29 research outputs found
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
PluÄna fibroza izazvana oksaliplatinom: prikaz sluÄaja
Oxaliplatin is part of the standard chemotherapy regimens for treating colorectal
carcinoma. Pulmonary fibrosis is a serious but rare side effect of oxaliplatin treatment, which resulted
in patient death in more than half of the reported cases. The precise pathophysiological mechanism of
this phenomenon has not been clarified yet. Analysis of the reported cases strongly suggests that
early diagnosis and immediate corticosteroid treatment are crucial for better prognosis. Here we report
a case of pulmonary fibrosis related to the FOLFOX regimen in a patient with early colorectal
carcinoma.Oksaliplatin je dio standardnih kemoterapijskih protokola za lijeÄenje kolorektalnog karcinoma. PluÄna fibroza je ozbiljna,
ali rijetka nuspojava primjene oksaliplatina, koja je rezultirala smrÄu bolesnika u viÅ”e od polovine prijavljenih sluÄajeva.
ToÄan patofizioloÅ”ki mehanizam nastanka ove nuspojave joÅ” nije u potpunosti razjaÅ”njen. Analiza prijavljenih sluÄajeva je
pokazala da su rana dijagnoza i rani poÄetak lijeÄenja kortikosteroidima od kljuÄne važnosti za bolju prognozu. Ovdje prikazujemo
sluÄaj pluÄne fibroze uz primjenu oksaliplatina u bolesnika s ranim kolorektalnim karcinomom
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
Povezivanje mehanizama kemorezistentnosti tumorskih stanica i suboptimalnih sistemskih citotoksiÄnih rezultata lijeÄenja
Systemic cytotoxic chemotherapeutic treatment of malignant tumors does not fully meet its goal due to the resistance of present tumor cells to the applied therapy. Chemoresistance is complex and multifactorial, caused by numerous mechanisms that alter drug concentration in the cell, by changes in expression of the epidermal growth factor and by activation of intracellular signaling pathways PI3K / Akt and MAPK. The factor of chemoresistance is also an increased level of antioxidative glutathione and glutathione transferase ā S enzyme and the presence of tumor stem cells that signifi cantly improve protection of DNA from damage. Apart from cellular factors, resistance is influenced by extracellular hypoxia and acidosisand autophagy.
Overcoming the chemoresistance is possible by using nanomechanisms for delivery of drugs to tumor cells, autophagy inhibitors like antimalarials chloroquine and hydroxychloroquine and plant polyphenols.
By better understanding the mechanisms of chemoresistance and itās overcoming it can be possible to achieve improvement in antitumor treatment.Sustavno citotoksiÄno kemoterapijsko lijeÄenje zloÄudnih tumora ne ispunjava u potpunosti svoj cilj zbog prisutne kemorezistencije tumorskih stanica na primjenjenu terapiju. Kemorezistencija je kompleksna i uzrokovana brojnim mehanizmima koji mijenjaju koncentraciju lijeka u stanici, promjenama u ekspresiji epidermalnog Äimenika rasta i aktivacije unutarstaniÄnih signalnih puteva PI3K/Akt i MAPK. Äimbenik kemorezistencije je porast antioksidativnog enzima glutationa i glutation-S transferaze te prisustvo matiÄnih stanica karcinoma koje znaÄajno bolje Å”tite DNA od oÅ”teÄenja. Osim staniÄnih
Äimbenika, na rezistenciju utjeÄe ekstracelularna hipoksija i acidoza te autofagija.
Prevladavanje kemorezistencije moguÄe je primjenom nanomehanizama u dostavi lijekova u tumorske stanice, inhibitorima autofagije antimalaricima klorokinom i hidroksiklorokinom te biljnim polifenolima.
