Selected articles

03/2018 MUDr. Yvetta Vantuchová, Ph.D.
Basal cell carcinoma is the most common carcinoma with low malignant potential and mortality, and in early diagnosis with high curability. It occurs in different clinical forms, histological variants with different risk. Early diagnostics, based on experience, good clinical knowledge and histological variants, is a prerequisite for choosing the optimal modal treatment of both primary and recurrent treatment. Dominant surgery is the only surgical procedure in which contraindication can be done with non-surgical methods, radiation therapy, cryodestruction, photodynamic therapy or topical treatment. For advanced or metastatic basal cell carcinoma, vismodegib the first inhibitor hedgehog signaling pathway is used.

03/2018 Prof. MUDr. Petr Arenberger, DrSc., MBA, FCMA
Metastatic melanoma was still relatively recently considered as a malignant tumor with a very poor prognosis, with only limited response to the available treatment methods. However, over the last five years, at least in part of the patients, metastatic melanoma has been slowly changing from being a disease with poor prognosis to disease with long-term survival. It is mostly due to new therapeutic options. Ten years ago, five-year survival rate was no more than 10% of patients. Nowadays, using the latest therapeutic options, the number is approximately 30%.

03/2018 MUDr. Jindřich Kopecký, Ph.D.; MUDr. Ondřej Kubeček
Thanks to gradually improving understanding of complex interactions between the immune system and cancer and thanks to deeper understanding of molecular interactions between tumour and immune cells at the level of so-called checkpoint inhibitors, there has been a renaissance of immunotherapy as a therapeutic modality in oncology in recent years. The following article focuses on the current status of checkpoint inhibitors for therapy of malignant melanoma and other possibilities for their use in the future.

03/2018 MUDr. Ing. Jakub Cvek, Ph.D.; Ing. Lukáš Knybel
Extracranial stereotactic radiotherapy is one of the rapid developing fields in oncology. Article deals with important aspects of precise quality assurance as well as results of prostate cancer treatment from different institutions.

03/2018 Doc. MUDr. Renata Soumarová, Ph.D.
Brachytherapy is one of the basic standard options for the treatment of localized prostate cancer. Long-term data confirm efficiency and safety of using brachytherapy for treating a prostate cancer and make it an adequate choice of treatment along with benefits, which this procedure provides. It is suitable for all risk groups either as a single treatment or in combination with external radiotherapy.

03/2018 MUDr. Jiří Kubeš, Ph.D.; Mgr. Vladimír Vondráček
External radiotherapy is used in the treatment of all stages of prostate cancer and generally has a high rate of success and low toxicity. It is applied in all its forms - conformal 3D radiotherapy, intensity modulated radiotherapy, intensity modulated proton therapy, and carbon ion radiotherapy.

03/2018 MUDr. Jana Katolická, Ph.D.; MUDr. Petr Filipenský, Ph.D.
Bone metastases in prostate cancer are a major cause of pain and bone complications. Radium-223 treatment of patients with bone metastasis in castration-resistant prostate cancer proved to be beneficial in prolonging overall survival. Administration of 5-6 doses of radium-223 compared to 1-4 doses is associated with a significantly longer overall survival. The most common haematological adverse event induced treatment is anemia and thrombocytopenia.

03/2018 MUDr. Igor Richter, Ph.D.; doc. MUDr. Josef Dvořák, Ph.D.
Prostate cancer is the most common male malignant neoplasm in men worldwide and second cause of cancer related death. In castrate-resistance prostate cancer (CRPC) we can see the development of the new therapeutic options. The chemotherapy is an important part of the CRPC treatment. Cabazitaxel, a new generation taxane, demonstrates the overall survival prolongation as first substances in patients with metastatic CRPC after previous treatment by docetaxel. The discussed issues are to find the optimal treatment sequences. The aim of this presented article is to define the status of cabazitaxel in CRPC.

03/2018 Doc. MUDr. Tomáš Büchler, Ph.D.
Axitinib is an oral, selective inhibitor of vascular endothelial cell growth factor receptor (VEGFR)-1, -2, -3. It is currently registered for the treatment of metastatic renal cell carcinoma progressing on sunitinib or cytokine therapy. The AXIS phase III registration trial was the first study to directly compare two different targeted agents for metastatic renal cell carcinoma. The study also validated hypertension as a clinical biomarker of axitinib efficacy. The main benefits of axitinib include a relatively favorable toxicity profile, with relatively uncommon, predictable and usually manageable side effects.

