D. Schrijvers MD, PhD

Head and neck cancer: The role of cisplatin

SUMMARY

Cisplatin has been the backbone of the treatment of patients with squamous cell carcinoma of the head and neck, both in recurrent/metastatic settings and in patients with locoregional disease. In patients with recurrent/metastatic disease and a combined positivity score (CPS) ≥20, cisplatin can be replaced by pembrolizumab. In patients with locoregional disease and treated with definitive chemoradiation or in the adjuvant setting, the 3-weekly high-dose cisplatin can be replaced by the weekly 40 mg/m² cisplatin regimen.

(Belg J Med Oncol 2023;17(2):52–7)

What are the treatment options for metastatic castration-resistant prostate cancer anno 2023?

SUMMARY

Patients developing metastatic castration-resistant prostate cancer are in most instances pre-treated with androgen deprivation treatment and a newer androgen receptor-targeting agent in the metastatic castration-sensitive setting.

In this article, I discuss the first- and second-line treatment options in this patient population.

(BELG J MED ONCOL 2023;17(1):15–8)

Audits in medical oncology

SUMMARY

The quality of oncological care can be ensured by different means, such as graduate and postgraduate education, guidelines, quality labels and audits. Audits in medical oncology departments are not routinely performed and are only used in case of problems. In this article, the introduction of audits in the medical oncology department is advocated, and a strategy to implement this quality improving tool is proposed.

(BELG J MED ONCOL 2023;17(1):19–26)

Elevated CA-15.3 in a patient with megaloblastic anaemia: A red herring in breast cancer follow-up

SUMMARY

The cancer antigen 15.3 (CA-15.3) is an important tumour marker for the evaluation of patients with a history of breast cancer. An increase of CA-15.3 can be a sign of breast cancer recurrence and warrants further investigation. However, CA-15.3 is not specific and can be elevated in several oncological and benign conditions. This case describes a megaloblastic anaemia due to folic acid deficiency and elevated CA-15.3 in a patient with a history of breast cancer. No signs of breast cancer recurrence were found, and serum CA-15.3 levels normalised after supplementation of folic acid. Benign causes of CA-15.3 elevation should be considered when evaluating a patient with a history of breast cancer.

(BELG J MED ONCOL 2022;16(6):360–2)

The benefit of anticancer drugs

SUMMARY

New anticancer drugs are continuously developed and show statistically significant differences compared to the standard treatment. However, their clinical impact is not always shown. In this review, two systems to evaluate the meaningful clinical benefit are discussed: the ESMO-MCBS, developed by ESMO, and the ASCO value framework, proposed by ASCO. Both systems evaluate clinical meaningful effects of new anticancer drugs based on available clinical research, and grade them according to the system they developed. Whereas the ESMO-MCBS is a tool directed to guide development and health care system professionals, the ASCO value framework is a tool to help the medical oncologist and the patient to make an informed decision in relation to the value of a new treatment, including costs.

(BELG J MED ONCOL 2022;16(7):355–9)

Giant cell tumour of the jaw: Long-term treatment with denosumab in two patients

SUMMARY

Giant cell tumour of the bone (GCTB) is an uncommon primary bone tumour with rare metastatic potential. Giant cell tumour of the jaw (GCTJ) is histologically similar to GCTB with comparable treatment options. Denosumab, a human monoclonal antibody working as a RANKL inhibitor is recommended for treating patients with unresectable giant cell tumours. However, data on long-term efficacy and toxicity (e.g. osteonecrosis of the jaw) remains scarce, especially in GCTJ. This article presents two cases of patients with a GCTJ who were treated with denosumab for over eight years with excellent disease control and without significant toxicity.

(BELG J MED ONCOL 2022;16(6):300–2)

Mazabraud’s Syndrome in association with other benign soft tissue tumours: A case report

SUMMARY

Mazabraud’s Syndrome is a rare benign disorder characterised by the association of two hallmark entities: fibrous dysplasia (FD) and intramuscular myxomas (IM). The aetiology of the disease is unclear, but molecular research of FD and IM points in the direction of post-zygotic mutations in the guanine nucleotide binding protein, alpha stimulating (GNAS) gene, which activates a trophic cascade leading to aberrant cellular proliferation. Although the diagnosis of Mazabraud’s Syndrome is rare, showing a prevalence lower than 1/1,000,000, it should be suspected in every patient presenting with FD and IM. These patients should get a bone scintigraphy and a magnetic resonance imaging (MRI) of the affected anatomical area. Other imaging techniques, such as positron emission tomography-computed tomography (PET-CT), may have additional value. Finally, the patients should perform a biopsy of the IM to confirm the diagnosis. The treatment includes bisphosphonates for FD, and surgery is reserved only for severe cases with persistent pain, deformity, fracture, or risk for a pathological fracture. Asymptomatic IM should be treated conservatively, but symptomatic lesions can be surgically excised. Follow-up is useful since malignant transformation of FD and recurrence of IM after excision are reported in the literature.

(BELG J MED ONCOL 2022;16(4):187–90)