BJMO - 2024, issue 4, june 2024
K. Punie MD, G. Jerusalem MD, PhD, I. Deleu MD, A. Gombos MD, T. Feys MBA, MSc, F.P. Duhoux MD, PhD
HER2 overexpression has been a therapeutic target in breast cancer (BC) for many years and the development of anti-HER2 therapies has markedly improved the outcome of patients exhibiting high levels of HER2 expression. In this, the HER2 status of patients was traditionally defined in a binary fashion, in which patients with high levels of HER2 expression were classified as HER2-positive, while all the rest were denominated as HER2-negative. Despite being classified as HER2-negative; the majority of these BCs do express some level of HER2. Until recently, however, these low levels of HER2 expression did not have any therapeutic implications. This has changed with the publication of the DESTINY-Breast04 (DB-04) study in which trastuzumab deruxtecan (T-DXd) was shown to significantly improve the progression-free (PFS) and overall survival (OS) of patients with HER2-low metastatic BC. These findings require a recalibration of the treatment paradigm for patients with advanced BC. Furthermore, the increased interest in HER2-low BC led to questions on the biology, epidemiology, heterogeneity, and prognostic relevance of HER2-low disease and confronts physicians with the challenge of incorporating the treatment of HER2-low disease in the rapidly evolving treatment landscape for patients with hormone-receptor-positive (HR+) and triple-negative BC (TNBC).
(BELG J MED ONCOL 2024;18(4):141–51)
Read moreBJMO - volume 16, issue 4, june 2022
G. Jerusalem MD, PhD, A. Awada MD, PhD, K. Detournay DVM , K. Punie MD
Several treatment guidelines exist for hormone receptor-positive/HER2-negative advanced breast cancer (HR+/HER2- aBC), but various factors influence their local implementation. We performed a 3-round Delphi methodbased study in search of a consensus regarding HR+/HER2- aBC management in Belgian practice. Panel questionnaires included questions related to treatment patterns, drug-drug interactions (DDIs) and side-effect management (SEM). A consensus threshold of 75% was applied. The results were evaluated for concordance with the ABC5 guidelines. Treatment patterns in HR+/HER2- aBC reached moderate to high consensus among Belgian oncologists and showed high concordance with ABC5 guidelines. A CDK4/6 inhibitor is the preferred first-line treatment, combined with an aromatase inhibitor or with fulvestrant in the endocrine-sensitive and -resistant setting, respectively. Alpelisib-fulvestrant is the preferred second-line treatment in presence of a PIK3CA-activating mutation. Some practices regarding DDI and SEM needed further discussion before reaching consensus highlighting the need for additional training and incorporation of these topics in guidelines.
(BELG J MED ONCOL 2022;16(4):176–86)
Read moreBJMO - volume 16, issue 1, february 2022
M. Moonen MD, PhD, C. Jacquemart MD, G. Jerusalem MD, PhD, P. Lancellotti MD, PhD
Thanks to the enormous progress made in cancer treatment, there are more and more cancer survivors. Oncologists are now concerned with the long-term management of patients who have recovered from their cancer. Giving them the best chance of a healthy survival is a very important issue. However, in this context, epidemiological studies and registries have revealed that the prognosis of cancer survivors is marred by the onset of more frequent and earlier cardiovascular disease. The emerging cardio-oncology discipline is seriously concerned about this issue as the number of patients potentially affected is large and growing. The task consists of identifying patients at increased risk of cardiovascular events after cancer treatment. Patients at risk are those with pre-existing cardiovascular risk factors and heart disease, and those exposed to anticancer treatment with cardiac toxicity that appears during their follow-up. Identifying those high-risk patients is possible thanks to clinical, biological and imaging monitoring. Furthermore, this monitoring allows therapeutic interventions, ranging from lifestyle recommendations to pharmacological treatment. However, several important pending questions remain, including whether cancer survivors would benefit from a more aggressive approach than that used to treat non-cancer survivor patients for the same cardiovascular problem.
