4 research outputs found
Povezivanje mehanizama kemorezistentnosti tumorskih stanica i suboptimalnih sistemskih citotoksiÄnih rezultata lijeÄenja
Systemic cytotoxic chemotherapeutic treatment of malignant tumors does not fully meet its goal due to the resistance of present tumor cells to the applied therapy. Chemoresistance is complex and multifactorial, caused by numerous mechanisms that alter drug concentration in the cell, by changes in expression of the epidermal growth factor and by activation of intracellular signaling pathways PI3K / Akt and MAPK. The factor of chemoresistance is also an increased level of antioxidative glutathione and glutathione transferase ā S enzyme and the presence of tumor stem cells that signifi cantly improve protection of DNA from damage. Apart from cellular factors, resistance is influenced by extracellular hypoxia and acidosisand autophagy.
Overcoming the chemoresistance is possible by using nanomechanisms for delivery of drugs to tumor cells, autophagy inhibitors like antimalarials chloroquine and hydroxychloroquine and plant polyphenols.
By better understanding the mechanisms of chemoresistance and itās overcoming it can be possible to achieve improvement in antitumor treatment.Sustavno citotoksiÄno kemoterapijsko lijeÄenje zloÄudnih tumora ne ispunjava u potpunosti svoj cilj zbog prisutne kemorezistencije tumorskih stanica na primjenjenu terapiju. Kemorezistencija je kompleksna i uzrokovana brojnim mehanizmima koji mijenjaju koncentraciju lijeka u stanici, promjenama u ekspresiji epidermalnog Äimenika rasta i aktivacije unutarstaniÄnih signalnih puteva PI3K/Akt i MAPK. Äimbenik kemorezistencije je porast antioksidativnog enzima glutationa i glutation-S transferaze te prisustvo matiÄnih stanica karcinoma koje znaÄajno bolje Å”tite DNA od oÅ”teÄenja. Osim staniÄnih
Äimbenika, na rezistenciju utjeÄe ekstracelularna hipoksija i acidoza te autofagija.
Prevladavanje kemorezistencije moguÄe je primjenom nanomehanizama u dostavi lijekova u tumorske stanice, inhibitorima autofagije antimalaricima klorokinom i hidroksiklorokinom te biljnim polifenolima.
Poznavanjem mehanizama kemorezistencije i njezinim nadilaženjem moguÄe je poboljÅ”ati dobrobit antitumorskog lijeÄenja
Taksani u lijeÄenju ranog raka dojke
Taxanes are irreplaceble drugs in treatment of many solid malignancies. In breast cancer they represent the backbone of adjuvant therapy and are important option in treatment of advanced and metastatic disease. Since their discovery in 1960ās they went through a long journey of clinical development and positioning in clinical practise of treatment of early breast cancer. Taxanes belong to the fourth group of cytotoxic drugs, which act as mytotic inhibitors, causing the death of the cell in metaphase. Clinical trials conducted in patients with breast cancer evaluated different combinations of other chemotherapeutics
with taxanes, different modes of administration, effectiveness of different chemotherapy regimens including taxanes in different subtypes and stages of the disease and effectiveness of individual taxanes in comparison with one another. Based on the results of those trials, today the relevant global oncology associations reccomend the use of taxanes in treatment of early breast cancer, pointing out their significant benefit in total reduction of breast cancer mortality and risk of disease reccurence by 20-30% comparing to anthracycline only protocols. The purpose of this literature review was to provide comprehensive information about development of taxanes and their position in routine everyday clinical practise.Taksani su nezamjenjivi lijekovi u lijeÄenju mnogih solidnih tumora. U karcinomu dojke predstavljaju okosnicu adjuvantne terapije i važna su opcija u lijeÄenju uznapredovale i metastatske bolesti. Od njihovog otkriÄa 1960-ih proÅ”li su dugi put kliniÄkog razvoja i pozicioniranja u kliniÄkoj praksi lijeÄenja ranog raka dojke. Taksani pripadaju Äetvrtoj skupini citotoksiÄnih lijekova koji djeluju kao inhibitori mitoze, koji uzrokuju smrt stanice u metafazi. KliniÄka istraživanja provedena
