Immunotherapy for Uveal Melanoma - Current Knowledge and Perspectives.

Uveal melanoma is the most prevalent primary intraocular tumour in adults with the incidence between five and six cases per million people in the United States and Europe. The prognosis of patients with uveal melanoma is unfavourable with a 5-year survival rate of 50-70% despite significant advances in local tumour treatment using radiotherapy or surgical resection. Approximately 50% of the patients develop metastases within 15 years from initial diagnosis, mostly in the liver. The median survival rate after the onset of metastases is 6 months. Potential treatment options for metastatic uveal melanoma are chemotherapy, targeted therapy, and immunotherapy but no method showed satisfactory results. Immunotherapy with checkpoint inhibition showed promising results in the treatment of cutaneous melanoma; however, it did not appear to be equally effective with uveal melanoma. This may be due to differences in mutational burden, expression of neoantigens between these two types of tumour, immunosuppressive tumour microenvironment, and low immunogenicity and immune privilege of uveal melanoma. Considering the disappointing results of treatment with anti-CTLA-4 and PD-1/PD-L1 blockade in patients with advanced uveal melanoma several new forms of therapies are being developed. This may include immunotherapy with IMCgp100, glembatumumab vedotin and the infusion of autologous TILs, targeted therapy with selective MEK inhibitors, epigenetic therapy, and nanotherapy. Better insight into the molecular and genetic profile of uveal melanoma will facilitate detection of new prognostic biomarkers and thus enable a better modification of the existing immunotherapy methods and development of new forms of treatment specifically designed for uveal melanoma patients.

[CLINICAL GUIDELINES FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH INVASIVE BREAST CANCER--CROATIAN ONCOLOGY SOCIETY]. / KLINICKE UPUTE HRVATSKOGA ONKOLOSKOG DRUSTVA ZA DIJAGNOZU, LIJECENJE I PRACENJE BOLESNICA/KA OBOLJELIH OD INVAZIVNOG RAKA DOJKE.

Breast cancer is the most common cancer in women. It can be diagnosed in early stage through screening, early detection and educational programs, and when diagnosed early it can be efficiently treated. Treatment modalities include surgery, chemotherapy, radiotherapy, hormonal therapy and targeted biologic therapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for diagnosis, management, treatment and monitoring of patients with breast cancer in the Republic of Croatia.

[Clinical recommendations for diagnosis, treatment and monitoring of patients with invasive breast cancer]. / Klinicke upute za dijagnozu, lijecenje i pracenje bolesnika oboljelih od invazivnog raka dojke.

Breast cancer is the most common malignancy in women. Preventive measures, early diagnosis and development of all treatment modalities (surgery, radiotherapy, chemotherapy, hormonal and targeted biologic therapy) led to improvement in survival and quality of life of the patient. In order to standardize and optimize the approach, following good clinical practice standards, we bring consensus guidelines for diagnosis, treatment and monitoring of breast cancer patients as a result of consensus of a multidisciplinary team of experts for breast cancer.

Minimally invasive therapy of cervical intraepithelial neoplasia for fertility preservation.

The aim of this study was to determine the extension of cervical intraepithelial neoplasia grade III (CIN III) into endocervical canal and depth of endocervical crypts involvement by CIN with the regard to patients' age and parity. Correlation between the area of CIN involvement and the extension into endocervical canal was estimated. A total of 218 cervical cone specimens with histologically proven CIN III were included in this study. Extension of CIN into the endocervical canal, depth of involved crypts and ectocervical area affected by CIN were histologically analyzed. The average endocervical crypt involvement was at 1.2 mm of depth. The excision of >4 mm (1.2 mm x 3S.D.) in depth removes >99% of CIN. With the cone length of 15 mm (nulliparous patients) and 18 mm (multiparous patients), no endocervical cone margins were affected with CIN. Since the cone length is the most important determining factor for fertility preservation, the measurement of cervical cone could be essential for future pregnancies.