579
ONKOLOGIE3418040010760120167227269329388409453
/8408040010731
Onkologie.9168040010761110147195214263313331375390
2025;19(4):246-2491326804001074487128172185223260284326347362406446492521560600642
/20138040010732
www.onkologiecs.cz48658040010765133201214262311348396415464514532576617652669709748
2461248020012657115174
SDĚLENÍ341200012656130188244301376409
Z772200012659
PRAXE853200012660123195263321
Toxicita34136001063068104121156173205242
kombinované59836001063473127162180221262299336377409
imunoterapie102336001061569109150191222254290331366383415
ipilimumabu1454360010615506798115169210263304339381
a1850360010638
nivolumabu19043600106395795134166205259300335376
u2296360010639
pokročilého235136001063273109145186221239270302343384
renálního275136001063365107147177219237278318
karcinomu308536001063476111146163204245299339
Toxicita3409200298132252371436542607693820
kombinované120892002981302644696116758149501072119713351460
imunoterapie27179200298662704085476837708959861109125113151440
ipilimumabu4205920029866208272336400604742947107212141352
a34011800298127
nivolumabu5151180029814120433046352866687199611381276
u184011800298139
pokročilého202811800298143281410503640748813877100211421279
renálního335511800298912173574825466847488921028
karcinomu4432118002981302563454525176567929971135
Michaela3401580013793124173238296354385443
Tkadlecová,8051580013761120179244274333383446502560590
Luboš14171580013756119185249297
Mastný17361580013793152199240305360
Onkologická3401740013376137188247273333395420469519573
a9361740013353
radioterapeutická1013174001333689150175235271325360413475531591627652701752805
klinika1842174001335178103163188239293
Fakultní21581740013354102153213239274335360
nemocnice25411740013361116208268318378403451505
Plzeň3069174001335983129184245
Systémová340225001214994133167216300355402451
protinádorová816225001215790145178201256304360416448503550599
imunoterapie14402250012124107162217272305354387436492516566
(IT)2032225001212851101132
je2190225001212475
dnes22902250012157112162202
základem2518225001214292139164212268319402
systémové2946225001214088127161210294349396445
léčby3417225001212474119176222
pokročilého36652250012157113340239001214781136182205228279335390
renálního759239001213282138186210265289346401
karcinomu.1189239001214796129173196252307391446467
I16852390012124
přes1737239001215790140180
její194523900121247599122
velký2096239001214897121168219
přínos2343239001215790114169225264
nelze26352390012156107131174224
zapomínat2887239001214393150206290314369418450
na33662390012155104
toxicitu3498239001213387133157202225258313
s3402530012140
ní409253001215679
spojenou.517253001214097154178229285341397419
Tato964253001215093126180
kazuistika1173253001214797141197221260294318365415
pojednává16172530012157114138189247303352399448
o20942530012155
51letém2178253001215299117168202252337
pacientovi25432530012158107153176227283316371419443
s30152530012140
generalizovaným30832530012157108164215249298322345389444492541597643728
světlobuněčným340267001214091142176200257316373430482529586633719
karcinomem1089267001214899132178202259316402454540
ledviny.1658267001212476135185210267314331
U20192670012166
pacienta21152670012158108154178230287321371
byla25162670012158106131181
indikována2726267001212481139164212267316366423472
imunoterapie32282670012124109166223279313364398448507531583
v3402810012149
kombinaci4182810012148102188245270326375421444
monoklonální8922810012184141197254302328384441490514570594
protilátky1515281001215891147181204228277310358409
proti1953281001215892148181205
antigenu21872810012149105138162219271327383
CTLA-425992810012159113162226258314
(ipilimumab2942281001212952109134158181266322407456514
v34852810012149
dávce35632810012157106154198248
13402950012151
mg/kg)4042950012183139174222277304
a7262950012149
protilátky793295001215790145178201224272304351401
proti1213295001215790144177200
receptoru1432295001213383128177234267321354410
programované1861295001215689144201233282365420467516571621
buněčné25012950012157113168218264319369
smrti28892950012140123155191214
PD-131222950012153118152198
(nivolumab3338295001212981104153207231285368417473
33403090012152
mg/kg).4053090012184141176225280307326
Léčba760309001214798144201251
byla10393090012158105129178
v12463090012148
počátku13233090012157114160209242289345
dobře16973090012157113171204254
tolerována,1980309001213388112163197252300349405453475
