Klinicka Onkologie最新文献

Background: Integrative medicine, which combines evidence-based conventional and complementary approaches, can significantly contribute to symptom management, improvement of quality of life, and empowerment of cancer patients. However, its implementation requires strict adherence to principles of safety, transparency, and informed decision-making. Non-specific effects of care, such as the placebo effect, the therapeutic relationship, and the meaningfulness of intervention, have measurable impacts on health outcomes and represent a legitimate part of the therapeutic process. Integrative oncology is not an alternative to science but rather an extension that deepens the understanding of the complex human response to illness and treatment. Key elements include open physician-patient communication, respect for individual needs, and critical appraisal of available evidence. Integrative medicine thus enhances not only the effectiveness of cancer care but also its ethical and human dimensions.

Aim: This is a narrative review and reflection on current knowledge regarding the use of integrative and complementary therapies in oncology, emphasizing both potential benefits and risks, with a focus on critical evaluation of scientific evidence and a pragmatic approach to patient care. The aim of this article is to introduce the concept of integrative oncology as an ethical and evidence-based approach that extends standard cancer care by addressing psychosocial and existential dimensions of health, without abandoning the principles of evidence-based medicine.

Background: HER2-positive breast cancer occurs in about 15-20 % of all breast cancers. It is both a prognostic and predictive biomarker and the introduction of anti-HER2 therapy over the last 20 years has significantly improved outcomes in this subset of patients, so that they are now comparable to or better than those of patients with HER2-negative tumors. Approximately 5-10% of patients are diagnosed with metastatic breast cancer. It was good news for these patients when, on April 17, 2020, the FDA approved tucatinib in combination with trastuzumab and capecitabine for adult patients with advanced unresectable or metastatic HER2-positive breast cancer who had received one or more prior anti-HER2-based regimens in the metastatic setting. The efficacy of the regimen was demonstrated in the HER2CLIMB trial, which enrolled 612 patients with HER2-positive metastatic breast cancer who had previously been treated with trastuzumab, pertuzumab, and/or trastuzumab emtansine. Median overall survival for patients in the tucatinib arm was 21.9 months (95% CI 18.3-31.0) compared with 17.4 months (95% CI 13.6-19.9) for patients in the control arm (HR 0.66; 95% CI 0.50-0.87; P = 0.00480).

Case: Our patient is a middle-aged woman without visceral metastatic involvement, but with extensive nodal involvement, skeletal metastatic involvement and left breast almost completely consumed by tumor. This woman had a more or less successful three lines of anti-HER2 therapy and the fourth line of one-year-long systemic treatment with the cytostatic eribulin. The inclusion of tucatinib with trastuzumab and capecitabine in the fifth line of systemic therapy achieved a very nice partial regression of the primary tumor without significant toxicity.

Conclusion: In this case report, we describe the case of a highly pretreated patient with HER-2 positive metastatic breast cancer.

Background: There is no doubt that PARP inhibitors (PARPi) have significantly improved the prognosis of patients with advanced-stage ovarian cancer. In the history of treatment for this disease, their impact is second only to the introduction of platinum-based chemotherapy. As with any new therapeutic modality, integrating PARPi into routine clinical practice is a complex process. In the Czech Republic, some agents, combinations, or indications are not reimbursed, and indication criteria often require several conditions to be met simultaneously. These factors may lead to uncertainties in the practical use of PARPi.

Aim: This article aims to highlight and discuss areas where such uncertainties may arise in clinical practice.

Background: The unfolded protein response (UPR) enables myeloma cells to overcome the stress conditions arising from excessive proteosynthesis and thus provides a survival advantage for myeloma cells. Extramedullary disease is a more aggressive form of multiple myeloma in which myeloma cells lose their dependence on the bone marrow microenvironment and are able to infiltrate other tissues and organs. The pathogenesis of extramedullary disease is not fully elucidated yet. The aim of this study was to determine whether there is a difference in the expression of UPR-related genes between bone marrow plasma cells from multiple myeloma and extramedullary disease patients.

