Neratynib w terapii uzupełniającej raka piersi z nadekspresją receptora HER2 — czy więcej zawsze znaczy lepiej?

Neratynib to nowa mała cząsteczka anty-HER2, która została ostatnio zatwierdzona w Stanach Zjednoczonych i Europie do stosowania w celu zapobiegania nawrotom u pacjentów z wczesnym stadium HER2-dodatniego raka piersi po leczeniu operacyjnym, którzy wcześniej co najmniej przez rok byli leczeni trastuzumabem. Mimo aprobaty istnieje jednak wiele czynników, takich jak niski wskaźnik redukcji nawrotu, brak ogólnych danych dotyczących przeżycia oraz wysoki odsetek działań niepożądanych, które mogą wpływać na powszechne stosowanie neratynibu w terapii adiuwantowej HER2-pozytywnego raka piersi. Dlatego leczenie neratynibem należy rozważyć u tych pacjentów z HER2-dodatnim rakiem piersi, u których występuje większe prawdopodobieństwo nawrotu, tak aby korzyści wyraźnie przewyższały działania niepożądane. W niniejszym artykule omówiono kontrowersje, jakie pojawiły się podczas badań III fazy, które doprowadziły do zatwierdzenia neratynibu w terapii raka piersi

Neratinib in adjuvant treatment of patients with HER2-positive breast cancer — less is more?

Neratinib is a new small molecule aimed at HER2 receptor. It has recently been approved in the United States of America and Europe for adjuvant treatment of patients with early, HER2-positive breast cancer, who underwent surgical resection followed by at least one year of adjuvant trastuzumab treatment. Despite initial enthusiasm, several factors limit the implementation of neratinib in clinical practice. These include: modest reduction of recurrence rate; limited data regarding the effect on overall survival; and a significant rate of adverse events. Thus, neratinib should be considered mainly in patients with high-risk HER2-positive breast cancer, because its clinical benefit might outweigh the side effects in this population. In the following article, we discuss the controversies regarding the pivotal phase III trial that eventually led to neratinib approval

Metastatic non-small-cell lung cancer with EGFR mutation — case report

W pracy zaprezentowano przypadek skutecznej terapii u chorej z rozpoznaniem raka gruczołowego płuca z obecną mutacją aktywującą w obrębie genu EGFR, u której w drugim rzucie leczenia zastosowano leczenie erlotynibem. U 79-letniej pacjentki rasy białej, niepalącej, w grudniu 2012 roku zdiagnozowano raka gruczołowego płuca prawego w IV stopniu zaawansowania klinicznego. W wykonanym wówczas badaniu tomografii komputerowej (TK) uwidoczniono guza płuca prawego wielkości 6 × 4 cm i liczne zmiany przerzutowe w obrębie obu płuc. Biopsja potwierdziła rozpoznanie raka gruczołowego. Jako pierwszy rzut leczenia zastosowano chemioterapię cisplatyna + pemetreksed (3 cykle) ze stabilizacją zmian. Leczenie powikłane zatorowością płucną. Czas przeżycia wolny od progresji choroby (PFS) po pierwszym rzucie leczenia wyniósł 7 miesięcy. Z powodu progresji choroby we wrześniu 2013 roku włączono leczenie drugiego rzutu — zastosowano erlotynib. W ocenie radiologicznej po 2 miesiącach stwierdzono częściową remisję choroby. Pacjentka nadal kontynuuje leczenie bez powikłań z efektem częściowej remisji.A case of successful and prolonged treatment of metastatic lung cancer (adenocarcinoma) with the activating mutation of epidermal growth factor receptor gene, treated with erlotinib is presented. A caucasian 79 years old, never-smoker female was diagnosed with stage IV lung cancer in December 2012. A chest CT scan showed tissue mass 6 × 4 cm in size in the right lung with multiple metastases in both lungs. A biopsy revealed a histological subtype adenocarcinoma. As a first line of treatment she received 3 courses of cisplatin and pemetreksed. It was complicated by pulmonary embolism. Progression-free survival after first line treatment was 7 months. Due to disease progression in September 2013 second line treatment with erlotinib was started. First radiological assessment after two months treatment with erlotinib showed partial response of the disease. Patient still continues the treatment with a favourable response and without any adverse reaction

Inhibitory PARP w terapii raka jajnika

Treatment of the malignant ovarian tumors remains challenging. Some of the reasons are as follows: lack of effective screening technique, usually asymptomatic early stages of the disease, which effects in detecting the disease in advanced stage, and eventually poor prognosis. Treatment of the relapse remains palliative. Inventing new drugs – like PARP inhibitors - gives hope for improvement of the treatment outcomes. This review paper presents actual knowledge on PARP inhibitors in the ovarian cancer therapy.Leczenie złośliwych nowotworów jajnika pozostaje wyzwaniem terapeutycznym. Składa się na to wiele czynników, m.in. brak skutecznych metod wczesnego wykrywania, nierzadko przebieg skąpo objawowy, co skutkuje wykryciem choroby w stadiach zaawansowanych, i ostatecznie złe rokowanie. Obecnie standardem postępowania jest zabieg operacyjny oraz chemioterapia uzupełniająca w oparciu o taksany oraz pochodne platyny w zależności od stopnia zaawansowania choroby. Leczenie nawrotu ma charakter paliatywny. Opracowanie nowych leków – jak inhibitory PARP - daje nadzieję na poprawę wyników leczenia w tej grupie chorych. Celem pracy jest przedstawienie aktualnego stanu wiedzy na temat inhibitorów PARP w terapii raka jajnika

