Magyar onkologia最新文献

Immuno-oncology treatments have revolutionized the therapeutic options for many types of cancer. The rapid clinical translation of the research results from the past decades has enabled the spread of immune checkpoint inhibitor therapy. In addition to cytokine treatments that modulate anti-tumor immunity, major advances have also been made in adoptive cell therapy, especially regarding the expansion and readministration of tumor-infiltrating lymphocytes. The study of genetically modified T cells is more advanced in hematological malignancies while the applicability in solid tumors is widely investigated. Neoantigens determine antitumor immunity, and neoantigen-based vaccines might contribute to therapy optimization. In this review, we present the diversity of immuno-oncology treatments both that are currently in use and those that are investigated in the research field.

Recently, oncological pharmacotherapy and the related imaging and laboratory techniques employed for the optimization and monitoring of interventions have undergone revolutionary development. The implementation of personalized treatments based on therapeutic drug monitoring (TDM) is, with a few exceptions, lacking. The key factor limiting the integration of TDM into oncological practice is the need for dedicated central laboratories with resource-intensive, specialized analytical instruments, as well as highly skilled multidisciplinary staff. Unlike in certain other fields, the monitoring of serum trough concentrations often fails to provide clinically relevant information. Instead, the clinical interpretation of the results requires clinical pharmacological and bioinformatics expertise. Our goal is to present the pharmacokinetic-pharmacodynamic considerations of interpreting oncological TDM assay outcomes with the aim of providing direct support for clinical decision making.

The term paraneoplastic syndrome refers to the conditions when tumor-related symptoms are not caused by the size, invasion or metastasis of a tumor, but due to soluble mediators produced or an immune reaction induced by a tumor. Paraneoplastic syndromes occur in about 8% of all malignant tumors. Hormone-related paraneoplastic syndromes are termed paraneoplastic endocrine syndromes. In this short synopsis, the main clinical and laboratory characteristics of the most important paraneoplastic endocrine syndromes are presented including humoral hypercalcemia, the syndrome of inappropriate ADH secretion, ectopic ACTH syndrome. Two very rare diseases, paraneoplastic hypoglycemia and tumor-induced osteomalatia are also briefly presented.

Molecular epidemiology of mismatch repair deficiency (dMMR)/microsatellite instability (MSI) are different in various ethnic groups; accordingly, our aim was to test this in a large single-center Hungarian cancer patient cohort. We have found that dMMR/MSI incidence correlates well with TCGA data in case of colorectal, gastric and endometrial cancers. We have also observed that immunohistochemistry- based dMMR incidences are higher as compared to MSI. We suggest that the testing guidelines must be fine-tuned for immune-oncology indications. Nádorvári ML, Kiss A, Barbai T, Rásó E, Tímár J. Molecular epidemiology of mismatch repair deficiency, microsatellite instability in a large single diagnostic center cancer cohort.

Cancers are known to increase the tendency for thrombosis, both on the venous and arterial side, which to this day is an important factor in the management of oncology patients. Malignant disease is an independent risk factor for developing venous thromboembolism (VTE). Thromboembolic complications in addition to the disease worsen prognosis and are accompanied by significant morbidity and mortality. VTE is the second most common cause of death in cancer after disease progression. Tumors are characterized by hypercoagulability, in addition to which venous stasis and endothelial damage also occur in cancer patients promoting increased clotting. Treatment of cancer-associated thrombosis is often complex; therefore, it is important to identify patients who benefit from primary thromboprophylaxis. The importance of cancer-associated thrombosis is indisputable in everyday oncology. We briefly summarize the frequency and characteristics of their occurrence, the underlying mechanisms, risk factors, clinical appearance, laboratory diagnostics, and the possibilities of prevention and treatment.