Materials and methods: Gene expression of six genes involved in UPR (ERN1, DDIT3, EIF2AK3, TUSC3, XBP1, HSPA5) was analyzed by quantitative reverse transcription polymerase chain reaction. In total, 76 bone marrow plasma cell samples were used, of which 44 were from patients with multiple myeloma and 32 from patients with extramedullary disease.

Results: A statistically significant difference was observed between the multiple myeloma and extramedullary disease groups regarding the expression of HSPA5, DDIT3, EIF2AK3, and ERN1 genes. However, in the case of XBP1 and TUSC3 genes, no statistically significant difference in the expression was found. Several statistically significant correlations between the expression levels of the analyzed genes and the clinical data of the patients were observed as well.

Conclusion: Our results suggest the importance of UPR in the pathogenesis of extramedullary disease. UPR appears to be a promising avenue for further research.

Background: In present days we have the possibility to use new antibiotic drug cefiderocol for the treatment of multiple drug resistant bacterial infections. This infections are the result of preceding and repeating antibiotic therapy mainly in immunocompromised patients.

Case: In our case report we present a young woman with acute leukemia with complicated infection in the perianal and rectal area with sepsis development caused by Pseudomonas aeruginosa with lower sensitivity for carbapenems at the early time of allogeneic transplantation of hematopoiesis due to acute leukemia, when she is under the negative influence of chemotherapy and immunosuppressive drugs. We emphasize the adverse effects of colimycine type antibiotics and their interactions with other drugs with the organ toxicity development.

Conclusion: The newly available antibiotic cefiderocol with low potential of adverse events and drug interactions demonstrates a benefit in the treatment of the patient described.

Background: Extravasation (paravasation) of chemotherapy and other anticancer drugs represents a significant complication in the patient care. Preventive and therapeutic measures effectively reduce the incidence, severity and extent of extravasation-related complications and its consequences. A working group of authors from expert groups developed recommendations for standard care.

Aim: To provide a concise summary of recommended interventions for daily clinical practice. These recommendations are based either on long-term, evidence-based clinical experience or consensus opinions among expert groups representatives.

Results: Preventive measures are critical and include early consideration of indications for long-term venous access devices, appropriate selection of the injection and exit sites, thorough venous access device assessment before each anticancer drug administration, and comprehensive patient education. Therapeutic interventions following extravasation primarily involve the administration of specific antidotes (dimethylsulfoxide, hyaluronidase, dexrazoxane) along with the application of dry cold or heat, depending on the specific anticancer agent involved. The use of subcutaneous corticosteroids, moist heat or moist cooling, and compression is not recommended.

Conclusion: Adherence to these recommendations significantly decreases the risk and mitigates the consequences of extravasation. Clinical sites may adapt and expand these guidelines based on local policies and specific patient care requirements.

Background: Treatment of patients with malignant undifferentiated lung tumors who also have diffuse lung disease is difficult, especially when the tumor grows rapidly. Herein we present a malignant undifferentiated tumor of the lung with rapid growth.

Case: A 57-year-old man was diagnosed with chronic obstructive pulmonary disease and was receiving inhalation of long-acting muscarinic antagonist / long-acting beta2 agonist. At the age of 65, dyspnea became worse and he had hemoptysis. A chest radiograph revealed an 11 × 9 mm nodule in the right upper lung field. This nodule grew to 89 × 60 mm and 102 × 68 mm on radiographs taken 63 and 79 days after the date of the first radiograph. The volume doubling times were 7 and 23 days, respectively, and it was a rapidly growing, highly malignant tumor. The tissue specimens obtained by percutaneous biopsy from this lesion was pathologically diagnosed as malignant undifferentiated tumor of the lung. Chemotherapy including immune checkpoint inhibitors was effective. Although the patient still has cancer, he is constantly undergoing treatment 2.5 years after its initiation.

Conclusion: It is interesting to note that the course of the rapidly growing lung tumor and the effectiveness of chemotherapy including immune checkpoint inhibitors in patients with such a rapid growth. We believe that information about the clinical course of this patient may provide insight into the treatment of future patients who may have a similar clinical course.

