Selected articles
Colorectal cancer screening
06/2019 MUDr. Tomáš Grega; MUDr. Gabriela Vojtěchová; Mgr. Ondřej Ngo; Mgr. Renata Chloupková; RNDr. Ondřej Májek, Ph.D.; prof. RNDr. Ladislav Dušek, Ph.D.; prof. MUDr. Miroslav Zavoral, Ph.D.; doc. MUDr. Štěpán Suchánek, Ph.D.
The Czech Republic belongs to countries with long-term decreasing incidence and mortality of colorectal cancer. An organized population screening program has a major contribution to positive epidemiological trends. Sufficient coverage of the target population by screening tests and monitoring of screening quality indicators are key to an effective screening program. The principles of the screening program are defined in the European Recommendations. Most quality indicators in the Czech Republic are fulfilled. Participation of the target population in colorectal cancer screening is still unsatisfactory, however, it is gradually increasing by introducing a population screening program. This article summarizes current epidemiology, screening settings and current results of the National Colorectal Cancer Screening Program in the Czech Republic.
ENTIRE ARTICLE
The Czech Republic belongs to countries with long-term decreasing incidence and mortality of colorectal cancer. An organized population screening program has a major contribution to positive epidemiological trends. Sufficient coverage of the target population by screening tests and monitoring of screening quality indicators are key to an effective screening program. The principles of the screening program are defined in the European Recommendations. Most quality indicators in the Czech Republic are fulfilled. Participation of the target population in colorectal cancer screening is still unsatisfactory, however, it is gradually increasing by introducing a population screening program. This article summarizes current epidemiology, screening settings and current results of the National Colorectal Cancer Screening Program in the Czech Republic.
Adverse events of oncological treatment in a general practitioner’s ambulance
05/2019 MUDr. Jiří Navrátil, Ph.D.
Cancer treatment may be accompanied by a number of side effects. We always try to educate our patients, they are equipped with a telephone emergency number and often also with rescue medication, which they can use in case of problems (antiemetics, antidiarrheals, analgesics, etc.). Nevertheless, there may be situations where patients go with their problems primarily to a general practitioner (they do not use the recommended medication, or the recommended medication is not enough, the patient did not pick up the drugs in the pharmacy and so on). Good cooperation between a general practitioner and an oncologist is therefore very important. The most common side effects of oncological treatment including immunotherapy and their management in general practitioner will be presented in the article.
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Cancer treatment may be accompanied by a number of side effects. We always try to educate our patients, they are equipped with a telephone emergency number and often also with rescue medication, which they can use in case of problems (antiemetics, antidiarrheals, analgesics, etc.). Nevertheless, there may be situations where patients go with their problems primarily to a general practitioner (they do not use the recommended medication, or the recommended medication is not enough, the patient did not pick up the drugs in the pharmacy and so on). Good cooperation between a general practitioner and an oncologist is therefore very important. The most common side effects of oncological treatment including immunotherapy and their management in general practitioner will be presented in the article.
Gastric neuroendocrine neoplasms
05/2019 MUDr. Michaela Miškovičová
Gastric neuroendocrine neoplasms are rare lesions consisting of a heterogenous group of neoplasms. The majority of them arise from ECL (enterochromaffin-like) cells - neuroendocrine cells of gastric mucosa, which produce histamin and have the impact on the regulation of gastric secretion. This is why we can call them “ECLomas”. Their incidence is increasing, due to the widespread use of upper digestive endoscopy and the technical refinement of endoscopists. Gastric neuroendocrine neoplasms comprise tumor types of varying pathogenesis, histomorphologic characteristic, biological behavior and prognosis. They can present with clinical symptoms, or can be asymptomatic, carcinoid syndrome is extremely rare. The correct management of patients with gastric neuroendocrine neoplasms can only be proposed when the tumor has been classified by an accurate pathological and clinical evaluation of the patient.