Genetic testing for prostate cancer (PC) is becoming more widely used in the clinical routine, primarily due to the introduction of PARP inhibitors targeting genetically affected patients in their BRCA1/2 and other homologous recombination repair (HRR) genes. Simultaneously, the number of available therapies that are specifically targeting genetically defined PC subgroups is steadily increasing. As a result, the selection of treatment for PC patients is likely to require testing of multiple genes to enable more specific treatment sequences that consider the genetic characteristics of the tumor. Some of the mutations discovered by genetic testing may be hereditary, necessitating the use of germline testing from normal tissue, which is only permitted within the framework of clinical counseling. This change in PC care requires the collaboration by multiple specialists, including experts in molecular pathology, bioinformatics, biology, and genetic counseling. In this review, we aim to provide an overview on the currently relevant genetic alterations in PC for therapeutic purposes and their implications for familial testing.

Malignancies are considered as leading cause of death in parallel to cardio- and cerebrovascular diseases and their incidence is still growing from year to year. Early detection and monitoring of cancers after complex therapeutic interventions are essential for the survival of patients. In these aspects, beside radiological investigations, some lab tests play a key role, namely the tumor markers. These mostly protein-based mediators are produced in a large quantity by either cancer cells or the human body itself in response to the development of tumor. Measurement of tumor markers is usually assessed in serum samples, however, to locally detect an early malignant event, other body fluids, such as ascites, cerebrospinal fluid, or pleural effusion sample can also be analyzed. Due to the potential effects of other non-malignant conditions on the serum level of a tumor marker, the entire clinical status of investigated person needs to be considered for the correct interpretation of these results. In this review article, we summarized some important characteristics of the most widely used tumor markers.

The incidence of cancer is rising significantly in Hungary and worldwide. It is one of the leading causes of both morbidity and mortality. In recent years, the advent of personalised treatments and targeted therapies have brought significant advances in the treatment of cancer. Targeted therapies are based on the identification of genetic variations in patients' tumour tissue. However, tissue or cytological sampling poses a number of difficulties, while non-invasive procedures such as liquid biopsy studies can be a good alternative to overcome these problems. In nucleic acids from liquid biopsy samples, circulating tumour cells or free circulating tumour DNA, RNA present in the plasma the same genetic abnormalities can be detected that are present in tumours and their quantification is suitable for therapy monitoring and prognosis estimation. In our summary, we describe the advantages and difficulties of liquid biopsy specimen analysis and its potential for use in everyday clinical practice for molecular diagnosis of solid tumours.

More and more asymptomatic renal lesions are diagnosed as a result of the growing number of routine imaging examinations. Lesion characterization is often only possible with percutaneous biopsy. Stage T1 renal cell carcinoma is potentially curable not only by partial nephrectomy, but also with thermoablations. The most common ones used in renal cell carcinoma are radiofrequency (RFA), microwave (MWA) and cryoablation (CA). All of them have different physical background with different advantages. They have excellent oncological results, though only a few prospective trials compare their results to surgery. Apart from local renal cell carcinoma, metastatized renal cell carcinomas are also possible to treat with interventional radiological procedures. Renal artery embolization may be done prior to nephrectomy or as a palliative step. Furthermore, hypervascularized renal cell carcinoma metastases can also be embolized preoperatively. Interventional radiological tools may be used for the diagnosis, curative and palliative treatment and also as an aid to surgical procedures of renal cell carcinoma.

The therapeutic approach to brain metastases has changed significantly in the last 30 years. The development of surgical technique, the use of new MRI techniques, preoperative surgical planning and the administration of intraoperative navigation reduced the risks of surgery and improved the results. In the case of aggressive renal cell carcinomas, we detect brain metastases relatively often, which are difficult to treat, but the improved surgical and radiosurgery techniques can also be used with success. In our report, we present the neurosurgical management of metastatic spreading of renal cell carcinoma to the brain. Modern surgical planning and more precise, tailored approach with modern radiosurgery techniques are able to improve the outcome and prolong survival even in aggressive types of renal cell carcinomas that give rise to brain metastases. In more severe cases and even in the case of multiple brain metastases, cranial surgery can be recommended.