Clinical Oncology

[The highlights of the 2020 ESMO virtual congress]

SZÖLLŐSI Regő1

DECEMBER 30, 2020

Clinical Oncology - 2020;7(4)

[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.]

AFFILIATIONS

  1. Dél-pesti Centrumkórház, Országos Hematológiai és Infektológiai Intézet, Onkológiai Osztály, Budapest

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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

[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.]

Clinical Oncology

[The antiemetic treatment of oncologic procedures]

[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.]

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Lege Artis Medicinae

[Complex pathological diagnosis of breast cancer and the patient care based on it over the past 20 years]

CSERNI Gábor

[The diagnosis of breast cancer has become more complex in the past 20 years. Intraoperative diagnosis has been mostly replaced by multidisciplinary preoperative/ nonoperative diagnostics. Surgical treatment can be planned in advance for the breast as well as for the axilla. In many cases, routinely performed radical surgery has been replaced by selectively applied, less radical, conservative operations (sectoral or wide local excisions, sentinel lymph node biopsy) that are suitable for smaller tumours mostly detected by screening. In addition to prognostic markers listed in the pathology reports (lymph node status, tumour size, vascular invasion, status of resection margins), an increasing emphasis has been placed on predictive markers (estrogen receptors, progesterone receptors, HER-2, basal and proliferation markers) that allow molecular typing of breast carcinomas and that mostly influence systemic treatment. Tools to predict the efficiency of treatment have become increasingly available, and these might also help in planning neoadjuvant therapies, a modality which has also been introduced in the past 20 years. The present article gives a brief, subjective, thematic insight into some of these changes, selected on the basis of their relation to the pathological diagnosis of breast carcinoma.]

Clinical Oncology

[Clinical role of multigenic prognostic tests in breast cancer therapy]

GYŐRFFY Balázs

[Current clinical practice for breast cancer originates in “evidence based medicine”. In this, each tumor receives a therapy optimal for a given patient population - which might not be optimal for each individual patient. Multigenic tests determining expression of a set of genes can provide additional support in this decision process. Two such tests (MammaPrint and Prosigna) have already received FDA clearance. A number of additional test are commercially available (IHC4, Oncotype DX, EndoPredict, BCI). A common property of these assays is their utility in estrogen receptor positive early breast cancer. The main clinical problem answered by them is the necessity of adjuvant chemotherapy. To date, no reliable algorithm has been identifi ed capable to pinpoint the most effective chemotherapy combination for a given patient. Furthermore, there is no trustworthy test for triple negative breast cancer. The assays utilize different technologies (immunohistochemistry, gene chips, RT-PCR) and a discrepant list of genes - these result in discordance of the predictions for the individual patient. Despite these shortcomings, multigenic tests quickly gained foothold in breast cancer therapy decision process. Their utility is supported by the cost reduction for the health care providers by lowering the number of patients eligible for chemotherapy.]

Hungarian Radiology

[Results of breast cancer screening and clinical mammography at the Kenezy Breast Center, Debrecen between 2002-2003]

SEBŐ Éva, SARKADI László, KOVÁCS Ilona, VAJDA Olga

[INTRODUCTION - Breast cancer screening has been started in January 1. 2002. in Hungary in the course of the National Health Program. Breast cancer is the main cause of death among women’s malignant tomors, and the aim of the project is to reduce this mortality. The chance of survival is highly increased by the early detection of the disease. Kenezy Breast Center was connected to this project. PATIENTS AND METHODES - Females between 45-65 years without symptoms participated in the project. Paralel to this women with symptoms, sometimes with palplable masses were clinically examined. Screening mammography films were read by two radiologists and the complementary examinations of the breast and the axillary lymph nodes - ultrasonography, guided biopsy (FNAB, core biopsy) - were performed always by the same doctor. Results of the two projects were compared. RESULTS - The incidence of malignant breast cancer was 4‰ in the screening and 1,5% in the clinical group. 46.5% of the malignant breast cancers revealed by the clinical examinations was diagnosed in the group of women between the age of 45 to 65 years. This is the age when most women are involved in the screening program. 7.3% of the tumors was diagnosed in the 40- 44 year age-group and 11.3% among women aging 66-77 years. The rate of malignant tumors smaller than 1.5 cm was 49.1% according to screening records and 36% in the clinical trial. In both groups, tumor size of 1.5 cm proved to be a critical limit regarding to the development of metastases, mainly in the axillary region. Above this size, metastases were more frequent. CONCLUSIONS - Both breast screening program and clinical exams are of great significance. Based on the data obtained during two years, authors found that women below the age of 40 and above the age of 65 should also be involved in the screening program. Detection of breast tumor is possible at an early stage by screening. In the case of small tumors (smaller than 1.5 cm) the development of axillary metastases is less likely than in the case of larger ones. The lack of metastases in the axillary lymph nodes offers better prognosis according to the published scientific data, which reinforces the importance and necessity of the screening programs.]

Clinical Oncology

[Treatments of brain tumors in adults – an up-date]

BAGÓ Attila György

[The prognosis of brain metastases is very poor. Surgery and radiotherapy provides the fi rst line treatment, while systemic therapy has limited value. Nevertheless, our knowledge is increasing: normal cells contribute signifi cantly to the homing and growth of tumor cells; the molecular profi le of the primary tumor and its metastases could be different, which infl uences the therapeutic strategies; the type of blood supply can change during the tumor growth. It would be very important to optimize the cooperation of the different therapeutic modalities, and to fi nd markers which could predict the risk of metastatization.]

Lege Artis Medicinae

[Cervix and breast cancer screening in the districts of Hungary]

SÁNDOR János, SZÜCS Mária, KISS István, BONCZ Imre, SEBESTYÉN Andor, KISS Adrienn, EMBER István

[INTRODUCTION - Life expectancy in Hungary has been increasing recently but in a geographically uneven distribution. The mortality trends has remained disadvantageous for cancer patients and also for the malignancies of cervix and breast that can be preventable with screening. The study aimed to describe the participation at the district level in the screening programmes as well as to investigate the relative role of health behaviour of women and of the health services in determining the screening success. METHODS - Age standardised relative screening participation rates were computed for 150 districts of Hungary using discharge reports of the outpatient services for cervical cytology and mammography. RESULTS - 20,12% of all 25-65 years old women was screened for cervical cytology during 3 years (1. July 1998. - 31. June 2001.) and 17,22% of all women aged 45-65 years participated in mammography in a 23 months period (1. July 1998. - 31. May 2000.). The results scattered in a certain fashion. Summarising the screening results, the highest participation ratios were observed in Bonyhád, Kiskunfélegyháza, Paks, Zalaszentgrót, Pécs while the lowest were in Csengeri, Mór, Nyírbátor, Sárbogárd, Enying districts. The screening performances did not correlate with each other and with the socioeconomic indicators (education, unemployment, income), apart from the significant influence of education on mammography participation rate. The emerging explanation is that the health behaviour was not important determinant of screening participation. In this case, the behaviour of target populations would have affected similarly both screening results resulting in a correlation. CONCLUSIONS - Consequently, the performances of providers responsible for screening organisation have been reflected in the observed screening rates. This result and the wide scattering of screening participation rates, which developed in spite of the uniform legislative-economic environment, emphasises the importance of regular monitoring of screening performance.]