Sunitynib i ewerolimus w leczeniu pacjentki z jasnokomórkowym rakiem nerki

W pracy opisano przypadek 52-letniej chorej na rakanerki. U pacjentki nie stwierdzono czynników ryzyka, jakna przykład palenie tytoniu

Surowiczy piaszczakorak otrzewnej o agresywnym przebiegu: opis przypadku i przeglad literatury

Abstract Background. Primary serous peritoneal psammocarcinoma (PSPP) is a rare variant of serous carcinoma characterized by massive psammoma body formation and low-grade cytological features. Patients with serous psammocarcinoma have a protracted clinical course and relatively favourable prognosis, although a more aggressive course of PSPP may occur. Case presentation: A 52-year-old woman suffering from abdominal pain with ascites and serum CA-125 level substantially elevated underwent an exploratory laparoscopy which revealed bulk disease. The pathology report detected PPSP at the FIGO stage IIIC. The patient received neoadjuvant chemotherapy (3 courses of paclitaxel / pegylated liposomal doxorubicin / carboplatin). Optimal interval debulking surgery was performed as the next step, followed by three courses of adjuvant chemotherapy (paclitaxel / carboplatin). Due to the fact that the patient had residual disease, at the second-look surgery she received consolidation therapy with intraperitoneal and intravenous chemotherapy carboplatin. Eight months after the completion of treatment the patient developed disease recurrence in the peritoneum. Palliative surgery (enterostomy) was performed. Furthermore, the patient received two lines of chemotherapy consisting of cyclophosphamide / cisplatin and then gemcitabine. After twenty five months she developed brain metastases, treated with palliative radiotherapy. The patient died twenty eight months since her primary presentation of PSPP. Conclusion: PSPP is an infrequent variant of epithelial cancer with favourable prognosis. The disease may, however, take a more aggressive course. Thus, an aggressive therapy is required to postpone the progression.Streszczenie Pierwotny surowiczy piaszczakorak otrzewnej (PSPSP) jest rzadką odmianą raka surowiczego, charakteryzujący się obecnością licznych ciałek piaszczakowatych oraz niską złośliwością histologiczną. Chore mają względnie korzystne rokowanie, chociaż zdarza się przebieg bardziej agresywny tak jak w prezentowanej pracy. Opis przypadku: Chora lat 52 uskarżająca się na bole brzucha, z cechami wodobrzusza w badaniach obrazowych i znacznie podwyższonym markerem CA 125 została poddana zwiadowczej laparoskopii. Podczas operacji stwierdzono zaawansowaną chorobę nowotworową w jamie brzusznej przy niezmienionych przydatkach. W badaniu histopatologicznym rozpoznano PPSP. W zestawieniu z danymi klinicznymi zaawansowanie określono na IIIC wg klasyfikacji FIGO. Chorą zakwalifikowano do neoadjuwantowej chemioterapii (3 kursy Paklitaksel/ Pegylowana Liposomalna Doxorubicyna/Karboplatyna) a następnie poddano odroczonej optymalnej operacji cytoredukcyjnej, po której zastosowano 3 cykle adjuwantowej chemioterapii (Paklitaksel/ Karboplatyna). W związku z obecnością minimalnej choroby resztkowej stwierdzonej w trakcie operacji drugiego wglądu, zakwalifikowano pacjentkę do monoterapii karboplatyną (3 cykle) podawaną dootrzewnowo i dożylnie. Po ośmiu miesiącach od zakończenia chemioterapii stwierdzono nawrot choroby nowotworowej w otrzewnej. Z powodu niedrożności przewodu pokarmowego przeprowadzono paliatywną operację z wyłonieniem stomii na jelicie grubym. Po zabiegu pacjentka otrzymała dwie linie chemioterapii według schematu Cyklofosfamid/ Cisplatyna, następnie monoterapię Gemcytabiną. Po 25 miesiącach od rozpoznania PSPP chorą poddano paliatywnej radioterapii z powodu zmian przerzutowych do mózgu. Pacjentka zmarła 28 miesięcy po zdiagnozowaniu PSPP. PSPP jest rzadkim podtypem nowotworów nabłonkowych o względnie korzystnym rokowaniu. Choroba ta może mieć jednak agresywny przebieg tak, jak opisano w tej pracy i chorzy ci mogą wymagać intensyfikacji leczenia

The role of Tau protein in resistance to paclitaxel

Resistance to taxanes, related to limited efficacy of systemic therapy in cancer patients, is multifactorial. Among mechanisms of resistance to taxanes, those related to microtubule-associated proteins (MAP), including protein Tau, are of great importance. Protein Tau (50–64 kD) binds to beta-tubulin in the same place as paclitaxel. In preclinical studies, low expression of Tau in cancer cells was associated with increased sensitivity to paclitaxel. High expression of Tau protein in ER-positive breast cancers indicates resistance to taxane-containing chemotherapy and sensitivity to hormonal treatment. This article reviews current knowledge on predictive value of protein Tau in response to taxanes. Better understanding of its role may facilitate patients selection to this sort of treatment and lead to treatment optimization

Surgical treatment in ovarian cancer prevention in carriers of the BRCA1/BRCA2 mutation

