Serwis onkologiczny

27 stycznia 2012 roku Amerykańska Agencja ds. Żywności i Leków (FDA – Food & Drug Administration) zatwierdziła aksytynib (Inlyta) stosowany do leczenia chorych na zaawansowanego raka nerkowokomórkowego (RCC) po niepowodzeniu terapii pierwszej linii.

Rozpoczęto rekrutację do dwóch badań z zastosowaniem afatynibu* u chorych z miejscowo zaawansowanym lub nawrotowym/przerzutowym rakiem głowy i szyi. Firma Boehringer Ingelheim poinformowała o rozpoczęciu dwóch badań klinicznych fazy III, LUX-Head&Neck 1 oraz LUX-Head&Neck 2, których celem jest ocena zastosowania afatynibu* u chorych z nawrotowym i przerzutowym rakiem głowy i szyi oraz u chorych z nowotworem miejscowo zaawansowanym.

W San Francisco podczas Gastrointestinal Cancer Symposium zaprezentowano wyniki badania III fazy (CORRECT) oceniającego skuteczność regorafenibu, u chorych na raka jelita grubego z przerzutami, u których doszło do progresji choroby po zastosowaniu wszystkich zarejestrowanych standardowych terapii systemowych.

Podczas Gastrointestinal Cancer Symposium, które odbyło się w San Francisco zaprezentowano długoterminowe wyniki badania III fazy, w którym porównano skuteczność leczenia schematem XELOX (kapecytabina z oksaliplatyną – 8 cykli) ze schematem Mayo (5-fluorouracylem/leukoworyną – 6 cykli) u chorych po operacji z powodu raka jelita grubego w III stopniu zaawansowania.

Wemurafenib jest drugim w kolejności (po ipilimumabie) nowym lekiem zarejestrowanym do leczenia chorych na zaawansowanego czerniaka. Wemurafenib jest selektywnym inhibitorem BRAF, skutecznym jedynie u chorych, których guz prezentuje mutację BRAF. Leczenie wemurafenibem jest dosyć dobrze tolerowane przez chorych, jednak u 15-30% średnio po 10 tygodniach (najwcześniej po 3 tygodniach) terapii rozwija się rak podstawnokomórkowy skóry lub keratoacanthoma.

Poniżej zaprezentowano zalecenia European Society of Medical Oncology dotyczące oceny kardiologicznej u chorych poddanych terapii antracyklinami oraz przeciwciałami monoklonalnymi.

Podczas San Antonio Breast Cancer Symposium zaprezentowano wyniki badania III fazy oceniającego skuteczność terapii pierwszej linii anastrozolem skojarzonym z fulwestrantem, u kobiet po menopauzie chorych na przerzutowego raka piersi wykazującego ekspresję receptorów hormonalnych.

Poniżej przedstawiono uzupełnienie wcześniej zamieszczonej listy leków zatwierdzonych w Europie do leczenia nowotworów złośliwych.

Leczenie chirurgiczne związane jest z 3-5 krotnie wyższym ryzykiem wystąpienia incydentu zakrzepowo-zatorowego u chorych, u których rozpoznany jest nowotwór złośliwy w porównaniu do osób bez obciążenia onkologicznego. Ryzyko wystąpienia zakrzepicy w chirurgii onkologicznej wynosi 20%, w neurochirurgii 28%, chirurgii ogólnej 29%, chirurgii urologicznej 41%, a w ortopedii aż 60%.

Wyniki badania opublikowanego we wrześniu tego roku w New England Journal of Medicine wskazują, że znajdujący się w fazie badań klinicznych lek onkologiczny BIBF 1120 wykazuje również korzystne działanie w idiopatyczny włóknieniu płuc.

Erytropoetyna jest białkiem stymulującym erytropoezę (ESP – erythropoesis stimulating protein) odpowiedzialnym za wzrost i różnicowanie prekursorów erytrocytów, odpowiada również za masę krwinek czerwonych krążących w krwiobiegu. Głównym miejscem wytwarzania erytropoetyny są nerki, które produkują ją w odpowiedzi na niedotlenienie tkanek.

