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Maráz A, Nagy B, Macher T, Jeskó J, Tischler E, Csongvai C, Kearney M. Correction to: Nationwide Study of Real-World Treatment Patterns and Clinical Outcomes in Patients with Metastatic Urothelial Carcinoma in Hungary. Adv Ther 2024; 41:881-882. [PMID: 38070042 PMCID: PMC10838830 DOI: 10.1007/s12325-023-02740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Korányi Fasor 12, H-6720, Szeged, Hungary.
| | - Bence Nagy
- Healthware Consulting Ltd., Budapest, Hungary
| | | | | | - Erika Tischler
- Merck Kft., Budapest, Hungary, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Csaba Csongvai
- Merck Kft., Budapest, Hungary, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Mairead Kearney
- Global Value Demonstration, Market Access and Pricing (GVAP), the healthcare business of Merck KGaA, Darmstadt, Germany
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Farkas I, Sipka G, Bakos A, Maráz A, Bajory Z, Mikó Z, Czékus T, Urbán S, Varga L, Pávics L, Besenyi Z. Diagnostic value of [ 99mTc]Tc-PSMA-I&S-SPECT/CT for the primary staging and restaging of prostate cancer. Ther Adv Med Oncol 2024; 16:17588359231221342. [PMID: 38249326 PMCID: PMC10798073 DOI: 10.1177/17588359231221342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024] Open
Abstract
Background A large number of studies have proved that prostate-specific membrane antigen-positron emission tomography/computer tomography (PSMA-PET/CT) provides excellent accuracy in primary staging and restaging of prostate cancer. Less data exist with PSMA-single photon emission computed tomography (SPECT)/CT investigations. Objective The aim of this study was to evaluate the performance of [99mTc]Tc-PSMA-I&S (for imaging and surgery) in prostate cancer. Design and methods We retrospectively analysed PSMA-SPECT/CT scans of 20 healthy volunteers and 100 male patients with prostate cancer. All of them had histologically confirmed prostate cancer. In all, 28 patients were examined for primary staging and 72 for biochemical recurrence or progressive disease. Whole body SPECT/CT imaging was carried out 6 h after the intravenous administration of 666 ± 102 MBq [99mTc]Tc-PSMA-I&S. Images were evaluated visually and semi-quantitatively. Results Patient-based sensitivity, specificity, positive predictive value, negative predictive value and accuracy for primary prostate cancer were 86%, 100%, 100%, 83% and 92%, respectively. For detecting metastases in primary staging, these values were 88%, 100%, 100%, 85% and 93%, respectively. The radiopharmaceutical uptake of primary prostate cancer was significantly higher than in normal prostate. The patient-based sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the method in the visualization of local recurrence were 67%, 100%, 100%, 86% and 89%, and for detecting metastases in restaging were 91%, 92%, 98%, 75% and 91%, respectively. In restaging, detection rates were 37% under prostate-specific antigen level of 1 ng/mL, 74% between 1 and 5 ng/mL and 80% >5 ng/mL. Conclusion [99mTc]Tc-PSMA-I&S-SPECT/CT can be easily integrated into the routine diagnostic practice, and it provides usable data in primary staging and restaging of prostate cancer. Quantitative assessment of PSMA-SPECT/CT has the potential to be used to differentiate between physiological and pathological intraprostatic tracer uptake.
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Affiliation(s)
- István Farkas
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Sipka
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Annamária Bakos
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Bajory
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Zsófia Mikó
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Czékus
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Szabolcs Urbán
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Linda Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - László Pávics
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Besenyi
- Department of Nuclear Medicine, University of Szeged, Korányi Fasor 6, H-6720 Szeged, Hungary
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Maráz A, Nagy B, Macher T, Jeskó J, Tischler E, Csongvai C, Kearney M. Nationwide Study of Real-World Treatment Patterns and Clinical Outcomes in Patients with Metastatic Urothelial Carcinoma in Hungary. Adv Ther 2023; 40:5475-5488. [PMID: 37831384 PMCID: PMC10611888 DOI: 10.1007/s12325-023-02694-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Data describing real-world treatment patterns in patients with metastatic urothelial carcinoma (mUC) in Central-Eastern Europe are scarce, and data from Hungary have not been published. This retrospective, nationwide, real-world study investigated patient characteristics, treatment patterns, comorbidities, and clinical outcomes in patients with mUC in Hungary. METHODS Adults diagnosed with mUC from January 2016 through June 2021 were identified using the National Health Insurance Fund Administration database. Overall survival (OS) was estimated using the Kaplan-Meier method. RESULTS In total, 2523 patients with mUC were identified. Median follow-up was 7.1 months. Overall, 50% of patients received an identified systemic anticancer treatment; within this subgroup, first-line treatment was platinum-based chemotherapy (PBC) in 86%, non-PBC in 8%, and immune checkpoint inhibitor (ICI) in 6%. The proportion of patients receiving treatment increased from 41% in 2016 to 59% in 2020, driven by increased use of first-line PBC or first-line ICI treatment. Comorbidities were more common in patients receiving first-line ICI treatment vs PBC or non-PBC and in patients receiving carboplatin + gemcitabine vs cisplatin + gemcitabine. Overall, only 24% received a second-line treatment. Unadjusted median OS from the start of first-line treatment in the PBC, non-PBC, and ICI subgroups was 12.8, 7.5, and 6.3 months, respectively. Median OS from date of diagnosis in untreated patients was 7.8 months. OS comparisons adjusted for differences in baseline characteristics between subgroups could not be performed. CONCLUSION To our knowledge, this is the first study to assess treatment patterns in patients with mUC in clinical practice in Hungary, using the national health insurance database. Rates of first- and second-line treatment were consistent with those observed in other countries. Avelumab first-line maintenance treatment became available for reimbursement in Hungary in late 2022, after the study period. Given the evolving landscape of reimbursed treatments in Hungary, further analyses are warranted.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Korányi Fasor 12, 6720, Szeged, Hungary.
| | - Bence Nagy
- Healthware Consulting Ltd., Budapest, Hungary
| | | | | | - Erika Tischler
- Merck Kft., Budapest, Hungary
- Merck KGaA, Darmstadt, Germany
| | - Csaba Csongvai
- Merck Kft., Budapest, Hungary
- Merck KGaA, Darmstadt, Germany
| | - Mairead Kearney
- Global Value Demonstration, Market Access and Pricing (GVAP), The Healthcare Business of Merck KGaA, Darmstadt, Germany
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Váradi M, Horváth O, Módos O, Fazekas T, Grunewald CM, Niegisch G, Krafft U, Grünwald V, Hadaschik B, Olah C, Maráz A, Furka A, Szűcs M, Nyirády P, Szarvas T. Efficacy of immune checkpoint inhibitor therapy for advanced urothelial carcinoma in real-life clinical practice: results of a multicentric, retrospective study. Sci Rep 2023; 13:17378. [PMID: 37833455 PMCID: PMC10575904 DOI: 10.1038/s41598-023-44103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Clinical trials revealed significant antitumor activity for immune checkpoint inhibitors (ICI) in metastatic urothelial carcinoma (mUC). Due to their strict eligibility criteria, clinical trials include selected patient cohorts, and thus do not necessarily represent real-world population outcomes. In this multicentric, retrospective study, we investigated real-world data to assess the effectiveness of pembrolizumab and atezolizumab and to evaluate the prognostic value of routinely available clinicopathological and laboratory parameters. Clinical and follow-up data from mUC patients who received ICIs (01/2017-12/2021) were evaluated. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and duration of response (DOR) were used as endpoints. Patients' (n = 210, n = 76 atezolizumab and 134 pembrolizumab) median OS and PFS were 13.6 and 5.9 months, respectively. Impaired ECOG-PS, the presence of visceral, liver or bone metastases, and hemoglobin levels were independently associated with poor OS and DCR. Furthermore, Bellmunt risk factors and the enhanced Bellmunt-CRP score were shown to be prognostic for OS, PFS and DCR. In conclusion, ICIs are effective treatments for a broad range of mUC patients. Our results confirmed the prognostic value of numerous risk factors and showed that Bellmunt risk scores can further be improved when adding CRP to the model.
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Affiliation(s)
- Melinda Váradi
- Department of Urology, Semmelweis University, Üllői út 78/B, Budapest, 1082, Hungary
| | - Orsolya Horváth
- Department of Genitourinary Medical Oncology and Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - Orsolya Módos
- Department of Urology, Semmelweis University, Üllői út 78/B, Budapest, 1082, Hungary
| | - Tamás Fazekas
- Department of Urology, Semmelweis University, Üllői út 78/B, Budapest, 1082, Hungary
| | - Camilla M Grunewald
- Department of Urology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Günter Niegisch
- Department of Urology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ulrich Krafft
- Department of Urology, University of Duisburg-Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Viktor Grünwald
- Department of Urology, University of Duisburg-Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Csilla Olah
- Department of Urology, University of Duisburg-Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Andrea Furka
- Department of Oncology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Clinical Radiology, Institute of Practical Methodology and Diagnostics, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
| | - Miklós Szűcs
- Department of Urology, Semmelweis University, Üllői út 78/B, Budapest, 1082, Hungary
| | - Péter Nyirády
- Department of Urology, Semmelweis University, Üllői út 78/B, Budapest, 1082, Hungary
| | - Tibor Szarvas
- Department of Urology, Semmelweis University, Üllői út 78/B, Budapest, 1082, Hungary.
- Department of Urology, University of Duisburg-Essen, Hufelandstr 55, 45147, Essen, Germany.