Ovarian cancer remains to be a real challenge in spite of considerable progress in many areas of modern medicine. The use of genetic testing for detecting mutations of the BRCA genes has been offering clinical scrutiny between mutated versions of the BRCA genes and higher risk of both breast and ovarian cancer. A population survey is a method of choice to find out more efficient screening management in order to identify cancer patients who further will be treated effectively early. A review of literature on surgical PBSO (prophylactic bilateral salpingooophorectomy) in the BRCA genes mutations carriers with focus on preventive results against morbidity of ovarian cancer has been presented in the article

Tau protein as a potential predictive marker in epithelial ovarian cancer patients treated with paclitaxel/platinum first-line chemotherapy

BACKGROUND: The aim of the study was to evaluate predictive and prognostic significance of microtubule-associated protein Tau in epithelial ovarian cancer (EOC) patients treated with paclitaxel and platinum-based chemotherapy. METHODS: 74 patients with EOC (stage I-IV) who underwent cytoreductive surgery followed by standard paclitaxel/platinum chemotherapy were included in the retrospective analysis. Their formalin-fixed, paraffin-embedded tissue specimens were immunohistochemically stained for Tau protein, using semi-quantitative DAKO test. Tau expression was acknowledged as negative (0 and 1+) or positive (2+ and 3+). The correlation between Tau expression, progression free survival (PFS) and overall survival (OS) was evaluated. Statistical analysis included Kaplan-Meyer estimator, long rank test, Mann Whitney test and Cox proportional hazards model. RESULTS: 25.7% (19/74) and 74.3% (55/74) of the patients were classified as Tau-negative and Tau-positive, respectively. Median PFS was 28.7 months for Tau-negative group and 15.9 months for Tau-positive group (p = 0.0355). In the univariate analysis 3-year OS in Tau-negative and Tau-positive groups was 80.2% and 52.4%, respectively (p = 0.0198). Low expression of protein Tau was associated with better OS, whereas an advanced stage at diagnosis, suboptimal surgery, serous histological type and resistance to first line chemotherapy were each correlated with worse OS (p <0,05). In multivariate analysis only resistance to first line chemotherapy remained significant (HR 22.59; 95% CI, 8.71-58.55; p <0.0001). CONCLUSIONS: Negative tau protein seems to be both good prognostic factor and a predictor of response to paclitaxel/platinum-based chemotherapy in EOC patients

Implementation of the Polish version of the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11): importance for oncology

Member States of the World Health Organization (WHO), after several years of joint review, approved and implemented the update of the International Statistical Classification of Diseases and Related Health Problems (ICD) in May 2019. Usually, the abbreviated name ICD-11 (International Classification of Diseases, 11th Revision) is used. The new version was created in fully digital form with a search easy-to-use search engine available to every user. Many changes were introduced, and the most important is the redesign of the coding system to adapt it for digital use. ICD-11 codes are divided into main and supplementary codes. Main codes are at least 4 characters long, and 2 levels of extensions, up to 7 characters, are possible. In Poland, the entire process of implementing the ICD-11 is carried out as part of a project coordinated by the Medical Center for Postgraduate Education in cooperation with the Department of Healthcare of the Ministry of Health and the e-Health Centre. The implementation of the new version and the official introduction of ICD-11 in Poland must be preceded primarily by the amendment of legal acts (laws and regulations) and orders of the President of the National Health Fund, such as those regarding the reimbursement for refunded services and the keeping of medical records. An important element is the change in the cluster codes in oncology. Selected oncology groups were based on analyses of international reports on morbidity, mortality, cancer registries, and clinical reports. Cluster 02, which deals with cancer, contains 8 subsections detailing disease states associated with abnormal or uncontrolled cell proliferation. This article summarizes and discusses the most important changes in ICD-11, along with providing an introduction to the classification rules in the coding system and individual subsections on cancer

Wnt/β-catenin pathway as a potential prognostic and predictive marker in patients with advanced ovarian cancer

BACKGROUND: β-catenin is the key protein in the WNT signalling pathway and it forms adherent junctions together with E-cadherin. In ovarian carcinoma, abnormal expression of β-catenin, E-cadherin and WNT-1 was observed, but their prognostic and predictive role is unclear. The aim of this study was to clarify the prognostic and predictive role of E-cadherin, β-catenin and WNT-1 in advanced epithelial ovarian carcinoma (AEOC). METHODS: The expression of E-cadherin, β-catenin and WNT-1 was determined by immunohistochemistry in AEOC. The correlation between expression of these proteins and progression-free survival (PFS) and overall survival (OS) was evaluated. Statistical analyses included Kaplan-Meier estimation, log-rank test, Spearman correlation and Cox proportional-hazards model. RESULTS: In ovarian cancer, intense expression of E-cadherin, β-catenin and WNT-1 was found. In multivariate analysis, strong membrane β-catenin expression was an independent unfavourable predictor for PFS (HR 2.19, 95% CI 1.09-4.39; p = 0.028), while in univariate analysis, strong membrane β-catenin expression was a prognostic factor for OS in patients with AOC (p = 0.039). In multivariate analysis, only resistance to first-line chemotherapy was an adverse independent prognostic factor for OS (HR 16.84; 95% CI 5.07-55.98; p < 0.0001). Additionally, strong membranous β-catenin expression was associated with resistance to platinum-based chemotherapy (p = 0.027). CONCLUSIONS: These findings support that WNT/β-catenin pathway and E-cadherin are important factors in advanced epithelial ovarian cancer