Tebentafusp in the treatment of metastatic uveal melanoma - the first patient treated in the Czech Republic.

BACKGROUND: Uveal melanoma is a rare cancer, in which metastases occur in approximately one half of cases. In metastatic disease, the prognosis is unfavorable and the median of survival does not exceed 6 months. Effective treatment options were very limited up to date. Tebentafusp is a bispecific fusion protein, which as the first drug proved efficacy in uveal melanoma. CASE: The patient was referred for suspected uveal melanoma of the left eye. She was treated for Hodgkin's disease in the past. Primarily, the tumor was treated by radiosurgery with radiotherapy of a small lesion of the vertebral body. However, later the patient had to undergo bulbus enucleation with confirmation of a large tumor category pT4b. PET/CT revealed metastases of the bones and the liver; simultaneously, haplotype A*02: 01 was confirmed. The patient underwent radiotherapy of the sternum and later, after confirmation of payment from the health insurance company, she started treatment with tebentafusp. The first three doses were administered during admission to the hospital, with a need to treat cytokine release syndrome by corticosteroids. Later, the administration was performed in an out-patient regimen, without complications, except for a transient elevation of transaminases. The first CT restaging confirmed stable disease; however, the second restaging confirmed a new osteolytic lesion in the processus of Th11. Because of progression, the treatment with tebentafusp was withdrawn after 6 months. Unfortunately, the lesion could not be treated by radiotherapy. Two months later, the patient was urgently admitted to the hospital because of right-sided hemiplegia; MRI revealed bleeding metastatic lesion in the brain stem. CONCLUSION: In this case report, we present the case of the first patient treated with this drug in the Czech Republic.

[Disturbances of the plasma coagulation defects in retinal venous occlusions]. / Poruchy hemokoagulacní kaskády u retinálních venózních okluzí.

Occlusions of retinal veins (central and branch) represent multifactorialy-conditioned disease involving presumably older patients, in whom the changes of retinal vessels caused by hypertension and atherosclerosis present the most important pathophysiological factors for development of this disease. In last years, the intensive scientific research is focused to the explanation of the role of the defects of the coagulations cascade. Especially in younger patients, the most often mentioned defect of the coagulations cascade is called as APC-resistance. Up to 95% of all patients with APC-resistance are carriers of so called Leiden mutation. The aim of our study was to establish the prevalence of the ACP-resistance in 92 patients with central or branch occlusion of the retinal vein verified by means of angiography treated at the Department of Ophthalmology, Faculty Hospital, Olomouc, Czech Republic, EU, during the period 1999-2005. The control group consisted of 40 patients without any vascular, eye-related disease. In the group of patients with occlusion of the retinal vein, the prevalence of the APC-resistance was 10.9% and in the control group 5%. In the group of patients 55 years old and younger the prevalence of the ACP-resistance was 14.3%, in patients older than 55 years it was 5.6%. According to the relatively small groups of patients, the established difference did not reach the level of statistical evidence. Results of our study confirmed the conclusions of previously published papers that the prevalence of the APC-resistance is not significantly higher in patients with retinal vein occlusion according to the prevalence in controls.

[Ultrasound findings in endophthalmitis]. / Ultrazvukové nálezy u endoftalmitidy.

The ultrasound examination is the integral part of diagnostic procedure in endophthalmitis. During the ultrasound examination we may follow the organization of opacities in the vitreous, membranes formation, the thickening of the choroid, posterior vitreous membrane detachment, detachment of the choroid, the retinal detachment, chorideal abscess or granuloma, the edema of the optic nerve head and thickening of sclera. Not all of these ultrasound findings are always present. In our retrospective study, ultrasound findings of 17 eyes of 17 patients hospitalized at the Department of Ophthalmology at the School of Medicine, Palacký University in Olomouc during the period September 1999 - December 2002, were followed. Ultrasound findings in all eyes were evaluated and the final central visual acuity (VA) was followed. In eyes with VA 6/60 (20/200 or 0.1) or worse, the posterior vitreous membrane was not at all or only partially detached. In this group the finding of choroid thickening was more common. The finding of incomplete or absent posterior vitreous membrane detachment, and/or the thickening of the choroid might be prognostic unfavorable ultrasound finding in endophthalmitis.