[Antiangiogenic biotherapy and chemotherapy in breast cancer: review of literature and case report]. / Antiangiogenní bioterapie a chemoterapie v terapii karcinomu prsu: prehled literatury a kazuistika.

Breast cancer incidence is 120/100,000 women and thus, it is the most frequent malignant disease in women. Despite the ever-increasing incidence, mortality has stayed stable; this is due to screening with detection of early breast cancers, adjuvant treatment and advances in targeted therapy. Currently, we perceive breast cancer as a phenotypically different subunits, influenced by genetic and epigenetic changes. All 5 basic subgroups (luminal A, B, basal-like, HER-2 positive and claudin-low) vary significantly in their prognosis and therapeutic options. The subgroup of basal-like tumors without hormone receptors positivity and HER-2 antigen (triple-negative breast cancer) is prognostically and therapeutically a very unfavorable group. Hormonal and anti-HER-2 therapy is excluded, and the effect of chemotherapy is limited and short-lived. Research for this sub-group of breast tumors in recent years focused on the influence of angiogenesis and DNA repair systems. Therapeutic manipulation of angiogenesis is based on the concept of its influence in the development and maintenance of the malignant process. The longest used and in terms of studies and clinical practice explored treatment is the main path of angiogenesis, the vascular endothelial growth factor. In the last few years, the real effect in the metastatic breast cancer is discussed. The initial positive results of pilot clinical trials showing a significant extension of the progression free survival bring disappointment since they were not translated into prolongation of overall survival. The following case-report presents a patient with metastatic triple-negative breast cancer with combined chemobiotherapy (capecitabine + bevacizumab). In the second part of the article, we discuss possible causes of inconsistent outcomes with antiangiogenic therapy in breast cancer, new directions in scientific research and today knowledge of prediction of its therapeutic effect.

Reorganization of language-related neuronal networks in patients with left temporal lobe epilepsy - an fMRI study.

To investigate the inter- and intrahemispheric reorganization of the language cortex in left temporal lobe epilepsy (TLE) with left-sided hippocampal sclerosis. A functional magnetic resonance imaging was performed on 13 right-handed patients suffering from medically intractable left TLE, and in 13 sex- and age-matched healthy controls. The activation paradigm used was a silent word generation task. A language laterality index (LI) was calculated from the number of activated voxels in the right and left anterior two-thirds of the hemispheres. Significant differences between the patients and the controls were observed in the activation of the left-sided inferior frontal gyrus. Less consistent findings in this region, as well as the relative protection of Broca's area from the activation, were revealed in the patients. In addition, different patterns of activation were proven in the cerebellum and other cortical as well as subcortical brain structures within both hemispheres. Significant differences were also found in the values of the language LIs between the investigated groups: these values suggested a more bihemispheric language representation in the patients. As anticipated, lateralization of the language functions in the epileptics significantly decreased in connection with an earlier age of initial insult. Our results support the hypothesis of a significant intra- and interhemispheric functional reorganization of language-related neuronal networks in left TLE.