[Heterogeneity in cancer]
KOPPER László1, TIMÁR József2
DECEMBER 30, 2020
Clinical Oncology - 2020;7(4)
KOPPER László1, TIMÁR József2
DECEMBER 30, 2020
Clinical Oncology - 2020;7(4)
[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
[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.]
Clinical Oncology
[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 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
[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
[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.]
Lege Artis Medicinae
[The aim of COVID-19 Host Genetics Initiative (HGI) research collaboration is to identify human genetic variation that influences responses to SARS-CoV-2 infection and its subsequent disease, COVID-19. In the COVID-19 HGI consortium more than 1000 scientists share their own data. The authors of this study participate in the Hungarian communication of the published results at the request of COVID-19 HGI.]
Clinical Neuroscience
Purpose - In cancer patients, an ischemic stroke can be seen as both a direct effect of cancer and a complication of treatment. This condition can negatively affect the follow-up and treatment of these patients. For this research, we aimed to evaluate the clinical features, stroke types and etiological features of ischemic stroke patients with histories of cancer or found to have cancer during the aetiological investigation. Materials and methods - We retrospectively evaluated 100 patients (57 males, 43 females) who were hospitalized with acute stroke and determined to have the presence of cancer or a cancer history during the aetiological investigation between 2011 and 2016. All the demographic features, stroke types and localizations, National Institutes of Health Stroke Scale (NIHSS) scores, Rankin Scale scores, durations of cancer and cancer treatments were recorded. Results - The mean age of the patients was 67.07 ± 10.9 years old, the median NIHSS score was 5, and the median Rankin Scale score was 4. While 79% of patients had ischemic stroke risk factors, 21% did not. Atherosclerotic stroke was the most common stroke type (49%, n=49) and cryptogenic strokes were detected in 21% (n=21). In addition, 63% of the patients had chronic cancer (later than 6 months), 31% of the patients had recent cancer histories (less than 6 months), and 29% of the patients had metastases. Among all the malignancies, lung cancer (n=23), gastrointestinal cancer (n=20) and gynaecological-breast cancer (n=16) were the three most common. Moreover, 37% of the patients underwent chemotherapy, 29% underwent radiotherapy, and 88% of the patients had Carotid/Vertebral Doppler USG abnormalities. Conclusion - Similar to what is stated in the literature, an atherosclerotic stroke was the most common type of stroke in the cancer patients. Stroke risk factors were not detected in 21% of the patients, and in the majority of the patients, atherosclerotic changes in the carotid artery were observed in the Doppler examinations. In the aetiology and prognosis of ischemic stroke, it is important to keep in mind the existence of cancer in addition to the classical stroke risk factors.
Clinical Oncology
[The role of obesity in the development of cancer is well-known from ages. However, these days we witness the explosion-like increase of obesity, globally, but mainly in the economically advanced population, and, which is even more alarming, among youngsters. The prognosis of the obesity-related cancer is rather poor, therefore, the prevention, including the screening, have outstanding importance. Unfortunately, the participation of the obes persons, especially obes women, in these programs is very low. The diagnostics and therapies should consider the special features of obesity, which are related to the magnitude, distribution, composition of fatty tissue connected to the changes in pharmacokinetics. Moreover, the problems might be complicated with obesity-associated non-tumorous severe diseases (e.g. cardiovascular, diabetes type 2).This review covers different aspects of obesity-cancer relationships, with an emphasis on everyday oncology.]
Clinical Oncology
[The joint appearance of pregnancy and cancer is rare. It is highly recommended that the tumorous pregnant should be managed by a multidisciplinary team. The early diagnosis is very important, but it is not easy, because the symptoms of pregnancy and cancer are rather similar. Imaging diagnosis has to avoid ionizing radiation (e.g. PET/CT). The same is true for chemotherapy in the fi rst trimester, due to the increased risk of developmental abnormalities. Consequently, radiation therapy is not allowded throughout the pregnancy, and the chemotherapy in the fi rst trimester is a strong indication for the interruption of pregnancy. Surgery, with good practice, usually can be performed without complications. Chemotherapy, given in the second and third trimester generally follows the standard protocols with a low frequency of developmental errors. Early delivery should not be encouraged, except the delay has a hazardous effect on the mother and/or on the child. The pregnant should be informed about all steps to be an active part of the fi nal decision.]
Clinical Neuroscience
[Parkinson’s disease is a promising target of applying personalized medicine. For this purpose it is crucial to reveal the genetic and environmental factors, which contribute to the disease, also to collect epidemiologic data and to preserve the patients samples and data in a proper biobank. In our investigation we examined the prevalence of the most frequent Parkinson’s disease causing LRRK2 G2019S mutation in a Hungarian Parkinson-patient group. From 120 patients, we haven’t detected this substitution in anyone. Our investigation suggest that the mutation LRRK2 G2019S may be a rare cause of Parkinson disease in the Hungarian population.]
1.
2.
3.
4.
Journal of Nursing Theory and Practice
[Correlations Between Burnout and Socio-demographic and Workplace Related Factors Among Health-care Workers During The Covid-19 Pandemics]5.
Journal of Nursing Theory and Practice
[Operational Efficiency Investigation from APN Perioperative Perspective]1.
2.
3.
4.
5.
COMMENTS
0 comments