Klinicka Onkologie最新文献

Background: Haematopoietic stem cell transplantation is associated with increased demands for adequate caloric intake and heightened risk of macronutrient and micronutrient depletion. Carbohydrates, proteins, and fats represent a key source of energy and structural components for transplanted patients, who often have limited oral intake because of mucositis and loss of appetite and increased nutritional requirements due to catabolism, inflammation, and tissue regeneration. Deficiencies in vitamins and trace elements occurring in some patients play a crucial role in enzymatic reactions, antioxidant defense, immune function, and tissue repair. Preparative regimen also causes damage of the intestinal mucosa and, in combination with antibiotic therapy, reduces the diversity of the microbiome. According to the latest evidence, patient nutrition has an impact on the short- and long-term outcomes of transplantation. Recognition of malnutrition and catabolism in these patients is difficult in routine practice; closer analysis of body composition and early intervention by a clinical nutritionist may be helpful. Adequate nutrient replacement is an important aspect of maintaining nutritional balance and good recovery.

Aim: The aim of this article is to provide an overview of nutrition, its specific components and nutritional disorders in oncology patients, as well as to summarize specific complications of aggressive treatment in patients undergoing hematopoietic stem cell transplantation and underline the need for early nutritional intervention in this group of patients.

Background: This study aimed to describe real-world PD-L1 testing and first-line (1L) treatment patterns for advanced non-small cell lung cancer (NSCLC), and clinical outcomes for metastatic NSCLC after 1L pembrolizumab monotherapy became reimbursed in the Czech Republic (February 2019).

Patients and methods: This descriptive noninterventional study drew on two Czech lung cancer registries. We examined PD-L1 testing patterns and results in the KELLY registry for samples submitted on/after 1-Feb-2019 from adult patients with advanced NSCLC. Using the TULUNG registry, we summarized 1L targeted therapies initiated on/after 1-Feb-2019 for advanced NSCLC, in addition to characteristics and outcomes for patients treated with 1L pembrolizumab monotherapy for metastatic NSCLC, PD-L1 tumor proportion score (TPS) ≥ 50%, and no known EGFR/ALK alterations. Real-world time on treatment (rwToT) and overall survival (OS) were determined using Kaplan-Meier curves. The data cutoff was 16-Sept-2021.

Results: The percentage of NSCLC samples in the KELLY registry tested for PD-L1 expression increased from 70.5% in 2019 to 84.4% in 2021. Pembrolizumab monotherapy was the most common 1L targeted therapy in 2019-2021 for patients with advanced NSCLC and PD-L1 TPS ≥ 50% (N = 315), administered to 70-80% each year. Of 235 patients with metastatic NSCLC who received 1L pembrolizumab monotherapy, median age was 69 years, 54% were men, 52% were current smokers, and 28% had squamous NSCLC. Median rwToT was 8.5 months (95% CI; 6.7-10.1), with 6- and 12-month on-treatment rates of 59% and 36%, respectively, for 199 patients with ≥ 6 months of follow-up. With added national registry mortality data, estimated median OS was 13.7 months (12.3-17.7); 6- and 12-month OS rates were 70% and 59%, respectively.

Conclusions: The rates of PD-L1 testing increased from 2019 to 2021. Median OS among patients with metastatic NSCLC and PD-L1 TPS ≥ 50% treated with pembrolizumab was lower than in clinical trials, likely due to differences between real-world patients and trial participants in age, smoking status, performance status, and squamous histology.

Background: The group of monoclonal gammopathies includes both malignant diseases, such as multiple myeloma and Waldenström's macroglobulinemia, and benign proliferations of plasma cells or lymphoplasmacytic cells with the formation of usually low concentrations of monoclonal immunoglobulin and/or free light chains. The term monoclonal gammopathy of undetermined significance (MGUS) is used for conditions with non-malignant proliferation.

Aim: In the last 25 years, understanding of the various forms of diseases caused by products of benign lymphoplasmacytic or plasma cell proliferation has significantly increased. The following terms have been used for them: monoclonal gammopathy of renal significance, monoclonal gammopathy of cutaneous significance, monoclonal gammopathy of neurological significance. In the years 2018-2020, the international hematology community accepted the group name monoclonal gammopathy of clinical significance for all conditions in which organ damage is etiopathogenetically related to the products (MGCS) of these cell clones. The text presents an overview of all clinical units that belong to this group and briefly discusses the etiopathogenesis and therapy of these diseases.

