Leczenie przerzutowego, hormonozależnego, HER-2 ujemnego raka piersi – czy jest miejsce dla ewerolimusu? Opis przypadku

Rak piersi jest najczęściej występującym na świecie nowotworem złośliwym u kobiet. Obecnie standardem postępowania w leczeniu rozsianego, hormonozależnego, HER-2 ujemnego raka piersi, bez cech kryzy trzewnej jest terapia hormonalna z inhibitorami kinaz cyklinozależnych (CD4/6). Ewerolimus, pochodna rapamycyny, nie jest obecnie rutynowo stosowany w praktyce klinicznej, jednak wykazano jego skuteczność w skojarzeniu z hormonoterapią. W artykule zaprezentowano przypadek pacjentki z nawrotowym, hormonoopornym rakiem piersi, u której zastosowano ewerolimus z eksemestanem w ramach terapii niestandardowej po dwóch liniach paliatywnej hormonoterapii (inhibitor aromatazy i fulwestrant) i chemioterapii FAC (fluorouracyl, adriamycyna, cyklofosfamid). Zastosowane leczenie zapewniło 24-miesięczny czas wolny od nawrotu choroby. Miejsce ewerolimusu w leczeniu zaawansowanego raka piersi w obecnej erze leczenia cyklibami (inhibitory cyklin CD4/6) jest poddawane ocenie w toczących się badaniach klinicznych.Among females, breast cancer is across the world the most common malignancy. Currently, the standard in the treatment of metastatic, hormone receptor-positive HER2-negative breast cancer without visceral crisis, is hormonal therapy with cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors. Everolimus, a rapamycin derivative, is not routinely used in clinical practice but together with hormonal therapy it has been found to be an effective treatment option. We present a patient with recurrent, hormone-resistant breast cancer who was treated with everolimus with exemestane in beyond-standard therapy after two lines of palliative hormonal therapy (aromatase inhibitor and fulvestrant) and chemotherapy FAC (fluorouracil, adriamycin, cyclophosphamide). This treatment provided 24-months of progression-free survival. The place of everolimus in the treatment of advanced breast cancer in the era of CDK 4/6 inhibitors is being investigated in clinical trials

Wnt pathways in focus – mapping current clinical trials across the cancer spectrum

The Wnt pathway has a pivotal function in tissue development and homeostasis, overseeing cell growth or differentiation. Aberrant Wnt signalling pathways have been associated with the pathogenesis of diverse malignancies, influencing cell proliferation, differentiation, cancer stem cell renewal, the tumour microenvironment and thereby significantly im­pacting tumour development and therapeutic responsiveness. Promisingly, current research underscores the potential therapeutic value of targeting Wnt pathways, particularly canonical Wnt/β-catenin signalling, in the context of numerous cancer types. Key constituents of the Wnt pathway, such as the Wnt/receptor, β-catenin degradation or transcription complexes, have been focal points for interventions in preclinical studies. To comprehend potential therapeutic strate­gies, we conduct an analysis of ongoing clinical trials that specifically aim to target components of the Wnt pathways across a diverse spectrum of cancer types. By scrutinizing these trials, including their respective phases, targeted pa­tient populations ,and observed outcomes, this review provides a consolidated overview of the current translational landscape of Wnt-targeted therapies, thus offering a roadmap for future research endeavours

Wnt pathways in focus – mapping current clinical trials across the cancer spectrum

The Wnt pathway has a pivotal function in tissue development and homeostasis, overseeing cell growth or differentiation. Aberrant Wnt signalling pathways have been associated with the pathogenesis of diverse malignancies, influencing cell proliferation, differentiation, cancer stem cell renewal, the tumour microenvironment and thereby significantly im­pacting tumour development and therapeutic responsiveness. Promisingly, current research underscores the potential therapeutic value of targeting Wnt pathways, particularly canonical Wnt/β-catenin signalling, in the context of numerous cancer types. Key constituents of the Wnt pathway, such as the Wnt/receptor, β-catenin degradation or transcription complexes, have been focal points for interventions in preclinical studies. To comprehend potential therapeutic strate­gies, we conduct an analysis of ongoing clinical trials that specifically aim to target components of the Wnt pathways across a diverse spectrum of cancer types. By scrutinizing these trials, including their respective phases, targeted pa­tient populations ,and observed outcomes, this review provides a consolidated overview of the current translational landscape of Wnt-targeted therapies, thus offering a roadmap for future research endeavours

