Selected articles

03/2019 MUDr. Igor Richter, Ph.D.; doc. MUDr. Josef Dvořák, Ph.D.; MUDr. Jiří Baroš; MUDr. Vladimír Šámal
Renal cell cancer accounts 2-3 % of all cases of malignancy. Sunitinib and Pazopanib have so far been standard in first line treatment of metastatic renal cell cancer. In this review we discuss current first-line treatment options as new tyrosine kinase inhibitor cabozantinib, the new combination of immunotherapy (nivolumab plus ipilimumab), and combination of immunotherapy and tyrosine kinase inhibitor. With the growing therapeutic options, identification of new biomarkers will be crucial for optimizing first-line selection.

03/2019 MUDr. Jindřich Kopecký, Ph.D.
In the last decade, we are witnesses of great development and improvement in renal cancer therapy. Based on better understanding of the mechanisms of pathogenesis and the improvement in immunotherapy, we are able to reach long-term responses. Currently, it is still not clear, if there is a choice of, which drug to use. We do not always have head to head comparisons of drugs. In our conditions is this issue partially artificially simplified due to reimbursement. The following article discusses the current status, advantages and disadvantages of immunotherapy and targeted therapy in renal cancer.

03/2019 MUDr. Jana Katolická, Ph.D.
Immunotherapy is not used in routine clinical practice in the treatment of prostate cancer. Traditional endpoints used to evaluate chemotherapy may not assess accurately the clinical benefit from immune therapies. The mechanism of action of most immune therapies is not directly cytotoxic. The higher clinical benefit was found in favorable subgroups with a lower tumor burden and a less immunosuppressive tumor microenvironment.

03/2019 MUDr. Otakar Čapoun, Ph.D., FEBU
Metastatic prostate cancer has a significantly worse prognosis compared to localized or locally advanced disease. The first choice in most patients is androgen deprivation therapy, i.e. castration. The effect of docetaxel chemotherapy and novel hormonal agents (abiraterone, enzalutamide) was first demonstrated in the stage of castration resistance. Docetaxel has also been tested in combination with androgen deprivation therapy for newly diagnosed metastatic prostate cancer without prior castration. Significantly longer overall survival was achieved in the group of combined therapy. However, a significant effect was observed only in patients with high volume metastatic disease. Abiraterone has also been studied in combination with androgen deprivation therapy in the first line of therapy of high-risk metastatic hormone-sensitive prostate cancer. Again, overall survival was significantly longer for combined therapy. The safety profile of both docetaxel and abiraterone is favorable, but when choosing between these strategies, one must consider the general condition of the patient, his symptoms and comorbidities as well as his preferences.

02/2019 MUDr. Radka Šimečková
Acute promyelocytic leukemia (APL) is a rare disease. APL is frequently associated with disseminated intravascular coagulation and increased fibrinolysis. The origin and development of the disease is 99 % associated with the reciprocal translocation of the alpha-retinoic acid (RARα) gene from chromosome 17 on chromosome 15 to the region of the gene called the promyelocytic leukemia gene (PML). The result of this translocation is the PML/RARα fusion gene. In less than 1%, the RARα gene fuses with other variant genes than PML. This article presents the case of APL with variant RARα translocation, focused on morphological findings.

02/2019 MUDr. Dana Mikulenková
PML/RARα positive acute promyelocytic leukemia (APL) is characterized by the presence of leukemic promyelocytes in peripheral blood smear and bone marrow aspirate, genetically confirmed PML/RARAα fusion, clinical signs of bleeding and disseminated intravascular coagulation. The majority of cases present with pancytopenia, leukocytosis (more frequently in microgranular variants) is rare. Leukemic promyelocytes differ in nucleus shape and cytoplasmic granulation as compared to their physiological counterparts. The following case report focuses on morphological findings in a patient with hypergranular APL at presentation and relapse.

02/2019 MUDr. Hana Šiffnerová, Ph.D., MUDr. Taťána Karpianusová
A case report presents the long-term treatment of men with generalized neuroendocrine tumour of the pancreas, which gradually developed a carcinoid syndrome.

02/2019 MUDr. Jana Zuchnická, MUDr. Petra Richterová, MUDr. Zuzana Rusiňáková, prof. MUDr. Edgar Faber, CSc., MUDr. Roman Hájek, CSc.
Atypical chronic myeloid leukemia BCR/ABL1 negative is a rare disease. The prognosis is unfavorable; patients have a high risk of transformation in acute myeloid leukemia. Transplantation of allogeneic haematopoietic stem cells should therefore be considered in younger patients without significant associated illnesses for which a suitable donor has been found early in the course of disease. We use paliative treatment procedures for patients who are unsuitable for transplantation.

02/2019 MUDr. Ludmila Křížová
In sequencing technologies of nucleic acids, significant progress has been made in recent years, and the use of these methods is slowly but surely endorsed in the practice of clinical oncologists. Next-generation sequencing (NGS) is relatively fast and reliable method and nowadays it became to be also financially available.¹ The main idea of personalized oncology is prediction of response to targeted treatment based on molecular markers independently to histological finding. And for this approach the understanding of molecular methods is necessary.² Therefore, we decided to show possibilities of NGS and its implication to daily practice in this article.

