Magyar onkologia最新文献

The treatment of spinal metastases is a huge challenge, but both oncological and surgical treatment have improved significantly. Spine surgeons use the experience of spine surgeries performed for an increased number of degenerative causes during spine surgeries performed for an increased number of tumors. Establishing an indication for surgery is at least as much of a challenge as the surgery itself, for which there are many objective point systems available. Renal cell carcinoma metastases are less sensitive to radiation, which is why careful surgery is even more important. In our short summary, we review the symptoms, the examination, the grading systems used and the surgical options.

The evolution of radiotherapy (RT) technologies in the last two decades has changed the RT treatment attitude, and the routine application of novel stereotactic methods has opened new avenues in the complex cancer care. To prove the clinical consequences of this paradigm shift, a good example is the transformation of the renal cell carcinoma (RCC) treatment strategy. RCC was originally considered as a radioresistant disease, however, the introduction of new RT technologies has provided a risk-free focal dose escalation, so RT in primary or metastatic RCCs has become a more efficient method. Meanwhile, there has also been a spectacular development in the medical treatment of advanced RCC, thus the treatment strategy has radically changed in this field of oncology, resulting in a remarkably increased effectiveness. In the present communication, we summarize the steps of recent RT evolution, the new fields of indications and possibilities of combination therapies in RCC.

First-line treatment of metastatic renal cancer can be divided into three main phases. The cytokine era was replaced by targeted therapies in 2006 with the introduction of tyrosine kinase inhibitors. Until 2018, the standard first-line therapy was the use of sunitinib or pazopanib. Over the past decade, numerous attempts have been made to combine these drugs, which are already approved or in development, but these attempts have not been successful, primarily because of intolerable toxicity. In 2018, we reached a new stage in the treatment of metastatic renal tumors. This year, the combination immunotherapy of ipilimumab and nivolumab was approved. Since then, the combination of immunotherapy and targeted therapies has led to success. The main objective of our summary is to present in chronological order the clinical trials of combination therapies already approved in Europe, as well as the most recent phase III clinical trials. It is also intended to provide a brief practical guide on how to decide on first-line therapy based on the results of these trials.

Chemotherapy resistance in tumours is due to complex processes and is responsible for about half of all cancer deaths. In my thesis, I have investigated multiple different resistance mechanisms, most in depth the effect of multidrug resistance (MDR) caused by expression and function of P-glycoprotein (Pgp), and the MDR-selective compounds (such as NSC297366) effectively targeting it. The mechanism was investigated using cell models with different Pgp expression. Seeking the mechanism of action of the MDR-selective NSC297366, we showed that the intracellular iron-binding chelator molecule is able to reduce the amount of free iron available within the cell. Furthermore, by active efflux through Pgp in MDR cells, the compounds can lead to intracellular iron deficiency, upregulation of iron-demanding processes such as cell cycle and apoptosis, and selective death of MDR cancer cells. Our results raise the possibility of targeted killing of MDR phenotypic cancer cells resistant to other therapies, which in combination with conventional chemotherapeutic approaches may form the basis of a strategy of long-term control of the disease.

Our research was based on studies involving N-methyl- D-aspartate type glutamate receptors in chicken-derived differentiating chondrocytes, as well as in healthy and pathological human pigment cells. Given that NMDARs primarily mediate Ca2+ currents, we focused on the changes of Ca2+ homeostasis. The experiments proved that NMDARs may have roles in the precisely regulated intracellular Ca2+ oscillations of chondroprogenitor cells, and NMDAR-evoked Ca2+ signals are associated with optimal chondrogenesis. NMDAR subunit protein expression profiles in melanoma cells, involving subcellular fractions, revealed major differences between melanocytes and melanoma cells with potentially functional nuclear NMDARs in the latter. In summary we demonstrated in vitro, for the first time, in non-excitable cells from outside the nervous system the presence of functional NMDARs (in differentiating chondrocytes), and the nuclear localisation of NMDARs (in melanoma cells). The former mediate Ca2+-dependent pathways that are indispensable to chondrogenesis, while the latter may have appeared as a result of malignant transformation.

Considering the data of the past years, the number of kidney tumor patients grows constantly. These patients are usually found incidentally with the help of common imaging procedures. The classic triad - lower back pain, bloody urine, and palpable flank terime - occurs rarely. Their presence foresees an advanced disease. In our article, in addition to the mentioning of the epidemiological and etiological data, symptoms, surgical therapy and histological types of the kidney tumors, we present the adjuvant treatment options, their types and effectiveness.

The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.

Robotic-assisted partial nephrectomy (RAPN) was first described in 2004 and, since its introduction in clinical practice, has progressively gained increasing popularity. Over the years, the indications have also expanded, enabling robot-assisted surgical removal of complex kidney tumors. Important considerations for clinicians when choosing a minimally invasive technique are complete resection of the tumor, maximum protection of kidney function, and avoidance of complications. The first Da Vinci robotic surgery system was installed in Hungary at the Jahn Ferenc Dél- Pest Hospital and the National Institute of Oncology. The first robotic surgery took place at the National Institute of Oncology, and then at the Jahn Ferenc Dél-Pest hospital. In addition to open surgeries, only the laparoscopic procedure was available to perform kidney tumor surgeries in Hungary. The short one-year robotic surgery experience in our country supports the results of the international literature. Due to the introduction of robotics, a higher level of precision and freedom of movement creates new opportunities compared to open or laparoscopic kidney tumor surgeries.

Renal cell carcinoma (RCC) is the most common malignant kidney tumor. It is not a single entity but an umbrella term for several distinct tumor types. The most prevalent and clinically significant subtype of RCC is clear cell carcinoma, which consists of cells with empty cytoplasm. These tumor cells harbor biallelic loss of the VHL gene, resulting in a pseudohypoxic state that promotes angiogenesis and cellular proliferation. Papillary RCC and chromophobe carcinoma are also common subtypes, with the former displaying a papillary appearance and cMET mutation. The latter is characterized by eosinophilic tumor cells and multiple chromosomal losses. These subtypes are responsible for 90-95% of all kidney cancers in adults. Additionally, rare tumor subtypes with unique immunohistochemical features, genetic abnormalities, or a specific clinical course may be identified. Currently, the RCC subtype only holds prognostic significance, and no treatment is associated with any subtype. However, therapies associated with histological subtypes may emerge in the future, and thus, the diagnosis of RCCs should be made following current recommendations.

The treatment of locally advanced, inoperable or metastatic kidney tumors is a dynamically changing field of oncology. Since the registration of the first targeted therapeutic product (2005), more and more new products have been internationally accepted and registered almost every year. The development of immune checkpoint inhibitors and their inclusion in care algorithms (2015) further expanded the therapeutic possibilities. Despite all this, the optimal selection of medication used in different therapeutic lines poses a significant challenge to clinicians. In this review we have collected the data, aspects, and results of clinical tests necessary for the choice of therapy that can be applied in second and further lines. We also present the domestic treatment options.