Options and rationale for reinstituting anti-EGFR therapy in pretreated RAS wild-type advanced colorectal carcinomasMain topic

Zdeněk Linke

Onkologie. 2023:17(4):233-240 | DOI: 10.36290/xon.2023.045  

Failure of anti-EGFR therapy in advanced RAS wild-type colorectal carcinoma at the initial lines of treatment may not necessarily mean its permanent and definitive inefficacy. One option is retreatment with anti-EGFR based therapies after previous progression (i. e., rechallenge). Another option is to reinitiate anti-EGFR treatment after previous discontinuation for a reason other than progression (i. e., reintroduction). Alternatively, sequential treatment can be used, i. e., switching between various anti-EGFR agents. A last option is to reinstitute anti-EGFR treatment in an effort to overcome the resistance of anti-EGFR therapy by dose escalation...

Treatment of BRAF V600E-mutated metastatic colorectal cancerMain topic

Jiří Tomášek

Onkologie. 2023:17(4):230-232 | DOI: 10.36290/xon.2023.044  

Colorectal cancers can be divided into several subgroups according to their molecular characteristics. A small subgroup comprises cancers with a BRAF mutation. The negative prognostic significance of this mutation in metastatic colorectal cancer (mCRC) has long been known; in recent years, we have made use of the fact that it is also a strong predictor of the efficacy of combined targeted therapy with cetuximab + encorafenib. The present paper deals with the treatment of patients with mCRC and BRAF V600E mutation.

Recent advances in immunotherapy for metastatic colorectal cancerMain topic

Stanislav Batko

Onkologie. 2023:17(4):224-229 | DOI: 10.36290/xon.2023.043  

Immunotherapy has a established role in the treatment of metastatic colorectal cancer in patients with microsatellite instability/deficiency in mismatch repair genes accounting for roughly 5% of all metastatic colorectal cancers. Data from smaller studies also strongly support similarly good efficacy in tumors with the POLE1/POLD1 mutation. Intensive research is underway to break down the resistance to immunotherapy observed in microsatellite stable colorectal cancers. Some smaller non-randomized studies suggest a possible benefit of combining immunotherapy with multikinase inhibitors or chemotherapy and targeted treatment in the population of microsatellite...

Všechno, co jste kdy chtěli vědět o karcinomu prsu u mladých žen, ale báli jste se zeptatEditorial

MUDr. Markéta Palácová

Onkologie. 2023:17(3):135  

Léčba pacientů s mnohočetným myelomem po expozici lenalidomidu a postavení přípravku Ninlaro v terapeutické sekvenciHeard at a congress

Dr. Karthik Ramasamy

Onkologie. 2023:17(3):209-214  

Patient with upgrading gangliogliomaCase report

Marek Šlachta, Ondřej Kalita, Dominik Hraboš, Lumír Hrabálek, Martin Doležel, Jiří Drábek, Miroslav Vaverka

Onkologie. 2023:17(3):205-208 | DOI: 10.36290/xon.2023.041  

Ganglioglioma is a rare primary brain tumor. It is commonly located supratentorialy, in the temporal lobe (>70%). The main clinical manifestation is a drug-resistant epileptic seizures. A rare, anaplastic, form is considered based on histological anaplastic signs of the glial component. Our patient with WHO grade 1 ganglioglioma underwent several surgeries for the gradual neoplasm progression. The histological examination shows the tumor development and its gradual up-grading into an anaplastic form (WHO grade 3), of which biology corresponded with the IDH wild-type glioblastoma. Current molecular-genetic tumor profiling is underpinnings for predilection...

Treatment with trifluridine/tipiracil in the third line of treatment for metastatic colorectal carcinoma in a patient with symptoms of toxicity during previous systemic treatmentCase report

Eva Čmuchařová

Onkologie. 2023:17(3):201-204 | DOI: 10.36290/xon.2023.040  

The following case report confirms the efficacy and good tolerability of trifluridine/tipiracil in a pretreated patient with mCRC who poorly tolerated previous systemic treatment.

