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Aim To investigate potential associations between clinical and standard peripheral blood biomarkers and clinical outcome in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Patients and methods A total of 120 patients with advanced NSCLC treated at seven comprehensive cancer care centers were analyzed in this national retrospective study. Survival statistics were evaluated using the Kaplan-Meier method and Cox analysis. Results Among clinical parameters, histology was significantly associated with progression-free survival. Univariate Cox-proportional hazards model indicated prognostic and predictive role of a panel of laboratory parameters reflecting chronic inflammatory pattern (elevated neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein and decrease in hemoglobin and albumin). Higher serum calcium concentration was also associated with nivolumab treatment effect. Conclusion Tumor histology was the only clinical parameter predicting the outcome of nivolumab treatment. Among the laboratory parameters, our analysis identified a laboratory panel reflecting chronic inflammation as a potential predictive marker of nivolumab treatment.

Background. Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition with multiple clinical faces. Metabolomic profiling studies small molecules present in biological samples by combined use of chromatography with mass spectrometry. Objectives. The goal of our work was to perform a high performance liquid chromatography combined with tandem mass spectrometry (HPLC-MS/MS) metabolomic study to compare the concentrations of metabolites in COPD patients and in controls. Material and methods. Participants were recruited at the University Hospital, Hradec Kralove, Czech Republic, with the approval of the ethics committee. The analysis of blood samples was performed at Health Sciences Center (HSC) in Kuwait. The blood samples were analyzed for concentrations of acylcarnitines and amino acids by high performance liquid chromatography (Waters 2690 HPLC; Waters, Milford, USA) and a triple-quadruple tandem mass spectrometer (Quattro LC, Micromass, Manchester, United Kingdom). Results. Groups of 10 subjects with COPD and 10 healthy controls were analyzed. Carnitine analysis showed that the free carnitine to acylcarnitine ratio (CO/AC ratio) was significantly lower in COPD (0.58 mu M/L) compared to the controls (0.73 mu M/L; p = 0.002). The mean C8/C2 ratio in the COPD group was significantly higher (0.03 mu M/L) - in the control group it was 0 mu M/L (p = 0.03). Amino acid analysis showed lower levels of phenylalanine in the COPD group (22.05 mu M/L) compared to the controls (30.05 mu M/L; p = 0.008). The alanine concentrations were significantly lower in the COPD group (173 mu M/L) than in the control group (253 mu M/L; p = 0.001). The pyroglutamate levels were higher in COPD (1.58 mu M/L) than in the controls (1 mu M/L; p = 0.040). Conclusions. The carnitine and acylcarnitine levels in COPD subjects in this study possibly indicate a predisposition to atherosclerosis as a result of inadequate p-oxidation of fatty acids and show the presence of oxidative stress. Furthermore, the high sensitivity to changes in circulating amino acid levels may allow us to detect subclinical malnutrition and take early preventative interventions such as nutritional supplementation and patient education.

Purpose To investigate the efficacy and safety of an active cellular immunotherapy (DCVAC/LuCa) and chemotherapy in patients with stage IV non-small cell lung cancer (NSCLC). Patients and Methods SLU01 was a multicenter, open-label, parallel-group, randomized, phase I/II trial. NSCLC patients were randomized in a ratio of 1:1:1 to receive: DCVAC/LuCa and chemotherapy (carboplatin and paclitaxel; Group A); DCVAC/LuCa, chemotherapy, pegylated interferon-α2b, and hydroxychloroquine (Group B); or chemotherapy alone (Group C). DCVAC/LuCa was administered subcutaneously every 3–6 weeks (up to 15 doses). The primary endpoint was overall survival (OS). During the study, enrollment into Group B was discontinued for strategic reasons. Results Forty-five patients were randomized to Group A, 29 patients to Group B, and 38 patients to Group C. The median OS in the modified intention-to-treat (mITT) population was 3.7 months longer in Group A than in Group C (15.5 vs. 11.8 months; p = 0.0179; hazard ratio = 0.54; 95% confidence interval: 0.32–0.91). This OS effect was consistent across subgroups of the mITT population (females, males, current smokers, former smokers, and patients with non-squamous and squamous cell histology). The most common treatment-emergent adverse events of any grade reported in Groups A, B, and C, respectively, were neutropenia (50.0%, 29.6%, and 20.6%), fatigue (40.0%, 18.5%, and 20.6%), anemia (35.0%, 44.4%, and 32.4%), paresthesia (27.5%, 25.9%, and 17.6%), and alopecia (25.0%, 29.6%, and 41.2%). Conclusion DCVAC/LuCa in combination with carboplatin and paclitaxel extended OS and was well tolerated.

