Clinical Oncology

[The antiemetic treatment of oncologic procedures]

DECEMBER 30, 2020

Clinical Oncology - 2020;7(4)

[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.]

COMMENTS

0 comments

Further articles in this publication

Clinical Oncology

[Contemporary treatment of the malignant tumors of the uterus]

ÁROKSZÁLLÁSI Anita

[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 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.]

All articles in the issue

Related contents

Clinical Oncology

[Cancer treatment induced gastrointestinal complications]

AL-FARHAT Yousuf, AUTH Péter

[Systemic therapy (ST) (including chemotherapy, targeted therapy, and immunotherapy) or radiation therapy (RT) can induce gastrointestinal side effects, which frequently affect patient’s quality of life. Sometimes side effects could be dose-limiting, or a reason to stop the treatment. The incidence and severity of gastrointestinal complications in patient’s receiving ST, RT, or chemoradiotherapy are affected by numerous factors, including: therapeutic agents, doses and route of administration, target of the RT (upper, lower abdomen or body) and individual patient variability (age, sex, prior cancer therapy, comorbidities, performance status). Mucositis occurs in approximately 20% to 40% of patients receiving conventional chemotherapy, 80% of patients receiving high-dose chemotherapy, nearly all patients receiving head and neck radiation therapy. mTOR inhibitor-associated stomatitis (mIAS) is the most frequent dose-limiting toxicity (52.5%). More than 90% of patients receiving highly emetogenic chemotherapy will have episodes of vomiting. However, only about 30% of these patients will vomit if they receive prophylactic antiemetic regimens.]

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

BALÁZS Nóra , BERECZKI Dániel, KOVÁCS Tibor

In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.