Selected articles
Menopause hormone therapy in female cancer survivors
04/2019 Doc. MUDr. Tomáš Fait, Ph.D.
Menopause hormone therapy is the best therapy for acute climacteric syndrome, osteoporosis' prevention and urogenital atrophy. It is absolutely safety in personal history of cervical cancer, endometrial cancer, hematologic malignancies, local malignant melanoma, colorectal cancer and liver cancer. It is strictly contraindicated in cases history of breast cancer, endometrial stromal sarcoma, meningioma and estrogen receptor positive gastric and bladder cancer.
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Menopause hormone therapy is the best therapy for acute climacteric syndrome, osteoporosis' prevention and urogenital atrophy. It is absolutely safety in personal history of cervical cancer, endometrial cancer, hematologic malignancies, local malignant melanoma, colorectal cancer and liver cancer. It is strictly contraindicated in cases history of breast cancer, endometrial stromal sarcoma, meningioma and estrogen receptor positive gastric and bladder cancer.
Borderline ovarian tumors
04/2019 MUDr. Jaroslav Klát, Ph.D.
Borderline ovarian tumors represent 10-20 % of all epithelial tumors of ovary. Borderline ovarian tumors are characterized by cellular proliferation and nuclear atypia, but they usually do not show infiltrative growth pattern. They differ from epithelial ovarian cancer by their low incidence, early stage diagnosis, different percentages of the most common histological types, and high survival rate even when associated with advanced stage of the disease. They occur in young women, which is why one of the objectives in these patients will be preservation of fertility. The management of these tumors is still controversial and widely discussed. Due to higher risk of recurrence in patients undergoing a conservative surgical treatment, the long-time follow-up is needed.
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Borderline ovarian tumors represent 10-20 % of all epithelial tumors of ovary. Borderline ovarian tumors are characterized by cellular proliferation and nuclear atypia, but they usually do not show infiltrative growth pattern. They differ from epithelial ovarian cancer by their low incidence, early stage diagnosis, different percentages of the most common histological types, and high survival rate even when associated with advanced stage of the disease. They occur in young women, which is why one of the objectives in these patients will be preservation of fertility. The management of these tumors is still controversial and widely discussed. Due to higher risk of recurrence in patients undergoing a conservative surgical treatment, the long-time follow-up is needed.
Benefits of multidisciplinary approach in the management of ovarian cancer
04/2019 Prof. MUDr. Michal Zikán, Ph.D.
Ovarian cancer is beyond the usual behavior of other solid tumors due to its biological behavior, spreading to serous surfaces, high metabolic demands and high recurrence rates. Although not the most common malignancy, it is a gynecological cancer with the highest mortality. Early or earlier diagnosis, proper therapeutic management, and metabolic care are crucial for the quality of life of patients and their survival. In the diagnosis and other care of a woman with ovarian cancer, experts from other medical specializations should be involved. Therefore, it is essential that they are informed about special characteristics of this type of cancer.
ENTIRE ARTICLE
Ovarian cancer is beyond the usual behavior of other solid tumors due to its biological behavior, spreading to serous surfaces, high metabolic demands and high recurrence rates. Although not the most common malignancy, it is a gynecological cancer with the highest mortality. Early or earlier diagnosis, proper therapeutic management, and metabolic care are crucial for the quality of life of patients and their survival. In the diagnosis and other care of a woman with ovarian cancer, experts from other medical specializations should be involved. Therefore, it is essential that they are informed about special characteristics of this type of cancer.
Complete and long‑term response of HER2 positive locally highly advanced metastatic breast cancer – case report
04/2019 MUDr. Lenka Rušinová; doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Marián Liberko
Unfortunately, we are currently encountering locally very advanced and generalized breast cancers. However, due to systemic therapy and especially targeted therapy, we can see excellent long-term responses in patients with HER2 positive tumors. The discovery of novel products targeting the extracellular domain of the human epidermal growth factor receptor 2 (HER2) and the combination of this monoclonal antibody with the microtubule inhibitor T-DM1 (trastuzumab emtansine) has resulted in a statistically significant increase in overall survival and has changed metastatic HER2 positive breast cancer to chronic disease.
