E. Seront MD, PhD

New mechanisms of action and new combinations in urothelial cancer

SUMMARY

The year 2023 marked a significant revolution in urothelial cancer, introducing novel anticancer strategies. The synergy between antibody-drug conjugates and immune checkpoint inhibitors has led to a drastic improvement in patient outcomes. Using this combination in first-line metastatic urothelial carcinoma has achieved a median overall survival exceeding 30 months, a milestone in the field. This breakthrough not only paves the way for a deeper comprehension of the disease’s pathogenesis but also underscores the pivotal role of combinations in urothelial carcinoma, applicable not only in advanced stages but also in the localised setting. This review serves as a reminder of the novel mechanism of action of these drugs, alongside highlighting their safety profile. Additionally, we emphasise the critical importance of refining patient selection criteria, particularly in the context of immune checkpoint inhibitors and bladder sparing strategies.

(BELG J MED ONCOL 2024;18(6):227-234)

Update on the management of renal cell carcinoma: The BSMO expert panel recommendations

SUMMARY

The management of renal cell carcinoma is evolving rapidly. Here, the BSMO expert panel discusses recent advances focusing on systemic therapies, and provides guidelines adapted to the Belgian context.

(BELG J MED ONCOL 2023;17(4):118–27)

Vascular malformations: Repurposing the role of anti-cancer targeted molecular inhibitors

SUMMARY

Vascular malformations are rare diseases that result from anomalies in the angiogenesis process. They are subdivided into capillary, lymphatic, venous, arteriovenous, and mixed malformations, according to the type of affected vessels. Until a few years ago, therapeutic options were limited to sclerotherapy and/or surgery, but these treatments are rarely curative or not feasible. Most vascular malformations are caused by inherited or somatic mutations in various genes. These mutations are similar to oncogenic mutations detected in cancer, leading to hyperactivity of important signalling pathways, including MAPK and PI3K/AKT/mTOR cascades. This article highlights the role of targeted molecular inhibitors as therapies for vascular anomalies via repurposing of anticancer drugs.

(BELG J MED ONCOL 2022;16(6):293–99)

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)

Appropriateness of treatment options in patients with metastatic castrationresistant prostate cancer with a focus on radium-223: outcomes of a Belgian multidisciplinary Consensus Meeting

SUMMARY

The treatment landscape for metastatic castration-resistant prostate cancer (mCRPC) has changed dramatically with the approval of a variety of therapeutic agents including abiraterone acetate, cabazitaxel, docetaxel, enzalutamide and radium-223 dichloride and the introduction of docetaxel and abiraterone acetate in combination with androgen deprivation therapy in newly diagnosed metastatic prostate cancer. Evidence on the optimal sequence of these therapies is scarce. In practice, the most appropriate treatment (sequence) depends on patient and disease characteristics. This article summarises the recommendations of a multidisciplinary group of Belgian experts in sequencing treatments for patients with mCRPC, with a focus on radium-223 dichloride.

(BELG J MED ONCOL 2019;13(6): 240–250)

Current immunotherapeutic approach to bladder cancer

Multiple immune checkpoint inhibitors (ICIs) are currently available for the treatment of bladder cancer. The question raised by Dr Seront in his lecture was: “which agent should be used for which patient?”

Immunotherapy for genitourinary cancers: where are we?

Immunotherapy harnesses the immune system to recognize and destroy cancer cells. This review focuses on the different agents that are currently approved in genitourinary cancers and highlights promising therapeutic strategies in this field. The clinical data generated in advanced urological cancer, advanced renal cell carcinoma (RCC) and metastatic prostate cancer will be discussed