Nové trendy v léčbě pokročilého kolorektálního karcinomu

MUDr. Zdeněk Linke

Onkologie. 2023:17(4):219  

Recent advances in immunotherapy for metastatic colorectal cancer

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...

Treatment of BRAF V600E-mutated metastatic colorectal cancer

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.

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

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 metastatic colorectal carcinoma - 3^rd line and above

Pavel Pacas, Adam Lukáč

Onkologie. 2023:17(4):241-245 | DOI: 10.36290/xon.2023.046  

Terapeutic possbilities in mCRC in 3rd and higher line of treatment are constantly expanding not only by new combinations of actual treatment possibilities, but also by discoveries of new small targeted molecules. Results of clinical studies prove that by right therapeutic intervention, we can prolong lives of highly pre-treated patients without worsening their quality of life. Ever evolving clinical oncology require us to have constant knowledge of actual therapeutic regimes and formation of new approach in higher lines of treatment in advanced illness.

Neo-/adjuvant immunotherapy and targeted therapy of non-small cell lung cancer

Martin Svatoň, Jiří Blažek

Onkologie. 2023:17(4):246-251 | DOI: 10.36290/xon.2023.047  

For many years, operable non-small cell lung cancer has been associated with a high percentage of recurrences with a limited possibility of neo-/adjuvant treatment in the form of chemotherapy alone. However, recent years have seen great development in this field. The first phase III studies yielded positive data for the adjuvant use of osimertinib, atezolizumab and pembrolizumab. Neoadjuvant use of nivolumab together with chemotherapy and perioperative approach with pembrolizumab and chemotherapy also brought other positive results. The aim of this article is therefore to bring a summary of the changes and new findings in this area and to point out...

Role of ruxolitinib in treatment of polycythemia vera

Natália Podstavková

Onkologie. 2023:17(4):252-255 | DOI: 10.36290/xon.2023.048  

Ruxolitinib, selective oral inhibitor of Janus kinases JAK1/JAK2, is approved for therapy of primary myelofibrosis but also as a second line therapy of patients with polycythemia vera which are resistant or intolerant to hydroxyurea. Randomized studies RESPONSE and RESPONSE-2 have shown its superiority in achieving hematological remission and decreased symptom burden when compared to best available therapy. MAJIC-PV study demonstrated in PV benefits of ruxolitinib in superior event-free survival and prolonged overall survival of patients.

Current status of nephrectomy in the treatment of metastatic renal cell carcinoma

Vladimír Šámal, Igor Richter, Vít Paldus, Marie Pechová

Onkologie. 2023:17(4):257-260 | DOI: 10.36290/xon.2023.049  

Renal cell carcinoma (RCC) accounts for approximately 3% of all malignant tumors, and 15% of tumors are metastatic at time of diagnosis. For many years,  cytoreductive nephrectomy was the mainstay of treatment. For the patients with metastatic disease, cytoreductive nephrectomy (CN) is predominantly a palliative procedure and systemic therapy is essential. Adrenalectomy as a part of CN is not considered as a standard part of the procedure except for obvious tumor invasion into the adrenal gland. Lymfadenectomy as a part of CN has only staging effect. Results of cytokine study comparing CN plus interferon-based immunotherapy vs. interferon immunotherapy...

Cemiplimab: monotherapy and combination therapy of NSCLC - analysis of locally advanced disease

Marie Drösslerová

Onkologie. 2023:17(4):261-266 | DOI: 10.36290/xon.2023.050  

Patients with unresectable locally advanced NSCLC who are not candidates for concurrent chemoradiation have been excluded from trials with immunotherapy. Trials with cemiplimab are exception. Trials EMPOWER-Lung 1 (first-line cemiplimab monotherapy) and EMPOWER-Lung 3 (first-line cemiplimab with chemotherapy) were not only focused on metastatic stage but also included patients mentioned above.

