Systemic treatment of breast cancer in young patients with a germline mutation in the BRCA1 and BRCA2 genesMain topic

Markéta Palácová

Onkologie. 2023:17(3):145-149 | DOI: 10.36290/xon.2023.029  

All breast cancer phenotypes occur in tumors with a germline BRCA1/2 (gBRCA1/2) mutation. A mutation in the BRCA1/2 gene brings with it, with regard to the function of repair genes, a higher chemosensitivity to cytostatics causing DNA damage. A higher sensitivity to platinum derivatives and anthracyclines is known. A group of PARP inhibitors can now be administered not only in metastatic disease, but data on effectiveness are now also available in adjuvant setting. According to the limited data, there is no difference in the effectiveness of immunotherapy in germinal or sporadic breast cancer. For endocrine therapy, there are only data on the risk...

Adjuvant hormone therapy in young women with early breast cancer in 2023Main topic

Vlastimila Čmejlová

Onkologie. 2023:17(3):140-144 | DOI: 10.36290/xon.2023.028  

Hormone therapy in patients with hormone-dependent breast cancer is an important part of comprehensive cancer treatment. Premenopausal patients continue to be treated with tamoxifen, and in high-risk patients we consider the administration of the aromatase inhibitor exemestane with or without ovarian ablation. The duration of adjuvant treatment is extended; small low-risk cancers can be treated for only 5 years, while high-risk cancers with lymph node positivity and higher proliferative activity benefit from extended administration up to 10 years. Multigene assays can identify patients at low risk of recurrence, where adjuvant chemotherapy is not necessary,...

Karcinom pankreatu – změna k lepšímu?Editorial

MUDr. Marián Liberko

Onkologie. 2023:17(2):79  

Hidradenocarcinoma arising in the axilla - a report of a rare caseCase report

Vladimír Bartoš, Zuzana Murárová

Onkologie. 2023:17(2):127-130 | DOI: 10.36290/xon.2023.026  

Introduction: Hidradenocarcinoma is a rare malignant adnexal tumor which arises from the intradermal ducts of sweat glands. It often clinically mimics a benign (non-neoplastic) skin disease, which contributes to delayed diagnosis. Case report: A 51-year old man had noticed an "inflamed lump" in his right armpit for the last year. The lesion clinically appeared as a suppurative hidradenitis. After its surgical incision, it was seen a progression of cutaneous tumorous resistance at a given location. The mass was completely excised. Histopathology revealed a solid high-grade carcinoma with a histomorphology and immunophenotype favoring the diagnosis of...

Long­‑term survival of a patient with disseminated adenocarcinoma of the ampulla of Vater: a complex therapeutic approach in metastases recurrenceCase report

Martin Gryc, Michal Eid

Onkologie. 2023:17(2):123-126 | DOI: 10.36290/xon.2023.025  

Adenocarcinoma of the ampulla of Vater is a rare but aggressive disease with a poor prognosis. While radical surgical resection is the standard treatment of choice, recurrence and metastatic dissemination remain common clinical challenges. Furthermore, there is no clear guideline consensus regarding adjuvant treatment. Precise histopathological characterization is paramount in terms of disease prognosis. We report a case of a patient who underwent a multimodal treatment for recurrent lung metastasis with a good clinical outcome.

Types and characteristics of renal lesions - diagnosis, treatment and prognosisReview articles

Vít Paldus, Vladimír Šámal, Marie Pechová, Igor Richter

Onkologie. 2023:17(2):119-122 | DOI: 10.36290/xon.2023.024  

Characteristics of renal lesions may predict further development of the disease, its prognosis and thus becomes part of the decision-making process, as to which treatment strategy to choose, right from the beginning. Unfortunately, a simple TMN classification of the disease stage may not always be sufficient. Some of the centrally localized renal cell carcinomas (RCC) may be re-evaluated from the primary stage cT1 to the final pathological stage pT3a. Cystic renal lesions represent another specific group in the evaluation of RCC. Their diagnostic work up and treatment strategy is guided by the Bosniak classification based on the CT. The clinical approach...

