Selected articles
Concomitant administration of nivolumab and targeted radiotherapy with a significant clinical effect on metastatic melanoma in an elderly patient – ca
06/2020 MUDr. Ivo Kocák, Ph.D.; doc. MUDr. Ilona Kocáková, Ph.D.; doc. MUDr. Zdeněk Řehák, Ph.D.
The following case report describes a comprehensive diagnostic and therapeutic procedure in an elderly patient with generalized melanoma.
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The following case report describes a comprehensive diagnostic and therapeutic procedure in an elderly patient with generalized melanoma.
BRCA‑positive ovarian cancer – case report
06/2020 MUDr. Klaudia Regináčová; doc. MUDr. Martina Kubecová, Ph.D.
In our case report we present a patient with BRCA-positive ovarian cancer, who was diagnosed with stage IV and underwent treatment modalities which were accessible. In the case report, we wanted to emphasize the importance of a multidisciplinary team, the need for genetic testing in treatment decisions, as well as the impact of antiangiogenic and targeted treatment on the patienťs survival in a good quality of life.
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In our case report we present a patient with BRCA-positive ovarian cancer, who was diagnosed with stage IV and underwent treatment modalities which were accessible. In the case report, we wanted to emphasize the importance of a multidisciplinary team, the need for genetic testing in treatment decisions, as well as the impact of antiangiogenic and targeted treatment on the patienťs survival in a good quality of life.
The importance of a multidisciplinary approach to the treatment of ovarian cancer and its effect on prolonging overall survival – case reports
06/2020 Doc. MUDr. Martina Kubecová, Ph.D.; MUDr. Klaudia Regináčová
Using the example of patients with advanced ovarian cancer, we try to demonstrate the importance of a multidisciplinary approach to this disease and its effect on prolonging survival.
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Using the example of patients with advanced ovarian cancer, we try to demonstrate the importance of a multidisciplinary approach to this disease and its effect on prolonging survival.
Ribociclib in the first‑line therapy of hormone‑dependent generalized breast cancer in a young patient with liver toxicity – case report
06/2020 MUDr. Michaela Miškovičová
The case report describes the case of a young premenopausal patient with hormone-dependent, HER2-negative breast cancer diagnosed in the stage of generalization to the skeleton and lymph nodes. Due to the extent of disease, no risk of visceral crisis and histopathological characteristics of the tumor, a combination of the cyclin-dependent kinase 4/6 (CDK4/6) inhibitor ribociclib with the aromatase inhibitor letrozole and a luteinizing hormone-releasing hormone (LHRH) agonist was selected for first line palliative therapy. This treatment has very promising results from randomized trials in which the ribociclib arms show significant long-term superiority over hormonal treatment alone. The effectiveness and benefit of treatment is evident in our patient, the use of therapy is initially complicated by severe hepatotoxicity, but the etiology in this case is very suspiciously multifactorial. After a slight adjustment of the dosage and careful monitoring of liver parameters, she continues the therapy with very good tolerance, now for the tenth cycle.
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The case report describes the case of a young premenopausal patient with hormone-dependent, HER2-negative breast cancer diagnosed in the stage of generalization to the skeleton and lymph nodes. Due to the extent of disease, no risk of visceral crisis and histopathological characteristics of the tumor, a combination of the cyclin-dependent kinase 4/6 (CDK4/6) inhibitor ribociclib with the aromatase inhibitor letrozole and a luteinizing hormone-releasing hormone (LHRH) agonist was selected for first line palliative therapy. This treatment has very promising results from randomized trials in which the ribociclib arms show significant long-term superiority over hormonal treatment alone. The effectiveness and benefit of treatment is evident in our patient, the use of therapy is initially complicated by severe hepatotoxicity, but the etiology in this case is very suspiciously multifactorial. After a slight adjustment of the dosage and careful monitoring of liver parameters, she continues the therapy with very good tolerance, now for the tenth cycle.
Treatment of metastatic hormone‑dependent breast cancer with a combination of palbociclib and letrozole – case report
06/2020 MUDr. Věra Benešová
The antitumor effect of cyclin-dependent kinase 4/6 (CDK4 / 6) inhibitors in combination with hormonal therapy significantly prolongs progression-free survival with prolonged lifespan. The use of this combination therapy in routine clinical practice is fundamentally changing the treatment options of our patients.
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The antitumor effect of cyclin-dependent kinase 4/6 (CDK4 / 6) inhibitors in combination with hormonal therapy significantly prolongs progression-free survival with prolonged lifespan. The use of this combination therapy in routine clinical practice is fundamentally changing the treatment options of our patients.