Conclusion: MGCS is a new term that deserves to be incorporated into the new International Classification of Diseases, which would help improve epidemiological information about these very rare diseases. The same drugs used to treat malignant gammopathies are used in the treatment of MGCS. Patients with MGCS are discriminated, because their diagnoses are not included in the registration studies of new drugs. Therefore, targeted treatment can only be used with the approval of the healthcare payer.

Background: Chemotherapy is a key therapeutic modality in the treatment of malignant diseases. While it represents an effective tool in managing these conditions, it is simultaneously a toxic treatment associated with numerous adverse effects, particularly in fragile patients, such as the elderly. Adverse effects of cytotoxic therapy are among the key factors contributing to the poor prognosis of older cancer patients, often resulting in treatment delays, dose reductions, or even premature termination of therapy. The increased susceptibility of geriatric patients to the toxic effects of chemotherapy arises from their unique characteristics. Alterations in the pharmacokinetics of anticancer drugs in elderly patients represent one of the main mechanisms of chemotherapy toxicity in this patient population. The presence of comorbidities further elevates the risk of adverse effects and diminishes the body's tolerance to treatment. As a consequence, there may be an increased vulnerability to organ-specific toxicity of cytotoxic agents. Due to the presence of multiple comorbidities, older patients are often exposed to polypharmacy, which represents an additional risk factor for chemotoxicity due to the increased likelihood of drug interactions at both the pharmacodynamic and pharmacokinetic levels. Identifying at-risk patients through the application of comprehensive geriatric assessment and scoring tools provides an approach to evaluating chemotherapy-related risks, thereby supporting the personalization of treatment and the reduction of toxicity.

Aim: The article provides an analysis of the various mechanisms of chemotherapy toxicity in elderly patients, the factors contributing to their vulnerability, as well as the possibilities for safely administering cytotoxic agents while preserving their therapeutic efficacy in this patient population.

Background: Space still exists in the management of patients with colorectal cancer (CRC) for improving risk stratification and thus the precision of treatment tailoring. Quite promising in this regard are biomarkers acquired via liquid biopsy, which is a non-invasive method of body fluid draw, most commonly peripheral blood. A variety of biomarkers associated with the tumor are analyzed, which can have either prognostic or predictive value. Circulating tumor DNA (ctDNA) is one of the most explored tumor biomarkers. Initially, its utility spectrum was only in advanced or metastatic cancers and consisted of molecular profiling and detecting acquired resistance to treatment. Nowadays, the use of circulating tumor DNA has shifted to earlier cancer stages, where it can identify minimal residual disease or diagnose colorectal cancer early. Existing studies show promising potential of these biomarkers, but more information needs to be gathered and information from ongoing studies needs to be obtained in order to use them in everyday practice.

Aim: In this review article, we will discuss ctDNA, its aspects, diag- nostic possibilities and current use in CRC.

Background: Human cytomegalovirus (hCMV) is a widely prevalent herpesvirus that typically remains asymptomatic in immunocompetent individuals. However, in immunocompromised patients, it can cause severe clinical complications. In the context of cancer, hCMV exhibits oncomodulatory effects, influencing tumor growth, immune response, and treatment efficacy. Growing evidence suggests that therapeutic strategies targeting hCMV could improve cancer patient prognosis. Nevertheless, detecting this virus in tumor tissue or body fluids remains challenging, with results often varying depending on the methodology used and the type of sample analyzed.

Aim: This study provides a comprehensive overview of the role of hCMV in cancer. It describes the hCMV genome and the functions of its key proteins, focusing on their involvement in oncomodulation. The study thoroughly examines the mechanisms of viral interactions with cellular signaling pathways, the effects of infection and reactivation on the clinical course of cancer, and pays special attention to the impact of hCMV on glioblastoma, including studies assessing the effectiveness of antiviral therapy. Furthermore, standard diagnostic methods, including immunohistochemistry, ELISA, and polymerase chain reaction, are discussed, along with the most commonly used commercially available diagnostic kits approved for clinical practice. The study concludes by summarizing the key challenges associated with hCMV diagnosis and treatment in oncology and explores future therapeutic approaches, including the development of dendritic cell vaccines.

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive solid malignancies, characterized by poor five-year survival and limited options for early detection. The development of precision oncology and personalized treatment requires structured and longitudinal collection of clinical and biological data. For this purpose, the REDCap web-based data management platform was utilized.

Materials and methods: A project initiated by the Faculty of Medicine, Masaryk University, and University Hospital Brno aims to establish an integrated clinico-biological ecosystem for patients with PDAC. Data are managed within the REDCap system and include demographic characteristics, clinical features, treatment courses, molecular-genetic results, and survival outcomes. The pilot biobank stores patient-derived samples for the development of 3D models (organoids and spheroids). Data are analyzed using machine learning and artificial intelligence methods.

