Clinical Oncology

[Adjuvant chemotherapy for operable breast cancer]

NAGYKÁLNAI Tamás, LANDHERR László

MAY 10, 2015

Clinical Oncology - 2015;2(02)

[The use of adjuvant chemotherapy in early stage breast cancer has made signifi cant progress in the last decades. This review will focus on the benefi cial effects of different chemotherapy regimens on the risk of recurrence and breast cancer mortality.]

COMMENTS

0 comments

Further articles in this publication

Clinical Oncology

[Chemotherapy of the thyroid cancer]

UHLYARIK Andrea, PETRÁNYI Ágota, RÁCZ Károly, BODOKY György

[The incidence of thyroid cancers increased signifi cantly over the past few decades, but the mortality rate decreased. The clinical course and therapy for the three types of thyroid cancer (differentiated, medullary and anaplastic) are different. The medical therapy consists of levothyroxin therapy, conventional chemotherapeutic agents and tyrosin kinase inhibitors. The aim of this review is to summarize the therapeutic options of each histological subtype.]

Clinical Oncology

[Diagnosis and therapy of childhood brain tumors – an update]

GARAMI Miklós

[Childhood cancers are rare disorders. The average annual age-standardized incidence is 149/1000000 (0-14 yrs). Diagnosis of childhood brain tumors, despite the specifi c localization and advanced imaging techniques can cause diffi culties. In recent years, due to better early recognition, number of surgically removable brain tumors is increasing. Early detection of the disease (clinical knowledge), use of modern imaging (fMRI) techniques and detection of characteristic molecular lesions allow up-to-date diagnosis and successful treatments. These approaches provide the basis for risk-adapted personalized treatment options]

Clinical Oncology

[How the molecular informations infl uence the therapeutic strategy against colorectal cancer?]

AXEL Grothey

[Colorectal cancer is not a homogenous disease, but it has different subgroups based on their molecular characteristics. NCCN and ESMO guidelines emphasize the importance of the determination of RAS and BRAF mutations in those patients who are intended to treat with targeted therapy. The increase in knowledge on the molecular changes will help to design and start a new generation of clinical trials, which will be designed not on their randomization of large groups of unselected patients, but rather on the consideration of the molecular subgroups determined before introducing therapy.]

Clinical Oncology

[Circulating tumor cells - a promising new approach]

KOPPER László

[It is an old observation, that tumor cells can escape from the primary, travel with the circulation, and fi nally be arrested in distant places. To know the potential „advantage” of this phenomenon (circulating tumor cells, CTC) is very important. One of the key questions is the proper sensitivity of isolation and characterisation techniques being able to represent the heterogeneity of tumorous clones. There is no doubt that the time arrived for the application of minimal invasive markers in oncology, with the hope that the survival of the patients can be improved using real-time monitoring and more effective therapy. The analysis of CTCs/cfDNA and other markers (e.g. miRNA, exosomes) obtained from the blood will be, hopefully, rutine tool in designing therapeutic strategy, and monitoring tumor response.]

Clinical Oncology

[Nutritional support in cancer anorexia-cachexia syndrome]

HARISI Revekka

[Cancer anorexia-cachexia syndrome (CACS) defi ned by ongoing loss of skeletal muscle mass, with or without loss of fat mass. In contrast to serious non tumorous cachexia it can not be reversed by conventional nutritional support. CACS affects most of cancer patients and has negative impact on physical function, anticancer treatment response, quality of life and survival. It is known that interactions between tumor and reactive host cells are responsible for tumor progression, metastasis formation and chronic infl ammation, as well. All of the processes are induced by cytokines. The CACS associated changes in carbohydrate, protein and lipid metabolism are caused by the elevated level of infl ammatory cytokines. The new anti-CACS drug development aimed at normalizing of the pathologic pathways. Up to now, megestrol-acetate (MA) administration seems to be the most effective drug in CACS treatment. MA has dual effect, stimulates the NPY activation and inhibits the synthesis and expression of infl ammatory cytokines. Its clinical effects are on line with the aboves, improves appetite, calorie intake and increases body weight. There is paradigm shift in CACS treatment, the traditional nutritional support is replaced by combination of pharmaceutical interventions, nutritional support and use of dietary supplements.]

All articles in the issue

Related contents

Lege Artis Medicinae

[Complex pathological diagnosis of breast cancer and the patient care based on it over the past 20 years]

CSERNI Gábor

[The diagnosis of breast cancer has become more complex in the past 20 years. Intraoperative diagnosis has been mostly replaced by multidisciplinary preoperative/ nonoperative diagnostics. Surgical treatment can be planned in advance for the breast as well as for the axilla. In many cases, routinely performed radical surgery has been replaced by selectively applied, less radical, conservative operations (sectoral or wide local excisions, sentinel lymph node biopsy) that are suitable for smaller tumours mostly detected by screening. In addition to prognostic markers listed in the pathology reports (lymph node status, tumour size, vascular invasion, status of resection margins), an increasing emphasis has been placed on predictive markers (estrogen receptors, progesterone receptors, HER-2, basal and proliferation markers) that allow molecular typing of breast carcinomas and that mostly influence systemic treatment. Tools to predict the efficiency of treatment have become increasingly available, and these might also help in planning neoadjuvant therapies, a modality which has also been introduced in the past 20 years. The present article gives a brief, subjective, thematic insight into some of these changes, selected on the basis of their relation to the pathological diagnosis of breast carcinoma.]