Atypical manifestation of non‑small cell lung carcinoma – case report
06/2020 MUDr. Tomáš Hanslík; MUDr. Zdeněk Chovanec, Ph.D.; MUDr. Alena Berková, Ph.D.; MUDr. Stanislav Špelda; MUDr. Michal Benej, Ph.D.; MUDr. Adam Peštál, Ph.D.; MUDr. Vadim Prudius, Ph.D.; prof. MUDr. Ivan Čapov, CSc.; MUDr. Vladimír Červeňák; MUDr. Tetiana Shatokhina
The authors acquaint the readers through a case report with a patient in whom non-small cell lung cancer manifested itself in an atypically bulky arching of the chest wall. Initially, it acted clinically and radiologically as chest wall sarcoma, as no tumorous infiltration of the lung parenchyma was evident. There was also a deposit of the right thyroid lobe of uncertain origin. Finally a number of immunohistochemical tests have brought about the resolution and diagnosis. According to genetic examination, the presence of a programmed cell death-ligand 1 (PD-L1) mutation was demonstrated in the cancer, and subsequently immunological therapy was used, which led to a significant regression of the tumor mass of the chest wall.
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The authors acquaint the readers through a case report with a patient in whom non-small cell lung cancer manifested itself in an atypically bulky arching of the chest wall. Initially, it acted clinically and radiologically as chest wall sarcoma, as no tumorous infiltration of the lung parenchyma was evident. There was also a deposit of the right thyroid lobe of uncertain origin. Finally a number of immunohistochemical tests have brought about the resolution and diagnosis. According to genetic examination, the presence of a programmed cell death-ligand 1 (PD-L1) mutation was demonstrated in the cancer, and subsequently immunological therapy was used, which led to a significant regression of the tumor mass of the chest wall.
Long‑term surviving patient with EGFR mutation – deletion on exon 19 and acquired resistant mutation T790 – case report
06/2020 MUDr. Gabriela Krákorová, Ph.D.; doc. MUDr. Jan Baxa, Ph.D.; prof. MUDr. Miloš Pešek, CSc.
Metastatic lung cancer has a very poor prognosis, with a 5-year survival of about 5%. Pulmonary malignancies with a control mutation for which biologically targeted drugs are available have a better prognosis, as shown by a case report of a patient with a sensitive control EGFR mutation. Tumor biopsy and peripheral blood sampling, liquid biopsy, were performed repeatedly during treatment to detect the acquired T790 resistance mutation, among other things. The patient survives with metastatic lung adenocarcinoma for eight years, still with a good quality of life. The case report shows that due to a suitably selected treatment sequence according to the presumed or known genetic profile of the tumor, even metastatic lung cancer can change from such a serious disease to a chronic one.
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Metastatic lung cancer has a very poor prognosis, with a 5-year survival of about 5%. Pulmonary malignancies with a control mutation for which biologically targeted drugs are available have a better prognosis, as shown by a case report of a patient with a sensitive control EGFR mutation. Tumor biopsy and peripheral blood sampling, liquid biopsy, were performed repeatedly during treatment to detect the acquired T790 resistance mutation, among other things. The patient survives with metastatic lung adenocarcinoma for eight years, still with a good quality of life. The case report shows that due to a suitably selected treatment sequence according to the presumed or known genetic profile of the tumor, even metastatic lung cancer can change from such a serious disease to a chronic one.
Patient with non‑small cell lung cancer treated with osimertinib – case report
06/2020 MUDr. Leona Koubková
We know that non-small cell lung cancer (NSCLC) is a genetically inhomogeneous group of tumors. Demonstration of genetic aberrations then allows us to predict the effectiveness of targeted treatment. Mutations in the epidermal growth factor receptor (EGFR) gene have been investigated for many years. We already have three generations of EGFR tyrosine kinase inhibitors available. Osimertinib is a third-generation EGFR tyrosine kinase inhibitor that was first approved for the treatment of patients with locally advanced or metastatic NSCLC with a proven T790M EGFR mutation (FDA 11/2015 and EMA 2/2016). Osimertinib is also currently approved for first-line treatment in patients with a proven activating mutation in the EGFR gene (FDA 4/2018 and EMA 6/18).
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We know that non-small cell lung cancer (NSCLC) is a genetically inhomogeneous group of tumors. Demonstration of genetic aberrations then allows us to predict the effectiveness of targeted treatment. Mutations in the epidermal growth factor receptor (EGFR) gene have been investigated for many years. We already have three generations of EGFR tyrosine kinase inhibitors available. Osimertinib is a third-generation EGFR tyrosine kinase inhibitor that was first approved for the treatment of patients with locally advanced or metastatic NSCLC with a proven T790M EGFR mutation (FDA 11/2015 and EMA 2/2016). Osimertinib is also currently approved for first-line treatment in patients with a proven activating mutation in the EGFR gene (FDA 4/2018 and EMA 6/18).
