Zastosowanie panitumumabu w terapii pierwszej linii u chorej z rozpoznanym przerzutowym rakiem jelita grubego

Nowotwór jelita grubego stanowi niezmiennie jedno z większych wyzwań w onkologii. Rozpoznanie to dotyczy około 10% wszystkich nowotworów złośliwych w Polsce. Leczenie onkologiczne chorych na raka jelita grubego na etapie uogólnienia choroby uległo w ostatnich latach znacznym zmianom. Pojawienie się nowych możliwości leczenia systemowego (terapie celowane anty-EGFR) spowodowało istotne wydłużenie przeżycia u chorych na przerzutowego raka jelita grubego. W niniejszym artykule przedstawiono przypadek 57-letniej chorej z rozpoznanym rakiem odbytnicy, pierwotnie leczonej radykalnie. Z uwagi na uogólnienie procesu chorobowego pacjentka została zakwalifikowana i otrzymywała immunochemioterapię według schematu panitumumab + FOLFOX4, uzyskując stabilizację choroby. U chorej obserwowano większość działań niepożądanych leczenia, które mogą się pojawić podczas immunochemioterapii. W grudniu 2018 roku chora zgłosiła wysypkę (G2). Ustalono, że prawdopodobną przyczyną może być stosowanie zabiegów w kriokomorze. Przyczyną odroczenia immunochemioterapii były neutropenia (G3), wysypka (G2) i osłabienie (G2). Po wyleczeniu działań niepożądanych chora kontynuowała terapię. Leczenie zakończono na prośbę pacjentki

Zastosowanie długotrwałej terapii systemowej dabrafenibem z trametynibem u 72-letniego pacjenta z przerzutami czerniaka do ośrodkowego układu nerwowego

W niniejszej pracy opisano przypadek 72-letniego pacjenta z czerniakiem skóry rozpoznanym w stadium IV. Pacjenta zakwalifikowano do leczenia inhibitorami BRAF/MEK po uprzedniej radioterapii stereotaktycznej. Pomimo złego rokowania związanego z obecnością przerzutów do ośrodkowego układu nerwowego, wiekiem pacjenta oraz obecnością mutacji BRAF, pacjent przyjmował terapię systemową dabrafenibem z trametynibem przez okres ponad dwóch lat. Zastosowana u chorego linia leczenia pozwoliła na dobrą kontrolę objawów choroby oraz akceptowalną przez pacjenta jakość życia. W badaniach obrazowych wykonywanych w celu monitorowania leczenia obserwowano zmniejszanie się wymiarów zmian przerzutowych przez ponad rok. Terapia skojarzona inhibitorami BRAF/MEK była przez pacjenta dobrze tolerowana, a jedynymi zgłaszanymi przez chorego objawami niepożądanymi była gorączka, zmęczenie oraz bezsenność. Dolegliwości te nie skutkowały konicznością redukcji dawki leków lub przerwaniem leczenia

Possibilities of using radiotherapy in the treatment of vaginal recurrence in patients with uterine cancers

A major problem in cancer treatment is disease recurrence, i.e. a situation in which the standard procedures turned out to be ineffective and the previously used therapy significantly limits its next use. Vaginal recurrence is found in 2.4–15% of patients with uterine cancer. For large recurrent tumors radical treatment involves surgical pelvic exenteration. However, indications for this procedure are significantly limited; in addition, it is associated with a high risk of complications and a significantly compromised quality of life. For this reason, brachytherapy and/or another course of radiotherapy are administered, which until recently were used as a further-line treatment option or as palliative care. Over the last few years extension of indications for radiotherapy and brachytherapy has been noted due to the dynamic development of new techniques for planning and conducting treatment. These allow for the irradiation of the target volume which causes radiation-related reactions that are acceptable for the patient while protecting critical organs. The introduction of new therapeutic devices allowed for the use of different treatment techniques, including intensity-modulated radiation therapy, image-guided radiotherapy, RapidArc, tomotherapy, intraoperative radiotherapy and stereotactic body radiotherapy, which contributed to a significant increase in the role of repeat radiotherapy. One needs to remember about the possibilities of systemic treatment, although it is usually palliative in nature. Brachytherapy may be considered for the treatment of recurrent disease if the lesions are located in the region of the vagina or vaginal stump or if infiltration is found in the parametria; in other situations treatment combined with external beam radiotherapy should always be considered. The choice of brachytherapy method depends on the location of the lesion and the extent of infiltration. If the infiltration is up to 5 mm deep, intracavitary brachytherapy is performed. If the infiltration is deeper, the use of interstitial brachytherapy is indicated