Deeskalacja terapii systemowej zaawansowanego raka jelita grubego – uzasadniona praktyka kliniczna w aspekcie skuteczności i bezpieczeństwa

Colorectal cancer is one of the most frequent malignant tumours in Poland, making up the third cause of cancer deaths both in women and in men with regards to the frequency of occurrence. The therapy of patients with high-stage colorectal cancer is palliative and should be conducted in a continual manner until the disease progression or unacceptable toxicity of treatment. By definition, palliative care aims at prolongation of the period to the exacerbation of the disease and of the overall survival with simultaneous guarantee of appropriate quality of life to the patients. A long-term use of a multidrug chemotherapy is often connected with the presence of clinically significant toxicity, therefore, de-escalation of systemic treatment is currently the subject of numerous analyses. The studies evaluating the effect of maintenance therapy on patient survival, prove that this kind of treatment makes up a valuable option in the case of patients in whom a good clinical effect is maintained with a concurrent reduction of toxicity of treatment. Especially in the context of the ongoing SARS-CoV-2 pandemic, monotherapy or less aggressive therapy should be discussed with patients.Rak jelita grubego to jeden z najczęściej występujących nowotworów złośliwych w Polsce i stanowi trzecią przyczynę zgonów z powodu nowotworów zarówno u kobiet jak i mężczyzn. Terapia chorych z rozpoznaniem zaawansowanego raka jelita grubego ma charakter paliatywny i powinna być prowadzona w sposób ciągły do progresji choroby lub nieakceptowalnej toksyczności leczenia. Z założenia, opieka paliatywna ma na celu wydłużenie czasu do zaostrzenia choroby i przeżycia całkowitego przy jednoczesnym zapewnieniu chorym odpowiedniej jakość życia. Długotrwałe stosowanie wielolekowej chemioterapii często wiąże się z występowaniem istotnej klinicznie toksyczności, dlatego deeskalacja leczenia systemowego jest obecnie przedmiotem licznych analiz. Badania oceniające wpływ leczenia podtrzymującego na przeżycie pacjentów dowodzą, że strategia ta jest cenną opcją u tych chorych, u których utrzymuje się dobry efekt kliniczny przy jednoczesnej redukcji toksyczności terapii. Szczególnie w kontekście trwającej pandemii SARS-CoV-2 monoterapia lub mniej agresywna terapia powinny być omawiane z chorymi

Effects of transcutaneous electrical nerve stimulation on pain and chemotherapy-induced peripheral neuropathy in cancer patients : a systematic review

Transcutaneous electrical nerve stimulation (TENS) is the usage of a mild electrical current through electrodes that stimulate nerves. Patients with malignancies experience pain and chemotherapy-induced peripheral neuropathy. A systematic review was performed to find research evaluating the effect of TENS on these two common symptoms decreasing the quality of life in cancer patients. PubMed, the Cochrane Central Register of Controlled Trials and EMBASE were searched. Original studies, namely randomized controlled trials, quasi-randomized controlled trials and controlled clinical trials, published between April 2007 and May 2020, were considered. The quality of the selected studies was assessed. Seven papers were incorporated in a qualitative synthesis, with 260 patients in total. The studies varied in terms of design, populations, endpoints, quality, treatment duration, procedures and follow-up period. Based on the results, no strict recommendations concerning TENS usage in the cancer patient population could be issued. However, the existing evidence allows us to state that TENS is a safe procedure that may be self-administered by the patients with malignancy in an attempt to relieve different types of pain. There is a need for multi-center, randomized clinical trials with a good methodological design and adequate sample size