21 research outputs found
Az emlőrák szisztémás kezelése: szakmai útmutatás
The article presents the practice guideline of systemic treatment of breast cancer and recommendations of the 3rd Hungarian Breast Cancer Consensus Conference. It reflects the recent international guidelines (ESMO, NCCN, ABC2, St Gallen's) irrespectively of the current financial opportunities. Here we follow the early - locally advanced - locally relapsed - metastatic breast cancer line for didactic considerations and we discuss the different subgroups of breast cancer based on hormone receptor and HER2 receptor status. Diagnosis and treatment options of rare clinical entities are summarised at the end of the paper
Opposite trends In incidence of breast cancer in young and old female cohorts in Hungary and the impact of the COVID-19 pandemic: a nationwide study between 2011–2020
Opposite trends in incidence of breast cancer in young and old female cohorts in Hungary and the impact of the Covid-19 pandemic: a nationwide study between 2011–2020
BackgroundThis nationwide study examined breast cancer (BC) incidence and mortality rates in Hungary between 2011–2019, and the impact of the Covid-19 pandemic on the incidence and mortality rates in 2020 using the databases of the National Health Insurance Fund (NHIF) and Central Statistical Office (CSO) of Hungary.MethodsOur nationwide, retrospective study included patients who were newly diagnosed with breast cancer (International Codes of Diseases ICD)-10 C50) between Jan 1, 2011 and Dec 31, 2020. Age-standardized incidence and mortality rates (ASRs) were calculated using European Standard Populations (ESP).Results7,729 to 8,233 new breast cancer cases were recorded in the NHIF database annually, and 3,550 to 4,909 all-cause deaths occurred within BC population per year during 2011-2019 period, while 2,096 to 2,223 breast cancer cause-specific death was recorded (CSO). Age-standardized incidence rates varied between 116.73 and 106.16/100,000 PYs, showing a mean annual change of -0.7% (95% CI: -1.21%–0.16%) and a total change of -5.41% (95% CI: -9.24 to -1.32). Age-standardized mortality rates varied between 26.65–24.97/100,000 PYs (mean annual change: -0.58%; 95% CI: -1.31–0.27%; p=0.101; total change: -5.98%; 95% CI: -13.36–2.66). Age-specific incidence rates significantly decreased between 2011 and 2019 in women aged 50–59, 60–69, 80–89, and ≥90 years (-8.22%, -14.28%, -9.14%, and -36.22%, respectively), while it increased in young females by 30.02% (95%CI 17,01%- 51,97%) during the same period. From 2019 to 2020 (in first COVID-19 pandemic year), breast cancer incidence nominally decreased by 12% (incidence rate ratio [RR]: 0.88; 95% CI: 0.69–1.13; 2020 vs. 2019), all-cause mortality nominally increased by 6% (RR: 1.06; 95% CI: 0.79–1.43) among breast cancer patients, and cause-specific mortality did not change (RR: 1.00; 95%CI: 0.86–1.15).ConclusionThe incidence of breast cancer significantly decreased in older age groups (≥50 years), oppositely increased among young females between 2011 and 2019, while cause-specific mortality in breast cancer patients showed a non-significant decrease. In 2020, the Covid-19 pandemic resulted in a nominal, but not statistically significant, 12% decrease in breast cancer incidence, with no significant increase in cause-specific breast cancer mortality observed during 2020
Fulvestrant in advanced breast cancer: evidence to date and place in therapy
