Znaczenie hipertermii w leczeniu onkologicznym

In oncology, hyperthermia is known as the procedure of raising the temperature of a part or the wholebody to damage cells of the neoplasm or significantly suppress tumour growth. It is applied with othermodalities such as radiotherapy, chemotherapy, immunotherapy and gene therapy. The article provides anoverview of biological mechanisms of heat-induced cell death as well as radio- and chemo-sensitizationand presents clinical benefits and risks of using hyperthermia in combination with other methods ofoncological treatment. It also discusses various types of hyperthermia and heating devices. The paperconcludes with a summary of current trials connected with the issue and future research directions.W onkologii, hipertermia rozumiana jest jako planowa, kontrolowana technika nagrzewania zmian nowotworowych w celu bądź zniszczenia ich komórek, bądź zahamowania ich wzrostu.W praktyce klinicznej, hipertermia stosowana jest w leczeniu skojarzonym z radioterapią, chemioterapią, terapią immunologiczną czy terapią genową. W poniższym artykule, w oparciu o dostępną literaturę przedmiotu, przedstawiono biologiczno-molekularne mechanizmy działania wysokich temperatur, korzyści z klinicznego zastosowania hipertermii, jak również idące za nią ryzyko. Omówiono różne znane obecnie rodzaje hipertermii,  podjęto także próbę podsumowania najnowszych badań i dokonań dotyczących tego tematu oraz wskazano przewidywane przyszłe kierunki doświadczeń

Mechanizmy utraty magnezu w trakcie leczenia cetuksymabem i panitumumabem

Cetuximab and panitumumab are monoclonal antibodies (mAbs) against epidermal growth factor receptor(EGFR). Their function is to bind specifically to the extracellular domain of EGFR on both neoplasticand normal cells which blocks the influence of EGF on the receptor. The important side effect of thetreatment with those drugs, apart from skin toxicity, infusion reactions or nausea, is hypomagnesemia.Studies show that the mechanism responsible for this effect is the inhibition of EGFR by mAbs in distalconvoluted tubule of the nephron. The EGFR blockage through Ras and mitogen-activated protein kinasesuppress transient receptor potential melastatin submember 6 ion channel responsible for magnesiumreabsorption. The inhibition results in magnesium wasting and secondary hypomagnesemia. Almost allpatients treated with mAbs anty-EGFR have decreased level of blood serum magnesium but only fewdevelop severe hypomagnesemia.Cetuksymab i panitumumab to monoklonalne przeciwciała (ang. monoclonal antibodies, mAbs) przeciw receptorowi nabłonkowego czynnika wzrostu (ang. epidermal growth factor receptor, EGFR). Ich działanie polega na wiązaniu się do zewnątrzkomórkowej domeny EGFR, zarówno w komórkach nowotworowych jak i prawidłowych, co blokuje wpływ EGF na receptor. Ważnym skutkiem ubocznym tych leków, obok powikłań skórnych, reakcji nadwrażliwości, czy nudności, jest hipomagnezemia. Badania wykazały, że mechanizmem odpowiedzialnym za ten efekt jest hamowanie funkcjonowania EGFR w części krętej kanalika dystalnego nefronu. Zablokowany EGFR, poprzez brak aktywacji szlaku sygnalizacyjnego kinaz Ras i MAPK (ang. miogen-activated protein kinase) wpływa supresyjnie na kanał jonowy TRPM6 (ang. transient receptor potential melastatin submember 6), który jest odpowiedzialny za resorpcję zwrotną magnezu. W rezultacie dochodzi do utraty tego jonu z moczem i następczej hipomagnezemii. Obniżenie poziomu magnezu w surowicy obserwuje się u niemal wszystkich pacjentów otrzymujących mAbs przeciw EGFR, jednak tylko część z nich rozwija ciężki stopień hipomagnezemii

Acupuncture: could it become everyday practice in oncology?

Acupuncture is a complementary and alternative medical treatment (CAM) which is increasingly used in the care of cancer patients. Traditionally derived from Chinese medicine, nowadays it is becoming a part of evidence-based oncology. The use of acupuncture in these patients has been recommended by the American Cancer Society (ACS) for the treatment of side effects associated with conventional cancer therapy and cancer-related ailments. A growing body of evidence supports the use of acupuncture in the treatment of cancer-induced pain and chemotherapy-related nausea and vomiting. Also other indications, such as xerostomia, fatigue, hot flashes, anxiety and peripheral neuropathy, are being constantly evaluated. This article summarizes the most important discoveries related to the possible usefulness of this method in contemporary oncology. Emphasis is placed on the results of randomized controlled trials with an adequate level of evidence. However, explanation of the mechanisms responsible for these effects requires confirmation in further studies with an adequate level of evidence. In future, acupuncture may become an interesting and valuable addition to conventional medicine