na bolesnicama s karcinomom dojke procjenjivala su razliÄite kombinacije drugih kemoterapeutika s taksanima, razliÄite naÄine primjene, djelotvornost razliÄitih kemoterapijskih protokola koji ukljuÄuju taksane u razliÄitim podtipovima i stadijima bolesti te uÄinkovitosti pojedinih taksana u usporedbi s drugim. Na temelju rezultata tih pokusa, danas relevantne globalne onkoloÅ”ke udruge preporuÄuju uporabu taksana u lijeÄenju ranog raka dojke, pokazujuÄi njihovu znaÄajnu korist u ukupnom smanjenju rizika od smrti i povrata bolesti za 20-30% u odnosu na protokole bazirane samo na antraciklinu. Svrha ovog pregleda literature je pružanje sveobuhvatne informacije o razvoju taksana i njihove pozicije u rutinskoj svakodnevnoj kliniÄkoj praksi
OÄuvanje plodnosti u mladih žena s ranim rakom dojke
Although breast cancer (BC) occurs more often in older women, it is the most commonly diagnosed malignancy in women of childbearing age. Owing to the overall advancement of modern medicine and the growing global trend of delaying childbirth until later age, we find ever more younger women diagnosed and treated for BC who have not yet completed their family. Therefore, fertility preservation has emerged as a very important quality of life issue for young BC survivors. This paper reviews currently available options for fertility preservation in young women with earlystage BC and highlights the importance of a multidisciplinary approach to fertility preservation as a very important quality of life issue for young BC survivors. Pregnancy after BC treatment is considered not to be associated with an increased risk of BC recurrence; therefore, it should not be discouraged for those women who want to achieve pregnancy after oncologic treatment. Currently, it is recommended to delay pregnancy for at least 2 years after BC diagnosis, when the risk of recurrence is highest. However, BC patients of reproductive age should be informed about the potential negative
effects of oncologic therapy on fertility, as well as on the fertility preservation options available, and if interested in fertility preservation, they should be promptly referred to a reproductive specialist. Early
referral to a reproductive specialist is an important factor that increases the likelihood of successful fertility preservation. Embryo and mature oocyte cryopreservation are currently the only established fertility preservation methods but they require ovarian stimulation (OS), which delays initiation of chemotherapy for at least 2 weeks. Controlled OS does not seem to increase the risk of BC recurrence. Other fertility preservation methods (ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists) do not require OS but are still considered to be experimental techniques for fertility preservation.Premda se karcinom dojke ÄeÅ”Äe javlja u starijoj životnoj dobi, to je i najuÄestaliji malignitet u žena reproduktivne dobi. Zbog sveukupnog napretka moderne medicine i rastuÄeg globalnog trenda odgaÄanja raÄanja djece za kasniju dob suoÄavamo se sa sve viÅ”e mladih žena s dijagnosticiranim i lijeÄenim karcinomom dojke koje joÅ” nisu kompletirale obitelj. Stoga je podruÄje oÄuvanja plodnosti postalo jako bitno u oÄuvanju kvalitete života mladih žena koje su preboljele karcinom dojke. Ovaj rad iznosi trenutno dostupne metode za oÄuvanje plodnosti u mladih žena s ranim karcinomom dojke i istiÄe važnost
multidisciplinarnog pristupa u oÄuvanju plodnosti kao bitnog Äimbenika kvalitete života tih žena. Smatra se da trudnoÄa nakon karcinoma dojke nije povezana s poviÅ”enim rizikom od recidiva pa stoga ne treba obeshrabriti žene koje žele ostvariti trudnoÄu nakon provedenog onkoloÅ”kog lijeÄenja. Danas se preporuÄa priÄekati s trudnoÄom barem 2 godine nakon postavljene dijagnoze za vrijeme kada je rizik od povrata bolesti najveÄi. No, isto tako bi bolesnice reproduktivne dobi trebalo obavijestiti o moguÄem negativnom uÄinku onkoloÅ”ke terapije na plodnost te o dostupnim metodama oÄuvanja plodnosti i u sluÄaju zainteresiranosti za oÄuvanje plodnosti bolesnice treba žurno uputiti reproduktivnom specijalistu. Rano upuÄivanje reproduktivnom specijalistu je bitan Äimbenik koji poveÄava izglede za uspjeÅ”no oÄuvanje plodnosti. Krioprezervacija embrija i zrelih oocita su trenutno jedine standardne metode oÄuvanja plodnosti koje zahtijevaju stimulaciju ovarija kojom se odgaÄa poÄetak kemoterapijskog lijeÄenja barem 2 tjedna. Smatra se da kontrolirana stimulacija ovarija ne poveÄava rizik od povrata karcinoma dojke. Druge metode oÄuvanja plodnosti (krioprezervacija tkiva jajnika, krioprezervacija nezrelih oocita,
