Lege Artis Medicinae

[Multidisciplinary medical oncological treatment of colorectal cancer]

LÁNG István

FEBRUARY 20, 2001

Lege Artis Medicinae - 2001;11(02)

[All stage III. patients and some high risk patients with stage II. colorectal cancer (CRC) should be treated with bolus 5-fluorouracilfolinic acid adjuvant chemotherapy. The usual adjuvant/neoadjuvant treatment for rectal cancer is chemo-radiotherapy. In stage IV. CRC various combinations of 5-fluorouracil, folinic acid, irinotecan or raltitrexed can be used. Patients should be treated in specialised multidisciplinary oncological centers - and, if possible, as participants of clinical trials.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[„There should be someone to hold the hand of the dying!” Deep interviews on the difficulties of caring for the dying]

BOGNÁR Tamás, KOLOSAI Nedda, HEGEDÛS Katalin, PILLING János

Lege Artis Medicinae

[A doctor who will be remembered: Gustav Rau]

NÉMETH István

Lege Artis Medicinae

[No, non and variations]

GRÉTSY Zsombor

Lege Artis Medicinae

[SCIENTIFIC DIGEST]

Lege Artis Medicinae

[Ágnes Jobst: Healing stars]

MAGYAR László András

All articles in the issue

Related contents

Clinical Neuroscience

[Chemotherapy of recurrent supratentorial malignant gliomas (Phase II study)]

ÁFRA Dénes, SIPOS László, VITANOVICS Dusan

[At the Hungarian National Institute of Neurosurgery 73 recurrent supratentorial malignant tumours were treated by chemotherapy during the last ten years. Chemotherapy was applied after postoperative radiotherapy but in some cases following reoperation only. All cases were clinically and by CT or MRI verified recurrences. Forty-three patients received BCNU-DBD (dibromodulcitol) treatment (23 anaplastic astrocytoma - AA, and 20 glioblastoma multiforme - GM): day 1. BCNU 150 mg/sq.m. in iv. infusion, day 2. dibromdulcitol 1000 mg/sq orally was given. This course was repeated every six weeks, altogether 2-8 times. Sixteen patients with AA responded with complete or partial regression but only 6 did with GM. Median survival was 14 and 7 months, the difference proved to be significant, p=0.0091. PCV combination (procarbazine, CCNU, vincristine) was applied to 16 patients with AA and 14 cases with recurrent oligodendroglioma (O). Treatment started with vincristine 1.5 mg/sq. m. iv. (2.0 mg maximum), the next day CCNU 100 mg/sq.m. was given, followed by procarbazine 60 mg/sq.m. on days 8-22. and finished by the same dose of vincristine on day 30. The course was repeated after one month, mostly six times. Six patients with AA did not respond; in cases of oligodendroglioma all but one responded with complete or partial improvement. It is remarkable that no significant difference was found between the survivals of BCNU-DBD or PCV treated AA patients. Chemotherapy of supratentorial malignant glioma recurrences with nitroso-ureas and their combination proved to be efficacious. It also seems, that in recurrent cases lower grade gliomas show better response rate than glioblastomas.]

Clinical Neuroscience

[Temozolomide chemotherapy of patients with recurrent anaplastic astrocytomas and glioblastomas]

SIPOS László, VITANOVICS Dusan, ÁFRA Dénes

[Introduction - Anaplastic astrocytomas and glioblastomas are the most frequent and most malignant hemispherial tumours. Unfortunately, astrocytic tumours are of infiltrative character and radical removal is not possible. Recurrent malignant gliomas are rarely suitable for reoperation. In most of the cases of recurrent gliomas chemotherapy is the last choice. Patients and method - Seventy-five consecutive patients with recurrent malignant astrocytomas and glioblastomas had been treated at our institute with per os temozolomide for five days every month. The patients received two to 16 courses of chemotherapy. The toxicity, quality of life, response to chemotherapy and survival data were analysed. Results - Out of 75 patients four were excluded following the first treatment due to myelotoxicity, and allergic reactions. Among the patients treated with temozolomide in seven cases complete response, 17 partial response, 14 progressive disease were observed. In 33 cases the disease stabilized and out of them in 27% a significant neurological improvement was detected. The time to progression was 6.8 months and the median survival time 8.75 months for patients with glioblastoma and with malignant astrocytoma or malignant mixed oligoastrocytoma 9.45 and 11.15 months, respectively. The overall survival for patients with originally lower grade glioma was 70.32 and for patients with glioblastoma multiforme 17.43 months. Conclusions - Temozolomide chemotherapy in patients with recurrent malignant astrocytoma and glioblastoma proved to be efficacious and similar good results were achieved as with a nitrosourea based combined chemotherapy. Even in those patients who received previous chemotherapy temozolomide is well tolerated and a relatively long time to progression was achieved in cases of recurrent malignant gliomas. In a few number of patients where BCNU had been previously failed with temozolomide stable disease was achieved. Temozolomide seems to be a promising drug in the chemotherapy of malignant gliomas and can be applied as a second line chemotherapy, as well.]