(BELG J MED ONCOL 2022;16(1):11–16)
Read moreBJMO - volume 13, issue 6, october 2019
C. Gennigens MD, PhD, G. Jerusalem MD, PhD
Soft tissue sarcomas represent 75% of all sarcomas and constitute a group of more than 50 different histological subtypes, with an even greater number of molecular subtypes. Localised STSs are generally treated by surgery followed, or preceded, by radiotherapy and according to criteria linked with the risk of local recurrence. Metastatic STSs are principally treated by systemic treatments such as chemotherapy and targeted drugs. The most important drugs used are doxorubicin, ifosfamide, dacarbazine, gemcitabine/docetaxel, eribulin and trabectedin; but also pazopanib. The place of localised treatments (surgery, radiotherapy, radiofrequency, etc.) in this setting is reserved for oligometastatic disease. A multidisciplinary approach is mandatory, with centralisation of all cases in reference centres, as early as at the time of clinical diagnosis of a suspected sarcoma. This ‘centralised’ approach, for this rare and complex disease, has an impact on the oncologic outcomes (quality of resection and overall survival) of patients.
(BELG J MED ONCOL 2019;13(6): 227–233)
Read moreBJMO - volume 12, issue 3, february 2018
Pierre Foidart , Nor-Eddine Sounni , G. Jerusalem MD, PhD
BJMO - volume 11, issue 6, october 2017
P. Frères MD, C. Gennigens MD, PhD, D. Martin MD, PhD, G. Jerusalem MD, PhD
Leptomeningeal carcinomatosis (LC), or neoplastic meningitis, is a disastrous complication of advanced cancer. This disease occurs in approximately 5% of patients with solid tumour and results from the dissemination of tumour cells from the cerebral spinal fluid (CSF) flow throughout the entire central nervous system (CNS). LC is characterized by multiple and fluctuant neurologic symptoms and signs. Useful tests for the diagnosis include magnetic resonance imaging (MRI) and CSF analysis. Unfortunately, the diagnosis remains challenging due to pleomorphic symptoms and false negative results of diagnostic procedures. For most patients, the aim of the treatment is to control symptoms, by using targeted radiotherapy and corticosteroids. More aggressive therapeutic approaches, such as intrathecal (IT) or systemic chemotherapy, should be restricted to highly selected and good-risk patients. Moreover, only few randomized clinical trials are available in the field and studies using more recent targeted therapies or immunotherapy should always be considered in these patients, as outcome with standard of care is disappointing.
(BELG J MED ONCOL 2017;11(6):259–264)
Read moreBJMO - volume 10, issue 4, july 2016
P. Frères MD, L. Lousberg MD, G. Jerusalem MD, PhD
Dysregulation of the cell cycle is a classic hallmark of cancer. Cell cycle control by the inhibition of cyclin-dependent protein kinases represents new options for anticancer therapy. Abemaciclib (LY2835219), ribociclib (LEE011) and palbociclib (PD0332991) are selective oral inhibitors of CDK4/6 and are largely under evaluation in clinical trials in the field of breast cancer. In an open-label, randomised phase II study (PALOMA-1/TRIO-18 trial), the combination of palbociclib and letrozole, compared to letrozole alone, significantly prolongs progression-free survival of patients suffering from ER positive HER2 negative advanced breast cancer and who had not received any systemic treatment for their advanced disease. More recently, it has also been shown that palbociclib combined with fulvestrant resulted in longer progressionfree survival than fulvestrant alone in patients presenting ER positive HER2 negative advanced breast cancer and who had progression of disease during endocrine therapy. The toxicity profile of palbociclib is manageable. The most common grade 3 or 4 adverse events include neutropenia, anaemia, thrombocytopenia and fatigue. Toxicity related permanent discontinuation is unusual. Additional phase III data evaluating CDK4/6 inhibitors in patients with endocrine sensitive disease or after failure of previous endocrine therapy are expected in the very near future. Impact of CDK4/6 inhibitors on overall survival and the role of CDK4/6 inhibitors in the adjuvant or neoadjuvant setting are under evaluation. More treatment options are now evaluable for patients with ER positive HER2 negative advanced breast cancer. Optimal sequence of the available therapies remains unknown. Unfortunately, no trials have been designed to answer this important question.
(BELG J MED ONCOL 2016;10(4):132–138)
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