Poznavanjem mehanizama kemorezistencije i njezinim nadilaženjem moguÄe je poboljÅ”ati dobrobit antitumorskog lijeÄenja
Utjecaj sastava tijela na kvalitetu života premenopauzalnih bolesnica s ranim stadijem raka dojke tijekom kemoterapije
Body composition has been studied relatively recently as part of oncology trials
in different types of tumors. There are numerous studies that define the impact of chemotherapy side
effects on the quality of life (QoL) of breast cancer patients, however, there are few studies that analyze
the impact of body composition on the QoL of premenopausal patients in the course of cytotoxic
treatment. The study was performed on a sample of premenopausal patients treated with neoadjuvant
or adjuvant AC chemotherapy for early-stage breast cancer at Day Hospital of the Department of
Medical Oncology, University Hospital for Tumors in Zagreb. The study included 68 patients, median
age 46.6 years. Analysis of the QoL questionnaires and their association with body composition indicated
several interesting results. At the beginning of treatment, most pronounced was the connection
between body composition and physical and sexual functioning and hair loss, while in subsequent
treatment cycles the effect on other QoL subdomains, in particular fatigue and diarrhea, was more
pronounced. In conclusion, we found body composition to have a significant impact on certain QoL
subdomains during treatment.Sastav tijela se poÄeo prouÄavati relativno nedavno u sklopu onkoloÅ”kih ispitivanja u razliÄitim vrstama tumora. Postoje
brojne studije koje definiraju utjecaj nuspojava kemoterapije na kvalitetu života bolesnika oboljelih od raka dojke, meÄutim,
malo je studija koje su analizirale utjecaj sastava tijela na kvalitetu života premenopauzalnih bolesnica tijekom citotoksiÄnog
lijeÄenja. Studija je provedena na uzorku premenopauzalnih bolesnica lijeÄenih neoadjuvantnom ili adjuvantnom kemoterapijom
po protokolu AC za rani stadij raka dojke u Dnevnoj bolnici Zavoda za internistiÄku onkologiju Klinike za tumore u
Zagrebu. U istraživanju je sudjelovalo 68 bolesnica, medijan dobi od 52,6 godina. Analiza upitnika kvalitete života i njihova
povezanost sa sastavom tijela ukazali su na nekoliko zanimljivih rezultata. Na poÄetku lijeÄenja najizraženija je bila veza
izmeÄu sastava tijela i fiziÄkog i seksualnog funkcioniranja te gubitka kose, dok je u kasnijim ciklusima lijeÄenja utjecaj na
druge poddomene kvalitete života, osobito umor i proljev, bio viÅ”e izražen. ZakljuÄno, sastav tijela ima znaÄajan utjecaj na
odreÄene poddomene kvalitete života u tijeku kemoterapijskog lijeÄenja
Rak jajnika ā sustavna terapija i uloga biomarkera
Ovarian cancer is typically a disease susceptible to systemic antineoplastic treatment. Systemic antineoplastic therapy is indicated in almost all FIGO stages of ovarian cancer. In very early stage, well diff erentiated disease, benefi t gained with chemotherapy (CT) is no bigger than the 5-year survival rate per se, 90-98%, therefore CT is not indicated in these stages. Inall other stages, the systemic antineoplastic therapy is aplicable and desirable. It is based on platinum compounds, cisplatin and carboplatin, with addition of paclitaxel. For years, there was no advance in systemic chemotherapy treatment in ovarian cancer. The disease is treated as early, advanced and recurrent, and recurrent as platinum sensitive and platinum resistant disease, and this is how the drugs are being applied. Platinum basis, along with taxane partner is the basis and standard protocol, precisely carboplatinum ā paclitaxel. There are also some other active agents, such as pegylated liposomal doxorubicin, topotecan etc. Beside the chemotherapy, a biological therapy holds an important spot in treating (epithelial) ovarian
