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Actual immunotherapeutic options in pneumooncology
05/2021 MUDr. Daniel Krejčí; doc. MUDr. Norbert Pauk, Ph.D.
Lung carcinoma remains aggressive tumour with bad prognosis. In the last decades there was a significant improvement in lung cancer treatment especially with contribution of immunotherapy and targeted therapy. The use of check point inhibitors brought better overall survival and quality of life in lung cancer patients. Following text summarizes actual immunotherapeutic options in lung cancer and other thoracic malignancies.
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Lung carcinoma remains aggressive tumour with bad prognosis. In the last decades there was a significant improvement in lung cancer treatment especially with contribution of immunotherapy and targeted therapy. The use of check point inhibitors brought better overall survival and quality of life in lung cancer patients. Following text summarizes actual immunotherapeutic options in lung cancer and other thoracic malignancies.
Living with tetraplicity is a struggle
02/2021 MUDr. Jana Krejčí; MUDr. Petr Opálka, CSc., MBA; MUDr. Bc. Petr Zůna; MUDr. Daniel Krejčí; MUDr. Ferdinand Třebický; doc. MUDr. Norbert Pauk, Ph.D.
Multiple tumors are not common in oncology, but their proportion is increasing and they need attention. Our patient with tetraplicity (kidney cancer, laryngeal cancer and two bronchogenic carcinomas) is a demonstration of struggle and determination. Although all these diagnoses are serious and the patient has been treated since 2018, among other things, for the generalization of bronchogenic carcinoma to the brain, he has a zest for life and does not give up. He underwent operations, tracheostomy, gastrostomy, chemotherapy and radiotherapy. In the near future, we will have to decide which treatment path to take next.
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Multiple tumors are not common in oncology, but their proportion is increasing and they need attention. Our patient with tetraplicity (kidney cancer, laryngeal cancer and two bronchogenic carcinomas) is a demonstration of struggle and determination. Although all these diagnoses are serious and the patient has been treated since 2018, among other things, for the generalization of bronchogenic carcinoma to the brain, he has a zest for life and does not give up. He underwent operations, tracheostomy, gastrostomy, chemotherapy and radiotherapy. In the near future, we will have to decide which treatment path to take next.
Lambert‑Eaton myasthenic syndrome and small cell lung cancer – case report
02/2021 MUDr. Daniel Krejčí; MUDr. Lukáš Hruška
Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune, presynaptic disorder of neuromuscular transmission characterized by fluctuating muscle weakness, autonomic dysfunction and depressed tendon reflexes.1 The coappearance with small cell lung cancer happens to be typical and sometimes the symptoms may precede the radiological cancer confirmation. There is a symptomatic therapy of LEMS as a complement of the causal cancer treatment. This case report presents patient with Lambert-Eaton myasthenic syndrome and concurrent atypical long small cell lung cancer survival.
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Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune, presynaptic disorder of neuromuscular transmission characterized by fluctuating muscle weakness, autonomic dysfunction and depressed tendon reflexes.1 The coappearance with small cell lung cancer happens to be typical and sometimes the symptoms may precede the radiological cancer confirmation. There is a symptomatic therapy of LEMS as a complement of the causal cancer treatment. This case report presents patient with Lambert-Eaton myasthenic syndrome and concurrent atypical long small cell lung cancer survival.
The role of alectinib in the treatment of advanced non‑small cell lung cancer
04/2020 MUDr. Daniel Krejčí; MUDr. Jana Krejčí; MUDr. Petr Opálka, CSc., MBA; MUDr. Bc. Petr Zůna; doc. MUDr. Norbert Pauk, CSc.
