Karcinom plic v roce 2023 – méně známé aspekty nemoci

doc. MUDr. Kristián Brat, Ph.D.

Onkologie. 2023:17(1):3  

Actual role of immunotherapy in a treatment of lung cancer

Monika Bratová

Onkologie. 2023:17(1):8-11 | DOI: 10.36290/xon.2023.003  

Immunotherapy plays an important role in management of lung cancer. Its incorporation in a treatment strategy helps to improve survival of patients with NSCLC and SCLC. Crucial principles of immunit control, check points and their inhibitors available in Czech Republic are discussed. Particular indications of immunotherapy for a diagnosis of lung cancer together with practical points and diagram of the first line treatment of NSCLC are presented.

Perspectives in the treatment of less common mutations in patients with non-small cell lung carcinoma

Miloš Pešek

Onkologie. 2023:17(1):12-15 | DOI: 10.36290/xon.2023.004  

The author presents an overview of current information regarding the state-of-the-art in diagnosing less common driver mutations in non-small cell lung carcinoma (NSCLC) in association with the current options of treatment targeted at these molecular subtypes of cancer. In the majority of patients, targeted therapy elicits a rapid treatment response, prolongs the time to tumour progression, extends overall survival of patients, and usually has fewer adverse effects than chemotherapy in a possible combination with cancer immunotherapy. Most oncogene-dependent lung cancer occurs in non-smokers and in young individuals. NGS and RT-PCR methods are increasingly...

Update on diagnosis and management of malignant pleural effusions

Kristián Brat

Onkologie. 2023:17(1):16-21 | DOI: 10.36290/xon.2023.005  

Malignant pleural effusion (MPE) occurs in a significant proportion of patients with malignancy, more frequently in certain types of tumors. Diagnosis of MPE is based on imaging, but in most patients, a pleural intervention is required (thoracentesis, pleural biopsy, medical thoracoscopy or video-assisted thoracoscopy) for cytology and/or histology sampling. Management of MPE depends on the fluid volume, patient's symptoms and reaccumulation rate. Further considerations include patient´s general health condition, life expectancy and anticancer treatment options. In patients with recurrent MPE, talc pleurodesis or insertion of an indwelling pleural...

Experience with the treatment of lung cancer from real clinical practice - findings from registries TULUNG and LUCAS

Ondřej Venclíček

Onkologie. 2023:17(1):22-25 | DOI: 10.36290/xon.2023.006  

The TULUNG and LUCAS pneumooncology registries are databases used to store, analyze, interpret and publish data from patients with lung cancer. The TULUNG registry was terminated at the end of March 2022, the LUCAS registry is ongoing. Pneumooncology centers from all over the Czech Republic participated in both projects. The data gained from the registries are a valuable source of information for clinical practice.

Current status of immunotherapy in the adjuvant treatment of invasive urothelial carcinoma

Vladimír Šámal, Igor Richter, Vít Paldus

Onkologie. 2023:17(1):26-30 | DOI: 10.36290/xon.2023.007  

Radical cystectomy or nephroureterectomy with lymphadenectomy is the standard treatment for muscle-invasive urothelial carcinomas. Patients after curative surgery without clinically detectable metastases are at high risk of disease recurrence. Neoadjuvant cisplatin-based chemotherapy provides the benefit of prolonging overall survival (OS) versus surgery alone. There is no clear treatment standard for patients with a high risk of recurrence after radical surgery. Adjuvant cisplatin-based chemotherapy is often used (if not given neoadjuvantly). Some patients refuse chemotherapy or are unable to undergo it. The efficacy and safety of treatment with checkpoint...

The use of PET/MRI in rectal cancer

Andrea Šprláková-Puková, Hana Petrášová, Alexandra Litavcová, Zdeněk Kala, Lenka Ostřížková, Marek Dostál

Onkologie. 2023:17(1):31-34 | DOI: 10.36290/xon.2023.008  

Magnetic resonance is currently a key examination for rectal tumors invading through muscularis propria. The reason is accurate TNM staging and selection of appropriate treatment. The use of PET/MRI combines the possibility not only to examine the rectum and performe T staging, but it can help delineate extent of tumor better and also better characterize small lymph nodes and improve detection of distant metastases. The use of hepatospeific contrast agent improves detection and specification of the focal liver lesion. This aproach called one - stop - shop ensures to determine TNM classification in one examination. Moreover, this approach is beneficial...

Are we in the era of total neoadjuvant treatment in rectal cancer?

Marián Liberko, Renata Soumarová

Onkologie. 2023:17(1):35-39 | DOI: 10.36290/xon.2023.009  

Long term standard for treatment of locally advanced rectal cancer was neoadjuvant chemoradiotherapy followed by radical surgery and eventually adjuvant chemotherapy in selected patients. Stagnation of oncological outcomes of clasical approach lead to a new concept called total neoadjuvant treatment (TNT). This article offers review of most recent TNT studies and their significance for clinical pratice.

The issue of the health condition assessment for the purposes of the special aid allowance and disabled person ID card with the view to the involvement of general practitioners and specialists, including oncologists

Libuše Čeledová, Rostislav Čevela

Onkologie. 2023:17(1):40-46 | DOI: 10.36290/xon.2023.010  

The article provides a clear introduction to the issue of the health condition assessment for the purposes of the special aid allowance and disabled person ID card. The text is supplemented with a case report on the health condition assessment for the purposes of a disability certificate of a man with testicular seminoma. The authors propose to unify the assessment criteria for the health condition assessment for the purposes of the disabled person ID card and for the purposes of the care allowance, which would simplify and accelerate the assessment process. Furthermore, in order to make the assessment process more efficient, they propose to transfer...