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Varga L, Besenyi Z, Paczona VR, Farkas I, Urbán S, Sipka G, Pávics L, Varga Z, Fodor E, Hideghéty K, Olah J, Bajory Z, Maráz A. Prostate-specific membrane antigen-based imaging for stereotactic irradiation of low-volume progressive prostate cancer: a single-center experience. Front Oncol 2023; 13:1166665. [PMID: 37637070 PMCID: PMC10448522 DOI: 10.3389/fonc.2023.1166665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Prostate-specific membrane antigen (PSMA) is a transmembrane protein that may be expressed on the surface of prostate cancer (PC) cells. It enables a more sensitive and specific diagnosis PC, compared to conventional anatomical imaging. Aim The integration of PSMA-based imaging in the personalized radiotherapy of PC patients and the evaluation of its impact on target volume definition if stereotactic body radiotherapy (SBRT) is planned for locally recurrent or oligometastatic disease. Patients and methods The data from 363 examinations were analyzed retrospectively. Inclusion criteria were histologically verified PC and clinical data suggesting local recurrence or distant metastasis. Whole-body 99mTc-PSMA-I&S single-photon emission computed tomography (SPECT)/CT or 18F-JK-PSMA-7 positron emission tomography/computer tomography (PET/CT) was carried out, and the evaluation of the scans and biological tumor volume contouring was performed at the Department of Nuclear Medicine. The target volume delineation on topometric CT (TCT) scan was performed at the Department of Oncotherapy. The comparison of the two volumes was performed by image fusion and registration. Results From 363 PSMA isotope-based examinations, 84 lesions of 64 patients were treated with SBRT. In 50 patients, 70 lesions were examined for intermodality comparison. The target volume defined by the PSMA density was significantly smaller than the tumor size defined by the TCT scan: GTVCT (gross tumor volume on the TCT), 27.58 ± 46.07 cm3; BTVPSMA (biological target volume on the PSMA-based examination), 16.14 ± 29.87 cm3. During geometrical analyses, the Dice similarity coefficient (DSC) was 0.56 ± 0.20 (0.07-0.85). Prostate-specific antigen (PSA) control was performed to evaluate the response: mean pre-radiotherapy (pre-RT) PSA was 16.98 ng/ml ( ± SD: 33.81), and post-RT PSA at 3 months after SBRT was 11.19 ng/ml ( ± SD: 32.85). Three-month post-therapy PSMA-based imaging was performed in 14 cases, in which we observed a decrease or cessation of isotope uptake. Conventional imaging control was performed in 42 cases (65.6% of all cases): 22 (52.4%) complete remissions, 14 (33.3%) partial remissions, four (9.5%) stable diseases, and two (4.8%) progressive diseases were described. Conclusion PSMA-based imaging is a promising diagnostic method for specifying the stage and detecting the low-volume progression. Our results suggest that PSMA-based hybrid imaging can influence treatment decisions and target volume delineation for SBRT.
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Affiliation(s)
- Linda Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Besenyi
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | | | - István Farkas
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Szabolcs Urbán
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Sipka
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - László Pávics
- Department of Nuclear Medicine, University of Szeged, Szeged, Hungary
| | - Zoltan Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Emese Fodor
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Judit Olah
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Bajory
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
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Maráz A, Nagyiványi K, Balogh I, Bodoky G, Mangel L, Küronya Z, Géczi L, Torday L, Dudás S, Szűcs M, Nagy Z, Hornyák L, Zolcsák Z, Bassam A, Kocsis J, Keresztes T, Kullmann T, Máhr K, Solymosi T, Papdán T, Szabó I, Varga Z, Biró K. [Multicentric Hungarian results of cabozantinib therapy in patients with metastatic kidney cancer based on real-world data]. Magy Onkol 2023; 67:73-83. [PMID: 37086460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/04/2023] [Indexed: 04/24/2023]
Abstract
The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Krisztián Nagyiványi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Ingrid Balogh
- Onkológiai Klinika, Debreceni Egyetem Klinikai Központ, Debrecen, Hungary
| | - György Bodoky
- Onkológiai Centrum, Dél-pesti Centrumkórház, Budapest, Hungary
| | - László Mangel
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - László Torday
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Szilvia Dudás
- Onkológiai Centrum, Dél-pesti Centrumkórház, Budapest, Hungary
| | - Miklós Szűcs
- Urológiai Klinika, Semmelweis Egyetem, Budapest, Hungary
| | - Zsófia Nagy
- Onkológiai Osztály, Észak-pesti Centrumkórház, Budapest, Hungary
| | - Lajos Hornyák
- Közép-dunántúli Regionális Onkológiai Centrum, Veszprém Megyei Csolnoky Ferenc Kórház, Veszprém, Hungary
| | - Zita Zolcsák
- Onkoradiológiai Osztály, Uzsoki Utcai Kórház, Budapest, Hungary
| | - Ali Bassam
- Megyei Onkológiai Központ, Békés Megyei Központi Kórház Pándy Kálmán Tagkórház, Gyula, Hungary
| | - Judit Kocsis
- Onkoradiológia, Bács-Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Tamás Keresztes
- Onkoradiológia, Bács-Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Tamás Kullmann
- Onkoradiológiai Osztály, Petz Aladár Egyetemi Oktató Kórház, Győr, Hungary
| | - Károly Máhr
- Onkológiai Osztály, Zala Megyei Szent Rafael Kórház, Zalaegerszeg, Hungary
| | - Tibor Solymosi
- Klinikai Onkológiai és Sugárterápiás Centrum, Borsod-Abaúj-Zemplén Megyei Központi Kórház, Miskolc, Hungary
| | - Tímea Papdán
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Imre Szabó
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Zoltán Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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Küronya Z, Biró K, Géczi L, Maráz A. [Immune combination possibilities in the first-line treatment of metastatic renal cell cancer]. Magy Onkol 2023; 67:53-58. [PMID: 37086458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/26/2023] [Indexed: 04/24/2023]
Abstract
First-line treatment of metastatic renal cancer can be divided into three main phases. The cytokine era was replaced by targeted therapies in 2006 with the introduction of tyrosine kinase inhibitors. Until 2018, the standard first-line therapy was the use of sunitinib or pazopanib. Over the past decade, numerous attempts have been made to combine these drugs, which are already approved or in development, but these attempts have not been successful, primarily because of intolerable toxicity. In 2018, we reached a new stage in the treatment of metastatic renal tumors. This year, the combination immunotherapy of ipilimumab and nivolumab was approved. Since then, the combination of immunotherapy and targeted therapies has led to success. The main objective of our summary is to present in chronological order the clinical trials of combination therapies already approved in Europe, as well as the most recent phase III clinical trials. It is also intended to provide a brief practical guide on how to decide on first-line therapy based on the results of these trials.
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Affiliation(s)
- Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary
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Maráz A, Nagyiványi K, Balogh I, Bodoky G, Mangel L, Küronya Z, Géczi L, Torday L, Dudás S, Szűcs M, Nagy Z, Hornyák L, Zolcsák Z, Bassam A, Kocsis J, Keresztes T, Kullmann T, Máhr K, Solymosi T, Papdán T, Szabó I, Varga Z, Biró K. [Multicentric Hungarian results of cabozantinib therapy in patients with metastatic kidney cancer based on real-world data]. Magy Onkol 2023; 67:1-10. [PMID: 36989491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/04/2023] [Indexed: 03/31/2023]
Abstract
The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Krisztián Nagyiványi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Ingrid Balogh
- Onkológiai Klinika, Debreceni Egyetem Klinikai Központ, Debrecen, Hungary
| | - György Bodoky
- Onkológiai Centrum, Dél-pesti Centrumkórház, Budapest, Hungary
| | - László Mangel
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - László Torday
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Szilvia Dudás
- Onkológiai Centrum, Dél-pesti Centrumkórház, Budapest, Hungary
| | - Miklós Szűcs
- Urológiai Klinika, Semmelweis Egyetem, Budapest, Hungary
| | - Zsófia Nagy
- Onkológiai Osztály, Észak-pesti Centrumkórház, Budapest, Hungary
| | - Lajos Hornyák
- Közép-dunántúli Regionális Onkológiai Centrum, Veszprém Megyei Csolnoky Ferenc Kórház, Veszprém, Hungary
| | - Zita Zolcsák
- Onkoradiológiai Osztály, Uzsoki Utcai Kórház, Budapest, Hungary
| | - Ali Bassam
- Megyei Onkológiai Központ, Békés Megyei Központi Kórház Pándy Kálmán Tagkórház, Gyula, Hungary
| | - Judit Kocsis
- Onkoradiológia, Bács-Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Tamás Keresztes
- Onkoradiológia, Bács-Kiskun Megyei Oktatókórház, Kecskemét, Hungary
| | - Tamás Kullmann
- Onkoradiológiai Osztály, Petz Aladár Egyetemi Oktató Kórház, Győr, Hungary
| | - Károly Máhr
- Onkológiai Osztály, Zala Megyei Szent Rafael Kórház, Zalaegerszeg, Hungary
| | - Tibor Solymosi
- Klinikai Onkológiai és Sugárterápiás Centrum, Borsod-Abaúj-Zemplén Megyei Központi Kórház, Miskolc, Hungary
| | - Tímea Papdán
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Imre Szabó
- Onkoterápiás Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Zoltán Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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9
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Küronya Z, Biró K, Géczi L, Maráz A. [Forward directions for targeted treatment of urothelial tumors]. Magy Onkol 2021; 65:348-353. [PMID: 34874366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
Platinum-based chemotherapy is the standard therapy for inoperable, locally advanced, or metastatic urothelial tumors. Although the initial response rate with combination chemotherapy is very high, the median survival is approximately 15 months. Secondary chemotherapy has had modest clinical benefit and toxicity, with the breakthrough coming from the introduction of checkpoint inhibitory immunotherapies. After chemotherapy and immunotherapy, there is currently no accepted standard of care in the third line. Based on the results of the two phase II and one phase III studies available so far, the use of targeted treatments in tertiary treatment may be a new direction. The purpose of our review is to present these clinical trials, and we would also like to draw attention to promising targeted therapies in the future.
