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Stupar D, Jungić S, Gojković Z, Berendika J, Janičić Ž. Risk-factors for locally advanced rectal cancer relapse after neoadjuvant chemoradiotherapy: A single center experience. Medicine (Baltimore) 2023; 102:e35519. [PMID: 37933003 PMCID: PMC10627596 DOI: 10.1097/md.0000000000035519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 11/08/2023] Open
Abstract
The overall prognosis of locally advanced rectal cancer (LARC) remains unsatisfactory due to a high incidence of disease relapse. The present understanding of the factors that determine the likelihood of recurrence is limited or ineffective. We aimed to identify the main risk factors influencing tumor relapse in LARC patients after neoadjuvant chemoradiotherapy (nCRT) and surgical treatment in a single center in Republika Srpska. Patients with stage II or stage III who received nCRT before surgery for primary rectal cancer at the Oncology Clinic, University Clinical Center of Republika Srpska from January 2017 and December 2022 were included in the study. We collected patient demographics, clinical stage and characteristics, neoadjuvant therapy, and surgical methods, along with the pathological response after treatment completion, and analyzed them to identify the risk factors for tumor relapse. Out of 109 patients diagnosed with LARC, 34 (31,2%) had tumor relapse. The median time to relapse was 54 months. Participants with clinical T4 stage had a significantly shorter relapse time compared to the patients with clinical T2/3 stage. Subjects with positive lymph nodes removed, perivascular and perineural invasion, intraoperative perforation and patients without ypN stage improvement had significantly shorter time to relapse. Subjects with T4 stage had more than 4 times higher risk of relapse than patients with clinical T2/3 stage. Higher clinical T stage was an essential risk factor for tumor relapse in LARC patients after nCRT and surgical treatment. Comprehensive understanding and identification of the risk factors for tumor relapse in LARC patients are crucial for improving their long-term outcomes.
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Affiliation(s)
- Dragana Stupar
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- General Hospital Prijedor, Prijedor, The Republic of Srpska, Bosnia and Herzegovina
| | - Saša Jungić
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Zdenka Gojković
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Jelena Berendika
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Živojin Janičić
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
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Tubić B, Jungić S. Regulatory aspects of biological medicines in Bosnia and Herzegovina. Bosn J Basic Med Sci 2022; 22:511-522. [PMID: 35460398 PMCID: PMC9392977 DOI: 10.17305/bjbms.2021.6910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
The use of the biological medicines, also called “biologics,” has contributed to the progress of the treatment of many chronic diseases, such as cancer, rheumatoid arthritis, Crohn’s disease, multiple sclerosis, and psoriasis. However, biologicals are expensive for healthcare systems in several countries. Their availability has been a global issue, which has affected many patients that suffer from various diseases. A biosimilar medicine, also called “biosimilar,” is a medicine with similar characteristics in terms of quality, biological activity, safety, and efficacy as the approved original biological medicine, known as “originator biologic.” Biosimilars generate competition within the market because they lower the prices of biologics and thus allow for an increase in patient access. However, there are barriers when it comes to the acceptability rate of biosimilars and how interchangeable they are with the originator biologic. In this review, we present a national regulatory framework for biologics along with its limitations, a system of monitoring the safety profile of biologics, the guideline for interchangeability, and a list of approved and available biologics in Bosnia and Herzegovina. Additionally, recommendations were made here in order to provide opportunities for greater acceptance of biosimilars and better access to biologics. These recommendations include, but are not limited to, strengthening the national regulatory framework for biologics, capacity building, increasing awareness among healthcare providers for reporting adverse drug events and active pharmacovigilance, and better definitions of interchangeability. Finally, awareness among healthcare providers regarding biosimilars and biologics should be raised through continuous education and workshops, and by including this important topic in the graduate and postgraduate curriculum programs in the country.
