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Radiotherapy in the treatment of breast cancer
04/2021 MUDr. Tomáš Svoboda, Ph.D.; Bc. Daniela Čechová
Radiotherapy is one of the most basic methods of anticancer treatment, including breast cancer. It is used in a number of situations in terms of use, it is most often a standard part of adjuvant treatment, but it can be used at any time with a palliative intention, both in the area of primary tumor and metastatic disease in virtually any location. The method is undergoing huge development. Thanks to the use of modern diagnostic methods, planning has been significantly refined, fractionation regimes are undergoing development, and with much better instrumentation, much stricter limits can be applied to protect the surrounding organs. Radiation oncologists are able to respond to a wide range of situations, such as reconstructive procedures, adjustments of target volumes based on a comparison of risks against benefits, but also to replace previously common radical surgical procedures. Breast saving surgery and removal of only the sentinel node, in most cases supplemented by radiation therapy, represent a completely comparable alternative while maintaining the mental state, body integrity and quality of life of patients. On the contrary, studies based on the administration of systemic therapy in combination with radiotherapy with the omission of surgical treatment are currently underway. The results will certainly be interesting, but a relatively long follow up time will be needed to sufficiently compare the different approaches.
ENTIRE ARTICLE
Radiotherapy is one of the most basic methods of anticancer treatment, including breast cancer. It is used in a number of situations in terms of use, it is most often a standard part of adjuvant treatment, but it can be used at any time with a palliative intention, both in the area of primary tumor and metastatic disease in virtually any location. The method is undergoing huge development. Thanks to the use of modern diagnostic methods, planning has been significantly refined, fractionation regimes are undergoing development, and with much better instrumentation, much stricter limits can be applied to protect the surrounding organs. Radiation oncologists are able to respond to a wide range of situations, such as reconstructive procedures, adjustments of target volumes based on a comparison of risks against benefits, but also to replace previously common radical surgical procedures. Breast saving surgery and removal of only the sentinel node, in most cases supplemented by radiation therapy, represent a completely comparable alternative while maintaining the mental state, body integrity and quality of life of patients. On the contrary, studies based on the administration of systemic therapy in combination with radiotherapy with the omission of surgical treatment are currently underway. The results will certainly be interesting, but a relatively long follow up time will be needed to sufficiently compare the different approaches.
Current position of multikinase inhibitors monotherapy in the treatment of metastatic kidney cancer
04/2020 MUDr. Tomáš Svoboda, Ph.D.
We have a long-term and good experience with multikinase inhibitors in the treatment of metastatic kidney cancer. However, modern immunotherapy by inhibitors of programmed cell death receptor 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) shows itself to be highly effective and represents next treatment alternative moving from further therapy lines to primary treatment. Both groups of these drugs are highly different, we do not have any appropriate predictors to prefer one of them and also it's toxicity profiles seem to vary but are frequent. Moreover, we do not have enough data of higher immunotherapy effectivity in this indication so we to acknowledge position of tyrosine kinase inhibitor monotherapy remains to be strong, it can be used successfuiiy in primary treatment whiie ieaving immunotherapy for further lines, as far as it is possible to switch sequencing of these groups of drugs.
ENTIRE ARTICLE
We have a long-term and good experience with multikinase inhibitors in the treatment of metastatic kidney cancer. However, modern immunotherapy by inhibitors of programmed cell death receptor 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) shows itself to be highly effective and represents next treatment alternative moving from further therapy lines to primary treatment. Both groups of these drugs are highly different, we do not have any appropriate predictors to prefer one of them and also it's toxicity profiles seem to vary but are frequent. Moreover, we do not have enough data of higher immunotherapy effectivity in this indication so we to acknowledge position of tyrosine kinase inhibitor monotherapy remains to be strong, it can be used successfuiiy in primary treatment whiie ieaving immunotherapy for further lines, as far as it is possible to switch sequencing of these groups of drugs.
Immunotherapy and radiotherapy in locally advanced (metastatic) non‑small cell lung cancer
01/2020 Special Edition - MUDr. Gabriela Krákorová, Ph.D.; MUDr. Hana Steinbergerová; prof. MUDr. Miloš Pešek, CSc.; prof. MUDr. Jindřich Fínek, Ph.D., MHA; MUDr. Tomáš Svoboda, Ph.D.
