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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.
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Lung carcinoma – imaging on the molecular level

05/2020 Prof. MUDr. Jiří Ferda, Ph.D., MUDr. Eva Ferdová, doc. MUDr. Jan Baxa, Ph.D., prof. MUDr. Miloš Pešek, CSc., MUDr. Petr Mukenšnabl, Ph.D., doc. MUDr. Hynek Mírka, Ph.D.
Molecular imaging in lung carcinoma are being the basic diagnostic approaches in the confirmation of the tumorous origin of the disease, but also in staging and restaging of the disease. Positron emission tomography / computed tomography (PET/CT) with the application of 18F-fluorodeoxyglucose is the most frequent molecular imaging in lung tumors, it is used as the fundament of the clinical stage of the disease before start of the treatment. Positron emission tomography / magnetic resonance imaging (PET/MRI) enables to complete the imaging with the full valid brain magnetic resonance imaging during the own procedure, the main disadvantage of PET/MRI is the prolonged scanning, making time unacceptable for those patients, who are heavier clinical state. The alternative way of the pharmacokinetics evaluation could be the analysis of iodine content within tissues using dynamic perfusion computed tomography (CT) or dual-energy CT. The use of other radiopharmaceuticals like 18F-ftuorthymidine in tissue proliferation or 68Ga-DOTA derivate in the assessment of somatostatin receptor density could provide the supplementary information about tumor biology.
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Atypical response to anti‑PD‑1 therapy followed by long‑term survival in non‑small cell lung cancer – case reports

02/2020 MUDr. Gabriela Krákorová, Ph.D.; MUDr. Marek Šťastný, Ph.D.; MUDr. Hana Steinbergerová; MUDr. Jana Důrová; prof. MUDr. Miloš Pešek, CSc.; doc. MUDr. Jan Baxa, Ph.D.
Metastatic non-small cell lung cancer has poor prognosis. In the absence of driving mutations (EGFR, ALK, ROS, BRAF) or high expression of programmed death-ligand 1 (PD-L1), chemotherapy or its combination with bevacizumab is the initial treatment option with respect to reimbursement conditions in the Czech Republic. The second line possibility is the use of immunotherapy with inhibitors of protein 1 of programmed cell death (anti-programmed death-1, anti-PD-1) or inhibitors its ligand, anti-PD-LI. The authors present two case reports of patients, who had an atypical response following immunotherapy. This was the persistent effect of immunotherapy, despite the progression on this treatment. The first patient had no need for another active oncology treatment for further 12 months after immunotherapy and the malignancy had not been significantly progressing. The second patient developed a significant response to chemotherapy following anti-PD-1 immunotherapy. This phenomenon, in the literature referred not quite correctly to as chemosensitization, is repetitively described. Next the authors also consider the possibilities of treatment of the next line after immunotherapy failure.
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