Doba precizní a personalizované onkologie je zde, navzdory tomu dochází při zavádění nových terapeutických postupů a nových léčiv k mnohým dosud nepozorovaným překážkám. V drtivé většině případů jsou to onkologicky nemocní starších věkových skupin s komorbiditami a chronickou medikací, která často komplikuje aplikaci nových léků nebo lékových kombinací. V kazuistice bychom rádi prezentovali průběh nemoci a výzev spojených s protinádorovou terapií u pacienta po jaterní transplantaci s karcinomem prostaty.
The age of precision and personalized oncology is now, but application of new therapeutic possibilities and new pharmaceuticals brings new challenges. In most cases, patients with malignant tumors are of older age with chronic diseases, which complicate usage of new pharmaceuticals or their combination. In this clinical case, we would like to present treatment challenges on a patient with hepatic transplantation, who was diagnosed with prostate carcinoma.
- MeSH
- antitumorózní látky aplikace a dávkování MeSH
- individualizovaná medicína * metody MeSH
- kostra diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prostaty rezistentní na kastraci diagnostické zobrazování farmakoterapie patologie terapie MeSH
- nádory prostaty * diagnostické zobrazování farmakoterapie patologie terapie MeSH
- progrese nemoci MeSH
- radioisotopová scintigrafie MeSH
- takrolimus aplikace a dávkování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: In the two European Union (EU)-funded projects, PCM4EU (Personalized Cancer Medicine for all EU citizens) and PRIME-ROSE (Precision Cancer Medicine Repurposing System Using Pragmatic Clinical Trials), we aim to facilitate implementation of precision cancer medicine (PCM) in Europe by leveraging the experience from ongoing national initiatives that have already been particularly successful. PATIENTS AND METHODS: PCM4EU and PRIME-ROSE gather 17 and 24 partners, respectively, from 19 European countries. The projects are based on a network of Drug Rediscovery Protocol (DRUP)-like clinical trials that are currently ongoing or soon to start in 11 different countries, and with more trials expected to be established soon. The main aims of both the projects are to improve implementation pathways from molecular diagnostics to treatment, and reimbursement of diagnostics and tumour-tailored therapies to provide examples of best practices for PCM in Europe. RESULTS: PCM4EU and PRIME-ROSE were launched in January and July 2023, respectively. Educational materials, including a podcast series, are already available from the PCM4EU website (http://www.pcm4eu.eu). The first reports, including an overview of requirements for the reimbursement systems in participating countries and a guide on patient involvement, are expected to be published in 2024. CONCLUSION: PCM4EU and PRIME-ROSE were launched in January and July 2023, respectively. Educational materials, including a podcast series, are already available from the PCM4EU website (http://www.pcm4eu.eu). The first reports, including an overview of requirements for the reimbursement systems in participating countries and a guide on patient involvement, are expected to be published in 2024. CONCLUSION: European collaboration can facilitate the implementation of PCM and thereby provide affordable and equitable access to precision diagnostics and matched therapies for more patients.
- MeSH
- Evropská unie MeSH
- individualizovaná medicína * metody MeSH
- klinické zkoušky jako téma organizace a řízení MeSH
- lidé MeSH
- nádory * terapie MeSH
- přehodnocení terapeutických indikací léčivého přípravku MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
PURPOSE OF REVIEW: Bladder cancer (BC) is a highly heterogenous disease comprising tumours of various molecular subtypes and histologic variants. This heterogeneity represents a major challenge for the development of novel therapeutics. Preclinical models that closely mimic in vivo tumours and reflect their diverse biology are indispensable for the identification of therapies with specific activity in various BC subtypes. In this review, we summarize efforts and progress made in this context during the last 24 months. RECENT FINDINGS: In recent years, one main focus was laid on the development of patient-derived BC models. Patient-derived organoids (PDOs) and patient-derived xenografts (PDXs) were demonstrated to widely recapitulate the molecular and histopathological characteristics, as well as the drug response profiles of the corresponding tumours of origin. These models, thus, represent promising tools for drug development and personalized medicine. Besides PDXs, syngenic in vivo models are of growing importance. Since these models are generated using immunocompetent hosts, they can, amongst others, be used to develop novel immunotherapeutics and to evaluate the impact of the immune system on drug response and resistance. SUMMARY: In the past two years, various in vivo and in vitro models closely recapitulating the biology and heterogeneity of human bladder tumours were developed.
