53 research outputs found
Rijetke nuspojave terapije sunitinibom u bolesnice s metastatskim karcinomom bubrega: prikaz sluÄaja
Sunitinib is an orally administered multikinase inhibitor. This therapy can provoke uncommon side effects such as pancytopenia, tumor lysis syndrome, cardiac disorders, thromboembolic incidents, intestinal perforation, pancreatitis, acute renal failure, etc. We report a case of a 63-year-old female admitted to the hospital due to abdominal pain, nausea, vomiting and elevated blood pressure. One month earlier, sunitinib therapy for metastatic renal cell carcinoma was initiated. During the first cycle of therapy, after three weeks of sunitinib 50 mg daily, symptoms started and she stopped taking the drug. At admission, laboratory tests revealed elevated serum and urine amylase, C-reactive protein, urea and creatinine, and lowered platelet and leukocyte counts and hemoglobin value. Urine test showed proteinuria, erythrocyturia, leukocyturia and granulated cylinder. The patient was diagnosed with acute pancreatitis grade III, acute renal failure grade II, pancytopenia and urinary infection, and was hospitalized for five days. She was treated symptomatically and with antibiotic therapy because of persistently elevated C-reactive protein and pathologic urinary sediment, which led to subjective and clinical improvement. Acute pancreatitis, renal insufficiency and pancytopenia are rarely described side effects of sunitinib therapy, and clear connection between these conditions and drug activity is not yet determined. Medical specialists who prescribe and treat patients with sunitinib should be aware of the possible occurrence of these conditions and perform regular checkups of sunitinib treated patients.Sunitinib je oralni multikinazni inhibitor. LijeÄenje može izazvati pojavu rijetkih nuspojava kao Å”to su pancitopenija, sindrom lize tumora, srÄani poremeÄaji, tromboembolijski incidenti, perforacija crijeva, pankreatitis, akutno zatajenje bubrega itd. Ovdje prikazujemo sluÄaj 63-godiÅ”nje bolesnice hospitalizirane zbog bolova u trbuhu, muÄnine, povraÄanja i poviÅ”enog krvnog tlaka. Mjesec dana ranije je zapoÄela lijeÄenje sunitinibom zbog metastatskog karcinoma bubrega. U bolesnice su se tijekom prvog ciklusa lijeÄenja, nakon tri tjedna uzimanja 50 mg sunitiniba na dan, pojavili navedeni simptomi zbog Äega je bolesnica prekinula uzimati lijek. Pri prijmu u bolnicu su laboratorijski nalazi pokazali poviÅ”ene vrijednosti serumskih i mokraÄnih amilaza, C-reaktivnog proteina, ureje i kreatinina, sniženi broj trombocita i leukocita te sniženu vrijednost hemoglobina. Postavljena je dijagnoza akutnog pankreatitisa gr. III., akutnog bubrežnog zatajenja gr. II, pancitopenije i urinarne infekcije te je bolesnica hospitalizirana tijekom pet dana. LijeÄena je simptomatski te antibiotikom zbog poviÅ”ene vrijednosti C-reaktivnog proteina i patoloÅ”kog sedimenta mokraÄe, Å”to je dovelo do subjektivnog i kliniÄkog poboljÅ”anja stanja. Akutni pankreatitis, bubrežno zatajenje i pancitopenija su rijetko opisivane nuspojave primjene sunitiniba i jasna veza izmeÄu tih stanja i aktivnosti lijeka joÅ” nije utvrÄena. Specijalisti koji propisuju i lijeÄe bolesnike sunitinibom trebali bi biti svjesni moguÄnosti pojave ovih stanja i provoditi redovite kontrole u bolesnika lijeÄenih ovim lijekom
ASSOCIATION OF BREAST CANCER SYMPTOMS WITH PATIENTSā QUALITY OF LIFE AND DEPRESSION; A CROATIAN CROSS-SECTIONAL STUDY
Aim: To find out which symptoms are the most associated with a breast cancer patientsā quality of life (QoL) and depression.