Non-small cell lung cancer even today is a big socioeconomic problem for beeing diagnosed in an advanced or metastatic stage in majority of tumors when our treatment methods available at that time unfortunately are not associated with satisfactory results except few patients with tumors carrying specific mutations. Radiochemotherapy remains the basic standard regimen while adding induction or maintenance cytotoxic treatment did not count for any other benefit. However, modern immunotherapy by PD-1 and PD-L1 inhibitors brings a huge hope today. Mainly it's combination with radiation therapy sensibilizing to a better immunotherapy effect could become a standard part in majority of treatment guidelines. In this context, hypofractionated radiation regimens with limited target volumes seem to be preferred to normofractionation and larger fields. The role of abscopal effect remains still uncertain.
ENTIRE ARTICLE
Non-small cell lung cancer even today is a big socioeconomic problem for beeing diagnosed in an advanced or metastatic stage in majority of tumors when our treatment methods available at that time unfortunately are not associated with satisfactory results except few patients with tumors carrying specific mutations. Radiochemotherapy remains the basic standard regimen while adding induction or maintenance cytotoxic treatment did not count for any other benefit. However, modern immunotherapy by PD-1 and PD-L1 inhibitors brings a huge hope today. Mainly it's combination with radiation therapy sensibilizing to a better immunotherapy effect could become a standard part in majority of treatment guidelines. In this context, hypofractionated radiation regimens with limited target volumes seem to be preferred to normofractionation and larger fields. The role of abscopal effect remains still uncertain.
Winning smile of Monaleesa – ribociclib in the first line of palliative treatment of hormone dependent breast cancer
04/2017 MUDr. Tomáš Svoboda, Ph.D.
A new group of targeted drugs is coming to the fore of clinical practice in endocrine dependent metastatic breast cancer. At this point CDK4/6 inhibitors are introduced whereas given in combination with aromatase inhibitors. The most recently published data from MONALLESA-2 study with letrozol and ribociclib show very high efectivity and good toxicity profile of this combination. The median PFS in ribociclib arm was not reached in this study until now. It seems to us that this regimen has a big chance to become a new treatment standard in the first line setting soon as it is proved already in the most important treatment guidelines worldwide.
ENTIRE ARTICLE
A new group of targeted drugs is coming to the fore of clinical practice in endocrine dependent metastatic breast cancer. At this point CDK4/6 inhibitors are introduced whereas given in combination with aromatase inhibitors. The most recently published data from MONALLESA-2 study with letrozol and ribociclib show very high efectivity and good toxicity profile of this combination. The median PFS in ribociclib arm was not reached in this study until now. It seems to us that this regimen has a big chance to become a new treatment standard in the first line setting soon as it is proved already in the most important treatment guidelines worldwide.
Palbociclib in the treatment of advanced and/or metastatic hormone‑sensitive HER2‑negative breast cancer
02/2017 MUDr. Tomáš Svoboda, Ph.D.
Recently, we have the possibility to use in clinical practice a new targeted drug – palbociclib in the treatment of endocrine receptor positive, HER2 negative breast cancer. In the first line setting of treatment advanced/metastatic disease it is combined with letrozole and in the second line with fulvestrant. Cyclin dependent kinases 4 and 6 (CDK4/6) blockade inhibit the cell cycle progression in G1 phase and is associated with tumor cells proliferation prevention. The drug obtained a very high degree of recommendation and is a part of international guidelines.
ENTIRE ARTICLE
Recently, we have the possibility to use in clinical practice a new targeted drug – palbociclib in the treatment of endocrine receptor positive, HER2 negative breast cancer. In the first line setting of treatment advanced/metastatic disease it is combined with letrozole and in the second line with fulvestrant. Cyclin dependent kinases 4 and 6 (CDK4/6) blockade inhibit the cell cycle progression in G1 phase and is associated with tumor cells proliferation prevention. The drug obtained a very high degree of recommendation and is a part of international guidelines.