Non-small cell lung cancer (NSCLC) with a KRAS mutation is the most common type of lung tumour with a sensitive mutation. At the same time, KRAS mutation is associated with a poor prognosis for patients. Therefore, the outlook for longer survival of patients with KRAS-mutated metastatic NSCLC has not been good for a long time. However, the prognosis of these patients has changed dramatically in recent years. The possibility of immunotherapy treatment as well as targeted treatment using tyrosine kinase inhibitors for the KRAS G12C point mutation has increased prognosis of this patients. The article presents these option of targeted therapy for the second line of treatment and also points out a comparison with previously used chemothe­rapy. The possibility of developing resistance to targeted treatment is also discussed. Last but not least, the text also describes the prospects for the near future with the expansion of targeted treatment options beyond the KRAS G12C point mutation.

The authors describe a clinical case of a patient with metastatic melanoma treated with the targeted therapy by encorafenib and binimetinib. In the very beginning of the treatment, the ocular toxicity in the form of the bilateral detachment of the outer retinal layers was detected. Subjective symptoms disappeared in 2 months and follow-up OCT confirmed the restoration of the detachment. The targeted therapy with dabrafenib and trametinib in the subsequent line of the treatment was not complicated by the symptoms of the ocular toxicity. The article discusses the ocular toxicity of the targeted therapy in melanoma, its types, grading, and management. During each patient's visit in case the patient is treated with the targeted therapy by BRAF and MEK inhibitor, the patient should be asked about any subjective vision impairment. The close cooperation with the ophthalmology specialist is crucial for the early and correct diagnosis of the ocular toxicity.

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.

This case report describes a patient in whom initial treatment with immunotherapy followed by targeted therapy was associated with limited efficacy. Subsequent treatment with a combination of trifluridine-tipiracil and bevacizumab led to long-term disease stabilization with a satisfactory quality of life, with laboratory toxicity being the predominant side effect. At the same time, the results of the Sunlight registration study are discussed, including the effect of combination therapy within individual subgroups, along with real-world data confirming the clinically significant benefit of the treatment for previously treated patients with metastatic disease.

This work deals with a wide range of treatment options for patients with stage III non-small cell lung cancer (NSCLC). The article discusses the possibilities of surgical solutions, where it points to the irreplaceable role of a multidisciplinary team, especially in patients with positive lymph nodes of category N2. In this part, the possibilities of neoadjuvant/adjuvant chemotherapy or immunotherapy are also discussed. The issue of postoperative radiotherapy is also discussed. In patients who are not suitable for resection, the work deals with the reasons for the preference for concomitant over sequential chemoradiotherapy. Furthermore, the article discusses the addition of durvalumab as a consolidation therapy and some issues related to immunotherapy in this context. The last part is devoted to targeted treatment in patients with stage III NSCLC, especially the study with adjuvant administration of osimertinib.

Antitumor immunotherapy using checkpoint inhibitors brings significant improvement in treatment outcomes for patients with stage III NSCLC. To determine the treatment strategy in stage III, multidisciplinary team decision-making is necessary with the most precise definition of operable vs. inoperable cases. In the case of inoperable stage III, consolidation treatment with immunotherapy is the standard with the condition of PD-L1 expression above 1 %. One-year treatment after concomitant chemoradiothe­rapy significantly increases the chance of long-term survival and has also been shown to significantly prolong the time to disease recurrence. In inoperable and marginally resectable patients, new approaches are now in advanced stages of testing, such as early concomitant immuno-chemo-radiotherapy or induction treatment with chemoimmunotherapy before radiation with subsequent immune consolidation. In inoperable patients with EGFR mutations, concomitant chemoradiotherapy is still the standard, immunotherapy does not provide benefit, but immediately following targeted therapy with osimertinib significantly reduces the risk of recurrence, especially in the brain, and a trend towards prolonged survival is observed. In a significant group of stage III patients who are inoperable and cannot be irradiated with a radical dose, immunotherapy alone is an option, especially in the case of high PD-L1 expression.