Brentuximab vedotin consolidation therapy after autologous stem cell transplantation in relapsed/refractory classic Hodgkin lymphoma patients in the Czech Republic

Jozef Michalka, Zdeněk Král, Jana Marková, Ľubica Gahérová, Mária Maco, Vít Procházka, Andrea Janíková, Jan Kořen, Alice Sýkorová, Pavla Štěpánková, Kateřina Steinerová, Lekaa Mohammad, Juraj Ďuraš, Barbora Velacková, Tomáš Doležal, Kateřina Benešová, Marie Lukášová, Heidi Móciková

Onkologie. 2023:17(4):267-272 | DOI: 10.36290/xon.2023.051  

The results from the clinical trial AETHERA showed that consolidation therapy with brentuximab vedotin after high-dose chemotherapy followed by autologous stem cell transplantation increases progression free survival in high-risk patients with relapsed/refractory classic Hodgkin lymphoma. In this multicenter retrospective analysis from seven hematological centers in the Czech republic we have analysed real-life data of 39 patients treated between January 2015 and December 2021. Brentuximab vedotin was not administered in the previous treatment and the patients were at increased risk of subsequent lymphoma relapse with at least one defined risk factor....

Modern approach to the treatment of chronic lymphocytic leukemia

Lukáš Smolej

Onkologie. 2023:17(4):273-281 | DOI: 10.36290/xon.2023.052  

Chronic lymphocytic leukemia (CLL) is the most common lymphoid malignancy of adults in the Euro-American population and predominantly affects the elderly: the median age at diagnosis is between 65 and 72 years. Most patients are nowadays diagnosed at an early asymptomatic stage and do not require treatment. The heterogeneity of the prognosis of CLL is extraordinary. Even with long-term follow-up, about 50% of CLL patients do not progress and never require treatment, which is initiated only in case of the disease´s clinical activity. Prognostic factors, especially TP53 gene deletion/mutation, other cytogenetic abnormalities, and mutation status...

The use of immunotherapy and targeted therapy in Richter's transformation

Tereza Líkařová, Martin Špaček

Onkologie. 2023:17(4):282-286 | DOI: 10.36290/xon.2023.053  

Richter´s syndrome (RS) is a serious complication of chronic lymphocytic leukemia, occurring yearly in 2-10 % of cases. Despite new treatment modalities in the field of haematooncology, RS remains a major clinical challenge. This case report presents a patient in whom disease control was not achieved despite the use of various novel therapeutic approaches. This case thus demonstrates the extremely unfavorable prognosis of RS patients and the clinical urgency of developing new therapeutic approaches.

Nivolumab in the treatment of pretreated patients with metastatic colorectal carcinoma with high microsatellite instability

Beatric Bencsiková

Onkologie. 2023:17(4):287-289 | DOI: 10.36290/xon.2023.054  

Nivolumab in combination low-dose ipilimumab has provided a robust and long-term clinical benefit with a manageable safety profile in previously treated patients with metastatic colorectal carcinoma (mCRC) harboring high microsatellite instability/mismatch repair protein deficiency (MSI-H/dMMR) with a median follow-up of 13.4 and 25.4 months in the phase-2 multicohort CheckMate 142 study. The 5-year follow-up data on the efficacy and safety were presented at ASCO 2022. The effect of treatment has also been confirmed by clinical experience and a particular patient case.

Effect of immunotherapy and radiotherapy in the treatment of Merkel cell carcinoma in a patient with myelodysplastic syndrome

Miroslav Důra, Ivana Krajsová, Jolana Mertová

Onkologie. 2023:17(4):290-294 | DOI: 10.36290/xon.2023.055  

The authors present a case of a complete treatment response in a patient treated for metastatic Merkel cell carcinoma with a combination of radiotherapy and immunotherapy with avelumab. Immunotherapy was terminated prematurely due to relapse of myelodysplastic syndrome. Despite premature termination of immunotherapy, complete disease remission has been sustained. Clinical and histopathological properties of Merkel cell carcinoma and the recommended treatment algorithm are discussed. Attention is paid to the management of avelumab treatment.