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Affiliation(s)
- Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary
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10
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Géczi L, Dienes T, Küronya Z, Maráz A, Nagyiványi K. [Immunotherapy in advanced urothelial cancer]. Magy Onkol 2021; 65:339-346. [PMID: 34874365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Abstract
Cisplatin containing chemotherapy has proven benefit for muscle-invasive locally advanced and metastatic urothelial cancer. The carboplatin based combinations are less effective in these settings. In most cases for the platinum based chemotherapy ineligible patients only the best supportive care could be given. The treatment options have expanded in the past few years with the introduction of systemic immunotherapy with checkpoint inhibitors. We review the relevant clinical trials' data which can completely transform the treatment landscape of locally advanced or metastatic urothelial cancer.
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Affiliation(s)
- Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Tamás Dienes
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary
| | - Krisztián Nagyiványi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
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11
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Maráz A, Varga L, Pósfai B, Géczi L, Küronya Z. [New aspects of chemotherapy and indications for maintenance immunotherapy in urothelial cancers]. Magy Onkol 2021; 65:329-337. [PMID: 34874364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
Chemotherapy for the treatment of urothelial and bladder cancers has focused on renewed indications in light of clinical trials of modern therapies, which are described in our review. In stage T2-T4a N0-1 M0 cases, that are suitable for cisplatin, surgery is performed after neoadjuvant cisplatin- based chemotherapy. Less significant result is observed with adjuvant chemotherapy, especially in pT3-4 and/or N+ stage, if no neoadjuvant chemotherapy was administered. Cisplatin-based chemotherapy is the first-line treatment of cisplatin-eligible metastatic patients. First-line choice in chemo-fit cases with cisplatin ineligibility can be carboplatin- based chemotherapy. 4-6 cycles of cisplatin or carboplatin cause stable disease or regression, maintenance avelumab immunotherapy improves patient's survival. For those patients who progress during or after platinum-based chemotherapy, the effectiveness of chemotherapy in the second/multiple lines is less favourable in comparison with immunotherapy and targeted therapy. Modern antibody - cytotoxic drug conjugates have been discovered in the form of enfortumab vedotin and sacituzumab govitecan, and currently they seem to be effective in the third line after chemotherapy and immunotherapy.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Linda Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Boglárka Pósfai
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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12
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Maráz A, Géczi L, Biró K, Varga L, Küronya Z. [Therapeutic sequences in the treatment of advanced/metastatic prostate cancer]. Magy Onkol 2020; 64:263-272. [PMID: 32966355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
The unprecedented development of prostate cancer therapy is a challenge for the proper sequential use of modern medicines. Patients' life expectancies improve when we use treatment lines, one after the other. There is no evidence- based guideline regarding the optimal sequence, but a number of data are available to help the physician selecting the best individualized therapeutic option. The basic treatment for advanced prostate cancer is still androgenic deprivation (ADT), to which we can add additional therapeutic agents. New types of hormonal (androgen receptor targeted, ARTA) agents are being used in an increasingly early line. Chemotherapy (CT) is the first choice in case of metastatic, hormone-sensitive disease especially in high volume cases that are causing symptoms or visceral crisis. CT is otherwise applied after ARTA. We have little but encouraging data about the early, sequential use of ARTAs with different mechanisms of action. In later lines, cross-resistance may develop between ARTA treatments, in which cases CT is the right decision. In this paper, we summarize the results of clinical trials that may help in therapeutic decision making, maximizing the benefits for patients.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Linda Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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13
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Németh T, Szabó Z, Pécsy B, Barta ZV, Lázár G, Torday L, Maráz A, Zombori T, Furák J. Changes in the surgical treatment of pulmonary metastases during the last 12 years. Orv Hetil 2020; 161:1215-1220. [PMID: 32628621 DOI: 10.1556/650.2020.31770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In our retrospective study, we examined changes in the histological results and types of metastatectomies of pulmonary metastases during the last 12 years, in two 5-year periods. AIM AND METHOD There were 55 patients in the first group (2006-2010), 54.5% of the patients were male (n = 30), 45.5% were female (n = 25), the mean age was 57.9 years (24-80). The second group (2014-2018) consisted of 115 patients, with 60% male (n = 69) and 40% female (n = 46), the mean age was 62.2 years (26-82). RESULTS During the first period, the primary tumor was found in the rectum 19.3% (n = 11), colon 17.5% (n = 10), or kidney 14% (n = 8), while during the second period, the primary tumor was in the colon in 23.1% (n = 31), in the rectum in 15.7% (n = 21), or in the kidney in 9% (n = 12). The following types of surgeries were performed: atypical resection: 38.6% (n = 22) and 46.3% (n = 62); lobectomy in 31.6% (n = 18) and 26.9% (n = 36); pulmonectomy in 10.5% (n = 6) and 1.5% (n = 2); segmentectomy in 7% (n = 4) and 9.7% (n = 13); and bilobectomy in 1.8% (n = 1) and 0.7% (n = 1) in the first and second group, respectively. The ratio of video-assisted thoracic surgery (VATS) was 5.3% (n = 3) during the first period, and this ratio increased to 64.9% (n = 87) during the second period. The mean disease-free survival between the surgery of the primary tumor and the removal of the pulmonary metastasis was 45.2 months (0-144) during the first period and 33.8 months (0-180) during the second period. The median survival was 39 months in the first period, and it increased to 59 months in the second group. The mean 5-year survival was 41% in both groups. CONCLUSION During the last 12 years, there was a more than two-fold increase in the number of patients requiring surgery due to pulmonary metastases, and the ratio of VATS metastasectomy increased significantly as well (5.3% vs. 64.9%). No significant difference was found in the ratio of the types of the primary tumors. The median survival was slightly better in the second group. Orv Hetil; 161(29): 1215-1220.
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Affiliation(s)
- Tibor Németh
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
| | - Zsolt Szabó
- Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Intézet,Szegedi Tudományegyetem, Szeged
| | - Balázs Pécsy
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
| | - Zsanett Virág Barta
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
| | - György Lázár
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
| | - László Torday
- Általános Orvostudományi Kar, Onkoterápiás Klinika,Szegedi Tudományegyetem, Szeged
| | - Anikó Maráz
- Általános Orvostudományi Kar, Onkoterápiás Klinika,Szegedi Tudományegyetem, Szeged
| | - Tamás Zombori
- Általános Orvostudományi Kar, Patológiai Intézet,Szegedi Tudományegyetem, Szeged
| | - József Furák
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
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Dobi Á, Darázs B, Fodor E, Cserháti A, Együd Z, Maráz A, László S, Dodd L, Reisz Z, Barzó P, Oláh J, Hideghéty K. Low Fraction Size Re-irradiation for Large Volume Recurrence of Glial Tumours. Pathol Oncol Res 2020; 26:2651-2658. [PMID: 32648211 PMCID: PMC7471107 DOI: 10.1007/s12253-020-00868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to evaluate the efficacy of re-irradiation (re-RT) in patients with advanced local relapses of glial tumours and to define the factors influencing the result of the hyper-fractionated external beam therapy on progression after primary management. We have analysed the data of 55 patients with brain tumours (GBM: 28) on progression, who were re-irradiated between January 2007 and December 2018. The mean volume of the recurrent tumour was 118 cm3, and the mean planning target volume (PTV) was 316 cm3, to which 32 Gy was delivered in 20 fractions at least 7.7 months after the first radiotherapy, using 3D conformal radiotherapy (CRT) or intensity modulated radiotherapy (IMRT). The median overall survival (mOS) from the re-RT was 8.4 months, and the 6-month and the 12-month OS rate was 64% and 31%, respectively. The most important factors by univariate analysis, which significantly improved the outcome of re-RT were the longer time interval between the diagnosis and second radiotherapy (p = 0.029), the lower histology grade (p = 0.034), volume of the recurrent tumour (p = 0.006) and Karnofsky performance status (KPS) (p = 0.009) at the re-irradiation. Our low fraction size re-irradiation ≥ 8 months after the first radiotherapy proved to be safe and beneficial for patients with large volume recurrent glial tumours.