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Affiliation(s)
- Biljana Tubić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Agency for Medicines and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
- Corresponding author: Biljana Tubić, Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Save Mrkalja 4, 78000 Banja Luka, Bosnia and Herzegovina. E-mail:
| | - Saša Jungić
- Department of Medical Oncology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Clinic of Medical Oncology, University Clinical Centre Republic of Srpska, Banja Luka, Bosnia and Herzegovina
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Petković S, Petković S, Tadić-Latinović L, Berendika J, Tubić B, Jungić S. A case report of malignant peripheral nerve sheath tumour of the left thigh and popliteal fossa with lungs, spleen, and brain dissemination related to neurofibromatosis type 1. Scripta Medica 2022. [DOI: 10.5937/scriptamed53-32417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A malignant peripheral nerve sheath tumour (MPNST) is a highly aggressive sarcoma. This disease develops in a number of people with neurofibromatosis type 1 (NF1), which is a common genetic disease. The paper presents a patient with typical manifestations of a malignant tumour of the peripheral nerve sheath, in the form of a large tumour of primary localisation in the distal part of the left thigh and left popliteal fossa and with significant dissemination into the lung parenchyma, which was accompanied by respiratory risk. The first operation of the tumour was done four years earlier, after which the patient did not come for regular check-ups. Nine cycles of chemotherapy were performed by Doxorubicin / Ifosfamide / Mesna protocol with clinical improvement and stabilisation, but without a significant impact on the dynamics of the disease and the overall survival was 14 months. It is of utmost importance to early recognise clinical presentation of the malignant form of this tumour and active supervision of a patient with a benign form by experts. In this way, it is possible to apply the optimal treatment modality in a timely manner.
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Berendika J, Jungić S, Tubić B, Rakita I, Vještica M, Đokanović D, Gojković Z, Mirčeta N, Petković S, Marković-Peković V. First experiences with the use of targeted and immunotherapy in the treatment of cutaneous melanoma: A single centre experience. Scripta Medica 2022. [DOI: 10.5937/scriptamed53-35184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background / Aim: Up until ten years ago stage four melanoma was considered a disease with extremely poor prognosis. Standard therapy during this period of time was dacarbazine chemotherapy. Patients with better performance status were treated with immunotherapy cytokine IL-2. In the last ten years eight medications have been approved by the FDA for the therapy of melanoma. The goal of this study was to determine objective response rate (ORR), median overall survival (OS), median progression free survival (PFS) and safety in patients with advanced and metastatic cutaneous melanoma treated with targeted therapy and immunotherapy at the University Clinical Centre of the Republic of Srpska (Centre). Methods: A non-randomised observational retrospective/prospective trial was conducted to investigate first experiences with the use of targeted therapy and immunotherapy at the Centre and compare the results with the literature data. A total of 23 patients received BRAF targeted therapy for the treatment of metastatic cutaneous melanoma in the first line of treatment. Nine patients received vemurafenib, fourteen patients received a combination of BRAF/MEK inhibitor. Nine patients were treated with pembrolizumab immunotherapy. The trial was performed in a period from May 2017 until December 2020. Results: In patients receiving vemurafenib ORR was 44.4 %, median PFS was 5 months (95 % CI, 1 to 11) and the median OS was 9 months (95 % CI, 2 to 17). In the vemurafenib/cobimetinib group ORR was 71.4 %. Median PFS was 9 months and median OS was 12 months. ORR in patients receiving pembrolizumab was 22.9 %, median PFS was 3 months (95 % CI, 1 to 11) and the median OS was 4.5 months (95 % CI, 2 to 12). Results in all three groups were inferior compared to the results from the literature except for ORR in patients receiving vemurafenib and vemurafenib/cobimetinib. Adverse events were tolerable and manageable and were similar to those described in the literature. Conclusion: Based on the experience with the targeted and immunotherapy in the Centre, which was presented in this study, it was concluded that in conditions when there is limited access to drugs, the greatest benefit have the patients who meet the inclusion criteria in clinical trials.