ale2484309001214872123
po26363090012157114
podání27783090012158114172221277300
431073090012152
cyklů3188309001214595143169224
uvedené34413090012155104154212263319370
kombinace3403230012147101184241265320368413462
došlo8283230012157112151175230
k10853230012146
rozvoji1158323001213387129180234258281
gastrointestinální14663230012155104143176209264287342375424463497520575623647702725
toxicity2218323001213387132156200223256306
3–425513230012151102157
stupně2735323001214073128185241291
–30533230012150
průjmovité3130323001215689145168252307354378411460
onemocnění361732300121551111613403370012183139184239290345368
s7353370012139
četností801337001214493127182237276310333
10–151161337001215198151196241
stolic1428337001214074128152175219
denně.16743370012156106162217268287
Dle1987337001216791142
doporučených21553370012156111169225257313358407462508552607
postupů27883370012157113152186241298353
byla31673370012157104128176
u33693370012155
pacienta34513370012156105150173223279311360
imunoterapie3403510012123107161217272305354387435492516566
přerušena927351001215789139172227266317372420
a13683510012148
zahájena1437351001214393148196220270326374
léčba1832351001212374119176224
kortikosteroidy20773510012147101134170193239293332366415448503526583630
(KS)2728351001212982133160
s29093510012140
částečným2970351001214593132166215261316362446
ústupem3437351001215594128182239290374
potíží.3403650012157114147171214238259
Pacient6283650012153101146170220276309
byl9663650012157104129
dále11243650012156105129180
indikován1332365001212480137160208262310359414
k17753650012147
provedení1851365001215791146194243301352408432
koloskopie23113650012148102126182222269323381405456
s27953650012140
odběrem28643650012155113170222255306390
biopsie3283365001215781137194234257308
a36203650012148
při3697365001215791114
průkazu340379001215790146193242286341
autoimunitní7103790012148103136191214298353409432465521544
kolitidy12833790012147101125148181205261309
k16213790012147
podání16963790012157114171219275298
infliximabu.2023379001212379108134158205229312361418473495
Nález25463790012166115138189233
byl28073790012157104128
ovšem29643790012155102142193277
komplikován32693790012147101185242266290336391438487542
nasedající3403930012155101139189245291314337380402
cytomegalovirovou759393001214492128180262312367414436490536559591644690742796
(CMV)1572393001212882161215245
kolitidou,1834393001214698122144176198253307361381
podání22313930012157111167214268290
infliximabu2538393001212377105130152198221302349404459
tedy3013393001213381137183
nebylo32133930012155104160205228282
možné.35123930012182136177231280299
Při340407001215385108
opakovaných4724070012155113161208262309357413458502557
pokusech10534070012157113160216255305351406
o14834070012155
snížení1562407001214095118161211266290
dávky18764070012156104151198248
KS21484070012155106
docházelo22784070012157112157212260304354378433
k27354070012147
recidivám2806407001213383128151208231279328411
průjmů,3241407001215790145169252307328
navíc35934070012155103150174218
komplikovaných340421001214698180235258280325377423470523567610663
clostridiovou1020421001214466119157190221244299321374420472526
kolitidou.1562421001214698121143175197252305359379
Po19584210012152103
prolongované2078421001215687140163217271325379425472525574
kortikoterapii2669421001214698129164186231283315363394441496519541
došlo32264210012156109147170223
nakonec34664210012154101146198252301345
k3404350012147
neúplnému4114350012156106161218242297348431486
ústupu922435001215594127182239295
obtíží,12414350012155112145168211235255
dle1520435001215780130
kontrolní16754350012147101156189221276300355378
koloskopie20774350012147101125180219266319377400450
byla25524350012157103127175
sliznice275243500121396386128184207252301
tlustého3077435001213356111150184233289344
střeva3445435001214074106156204252
se3721435001214091
zachovalou340449001214393137192248295343367422477
architektonikou837449001214880125180203236285332368422478501547601656
a15134490012148
se1581449001214090
smíšenou16914490012140123146187237293348403
zánětlivou2114449001214393148198232255278326380435
infiltrací2569449001212479108134157190223271316339
lamina2928449001212371154178233281
propria.3229449001215790144201234258306327
Tento3576449001214993149181235
stav340463001214073122169
umožnil5334630012155138194236291314338
opětovné8954630012155112163196250297354404