Clinical Oncology

[Clinical role of multigenic prognostic tests in breast cancer therapy]

GYŐRFFY Balázs

[Current clinical practice for breast cancer originates in “evidence based medicine”. In this, each tumor receives a therapy optimal for a given patient population - which might not be optimal for each individual patient. Multigenic tests determining expression of a set of genes can provide additional support in this decision process. Two such tests (MammaPrint and Prosigna) have already received FDA clearance. A number of additional test are commercially available (IHC4, Oncotype DX, EndoPredict, BCI). A common property of these assays is their utility in estrogen receptor positive early breast cancer. The main clinical problem answered by them is the necessity of adjuvant chemotherapy. To date, no reliable algorithm has been identifi ed capable to pinpoint the most effective chemotherapy combination for a given patient. Furthermore, there is no trustworthy test for triple negative breast cancer. The assays utilize different technologies (immunohistochemistry, gene chips, RT-PCR) and a discrepant list of genes - these result in discordance of the predictions for the individual patient. Despite these shortcomings, multigenic tests quickly gained foothold in breast cancer therapy decision process. Their utility is supported by the cost reduction for the health care providers by lowering the number of patients eligible for chemotherapy.]

Hungarian Radiology

[Results of breast cancer screening and clinical mammography at the Kenezy Breast Center, Debrecen between 2002-2003]

SEBŐ Éva, SARKADI László, KOVÁCS Ilona, VAJDA Olga

[INTRODUCTION - Breast cancer screening has been started in January 1. 2002. in Hungary in the course of the National Health Program. Breast cancer is the main cause of death among women’s malignant tomors, and the aim of the project is to reduce this mortality. The chance of survival is highly increased by the early detection of the disease. Kenezy Breast Center was connected to this project. PATIENTS AND METHODES - Females between 45-65 years without symptoms participated in the project. Paralel to this women with symptoms, sometimes with palplable masses were clinically examined. Screening mammography films were read by two radiologists and the complementary examinations of the breast and the axillary lymph nodes - ultrasonography, guided biopsy (FNAB, core biopsy) - were performed always by the same doctor. Results of the two projects were compared. RESULTS - The incidence of malignant breast cancer was 4‰ in the screening and 1,5% in the clinical group. 46.5% of the malignant breast cancers revealed by the clinical examinations was diagnosed in the group of women between the age of 45 to 65 years. This is the age when most women are involved in the screening program. 7.3% of the tumors was diagnosed in the 40- 44 year age-group and 11.3% among women aging 66-77 years. The rate of malignant tumors smaller than 1.5 cm was 49.1% according to screening records and 36% in the clinical trial. In both groups, tumor size of 1.5 cm proved to be a critical limit regarding to the development of metastases, mainly in the axillary region. Above this size, metastases were more frequent. CONCLUSIONS - Both breast screening program and clinical exams are of great significance. Based on the data obtained during two years, authors found that women below the age of 40 and above the age of 65 should also be involved in the screening program. Detection of breast tumor is possible at an early stage by screening. In the case of small tumors (smaller than 1.5 cm) the development of axillary metastases is less likely than in the case of larger ones. The lack of metastases in the axillary lymph nodes offers better prognosis according to the published scientific data, which reinforces the importance and necessity of the screening programs.]

Clinical Oncology

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[The prognosis of brain metastases is very poor. Surgery and radiotherapy provides the fi rst line treatment, while systemic therapy has limited value. Nevertheless, our knowledge is increasing: normal cells contribute signifi cantly to the homing and growth of tumor cells; the molecular profi le of the primary tumor and its metastases could be different, which infl uences the therapeutic strategies; the type of blood supply can change during the tumor growth. It would be very important to optimize the cooperation of the different therapeutic modalities, and to fi nd markers which could predict the risk of metastatization.]

Lege Artis Medicinae

[Cervix and breast cancer screening in the districts of Hungary]

SÁNDOR János, SZÜCS Mária, KISS István, BONCZ Imre, SEBESTYÉN Andor, KISS Adrienn, EMBER István

[INTRODUCTION - Life expectancy in Hungary has been increasing recently but in a geographically uneven distribution. The mortality trends has remained disadvantageous for cancer patients and also for the malignancies of cervix and breast that can be preventable with screening. The study aimed to describe the participation at the district level in the screening programmes as well as to investigate the relative role of health behaviour of women and of the health services in determining the screening success. METHODS - Age standardised relative screening participation rates were computed for 150 districts of Hungary using discharge reports of the outpatient services for cervical cytology and mammography. RESULTS - 20,12% of all 25-65 years old women was screened for cervical cytology during 3 years (1. July 1998. - 31. June 2001.) and 17,22% of all women aged 45-65 years participated in mammography in a 23 months period (1. July 1998. - 31. May 2000.). The results scattered in a certain fashion. Summarising the screening results, the highest participation ratios were observed in Bonyhád, Kiskunfélegyháza, Paks, Zalaszentgrót, Pécs while the lowest were in Csengeri, Mór, Nyírbátor, Sárbogárd, Enying districts. The screening performances did not correlate with each other and with the socioeconomic indicators (education, unemployment, income), apart from the significant influence of education on mammography participation rate. The emerging explanation is that the health behaviour was not important determinant of screening participation. In this case, the behaviour of target populations would have affected similarly both screening results resulting in a correlation. CONCLUSIONS - Consequently, the performances of providers responsible for screening organisation have been reflected in the observed screening rates. This result and the wide scattering of screening participation rates, which developed in spite of the uniform legislative-economic environment, emphasises the importance of regular monitoring of screening performance.]