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
- farmakoterapie metody MeSH
- kvalita života * MeSH
- lidé středního věku MeSH
- lidé MeSH
- management nemoci MeSH
- nádory plic * diagnóza farmakoterapie psychologie MeSH
- prospektivní studie MeSH
- průzkumy a dotazníky MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND/AIM: The aim of this study was to investigate possible association between adverse events of nivolumab therapy and the effectiveness of treatment in patients with non-small cell lung cancer (NSCLC). Focusing on serious adverse events (i.e., those of grade ≥3), we evaluated overall survival (OS), progression-free survival (PFS), as well as objective response rate (ORR) to treatment. PATIENTS AND METHODS: We retrospectively analyzed a set of patients from the TULUNG database of NSCLC treated with nivolumab in eight oncology centers. We evaluated OS data based upon this set. To reduce possible bias, we further evaluated a subgroup of patients treated at the University Hospital in Pilsen, where the occurrence of adverse events, PFS, and ORR were independently examined by two experienced physicians. Survival statistics were evaluated using the Kaplan-Meier method and Cox analysis. RESULTS: We observed significantly greater OS, PFS, and ORR in the group of patients experiencing adverse events upon nivolumab treatment versus in those patients without such events. Although the univariable model analyzing the data set of all patients demonstrated higher OS in patients with serious adverse events, only a nonsignificant trend was observed in the Cox multivariable model. In a subgroup of patients with PFS and ORR evaluation, we did observe significant, favorable effects for patients having had serious adverse effects. CONCLUSION: Patients experiencing severe adverse events show a tendency toward better OS, PFS, and ORR compared to patients without or having only mild adverse events with nivolumab treatment.
- Publikační typ
- časopisecké články 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.
Pneumologie a ftizeologie je pestrý medicínský obor, který v posledních dvou dekádách prochází dynamickým rozvojem. Minulost pneumologie patřila léčbě tuberkulózy a pneumonií, v dnešní době je těžištěm oboru péče o pacienty s chronickými plicními nemocemi (chronická obstrukční plicní nemoc, astma bronchiale, intersticiální plicní procesy), ale také s akutními plicními stavy (pneumonie, nemoci pleury, respirační selhání), pneumoonkologie či vysoce specializovaná péče o vzácné plicní nemoci (cystická fibróza, vzácné nemoci intersticia). Významnou složkou oboru je také bronchologie, intervenční pneumologie a funkční vyšetřovací metody. Význam oboru také podtrhla pandemie covidu-19, během které patřila pneumologická pracoviště k nejvíce vytíženým. V tomto článku přinášíme stručný přehled novinek v oboru pneumologie a ftizeologie za rok 2022, kdy se postupně věnujeme tematickým okruhům bronchologie, cystické fibrózy, chronické obstrukční plicní nemoci, bronchiálního astmatu, intersticiálních plicních procesů, pleurálních nemocí, pneumoonkologie a tuberkulózy a netuberkulózních mykobakterióz.
Pneumology and phthisiology (respiratory medicine) has undergone dynamic development in the last two decades. The main focus of pulmonology in the past was care for patients with tuberculosis and pneumonia. Since then, respiratory medicine evolved and the current focus is on chronic pulmonary diseases, including chronic obstructive pulmonary disease, bronchial asthma, interstitial lung diseases, but also on acute lung conditions (e.g., pneumonia, pleural diseases, respiratory failure), pneumooncology or highly specialized care for rare lung diseases (e.g., cystic fibrosis, rare interstitial diseases). Bronchology, interventional pneumology and pulmonary function testing are also important components of respiratory medicine. The importance of respiratory medicine was apparent during the COVID-19 pandemic. In this article, we provide a brief overview of the most important news to the field of respiratory medicine in the year 2022, addressing the thematic areas of bronchology, cystic fibrosis, chronic obstructive pulmonary disease, asthma, interstitial lung diseases, pleural diseases, pneumooncology, tuberculosis and non-tuberculous mycobacteria.