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Gastric neuroendocrine neoplasms are rare lesions consisting of a heterogenous group of neoplasms. The majority of them arise from ECL (enterochromaffin-like) cells - neuroendocrine cells of gastric mucosa, which produce histamin and have the impact on the regulation of gastric secretion. This is why we can call them “ECLomas”. Their incidence is increasing, due to the widespread use of upper digestive endoscopy and the technical refinement of endoscopists. Gastric neuroendocrine neoplasms comprise tumor types of varying pathogenesis, histomorphologic characteristic, biological behavior and prognosis. They can present with clinical symptoms, or can be asymptomatic, carcinoid syndrome is extremely rare. The correct management of patients with gastric neuroendocrine neoplasms can only be proposed when the tumor has been classified by an accurate pathological and clinical evaluation of the patient.
Pregnancy after breast cancer treatment
05/2019 MUDr. Renata Koževnikovová
Breast cancer is the most common malignity in female population. Over the past years, incidence hasn't risen as well as prognosis has improved. Although the newly diagnosed women under 40 makes just small part of all cases, with higher age of reproduction start, after-treatment pregnancy has been increasingly frequent question. Available data shows that pregnancy after treatment is safe regardless of type and stage, if started after treatment, respectively after breast cancer diagnose. Pregnancy was observed in patients treated at our center in years 2003-2016. It was recorded 44 pregnancies at 29 women in total. It was born 38 healthy children; 1 dead and 5 gravidities were early terminated. Only one patient died of disease progression, which occurred during pregnancy, other patients are in long term disease remission. Average observation time is 9,5 years. Our observation results confirm after treatment pregnancy safety, according to published data.
ENTIRE ARTICLE
Breast cancer is the most common malignity in female population. Over the past years, incidence hasn't risen as well as prognosis has improved. Although the newly diagnosed women under 40 makes just small part of all cases, with higher age of reproduction start, after-treatment pregnancy has been increasingly frequent question. Available data shows that pregnancy after treatment is safe regardless of type and stage, if started after treatment, respectively after breast cancer diagnose. Pregnancy was observed in patients treated at our center in years 2003-2016. It was recorded 44 pregnancies at 29 women in total. It was born 38 healthy children; 1 dead and 5 gravidities were early terminated. Only one patient died of disease progression, which occurred during pregnancy, other patients are in long term disease remission. Average observation time is 9,5 years. Our observation results confirm after treatment pregnancy safety, according to published data.
Advances in adjuvant treatment for high‑risk BRAF mutated malignant melanoma
05/2019 MUDr. Radek Lakomý, Ph.D., MUDr. Alexandr Poprach, Ph.D.
Surgical excision is the curative treatment in most cases of early cutaneous melanoma. Prognosis of patients with high-risk primary melanoma or with nodal involvement remains poor. Impact of adjuvant interferon alfa on overall survival is limited. The recently published results from the randomized phase III trials with immunotherapy - anti-PD-1 antibodies (nivolumab, pembrolizumab) and with targeted therapy (dabrafenib + trametinib) are very promising. These new adjuvant treatment modalities are able significantly reduce the rate of disease recurrence. However, there are many unresolved questions. Especially, we do not know what is better in BRAF mutant melanoma, if targeted therapy or modern immunotherapy? We need reliable biomarkers of tumor progression and prognosis for better selection really high-risk patients and the optimal type of adjuvant treatment. The side effect profile of treatment and patient preference will play an important role in decision-making process.
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Surgical excision is the curative treatment in most cases of early cutaneous melanoma. Prognosis of patients with high-risk primary melanoma or with nodal involvement remains poor. Impact of adjuvant interferon alfa on overall survival is limited. The recently published results from the randomized phase III trials with immunotherapy - anti-PD-1 antibodies (nivolumab, pembrolizumab) and with targeted therapy (dabrafenib + trametinib) are very promising. These new adjuvant treatment modalities are able significantly reduce the rate of disease recurrence. However, there are many unresolved questions. Especially, we do not know what is better in BRAF mutant melanoma, if targeted therapy or modern immunotherapy? We need reliable biomarkers of tumor progression and prognosis for better selection really high-risk patients and the optimal type of adjuvant treatment. The side effect profile of treatment and patient preference will play an important role in decision-making process.