Minimal invasive treatment and active surveillance of renal cell carcinomaReview articles

Marie Pechová, Vladimír Šámal, Vít Paldus, Igor Richter, Miroslav Šercl

Onkologie. 2023:17(3):197-200 | DOI: 10.36290/xon.2023.039  

Small Renal Masses (SRM) are defined as incidentally diagnosed, circumscribed solid or cystic tumors of the kidney < 4 cm with signs of saturation on a contrast-enhanced CT scan, corresponding to stage cT1aN0M0. In up to 60% of patients, the kidney tumor is detected incidentally. The incidence of SRM in elderly and polymorbid patients is also increasing. The standard of care for a localized kidney tumor is surgical treatment. In elderly patients or patients with serious comorbidities, SRM can only be actively monitored (Active Surveillance - AS). It is known that surgical treatment in the population over 75 years of age does not lead to a prolongation...

Bruton's tyrosine kinase inhibitors and their current status in the treatment of chronic lymphocytic leukemiaReview articles

Tereza Líkařová, Martin Špaček

Onkologie. 2023:17(3):192-196 | DOI: 10.36290/xon.2023.038  

Bruton's tyrosine kinase inhibitors (BTKi) are small molecules that interfere with the B-cell receptor signaling pathway and have an anti-tumor effect in chronic lymphocytic leukemia. Since the approval of ibrutinib in 2014, together with other targeted drugs, they have almost completely replaced standard chemotherapy regimens in relapsed disease and in the group of patients with proven TP53 aberrations are also preferred in the first-line setting. In addition to ibrutinib, a second-generation BTKi with a lower risk of cardiac adverse events, acalabrutinib, is now available in the Czech Republic. A number of other third-generation agents are in clinical...

Rechallenge with anti-EGFR therapyReview articles

Marián Liberko, Renata Soumarová

Onkologie. 2023:17(3):188-191 | DOI: 10.36290/xon.2023.037  

Continuum of care is a concept of treatment in which periods of aggressive, induction chemotherapy are followed by maintenance treatment with the aim to prolong overall survival of mCRC patients. Rechallenge with anti-EGFR drugs is a part of this concept. With this strategy, we may achieve significant response and control of disease, even in later lines of treatment, in selected group of patients. The aim of this review is to provide an overview of rechallenge with anti-EGFR therapy in the treatment of mCRC.

Tolerability of antidepressants and mechanisms of their adverse effects with regard to their use in cancer patientsReview articles

Jan Juřica

Onkologie. 2023:17(3):180-187  

Antidepressants represent an essential and effective therapeutic approach in treating depressive disorders and many other neuropsychiatric diseases. This review article summarises the most common adverse effects of the most commonly used antidepressants in the Czech Republic with respect to the frailty of cancer patients and their specific needs. These side effects usually have a completely logical explanation based on their receptor profile or pharmacokinetics. In this context, the advantages and disadvantages of these selected most commonly used antidepressants in cancer patients are summarised, especially regarding their tolerability and their desirable...

Small cell lung cancer, current treatment and perspectivesReview articles

Miloš Pešek

Onkologie. 2023:17(3):175-179 | DOI: 10.36290/xon.2023.035  

Small cell lung cancers are among cancer diseases in which treatment outcomes have improved very little during the previous decades. In recent years, however, there has been some improvement in early as well as long-term treatment outcomes in patients with extensive-stage disease. Clinical trials using the combination of standard chemotherapy of etoposide and a platinum derivative with durvalumab, atezolizumab, and pembrolizumab have yielded positive results. The results of trials mentioned here which focused on epigenetic changes in tumour tissue and on investigating gene expression profiles hold promise in terms of possible personalization of systemic...

Breast cancer and pregnancyMain topic

Marta Krásenská

Onkologie. 2023:17(3):169-174 | DOI: 10.36290/xon.2023.034  

The coincidence of breast cancer and pregnancy is increasing due to the postponement of childbearing until later in life. This article describes the newly proposed division into breast cancer in pregnancy and breast cancer in the postpartum period, which differ in biological characteristics and prognosis. Pregnancy after treatment for breast cancer has long been considered inappropriate, especially in patients with hormone-dependent forms of the disease (luminal carcinomas). However, the available data show that pregnancy in women in remission after treatment for breast cancer is possible and safe, even with the use of assisted reproductive techniques.

