In patients with metastatic renal cell cancer, based on limited evidence, increased sunitinib exposure is associated with better outcome. The survival and toxicity data of patients receiving ...individualized dose escalated sunitinib therapy as compared to standard management were analyzed in this study.
From July 2013, the data of metastatic renal cell cancer patients with slight progression but still a stable disease according to RECIST 1.1 criteria treated with an escalated dose of sunitinib (first level: 62.5 mg/day in 4/2 or 2 × 2/1 scheme, second level: 75 mg/day in 4/2 or 2 × 2/1 scheme) were collected prospectively. Regarding characteristics, outcome, and toxicity data, an explorative retrospective analysis of the register was carried out, comparing treatments after and before July 1, 2013 in the study (selected patients for escalated dose) and control (standard dose) groups, respectively.
The study involved 103 patients receiving sunitinib therapy with a median overall and progression free survival of 25.36 ± 2.62 and 14.2 ± 3.22 months, respectively. Slight progression was detected in 48.5% of them. First and second-level dose escalation were indicated in 18.2% and 4.1% of patients, respectively. The dosing scheme was modified in 22.2%. The median progression free survival (39.7 ± 5.1 vs 14.2 ± 1.3 months (p = 0.037)) and the overall survival (57.5 ± 10.7 vs 27.9 ± 2.5 months (p = 0.044)) were significantly better in the study group (with dose escalation) than in the control group. Patients with nephrectomy and lower Memorial Sloan Kettering Cancer Center (MSKCC) scores showed more favorable outcomes. After dose escalation, the most common adverse events were worsening or development of fatigue, hypertension, stomatitis, and weight loss of over 10%.
Escalation of sunitinib dosing in selected patients with metastatic renal cell cancer, especially in case of slight progression, based on tolerable toxicity is safe and improves outcome. Dose escalation in 12.5 mg steps may be recommended for properly educated patients.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In advanced cancer stage the incidence of cancerous wounds is about 5%, and the estimated life expectancy is not more than 6 to 12 months. Without interdisciplinary and individualized treatment ...strategy, symptoms progress, and adversely influence quality of life.
Authors collected different treatment algorithms for cancerous wound published by wide scale of medical expertise, and summarized surgical, oncological, radiation oncological, nursing and palliative care aspects based on radiological information.
Interdisciplinary approach with continuous consultation between various specialists can solve or ease the hopeless cases.
This distressing condition needs a comprehensive treatment solution to alleviate severe symptoms. Non-healing fungating wounds without effective therapy are severe socio-economic burden for all participants, including patients, caregivers, and health services. In this paper authors collected recommendations for further guideline that is essential in the near future.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Neuroendocrine neoplasms include a heterogeneous group of malignant tumors. Primary neuroendocrine tumors in the genitourinary tract are rare, comprising approximately 1-2% of genitourinary ...malignancies.
An extensive search was performed for publications between 2000 and 2018 regarding neuroendocrine tumors of the genitourinary tract. Epidemiological, clinical, histopathological, prognostic and therapeutic data were evaluated.
Neuroendocrine tumors of the kidneys are exceedingly rare, mostly well-differentiated. 0.5-1% of all primary bladder malignancies are small cell neuroendocrine carcinomas. Characteristically, prostatic adenocarcinoma with neuroendocrine differentiation occurs in androgen receptor-independent/castrate-resistant cancer. Small cell and large cell neuroendocrine carcinomas are the most aggressive tumors in each location.
Due to the rarity and poor prognosis of these tumors, proper pathological diagnosis and early therapy are important. Therapeutic guidelines are not available. Surgery, radiotherapy and/or chemotherapy are possible treatment options; somatostatin analogs are used as standard therapy in case of well-differentiated neuroendocrine tumors.
Background: Total body irradiation (TBI) 2 × 2 Gy for 3 consecutive days followed by chemotherapy for conditioning pediatric patients with acute lymphoid leukemia (ALL) before bone marrow ...transplantation is superior to chemo-conditioning alone. The globally used anterior-posterior/posterior-anterior (AP/PA) technique is the most referable method, but volumetric modulated arc therapy (VMAT) with modern linear accelerators is more precise in terms of ensuring better dose distribution, especially for skin, and higher protection of organs at risk, resulting in less side effects. Method: For TBI, a modern VMAT technique was used. Whole-body immobilization in the supine position was performed using a vacuum mattress with a full body coverage, with a water-equivalent bolus of 1 cm thickness. The design goal was to achieve dose inhomogeneity of less than ±10%. Results: From 2020 to 2022, we performed TBI for five pediatric patients with ALL, with full body bolus and VMAT, who later received hematopoietic stem cell transplantation. No acute complications related to TBI were observed during the treatment period with a median follow-up of 1.27 (0.43–2.11) years. Conclusion: Using full body water-equivalent bolus with VMAT for TBI provides a safe method for children with a better organ sparing in the short term follow-up.