Immunotherapy of triple negative breast cancer
05/2019 Doc. MUDr. Josef Dvořák, PhD., MUDr. Igor Richter, Ph.D., MUDr. Jan Prokš, MUDr. Aneta Rozsypalová, MUDr. Jana Grimová
Triple negative breast cancer constitutes a heterogeneous group of diseases with limited systemic treatment options. A new perspective treatment modality is immunotherapy with check point inhibitors. The phase III randomized control trial IMpassion130 demonstrated a significantly prolonged progression free survival and overall survival in first line treatment of metastatic or locally advanced inoperable triple negative breast cancer with atezolizumab and nab-paclitaxel, exclusively in patients with programmed death-ligand 1 (PD-L1) ≥ 1 % expression on tumor infiltrating immune cells.
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Triple negative breast cancer constitutes a heterogeneous group of diseases with limited systemic treatment options. A new perspective treatment modality is immunotherapy with check point inhibitors. The phase III randomized control trial IMpassion130 demonstrated a significantly prolonged progression free survival and overall survival in first line treatment of metastatic or locally advanced inoperable triple negative breast cancer with atezolizumab and nab-paclitaxel, exclusively in patients with programmed death-ligand 1 (PD-L1) ≥ 1 % expression on tumor infiltrating immune cells.
Pembrolizumab in our country and over the ocean
05/2019 Prof. MUDr. Jindřich Fínek, Ph.D., MHA
Pembrolizumab is a humanized monoclonal antibody against programmed cell death 1 receptors (PD-1) (an IgG4/K isotype with a stabilizing sequence change in the Fc region) produced by recombinant DNA technology in Chinese hamster ovary cells.
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Pembrolizumab is a humanized monoclonal antibody against programmed cell death 1 receptors (PD-1) (an IgG4/K isotype with a stabilizing sequence change in the Fc region) produced by recombinant DNA technology in Chinese hamster ovary cells.
A rare case of choroidal metastasis in ALK‑positive NSCLC that responds to crizotinib
05/2019 MUDr. Marie Drosslerová, MUDr. Libor Havel
Targeted therapy enables patients with non-small cell lung cancer (NSCLC) with driver mutations prolongation of overall survival and improvement quality of life compared to chemotherapy. Crizotinib is one of biological drugs. It is a tyrosine kinase inhibitor targeting ALK (anaplastic lymphoma kinase) gene rearrangement. Crizotinib is indicated for the first-line treatment of adults with ALK positive advanced NSCLC and for the treatment of adults with previously treated ALK positive advanced NSCLC. It is also indicated for the treatment of ROS1 positive advanced NSCLC. Crizotinib has a good safety profile and tolerability. Our article describes a clinical case report of ALK positive advanced NSCLC patient with rare choroidal metastasis that responds to crizotinib. Vision of our patient improved with crizotinib. The quality of life was definitely better.
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Targeted therapy enables patients with non-small cell lung cancer (NSCLC) with driver mutations prolongation of overall survival and improvement quality of life compared to chemotherapy. Crizotinib is one of biological drugs. It is a tyrosine kinase inhibitor targeting ALK (anaplastic lymphoma kinase) gene rearrangement. Crizotinib is indicated for the first-line treatment of adults with ALK positive advanced NSCLC and for the treatment of adults with previously treated ALK positive advanced NSCLC. It is also indicated for the treatment of ROS1 positive advanced NSCLC. Crizotinib has a good safety profile and tolerability. Our article describes a clinical case report of ALK positive advanced NSCLC patient with rare choroidal metastasis that responds to crizotinib. Vision of our patient improved with crizotinib. The quality of life was definitely better.
EGFR mutations in non‑small cell lung cancer – treatment options
05/2019 MUDr. Daniel Krejčí; MUDr. Jana Krejčí; doc. MUDr. Norbert Pauk, Ph.D.