Preservation of fertility in young patients with breast cancer, including BRCA1, BRCA2 mutation carriersMain topic

Martina Zimovjanová

Onkologie. 2023:17(3):164-168 | DOI: 10.36290/xon.2023.033  

Preservation of fertility in cancer patients, also known as oncofertility, is a relatively new trend. For breast cancer patients with unfulfilled reproductive plans, the possibility of starting a family is a fundamental parameter of quality of life after overcoming cancer. This review aims to summarize current information on fertility preservation options for young patients. Available and effective options for preserving fertility include cryopreservation of oocytes/embryos or cryopreservation of ovarian tissue. When evaluating individual strategies, it is necessary to carefully consider the patient's characteristics, her disease, and the type of treatment....

Sacituzumab govitecan in the treatment of metastatic triple negative breast cancerMain topic

Markéta Palácová

Onkologie. 2023:17(3):160-163 | DOI: 10.36290/xon.2023.032  

Triple negative breast cancer (TNBC) continues to have the worst prognosis compared to other phenotypes. However, in the last 2 years it has been shining on better times. In addition to chemotherapy, new treatment options for metastatic disease - immunotherapy, PARP inhibitors and monoclonal antibody conjugate with cytostatic - sacituzumab govitekan have entered clinical practice. This drug demonstrated effectiveness not only in the progression free survival, but also in overall survival. Sacituzumab govitekan was introduced into clinical practice by the ASCENT registration study. Adverse events should be monitored for the most frequent occurrence...

Treatment strategy of triple negative breast cancer in young women - do we treat them differently?Main topic

Zuzana Bielčiková

Onkologie. 2023:17(3):157-159 | DOI: 10.36290/xon.2023.031  

Breast cancer in young women (YBC) is often associated with aggressive histology and a higher stage of the disease at the time of diagnosis. Triple-negative breast cancer (TNBC), the presence of a hereditary mutations, concerns about chemotherapy-induced amenorrhoea and/or concerns about prognosis are key words in the treatment of patients with YBC. However, current data have not shown a superiority of a particular type of systemic treatment or local methods of therapy tied to a population of patients under 40 years of age with TNBC. Also, the prognosis of TNBC in patients with YBC does not differ significantly from that of older women with TNBC. This...

Treatment issues of HER2 positive breast cancer in adult young patientsMain topic

Miloš Holánek

Onkologie. 2023:17(3):150-156 | DOI: 10.36290/xon.2023.030  

HER2-positive cancer is an aggressive subtype of breast tumors and requires complex oncological treatment. In patients with early-stage disease, the goal is to achieve long-term remission of the disease, while in patients with metastatic disease, the goal of treatment is to achieve long-term disease control, prolong overall survival and influence disease symptoms to improve quality of life. The treatment of adult young breast cancer patients is specific in many ways. This subset of patients is more likely to be diagnosed with aggressive subtypes, more advanced diseases, and higher-grade tumors with lower steroid receptor expression. Hereditary carcinomas...

Systemic treatment of breast cancer in young patients with a germline mutation in the BRCA1 and BRCA2 genesMain topic

Markéta Palácová

Onkologie. 2023:17(3):145-149 | DOI: 10.36290/xon.2023.029  

All breast cancer phenotypes occur in tumors with a germline BRCA1/2 (gBRCA1/2) mutation. A mutation in the BRCA1/2 gene brings with it, with regard to the function of repair genes, a higher chemosensitivity to cytostatics causing DNA damage. A higher sensitivity to platinum derivatives and anthracyclines is known. A group of PARP inhibitors can now be administered not only in metastatic disease, but data on effectiveness are now also available in adjuvant setting. According to the limited data, there is no difference in the effectiveness of immunotherapy in germinal or sporadic breast cancer. For endocrine therapy, there are only data on the risk...