Subjects and methods: We performed this cross-sectional study from February to April 2015 at the Department of Medical
Oncology, University Hospital for Tumors, Zagreb University Hospital Center "Sestre milosrdnice", Zagreb, Croatia on the sample of 147 breast cancer patients. Primary outcomes were EORTC QLQ-C30 version 3.0 Global QoL scale and Beck Depression Inventory II.
Results: After the adjustment for other symptoms, sociodemographic and clinical variables, fatigue (Č=-0.47, P<0.001), pain
(Č=-0.24, P=0.023), and appetite loss (Č=-0.18, P=0.037) were statistically significantly correlated with QoL. Fatigue was the only symptom significantly associated with depression (Č=0.39, P=0.006).
Conclusion: Fatigue, pain, appetite loss contributes the most to the overall breast cancer patients QoL. Although correlated,
fatigue and pain contribution to lower QoL is independent from each other. Future studies should investigate whether there is an interaction between fatigue and pain changes over course of treatment. Fatigue and number of children are positively, while age and treatment in daily hospital are negatively associated with depression measured by BDI-II
USE OF IMMUNOTHERAPY IN THE TREATMENT OF A PATIENT WITH TWO SIMULTANEOUS METASTATIC DISEASES
Immunotherapy is an evolving and promising cancer treatment proven to significantly prolong survival in a multitude of oncological diseases. Nivolumab, a monoclonal antibody to the PD-1 receptor, is an immunotherapy used in the treatment of several cancers, including melanoma and renal cell carcinoma (RCC)
GISTsā Classifications in Predicting Aggressive Behavior: A Single Institution Experience
Gastrointestinal stromal tumors (GISTs)are the most common mesenchymal neoplasms of the gastrointestinal tract. When making treatment plan it is very important to make proper tumor aggressiveness estimation. Traditionally, the best prognostic factors are tumor size and number of mitoses. The aim of this study was to define which GIST classifica- tion (Aminās or Newmanās classification or Fletcherās Consensus Criteria) is the most significant determining prognosis and has the strongest impact on survival. This study included 63 GIST patients whose tumor specimens were evaluated by standard histopathological methods and classified based on histological assessment of malignant behavior to the three different systems. Comparison of those classification systems was done and none of them was proven to be statisti- cally significantly better in predicting overall survival and probability of lethal outcome. We conclude that all three clas- sifications are comparable in prediction of malignant behavior. The worst prognostic factor is existence of metastases at the time of disease diagnosis
OnkoloŔko savjetovanje bolesnika i obitelji oboljelih od nasljednog karcinoma debelog crijeva
Colorectal cancer (CRC) is the third most common malignancy in the world. Thirty percent of all CRC cases are hereditary or familial forms of the disease. Approximately 5% of them represent well defined hereditary syndromes. Colon cancer syndromes are inherited autosomal dominant diseases, with exception of MUTYH associated polyposis, which is inherited in autosomal recessive manner. Most of CRC syndromes also carry significant risk of developing cancers of extra
