Vnitr Lek 2001, 47(8):553-554

[Intensified chemotherapy of solid tumours].

R Vyzula: Masarykův onkologický ústav Brno.

Treatment of solid malignant diseases is despite significant scientific advances during the last decade still a problem. The results of treatment do not satisfy oncologists. New substances are sought which influence the proliferation of malignant cells and some of them are promising. At present however rather new therapeutic approaches are sought which use already known cytostatic substances. With the help of hithero known laws of chronobiology therapeutic regimes are elaborated which are less toxic than classical standard administration. The advances of high-dose chemotherapy in haematooncology led oncologists to create intensified cytostatic therapeutic regimes also for solid malignant diseases. The most extensive experience was obtained with such approaches in breast cancers, germinal tumours of the testes and partly also of the ovaries. The great importance of breast cancer in oncological problems caused that experience with high-dose cytostatic treatment are most extensive. Results of this treatment were assembled in particular from the North American register and compared with conventional treatment. Metastatic diseases and inflammatory breast cancer did not have significantly remarkable results as compared with classical treatment and therefore they were abondoned. Promising seemed the results of adjuvant treatment of patients with a high risk of relapse. Further studies presented at ASCO (American Society of Clinical Oncology) 1998 however did not confirm these hopes and shifted high-dose therapy only to strictly followed up clinical studies. On the other hand mathematical models based on cytokinetic and pharmacodynamic studies prove a possible complete eradication of malignant cells in case of adjuvant administration in high risk patients. A pattern was elaborated, doxorubicin-paclitaxel-cyclophosphamide in a so-called dose density regime (with shortened intervals between cycles of chemotherapy and with a higher or equal dosage of cytostatics than is common). This regime is still the subject of studies, nevertheless preliminary results from the aspect of total survival and toxicity are statistically significant. The application of this regime is so far possible only in specialized centres such as Masaryk's Oncology Institute in Brno.