Karcinom prsu: od deeskalace lokální léčby po péči o kvalitu života v éře personalizované onkologie

prof. MUDr. Tomáš Büchler PhD.

Onkologie. 2026:20(4):199

Axillary management in breast cancer: a review of current diagnostic and therapeutic approaches

Eva Strecková, Michaela Klimeš Lipánová, Tomáš Büchler

Onkologie. 2026:20(4):202-206 | DOI: 10.36290/xon.2026.037

Axillary management in breast cancer patients has undergone a significant transformation over the past decade, moving towards a de-escalation of surgical and radiotherapeutic therapy while maintaining oncological safety. This review article summarizes current approaches to the diagnosis and treatment of the axilla. It discusses in detail the indications for various treatment modalities, including modern systemic therapy and current trends in the de-escalation of surgical treatment and radiotherapy. Attention is also paid to post-treatment complications, particularly the prevention and treatment of lymphedema and rehabilitation.

Breast cancer with brain metastases: clinical and therapeutic aspects

Michaela Klimeš Lipánová, Eva Strecková, Tomáš Büchler

Onkologie. 2026:20(4):207-212 | DOI: 10.36290/xon.2026.036

Brain metastases from breast cancer represent a serious complication of advanced disease and significantly affect patient morbidity and mortality. The highest risk of their development is associated with HER2-positive and triple-negative subtypes, while the incidence is lower in hormone receptor-positive tumors. The pathogenesis involves a complex metastatic cascade with a key role of the blood-brain barrier. Clinical presentation is variable and depends on the location and extent of involvement, with the most common symptoms including headache, neurological deficits, and cognitive impairment. Diagnosis is primarily based on contrast-enhanced magnetic...

Treatment-induced hot flushes in breast and prostate cancer: a review of pathophysiology and management options

Tomáš Büchler, Eva Strecková, Michaela Klimeš Lipánová

Onkologie. 2026:20(4):213-218 | DOI: 10.36290/xon.2026.038

Hot flashes and night sweats are common and clinically significant adverse effects of adjuvant endocrine therapy for breast cancer and androgen deprivation therapy for prostate cancer. They affect the majority of patients treated with tamoxifen or aromatase inhibitors and up to 80 % of men receiving androgen-deprivation therapy (ADT), substantially impairing sleep, mood, cognitive and sexual function, and overall quality of life. Severe vasomotor symptoms are an important cause of non-adherence or premature discontinuation of endocrine therapy, which may adversely affect oncologic outcomes. Because hormone replacement therapy is generally contraindicated...

Treatment of Small Cell Lung Cancer (SCLC)

Martin Svatoň

Onkologie. 2026:20(4):219-224 | DOI: 10.36290/xon.2026.039

Small cell lung cancer (SCLC) continues to be a disease with a poor prognosis. Therefore, efforts are underway to develop new treatments that would change this characteristic. Immunotherapy in extensive stage (ES) SCLC (both in the form of checkpoint inhibitors and tarlatamab) has only brought a modest benefit for long-term survival. The addition of chemotherapy with lurbinectedin appears to have also modest effect. In limited stage (LS) SCLC, long-term data on the benefit of immunotherapy are not yet known, but medium-term data are promising. With the adding of immunotherapy to treatment schedule, it will also be necessary to reassess the effect of...

BRAF-mutated tumors

Marián Liberko

Onkologie. 2026:20(4):225-229 | DOI: 10.36290/xon.2026.040

BRAF gene mutations represent a key oncogenic alteration across a range of solid tumors and, at the same time, a significant therapeutic target in the era of precision oncology. This article aims to provide an overview of current options for targeted thera­py of BRAF-mutated tumors and key clinical data. Based on the results of melanoma studies demonstrating the high efficacy of combined BRAF and MEK inhibition, and subsequent basket studies confirming activity across various diagnoses, BRAF has established itself as a model example of a tumor-agnostic therapeutic approach. At the same time, differen­ces in treatment efficacy depending on the biological...

Treatment of pain during oncological disease

Lenka Kocmichová

Onkologie. 2026:20(4):230-234 | DOI: 10.36290/xon.2026.041

A serious illness has a significant impact on the lives of both the patient and their family. Medicine does everything in its power to cure the patient, but it is not always successful. Patients therefore often have many fears and doubts. Above all, they do not want to suffer from pain, which is a very distressing symptom. Many effective medications can be used to relieve it. Their selection depends on the specific patient's condition, as well as on the treating physician's experience. Patients have the right not only to proper treatment, but also to pain relief (1).