Novel systemic treatment for hepatocellular carcinoma: a step-by-step review of current indications

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the main cause of cancer-related death worldwide. The available treatment options for HCC include liver transplant, locoregional therapy (such as ablation, embolization, and radiotherapy), and systemic treatment. The latter encompasses targeted therapy, immunotherapy, and angiogenesis inhibitors, alone or in combination. The introduction of immune checkpoint inhibitors and targeted drug therapy has been one of the most significant advances in HCC treatment. These therapies were shown to prolong overall survival and progression-free survival in clinical trials including patients with advanced HCC. In recent years, the systemic treatment of advanced HCC has vastly improved, with a median survival of 19.2 months in the IMbrave150 trial. However, further research is needed to determine the optimal sequence of treatment

Use of complementary and alternative medicine among Polish cancer patients

Introduction. The aim of this prospective study was to estimate the perception and popularity of complementary and alternative medicine (CAM) subtypes and the reasons for usage among adult Polish cancer patients. Material and methods. The validated questionnaire was conducted among 310 patients. 24.1% of the patients used CAM during their oncological treatment. Risk factors for CAM usage were: female gender, university degree and radical treatment. The most common reasons for CAM usage were: boosting the immune system (46.1%), improving well-being/ counteracting the ill effects of cancer and its treatment (40.8%). The average level of satisfaction with CAM was high (≥3/5 on a Likert scale). Nearly half of the patients (46.6%) admitted not informing their doctors about their CAM usage. Conclusions. The growing popularity and heterogeneity of CAM methods make it an important issue for patient–doctor relations in Poland and other Central European countries. The results of this study indicate what topics should be covered while introducing patient education programs

Use of complementary and alternative medicine among Polish cancer patients

Introduction. The aim of this prospective study was to estimate the perception and popularity of complementary and alternative medicine (CAM) subtypes and the reasons for usage among adult Polish cancer patients. Material and methods. The validated questionnaire was conducted among 310 patients. 24.1% of the patients used CAM during their oncological treatment. Risk factors for CAM usage were: female gender, university degree and radical treatment. The most common reasons for CAM usage were: boosting the immune system (46.1%), improving well-being/ counteracting the ill effects of cancer and its treatment (40.8%). The average level of satisfaction with CAM was high (≥3/5 on a Likert scale). Nearly half of the patients (46.6%) admitted not informing their doctors about their CAM usage. Conclusions. The growing popularity and heterogeneity of CAM methods make it an important issue for patient–doctor relations in Poland and other Central European countries. The results of this study indicate what topics should be covered while introducing patient education programs

Clinical effectiveness and toxicity of second-line irinotecan in advanced gastric and gastroesophageal junction adenocarcinoma: a single-center observational study

Background: Randomized clinical trials showed improved overall survival (OS) of advanced gastroesophageal adenocarcinoma (GEA) patients treated with second-line taxane or irinotecan. However, most data on irinotecan efficacy in this setting come from large Asian trials. We retrospectively analyzed clinical effectiveness and toxicity of irinotecan in a cohort of patients with advanced GEA treated in our department. Methods: Advanced GEA patients who received at least one cycle of second-line irinotecan were eligible for inclusion. Irinotecan was administered every 3 weeks at an initial dose of 250 mg/m 2 of body surface area with subsequent gradual (every 50 mg/m 2 ) dose escalation up to 350 mg/m 2 , in the case of good treatment tolerance. OS was estimated using the Kaplan–Meier method. A multivariate Cox regression analysis was used to examine the association between clinical and laboratory parameters and survival. Results: A total of 48 patients were identified. Median OS was 6.2 months [95% confidence interval (CI): 3.9–7.6]. In multivariate analysis, age < 65 years, baseline total lymphocyte count (TLC) < 1500/µl and presence of peritoneal metastases were associated with shorter OS. Most adverse events were grade 1–2 and included: anemia (52.3%), leukocytopenia (40.9%), neutropenia (59.1%), nausea (25.0%), vomiting (31.8%), diarrhea (31.8%), anorexia (29.5%) and fatigue (43.2%). Febrile neutropenia occurred in three patients (6.8%). Nine patients (20.5%) experienced a toxicity grade 3–4 of any kind. Conclusions: This retrospective analysis confirms clinical effectiveness and manageable toxicity of second-line irinotecan in an unselected cohort of advanced GEA patients. Age < 65 years, baseline TLC < 1500/µl and presence of peritoneal metastases were independent prognostic factors associated with shorter OS