Breast reconstruction and radiotherapyReview articles

Igor Sirák, Aleš Fibír, Igor Slaninka, Adam Paulík, Iveta Kolářová, Petr Motyčka, Jakub Grepl, Petr Paluska, Milan Vošmik

Onkologie. 2023:17(2):113-118 | DOI: 10.36290/xon.2023.023  

Breast-conserving surgical treatment combined with perioperative systemic therapy and postoperative radiotherapy is the standard treatment for early-stage breast carcinoma. Mastectomy continues to be performed in patients in whom breast-conserving surgery cannot be recommended for therapeutic or cosmetic reasons. They often have locally or regionally advanced disease in which mastectomy is virtually always followed by adjuvant radiotherapy. Breast reconstruction following mastectomy is increasingly encountered, and this trend will continue to grow in the future. With advances in medicine, there has been progress in both the surgical procedures used...

Effect of target therapy with BRAF and MEK inhibitors on the immune system in metastatic melanomaReview articles

Linda Řandová, Ondřej Kodet

Onkologie. 2023:17(2):108-112 | DOI: 10.36290/xon.2023.022  

Target therapy with BRAF and MEK inhibitors is one of the main pillars of treating patients with BRAF-mutated melanoma. Despite a good therapeutic response, this treatment is burdened by early development resistance. A particular possibility to overcome this resistance is the combination of target therapy and immunotherapy. BRAF-mutated melanomas themselves have immunosuppressive properties that stimulate the tumour microenvironment. Target therapy with BRAF and MEK inhibitors significantly affects the immune tumour microenvironment, which could support the use of combination therapy with checkpoint inhibitors. However, these findings have not...

Metastatic pancreatic cancer and personalized therapy: a case reportMain topic

Marián Liberko, Renata Soumarová

Onkologie. 2023:17(2):101-107 | DOI: 10.36290/xon.2023.021  

We present a case report of a patient with pancreatic cancer who developed metastatic disease early after surgery and adjuvant therapy. Palliative systemic treatment resulted in long-term control of the disease, followed by pulmonary metastasectomy of residual lesions. Early relapse of the disease after metastasectomy was treated with platinum derivatives, based on the results of NGS testing. Personalized treatment has led to a rapid response and stabilization of the disease. Maintenance therapy with PARP inhibitors will follow in the future.

Personalized therapy in pancreatic cancerMain topic

Marián Liberko, Renata Soumarová

Onkologie. 2023:17(2):95-100 | DOI: 10.36290/xon.2023.020  

Pancreatic cancer is a disease with increasing incidence and mortality worldwide. Current standard of treatment is chemotherapy regardless of clinical stage. Despite improvements in survival thanks to multi-agent regimens in adjuvant, neoadjuvant and paliative setting, pancreatic cancer still has the worst prognosis across all malignancies. Oncology nowadays is more or less personalized/precise. With help of NGS we are able to identify specific subtypes of patients with pancreatic cancer, which have both, different prognosis and require specific approach to treatment. The aim of this review is to provide information about pancreatic cancer as a molecularly...

The role of radiotherapy in the treatment of pancreatic cancerMain topic

Renata Soumarová, Marián Liberko

Onkologie. 2023:17(2):90-94 | DOI: 10.36290/xon.2023.019  

Surgery remains the most important modality in the treatment of resectable pancreatic cancer, but only 10-15% of patients are suitable candidates. Despite the still high rate of local recurrence after radical surgery, adjuvant radiotherapy has now been replaced by chemotherapy, which has been shown to have better outcomes in randomized trials. Systemic therapy is also preferred in the neoadjuvant indication, but further studies investigating the position of radiotherapy in this group of patients are needed. Radiotherapy has a place in unresectable disease, where in combination with systemic therapy it affects local disease control and overall survival....

