Východiska: Navzdory rozvoji protinádorové léčby karcinomu v posledních dekádách je kvalita života (quality of life – QoL) těchto pacientů špatná. Cílem této práce bylo zmapovat QoL nemocných s nádory plic v průběhu 1. linie moderní protinádorové terapie v ČR. Materiál a metody: Jedná se o prospektivní multicentrickou práci realizovanou na třech pneumoonkologických pracovištích ve Fakultních nemocnicích Brno, Olomouc a Plzeň. V období od dubna do srpna 2023 byli dotazováni nemocní s nádory plic začínající 1. linii protinádorové terapie o vyplnění dotazníku QoL EQRTC QoL-C30 v době 0, 6 a 12 týdnů. Výsledky: Soubor sestává z 50 pacientů, 60 % mužů, průměrný věk 66,9 roku, 76 % kuřáků, 22 % stadia III, 78 % stadia IV, 84 % nemalobuněčný karcinom plic, 16 % malobuněčný karcinom plic. Celkem 50 % nemocných bylo léčeno chemo/imunoterapií, 20 % imunoterapií, 24 % chemoterapií +/− radioterapií, 6 % tyrozinkinázovými inhibitory. Bylo patrno zlepšení QoL ve smyslu dušnosti, slabosti, deprese a strachu v průběhu léčby. V podskupině léčené chemo/imunoterapií bylo zaznamenáno také zlepšení celkové QoL. Pacienti dosahující kompletní či parciální odpovědi prokazovali zlepšení některých aspektů QoL. Z laboratorních parametrů byla s QoL spjata hladina albuminu. Závěr: QoL pacientů s nádory plic léčených 1. linií protinádorové terapie v české reálné praxi je uspokojivá.
Introduction: Despite of a progress in anticancer treatment in the last decades, quality of life (QoL) of these patients is still very poor. The aim of this study was to monitor QoL during the first line of modern era treatment in lung cancer patients in Czechia. Material and methods: It is a prospective multicenter study realized at three pneumo-oncology departments of University Hospitals in Brno, Olomouc and Pilsen. In the period of time from April to August 2023 we asked patients with non-small cell lung cancer starting the first line of anticancer treatment to fill the questionnaire of QoL “EQRTC QoL-C30” in the time 0 and 6 and 12 weeks. Results: We studied data from 50 patients, 60% men, the average age 66,9 years, 76% smokers, 22% in stage III, 78% in stage IV, 84% non-small cell lung cancer, 16% small cell lung cancer. A total of 50% patients were treated with chemoimmunotherapy, 20% by immunotherapy, 24% by chemotherapy +/− irradiation, and 6% by tyrosine kinase inhibitors. There was a significant improvement of QoL in the mean of dyspnoe, weakness, depression and fear during the treatment. In the subgroup analysis, patients treated with chemo/immunotherapy reached an improvement in total QoL. Subjects with complete/partial response to treatment reached improvement in some aspects of QoL. Out of laboratory parameters, albumin levels were associated with QoL. Conclusion: QoL of patients with lung cancer treated with first-line anticancer treatment in the Czech real-life practice is acceptable.
- MeSH
- Drug Therapy methods MeSH
- Quality of Life * MeSH
- Middle Aged MeSH
- Humans MeSH
- Disease Management MeSH
- Lung Neoplasms * diagnosis drug therapy psychology MeSH
- Prospective Studies MeSH
- Surveys and Questionnaires MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Multicenter Study MeSH
- Geographicals
- Czech Republic MeSH
PURPOSE: The aim of our study was to evaluate if therapeutic success in the first-line of anticancer treatments in patients with NSCLC may predict treatment success in the following lines. METHODS: We analyzed the data of patients with NSCLC stage III/IV from the TULUNG registry separately for chemotherapy, TKIs, ALK inhibitors, and immunotherapy in the first line during the years 2011-2019. "Succesful treatment " was defined as PFS ≥ 6 months, a "good responder " was a patient with ˃50% of "successful treatment " lines. Treatment responses were analyzed separately for each drug group. Descriptive statistics, Fisher exact test, Pearson Chi-Squared test, log-rank test, and univariate/multivariate logistic regression models were used. RESULTS: The first-line TKI therapy was successful in 66.2%, while good responders accounted for 50.7% of the cohort and their rates were similar for all types of TKIs. First-line platinum-based chemotherapy was successful in 43.1% and 48.6% for combinations with pemetrexed and bevacizumab, respectively. Good responders accounted for 29.5% and 25.9%, respectively. In the group of ALK inhibitors, we observed treatment success in 52.3% of cases, while alectinib showed the highest effectiveness (up to 70%). Good responders constituted 50% of the group. In the first-line immunotherapy group, survival benefit was observed in 52.3%, and good responders constituted 52.3% of the cohort. CONCLUSION: We concluded that the treatment success in first-line therapies in patients with NSCLC may predict survival benefits in the subsequent lines, particularly in EGFR- or ALK-positive disease and immunotherapy-treated patients.
