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Atezolizumab in the treatment of lung cancer
05/2021 MUDr. Leona Koubková
Immuno-oncotherapy is already an integral part of lung cancer treatment. Especially in the first line treatment of non-small cell lung cancer (NSCLC) either in monotherapy of tumors with high expression of programmed cell death protein ligand 1 (PD-L1) or in combination with other treatment modalities leads to prolongation of overall survival and survival without progress. Atezolizumab, a monoclonal antibody against PD-L1, has been approved by the European Medicines Agency based on a number of studies to treat firstand higher-line NSCLC and as a first-line checkpoint inhibitor for first-line extensive small cell lung cancer.
ENTIRE ARTICLE
Immuno-oncotherapy is already an integral part of lung cancer treatment. Especially in the first line treatment of non-small cell lung cancer (NSCLC) either in monotherapy of tumors with high expression of programmed cell death protein ligand 1 (PD-L1) or in combination with other treatment modalities leads to prolongation of overall survival and survival without progress. Atezolizumab, a monoclonal antibody against PD-L1, has been approved by the European Medicines Agency based on a number of studies to treat firstand higher-line NSCLC and as a first-line checkpoint inhibitor for first-line extensive small cell lung cancer.
Entrectinib in the treatment of patients with ROS1‑positive advanced non‑small cell lung cancer
02/2021 MUDr. Leona Koubková
In recent years, we have witnessed the expanding possibilities of genotyping tumors, which allows us to strengthen precision medicine, the essence of which is the pursuit of individualized treatment. There is also an increase in the number of drugs that enable molecularly targeted therapy of tumors with proven genetic aberrations. These include entrectinib, which is effective in patients with non-small cell lung cancer who have been shown to rebuild the ROS1 gene or fuse the NTRK gene, even with metastatic central nervous system involvement.
ENTIRE ARTICLE
In recent years, we have witnessed the expanding possibilities of genotyping tumors, which allows us to strengthen precision medicine, the essence of which is the pursuit of individualized treatment. There is also an increase in the number of drugs that enable molecularly targeted therapy of tumors with proven genetic aberrations. These include entrectinib, which is effective in patients with non-small cell lung cancer who have been shown to rebuild the ROS1 gene or fuse the NTRK gene, even with metastatic central nervous system involvement.
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).
Current status and recommendations for biologically targeted treatment
05/2020 MUDr. Leona Koubková
A better understanding of the molecular biology of tumors and the expanding possibilities of their genotyping lead to the strengthening of precise medicine, which allows us personalized treatment. It is mainly genetic changes in the tumor that help us predict the response to molecularly targeted therapy and thus choose the most effective treatment for our patients. The introduction of targeted therapy based on molecular typing into clinical practice has succeeded in significantly prolonging the survival of patients with non-small cell lung cancer, sometimes by several years with a very good quality of life.
ENTIRE ARTICLE
A better understanding of the molecular biology of tumors and the expanding possibilities of their genotyping lead to the strengthening of precise medicine, which allows us personalized treatment. It is mainly genetic changes in the tumor that help us predict the response to molecularly targeted therapy and thus choose the most effective treatment for our patients. The introduction of targeted therapy based on molecular typing into clinical practice has succeeded in significantly prolonging the survival of patients with non-small cell lung cancer, sometimes by several years with a very good quality of life.
Atezolizumab in the treatment of lung cancer
03/2020 MUDr. Leona Koubková
Immunotherapy is already an integral part of lung cancer treatment. The results of a number of studies with checkpoint inhibitors have shown an improvement in overall survival first in higher treatment lines in advanced non-small cell lung cancer (NSCLC), results are now available in combination with chemotherapy in first-line treatment regardless of PD-L1 (programmed cell death protein ligand) expression, including small cell lung cancer (SCLC). Atezolizumab is approved by the European Medicines Agency as monotherapy for the second-line therapy of advanced NSCLC, in combination with bevacizumab, paclitaxel and carboplatin for the first-line treatment of metastatic non-squamous NSCLC, including patients with evidence of EGFR (epidermal growth factor receptor) mutation or ALK rearrangement after failure of target therapy, in combination with nab-paclitaxel and carboplatin in the first line of non-squamous NSCLC without evidence of EGFR mutation or ALK gene rearrangement, and in combination with etoposide and carboplatin as the first checkpoint inhibitor for extensive first-line SCLC treatment.
