Clinical Oncology

[Contemporary treatment of the malignant tumors of the uterus]

ÁROKSZÁLLÁSI Anita1

DECEMBER 30, 2020

Clinical Oncology - 2020;7(4)

[Yearly around half a million women are diagnosed with uterine cancer worldwide, having leaded to 90,000 deaths in 2018. Endometrial cancers (ECs) are the most common forms of gynaecological malignancies, while sarcomas represent not more than 3% of uterine cancers. In 80-85% of cases ECs are low-grade and diagnosed at an early stage, therefore potentially curable by surgical procedure and postoperative radiotherapy (if necessary). However, the optimal adjuvant management of high risk ECs is still an issue and the recognition of molecular subtypes is generating further clinical investigations in the field. Surgery is also the only curative method in sarcoma-care, but evidences for adjuvant management is scarce and indefinite. Beyond therapeutic benefits, quality of life is also an important factor in modern oncology. Therefore in gynaecological oncology there are intentions like preserving fertility and ovarian function, avoiding systemic lymphadenectomy or using minimal invasive technique to improve the patients’ quality of life without the deterioration of the therapeutic outcome. In the management of advanced endometrial cancer, the biological agents have opened a new era in recent years: pembrolizumab as second line option for MSI-H/dMMR/TMB high EC and the combination of lenvatinib-pembrolizumab for MSS/pMMR EC have been approved. But there are also promising results or ongoing studies with other agents: anti-HER2 therapy for serous EC, cabozantinib-nivolumab or ipilimumab-nivolumab for carcinosarcoma, PARP inhibitors with endocrine therapy for ER positive ECs. Here I present a short summary on the current therapeutic options and the most important ongoing clinical trials in uterine cancer.]

AFFILIATIONS

  1. Debreceni Egyetem, Klinikai Központ, Onkológia Klinika, Debrecen

COMMENTS

0 comments

Further articles in this publication

Clinical Oncology

[The highlights of the 2020 ESMO virtual congress]

SZÖLLŐSI Regő

[The year of 2020 brought unexpected challenges to the healthcare systems all around the globe. Every country had to reorganise their medical priorities to face the COVID19 pandemic. The practice of virtual medicine has expanded in the past years, these new circumstances have increased its speed drastically. Within these unusual circumstances we could take part in the virtual congress of the ESMO 2020 where we were able to hear about the new results of oncology to provide up-to-date care for our patients. Compared to the past years, we did not learn too many breakthrough results, the most of the novelties helped us place our experiences to their ideal place in patient care. The investigations which examined the SARS-CoV2 virus effects on oncologic patients showed grave results, the infection increases the vulnerability and mortality of patients receiving active anticancer therapies or suffering from an active cancer.]

Clinical Oncology

[Tumor-agnostic therapy in oncology]

UHLYARIK Andrea

[Tumor-agnostic therapy is considered as a promising therapeutic approach in oncology, however classification, validation of the targets and standardized methodology for their evaluation is mandatory. The development and approval of the tumor-agnostic drugs should be based on biomarker driven clinical trials. To date three validated biomarkers are known, the high microsatellite instability (MSI-H), the fusion of the neurotrophic-receptor-tyrosine-kinase (NTKR) genes, and the high mutation burden (TMB-H) of the tumors. Pembrolizumab (anti-PD-1 antibody) was the first approved tumor-agnostic drug, the MSI-H status of the tumor was the first indication, then later the TMB-H status was also approved. Larotrectinib and entrectinib are approved for the treatment of NTKR fusion-positive tumours.]