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Affiliation(s)
- Ágnes Dobi
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary.
| | - Barbara Darázs
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Emese Fodor
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Adrienne Cserháti
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Zsófia Együd
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Anikó Maráz
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Szilvia László
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Leopold Dodd
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Zita Reisz
- Department of Pathology, University of Szeged, Állomás utca 1, Szeged, H-6725, Hungary
| | - Pál Barzó
- Department of Neurosurgery, University of Szeged, Semmelweis utca 6, Szeged, H-6725, Hungary
| | - Judit Oláh
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Katalin Hideghéty
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
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Maráz A, Varga L, Küronya Z. [Opportunities that improve the effectivity of immunotherapy, bringing targeted therapies into focus]. Magy Onkol 2019; 63:209-216. [PMID: 31533141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
Immunotherapy is getting more and more successful therapeutic option in case of many cancer types. Despite the clinical effectiveness of checkpoint inhibitor antibodies, long-lasting advantages can only be seen in a part of the patients, which makes necessary to examine immunotherapy more thoroughly. Immunity is influenced by the tumor, its microenvironment, and patient's characteristic and environmental factors. These elements control the strength and duration of antitumor response. Immunotherapeutic response may be more significant and may even last for years in case of hot tumors, while in most of the cases immunotherapy is not so effective in poorly immunogenic cold tumors. Combined therapies potentially increase efficiency. In our article T-cell activation phases of antitumor immune response, possible defects, their consequences and the potentially effective therapeutic opportunities are summarized shortly. Combined immunotherapy is a novel, promising possibility for modern oncology.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Linda Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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16
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Küronya Z, Biró K, Maráz A, Géczi L. [The modern treatment of metastatic castration-resistant prostate cancer]. Magy Onkol 2019; 63:41-50. [PMID: 30889620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 06/09/2023]
Abstract
The basic therapy of metastatic prostate carcinoma is androgen deprivation therapy. Unfortunately, almost all patients develop resistance to treatment that leads to castration-resistant prostate cancer. From 2010, 6 new active substances were registered for the treatment of metastatic castration-resistant prostate cancer, which dramatically improved the overall survival of patients. Two of these are treatments for the androgenic axis, the other drugs or therapeutic methods are immunotherapy, chemotherapy, isotope treatment and RANK-ligand inhibition. The year 2018 was a major success in the treatment of nonmetastatic castration-resistant prostate carcinoma, with the FDA authorizing both apalutamide and enzalutamide at this stage. The aim of this review is to present the standard of care of metastatic castration-resistant prostate cancer by disease stage, and to introduce the emerging treatment modalities presently assessed in clinical trials and discuss the open questions.
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Affiliation(s)
- Zsófia Küronya
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Krisztina Biró
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary
| | - Lajos Géczi
- Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
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Maráz A, Géczi L, Küronya Z. [New therapeutic options for hormone sensitive prostate cancers]. Magy Onkol 2019; 63:33-39. [PMID: 30889619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 06/09/2023]
Abstract
During the last decades androgen deprivation therapy (ADT) was the standard treatment of prostate cancers. Survival of metastatic patients is 4 years if they receive ADT, but in case of poor prognosis survival rate is under 3 years. Since 2014 two prospective phase III studies have proven the survival advantage of early docetaxel therapy, administered together with ADT, for metastatic hormone-sensitive prostate cancer patients. Its advantage was even more considerable in case of high-volume metastatic cases. In two other studies the benefit of abiraterone-prednisone therapy combined with ADT was proven in comparison with ADT itself in case of newly diagnosed, metastatic, high-risk, hormone-naïve patients. One prospective study has proven the survival benefit of ADT administered together with radiotherapy of the prostate in case of low volume metastatic diseases. In our analysis we demonstrate these clinical studies and try to answer the contradictory questions about the occasionally overlapping therapeutic options.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Lajos Géczi
- Urogenitális tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Zsófia Küronya
- Urogenitális tumorok és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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Abstract
Li-Fraumeni syndrome is a rare genetic disorder predisposing the individual to multiple different cancer types, caused by a germline mutation of the TP53 or CHEK2 genes inherited in an autosomal dominant manner. We hereby describe the case of a family with Li-Fraumeni syndrome. An asymptomatic 40-year-old female was diagnosed with primary lung leiomyosarcoma (T3N0), adenocarcinoma (T1aN0), and inflammatory myofibroblastic tumor, which were surgically removed without further treatment. Twenty months later she underwent surgery for retroperitoneal liposarcoma and even though she received adjuvant chemotherapy, deceased shortly after. Due to family history, the patient underwent TP53 mutation testing, using peripheral blood genomic DNA, which identified a heterozygous, likely pathogenic missense mutation (c.722C>G p.Ser241Cys) in case of the mother and her son. Three years after the patient's death, her 17-year-old son was diagnosed with a 3.5 cm osteosarcoma of the right second rib, which was surgically removed, followed by adjuvant chemotherapy. However, despite treatment, he deceased after two years. Throughout four generations of the patient's family, 10 malignant tumors (stomach-, breast-, 2 lung-, and colon cancer, leukemia, leiomyosarcoma, liposarcoma and 2 osteosarcoma) were diagnosed with a mean age of 43.2 (13-70 years) years. The simultaneous appearance of primary lung leiomyosarcoma, inflammatory myofibroblastic tumor and adenocarcinoma in the same organ is extremely rare. When possible, surgical resection should be carried out. Genetic testing for TP53 is recommended when family history is suggestive of Li-Fraumeni syndrome. Prognosis remains poor. Orv Hetil. 2019; 160(6): 228-234.
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Affiliation(s)
- Anita Sejben
- Pathologiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Tiszlavicz
- Pathologiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Kornélia Polyák
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School Boston, MA, Amerikai Egyesült Államok
| | - László Kovács
- Reumatológiai és Immunológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Dóra Török
- Orvosi Genetikai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Ádám Leprán
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - Aurél Ottlakán
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
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Küronya Z, Sükösd F, Varga L, Bíró K, Gyergyay F, Géczi L, Nagyiványi K, Jorgo K, Szarvas T, Kovács Á, Laczó I, Varga Z, Pósfai B, Pepó J, Maráz A. ERG expression can predict the outcome of docetaxel combinedwith androgen deprivation therapy in metastatic hormone-sensitiveprostate cancer. Urol Oncol 2019; 37:289.e1-289.e9. [PMID: 30679082 DOI: 10.1016/j.urolonc.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Our study aimed to analyze the potential association between clinical parameters and ERG expression and the outcome of docetaxel chemotherapy among patients with metastatic hormone-sensitive prostate cancer. PATIENTS AND METHODS Fifty-five patients with metastatic hormone-sensitive prostate cancer were treated with docetaxel in addition to androgen deprivation therapy. Patient characteristics, clinical factors, and tumor expression of ERG by immunohistochemistry were analyzed with respect to therapeutic response and survival data. RESULTS Relapse free survival (RFS) and overal survival (OS) were 10.5 and 40.4 months, respectively, and both correlated with PSA response (RFS: 16.8 with a ≥50% decrease in PSA vs. 5.9 months in the case of <50% decrease, P < 0.001; OS: 40.4 vs. 11.6 months, respectively, P < 0.001). There was an association between OS and early progression (OS: 40.4 months with progression after 12 months vs. 17.9 months with progression within 12 months, P = 0.009). ERG expression was detected in 21 (42%) samples. ERG positivity was associated with favorable RFS (ERG pos. vs. neg.: 26.0 vs. 11.4 months, P = 0.003). CONCLUSION ERG expression may have a potential predictive value with respect to the effectiveness and outcome of docetaxel chemotherapy combined with androgen deprivation therapy.
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Affiliation(s)
- Zsófia Küronya
- National Institute of Oncology, Department of Medical Oncology and Clinical Pharmacology "C", Budapest, Hungary
| | - Farkas Sükösd
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Linda Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Krisztina Bíró
- National Institute of Oncology, Department of Medical Oncology and Clinical Pharmacology "C", Budapest, Hungary
| | - Fruzsina Gyergyay
- National Institute of Oncology, Department of Medical Oncology and Clinical Pharmacology "C", Budapest, Hungary
| | - Lajos Géczi
- National Institute of Oncology, Department of Medical Oncology and Clinical Pharmacology "C", Budapest, Hungary
| | - Krisztián Nagyiványi
- National Institute of Oncology, Department of Medical Oncology and Clinical Pharmacology "C", Budapest, Hungary
| | - Kliton Jorgo
- National Institute of Oncology, Department of Radiotherapy, Budapest, Hungary; Semmelweis University, Department of Oncology, Budapest
| | - Tibor Szarvas
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Ágnes Kovács
- Boehringer Ingelheim RCV GmbH & Co. KG Branch Office Hungary, Budapest, Hungary
| | | | - Zoltán Varga
- University of Szeged, Department of Oncotherapy, Szeged, Hungary
| | - Boglárka Pósfai
- University of Szeged, Department of Oncotherapy, Szeged, Hungary
| | - Judit Pepó
- University of Szeged, Department of Oncotherapy, Szeged, Hungary
| | - Anikó Maráz
- University of Szeged, Department of Oncotherapy, Szeged, Hungary.
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Urbán R, Kun B, Mózes T, Soltész P, Paksi B, Farkas J, Kökönyei G, Orosz G, Maráz A, Felvinczi K, Griffiths MD, Demetrovics Z. A Four-Factor Model of Work Addiction: The Development of the Work Addiction Risk Test Revised. Eur Addict Res 2019; 25:145-160. [PMID: 30982051 DOI: 10.1159/000499672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Work has a crucial role in individuals' productivity, social life, and psychological well-being. Despite various definitions of work addiction in the literature, the number of psychometrically reliable instruments is limited. OBJECTIVES The aim of this study was to psychometrically test and revise the factor structure of the Work Addiction Risk Test (WART), one of the most widely used instruments assessing work addiction. METHOD The full version of the WART [Robinson, Post, & Khakee, 1992] was assessed using a nationally representative sample of Hungary (n = 2,710). To increase validity, the analyses were conducted among individuals who worked at least 40 h a week (n = 1,286, 43% women, mean age = 38.9 years, SD = 10.8). RESULTS Using confirmatory factor analysis, the originally proposed 4- and 5-factor solutions did not have adequate model fit indices. Thus, the sample was randomly divided into 2 subsamples. Exploratory factor analysis conducted in the first half of the sample supported a 4-factor solution, which was confirmed in the other half of the sample. The Work Addiction Risk Test Revised (WART-R) comprises 17 items and 4 factors (i.e., Overcommitment, Impatience, Hard-working, and Salience). Using a latent class analysis, a cutoff score (51 points out of 68) for the high risk of work addiction was determined. Almost one in 10 participants (9.3%) were identified as being symptomatic of work addiction, and these individuals also reported an elevated level of mental distress and hostility. CONCLUSIONS As a conclusion, the WART-R is suitable to be used as an indicator of work addiction based on clinically relevant symptom dimensions.
