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

MUDr. Markéta Palácová

Onkologie. 2023:17(3):135  

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

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,...

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

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...

Treatment issues of HER2 positive breast cancer in adult young patients

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...

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

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...

Sacituzumab govitecan in the treatment of metastatic triple negative breast cancer

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...

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

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....

Breast cancer and pregnancy

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.

Small cell lung cancer, current treatment and perspectives

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...

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

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...

Rechallenge with anti-EGFR therapy

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.

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

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...

Minimal invasive treatment and active surveillance of renal cell carcinoma

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...

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

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.

Patient with upgrading ganglioglioma

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...

Léčba pacientů s mnohočetným myelomem po expozici lenalidomidu a postavení přípravku Ninlaro v terapeutické sekvenci

Dr. Karthik Ramasamy

Onkologie. 2023:17(3):209-214