Clinical Oncology

[New systemic treatment possibilities in non-small cell lung cancer]

OSTOROS Gyula1, BOGOS Krisztina1

NOVEMBER 30, 2021

Clinical Oncology - 2021;8(4)

AFFILIATIONS

  1. Országos Korányi Pulmonológiai Intézet, Budapest

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Further articles in this publication

Clinical Oncology

[Gastrointestinal cancers: role of biomarkers and based on driven treatment of gastrointestinal cancers]

PAJKOS Gábor

[Remarkable advancements in techniques of genomic profiling and bioinformatics have led to the precision medicine in oncology approach, targeted therapy and immune checkpoint inhibitors achieved radically change in treatment efficacy based on accumulation of knowledge on the genomic profiles of gastrointestinal tract cancer (GI). Advanced or disseminated poor risk GI cancer patients have had a better chance for that progression free and/or overall survival. Highly effective treatment needs to incorporate numerous molecular characteristic into clinics – expression of PD-L1, MSI (micro satellite instability)/dMMR (defective mismatch repair), TMB (tumor mutation burden), resistance mutation, insertions/deletions and other genomic alterations. This review aims to summarize predictive and prognostic biomarkers might suggested for precision oncology treatment of GI cancers.]

Clinical Oncology

[Microbiome and cancer]

MIKÓ Edit, BAI Péter

[Most compartments and organs of the human body are not sterile, bacterial DNA and RNA can be detected using next generation sequencing techniques. All bacterial DNA in a compartment is called the metagenome, all bacterial transcripts are termed metatranscriptome, while all bacterial species is coined the microbiome. The microbiome transforms in neoplastic diseases that is called the oncobiome. Most tumors are colonized by bacteria that supports tumor growth and development. Microbiome compartments distant to the tumors (as the microbiome of the gastrointestinal tract) can also undergo oncobiotic transformation. The metabolic capacity of the oncobiotic microbiome in the gastrointestinal tract is suppressed and the production of a large set of cytostatic and antimetastatic bacterial metabolites is blunted supporting cancer cells proliferation and metastasis. The microbiome of the gastrointestinal tract has pivotal role in setting the tolerance of the immune system against cancer cells, therefore, has prime importance in tumor immunity. Oncobiosis, by itself, cannot induce tumors, but can support tumor growth and metastasis formation. Bacteria have key role in the success of cytostatic therapy and in setting the side effect profile.]

Clinical Oncology

[Pancreas cancer: Therapeutic trials in metastatic disease]

SMITHY W. James , O’REILLY M. Eileen

Clinical Oncology

[Mechanisms of metastasis formation as potential therapeutic targets]

TÍMÁR József, SEBESTYÉN Anna, KOPPER László

[The end-stage of the tumor progression is the development of the metastatic disease. The biological basis of this progression is well known, however the exact molecular background of it is not. In this process the metastatic cancer cells develop maximal adaptation to extreme environmental clues and collaborative potential with wide array of host cells, accordingly the metastatization takes place in an organ specific manner. The metastases are different from the primary tumor but from each other as well, and this true for their genetic background as well. The ultrasensitive monitoring of this process is possible with the use of liquid biopsy and molecular tests. Till we don’t have organ metastasis specific therapeutic modalities similarly to bone metastases, the available modalities must be fine-tuned for metastatic disease and not for the primary tumor. ]

Clinical Oncology

[The concept and use of placebo and nocebo in oncology]

VÉGH Éva, BAKI Márta

[Placebo and nocebo effects recognised through all of the history of medicine, and these effects can be found also in the field of oncology research and clinical practice. Placebo effect are more than the effects of an inert substance. Placebo benefits the health status because of the person’s belief and nocebo worsens the health status of the patient. Several psychological mechanisms are involved in placebo/nocebo effects; expectation, learning processes (classical conditioning and observational learning), reinforced expectations, personality traits of the patient and the health care provider. At the same time placebo effects rely on neurobiologic mechanism (neurotransmitters like dopamine, cholecystokinin, opioids and activation of specific brain areas). The use of placebo is an important methodological tool in oncological research and drug development. Inert substance can be associated with positive (placebo) and negative (nocebo) adverse event profiles also can modify the measured therapeutic effects in randomized clinical trials.]

