Clinical Oncology

[Treatment of metastatic breast cancer – an update]


DECEMBER 10, 2015

Clinical Oncology - 2015;2(04)

[Due to the effi cient screening and early detection most breast cancer cases are recognized today in early stage. Approximately 5% of newly detected cases have distant metastasis. In Hungary the situation is worse. Early stage disease will relapse in about 30%, mainly with distant metastasis. Metastatic breast cancer is incurable disease, except some rare, special cases. As systemic therapeutic options are developing rapidly, most breast cancer subtypes can be treated successfully and long term survival is not rare. Primary objective of the treatment is increasing overall survival and quality of life, by decreasing disease related symptoms. In this review we summarize the systemic therapeutic options of metastatic breast cancer according to the subtypes. It is recommended to use an individual treatment plan for every patient.]



Further articles in this publication

Clinical Oncology

[The role of physical activity in oncology]


[Although nowadays there are a lot spoken about the role of physical activity in illness prevention, however it is barely connected to the treatment of malignant diseases. The regular exercises can improve physical performance and fi tness; increase muscle mass; change the body composition and proportion favorably. The positive psychological effects can decrease distress and depression; improve mood of patient; increase self-confi dence and self-respect. Finally, all of these will result in an improved quality of life. The malignant disease and the treatments can draw down either short-term or long-term consequences and side-effects that can largely infl uence or restrict everyday life. Most of them could be essentially reduced by the help of a physiotherapist experienced in oncology adopting a well-defi ned and customized workout.]

Clinical Oncology

[Non surgical treatment of urinary bladder cancer]

PIKÓ Béla, LACZÓ Ibolya

[According to our present knowledge the surgical intervention in the treatment of bladder cancer is essential, but some non-surgical treatment methods play an indispensable role as well. Super- fi cial (non-muscle-invasive) form of bladder cancer can be treated by intravesical chemotherapy or BCG instillation, radiotherapy; the muscle-invasive forms of this tumour (≥pT2a) need neoadjuvant, adjuvant chemotherapy, radiotherapy or radio-chemotherapy. In case of metastatic disease (or locally advanced, recurrent disease) the treatment regimen consist of chemotherapy (given as fi rst line or second line), palliative radiotherapy, interventional methods, radio-isotope therapy and symptoms relief drugs. We present each of the therapeutic modalities and their indications category based on the ESMO and NCCN guidelines.]

Clinical Oncology

[The role of EGFR receptor family in the oncological practice]


[The EGFR receptor family is a set of membrane tirosine kinase receptors with signifi cant homology which are responsible for cellular activation through intracellular signaling due to ligand binding. The four members of the family (EGFR1, EGFR2/HER2/neu, EGFR3/HER3, EGFR4/HER4) earned special interest in tumor biology while becoming one of the most potent targets of anti-cancer therapies. Changes in the receptor expression or in the kinase activity fundamentally modify cellular functions, survival and tumorigenic potential. Moreover, mutations are associated with reduced or altered treatment effi cacy. The basic function and major genetic and biological mechanisms affecting the function of EGFR receptors and related therapies are subjects of this overview.]

Clinical Oncology

[Hematopoietic stem cell transplantation for solid tumors in adults]