Worldwide, lung cancer is one of the most common oncological disease. Targeted analysis of the mutation status in non-small cell lung carcinoma detects 10-15 % of patients with a mutated epidermal growth factor receptor gene, whose presence is significant prognostically and therapeutically.1 Diagnosis is based on molecular-genetic methods.2 Depending on the patient's performance status and type of mutation, the patient is indicated for therapy with tyrosine kinase inhibitors, which in this group of patients promise a good response to treatment with a favorable safety profile.13
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Worldwide, lung cancer is one of the most common oncological disease. Targeted analysis of the mutation status in non-small cell lung carcinoma detects 10-15 % of patients with a mutated epidermal growth factor receptor gene, whose presence is significant prognostically and therapeutically.1 Diagnosis is based on molecular-genetic methods.2 Depending on the patient's performance status and type of mutation, the patient is indicated for therapy with tyrosine kinase inhibitors, which in this group of patients promise a good response to treatment with a favorable safety profile.13
Osimertinib in locally advanced or metastatic non‑small cell lung cancer therapy
05/2019 MUDr. Libor Havel
Epidermal growth factor receptor (EGFR) mutations are found in 10-14 % lung cancer patients in Central Europe. Therapeutic standard for these patients are EGFR-tyrosinkinase inhibitors (TKI). Screening for these mutations became a diagnostic standard in adenocarcinoma histology. Majority of these mutations are sensitizing mutations (Del 19, exon 21 point mutations). Main resistance mechanism after prior EGFR tyrosinkinase inhibitors therapy is exon 20 mutation T790M. Osimertinib is third generation EGFR tyrosinkinase inhibitors that selectively inhibits both EGFR-TKI sensitizing and EGFR T790M resistance mutations.
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Epidermal growth factor receptor (EGFR) mutations are found in 10-14 % lung cancer patients in Central Europe. Therapeutic standard for these patients are EGFR-tyrosinkinase inhibitors (TKI). Screening for these mutations became a diagnostic standard in adenocarcinoma histology. Majority of these mutations are sensitizing mutations (Del 19, exon 21 point mutations). Main resistance mechanism after prior EGFR tyrosinkinase inhibitors therapy is exon 20 mutation T790M. Osimertinib is third generation EGFR tyrosinkinase inhibitors that selectively inhibits both EGFR-TKI sensitizing and EGFR T790M resistance mutations.
HITHOC – possibility of combined treatment of malignant pleural mesothelioma
05/2019 Doc. MUDr. David Vrána, Ph.D.; MUDr. Nikol Rušarová; MUDr. Marek Szkorupa, Ph.D.
Malignant pleural mesothelioma represents a disease with poor prognosis. There is currently no accepted general standard of care however as available published data indicate the multimodality approach combining chemotherapy (neoadjuvant or adjuvant, based on cisplatin/carboplatin and pemetrexed), surgery and eventually perioperative pleural chemotherapy lavage seem to bring the most benefit. This approach is suitable for only limited group of patients in a good performance status, without any distant metastatic disease and without clinically significant comorbidities. Further research is therefore needed to define the optimal treatment algorithm for malignant pleural mesothelioma.
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Malignant pleural mesothelioma represents a disease with poor prognosis. There is currently no accepted general standard of care however as available published data indicate the multimodality approach combining chemotherapy (neoadjuvant or adjuvant, based on cisplatin/carboplatin and pemetrexed), surgery and eventually perioperative pleural chemotherapy lavage seem to bring the most benefit. This approach is suitable for only limited group of patients in a good performance status, without any distant metastatic disease and without clinically significant comorbidities. Further research is therefore needed to define the optimal treatment algorithm for malignant pleural mesothelioma.
Immunotherapy of lung cancer
05/2019 MUDr. Bohdan Kadlec, Ph.D.
Immunotherapy, a new modality in the treatment of non-small cell lung cancer, provides patients with advanced disease with the possibility of effective treatment with less toxicity. Immune checkpoints treatment utilizes highly selective humanized monoclonal antibodies in order to reactivate anti-tumor response. This treatment improves overall survival, extends the spectrum of treatment options, and is less toxic compared to chemotherapy. Immune-mediated adverse reactions can lead to a variety of clinical conditions and can include any organ in the body. While the indication of immunotherapy is likely to expand in the future, further knowledge is needed to determine the optimal combination with chemotherapy, radiotherapy and other anticancer drugs, as well as finding optimal biomarkers to predict the therapeutic effect and toxicity of immunotherapy.
