Moderní terapeutické přístupy v hematoonkologii

MUDr. Martin Špaček, Ph.D.

Onkologie. 2024:18(2):87  

Current targeted therapy options in chronic lymphocytic leukemia

Martin Špaček

Onkologie. 2024:18(2):92-97 | DOI: 10.36290/xon.2024.017  

The treatment of chronic lymphocytic leukemia (CLL) has undergone profound changes in the last decade with significant improvements in therapeutic outcomes and longer survival of patients with this disease. A major change has been the advent of targeted drugs, especially Bruton's tyrosine kinase inhibitors (acalabrutinib, ibrutinib, zanubrutinib) and Bcl2 inhibitors (venetoclax). These small molecules have already practically replaced chemotherapy in routine practice, first in relapse setting and more recently in first-line treatment of CLL. The main advantages of targeted therapy include better tolerance to treatment and high efficacy, including in...

Rituximab-venetoclax in the second line of treatment of chronic lymphocytic leukemia in a patient with TP53 mutation

Tereza Shokralla, Martin Špaček

Onkologie. 2024:18(2):98-102 | DOI: 10.36290/xon.2024.018  

Currently available data from clinical trials clearly demonstrate the benefit of targeted therapy over chemoimmunotherapy in the treatment of relapsed or refractory chronic lymphocytic leukemia (R/R CLL). One of the predominantly used modalities of targeted therapy is the combination of the antiCD20 antibody rituximab and the BCL-2 anti­apoptotic protein inhibitor venetoclax, whose efficacy and safety were confirmed in the Murano trial. The main advantages of this regimen are the time-limited therapy, the high percentage of long-lasting treatment responses and the high percentage of deep remissions at the measurable residual disease (MRD) level. In...

CAR T-lymphocytes in the treatment of non-Hodkgin's lymphoma: current perspectives

Kamila Polgárová

Onkologie. 2024:18(2):103-108 | DOI: 10.36290/xon.2024.019  

T-lymphocytes with chimeric antigen receptor have been used in the therapy of refractory or relapsed B-non-Hodgkin's lymphomas in the Czech Republic for several years. In the context of the available data, their use is expanding - in the sense of indicated diagnoses and also moving to earlier therapeutic lines. Some products are already approved for use in the Czech Republic in the second treatment line for diffuse large cell lymphoma; data reflecting front line use are also available. The spectrum of diagnoses for which this therapy has been approved currently includes mantle cell lymphoma and follicular lymphoma. Data from clinical trials and real-world...

Novel therapeutical strategies in diffuse large B-cell lymphoma

Prokop Vodička, Marek Trněný

Onkologie. 2024:18(2):109-115 | DOI: 10.36290/xon.2024.020  

Diffuse large B-cell lymphoma is a prototype of aggressive lymphomas. Until recently, the standard of care in the first-line setting has been the chemoimmunotherapeutic regimen R-CHOP (consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) with a 60-70% chance of achieving long-term remission. The newly introduced Pola-R-CHP regimen (replacing vincristine by the antibody-drug conjugate polatuzumab vedotin) decreases the risk of DLBCL relapse and prolongs the progression-free survival of the patients. This regimen is being gradually implemented into a daily practice and is currently approved for patients with high-intermediate...

The importance of the microbiome in hematooncology patients

Lucie Dlouhá

Onkologie. 2024:18(2):116-120 | DOI: 10.36290/xon.2024.021  

The role of particular bacteria such as Helicobacter pylori in the etiology and pathoge­nesis of lymphoma has been well known, but in recent years the importance of the micro­biome complex (made up of 10¹³ to 10¹⁸ microbes that inhabit the human body) has also become apparent. Its effect is mediated by the regulation of the immune system, either by direct action or through produced metabolites. Accumulating data suggest that the composition of the gut microbiota impacts a wide range of disea­ses, inclu­ding cancer. Patients with hematological malignancies often show reduced species diversity and different microbiota composition...

Ruxolitinib in treating polycythemia vera: what is it that we do not know yet?

Petra Bělohlávková

Onkologie. 2024:18(2):121-124 | DOI: 10.36290/xon.2024.022  

Polycythemia vera (PV) is a frequent Ph-negative myeloproliferative disease where the primary therapeutic goals are to reduce and maintain haematocrit below 0.45 and to reduce the risk of developing thrombotic or haemorrhagic complications. Patients are classified into low-risk and high-risk categories according to age and a past thrombotic event. In low-risk patients, only venepuncture can be performed, but in the case of its infeasibility or a significant increase in leukocytes and thrombocytes or progression of splenomegaly, initiation of cytoreductive therapy is indicated. Cytoreductive therapy is always indicated for the treatment of high-risk...