GOPCSA László Zsolt, MASSZI Tamás

[We revised the medical literature regarding autologous and allogeneic hematopoietic stem cell transplantation (HSCT) in the setting of solid tumors. Autologous-HSCT for solid tumors in adult patients show changing patterns in past decades with decreases numbers for many types of solid tumors. Most marked is the previously well-described increase and decrease in autologous HSCT for breast cancer (BC). Autologous-HSCT for BC has been an area of intense controversy. The role of autologous-HSCT for BC at high risk of recurrence (at least four involved axillary lymph nodes) has been assessed by several randomized trials. Overall, it was shown that high-dose therapy prolonged disease-free survival when used as adjuvant therapy, and showed a benefi t on overall survival in only selected cohorts of patients. In second or further relapsed or primary refractory germ cell tumor, highdose therapy is considered to be a standard therapeutic option, especially when poor prognostic factors are present. In addition, sequential therapy with two to three cycles is felt to be superior to single cycle of HSCT. High-dose therapy can be regarded as a potential clinical option in selected adult patients with Ewing’s sarcoma and medulloblastoma. Currently, in other types of solid tumors the autologous- HSCT is generally not recommended or developmental and only used in the context of prospective studies. Numbers of allogeneic HSCT for solid tumors remained stable low number throughout the recent years. Transient increase is observed over the last decade and is primarily due to renal cell carcinoma, BC and colon cancer. Concepts of allogeneic HSCT for solid tumors do not rely on highdose chemotherapy and tumor load reduction but rather on a graft-versus-tumor effect. Attempts to improve the therapeutic effect of allo-HSCT or other cellular therapies in solid tumors by innovative clinical strategies are underway.]

Clinical Oncology

[Current treatment of gastrointestinal lymphomas]


[The most common extranodal site involved by lymphoma is the gastrointestinal tract. The majority of extranodal lymphoma cases are of the non-Hodgkin subtype. Usually, the involvement of the gastrointestinal tract by nodal lymphomas is secondary, the primary gastrointestinal localisation is rather rare. The most common pathological types are diffuse large B-cell lymphomas and extranodal marginal zone lymphomas of the mucosa-associated tissue (MALT) subtype. Although the primary gastrointestinal lymphoma can involve any part of the gastrointestinal tract, the stomach is the most frequently involved site. The treatment and prognosis are determinated primarily by the histologic type of lymphoma, the stage of disease and the patient’s age and general condition. Helicobacter pylori (HP) infection is one of the major risk factors for gastric lymphomas, the presence or abscence of which radically infl uences the effectivity of treatment. In case of HP positivity, HP eradication itself can result in complete remission. In most cases the treatment is immuno- and/or combination chemotherapy, which is performed according to the internationally accepted protocols, specifi c to the type of lymphoma. Radiotherapy plays a lesser role in the treatment of GI lymphomas, while surgery is performed almost only in complicated cases, such as haemorrhage, occlusion or perforation.]

All articles in the issue

Related contents

Lege Artis Medicinae

[Long survival with multimodal therapy]


[Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death in women worldwide. Approxi­mately two-thirds of cases are potencially sensitive to endocrine therapy. Fulvestrant is a selective estrogen receptor downregulator indicated for the treatment of postmenopausal women with estrogen receptor positive, locally advanced or metastatic breast cancer for disease relapse on or after adjuvant antiestrogen therapy, or disease progression on therapy with antiestrogen. We are reporting here a nearly ten-years-long sucessful combination of multiple treatment lines of anti-estrogen treatment, chemotherapy and radiotherapy in a case of a patient with hormone receptor positive, HER2 negative breast cancer with pulmonary metastases.]

Clinical Oncology

[Practical use of meta-analyses in predicting disease risk, outcome, and therapy response in breast cancer]

KAHÁN Zsuzsanna, TARI Gergely, ENYEDI Márton, HARACSKA Lajos

[Germinal BRCA status infl uences patient care both in early and advanced/metastatic breast cancer. Ideally, the patient should make the decision on the type of surgery or the avoidance of radiotherapy being aware of the BRCA status; based on the most recent clinical studies, this knowledge may infl uence the type of chemotherapy in the neoadjuvant, adjuvant, or metastatic setting or may raise the use of emerging targeted therapies. DNA-targeting cytostatic agents, mostly platinum agents and PARP inhibitors that act by inducing synthetic lethality, provide specifi c therapies in BRCA-mutant cases. The optimum place and sequence of these specifi c agents in treatment, however, are not known yet. International guidelines promote BRCA testing for the specifi cation of treatment strategy in all HER2-negative advanced/metastatic breast cancer cases (NCCN) or at least in all cases when, based on certain predictors, the presence of mutations is likely (ESMO). Recently, the methods employed for BRCA testing have improved immensely and are widely available through the services of various providers. For the identifi cation of the mutation, sequencing of the whole genes is needed, which can be achieved faster and more cost-effi ciently using next-generation sequencing (NGS) platforms compared to previous methods. It is the responsibility of the physician to consider the possibility of BRCA mutations and to raise the issue of BRCA testing to the patient if the family history, the age, previous malignant disease(s) of the patient, or the cancer features are suggestive of genetic risk.]