- MeSH
- antitumorózní látky terapeutické užití farmakologie MeSH
- individualizovaná medicína metody MeSH
- lidé MeSH
- modely nemocí na zvířatech MeSH
- nádory močového měchýře * terapie patologie farmakoterapie genetika imunologie MeSH
- organoidy MeSH
- xenogenní modely - testy antitumorózní aktivity MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE OF REVIEW: Bladder cancer incidence is on the rise, and until recently, there has been little to no change in treatment regimens over the last 40 years. Hence, it is imperative to work on strategies and approaches to untangle the complexity of intra- and inter-tumour heterogeneity of bladder cancer with the aim of improving patient-specific care and treatment outcomes. The focus of this review is therefore to highlight novel targets, advances, and therapy approaches for bladder cancer patients. RECENT FINDINGS: The success of combining an antibody-drug conjugate (ADC) with immunotherapy has been recently hailed as a game changer in treating bladder cancer patients. Hence, interest in other ADCs as a treatment option is also rife. Furthermore, strategies to overcome chemoresistance to standard therapy have been described recently. In addition, other studies showed that targeting genomic alterations (e.g. mutations in FGFR3 , DNA damage repair genes and loss of the Y chromosome) could also be helpful as prognostic and treatment stratification biomarkers. The use of single-cell RNA sequencing approaches has allowed better characterisation of the tumour microenvironment and subsequent identification of novel targets. Functional precision medicine could be another avenue to improve and guide personalized treatment options. SUMMARY: Several novel preclinical targets and treatment options have been described recently. The validation of these advances will lead to the development and implementation of robust personalized treatment regimens for bladder cancer patients.
- MeSH
- cílená molekulární terapie metody MeSH
- imunokonjugáty terapeutické užití MeSH
- imunoterapie metody MeSH
- individualizovaná medicína * metody MeSH
- lidé MeSH
- nádorové biomarkery genetika metabolismus MeSH
- nádorové mikroprostředí účinky léků MeSH
- nádory močového měchýře * genetika terapie farmakoterapie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Among medical specialties, laboratory medicine is the largest producer of structured data and must play a crucial role for the efficient and safe implementation of big data and artificial intelligence in healthcare. The area of personalized therapies and precision medicine has now arrived, with huge data sets not only used for experimental and research approaches, but also in the "real world". Analysis of real world data requires development of legal, procedural and technical infrastructure. The integration of all clinical data sets for any given patient is important and necessary in order to develop a patient-centered treatment approach. Data-driven research comes with its own challenges and solutions. The Findability, Accessibility, Interoperability, and Reusability (FAIR) Guiding Principles provide guidelines to make data findable, accessible, interoperable and reusable to the research community. Federated learning, standards and ontologies are useful to improve robustness of artificial intelligence algorithms working on big data and to increase trust in these algorithms. When dealing with big data, the univariate statistical approach changes to multivariate statistical methods significantly shifting the potential of big data. Combining multiple omics gives previously unsuspected information and provides understanding of scientific questions, an approach which is also called the systems biology approach. Big data and artificial intelligence also offer opportunities for laboratories and the In Vitro Diagnostic industry to optimize the productivity of the laboratory, the quality of laboratory results and ultimately patient outcomes, through tools such as predictive maintenance and "moving average" based on the aggregate of patient results.
- MeSH
- algoritmy MeSH
- big data * MeSH
- individualizovaná medicína metody MeSH
- lidé MeSH
- poskytování zdravotní péče MeSH
- umělá inteligence * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
[Precision neuro-oncology: reality and perspectives]
Precizní onkologie představuje nové pojetí onkologické péče, které umožňuje co možná nejlepší individualizaci léčby pro konkrétního pacienta a konkrétní tumor. Toho je dosaženo s využitím výsledků pokročilých molekulárně‐genetických diagnostických metod, které umožňují detailní molekulární profilování nádorové choroby a zjištění potenciálních cílů moderní protinádorové terapie, tzv. cílené léčby. Toto sdělení pojednává o postupných změnách v klasifikaci nádorů centrálního nervového systému, které byly nutné právě vzhledem k enormnímu rozvoji poznání o molekulárních mechanismech onkogeneze v posledních letech. Součástí jsou také některé důležité příklady využití přístupů precizní onkologie u nádorů centrálního nervového systému s podrobným zaměřením na difuzní gliomy.
Precision oncology represents a new concept of cancer care that allows the best possible individualization of treatment for a particular patient and a particular tumour. This is achieved by using the results of advanced molecular-genetic diagnostic methods which enable detailed tumour molecular profiling and identification of potential targets of modern anticancer treatment, i.e. targeted therapy. The present article deals with gradual changes in the classification of central nervous system tumours which were necessary given the enormous development of knowledge on molecular mechanisms of oncogenesis in recent years. Also included are some important examples of using precision oncology approaches in central nervous system tumours, with a detailed focus on diffuse gliomas.