zahájení1323463001214393148196220270326349
onkologické16964630012155111157211235290347370415461510
léčby,2231463001212374119176222238
tentokrát2493463001213483138171225272306355387
inhibitorem2904463001212479134157214238271325358408491
tyrosinkinázy34194630012134831171712112342893353603404770012155103147197
VEGFR,5634770012156106170219271294
cabozantinibem,883477001214593150206248298353385408464487543594678699
který1608477001214783132165215
pacient18494770012157106151174224280312
toleruje2187477001213387111162194250274324
bez25374770012157108151
potíží.27154770012156112145168211235255
Dle2997477001216691141
restagingových3164477001213383122156205261284339395451498548592647
vyšetření340491001214899138189222254304360383
přetrvává744491001215790139173205257305352400
parciální11654910012157106138183206253277332355
regrese1541491001213383139172222261312
nálezu.18744910012155103127177221276297
Klíčová340507001246189117161219270323
slova:679507001244471129181233258
renální955508001213382137185208262285
karcinom,1258508001214695127171194248303386407
toxicita1682508001213387131155199222255303
imunoterapie,20025080012124106161215270303351384432488512561581
nivolumab,2600508001215678126180203258340388444464
ipilimumab,3081508001212380103126149231285368416472491
autoimunitní359050800121481021351883405220012123107161217240273328351
kolitida.7125220012147101125148181204261309330
Toxicity3405480012455106157185231259296350
of711548001245792
combined8235480012445103189250278337390450
immunotherapy12935480012428114200259318376413473526565618678729
with20425480012476104141201
ipilimumab2263548001242788115143171257316402456516
and27995480012453111171
nivolumab2991548001245886139196224283369422482
in340561001242786
advanced4465610012453113167220279324377437
renal903561001243892151204232
cell1155561001244598126154
carcinoma1329561001244599137183211270328414468
Systemic340579001214992131164212294317361
Antitumor7185790012160115146169201255337391423
Immunotherapy11585790012124106188241296350382436485518565621666
(IT)1841579001212850100130
is1988579001212361
now20665790012155109181
the2264579001213387136
cornerstone2417579001214497129184234266305338391446496
of2930579001215482
systemic3029579001213987125158207289311355
treatment3401579001213365113161192274324379410
for340593001213085119
advanced4885930012149107156205261307357415
renal933593001213383140189213
carcinoma.1175593001214595128173196253309394443464
Despite16695930012167119159217241275325
the2023593001213389141
significant2193593001214063120177200230257303352408441
benefits26635930012158110167218248275309350
of3042593001215686
this3157593001213389113152
therapy,3339593001213389140174223281328345
its371359300121245799
associated340607001214887126182227250298330380437
toxicity800607001213387132156201224257307
must11306070012183138177211
not13646070012155111143
be15306070012157109
overlooked.16626070012155102151184207263318366414472493
This21786070012149106129168
case2369607001214593132183
report2575607001213282139195228264
discusses2862607001215780118164218257296347386
a32726070012148
51-year-old3343607001215198125172222270302330387411468
patient3406210012158107140164215271304
with673621001217499132188
generalized8906210012157108164215249298322346389440498
clear1417621001214569120169202
cell1648621001214595119143
renal1820621001213383140189212
carcinoma.2061621001214695128173196252308393442464
The25546210012150107158
patient27416210012158107140164215271304
was30746210012174124163
indicated3266621001212480137161207256289339397
for3692621001213085119
immunotherapy3406350012123106190245300355388443493526575631678
in1036635001212479
combination1134635001214598182239262318366398421476532
with1684635001217498131186
a18896350012148
monoclonal19566350012183138194249295318373429477500
antibody24756350012148103136159215271328376
against28706350012148104152175230269303
the3192635001213388138
CTLA-433496350012158110158222253307
antigen36756350012148103340649001213355111161216
(ipilimumab573649001212850106129152175257311394441497
at1088649001214880
a11856490012148
dose12516490012155110149199
of1467649001215583
115686490012151
mg/kg)16306490012183138173220274301
and19486490012148102158
an21246490012148102
antibody22446490012148102134157213268325372
against26336490012148103151173228266300
the2950649001213387137
programmed3105649001215689143199231279361443493550
cell3672649001214593117140