One of the fundamental objectives of palliative care is to ensure patient comfort and enhance quality of life in the context of incurable illness. While clinical attention has traditionally centred on the management of physical symptoms, the significance of psychological well-being should not be underestimated. Mental health constitutes an integral component of comprehensive palliative care, influencing the overall care trajectory. Anxiety, depression, and delirium represent the most prevalent psychiatric disorders encountered in palliative settings, each exerting a substantial impact on patients and their families. Despite their high prevalence, these conditions are frequently underdiagnosed or inadequately treated. This review aims to summarize current knowledge on the clinical features, prevalence, and diagnostic challenges associated with anxiety, depression, and delirium in palliative care as well as an overview of pharmacological and non-pharmacological treatment options. This article is intended as a concise resource for inpatient healthcare professionals engaged in palliative and supportive care. Given the scope of the topic, the aim is not to provide an exhaustive or detailed review.

Febrile neutropenia represents one of the most serious and common acute situations in oncology. It is defined as a condition in which a cancer patient's temperature rises above 38 °C for more than 1 hour or rises above 38 °C twice in 12 hours, and the neutrophil count is ≤ 0.5 × 10⁹/l or below 1.0 × 10⁹/l with a further decline expected. These infections tend to be very aggressive and unrestricted, and less frequent viral (e. g. CMV infections) or mycotic infections occur. They therefore represent a significant clinical challenge.

Hypersensitivity drug reactions represent an unexpected complication of oncological treatment. They impair the patient's quality of life and may pose a life-threatening risk. Another negative consequence is the necessity to interrupt the administration of first-line oncological therapy, which, in the best-case scenario, can be replaced with an equally effective alternative. However, when no equally effective alternative exists, the only option to maintain the patient on their primary treatment is desensitization. For successful and safe desensitization, risk stratification based on knowledge of the phenotype, endotype, and biomarkers of the prior hypersensitivity reaction, along with close collaboration between the oncologist and allergist, is essential.

The aim of this article is to provide an overview of the data with regard to the combination trifluridine-tipiracil + bevacizumab in the third line treatment of metastatic disease. The main results of the SUNLIGHT registration study, the current meta-analysis and a subgroup analysis of the SUNLIGHT study are presented. At the same time, data from real-world clinical practice are discussed, including results from our own cohort of patients treated with this combination.

Despite general advances in the systemic treatment of solid malignant tumours in recent decades, limited-stage small cell lung cancer has remained one of the few in which novel types of anticancer therapy (immunotherapy or targeted therapy with tyrosine kinase inhibitors) had not been implemented into the therapeutic algorithm. This was logically associated with a limited progress in the parameters of overall survival, speci­fically the 5-year survival rates of patients. Currently, we are witnessing the introduction of adjuvant immunotherapy after chemoradiotherapy in real-world clinical practice for limited-stage small cell lung cancer. This option was achieved based on the results of the ADRIATIC clinical trial in which durvalumab (a PD-L1 inhibitor) administered in patients after concomitant platinum-based chemoradiotherapy, in whom there was no progression after the initial treatment, was shown to have a statistically significant improvement in the primary endpoints - time to progression and overall survival - compared with the control arm with placebo. This fact was reflected by the regulatory authorities of the European Union in February/March 2025, which recommended the use of durvalumab in this setting.

The Czech Head and Neck Cancer Cooperative Group (CHNCCG) held a meeting in Tabor on 11-12 October 2019 with the aim of reaching an interdisciplinary consensus on some controversial points where international unity is absent. The meeting resulted in recommendations on resection margin size terminology (definition of terms: negative margin, close margin and positive margin) and on the adoption of terminology for neck dissections reporting according to the International Recommendation of the International Head and Neck Scientific Group and on assessment of HPV/p16 status in head and neck tumors.

Basal cell carcinoma (BCC) is the most common skin tumor in fair-skinned people with a constantly increasing worldwide incidence. Patients with BCC represent a great burden on the health care system, because of their high incidence, which constantly increases the costs of the provided health care. It is therefore very important to work on the continuous improvement of preventive programs dedicated to the issue and solving the growing problem of skin cancer.

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 and high-risk disease according to IPI prognostic index. CAR (chimeric antigen receptor) T-cell therapy is approved for primary progressive disease and early relapses up to 12 months after the first-line treatment. The salvage platinum-based regimen with consolidation treatment using the high-dose chemotherapy and autologous stem cell transplantation for younger and fit patients remains the standard of care for late DLBCL relapses. The spectrum of therapeutic strategies in the third and subsequent lines of treatment is expanding with innovative treatment options, including bispecific antibodies, and other targeted therapy. Thanks to these advances, the strategy for third-line treatment is now shifting from palliative to curative intent.