AIMS: The authors focused on a group of young lung cancer patients with the aim of better understanding the mechanisms of tumor pathogenesis in these patients and search for potential targetable mutations. METHODS: We collected retrospective data on patients under 40 years diagnosed with lung cancer (NSCLC or small-cell lung cancer) from 2011-2020 at the Department of Respiratory Diseases, University Hospital Brno, Czech Republic. Tumor tissue of these patients was analysed by next-generation sequencing (NGS, a panel of 550 variants in 19 genes). Demographic characteristics, smoking history, histology, molecular-genetic results and clinical stage of the disesase were recorded in all eligible patients from accessible medical databases. RESULTS: Of 17 identified patients in only 8 cases was successful NGS carried out due to lack of sufficient good quality material in the other cases. The most frequently found molecular genetic changes were EGFR, RICTOR and HER2 amplification and MET and FGFR1 amplification. In addition, we found rare pathogenic variants in BRAF and PIK3CA genes. Actionable variants were detected in 75% patients. CONCLUSION: We detected very frequent driver and potentially actionable alterations in young patients with lung cancer. This suggests different mechanisms of carcinogenesis in these patients and indicates that they might benefit more from a specific approach than older lung cancer patients.
- MeSH
- Humans MeSH
- Small Cell Lung Carcinoma * MeSH
- Mutation MeSH
- Lung Neoplasms * genetics pathology MeSH
- Carcinoma, Non-Small-Cell Lung * genetics MeSH
- Retrospective Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Imunoterapie hraje v léčbě karcinomu plic nezastupitelnou roli. Její zařazení do léčebných algoritmů přispívá ke zlepšení přežívání pacientů s nemalobuněčným (NSCLC) i malobuněčným karcinomem plic (SCLC). Autorka rozebírá základní principy imunitního dohledu nad kancerogenezí, popisuje kontrolní body imunity a jejich ovlivnění check point inhibitory dostupnými v ČR. Jsou rozebírány jednotlivé indikace imunoterapie pro karcinom plic včetně praktických připomínek a schématu léčby 1. linie NSCLC.
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.
- MeSH
- Immunotherapy methods MeSH
- Humans MeSH
- Small Cell Lung Carcinoma drug therapy MeSH
- Lung Neoplasms * drug therapy MeSH
- Carcinoma, Non-Small-Cell Lung drug therapy MeSH
- Antineoplastic Agents pharmacology therapeutic use MeSH
- Antineoplastic Combined Chemotherapy Protocols MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Purpose: Aim was to analyze demographic and tumor characteristics, treatment, and survival of patients with lung cancer younger than 40 years of age (U40) compared to older subgroups (41-70 and >70 years). Methods: We analyzed data of young patients diagnosed and treated in 2011-2019 in five pneumo-oncology centers in Czechia. Standard descriptive statistics, chi-squared test, Fisher exact test, and Kaplan-Meier survival analysis were used. p-Values <0.05 were considered significant. These data were compared with two control subgroups (cohort 1: 41-70 years, cohort 2: >70 years). Results: We identified 66 patients U40, 61 with non-small cell lung cancer (NSCLC)-50.8% men, mean age 34.6 years, 54.1% nonsmokers, daily good performance status, and 82% in stage IV. Adenocarcinomas dominated, endothelial growth factor receptor (EGFR) positivity was less common than in older groups contrary to anaplastic lymphoma kinase (ALK) mutations. Median progression-free survival was 3.7 months (vs. 4.9 and 6.2 months; p = 0.006) and overall survival reached 11.7 months (vs. 22.3 and 27.3 months; p < 0.001). Young patients in stage IV and never-smokers had shorter survival than older patients. Conclusion: Patients with NSCLC U40 had significantly worse prognosis than older patients.
