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Adjuvant systemic therapy after radical resection of non‑small cell lung cancer – reality and new possibilities
01/2019 Prof. MUDr. Vítězslav Kolek, DrSc.
Adjuvant chemotherapy (AC) after radical resection is a standard treating method of non-small cell lung cancer (NSCLC) in stage IB (in tumors of 4 cm in diameter), II and IIIA. The recommendation is based on the results of extensive meta-analyzes, which confirmed the reduction in the relative risk of death and an absolute improvement in the 5-year survival rate from 4% to 5%. Due to relatively low profits and side effects, AC use is limited in practice. Combination of vinorelbine with cisplatin is preferred, but carboplatin is used as well, particularly in patients with older age, worse performance status and co-morbidities. Current efforts aim to improve efficacy and patient selection. Prognostic and predictive biomarkers are sought to allow the personalization of adjuvant chemotherapy. In patients with NSCLC after radical surgery, other systemic treatment options are verified. Biologically targeted treatment has not yet been unambiguously put into common practice although two studies have shown improved survival with long-term TK inhibitors in the epidermal growth factor receptor (EGFR) mutation tumors. There are several extensive Phase 3 studies with immunotherapy in patients with different PDL-1 expressions. Their results are expected with great hope.
ENTIRE ARTICLE
Adjuvant chemotherapy (AC) after radical resection is a standard treating method of non-small cell lung cancer (NSCLC) in stage IB (in tumors of 4 cm in diameter), II and IIIA. The recommendation is based on the results of extensive meta-analyzes, which confirmed the reduction in the relative risk of death and an absolute improvement in the 5-year survival rate from 4% to 5%. Due to relatively low profits and side effects, AC use is limited in practice. Combination of vinorelbine with cisplatin is preferred, but carboplatin is used as well, particularly in patients with older age, worse performance status and co-morbidities. Current efforts aim to improve efficacy and patient selection. Prognostic and predictive biomarkers are sought to allow the personalization of adjuvant chemotherapy. In patients with NSCLC after radical surgery, other systemic treatment options are verified. Biologically targeted treatment has not yet been unambiguously put into common practice although two studies have shown improved survival with long-term TK inhibitors in the epidermal growth factor receptor (EGFR) mutation tumors. There are several extensive Phase 3 studies with immunotherapy in patients with different PDL-1 expressions. Their results are expected with great hope.
Malignant pleural mesothelioma – present and prospects
05/2018 Prof. MUDr. Vítězslav Kolek, DrSc.
In clinical practice, the majority of tumors affecting pleura are tumors of other primary location, as they generalize. The most common primary tumor in this area is malignant mesothelioma.
Its cause is mostly contact with asbestos and the incidence is increasing even though working with asbestos in European countries is already prohibited. Diagnosis is based primarily on immunohistochemical examination of the tumor. The main treatment has been chemotherapy with the combination of cisplatin and pemetrexed in the last 10 years. Tumor aggression is high, and it cannot be fully cured. The surgical approach is limited by appropriate selection of patients and sufficient experience of the workplace. Extrapleural pneumonectomy is performed and lately preferred enlarged pleurectomy in combination with adjuvant or neoadjuvant chemotherapy or radiotherapy. However, randomized trials did not show any significant prolongation of survival compared to standard chemotherapy. Unfortunately, the same can still be said of a large number of studies with biologically targeted treatment, immunotherapy and other drugs. However, research into the genetic and biological characteristics of the tumor is still ongoing and endeavor to improve patient prognosis is enormous.
ENTIRE ARTICLE
In clinical practice, the majority of tumors affecting pleura are tumors of other primary location, as they generalize. The most common primary tumor in this area is malignant mesothelioma.
Its cause is mostly contact with asbestos and the incidence is increasing even though working with asbestos in European countries is already prohibited. Diagnosis is based primarily on immunohistochemical examination of the tumor. The main treatment has been chemotherapy with the combination of cisplatin and pemetrexed in the last 10 years. Tumor aggression is high, and it cannot be fully cured. The surgical approach is limited by appropriate selection of patients and sufficient experience of the workplace. Extrapleural pneumonectomy is performed and lately preferred enlarged pleurectomy in combination with adjuvant or neoadjuvant chemotherapy or radiotherapy. However, randomized trials did not show any significant prolongation of survival compared to standard chemotherapy. Unfortunately, the same can still be said of a large number of studies with biologically targeted treatment, immunotherapy and other drugs. However, research into the genetic and biological characteristics of the tumor is still ongoing and endeavor to improve patient prognosis is enormous.
