Clinical Oncology

[Thromboprophylaxis in cancer patients]


MAY 20, 2014

Clinical Oncology - 2014;1(02)

[Cancer- and chemotherapy-associated venous thromboembolism (VTE) is a serious complication in patients with malignancies. Most important questions and challenges are summarized in the review and an attempt is made to answer some of them. Epidemiology, causes of thrombophilia and risk factor analysis including thrombogenicity of both tumorous disease and chemotherapy are discussed. The following special risk groups are detailed: (a) postoperative, (b) hospitalized non-surgical patients, (c) ambulatory patients with chemotherapy, (d) tumorous patients without chemotherapy. As conclusion, most important messages of the recent guidelines for preventing and treating cancer-associated thrombosis are discussed.]



Further articles in this publication

Clinical Oncology

[EGFR family and gynecologic cancers]


[The HER family of receptor tyrosine kinases may potentially play an important role in gynecologic malignancies. Amplifi cation and overexpression of various HER family members including epidermal growth factor receptor (EGFR/HER1) and HER2 have been reported in epithelial ovarian cancer and endometrial carcinoma as well as in cancer of the uterine cervix. High expression of EGFR has been associated with poor prognosis independent from histiotype while HER2 expression may be more histotype dependent. This review summarizes the clinical experience with anti EGFR/HER2 directed monoclonal antibody therapy in the three major gynecologic cancer types to date.]

Clinical Oncology

[Radiological response evaluation of targeted therapy]


[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

[Neoadjuvant therapy in breast cancer – an update]

KAHÁN Zsuzsanna, RUSZ Orsolya, UHERCSÁK Gabriella, NIKOLÉNYI Alíz

[Traditionally, neoadjuvant systemic therapy (NST) serves as treatment of advanced breast cancer to achieve technical operability by resulting in tumor regression. Nowadays, NST is advantageous in all cases if adjuvant systemic therapy is needed, since the in vivo study of its effect provides possibility for the estimation of prognosis, the treatment may be modifi ed according to the therapeutic response, the systemic therapy starts earlier as compared to adjuvant therapy, and fi nally, it may result in the reduction of surgical and radiotherapeutical radicality. The type of NST should be selected on the basis of tumor features refl ecting treatment sensitivity. In case of chemosensitive cancers, chemotherapy is taxane- and anthracycline-based, and the planned dose should be delivered prior to surgery. In HER2-positive cancers, the addition of an anti-HER2 agent doubles the rate of pathological complete regressions. In hormone-sensitive tumors, the standard neoadjuvant endocrine therapy consists of an aromatase inhibitor (postmenopause), or tamoxifen or an aromatase inhibitor combined with an LHRH analog (premenopause) for 4-8 months that is continued following the surgery in the adjuvant setting. For the early evaluation of the effect of NST, serial tumor biopsy or imaging studies (MRI, PET) seem promising. Sentinel lymph node biopsy around the NST should be practiced with prudence; it may warrant the avoidance of axillary blockdissection in some cases. For the design of radiotherapy, the initial stage and the degree of regression are considered.]

Clinical Oncology

[Complex medical treatment of non small cell lung cancer - new challenges, new possibilities]


[Previously, it was suffi cient to differentiate small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC) in the decision making process for the therapeutic strategy of lung cancer. Recently, the situation has changed signifi cantly. There are only few new cytotoxic agents, and platinum based chemotherapy remains the standard combination in the treatment of NSCLC. In the last decade no further development has been discovered in the treatment of SCLC. However, the new molecular diagnostic and therapeutic possibilities have altered dramatically the management of NSCLC. NSCLC could not be considered as a separate entity anymore. The complex medical treatment of advanced NSCLC includes the molecular target driven therapies the histopathological subtype based chemotherapies and the immunotherapy. Immunotherapy is a new challenge in the treatment of lung cancer. Tumor-vaccines, inhibition of immune checkpoint pathways are investigated in clinical trials. Ongoing studies will defi ne the true effi cacy of these drugs. The complex combination of genes, proteins, different molecular pathways and patients characteristics, called “panomics”, are all parts of the treatment of lung cancer in the daily clinical practice.]