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Unfortunately, we are currently encountering locally very advanced and generalized breast cancers. However, due to systemic therapy and especially targeted therapy, we can see excellent long-term responses in patients with HER2 positive tumors. The discovery of novel products targeting the extracellular domain of the human epidermal growth factor receptor 2 (HER2) and the combination of this monoclonal antibody with the microtubule inhibitor T-DM1 (trastuzumab emtansine) has resulted in a statistically significant increase in overall survival and has changed metastatic HER2 positive breast cancer to chronic disease.
Treatment of metastatic HER2 positive breast cancer in young patient with very advanced disease – case report
04/2019 MUDr. Markéta Protivánková; MUDr. Dagmar Brančíková, Ph.D.; MUDr. Jiří Vašina
Although the percentage of patients diagnosed in the early stage of the disease is increasing after the introduction of breast cancer screening, a large group of patients still have metastatic breast cancer. Advanced HER2 positive breast cancer has been therapeutically difficult to treat with adverse prognosis until the introduction of targeted anti-HER2 therapy, and its therapy has been complicated by a number of possible side effects and considerable toxicity. Our case report describes a case of a 42-year-old patient who had HER2 positive breast cancer diagnosed at a very advanced stage of the disease. After the use of dual-block treatment with concomitant administration of trastuzumab and pertuzumab, a high-quality and long-term response of the disease was achieved in which the quality of life of the patient significantly increased. At the same time, this treatment was very well tolerated.
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Although the percentage of patients diagnosed in the early stage of the disease is increasing after the introduction of breast cancer screening, a large group of patients still have metastatic breast cancer. Advanced HER2 positive breast cancer has been therapeutically difficult to treat with adverse prognosis until the introduction of targeted anti-HER2 therapy, and its therapy has been complicated by a number of possible side effects and considerable toxicity. Our case report describes a case of a 42-year-old patient who had HER2 positive breast cancer diagnosed at a very advanced stage of the disease. After the use of dual-block treatment with concomitant administration of trastuzumab and pertuzumab, a high-quality and long-term response of the disease was achieved in which the quality of life of the patient significantly increased. At the same time, this treatment was very well tolerated.
Neoadjuvant systemic treatment of HER2 positive breast cancer – case report
04/2019 MUDr. Katarína Petráková, Ph.D.
The primary goal of neoadjuvant systemic therapy in patients with early breast cancer is the down-staging of the disease and achieving operability of the primarily inoperable tumor or achieving less radical surgery. Achieving complete pathological remission affects the long-term prognosis of patients, mainly in triple negative breast cancer and non-luminal HER2 (human epidermal receptor 2, positive for breast epidermal growth factor 2). In the case report we present a case of a patient with locally advanced HER2-positive breast cancer who achieved complete remission by intensive neoadjuvant systemic treatment using dual HER2 receptor blockade, which could significantly reduce subsequent surgical treatment.
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The primary goal of neoadjuvant systemic therapy in patients with early breast cancer is the down-staging of the disease and achieving operability of the primarily inoperable tumor or achieving less radical surgery. Achieving complete pathological remission affects the long-term prognosis of patients, mainly in triple negative breast cancer and non-luminal HER2 (human epidermal receptor 2, positive for breast epidermal growth factor 2). In the case report we present a case of a patient with locally advanced HER2-positive breast cancer who achieved complete remission by intensive neoadjuvant systemic treatment using dual HER2 receptor blockade, which could significantly reduce subsequent surgical treatment.
Breast cancer immunotherapy – a promising way?