death3406630012156107155187242
receptor606663001213282128177234267321354
PD-19836630012153119153198
(nivolumab1204663001212981104152206230285368416473
317006630012152
mg/kg).Initially,17646630012184140175223277304323348404427460483531554577624641
the2428663001213388138
treatment2590663001213365115163196279330385418
was30316630012173122161
well32156630012174123147170
tolerated,3409663001213387111161194243275324382402
but3406770012157112144
after502677001214876112161194
four713677001212984138171
cycles901677001214594137160210249
of1167677001215584
the1268677001213388138
mentioned14236770012183133188220243298353403459
combination,1900677001214598181237260315363395417472527547
the2465677001213388137
patient26206770012157105137160209265297
developed29346770012156106153202225280337387444
grade3396677001215587135192241
3–436556770012151101156
gastrointestinal3406910012156104143177209264287343375424464498521576624647
toxicity1008691001213387133156201224257307
–13366910012150
diarrheal1407691001215780128160193249299347371
disease1799691001215679118168217256306
with2126691001217497131186
a23336910012148
frequency2402691001212963113170225275331375425
of2848691001215584
10–152953691001215298152197242
stools3216691001213973127183207246
per34836910012157108141
day.36456910012156104150166
Following3407050012149103127150205278301357413
recommended781705001213382128182265349399455512562619
guidelines,14287050012156111134191241265288343394433454
immunotherapy19117050012123106189244300355388443493526575631678
was26177050012173122161
discontinued,2806705001215780118164217273305328384438488546566
and34017050012148103160
corticosteroid3589705001214598131167190340719001214598138172221254308332388
(CS)755719001212884134161
treatment943719001213366115163196279330385418
was13887190012173122161
initiated,1575719001212479102135158206239288345366
leading1968719001212374122178201257313
to2307719001213488
a24217190012149
partial24967190012157106138174197245269
resolution2791719001213383122178202256290313368423
of3241719001215584
symptoms.3352719001213988172229262316399438459
The3407330012150106157
patient5197330012157105138161211267299
was8407330012174122161
subsequently1023733001214094151191241298353403459491515562
indicated1607733001212379135158203252284334391
for2020733001212984117
colonoscopy2159733001214599123178234289328373427484530
with2711733001217498131186
biopsy2919733001215781136193232280
sampling,3221733001214089172229253276331387408
and36517330012148104160
upon3407470012155112168224
confirmation583747001214498154183209241325373406429484539
of1142747001215483
autoimmune12457470012148102135189213296379434489540
colitis,1804747001214598122145179202240261
infliximab2085747001212378107133156203227310358415
administration25197470012148105188211267290328362395443476499554609
was31487470012173122161
considered.3328747001214598154193216272322355405462483
However,3407610012165119191240287335368383
the740761001213388137
findings895761001212854109164187241297335
were12477610012173122154203
complicated1467761001214598180236260282326374406455511
by19957610012157102
concurrent2115761001214497152196250282315364419450
cytomegalovirus2583761001214493129182264314370418440495541565596651689
(CMV)3290761001212883162216247
colitis,3554761001214497121143176198237257
making3407750012183132178203258314
infliximab679775001212479108134157204228311359416
administration11197750012149105188212267290329362395444476499554610
impossible.17547750012123106163219258297320377401451471
Repeated22507750012154104161213261293342400
attempts2674775001214981117166249306339380
to3079775001213387
taper3190775001213482139190223
CS34387750012158108
doses35707750012157112151202241
DECLARATIONS:4068227008648871301662142563043393604124625014570227008514
Declaration406824100874987120141179206244271291333375
of445724100874066
originality:45372410087406888130150192230251271298337356
The406825200853473109
manuscript418825200855891130168195227249266306329
is452825200851744
original45832520085386178117133172205222
and481625200853472112
has49392520085387299
not50502520085387699
been516125200853975110149
published532225200853977117134150177216251291
or406826300853862
submitted414526300852867108167184208234269310
elsewhere.44702630085355381117169209245269305320
Ethical406827700873764107127160198218
principles43002770087427090132165185228249287319
compliance:463327700873173134177197218256298330368387