Background: Eye tumors are moving targets, but there have been no reports of radiation therapy with real-time monitoring.

Case: A 54-year-old woman with metastatic breast cancer was referred for treatment of diplopia due to choroidal metastasis after hippocampal avoiding whole brain radiotherapy. Since visual acuity was preserved and long-term survival was expected, real-time MRI-guided intensity-modulated radiation therapy (36 Gy in 20 fractions) was performed. No adverse events occurred during treatment or during the subsequent one-year follow-up period. The patient's diplopia resolved and no choroidal recurrence was observed during the follow-up period.

Conclusion: MRI-guided radiation therapy may be a safe and effective treatment for choroidal metastases after hippocampal avoiding whole brain radiotherapy.

Background: Literature about critically ill cancer patients admitted to intensive care units (ICUs) is scarce. The decision to recommend ICU admission is complex and usually involves many subjective factors, making it an intricate issue for both medical oncologists and intensive care physicians. As oncologic and supportive measure treatments improve, a question that becomes increasingly relevant is which patients should be admitted to the ICU, as the natural history of cancer is clearly shifting and newer admission parameters should be established.

Material and methods: We performed a retrospective analysis of all patients with a diagnosed malignancy admitted to our ICU from 2008 to 2014. Data were collected from electronic medical records and analyzed to establish factors associated with outcomes including length of stay, complications, mechanical ventilation requirements, and mortality.

Results: We surveyed a total of 165 consecutive patients, of which 79 (47.9%) were female and 86 (52.1%) were male. Patients with solid tumors (N = 93) were significantly older than those with non-solid tumors (N = 68) (60.12 ± 15.86 vs. 45.43 ± 17.42 years; P < 0.001). The most common reason for ICU admission was respiratory failure (55.76%), followed by septic shock (21.82%). Mechanical ventilation was strongly associated with mortality (P < 0.001), with 98.2% of deaths occurring in ventilated patients. Complications during ICU stay were associated with significantly longer length of stay (P < 0.001), particularly for patients with solid tumors.

Conclusion: Given the high heterogeneity of cancer patients, it is difficult to establish definitive guidelines for ICU admission. Our findings demonstrate that traditional criteria such as age or tumor type alone should not determine ICU admission decisions. Instead, decisions should be based on comprehensive clinical judgment for each individual case. Further studies are warranted to develop evidence-based guidelines for critically ill cancer patients.

Background: Biological sex and gender significantly influence cancer incidence, biology, disease progression, treatment response, and long-term survival. These differences arise from a complex interplay of hormonal, genetic, epigenetic, immunological, and behavioral factors. Notable disparities have been observed in colorectal, lung, and bladder cancers - including histological subtypes, immune responses, and treatment outcomes. Women are more susceptible to chemotherapy toxicity, often face delayed diagnosis, and experience higher psychosocial burden. In contrast, men tend to show higher cancer-related morbidity and mortality. Transgender and non-binary individuals remain largely underrepresented in cancer research. Furthermore, preclinical models frequently overlook the sex of animal or cellular samples, limiting translational relevance. Emerging technologies - such as multi-omics approaches, 3D human organoids, and artificial intelligence - provide promising tools to better understand sex-specific mechanisms in cancer development and treatment, and will enable future personalization of oncological care according to the patient's sex.

Purpose: This review aims to summarize current knowledge on the influence of biological sex and gender on cancer incidence, tumor biology, and therapeutic response, with additional focus on behavioral and psychosocial factors. Special attention is given to colorectal, lung, and bladder cancers as model malignancies with sex-specific differences, and to the ongoing challenges in preclinical research and clinical practice.

Conclusion: Sex and gender are key determinants of oncological outcomes and should be systematically incorporated into research design, clinical trial methodology, personalized therapy, and health policy. Their integration is not only a scientific imperative but also an ethical necessity on the path toward precise and equitable cancer care.