HER2-low napredno liječenje raka dojke

Breast cancer cells can express HER2 receptors on their membranes to varying degrees. HER2 signalling pathway is important for tumor growth and metastasis. Patients with HER2-positive disease had worse treatment outcomes until the implementation of trastuzumab started, followed by other anti-HER2 drugs. So far, they have been used exclusively for strong HER2 expression. The development of new drugs, primarily antibody-drug conjugates, has proven their efficacy on tumor cells that have lower levels of the HER2 receptors, today referred to as HER2-low tumors. Since the results of the DESTINY breast04 study showed a prolongation of progression free survival and overall survival in HER2-low pretreated patients, a new perspective opens up in the treatment, as well as in HER2 testing.Stanice karcinoma dojke na svojim membranama mogu imati različitu razinu ekspresije HER2 receptora. HER2 signalni put važan je za rast tumora i metastaze. Bolesnice s HER2 pozitivnom bolešću imale su lošije ishode liječenja sve dok nije uvedena upotreba trastuzumaba, a potom i drugih anti-HER2 lijekova. Do sada su se koristili isključivo za jaku ekspresiju HER2 receptora. Razvojem novih lijekova, prije svega konjugata protutijelo-citostatik, dokazana je učinkovitost djelovanja na tumorske stanice koje imaju niže razine HER2 receptora, danas poznatih kao HER2-low tumori. Budući da su rezultati studije DESTINY Breast04 pokazali produljenje preživljenja bez progresije bolesti i ukupnog preživljenja u prethodno liječenih pacijenatica s HER-low tumorima, otvaraju se nove mogućnosti, kako u liječenju, tako i u testiranju HER2 receptora

Do we need breast cancer centers?

Hrvatskoj su potrebni centri za rak dojke koji će biti sveobuhvatne baze za dijagnosticiranje, liječenje, praćenje i istraživanje te bolesti. Ustanove u manjim bolnicama trebaju biti sastavni dio šireg tima za liječenje raka dojke. Aktivnosti u takvim centrima izvrsnosti uključuju prije svega timski rad, izradu smjernica, lokalizacijsku onkologiju, trajno usavršavanje stručnjaka, provođenje kliničkih studija, implementaciju novih tehnika liječenja, te kontrolu kvalitete. Organizacija centara izvrsnosti za rak dojke je također u funkciji prilagodbe zdravstvenoga sustava standardima Europske unije.Croatia needs certified breast cancer centers that will cover all aspects of breast cancer treatment; diagnostics, treatment, follow-up and basic and clinical research. Units in smaller hospitals have to be a part of broader multidisciplinary breast cancer teams. Activities in such breast cancer centers primarily include team-work, defining guidelines, localization related oncology sub-specialization, continuous education of experts, clinical trial execution, implementation of new treatment techniques and quality control. The development of certified breast cancer centers also represents health care system adjustment to EU standards

Ovarian Cancer

Karcinom jajnika glavni je uzrok smrtnosti među karcinomima ženskoga spolnog sustava. Ne postoje rutinski testovi rane dijagnostike raka jajnika, a rano prepoznavanje bolesti otežano je zbog oskudne simptomatologije. Ukupna stopa preživljenja bolesnica od karcinoma jajnika iznosi gotovo 50%, što je velik napredak u odnosu na rane 80-e godine kada je iznosila oko 35%, a može se zahvaliti uvođenju paklitaksela u liječenje.Ovarian cancer is the main reason of death among gynecological cancers. There is no routine test for early diagnosis of ovarian cancer and early detection of this cancer is difficult because of lack of simptomatology. Overall survival rate among patients with ovarian cancer is almost 50 % and it represents a significant increase of survival in the last decade due the introduction of paclitaxel in the treatment of advanced stages of ovarian carcinoma

Role of CDK4/6 inhibitors in metastatic hormon positive HER2 negative breast cancer treatment