Cytoplasmic and membranous receptor-binding cancer antigens expressed on SiSo cells (RCAS1) immunoreactivity in epithelial ovarian cancer cells represent differing biological function of RCAS1

Introduction. Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) is a selective suppressor of the immune response that has been linked to the evasion of immune surveillance by cancer cells. However, the exact prognostic impact of RCAS1 on epithelial ovarian cancer (EOC) has not been fully elucidated. The main aim of our study was to evaluate the influence of RCAS1 immunoreactivity (RCAS1-Ir) in EOC cells and in tumor stroma cells on patient overall survival. We also focused on RCAS1-Ir and the structure of the tumor stroma. Material and methods. RCAS1-Ir was evaluated by means of immunohistochemistry in 67 patients with EOC. We distinguished cytoplasmic and membranous immunoreactivity patterns. Results. We found that high cytoplasmic RCAS1-Ir in cancer cells was associated with more than a two-time shortened period of overall survival. Membranous RCAS1-Ir in cancer cells, as well as in tumor stroma macrophages and fibroblasts, did not correlate with patient survival. RCAS1-Ir in the cytoplasm of cancer cells was positively correlated with the degree of tumor stroma infiltration by fibroblasts and macrophages, but not with RCAS1-Ir in these cells. On the other hand, membranous RCAS1-Ir in cancer cells was positively correlated with RCAS1-Ir in fibroblasts and macrophages, but not with their quantity. Conclusions. Due to their different impacts on patient prognosis and tumor stroma structure, it seems that cytoplasmic and membranous RCAS1-Ir in EOC cells may have different biological functions

Intensive anticancer therapy in elderly patients – does it make sense? A case report

Anticancer therapy in elderly patients poses a great challenge for doctors since not all available therapeutic modalities can improve the wellbeing, alleviate symptoms or improve prognosis in this patient population. The paper presents a case of a 75-year-old woman diagnosed with advanced ovarian cancer who, despite advanced age, received intensive anticancer therapy, i.e. surgical treatment (modified posterior exenteration with the resection of pelvic peritoneum and tumor invasion in the diaphragmatic peritoneum along with its fragment, subtotal colectomy, resection of the omentum, spleen and gastric fragment along with the gastro-transverse ligament and an end ileostomy) as well as adjuvant chemotherapy. Severe complications occurring during treatment were not directly related to the therapy, but resulted from the lack of proper patient care in a home setting

High tumor cell vimentin expression indicates prolonged survival in patients with ovarian malignant tumors

Objectives: The main aims of the study were to investigate the expression of vimentin and its correlation with the overall survival (OS) of patients with malignant ovarian tumors, and the correlation between vimentin expression and tumor stroma characteristics. Material and methods: The study focused on 94 malignant ovarian tumors that had been collected from women who were treated in the Department of Gynecology and Oncology of the Lukaszczyk Oncological Center, Bydgoszcz, Poland. Vimentin expression was assessed in both the cancer cells (expression intensity and quantitative analysis) and the tumor stroma (expression intensity). Vimentin expression was analyzed according to both stromal cellularity and the clinicopatho- logical features of the disease. Results: Both high cancer cell vimentin expression intensity and high quantitative vimentin expression (up to and includ- ing 30% of cells) indicated a significantly prolonged OS. Low vimentin stromal expression was associated with prolonged OS, although the difference did not reach the level of significance. High tumor cell vimentin expression intensity was as- sociated with significantly higher vimentin stromal expression. High vimentin expression in the tumor stroma indicated a significantly higher cellularity of the tumor stroma. Vimentin expression in cancer cells and the tumor stroma were not dependent on the histopathological type, the tumor grade or the FIGO stageof the disease. Conclusions: High cancer cell vimentin expression is associated with an improved OS of patients with malignant ovar- ian tumors. The expression of vimentin in ovarian malignancies may influence the structure of the tumor stroma