Incydenty zakrzepowo-zatorowe są najczęstszym powikłaniem i drugą najczęstszą przyczyną zgonu u chorych na nowotwory złośliwe. Ryzyko zachorowania na zakrzepicę jest 4-6 krotnie częstsze u chory na nowotwory niż u ludzi zdrowych. Aż u około 15% chorych na nowotwory występują kliniczne objawy zakrzepicy. Poniżej przedstawiono standardy leczenie zakrzepicy w oparciu o zalecenia ESMO (European Society of Medical Oncology) 2011.

15 grudnia 2011 Komitet Europejskiej Agencji Medycznej (CHMP) przyjął pozytywne rekomendacje dla przyznania rejestracji nowego leku: Wemurafenib (Zelboraf) do leczenia nieoperacyjnego lub przerzutowego czerniaka z potwierdzoną mutacją BRAF V600.

NCCN (National Comprehensive Cancer Network) na podstawie wyników badania National Lung Cancer Screening Trial (NLST) zaleca wykonywanie badań przesiewowych w kierunku raka płuca u osób o wysokim ryzyku zachorowania.

Background: Oesophageal squamous cell carcinoma is one of the most common malignancies in China. The association of trace elements and high cancer risk has been found in many studies. The present study was performed to investigate the relationship between the concentration of magnesium, copper and chrome and the incidence and prognosis of oesophageal squamous cell carcinoma. Material and methods: The study was conducted on 36 patients with oesophageal squamous cell carcinoma and all patients underwent oesopha-gectomy. The cancerous tissue samples and the normal tissue samples came from the patients. The concentration of magnesium, copper and chrome was measured by flame atomic absorption spectroscopy and comparison was made using Student’s t-test. Results: The content of magnesium in cancerous tissues was significantly lower than that in the normal tissues. In contrast, copper level in cancerous tissues was significantly higher than that in the normal tissues. Copper level in patients with lymph node metastasis was significantly higher than in patients without lymph node metastasis. There was a significant increase in mean copper in cancerous tissues with a worse histological grade. Our study showed that a lower magnesium level and a higher copper level may play an important role in oesophageal squamous cell carcinoma induction. And the chrome level may not be associated with the induction of oesophageal squamous cell carcinoma.

Aim of the study : The objective of the study was to determine the body composition (BC) changes in women with breast cancer after endocrine therapy, and the influence of aerobic training on the parameters under discussion. Material and methods : 41 women aged 32-48 (mean ± SD 44.1 ±4.4) with breast cancer during endocrine therapy (ET). This was a nonrandomized, prospective trial. The following examinations were conducted in patients according to the schedule: I before the beginning of ET; II after 6 months of the ET; III after 12 months of ET and after 6-month aerobic training. Body composition was evaluated using dual X-ray absorptiometry (DEXA) with respect to free fatty mass, lean, fat and the percentage location of android and gynoid fat. The body build was evaluated with respect to body height, body weight and selected anthropometric parameters BMI and WHR. Results : During the first six months of ET without regular physical activity the following was reported: a significant increase of body weight, BMI, the amount of fatty tissue, including android fat distribution (p < 0.05); the lack of any significant change in the amount of gynoid fatty tissue (p > 0.05). At that time muscle (p < 0.05) and free fatty mass (p > 0.05) reductions were reported. After the six-month aerobic workout no significant body weight or BMI increase was observed. However, there was a significant reduction in WHR (p < 0.05), which correlated with the decrease of android fatty tissue (p < 0.05). The other elements evaluated in the DEXA underwent statistically insignificant changes. Conclusions : The outcome analysis allows us to conclude that during breast cancer ET the patients are reported to have negative changes in BC and phy­sique. Therefore, this patient group is advised to receive regular rehabilitation with the aim of reducing the side effects of the treatment. However, aerobic train­ing seems to be insufficient in order to fully reduce the side effects of this form of cancer therapy.

