Title Precision oncology in the treatment of gynecological cancers Title (croatian) Precizna onkologija u liječenju ginekoloških karcinoma Author Dora Čerina Mentor Eduard Vrdoljak (mentor)Committee member Antonio Juretić (predsjednik povjerenstva)Committee member Tomislav Omrčen (član povjerenstva)Committee member Snježana Tomić (član povjerenstva)Granter University of Split Defense date and country 2023-03-23, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616 - Pathology. Clinical medicine Abstract Due to the scientifical and technological evolution, development of precise diagnostic-therapeutic tools, such as comprehensive genomic profiling, as well as targeted therapy, approach to patient is dramatically changing and medicine is turning towards an individual. Also, the emphasis is put on the real-world data and learning from every patient individually. This personalization is most noticeable in oncology, as it is the most propulsive branch. However, its application in everyday clinical practice is still debatable. In order to question the real position of precision medicine in oncology, we conducted several studies on a national level in patients diagnosed with gynecological cancer. Gynecological cancers, precisely uterine, cervical and ovarian cancer, present the major public and health burden worldwide. The aim was to set path for personalized approach to a patient diagnosed with the cancer of female reproductive system. Two studies have shown utility of CGP as the backbone diagnostic and decision-making therapeutic tool for locally advanced and metastatic ovarian and uterine cance. CGP revealed one third of patients with metastatic uterine cancer who would potentially have benefit from immunotherapy with checkpoint inhibitors and it revealed almost 30% extra patients in ovarian cancer who would potentially benefit from PARP inhibitors. One study conducted on a national level as well has proved the results from phase III RCT in the real-world setting, regarding the optimal treatment of patients with metastatic cervical cancer, which is bevacizumab and chemotherapy. This is particularly important for other developing countries where bevacizumab is still not reimbursed. Meanwhile, review article presents current knowledge regarding the treatment of locally advanced cervical cancer with critical appraisal of the OUTBACK trial which results affirmed negative recommendation on adjuvant chemotherapy. Challenging its results and after calculating pooled hazard ratio from all RCT`s, there is subgroup of patients who would potentially have benefit from adjuvant chemotherapy. Thus, there is absolute need for further research in order to optimally address matter of adjuvant chemotherapy in locally advanced cervical cancer.
Abstract (croatian) Znanstveno-tehnološki napredak te razvoj preciznih dijagnostičko-terapijskih metoda, kao i ciljanih lijekova doveo je do fundamentalnih promjena u pristupu bolesniku te je upravo pojedinca smjestio u fokus medicine. Samim tim podatci iz stvarne kliničke prakse postaju sve važniji i do novih saznanja se dolazi učeći od svakog bolesnika. Personalizacija dolazi najbolje do izražaja u onkologiji koja je trenutno najpropulzivnija grana medicine. Unatoč tome, postoje oprečna mišljenja o aplikaciji precizne medicine u svakodnevnom onkološkom kliničkom radu. Proveli smo nekoliko studija na razini države kod bolesnica dijagnosticiranih s ginekološkim tumorom kako bismo ispitali stvarnu poziciju precizne medicine u onkologiji. Ginekološki tumori, točnije tumor vrata maternice, tijela maternice te jajnika, predstavljaju značajan javno-zdravstveni problem u svijetu. Cilj studija je bio opisati personalizirani pristup bolesnici oboljeloj od tumora ženskog spolnog sustava. Dvije studije su pokazale korist sveobuhvatnog genskog profiliranja kod bolesnica s lokalno uznapredovalim i metastatskim rakom jajnika te metastatskim rakom maternice. Sukladno nalazu SGP-a trećina bolesnica s metastatskim tumorom maternice bi imala potencijalnu korist od imunoterapijskog liječenja inhibitorima kontrolnih točaka te je otkriveno gotovo 30% više bolesnica s tumorom jajnika koje bi imale potencijalnu korist od terapije PARP inhibitorima. Nadalje, studija koja je također provedena na državnoj razini je podatcima iz stvarne kliničke prakse dokazala kako je optimalno liječenje metastatskog raka vrata maternice kemoterapija uz bevacizumab i time je potvrdila rezultate registracijske kliničke studije faze III. Navedeno je iznimno važno za druge zemlje u razvoju koje nemaju bevacizumab odobren u navedenoj indikaciji. Naposljetku, pregledni članak donosi trenutna saznanja o liječenju lokalno uznapredovalog raka vrata maternice te donosi kritički osvrt na OUTBACK studiju čiji su rezultati etablirali negativan stav o adjuvantnoj kemoterapiji u liječenju istog. Analizom rezultata OUTBACK studije i izračunom združenog omjera rizika svih randomiziranih kliničkih studija, evidentno je kako postoji podskupina bolesnica koja bi potencijalno imala korist od primjene adjuvantne kemoterapije. Stoga njegovi rezultati nebi smjeli biti definitivni te postoji potreba daljnjih istraživanja kako bi se došlo do optimalne strategije liječenja lokalno uznapredovalog raka vrata maternice.
Keywords
female genital neoplasms
Keywords (croatian)
novotvorine ženskih spolnih organa
Language english URN:NBN urn:nbn:hr:171:831938 Study programme Title: Translational Research in Biomedicine - TRIBE Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-04-20 10:18:06