Is surgical treatment of liver metastases from pancreatic adenocarcinoma currently indicated?Main topic

Robert Gürlich

Onkologie. 2023:17(2):86-89  

At the time of primary diagnosis, metastatic pancreatic ductal adenocarcinoma (mPDAC) occurs in up to 60%. In approximately half of these patients, synchronous distant metastases are present, with around 37-42% of them being liver metastases. The existing recommendations do not indicate a primary surgical procedure in stage IV of the disease. Recently, particularly with the advancement of systemic treatment, initial results have been published demonstrating the benefit of the primary surgical approach. The results of ongoing randomized trials have been unavailable so far; therefore, there is not strong enough evidence to recommend a change in the strategy...

Surgical treatment of resectable and borderline resectable pancreatic cancerMain topic

Martin Oliverius

Onkologie. 2023:17(2):82-85 | DOI: 10.36290/xon.2023.018  

Surgical treatment remains the only treatment method that gives patients hope of cure, or of a significant prolongation of the asymptomatic period. In combination with multimodal oncological treatment, survival of patients has improved in recent years, although from the point of view of other cancers of the gastrointestinal tract it continues to be one of the worst. The mortality rate of patients operated in large centers ranges between 3-5%, although the morbidity due to the complexity of the procedure and the predominantly higher age composition of patients remains around 40%. A single examination is sufficient for the indication and the right decision...

Karcinom plic v roce 2023 – méně známé aspekty nemociEditorial

doc. MUDr. Kristián Brat, Ph.D.

Onkologie. 2023:17(1):3  

Risks associated with central venous catheter care in a pediatric patient in palliative careCase report

Lenka Horáková, Kateřina Horáčková

Onkologie. 2023:17(1):72-74 | DOI: 10.36290/xon.2023.017  

Introduction: For a paediatric patient on palliative care, the provision of venous access may be required, which can be used in the home or hospital setting. However, disruption of skin integrity may increase the risks, which can be life-threatening for the paediatric patient. Objective: Identify and assess the risks associated with central venous catheter care.  Methodology: FMEA (Failure Mode and Effect Analysis), expert team brainstorming. Results: The risks analysed were assessed as significant. Even corrective measures cannot eliminate the risks completely, but they can be reduced to a minimum. Conclusion: Appropriate education and proper...

Clear-cell renal cell carcinoma with sarcomatoid dedifferentiation treated with immunotherapyCase report

Andrea Ondrušková, Hana Študentová, Anežka Zemánková

Onkologie. 2023:17(1):70-71 | DOI: 10.36290/xon.2023.016  

Sarcomatoid renal cell carcinoma occurs rarely. It is characterized by a very poor prognosis and a low response to treatment with tyrosine kinase inhibitors. Combination of the checkpoint inhibitors ipilimumab and nivolumab is becoming a new standard of treatment. The case report presents a patient with clear-cell renal cell carcinoma with sarcomatoid dedifferentiation that was already generalized at presentation and had a poor prognosis. The patient was treated with the combination of ipilimumab and nivolumab, resulting in a good clinical response, a radiological response in the form of disease stabilization, and a survival of more than two years.

CheckMate 9LA trial: commentary and clinical case report of patient with cerebellar metastasisCase report

Marie Drösslerová

Onkologie. 2023:17(1):67-69 | DOI: 10.36290/xon.2023.015  

Patients with non-oncogene-addicted metastatic NSCLC are treated with first- line immunotherapy with or without chemotherapy. CheckMate 9LA trial demonstrated survival benefits and safety of dual immunotherapy (nivolumab, ipilimumab) with limited chemotherapy. Survival outcomes were significantly improved in patients with tumor PD-L1 expression < 1% and baseline brain metastases. We present a clinical case of a 72 years old patient with NSCLC and cerebellar metastasis treated according to CheckMate 9LA trial.

Cemiplimab in treating locally advanced NSCLCCase report

Andrea Müllerová, Juraj Kultan

Onkologie. 2023:17(1):62-66 | DOI: 10.36290/xon.2023.014  

A case is reported of a female patient who was diagnosed with an inoperable, stage IIIB adenocarcinoma of the right lung. Given the high PD-L1 positivity of 90% and negativity of activating mutations, immunotherapy was chosen as the treatment modality with a real chance for a therapeutic response. Due to comorbidities, disease extent (carcinomatous lymphangitis, satellite lesion), and the patient's age, chemoradiotherapy (CRT), whether in concurrent (cCRT) or sequential (sCRT) form, was not indicated because of a high risk of serious complications. For these reasons, the patient was started on cemiplimab which is currently the only molecule among immuno-oncology...