Karcinom plic zaujima předni mista jak v incidenci, tak v mortalitě nadorových onemocněni celosvětově i v Ceske republice. V poslednich letech zaznamenala lecba NSCLC prudký rozvoj. Již v době stanoveni diagnozy je snahou co nejpřesněji urcit morfologickou diagnozu a pokud je to indikovano, provest geneticke testovani. Toto plati předevsim o nedlaždicobuněcných NSCLC. V roce 2013 byla publikovana ucinnost a bezpecnost pokracovaci udržovaci lecby (continuation maintenace) monoterapii pemetrexedem a diky pozitivnimu výsledku je tato lecba možna od května 2013 v Ceske republice. V nasi praci prezentujeme soubor 134 hodnocených pacientů, kteři absolvovali výse uvedenou lecbu. V realne klinicke praxi v Ceske republice bylo dosaženo lecbou pemetrexedem v pokracovaci udržovaci lecbě lepsich výsledků než v registracni studii a lecba byla velmi dobře snasena. Zatim median celkoveho přežiti (OS) byl stanoven na 23,5 měsice.

Background and Aim: From October 2013 there is a possibility to treat patients with NSCLC and with activated epidermal growth factor receptor (EGFR) mutations with three TKI in the Czech Republic. We have tried to find differences among patient groups treated with single TKI in 1st line of treatment. Patients and methods: Only patients with EGFR mutation and in which 1st line treatment started in October 2013 until October 2017 were included in analysis. We analysed 347 patients (gefitinib - 164 patients, afatinib - 130 patients, erlotinib - 53 patients). Results: Between these three groups of patients there was no statistically significant difference in sex (p=0.988), in smoking habits (p=0.549), in type of EGFR mutation (p=0.200), in adenocarcinoma proportion (p=0.256). There was statistically significant difference according to age (p=0.001), PS ( Conclusion: We have not found any important difference in basic characteristic of patients treated in 1st line treatment with TKI (sex, smoking, histology and type of EGFR mutation) except for the age – patients treated with afatinib were younger. We have not found any important difference in response to treatment, in disease control and OS. We found a significant difference in PS segmentation, in occurrence of adverse events and PFS.

Background and Aim: From October 2013 there is a possibility to treat patients with NSCLC and with activated epidermal growth factor receptor (EGFR) mutations with three TKI (afatinib, eriotinib, gefitinib) in the Czech Republic. We have tried to find differences among patient groups treated with single TKI in 1st line of treatment. Patients and methods: As data source we used the TULUNG registry, which is focused on the data collection of patients with NSCLC treated with target therapy in the Czech Republic. We analysed 232 patients (gefitinib - 115 patients, afatinib - 77 patients, eriotinib - 40 patients.). Statistical significance was assessed using the Fisher's exact test or Kruskal-Wallis test (a=0.05).

Pemetrexed is an antifolate cytostatic agent targeting several folate-dependent enzymatic pathways, widely used in the treatment of locally advanced or metastatic stage non-small cell lung cancer. Aside from the non-squamous histology, there is still no available molecular biomarker predicting treatment efficacy of pemetrexed-based chemotherapy. The aim of our retrospective study was to evaluate the association of thyroid transcription factor 1 expression with outcome of a large cohort of patients with non-squamous non-small cell lung cancer treated with pemetrexed. We retrospectively analysed clinical data of 463 patients with advanced-stage non-small cell lung cancer (IIIB or IV) treated with pemetrexed-based chemotherapy. Thyroid transcription factor 1 expression was assessed using indirect immunohistochemical detection in formalin-fixed paraffin-embedded tumour tissue at the time of diagnosis. Thyroid transcription factor 1 expression was detected in the tumour tissue from 76.0% of patients, and tumours from 24.0% of patients were thyroid transcription factor 1 negative. The median progression-free survival and overall survival for patients with thyroid transcription factor 1 positive tumours were 4.8 and 11.8 months compared to 2.8 and 8.3 months for those with thyroid transcription factor 1 negative tumours (p = 0.001 and p