Primjena inhibitora CDK4/6 u liječenju hormonski ovisnoga metastatskog raka dojke negativnog na HER-2 dovela je do bitnog poboljšanja kontrole bolesti, i to ponajprije znatnim produljenjem preživljenja bez progresije bolesti, uz prihvatljiv profil toksičnosti. Osnovno djelovanje inhibitora CDK4/6 jest odgađanje razvoja rezistencije na endokrinu terapiju, odnosno reverziju već nastale rezistencije. Medijani preživljenja bez progresije bolesti kreću se oko 20 i više mjeseci u prvoj liniji liječenja i 10-ak mjeseci i više u drugoj liniji. U prvoj liniji liječenja kombinirani su s aromataznim inhibitorima, a u drugoj s fulvestrantom. Produljenjem vremena bez napredovanja bolesti odgađa se primjena kemoterapije, a bolesnicama se osigurava bolja kvaliteta života. Zbog svega navedenoga ovi lijekovi u kombinaciji s endokrinom terapijom nova su, visokovrijedna terapijska opcija u liječenju metastatskog raka dojke. Međutim, ostaju brojna otvorena pitanja za svakodnevnu kliničku praksu kao što su optimalan odabir bolesnica za prvolinijsko i drugolinijsko liječenje, sekvenciranje drugih lijekova nakon progresije bolesti na inhibitore CDK4/6 te dostupnost i cijena liječenja.Implementation of CDK4/6 inhibitors in metastatic hormone receptor positive, HER2 negative breast cancer treatment significantly improves progression free survival. CDK4/6 inhibitors are characterized by favorable toxicity profile. CDK4/6 inhibitor administration delays and/or overcomes endocrine therapy resistance in metastatic breast cancer. CDK4/6 inhibitors were tested in both first line treatment in combination with aromatase inhibitors, and in second line treatment in combination with fulvestrant. Progression free survival longer than 20 months in the first and longer than 10 months in the second treatment line has been achieved. Progression free survival prolongation may delay chemotherapy administration and consequently enable longer period with maintained quality of life. CDK4/6 inhibitors in combination with endocrine therapy represent a new valuable treatment option for metastatic hormone receptor positive HER2 negative breast cancer. However , many questions such as optimal patient selection as well as positioning of the CDK4/6 inhibitors and other endocrine therapy options during the course of metastatic disease treatment, remain unanswered. Furthermore, availability and cost of CDK4/6 inhibitors are also important issues

Ovarian Cancer

Karcinom jajnika glavni je uzrok smrtnosti među karcinomima ženskoga spolnog sustava. Ne postoje rutinski testovi rane dijagnostike raka jajnika, a rano prepoznavanje bolesti otežano je zbog oskudne simptomatologije. Ukupna stopa preživljenja bolesnica od karcinoma jajnika iznosi gotovo 50%, što je velik napredak u odnosu na rane 80-e godine kada je iznosila oko 35%, a može se zahvaliti uvođenju paklitaksela u liječenje.Ovarian cancer is the main reason of death among gynecological cancers. There is no routine test for early diagnosis of ovarian cancer and early detection of this cancer is difficult because of lack of simptomatology. Overall survival rate among patients with ovarian cancer is almost 50 % and it represents a significant increase of survival in the last decade due the introduction of paclitaxel in the treatment of advanced stages of ovarian carcinoma

Cancer epidemiology in Central and South Eastern European countries

Aim To collect cancer epidemiology data in South Eastern European countries as a basis for potential comparison of their performance in cancer care. Methods The South Eastern European Research Oncology Group (SEEROG) collected and analyzed epidemiological data on incidence and mortality that reflect cancer management in 8 countries – Croatia, Czech Republic, Hungary, Romania, Poland, Slovakia, and Serbia and Montenegro in the last 20-40 years. Results The most common cancer type in men in all countries was lung cancer, followed by colorectal and prostate cancer, with the exception of the Czech Republic, where prostate cancer and colorectal cancer were more common. The most frequent cancer in women was breast cancer followed by colorectal cancer, with the exceptions of Romania and Central Serbia where cervical cancer was the second most common. Cancer mortality data from the last 20-40 years revealed two different patterns in men. In Romania and in Serbia and Montenegro, there was a trend toward an increase, while in the other countries mortality was declining, after increasing for a number of years. In women, a steady decline was observed over many years in the Czech Republic, Hungary, and Slovakia, while in the other countries it remained unchanged. Conclusions There are striking variations in the risk of different cancers by geographic area. Most of the international variation is due to exposure to known or suspected risk factors which provides a clear challenge to prevention. There are some differences in incidence and mortality that cannot be explained by exposure to known risk factors or treatment availabilities

Pharmacoeconomic and clinical implications of sequential therapy for metastatic renal cell carcinoma patients in Central and Eastern Europe

Introduction: The incidence and mortality rates of kidney cancer in the Central and Eastern European (CEE) region are among the highest in the world. Access to second and subsequent lines of metastatic renal cell carcinoma (mRCC) therapies is highly varied in the region. Despite the increasing body of evidence supporting the clinical benefit of multiple lines of treatment, access to treatment beyond first line is restricted in many of these countries.Areas covered: The adoption of targeted therapies for the first-line treatment of mRCC in the region was slow and faced many obstacles. In order to evaluate the current status of treatment beyond the first-line setting in the CEE region, this review examines the availability and reimbursement of mRCC drugs and clinical practice in institutions that treat patients with mRCC.Expert opinion: This review highlights the need to raise awareness among physicians, payers and regulators on clinical trial and cost-effectiveness data regarding the treatment of mRCC beyond the first line. The obstacles to mRCC drug access highlighted in this review need to be overcome to ensure that patients are receiving the best treatment available