- MeSH
- Anaplastic Lymphoma Kinase MeSH
- Adult MeSH
- ErbB Receptors genetics MeSH
- Middle Aged MeSH
- Humans MeSH
- Mutation MeSH
- Lung Neoplasms * MeSH
- Carcinoma, Non-Small-Cell Lung * genetics pathology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Východiska: Pandemie onemocnění COVID-19 významně ovlivnila diagnostiku i léčbu pacientů s nádory plic a pleury. Mezi ostatními nádorovými diagnózami patří tato skupina k nejrizikovějším z hlediska morbidity i mortality. Soubor pacientů a metody: Byly analyzovány záznamy pacientů s nádory plic a pohrudnice s prokázanou COVID-19 pozitivitou na Klinice nemocí plicních a tuberkulózy LF MU a FN Brno v období říjen 2020 až květen 2021. Byly sledovány demografické údaje, informace o průběhu infekce virem SARS-CoV-2 a onkologické nemoci a mortalita. Údaje ze souboru jsou doplněny třemi kazuistikami. Výsledky: Bylo nalezeno 53 nemocných (z nich 79 % mužů) průměrného věku 69,4 let, histologicky dominovala diagnóza adenokarcinomu. Lehký průběh infekce virem SARS-CoV-2 mělo 47,1 % nemocných, 56,6 % bylo hospitalizováno, 24,5 % zemřelo. U 62,4 % aktivně léčených nemocných došlo kvůli infekci virem SARS-CoV-2 k odkladu v podání léčby, a to v průměru o 14,5 dne. Závěr: Pacienti s nádory plic a pleury mají vysoké riziko těžkého průběhu a smrti na infekci SARS-CoV-2. Mimo to probíhající infekce virem SARS-CoV-2, ale i postcovidové změny, mohou komplikovat samotnou onkologickou léčbu.
Background: The pandemic of COVID-19 has significantly influenced the diagnostics and treatment of patients with lung and pleural malignancies. This group of patients is the riskiest, compared to patients with other cancers, both in morbidity and mortality. Study population and methods: The data of patients with lung/pleural malignancies and proved COVID-19 positivity were analyzed at the Department of Respiratory Diseases and Tuberculosis, University Hospital Brno, during the period from October 2020 to May 2021. Demographic data, information about the course of SARS-CoV-2 infection and oncological disease as well as mortality were monitored. Together with the data from the study population, three case reports are also presented. Results: Fifty-three patients were found (79% males), mean age 69.4 years, mainly with adenocarcinoma histology. A total of 47.1% patients experienced mild course of SARS-CoV-2 infection, 56.6% needed hospitalization, 24.5% died. Active anticancer treatment was delayed in 62.4% cases due to SARS-CoV-2 infection; the mean time of the delay reached 14.5 days. Conclusion: Patients with lung and pleural malignancies have a high risk of severe course of SARS-CoV-2 infection and mortality. Moreover, the ongoing SARS-CoV-2 infection as well as postcovid changes can complicate the anticancer treatment itself.
- MeSH
- COVID-19 * MeSH
- Humans MeSH
- Pleural Neoplasms * MeSH
- Lung Neoplasms * MeSH
- Retrospective Studies MeSH
- Check Tag
- Humans MeSH
Karcinom plic je na smutné první příčce, co se týče mortality na nádorová onemocnění. Ačkoliv u valné většiny nemocných představuje hlavní rizikový faktor kouření, u části pacientů spočívá odstartování kancerogeneze v molekulárně-genetických změnách. Autorka předkládá kazuistiku nemocného, u něhož došlo k recidivě nemalobuněčného karcinomu plic s pozitivní mutací EGFR a který velmi dobře profitoval z podávání osimertinibu ve vyšší linii léčby. Významnou roli hrál také multimodální přístup při vedení onkologické léčby tohoto nemocného.