colonic localization.The clinician who deals with hereditary CRC patients should have a wide knowledge ofpresentation, genetics and cancer risks in hereditary CRC syndromes.In Croatia we donot have the center that systematically deals with CRC genetics, pharmacogenetics and hereditary CRC syndromes. Therefore, with this article, we systematically review the characteristics CRC syndromes.Kolorektalni karcinom je treÄi najÄeÅ”Äi maligni tumor u svijetu. 30% sluÄajeva su nasljedni i familijarni oblici bolesti. Približno 5% nasljednih oblika Äine dobro definirani nasljedni sindromi kolorektalnog karcinoma.To su nasljedne autosomno dominantne bolesti, s izuzetkom tzv. MUTYH polipoze koja se naslje|uje autosomno recesivno. VeÄina nasljednih sindroma kolorektalnog raka nosi rizik razvoja karcinoma drugih lokalizacija. KliniÄar koji sudjeluje u lijeÄenju oboljelih od kolorektalnog karcinoma trebao bi imati Å”iroko znanje o kliniÄkoj slici, genetici i rizicima za pojedine tumore u nasljednim sindromima kolorektalnog raka.U Hrvatskoj joÅ” uvijek nemamo centar koji bi se sustavno bavio genetikom kolorektalnog karcinoma, farmakogenetikom i nasljednim sindromima kolorektalnog raka. U ovom Älanku donosimo pregled i karakteristike nasljednih sindroma kolorektalnog raka
A patient with metastasis of breast cancer which was originally described as primary colorectal cancer: case report
Breast cancer metastases can be found in almost all organs in the body - but are most commonly found in the lungs, liver, bones, skin and brain. Metastatic breast cancer often occurs years or decades after initial diagnosis and treatment. In this case report, we will present a 62-year-old patient with metastasis of breast cancer which was originally described as primary colorectal cancer
Vrijeme primjene trastuzumaba i rizik za razvoj srÄane disfunkcije u bolesnica sa ranim HER2 pozitivnim karcinomom dojke
Breast cancer is the most common malignant tumor in females in the world. Age is signifi cant risk factor and incidence increases rapidly after age of 35. Approximately one fourth of patients with breast cancer have tumors that overexpress HER2 protein or amplify the HER2/neu gene.Trastuzumab is a recombinant humanized monoclonal antibody that binds to a specific extracellular growth factor, human epidermal growth factor type 2 HER 2-neu or ErbB2, tyrosine kinase receptor
responsible for alterations in cellular metabolism and growth.Clinical studies have shown that trastuzumab given concurrently or following adjuvant chemotherapy improves disease-free survival (DFS) and overal survival (OS) in early-stage HER-2 positive breast cancer. HERA study (Herceptin in Adjuvant breast cancer) showed that one of fifty women treated with trastuzumab adjuvantly developes congestive heart failure during treatment.Mechanisms of trastuzumab induced cardiac dysfunction are not clear yet. Studies have shown that differences in timing of trastuzumab after chemotherapy an ddifferences in total dose of anthracyclines can explain differences in incidence of cardiac dysfunction. The aim of our study was to determine incidence of trastuzumab induced cardiac dysfunction in patients with HER2 positive early breast cancer and impact of time interval between administration of chemotherapy and trastuzumab on prevalence of cardiac dysfunction.
Follow up included 140 patients with early HER2 positive breast cancer treated with trastuzumab adjuvantly. Seventeen patients developed symptomatic cardiac dysfunction (12.1%) of which 6 developed severe congestive heart failure NYHA III/IV(4.2%) and 11 moderate NYHA II/III (7.9%).Patients who started trastuzumab therapy 11 to 20 days after finishing chemotherapy had 11% incidence of symptomatic heart failure, same as those patients who started trastuzumab 26 to 35
days after chemotherapy. There were no cardiac events if treatment was started 35 days after chemotherapy. Highest incidence of congestive heart failure was registered when trastuzumab was applied 21 to 25 days after adjuvant chemotherapy (22%). Time interval between cessation of adjuvant chemotherapy and fi rst trastuzumab application has a signifi cant impact on prevalence of trastuzumab induced cardiac dysfunction.Karcinom je najÄeÅ”Äi maligni tumor u žena u svijetu. Dob je znaÄajan riziÄni faktor i incidencija se poveÄava iznad dobi od 35 godina. Otprilike Äetvrtina bolesnica oboljelih od raka dojke ima tumor koji prekomjerno izražava HER2. Trastuzumab je rekombinantno humanizirano monoklonalno protutijelo koje se veže na humani epidermalni faktor rasta tip 2 HER2-neu ili ErbB2, tirozin kinazni receptor odgovoran za promjene u metabolizmu i rastu stanice. KliniÄke studije su pokazale