Despite a small percentage of these patients, the issue of patients with a positive mutation in the anaplastic lymphoma kinase (ALK) gene is highly debated. Alectinib demonstrated a statistically significant prolongation of progression-free time and an excellent therapeutic and preventive effect in the central nervous system in phase III ALEX, J-ALEX and ALUR studies.1-3 At the time of writing, alectinib is fully reimbursed in first-line treatment even after crizotinib failure.4
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Despite a small percentage of these patients, the issue of patients with a positive mutation in the anaplastic lymphoma kinase (ALK) gene is highly debated. Alectinib demonstrated a statistically significant prolongation of progression-free time and an excellent therapeutic and preventive effect in the central nervous system in phase III ALEX, J-ALEX and ALUR studies.1-3 At the time of writing, alectinib is fully reimbursed in first-line treatment even after crizotinib failure.4
The role of pembrolizumab in the treatment of recurrent malignant pleural mesothelioma - case report
06/2019 MUDr. Daniel Krejčí; MUDr. Jana Krejčí; MUDr. Petr Opálka, CSc.; doc. MUDr. Norbert Pauk, Ph.D.
Malignant mesothelioma belongs to a group of rare tumors and is feared due to the short survival period and limited therapeutic options. Presented case report summarizes the diagnosis and treatment of a patient with extensive malignant mesothelioma, documenting significant late response to the first line standard therapy, and particularly the considerable effect of pembrolizumab in the second line treatment after progression.
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Malignant mesothelioma belongs to a group of rare tumors and is feared due to the short survival period and limited therapeutic options. Presented case report summarizes the diagnosis and treatment of a patient with extensive malignant mesothelioma, documenting significant late response to the first line standard therapy, and particularly the considerable effect of pembrolizumab in the second line treatment after progression.
EGFR mutations in non‑small cell lung cancer – treatment options
05/2019 MUDr. Daniel Krejčí; MUDr. Jana Krejčí; doc. MUDr. Norbert Pauk, Ph.D.
Worldwide, lung cancer is one of the most common oncological disease. Targeted analysis of the mutation status in non-small cell lung carcinoma detects 10-15 % of patients with a mutated epidermal growth factor receptor gene, whose presence is significant prognostically and therapeutically.1 Diagnosis is based on molecular-genetic methods.2 Depending on the patient's performance status and type of mutation, the patient is indicated for therapy with tyrosine kinase inhibitors, which in this group of patients promise a good response to treatment with a favorable safety profile.13
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Worldwide, lung cancer is one of the most common oncological disease. Targeted analysis of the mutation status in non-small cell lung carcinoma detects 10-15 % of patients with a mutated epidermal growth factor receptor gene, whose presence is significant prognostically and therapeutically.1 Diagnosis is based on molecular-genetic methods.2 Depending on the patient's performance status and type of mutation, the patient is indicated for therapy with tyrosine kinase inhibitors, which in this group of patients promise a good response to treatment with a favorable safety profile.13
Crizotinib in the treatment of ALK‑positive patients with advanced non‑small cell lung cancer
01/2019 MUDr. Jana Krejčí; MUDr. Daniel Krejčí; MUDr. Petr Opálka, CSc., MBA
Lung cancer is one of the most common and most serious diseases. At present, we have different treatment approaches for non-small cell lung cancer not only according to histology but also on the basis of molecular genetic properties. Different treatment strategies exist according to molecularly defined markers in non-small-cell lung cancer. Molecular testing for at least epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) should be performed in all patients before therapy. Crizotinib is a tyrosine kinase inhibitor targeting ALK translocation. Based on Profile 1007 and Profile 1014 trial, it has become the basis of treatment for patients with ALK translocation. Our case report is a demonstration of the good performance of crizotinib in the second line of treatment of patients with lung adenocarcinoma.
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Lung cancer is one of the most common and most serious diseases. At present, we have different treatment approaches for non-small cell lung cancer not only according to histology but also on the basis of molecular genetic properties. Different treatment strategies exist according to molecularly defined markers in non-small-cell lung cancer. Molecular testing for at least epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) should be performed in all patients before therapy. Crizotinib is a tyrosine kinase inhibitor targeting ALK translocation. Based on Profile 1007 and Profile 1014 trial, it has become the basis of treatment for patients with ALK translocation. Our case report is a demonstration of the good performance of crizotinib in the second line of treatment of patients with lung adenocarcinoma.
Osimertinib and its use in the treatment of non‑small cell lung carcinoma in the Czech Republic
06/2018 MUDr. Daniel Krejčí; MUDr. Jana Krejčí; doc. MUDr. Norbert Pauk, Ph.D.