Results: A structured database linking clinical data with biological materials has been established. To date, detailed longitudinal data have been collected from 117 patients with pancreatic (predominantly PDAC) and extrahepatic biliary tract tumors. The database records diagnostic and therapeutic procedures as well as molecular-genetic profiling data and their relationship to treatment response. It serves as a foundation for the development of predictive models and biomarker validation.

Discussion: The project demonstrates the feasibility of comprehensive data collection within a university hospital setting. A major benefit is the ability to monitor treatment trajectories and implement precision oncology principles in clinical practice. Challenges include capacity and logistical demands, as well as the need for harmonization of input data. The initiative has the potential to expand into a national research infrastructure for PDAC.

Conclusion: The established infrastructure represents a foundation for a data-driven approach to PDAC management. By integrating clinical data and biological models, it contributes to the advancement of personalized care and provides a platform for research and decision support in oncology.

Background: Comprehensive treatment of patients with cancer includes various forms of psychosocial support aimed at improving the quality of life of patients. Psychosocial interventions help manage psychological distress and physiological symptoms associated with cancer and its treatment. These interventions include art therapy, conducted by a qualified art therapist, and independent art-making, which does not require the presence of a therapist. Both interventions have proven to be effective ways to improve psychological and some physiological symptoms in patients. Current research suggests that art interventions enable patients to express and process their emotions, reduce stress, and enhance emotional well-being. Art therapy and art-making have the potential to significantly reduce symptoms of depression, anxiety, pain, and fatigue in patients. Benefits are also seen in the development of coping strategies, strengthening feelings of control, and improving interpersonal relationships. Randomized clinical trials and systematic reviews confirm positive effects on psychological resilience and overall quality of life. However, research highlights the need for higher methodological quality and addressing heterogeneity in applied art interventions.

Aim: The aim of this paper is to present current knowledge on the effects of art therapy and independent art-making on psychological and physiological symptoms in cancer patients. The work focuses on identifying the therapeutic potential of these interventions and evaluating their impact on patients' quality of life. Our intention is to contribute to a deeper understanding of the effects of art-making in the context of psycho-oncological care and to support its implementation into treatment strategies.

Background: TEMPI syndrome (telangiectasia, erythrocytosis with increased erythropoietin, monoclonal gammopathy, perinephritic fluid collections, and intrapulmonary shunts) was described by David Sykes in 2011. By the end of March 2025, we have found descriptions of 35 cases of TEMPI syndrome in the literature. Non-IgM monoclonal gammopathy of clinical significance was diagnosed in 23 patients, multiple myeloma in 10 patients and Waldenström's macroglobulinemia in only 2 cases. Sykes estimated the median interval from the first symptoms to the diagnosis at 10 years. For many years, these patients were treated for a misdiagnosis of secondary erythrocytosis or primary polycythemia.

Observation: In 2015, an increase in hemoglobin and hematocrit concentrations was found in the patient. The diagnosis was concluded as secondary erythrocytosis in obstructive bronchopulmonary disease. Telangiectasias, which appeared soon after the detection of erythrocytosis, were misinterpreted as a manifestation of hepatopathy. The patient was treated with therapeutic phlebotomy. In 2024, symptoms of pleural effusion, ascites, swelling of the perineum and genitals appeared. This was the reason for admission to the hospital.

Results: CT scan in 2024 revealed pleural effusions, large perinephritic fluid collections and confirmed clinically evident swelling of the perineum and genitals (pelvic effusion). This gave rise to the suspicion of TEMPI syndrome. The results of morphological, flow-cytometric and molecular biological examination of the bone marrow and high concentrations of total immunoglobulin type IgM (40.6 g/L) and monoclonal immunoglobulin type IgM (23.6 g/L) with cryoglobulin properties corresponded to Waldenström's macroglobulinemia. Contrast echocardiography confirmed the existence of arteriovenous shunts, which could not be localized by other methods. Other abnormalities included very low levels of vitamin B12 and folic acid. Laboratory examination did not show significant endocrinopathy. After therapeutic plasmapheresis, treatment with rituximab, bendamustine and dexamethasone was started in December 2024.

Conclusion: In each differential diagnosis of secondary erythrocytosis, it is necessary to examine monoclonal immunoglobulin to exclude its cause in TEMPI or POEMS syndrome. A large perinephritic fluid collection is diagnostic of only two diagnoses, TEMPI syndrome or renal lymphangiomatosis, while other renal diseases can cause a smaller volume of perirenal fluid collection.