Erlotinib is an epidermal growth factor receptor tyrosine-kinase inhibitor. Clinical trials have shown its efficacy in advanced non-small cell lung cancer (NSCLC). We conducted a large retrospective study based on clinical experience aiming to prove erlotinib’s efficacy and safety in patients with advanced-stage squamous cell NSCLC. Totally 375 patients with advanced-stage (IIIB, IV) squamous cell NSCLC were treated with erlotinib. Erlotinib was continued until disease progression or intolerable toxicity. 1 (0.3%) complete response (CR), 28 (7.5%) partial responses (PR) and 198 (52.8%) stable diseases (SD) were achieved. Overall response rate (ORR) and disease control rate (DCR) were 7.8% and 60.5%, respectively. Median progression-free survival (PFS) was 3.0 months and median overall survival (OS) was 7.6 months. PFS of patients with CR/PR, SD and PD were 7.6, 3.9 and 1.0 months, respectively (P

The effectiveness of continuation maintenance therapy with pemetrexed versus the watch-and-wait approach was proved by a large randomised phase III trial. We focused on continuance maintenance therapy with pemetrexed in routine clinical practice in the Czech Republic.

Summary Background In the treatment of advanced cancer, a physician's ability to accurately identify a patient's attitude towards treatment is critical. This paper describes the extent of any differences observed between patient attitudes towards chemotherapy for advanced non-small cell lung cancer (NSCLC) as assessed by patients themselves versus their physicians. Patients and methods Patients with stage IIIB or IV NSCLC who received gemcitabine plus cisplatin or carboplatin were enrolled into this prospective observational study. Patients and their physicians completed questionnaires containing descriptions of seven patient-specific attitudes. A pre-defined algorithm was used to categorize patients into one of the three ‘need' categories based on the questionnaire responses: (A) "maximum extension of survival with acceptance of high toxicity", (B) "maximum extension of survival only if coupled with normal life style", and (C) "relief of symptoms". Each patient was categorized based on his own response, as well as his physician's response. Results A total of 1895 patients were enrolled from 19 countries across 3 continents. Data from 1884 patients were analysed. Based on patient versus physician responses, respectively, the distribution of patients was 60% versus 39% in need category A, 26% versus 33% in B, and 14% versus 29% in C. Patient self-assessed versus physician-assessed need category identification was aligned for 891 patients (47.3%): 541 (29%) in A, 218 (12%) in B, 132 (7%) in C. While there was slight agreement between the identification of ‘need' categories by physicians and patients (kappa=0.18, 95% CI: 0.15–0.21), physicians also tended to place patients further down the scale (towards C) than patients placed themselves ( P Conclusions Patients have varying needs from cancer chemotherapy and it may not always be correctly identified by the treating physician. Physicians may underestimate patient's desire for extended survival compared with symptom relief.

Introduction and Aims: COPD is a heterogeneous syndrome marked by pulmonary obstruction and the presence of multiple comorbidities. The high incidence of cardiovascular disease in patients with COPD may be the result of common risk factors, particularly smoking, systemic inflammation and hypoxia.The aim of this work is to examine the cardiovascular status of patients with a severe form of COPD (post-BD FEV1 Method: The analyzed data is taken from The Czech Multicenter Database of COPD[1], a prospective study. This is the first-stage analysis at enrollment. Results: The presence of cardiovascular disease was analyzed in 343 patients. Ischemic heart disease (IHD) was present in 25.9%, heart failure (HF) 13.7%, atrial fibrillation 13.1% and hypertension 53.9%. Cachexic patients were less likely to have hypertension and HF (p= 0.055, p=0.002 respectively). The presence of IHD was statistically significant in patients with Asthma COPD overlap syndrome (p= 0.035). The incidence of hypertension was most significant in the D category (GOLD 2011) (57.3%, p=0.036). The use of cardiovascular medications was monitored; Diuretics 38.5%, ACEI 32.9%, Antiaggregants 32.7%, Statins 28.9%, Calcium antagonists 21.3%, Amiodarone 5.5%. Betablockers are used by 23%, out of which 2.4% used a known non-selective betablocker. Conclusions: Some COPD phenotypes seem to have a higher prevalence to certain types of comorbidities. Due to the high prevalence of heart disease in COPD patients, cardiovascular diseases should be actively searched for in clinical practice. NCT 01923051. 1. Novotna B et al. Czech multicenter research database of severe COPD. Int J Chron Obstruct Pulmon Dis. 2014 Nov 10;9:1265-74.