The potential predictive value of serum sRCAS1 levels for overall survival in endometrial cancer

Objectives: The main aim of the study was to evaluate the impact of levels of serum soluble receptor-binding cancer antigen expressed on SiSo cells (sRCAS1) on the overall survival (OS) rates in patients with endometrial cancer. Furthermore, we analyzed sRCAS1 levels according to the clinicopathological characteristics of the disease.  Material and methods: The study group comprised 43 patients who were being treated for endometrial cancer. We included 10 low-risk, 20 intermediate-risk and 13 high-risk endometrial cancers using the criteria of the European Society for Medical Oncology (ESMO), the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Gynaecological Oncology (ESGO). Serum sRCAS1 levels were obtained before and after surgery. Serum sRCAS1 levels were assessed using the ELISA method.  Results: In our univariate analysis, both the pre- and post-surgery high sRCAS1 groups of patients with endometrial cancer indicated a shortened OS. However, in our multivariate analysis, when patients’ age and disease-related risk was taken into consideration, only the post-surgery sRCAS1 levels remained as independent prognostic factors of a poor OS. Pre-treatment serum sRCAS1 levels were statistically significantly higher than post-surgery sRCAS1 levels; however, the difference between pre- and post-surgery sRCAS1 levels did not influence the patients’ OS rate. Pre- and post-surgery sRCAS1 levels did not differ according to tumor grade, stage of the disease or the disease-related risk group.  Conclusions: High post-surgery serum sRCAS1 levels seem to be an independent indicator of shortened overall survival in patients with endometrial cancer.

The impact of primary radical treatment on the effectiveness and safety of systemic treatment with ribociclib in female patients with advanced breast cancer

Aim of the study: To assess the impact of primary radical treatment on the effectiveness and safety of systemic treatment with ribociclib in patients with advanced breast cancer. Material and methods: Retrospective data analysis of 180 patients with advanced breast cancer undergoing systemic treatment with ribociclib. The study included a retrospective analysis of data from 180 patients with advanced breast cancer undergoing systemic treatment with ribociclib. The study group included 106 (59%) patients who underwent radical treatment at earlier stages. The control group consisted of 74 patients (41%) diagnosed at an advanced stage. Results: The analysis showed that progression-free survival is longer in patients with primary advanced disease compared to patients with a history of radical treatment. The median PFS is 21.91 months for patients with a history of radical treatment, while for primary patients it is longer than the total observation time (p = 0.049). The median overall survival time did not reach statistical significance and was longer than the time of observation for both groups. In this study, it was observed that the most common adverse event was haematological complications. Neutropenia of any grade was observed in 82.78% of all patients, including G3/G4 neutropenia in 43.89% of patients. Anaemia of any degree was observed in 62.78% of patients, including G3/G4 anaemia in 1.67% of patients. Thrombocytopenia of any degree was observed in 62.78%. For the above complications, no statistically significant differences were observed between the study group and the control group. Conclusions: A higher benefit (expressed in PFS) from the use of ribociclib will be achieved by patients whose treatment was initiated at a locally advanced or metastatic stage compared to patients with a history of radical treatment of breast cancer. A history of primary radical treatment has no impact on either overall survival or the safety profile of ribociclib treatment