Possibilities of predicting immune-related adverse events in patients treated with checkpoint inhibitors: the role of autoantibodies

Jiří Nevrlka, Lenka Zdražilová Dubská

Onkologie. 2026:20(4):235-240 | DOI: 10.36290/xon.2026.042

Immunotherapy with immune checkpoint inhibitors represents a significant advancement in cancer treatment. While this therapy restores the anti-tumour immune response, it can also trigger adverse immune reactions against healthy tissues and organs, known as immune-related adverse events (irAEs). Early prediction of irAEs would enable better management and potentially prevent premature discontinuation of anticancer treatment. This review focuses on autoantibodies, both pre-existing and those emerging after the initiation of immunotherapy. Current data suggest that organ-specific autoantibodies show the strongest correlation with corresponding irAEs:...

Durvalumab in the treatment of limited-stage SCLC: experience from clinical practice

Juraj Kultan

Onkologie. 2026:20(4):241-245 | DOI: 10.36290/xon.2026.043

Consolidation therapy with durvalumab following chemoradiotherapy is the new standard of care for patients with limited-stage small-cell lung cancer (LS-SCLC) that is based on the results of the ADRIATIC study. We present a case report of a 75-year-old multimorbid patient with LS-SCLC and significant pulmonary dysfunction, in whom concomitant chemoradiotherapy was associated with severe toxicity, but nevertheless resulted in a marked therapeutic response, which made it possible to continue active anticancer therapy with durvalumab administered as consolidation therapy. To date, no immune-mediated adverse effects have developed during immunotherapy,...

Even a palliative dose of radiotherapy can bring long-term survival in HPV+ locoregionally advanced squamous cell carcinoma of the oropharynx

Antonín Vrána, Tereza Drbohlavová, Miloslav Pála

Onkologie. 2026:20(4):246-249 | DOI: 10.36290/xon.2026.044

The treatment of HPV-positive, human papillomavirus-induced squamous cell carcinoma of the head and neck (HNSCC) is the daily bread of radiation oncologists worldwide. Due to the increasing incidence of infection with this virus, elderly or frail patients who are unable to undergo radical oncological treatment are also being treated. Therefore, radiation oncologists are forced to choose suboptimal treatment strategies where the probability of local control of the tumor and cure rate are significantly reduced. These strategies include for example palliative radiotherapy targeted on tumor foci without irradiation of elective lymph node areas and without...

Kapivasertib in the treatment of metastatic HR+ breast cancer - real-world clinical experience

Věra Benešová

Onkologie. 2026:20(4):250-252

Breast cancer is among the most common oncological diseases in women in the world and in our country. The incidence in the Czech Republic from 2021 is 139.6 cases per 100,000 women. Thanks to an established screening programme, diseases are diagnosed at an early stage and so breast cancer mortality has been decreasing in recent years. However, despite the early detection of the disease and effective adjunctive treatment, metastatic disease develops.

PD-L1 expression status in head and neck carcinomas - a topic review and the results of own study

Vladimír Bartoš, Katarína Janíková, Michal Urda, Anna Farkašová

Onkologie. 2026:20(4):253-257 | DOI: 10.36290/xon.2026.045

In head and neck cancers, PD-L1 protein expression in tumor tissue is a key predictive parameter that helps determine which patients will respond best to treatment with checkpoint inhibitors. PD-L1 status is standardly determined using the combined positive score (CPS). CPS ≥ 1 is a prerequisite for the use of pembrolizumab with chemotherapy in the first-line treatment of unresectable, recurrent and/or metastatic disease. In CPS ≥ 20, first-line treatment with pembrolizumab as a single agent may be considered. Previous studies on head and neck cancers have reported diverse conclusions regarding the prevalence of PD-L1-positive tumors and...

Less visible forms of distress associated with health loss in cancer patients: implications for nursing care

Olga Klepáčková, Milan Tomka

Onkologie. 2026:20(4):258-262 | DOI: 10.36290/xon.2026.046

The experience of health loss in oncology patients represents a complex, dynamic, and multidimensional process that significantly affects psychosocial adaptation and quality of life. In addition to the evident physical burden, patients also face less apparent, often not explicitly expressed forms of psychological, relational, and existential distress that may remain more difficult to recognize in clinical practice. The article focuses on selected aspects of experiencing health loss based on qualitative research conduc­ted using interpretative phenomenological analysis. Particular attention is devoted to the experience of health loss as a cumulative...