MUDr. Ivo Kocák, Ph.D.; doc. MUDr. Ilona Kocáková, Ph.D.; doc. MUDr. Zdeněk Řehák, Ph.D.
The following case report describes a comprehensive diagnostic and therapeutic procedure in an elderly patient with generalized melanoma.
ENTIRE ARTICLE
The following case report describes a comprehensive diagnostic and therapeutic procedure in an elderly patient with generalized melanoma.
Neuroendocrine carcinoma of the liver – case report
06/2020 MUDr. Andrea Jurečková
A case report of a patient with neuroendocrine carcinoma of the liver with hormonal symptomatology is presented. Despite the massive initial involvement of the liver and non-effective 1st line platinum-based treatment, the patient was eventually treated with three subsequent lines of palliative chemotherapy and survived more than 2,5 years.
ENTIRE ARTICLE
A case report of a patient with neuroendocrine carcinoma of the liver with hormonal symptomatology is presented. Despite the massive initial involvement of the liver and non-effective 1st line platinum-based treatment, the patient was eventually treated with three subsequent lines of palliative chemotherapy and survived more than 2,5 years.
Mucinous neoplasms of the appendix – case report
06/2020 MUDr. Alena Berková, Ph.D.; MUDr. Petr Vlček, Ph.D.; MUDr. Ilona Krejčová; MUDr. Tamara Vystrčilová; MUDr. Vladimír Červeňák; MUDr. Zdeněk Chovanec, Ph.D.; MUDr. Sabina Svobodová
Patient, 59year-old, with ulcerative colitis was examined with intermittent abdominal pain. An abdominal ultrasound examination was performed, mucocele of the appendix was suspected, and subsequently confirmed by magnetic resonance imaging. Mucocele is a cystic dilatation of the appendix caused by luminal obstruction leading to intraluminal mucous accumulation. Mucocele is very often asymptomatic. However, due to the potential malignancy and the risk of rupture with development of pseudomyxoma of the peritoneum, mucocele should be surgically removed. Laparoscopic appendectomy was indicated. Histological examination revealed low-grade mucinous neoplasia of appendix, evaluated as pTis according to WHO 2019 and 8th edition of the TNM classification. Surgical margins were without pathological involvement. According to the histological findings, appendectomy was a sufficient treatment mode, and the patient was further followed up in the oncology and gastroenterology outpatient department.
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Patient, 59year-old, with ulcerative colitis was examined with intermittent abdominal pain. An abdominal ultrasound examination was performed, mucocele of the appendix was suspected, and subsequently confirmed by magnetic resonance imaging. Mucocele is a cystic dilatation of the appendix caused by luminal obstruction leading to intraluminal mucous accumulation. Mucocele is very often asymptomatic. However, due to the potential malignancy and the risk of rupture with development of pseudomyxoma of the peritoneum, mucocele should be surgically removed. Laparoscopic appendectomy was indicated. Histological examination revealed low-grade mucinous neoplasia of appendix, evaluated as pTis according to WHO 2019 and 8th edition of the TNM classification. Surgical margins were without pathological involvement. According to the histological findings, appendectomy was a sufficient treatment mode, and the patient was further followed up in the oncology and gastroenterology outpatient department.
Long‑term survival of a patient with primarily metastatic prostate cancer – case report
06/2020 MUDr. Jana Katolická, Ph.D.
There were limited options for patients with metastatic castration-resistant prostate cancer (mCRPC) following docetaxel failure or resistance, but now the approved treatment choices for these patients have expanded to include abiraterone acetate, cabazitaxel, enzalutamide and radium-223 dichloride. Although each of these agents has been shown to convey significant survival benefit as a monotherapy, findings suggest that sequence such innovative strategies with traditional treatments may achieve additive or synergistic effects, further augmenting patient benefit.
ENTIRE ARTICLE
There were limited options for patients with metastatic castration-resistant prostate cancer (mCRPC) following docetaxel failure or resistance, but now the approved treatment choices for these patients have expanded to include abiraterone acetate, cabazitaxel, enzalutamide and radium-223 dichloride. Although each of these agents has been shown to convey significant survival benefit as a monotherapy, findings suggest that sequence such innovative strategies with traditional treatments may achieve additive or synergistic effects, further augmenting patient benefit.
Mature teratoma of the thymus, random diagnosis in patient with ebrieta
06/2020 MUDr. Zdeněk Chovanec, Ph.D.; MUDr. Alena Berková, Ph.D.; MUDr. Vladimír Červeňák; MUDr. Tomáš Hanslík; MUDr. Adam Peštál, Ph.D.; MUDr. Vadym Prudius, Ph.D.; prof. MUDr. Ivan Čapov, CSc.