Clinical Oncology

[Molecular profi les in therapeutic strategy]

PETÁK István, SCHWAB Richárd

[In 2013, 10 years after the completion of the human genome, the cancer genome project has identifi ed almost all possible cancer genes, which could be responsible for the malignant transformation and progression. These genes are called „driver” genes, and the pathogenic mutations to be „driver” mutations. The census of „driver genes” in 2013 counted 138 genes and 1.5 million mutations. The situation is further complicated by the fact that up to 8 „driver” gene can be activated simultaneously in the same tumor, furthermore, the profi le may change during tumor growth and metastatization. 2013 was a turning point also because several targeted therapies were registered. Currently there are about 30 targeted drugs in clinical use and more than 200 targeted compounds in clinical development. This means that in 3-4 years the number of drugs will at least double. Most of the current patients can only access these compounds in clinical trials. But, patient already benefi t signifi cantly more even from phase I clinical trials, if they are selected based on the molecular profi le of the tumor. Fortunately, the advancements of next generation sequencing technologies provide the opportunity to identify all „driver” genes, - the whole molecular profi le, - in the patient’s tumor for the cost of one month targeted therapy. But the information generated can be only used in clinical practice if the results are processed by „molecular info-bionics”.]

All articles in the issue

Related contents

Lege Artis Medicinae

[Roma cancer patients’ illness cognition and their attitudes toward medical treatment]


[INTRODUCTION - In this qualitative pilot study, our goal was to investigate the illness representation of gipsy cancer patients and to examine their attitudes toward medical treatment. SAMPLE AND METHODS - Deep interviews were made with 20 persons (60% female; Mage=39.2±15.1 years). The included participants approximately represented the group composition of the Hungarian Roma population. RESULTS - For most of our respondents, cancer is a frightening disease meaning some kind of punishment and the end of life. The potential causes of the disease usually remain completely incomprehensible. The participants proved to be very under-informed in relation to their treatment - even when compared to the low level of information among Hungarian cancer patients in general. In the face of the supporting presence of family members, our respondents often stated that there was nobody to share their deeper emotional problems with. About half of the patients reported on impolite and inefficient treatment attributed to prejudice against their Gipsy identity. However, deeper analyses revealed, that in most of these cases, mistreatment was a consequence of the general shortcomings of the health care system (e.g. lack of time) - being labelled as discrimination by our respondents. Almost every participant sees his/her only role in recovery merely in the participation in medical treatment - not attributing enough significance to life style changes and even less to alternative / complementary medicine. CONCLUSION - Special training to improve communication skills with gipsy patients is needed - especially for general practitioners. We also suggest preparing handouts to Roma cancer patients that provide easy-to-understand information on the medical treatments and health behaviours that serve the coping with cancer and their prevention.]

Clinical Oncology

[Obesity and cancer]


[The role of obesity in the development of cancer is well-known from ages. However, these days we witness the explosion-like increase of obesity, globally, but mainly in the economically advanced population, and, which is even more alarming, among youngsters. The prognosis of the obesity-related cancer is rather poor, therefore, the prevention, including the screening, have outstanding importance. Unfortunately, the participation of the obes persons, especially obes women, in these programs is very low. The diagnostics and therapies should consider the special features of obesity, which are related to the magnitude, distribution, composition of fatty tissue connected to the changes in pharmacokinetics. Moreover, the problems might be complicated with obesity-associated non-tumorous severe diseases (e.g. cardiovascular, diabetes type 2).This review covers different aspects of obesity-cancer relationships, with an emphasis on everyday oncology.]