Almost complete spontaneous regression of squamous cell lung cancer – case report
05/2020 MUDr. Lukáš Chlachula
Although both the incidence and mortality of lung cancers have tended to decline in recent years in the Czech Republic, they are still among the most common cancers in our country in both sexes. In recent years, we have been able to offer patients more and more products that use the natural properties of their own immune system to fight this insidious disease. The case documented below describes the spontaneous regression of a squamous cell lung tumor.
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Although both the incidence and mortality of lung cancers have tended to decline in recent years in the Czech Republic, they are still among the most common cancers in our country in both sexes. In recent years, we have been able to offer patients more and more products that use the natural properties of their own immune system to fight this insidious disease. The case documented below describes the spontaneous regression of a squamous cell lung tumor.
Significant response to neoadjuvant treatment in locally advanced pancreatic cancer – case report
05/2020 MUDr. Marián Liberko; doc. MUDr. Renata Soumarová, Ph.D., MBA
This case report describes a patient with locally advanced pancreatic cancer. By combination of chemotherapy and chemoradiotherapy, conversion of unresectable disease (locally advanced pancreatic cancer) in to resectable disease with significant pathological response was achieved.
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This case report describes a patient with locally advanced pancreatic cancer. By combination of chemotherapy and chemoradiotherapy, conversion of unresectable disease (locally advanced pancreatic cancer) in to resectable disease with significant pathological response was achieved.
Use of obinutuzumab in clinical practice – case report
05/2020 MUDr. Mária Maco
Obinutuzumab with bendamustine is currently used for the treatment of follicular lymphoma in patients who are refractory to rituximab alone or to combination of chemotherapy with rituximab. This case report describes a successful treatment with obinutuzumab and bendamustine followed by obinutuzumab maintenance in a patient with multiple relapses of follicular lymphoma after several treatment lines with rituximab.
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Obinutuzumab with bendamustine is currently used for the treatment of follicular lymphoma in patients who are refractory to rituximab alone or to combination of chemotherapy with rituximab. This case report describes a successful treatment with obinutuzumab and bendamustine followed by obinutuzumab maintenance in a patient with multiple relapses of follicular lymphoma after several treatment lines with rituximab.
Benefit of panitumumab in colorectal carcinoma treatment – case report
05/2020 MUDr. Stanislav John
Epidermal growth factor receptor (EGFR) inhibitors have become a standard part of combined treatment regimens for metastatic/advanced colorectal cancer. Their long-term use is linked to the mutational status of KRAS and NRAS genes, furthermore it is recommended rather for left-sided tumors.1,2 Following case report shows the significant benefit of EGFR inhibition with panitumumab during the treatment of a patient with a locally advanced rectosigmoid tumor, which, even after years, eventually led for a high hope for complete recovery.
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Epidermal growth factor receptor (EGFR) inhibitors have become a standard part of combined treatment regimens for metastatic/advanced colorectal cancer. Their long-term use is linked to the mutational status of KRAS and NRAS genes, furthermore it is recommended rather for left-sided tumors.1,2 Following case report shows the significant benefit of EGFR inhibition with panitumumab during the treatment of a patient with a locally advanced rectosigmoid tumor, which, even after years, eventually led for a high hope for complete recovery.
Trifluridine/tipiracil in metastatic colorectal cancer – case report
05/2020 MUDr. Petra Pokorná
In the case report described below, we will try to pass on the experience with the administration of a new modern chemotherapy in a long-term treated patient with generalized adenocarcinoma of the appendix.
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In the case report described below, we will try to pass on the experience with the administration of a new modern chemotherapy in a long-term treated patient with generalized adenocarcinoma of the appendix.
Epithelial tumors of the thymus and diagnostic options
05/2020 MUDr. Vladimír Červeňák, MUDr. Zdeněk Chovanec, Ph.D., MUDr. Alena Berková, Ph.D., doc. MUDr. Jiří Vaníček, Ph.D., MUDr. Tomáš Hanslík, MUDr. Sabina Svobodová, MUDr. Robert Novák
Epithelial tumors are the most common tumors of the thymus. This group of tumors includes thymomas and thymic carcinoma and these tumors are very rare, although they are among the most common tumors of the anterior mediastinum in adults. The thymus is an organ of the immune system that can be routinely monitored by various chest examination methods. We encounter it more in children, but it is no exception in adults either. The problem in adults is its variable appearance, as it goes through the process of involution. Involution is support by the corticosteroids during excessive stress. Likewise, these conditions can change its shape and size. The basics of embryology, anatomy together with knowledge of imaging methods, are a necessary condition for accurate diagnosis of benign and malignant thyroid tumors. Only the correct identification of these pathologies allows you to choose the appropriate method of therapy.