Case reports of patients with ALK-positive NSCLC and brain metastasesCase report

Petra Zemanová, Milada Zemanová, Vladimír Černý

Onkologie. 2023:17(1):57-61 | DOI: 10.36290/xon.2023.013  

The present case reports describe a young male and a young female patient diagnosed with generalized non-small cell lung adeno­carcinoma with brain metastases and ALK translocation. Brain metastases are detected in 30% of patients with ALK-positive NSCLC at the time of cancer diagnosis. The discussion section deals with the intracranial efficacy of individual ALK inhibitors.

Mechanisms of resistance to melanoma immunotherapyReview articles

Linda Řandová, Ondřej Kodet

Onkologie. 2023:17(1):51-56 | DOI: 10.36290/xon.2023.012  

The treatment of melanoma has seen significant progress over the past 12 years. Its basis is immunotherapy using check-point inhibitors. Unfortunately, despite the long-term therapeutic response that can be achieved, many patients experience lower rates of therapeutic responses and failure with this form of treatment even after an initial good treatment response. These treatment complications are the subject of many studies that document individual mechanisms of primary and secondary resistance to melanoma immunotherapy. The study comprehensively describes contemporary knowledge about particular resistance mechanisms to melanoma treatment.

Nevoid melanoma as a diagnostic problemReview articles

Paula Ďuríková

Onkologie. 2023:17(1):47-50 | DOI: 10.36290/xon.2023.011  

Nevoid melanoma is one of the most difficult types of malignant melanoma to diagnose. Most often, it is clinically and histopathologically similar to the common intradermal and compound melanocytic nevus. This rare lesion defies conventional ideas about the morphology of malignant melanocytic neoplasm. It is an aggressive tumor. Its poor prognosis is in contrast to its organized architecture, which resembles a banal benign lesion. A significant part of the diagnostic process in cases of melanocytic neoplasms is based on the subjective assessment of the lesions. Therefore, increasing awareness of this rare type of malignant melanoma can aid decision-making...

The issue of the health condition assessment for the purposes of the special aid allowance and disabled person ID card with the view to the involvement of general practitioners and specialists, including oncologistsReview articles

Libuše Čeledová, Rostislav Čevela

Onkologie. 2023:17(1):40-46 | DOI: 10.36290/xon.2023.010  

The article provides a clear introduction to the issue of the health condition assessment for the purposes of the special aid allowance and disabled person ID card. The text is supplemented with a case report on the health condition assessment for the purposes of a disability certificate of a man with testicular seminoma. The authors propose to unify the assessment criteria for the health condition assessment for the purposes of the disabled person ID card and for the purposes of the care allowance, which would simplify and accelerate the assessment process. Furthermore, in order to make the assessment process more efficient, they propose to transfer...

Are we in the era of total neoadjuvant treatment in rectal cancer?Review articles

Marián Liberko, Renata Soumarová

Onkologie. 2023:17(1):35-39 | DOI: 10.36290/xon.2023.009  

Long term standard for treatment of locally advanced rectal cancer was neoadjuvant chemoradiotherapy followed by radical surgery and eventually adjuvant chemotherapy in selected patients. Stagnation of oncological outcomes of clasical approach lead to a new concept called total neoadjuvant treatment (TNT). This article offers review of most recent TNT studies and their significance for clinical pratice.

The use of PET/MRI in rectal cancerReview articles

Andrea Šprláková-Puková, Hana Petrášová, Alexandra Litavcová, Zdeněk Kala, Lenka Ostřížková, Marek Dostál

Onkologie. 2023:17(1):31-34 | DOI: 10.36290/xon.2023.008  

Magnetic resonance is currently a key examination for rectal tumors invading through muscularis propria. The reason is accurate TNM staging and selection of appropriate treatment. The use of PET/MRI combines the possibility not only to examine the rectum and performe T staging, but it can help delineate extent of tumor better and also better characterize small lymph nodes and improve detection of distant metastases. The use of hepatospeific contrast agent improves detection and specification of the focal liver lesion. This aproach called one - stop - shop ensures to determine TNM classification in one examination. Moreover, this approach is beneficial...