Clinical Oncology

[The forefront of ovarian cancer therapy: update on PARP inhibitors]

MIRZA M R, COLEMAN R L, GONZÁLEZ-MARTIN A, MOORE K N, COLOMBO N, RAY-COQUARD I, PIGNATA S

[In recurrent ovarian cancer, poly(ADP-ribose) polymerase (PARP)-inhibiting agents have transformed the treatment of platinum-sensitive disease. New data support use of PARP inhibitors earlier in the treatment algorithm. We review results from recent phase III trials evaluating PARP inhibitors as treatment and/or maintenance therapy for patients with newly diagnosed ovarian cancer. We discuss the efficacy and safety of these agents in the all-comer and biomarker-selected populations studied in clinical trials, and compare the strengths and limitations of the various trial designs. We also consider priorities for future research, with a particular focus on patient selection and future regimens for populations with high unmet need. Four phase III trials (SOLO-1, PAOLA-1/ENGOT-OV25, PRIMA/ENGOT-OV26 and VELIA/GOG-3005) demonstrated remarkable improvements in progression-free survival with PARP inhibitor therapy (olaparib, niraparib or veliparib) for newly diagnosed ovarian cancer. Differences in trial design (treatment and/or maintenance setting; single agent or combination; bevacizumab or no bevacizumab), patient selection (surgical outcome, biomarker eligibility, prognosis) and primary analysis population (intention-to-treat, BRCA mutated or homologous recombination deficiency positive) affect the conclusions that can be drawn from these trials. Overall survival data are pending and there is limited experience regarding long-term safety. PARP inhibitors play a pivotal role in the management of newly diagnosed ovarian cancer, which will affect subsequent treatment choices. Refinement of testing for patient selection and identification of regimens to treat populations that appear to benefit less from PARP inhibitors are a priority.]

Clinical Oncology

[Heterogeneity in cancer]

KOPPER László, TIMÁR József

[The basic function of cells is to maintain a balance between proliferation and programmed cell death, which allows the cell to perform its specific function. This activity fits closely, partly with neighboring cells and partly with the intercellular population. Errors can occur in the regulation of all this, of course mutations are the most common. Some of these can cause disturbances in cell life, but most mutations do not play an important role. It is well known to distinguish between benignity and malignancy, of which metastasis of tumor cells is the real danger (in fact, a tumor can be considered malignant clinically if it forms metastasis in hematological tumors rather than solids) and this polyclonality interferes with cellular function. It is understandable, therefore, that these two phenomena, metastasis and selection, can be considered the primary targets of therapy. Heterogeneity plays an important role in cell life.]

Clinical Oncology

[The antiemetic treatment of oncologic procedures]

[Nausea and vomiting are multistep pathway controlled by the brain. The emetic impulses come form cortex, as a psyhotic reaction or throught nervus vagus. In the medulla in the area postrema are the specific nuclei concerning to the emetic episodes. Most important neurotransmitters are the serotonin, substance P and dopamins. The chemotherapeutic drugs caused the emesis and vomiting at different frequences. The effect of 5-HT3 and NK-1 receptor antagonist have not are the most important antiemetic role. The fixed oral combination: netupitant and palonosetron (NEPA) increase instead of ensure the patient adherence. Guidelines recommend the antiemetic combinations in different types of chemotherapy. This rewiev covers the specific nausea and vomitig forms: breakthrough, multiday chemotherapy induced, radiation induced and anticipatory emesis. We summarise also the antiemetic therapy in childhood.]

All articles in the issue

Related contents

Clinical Neuroscience

Attitude of spine surgeons towards the application of 3D technologies - a survey of AOSpine members

ÉLTES Endre Péter, KISS László, BARTOS Márton, EÖSZE Zsolt, SZÖVÉRFI Zsolt, VARGA Pál Péter, LAZÁRI Áron