Breast cancer is a classical hormone-dependent tumour; therefore, endocrine therapy is the mainstay of treatment for hormone receptor-positive, human epidermal growth factor 2-negative advanced breast cancer. Until recently, classical endocrine agents such as tamoxifen, steroidal and nonsteroidal aromatase inhibitors and fulvestrant have been widely used in postmenopausal patients to treat locally advanced or metastatic disease. However, for patients with this subtype of breast cancer, the landscape of endocrine therapy is rapidly changing. Therapies targeting oestrogen modulation have evolved in recent years following the introduction of targeted agents, mTOR and CDK 4/6 inhibitors that are administered in combination with hormone therapy. As a result, options for endocrine therapy have expanded in recent years, and a variety of single-agent or combinations of targeted drugs and endocrine therapies are accepted. Fulvestrant is a selective oestrogen receptor downregulator (SERD) which was introduced to clinical practice in 2002, initially with the indication to treat postmenopausal women with hormone-receptor-positive advanced breast cancer as second-line therapy postdisease progression after aromatase inhibitors or tamoxifen. Additionally, fulvestrant has also been shown to be active in patients previously untreated with endocrine therapy, either both in the neoadjuvant and the metastatic setting, alone or in combination with other targeted therapies. Currently, the standard dose is 500 mg, which is administered with a loading dose. Fulvestrant received a new FDA indication in December 2016, in combination with palbociclib, both in pre/peri/postmenopausal women with breast cancer progressing after endocrine therapy. This manuscript aims to give an overview of new efficacy data and the current role of fulvestrant in the systemic therapy of hormone-receptor-positive advanced breast cancer, in the context of other available therapeutic modalities
A gyógyszeres kezelés szerepe a korai emlőrák kezelésében = Adjuvant systemic therapy of early stage breast cancer
Az adjuváns gyógyszeres terápia sikeres alkalmazásával elsősorban a távoli metasztázisok kialakulásának esélye csökkenthető, a diagnózis idején fennálló mikrometasztázisok megszüntetése révén.
Célkitűzés:
A korai emlĹ‘rák posztoperatĂv szisztĂ©más gyĂłgyszeres kezelĂ©si lehetĹ‘sĂ©geinek áttekintĂ©se.
MĂłdszer:
A szerző az irodalmi adatok és saját tapasztalata alapján összefoglalja a korai emlőrák műtéti megoldását követő szisztémás terápia legfontosabb szempontjait.
Eredmények:
Az adjuváns kezelĂ©s során citotoxikus kezelĂ©s, hormonterápia Ă©s HER2 receptort cĂ©lzĂł biolĂłgiai terápia, illetve ezek kombináciĂłja kerĂĽl alkalmazásra. Az endokrin kezelĂ©sben fontos szerepe van a tamoxifenterápiának, amelyet mind a premenopauzális, mind a posztmenopauzális emlĹ‘rák kezelĂ©sĂ©ben alkalmaznak. Premenopauzában az elfogadott standard hormonterápiát az LH-RH analĂłggal vĂ©gzett petefĂ©szek-szuppressziĂł Ă©s/vagy tamoxifenkezelĂ©s kĂ©pezi. Posztmenopauzában az adjuváns endokrin kezelĂ©sben ma már a harmadik generáciĂłs aromatázgátlĂłk is szerepet kapnak, bár mĂ©g nem tisztázott, hogy az iniciális, a szekvenciális vagy a meghosszabbĂtott terápia jelenti-e az optimális stratĂ©giát. Az adjuváns polikemoterápia elsĹ‘sorban a nyirokcsomóáttĂ©tes esetekben kerĂĽl alkalmazásra, emellett a magas rizikĂłjĂş nyirokcsomĂł-negatĂv betegek posztoperatĂv kezelĂ©sĂ©ben is egyre gyakrabban alkalmazzák. Az alkilálĂłk Ă©s antraciklinek mellett a taxánok (docetaxel Ă©s paclitaxel) bevezetĂ©se komoly elĹ‘rehaladást hozott az adjuváns kemoterápiában. Ma már biolĂłgiai cĂ©lzott terápia, a trastuzumabterápia is fontos rĂ©szĂ©t kĂ©pezi a műtĂ©t utáni kezelĂ©snek, amelynek idĹ‘tartama a jelenlegi szakmai ajánlások alapján egy Ă©v.
Következtetések:
Az elmúlt években bevezetett taxántartalmú kemoterápiák, a posztmenopauzális emlőrákban alkalmazott harmadik generációs aromatázgátlók és az adjuváns trastuzumab alkalmazása mind lényegesen hozzájárulnak a korai emlőrákban szenvedő betegek gyógyulási esélyeihez.
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Adjuvant systemic therapy reduces the likelihood of both local and distant relapses by eradicating micrometastases.