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Immunotherapy, a new modality in the treatment of non-small cell lung cancer, provides patients with advanced disease with the possibility of effective treatment with less toxicity. Immune checkpoints treatment utilizes highly selective humanized monoclonal antibodies in order to reactivate anti-tumor response. This treatment improves overall survival, extends the spectrum of treatment options, and is less toxic compared to chemotherapy. Immune-mediated adverse reactions can lead to a variety of clinical conditions and can include any organ in the body. While the indication of immunotherapy is likely to expand in the future, further knowledge is needed to determine the optimal combination with chemotherapy, radiotherapy and other anticancer drugs, as well as finding optimal biomarkers to predict the therapeutic effect and toxicity of immunotherapy.
Targeted biological treatment of non‑small cell lung cancer
05/2019 Prof. MUDr. Jana Skřičková, CSc.; MUDr. David Petr
In recent years, non-small cell lung carcinoma (NSCLC) treatment has developed rapidly. Biological treatment preparations have improved survival in NSCLC, particularly in non-operable locally advanced and metastatic NSCLC. Substances that target the processes inside tumor cells are particularly useful in adenocarcinomas. At the time of diagnosis, it is necessary to determine the morphological diagnosis as accurately as possible and, if indicated, to perform genetic testing. In our paper we give an overview of the development and possibilities of biological treatment.
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In recent years, non-small cell lung carcinoma (NSCLC) treatment has developed rapidly. Biological treatment preparations have improved survival in NSCLC, particularly in non-operable locally advanced and metastatic NSCLC. Substances that target the processes inside tumor cells are particularly useful in adenocarcinomas. At the time of diagnosis, it is necessary to determine the morphological diagnosis as accurately as possible and, if indicated, to perform genetic testing. In our paper we give an overview of the development and possibilities of biological treatment.
Chemotherapy of lung cancer
05/2019 MUDr. Jaromír Roubec, Ph.D.
In a short review, the author presents the historical development of the use of chemotherapy in the treatment of non-small cell and small cell lung cancer from the early 1990s to the present.
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In a short review, the author presents the historical development of the use of chemotherapy in the treatment of non-small cell and small cell lung cancer from the early 1990s to the present.
Radiotherapy of lung cancer alone and with relation to chemotherapy
05/2019 Doc. MUDr. Milada Zemanová, Ph.D.
In the treatment of lung cancer, the basic modality is radiotherapy, which has proven therapeutic benefits in both radical and palliative indications in up to 76% of all patients. In the Czech Republic, the proportion of patients with bronchogenic carcinoma receiving radiotherapy has not exceeded 25% in the long term. In the case of clinically inoperable non-small-cell lung cancer (NSCLC) in stage I, the method of choice is stereotactic radiotherapy, which allows local control in more than 80% after three years. Postoperative radiotherapy is suitable in the case of involvement of mediastinal nodes. In locally advanced inoperable NSCLC, the standard of treatment is concomitant chemoradiotherapy given concomitantly with chemotherapy based on a double combination of cytostatics containing a platinum derivative. A flat dose escalation above 60 Gy / 6 weeks has not been shown to be useful, as it increases toxicity with a higher risk of death. Technical innovations such as beam intensity modulated radiotherapy, image-guided radiotherapy or time-tracking of breathing movements bring improvements in treatment outcomes. The clear benefit of proton beam therapy has not been demonstrated. In small cell carcinoma, concomitant chemoradiotherapy is the most effective in the stage of limited disease, starting at the latest from the third cycle of chemotherapy. Radiotherapy is also recommended in the stage of extensive disease as a consolidation treatment after chemotherapy with a very good response. For the treatment of small cell carcinomas, preventive brain irradiation is recommended as a standard, although recent studies have reported close and frequent MRI monitoring and early treatment in asymptomatic as an alternative. In NSCLC, preventive radiation reduces the proportion of patients with the development of brain metastases from 30% to 8%, but this has not been shown to prolong survival.