Background - 3D technologies (3D virtual and physical model, 3D printing, computer aided engineering, finite element analysis based simulations) play an important role in personalized spine surgery. Objective - In collaboration with AOSpine a global, online survey-based study was performed in order to determine the acceptance rate and the factors which stand against the wider spread of 3D technologies. Methods - A survey containing 21 questions was developed and divided into five pages, every page corresponding to one chapter. Our analysis is based on the responses of 282 spine surgeons from 57 countries. To interpret our results in a global context, we used the Human Development Index of the respondent's countries in comparisons. Results - Significant difference between the AOSpine regions (p ≤ 0.05) was found, with the highest acceptance in Asia-Pacific region. There was no significant difference in acceptance score according to the field of spine surgery, or the surgical experience in years (p=0.77, and p=0.19). In the case of public practice, we found significantly higher acceptance compared to private and mixed (public and private) surgical practice (p ≤ 0.05). The acceptance of the technology varied based on the respondent’s resident country’s Human Development Index and was significantly different between „Medium” vs “Very high” (p = 0.0005) and „High” vs „Very high” (p=0.019) category. Significant positive correlation was found between the acceptance score and the HDI score (Spearman test, ρ = 0.37, p = 0.007). The main limitation factor was identified as the lack of information. Conclusion - There is high interest among spine surgeons towards the incorporation of 3D technologies into the clinical practice. Education, the healthcare system, and the economic environment plays a major role in acceptance. Our results provide the basis of a strategy to promote the application of 3D technologies.

Clinical Neuroscience

[Tension-type headache in ulcerative colitis]

TAJTI Jr. János, LÁTOS Melinda, ÁBRAHÁM Szabolcs, SIMONKA Zsolt, PASZT Attila, LÁZÁR György

[Background and purpose - Tension-type headache is a very common disease with a high socio-economic impact as its lifetime prevalence is 30-78% in the general population. The incidence of inflammatory bowel diseases is continuously rising. Limited data are accessible on quality of life in patients with surgically treated ulcerative colitis. The aim of our study is to examine quality of life, concerning headache, among patients who had undergone surgery due to ulcerative colitis. Methods - Between 1 January 2005 and 1 March 2016, surgery was performed due to ulcerative colitis in 75 patients. During this retrospective analysis the average duration of the follow-up was 46 (1-124) months. The pre-sence of headache was evaluated by the use of Brief Illness Perception and Headache Questionnaires. Results - Among the primary headache disorders (n=27), tension-type headache occurred in 19 (70.4%) cases, and 8 (29.6%) patients had migraine (without aura). Among tension-type headache cases 17 (89.5%) patients experienced episodic form and 2 (10.5%) suffered from chronic form. Patients with headache had obtained a significantly higher score on Brief Illness Perception Questionnaire. Conclusions - According to our study tension-type headache is common among patients with ulcerative colitis. This observation raises the question whether stress plays role in the pathogenesis of both diseases, which influences and worsens considerably quality of life. Neurological examination, psychological and psychiatric guidance are worth considering in patients with ulcerative colitis.]

Clinical Neuroscience

Association of anterior thoracic meningocele and azygos lobe of the lung

DENIZ Ersay Fatih, SENAYLI Atilla, BICAKCI Ünal

Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

Clinical Oncology

[Therapy of endometrial cancer - an update]

SIPOS Norbert

[Endometrial cancer is the most frequent gynecologic malignancy in developed countries. Recently, there is a signifi cant increase of incidence caused by epidemic obesity. While the etiology of endometrial cancer can be heterogeneous, the effective therapy should be rather personalized. The primary therapy of endometrial cancer is operative. The recommended surgery is total abdominal hysterectomy and bilateral salpingo-oophorectomy. Management of pelvic and paraaortic lymphadenectomy is supported by the latest international recommendations, except cases of low-risk tumors (stage I/A, grade 1 or 2, endometrioid type, diameter of tumor <2 cm). Method of adjuvant therapy, especially in developed stages, is still controversial. Efficacy of postoperative irradiation, chemotherapy and chemoirradiation is under investigation by several ongoing studies. Recurrent endometrial cancer has bad prognosis, the best solution in this case is chemotherapy. In recent years targeted therapy (especially antiangiogenetic drugs, mTORinhibitors and hormontherapy) gave us some promising results. Around 80% of endometrial cancers can be diagnosed at early stages and cured with efficacy. Unfortunately, there is a group of tumors with bad prognosis, low differentiation, or recurrency, which can be a real challenge for clinicians. In this review we discuss the latest and most promising studies and scientifi c results in connection with treatment of high-risk endometrial cancers.]

Mechanical circulatory support - Zsolt Prodán pediatric heart surgeon