cancer. Bevacizumab showed effi ciency and benefi t in platinum resistant and platinum sensitive recurrent disease, as well as in advanced, nonmetastatic and nonrecurrent disease. PARP inhibitor olaparib gained accelerated approval on the basis of significantly improved fast overall response rate and duration of response. It is yet to be shown, whether all the benefits of neoadjuvant approach, dose dense regimen, metronomic chemotherapy and intraperitoneal way of application of CT in treating ovarian cancer are being explored.Rak jajnika u naÄelu je bolest osjetljiva na sustavnu antineoplastiÄnu terapiju. Sustavno antineoplastiÄno lijeÄenje indicirano je u gotovo svim FIGO stadijima bolesti. U vrlo ranom, dobro diferenciranom raku jajnika, benefi t postignut kemoterapijom ne razlikuje se od 5 āgodiÅ”nje stope preživljenja same po sebi, stoga kemoterapija u ovim stadijima nije indicirana. U svim drugim stadijima, sustavna antineoplastiÄna terapija primjenjiva je i poželjna. Temeljena je na derivatima platine,
cisplatini i karboplatini, uz dodatak paklitaksela. Godinama u sustavnoj terapiji raka jajnika nije bilo napretka. Bolest se lijeÄi kao rani, uznapredovali te rekurentni rak jajnika, a rekurentna bolest kao platina - rezistentna i platina ā osjetljiva bolest i na taj naÄin se primjenjuju i lijekovi. Platinska baza uz taksanski partner, toÄnije karboplatina ā paklitaksel temelj su i standardni protokol lijeÄenja. TakoÄer su aktivni i neki drugi agensi, poput pagiliranog liposomalnog doksorubicina, topotekana i sl. Osim kemoterapije, važnu ulogu ima i bioloÅ”ka terapija. Bevacizumab se pokazao uÄinkovitim i donio benefi t u lijeÄenju rekurentnog paltina ā rezistentnog, paltina ā osjetljivog , kao i u lijeÄenju uznapredovalog, nemetastatskog nerekurentnog raka jajnika. PARP inhibitor olaparib dobio je odobrenje ubrzanim postupkom na temelju znaÄajno poboljÅ”ane brze sveukupne stope odgovora te trajanja odgovora. Ostaje za vidjeti jesu li i koliko iskoriÅ”tene prepoznate prednosti neoadjuvantnog pristupa, dose dense režima primjene, metronomiÄke terapije te intraperitonealnog naÄina apliciranja terapije
Procjena nutritivnog rizika bolesnika tijekom sustavnog antineoplastiÄnog lijeÄenja
This study aims to explore if there is a change in nutritional risk and body mass index (BMI) in cancer patients during the systemic antineoplastic treatment. We retrospectively analyzed data collected from 216 cancer patients treated at the Department of Medical Oncology, University Hospital for tumors, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia, with systemic antineoplastic therapy in the period from 05/2016 to 05/2018. In our study, we included both patients treated with systemic therapy for the first time and patients treated repeatedly (only patients who have had at least six months free period after the last treatment course were eligible). We included male and female patients with breast cancer, colorectal cancer, pancreatic cancer, and head and neck cancer. Around 75% of patients had metastatic disease. We analyzed data collected from Nutritional Risk Score-2002 (NRS-2002) screening and results of BMI, at first hospitalization, and after three months of systemic antineoplastic treatment. All patients at high nutritional risk (NRS 3-4) received the nutritional intervention, which included enteral nutritional supplement and education of patient and patientās family about nutrition in oncological patients. We used the Wilcoxon test for the NRS score and t-test for a depended variable for BMI data. The initial average BMI of all patients was 26,45 kg/mĀ². Of all screened patients, around 78% of them were at mild nutritional risk (NRS 1-2), while around 22% of them were at high nutritional risk (NRS 3-4). We recorded a statistically significant decrease both in NRS of the entire screened population of patients after three months of systemic antineoplastic treatment and after specific nutritional intervention in high-risk patients (most patients were at mild nutritional risk, while less than 8% of them were at high nutritional risk). There was no significant change in BMI in the observed period (average BMI was 26, 59 kg/mĀ²). It seems, systemic antineoplastic treatment, along with early nutritional intervention with enteral nutritive supplementation and education, can significantly contribute to the decrease of the nutritional risk.Cilj ovog rada je procijeniti promjena u nutritivnom riziku i indeksu tjelesne mase (ITM) onkoloÅ”kih bolesnika tijekom sustavnog antineoplastiÄnog lijeÄenja. Retrospektivno su analizirani podatci 216 bolesnika koji su od 05/2016 do 05/2018 lijeÄeni na Odjelu internistiÄke onkologije Klinike za tumore, KBC Sestre milosrdnice, Zagreb, Hrvatska. ObuhvaÄeni