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In the treatment of lung cancer, the basic modality is radiotherapy, which has proven therapeutic benefits in both radical and palliative indications in up to 76% of all patients. In the Czech Republic, the proportion of patients with bronchogenic carcinoma receiving radiotherapy has not exceeded 25% in the long term. In the case of clinically inoperable non-small-cell lung cancer (NSCLC) in stage I, the method of choice is stereotactic radiotherapy, which allows local control in more than 80% after three years. Postoperative radiotherapy is suitable in the case of involvement of mediastinal nodes. In locally advanced inoperable NSCLC, the standard of treatment is concomitant chemoradiotherapy given concomitantly with chemotherapy based on a double combination of cytostatics containing a platinum derivative. A flat dose escalation above 60 Gy / 6 weeks has not been shown to be useful, as it increases toxicity with a higher risk of death. Technical innovations such as beam intensity modulated radiotherapy, image-guided radiotherapy or time-tracking of breathing movements bring improvements in treatment outcomes. The clear benefit of proton beam therapy has not been demonstrated. In small cell carcinoma, concomitant chemoradiotherapy is the most effective in the stage of limited disease, starting at the latest from the third cycle of chemotherapy. Radiotherapy is also recommended in the stage of extensive disease as a consolidation treatment after chemotherapy with a very good response. For the treatment of small cell carcinomas, preventive brain irradiation is recommended as a standard, although recent studies have reported close and frequent MRI monitoring and early treatment in asymptomatic as an alternative. In NSCLC, preventive radiation reduces the proportion of patients with the development of brain metastases from 30% to 8%, but this has not been shown to prolong survival.
Surgery treatment of lung cancer
05/2019 MUDr. Adam Peštál, Ph.D.
Surgery is mostly used to treat non-small cell lung cancer in early stage I and II. Surgery can be used in stage IIIA but also together with chemoradiotherapy. Surgery is not normally used to treat small cell cancer; small cell lung cancer is treated only with T1—2(3) NO M0 attributes. The aim of surgery treatment is complete removal of tumorous cells (RO) with surrounding lymphatic tissue.
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Surgery is mostly used to treat non-small cell lung cancer in early stage I and II. Surgery can be used in stage IIIA but also together with chemoradiotherapy. Surgery is not normally used to treat small cell cancer; small cell lung cancer is treated only with T1—2(3) NO M0 attributes. The aim of surgery treatment is complete removal of tumorous cells (RO) with surrounding lymphatic tissue.
Trifluridine and tipiracil for the treatment of advanced colorectal cancer – case report
04/2019 MUDr. Stanislav John
The treatment of colorectal cancer in the first two lines is based on a combination of chemotherapy (FOLFOX and FOLFIRI, also in variations) and biological therapy in the form of vascular endothelial growth factor (VEGF) and epidermal growth factor (EGFR) inhibitors. Although this therapy is challenging and brings a lot of side effects, many patients are in good condition after progression. Especially for these patients the treatment with trifluridine/tipiracil is appropriate. This preparation contains a nucleoside analogue trifluridine and a thymidine phosporylase inhibitor tipiracil - inhibitor of the enzyme metabolizing just that nucleoside analogue. Trifluridine/tipiracil demonstrated efficacy in phase 3 clinical trial RECOURSE.1 Based on that the treatment was approved as well in the Czech Republic.
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The treatment of colorectal cancer in the first two lines is based on a combination of chemotherapy (FOLFOX and FOLFIRI, also in variations) and biological therapy in the form of vascular endothelial growth factor (VEGF) and epidermal growth factor (EGFR) inhibitors. Although this therapy is challenging and brings a lot of side effects, many patients are in good condition after progression. Especially for these patients the treatment with trifluridine/tipiracil is appropriate. This preparation contains a nucleoside analogue trifluridine and a thymidine phosporylase inhibitor tipiracil - inhibitor of the enzyme metabolizing just that nucleoside analogue. Trifluridine/tipiracil demonstrated efficacy in phase 3 clinical trial RECOURSE.1 Based on that the treatment was approved as well in the Czech Republic.
Optimal procedure in treatments of advanced ALK‑positive and ROS1‑positive non‑small cell lung cancers
04/2019 MUDr. Jana Krejčí; MUDr. Petr Opálka, CSc., MBA
Lung cancer is one of the most common and most dangerous diseases. Currently, various treatments for non-small cell lung cancers are used, not only by histology but also by molecular genetic properties. A pre-treatment normative procedure should be performed with regard to the fact that ALK (anaplastic lymphoma kinase) translocation in all patients without magnificent histologies prior to treatment. ROS1 (ROS proto-oncogene 1) translocation and PD-L1 (programmed cell death 1 ligand 1) expression are also recommended. If you resort to being an ALK positivity that could be compromised. If ROS1 positive patients do not yet have any drugs in the Czech Republic, they will need to be covered by the rules that apply to ALK-positive patients, and there should also be an exception to the revision doctor.