LAM Extra for General Practicioners



[The effects of vitamin D in bone health have been known since the 1920s. Recently, it has been proven that its role in the body is much more complex. Activated vitamin D is a steroid hormone that regulates transcription of more than 200 human genes through its receptor that is detectable in almost all types of cells. In contrast to the former conceptions, it can be activated not only in the kidneys; moreover, local 1-α-hydroxylation plays a greater role in its extraskeletal effects. Vitamin D deficiency, currently defined as serum levels of <30 ng/ml, is caused by the lack of ‘effective’ sunlight exposition. Thus, vitamin D deficiency is one of the most frequent deficiencies in the developed world that plays a role not only in the development of skeletal conditions but many other diseases, as well. A low vitamin D level causes a reduced calcium absorption, a higher bone remodelling rate and increased bone loss. It also reduces muscle strength and increases the risk of falling. Normal vitamin D status is required for the effectiveness of drugs for osteoporosis treatment; however vitamin D treatment in itself is not effective in osteoporosis. An increasing number of studies show the benefits of vitamin D supplementation and treatment in extraskeletal conditions. Vitamin D plays an important role in the prevention of several auto-immune diseases, infections, cardiovascular diseases, and cancers. Therefore, all UV-B radiation-deprived adults require an intake of vitamin D to maintain a level of >30 ng/ml. Vitamin D3 treatment is safe. The necessary dose can be reliably approximated by the calculation that an incremental consumption of 100 IU/day raises serum vitamin levels by 1,0 ng/ml. Clinical trials suggest that for the vast majority of individuals, a prolonged intake of 10,000 IU/day does not pose any risk.]

Lege Artis Medicinae

[Haemophilia today]


[Haemophilia is the most well-known inherited bleeding disorder, which has an X-linked inheritance and affects men. Its severity is classified on the basis of the amount of circulating functional clotting factors: patients with values < 1% have severe disease, those with values of 1-5% have moderate disease, and those with values >5% are classified as having mild disease. Severe haemophilia is characterised by frequent, spontaneous bleeding episodes, whereas in those with moderate or mild haemophilia, bleeding is only caused by trauma or surgery. Although bleeding can occur almost anywhere, the most common clinical manifestation is haemarthrosis. Haemophilic arthrpathy that develops as a result of repeated episodes of joint haemorrhage is the most important factor of morbidity in those with haemophilia. Intravenous replacement of the missing clotting factor is used to treat and prevent bleeding episodes. Controlled therapy at home that provides immediate replacement is the optimal early approach. Prophylaxis includes administration of clotting factors at regular intervals to prevent bleeding, which must be the main goal of management until a cure becomes available. The development of inhibitors during treatment is the most significant complication of factor replacement, and management of bleeding in patients with such inhibitors is difficult.]

Clinical Oncology

[Paleo-oncology - messages from the past]

MOLNÁR Erika, MARCSIK Antónia, PÁLFI György, ZÁDORI Péter, BUCZKÓ Krisztina, TAKÁCS Vellainé Krisztina, HAJDU Tamás

[Nowadays, cancer is one of the greatest challenges facing mankind. However, there is still no consensus among researchers regarding the antiquity of cancer. Written sources and paleo-oncological studies may help to answer this question. The aim of this study is to present data on the history of cancer based on historical sources, literature data and own research fi ndings. Early historical sources indicate that cancer was already known in antiquity. Paleopathological studies of animal and human fossils show that malignant bone tumors were present in ancient times, although the frequency of the disease was seemingly very low. The increasing number of unearthed fossils and the use of modern diagnostic tools have led to a rise of the number of diagnosed cancer cases. Our comprehensive paleo-oncological study, focusing on the occurrence and frequency change of malignant tumors in historic populations of Hungary was based on the analysis of skeletal remains belonging to 11,000 individuals dated from the Early Neolithic to the late medieval period. During the analysis macromorphological, modern imaging and histological methods were applied. As a result of the extensive investigations osteological evidences of malignant bone tumors were identifi ed in 39 cases. Neoplastic bone diseases were present in all studied historical periods and there were no differences in their occurrence and frequency between the different archaeological periods.]