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[Radiological response evaluation of targeted therapy]

KALINA Ildikó, OSZLÁNSZKY György

[The objective assessment of the changes in the tumor burden along with cancer therapy has essential importance. Recently, the quantitative evaluation of the radiological tumor response was undergone several changes. For conventional chemotherapy of solid tumors the standard procedure has been RECIST since 2000. The targeted therapies trigger other pathophysiological changes in the cells than the cytotoxic agents, accordingly the morphological changes show a new picture. Therefore the targeted therapies require a new evaluation system, that takes into consideration not only the tumor size, but other changes as well, the changes of attenuation that corresponds with the proportion of the viable cells. In case of the targeted therapies in substantial clinical was experienced even without signifi cant morphological changes in the tumour size. As a consequence, the traditional, size-based criteria system can underestimate the effi ciency of the new types of treatments. To eliminate this problem new evaluation systems were created taking the tumortypes and treatment protocolls into consideration. The estimation of the early tumor response to targeted therapy also has high importance. In assessment of the response functional imaging methods are used more frequently. The role of PET has already been defi ned in numerous tumortypes, however the determination of the position of some promising functional examinations still require further studies.]

Clinical Oncology

[Treatment of hepatocellular carcinoma - today]

VÉGH Éva, DEMETER Gyula, BODOKY György

[The hepatocellular carcinoma (HCC) is one of the main causes of cancer-related death globally, and at the same time, it is the main event leading to death in cirrhotic patients. In the etiology of HCC, the non-alcoholic liver disease may be an important cause besides the viral cirrhosis. The HCC’s staging systems (Child-Pugh scores, Cancer of the Liver Italian Programme/CLIP, Barcelona Clinic Liver Cancer/ BCLC) play an important role in predicting the prognosis and determining the appropriate therapy. In Europe, the treatment strategy is based on the BCLC staging system. Screening of cirrhotic patient is also important because curative therapy is available only for the early-stage HCC. Several therapeutic options exist in the intermediate stage disease; among them the radiofrequency ablation (RFA), the transarterial chemoembolization (TACE) and the percutan ethanol injection (PEI) are most important. For the advanced disease, the only approved systemic therapy is sorafenib, which has been well-tolerated and yielded a substantially relative improvement in overall survival. For patient in end-stage disease with impaired liver function or a poor performance status, only supportive care is recommended.]

Clinical Oncology

[Current management of GIST]

LAKATOS Gábor, BODOKY György

[Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs are generally resistant to chemotherapy and radiotherapy. The understanding of pathology at molecular level promised the development of novel treatment modalities. KIT and PDGFRA gene mutations play an important role in the pathogenesis of GIST. IMutational analysis should be considered as standard practice during the diagnostic work-up, since it has a predictive value for sensitivity to molecular-targeted therapy and also has prognostic value. The aim of this review is to summarize recent knowledge about diagnosis, treatment and follow up of GIST.]

Clinical Oncology

[Signaling pathways in cancer stem cells (Notch, Hedgehog, Wnt)]

KOPPER László, NAGY Noémi, SEBESTYÉN Anna

[OThe key regulators in the embryonic life, and later in the differentiation of tissues and organs are the evolutionary reserved signalling pathways, as Notch, Hedgehog and Wnt. Mutations of these pathways have been identifi ed in many tumor types, increasing the risk to the appearance of cancer stem cells (CSC), with very similar geno- and phenotype as normal stem cells have. Such CSCs with stemness functions can be developed not only from normal stem cells, but also from progenitor and differentiated cells. The main characteristics of CSC are the self maintenance, slow growth rate, very effective DNA-repair system, etc. All of these can contribute to the resistance. Further problems are the low number of CSC in the whole tumor mass, which makes rather diffi cult to achieve the effective drug concentration in CSC. The mentioned ancient pathways interact with many other pathways to form a network, which can infl uence the strategy of therapy. No doubt, that these pathways are promising targets, however, till now the clinical effectiveness is very low due to some reasons mentioned above. Nevertheless, some drugs are already in clinical use, either as monotherapy or part of the combinations. Little is known about the relationship between the pathways and the microenvironment, which has an outstanding role in the cellular activities, sometimes resulting opposite output. It is a great challenge to design effective drugs against CSC, similarly to fi nd reliable predictive biomarkers, which unfortunately still missing, since a reasonable drug-marker interactions would speed up the personalized treatment.]

Clinical Oncology

[Immuno(onco)therapy – road to the future]

DANK Magdolna, SZENTMÁRTONI Gyöngyvér, OROSZ Zsuzsanna, TÓTH Andrea, TŐKÉS Tímea

[Our immune system fi ghts effectively against infections, but the same activity exists against invading cancer cells, as well. However, malignant tumors are able to escape from these mechanisms; therefore tumor cells become unrecognizable for the immune system. Immuno-oncology is a novel and innovative discipline, focusing on a long-term purpose: to enhance the immune-response against malignancies. The main goal is to stimulate the immune system to properly recognize and destroy malignant tumor cells. This approach is comprehensive, includes the initiation of antitumor immune-response and enhancing its controlling mechanisms, moreover, provides active, anti-tumor effector cells. Recent results of anticancer research highlighted a new era of oncology, which is based on targeted, personalized medicine over cytotoxic therapies, and mainly focusing on the rapidly evolving discipline of immuno-oncology.]