Aim:
To survey the adjuvant treatment of early breast cancer. Methods: Author presents an overview of the systemic therapy of early breast cancer based on relevant literature and own experiences.
Results:
Three systemic treatment modalities are widely used as adjuvant therapy for early stage breast cancer such as endocrine treatments, chemotherapy, and anti-HER2 therapy with the humanized monoclonal antibody, trastuzumab. As regards endocrine therapy, the most firmly established adjuvant therapy is tamoxifen for both premenopausal and postmenopausal women. Ovarian suppression and/or tamoxifen are accepted therapy for premenopausal patients. The third generation of aromatase inhibitors should be incorporated in the adjuvant endocrine therapy of postmenopausal women. Thus, it is not known whether initial, sequential, or extended use of adjuvant aromatase inhibitors is the optimal strategy. Adjuvant chemotherapy consisting of multiple cycles of polychemotherapy is an important strategy for lowering the risk of breast cancer recurrence and improving survival, not only in women with higher risk, but in node-negative patients, as well. The introduction of taxanes into treatment strategy constitutes an important advance over the traditional therapy with alkylator- and anthracycline-based regimens. The biologically-targeted drug, trastuzumab has been incorporated in the adjuvant management of HER2 positive tumors, and its duration of treatment is conventionally 1 year to date.
Conclusions:
Adjuvant systemic treatment in breast cancer is a rapidly advancing field of clinical oncology. Taxane-based chemotherapy, aromatase inhibitors in the adjuvant endocrine therapy of postmenopausal women, and the availability of trastuzumab as adjuvant treatment have all led to substantial improvement in the outcome of early breast cancer
<sup>18</sup>F-FDGPET/CT klinikai alkalmazása colorectalis carcinomában | Clinical significance of <sup>18</sup>F-FDG PET/CT in colorectal carcinoma
A modern kĂ©palkotĂł vizsgálatoknak a daganatos betegsĂ©gek diagnosztikájában Ă©s a kezelĂ©s hatĂ©konyságának megĂtĂ©lĂ©sĂ©ben fontos szerep jut. Colorectalis carcinomák esetĂ©n a 18F-FDG PET/CT vizsgálatot a műtĂ©t elĹ‘tti stádiummeghatározásra Ă©s a kiĂşjulás igazolására javasolják. A morfolĂłgiai kĂ©palkotĂł mĂłdszereknek korlátai vannak, elsĹ‘sorban az Ăşj kemoterápiás kombináciĂłban alkalmazott Ăşgynevezett cĂ©lzott terápiák hatásosságának korai megĂtĂ©lĂ©sĂ©ben. Mivel a metabolikus változások megelĹ‘zik a tumor mĂ©retbeli változását, ezĂ©rt ezen a terĂĽleten a PET/CT vizsgálatok egyre nagyobb szerephez jutnak. Az eddig alkalmazott RECIST-kritĂ©riumok mellett a metabolikus válasz mĂ©rĂ©sĂ©re szolgálĂł kritĂ©riumrendszert is lĂ©trehoztak. A szerzĹ‘k közlemĂ©nyĂĽkben az irodalmi adatok alapján a kombinált PET/CT technika javallatait Ă©s szerepĂ©t tekintik át vastag- Ă©s vĂ©gbĂ©lrákok esetĂ©n. Orv. Hetil., 2013, 154, 1447–1453.
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Modern imaging techniques have an important role in the diagnostic procedures of malignancies, and assessing response to therapy. The 18F-FDG PET/CT revolutionized the evaluation of colorectal cancer in terms of preoperative staging and monitoring of recurrence. Conventional imaging techniques have limitations in early assessment of response to therapy. 18F-FDG PET has been shown to allow earlier treatment monitoring, because the metabolic change appears before any anatomic change occurs. The Response Evaluation Criteria in Solid Tumours (RECIST) are widely applied, but they have some limitations. There are new international guidelines for treatment response assessment using PET/CT in solid tumours. The authors review indications and the role of hybrid PET/CT in colorectal cancer. Orv. Hetil., 2013, 154, 1447–1453