Monoclonal gammopathy of undetermined significance (MGUS) is characterized by the presence of a monoclonal protein (M-protein) without evidence of multiple myeloma (MM), Waldenstrom‘s macroglobulinemia (WM), amyloidosis (AL), or a related plasma cell proliferative disorder. MGUS is found in approximately 3 % of persons > 70 years of age and in about 1 % of those > 50 years old. At Mayo Clinic from 1960 through 1994, the risk of progression was 1 % per year. This risk of progression continued even after  of a stable M-protein. The risk for developing MM, WM, or AL was increased 25-fold, 46-fold, and 8.4-fold, respectively.  The concentration of the serum M-protein, abnormal serum free light-chain ratio, and the presence an immunoglobulin (Ig)M or an IgA M-protein were risk factors for progression. The presence of a urine M-protein was not a risk factor for disease progression. Variants of MGUS consist of IgM MGUS, biclonal gammopathies, triclonal gammopathies, idiopathic Bence Jones (light-chain) proteinuria, and IgD MGUS. Monoclonal gammopathy of undetermined significance may be associated with many disorders, including lymphoproliferative diseases, leukemia, von Willebrand‘s disease, connective tissue diseases, and neurologic disorders. MGUS results from a small and/or quiescent secreting B-cell clone, is completely asymptomatic, and requires regular monitoring only. Sometimes, although plasma cell are quiescent and not requiring any treatment per se, the clone is associated with potentially severe organ damage due to the toxicity of the monoclonal immunoglobulin or to other mechanisms. The latter situation is increasingly observed but still poorly recognized and frequently undertreated, although it often requires rapid specific intervention to preserve involved organ function. To improve early recognition and management of these small B-cell clone-related disorders, autors from Mayo Clinic proposed to introduce the concept of monoclonal gammopathy of clinical significance (MGCS). This report identifies the spectrum of MGCSs that are classified according to mechanisms of tissue injury. It highlights the diversity of these disorders for which diagnosis and treatment are often challenging in clinical practice and require a multidisciplinary approach. Principles of management, including main diagnostic and therapeutic procedures, are also described. Importantly, efficient control of the underlying B-cell clone usually results in organ improvement. Currently, it relies mainly on chemotherapy and other anti-B-cell/plasma cell agents, which should aim the best hematological response. Combinations of daratumumab with other anti-myeloma drugs may be best solution. High immunomodulatory dosis of IVIGs can help in failure of the anti-plasma cell therapy.

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 the health condition assessment for the purposes of awarding the special aid allowance to specialist and general practitioners so that the entire procedure for the applicant would be simplified.

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.

Monoclonal gammopathy of undetermined significance (MGUS) is characterized by the presence of a monoclonal protein (M-protein) without evidence of multiple myeloma (MM), Waldenstrom‘s macroglobulinemia (WM), amyloidosis (AL), or a related plasma cell proliferative disorder. MGUS is found in approximately 3 % of persons > 70 years of age and in about 1 % of those > 50 years old. At Mayo Clinic from 1960 through 1994, the risk of progression was 1 % per year. This risk of progression continued even after  of a stable M-protein. The risk for developing MM, WM, or AL was increased 25-fold, 46-fold, and 8.4-fold, respectively.  The concentration of the serum M-protein, abnormal serum free light-chain ratio, and the presence an immunoglobulin (Ig)M or an IgA M-protein were risk factors for progression. The presence of a urine M-protein was not a risk factor for disease progression. Variants of MGUS consist of IgM MGUS, biclonal gammopathies, triclonal gammopathies, idiopathic Bence Jones (light-chain) proteinuria, and IgD MGUS. Monoclonal gammopathy of undetermined significance may be associated with many disorders, including lymphoproliferative diseases, leukemia, von Willebrand‘s disease, connective tissue diseases, and neurologic disorders. MGUS results from a small and/or quiescent secreting B-cell clone, is completely asymptomatic, and requires regular monitoring only. Sometimes, although plasma cell are quiescent and not requiring any treatment per se, the clone is associated with potentially severe organ damage due to the toxicity of the monoclonal immunoglobulin or to other mechanisms. The latter situation is increasingly observed but still poorly recognized and frequently undertreated, although it often requires rapid specific intervention to preserve involved organ function. To improve early recognition and management of these small B-cell clone-related disorders, autors from Mayo Clinic proposed to introduce the concept of monoclonal gammopathy of clinical significance (MGCS). This report identifies the spectrum of MGCSs that are classified according to mechanisms of tissue injury. It highlights the diversity of these disorders for which diagnosis and treatment are often challenging in clinical practice and require a multidisciplinary approach. Principles of management, including main diagnostic and therapeutic procedures, are also described. Importantly, efficient control of the underlying B-cell clone usually results in organ improvement. Currently, it relies mainly on chemotherapy and other anti-B-cell/plasma cell agents, which should aim the best hematological response. Combinations of daratumumab with other anti-myeloma drugs may be best solution. High immunomodulatory dosis of IVIGs can help in failure of the anti-plasma cell therapy.