04/2019 MUDr. Dagmar Brančíková, Ph.D.; MUDr. Markéta Protivánková
Immunotherapy is an emerging new modality in the treatment of many tumors. In the treatment of breast carcinomas, there is already the first experience with this treatment, which gradually defines the subgroups of patients and stages of breast malignancies that receive the highest profits from immunotherapy alone or in combinations with chemotherapy and target therapy. We present a review of the literature on clinical (age, weight, gender) and laboratory parameters that predict the response to immunotherapy and an overview of suitable combinations with chemotherapy or targeted agents in the treatment of metastatic breast cancer. Monotherapy checkpoint inhibitors do not yet appear to be effective but combinations atezolizumab or pembrolizumab with nab-paclitaxel and eribulin mesylate in neoadjuvant and in the first line of palliation are very promising in the treatment of triple-negative breast cancer locally advanced. So far, in the treatment of HER (epidermal growth factor receptor) positive tumors and ER (estrogen receptor) positive, a subset of patients with significant immunotherapy benefit cannot be unequivocally established.
ENTIRE ARTICLE
Immunotherapy is an emerging new modality in the treatment of many tumors. In the treatment of breast carcinomas, there is already the first experience with this treatment, which gradually defines the subgroups of patients and stages of breast malignancies that receive the highest profits from immunotherapy alone or in combinations with chemotherapy and target therapy. We present a review of the literature on clinical (age, weight, gender) and laboratory parameters that predict the response to immunotherapy and an overview of suitable combinations with chemotherapy or targeted agents in the treatment of metastatic breast cancer. Monotherapy checkpoint inhibitors do not yet appear to be effective but combinations atezolizumab or pembrolizumab with nab-paclitaxel and eribulin mesylate in neoadjuvant and in the first line of palliation are very promising in the treatment of triple-negative breast cancer locally advanced. So far, in the treatment of HER (epidermal growth factor receptor) positive tumors and ER (estrogen receptor) positive, a subset of patients with significant immunotherapy benefit cannot be unequivocally established.
Adjuvant chemotherapy in hormonal‑dependent breast cancer patients – options in using of multigene assays
04/2019 MUDr. Zuzana Bielčiková, Ph.D.
The time before 2000, when adjuvant chemotherapy was a standard part of the treatment of almost all breast cancers, including hormonal-dependent, is long gone. Multigene assays help us to clarify the biological behavior of estrogen/progesterone-positive tumors and thus the prognosis of patients. In the past, chemotherapy was indicated in the majority of patients without lymph node involvement, now is shown that even tumors with 1-3 metastatic lymph nodes may be those with a good prognosis that does not require chemotherapy. The challenge of the upcoming period is prognostic stratification of the disease according to the risk of relapse and predictive administration of systemic therapy. The more prognostic groups we create, the more targeted will be the treatment and the smaller group of patients will be exposed to its side effects.
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The time before 2000, when adjuvant chemotherapy was a standard part of the treatment of almost all breast cancers, including hormonal-dependent, is long gone. Multigene assays help us to clarify the biological behavior of estrogen/progesterone-positive tumors and thus the prognosis of patients. In the past, chemotherapy was indicated in the majority of patients without lymph node involvement, now is shown that even tumors with 1-3 metastatic lymph nodes may be those with a good prognosis that does not require chemotherapy. The challenge of the upcoming period is prognostic stratification of the disease according to the risk of relapse and predictive administration of systemic therapy. The more prognostic groups we create, the more targeted will be the treatment and the smaller group of patients will be exposed to its side effects.
Neoadjuvant hormonal therapy possibilities in breast cancer
04/2019 MUDr. Lucie Reifová
Hormonal therapy is an integral part of a multidisciplinary approach to the treatment of breast cancer with positive estrogen and/or progesteron receptors. While neoadjuvant chemotherapy is well established as a part of therapeutic regimes based on outcomes of clinical trials even in operable tumors, neoadjuvant hormonotherapy is generally used only in the treatment of locally advanced tumors, particularly in elderly population. There are a number of clinical trials comparing the efficacy of aromatase inhibitors with tamoxifen in the neoadjuvant setting, but there is a lack of comparison studies of neoadjuvant and adjuvant hormonal therapies. In addition to the effectiveness of neoadjuvant hormonotherapy in primary inoperable tumors, this treatment also leads to a reduction of mastectomies compared to breast conservation surgery. It is necessary to specify the optimal length of neoadjuvant hormonotherapy.