Działania opiekuńcze w profilaktyce i terapii

Praca recenzowana / Peer-reviewed paperOpieka jest potrzebna wszystkim, zarówno dzieciom, jak i dorosłym, a w sposób szczególny osobom starszym, w tym terminalnie chorym. Prezentowane w niniejszej monografi i teksty uwzględniają właśnie tę wieloczynnikową aktywność opiekuńczą. Autorami poszczególnych rozdziałów są pracownicy naukowi zaangażowani w proces edukacyjny w zakresie nauk o zdrowiu, pracujący w Krakowskiej Akademii im. Andrzeja Frycza Modrzewskiego, ale także studenci PWSZ w Tarnowie. W różnorodnym zakresie przedstawili i omówili oni główne tezy monografii

Neratinib in adjuvant treatment of patients with HER2-positive breast cancer - less is more?

To access publisher's full text version of this article click on the hyperlink belowNeratinib is a new small molecule aimed at HER2 receptor. It has recently been approved in the United States of America and Europe for adjuvant treatment of patients with early, HER2-positive breast cancer, who underwent surgical resection followed by at least one year of adjuvant trastuzumab treatment. Despite initial enthusiasm, several factors limit the implementation of neratinib in clinical practice. These include: modest reduction of recurrence rate; limited data regarding the effect on overall survival; and a significant rate of adverse events. Thus, neratinib should be considered mainly in patients with high-risk HER2-positive breast cancer, because its clinical benefit might outweigh the side effects in this population. In the following article, we discuss the controversies regarding the pivotal phase III trial that eventually led to neratinib approval

Everolimus – effectively reverses acquired resistance on endocrine therapy of patients with advanced breast cancer. A case report

Breast cancer is the most common malignancy among women in Poland. Endocrine therapy is the first line of treatment in hormone-receptor-positive advanced breast cancer. Progression during endocrine therapy is unavoidable. Administration of mTOR inhibitor gives a chance of reversing the acquired resistance. This paper presents a case report of a patient with metastatic breast cancer successfully treated with everolimus added to endocrine therapy

Advanced skin melanoma – systemic treatment

In Poland, morbidity and mortality rates for melanoma are constantly increasing. In the case of inoperable disease or distant metastases, prognosis remains poor. For many years, dacarbazine has been the gold standard in systemic treatment. Recently, a significant progress in melanoma therapy has been observed. Introducing targeted therapy or immunotherapy significantly improved treatment outcomes. This review paper presents current knowledge on systemic treatment of advanced melanoma, including treatment availability in Poland

Complications of palliative antiangiogenic therapy in patients with colorectal cancer

Introduction: Bevacizumab is an antiangiogenic drug used in the therapy of numerous solid tumours including colorectal adenocarcinoma. The efficacy and safety of bevacizumab has been demonstrated in many multicenter clinical trials. The scope of this paper is to analyze the safety profile of bevacizumab in patients with stage IV colorectal cancer. Aim of the study: Analysis of toxicity and safety of the treatment with bevacizumab patients with colorectal cancer in the metastatic stage. Material and methods: Retrospective analysis of medical records of 42 patients with advanced colorectal cancer treated in the Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Institute of Oncology, Kraków Branch, in the period 2007–2014. Results: The median time of treatment with bevacizumab was 6 months. The median duration of progression-free survival (PFS) was 8.5 months. Toxicity of treatment with bevacizumab affected 43 percent of patients. The most common adverse events observed was hypertension and bleeding. In 6 patients (14.3%) the treatment with bevacizumab was interrupted due to adverse events (thromboembolic events, bleeding and gastrointestinal perforation). Conclusions: Bevacizumab is a safe therapeutic option in patients with metastatic colorectal cancer, provided that patients are provided close oncological and general medical monitoring

Systemic treatment of non-small cell lung cancer brain metastases

In the systemic treatment of brain metastases from non-small cell lung cancer (BMF-NSCLC) chemo- and targeted therapy are used. Response rates after platinum-based chemotherapy, range from 23% to 45%. Development of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs): gefitinib or erlotinib, was an improvement in treatment of advanced NSCLC patients. EGFR mutations are present in 10–25% of NSCLC (mostly adenocarcinoma), and up to 55% in never-smoking women of East Asian descent. In the non-selected group of patients with BMF-NSCLC, the overall response rates after gefitinib or erlotinib treatment range from 10% to 38%, and the duration of response ranges from 9 to 13.5 months. In the case of present activating EGFR mutation, the response rate after EGRF-TKIs is greater than 50%, and in selected groups (adenocarcinoma, patients of Asian descent, never-smokers, asymptomatic BMF-NSCLC) even 70%. Gefitinib or erlotinib treatment improves survival of BMF-NSCLC patients with EGFR mutation in comparison to cases without the presence of this mutation. There is no data on the activity of the anti-EML4-ALK agent crizotinib. Bevacizumab, recombinant humanised monoclonal antibody anti-VEGF, in the treatment of advanced non-squamous NSCLC patients is a subject of intense research. Data from a clinical trial enrolling patients with pretreated or occult BMF-NSCLC proved that the addition of bevacizumab to various chemotherapy agents or erlotinib is a safe and efficient treatment, associated with a low incidence of CSN haemorrhages. However, the efficacy and safety of bevacizumab used for therapeutic intent, regarding active brain metastases is unknown