Selected articles
Patient with metastatic colorectal cancer treated in the third line of therapy with trifluridin/tipiracil
04/2018 MUDr. Jan Prokš, doc. MUDr. Josef Dvořák, Ph.D.
2015 was approved, after the placebo controled phase III trial RECOURSE, trifluridin/tipiracil (Lonsurf®, formerly TAS 102) for the treatment of patients with metastatic colorectal cancer who have been treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy, an anti-VEGF biological therapy, and if RAS wild-type, an anti-EGFR therapy. Trifluridin/tipiracil is an oral analog of fluoropyrimidin in combination with thymidinfosforylase inhibitor. Following case report demonstrates efficiency and good tolerance in the third line of therapy of the patient with metastatic colorectal cancer.
ENTIRE ARTICLE
2015 was approved, after the placebo controled phase III trial RECOURSE, trifluridin/tipiracil (Lonsurf®, formerly TAS 102) for the treatment of patients with metastatic colorectal cancer who have been treated with fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy, an anti-VEGF biological therapy, and if RAS wild-type, an anti-EGFR therapy. Trifluridin/tipiracil is an oral analog of fluoropyrimidin in combination with thymidinfosforylase inhibitor. Following case report demonstrates efficiency and good tolerance in the third line of therapy of the patient with metastatic colorectal cancer.
Bone pain syndrome in malignant diseases
04/2018 MUDr. Štěpán Rusín; MUDr. Petr Jelínek, Ph.D.
Bone tumors and bone metastases are one of the main sources of pain at patients with advanced oncological diseases and thus one of the main causes of lowering with quality of the in lives. They represent the loss of functional independence of a patient, limit the ability to participate in common daily activities, are often associated with the terminal oncological illness and lead to far, anxiety and depression. Prevalence of pain in bone tumors is 85-100 %.
ENTIRE ARTICLE
Bone tumors and bone metastases are one of the main sources of pain at patients with advanced oncological diseases and thus one of the main causes of lowering with quality of the in lives. They represent the loss of functional independence of a patient, limit the ability to participate in common daily activities, are often associated with the terminal oncological illness and lead to far, anxiety and depression. Prevalence of pain in bone tumors is 85-100 %.
Individualized treatment of patients with non‑small cell lung cancer
04/2018 MUDr. Jaromír Roubec, Ph.D.
Author in this article describes crucial periods and changes in the attitude to the therapy of the local progressive and metastatic bronchogenic carcinoma during the last three decades with the accent on the rapid progress in the personalized target therapy and immunotherapy of this disease together with next perspectives in the research and clinical practice.
ENTIRE ARTICLE
Author in this article describes crucial periods and changes in the attitude to the therapy of the local progressive and metastatic bronchogenic carcinoma during the last three decades with the accent on the rapid progress in the personalized target therapy and immunotherapy of this disease together with next perspectives in the research and clinical practice.
Merkel cell carcinoma – new treatment options
04/2018 MUDr. Ivana Krajsová
Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. Approximately 80% of tumors are Merkel cell polyomavirus (MCPyV) positive and in the rest 20% high rates of UV induced mutations is proven. MCC is very aggressive malignancy with tendency to metastasize into skin, lymph nodes and distant organs. Recently used chemotherapy had quite high response rate, achieved in some cases almost 60%, but the responses were short term and they did not project into prolongation of overall survival. Implementation of immunotherapy with inhibitory monoclonal antibodies against PD-1 and PD-L1 receptors led to significant prolongation of progression free survival and overall survival in patients with metastatic MCC (mMCC). The only checkpoint inhibitor, which is currently approved by FDA (Food and Drug Administration) and EMA (European Medicines Agency) for the treatment of mMCC is avelumab. It is IgG1 monoclonal antibody against PD-L1, highly efficient in the first and further lines of treatment.