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Hormonal therapy is an integral part of a multidisciplinary approach to the treatment of breast cancer with positive estrogen and/or progesteron receptors. While neoadjuvant chemotherapy is well established as a part of therapeutic regimes based on outcomes of clinical trials even in operable tumors, neoadjuvant hormonotherapy is generally used only in the treatment of locally advanced tumors, particularly in elderly population. There are a number of clinical trials comparing the efficacy of aromatase inhibitors with tamoxifen in the neoadjuvant setting, but there is a lack of comparison studies of neoadjuvant and adjuvant hormonal therapies. In addition to the effectiveness of neoadjuvant hormonotherapy in primary inoperable tumors, this treatment also leads to a reduction of mastectomies compared to breast conservation surgery. It is necessary to specify the optimal length of neoadjuvant hormonotherapy.
Platinum‑based chemotherapy in neoadjuvant treatment of breast cancer
04/2019 MUDr. Marta Krásenská
Triple-negative breast cancer is associated with poor outcomes compared to other breast cancer subtypes. It is known to have an aggressive behaviour but on the other hand it is exceptionally chemosensitive. Currently, the only standard treatment modality that is used in both early and advanced triple-negative breast cancer is conventional chemotherapy. When anthracyclines, alkylating agents, and taxanes are administered, 30-40 % of patients treated with neoadjuvant chemotherapy achieve pathological complete remission associated with excellent prognosis. The prognosis of patients with a residual disease after neoadjuvant chemotherapy is poor. In clinical trials, the addition of platinum to standard chemotherapy was attempted to achieve more complete pathological responses. Importance of platinum remains unclear, controversial are the data on their effectiveness especially in patients with germline mutation in the BRCA (breast cancer) genes.
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Triple-negative breast cancer is associated with poor outcomes compared to other breast cancer subtypes. It is known to have an aggressive behaviour but on the other hand it is exceptionally chemosensitive. Currently, the only standard treatment modality that is used in both early and advanced triple-negative breast cancer is conventional chemotherapy. When anthracyclines, alkylating agents, and taxanes are administered, 30-40 % of patients treated with neoadjuvant chemotherapy achieve pathological complete remission associated with excellent prognosis. The prognosis of patients with a residual disease after neoadjuvant chemotherapy is poor. In clinical trials, the addition of platinum to standard chemotherapy was attempted to achieve more complete pathological responses. Importance of platinum remains unclear, controversial are the data on their effectiveness especially in patients with germline mutation in the BRCA (breast cancer) genes.
When and why to indicate breast cancer radiotherapy after neoadjuvant systemic therapy
04/2019 Doc. MUDr. Renata Soumarová, Ph.D.; MUDr. Lenka Rušínová
Adjuvant radiotherapy after both radical and partial mastectomy has an effect on local disease control as well as overall survival, as evidenced by large studies with long-term follow-up. However, postoperative radiotherapy indications for patients after neoadjuvant chemotherapy are controversial. This is due to a different tumor response to neoadjuvant treatment and a lack of prospective studies. Currently, when considering post-operative radiotherapy after neoadjuvant treatment, both the very accurate pre-treatment classification and the tumor characteristics including molecular subtypes and the definitive pathological classification must be taken into account. The most difficult decision is especially in the group of patients who have achieved a pathological complete response.
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Adjuvant radiotherapy after both radical and partial mastectomy has an effect on local disease control as well as overall survival, as evidenced by large studies with long-term follow-up. However, postoperative radiotherapy indications for patients after neoadjuvant chemotherapy are controversial. This is due to a different tumor response to neoadjuvant treatment and a lack of prospective studies. Currently, when considering post-operative radiotherapy after neoadjuvant treatment, both the very accurate pre-treatment classification and the tumor characteristics including molecular subtypes and the definitive pathological classification must be taken into account. The most difficult decision is especially in the group of patients who have achieved a pathological complete response.
