A. Awada MD, PhD

Future perspectives and opportunities to improve the treatment of brain metastases in solid tumours: Brainstorm program – an initiative from the Oncodistinct network

SUMMARY

Patients with central nervous system (CNS) metastases have a poor prognosis, which is generally worse than in those with disease only outside the CNS. Treatment options for CNS metastases are still limited and suboptimal. New systemic therapies such as targeted therapies and immunotherapy have emerged for different cancers and differences in survival of patients with CNS metastases by tumour subtype have been observed. A better knowledge on the evolving epidemiology and biology of CNS metastases are key elements in the development of new treatment strategies whereby the identification of promising therapeutic targets for new compounds may play an important role in improving patient outcome. This article will provide a general overview of the recent improvement in systemic therapies for CNS metastases, highlighting perspectives to improve the management of CNS metastases and introduce the BrainStorm program- an innovative research program from the Oncodistinct network aiming to overcome the challenges of CNS metastases.

(BELG J MED ONCOL 2021;15(7):357-61)

Clinical management of first-line advanced triple-negative breast cancer patients

SUMMARY

Chemotherapy has represented the main treatment option for patients with advanced triple-negative breast cancer for a long time. However, due to our better understanding of tumour biology, recent clinical trials led to a change in the treatment paradigm of this disease, identifying clinically relevant subgroups with different therapeutic options. Both clinical and biological factors have become relevant and need to be considered in the treatment decision algorithm of this heterogeneous disease.

(BELG J MED ONCOL 2020;14(7):333-38)

Triple-negative breast cancer: current treatment and future perspectives

SUMMARY

Triple-negative breast cancer is a heterogeneous subtype of breast carcinoma lacking the expression of oestrogen, progesterone and human epidermal growth factor 2 receptors. For many decades, cytotoxic chemotherapy has been the standard of care offering only a short-living disease control. Knowing its poor outcome and aggressive behaviour, researchers are trying to find new therapeutic options hoping to improve the survival of this population. Many cytotoxic and targeted therapies were tested without major benefit. However, in the era of molecular and mutational classification of tumours, as well as the immune mediated mechanisms of proliferation and progression, the trials are currently oriented towards the identification of potential targets in the tumoral heterogenic environment. Here, we present a review of literature concerning the potential anti-neoplastic options and novel therapies for metastatic triple-negative breast cancers: new cytotoxic agents, new targeted therapies, anti-angiogenic agents, antibody-drug conjugates, poly-ADP ribose transferase inhibitors and immunotherapy. Many agents are promising, yet not powerful enough to get approvals for use into clinical practice.

(BELG J MED ONCOL 2019;13(3):84–92)

The role of direct oral anticoagulants in the management of cancer-associated thrombosis

SUMMARY

Cancer patients are at an increased risk of venous thromboembolism (VTE). The current standard initial treatment of an acute episode of VTE in cancer patients consists of the administration of three to six months of subcutaneous low molecular weight heparin (LMWH) at a dose adjusted to the body weight. The efficacy and safety profile of LMWHs are well established, but a drawback of these agents is that they require daily subcutaneous administration. In addition, they are mainly cleared through the kidneys, and their use in patients with severe renal insufficiency may require dose reduction or monitoring of the anti-Xa activity. To address the issues with LMWH, several direct oral anticoagulants (DOAC) have been developed for the treatment of VTE. In contrast to LMWHs and vitamin K antagonist, DOACs directly interfere with thrombin or activated factor X (FXa). DOACs have now become standard treatment options in the general management of VTE, but until recently, there were no results of clinical trials specifically assessing the role of DOACs in the treatment of cancer-associated thrombosis. Recently, the Hokusai VTE cancer study and preliminary data from the Select-D trial demonstrated that DOACs are non-inferior to LMWH in preventing recurrent VTE. However, both studies also show that this comes at the cost of an increased rate of both major and clinically-relevant non-major bleeding. Especially in the subgroup of patients with gastrointestinal cancer, the benefit in VTE recurrence with the DOAC seems to be outbalanced by a significantly increased bleeding risk. Based on the available results, DOACs might represent an interesting alternative for LMWH in certain subgroups of patients, but with an important list of exceptions. It seems reasonable not to use DOACs in patients with a high bleeding risk, and especially in patients with gastrointestinal cancer, DOACs should not be the first-line choice. In summary, while LMWHs are currently the standard of care in the acute management of cancer-associated thrombosis, the advent of DOACs is welcomed for patients at a low bleeding risk who are in need of long-term anticoagulation.

(BELG J MED ONCOL 2019;13(2):46–53)

Screening for occult cancer in patients with unprovoked venous thromboembolism: Belgian expert guidance

Unprovoked venous thromboembolism (VTE) may be the earliest sign of malignancy, and as a result, screening for occult cancer in these patients has become routine practice. However, the elaborateness of this screening is subject to debate and varies between medical centres. This study’s expert panel, consisting of oncologists and thrombosis specialists, aimed to develop a practical Belgian guidance for adequate cancer screening in patients with unprovoked VTE. In summary, comprehensive non-invasive cancer screening consisting of a medical history assessment, physical examinations, basic blood tests and a chest X-ray is sufficient to pick up the vast majority of occult cancers. When specific abnormalities are picked up by the battery of tests in the comprehensive non-invasive cancer screening, more extensive screening using CT scans are recommended. Routine CT screening in all patients presenting with an unprovoked VTE does not provide a significant clinical benefit and should not be routinely performed. In the presence of specific risk factors (e.g., older age, smoking history, previous VTE), physicians are advised to be more vigilant. Finally, given the significant anxiety that cancer screening may cause to patients, accurate and clear patient communication is key. A complete list of guidance statements is provided at the end of the article.

(BELG J MED ONCOL 2018;12(7):326–329)

P.08 AUTOIMMUNE POLYARTHRITIS: A RARE COMPLICATION OF RENAL CLEAR CELL CARCINOMA ON IMMUNOTHERAPY

P.13 UNEXPECTED TOXICITY IN A PATIENT TREATED WITH FLUOROPYRIMIDINES FOR A METASTATIC BREAST CANCER