Summary:
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 soalled 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.
Key words:
Breast cancer - High-Dose chemotherapy - Dose-Density chemotherapy
|