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 and undesirable additive effects.

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 stable tumors, but negative results from several recently published studies indicate the need for further research before implementation into clinical praxis. Promising results were seen with novel generation of immunotherapy agents.

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 of the immunoglobulin heavy chain variable region (IGHV) are very useful in refining the prognosis of individual patients. These markers can also help to tailor the treatment, thus becoming predictive factors. The therapeutic approach to CLL has undergone truly revolutionary changes over the last 20 years: from chemotherapy to chemoimmunotherapy through addition of the anti-CD20 monoclonal antibodies rituximab or obinutuzumab, which for the first time in the history of CLL treatment has led to prolonged overall survival, to new, oral targeted agents, in particular regimens based on the BCL-2 inhibitor venetoclax with an anti-CD20 antibody and the Bruton's tyrosine kinase inhibitors ibrutinib and acalabrutinib. These targeted inhibitors are now considered the standard choice for relapsed/refractory CLL and have largely replaced chemoimmunotherapy from first-line treatment in the vast majority of patients as well. Chemoimmunotherapy (especially the combination fludarabine-cyclophosphamide-rituximab [FCR] in younger fit patients without comorbidities) can still be considered as a treatment alternative in a selected group of previously untreated patients with a biologically highly very favourable prognosis (mutated IGHV gene and favourable cytogenetics, e.g. del 13q).

Breast cancer (BC) and pregnancy can be viewed from several perspectives (see points below). Current knowledge and recommendations by their complexity include all of them and can be summarized as follows: 1. Pregnancy planning in women after treatment for BC: „„there is no doubt about the safety of pregnancy in women after treatment of BC, „„the optimum gap between treatment of BC and pregnancy is the subject of ongoing studies. 2. Fertility preservation in BC patients: „„optimal strategy includes oocyte/embryo cryopreservation in the period prior to chemotherapy and LHRH analogue administration during its course. 3. Management of gestational BC treatment: „„gestational BC therapy should mimic as much as possible the treatment of non-pregnant women, „„chemotherapy can be applied in the 2nd and 3rd trimester of pregnancy, breast surgery and sentinel node scintigraphy is generally possible at any time during pregnancy, endocrine therapy, targeted anti-HER2 therapy must be postponed for the postpartum period, „„induction of abortion has no effect on the prognosis of mother.

Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with immunoglobulin M (IgM) monoclonal protein. Clinical features include anemia, thrombocytopenia, hepatosplenomegaly, lymphadenopathy, in advanced disease hyperviscosity, kryoglobulinemia, B-symptoms and in rare cases the disease can infiltrate CNS (Big-Neel syndrom) or lungs. Presence of IgM monoclonal protein associated with clonal lymphoplasmacytic cells in bone marrow confirms the diagnosis. The L265P mutation in MYD88 is detectable in more than 90% of patients and is found in the majority of IgM MGUS patients. Not all patients who fulfill WM criteria require therapy; these patients can be observed until symptoms develop. Standard therapy is antiCD20 antibody with combination with bendamustine or cyclophospamide and dexamethasone or antiCD20 antibody with a proteosome inhibitor. In patients with early relaps after this therpay we use ibrutinib. Purine nucleoside analogues are active but usage is declining in favor of less toxic alternatives. In the 2022 we prefere for induction rituximab and bendamustine and in case of rituximab intolerance we used obinutuzumab. Given WM‘s natural history, reduction of therapy toxicity is an important part of treatment selection.

