A. Enguita PhD

Highlights in breast cancer

SUMMARY

At ESMO 2023, updated results of monarchE and NATALEE further reinforced the efficacy and safety of combining a CDK4/6 inhibitor with endocrine therapy (ET) in patients with early-stage hormone receptor positive (HR+) breast cancer (BC). In addition to this, the CheckMate 7FL and KEYNOTE-756 studies demonstrated a potential clinical benefit of adding an immune checkpoint inhibitor to neoadjuvant chemotherapy and adjuvant ET in this setting. In early-stage triple negative breast cancer (TNBC), updated results of the KEYNOTE-522 study confirmed the benefit of perioperative pembrolizumab, while the NeoTRiP trial, assessing the addition of atezolizumab to neoadjuvant chemotherapy, did not show a significant benefit in event-free survival (EFS). In metastatic disease, promising results were obtained with new selective oestrogen receptor degraders (SERD) and antibody-drug conjugates (ADC). In addition, results of a real-world study indicate that patients with HER2-/ER-low disease should preferably be treated as TNBC.

(Belg J Med Oncol 2023;17(8):304–12)

Highlights in gynaecological cancers

SUMMARY

The 2023 annual ESMO meeting featured several presentations with the potential to reshape the standard of care in gynaecological cancers. New approaches emerged as promising treatments in cervical cancer, such as chemoradiotherapy combined with induction chemotherapy or pembrolizumab in patients with newly diagnosed locally advanced cervical cancer, or the antibody-drug conjugate tisotumab vedotin in the recurrent or metastatic setting. In addition, several trials further solidified the efficacy and safety of combining immunotherapy (durvalumab, atezolizumab, dostarlimab or pembrolizumab) with chemotherapy, in the treatment of advanced or recurrent mismatch repair deficient (MMRd) endometrial cancer. In contrast, the combination of atezolizumab plus chemotherapy followed by niraparib maintenance failed to demonstrate clinical benefits in patients with recurrent ovarian cancer.

(Belg J Med Oncol 2023;17(8):298–303)

Amivantamab plus lazertinib as a first-line treatment for patients with EGFR-mutant advanced NSCLC

Since the publication of the ADAURA trial, osimertinib has been the undisputed standard of care first line treatment for patients with advanced, EGFR-mutant non-small cell lung cancer (NSCLC). Despite a high initial response rate with this agent, most patients treated with osimertinib will eventually relapse. During the 2023 annual meeting of the European Society of Medical Oncology (ESMO), results of the randomized, phase 3 MARIPOSA trial demonstrated that a combination of amivantamab and lazertinib was associated with a better progression-free survival (PFS) and more durable responses than osimertinib in previously untreated advanced, EGFR-mutant NSCLC patients. With these findings, amivantamab plus lazertinib challenges osimertinib as the standard of care in this setting.

Optimising outcomes in BRAF-mutant melanoma: sequencing or combining?

Over the last decades, immune checkpoint inhibitors (ICI) and dual BRAF/MEK inhibition have transformed the treatment landscape for patients with advanced melanoma. However, the availability of two effective treatment strategies for patients with BRAF-mutant advanced melanoma brings about the question of the optimal treatment sequence for patients. This article summarizes the currently available evidence on the efficacy and safety of sequential immunotherapy with targeted therapy in this setting.

Immunotherapy for the treatment of gastric cancer

In recent years, immunotherapy has become a vital part of the treatment algorithm for patients with advanced gastric cancer (AGC). Initially, immunotherapy-based regimens proved their worth in (heavily) pre-treated patients. More recently, however, immune-checkpoint inhibitors (ICIs) were also introduced in the first-line treatment of advanced gastric cancer. This article provides a brief overview of the clinical trials that form the rationale for this immunotherapy-shift in the management of gastric cancer.

Journal Scan

In this section of the BJMO, we aim to provide a snapshot of pivotal studies published in recent issues of the most important international journals focusing on oncology. Importantly, the selection of the studies discussed here is the sole responsibility of the publisher and was not influenced by third parties. Do you miss an important study, or did you read a hidden jewel that deserves to be shared with your colleagues? Please, let us know (editor@bjmo.be) and we will make sure to include it in the journal scan section of the next BJMO issue.

(BELG J MED ONCOL 2023;17(6):239–44)

Highlights in breast cancer

The 2023 ASCO meeting again featured several ground-breaking presentations in the field of breast cancer (BC). Early-stage highlights include the long-awaited data of the NATALEE trial assessing adjuvant ribociclib in combination with endocrine therapy (ET) and the PHERGain trial exploring chemotherapy de-escalation using 18F-FDF PET/CT metabolic response assessment. Other studies discussed new molecular biomarkers for recurrence and response, and the impact of ET timing intake on outcomes. Finally, flibanserin was shown to be effective in countering sexual dysfunction in BC patients receiving adjuvant ET. In the metastatic setting, the SONIA trial questioned the universal use of CDK4/6 inhibitors in the first line treatment of patients with hormone-receptor (HR) positive metastatic BC. Furthermore, a pooled analysis of the DESTINY-Breast01, -02, and -03 trials reaffirmed trastuzumab deruxtecan as an effective treatment option for patients across all age subgroups in HER2-positive BC. Finally, a less toxic capecitabine regimen emerged as an alternative to standard treatment in metastatic BC. These results, along with other important findings, are summarised in this report. We would like to acknowledge Prof. Hans Wildiers and Prof. Patrick Neven (University Hospitals Leuven) for their help in selecting the abstracts and adding a clinical interpretation to this overview.

(BELG J MED ONCOL 2021;15(5):193–201)