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Tubic B, Marković-Peković V, Jungić S, Allocati E, Godman B. Availability and accessibility of monoclonal antibodies in Bosnia and Herzegovina: Findings and implications. Medicine Access @ Point of Care 2021; 5:23992026211027692. [PMID: 36204505 PMCID: PMC9413607 DOI: 10.1177/23992026211027692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Monoclonal antibodies (mAbs) represent the most numerous and significant
group of biotherapeutics. While mAbs have undoubtedly improved treatment for
many chronic diseases, including inflammatory diseases, they are typically
expensive for health care systems and patients. Consequently, access to mAbs
has been a problem for many patients especially among Central and Eastern
European (CEE) countries. However, biosimilars can potentially help with
costs, although there are concerns with their effectiveness and safety. This
includes biosimilars for long-acting insulin analogues. Aim: Assess the availability and use of biological medicines, including
biosimilars within Bosnia and Herzegovina (B&H). Methods: Assess the availability of mAbs via the current lists of approved and
accessed mAbs versus those licenced in Europe and the United States and
their utilisation, as well as specifically insulin glargine and its
biosimilars, within B&H. Results: The availability of the mAbs in B&H appears satisfactory, which is
encouraging. However, current usage is limited to a few mAbs which is a
concern for subsequent patient care especially with limited use of
biosimilars to address issues of affordability. We also see limited use of
biosimilar insulin glargine. Conclusion The limited use of mAbs including biosimilars needs to be addressed in
B&H to improve the future care of patients within finite resources. We
will monitor these developments.
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Affiliation(s)
- Biljana Tubic
- Agency for Medicinal Products and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
- Department of Medicinal Chemistry, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Saša Jungić
- University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- University Clinical Centre of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche ‘Mario Negri’ IRCCS, Milan, Italy
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
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Berendika J, Jungić S, Tubić B, Malčić Kecman G, Rakita I, Gojković Z, Vještica M, Nikić G, Babić B. Adjuvant Treatment of the Salivary Duct Carcinoma with Her2 Overexpression. Case Rep Oncol 2021; 14:610-615. [PMID: 33976642 PMCID: PMC8077616 DOI: 10.1159/000514850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/26/2022] Open
Abstract
Malignant salivary gland tumors form 11% of all head and neck tumors. Salivary duct carcinoma (SDC) of the parotid gland is an uncommon and highly aggressive tumor accounting for 2% of all salivary gland malignancies. The fourth edition of the WHO Classification of Head and Neck Tumors reported global annual incidence of 0.4–2.6/100,000 people. Standard treatment for SDC is wide surgical resection along with lymph node dissection followed by adjuvant radiation therapy. The role of adjuvant chemotherapy is not known. Here, we present a case of an SDC of the parotid gland in a 55-year-old female. She presented with a painless swelling behind her right ear. Surgery was performed, and total right parotidectomy was done along with selective neck dissection (levels II, III, VA). The pathology report concluded that it was a G3 (poorly differentiated) SDC (micropapillary variant) with lymphovascular and perineural invasion. The clinical stage of the disease was T4aN2bM0. Adjuvant therapy consisted of concurrent radiation (TD 66 Gy) and chemotherapy with weekly paclitaxel (45 mg/m<sup>2</sup>), carboplatin (AUC 1.5), and trastuzumab (2 mg/kg; THC) for 6 weeks followed by 4 cycles of THC every 3 weeks. Adjuvant trastuzumab was continued for a total of 1 year. She is still without the evidence of the disease 7 years later. The consensus regarding the use of adjuvant chemotherapy does not exist. Based on all the data that have been presented before, the conclusion is that we need new treatment modalities to improve the outome of this aggressive disease.