02/2019 MUDr. Gabriela Krákorová, Ph.D.
The article provides a basic orientation in the processes and concepts involved in carcinogenesis. It does not aim to bring exhaustive expert information, but in a simple and comprehensible form it presents a terminological interpretation of the terms commonly used by a beginning oncologist. These concepts are useful to know, but also to understand them. The article explains the characteristics of transcription of genetic information and protein synthesis, deals with both chromosomal and gene mutations. It describes the importance of genetic mutations for lung cancer.

02/2019 Mgr. Libuše Kalvodová
The article describes psychopathological states of oncological patients during a cancer treatment. Fear which accompanies us throughout our whole lives is identified together with another negative emotion, anxiety. Furthermore, we discuss stress and insufficient evidence of it being the cause of tumor development. Aggression and resistance are understood as a part of dealing with cancer treatment. Depression is the gravest psychopathological state and its continuation is a direct risk to patient's life. In addition, we show various examination methods followed by a section about psychotherapeutic care and notes on psychopharmacotherapy.

02/2019 Prof. MUDr. Pavel Klener, DrSc.
Vitamin C (ascorbic acid) is a mikronutrient with multiple functions. The most important of them is its antioxidant property, which may play the role in carcinogenesis. It neutralizes action of reactive oxygen species. The intravenous administration of high dose of ascorbate can modified antioxidant role to pro-oxidant effect, which could have direct anticancer property. However, this has not been confirmed in clinical trials. The main role of ascorbate remain as very useful complementary therapy, particularly when combined with glutathione.

02/2019 MUDr. Štěpán Rusín, MUDr. Petr Jelínek
Phantom pain sensations are described as perceptions that an individual experiences relative to a limb or an organ that is not physically part of the body.

02/2019 MUDr. Marek Hakl, Ph.D.
Breakthrough pain affects 60-85% of patients and is characterized by onset within seconds to minutes and short duration. We consider breakthrough pain as a sudden, transient, and short-lasting pain that occurs in opioid-treated patients. Breakthrough pain is a temporary worsening of pain in patients with well-controlled underlying pain. Poorly controlled breakthrough pain has a very negative impact on the quality of life of patients. The current treatment options for breakthrough pain include the use of transmucosal fentanyl and, in addition, IR oxycodone. Oxycodone has a relatively rapid onset of action, is well tolerated and easily titrated. It is a welcome enrichment of therapeutic options for treatment of oncological and non-oncological breakthrough pain.

02/2019 MUDr. Nikol Rušarová, MUDr. Marie Bartoušková, doc. MUDr. David Vrána, Ph.D.
Breast cancer is the most frequently diagnosed cancer and despite the gains in early detection, up to 5 percent of women are diagnosed with metastatic disease at the time of first presentation. Due to development of new molecules breast cancer is now a chronic disease, while metastatic disease is still incurable. It is a heterogeneous diverse disease composed of several biologic subtypes that have distinct behaviors and responses to therapy.

02/2019 MUDr. Miroslav Důra
This case report describes a treatment response in a patient with metastatic melanoma, who was treated with nivolumab. Objective response and also visible improvement of his quality of life were observed.

02/2019 MUDr. Taťána Šuková
Treatment of advances malignant melanoma has seen significant changes in recent years. After decades of stagnation when chemotherapy was used to treat metastatic melanoma the efficacy of which is limited in this tumor, two new drug regimens are now available - advanced imunotherapy offer the chance of long-term survival of nearly 30% of patients.

02/2019 MUDr. Ilona Procházková
Targeted treatment of BRAF and MEK inhibitors and targeted antibody treatment against immune response checkpoints showed a significant advance in the treatment of generalized malignant melanoma against previously used chemotherapy and radiotherapy. The results of the clinical studies confirmed a markedly higher response rate and an increase in overall survival in patients treated with both types of this medications.

02/2019 Prof. MUDr. Petr Arenberger, DrSc, MBA, FCMA
Basal cell carcinoma is the most common skin tumor, yet little attention has been paid to its treatment. The vast majority of patients are cured by surgical removal of the tumor. Other therapeutic options include radiotherapy, cryotherapy or photodynamic therapy. However, in a limited number of cases, current treatment options do not lead to cure and basal cell carcinoma develops into an advanced stage. A locally advanced stage can cause significant destruction and disfigurement of surrounding tissues. In extremely rare cases, the disease may develop into a metastatic stage that directly threatens the patient's life.

02/2019 MUDr. Ondřej Kodet, Ph.D., MUDr. Ivana Krajsová, MBA
Melanoma is probably the most malignant skin cancer. Its incidence has increased significantly five times for the past 40 years, although mortality has been rather stationary in recent years. Complex treatment of melanoma is radical surgery, adjuvant therapy, and therapy of metastatic melanoma. The basis of therapy remains a radical surgery with a sufficient resection margin and histological examination of Breslow and, possibly examination of sentinel lymph node. In adjuvant therapy, checkpoint inhibitors are being used more recently, but currently only interferon alpha is approved. Therapy of metastatic melanoma has made great progress, and now it represents by BRAF and MEK inhibitors as targeted therapy, and immunooncology therapy using a checkpoint inhibitor, especially anti-PD-1. The newly introduced combined treatment options, immunotherapy, and combination with target therapy, are particularly prone to possible higher toxicity. More recently, oncolytic viruses have been used in combination with checkpoint inhibitors. New approaches to complex melanoma therapy have brought major advances that have significantly affected the prognosis of patients with melanoma.