ENTIRE ARTICLE
Immunotherapy is already an integral part of lung cancer treatment. The results of a number of studies with checkpoint inhibitors have shown an improvement in overall survival first in higher treatment lines in advanced non-small cell lung cancer (NSCLC), results are now available in combination with chemotherapy in first-line treatment regardless of PD-L1 (programmed cell death protein ligand) expression, including small cell lung cancer (SCLC). Atezolizumab is approved by the European Medicines Agency as monotherapy for the second-line therapy of advanced NSCLC, in combination with bevacizumab, paclitaxel and carboplatin for the first-line treatment of metastatic non-squamous NSCLC, including patients with evidence of EGFR (epidermal growth factor receptor) mutation or ALK rearrangement after failure of target therapy, in combination with nab-paclitaxel and carboplatin in the first line of non-squamous NSCLC without evidence of EGFR mutation or ALK gene rearrangement, and in combination with etoposide and carboplatin as the first checkpoint inhibitor for extensive first-line SCLC treatment.
Patient with NSCLC and brain metastases and positive reassortment ALK treated with alectinib - case report
01/2020 MUDr. Leona Koubková
A better understanding of the molecular biology of tumors and the expanding possibilities of their genotyping lead to the enhancement of precise medicine, which is based on the pursuit of individualized treatment. It is primarily the genetic changes of the tumor that help us to predict the response to molecularly targeted treatment. These also include rearrangement of the ALK (anaplastic lymphoma kinase) gene in NSCLC (non-small cell lung cancer), which predicts the efficacy of ALK inhibitors, which significantly improve treatment outcomes in patients with this severe disease. Alectinib, the current standard for the first line ALK-positive NSCLC treatment, is a highly selective and potent inhibitor of ALK and RET (rearranged during transfection) tyrosine kinase and has been set to be reimbursed in the 1st line of treatment in the Czech Republic from 1st November 2019.
ENTIRE ARTICLE
A better understanding of the molecular biology of tumors and the expanding possibilities of their genotyping lead to the enhancement of precise medicine, which is based on the pursuit of individualized treatment. It is primarily the genetic changes of the tumor that help us to predict the response to molecularly targeted treatment. These also include rearrangement of the ALK (anaplastic lymphoma kinase) gene in NSCLC (non-small cell lung cancer), which predicts the efficacy of ALK inhibitors, which significantly improve treatment outcomes in patients with this severe disease. Alectinib, the current standard for the first line ALK-positive NSCLC treatment, is a highly selective and potent inhibitor of ALK and RET (rearranged during transfection) tyrosine kinase and has been set to be reimbursed in the 1st line of treatment in the Czech Republic from 1st November 2019.
Durvalumab in the treatment of lung cancer
03/2019 MUDr. Leona Koubková
Immunotherapy has already become an integral part of advanced non-small cell lung cancer treatment. The results of a number of studies have shown an improvement in the overall survival time, which is often long-lasting at a very good quality of life for patients. Recent studies have also been conducted at lower stages of non-small cell lung cancer or in post-operative adjuvant mode. The results of studies in advanced small cell lung cancer are also promising, with no progress in treatment for decades. Durvalumab is an anti PD-L1 monoclonal antibody that is approved by the Food and Drug Administration and European Medicines Agency based on the results of the PACIFIC study, for the treatment of patients with non-recurrent non-small cell lung cancer stage III, whose disease did not progress after chemoradiotherapy.
ENTIRE ARTICLE
Immunotherapy has already become an integral part of advanced non-small cell lung cancer treatment. The results of a number of studies have shown an improvement in the overall survival time, which is often long-lasting at a very good quality of life for patients. Recent studies have also been conducted at lower stages of non-small cell lung cancer or in post-operative adjuvant mode. The results of studies in advanced small cell lung cancer are also promising, with no progress in treatment for decades. Durvalumab is an anti PD-L1 monoclonal antibody that is approved by the Food and Drug Administration and European Medicines Agency based on the results of the PACIFIC study, for the treatment of patients with non-recurrent non-small cell lung cancer stage III, whose disease did not progress after chemoradiotherapy.
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.
Alecensa – a new hope for patients with ALK positive non‑small cell lung cancer
04/2018 MUDr. Leona Koubková
The possibilities of non-small-cell lung cancer treatment are expanding on the basis of a better understanding of the molecular biology of the tumors. Identification of genetic changes has led to the development of a number of small molecule tyrosine kinase inhibitors, designed to disrupt altered signaling pathways in tumors with these genetic changes. One of these genetic changes is the anaplastic lymphoma kinase (ALK) gene transformation, in which ALK inhibitors are indicated. ALK inhibitor of the 2nd generation alectinib has proven its efficacy not only in the first-generation treatment ALK failure, but also in the first line of treatment, also thanks to its effectiveness in the CNS.