da davanje trastuzumaba konkomitantno s ili nakon adjuvantne kemoterapije produžuje period bez povrata bolesti (DSF) i ukupno preživljenje (OS) u ranog HER2 pozitivnog karcinoma dojke. Studija HERA (Herceptin in Adjuvant Breast Cancer) je pokazala da jedna od pedeset žena lijeÄenih trastuzumabom adjuvantno, razvija kongestivno zatajenje srca tijekom lijeÄenja. Mehanizmi nastanka trastuzumabom inducirane kardiotoksiÄnosti joÅ” nisu potpuno razjaÅ”njeni. Studije su
pokazale da razlike u vremenu zapoÄimanja terapije trastuzumabom nakon zavrÅ”ene adjuvantne kemoterapije i razlike u ukupnoj dozi antraciklina mogu objasniti razlike u incidenciji srÄanog zatajenja. Cilj naÅ”eg istraživanja je bio odrediti incidenciju trastuzumabom inducirane kardiotoksiÄnosti u bolesnica s ranim HER2 pozitivnim karcinomom dojke te odrediti utjecaj vremenskog intervala od zavrÅ”etka kemoterapije do poÄetka lijeÄenja trastuzumabom na pojavnost srÄanog zatajenja. PraÄenje je ukljuÄilo 140 bolesnica s ranim HER2 pozitivnim karcinomom dojke koje su lijeÄenje trastuzumabom adjuvantno. 17 bolesnica je razvilo simptomatsko srÄano zatajenje (12.1%) od kojih 6 teÅ”kog stupnja NYHA III/IV(4.2%) a 11 umjerenog NYHA II/III (7.9%).Bolesnice koje su zapoÄele lijeÄenje trastuzumabom 11 do 20 dana po zavrÅ”etku kemoterapije su imale incidenciju simptomatskog srÄanog zatajenja 11%, kao i bolesnice koje su zapoÄele terapiju trastuzumabom 26 do 35 dana nakon kemoterapije. U bolesnica koje su lijeÄenje zapoÄele 35 dana nakon kemoterapije nije zabilježeno kardijalnih dogaÄanja. NajviÅ”a incidencija kongestivnog zatajenja srca je zabilježena kada je terapija trastuzumabom zapoÄeta 21 do 25
dana nakon adjuvantne kemoterapije (22%). Vremenski interval izmeÄu zavrÅ”etka adjuvantne kemoterapije i prve aplikacije trastuzumaba ima znaÄajan utjecaj na pojavnost trastuzumabom induciranog srÄanog zatajenja
Sustavno lijeÄenje karcinoma glave i vrata
Systemic therapy of head and neck carcinoma is reserved for locally advanced and metastatic disease. Concomitant use of cisplatin and irradiation is still standard protocol for treatment of locally advanced disease although immunoradiotherapy with cetuximab seems to be a good alternative with similar results. The best option for fi rst-line treatment of advanced or metastatic disease is polychemotherapy with addition of cetuximab in patients in good clinical condition. Limited options are available for second-line therapy mostly due to poor performance status of the patients. HPV-positive tumors make a special subgroup of HNSCC in which targeted therapy plays the most important role.Sustavno lijeÄenje karcinoma glave i vrata je rezervirano za lokalno uznapredovalu i metastatsku bolest. Konkomitantna primjena cisplatine uz zraÄenje joÅ” uvijek predstavlja standard lijeÄenja za lokalno uznapredovalu bolest, iako imunoradioterapija s cetuximabom predstavlja dobru alternativu sa sliÄnim rezultatima. Najbolja opcija za lijeÄenje uznapredovale ili metastatske bolesti je polikemoterapija uz dodatak cetuximaba za sve bolesnike u dobrom kliniÄkom stanju. MoguÄnosti druge linije lijeÄenja su vrlo ograniÄene, najviÅ”e zbog loÅ”eg opÄeg stanja bolesnika. HPV-pozitivni tumori predstavljaju posebnu podgrupu karcinoma ploÄastih stanica glave i vrata u kojima najvažniju ulogu igra lijeÄenje ciljanom terapijom
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