ovarijska supresija GnRH agonistima) ne zahtijevaju primjenu ovarijske stimulacije, ali se i dalje smatraju eksperimentalnim metodama za oÄuvanje plodnosti
Point prevalence of significant nutritional risk among cancer patients in Croatia ā research study of the Section of young oncologists, Croatian society for medical oncology of Croatian medical association
Cilj istraživanja: Utvrditi trenutaÄnu prevalenciju znatnoga nutritivnog rizika meÄu onkoloÅ”kim bolesnicima u Republici Hrvatskoj. Ispitanici i metode: Ova presjeÄna studija ugniježÄena je u prospektivnu kohortnu studiju Sekcije mladih onkologa HDIO-a HLZ-a, koja je provedena u Hrvatskoj tijekom 2017. godine na susljednom uzorku onkoloÅ”kih bolesnika biranome prema redoslijedu dolaska na lijeÄenje. Nutritivni probir proveli smo uporabom upitnika za procjenu nutritivnog rizika NRS-2002. Prema njemu, bolesnik se smatra nutritivno ugroženim ako je rezultat ā„ 3. Rezultati: U istraživanje je ukljuÄeno 275 bolesnika, medijana (interkvartilnog raspona) dobi od 61 godine (51 ā 68), meÄu kojima je bila 161 žena (58,5%). Bolesnici su lijeÄeni u jedanaest onkoloÅ”kih centara u Hrvatskoj. U 60 bolesnika (21,8%; 95%-tni CI 17,1 ā 27,2%) utvrÄen je znatan nutritivni rizik (NRS-2002 ā„ 3) koji indicira potrebu za nutritivnom intervencijom. Bilo kakvu nepovoljnu promjenu tijekom 30 dana prije ukljuÄivanja, dakle, gubitak tjelesne mase ili smanjen unos hrane, primijetilo je 127 (46,2%) sudionika. ZakljuÄak: NaÅ”e istraživanje potvrdilo je da znatan broj onkoloÅ”kih bolesnika u Hrvatskoj ima neki stupanj nutritivnog rizika te da je u viÅ”e od Äetvrtine potrebna nutritivna intervencija. Nutritivni probir prvi je korak u dugoroÄnoj kontroli komplikacija vezanih uz promijenjen
unos hrane i nutritivni rizik, kao i pri poboljŔanju kvalitete života onkoloŔkih bolesnika te prognoze ishoda bolesti pa bi ga, s obzirom na prikazane rezultate, trebalo rutinski provoditi.Objective of the Study: To determine the point prevalence of significant nutritional risk among cancer patients in Croatia. Subjects and Methods: This cross-sectional study was nested in the prospective cohort study of
the Section of Young Oncologists of the Croatian Society for Medical Oncology, Croatian Medical Association, conducted in Croatia during 2017 on the consecutive sample of cancer patients selected by the order of their arrival to the exam.Nutritional screening was performed using the NRS-2002, According to NRS-2002, the patient is considered to be at significant nutritional risk if the result is ā„3. Results: We included 275 patients treated at eleven cancer centers in Croatia. In 60 patients (21.8%, 95% CI 17.1% -27.2%) we identified the significant
nutritional risk (NRS-2002 ā„3) what indicates the need for the nutritional intervention. Any change during 30 days prior to screening, such as loss of body weight or reduced intake of food, was expressed by 127 (46.2%) participants. Conclusion: Our study has confirmed that a significant number of cancer patients in Croatia are in some degree at nutritional risk, and that more than one quarter need nutritional intervention. Nutritional screen poing is the first step in the long-term control of complications associated with altered food intake and nutritional risk, as well as in improving the overall quality of life of cancer patients and the prognosis of disease outcomes, so
regarding the presented results, it should be routinely implemented