The case report presents the case of the 23-year-old, an asthmatic man, being investigated for sudden shortness of breath, non-traumatic pain in the left shoulder and back after abuse alcohol. On the X-ray there was dilated mediastinum to the left side and in CT of chest was 4 * 5 * 5 cm size infiltration of anterior mediastinum. A pulmonary examination and fine needle biopsy were performed during the first hospitalization. In differential diagnosis was from low grade myofibroblastic sarcoma to mediastinal teratoma. It was indicated surgery revision. Procedure start uncomplicated diagnostic videothoracoscopy with frozen section and continuing to sternotomy extended to anterior left thoracotomy with extirpation on the mediastinal infiltration. Definitive histology confirms mature teratoma of the thymus.
ENTIRE ARTICLE
The case report presents the case of the 23-year-old, an asthmatic man, being investigated for sudden shortness of breath, non-traumatic pain in the left shoulder and back after abuse alcohol. On the X-ray there was dilated mediastinum to the left side and in CT of chest was 4 * 5 * 5 cm size infiltration of anterior mediastinum. A pulmonary examination and fine needle biopsy were performed during the first hospitalization. In differential diagnosis was from low grade myofibroblastic sarcoma to mediastinal teratoma. It was indicated surgery revision. Procedure start uncomplicated diagnostic videothoracoscopy with frozen section and continuing to sternotomy extended to anterior left thoracotomy with extirpation on the mediastinal infiltration. Definitive histology confirms mature teratoma of the thymus.
Long‑term treatment response in myelodysplastic syndrome 5q minus after discontinuation of lenalidomide – a case report
06/2020 MUDr. Petra Bělohlávková, Ph.D.
MDS 5q minus syndrome belongs to the category of low-risk MDS with a good prognosis. Lenalidomide treatment can effectively lead to transfusion independence and cytogenetic remission with improved the overall survival. We present a case of a patient in whom long-term remission of the disease lasts 5,5 years after discontinuation of treatment by lenalidomide.
ENTIRE ARTICLE
MDS 5q minus syndrome belongs to the category of low-risk MDS with a good prognosis. Lenalidomide treatment can effectively lead to transfusion independence and cytogenetic remission with improved the overall survival. We present a case of a patient in whom long-term remission of the disease lasts 5,5 years after discontinuation of treatment by lenalidomide.
Hemodialysis dependent patient with relapsed acute promyelocytic leukemia treated by arsenic trioxide
06/2020 MUDr. Kateřina Benková; MUDr. Zdeněk Kořístek, Ph.D.; MUDr. Petra Richterová; MUDr. Jana Mihályová; Mgr. Dagmar Zámoravcová; Ing. Karel Lach, CSc.; prof. MUDr. Roman Hájek, CSc.
Arsenic trioxide (ATO) is a drug of choice in the treatment of relapsed acute promyelocytic leukemia (APL). Guidelines for the treatment of hemodialysis dependent patients with APL do not exist. Here we describe the treatment of relapsed APL in a hemodialysis dependent patient by ATO at the dose of 10 mg three times a week after hemodialysis with frequent monitoring of laboratory values and QT interval. Molecular remission was achieved without serious adverse events. The authors further discuss the use of ATO in hemodialysis dependent patients and conclude, that ATO can be safely and effectively used in such patients under the condition of close monitoring of toxicity and adverse events; assessment of the arsenic concentration in blood is not useful for treatment management.
ENTIRE ARTICLE
Arsenic trioxide (ATO) is a drug of choice in the treatment of relapsed acute promyelocytic leukemia (APL). Guidelines for the treatment of hemodialysis dependent patients with APL do not exist. Here we describe the treatment of relapsed APL in a hemodialysis dependent patient by ATO at the dose of 10 mg three times a week after hemodialysis with frequent monitoring of laboratory values and QT interval. Molecular remission was achieved without serious adverse events. The authors further discuss the use of ATO in hemodialysis dependent patients and conclude, that ATO can be safely and effectively used in such patients under the condition of close monitoring of toxicity and adverse events; assessment of the arsenic concentration in blood is not useful for treatment management.
