H. Wildiers MD, PhD

Highlights in breast cancer

During the 2020 Virtual ESMO meeting, long-awaited results were presented of several important breast cancer studies. For hormone receptor positive (HR+) breast cancer, ESMO 2020 featured conflicting results on the use of CDK4/6 inhibitors in the adjuvant treatment of patients with hormone-receptor positive (HR+) early breast cancer. In HR+ metastatic breast cancer, final overall survival data were presented of the SOLAR-1 trial evaluating alpelisib in PIK3CA mutant patients. In triple negative breast cancer (TNBC), new data on immune therapy were presented. In early-stage TNBC, the addition of atezolizumab to neoadjuvant chemotherapy resulted in a significant increase in the rate of pathological complete responses (pCR). In the metastatic setting, final results of the IMpassion130 trial confirmed the benefit of atezolizumab combined with nab-paclitaxel as first-line treatment for metastatic PD-L1 positive TNBC. Unexpectedly, the IMpassion131 trial evaluating atezolizumab plus paclitaxel in first-line treatment of patients with metastatic TNBC failed to meet its primary endpoint. Finally, the phase III randomized controlled ASCENT trial identified the antibody-drug conjugate (ADC) sacituzumab govitecan as a safe and highly effective treatment option for heavily pre-treated metastatic TNBC patients.

Clinical management of first-line advanced triple-negative breast cancer patients

SUMMARY

Chemotherapy has represented the main treatment option for patients with advanced triple-negative breast cancer for a long time. However, due to our better understanding of tumour biology, recent clinical trials led to a change in the treatment paradigm of this disease, identifying clinically relevant subgroups with different therapeutic options. Both clinical and biological factors have become relevant and need to be considered in the treatment decision algorithm of this heterogeneous disease.

(BELG J MED ONCOL 2020;14(7):333-38)

Highlights in geriatric oncology

Summary

Cancer is primarily a disease of older adults, and as a result improving the care for older patients with cancer is becoming increasingly important. In this respect, the 2020 virtual ASCO meeting featured a fascinating and very important session entitled “You’re only old once: improving outcomes for older adults with cancer.” In this session, positive results were presented of four randomised controlled trials evaluating whether or not geriatric assessment has the potential to improve treatment outcomes in older patients with cancer. Three of these trials focused on the geriatric management of patients receiving chemotherapy or other cytotoxic agents, while a fourth study evaluated to what extent perioperative oncogeriatric management could improve the outcome of patients undergoing surgery for gastrointestinal cancer. Overall, all these studies indicate that an integrated geriatric oncology assessment provides an important clinical benefit to older cancer patients.

(BELG J MED ONCOL 2020;14(5):218-21)

Highlights in breast cancer

Summary

During the 2020 Virtual ASCO meeting, no less than 226 presentations were dedicated to breast cancer. It is beyond the scope of this article to discuss all these abstracts, but instead we try to focus on the data that are most relevant for your daily clinical practice.

(BELG J MED ONCOL 2020;14(5):191-200)

Geriatric oncology: targeting older patients with cancer

SUMMARY

As the cancer population ages, treatment decisions in the older patients should not only be guided by the tumour characteristics but also by patient characteristics. The performance of a comprehensive geriatric assessment as well as a health related quality of life evaluation are important in order to deliver the optimal personalised care in older patients with cancer. The current PhD thesis focused on the use of screening tools, geriatric assessment and interventions as well as on health-related quality of life in older patients with cancer.

(BELG J MED ONCOL 2020;14(3):106–8)

Immune checkpoint inhibition in triple negative breast cancer: targeting Achilles’ heel?

Triple negative breast cancers pose an important challenge both for patients and their clinicians due to their aggressive disease course, poor long-term survival and lack of effective systemic treatment options. Recent scientific advances show that the adaptive immune system harbors the intrinsic capacity to eradicate cancer, generally through mechanisms that involve cytotoxic T-cells. Immune checkpoint inhibition boosts the host-anti-tumor response in many solid tumors, including breast cancer. However, cancer cells acquire ways to evade immunosurveillance and intra-tumoral T-cells are often functionally impaired, resulting in overt clinical cancer. Interestingly, the efficacy of immune checkpoint inhibition appears to correlate with tumor immunogenicity and the tumor mutational burden. Triple negative breast cancer has the highest tumor mutational burden of all breast cancer subtypes and therefore is believed to be the most immunogenic subtype. For this reason, clinical trials to date mainly focus on this specific subtype. Here, we review the accumulating evidence for immune checkpoint blockade in triple negative breast cancer.

Highlights in breast cancer

During ESMO 2018 an entire presidential session was dedicated to breast cancer. In addition to exciting immuno-oncology data in the treatment of triple negative breast cancer (TNBC), this session featured the presentation of the overall survival (OS) data of the phase III PALOMA-3 trial, evaluating the alpha-specific PI3K-inhibitor alpelisib in PI3KCA-mutant advanced breast cancer, and results of a clinical trial demonstrating improved outcomes when adding a histone deacetylase (HDAC) inhibitor to exemestane in hormone-receptor positive advanced breast cancer. In early breast cancer it was further demonstrated that non-compliance with adjuvant endocrine treatment is an under-appreciated and under-reported problem. In addition, the HOBOE-2 adds to the evidence that adjuvant bisphosphonates also improve the disease-free survival (DFS) in premenopausal luminal breast cancer patients who have received ovarian function suppression combined with an aromatase inhibitor. Finally, a subgroup analysis of the ShortHER trial suggests that for low- and intermediate risk cancer HER2-positive early breast cancer, 9 weeks of trastuzumab might be non-inferior to the standard 1-year treatment duration. However, the interpretation of this trial is challenging and as such, one year of trastuzumab should remain the standard for now.