Current status of immunotherapy in the adjuvant treatment of invasive urothelial carcinomaReview articles

Vladimír Šámal, Igor Richter, Vít Paldus

Onkologie. 2023:17(1):26-30 | DOI: 10.36290/xon.2023.007  

Radical cystectomy or nephroureterectomy with lymphadenectomy is the standard treatment for muscle-invasive urothelial carcinomas. Patients after curative surgery without clinically detectable metastases are at high risk of disease recurrence. Neoadjuvant cisplatin-based chemotherapy provides the benefit of prolonging overall survival (OS) versus surgery alone. There is no clear treatment standard for patients with a high risk of recurrence after radical surgery. Adjuvant cisplatin-based chemotherapy is often used (if not given neoadjuvantly). Some patients refuse chemotherapy or are unable to undergo it. The efficacy and safety of treatment with checkpoint...

Experience with the treatment of lung cancer from real clinical practice - findings from registries TULUNG and LUCASMain topic

Ondřej Venclíček

Onkologie. 2023:17(1):22-25 | DOI: 10.36290/xon.2023.006  

The TULUNG and LUCAS pneumooncology registries are databases used to store, analyze, interpret and publish data from patients with lung cancer. The TULUNG registry was terminated at the end of March 2022, the LUCAS registry is ongoing. Pneumooncology centers from all over the Czech Republic participated in both projects. The data gained from the registries are a valuable source of information for clinical practice.

Update on diagnosis and management of malignant pleural effusionsMain topic

Kristián Brat

Onkologie. 2023:17(1):16-21 | DOI: 10.36290/xon.2023.005  

Malignant pleural effusion (MPE) occurs in a significant proportion of patients with malignancy, more frequently in certain types of tumors. Diagnosis of MPE is based on imaging, but in most patients, a pleural intervention is required (thoracentesis, pleural biopsy, medical thoracoscopy or video-assisted thoracoscopy) for cytology and/or histology sampling. Management of MPE depends on the fluid volume, patient's symptoms and reaccumulation rate. Further considerations include patient´s general health condition, life expectancy and anticancer treatment options. In patients with recurrent MPE, talc pleurodesis or insertion of an indwelling pleural...

Perspectives in the treatment of less common mutations in patients with non-small cell lung carcinomaMain topic

Miloš Pešek

Onkologie. 2023:17(1):12-15 | DOI: 10.36290/xon.2023.004  

The author presents an overview of current information regarding the state-of-the-art in diagnosing less common driver mutations in non-small cell lung carcinoma (NSCLC) in association with the current options of treatment targeted at these molecular subtypes of cancer. In the majority of patients, targeted therapy elicits a rapid treatment response, prolongs the time to tumour progression, extends overall survival of patients, and usually has fewer adverse effects than chemotherapy in a possible combination with cancer immunotherapy. Most oncogene-dependent lung cancer occurs in non-smokers and in young individuals. NGS and RT-PCR methods are increasingly...

Actual role of immunotherapy in a treatment of lung cancerMain topic

Monika Bratová

Onkologie. 2023:17(1):8-11 | DOI: 10.36290/xon.2023.003  

Immunotherapy plays an important role in management of lung cancer. Its incorporation in a treatment strategy helps to improve survival of patients with NSCLC and SCLC. Crucial principles of immunit control, check points and their inhibitors available in Czech Republic are discussed. Particular indications of immunotherapy for a diagnosis of lung cancer together with practical points and diagram of the first line treatment of NSCLC are presented.

Monoklonální gamapatie - úvodní slovo k supplementuSupplementum

prof. MUDr. Zdeněk Adam, CSc.

Onkologie 2022: 16(Suppl.B): 4-6