Skin care in oncology patients

Linda Vavříková, Kateřina Libigerová, Renáta Kopová

Onkologie. 2024:18(2):125-129 | DOI: 10.36290/xon.2024.023  

Skin is the biggest organ that indicates internal diseases. Skin and mucous membrane manifestations can be initial symptoms during serious internal diseases. The number of patients living with cancer has increased, and this is the reason, why the skin deserves specific attention. Dermatologic symptoms are very different. We focus on adverse effects during cancer treatment and skin care.

Hepatocellular carcinoma - systemic treatment in 2024

Marián Liberko, Renata Soumarová

Onkologie. 2024:18(2):130-136 | DOI: 10.36290/xon.2024.024  

After years of stagnation since the introduction of sorafenib, the treatment options for hepatocellular carcinoma have expanded significantly, especially in recent years. There are now several first-line treatment options (sorafenib, lenvatinib, atezolizumab + bevacizumab, tremelimumab + durvalumab) as well as more options in second-line treatment (regorafenib, cabozantinib, ramucirumab, pembrolizumab). Immunotherapy is increasingly making its way into the treatment of patients with hepatocellular carcinoma. This article aims to provide an overview of the current treatment options for this disease with a focus on the treatment of advanced stages in...

Adverse effects of radiotherapy and radiobiological modelling

Zdeňka Pechačová, Radka Lohynská, Tomáš Kořínek, Tereza Drbohlavová, Miloslav Pála

Onkologie. 2024:18(2):137-141 | DOI: 10.36290/xon.2024.025  

Radiotherapy is one of the most effective modalities of cancer treatment, however its application is associated with the risk of adverse effects. When planning radiation treatment, it is essential to spare the surrounding healthy tissues as much as possible to ensure an acceptable risk of toxicity and to maintain a good quality of life for patients. Radiation side effects result from diverse pathophysiological mechanisms and their severity is modulated by a variety of biological and clinical factors, as well as the applied dose, the size of the irradiated volume, radiomic characteristics or individual radiosensitivity. Based on these parameters, the...

Hypophosphatemia - an overlooked electrolyte

Ondřej Lukáč

Onkologie. 2024:18(2):142-144 | DOI: 10.36290/xon.2024.026  

Phosphorus is one of the so-called macronutrients and is found in all living cells. Phosphate is often overlooked during electrolyte testing and is more likely to be examined in suspected cases of Tumor lysis syndrome (TLS), where it is typically elevated. However, hypophosphatemia is often underestimated. Yet phosphate plays an important role in the body in energy production (in the form of ATP - adenosine triphosphate), bone building and also has a role in regulating the affinity of haemoglobin for oxygen as 2,3-bisphosphoglycerate. With the following case report, I would like to highlight the importance of measuring phosphatemia and the benefit...

Atypical intradermal smooth muscle tumor (cutaneous leiomyosarcoma): a case report

Vladimír Bartoš

Onkologie. 2024:18(2):145-148 | DOI: 10.36290/xon.2024.027  

Introduction: Atypical intradermal smooth muscle tumor, also called cutaneous leiomyosarcoma, represents a very rare oncodermatological entity. Due to indolent clinical behaviour it is classified as a tumor of uncertain malignant potential. Case report: A 63year old man presented with a papular skin tumor arising on the extensor size of the upper part of his left arm. The patient claimed that the lesion had been growing for several years. The tumor was completely removed by surgical excision. Histology revealed an intradermal nodule composed of a solid neoplastic smooth muscle population that exhibits focal nuclear atypia, slightly increased...

Coping strategies in older adults with cancer - implications for nursing care

Olga Klepáčková, Jana Gabrielová, Martina Černá

Onkologie. 2024:18(2):149-151 | DOI: 10.36290/xon.2024.028  

Older adults with cancer represent a large non-homogeneous group of patients with specific characteristics that also relate to their coping with stress and challenging life situations. These coping strategies are affected not only by the type of disease, overall difficulty of treatment, and prognosis but also by biopsychosocial factors typically associated with old age, personality characteristics, and previous life experiences. Strategies for managing the stress of older adults with cancer represent an effect that, by its impact, interferes with all areas of complex care, including nursing. Its reflection can contribute to more effective management...

Brief history of ovarian cancer treatment

Monika Náležinská, Renata Kalábová, Josef Chovanec

Onkologie. 2024:18(2):152-158 | DOI: 10.36290/xon.2024.029  

In this article we present an overview of available facts about the treatment of ovarian cancer in the territory of the current Czech Republic. We used data stored in paper form in the mother institute of the authors as well as data from the internet database Medvic. We present a brief history of all known therapeutical modes in ovarian cancer treatment: cytoreductive surgery, radiotherapy, systemic chemotherapy, immunotherapy, target therapy.