BJMO - volume 18, issue 5, september 2024
A. Awada MD, PhD
ASCO 2024 was, as usual, an important meeting for the oncology community.
Therapeutic innovations such as antibody-drug conjugates, new immunotherapy approaches and molecular targeted therapies were the basis of many presentations changing clinical practice or clinically of interest. In addition, cancer biology understanding, artificial intelligence and Telehealth were also on the menu.
This article summarises important reports from the breast cancer field. The basis of the selection is the following:
This review will be divided into three categories:
To facilitate the reading, the classical molecular subdivision of breast cancer from luminal disease to triplenegative breast cancer to the HER2 molecular subtype was followed. With the development of the group of HER2 disease called HER2 low/ultra-low expressors, in which trastuzumab deruxtecan showed significant antitumour activity, the original molecular subtyping in three different subgroups is currently not so sharp.
(Belg J Med Oncol 2024;18(5):191–4)
Read moreBJMO - volume 18, issue 1, february 2024
I. Demedts MD, PhD, J. Van Meerbeeck MD, PhD, A. Awada MD, PhD, T. Berghmans MD, PhD
All.Can Belgium is multi-stakeholder, non-profit organisation working to improve the efficiency of cancer care by focusing on what matters to patients. In this spirit, they bring together healthcare professionals, representatives from patient organisations, policymakers, researchers, and the pharmaceutical industry. Over the last decade, we have witnessed a dramatic evolution in the treatment landscape for patients with lung cancer. However, to have a more profound impact on the lung cancer burden, these therapeutic advances need to be coupled with effective strategies for lung cancer screening, prevention, and patient support. By leveraging on the collaboration between healthcare professionals, patient organisations, policy makers and the pharmaceutical industry, the Lung Cancer Working Group established by All.Can Belgium wants to address the most prominent needs in the care pathway for patients with lung cancer. On the 16th of November 2023, the official launch of the Lung Cancer Working Group was celebrated with a symposium coupling lectures on pertinent issues in lung cancer with patient testimonials.
(BELG J MED ONCOL 2024;18(1):33–9)
Read moreBJMO - volume 17, issue 6, october 2023
M. Piccart MD, PhD, J. Vansteenkiste MD, PhD, H. Prenen MD, PhD, F. Duhoux MD, PhD, A. Janssens MD, PhD, M. Delforge MD, PhD, A. Awada MD, PhD, P. Neven MD, PhD, A. Sibille MD, B. Neyns MD, PhD
The oncological treatment landscape is evolving at a very rapid pace with a continuous stream of novel treatment options. To fully leverage these therapeutic advances in clinical practice it is important to facilitate a rapid access to innovative anticancer drugs for patients. Specifically for Belgium, the delay from EMA approval to reimbursement for anticancer drugs is very long, with an average of almost 600 days, and a substantial proportion of innovative drugs never make it to the patient. The stringent focus of the Belgian Commission for Reimbursement of Medicines (CRM) on overall survival (OS) data in reimbursement decisions is believed to be an important contributor to this situation. However, the ever-increasing pace at which new anticancer therapies are being developed in combination with an earlier detection of cancer will make it increasingly difficult to present mature OS data at the time of regulatory approval in the years to come. As such, there is an urgent need for a debate with the regulators to consider more readily available endpoints in their reimbursement assessments. In fact, when a strong treatment effect is seen on an intermediate endpoint such as disease-free or progression-free survival, a benefit in OS is quite likely. As such, our reimbursement system needs to be adapted to better align with the scientific progress in oncology. In this, a temporary reimbursement decision based on intermediate endpoints could give Belgian patients earlier access to promising lifesaving medicines. In this, we as oncologists, including specialists in haematology, respiratory oncology, and gastrointestinal cancer, strongly encourage the CRM to use the grading provided by the ESMO magnitude of clinical benefit scale to evaluate the clinical added value of future cancer treatments. This will not only facilitate a faster patient access to innovative therapies, but will also help policy-makers in advancing ‘accountability for reasonableness’ in their resource allocation deliberations.