Experience with trifluridin/tipiracil in treatment of patient with metastatic rectal cancer
03/2019 MUDr. Michal Vočka
Trifluridine/tipiracil (Lonsurf), combination of trifluridine (analogue of thymidine-nucleoside) and tipiracil (thymidine phosphorylase inhibitor involved in thymidine catabolism), is one of the options for a higher-line treatment in metastatic colorectal cancer patients. The case report describes the use of this drug in the fourth line, when the disease was stabilized for 17 months without any significant side effects associated with the therapy.
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Trifluridine/tipiracil (Lonsurf), combination of trifluridine (analogue of thymidine-nucleoside) and tipiracil (thymidine phosphorylase inhibitor involved in thymidine catabolism), is one of the options for a higher-line treatment in metastatic colorectal cancer patients. The case report describes the use of this drug in the fourth line, when the disease was stabilized for 17 months without any significant side effects associated with the therapy.
The fatal side‑effect after the first dose of nivolumab – case report
03/2019 Doc. MUDr. Alexandr Poprach, Ph.D.; MUDr. Radek Lakomý, Ph.D.
The patients with metastatic malignant melanoma had a very poor prognosis in the past, chemotherapy was highly palliative and not so efficient. The use of checkpoint inhibitors (such as the anti-PD-1 antibody nivolumab) changed the prognosis and treatment results. The probability of 5-years overall survival is approximately 50 % by using the combination of anti-CTLA-4 and anti-PD-1 antibodies. However, the use of checkpoint inhibitors could cause the immune-related side effects that may be fatal. Herein we introduce a story of our patient with metastatic renal cell carcinoma with Guillain-Barré syndrome after the first dose of nivolumab. We had treated him with combined immunosuppressive therapy, plasmapheresis and intensive supportive care but he died of this complication in the end. The onset of first signs of this side effect was 5 days after the first dose of nivolumab which is remarkable.
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The patients with metastatic malignant melanoma had a very poor prognosis in the past, chemotherapy was highly palliative and not so efficient. The use of checkpoint inhibitors (such as the anti-PD-1 antibody nivolumab) changed the prognosis and treatment results. The probability of 5-years overall survival is approximately 50 % by using the combination of anti-CTLA-4 and anti-PD-1 antibodies. However, the use of checkpoint inhibitors could cause the immune-related side effects that may be fatal. Herein we introduce a story of our patient with metastatic renal cell carcinoma with Guillain-Barré syndrome after the first dose of nivolumab. We had treated him with combined immunosuppressive therapy, plasmapheresis and intensive supportive care but he died of this complication in the end. The onset of first signs of this side effect was 5 days after the first dose of nivolumab which is remarkable.
Prevention of chemotherapy‑induced alopecia by the using the scalp cooling with the system DigniCap® – our 4‑year experience
03/2019 MUDr. Karolína Hovorková
Alopecia is one of the most common and unpleasant side effects of chemotherapy when treating solid tumors. So far, the only method preventing/reducing chemotherapy induced hair loss is hair scalp cooling system DigniCap®. The cooling system has been used at our clinic since 2014. Producer declared effects correspond with our experience.
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Alopecia is one of the most common and unpleasant side effects of chemotherapy when treating solid tumors. So far, the only method preventing/reducing chemotherapy induced hair loss is hair scalp cooling system DigniCap®. The cooling system has been used at our clinic since 2014. Producer declared effects correspond with our experience.
Chemotherapy‑induced peripheral neuropathy
03/2019 MUDr. Aneta Rajdová; MUDr. Jana Raputová; MUDr. Eva Vlčková, Ph.D.