- MeSH
- antitumorózní látky farmakologie terapeutické užití MeSH
- cílená molekulární terapie metody MeSH
- glioblastom genetika patologie terapie MeSH
- gliom klasifikace patologie terapie MeSH
- individualizovaná medicína metody MeSH
- karcinogeneze genetika MeSH
- lidé MeSH
- nádorové biomarkery genetika MeSH
- nádory centrálního nervového systému * klasifikace patologie terapie MeSH
- protinádorové látky imunologicky aktivní terapeutické užití MeSH
- protokoly antitumorózní kombinované chemoterapie terapeutické užití MeSH
- Check Tag
- lidé MeSH
The gut microbiome has been increasingly recognized as a key player in the development and progression of colon cancer. Alterations in the gut microbiota, known as dysbiosis, can lead to a variety of medical issues. Microbial adaptation through signals and small molecules can enhance pathogen colonization and modulate host immunity, significantly impacting disease progression. Quorum sensing peptides and molecules have been linked to the progression of colon cancer. Various interventions, such as fecal microbiota transplantation, probiotics, prebiotics, synbiotics, and antibiotics, have been used to reverse dysbiosis with mixed results and potential side effects. Thus, a personalized approach to treatment selection based on patient characteristics, such as individual gut microbiota manipulation, is necessary to prevent and treat diseases like colon cancer. With advances in metagenomic sequencing and other omics technologies, there has been a growing interest in developing precision medicine strategies for microbial imbalance-induced colon cancer. This review serves as a comprehensive synthesis of current knowledge on the gut microbiome involvement in colon cancer. By exploring the potential of utilizing the gut microbiome as a target for precision medicine, this review underscores the exciting opportunities that lie ahead. Although challenges exist, the integration of microbiome data into precision medicine approaches has the potential to revolutionize the management of colon cancer, providing patients with more personalized and effective treatment options.
- MeSH
- dysbióza terapie MeSH
- individualizovaná medicína metody MeSH
- lidé MeSH
- nádory tračníku * terapie MeSH
- probiotika * terapeutické užití MeSH
- střevní mikroflóra * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Klíčová slova
- URIS,
- MeSH
- hyperaktivní močový měchýř * diagnóza farmakoterapie terapie MeSH
- individualizovaná medicína metody MeSH
- lidé MeSH
- transkutánní elektrická neurostimulace metody trendy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- rozhovory MeSH
- Geografické názvy
- Česká republika MeSH
Karcinom pankreatu je onemocnění s rostoucí incidencí a mortalitou celosvětově. Současným standardem terapie je systémová chemoterapie bez ohledu na stadium onemocnění. I když kombinované režimy v adjuvanci, neoadjuvanci a paliaci vedly k prodloužení přežití, je karcinom pankreatu stále spojený s nejkratší dobou přežití v rámci onkologických diagnóz. Synonymem pro současnou onkologii je personalizovaná/precizní onkologie, kdy zásluhou lepší dostupnosti NGS jsme schopni identifikovat specifické podskupiny pacientů s karcinomem pankreatu, které mají jednak odlišnou prognózu, jednak vyžadují specifický přístup k léčbě. Cílem tohoto přehledu je podat informace o karcinomu pankreatu jako o heterogenním onemocnění, které vyžaduje personalizovaný přístup. Největší část je věnovaná podskupině s defekty v systému DDR/HRD vzhledem k poměrně vysoké frekvenci výskytu a možnosti víceméně personalizované terapie platinovými deriváty s ev. následnou maintenance terapií PARP inhibitory. Menší molekulárně definované podskupiny jsou diskutovány stručně i s ohledem na menší množství dat.
Pancreatic cancer is a disease with increasing incidence and mortality worldwide. Current standard of treatment is chemotherapy regardless of clinical stage. Despite improvements in survival thanks to multi-agent regimens in adjuvant, neoadjuvant and paliative setting, pancreatic cancer still has the worst prognosis across all malignancies. Oncology nowadays is more or less personalized/precise. With help of NGS we are able to identify specific subtypes of patients with pancreatic cancer, which have both, different prognosis and require specific approach to treatment. The aim of this review is to provide information about pancreatic cancer as a molecularly heterogeneous disease, which require personalized approach. Main part of review is about pancreatic cancer with defects in DDR/HRD system with an option for more or less personalized therapy with platinum derivatives, followed in some cases with maintenance with PARP inhibitors. Smaller molecularly defined subgroups are described briefly, because of smaller amount of data from the literature.
