BJMO - 2024, issue 4, june 2024
S. Lobo-Martins MD, L. Arecco MD, E. Agostinetto MD, E. de Azambuja MD, PhD
Five years used to be the standard duration for adjuvant endocrine therapy (ET) for hormone receptor-positive early breast cancers, but the benefit of extending treatment duration beyond this period to reduce the risk of disease recurrence has been investigated in several randomised trials, mostly including postmenopausal patients and investigating the extension of aromatase inhibitors as part of the ET. Premenopausal patients represent, to date, a small proportion of the population in a few trials, and the options for extending adjuvant ET, especially in those patients receiving ovarian function suppression (OFS), are underexplored yet. For post-menopausal women, numerous sequences and durations have been proposed, but the optimal duration of extended adjuvant ET remains controversial. Distinct aspects influence this choice, such as the patient’s menopausal status, risk of recurrence, toxicity profile and patient’s preference. Furthermore, the introduction of new targeted agents into the adjuvant setting has brought new uncertainty regarding the ideal length of ET.
(BELG J MED ONCOL 2024;18(4):124–31)
Read moreBJMO - volume 16, issue 6, october 2022
E. Agostinetto MD, V. Debien MD, G. Nader-Marta MD, D. Martins-Branco MD, E. de Azambuja MD, PhD
Neoadjuvant treatments in patients with breast cancer provide the opportunity for a direct evaluation of treatment effect on tumour size, allow higher rates of conservative surgery and give the chance to tailor systemic treatments after surgery. Patients who achieve a pathological complete response experience better long-term survival, compared to those with residual disease after the completion of neoadjuvant therapy, and those with residual invasive disease at surgery may benefit from additional post-neoadjuvant treatment strategies. Some systemic post-neoadjuvant treatments for patients with residual disease at surgery are already approved in clinical practice (i.e., capecitabine for patients with triple-negative breast cancer, or T-DM1 for patients with HER2-positive disease), and several new strategies are currently under evaluation. The present review discusses the available evidence for the implementation of systemic post-neoadjuvant treatment strategies into clinical practice for patients with early breast cancer, shading light on the pitfalls and limitations of different studies, and summarising data on novel promising treatment strategies that are being explored in clinical trials.
(BELG J MED ONCOL 2022;16(6):262–73)
Read moreBJMO - volume 16, issue 1, february 2022
E. Agostinetto MD, E. de Azambuja MD, PhD
Immune checkpoint inhibitors (ICI) represent a class of drugs that has dramatically improved survival outcomes of patients with several solid and haematological malignancies. Due to their mechanism of action, treatment-related adverse events (AEs) induced by ICI are mostly immune-related AEs, which can affect any organ, including the cardiovascular system. Immune-related cardiac AEs are rare, occurring in less than 1% of patients receiving ICI. However, they are associated with a high fatality rate compared to other AEs. Together with an increasing awareness among physicians, cardiotoxicity of ICI requires further investigation to better understand the pathophysiology of this rare but possibly fatal complication, and to improve its diagnosis and treatment. The present narrative review aimed to describe the incidence and the underlying mechanism of ICIs’ cardiotoxicity, providing key messages for clinical practice for oncologists and cardiologists on their clinical manifestations and management.
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