Nevoid melanoma as a diagnostic problem

Paula Ďuríková

Onkologie. 2023:17(1):47-50 | DOI: 10.36290/xon.2023.011  

Nevoid melanoma is one of the most difficult types of malignant melanoma to diagnose. Most often, it is clinically and histopathologically similar to the common intradermal and compound melanocytic nevus. This rare lesion defies conventional ideas about the morphology of malignant melanocytic neoplasm. It is an aggressive tumor. Its poor prognosis is in contrast to its organized architecture, which resembles a banal benign lesion. A significant part of the diagnostic process in cases of melanocytic neoplasms is based on the subjective assessment of the lesions. Therefore, increasing awareness of this rare type of malignant melanoma can aid decision-making...

Mechanisms of resistance to melanoma immunotherapy

Linda Řandová, Ondřej Kodet

Onkologie. 2023:17(1):51-56 | DOI: 10.36290/xon.2023.012  

The treatment of melanoma has seen significant progress over the past 12 years. Its basis is immunotherapy using check-point inhibitors. Unfortunately, despite the long-term therapeutic response that can be achieved, many patients experience lower rates of therapeutic responses and failure with this form of treatment even after an initial good treatment response. These treatment complications are the subject of many studies that document individual mechanisms of primary and secondary resistance to melanoma immunotherapy. The study comprehensively describes contemporary knowledge about particular resistance mechanisms to melanoma treatment.

Case reports of patients with ALK-positive NSCLC and brain metastases

Petra Zemanová, Milada Zemanová, Vladimír Černý

Onkologie. 2023:17(1):57-61 | DOI: 10.36290/xon.2023.013  

The present case reports describe a young male and a young female patient diagnosed with generalized non-small cell lung adeno­carcinoma with brain metastases and ALK translocation. Brain metastases are detected in 30% of patients with ALK-positive NSCLC at the time of cancer diagnosis. The discussion section deals with the intracranial efficacy of individual ALK inhibitors.

Cemiplimab in treating locally advanced NSCLC

Andrea Müllerová, Juraj Kultan

Onkologie. 2023:17(1):62-66 | DOI: 10.36290/xon.2023.014  

A case is reported of a female patient who was diagnosed with an inoperable, stage IIIB adenocarcinoma of the right lung. Given the high PD-L1 positivity of 90% and negativity of activating mutations, immunotherapy was chosen as the treatment modality with a real chance for a therapeutic response. Due to comorbidities, disease extent (carcinomatous lymphangitis, satellite lesion), and the patient's age, chemoradiotherapy (CRT), whether in concurrent (cCRT) or sequential (sCRT) form, was not indicated because of a high risk of serious complications. For these reasons, the patient was started on cemiplimab which is currently the only molecule among immuno-oncology...

CheckMate 9LA trial: commentary and clinical case report of patient with cerebellar metastasis

Marie Drösslerová

Onkologie. 2023:17(1):67-69 | DOI: 10.36290/xon.2023.015  

Patients with non-oncogene-addicted metastatic NSCLC are treated with first- line immunotherapy with or without chemotherapy. CheckMate 9LA trial demonstrated survival benefits and safety of dual immunotherapy (nivolumab, ipilimumab) with limited chemotherapy. Survival outcomes were significantly improved in patients with tumor PD-L1 expression < 1% and baseline brain metastases. We present a clinical case of a 72 years old patient with NSCLC and cerebellar metastasis treated according to CheckMate 9LA trial.

Clear-cell renal cell carcinoma with sarcomatoid dedifferentiation treated with immunotherapy

Andrea Ondrušková, Hana Študentová, Anežka Zemánková

Onkologie. 2023:17(1):70-71 | DOI: 10.36290/xon.2023.016  

Sarcomatoid renal cell carcinoma occurs rarely. It is characterized by a very poor prognosis and a low response to treatment with tyrosine kinase inhibitors. Combination of the checkpoint inhibitors ipilimumab and nivolumab is becoming a new standard of treatment. The case report presents a patient with clear-cell renal cell carcinoma with sarcomatoid dedifferentiation that was already generalized at presentation and had a poor prognosis. The patient was treated with the combination of ipilimumab and nivolumab, resulting in a good clinical response, a radiological response in the form of disease stabilization, and a survival of more than two years.

Risks associated with central venous catheter care in a pediatric patient in palliative care

Lenka Horáková, Kateřina Horáčková

Onkologie. 2023:17(1):72-74 | DOI: 10.36290/xon.2023.017  

Introduction: For a paediatric patient on palliative care, the provision of venous access may be required, which can be used in the home or hospital setting. However, disruption of skin integrity may increase the risks, which can be life-threatening for the paediatric patient. Objective: Identify and assess the risks associated with central venous catheter care.  Methodology: FMEA (Failure Mode and Effect Analysis), expert team brainstorming. Results: The risks analysed were assessed as significant. Even corrective measures cannot eliminate the risks completely, but they can be reduced to a minimum. Conclusion: Appropriate education and proper...