ENTIRE ARTICLE
Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. Approximately 80% of tumors are Merkel cell polyomavirus (MCPyV) positive and in the rest 20% high rates of UV induced mutations is proven. MCC is very aggressive malignancy with tendency to metastasize into skin, lymph nodes and distant organs. Recently used chemotherapy had quite high response rate, achieved in some cases almost 60%, but the responses were short term and they did not project into prolongation of overall survival. Implementation of immunotherapy with inhibitory monoclonal antibodies against PD-1 and PD-L1 receptors led to significant prolongation of progression free survival and overall survival in patients with metastatic MCC (mMCC). The only checkpoint inhibitor, which is currently approved by FDA (Food and Drug Administration) and EMA (European Medicines Agency) for the treatment of mMCC is avelumab. It is IgG1 monoclonal antibody against PD-L1, highly efficient in the first and further lines of treatment.
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.
Which tumors are really rare?
04/2018 Prof. MUDr. Luboš Petruželka, CSc.
Precision oncology implies customizing treatment for each individual and cancer based on unique molecular and biologic characteristics. In the pregenomic era cancers are classified based on tumor site and histology. In the upcoming genomic era malignant diseases are reclassified based on molecular and biologic characteristics which results in increased number of cancer types. In the future, more and more identifiers of tumor diversity will be defined and the end of the pregenomic era of rare tumors can be expected.
ENTIRE ARTICLE
Precision oncology implies customizing treatment for each individual and cancer based on unique molecular and biologic characteristics. In the pregenomic era cancers are classified based on tumor site and histology. In the upcoming genomic era malignant diseases are reclassified based on molecular and biologic characteristics which results in increased number of cancer types. In the future, more and more identifiers of tumor diversity will be defined and the end of the pregenomic era of rare tumors can be expected.
Does proton radiation have a role in adjuvant breast cancer treatment?
04/2018 Doc. MUDr. Renata Soumarová, Ph.D.
Adjuvant radiotherapy in breast cancer using proton bundles is not yet part of any recommendations despite undisputable dosimetric benefits, including mainly lower doses for the heart, the lungs and the second-sided breast. The reason is the lack of clinical data on proton radiotherapy in breast cancer, which would confirm its theoretical advantage in practice. The results of studies evaluating cardiovascular morbidity after irradiation of the left side of the chest are not unambiguous; however, cardiac doses should be monitored and reduced even when performing photon radiotherapy. Modern techniques that allow this to happen include the technique of breath holding or irradiating only tumor beds in a certain group of patients, or by placing a patient on the abdomen using a so-called breast board. Questions about the clinical benefit of proton RT in breast cancer should be answered by ongoing clinical trials.
ENTIRE ARTICLE
Adjuvant radiotherapy in breast cancer using proton bundles is not yet part of any recommendations despite undisputable dosimetric benefits, including mainly lower doses for the heart, the lungs and the second-sided breast. The reason is the lack of clinical data on proton radiotherapy in breast cancer, which would confirm its theoretical advantage in practice. The results of studies evaluating cardiovascular morbidity after irradiation of the left side of the chest are not unambiguous; however, cardiac doses should be monitored and reduced even when performing photon radiotherapy. Modern techniques that allow this to happen include the technique of breath holding or irradiating only tumor beds in a certain group of patients, or by placing a patient on the abdomen using a so-called breast board. Questions about the clinical benefit of proton RT in breast cancer should be answered by ongoing clinical trials.
Immediate breast reconstruction – pros and cons…
04/2018 MUDr. Lucie Zárubová
Take home message of this article is, besides technical aspects of breast surgery view by general surgeon and plastic surgeon, opening eyes to surgeons, plastic surgeons, oncologists and at least management of Czech health system. That in other countries, even in Romania, or Hungary, treatment of breast cancer is on a higher level than in our country, at least surgical and oncoplastic part of complex breast cancer therapy. Even the numbers of breast cancer are increasing. Immediate breast reconstruction should be available for every woman patient with breast carcinoma and of course the right indication.
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Take home message of this article is, besides technical aspects of breast surgery view by general surgeon and plastic surgeon, opening eyes to surgeons, plastic surgeons, oncologists and at least management of Czech health system. That in other countries, even in Romania, or Hungary, treatment of breast cancer is on a higher level than in our country, at least surgical and oncoplastic part of complex breast cancer therapy. Even the numbers of breast cancer are increasing. Immediate breast reconstruction should be available for every woman patient with breast carcinoma and of course the right indication.
Breast cancer metastases to ovaries – does exist rules for diagnosis and treatment?