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Lung cancer is one of the most common and most dangerous diseases. Currently, various treatments for non-small cell lung cancers are used, not only by histology but also by molecular genetic properties. A pre-treatment normative procedure should be performed with regard to the fact that ALK (anaplastic lymphoma kinase) translocation in all patients without magnificent histologies prior to treatment. ROS1 (ROS proto-oncogene 1) translocation and PD-L1 (programmed cell death 1 ligand 1) expression are also recommended. If you resort to being an ALK positivity that could be compromised. If ROS1 positive patients do not yet have any drugs in the Czech Republic, they will need to be covered by the rules that apply to ALK-positive patients, and there should also be an exception to the revision doctor.
Panitumumab as first‑line treatment of colorectal cancer
04/2019 MUDr. Stanislav Batko
This article reviews the efficacy panitumumab in the 1st line systemic treatment of metastatic colorectal carcinoma (mCRC). First study published was PRIME in which panitumumab plus FOLFOX compared to chemotherapy alone prolonged overall survival in patients with nonresectable mCRC, furthermore it showed trend towards higher resection rate in patients with liver limited disease. The PEAK trial was comparing panitumumab and bevacizumab with chemotherapy backbone. Both overall survival and progression-free survival favored panitumumab compared to bevacizumab. PLANET trial was exploring potential of panitumumab to enhance overall response rate and allow for more curative resections in LLD population of mCRC patients. PLANET trial provided evidence high resectability and long overall survival. VOLFI trial represents a reasoned step in searching for more potent combination therapy. In randomized manner it compared FOLFOXIRI alone to FOLFOXIRI plus panitumumab. This study met its primary point, which was objective response rate, furthermore it showed greatly increased resectability in panitumumab arm and suggested better overall survival. Panitumumab plus FOLFOXIRI pose viable and efficient option for patients with mCRC, where deep tumor response could open way to surgical resection.
ENTIRE ARTICLE
This article reviews the efficacy panitumumab in the 1st line systemic treatment of metastatic colorectal carcinoma (mCRC). First study published was PRIME in which panitumumab plus FOLFOX compared to chemotherapy alone prolonged overall survival in patients with nonresectable mCRC, furthermore it showed trend towards higher resection rate in patients with liver limited disease. The PEAK trial was comparing panitumumab and bevacizumab with chemotherapy backbone. Both overall survival and progression-free survival favored panitumumab compared to bevacizumab. PLANET trial was exploring potential of panitumumab to enhance overall response rate and allow for more curative resections in LLD population of mCRC patients. PLANET trial provided evidence high resectability and long overall survival. VOLFI trial represents a reasoned step in searching for more potent combination therapy. In randomized manner it compared FOLFOXIRI alone to FOLFOXIRI plus panitumumab. This study met its primary point, which was objective response rate, furthermore it showed greatly increased resectability in panitumumab arm and suggested better overall survival. Panitumumab plus FOLFOXIRI pose viable and efficient option for patients with mCRC, where deep tumor response could open way to surgical resection.
Platinum‑sensitive recurrent ovarian cancer and olaparib maintenance treatment – case report
04/2019 Prof. MUDr. Michal Zikán, Ph.D.
Poly(ADP-ribose) polymerase inhibitors (PARP) represent the most modern approach to ovarian cancer treatment. This treatment is exclusive for individuals harbouring germline or somatic BRCA1 or BRCA2 gene mutations. This case report presents a patient with recurrent ovarian cancer treated with oral PARP inhibitor olaparib as a part of third line treatment. Well tolerated treatment led to excellent long-term survival and quality of life.
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Poly(ADP-ribose) polymerase inhibitors (PARP) represent the most modern approach to ovarian cancer treatment. This treatment is exclusive for individuals harbouring germline or somatic BRCA1 or BRCA2 gene mutations. This case report presents a patient with recurrent ovarian cancer treated with oral PARP inhibitor olaparib as a part of third line treatment. Well tolerated treatment led to excellent long-term survival and quality of life.