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Affiliation(s)
- Róbert Urbán
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Bernadette Kun
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary,
| | - Tamás Mózes
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Péter Soltész
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Borbála Paksi
- Institute of Education, Eötvös Loránd University, Budapest, Hungary.,Centre for Behavioral Research, Corvinus University of Budapest, Budapest, Hungary
| | - Judit Farkas
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gábor Orosz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Anikó Maráz
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Katalin Felvinczi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Mark D Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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21
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Küronya Z, Bíró K, Géczi L, Maráz A. [Modern treatment of metastatic hormone-sensitive prostate cancer]. Orv Hetil 2018; 159:1664-1671. [PMID: 30295043 DOI: 10.1556/650.2018.31218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The treatment of metastatic prostate cancer can be divided into two pathophysiological phases: hormone-sensitive and castration-resistant phases. Huggins' observation in the year 1941, which was awarded with the Nobel Prize in 1966, has a key role in treatment during the hormone-sensitive phase, stating that if the testicles are removed, the size of the prostate cancer decreases. Inducing androgen deprivation, i.e., testosterone depletion is the basic treatment of metastatic prostate cancer that patients have to receive life-long. In the past eight years, five new agents have been approved besides docetaxel in the treatment of metastatic castration-resistant prostate cancer: sipuleucel-T, cabazitaxel, abiraterone, enzalutamide, and radium-223. With the sequential application of these agents, significant improvement can be achieved in survival. Besides the latest developments, the hormone-sensitive phase has become the focus of attention, especially in the treatment of patients with de novo metastases and poor prognosis. Many studies have proven the outstanding efficacy of adding early docetaxel and abiraterone to androgen deprivation therapy. The authors give a detailed overview of clinical studies leading to a paradigm change in treatment during the hormone-sensitive phase, and call attention to the difficulties encountered in Hungarian practice. Orv Hetil. 2018; 159(41): 1664-1671.
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Affiliation(s)
- Zsófia Küronya
- "C" Belgyógyászati, Onkológiai és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet Budapest, Ráth Gy. u. 7-9., 1122
| | - Krisztina Bíró
- "C" Belgyógyászati, Onkológiai és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet Budapest, Ráth Gy. u. 7-9., 1122
| | - Lajos Géczi
- "C" Belgyógyászati, Onkológiai és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet Budapest, Ráth Gy. u. 7-9., 1122
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
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22
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Farkas I, Besenyi Z, Maráz A, Bajory Z, Palkó A, Sipka G, Pávics L. [Initial experiences with 99mTc-PSMA-SPECT/CT in patients with prostate cancer]. Orv Hetil 2018; 159:1433-1440. [PMID: 30146905 DOI: 10.1556/650.2018.31128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The prostate-specific membrane antigen (PSMA) is a transmembrane protein, that is highly expressed on the surface of prostate cancer cells. In the last few years, several PSMA-specific ligands have been developed, that can be successfully used to detect primary prostate cancer, tumor recurrences and metastases as well. AIM The goal of our work was to examine the clinical application of a 99mtechnetium-labeled PSMA-radiopharmaceutical as part of the routine diagnostics of prostate cancer. METHOD We examined 15 male patients with verified prostate adenocarcinoma with suspicion of progression or recurrence of the disease. We performed whole-body PSMA-SPECT/CTs and multiparametric MRIs of the prostate and the pelvic regions within a week. We used 99mTc-mas3-y-nal-k(Sub-KuE) for the PSMA-SPECT scans. The images were visually evaluated by independent observers. The results were compared with the follow-up bone scintigraphies as well. RESULTS Twenty-two PSMA-positive lesions were found. Nine of them were localized outside, 13 were within the MRI's field of view. From these 13 lesions, 7 matched with the SPECT/CT results and in 5 cases the MRI images showed no abnormalities. In one case, bone metastasis was suspected on the MRI scan but there was no corresponding pathological tracer uptake on the SPECT images. In two patients, none of the examinations showed signs of prostate malignancy. Four patients had PSMA-positive bone metastases. One of them had a matching PSMA/SPECT and bone scintigraphy result and in one case the PSMA examination showed metastasis in contrast to the negative bone scintigraphy. CONCLUSION PSMA-SPECT/CT with 99mTc-mas3-y-nal-k(Sub-KuE) is a promising diagnostic tool. This technique is capable of visualizing bone metastases and it can detect local recurrences and visceral metastases as well. Orv Hetil. 2018; 159(35): 1433-1440.
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Affiliation(s)
- István Farkas
- Nukleáris Medicina Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 6., 6720
| | - Zsuzsanna Besenyi
- Nukleáris Medicina Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 6., 6720
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Zoltán Bajory
- Urológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - András Palkó
- Radiológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Gábor Sipka
- Nukleáris Medicina Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 6., 6720
| | - László Pávics
- Nukleáris Medicina Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 6., 6720
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23
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Varga L, Bajory Z, Pajor L, Révész J, Sükösd F, Maráz A. [Edifications and modern strategies of localized prostate cancers' definitive therapy]. Orv Hetil 2018; 159:1317-1325. [PMID: 30078360 DOI: 10.1556/650.2018.31105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION 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. AIM 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. METHOD 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Linda Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 12., 6720
| | - Zoltán Bajory
- Urológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Pajor
- Urológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - János Révész
- Onkoterápiás Centrum, Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktató Kórház Miskolc
| | - Farkas Sükösd
- Pathologiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 12., 6720
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24
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Pósfai B, Kuthi L, Varga L, Laczó I, Révész J, Kránicz R, Maráz A. The Colorful Palette of Neuroendocrine Neoplasms in the Genitourinary Tract. Anticancer Res 2018; 38:3243-3254. [PMID: 29848671 DOI: 10.21873/anticanres.12589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Boglárka Pósfai
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Levente Kuthi
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Linda Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - János Révész
- Institute of Radiotherapy and Clinical Oncology, Borsod County Hospital and University Academic Hospital, Miskolc, Hungary
| | - Réka Kránicz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
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25
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Varga L, Kószó RL, Fodor E, Cserháti A, Varga Z, Darázs B, Kahán Z, Hideghéty K, Borzási E, Szabó D, Müllner K, Maráz A. Daily Setup Accuracy, Side-effects and Quality of Life During and After Prone Positioned Prostate Radiotherapy. Anticancer Res 2018; 38:3699-3705. [PMID: 29848730 DOI: 10.21873/anticanres.12648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Exposure of organs at risk with prostate radiotherapy (RT) is lower in the prone position. This study is a prospective evaluation of setup accuracy, side-effects, and quality of life (QOL) during and after prone positioned RT. PATIENTS AND METHODS Image-guided (IG) intensity-modulated (IM) RT was administered in prone position on belly-board to 55 high-risk prostate cancer (PC) patients. Rectum diameters were measured in two areas of the symphysis at the beginning of RT and during it. Side-effects, QOL, and prostate specific symptoms (PSS) were evaluated. RESULTS Setup accuracy was similar to that reported in the literature. In the upper area of symphysis rectal diameters were significantly changed during treatment, but in the prostate region, no difference was detected. No change was detected in patients' QOL and PSS during treatment, but after RT, they improved. CONCLUSION Prone positioned IG-IMRT is feasible with tolerable side-effects for high-risk PC patients. Changes in QOL and PSS are insignificant during RT, while improvement after RT suggests a rapid recovery.
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Affiliation(s)
- Linda Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Emese Fodor
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Zoltán Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Barbara Darázs
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Emőke Borzási
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Dorottya Szabó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Kitti Müllner
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
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Ottlakán A, Pécsy B, Csada E, Ádám G, Maráz A, Borda B, Lázár G, Furák J. Tüdőlebeny-eltávolítást követő kemoterápia tolerabilitását befolyásoló perioperatív tényezők. Orv Hetil 2018; 159:748-755. [DOI: 10.1556/650.2018.31016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract: Introduction: Lung cancer is the leading cause of malignancy-related deaths in Hungary, involving complex surgical and oncological treatment. Aim: Factors influencing the tolerability of complete/planned and incomplete postoperative chemotherapy after surgery were analyzed. Method: During a 6-year period (January 1, 2011–December 31, 2016), data of 72 patients operated with lung cancer (adenocarcinoma and squamous cell carcinoma), receiving complete (4 cycles) and incomplete (<4 cycles) postoperative chemotherapy were analyzed. The following factors among the two groups [complete: n = 53; incomplete: n = 19] were analyzed: gender, mean age, body mass index, Malnutrition Universal Screening Tool, Charlson Comorbidity Index, second malignant tumor, atrial fibrillation, Forced Expiratory Volume 1 sec, Performance Status, open/Video-Assisted Thoracic Surgery (VATS) lobectomy, duration of surgery, postoperative fever, need for transfusion, prolonged air leak, redo surgery, histology, tumor stage. Results: The rate of complete postoperative cycles obtained from logistic regression analysis, were substantially higher after VATS lobectomies [n = 26 (83.87%)] compared to open procedures [n = 27 (65.85%)]; (p = 0.092; OR = 0.356), without significance. Multivariate analysis (open/VATS lobectomy, upper/middle-lower lobe resection, diabetes, prolonged air leak, postoperative fever) showed significantly increased successful uptake of complete cycles after VATS (p = 0.0495), while upper/middle lobe resections (p = 0.0678) and the lack of diabetes (p = 0.0971) notably increased the number of complete cycles, without significance. Conclusion: Twenty-six percent of patients were unable to receive complete planned postoperative chemotherapy. VATS lobectomy patients received significantly higher number of complete cycles of postoperative chemotherapy. Diabetes and lower lobe lobectomies had a negative effect on the tolerability of postoperative chemotherapy. Orv Hetil. 2018; 159(19): 748–755.