04/2018 MUDr. Klaudia Regináčová, doc. MUDr. Martina Kubecová, Ph.D.
Breast cancer metastases to ovaries occur either in advanced, metastatic disease. In daily practice distinguish between primary and secondary ovarian tumours is often difficult. Ultrasound is irreplaceable in diagnosis. Definitive answer often gives surgery and histological findings.
ENTIRE ARTICLE
Breast cancer metastases to ovaries occur either in advanced, metastatic disease. In daily practice distinguish between primary and secondary ovarian tumours is often difficult. Ultrasound is irreplaceable in diagnosis. Definitive answer often gives surgery and histological findings.
Discrepancies between the histological findings of biopsy and the surgical specimen of breast cancer
04/2018 MUDr. Markéta Trnková
The introduction of a thick needle core cut biopsy in the diagnosis of non-palpable and palpable breast lesions at the beginning of the 1990s gradually replaced surgical diagnostic excision. A minimally invasive method which, under a stereotactic, ultrasound or magnetic resonance guidance, allows to obtain pieces of tissue that in contrast to a fine needle biopsy can be processed by a standard histological procedure, brought the acceleration of diagnostics of malignant tumors, saved patients with benign lesions from unnecessary surgery and, last but not least, reduced costs. On the other hand, it opens the question of reliability of diagnostics, based on the minimum tissue sample, i.e. the representativeness of this sample from the viewpoint of both the basic typing of the tumor and the determination of the prognostic and predictive parameters that are the basis for subsequent treatment. The histological result of core cut biopsy is the essential source of tumor information for the indication of neoadjuvant therapy, and often the only available tumor tissue in case of complete pathological response. These facts underline the importance of the accuracy of the core biopsy diagnosis and the need for awareness of the possible discrepancies between the histological findings of biopsy and the surgical specimen, and their causes. However, they also raise pressure on introducing of measures or new methods, in an effort to eliminate these discrepancies.
ENTIRE ARTICLE
The introduction of a thick needle core cut biopsy in the diagnosis of non-palpable and palpable breast lesions at the beginning of the 1990s gradually replaced surgical diagnostic excision. A minimally invasive method which, under a stereotactic, ultrasound or magnetic resonance guidance, allows to obtain pieces of tissue that in contrast to a fine needle biopsy can be processed by a standard histological procedure, brought the acceleration of diagnostics of malignant tumors, saved patients with benign lesions from unnecessary surgery and, last but not least, reduced costs. On the other hand, it opens the question of reliability of diagnostics, based on the minimum tissue sample, i.e. the representativeness of this sample from the viewpoint of both the basic typing of the tumor and the determination of the prognostic and predictive parameters that are the basis for subsequent treatment. The histological result of core cut biopsy is the essential source of tumor information for the indication of neoadjuvant therapy, and often the only available tumor tissue in case of complete pathological response. These facts underline the importance of the accuracy of the core biopsy diagnosis and the need for awareness of the possible discrepancies between the histological findings of biopsy and the surgical specimen, and their causes. However, they also raise pressure on introducing of measures or new methods, in an effort to eliminate these discrepancies.
Do CDK4/6 inhibitors change existing treatment practice in metastatic HR+/HER2– breast cancer?
04/2018 MUDr. Michaela Zezulová, Ph.D.
Hormonal therapy allows patients with metastatic hormone-positive tumours to control disease while maintaining the best quality of life. The problem of its long-term administration is the emergence of resistance. CDK4/6 inhibitors represent a new therapeutic group of drugs when combined with hormonal agents provide significant benefit in delaying resistance and prolonging progression free survival with a favourable safety profile. The greatest benefit is apparently achieved with the use of CDK4/6 inhibitors already in the first line, but even in the 2nd line, therapy is very beneficial. Common inclusion of CDK4/6 inhibitors in therapeutic practice is expected soon, but we have to wait for results of clinical trials for the optimal therapeutic sequence.