Programmed cell death (PD)-1/PD-ligand 1 (PD-L1) inhibitors have made a breakthrough in the therapy of advanced urothelial bladder cancer (UBC). The impact of Fibroblast Growth Factor Receptor 3 ...(FGFR3) mutation on the effectiveness of PD-L1 treatment remains still unclear. Objective: Our study aimed to investigate the frequency of FGFR mutations at different tumor stages, and their relation to PD-L1 status and survival.
310 patients with urothelial bladder cancer and subsequent radical cystectomy were included in a retrospective study over a 10-year study period at the University of Szeged, Hungary. FGFR3 mutations from the most infiltrative areas of the tumor were analyzed by targeted next-generation sequencing and PD-L1 (28-8 DAKO) tests (tumor positive score -TPS and combined positives score-CPS). In T0 cases FGFR3 mutations were analyzed from the earlier resection samples. Survival and oncological treatment data were collected from the National Health Insurance Fund (NHIF). Neoadjuvant, adjuvant and palliative conventional chemotherapies were allowed; immunotherapies were not. The relationship between the covariates was tested using chi-square tests, and survival analysis was performed using the Kaplan-Meier model and Cox proportional hazards regression.
PD-L1 and FGFR could be tested successfully in 215 of the 310 UBC samples pT0
19 (8.8%); St.0-I 43 (20%); St.II 41 (19%); St.III-IV 112 (52%). Significant pairwise dependency was found between tumor stage, FGFR3 mutation status and PD-L1 expression (
< 0.01). Samples with FGFR mutation were more common in less advanced stages and were also less likely to demonstrate PD-L1 expression. The effect of all investigated factors on survival was found to correlate with tumor stage.
FGFR alteration frequency varied between the different stages of cancer. Higher positivity rates were observed at early stages, but lower levels of PD-L1 expression were detected in patients with FGFR mutations across at all stages of the disease.
Everolimus is indicated for adults with metastatic renal cell carcinoma (mRCC) after failure of vascular endothelial growth factor receptor-tyrosine kinase inhibitors (TKI). Currently, the ...therapeutic applicability of EVE has been changing. Multicenter evaluation of efficacy and safety of everolimus in daily routine and definition of patient characteristics with favorable outcome. Data of 165 patients from 9 oncology institutes in Hungary were analyzed retrospectively. Everolimus therapy was used after one TKI in 10 mg starting dose. Physical and laboratory examinations and imaging tests were performed monthly and every 3 months, respectively. Median progression-free survival (PFS) was 5.4 months. Median overall survival (OS) was 16.2 months. PFS and OS results were more favorable in patients with ECOG 0–1 (
p
PFS
= 0.033,
p
OS
= 0.008) and after >9 months of TKI therapy (
p
PFS
= 0.019,
p
OS
= 0.045). Survival was longer in nonanemic patients with ECOG 0–1 than in anemic patients with ECOG 2–3, 30.9 and 7.7 months, respectively (
p
= 0.029). Dose reduction and treatment delay was required in 6.2% and 8.9% of patients, respectively. Common adverse events were exanthema, edema, stomatitis, anemia, and abnormal kidney functions and glucose levels. Results of this study show that everolimus is safe and efficacious in a real-world setting. Everyday practice showed that nonanemic patients with good performance status receiving TKI therapy for >9 months are favorable candidates for this treatment. Despite the efficiency of novel, registered drugs, everolimus still plays an important role during and after second-line therapy for mRCC when availability of modern remedies is limited.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Mortality of prostate carcinoma can be significantly decreased by the use of modern diagnostic and therapeutic options. Patients in early stages can be cured by radical surgery or radiotherapy.
...Overview and comparison of previous and present diagnostic and therapeutic methods regarding accuracy of diagnosis, improvement of efficiency and decrease of toxicities. We also aimed to explore general correlations in case of serious complications.
By the help of two prostate cancer patients we demonstrate the importance of accuracy and change of histological diagnosis, significance of proper imaging techniques, and also show parameters of conventional and modern radiotherapy and their acute and chronic complications. Differences of previous and present methods and their consequences were analyzed.
By now, histological findings in the patients' diagnosis have changed. Both patients received conventional three-dimensional definitive radiotherapy in 2009-2011, and their prostate cancer was cured. In one case, urinary bladder also received radiotherapy because prostate carcinoma had infiltrated it. In the other case, the contemporary radiotherapy involved urinary bladder's fundus due to safety margins. Although acute grade 2 cystitis developed in both cases and recovered in several weeks, as late complication bladder shrinkage developed, which after the ineffectiveness of conventional therapies had to be cured by radical cystoprostatectomy - in order to cease bleeding and to cure incontinence.