Lege Artis Medicinae

[RETROPERITONEAL LIPOSARCOMA]

NÉMETH Hajnalka, KOVÁCS Erzsébet, SÁPY Péter, PÁSZTOR Éva, DEZSŐ Balázs, SZŐLLŐSI Zoltán, PFLIEGLER György

[INTRODUCTION - Liposarcoma is a malignant soft tissue tumour, which represents less than 0.1% of all human cancers. Approximately 20% of liposarcomas arise in the retroperitoneum. Radical surgical excision is potentially curative, making it the first choice of treatment. For local tumour control palliative chemo- and/or radiotherapy can be used. CASE REPORT - A 28-year-old man with a history of weight loss, fatigue and abdominal tightness was diagnosed to have a giant dedifferentiated retroperitoneal liposarcoma, which showed aggressive growth and gave local recurrences. Multiple surgical excisions were performed, the first two times with curative, subsequently with palliative intent. To reduce the retroperitoneal tumour mass, several chemotherapeutic regimens were applied with complementary radiotherapy. As a result of the combinational therapy, tumour growth stopped temporarily, pressure pain subsided and the patient's quality of life was satisfactory. Finally, distant metastases developed in the bones of the right hip, in the lung and on the serous membranes and after 44 months of follow-up the patient died. CONCLUSION - It has been postulated that ifosfamide and doxorubicin based combined chemotherapy prevents or postpones the development of distant metastases. Considering the significant risk of local and distant recurrences, the use of ifosfamide-doxorubicin based combined chemotherapy is recommended in highgrade retroperitoneal liposarcoma, even following complete surgical excision.]

Clinical Oncology

[Molecular subtypes and the evolution of treatment decisions in metastatic colorectal cancer]

RODRIGO Dienstmann, RAMON Salazar, JOSEP Tabernero

[Colorectal cancer (CRC) has clinically-relevant molecular heterogeneity at multiple levels: genomics, epigenomics, transcriptomics and microenvironment features. Genomic events acquired during carcinogenesis remain drivers of cancer progression in the metastatic setting. For example, KRAS and NRAS mutations defi ne a population refractory to EGFR monoclonal antibodies, BRAFV600E mutations associate with poor outcome under standard therapies and response to targeted inhibitors in combinations, while HER2 amplifi cations confer unique sensitivity to double HER2 blockade. Multiple rare gene alterations driving resistance to EGFR monoclonal antibodies have been described with signifi cant overlap in primary and acquired mechanisms, in line with a clonal selection process. In this context, sequential analysis of circulating tumor DNA has the potential to guide drug development in a treatment refractory setting. Rare kinase fusion events and complex alterations in genes involved in DNA damage repair have been described, with emerging evidence for targetability. On the other hand, transcriptomic subtypes and pathway activation signatures have also shown prognostic and potential predictive value in metastatic CRC. These markers refl ect stromal and immune microenvironment interactions with cancer cells. For example, the microsatellite instable (MSI) or POLE ultramutant CRC population is particularly sensitive to immune checkpoint inhibitors, while tumors with a mesenchymal phenotype are characterized by activation of immunosuppressive molecules that mandate stratifi ed development of novel immunotherapy combinations. In this manuscript we review the expanding landscape of targetable oncogenic alterations and signatures in metastatic CRC and discuss the clinical implementation of novel molecular diagnostic tests.]

Clinical Oncology

[Treatment of the relapsed epithelial ovarian cancer ]

BOÉR Katalin

[Ovarian cancer remains the most lethal gynaecological cancer and most patients present with advanced FIGO stage disease. Despite optimal upfront surgery and the administration of front-line paclitaxel-carboplatin chemotherapy, approximately two-third of ovarian cancer patients will relapse in the fi rst 3 years. In the last years, the goal in the treatment of ovarian cancer has shifted to maintenance therapy, trying to extend the progression free intervals of the patients. Remarkable advances in the knowledge of molecular biology of relapses led to the introduction the combination of antiangiogenic agent bevacizumab and chemotherapy, which showed to be effective in all phases of the disease, in fi rst-line therapy, as maintenance therapy, and in platinum-sensitive and platinum-resistant recurrence as well. Very recently, a new maintenance therapy, olaparib monotherapy has been introduced into clinical practice to treat platinum-sensitive, relapsed, high-grade serous ovarian cancer. Despite progresses in this therapy, are still some areas of controversy on how to manage epithelial ovarian cancer relapses. The aim of this manuscript is to give an overview on the management of relapsed ovarian cancer in the context of new available therapeutic modalities.]