Clinical Oncology

[Pharmacological treatment of metastatic melanoma]

OLÁH Judit, GYULAI Rolland

SEPTEMBER 10, 2014

Clinical Oncology - 2014;1(03)

[Malignant melanoma belongs to the group of relatively easily manageable tumors; if detected and removed early, it rarely metastasizes. Although the visible nature of the primary tumor provides opportunity for early diagnosis, there is a signifi cant portion of patients who receive proper management only with substantial delay. The fact that there are annually 300-400 patients with metastatic disease in Hungary, can be mostly attributed to public unawareness about melanoma, and consequent delay in seeking medical treatment. Metastatic melanoma remains - even today - an incurable disease. Molecular genetic research, however, resulted in revolutionary changes in melanoma management. Today, apart from the classic pathological prognostic factors, information regarding specifi c molecular modifi cations (such as in the expression of the BRAF, NRAS, c-KIT genes and proteins) are inevitable for the setting up of a personalized oncological treatment plan. By targeting members of the MAPK signal transmission pathway (using BRAF- and MEK-inhibitors), signifi cant improvement could be achieved in metastatic melanoma. Similarly, new drugs targeting specifi c immune checkpoint regulators (such as CTLA-4 and PD-1/PD-1L) provide previously unprecedented survival benefi t for melanoma patients. In this review the most recent developments in the fi eld of melanoma management are summarized.]



Further articles in this publication

Clinical Oncology

[How to evaluate clinical trials?]


[Data from a clinical study should be always viewed with great care, and is recommended to examine and evaluate the data in-depth. First of all should be determined the evidence level of the trial’s results and what recommendations can be made based on them. The study’s type and the study design, the number of participating patients, statistical power, randomisation, stratifi cation, the balance between study arms, the endpoints and the adequacy of follow-up time should be examined. In addition the importance of the observed statistical signifi cance, the clinical relevance of the data and the real magnitude of the detected differences, and the time-dependent variables are worth to consider because these factors can determine the impact of the given clinical trial on the every-day clinical practice. In the era of the “creative study plans” a critical attitude is necessary to be convinced that the study does not contain any typical bias that could infl uence the real value and actual results of the trial.]

Clinical Oncology

[Treatment of hepatocellular carcinoma - today]


[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

[European examination for clinical oncologists]


[One of the major tasks of the European Examination Board is to harmonize the knowledge and practice of clinical oncologists throughout the world. The examination consits 100 questions and the positive result is aknowledged by a diploma. More and more countries replace the national exam by ESMO-exam. It is still a challenge how to evaluate the activity of clinical oncologists who are specialized in different area of oncology. The ESMO-exam is available mainly at the ESMO congresses.]

Clinical Oncology

[New aspects in cancer pain relief]


[Authors investigate the new advances in cancer pain relief among the long survival cancer patient, 25-30% of whom suffering from pain. The new molecular targets provide new druggable pain relief options. The changed strategy of pain-killing therapy enhance s the possibility for the long survival cancer patients to decrease problems of the side effects of opiod therapy. The lower doses of opioids in invasive theraputical techniques help patients to live in higher quality of life without the uncomfortable side effects of the drugs.]

Clinical Oncology

[Pregnancy and cancer]

NAGY Zsuzsanna, SZILLER István, VALTINYI Dorottya, HORVÁTH Orsolya

[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.]

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Related contents

Lege Artis Medicinae

[Intravenous immunoglobulin immunotherapy in immune mediated habitual abortions]


