The Oncology Association of Bosnia and Herzegovina's recommendations for fertility preservation in oncologic patients

Malignancy is one of the major public health problems in Bosnia and Herzegovina. Along with breakthroughs in specific oncological therapy, improving the quality of life of cancer patients and management of therapy-induced side effects need to be recognized as a priority in the comprehensive cancer patient care. Fertility loss after cancer treatment is a field requiring special attention due to its various consequences on patients themselves.  Although oncofertility is well-recognized area of oncology, low- to middle-income countries are facing issues with its implementation in everyday practice. Increased awareness about fertility preservation is of high priority for all specialists who participate in the medical care of cancer patients. The absence of a systemic solution and lack of expertise led to the founding of Fertility Preservation Working Group of the Oncology Association of Bosnia and Herzegovina. We have made recommendationsas an expert consensus with the ultimate goal of making the first step towards enhancement of oncofertility implementation in Bosnia and Herzegovina

2020 consensus guideline for optimal approach to the diagnosis and treatment of HER2-positive breast cancer in Bosnia and Herzegovina

The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards from healthcare institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held in order to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization and optimization of the procedures for the diagnosis, treatment and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a multidisciplinary tumor board comprised of at least: a medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist

2020 consensus guideline for optimal approach to the diagnosis and treatment of HER2-positive breast cancer in Bosnia and Herzegovina.

The HERe2cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards from healthcare institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held in order to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization and optimization of the procedures for the diagnosis, treatment and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a multidisciplinary tumor board comprised of at least: a medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist

Immunohistochemical markers: carcinoembryonic antigen, p53, Ki-67, and proliferating cell nuclear antigen as prognostic factors for colorectal cancer

Introduction. There has been a progressive increase in the frequency of colorectal carcinoma for the last twenty years. In order for a doctor to estimate the life expectancy and/or the treatment of these patients, oncology makes use of prognostic and predictive factors. They are divided into: clinicosurgical, pathohistological and immunohistochemical markers. The aim of this study is to determine the significance of immunohistochemical markers such as carcinoembryonic antigen (CEA), p53, Ki-67 as well as proliferating cell nuclear antigen (PCNA) for predicting survival in patients with colorectal carcinoma. Methods. From 1st January 2010 to 1st December 2017, 484 patients with colorectal carcinoma who underwent analysis of immunohistochemical markers in carcinoma tissue (CEA, p53, Ki-67 and PCNA) were treated in Public Hospital “St Vračevi“ in Bijeljina. Results. Immunohistochemical analysis of primary colorectal adenocarcinoma tissue showed a considerably high positive expression level of CEA in 301 (62%) patients, p53 in 329 (68%), PCNA in 314 and Ki-67 in 275 (56.8%) patients. Patients with a high positive expression of CEA, PCNA, and p53 had a statistically lower survival rate, compared to the patients with low CEA, PCNA and p53 expression score. There was no statistically significant difference in the survival of patients with a considerably high immunohistochemical Ki-67 expression score, compared to the ones with low score. Conclusion. Although immunohistochemical markers are useful predictors of survival in these patients, immunohistochemical analysis is not used for the routine examination of colorectal carcinom

Neoadjuvantna terapija HER2 pozitivnog karcinoma dojke

Receptor humanog epidermalnog faktora rasta 2 – HER2 (c-erb-B2) je prisutankod 15-20% karcinoma dojke u trenutku postavljanja dijagnoze. Prekomjernaekspresija HER2 receptora povezana je sa agresivnijom formomkarcinoma dojke. Trastuzumab je humano monoklonsko antitijelo kojevezujući se za HER2 receptor blokira signalne puteve ćelijske proliferacije.S obzirom na moguću pojavu rezistenzije na trastuzumab (vezuje se zapoddomenuII HER2 receptora te ostvaruje ligand nezavisnu inhibiciju ćelijskeproliferacije), tokom godina kreirano je drugo monoklonsko antitijelopertuzumab (vezuje se poddomenu IV HER 2 receptora i ostvaruje ligandzavisnu inhibiciju ćelijske proliferacije) te zajedno čine temelj dualne blokadeHER2 receptora. Brojne studije su pokazale korist od primjene trastuzumabai pertuzumaba, prvobitno u metastatskom, a potom i u adjuvantnomi neoadjuvantnom režimu. Neoadjuvantna (preoperativna) terapijase ordinira kod inoperabilnih tumora, kod bolesnika sa visokim rizikom odlošeg ishoda (HER2 pozitivni tumori, nodus pozitivni tumori, inflamatornikracinom dojke, veliki tumori), kao i kad postoje dodatni faktori rizika - HRnegativni tumori kod kojih se ne očekuje korist od hormonalne terapije uadjuvantnom miljeu. Neoadjuvantna terapija, takođe, omogućava in vivouvid u odgovor tumora na neoadjuvantnu terapiju. Kompletan patološkiodgovor (pCR – pathological complete response) je rani parametar efikasnostineoadjuvantnog tretmana koji takođe omogućava da se “na vrijeme”sazna senzitivost tumora i donese odluku o adjuvantnom tretmanu. pCRima prediktivnu i prognostičku vrijednost. Naime, stopa pCR u korelaciji jesa vremenom do progresije bolesti i ukupnim preživljenjem. Brojne studijesu na osnovu stope pCR pokazale da postoje podgrupe HER2 pozitivnihkarcinoma dojke: podgrupa hormon negativnih tumora koji imaju dobarodgovor na postojeću antiHER2 terapiju i HER2 pozitivni karcinomi dojke,podgrupa hormon zavisnih tumora, kod kojih se postojećim terapijskim opcijamajoš uvijek ne postiže adekvatna stopa pCR što predstavlja područjeza nova istraživanja i pronalaženje novih strategija liječenja

