Clinical Oncology

[Resistancy and/or progression - Failure or only a short stop]

KOPPER László, SEBESTYÉN Anna

FEBRUARY 20, 2014

Clinical Oncology - 2014;1(01)

[Nowadays, with the continuously in creasing demand for targeted diagnostics and therapy, we are approaching an ideal stage when the most effective treat ment for a given patient could be selected. However, some basic problems are still waiting to be solved. One major hurdle is the heterogeneity, the formation of subclones with different signifi cance during progression, but with the capacity to overgrow after the failure of the initial therapy. The importance of this phenomenon is refl ected in the daily practice where targeted therapy is allowed to treat only locally extended or metastatizing tumors. Therefore, it is not as to nishing, that the clinical success is usually tem po rary, the disease in spite of the good response at the beginning will progress. The main reason is the resistancy against the carefully analysed and applied therapeutic drugs, which has several options (e.g. new mutations, crosstalks between pathways, faults of feed-backs, etc.). This review focuses on the acquired resistancy with some relevant examples. Among the open questions we can recall e.g. the resistancy in combination therapy, or the suggested link between resistancy and progression including the potential use of drug rechallenge.]

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[The restructuration of Hungarian oncological attendance and medicinal fi nancing resulted in the more intensive participation of clinical oncologists in the therapy of patients with ovarian cancer. The aim of the authors was not to defi ne the taxative therapeutic recommendations, but to give an overview on the development of the therapy and to introduce the deliberation aspects and therapeutic alternatives. While the primary and secondary prevention have developed in case of cervical cancer - with the possibility of eradication - the improvement of surgical techniques and clinical oncological treatments may result in the decrease of mortality in ovarian cancer. It is important to emphasis that only the appropriately aligned application of the two therapeutic modalities can lead to the desired outcome. It has become clear by the end of the ‘90s, that paclitaxel-carboplatin combination is the standard chemotherapy against ovarian cancer. Alternative cytostatic treatments like intraperitoneal treatment and triplets were not breakthroughs. The dose intensive treatment increased the survival rates besides good tolerability, however the results require further confi rmation. Neoadjuvant therapy should be considered in case of patients with advanced and metastatic disease in selected cases. Recently, therapeutic use of angiogenesis inhibition comes with signifi cant improvement. Bevacizumab is the fi rst of targeted therapies, and studies on the effectiveness of similar compounds are under way.]

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[Pancreatic cancer (PC) is a major health problem with a poor prognosis. The number of patients with PC is increasing globally. There are no screening tests for early detection of PC, but even when diagnosed early, surgery is possible in only a minority of cases. Managing PC remains a big challenge. For selected patients with borderline or unresectable disease, neoadjuvant therapy offers the potential for tumor downstaging. In patients with resectable disease, adjuvant chemotherapy improves the fi ve year survival rate, whereas the use of adjuvant radiochemotherapy is still controversial. In metastatic cancer, monotherapy with gemcitabine remained the main therapeutic option during more than 10 years. Many different combinations with other drugs and new targeted therapies have been tested with gemcitabine. Only a combination of erlotinib and gemcitabine has shown a modest survival benefi t until now. Many gene alterations that directly contribute to pancreas tumorigenesis have been identifi ed or are under active investigation. Recently, the FOLFIRINOX regimen has been reported to be more active than gemcitabine in selected metastatic patients. Quality of life is an extremly important factor, when treating a patient with PC. CA 19-9 serum level can provide important information with regards to prognosis, overall survival, and response to chemotherapy as well as predict post-operative recurrence. There is a strong need for other predictive biomarkers to select patients, who might benefi t from available and new therapeutic options.]

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