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Affiliation(s)
- Aurél Ottlakán
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - Balázs Pécsy
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - Edit Csada
- Csongrád Megyei Mellkasi Betegségek Szakkórháza Deszk
| | - Gábor Ádám
- Csongrád Megyei Mellkasi Betegségek Szakkórháza Deszk
| | - Anikó Maráz
- Onkológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Bernadett Borda
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - György Lázár
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
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27
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Maráz A, Cserháti A, Uhercsák G, Szilágyi É, Varga Z, Révész J, Kószó R, Varga L, Kahán Z. Dose escalation can maximize therapeutic potential of sunitinib in patients with metastatic renal cell carcinoma. BMC Cancer 2018; 18:296. [PMID: 29544452 PMCID: PMC5856318 DOI: 10.1186/s12885-018-4209-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/09/2018] [Indexed: 12/24/2022] Open
Abstract
Background 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. Methods 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. Results 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%. Conclusions 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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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary.
| | - Adrienn Cserháti
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Gabriella Uhercsák
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Éva Szilágyi
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Zoltán Varga
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - János Révész
- Institute of Radiotherapy and Clinical Oncology, Borsod County Hospital and University Academic Hospital, Szentpéteri Kapu 72-76, Miskolc, H-3526, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Linda Varga
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
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Maráz A, Boér K, Dankovics Z, Dank M, Lahm E, Petrányi Á, Révész J, Ruzsa Á, Szûcs M, Valikovics A, Vas M, Küronya Z. [Experience with cabazitaxel therapy for patients with metastatic castrate resistant prostate cancer in Hungary]. Magy Onkol 2017; 61:353-360. [PMID: 29257155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
Our aim was to assess the efficacy and adverse effects of cabazitaxel (CBZ), a chemotherapeutic agent that can be administered to patients with metastatic castrate resistant prostate cancer (mCRPC) after docetaxel (DOC) therapy. We retrospectively analyzed data of CBZ received by mCRPC patients in 12 Hungarian oncological centers between 01/2016 and 06/2017. CBZ (25 or 20 mg/m2 q3w) was administered after DOC. Physical and laboratory examinations were performed in every cycle, tumor response was evaluated in every third cycle based on PCWG2 criteria. Adverse effects were evaluated based on CTCAE 4.0. Data of 60 patients were analyzed. CBZ was administered in 2nd and 3rd lines in 31.6% and 46.6%, while in 4th and 5th lines in 15% and 6.6% patients, respectively. Its starting dose was 25 mg/m2 and 20 mg/m2 in 65% and 35% of cases, respectively. The median number of cycles was 5. Progression-free survival and overall survival were 5.52 and 15.77 months, respectively. Survival results were similar in case of DOC-CBZ-ART/alfaradin and DOC-ART/alfaradin-CBZ sequences. Adverse effects were detected in 63,3% of patients. The most common adverse effects were neutropenia, anemia, and diarrhea. Our observations suggest that CBZ, with the appropriate support and chemotherapeutic experience, is well-tolerated and effective therapy of mCRPC after DOC.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Katalin Boér
- Onkológia, Szent Margit Kórház, Budapest, Hungary
| | - Zsófia Dankovics
- Onkoradiológiai Osztály, Markusovszky Egyetemi Oktató Kórház, Szombathely, Hungary
| | - Magdolna Dank
- Onkológiai Központ, Semmelweis Egyetem, Budapest, Hungary
| | - Erika Lahm
- Onkológiai Osztály, Magyar Honvédség Egészségügyi Központ, Budapest, Hungary
| | - Ágota Petrányi
- Onkológiai Osztály, Egyesített Szent István és Szent László Kórház, Budapest, Hungary
| | - János Révész
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház, Miskolc, Hungary
| | - Ágnes Ruzsa
- Klinikai Onkológiai Centrum, Somogy Megyei Kaposi Mór Oktató Kórház, Kaposvár, Hungary
| | - Miklós Szûcs
- Urológiai Klinika, Semmelweis Egyetem, Uroonkológiai Központ, Budapest, Hungary
| | - Anikó Valikovics
- Fõvárosi Onkoradiológiai Központ, Uzsoki Utcai Oktató Kórház, Budapest, Hungary
| | - Mária Vas
- Onkológia-Hematológia Osztály, Péterfy Sándor Utcai Kórház, Budapest, Hungary
| | - Zsófia Küronya
- C Belgyógyászati-Onkológiai és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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Füstös Z, Belák Á, Maráz A. Colonization ability of Escherichia coli and Listeria monocytogenes in the endosphere of sweet pepper (Capsicum annuum var. grossum). Acta Alimentaria 2017. [DOI: 10.1556/066.2017.46.4.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Z. Füstös
- Department of Nutritional Physiology, Food Science Research Institute, National Agricultural Research and Innovation Center, H-1022 Budapest, Herman Ottó út 15. Hungary
| | - Á. Belák
- Department of Microbiology and Biotechnology, Faculty of Food Science, Szent István University, H-1118 Budapest, Somlói út 14–16. Hungary
| | - A. Maráz
- Department of Microbiology and Biotechnology, Faculty of Food Science, Szent István University, H-1118 Budapest, Somlói út 14–16. Hungary
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Furak J, Geczi T, Polyak K, Kovacs L, Tiszlavicz L, Ottlakan A, Pecsy B, Maráz A. F-052SYNCHRONOUS MULTIPLE PRIMARY LUNG TUMOURS IN A GENETIC FAMILIAR SYNDROME: HOW TO APPROACH? Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Géczi L, Nagyiványi K, Maráz A. [Immunotherapy of renal cell cancer]. Magy Onkol 2017; 61:126-131. [PMID: 28585613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/23/2017] [Indexed: 06/07/2023]
Abstract
The authors briefly highlight the results of targeted therapy and present new solutions in kidney cancer immunotherapy. The important checkpoint inhibitors (anti-CTLA-4, -PD-1 and -PD-L1/2) and their combinations, together with the combinations of targeted drugs and immunotherapy are discussed. The newest checkpoint agents, vaccination and pegylated interleukin-2 are also presented. The most promising clinical trials (CheckMate-025, AGS-003, IMA 901) and the on-going first line phase III trials are shown in metastatic clear cell renal carcinoma.
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Affiliation(s)
- Lajos Géczi
- Kemoterápia C Belgyógyászati-Onkológiai és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Krisztián Nagyiványi
- Kemoterápia C Belgyógyászati-Onkológiai és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary
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Maráz A, Géczi L. [The role of immunotherapy in the modern treatment of urothelial carcinoma]. Magy Onkol 2017; 61:139-146. [PMID: 28585615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/10/2017] [Indexed: 06/07/2023]
Abstract
By the emergence of modern immunotherapies with active agents like PD-1 (nivolumab, pembrolizumab) and PD-L1 immune checkpoint blockers (atezolizumab, avelumab, durvalumab), new therapeutic options have become available for the treatment of patients with locally advanced and metastatic urothelial carcinoma. According to the recent publications, they have been effective in case of progression after platinum therapy, in or after second-line and in firstline therapies for cisplatin ineligible patients, respectively. Patient survival and tumor response data are very promising; in particular stages, they seem to be more effective than the previously administered chemotherapies. Their toxicity profiles also appear to be more favorable. Immunological side effects are rare; their identification and management require preparedness and multidisciplinary thinking. Current and ongoing trials are investigating the combinations of new remedies with other immunotherapeutic agents (e.g., CTLA-4 inhibitor ipilimumab, tremelimumab) or chemotherapies as well as trying to identify biomarkers in order to further increase effectiveness. In our review, we summarize the recently published data about urothelial carcinoma therapy and give a brief overview of the ongoing clinical trials.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Lajos Géczi
- C Belgyógyászati-Onkológiai és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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Hideghéty K, Cserháti A, Besenyi Z, Zag L, Gaál S, Együd Z, Mózes P, Szántó E, Csenki M, Rusz O, Varga Z, Dobi Á, Maráz A, Pávics L, Lengyel Z. [Role of 18FDG-PET/CT in the management and gross tumor volume definition for radiotherapy of head and neck cancer; single institution experiences based on long-term follow-up]. Magy Onkol 2015; 59:103-110. [PMID: 26035157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/11/2015] [Indexed: 06/04/2023]
Abstract
The purpose of our work is evaluation of the impact of 18FDG-PET/CT on the complex management of locoregionally advanced (T3-4N1-3) head and neck squamous cell cancer (LAHNSC), and on the target definition for 3D conformal (3DCRT) and intensity-modulated radiotherapy (IMRT). 18FDG-PET/CT were performed on 185 patients with LAHNSC prior to radiotherapy/chemoradiation in the treatment position between 2006 and 2011. Prior to it 91 patients received induction chemotherapy (in 20 cases of these, baseline PET/CT was also available). The independently delineated CT-based gross tumor volume (GTVct) and PET/CT based ones (GTVpet) were compared. Impact of PET/CT on the treatment strategy, on tumor response evaluation to ICT, on GTV definition furthermore on overall and disease-specific survival (OS, DSS) was analysed. PET/CT revealed 10 head and neck, 2 lung cancers for 15 patients with carcinoma of unknown primary (CUP) while 3 remained unknown. Second tumors were detected in 8 (4.4%), distant metastasis in 15 (8.2%) cases. The difference between GTVct and GTVpet was significant (p=0.001). In 16 patients (14%) the GTVpet were larger than GTVct due to multifocal manifestations in the laryngo-pharyngeal regions (4 cases) or lymph node metastases (12 cases). In the majority of the cases (82 pts, 72%) PET/CT-based conturing resulted in remarkable decrease in the volume (15-20%: 4 cases, 20-50%: 46 cases, >50%: 32 cases). On the basis of the initial and post-ICT PET/CT comparison in 15/20 patients more than 50% volume reduction and in 6/20 cases complete response were achieved. After an average of 6.4 years of follow-up the OS (median: 18.3±2.6 months) and DSS (median: 25.0±4.0 months) exhibited close correlation (p=0.0001) to the GTVpet. In cases with GTVpet <10 cm3 prior to RT, DSS did not reach the median, the mean is 82.1±6.1 months, while in cases with GTVpet 10-40 cm3 the median of the DSS was 28.8±4.9 months (HR = 3.57; 95% CI: 1.5-8.3), and in those with GTVpet >40 cm3 the median DSS was 8.4±0.96 months (HR= 11.48; 95% CI: 5.3-24.9). Our results suggest that 18FDG-PET/CT plays an important role for patient with LAHNSC, by modifying the treatment concept and improving the target definition for selective RT modalities. Volumetric PET/CT-based assessment of the tumor response after ICT gives valuable contribution to further therapy planning.
