Cutaneous melanomas

Zdaniem autorów opracowanie zawiera najbardziej uzasadnione zasady postępowania diagnostyczno-terapeutycznego. Zasady te powinny być jednak interpretowane w kontekście indywidualnej sytuacji klinicznej. Zalecenia nie zawsze odpowiadają bieżącym zasadom refundacji obowiązującym w Polsce. W przypadku wątpliwości należy się upewnić co do aktualnych możliwości refundacji poszczególnych procedur.

Treatment of BRAF+ melanoma in light of current drug programs

The past decade has seen significant advances in the understanding of molecular pathogenesis of cutaneous melanoma. Currently, mutations of BRAF oncogene have been a well established and powerful predictive role as validated target in recently developed molecular targeted therapy for melanoma. It has been proven in a number of studies that the effective treatment for this group of patients consists of the combination of a BRAF inhibitor and MEK inhibitor, two such combinations are currently registered and reimbursed in Poland — vemurafenib and cobimetinib, dabrafenib and trametinib. Median progression-free survival (PFS) exceeds one year for BRAF and MEK combined therapy, and overall survival (OS) reaches approximately 2 years. Currently, the first line therapeutic option for BRAF-mutated advanced melanoma include also immunotherapy with anti-PD-1 antibodies (combination of PD-1/CTLA-4 blockers can be an option in a specific group of patients, although not reimbursed in Poland).The past decade has seen significant advances in the understanding of molecular pathogenesis of cutaneous melanoma. Currently, mutations of BRAF oncogene have been a well established and powerful predictive role as validated target in recently developed molecular targeted therapy for melanoma. It has been proven in a number of studies that the effective treatment for this group of patients consists of the combination of a BRAF inhibitor and MEK inhibitor, two such combinations are currently registered and reimbursed in Poland — vemurafenib and cobimetinib, dabrafenib and trametinib. Median progression-free survival (PFS) exceeds one year for BRAF and MEK combined therapy, and overall survival (OS) reaches approximately 2 years. Currently, the first line therapeutic option for BRAF-mutated advanced melanoma include also immunotherapy with anti-PD-1 antibodies (combination of PD-1/CTLA-4 blockers can be an option in a specific group of patients, although not reimbursed in Poland)

Trabectedin in the treatment of patients with soft tissue sarcoma

Soft tissue sarcomas (STS) are rare malignant tumours derived from connective tissue. They constitute about 1% of malignancies occurring in adults. We distinguish over 60 subtypes of soft tissue sarcoma, each with a unique clinical course and a diversified response to systemic treatment. The prognosis for patients with locally advanced, unresectable or metastatic disease remains poor. For years, doxorubicin — used alone or in combination with ifosfamide — has been the basis of treatment for these patients. Trabectedin is a relatively new molecule registered in the treatment of patients diagnosed with STS. The drug was originally obtained from marine tunicates (Ecteinascidia turbinata), currently it is obtained semi-synthetically. So far, a number of potential mechanisms of trabectedin have been descri­bed, including DNA-binding, disruption of DNA repair mechanisms and cell cycle, as well as effects on transcription factors and the tumour microenvironment. The aim of the following review is to summarize the current knowledge on the efficacy and safety of trabectedin in the treatment of patients diagnosed with STS