ENTIRE ARTICLE
The possibilities of non-small-cell lung cancer treatment are expanding on the basis of a better understanding of the molecular biology of the tumors. Identification of genetic changes has led to the development of a number of small molecule tyrosine kinase inhibitors, designed to disrupt altered signaling pathways in tumors with these genetic changes. One of these genetic changes is the anaplastic lymphoma kinase (ALK) gene transformation, in which ALK inhibitors are indicated. ALK inhibitor of the 2nd generation alectinib has proven its efficacy not only in the first-generation treatment ALK failure, but also in the first line of treatment, also thanks to its effectiveness in the CNS.
Afatinib – drug profile
05/2017 MUDr. Leona Koubková
The epidermal growth factor receptor (EGFR) plays an important role in the development and progression of human epithelial carcinomas, including non-small cell lung cancer (NSCLC). Activation of the EGFR pathway promotes tumor growth and progression, stimulates tumor cell proliferation, angiogenic factors, invasion and metastasis, and suppresses apoptosis. Several studies have confirmed the predictive role of activation mutations in EGFR exons 19 and 21 for NSCLC. Their presence is clearly associated with higher efficacy of EGFR tyrosine kinase inhibitors (EGFR TKI). We have reversible EGFR TKI of the 1st generation erlotinib and gefitinib, the irreversible EGFR TKI 2nd generation afatinib, and also the already irreversible EGFR TKI 3rd generation osimertinib, the indication of which is above all the proven T790M mutation.
ENTIRE ARTICLE
The epidermal growth factor receptor (EGFR) plays an important role in the development and progression of human epithelial carcinomas, including non-small cell lung cancer (NSCLC). Activation of the EGFR pathway promotes tumor growth and progression, stimulates tumor cell proliferation, angiogenic factors, invasion and metastasis, and suppresses apoptosis. Several studies have confirmed the predictive role of activation mutations in EGFR exons 19 and 21 for NSCLC. Their presence is clearly associated with higher efficacy of EGFR tyrosine kinase inhibitors (EGFR TKI). We have reversible EGFR TKI of the 1st generation erlotinib and gefitinib, the irreversible EGFR TKI 2nd generation afatinib, and also the already irreversible EGFR TKI 3rd generation osimertinib, the indication of which is above all the proven T790M mutation.
Crizotinib in the treatment of generalized non‑small‑cell lung cancer – a case report
03/2017 MUDr. Leona Koubková
Targeted therapy on the basis of predictive biomarkers that predict the efficacy, at least some patients allows to individualize the treatment and in recent years led to improved treatment outcomes in patients with unfavorable diagnosis of NSCLC (non-small-cell lung cancer). One of these predictive biomarkers is a gene rearrangement EML-4-ALK and ROS1, where is indicated treatment with ALK and ROS1 inhibitors.
ENTIRE ARTICLE
Targeted therapy on the basis of predictive biomarkers that predict the efficacy, at least some patients allows to individualize the treatment and in recent years led to improved treatment outcomes in patients with unfavorable diagnosis of NSCLC (non-small-cell lung cancer). One of these predictive biomarkers is a gene rearrangement EML-4-ALK and ROS1, where is indicated treatment with ALK and ROS1 inhibitors.
Osimertinib – a new oral third‑generation EGFR TKI
02/2017 MUDr. Leona Koubková
Non-small cell lung cancer (NSCLC) is a disease with a poor prognosis. Today we know that it involves a genetically distinct group of tumors. And of such genetic diversity leads to the tendency of individualized treatments based on the predictive factors that predict the efficacy of treatment. One of the predictive factors in NSCLC are mutations of the epidermal growth factor receptor (EGFR), in which case is indicated treatment EGFR tyrosine kinase inhibitors (TKI). Even if this treatment, we have to calculate with the formation of resistance. The mechanisms of its formation are different, most (up 60%), it is the T790M mutation at exon 20. In 11/2015 FDA and 2/2016 EMA approved EGFR TKI 3rd generation osimertinib to treat patients with locally advanced or metastatic NSCLC T790M mutation of EGFR.
ENTIRE ARTICLE
Non-small cell lung cancer (NSCLC) is a disease with a poor prognosis. Today we know that it involves a genetically distinct group of tumors. And of such genetic diversity leads to the tendency of individualized treatments based on the predictive factors that predict the efficacy of treatment. One of the predictive factors in NSCLC are mutations of the epidermal growth factor receptor (EGFR), in which case is indicated treatment EGFR tyrosine kinase inhibitors (TKI). Even if this treatment, we have to calculate with the formation of resistance. The mechanisms of its formation are different, most (up 60%), it is the T790M mutation at exon 20. In 11/2015 FDA and 2/2016 EMA approved EGFR TKI 3rd generation osimertinib to treat patients with locally advanced or metastatic NSCLC T790M mutation of EGFR.