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Affiliation(s)
| | | | - Zsuzsanna Besenyi
- Nukleáris Medicina Tanszék, Szegedi Tudományegyetem, Szeged, Hungary
| | - Levente Zag
- Sürgõsségi Betegellátó Osztály, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
| | - Szilvia Gaál
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Zsófia Együd
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Petra Mózes
- Klinikum rechts der Isar, Technische Universität München, Department of Radiation Oncology, München, Germany
| | - Erika Szántó
- Klinikai Központ, Debreceni Egyetem, Onkológiai Intézet, Debrecen, Hungary
| | - Melinda Csenki
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Orsolya Rusz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Zoltán Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Ágnes Dobi
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - László Pávics
- Nukleáris Medicina Tanszék, Szegedi Tudományegyetem, Szeged, Hungary
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Dobi A, Cserhati A, Maráz A, Mózes P, Fodor E, Együd Z, Szabó C, Kószó R, Varga Z, Gróh F, Kahán S, Csenki M, Barzó P, Tiszlavicz L, Hideghéty K. EP-1299: Simultaneous integrated boost, a novel approach in the management of brain metastases. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Belák Á, Héher B, Füstös Z, Kovács M, Maráz A. Endophytic bacteria fromCapsicum annuumvar.grossumcultivars and their inhibitory effects onListeria monocytogenes. Acta Alimentaria 2014. [DOI: 10.1556/aalim.43.2014.suppl.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Maráz A, Cserháti A, Uhercsák G, Szilágyi E, Varga Z, Kahán Z. [Therapeutic significance of sunitinib-induced "off-target" side effects]. Magy Onkol 2014; 58:167-172. [PMID: 25260080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/02/2014] [Indexed: 06/03/2023]
Abstract
Sunitinib is a basic medicine in the therapy of metastatic clear cell renal carcinoma. Our aim was to retrospectively evaluate the efficacy of sunitinib in the everyday clinical practice taking the most common side effects and clinical features into consideration. Data of ninety-four patients with metastatic, clear cell renal carcinoma, receiving sunitinib therapy were analyzed retrospectively, regarding efficacy and toxicity. Factors potentially influencing progression-free survival (PFS) and overall survival (OS) [age, nephrectomy, "off-target" side effects that are not connected to vascular endothelial growth factor receptor (VEGFR)] were studied. Complete remission, partial remission and stable disease occurred in 8 (8.5%), 30 (31.9%) and 50 (53.1%) patients, respectively. Objective tumor response developed in 38 (40.4%) cases. Median PFS and OS were 18.3 (95% CI 14.45-22.14) and 27.9 (95% CI 20.95-34.85) months, respectively. PFS and OS were more favorable in case of hypothyreosis (pPFS=0.005, pOS=0.043), hand-foot syndrome (pPFS=0.006, pOS=0.008), grade ≥2 neutropenia (pPFS=0.003, pOS=0.008) and thrombocytopenia (pPFS=0.01, pOS=0.011). Effective therapy of manageable side effects (most of which have potential predictive effect) is important for favorable survival results. Maintenance of dose intensity is also essential in order to compare the daily routine with the efficacy and safety results of clinical trials.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | | | | | - Eva Szilágyi
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Zoltán Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Zsuzsanna Kahán
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
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Maráz A, Bodoky G, Dank M, Géczi L, Kahán Z, Mangel L, Révész J, Szűcs M. [Experience with everolimus therapy for patients with metastatic renal cancer in Hungary]. Magy Onkol 2014; 58:4-9. [PMID: 24712001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/04/2014] [Indexed: 06/03/2023]
Abstract
Everolimus is indicated for the therapy of adults with advanced renal cell carcinoma after failure of treatment with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI). The aim of the study was a multicenter evaluation of efficiency and toxicity of everolimus in patients with metastatic renal carcinoma who received one line of VEGFR-TKI therapy. Data of one hundred and one patients were analyzed retrospectively. Patients received everolimus therapy between January 2010 and July 2013. Data were collected in 7 different oncology institutes in Hungary. Starting daily dose of everolimus was 10 mg in 28-day cycles. Physical and laboratory examinations were done monthly. Imaging tests were performed every 3 months. Tumor response and toxicity were evaluated according to RECIST 1.0 and NCI CTCAE 3.0, respectively. Statistical analysis was performed with SPPS version 20.0 for Windows. Currently 26 (27%) patients are being treated, 52 (54.1%) patients are alive. Median progression-free survival (PFS) was 5.7 months (95% CI 4.07-7.33). Partial remission, stable disease and progression occurred in 6 (6%), 71 (74%) and 19 (20%) patients, respectively. Median overall survival (OS) was 14.3 months (95% CI 6.99-19.81). PFS and OS results were more favorable in patients with ECOG 0-1. Survival was poorer in case of anemia, while better if PFS was longer than 12 months. In anemic patients with ECOG 0-1 and ECOG 2-3 OS was 30.9 and 7.7 months, respectively (p=0.031). Dose reduction and treatment delay happened in 8 (7.9%) and 12 (11.9%) cases, respectively. The most common side effects were the following: exanthema, edema, stomatitis, pneumonitis, anemia and abnormal kidney-, liver functions, blood sugar and cholesterol levels. According to the Hungarian experience, everolimus can safely be administered. PFS and OS results representing the centers' everyday practice, are similar to the results of the respective subgroups in the registration study.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - György Bodoky
- Onkológiai Osztály, Egyesített Szent István és Szent László Kórház, Budapest, Hungary
| | - Magdolna Dank
- I. Sz. Belgyógyászati Klinika, Semmelweis Egyetem, Onkológiai Részleg, Budapest, Hungary
| | - Lajos Géczi
- C Belgyógyászati-Onkológiai és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Zsuzsanna Kahán
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - László Mangel
- Onkoterápiás Intézet, Pécsi Tudományegyetem Klinikai Központ, Pécs, Hungary
| | - János Révész
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház, Miskolc, Hungary
| | - Miklós Szűcs
- Urológiai Klinika és Uroonkológiai Centrum, Semmelweis Egyetem, Budapest, Hungary
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Maráz A, Bodrogi I, Csejtei A, Dank M, Géczi L, Küronya Z, Mangel L, Petrányi A, Szûcs M, Bodoky G. [First Hungarian experience with pazopanib therapy for patients with metastatic renal cancer]. Magy Onkol 2013; 57:173-176. [PMID: 24107823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/09/2013] [Indexed: 06/02/2023]
Abstract
Pazopanib, a tyrosine kinase inhibitor, is one of the new registered first-line therapeutic options in the treatment of metastatic clear cell renal carcinoma. Our aim was to evaluate the efficiency and toxicity of first-line pazopanib therapy administered for patients with metastatic clear cell renal carcinoma with good- and medium prognosis according to MSKCC criteria. Between January and May, 2011, 24 patients have been treated with pazopanib in 8 oncology centers in Hungary, out of them 21 patients' data were analyzed. The mean age was 65.3 (49-81) years, 10 males and 11 females. According to MSKCC the prognosis was good and medium in 3 and 18 cases, respectively. Daily dose of pazopanib was 800 mg administered continuously in 28 day cycles. Dose reduction was performed according to the instructions of the registration study. Tumor response was evaluated according to RECIST 1.0. Currently 6 (28.6%) patients are on treatment. Dose reduction was necessary in 6 (28.6%) cases with an average duration of 14.55 (7-150) days. Mean±SE daily dose was 692.97±13.67 (400-800) mg. Median PFS was 12.41 months (95% CI 11.52-12.94 months). Complete remission (CR), as the best tumor response occurred in 2 (9.5%) cases. Partial remission (PR), stable disease (SD) and progression was observed in 6 (28.6%), 10 (47.6%) and 3 (14.3%) cases, respectively. Objective tumor response was observed in 8 pts (38%). Median survival could not be statistically analyzed yet due to the insignificant number of fatal outcomes. Median follow-up was 25.22 months (95% CI 2.47-28.1 months). As common side-effect fatigue, weakness and diarrhea occurred in 11 (52.4%), 9 (42.9%) and 8 (38%) cases, respectively. Besides these, worsening of high blood pressure and ALT/AST elevation was observed in 5 (23.8%) and 6 (28.6%) cases, respectively. Based on the initial Hungarian experiences, pazopanib is a well tolerable product and can be administered safely. According to our results its efficiency in terms of tumor response and progression-free survival is comparable to the results of the registration study.
