Klinická onkologie : casopis Ceské a Slovenské onkologické spolecnosti
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Lenalidomide is a promising new drug in the treatment of patients with multiple myeloma. The analogue of thalidomide was created with the intention of improving the anticancer activity, its immunomodulatory properties as well as reducing the toxicity of the preparation. The mechanism of antitumor action of the preparation appears to be the effect on cells, tumour microenvironment and in particular the regulation of cytokinine production. ⋯ Patients treated with a combination of lenalidomide and dexamethasone had significantly higher therapeutic response and overall survival than patients treated with dexamethasone alone. Profound toxicity seems to be the myelosuppressive effect of lenalidomide. The work gives a summary of the information available on lenalidomide in the treatment of multiple myeloma.
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Breast cancer patients with a tumor size of < or = 1 cm are still rare but their number is increasing as a consequence of mammary screening. It is logical that the best adjuvant treatment in such cancers is often discussed with respect to the risk of relapse of the disease. The number of patients in clinical trials with very small breast cancer is quite low, and a specific clinical trial for such patients is not planned. ⋯ Indirectly, we can assume the application of adjuvant treatment with trastuzumab in such very small breast cancer. However, the decision should be individual with regards to further risk factors for the disease and risk of the treatment itself. This article is more a contemplation in order to provoke discussion on this provocative subject.
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Administration of cytotoxic drugs is accompanied by many serious side effects, with cardiac toxicity as one of the most dangerous. In clinical practice anthracyclines are the best known chemotherapeutic agents linked to cardiotoxicity, however there are a number of other anti-cancer drugs (cyclophosphamide, taxans, trastuzumab, 5-fluorouracil, imunomodulators etc) that may cause cardiac toxicity as well. Basic mechanism through which anthracylines cause cardiac damage is recognized, though many pathogenetic ways of their toxicity still remain to be elucidated. ⋯ Also liposomal encapsulation of anthacyclines may reduce heart damage, especially early cardiotoxicity. Cardiotoxicity of cytostatic agents is a very serious side effect of anti-cancer therapy, which may affect survival more than the malignancy itself. Therefore a concentrated effort should be expended to prevent cardiac damage or at least to its early identification and prompt treatment.