ENTIRE ARTICLE
Hormonal therapy allows patients with metastatic hormone-positive tumours to control disease while maintaining the best quality of life. The problem of its long-term administration is the emergence of resistance. CDK4/6 inhibitors represent a new therapeutic group of drugs when combined with hormonal agents provide significant benefit in delaying resistance and prolonging progression free survival with a favourable safety profile. The greatest benefit is apparently achieved with the use of CDK4/6 inhibitors already in the first line, but even in the 2nd line, therapy is very beneficial. Common inclusion of CDK4/6 inhibitors in therapeutic practice is expected soon, but we have to wait for results of clinical trials for the optimal therapeutic sequence.
Biosimilar trastuzumab – are we afraid or looking forward?
04/2018 Doc. MUDr. David Vrána, Ph.D.
Trastuzumab represents one of the fundamental targeted molecule in oncological practice. Due to the high breast cancer incidence, constantly increasing patient survival with HER2 positive breast cancer the overall treatment cost is increasing rapidly. Since the patent of Herceptin has expired there is an intense effort to replace the Herceptin with cheaper equivalents. Biosimilars represents one of the possible option. Recently there are several trastuzumab biosimilars registered by EMA (Ontruzant, Kanjinti, Herzuma) and further molecules are in the approval process. The usage of the biosimilars may represent the saving about 20-30% of the original price and this could possible extend the insurance reimbursement to further indications. Biosimilars are used in Czech Republic for many years with generally good experience however due to the different approval proces of the biosimilars compared with original drugs there has to be a caution about possible side effects which may not manifest during the testing on relatively small group of patients.
ENTIRE ARTICLE
Trastuzumab represents one of the fundamental targeted molecule in oncological practice. Due to the high breast cancer incidence, constantly increasing patient survival with HER2 positive breast cancer the overall treatment cost is increasing rapidly. Since the patent of Herceptin has expired there is an intense effort to replace the Herceptin with cheaper equivalents. Biosimilars represents one of the possible option. Recently there are several trastuzumab biosimilars registered by EMA (Ontruzant, Kanjinti, Herzuma) and further molecules are in the approval process. The usage of the biosimilars may represent the saving about 20-30% of the original price and this could possible extend the insurance reimbursement to further indications. Biosimilars are used in Czech Republic for many years with generally good experience however due to the different approval proces of the biosimilars compared with original drugs there has to be a caution about possible side effects which may not manifest during the testing on relatively small group of patients.
Will pertuzumab find its place in an neoadjuvant chemotherapy?
04/2018 MUDr. Markéta Protivánková
Neoadjuvant chemotherapy is a systemic treatment, which is given before a local procedure that leads to the removal of the tumor. In the treatment of breast cancer, it is intended especially for the patients in whom we want to achieve the downstaging of the tumor in order to improve its operability and to achieve breast conserving surgery. Although there is currently no longer long-term survival in patients who undergo neoadjuvant chemotherapy, patients who achieve complete pathological remission (pCR) have a better long-term prognosis. In patients with HER2 positive tumors, a significantly higher number of pCR is achieved if trastuzumab is added to neoadjuvant treatment, when dual blockade is added to the combination via simultaneous administration of trastuzumab and pertuzumab with chemotherapy, the pCR almost doubles. For this reason, pertuzumab should be used as a essential component of neoadjuvant chemotherapy in patients with high-risk HER2-positive breast cancer in combination with trastuzumab.
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Neoadjuvant chemotherapy is a systemic treatment, which is given before a local procedure that leads to the removal of the tumor. In the treatment of breast cancer, it is intended especially for the patients in whom we want to achieve the downstaging of the tumor in order to improve its operability and to achieve breast conserving surgery. Although there is currently no longer long-term survival in patients who undergo neoadjuvant chemotherapy, patients who achieve complete pathological remission (pCR) have a better long-term prognosis. In patients with HER2 positive tumors, a significantly higher number of pCR is achieved if trastuzumab is added to neoadjuvant treatment, when dual blockade is added to the combination via simultaneous administration of trastuzumab and pertuzumab with chemotherapy, the pCR almost doubles. For this reason, pertuzumab should be used as a essential component of neoadjuvant chemotherapy in patients with high-risk HER2-positive breast cancer in combination with trastuzumab.
Nab-paclitaxel in neoadjuvant treatment of breast cancer
04/2018 Doc. MUDr. Petra Tesařová, CSc.