Aims: This study evaluates treatment outcomes in 161 NSCLC patients from Czech Republic according to mutations located in exons 19 (Del19) and 21 (L858R). Methods: Patients were treated with gefitinib in first line between 02/2010 and 12/2014 in 10 institutions. Retrospective analyses were carried out to assess the effectiveness and safety of treatment according to mutations Del 19 and L858R. Results: Out of 161 patients, 105 had Del19, and 56 L858R mutation. Between these two groups there was not statistically significant difference in sex (p=0.727), age (p=0.204), in smoking status (p=0.354) and according to performance status (p=0.547).There was statistically borderline significant difference in adenocarcinoma proportion (p=0.045). In the group with Del19 were 96% patients with adenocarcinoma and 85% in the group with L858R. There was not statistically significant difference according to disease control (p=0.479) and according the response (p=0.052). There was not statistically significant difference in OS (p=0.390); in the group of patients with Del19 was 22.7 months (CI 95%: 17.7; 27.8), in the group with L858ROS was 16.3 months (CI 95%:10.8; 21.8), but 70% patients still alive. Without the statistical significance was the difference in PFS; in the group of patients with Del19 it was 11,0 months (CI 95%:9.1; 12.8) and in the group with L8538R it was 9.4 months (CI 95% 6.6; 12.2). SimiIar numbers of adverse effects were observed in either group (35,2% and 35.7%). Conclusion: The treatment with gefitinib was very safe and PFS and OS were satisfactory without statistically significant differences acoording Del19 and L858R mutations.

Introduction & Objectives: The combination of chromatographic methods with mass spectrometry is a widely applied analytical method for global metabolic profiling. Our aim was to perform LC-MS/MS study to compare levels of carnitines and amino acids in COPD patients and healthy volunteers. Methods: COPD patients for this study were recruited from Czech Multicenter Database of COPD. The analysis of blood samples was performed by triple-quadruple tandem mass spectrometer with a positive electrospray ionization probe with a designed MS/MS program for automatic profiling of acyl-carnitines and amino acids. Results: We analyzed 24 subjects with COPD, 10 controls and 6 with ischemic heart disease (IHD), out of which 4 had COPD. Small variations between the three groups were noted, most notably the C0/AC ratio where it was significantly decreased in COPD patients compared to the control p=0.001, COPD 0.59 (0.49; 0.68), IHD 0.65 (0.53; 0.74), Control 0.73 (0.57; 0.86). The analysis of amino acids shoved a lower level of Alanine in the COPD and IHD group, compared to the control. The value was statistically significantly lower in the IHD patients in comparison to control. COPD 152.50 (92.80; 226.00), IHD 107.65 (0.00; 156.00), Control 175.00 (118.00; 210.00) p=0.039. FFMI had a positive effect on Alanine blood levels in COPD patients (Sp. coef. 0.478, p=0.021).With increased age, higher levels of C14 (Sp. coef. 0.765, p= 0.010), Phelnylalnine (Sp. coef. 0.671, p= 0.034) and Phenylalanine/Tyrosine ratio (Sp. coef. 0.694, p= 0.026) were found in the control group. Conclusion: The long-term systemic effects of COPD may be marked by changes in metabolism and be reflected by altered concentrations of specific metabolites.

Characteristics of NSCLC Patients Treated in First Line Treatment with Tyrosine Kinase Inhibitors (TKI) - Real Data from the Czech Republic.

Fat free mass index (FFMI) is an independent predictor of metabolic and functional consequences in COPD. For its measurement dual energy X-ray absorptiometry (DEXA), skin-fold anthropometry (SFA), bioelectrical impedance analysis (BIA) and bioimpedance spectroscopy (BIS) are used in clinical practice. The aim of our pilot study was to analyse precisely and critically which method is most accurate and available for common use in clinical practice for measurement of FFM by assessment against relevant DEXA in patients with COPD.This was an observational cross-sectional study of consecutive COPD subjects. FFM by methods of SFA, two versions of BIA, and BIS was compared with that from clinically relevant DEXA in 41 outpatients (mean age 66.5 ± 7.7 yrs) with stable COPD, 34 men and 7 women, with mean BMI 28.2 ± 6.1 kg.m(-2).All methods underestimate FFM in comparison with DEXA. In the general evaluation non-significant differences with the smallest mean bias were demonstrated for SFA (1.2 kg) and BIA (3.8 kg), but there was a difference of more than 9 kg using BIS and BIA COPD methods (p0.0001). The best agreement between DEXA and SFA was demonstrated via Lin's concordance coefficient and Bland-Altman test.SFA has been demonstrated as an accurate, available and cheap method for determination of FFM and FM with application of the Durnin Womersley equation for body density and with the Siri equation for FM in patients with COPD. SFA can be easily applied in routine clinical practice.