su bolesnici po prvi put lijeÄeni sustavnom antineoplastiÄnom terapijom i/ili koji u prethodnih 6 mjeseci nisu bili lijeÄeni niti jednim vidom onkoloÅ”kog lijeÄenja. Zastupljeni su bolesnici obaju spolova, oboljeli od raka dojke, debelog i zavrÅ”nog crijeva, guÅ”teraÄe te glave i vrata. Oko 75% bolesnika imalo je metastatsku bolest. KoriÅ”teni su rezultati NRS 2002 nutritivnog probira te rezultati indirektne procjene sastava tijela izraÄunom indeksa tjelesne mase (ITM) prilikom prve hospitalizacije te nakon 3 mjeseca sustavnog antineoplastiÄnog lijeÄenja. U svih bolesnika koji su bili u visokom nutritivnom riziku (NRS 3-4) je provedena nutritivna intervencija uvoÄenjem enteralne prehrane te edukacije bolesnika i obitelji o prehrani onkoloÅ”kih bolesnika. Za statistiÄki izraÄun su koriÅ”teni Wilcoxonov test za podatke o NRS-u te t-test za zavisne uzorke za podatke o ITM-u. Inicijalni prosjeÄni ITM je na poÄetku lijeÄenja bio 26,45 kg/mĀ². Inicijalnim nutritivnim probirom je utvrÄen blagi nutritivni rizik (NRS 1-2) u oko 78% bolesnika, a oko 22% bolesnika je bilo u visokom nutritivnom riziku (NRS 3-4). Nakon 3 mjeseca specifiÄnog onkoloÅ”kog lijeÄenja te provoÄenja nutritivne potpore u visoko ugroženih bolesnika, zabilježen je statistiÄki znaÄajan pad u nutritivnom riziku u ukupnoj ispitivanoj populaciji (veÄina bolesnika je bila u blagom nutritivnom riziku, dok je manje od 8% bolesnika bilo visokog nutritivnog rizika). U periodu praÄenja nije bila zabilježena znaÄajnija promjena u indeksu tjelesne mase (prosjeÄni ITM je bio 26,59 kg/mĀ²). Sustavno antineoplastiÄno lijeÄenje uz ranu nutritivnu intervenciju i edukaciju doprinosi smanjenju znakova bolesti i poboljÅ”anju opÄeg stanja bolesnika te može znaÄajno smanjiti nutritivni rizik
Medicinska konoplja u onkologiji
Although today among oncology patients use of various preparations of complementary and alternative medicine is more and more frequent, there is unequivocal scientifi c base for their use. Among the often used preparations, especially in the treatment of cancer pain, is cannabis and its derivatives. Cannabinoids act on the endogenous cannabinoid system, with widespread receptors in the central nervous system and peripheral tissues. Although the pharmacology of the cannabinoids is still largely unknown, numerous of their eff ects were investigated. In oncology, studies have been conducted on the effect
of cannabinoids on nausea and vomiting during the oncological treatment, the cancer pain and neuropathy, on appetite and weight loss, and the impact on mood, depression and anxiety. It is also observed that some of the cannabinoids have antitumor, but also protumorous activity. There have been many diff erent side eff ects of cannabinoids detected, and in a smaller percentage also the development of addiction. Best known preparations nowadays are dronabinol, nabilon and nabiximol. At the moment, the evidence lack strenght, and large randomized clinical trials are required, which would confi rm predominatly positive results of the research.Iako je danas meÄu onkoloÅ”kim bolesnicima sve uÄestalija uporaba razliÄitih pripravaka komplementarne i alternativne medicine, za njihovu uporabu nema nedvojbene znanstvene potvrde. MeÄu ÄeÅ”Äe primjenjivanim pripravcima, osobito u lijeÄenju karcinomske boli, je i kanabis i njegovi derivati. Kanabinoidi djeluju u organizmu preko endokanabinoidnog sustava, s rasprostranjenim receptorima u srediÅ”njem živÄanom sustavu i perifernim tkivima. Iako je farmakologija kanabinoida joÅ” uvijek uglavnom nepoznata, do sada su istraživani njihovi brojni uÄinci. U onkologiji su provedena istraživanja utjecaja na muÄninu i povraÄanje prilikom onkoloÅ”kog lijeÄenja, na karcinomsku bol te neuropatiju, na apetit i gubitak tjelesne mase te utjecaj na raspoloženje, depresiju i tjeskobu. TakoÄer je opažen antitumorski, ali i protumorski uÄinak nekih kanabinoida. Zabilježeni su brojni razliÄiti neželjeni uÄinci kanabinoida, a u manjem postotku i razvoj ovisnosti. Najpoznatiji pripravci danas jesu dronabinol, nabilon i nabiksimol. Sveukupno, za sada nisu osigurani dovoljno snažni i nedvojbeni dokazi i potrebne su velike randomizirane kliniÄke studije, koje bi potvrdile do sada opažene pozitivne rezultate istraživanja