Neoadjuvant chemotherapy is able to convert unresectable breast tumors to resectable tumors and to provide more conservative surgery in some mastectomy candidates. Chemotherapy agents, including taxanes, which are recommended in the adjuvant setting, are also considered in the neoadjuvant setting. A number of clinical studies with nab paclitaxel have also been performed in the neoadjuvant setting. Nab-paclitaxel demonstrated antitumor activity and an acceptable safety profile in the neoadjuvant treatment of breast cancer. In some clinical trials, nab-paclitaxel was more effective than paclitaxel. Ongoing and future trials will further evaluate preoperative nab-paclitaxel in breast cancer, including in combination with many novel immunological targeted therapies.
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Neoadjuvant chemotherapy is able to convert unresectable breast tumors to resectable tumors and to provide more conservative surgery in some mastectomy candidates. Chemotherapy agents, including taxanes, which are recommended in the adjuvant setting, are also considered in the neoadjuvant setting. A number of clinical studies with nab paclitaxel have also been performed in the neoadjuvant setting. Nab-paclitaxel demonstrated antitumor activity and an acceptable safety profile in the neoadjuvant treatment of breast cancer. In some clinical trials, nab-paclitaxel was more effective than paclitaxel. Ongoing and future trials will further evaluate preoperative nab-paclitaxel in breast cancer, including in combination with many novel immunological targeted therapies.
Advances in the development of anti-cancer vaccines
03/2018 MUDr. Zuzana Střížová; MUDr. Michal Podrazil, Ph.D.; prof. MUDr. Jiřina Bartůňková, DrSc.
Immunotherapy has accomplished an impressive success within the past several years and therefore is widely accepted as a breakthrough therapy in the field of oncology. The rapid development of modern methods has led to generation of highly personalized biological and cellular therapy. In the solid tumor treatment, checkpoint inhibitors turned to be a very perspective therapeutic modality however, the prevention of undesired autoimmune events should be targeted in ongoing clinical trials. In hematological malignancies, application of CAR T cells showed significant results and combining CAR T cells with oncolytic viruses might be a promising approach in the future. Here we provide the systematic review of the modern immune-oncologic approaches and present the course of basic research in the field of cancer immunotherapy.
ENTIRE ARTICLE
Immunotherapy has accomplished an impressive success within the past several years and therefore is widely accepted as a breakthrough therapy in the field of oncology. The rapid development of modern methods has led to generation of highly personalized biological and cellular therapy. In the solid tumor treatment, checkpoint inhibitors turned to be a very perspective therapeutic modality however, the prevention of undesired autoimmune events should be targeted in ongoing clinical trials. In hematological malignancies, application of CAR T cells showed significant results and combining CAR T cells with oncolytic viruses might be a promising approach in the future. Here we provide the systematic review of the modern immune-oncologic approaches and present the course of basic research in the field of cancer immunotherapy.
Carfilzomib in the treatment of relapsed multiple myeloma – results of ASPIRE trial
03/2018 MUDr. Jan Straub
In the Czech Republic bortezomib and lenalidomide-based regimens (VD, CVD, VTD, RD) are the most commonly used second- and third-line therapies for patients with multiple myeloma (MM). Now is new combination - carfilzomib-lenalidomid-dexamethason (KRd) approved for the treatment for patients with relapse of MM. The approvals for the combination KRd were based on results of randomized ASPIRE trial, phase 3, which evaluated KRd versus Rd in patients with relapsed or refractory MM (1-3 previous lines of therapy). Treatment with KRd led to a significant reduction in the risk of disease progression or death. Progression-free survival was significantly improved with carfilzomib (median 26.3 months for KRd versus 17.6 months for Rd). Median overall survival was 48.3 months for KRd versus 40.4 months for Rd. Selected grade > 3 adverse events of interest included cardiac failure (4.3 % vs 2.1 %), ischemic heart disease (3.8 % vs 2.3 %) and arterial hypertension (6.4 % vs 2.3 %).