Background: Associations between nasal and bronchial impairment have been repeatedly described in chronic obstructive pulmonary disease (COPD), whereas nasal mucociliary clearance (MCC) in COPD patients is not yet fully understood. We studied nasal MCC parameters in COPD patients and compared them with healthy adults (HA) and with cystic fibrosis (CF) patients with compromised MCC. Methodology: An observational study of 98 COPD ex-smokers and subjects from control groups evaluated for nasal MCC time (NMCCt) and by digital video microscopy of nasal mucosa recording ciliary beat frequency (CBF) and ciliary beat pattern. Results: The NMCCt was decreased in HA compared to those with COPD and decreased in those with COPD compared to those with CF. CBF in COPD was lower compared to HA. The index of ciliary dyskinesia in COPD patients differed from HA. We detected higher NMCCt and lower nasal CBF in patients with chronic bronchitis phenotype (CB) compared to non-CB patients. Conclusions: We confirmed the presence of impaired nasal MCC in COPD ex-smokers. These impairments were apparent predominantly in the CB phenotype.

The Czech Tarceva Register collects data concerning all NSCLC patients treated with erlotinib in the Czech Republic. Increasing number of classified patients makes possible to analyze factors influencing the treatment results.

In a prospective randomized study, the efficacy of local anaesthetic inhalation during premedication before bronchoscopic examination was evaluated. Eighty patients with chronic nonproductive cough were inhaling either nebulized anaesthetics (10 ml of 1% trimecain; 40 patients--group A) or an isotonic chlorine solution (40 patients--group B). This was followed by topical anaesthesia using spray and laryngeal syringe. Comparing the score of cough and episodes of gagging, the inhalation of local anaesthetics appeared to make the procedure slightly more comfortable for some patients. Additional anaesthesia was less frequently needed in group A than in group B (12 vs. 19 patients). However, none of the observed differences reached statistical significance. In conclusion, the inhalation of local anaesthetics at the beginning of premedication before bronchoscopy was not confirmed as a useful method that made the examination more comfortable for patients with chronic non-productive cough, but did produce a moderately beneficial effect in some of them.

The Czech Republic has had an opportunity to use pemetrexed for 1st line treatment of advanced NSCLC from the year 2008. The purpose of this trial was to evaluate the activity and feasibility of pemetrexed in 1st line treatment NSCLC patients.

Non small cell lung cancer (NSCLC) is one of the most aggressive tumours with unsatisfactory prognosis and extremely high mortality. Pemetrexed and platinum became one of the therapeutic options in advanced NSCLC in routine practice. It is recommended both in the 1st and 2nd lines of chemotherapy.

This analysis, The Czech Republic experience with erlotinib in the treatment of a non-selected non-small cell lung cancer (NSCLC) population of 2365 patients, presented examines data obtained from the Czech population of NSCLC pts who received erlotinib.

Targeted biological therapy with inhibitors of tyrosine kinases is one of the therapeutic modality therapies of advanced stage non-small cell lung cancer (NSCLC). These drugs block activation cascade of epidermal growth factor receptor (EGFR). The sensitivity of tumor cells to tyrosine kinase inhibitors increases the “activating” mutations of tyrosine kinase domain and, especially, deletion in exon 19 or point mutation in exon 21.

e18062 Background: Erlotinib is approved for NSCLC treatment in Czech Rep since 2005. This analysis was performed to analyze the profile of pts treated with erlotinib longer than 6 months. Methods: This retrospective analysis evaluates data from Czech Tarceva Registry of pts treated outside clinical trials. Survival (mOS, mPFS) was evaluated by the Kaplan-Meier method, survival comparison was performed by Log Rank test. Results: Up to October 2011, 430 out of 2121 pts with completed data in registry were treated with erlotinib for 6 months and longer. Median age 65 years, 54.4% men; 29.8% smokers, 37.9% former smokers, 32.3 % non-smokers; 77% pts ECOG PS 0-1. 74.7% stage IV pts, 21.4% stage IIIB. 43.5% adenoca, 31.9% squamous ca,11% non-specific NSCLC, 6% bronchioloalveolar ca. Erlobinib administered as 1st line treatment in 13% pts, 2L in 50.9%, 3L in 34.9%. Till October 2011, 322 pts (74.9%) finished the treatment, 108 pts (25.1%) still on erlotinib therapy. Treatment discontinued due to progression in 75% pts, death in 15%, toxicity in 3%. The entire group results (n=430): CR in 2.3%, PR in 17.7%, SD in 65.8%, PD in 2.6%. mPFS and mOS from erlotinib initiation 12.4 and 21.4 months respectively. mOS from diagnosis was 43.5 months. Statistical difference in mOS (from the erlotinib initiation) was observed between groups with PS ECOG 0-1 and PS 2-3, 22.0 vs 16.4 months (p=0.001), although there was no difference in both groups in mPFS (12.9 vs. 10.6 months). mPFS and mOS in pts with adenoca (n=187) from erlotinib initiation 14.4 and 23.7 months respectively. mOS from diagnosis was 45.6 months. mPFS and mOS in pts with squamous ca (n=137) from erlotinib initiation was 11.3 and 17.6 months respectively. mOS from diagnosis was 42.2 months. Conclusions: This analysis documented good activity of erlotinib in both adeno and squamous cell carcinoma. The difference in mOS and mPFS between both groups was statistically significant when measured from erlotinib initiation (mOS: p= 0.017, mPFS: p=0.022), however not statistically significant when measured from the date of diagnosis (p=0.361). Patients with PS 0-1 have statistically significantly greater mOS than patients with worse PS (p=0.001).