In case of prostate carcinomas, serious complications can be avoided by the improvement of diagnostic and therapeutic options. Synthesis of data could be more successful if they were analyzed in the light of previous experiences. Orv Hetil. 2018; 159(32): 1317-1325.
Despite the considerable disease burden of ovarian cancer, there were no cost studies in Central and Eastern Europe. This study aimed to describe treatment patterns, health care utilization, and ...costs associated with treating ovarian cancer in Hungary, Poland, Serbia, and Slovakia.
Overall clinical practice for management of epithelial ovarian cancer was investigated through a 3-round Delphi panel. Experts completed a survey based on the chart review (n = 1542). The survey was developed based on clinical guidelines and the International Federation of Gynecology and Obstetrics Annual Report. Means, ranges, and outlier values were discussed with the experts during a telephone interview. Finally, consensus estimates were obtained in face-to-face workshops. Based on these results, overall cost of ovarian cancer was estimated using a Markov model.
The patients included in the chart review were followed up from presurgical diagnosis and in each phase of treatment, that is, surgical staging and primary surgery, chemotherapy and chemotherapy monitoring, follow-up, and palliative care. The 5-year overall cost per patient was €14,100 to €16,300 in Hungary, €14,600 to €15,800 in Poland, €7600 to €8100 in Serbia, and €12,400 to €14,500 in Slovakia. The main components were chemotherapy-associated costs (68%-74% of the total cost), followed by cost of primary treatment with surgery (15%-21%) and palliative care (3%-10%).
Patients with ovarian cancer consume considerable health care resources and incur substantial costs in Central and Eastern Europe. These findings may prove useful for clinicians and decision makers in understanding the economic implications of managing ovarian cancer in Central and Eastern Europe and the need for innovative therapies.
Treatment for advanced urothelial bladder- and renal cell cancers have significantly developed in recent years, in addition to modern targeted therapies immunotherapies have opened a new area. ...Optimal indications of the therapies are primarily based on the results of prospective clinical trials and the approved indications, but it is also useful to analyze the real-life results to predict the possible ineffectiveness of individual treatments or to reach the maximal efficiency of the therapeutic lines. The primary aim of the dissertation was to analyze novel aspects of the clinical and pathological prognostic and predictive markers of urinary bladder and kidney cancers to potentially improve the effectiveness of treatments and maximize the therapeutic effect. 2.1. To demonstrate the frequency of FGFR mutation in different tumor stages of cystectomy samples, and to reveal a possible relationship between the FGFR status, PD-L1 status, CPS score, tumour-stages and the survival of patients. 2.2. To analyze the maximum efficacy and side effects of increased dose first line sunitinib in metastatic RCC in daily practice, and to evaluate the correlation of prognostic factors 2.3.To investigate retrospectively the efficacy and tolerability of everolimus therapy in patients with metastatic renal carcinoma who previously received and progressed on one line of VEGFR-TKI therapy based on the experiences of nine Hungarian institutes and to search for prognostic clinical factors during treatment to predict outcome.
Abstract only
e16030
Background: Programmed cell death (PD)-1 / PD-ligand 1 (PD-L1) inhibitors have made a breakthrough mainly in the treatment of PD-L1 positive advanced urothelial bladder cancer ...(UBC). The effect of Fibroblast Growth Factor Receptor 3 (FGFR3) mutation on the treatment outcomes of PD-L1 treatment still remains unclear. Our goal was to assess the frequency of FGFR mutations in different tumor stages, in relation with PD-L1 status. Methods: Enrolled patients were diagnosed with UBC and underwent radical cystectomy between 2006-2016 at the University of Szeged, Hungary. FGFR3 mutation analysis by targeted next-generation sequencing and PD-L1 (28-8 DAKO
R
and SP142 Ventana
R
) tests were carried out from the most infiltrative area of tumors, in T0 cases from the earlier resection samples. The treatment and survival data were collected from the National Health Insurance Fund (NHIF), Hungary. Independence between covariates was tested using chi-square tests, survival analysis was performed using Kaplan-Meier models and Cox proportional hazards regression. Results: 215 of all 310 UBC samples (T0:19 (8.8%); superficial 43(20%); muscle invasive 41(19%); extraorgan 112 (52%)) could be tested for both PD-L1 and FGFR successfully. Pairwise dependency between tumor stage, FGFR3 mutation status and PD-L1 expression were all found to be significant (p < 0.01). In cases of less advanced diseases FGFR mutation was more often detected. We have found that FGFR mutated samples are less likely to be PD-L1 positive than wild type ones. The effect of all covariates on survival was found to be in accordance with the effect of tumor stage. Conclusions: FGFR alteration frequency varied with stage of disease, with higher positivity rates in early stages, but that lower PD-L1 expression was observed in FGFR mutant patients across disease stages.
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