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Cisplatin containing chemotherapy has proven benefit for muscle-invasive locally advanced and metastatic urothelial cancer. The carboplatin based combinations are less effective in these settings. In most cases for the platinum based chemotherapy ineligible patients only the best supportive care could be given. The treatment options have expanded in the past few years with the introduction of systemic immunotherapy with checkpoint inhibitors. We review the relevant clinical trials' data which can completely transform the treatment landscape of locally advanced or metastatic urothelial cancer.

Background. In Hungary, the mortality rate for testicular germ cell cancer (TGCC) is 7.6% which is significantly higher than the EU average. We prospectively evaluated the effect of socioeconomic status on patient delay, doctor’s delay, and therapy outcomes.Methods: Questionnaires on subjective (MacArthur Subjective Status Scale), objective (wealth, education, and housing data) social status, and on patient’s and doctors’ delays were completed by newly diagnosed TGCC patients.Results: Patients belonged to a relatively high socioeconomic class, a university degree was double the Hungarian average, Cancer-specific mortality in the highest social quartile was 1.56% while in the lowest social quartile 13.09% (p=0.02). In terms of patient delay, 57.2% of deceased patients waited more than a year before seeking help, while this number for the surviving patients was 8.0% (p=0.0000). Longer patient delay was associated with a more advanced stage in non-seminoma but not in seminoma, the correlation coefficient for non-seminoma was 0.321 (pConclusions: Based on our result, we conclude that to improve survival, we should promote testicular cancer awareness, especially among the most deprived populations, and their health care providers.

Background In Hungary, the mortality rate for testicular germ cell cancer (TGCC) is 0,9/100000 which is significantly higher than the EU average. We prospectively evaluated the effect of socioeconomic position on patient delay and therapy outcomes. Methods Questionnaires on subjective social status (MacArthur Subjective Status Scale), objective socioeconomic position (wealth, education, and housing data), and on patient’s delay were completed by newly diagnosed TGCC patients. Results Patients belonged to a relatively high socioeconomic class, a university degree was double the Hungarian average, Cancer-specific mortality in the highest social quartile was 1.56% while in the lowest social quartile 13.09% (p = 0.02). In terms of patient delay, 57.2% of deceased patients waited more than a year before seeking help, while this number for the surviving patients was 8.0% (p = 0.0000). Longer patient delay was associated with a more advanced stage in non-seminoma but not in seminoma, the correlation coefficient for non-seminoma was 0.321 (p p = 0.0003, and r = − 0.20, p = 0.0005), respectively. Since the patient delay was correlated with the social quartile and resulted in a more advanced stage in non-seminoma, the lower social quartile resulted in higher mortality in non-seminoma patients (p = 0.005) but not in seminoma patients (p = 0.36) where the patient delay was not associated with a more advanced stage. Conclusions Based on our result, we conclude that to improve survival, we should promote testicular cancer awareness, especially among the most deprived populations, and their health care providers.

The objective of our study was to assess the real-world safety and efficacy of nivolumab in the second- or later-line treatment of metastatic renal cell carcinoma (mRCC). We conducted a multicenter, retrospective, observational study of real-world data from patients who were treated with nivolumab under a patient expanded access program from 2015 to 2017 in Croatia, Hungary, and Malta. The primary safety endpoint was the discontinuation of therapy because of adverse events. The primary efficacy endpoint was overall survival (OS). We collected data from 87 patients with a median (interquartile range (IQR)) age of 63 (57-68) years, and 21% were females. The median (IQR) follow-up was 11 (5-31) months. Treatment was discontinued because of toxicity in 4 (5%) patients. Four (5%) patients experienced treatment-related adverse events of grade 3 or 4. The OS was 18.0 (95% CI: 11.0 to 28.6) months, and the PFS was 8.5 (95% CI: 4.9 to 12.1) months. Our study indicated a good safety and efficacy profile of nivolumab in the second- or later-line treatment of mRCC patients in a real-world clinical practice environment, which is comparable with the findings of the registrational trial.

Therapy with immune checkpoint inhibitors (ICPis) has become widespread in medical oncology, becoming part of the routine treatment for various malignancies. These antibodies induce an anti-cancer immune activation by blocking the natural immunosuppression, which is supposed to protect the human body's healthy cells from destruction by the immune system, caused also by cancers, and as a result, allow the immune system to take part in destroying malignant cells. However, the immune activation created by these molecules is not selective against cancer tissues, therefore adverse events associated to these therapies are similar to the signs and symptoms of autoimmune diseases. Common adverse events affect the skin, liver, lungs, gastrointestinal and endocrine systems, less frequently the heart and the nervous system, occasionally causing life-threatening complications. Therapy of these adverse events requires rapid diagnosis and adequate treatment in the form of various immunosuppressants.Napjainkban egyre inkább elérhetõ az immunellenõrzõpont-gátlókkal (immune checkpoint inhibitor, ICPi) végzett daganatellenes kezelés, mely több malignóma esetén is a rutinterápia részévé vált. E készítmények a daganatsejtek által is kiváltott, normális esetben csak a saját egészséges sejtek védelmére szolgáló természetes immunszuppressziót gátolva (a gátlás gátlásaként), daganatellenes immunaktivációt eredményeznek, melynek következtében az immunrendszer képes hatékonyan fellépni a daganatsejtek ellen, elpusztítva azokat. Mivel az immunrendszer e szerek által kiváltott aktivációja nem szelektíven, csak a daganatos szövetekre hat, a kialakuló mellékhatások a normális szövetek elleni autoimmun reakciók formájában jelennek meg leggyakrabban. Ezek között gyakoriságuk miatt kiemelt szerepe van a bõr, a tápcsatorna, a máj, a tüdõ és az endokrin szervek érintettségének. A szíveredetû, illetve neurológiai mellékhatások viszonylag ritkák, de jelentõsek az elõforduló súlyos, életveszélyes komplikációk szempontjából. Kezelésükben alapvetõ a korai felismerés és az immunszuppresszáns szerek megfelelõ dózisban történõ alkalmazása.