Background : HER2 consists of an extracellular domain (the target for trastuzumab), a transmembrane domain, and an intracellular domain, which is recognized by an antibody used in the immunohistochemical assessment of HER2 overexpression. The study consisted of 31 patients with metastatic breast cancer treated with trastuzumab. The aim of the study was to evaluate retrospectively expression of extracellular and intracellular HER2 domains in primary breast cancers treated with surgery and to assess their correlation with biological features of tumours, disease-free survival, overall survival, as well as progression-free survival and survival since the start of trastuzumab treatment. Material and methods : All these patients relapsed and were treated with tras­tuzumab because of metastatic disease – none of them received trastuzumab in an adjuvant setting. Two kinds of antibodies were used in immunohistochemical evaluation: against extracellular and intracellular domains of the HER2. Results : A significant correlation between different patterns of HER2 domain overexpression and disease-free survival was found. Disease-free survival (the time from the primary operation to relapse – prior to the start of any palliative treatment) was the shortest in patients with overexpression of both domains compared to patients without overexpression of both domains and the group with intracellular domain overexpression combined with absence of extracellular domain overexpression (median 13.2 vs. 24.3 vs. 52.4 months, p = 0.01). There was no significant difference between these 3 groups of patients in aspects of biological features of tumours, overall survival, progression-free survival and survival since the start of trastuzumab treatment. Conclusion: Concurrent assessment of extracellular and intracellular domains of HER2 may have prognostic value for HER2-positive patients.

Aim of the study : The purpose of this study is to investigate the complementary/alternative medicine (CAM) usage and the factors affecting this among cancer patients in the western region of Turkey. 220 adult cancer patients participated in the study and 93 patients (42.3%) were found to use at least one CAM method. Material and methods : Our study was done by face-to-face communication in a university hospital, in Turkey. Oncology patients’ primary diseases, sociodemographic characteristics, complementary alternative medicine usage, psychological conditions and quality of life were evaluated with proper psychological scales. Patients using and not using CAM were compared with respect to Beck Depression, State Trait Anxiety and Beck Hopelessness scores. No statistically significant difference was detected between/among the groups in BDI (12.0 ±8.4, 11.9 ±8.7, p = 0.96), BHS (5.5 ±4.9, 4.8 ±4.4, p = 0.27) or STAI (43.7 ±8.0, 44.3 ±8.2, p = 0.64) scores. Patients using and not using CAM were compared with respect to WHOQOL-BREF quality of life scores. There was no statistically significant difference between/among the groups in WHOQOL-BREF sub-group scores (physical, psychological, social relations, environment, standardized by culture (environment), general health). Results : Nearly half of the patients (42.3%) in this region were found to be using at least one of the CAM methods. The patients mostly preferred herbal methods, with the leading product being stinging nettle (Urtica dioica). The severity of disease (recurrence and dissemination) and patients’ knowledge of the diagnoses were the most important factors affecting the CAM usage. Conclusions : The usage of CAM by oncology patients and the effects of CAM on the present medication prescribed by oncology practitioners must be remembered when they are admitted to polyclinics. Also it must be known that patients with advanced stage and patients with recurrence are more likely to use complementary alternative medications than early stage patients. Therefore oncology patients must be informed about CAM besides their clinical situations. At least physicians should give answers about the CAM to their patients.

Aim of the study : To analyse practical aspects of implementing the Personal Data Security Management System (PDSMS) in an oncology centre based on applicable legal requirements and professional standards. Material and methods : The research method is based on the analysis of legal documents, quality standards, analysis of progress in the achievement of objectives of the PDSMS based on interviews with heads of units and on review of data protection documentation. Results : The implementation of the PDSMS has caused the processed data to be adequately protected, minimised the risk of such data being used in a manner incompatible with their purpose, while ensuring the hospital’s compliance with applicable legal regulations. Conclusions : The implementation of the PDSMS has required technical and organisational measures to be taken in the centre’s organisational units, in particular appointing data protection officers, engaging staff in the data protection process by awarding them with authorisations to process data and familiarising them with securities that have been put in place.