Multiple myeloma (MM) is a hematological malignancy characterized by renal insufficiency, bone lesions, anaemia, and hypercalcemia. In this modern era of medicine, even with the development of drugs like immunomodulatory drugs (IMiDs) and proteasome inhibitors (PI), the treatment of MM prevails as a challenge. However, even after the attainment of total remission, relapse of MM and disease progression is frequent. That is why there is an urgent requirement to develop novel monoclonal antibody drugs. The latest drugs for the treatment of relapsed and refractory MM (RRMM) approved by the Food and Drug Administration (FDA) is daratumumab. In this article, we will discuss daratumumab with different combination therapies in multiple myeloma, but also in other indications. Information about the efficacy in various type of Monoclonal Gammopathy of Clinical Significance are reviewed. Several studies tested daratumumab in autoimmune diseases with positive results. The goal of this publication is to give information about all indication in which daratumumab was tested with positive results. And we alsou inform about our own experiencies with daratumumab, lenalidomide dexamethasone in 74 pacients treated in the year 2018-2021.

Background: Breaking bad news is a common situation in the care of cancer patients and is challenging for both patients and healthcare professionals. Despite the fact that every patient or situation is unique there are generally valid rules of communication which can be considered as skills and it is possible to learn them. Purpose: The aim of this contribution is a brief description of tools for more confident communication - the protocol for breaking bad news SPIKES and the strategy for responding to emotions NURSE. Good management of specific communication situations in oncology significantly contributes to better patient compliance, prevents conflicts and reduces frustration and exhaustion of healthcare professionals.

Changes in the composition of human society and the living conditions in which people live are causing changes in the social meaning of illness. In a certain period, specific serious health problems come to the fore and the health service has to focus on them more intensively to bring them under control and gradually eliminate them. However, other diseases will then take their place, which will once again trigger the attention of public authorities, who must focus on tackling the next major challenge to population health. The First Czechoslovak Republic provided an opportunity for a general political, social and socio-economic modernisation of society, which was also reflected in the field of health service. After the construction of the new health system and its stabilization in the mid-twenties, a qualitative change took place in the field of health service, which shifted health care towards its modern concept based on health care for the overall health of the population. The main interest of the Czechoslovak health service in its preventive health activities could thus also focus on serious chronic diseases, including cancer.

Over the last decade, immunotherapy has been established as part of various treatment algorithms across solid tumors. And although the use of checkpoint inhibitors like anti-PD-1 and anti-CTLA-4 receptors and anti-PD-1 ligand provides a therapeutic benefit, there is still a large group of patients in whom this therapy is not effective. Further research is currently underway to find other possible ways to make improvements. In the following article, we present less known checkpoint inhibitors which have therapeutic potential in the near future.

Diagnosis of cutaneous lymphomas is one of the most complex and difficult parts of hematopathology particularly due to widerange of differential diagnosis from group of benign inflammatory lymphoproliferative lesions. Besides morphology, the diagnosisrely upon using immunohistochemisty, in situ hybridization (including fluorescent ISH) and molecular methods, mainly polymerasechain reaction (PCR) testing, to determine the type of B-cell receptor and or T-cell receptor rearrangement in particular.Nevertheless, there still exists a variety of overlapping and lymphoma-like appearing entities which needs to be rule out be forestablishing a diagnosis of malignit lymphoma. Next to the help of ancillary studies, clinical correlation and relevant clinical datasent to the pathologist are one of the most important clues in lymphoma diagnosis. This review article provils an overview ofdiagnostic possibilities in lymphoma diagnosis including current classification of cutaneous lymphomas as well as points outpossible pitfalls and troubles in terms of differential diagnosis of the most common types of cutaneous lymphomas.

Men with non-metastatic castration-resistant prostate cancer with short doubling time PSA are at risk for early disease progression. Results of new clinical studies with antiandrogens II. generations such as apalutamide, enzalutamide, darolutamide have been shown to delay the onset of metastatic disease and prolong survival in these patients.