Clinical Oncology

[Current views on the male breast cancer]

BAKI Márta

[Breast cancer in men is a rare disease, and accounts for only 1% of all diagnosed breast cancers. Hungarian incidence by available data much higher. The greatest risk factor of male breast cancer the elevated estrogen concentration in the body. Genetic disorders, as a Klinefelter syndrome and estrogen exposures and other metabolic changes might cause the male breast cancer. Symptom duration is longer than female population and the male breast cancers diagnosed in older ages and advanced stages. Frequency of BRCA2 mutation is probably 10% among male patients. The most common type is invasive ductal carcinoma with estrogen and progesterone receptor positivity. Diagnostic, surgical, radiation procedures and chemotherapy probably same as female breast cancer. The guidelines recommend as in adjuvant and curative setting the tamoxifen and other selective estrogen receptor modulators treatment. By large nation based registry the survival rate is different from male and female breast cancers. New biomarkers, genetic changes are under investigation to understand munch better the male breast cancer.]

Clinical Oncology

[CDK 4/6 Inhibitors in Breast Cancer: Current Controversies and Future Directions]


[Purpose of review: To describe the clinical role of CDK 4/6 inhibitors in hormone receptor-positive (HR+) metastatic breast cancer (HR+MBC) as well as current controversies and evolving areas of research. Recent fi ndings: Palbociclib, ribociclib, and abemaciclib are each approved in combination with an aromatase inhibitor or fulvestrant for HR+MBC. Abemaciclib is also approved as monotherapy for pre-treated patients. Key questions in the fi eld include whether all patients with HR+MBC should receive a CDK 4/6 inhibitor up front versus later line, impact on overall survival, role of continued CDK 4/6 blockade, mechanism of clinical resistance, and treatment sequencing. Summary: The development of CDK 4/6 inhibitors has changed the therapeutic management of HR+MBC. Additional research is needed to determine optimal treatment sequencing, understand mechanisms governing resistance, and develop novel therapeutic strategies to circumvent or overcome clinical resistance and further improve the outcomes of patients with MBC.]

Hungarian Radiology

[Male breast cancer]


[Male breast cancer does not get a sufficient attention which would be appropriate due to its special features. Diagnostical and therapeutical protocols are not existing, a national center and international collaboration would be necessary. Incidence of male breast cancer is one percent of the female breast cancers, and 5 percent of all male cancers. The absolute number of the cases increased in the past years. The mutation of gene BRCA2 plays the main role in the male breast cancer. The breast cancer of the men is a "late disease", because often neither the doctor nor the patient considers this opportunity. The diagnosis is often established at an advanced stage. Cancer can occur on both sides, but the right breast is more often affected. Staging is the same as in female patients. Prognosis is poorer than in females, the tumor-receptor rate is better, HER2 in men does not plays any role. Basic principles of diagnostics and therapy are same as in females, mainly because there is no consensus about the treatment of the male breast cancer. The same proved protocols are used in men which are applied in women. The ground-method is surgery, reduced radicality and mastectomy is usually applied. Males react on hormone therapy better, than women, mainly chemotherapy is suggested. Follow up of the patients and the psychological support is extremely important. A multidisciplinary collaboration is necessary in the treatment of the male patient, and education is of great importance.]