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Affiliation(s)
- Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary
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Furák J, Géczi T, Pécsy B, Maráz A, Morvay Z. F-062DAILY ROUTINE CHEST X-RAYS ARE NOT NECESSARY IN ASYMPTOMATIC PATIENTS WITH CHEST TUBE AFTER LOBECTOMY. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Maráz A, Furák J, Varga Z, Kahán Z, Tiszlavicz L, Hideghéty K. Thrombocytosis has a negative prognostic value in lung cancer. Anticancer Res 2013; 33:1725-1729. [PMID: 23564823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Solid tumours have worse prognosis when associated with thrombocytosis. Our study assessed the prognostic value of thrombocytosis, and its relation with smoking habits in lung cancer. PATIENTS AND METHODS A total of 398 patients were operated on then divided into two groups, those with normal platelet counts (n=312), and those with thrombocytosis (n=86); 348 out of 398 patients had data for smoking habits (99 non-smokers, 249 smokers). RESULTS The frequency of thrombocytosis was 18.6%, 19.3%, 27.5 and 28.6% in patients with tumor stages I to IV, respectively. Thrombocytosis appeared most frequently in patients with squamous cell lung cancer, and among smokers. The overall 5-year survival was worse in patients with thrombocytosis (p<0.001). By uni- and multivariate analyses, platelet count, and T and N status were found to be independent prognostic factors. CONCLUSION Our study indicates that the presence of perioperative thrombocytosis in patients undergoing surgery should be considered as an independent prognostic factor of poor survival, and should be taken into account in regard to therapy.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary.
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Maráz A, Furák J, Varga Z, Fodor E, Együd Z, Borzási E, Kahán Z, Pálföldi R, Tiszlavicz L, Hideghéty K. Acute oesophageal toxicity related to paclitaxel-based concurrent chemoradiotherapy for non-small cell lung cancer. Anticancer Res 2013; 33:1737-1741. [PMID: 23564825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Dosimetric data and acute oesophageal toxicity (AET) during chemoradiotherapy (CRT) were evaluated in patients with non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Fifty patients were treated with paclitaxel-based conformal CRT with a mean ± SD dose of 60.7 ± 9.8 Gy. The oesophageal toxicity was prospectively registered and evaluated in relation to the maximal dose (Dmax), mean dose (D(mean)), length and volume of oesophagus irradiated with 35-60 Gy (V(35-60Gy)), and according to the seriousness of AET. RESULTS Dmax and D(mean) to the oesophagus were 57.0 ± 10.8 Gy and 24.9 ± 9.0 Gy, respectively. AET of grade 1, 2 and 3 developed in 16 (32%), 14 (28%) and three (6%) cases, respectively. The Dmax, D(mean), length and the V(35-60Gy) were all related to dysphagia (p<0.001). V(45Gy) was the most reliable predictor of AET of grade 2 or more. CONCLUSION Our results indicate that keeping oesophageal V(45Gy) below 32.5% can prevent severe AET during CRT of NSCLC.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary.
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Maráz A, Rigó P, Harmatta J, Takách G, Zalka Z, Boncz I, Andó B, Laczkó Z, Kurgyis E, Demetrovics Z. P-925 - Delay discounting: the effect of borderline personality disorder and substance use. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Therapeutic options in advanced renal-cell cancer have expanded through better understanding of molecular pathology and development of novel targeted therapeutics. Vascular endothelial growth factor, the key ligand of angiogenesis, has a major role in the progression of vascularized kidney tumors and this is the target molecule of modern medications. The three types of the mechanism of action of current therapies are: monoclonal antibodies blocking directly vascular endothelial growth factor ligand (bevacizumab), tyrosine-kinase inhibitors blocking vascular endothelial growth factor receptors (sorafenib, sunitinib, pazopanib) and inhibitors of the intracellular mTOR-kinase (temsirolimus, everolimus). Based on randomized studies, sunitinib, pazopanib or interferon-α-bevacizumab combination should be the first-line therapy in patients with good/moderate prognosis, while temsirolimus is recommended in those with poor prognosis. Following an ineffective cytokine therapy sorafenib or pazopanib are the second-line treatment. In case of tyrosine-kinase inhibitor inefficacy, current evidence favors everolimus. Patient outcome can further be improved by the involvement of more modern and effective target products. Orv. Hetil., 2011, 152, 655–662.
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Affiliation(s)
- Anikó Maráz
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Onkoterápiás Klinika Szeged Korányi fasor 12. 6720
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Maráz A, Furák J, Pálföldi R, Eller J, Szántó E, Kahán Z, Thurzó L, Molnár J, Tiszlavicz L, Hideghéty K. Roles of BCL-2 and MDR1 expression in the efficacy of paclitaxel-based lung cancer chemoradiation. Anticancer Res 2011; 31:1431-1436. [PMID: 21508398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The associations between B-cell lymphoma 2 (BCL-2) and multi-drug resistance associated P-glycoprotein (MDR1) expressions and chemoradiotherapy outcome of patients with non-small cell lung cancer (NSCLC) were analysed. PATIENTS AND METHODS Thirty-two NSCLC patients were treated with paclitaxel-based chemoradiotherapy. The tumour expressions of BCL-2 and MDR1 were analysed by means of immunohistochemistry with regard to the clinical response and survival data. RESULTS Partial remission and stable disease were achieved in 19 (59%) and 10 (31%) cases, respectively. Significant differences in progression-free survival were observed between responders and non-responders (13.7 vs. 6.0 months, p=0.028), and between patients with or without a gross tumour volume (GTV) shrinkage (GTV(>50) 13.7 vs. 6.0 months, p=0.009). Overexpression of BCL-2 and of MDR1 was observed in 6 (21.4%) cases each. Overexpression of both markers together was associated with poor response (GTV reduction: p=0.005; RECIST: p=0.023) and lower progression-free survival (overexpression of both, low expression of both, mixed: 3.1, 13.4, 4.1 months, respectively, p<0.001). CONCLUSION BCL-2 and MDR1 overexpression may predict the inefficacy of paclitaxel-based chemoradiotherapy.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, H-6720 Szeged, Hungary.
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Maráz A, Demetrovics Z. [Delay of reward in borderline personality disorder: systematic literature review]. Psychiatr Hung 2011; 26:68-77. [PMID: 21653992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIM Numerous studies report on high impulsivity and preference for "here and now" of patients suffering from Borderline Personality Disorder (BPD). In our paper, we aimed to explore and summarise those studies which explored the connection between BPD and delay discounting using empirical approach. METHOD In July 2010 five databases (PsycInfo, ScienceDirect, MedLine, Web of Science and PubMed) were searched using the keywords borderline, reward, "delay discount*" and "delay gratification". RESULTS Out of five we identified as relevant, only two studies found any difference in delaying gratification of BPDpatients compared to controls. CONCLUSION The analysis of results, sampling (sample size, age, fitted control) and methods (hypothetical questions)used by the studies reveal new hypotheses, and directions in this field of research.
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Affiliation(s)
- Anikó Maráz
- Eotvos Lorand Tudomanyegyetem, Pszichologiai Intezet, Addiktologiai Tanszeki Szakcsoport, Budapest, Hungary.
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Belák Á, Kovács M, Hermann Z, Holczman Á, Márta D, Stojakovič S, Bajcsi N, Maráz A. Molecular analysis of poultry meat spoiling microbiota and heterogeneity of their proteolytic and lipolytic enzyme activities. Acta Alimentaria 2011. [DOI: 10.1556/aalim.40.2011.suppl.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Varga L, Baradnay G, Hohn J, Simonka Z, Hideghéthy K, Maráz A, Nikolényi A, Veréb B, Tiszlavicz L, Németh I, Mán E, Lázár G. [Clinical and histopathological results after the neo-adjuvant treatment of advanced rectal tumors]. Magy Onkol 2010; 54:129-35. [PMID: 20576589 DOI: 10.1556/monkol.54.2010.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radio-chemotherapy has improved the efficacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2-4 N 1-2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the first and last week for 5-5 days they received 350 mg/m 2 /day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3 x 1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average after restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per annum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insufficiency. The long-term neo-adjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations.
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Affiliation(s)
- László Varga
- Szegedi Tudományegyetem AOK Sebészeti Klinika 6720 Szeged Pécsi u. 6.
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Majoros L, Kardos G, Szabó B, Kovács M, Maráz A. Fluconazole susceptibility testing of Candida inconspicua clinical isolates: comparison of four methods. J Antimicrob Chemother 2005; 55:275-6. [PMID: 15649997 DOI: 10.1093/jac/dkh539] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Majoros L, Kardos G, Belák A, Maráz A, Asztalos L, Csánky E, Barta Z, Szabó B. Restriction enzyme analysis of ribosomal DNA shows that Candida inconspicua clinical isolates can be misidentified as Candida norvegensis with traditional diagnostic procedures. J Clin Microbiol 2004; 41:5250-3. [PMID: 14605175 PMCID: PMC262479 DOI: 10.1128/jcm.41.11.5250-5253.2003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We identified 29 yeast isolates from 22 patients using the API ID32C panel. Twenty-eight of these isolates were Candida norvegensis and one was C. inconspicua. Although C. norvegensis is considered a pseudohypha-producing species, only one isolate produced pseudohyphae. Restriction enzyme analysis of PCR-amplified ribosomal DNA with four different enzymes proved that all isolates were C. inconspicua.
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Affiliation(s)
- L Majoros
- Department of Medical Microbiology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
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