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Prague, Czech Republic

Tesarova P.,Onkologicka Klinika
Ceska a Slovenska Gastroenterologie a Hepatologie | Year: 2010

The advancement in the systemic treatment of hepatocellular carcinoma (HCC) has improved prospects for the overall survival rate in patients with the advanced form of the tumour. In this overview, the new targeted therapy is set in the context of both traditional and the latest therapeutical methods, which include - besides liver transplant, partial hepatectomy, radiofrequency ablation and alcoholization - also radiotherapy, immunotherapy, chemotherapy and biological therapy. Local therapy is usually preferred to systemic therapy. Patients for whom locoregional therapy is not suitable due to advanced disease can benefit from systemic therapy. The targeted therapy with sorafenib, a multiple tyrosine kinase inhibitor, which was proven in the SHARP study to produce a statistically significant improvement in the overall survival rate of patients with advanced HCC, has become a new standard in systemic therapy of advanced HCC. Sorafenib demonstrated high efficacy in monotherapy compared to the placebo and is the first and so far only drug which has significantly improved the overall survival rate in patients with HCC. Other biological drugs include bevacizumab, sunitinib and erlotinib. To conclude, current recommendations on HCC treatment are presented.

Targeted therapy is indicated for many types of solid malignancies, either in monotherapy or in combination with chemotherapy, hormonal therapy, or radiotherapy. The incorporation of targeted drugs into clinical algorithms has improved the prognosis of many cancers but also increased the risk of some less common adverse effects. Targeted therapy may increase haematological toxicity of chemotherapy and cause disruption of protective barriers or directly inhibit the function of immune cells. Routine prophylactic anti-infective therapy in patients treated with current targeted therapies for solid tumors is not recommended. Some targeted drugs, however, may predispose to specific infectious complications.

Petruzelka L.,Onkologicka Klinika
Vnitrni Lekarstvi | Year: 2011

Clinical use of targeted biological treatment was initiated in 1970s following a discovery of hormonal receptors and targeted clinical use of tamoxifen. Deeper understanding of molecular principles of the process of metastasizing and cell communication and signalling have contributed to the development of targeted molecular biological treatments based on direct impact on the key target structures of a tumour cell. Clinical effectiveness of targeted biological treatment has been shown in phase III clinical studies in advanced and metastasising solid tumours and importantly expanded our armamentarium of pharmacotherapeutic treatment options in breast cancer, colorectal cancer, non-small cell lung cancer, kidney cancer, hepatocellular carcinoma and gastrointestinal stromal tumour. Full implementation of targeted therapy is precluded by a lack of reliable predictors of efficacy of a number of targeted drugs. Therefore, full identification of such predictors is a subject to intensive clinical research. At present, selection of biological treatment is based on morphological, immunohistochemical and partly also molecular profile of a tumour. The future of biological treatment lies in a selection that is based on full molecular characterization of the primary tumour as well as metastasis.

Skacelikova E.,Onkologicka Klinika
Studia Pneumologica et Phthiseologica | Year: 2014

Background: Lung cancer is a common malignancy with a generally unfavorable prognosis. A novel treatment option for patients with early stages of the disease unable to undergo surgery due to various reasons is stereotactic body radiotherapy (SBRT), or stereotactic ablative radiotherapy (SABR).Patients and methods: Between August 2010 and March 2013, a total of 66 patients diagnosed with stage I or II primary lung cancer underwent SBRT in our center. All the patients were treated with the CyberKnife. In patients with a minimum follow-up of 1 year, their overall survival was assessed.Results: As of now (March 2014), sixteen patients treated with the CyberKnife in our center have died; the overall 3-year survival is 75% which is comparable with the available data in the literature. Acute treatment toxicity was very low in our patients.Conclusion: SBRT of early-stage lung cancer is a promising treatment method for a selected population of patients who cannot or refuse to undergo surgical therapy. In the future, the follow-up of patients after therapy should be standardized, namely the type (CT or PET/CT) and frequency of examinations.

Tesarova P.,Onkologicka Klinika
Aktuality v Nefrologii | Year: 2015

The therapy of overlapping problems of anemia in chronic renal failure and anemia of chronic disease associated with malignancies is one of a series of border issues between the oncology and nephrology, which may be included in the issue onconephrology (acute and chronic renal failure in patients with malignant tumor, nephrotoxicity of anticancer therapy, paraneoplastic syndromes with a the kidney injury, the patients after nephrectomy for kidney cancer, antitumor treatment and replacement of kidney function, kidney transplant in patients in remission of malignancy, systemic treatment of cancer patiens after kidney transplantation, treatment of pain in patients with malignancy and chronic renal insufficiency). New recommendations for the optimal therapeutic approach in these situations should most likely be based on the results of recent clinical studies in onconephrology A meta-analysis of clinical and preclinical trials with ESA in cancer patiens not confirmed the negative impact of the ESA on the progression of a malignant tumor, but some of the individual trials have demonstrated a link between the administration of the ESA and the progression of the disease. For the safe and a sufficient effect of the treatment, it is necessary to adhere to the principles of the administration of ESA based on the recommendations of the ASCO/ASH, ESMO, EORTC rules.

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