The406828800853678116
authors420528800853475100142183208238
attest44642880085356087124153179
that466428800852465101126
their481128800852465103121146
study49782880085295595138173
was517328800855389118
approved531228800853577120145186221258301
by406829900854073
the41582990085236399
local42742990085175689124141
Ethical44322990085345898115147182199
Committee464829900854179139198215239265300337
and500229900853373113
is513229900851745
in519429900851656
compliance526729900853169129169187204239278311346
with40683100085537298140
human423631000854081143180221
studies44863100085285596139157195226
and474031000853577119
animal48883100085347695156193212
welfare512831000855391110133170196234
regulations53903100085236110414516420140683210085234080120148
of423532100853960
the43153210085236399
authors’44343210085347397136176200229244
institutions46983210085165684109126150189213231270310338
as505632100853462
well513832100855187104122
as527932100853462
with53613210085526993133
the55143210085236299
World406833200856099124142184
Medical427333200855795137155188224242
Association453533200854474104144178196231256273314355
Declaration491133200854785119136172196232257274315356
of528833200853961
Helsinki537033200854684102131149189224243
on406834300853878
Ethical41653430085355898115147182199
Principles43833430085376178117150167207225261290
for46923430085205983
Medical479434300855693134151183218235
Research504834300853874102139173197229268
Involving53353430085175690128146181198238278
Human406835400854685145179219
Subjects430735400853474114132168201227256
adopted458335400853474114155179215256
by485835400854074
the49523540085236399
18th507135400853669514135400501437
WMA5198354008559116160
General537835400854582122158182217235
Assembly406836500854475105143204247266302
in439336500851758
Helsinki,447436500854785104134152193228248264
Finland,47613650085355394113149190232249
in503336500851758
June511536500852667109147
1964,528536500853771110150166
with54743650085537297139
subsequent406837600852867107136172213252288328352
amendments,443737600853493130169210269305345369398414
as486837600853462
well494837600855287105122
as508837600853362
with51673760085526993133
the53183760085236298
ICMJE543437600851759116143179
Recommendations406838700853977112153216278317359402439465483525568598
for46973870085226389
the481838700852466104
Conduct,495438700854283125168210245272290
Reporting,527538700853978121163189217236278321338
Editing,40683980085347491115132172212227
and430839800853373113
Publication443439800853776117134151183218242259298338
of478539800853859
Scholarly485739800853467106146163198221239273
Work514239800856097121155
in531039800851656
Medical537839800855693134151183218235
Journals,406840900852666105129169204221249265
updated435340900853980121155179215256
in462940900851656
December470540900854683116151211252289313
2018,503740900853673107140156
including52134090085165689106145186203243283
patient55164090085407540684200085234076116140
consent422242000853270110138174214238
where447542000855191127151187
appropriate.467742000853474115139178219243260295318354369
Conflict406843400874282124149171191223251
of433443400874065
interest44134340087196288126154192224251
and467843400873779122
financial48144340087244587125167200220258279
disclosures:51074340087416293126147188220261289327359378
None.406844500854686126162177
Funding/Support:406845800873777119162183225267291329371414457499526554574
None.406847000854686126162177
Cit.4068714008541588297
zkr:41807140085306489105
Onkologie.429971400864991127167186227268287324342
2025;19(4):246-249465571400863876113151167203238260296317334372410449474509547585
https://doi.org/10.36290/xon.2025.046406872500853962881291571721982194284725008641811004385725008514547811714345287250086387390130169206244283307342382423441481519556594611650689729
Článek40687360085415892132168202
přijat4285736008539638198132156
redakcí:445673600852359100134168199216231
23.47017360085367388
3.480473600853650
2025486973600853672107144
Článek40687470085415892132168202
přijat4285747008539638198132156
k4456747008533
tisku:45047470085234068101141156
10.46757470085366984
4.477474700853651
2025484074700853672107144
MUDr.4068766008759108158186202
Michaela428476600875980113155193231252290
Tkadlecová458876600873978116159179217250291329367
tkadlecovam@fnplzen.cz40687770085235792132150186219257291326385438460500541558589625665681713745