(BELG J MED ONCOL 2023;17(6):211–5)
Read moreBJMO - volume 17, issue 2, march 2023
C. Isnard-Bagnis MD, PhD, J. Nortier MD, PhD, C. Vulsteke MD, PhD, C. Hermans MD, PhD, S. Treille De Grandsaigne MD, P. Clement MD, PhD, A. Awada MD, PhD
Chronic kidney disease (CKD) and cancer are intertwined in many ways. In fact, cancer can cause CKD either directly or indirectly through the treatment adverse effects, while CKD may conversely be a risk factor for cancer. According to the Belgian Renal Insufficiency and Anticancer Medications (BIRMA) study, 64% of patients with cancer had a glomerular filtration rate (GFR) <90 ml/min/1.73m2 and 16% of them presented with a mildly to severely decreased GFR (i.e.; <30 ml/min/1.73m2 or 30–60 ml/min/1.73m2). As many anticancer drugs are predominantly excreted in the urine, tailoring the drug dose to the renal function of the individual patient is a crucial consideration. Furthermore, patients with cancer and CKD are also at an increased risk of thrombosis. Therefore, safe and effective drugs for the treatment and prevention of thrombotic events are necessary.
(BELG J MED ONCOL 2023;17(2):46–51)
Read moreBJMO - volume 16, issue 6, october 2022
G. Nader-Marta MD, F.P. Duhoux MD, PhD, D. Taylor MD, T. Van den Mooter MD, H. Denys MD, PhD, J-L. Canon MD, J. Mebis MD, A. Awada MD, PhD, H. Wildiers MD, PhD, K. Punie MD, E. de Azambuja MD, PhD
HER2-targeted agents are the central component of HER2-positive metastatic breast cancer (MBC) treatment. The combination of trastuzumab, pertuzumab and a taxane is the preferred first-line regimen in most settings. For patients with disease relapse after adjuvant therapy, treatment decisions in the first-line are influenced by the treatment-free interval and the regimens used in the (neo)adjuvant setting. T-DXd has been recently established as the preferred second-line therapy. T-DM1, or the combination of tucatinib, trastuzumab and capecitabine, are reasonable third-line options, although efficacy and safety data of these regimens after prior exposure to T-DXd are lacking. In fourth and later lines, trastuzumab duocarmazine, neratinib plus capecitabine, margetuximab plus chemotherapy, lapatinib-based combinations or the continuation of trastuzumab with different chemotherapy partners are valid alternatives.
(BELG J MED ONCOL 2022;16(6): 287–92)
Read moreBJMO - volume 16, issue 4, june 2022
G. Jerusalem MD, PhD, A. Awada MD, PhD, K. Detournay DVM , K. Punie MD
Several treatment guidelines exist for hormone receptor-positive/HER2-negative advanced breast cancer (HR+/HER2- aBC), but various factors influence their local implementation. We performed a 3-round Delphi methodbased study in search of a consensus regarding HR+/HER2- aBC management in Belgian practice. Panel questionnaires included questions related to treatment patterns, drug-drug interactions (DDIs) and side-effect management (SEM). A consensus threshold of 75% was applied. The results were evaluated for concordance with the ABC5 guidelines. Treatment patterns in HR+/HER2- aBC reached moderate to high consensus among Belgian oncologists and showed high concordance with ABC5 guidelines. A CDK4/6 inhibitor is the preferred first-line treatment, combined with an aromatase inhibitor or with fulvestrant in the endocrine-sensitive and -resistant setting, respectively. Alpelisib-fulvestrant is the preferred second-line treatment in presence of a PIK3CA-activating mutation. Some practices regarding DDI and SEM needed further discussion before reaching consensus highlighting the need for additional training and incorporation of these topics in guidelines.
(BELG J MED ONCOL 2022;16(4):176–86)
Read moreBJMO - volume 16, issue 2, march 2022
A. Awada MD, PhD, K. Jochmans MD, C. Vulsteke MD, PhD, T. Vanassche MD, J. Mebis MD, V. Mathieux MD, J-F. Baurain MD, PhD, P. Hainaut MD, P. Verhamme MD
Venous thromboembolism (VTE) is common in cancer patients. It is associated with poor outcomes and increased mortality. In fact, VTE is known as the second most common cause of mortality in cancer patients. Although the benefit of thromboprophylaxis is clear for acutely ill hospitalised cancer patients, routine prophylaxis is not recommended for all ambulatory cancer patients. The reason is the risk to treat a high proportion of patients who do not need treatment and an increased risk of major bleeding. Here we highlight the importance of adequate risk assessment models to select patients at an increased VTE risk and present pivotal trial results that form the basis for the latest international treatment guidelines related to thromboprophylaxis in cancer patients.
(BELG J MED ONCOL 2022;16(2):53–9)
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