03/2018 Prof. MUDr. Jindřich Fínek, Ph.D., MHA
Two new molecules, nivolumab (anti-PD-1) and cabozantinib (a multikinase inhibitor of the VEGF, AXL and MET pathway), are coming into the treatment of metastatic clear cell carcinoma of the kidneys. In the second treatment line, both offer an identical survival extension of five months compared to everolimus. Cabozantinib appears to be more appropriate in patients with bone metastases and when rapid onset of action is required. In contrast, nivolumab has an advantage in patients with high tumor burden.

03/2018 MUDr. Jana Katolická, Ph.D.
The most particular histological type of bladder cancer is urothelial carcinoma. The chemotherapeutic schedules for metastatic disease are based on derivatives of platinum. The imunotherapy is novel therapeutic possibility for patients with local advanced and metastatic disease.

02/2018 MUDr. Petr Kessler
The patients with cancer are prone to developing venous thromboembolism. The thromboprophylaxis and treatment of thrombosis in these patients are thus somewhat different from prophylaxis and treatment of thrombosis in patients without cancer.
Low molecular weight heparins (LMWH) are the best choice for pharmacological thromboprophylaxis. The pharmacological postoperative thromboprophylaxis should be extended to 4 weeks in patients undergoing large surgery (including laparoscopic surgery) for malignancy. The intermittent pneumatic compression or foot pumps are reasonable alternatives to LMWH in patients with very high risk of severe bleeding. The pharmacological thromboprophylaxis is recommended for patients with cancer, which are hospitalized for an acute illness or confined to bed. The pharmacological thromboprophylaxis is not generally recommended for ambulatory patients undergoing chemotherapy; it should be considered in patients with history of venous thromboembolism or multiple additional risk factors for thrombosis. The pharmacological thromboprophylaxis with LMWH is useful for patients undergoing chemotherapy for pancreatic cancer or lung cancer. LMWH is the best choice for most multiple myeloma patients undergoing therapy with the exception of patients which are not treated with imids or with anthracyclines combined with high dose of dexamethasone. Aspirin is an acceptable alternative to LMWH in patients with relapsed multiple myeloma, which are treated with imids monotherapy or using combination of imids with low dose of corticosteroids. Venous thromboembolism in patients with cancer should be treated with therapeutic dose of LMWH for 1 month; the dose can be reduced to 2/3-3/4 thereafter. Edoxaban is an alternative to LMWH with comparable efficacy and safety. The therapy should be re-evaluated after 6 months; subsequent therapy using LMWH or warfarin is recommended indefinitely, unless the cancer is resolved or any major contraindication of this therapy arises.

02/2018 Prof. MUDr. František Antoš, CSc., MUDr. Pavel Vítek, Ph.D., MUDr. Jiří Kopic, MUDr. Josef Marx, MUDr. Petr Bartoška
In our countries the cytoreductive surgery + hyperthemic peroperative chemotherapy (HIPEC) is a relatively new method in the treatment of peritoneal surfaces malignancy. The 15 years experience of only one center in the Czech Republic dealing with this conditions since 1999, where more than 300 operations were performed, shows a significant benefit for patients suffering from pseudomyxoma peritonei, malignant peritoneal mesothelioma, colorectal carcinoma, ovarial epithelial cancer and primary peritoneal carcinoma. On the other hand the results in gastric cancer diagnosis were not improved. In our group of patients the lethality 7.3 % and the morbidity 6.6 % has been detected. The gradual establishment of new centers dealing with this condition is desirable.

02/2018 Doc. MUDr. David Vrána, Ph.D.
Colorectal cancer represents second most frequent cancer in the population. In the last years there is a growing evidence about predictive and prognostic role of the tumor location in the gut in the case of metastatic cancer. There are several possible explanations based on the embryogenesis of the gut, bacterial colonization or genetic predisposition. Retrospective evaluation of clinical trials with targeted therapy (panitumumab, cetuximab) has clearly proven the advantage of anti-EGFR treatment in the case of left-sided colorectal cancer however not in right-sided cancer. Right-sided colorectal cancer has worse prognosis regardless of treatment. This difference is also apparent in subsequent treatment lines. In summary, side location represents predictive factor for anti-EGFR therapy and probably only predictive factor for bevacizumab treatment.

02/2018 MUDr. Kateřina Kopečková
In the European Union, Lartruvo® (olaratumab) has been conditionally registered and approved under the Phase 2 study in the European Union on 9 November 2016 with the status of Orphan Drug - rare disease medication for the treatment of patients with advanced soft-tissue sarcoma. Olaratumab is a human monoclonal antibody binding to the PDGFR (platelet derived growth factor receptor) alpha and blocking ligand binding and activation of the receptor signal pathway. It represents the first biological treatment that clinically significantly prolonged overall survival when combined with doxorubicin, compared to the standard of doxorubicin monotherapy and achieved a median survival of 80%, i.e. 11.8 months from 14.7 to 26.5 months, and reducing the risk of death by 54% (hazard ratio 0.463; p = 0.0003).