Chemotherapy-induced peripheral neuropathy (CIPN) is frequent adverse effect of anticancer treatment. It can severely affect the quality of life of cancer survivors, and lead to dose reduction or discontinuation of the treatment. Clinical symptoms completely or partially resolve after cessation of chemotherapy in most of the patients. However, in subset of them could be irreversible. The most neurotoxic agents are the platinum-based antineoplastic drugs, the vinca alkaloids, the taxanes, the proteasome inhibitors (bortezomib) and thalidomide. CIPN predominantly affects sensory neurons, less frequently autonomic or motor neurons which is manifested for instance by orthostatic hypotension or muscle weakness. Administration of neurotoxic chemotherapy should be carefully considered regarding protentional existence of neuropathy in high-risk patients to prevent CIPN development. If the polyneuropathy occurs during anticancer treatment, dose reduction or change of antineoplastic agent can prevent further worsening of the peripheral nerve impairment.
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Chemotherapy-induced peripheral neuropathy (CIPN) is frequent adverse effect of anticancer treatment. It can severely affect the quality of life of cancer survivors, and lead to dose reduction or discontinuation of the treatment. Clinical symptoms completely or partially resolve after cessation of chemotherapy in most of the patients. However, in subset of them could be irreversible. The most neurotoxic agents are the platinum-based antineoplastic drugs, the vinca alkaloids, the taxanes, the proteasome inhibitors (bortezomib) and thalidomide. CIPN predominantly affects sensory neurons, less frequently autonomic or motor neurons which is manifested for instance by orthostatic hypotension or muscle weakness. Administration of neurotoxic chemotherapy should be carefully considered regarding protentional existence of neuropathy in high-risk patients to prevent CIPN development. If the polyneuropathy occurs during anticancer treatment, dose reduction or change of antineoplastic agent can prevent further worsening of the peripheral nerve impairment.
Influence of neoadjuvant chemoradiotherapy on PD‑L1 expression change in rectal cancer patients
03/2019 MUDr. Igor Richter, Ph.D.; doc. MUDr. Josef Dvořák, Ph.D.; MUDr. Jiří Bartoš; doc. MUDr. Tomáš Jirásek, Ph.D.
The neoadjuvant chemoradiotherapy with following total mesorectal excision is a current standard of the treatment of locally advanced rectal adenocarcinoma. In addition to traditional prognostic factors (as clinical stage, surgery radicality, etc.), new biomarkers are also being sought with the aim to optimize the treatment of this malignancy. One of these biomarkers is detection of PD-L1 on the tumor cell surface. The aim of this paper is to determinate the prognostic influence of PD-L1 expression changes in patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy. The combination of PD-1/PD-L1 inhibitors has not gained an acceptance as a new standard of treatment of these malignancies.
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The neoadjuvant chemoradiotherapy with following total mesorectal excision is a current standard of the treatment of locally advanced rectal adenocarcinoma. In addition to traditional prognostic factors (as clinical stage, surgery radicality, etc.), new biomarkers are also being sought with the aim to optimize the treatment of this malignancy. One of these biomarkers is detection of PD-L1 on the tumor cell surface. The aim of this paper is to determinate the prognostic influence of PD-L1 expression changes in patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy. The combination of PD-1/PD-L1 inhibitors has not gained an acceptance as a new standard of treatment of these malignancies.