Adjuvant hormone therapy in young women with early breast cancer in 2023Main topic

Vlastimila Čmejlová

Onkologie. 2023:17(3):140-144 | DOI: 10.36290/xon.2023.028  

Hormone therapy in patients with hormone-dependent breast cancer is an important part of comprehensive cancer treatment. Premenopausal patients continue to be treated with tamoxifen, and in high-risk patients we consider the administration of the aromatase inhibitor exemestane with or without ovarian ablation. The duration of adjuvant treatment is extended; small low-risk cancers can be treated for only 5 years, while high-risk cancers with lymph node positivity and higher proliferative activity benefit from extended administration up to 10 years. Multigene assays can identify patients at low risk of recurrence, where adjuvant chemotherapy is not necessary,...

Karcinom pankreatu – změna k lepšímu?Editorial

MUDr. Marián Liberko

Onkologie. 2023:17(2):79  

Hidradenocarcinoma arising in the axilla - a report of a rare caseCase report

Vladimír Bartoš, Zuzana Murárová

Onkologie. 2023:17(2):127-130 | DOI: 10.36290/xon.2023.026  

Introduction: Hidradenocarcinoma is a rare malignant adnexal tumor which arises from the intradermal ducts of sweat glands. It often clinically mimics a benign (non-neoplastic) skin disease, which contributes to delayed diagnosis. Case report: A 51-year old man had noticed an "inflamed lump" in his right armpit for the last year. The lesion clinically appeared as a suppurative hidradenitis. After its surgical incision, it was seen a progression of cutaneous tumorous resistance at a given location. The mass was completely excised. Histopathology revealed a solid high-grade carcinoma with a histomorphology and immunophenotype favoring the diagnosis of...

Long­‑term survival of a patient with disseminated adenocarcinoma of the ampulla of Vater: a complex therapeutic approach in metastases recurrenceCase report

Martin Gryc, Michal Eid

Onkologie. 2023:17(2):123-126 | DOI: 10.36290/xon.2023.025  

Adenocarcinoma of the ampulla of Vater is a rare but aggressive disease with a poor prognosis. While radical surgical resection is the standard treatment of choice, recurrence and metastatic dissemination remain common clinical challenges. Furthermore, there is no clear guideline consensus regarding adjuvant treatment. Precise histopathological characterization is paramount in terms of disease prognosis. We report a case of a patient who underwent a multimodal treatment for recurrent lung metastasis with a good clinical outcome.

Types and characteristics of renal lesions - diagnosis, treatment and prognosisReview articles

Vít Paldus, Vladimír Šámal, Marie Pechová, Igor Richter

Onkologie. 2023:17(2):119-122 | DOI: 10.36290/xon.2023.024  

Characteristics of renal lesions may predict further development of the disease, its prognosis and thus becomes part of the decision-making process, as to which treatment strategy to choose, right from the beginning. Unfortunately, a simple TMN classification of the disease stage may not always be sufficient. Some of the centrally localized renal cell carcinomas (RCC) may be re-evaluated from the primary stage cT1 to the final pathological stage pT3a. Cystic renal lesions represent another specific group in the evaluation of RCC. Their diagnostic work up and treatment strategy is guided by the Bosniak classification based on the CT. The clinical approach...

Breast reconstruction and radiotherapyReview articles

Igor Sirák, Aleš Fibír, Igor Slaninka, Adam Paulík, Iveta Kolářová, Petr Motyčka, Jakub Grepl, Petr Paluska, Milan Vošmik

Onkologie. 2023:17(2):113-118 | DOI: 10.36290/xon.2023.023  

Breast-conserving surgical treatment combined with perioperative systemic therapy and postoperative radiotherapy is the standard treatment for early-stage breast carcinoma. Mastectomy continues to be performed in patients in whom breast-conserving surgery cannot be recommended for therapeutic or cosmetic reasons. They often have locally or regionally advanced disease in which mastectomy is virtually always followed by adjuvant radiotherapy. Breast reconstruction following mastectomy is increasingly encountered, and this trend will continue to grow in the future. With advances in medicine, there has been progress in both the surgical procedures used...