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Affiliation(s)
- Jelena Berendika
- Oncology Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Saša Jungić
- Oncology Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina.,University of Banjaluka Faculty of Medicine, Banja Luka, Bosnia and Herzegovina
| | - Biljana Tubić
- Department of Pharmacy, University of Banjaluka Faculty of Medicine, Banja Luka, Bosnia and Herzegovina.,Agency for Medicines and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
| | | | - Ivanka Rakita
- Oncology Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Zdenka Gojković
- Oncology Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina.,University of Banjaluka Faculty of Medicine, Banja Luka, Bosnia and Herzegovina
| | - Milka Vještica
- Oncology Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Gordan Nikić
- Oncology Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Božana Babić
- Pathology Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
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Gojković Z, Đokanović D, Jakovljević B, Maksimović S, Jungić S, Rakita I, Vještica M, Rašeta R, Vranješ Ž, Štrbac M. Analysis of Survival at Metastatic Melanoma Patients Treated with Vemurafenib - a Three Year Single Institution Study. SMD 2018. [DOI: 10.7251/scmed1802126g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: The introduction of BRAF inhibitor vemurafenib significantly improvedoverall survival (OS) in metastatic melanoma patients.Aim of the Study: The purpose of this study was to determine OS and progressionfree survival (PFS) in patients with advanced metastatic melanoma treated withvemurafenib in the Oncology Clinic, University Clinical Centre of the Republic ofSrpska (UKC RS). The secondary goal is to determine the effect of elevated serumlactate dehydrogenase (LDH) on OS.Patients and Methods: We analysed patients that received vemurafenib in theApril 2015. until March 2018. They had pathohistologically confirmed B-RAF positivemetastatic melanoma. LDH values were measured at the start of the treatment.Results: A total of 16 patients were analyzed, with an average age of 53 years(37-78). A large number of patients at the start had multiple sites of metastases.Calculated OS in patients who received vemurafenib is 11.8 months (p=0,23), withstandard deviation (SD) 9.18. The calculated PFS is 9.5, SD 7,57. OS in patients withnormal LDH is 14.4 months, SD 10.73, and with elevated LDH is 8.4 months, SD4.9 (p=0.079).Conclusion: Use of vemurafenib resulted in an improvement in PFS, with improvedOS in patients with advanced BRAF-mutated melanoma. In patients with elevatedLDH OS was reduced. This shows that LDH is a good prognostic marker and thatwe should do it routinely for all patients with melanoma. This study has indicatedthe need for new diagnostic and therapeutic options for melanoma in Republic ofSrpska.
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Mrđanović J, Jungić S, Šolajić S, Bogdanović V, Jurišić V. Effects of orally administered antioxidants on micronuclei and sister chromatid exchange frequency in workers professionally exposed to antineoplastic agents. Food Chem Toxicol 2012; 50:2937-44. [DOI: 10.1016/j.fct.2012.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/11/2012] [Accepted: 04/12/2012] [Indexed: 11/29/2022]
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Jungić S, Tubić B, Skrepnik T. The role of biomarkers in the development of novel cancer therapies. Drug Metabol Drug Interact 2012; 27:89-99. [PMID: 22706232 DOI: 10.1515/dmdi-2011-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 04/02/2012] [Indexed: 06/01/2023]
Abstract
The etiology of diverse patient responses to a given pharmaceutical treatment has eluded science for decades. Only during the last 10-15 years has our understanding of the interplay between genetics and pharmaceuticals advanced to the point that personalized medicine may optimize therapies for each individual patient. The primary goals of personalized medicine are identifying individuals at risk of developing disease to better prevent disease in the healthy population, accurately monitoring each patient's response to therapy and predicting recurrence in order to pre-empt it. This review gives an explanation of biomarkers and addresses their role in the diagnosis and surveillance of various cancers. It also addresses the challenges of developing novel therapies utilizing newly discovered biomarkers.
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Affiliation(s)
- Saša Jungić
- Clinic of Internal Oncology, Clincal Center of Banja Luka, Banja Luka, Bosnia and Herzegovina
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Jakovljević B, Rakita I, Jungić S, Gojković Z. Frequency of Helicobacter pylori infection in patients with gastric cancer treated in the Clinical Center Banja Luka. Scripta Medica 2004. [DOI: 10.5937/scrimed0402085j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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