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Epithelial tumors are the most common tumors of the thymus. This group of tumors includes thymomas and thymic carcinoma and these tumors are very rare, although they are among the most common tumors of the anterior mediastinum in adults. The thymus is an organ of the immune system that can be routinely monitored by various chest examination methods. We encounter it more in children, but it is no exception in adults either. The problem in adults is its variable appearance, as it goes through the process of involution. Involution is support by the corticosteroids during excessive stress. Likewise, these conditions can change its shape and size. The basics of embryology, anatomy together with knowledge of imaging methods, are a necessary condition for accurate diagnosis of benign and malignant thyroid tumors. Only the correct identification of these pathologies allows you to choose the appropriate method of therapy.
Autoimmune cytopenia in patients with chronic lymphocytic leukemia
05/2020 MUDr. Jana Zuchnická; MUDr. Jana Mihályová; MUDr. Jaromír Gumulec; prof. MUDr. Roman Hájek, CSc.
Chronic lymphocytic leukemia is accompanied by dysfunction of the immune system. Immune dysbalances are manifested, among other things, in an increased incidence of autoimmune cytopenias. In order to choose the right therapeutic procedure, it is important to differentially diagnose other causes of anemia, thrombocytopenia or granulocytopenia. Corticoids, intravenous immunoglobulins, rituximab, or other immunosuppressants are mainly used in therapy. Inadequate response to therapy is an indication to initiate treatment for chronic lymphocytic leukemia.
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Chronic lymphocytic leukemia is accompanied by dysfunction of the immune system. Immune dysbalances are manifested, among other things, in an increased incidence of autoimmune cytopenias. In order to choose the right therapeutic procedure, it is important to differentially diagnose other causes of anemia, thrombocytopenia or granulocytopenia. Corticoids, intravenous immunoglobulins, rituximab, or other immunosuppressants are mainly used in therapy. Inadequate response to therapy is an indication to initiate treatment for chronic lymphocytic leukemia.
Cemiplimab in patients with metastatic or locally advanced cutaneous squamous‑cell carcinoma
05/2020 MUDr. Jindřich Kopecký, Ph.D.
Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin tumors. Surgical intervention remains crucial in the treatment of cSCC. Inoperable or metastatic cSCC is one of the less common but it belongs to incurable diseases. Both systemic preparations (most often cisplatin, 5-fluorouracil) and tyrosine kinase inhibitors are used in systemic treatment. Although a relatively good therapeutic response is achieved with these drugs, their long-term efficacy remains problematic. Cemiplimab is another immunomodulatory drug that targets the PD-1 receptor. The results so far not only have a good therapeutic response, but above all, they maintain their long-term effectiveness. Due to these properties, they have become the drug of choice for inoperable/metastatic cSCC diseases.
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Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin tumors. Surgical intervention remains crucial in the treatment of cSCC. Inoperable or metastatic cSCC is one of the less common but it belongs to incurable diseases. Both systemic preparations (most often cisplatin, 5-fluorouracil) and tyrosine kinase inhibitors are used in systemic treatment. Although a relatively good therapeutic response is achieved with these drugs, their long-term efficacy remains problematic. Cemiplimab is another immunomodulatory drug that targets the PD-1 receptor. The results so far not only have a good therapeutic response, but above all, they maintain their long-term effectiveness. Due to these properties, they have become the drug of choice for inoperable/metastatic cSCC diseases.
Palliative care in pneumooncology
05/2020 MUDr. Gabriela Krákorová, Ph.D.
Palliative care is provided to patients with incurable disease and focuses on quality of life of patients and their families. It is not a “victory medicine”, it does not deny the death and does not try to postpone dying, but it is neither a “nihilistic medicine” in the sense of “there is nothing more we can do”. It is an active medicine, which seeks to decrease suffering. The article is than focusing on categorization of palliative care and, in detail, on the palliative care plan. This plan is made individually, based on the patienťs clinical status and in consonance with his or her preferences. A patient with lung cancer is usually significantly symptomatic. According to the published data, it is evident, that the early palliative care in lung cancer patients does not only lead to improvement of the quality of life and lower incidence of depression but it also prolongs survival. It is important to emphasize that superior palliative care cannot be delivered in health-care departments without the adequate number of educated caregivers, who have a high professional and human quality.