Effect of target therapy with BRAF and MEK inhibitors on the immune system in metastatic melanomaReview articles

Linda Řandová, Ondřej Kodet

Onkologie. 2023:17(2):108-112 | DOI: 10.36290/xon.2023.022  

Target therapy with BRAF and MEK inhibitors is one of the main pillars of treating patients with BRAF-mutated melanoma. Despite a good therapeutic response, this treatment is burdened by early development resistance. A particular possibility to overcome this resistance is the combination of target therapy and immunotherapy. BRAF-mutated melanomas themselves have immunosuppressive properties that stimulate the tumour microenvironment. Target therapy with BRAF and MEK inhibitors significantly affects the immune tumour microenvironment, which could support the use of combination therapy with checkpoint inhibitors. However, these findings have not...

Metastatic pancreatic cancer and personalized therapy: a case reportMain topic

Marián Liberko, Renata Soumarová

Onkologie. 2023:17(2):101-107 | DOI: 10.36290/xon.2023.021  

We present a case report of a patient with pancreatic cancer who developed metastatic disease early after surgery and adjuvant therapy. Palliative systemic treatment resulted in long-term control of the disease, followed by pulmonary metastasectomy of residual lesions. Early relapse of the disease after metastasectomy was treated with platinum derivatives, based on the results of NGS testing. Personalized treatment has led to a rapid response and stabilization of the disease. Maintenance therapy with PARP inhibitors will follow in the future.

Personalized therapy in pancreatic cancerMain topic

Marián Liberko, Renata Soumarová

Onkologie. 2023:17(2):95-100 | DOI: 10.36290/xon.2023.020  

Pancreatic cancer is a disease with increasing incidence and mortality worldwide. Current standard of treatment is chemotherapy regardless of clinical stage. Despite improvements in survival thanks to multi-agent regimens in adjuvant, neoadjuvant and paliative setting, pancreatic cancer still has the worst prognosis across all malignancies. Oncology nowadays is more or less personalized/precise. With help of NGS we are able to identify specific subtypes of patients with pancreatic cancer, which have both, different prognosis and require specific approach to treatment. The aim of this review is to provide information about pancreatic cancer as a molecularly...

The role of radiotherapy in the treatment of pancreatic cancerMain topic

Renata Soumarová, Marián Liberko

Onkologie. 2023:17(2):90-94 | DOI: 10.36290/xon.2023.019  

Surgery remains the most important modality in the treatment of resectable pancreatic cancer, but only 10-15% of patients are suitable candidates. Despite the still high rate of local recurrence after radical surgery, adjuvant radiotherapy has now been replaced by chemotherapy, which has been shown to have better outcomes in randomized trials. Systemic therapy is also preferred in the neoadjuvant indication, but further studies investigating the position of radiotherapy in this group of patients are needed. Radiotherapy has a place in unresectable disease, where in combination with systemic therapy it affects local disease control and overall survival....

Is surgical treatment of liver metastases from pancreatic adenocarcinoma currently indicated?Main topic

Robert Gürlich

Onkologie. 2023:17(2):86-89  

At the time of primary diagnosis, metastatic pancreatic ductal adenocarcinoma (mPDAC) occurs in up to 60%. In approximately half of these patients, synchronous distant metastases are present, with around 37-42% of them being liver metastases. The existing recommendations do not indicate a primary surgical procedure in stage IV of the disease. Recently, particularly with the advancement of systemic treatment, initial results have been published demonstrating the benefit of the primary surgical approach. The results of ongoing randomized trials have been unavailable so far; therefore, there is not strong enough evidence to recommend a change in the strategy...

Surgical treatment of resectable and borderline resectable pancreatic cancerMain topic

Martin Oliverius

Onkologie. 2023:17(2):82-85 | DOI: 10.36290/xon.2023.018  

Surgical treatment remains the only treatment method that gives patients hope of cure, or of a significant prolongation of the asymptomatic period. In combination with multimodal oncological treatment, survival of patients has improved in recent years, although from the point of view of other cancers of the gastrointestinal tract it continues to be one of the worst. The mortality rate of patients operated in large centers ranges between 3-5%, although the morbidity due to the complexity of the procedure and the predominantly higher age composition of patients remains around 40%. A single examination is sufficient for the indication and the right decision...