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
- lidé MeSH
- malobuněčný karcinom plic * MeSH
- mutace MeSH
- nádory plic * genetika patologie MeSH
- nemalobuněčný karcinom plic * genetika MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: According to the guidelines for preoperative assessment of lung resection candidates, patients with normal forced expiratory volume in 1 s (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) are at low risk for post-operative pulmonary complications (PPC). However, PPC affect hospital length of stay and related healthcare costs. We aimed to assess risk of PPC for lung resection candidates with normal FEV1 and DLCO (>80% predicted) and identify factors associated with PPC. METHODS: 398 patients were prospectively studied at two centres between 2017 and 2021. PPC were recorded from the first 30 post-operative days. Subgroups of patients with and without PPC were compared and factors with significant difference were analysed by uni- and multivariate logistic regression. RESULTS: 188 subjects had normal FEV1 and DLCO. Of these, 17 patients (9%) developed PPC. Patients with PPC had significantly lower pressure of end-tidal carbon dioxide (PETCO2 ) at rest (27.7 versus 29.9; p=0.033) and higher ventilatory efficiency (V'E/V'CO2 ) slope (31.1 versus 28; p=0.016) compared to those without PPC. Multivariate models showed association between resting PETCO2 (OR 0.872; p=0.035) and V'E/V'CO2 slope (OR 1.116; p=0.03) and PPC. In both models, thoracotomy was strongly associated with PPC (OR 6.419; p=0.005 and OR 5.884; p=0.007, respectively). Peak oxygen consumption failed to predict PPC (p=0.917). CONCLUSIONS: Resting PETCO2 adds incremental information for risk prediction of PPC in patients with normal FEV1 and DLCO. We propose resting PETCO2 be an additional parameter to FEV1 and DLCO for preoperative risk stratification.
- Publikační typ
- časopisecké články 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
- imunoterapie metody MeSH
- lidé MeSH
- malobuněčný karcinom plic farmakoterapie MeSH
- nádory plic * farmakoterapie MeSH
- nemalobuněčný karcinom plic farmakoterapie MeSH
- protinádorové látky farmakologie terapeutické užití MeSH
- protokoly protinádorové kombinované chemoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Cardiopulmonary exercise testing parameters including ventilatory efficiency (VE/VCO2 slope) are used for risk assessment of lung resection candidates. However, many patients are unable or unwilling to undergo exercise. VE/VCO2 slope is closely related to the partial pressure of end-tidal carbon dioxide (PETCO2). We hypothesized PETCO2 at rest predicts postoperative pulmonary complications. METHODS: Consecutive lung resection candidates were included in this prospective multicenter study. Postoperative respiratory complications were assessed from the first 30 postoperative days or from the hospital stay. Student t test or Mann-Whitney U test was used for comparison. Multivariate stepwise logistic regression analysis was used to analyze association with the development of postoperative pulmonary complications. The De Long test was used to compare area under the curve (AUC). Data are summarized as median (interquartile range). RESULTS: Three hundred fifty-three patients were analyzed, of which 59 (17%) developed postoperative pulmonary complications. PETCO2 at rest was significantly lower (27 [24-30] vs 29 [26-32] mm Hg; P < .01) and VE/VCO2 slope during exercise significantly higher (35 [30-40] vs 29 [25-33]; P < .01) in patients who developed postoperative pulmonary complications. Both rest PETCO2 with odds ratio 0.90 (95% confidence interval [CI] 0.83-0.97); P = .01 and VE/VCO2 slope with odds ratio 1.10 (95% CI 1.05-1.16); P < .01 were independently associated with postoperative pulmonary complications by multivariate stepwise logistic regression analysis. There was no significant difference between AUC of both models (rest PETCO2: AUC = 0.79 (95% CI 0.74-0.85); VE/VCO2 slope: AUC = 0.81 (95% CI 0.75-0.86); P = .48). CONCLUSIONS: PETCO2 at rest has similar prognostic utility as VE/VCO2 slope, suggesting rest PETCO2 may be used for postoperative pulmonary complications prediction in lung resection candidates.
- MeSH
- lidé MeSH
- oxid uhličitý * MeSH
- plíce MeSH
- prospektivní studie MeSH
- spotřeba kyslíku MeSH
- srdeční selhání * MeSH
- zátěžový test MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