Sequential treatment of metastatic colorectal carcinoma
03/2019 MUDr. Eugen Kubala
Dissatisfaction with the current state of the complex metastatic colorectal cancer treatment leads to a deeper analysis of the right choice of consecutive treatment line. Metastatic colorectal cancer remains incurable in most cases. We have a variety of cytostatics and biological treatments available. The right choice for the 1st line of treatment, which is crucial for the outcome of the whole treatment, seems to be crucial. The selection is based on knowledge of biological markers of RAS and BRAF and clinical factors. The result of successive lines depends on choosing the correct 1st line. In the 2nd line, anti-angiogenic agents (bevacizumab, ramucirumab and aflibercept) were used. Epidermal growth factor receptor (EGFR) inhibitors do not increase 2nd-line survival. The 3rd line is dependent on the molecular examination of the tumor. Knowing the status of the RAS BRAF mutation determines whether we use anti EGFR antibodies or BRAF and MEK inhibitors. The state of microsatellite stability is critical to the use of immunotherapy (pembrolizumab, nivolumab, and ipilimumab. Proper understanding of the mechanisms of selection of sequential therapy and its de-escalation and re-escalation may lead to prolonged positive treatment outcomes. A significant difference between progression to full treatment or de-escalated treatment, the latter allowing reuse of the substance that was used at the start of treatment, knowledge of the molecular profile of tumors that appears to be essential in the choice of treatment should contribute to the correct management of treatment. In the 1st, 2nd and 3rd line of therapy, the selective pressure of treatment on cell subpopulations of the tumor limits the success of the next treatment line.
ENTIRE ARTICLE
Dissatisfaction with the current state of the complex metastatic colorectal cancer treatment leads to a deeper analysis of the right choice of consecutive treatment line. Metastatic colorectal cancer remains incurable in most cases. We have a variety of cytostatics and biological treatments available. The right choice for the 1st line of treatment, which is crucial for the outcome of the whole treatment, seems to be crucial. The selection is based on knowledge of biological markers of RAS and BRAF and clinical factors. The result of successive lines depends on choosing the correct 1st line. In the 2nd line, anti-angiogenic agents (bevacizumab, ramucirumab and aflibercept) were used. Epidermal growth factor receptor (EGFR) inhibitors do not increase 2nd-line survival. The 3rd line is dependent on the molecular examination of the tumor. Knowing the status of the RAS BRAF mutation determines whether we use anti EGFR antibodies or BRAF and MEK inhibitors. The state of microsatellite stability is critical to the use of immunotherapy (pembrolizumab, nivolumab, and ipilimumab. Proper understanding of the mechanisms of selection of sequential therapy and its de-escalation and re-escalation may lead to prolonged positive treatment outcomes. A significant difference between progression to full treatment or de-escalated treatment, the latter allowing reuse of the substance that was used at the start of treatment, knowledge of the molecular profile of tumors that appears to be essential in the choice of treatment should contribute to the correct management of treatment. In the 1st, 2nd and 3rd line of therapy, the selective pressure of treatment on cell subpopulations of the tumor limits the success of the next treatment line.
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.
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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.
Achieving complete remission after sequential treatment with docetaxel‑cabazitaxel enzalutamide in a patient with metastatic castration‑resistant pros
03/2019 MUDr. Robert Novák; MUDr. Jana Katolická, Ph.D.; MUDr. Jiří Vašina
In our case report, we present a case of a patient initially with locally-regionally advanced prostate cancer. The complete remission was achieved after sequential treatment of docetaxel-cabazitaxel-enzalutamide, with maintaining good quality of life.
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In our case report, we present a case of a patient initially with locally-regionally advanced prostate cancer. The complete remission was achieved after sequential treatment of docetaxel-cabazitaxel-enzalutamide, with maintaining good quality of life.
Treatment of patients with metastatic urothelial cancer „unfit“ for cisplatin treatment
03/2019 MUDr. Kristýna Divišová; MUDr. Jana Katolická, Ph.D.; MUDr. Milan Kohoutek
Cisplatin-based chemotherapy is the standard first-line treatment in advanced urothelial cancers. However, more than 50 % of patients are not eligible for cisplatin. Urothelial cancer patients are of higher median age and often present with organ impairment and comorbidities. In frail patients, recommended treatment options include carboplatin or gemcitabine monotherapy, or GCa or imunotherapy if possible.
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Cisplatin-based chemotherapy is the standard first-line treatment in advanced urothelial cancers. However, more than 50 % of patients are not eligible for cisplatin. Urothelial cancer patients are of higher median age and often present with organ impairment and comorbidities. In frail patients, recommended treatment options include carboplatin or gemcitabine monotherapy, or GCa or imunotherapy if possible.