111 research outputs found
HER2-low napredno lijeÄenje raka dojke
Breast cancer cells can express HER2 receptors on their membranes to varying degrees. HER2 signalling pathway is important for tumor growth and metastasis. Patients with HER2-positive disease had worse treatment outcomes until the implementation of trastuzumab started, followed by other anti-HER2 drugs. So far, they have been used exclusively for strong HER2 expression. The development of new drugs, primarily antibody-drug conjugates, has proven their efficacy on tumor cells that have lower levels of the HER2 receptors, today referred to as HER2-low tumors. Since the results of the DESTINY breast04 study showed a prolongation of progression free survival and overall survival in HER2-low pretreated patients, a new perspective opens up in the treatment, as well as in HER2 testing.Stanice karcinoma dojke na svojim membranama mogu imati razliÄitu razinu ekspresije HER2 receptora. HER2 signalni put važan je za rast tumora i metastaze. Bolesnice s HER2 pozitivnom boleÅ”Äu imale su loÅ”ije ishode lijeÄenja sve dok nije uvedena upotreba trastuzumaba, a potom i drugih anti-HER2 lijekova. Do sada su se koristili iskljuÄivo za jaku ekspresiju HER2 receptora. Razvojem novih lijekova, prije svega konjugata protutijelo-citostatik, dokazana je uÄinkovitost djelovanja na tumorske stanice koje imaju niže razine HER2 receptora, danas poznatih kao HER2-low tumori. BuduÄi da su rezultati studije DESTINY Breast04 pokazali produljenje preživljenja bez progresije bolesti i ukupnog preživljenja u prethodno lijeÄenih pacijenatica s HER-low tumorima, otvaraju se nove moguÄnosti, kako u lijeÄenju, tako i u testiranju HER2 receptora
Do we need breast cancer centers?
Hrvatskoj su potrebni centri za rak dojke koji Äe biti sveobuhvatne baze za dijagnosticiranje, lijeÄenje, praÄenje i istraživanje te bolesti. Ustanove u manjim bolnicama trebaju biti sastavni dio Å”ireg tima za
lijeÄenje raka dojke. Aktivnosti u takvim centrima izvrsnosti ukljuÄuju prije svega timski rad, izradu smjernica, lokalizacijsku onkologiju, trajno usavrÅ”avanje struÄnjaka, provoÄenje kliniÄkih studija, implementaciju novih tehnika lijeÄenja, te kontrolu kvalitete. Organizacija centara izvrsnosti za rak dojke je takoÄer u funkciji prilagodbe zdravstvenoga sustava standardima Europske unije.Croatia needs certified breast cancer centers that will cover all aspects of breast cancer treatment; diagnostics, treatment, follow-up and basic and clinical research. Units in smaller hospitals have to be a part of broader multidisciplinary breast cancer teams. Activities in such breast cancer centers primarily include team-work, defining guidelines, localization related oncology sub-specialization, continuous education of experts, clinical trial execution, implementation of new treatment techniques and quality control. The
development of certified breast cancer centers also represents health care system adjustment to EU standards
Bisphosphonates and vascular endothelial growth factor-targeted drugs in the treatment of patients with renal cell carcinoma metastatic to bone
Role of CDK4/6 inhibitors in metastatic hormon positive HER2 negative breast cancer treatment
Primjena inhibitora CDK4/6 u lijeÄenju hormonski ovisnoga metastatskog raka dojke negativnog na HER-2 dovela je do bitnog poboljÅ”anja kontrole bolesti, i to ponajprije znatnim produljenjem preživljenja bez progresije bolesti, uz prihvatljiv profil toksiÄnosti. Osnovno djelovanje inhibitora CDK4/6 jest odgaÄanje razvoja rezistencije na endokrinu terapiju, odnosno reverziju veÄ nastale rezistencije. Medijani preživljenja bez progresije bolesti kreÄu se oko 20 i viÅ”e mjeseci u prvoj liniji lijeÄenja i 10-ak mjeseci i viÅ”e u drugoj liniji.