In a group of 656 patients examined for hemoptysis of unknown etiology the average amount of expectorated blood in individual diagnostic groups was evaluated and the patients with massive hemoptysis (100 ml/24 hrs) were selected. The hemoptysis was evaluated as massive in 53 patients (8%), being most frequent in patients with chronic anatomical changes of lung parenchyma (22/64) and active tuberculosis (4/26). The fact that massive hemoptysis endangers above all patients with bronchiectasis and other anatomical disorders of the lung parenchyma was evident through the comparison of the average maximal amount of expectorated blood, which was significantly higher in this group (78 ml/24 hrs) than in the majority of other diagnoses (total average 22 ml/24 hrs). In conclusion, the risk of sudden massive hemoptysis should be kept in mind in these patients even if only minimal bleeding occurs and energetic cautionary measures should be implemented right from the onset of bloody expectoration.

A patient with bronchial carcinoid tumour of the right lower lobe is presented. The tumour, although small in extent, and of benign nature, produced complete stenosis of the right lower bronchus, which had to be repaired by inserting an endobronchial stent.

To evaluate the correlation of the histological type of tumour and the bronchoscopic finding with the occurrence of haemoptysis in patients with pulmonary malignancy.In a retrospective study the records of all patients with proven lung tumours were reviewed with emphasis on histological type, location of endobronchial tumour, TNM stage in relation to the presence of haemoptysis in the patient's history.Out of 536 patients with pulmonary malignancy, haemoptysis was present in 113, being more frequent in patients with NSCLC than SCLC and in patients with primary pulmonary tumour than those with pulmonary metastases (both p0.05). According to the location of endobronchial tumours, haemoptysis occurred in 31% of patients with a central process, in 13% of patients with intermedial and 12% with peripheral locations, respectively. According to the TNM classification the portion of patients with haemoptysis increased with tumour size.Haemoptysis as the initial sign of pulmonary malignancy occurs mostly in patients with centrally located tumours. However, in individual patients the onset of bleeding is influenced by the histological type of tumour and the tumour size.

Background. Pulmonary hypertension (PH) in patients with advanced idiopathic pulmonary fibrosis (IPF) is a complication connected with unfavorable prognosis. Great efforts have been made in attempting to establish a reliable non-invasive method which would enable detection of this complication. In this context a formula using pulmonary function parameters was published with outstanding results. Methods. We tested the formula in 27 IPF patients who underwent a lung function examination, cardiac ultrasonography and catheterisation on the same day. Results. Pulmonary hypertension was detected by catheterisation in 17 patients (63%). In our group, contrary to the published data, the aforementioned formula was neither useful for detecting patients with a high probability of PH nor as a means of calculating the mean pulmonary artery pressure in individual patients (p=0.502 and p=0.833, respectively). Ultrasound examination reached borderline correlation with the values measured by catheterisation when we compare patients with relevant results (r=0.531, p=0.051). However, the examination gave no usable results in 13 patients (48%). Conclusion. Our data suggests that no reliable, noninvasive method is currently available for detecting and confirming PH in IPF patients. We did not confirm the usefulness of the published formula. Further carefully organised studies will be necessary to verify or refute it.

Non small cell lung cancer (NSCLC) is one of the most aggressive tumours with unsatisfactory prognosis and extremely high mortality. Pemetrexed became one of the standard chemotherapeutic options in advanced NSCLC. It is recommended both in the 1st line and in the 2nd line.