D. Schrijvers MD, PhD

Bone health in cancer

Bone health is an important factor in the quality of life of cancer patients. Complications of impaired bone health can impact the quality of life and the survival of these patients. Every oncologist should look at problems of bone health such as osteoporosis and complications related to patient characteristics, the oncological disease and the cancer treatment. Complications should be prevented and, if they occur, adequately treated.

(BELG J MED ONCOL 2022;16(4):161–5)

Doublets in the first-line treatment of metastatic renal cell cancer with clear cell histology

SUMMARY

The treatment of mRCC has undergone a tremendous evolution in the last decades. There are data that the doublets of checkpoints inhibitors with each other or with anti-angiogenic agents improve PFS compared to sunitinib alone.

In this article, we review the different combinations and give some guidance for their use.

(BELG J MED ONCOL 2022;16(2):48–52)

When is a cancer progressive on imaging?

SUMMARY

The outcome of a cancer treatment should be adapted according to the treatment the patient is receiving and, in some instances, to the tumour type.

The different evaluation systems (RECIST 1.1, iRECIST, mRECIST, EORTC and PERCIST) have all their specific indications and rules, and they should be known by the radiologist and the oncologist.

This review focuses on the criteria to consider cancer as progressive, in relation to cancer treatment and tumour type.

(BELG J MED ONCOL 2022;16(1):29–32)

BRCA1 and BRCA2 mutations in prostate cancer: consequences and implications

SUMMARY

BRCA mutations play an important role in prostate cancer. All patients with high-risk localised or metastatic prostate cancer should be tested for somatic mutations and, if present, for germline mutations. BRCA muta-tions translate in a more aggressive prostate cancer with a worse prognosis. If these mutations are present, PARP inhibitors may be part of the treatment strategy.

(BELG J MED ONCOL 2021;15(6):283-5)

Reactivations of prior infections in cancer patients treated with immunosuppressive/immunomodulatory treatments

SUMMARY

Prior infections may reactivate in cancer patients receiving immunosuppressive/immunomodulatory treatments. Depending on the severity of the immune suppression, chemoprophylaxis may be necessary and is recommended in Herpes simplex virus- and Herpes zoster virus-seropositive patients undergoing allogenous hematologic stem cell transplantation and in solid cancer patients with Hepatitis B surface antigen or hepatitis B core antibody seropositivity.

For other infections, a low threshold for performing diagnostic testing of potential viral or tuberculosis infections should be used should be used in daily clinical practice in order to prevent severe morbidity or mortality.

(BELG J MED ONCOL 2021;15(2):75-8)

BELFIGO – A retrospective observational study to evaluate the treatment patterns of mCRPC patients in Belgium treated with radium-223

SUMMARY

BELFIGO is a national retrospective chart review that aimed to assess the sequencing and application of radium-223 (Ra-223) within routine clinical practice, and evaluate the use of Ra-223 in monotherapy. The collection of data was primarily used to describe the proportion of Belgian metastatic Castration Resistant Prostate Cancer patients receiving one-four versus five-six Ra-223 injections, and the potentially associated patient characteristics. In total, 164 patients from eleven centres in Belgium were included and analysed in this study. Hundred-thirteen patients (69%) completed five-six injections of Ra-223. There was a trend that patients with a lower Eastern Cooperative Oncology Group Performance Status score, lower extent of disease on bone scan, alkaline phosphatase at baseline < 140 U/L and lactate dehydrogenase at baseline <250 U/L showed a higher chance of completing the six cycles of Ra-223. Median overall survival was estimated at 6.9 months for the patients having received one-four injections and 23.8 months for patients who completed five-six injections of Ra-223. More than 70% of patients received at least one treatment line after Ra-223, mainly enzalutamide, docetaxel or abiraterone acetate. These results show that the life-prolonging targeted alpha-therapy Ra-223 does not preclude the start of subsequent lines of treatment and that its use in an earlier line results, in a higher probability of reaching five-six doses. Patients with less advanced disease are more likely to complete five-six injections and tend to have a higher median overall survival.

(BELG J MED ONCOL 2020;14(7):347-54)

The hype of phase II trials

SUMMARY

Many of the new drugs are registered based on phase II data and surrogate endpoints. The medical oncologist should know the limitations and dangers of such an approach. The value of phase II trials and surrogate endpoints as well as clinical meaningful results are discussed.

(BELG J MED ONCOL 2019;13(7):273–6)