02/2018 MUDr. Hana Študentová, Ph.D.
Targeted therapy of renal cell carcinoma has evolved enormously during past ten years. Inhibitors of angiogenesis have dominated exclusively in the treatment algorithm until recently, when immunotherapy has become a potential rival. Immunotherapy has been going through a revival due to a different and attractive mechanism of fight against cancer. New molecules have emerged to show efficacy with a regard of response rate, improving survival outcome, however, the key question remains unanswered - what is the optimal sequence of therapy including immunotherapy in the treatment of renal cell carcinoma?

02/2018 MUDr. Adam Guňka, MUDr. Markéta Pospíšková, MUDr. Milan Kohoutek
Prostate cancer is after lung cancer the most common type of malignant tumor in the male population worldwide. We can gradually decrease the number of lung patients by educating the population and using anti-smoking campaigns and hopefully the incidence and prevalence of the illness can be changed in the future. The probability of prostate cancer rises with age. Despite frequent occurrence this disease is not one of the diagnoses with poor prognosis depending on incidence. 80% of the patients are diagnosed with the disease which is not locally advanced and there is approximately 95% survival rate that the patients would live up to five years. This is not only thanks to early diagnosis but also thanks to new medications available in clinical practice. In Hormone-Dependent Prostate Cancer, the development of  hormone-resistant disease can be delayed by an average of three years by the luteinizing hormone-releasing hormone analog. Subsequently, the inclusion of androgen receptor targeted agents in the therapeutic algorithm of cast rationally-resistant prostate cancer has brought great advances in the treatment. Also, we cannot forget about the chemotherapy systematic treatment for generalized carcinoma where, for example, the Tax 327 study in 2004 showed a significantly longer survival of docetaxel-treated patients in combination with prednisone against mitoxantrone with prednisone.

02/2018 MUDr. Ivo Kocák, Ph.D., MUDr. Zdenek Řehák, Ph.D.
In the present case, we present a possible sequential treatment for metastatic castration-resistant prostate cancer into the skeleton (mCRPC). Because of symptomatic disease, chemotherapy therapy has been launched that has been able to effectively reduce the symptoms of the disease. The tolerance of the docetaxel-cabazitaxel sequence was very good. Once the chemotherapy options have been exhausted, ARTA treatment with enzalutamide has been chosen, which further effectively stabilizes the disease, maintains overall good status. Sequential treatment of mCRPC has lasted nearly 4 years.

02/2018 MUDr. Aneta Rozsypalová, doc. MUDr. Josef Dvořák, Ph.D., MUDr. Igor Richter, Ph.D., MUDr. David Buka, MUDr. Jana Grimová, MUDr. Michaela Matoušková
Prostate cancer is mostly hormonal dependent disease from the beginning but during sometime develops in castration-resistant prostate cancer - it is time when the progression of the disease is occurring despite androgen deprivation therapy and patients have a testosterone level drawn. Many trials are interested in finding new opportunities of treatment of this stage. Thanks these trials we have new drugs: in category of cytotoxic chemotherapy cabazitaxel, new generation of androgen deprivation therapy ARTA (abirateron acetate, enzalutamide). For patients with bone-only metastatic disease, without visceral metastasis, there is an opportunity to use radium 223. And we can't forget immunotherapy agents as sipuleucel-T and check point inhibitors. So we have many opportunities which significantly prolong median of overall survival with good quality of life.

02/2018 MUDr. Markéta Černovská
Target therapy is a subcellular approach to the treatment of cancer. It is targeted on the intracellular mechanisms of signal transduction inhibiting. This treatment targets the natural regulatory mechanisms controlling metabolism, proliferation and migration of cancer cells. The most data are available on the epidermal growth factor receptor as a target for antitumor strategies. Inhibition of epidermal growth factor receptor has become an important target in the treatment of advanced non-small cell lung cancer. Erlotinib is small molecular agents that target the tyrosine kinase domain of the epidermal growth factor receptor. It is indicated for the treatment of locally advanced or metastatic non-small cell lung cancer as a first, second- or third-line regimen alone or combined with bevacizumab as first-line therapy for advanced epidermal growth factor receptor mutation-positive non-small cell lung cancer.