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Palliative care is provided to patients with incurable disease and focuses on quality of life of patients and their families. It is not a “victory medicine”, it does not deny the death and does not try to postpone dying, but it is neither a “nihilistic medicine” in the sense of “there is nothing more we can do”. It is an active medicine, which seeks to decrease suffering. The article is than focusing on categorization of palliative care and, in detail, on the palliative care plan. This plan is made individually, based on the patienťs clinical status and in consonance with his or her preferences. A patient with lung cancer is usually significantly symptomatic. According to the published data, it is evident, that the early palliative care in lung cancer patients does not only lead to improvement of the quality of life and lower incidence of depression but it also prolongs survival. It is important to emphasize that superior palliative care cannot be delivered in health-care departments without the adequate number of educated caregivers, who have a high professional and human quality.
Current indications and possibilities of immunooncological treatment
05/2020 MUDr. Libor Havel
Immunotherapy in the form of immune checkpoint inhibitors targeting PD-1/PD-L1 or CTLA-4 has become an integral part of lung cancer treatment algorithms. The dynamics of progress in this field can undoubtedly be called unbelievable. In the conditions of the Czech Republic, there is a certain delay towards the world in the availability of individual treatments. However, there are a number of patients who intend to make the most of all available treatment options, even if they are not covered by general health insurance. The following text is therefore conceived as an overview of available and in some parts of the world registered treatment methods, not what is currently covered in the Czech Republic by health insurance.
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Immunotherapy in the form of immune checkpoint inhibitors targeting PD-1/PD-L1 or CTLA-4 has become an integral part of lung cancer treatment algorithms. The dynamics of progress in this field can undoubtedly be called unbelievable. In the conditions of the Czech Republic, there is a certain delay towards the world in the availability of individual treatments. However, there are a number of patients who intend to make the most of all available treatment options, even if they are not covered by general health insurance. The following text is therefore conceived as an overview of available and in some parts of the world registered treatment methods, not what is currently covered in the Czech Republic by health insurance.
Current status and recommendations for biologically targeted treatment
05/2020 MUDr. Leona Koubková
A better understanding of the molecular biology of tumors and the expanding possibilities of their genotyping lead to the strengthening of precise medicine, which allows us personalized treatment. It is mainly genetic changes in the tumor that help us predict the response to molecularly targeted therapy and thus choose the most effective treatment for our patients. The introduction of targeted therapy based on molecular typing into clinical practice has succeeded in significantly prolonging the survival of patients with non-small cell lung cancer, sometimes by several years with a very good quality of life.
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A better understanding of the molecular biology of tumors and the expanding possibilities of their genotyping lead to the strengthening of precise medicine, which allows us personalized treatment. It is mainly genetic changes in the tumor that help us predict the response to molecularly targeted therapy and thus choose the most effective treatment for our patients. The introduction of targeted therapy based on molecular typing into clinical practice has succeeded in significantly prolonging the survival of patients with non-small cell lung cancer, sometimes by several years with a very good quality of life.
Current possibilities and limitations of chemotherapy
05/2020 Prof. MUDr. Jana Skřičková, CSc.
Worldwide, lung cancer is the most commonly diagnosed type of cancer in both men and women (11.6% of the total number of newly diagnosed cancers) and is the most common cause of cancer deaths (1.8 million deaths, i.e. 18.4% of total number of cancer deaths). The basic treatment modalities for lung cancer include surgical treatment, radiotherapy, chemotherapy, targeted treatment and immunotherapy. Combination chemotherapy is a basic and necessary treatment modality for all patients with small cell carcinoma. Chemotherapy also plays an important role in the treatment of non-small cell lung cancer during biological treatment and immunotherapy. It is used in adjuvant, neoadjuvant treatment and it is administered concomitantly with radiotherapy or it can follow it. Palliative chemotherapy, maintenance chemotherapy and metronomic chemotherapy are also important.
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Worldwide, lung cancer is the most commonly diagnosed type of cancer in both men and women (11.6% of the total number of newly diagnosed cancers) and is the most common cause of cancer deaths (1.8 million deaths, i.e. 18.4% of total number of cancer deaths). The basic treatment modalities for lung cancer include surgical treatment, radiotherapy, chemotherapy, targeted treatment and immunotherapy. Combination chemotherapy is a basic and necessary treatment modality for all patients with small cell carcinoma. Chemotherapy also plays an important role in the treatment of non-small cell lung cancer during biological treatment and immunotherapy. It is used in adjuvant, neoadjuvant treatment and it is administered concomitantly with radiotherapy or it can follow it. Palliative chemotherapy, maintenance chemotherapy and metronomic chemotherapy are also important.