Benefit of the combination of encorafenib + binimetinib in the treatment of BRAF V600 mutant melanoma – updated results of the COLUMBUS study
06/2020 MUDr. Eugen Kubala
Treatment of advanced and metastatic melanoma with the BRAF V600 mutation by combination therapy with BRAF and MEK inhibitors encorafenib and binimetinib was demonstrated in the COLUMBUS study, the results of which were updated in June 2020. Encorafenib is an ATP-competitive BRAF inhibitor capable of blocking several mutated forms of BRAF kinase for 30 hours (e.g. V600E, V600D and V600K) in tumor melanoma cells against other BRAF inhibitors dabrafenib (2 hours) or vemurafenib (0.5 hours). It allows almost permanent inhibition of the mutated form of BRAF protein kinase. According to the updated results of the COLUMBUS study, the median PFS results for the combination of encorafenib + binimetinib at 14.9 months versus vemurafenib were confirmed at 7.3 months. Significant is the comparison of the two BRAF inhibitors encorafenib and vemurafenib, which indicated a higher efficacy of encorafenib versus vemurafenib median PFS 9.6 vs 7.3 months HR 0.68 (95% CI 0.52-0.88; p = 0.0038) Combination of the BRAF inhibitor encorafenib and the MEK inhibitor binimetinib significantly shifted the median PFS of 16.4 months and the median overall survival (OS) of 33.6 months without increasing toxicity over the established and used combinations of BRAF and MEK inhibitors used in the treatment of BRAF V600 mutant melanoma. In long-term follow-up of COMBO 450 (the combination encorafenib 450 mg and binimetinib 45 mg) vs vemurafenib (vemurafenib 960 mg) patients, 26% vs 12% of patients achieved 48-month PFS. Another primary endpoint of the COLUMBUS study was an updated outcome of OS.4-year survival was achieved in 39% of patients treated with COMBO450 combination therapy, 37% of patients treated with encorafenib 300 mg (ENCO300) monotherapy, and 26% of patients treated with vemurafenib (VEM). The updated results of the COLUMBUS study presented at ASCO (American Society of Clinical Oncology Congress) 2020 confirmed that the combination of encorafenib and binimetinib is a highly effective treatment for BRAF V600 mutant melanoma.
ENTIRE ARTICLE
Treatment of advanced and metastatic melanoma with the BRAF V600 mutation by combination therapy with BRAF and MEK inhibitors encorafenib and binimetinib was demonstrated in the COLUMBUS study, the results of which were updated in June 2020. Encorafenib is an ATP-competitive BRAF inhibitor capable of blocking several mutated forms of BRAF kinase for 30 hours (e.g. V600E, V600D and V600K) in tumor melanoma cells against other BRAF inhibitors dabrafenib (2 hours) or vemurafenib (0.5 hours). It allows almost permanent inhibition of the mutated form of BRAF protein kinase. According to the updated results of the COLUMBUS study, the median PFS results for the combination of encorafenib + binimetinib at 14.9 months versus vemurafenib were confirmed at 7.3 months. Significant is the comparison of the two BRAF inhibitors encorafenib and vemurafenib, which indicated a higher efficacy of encorafenib versus vemurafenib median PFS 9.6 vs 7.3 months HR 0.68 (95% CI 0.52-0.88; p = 0.0038) Combination of the BRAF inhibitor encorafenib and the MEK inhibitor binimetinib significantly shifted the median PFS of 16.4 months and the median overall survival (OS) of 33.6 months without increasing toxicity over the established and used combinations of BRAF and MEK inhibitors used in the treatment of BRAF V600 mutant melanoma. In long-term follow-up of COMBO 450 (the combination encorafenib 450 mg and binimetinib 45 mg) vs vemurafenib (vemurafenib 960 mg) patients, 26% vs 12% of patients achieved 48-month PFS. Another primary endpoint of the COLUMBUS study was an updated outcome of OS.4-year survival was achieved in 39% of patients treated with COMBO450 combination therapy, 37% of patients treated with encorafenib 300 mg (ENCO300) monotherapy, and 26% of patients treated with vemurafenib (VEM). The updated results of the COLUMBUS study presented at ASCO (American Society of Clinical Oncology Congress) 2020 confirmed that the combination of encorafenib and binimetinib is a highly effective treatment for BRAF V600 mutant melanoma.
Denosumab – an important part of the treatment of patients with skeletal metastatic disease
06/2020 Prof. MUDr. Samuel Vokurka, Ph.D.
Denosumab, 120 mg inj. s.c., significantly contributes to delaying the development of skeletal related events (pathological fracture, spinal cord compression, a condition requiring radiotherapy or surgery to bone) and worsening pain in patients with skeletal metastatic disease. Initial dental care with prophylactic stomatology interventions and proper supplementation of calcium and vitamin D are an integral part and condition for successful treatment with denosumab.
ENTIRE ARTICLE
Denosumab, 120 mg inj. s.c., significantly contributes to delaying the development of skeletal related events (pathological fracture, spinal cord compression, a condition requiring radiotherapy or surgery to bone) and worsening pain in patients with skeletal metastatic disease. Initial dental care with prophylactic stomatology interventions and proper supplementation of calcium and vitamin D are an integral part and condition for successful treatment with denosumab.