It has been shown that patients with non-small cell lung cancer with confirmed mutation of epidermal growth factor receptors significantly benefit from treatment by tyrosine kinase inhibitors. However, resistant mutations develop within approximately 10 months, of which 60 % are formed by T790M mutations. Multiple clinical trials showed that osimertinib is an efficient molecule in both patients with common epidermal growth factor receptor mutations as well as in those with T790M positivity. AURA III met its primary endpoint showing that the PFS was significantly prolonged in T790M positive patients being treated with osimertinib compared to standard chemotherapy in the second line. Clinical study FLAURA also showed significant prolongation PFS in comparison to standard first line treatment in epidermal growth factor receptor mutated patients. Osimertinib has favorable safety profile and good efficacy even in CNS. In the Czech Republic osimertinib is registered for the first line treatment of patients with activating epidermal growth factor receptor mutations and for patients with confirmed T790M mutations. At the time that this article was written, full reimbursement of osimertinib is not available in the Czech Republic.
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It has been shown that patients with non-small cell lung cancer with confirmed mutation of epidermal growth factor receptors significantly benefit from treatment by tyrosine kinase inhibitors. However, resistant mutations develop within approximately 10 months, of which 60 % are formed by T790M mutations. Multiple clinical trials showed that osimertinib is an efficient molecule in both patients with common epidermal growth factor receptor mutations as well as in those with T790M positivity. AURA III met its primary endpoint showing that the PFS was significantly prolonged in T790M positive patients being treated with osimertinib compared to standard chemotherapy in the second line. Clinical study FLAURA also showed significant prolongation PFS in comparison to standard first line treatment in epidermal growth factor receptor mutated patients. Osimertinib has favorable safety profile and good efficacy even in CNS. In the Czech Republic osimertinib is registered for the first line treatment of patients with activating epidermal growth factor receptor mutations and for patients with confirmed T790M mutations. At the time that this article was written, full reimbursement of osimertinib is not available in the Czech Republic.
Efficacy of erlotinib in subsequent lines of non‑small cell lung cancer therapy
01/2018 MUDr. Jana Krejčí, MUDr. Daniel Krejčí, doc. MUDr. Norbert Pauk, Ph.D.
Targeted therapy is becoming more and more important part of bronchial carcinoma treatment. One of the approaches includes administering erlotinib in later lines of therapy of non-small cell carcinoma. Our two case studies document a very good therapeutical effect as well as minimal toxicity of such an approach when treating adenocarcinoma (EGFR wild-type) and/or squamous carcinoma.
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Targeted therapy is becoming more and more important part of bronchial carcinoma treatment. One of the approaches includes administering erlotinib in later lines of therapy of non-small cell carcinoma. Our two case studies document a very good therapeutical effect as well as minimal toxicity of such an approach when treating adenocarcinoma (EGFR wild-type) and/or squamous carcinoma.
Erlotinib in the first line treatment of the metastatic non‑small cell lung cancer
01/2018 MUDr. Daniel Krejčí, MUDr. Jana Krejčí, doc. MUDr. Norbert Pauk, Ph.D.
In the following text, we are discussing the case of a patient with non-small cell lung cancer, whom the presence of the activating mutation of the epidermal grow factor has been proved. We begun treatment with erlotinib in the first line until progression which appeared on computed tomography after 15 months. In the second line treatment she received three cycles of the chemotherapy with pemetrexed. The second line treatment was terminated due to progression and high hematotoxicity. Following the patient's wishes, further steps regarding treatment are now in the competence of the regional oncologist.
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In the following text, we are discussing the case of a patient with non-small cell lung cancer, whom the presence of the activating mutation of the epidermal grow factor has been proved. We begun treatment with erlotinib in the first line until progression which appeared on computed tomography after 15 months. In the second line treatment she received three cycles of the chemotherapy with pemetrexed. The second line treatment was terminated due to progression and high hematotoxicity. Following the patient's wishes, further steps regarding treatment are now in the competence of the regional oncologist.