ENTIRE ARTICLE
In the Czech Republic bortezomib and lenalidomide-based regimens (VD, CVD, VTD, RD) are the most commonly used second- and third-line therapies for patients with multiple myeloma (MM). Now is new combination - carfilzomib-lenalidomid-dexamethason (KRd) approved for the treatment for patients with relapse of MM. The approvals for the combination KRd were based on results of randomized ASPIRE trial, phase 3, which evaluated KRd versus Rd in patients with relapsed or refractory MM (1-3 previous lines of therapy). Treatment with KRd led to a significant reduction in the risk of disease progression or death. Progression-free survival was significantly improved with carfilzomib (median 26.3 months for KRd versus 17.6 months for Rd). Median overall survival was 48.3 months for KRd versus 40.4 months for Rd. Selected grade > 3 adverse events of interest included cardiac failure (4.3 % vs 2.1 %), ischemic heart disease (3.8 % vs 2.3 %) and arterial hypertension (6.4 % vs 2.3 %).
Current approaches to head and neck cancer treatment
03/2018 MUDr. Milan Vošmik, Ph.D.
The present review summarizes current treatment approaches for head and neck tumors. The basic therapeutic modalities for squamous cell carcinomas are surgery and radiotherapy. Systemic treatment is a part of concurrent chemoradiotherapy or it is indicated with a palliative intent alone. A new approach to palliative treatment is the use of immunotherapy. A partly different approach compared to other head and neck tumors is taken into consideration in nasopharyngeal cancer and salivary gland tumors.
ENTIRE ARTICLE
The present review summarizes current treatment approaches for head and neck tumors. The basic therapeutic modalities for squamous cell carcinomas are surgery and radiotherapy. Systemic treatment is a part of concurrent chemoradiotherapy or it is indicated with a palliative intent alone. A new approach to palliative treatment is the use of immunotherapy. A partly different approach compared to other head and neck tumors is taken into consideration in nasopharyngeal cancer and salivary gland tumors.
Tomotherapy – use in radiation treatment in oncological patients
03/2018 Doc. MUDr. Renata Soumarová, Ph.D.; Ing. Pavel Dvořák, Ph.D.; MUDr. Eva Kindlová; doc. MUDr. Martina Kubecová, Ph.D.
Tomotherapy is a radiotherapy procedure providing a highly conformal dose distribution that allows critical organs to be investigated and/or a local dose increase in the target volume. The principle of the technique is to place a small megavoltage linear accelerator on a rotating gantry, including the acquisition of a CT verification before each fraction. A similar technology is volumetric modulated arc therapy (so-called VMAT) on a conventional linear accelerator. There are several studies that directly compare volumetric radiotherapy and tomotherapy. The results indicate a generally faster delivery of the dose by VMAT technique, tomotherapy provides a relatively more consistent and homogeneous dose distribution. Tomotherapy is used in the adjuvant, neoadjuvant, radical and palliative treatment of a wide range of diagnoses.
ENTIRE ARTICLE
Tomotherapy is a radiotherapy procedure providing a highly conformal dose distribution that allows critical organs to be investigated and/or a local dose increase in the target volume. The principle of the technique is to place a small megavoltage linear accelerator on a rotating gantry, including the acquisition of a CT verification before each fraction. A similar technology is volumetric modulated arc therapy (so-called VMAT) on a conventional linear accelerator. There are several studies that directly compare volumetric radiotherapy and tomotherapy. The results indicate a generally faster delivery of the dose by VMAT technique, tomotherapy provides a relatively more consistent and homogeneous dose distribution. Tomotherapy is used in the adjuvant, neoadjuvant, radical and palliative treatment of a wide range of diagnoses.
Patient with brain metastases of malignant melanoma a long‑term surviving with BRAF and MEK inhibitor in combination therapy
03/2018 MUDr. Ilona Procházková
In recent years, there has been a significant shift in the treatment of generalized malignant melanoma due to the introduction of targeted BRAF and MEK inhibitors in patients with BRAF mutation in tumor cells and modern immunotherapy using antibodies against immune response checkpoints. The results of clinical trials have confirmed a significantly higher response rate and an increase in overall survival in patients treated with both types of medication.
ENTIRE ARTICLE
In recent years, there has been a significant shift in the treatment of generalized malignant melanoma due to the introduction of targeted BRAF and MEK inhibitors in patients with BRAF mutation in tumor cells and modern immunotherapy using antibodies against immune response checkpoints. The results of clinical trials have confirmed a significantly higher response rate and an increase in overall survival in patients treated with both types of medication.