U prvoj liniji lijeÄenja kombinirani su s aromataznim inhibitorima, a u drugoj s fulvestrantom. Produljenjem vremena bez napredovanja bolesti odgaÄa se primjena kemoterapije, a bolesnicama se osigurava bolja
kvaliteta života. Zbog svega navedenoga ovi lijekovi u kombinaciji s endokrinom terapijom nova su, visokovrijedna terapijska opcija u lijeÄenju metastatskog raka dojke. MeÄutim, ostaju brojna otvorena pitanja za svakodnevnu kliniÄku praksu kao Å”to su optimalan odabir bolesnica za prvolinijsko i drugolinijsko lijeÄenje, sekvenciranje drugih lijekova nakon progresije bolesti na inhibitore CDK4/6 te dostupnost i cijena lijeÄenja.Implementation of CDK4/6 inhibitors in metastatic hormone receptor positive, HER2 negative breast cancer treatment significantly improves progression free survival. CDK4/6 inhibitors are characterized
by favorable toxicity profile. CDK4/6 inhibitor administration delays and/or overcomes endocrine therapy resistance in metastatic breast cancer. CDK4/6 inhibitors were tested in both first line treatment in combination with aromatase inhibitors, and in second line treatment in combination with fulvestrant. Progression free survival longer than 20 months in the first and longer than 10 months in the second treatment
line has been achieved. Progression free survival prolongation may delay chemotherapy administration and consequently enable longer period with maintained quality of life. CDK4/6 inhibitors in combination with endocrine therapy represent a new valuable treatment option for metastatic hormone receptor positive HER2 negative breast cancer. However , many questions such as optimal patient selection as well as positioning of the CDK4/6 inhibitors and other endocrine therapy options during the course of metastatic disease treatment, remain unanswered. Furthermore, availability and cost of CDK4/6 inhibitors are also important issues
Ovarian Cancer
Karcinom jajnika glavni je uzrok smrtnosti
meÄu karcinomima ženskoga spolnog sustava. Ne postoje
rutinski testovi rane dijagnostike raka jajnika, a rano prepoznavanje
bolesti otežano je zbog oskudne simptomatologije.
Ukupna stopa preživljenja bolesnica od karcinoma jajnika
iznosi gotovo 50%, Ŕto je velik napredak u odnosu na rane
80-e godine kada je iznosila oko 35%, a može se zahvaliti
uvoÄenju paklitaksela u lijeÄenje.Ovarian cancer is the main reason of death
among gynecological cancers. There is no routine test for
early diagnosis of ovarian cancer and early detection of this
cancer is difficult because of lack of simptomatology. Overall
survival rate among patients with ovarian cancer is almost
50 % and it represents a significant increase of survival in the
last decade due the introduction of paclitaxel in the treatment
of advanced stages of ovarian carcinoma
Cancer epidemiology in Central and South Eastern European countries
Aim To collect cancer epidemiology data in South Eastern
European countries as a basis for potential comparison of
their performance in cancer care.
Methods The South Eastern European Research Oncology
Group (SEEROG) collected and analyzed epidemiological
data on incidence and mortality that reflect cancer management
in 8 countries ā Croatia, Czech Republic, Hungary,
Romania, Poland, Slovakia, and Serbia and Montenegro
in the last 20-40 years.
Results The most common cancer type in men in all countries
was lung cancer, followed by colorectal and prostate
cancer, with the exception of the Czech Republic, where
prostate cancer and colorectal cancer were more common.
The most frequent cancer in women was breast cancer
followed by colorectal cancer, with the exceptions of
Romania and Central Serbia where cervical cancer was the
second most common. Cancer mortality data from the last
20-40 years revealed two different patterns in men. In Romania
and in Serbia and Montenegro, there was a trend
toward an increase, while in the other countries mortality
was declining, after increasing for a number of years. In
women, a steady decline was observed over many years
in the Czech Republic, Hungary, and Slovakia, while in the
other countries it remained unchanged.
Conclusions There are striking variations in the risk of different
cancers by geographic area. Most of the international
variation is due to exposure to known or suspected
risk factors which provides a clear challenge to prevention.
There are some differences in incidence and mortality that
cannot be explained by exposure to known risk factors or
treatment availabilities
Pharmacoeconomic and clinical implications of sequential therapy for metastatic renal cell carcinoma patients in Central and Eastern Europe
Introduction: The incidence and mortality rates of kidney cancer in the Central and Eastern European (CEE) region are among the highest in the world. Access to second and subsequent lines of metastatic renal cell carcinoma (mRCC) therapies is highly varied in the region. Despite the increasing body of evidence supporting the clinical benefit of multiple lines of treatment, access to treatment beyond first line is restricted in many of these countries.Areas covered: The adoption of targeted therapies for the first-line treatment of mRCC in the region was slow and faced many obstacles. In order to evaluate the current status of treatment beyond the first-line setting in the CEE region, this review examines the availability and reimbursement of mRCC drugs and clinical practice in institutions that treat patients with mRCC.Expert opinion: This review highlights the need to raise awareness among physicians, payers and regulators on clinical trial and cost-effectiveness data regarding the treatment of mRCC beyond the first line. The obstacles to mRCC drug access highlighted in this review need to be overcome to ensure that patients are receiving the best treatment available
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