Erlotinib in the treatment of advanced non‑small cell lung cancer – present experience and results in the Czech Republic
04/2018 MUDr. Helena Čoupková, Mgr. Renata Chloupková, Marek Konečný, Mgr. Magda Bařinová, prof. MUDr. Jana Skřičková, CSc., prof. MUDr. Miloš Pešek, CSc., prof. MUDr. Vítězslav Kolek, DrSc., doc. MUDr. František Salajka, CSc., doc. MUDr. Milada Zemanová, CSc., MUDr. Leona Koubková, MUDr. Libor Havel, MUDr. Kateřina Košatová
Erlotinib is an inhibitor of epidermal growth factor receptor (EGFR) tyrosine-kinase activity, a potent drug in non-small-cell lung cancer (NSCLC) treatment. In this paper, we report a population of patients suffering from advanced NSCLC who are being treated with erlotinib in the Czech Republic under the terms of the TULUNG drug registry (excluding the patients from the University Hospital of Ostrava). By October 2nd 2017, 3763 patients were treated with erlotinib in this cohort. The overall response rate (ORR) in the entire group was 8,7 %, the disease control rate was 58,5 %. Survival data were updated on May 21st 2018. Progression-free survival and overall survival were 3,1 months and 7,7 months, respectively. In our evaluation, we noticed a statistically significant difference both in overall survival (OS) and progression free survival (PFS) in patients grouped according to status of EGFR mutation, performance status, gender and smoking habits. Moreover, there was a statistically significant difference in PFS among patients grouped according to treatment line. Based on our results, skin toxicity appears to be a prognostic factor. The efficacy difference in squamous and non-squamous carcinomas was not statistically significant. From the 3763 patients included in the safety analysis, 1592 (42,3 %) experienced therapy-related adverse events, the most common was rash (35,3 %) and diarrhea (16,3 %). Serious adverse events (G3/4) were reported in 13,6 % patients, the most common was rash (9 %) and diarrhea (3 %). Our results confirm the efficacy and safety of the erlotinib therapy in the first and in the following lines of advanced NSCLC.
ENTIRE ARTICLE
Erlotinib is an inhibitor of epidermal growth factor receptor (EGFR) tyrosine-kinase activity, a potent drug in non-small-cell lung cancer (NSCLC) treatment. In this paper, we report a population of patients suffering from advanced NSCLC who are being treated with erlotinib in the Czech Republic under the terms of the TULUNG drug registry (excluding the patients from the University Hospital of Ostrava). By October 2nd 2017, 3763 patients were treated with erlotinib in this cohort. The overall response rate (ORR) in the entire group was 8,7 %, the disease control rate was 58,5 %. Survival data were updated on May 21st 2018. Progression-free survival and overall survival were 3,1 months and 7,7 months, respectively. In our evaluation, we noticed a statistically significant difference both in overall survival (OS) and progression free survival (PFS) in patients grouped according to status of EGFR mutation, performance status, gender and smoking habits. Moreover, there was a statistically significant difference in PFS among patients grouped according to treatment line. Based on our results, skin toxicity appears to be a prognostic factor. The efficacy difference in squamous and non-squamous carcinomas was not statistically significant. From the 3763 patients included in the safety analysis, 1592 (42,3 %) experienced therapy-related adverse events, the most common was rash (35,3 %) and diarrhea (16,3 %). Serious adverse events (G3/4) were reported in 13,6 % patients, the most common was rash (9 %) and diarrhea (3 %). Our results confirm the efficacy and safety of the erlotinib therapy in the first and in the following lines of advanced NSCLC.
Immunotherapy of non‑small cell lung cancer with anti‑PD‑L1 antibodies
04/2017 Prof. MUDr. Vítězslav Kolek, DrSc.
An immuno-therapy directed at the inhibition of PD-L1 (programmed death-ligand 1) protein ligand in patients with non-small cell lung cancer in the second or third line of treatment is reported, according to the results of the POPLAR and OAK studies. The atezolizumab treatment product showed an improvement in survival compared to docetaxel in all subgroups of patients with the exception of tumors with epidermal growth factor receptor and anaplastic lymphoma kinase positivity. Efficacy was greatest in tumors with high expression of PD-L1 and large lymphocytic infiltration of the tumor but was found even in low or inconclusive expression. The drug was very well tolerated and is another hope for patients with metastatic and locally advanced non-small cell lung carcinoma.
ENTIRE ARTICLE
An immuno-therapy directed at the inhibition of PD-L1 (programmed death-ligand 1) protein ligand in patients with non-small cell lung cancer in the second or third line of treatment is reported, according to the results of the POPLAR and OAK studies. The atezolizumab treatment product showed an improvement in survival compared to docetaxel in all subgroups of patients with the exception of tumors with epidermal growth factor receptor and anaplastic lymphoma kinase positivity. Efficacy was greatest in tumors with high expression of PD-L1 and large lymphocytic infiltration of the tumor but was found even in low or inconclusive expression. The drug was very well tolerated and is another hope for patients with metastatic and locally advanced non-small cell lung carcinoma.