Povećana izraženost receptora vaskularnog endotelijalnog faktora rasta u recidivu karcinoma dojke

Uvod. Histološki gradus (HG), koji označava zrelost tumora, i nuklearni gradus(NG), koji predstavlja nuklearnu morfometriju, važni su prognostički faktorikarcinoma dojke. Sa progresijom tumora povezan je i vaskularni endotelijalnifaktor rasta (VEGF). Cilj rada je da se korelira stepen diferenciranosti tumorasa izraženošću receptora za VEGF u recidivu karcinoma dojke.Metode. Ukupno je analizirano 40 uzoraka recidiva karcinoma dojke i 45uzoraka primarnog tumora. Određeni su histološki i nuklearni gradusi i uprimarnom tumoru i u recidivu, te izraženost receptora za VEGF.Rezultati. U ispitivanom uzorku najučestaliji je duktalno invazivni karcinom(75,3%). Histološki gradus I je češći od gradusa III i bilo ih je 27,4% naspram13,7%. Bilo je 24,7% slučajeva nuklearnog gradusa (NG) I, 46,6% slučajevaNG II i 28,8% slučajeva NG III. Od ukupno 85 testiranih uzoraka na receptoreza VEGF samo je u jednom uzorku primarnog karcinoma dojki bio pozitivanreceptor za VEGF, ali je u 15,1% uzoraka recidiva receptor za VEGF biopozitivan. Ispitivanjem odnosa histoloških gradusa i receptora za VEGF nijenađena statistička značajna razlika u broju uzoraka sa pozitivnim receptoromza VEGF između različitih histoloških gradusa (Pearson Hi2=4,79; p=0,571).Međutim, nađena je značajna razlika u pozitivnosti receptora za VEGF uuzoricima različitih nuklearnih gradusa. Receptor za VEGF je bio srazmjernomanje zastupljen u NG II u odnosu na druga dva gradusa (Mann WhitheyU= 272,0; p=0,05 za NG I i NG II i Mann Whithey U=306.000 p=0,02 za NGII i NG III).Zaključak. Receptor za VEGF je bio pozitivan u uzorcima recidiva karcinomadojke i ekspresija receptora VEGF bila je češća u slabije diferenciranimkarcinomima

Analysis of Survival at Metastatic Melanoma Patients Treated with Vemurafenib - a Three Year Single Institution Study

Introduction: The introduction of BRAF inhibitor vemurafenib significantly improvedoverall survival (OS) in metastatic melanoma patients.Aim of the Study: The purpose of this study was to determine OS and progressionfree survival (PFS) in patients with advanced metastatic melanoma treated withvemurafenib in the Oncology Clinic, University Clinical Centre of the Republic ofSrpska (UKC RS). The secondary goal is to determine the effect of elevated serumlactate dehydrogenase (LDH) on OS.Patients and Methods: We analysed patients that received vemurafenib in theApril 2015. until March 2018. They had pathohistologically confirmed B-RAF positivemetastatic melanoma. LDH values were measured at the start of the treatment.Results: A total of 16 patients were analyzed, with an average age of 53 years(37-78). A large number of patients at the start had multiple sites of metastases.Calculated OS in patients who received vemurafenib is 11.8 months (p=0,23), withstandard deviation (SD) 9.18. The calculated PFS is 9.5, SD 7,57. OS in patients withnormal LDH is 14.4 months, SD 10.73, and with elevated LDH is 8.4 months, SD4.9 (p=0.079).Conclusion: Use of vemurafenib resulted in an improvement in PFS, with improvedOS in patients with advanced BRAF-mutated melanoma. In patients with elevatedLDH OS was reduced. This shows that LDH is a good prognostic marker and thatwe should do it routinely for all patients with melanoma. This study has indicatedthe need for new diagnostic and therapeutic options for melanoma in Republic ofSrpska