[INTRODUCTION - Based upon international and domestic research data authors summerize the humoral and cellular im­munregulatory disorders which can be found in the background of “immune me­diated abortions” (IMA). PATIENTS AND METHODS - Within the frame of a home research program a special examination protocol was elaborated in order to sepatare alloimmune habitual abortions from autoimmune and non immune backgrounds. After all other causes were excluded erythrocyte antibody inhibition assay (EAI) was used for measuring the serum level of FcgRII receptor blocking IgG antibody, because its lack an important diagnostic parameter. Among the cell mediated immunofuntional tests the mixed lymphocyte culture reaction (MLC) was the most useful. During the roughly last 16 years 67 out of 76 selected alloimmun IMA patients were administered Intratect IVIG treatment without any particular selection among them. IVIG treatment was first applied on the completed 5-6th week of pregnancy and doses of 0,3-0,4g/kg bodyweight per oc­casion were given 3 times with 3-week intervals. RESULTS - Altogether a significant rise in the serum level of blocking antibodies was shown after each IVIG treatment although a slight decrease was seen after every given dose. Of the 67 IMA patients 54 carried infants to term during the study period. In 4 cases of abortion no cause was identified with post hoc diagnosis. Thus the success rate of this type of IVIG therapy was 93.1% (58/54). Conclusion - In approprietly selected alloimmun IMA cases the IVIG generated immunoregulatory and antiimflammatory pathways may contribute to its net positive reproductive effect.]

Clinical Oncology

[Tumor vaccination]

LACZÓ Ibolya, PIKÓ Béla

[Although cancer immunotherapy was initiated by William Coley more than a century ago, the fi eld of cancer vaccines is in an early stage of development. Only recently, major advances in cellular and molecular immunology have allowed a comprehensive understanding of the interaction between the immune system and the tumor. Data from several preclinical and clinical trials have confi rmed the positive effect of the cancer vaccines which accompanied in several cases by positive clinical outcomes. In our article we try to discuss the new cancer vaccine strategies which are under development or in a clinical phase stage.]

Lege Artis Medicinae

[Gene modified immune cells: New weapons not exclusively against cancer]


[The oncological breakthrough of the last decade was the application of CD19-specific CAR T cells in different hematologic diseases. Experience gained by clinical trials, coupled with investments of the private stakeholders and the pharmaceutical industry resulted not only in commercial release to the public of already developed CAR T cell products, but drew the atten­tion of many researchers to the potentials of new type immune cells, and their non-oncological administration. This study aims to present briefly those preclinical applications, which approved successfully the administration of CAR T cells in autoimmune and infectious diseases.]

Clinical Oncology

[Treatment of mesothelioma - an update]

MOLDVAY Judit, HEGEDŰS Balázs, KOVÁCS Ildikó, DÖME Balázs

[Malignant pleural mesothelioma is an aggressive tumor arising from the mesothelial cells lining the pleura. It is an asbestos related disease with increasing incidence both in Europe and in Hungary. This often fatal disease is characterized by rapid progression, and unfortunately, treatment options are very limited to date. Thus every effort should be made to better understand the pathological and molecular biological characteristics of this disease in order to develop new treatment strategies. This summary reviews the treatment options available today as well as the new therapeutic approaches at the experimental and clinical investigation stage.]

Clinical Oncology

[Advancing therapies in metastatic castration-resistant prostate cancer]

GIULIA Baciarello, MARCO Gicci, KARIM Fizazi

[Introduction: Prostate cancer is the second most common cause of cancer world wide and is the most frequently detected cancer in the European Union in men over 50 years of age. Androgen deprivation therapy remains the corner stone of treatment for recurrent or metastatic disease. Unfortunately, nearly all patients will develop resistance to androgen blockade leading to castration-resistant prostate cancer (CRPC). Over the last 10 years, new treatment shaved ramatically improved overall survival of men with mCRPC. Current therapies are basedon AR-axis inhibitors and taxane-based chemotherapies, aswell as radiopharmaceuticals and Sipuleucel T. Areas covered: The authors provide a review of the current fi eld of systemic therapy in metastatic CRPC. This is followed by an in-depth analysis of recent developments in treatment, and the biological rationale behind these therapies. Expert opinion: Since several trials with docetaxel or novel hormonal agents showed improvement in overall survival in metastatic castration-sensitive prostate cancer, aswell as in non-metastatic castrationresistant patients, it is expected that a growing subgroup of patients will be expose dearlierto chemotherapy and to AR targeted agents. It becomes then fundamental to fi nd novel strategies to over come drug resistance and further improve survival.]