Lung cancer is a leading cause of death among other oncological diseases. Although the main risk factor is still smoking, in some patients molecular-genetic changes are drivers of the carcinogenicity. Author describes a case report of a patient with a relapse of EGFR-positive non-small cell lung cancer who experienced a clear benefit from osimertinib in further line of treatment. Multimodality of the oncological treatment also played an important role in the therapy of this patient.
- Keywords
- osimertinib,
- MeSH
- Acrylamides administration & dosage therapeutic use MeSH
- Aniline Compounds administration & dosage therapeutic use MeSH
- Diagnostic Imaging MeSH
- Middle Aged MeSH
- Carcinoma, Non-Small-Cell Lung * therapy MeSH
- Tomography, X-Ray Computed MeSH
- Antineoplastic Agents MeSH
- Check Tag
- Middle Aged MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
AIM: To compare survival outcomes in patients with non-small cell lung cancer (NSCLC) treated with modern-era drugs (antifolates, antiangiogenics, tyrosine kinase and anaplastic lymphoma kinase inhibitors, immunotherapy) with treatment initiation in 2011-12 and 2015-16, respectively. PATIENTS AND METHODS: Prospective data from Czech TULUNG Registry (960 patients from 2011-12 and 512 patients from 2015-16) were analyzed. Kaplan-Meier analysis was used to estimate overall survival (OS) and progression-free survival (PFS); Cox proportional hazards model to assess factors associated with 2-year survival. RESULTS: Survival at 2 years was more frequent in cohort 2015-16 compared to cohort 2011-12 (43.2% vs. 24% for adenocarcinoma; p<0.001 and 28.7% vs. 11.8% for squamous-cell lung carcinoma; p=0.002). Assignment to cohort 2015-16 and treatment multilinearity (two or more lines in sequence) were associated with higher probability of 2-year survival (hazard ratio=0.666 and hazard ratio=0.597; p<0.001). Comparison of 2-year survivors from both cohorts showed no differences. CONCLUSION: Survival at 2 years probability in stage IIIB-IV NSCLC doubled between 2011-12 and 2015-16; advanced-stage NSCLC may be considered a chronic disease in a large proportion of patients.
- MeSH
- Adenocarcinoma of Lung epidemiology mortality pathology therapy MeSH
- Chronic Disease MeSH
- Adult MeSH
- Cohort Studies MeSH
- Combined Modality Therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Lung Neoplasms epidemiology mortality pathology therapy MeSH
- Follow-Up Studies MeSH
- Carcinoma, Non-Small-Cell Lung epidemiology mortality pathology therapy MeSH
- Prognosis MeSH
- Registries statistics & numerical data MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Carcinoma, Squamous Cell epidemiology mortality pathology therapy MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
Vývoj v léčbě pokročilého nemalobuněčného karcinomu plic v posledních deseti letech významně prodloužil přežívání nemocných s touto diagnózou. Ačkoliv molekulárně genetické markery jsou jasným vodítkem v prognóze nemoci, pro pacienty bez těchto driverů neexistuje způsob, jak efekt protinádorové léčby předpovědět. Zvláště pak co se týče standardní chemoterapie. Autoři předkládají kazuistiku pacienta s adenokarcinomem plic, s výjimečně dlouhou léčebnou odpovědí na více druhů onkologické léčby, a zamýšlejí se nad existencí typu tzv. obecného „good respondera“.
Advances in the treatment of advanced-stage non-small cell lung cancer in the last decade have significantly prolonged the survival of patients with this diagnosis. Although molecular genetic factors are good markers of prognosis, it is complicated to predict the effect of anti-cancer treatment in patients without these drivers. Especially when it comes to standard chemotherapy. The authors present a case report of a patient with lung adenocarcinoma with an exceptionally long treatment response to several types of oncological treatment and consider the existence of a type of the so-called general good responder.
- Keywords
- prediktory,
- MeSH
- Adenocarcinoma of Lung * diagnostic imaging drug therapy secondary MeSH
- Immunotherapy methods MeSH
- Humans MeSH
- Neoplasm Metastasis MeSH
- Nivolumab administration & dosage economics MeSH
- Pemetrexed therapeutic use MeSH
- Disease Progression MeSH
- Aged MeSH
- Treatment Outcome * MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
