This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com PROGRESS IN THE TREATMENT OF LUNG CANCER MONIKA BRATOVA, MD DEPARTMENT OF RESPIRATORY DISEASES AND TB FACULTY HOSPITAL BRNO MEDICAL FAKULTY MASARYK UNIVERSITY This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com CONTENT •Epidemiology •Situation in the Czech Republic •Classification of lung cancer •Progress in the diagnosis of NSCLC • •Progress in the treatment of SCLC •Paliative management – what is new? •Future development • This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com EPIDEMIOLOGY •The publication from 1912 counting all cases of lung cancer over the world found 374 cases x in 2020 WHO described 2 206 771 new cases over the world •It is the second most common malignancy and the first cause of death among all oncological diseases in the world (GLOBOCAN) •In the Czech Republic 6 459 new cases were detected in 2018 (ÚZIS) • Orgánem měsíce listopadu jsou plíce | CestaBylin.cz This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com SITUATION IN THE CZECH REPUBLIC (ÚZIS 2018) •50% of patients are 63-75 years old •Male:Female = 1,9:1 •The lowest incidence – South Moravian region, the highest – North-west of Czech •70% of cases are diagnosed in stage III a IV, 5-years survival is 17,8% x breast cancer 89,2% • • Česká republika - TOP KVALITA | Vlajky.EU This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com CLASSIFICATION OF LUNG CANCER •According to the histology: oAdenocarcinoma oSquamous carcinoma oNSCLC NOS oLarge cell carcinoma a) oAdenosquamous carcinoma oSarcomatoid carcinoma oMucoepidermoid carcinoma oNeuroendocrinne tumors • This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com CLASSIFICATION OF LUNG CANCER •According to the biological features: oNSCLC – 85% of cases, slower growth, less sensitive to CHT and RT, lower risk of creating metastasis, TNM classification, molecular-genetic markers, more often in peripheral areas oSCLC – 15% of cases, quick growth and huge tendency to metastasis, sensitivity to CHT and RT, limited/extensive disease, central localisation • This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com CLASSIFICATION OF LUNG CANCER •According to the clinical stage: oI-IIB – tumor max 5cm, max unilateral hilar lymfnodes oIIIA, B, C – any size of tumor with/without lymfnodes (hilar, mediastinal, supraclavicular) oIV – any size of tumor, solitar or multiple intra or extrathoracic metastasis, pericardial and pleural effusion, carcinomatoid lymfangoitis • This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com CLASSIFICATION OF LUNG CANCER •According to the molecular-genetic changes: • Obsah obrázku snímek obrazovky, text, software, Počítačová ikona Popis byl vytvořen automaticky + PD-L1 expression (0-100%) This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com PROGRESS IN PREVENTION •Screening of lung cancer – project MZČR – since January 2022 •Inclusion criteria: smoking history, 20 pack-years, age 55-74 years •Indication of LD-CT scan •Radiological evaluation (positive/negative/nespecific finding), it leads to a control CT scan or examination at the pneumooncology This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com PROGRESS IN THE DIAGNOSIS •An urgent need of a sufficient tissue sample for histology and molecular diagnosis •Bronchology – endobronchial cryobiopsy, • EBUS, rEBUS •Transthoracal biopsy (CT, UZ), mini-invasive • VATS, lobektomy is still a golden standard 770 bronchoskopie snímků, stock fotografií 3D objektů a vektorů | Shutterstock This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com PROGRESS IN THE TREATMENT OF NSCLC •A focus on the first line therapy with the highest efficacy •In NSCLC wild-type immunotherapy and its combinations is preffered (neoadjuvant, adjuvant, stage III/IV) •Phenomena of personalised treatment, Next Generation Sequencing •Radiotherapy and its special modifications (Proton therapy, Cyber knife) • Léčebné metody Masarykův onkologický ústav Brno This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com > > > > > > > > > Standard chemotherapy (platin based chemotherapy) TKI‘s (x EGFR mutation) - gefitinib, erlotinib, afatinib, osimertinib, amivantamab ROS inhibitors - crizotinib, entrektinib Imunotherapy - pembrolizumab, nivolumab, atezolizumab, durvalumab, cemiplimab ALK inhibitors - crizotinib, alectinib, ceritinib, brigatinib, lorlatinib VEGFR inhibitors - bevacizumab NTRK inhibitors - entrektinib Other inhibitors (sotorasib – KRAS, pralsetinib - RET, dabrafenib - BRAF, tepotinib - MET) Chemo/ imunotherapy - pembrolizumab + CHT, nivolumab+ipilimumab+ CHT This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com PROGRESS IN THE TREATMENT OF SCLC •Standard chemotherapy is still crutial •The new aprroach - combination with immunotherapy (durvalumab) for LD/ED stage •No genetic markers, still with bad prognosis This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com PALIATIVE TREATMENT – WHAT IS NEW? •Improved management of malignant pleural effusion (pleuroscopy, tunelized pleural catheter) •Insuficient venous systém (iv port, PICC, CICC catheters) •The treatment of bone metastasis (denosumab) •Wider background of mobile hospices and hospice departments Paliativní péče | Nemocnice následné péče Praha This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com FUTURE DEVELOPMENT •Centralisation of the oncological care •Shortening of the time to diagnosis •Pneumooncosurgical centers •„ NGS for everyone“ •New agents and approach • • • • This presentation uses a free template provided by FPPT.com www.free-power-point-templates.com Ústav zdravotnických věd | MED MUNI Thank you for your attention