H. Wildiers MD, PhD

State of the art: gene expression profiles in early breast cancer

Summary

Gene expression profiles provide strong prognostic information and can predict breast cancer outcome mainly in women with lymph node-negative, oestrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. They are primarily designed to enable a more precise assessment on whether or not a patient needs adjuvant chemotherapy. However, the optimal use in clinical practice is still not established. The first set of data published from the TAILORx study and the results from the MINDACT study provide strong evidence for the clinical utility of gene expression profiles. Full disclosure of the results of prospective studies such as MINDACT and TAILORx on this topic is awaited in order to define their exact place in clinical decision-making. However, in several countries, these tests are already used in daily clinical practice, and are reimbursed. In addition, the use of gene expression profiles as a potential ancillary tool for treatment decisions is supported in several international treatment guidelines. Multiple studies have shown that there is a change in treatment decision based on gene expression profiles. In addition, different assays may provide different risk stratification at short-, middle- and long-term, so thoughtful use of these tests is recommended. Patients should be well informed about the benefits, risks, costs and uncertainties associated with these tests. Clinicians should also be educated on these matters. Furthermore, as gene expression profiles are expensive and not reimbursed in many countries, these tests are not accessible to all breast cancer patients. Patients’ preferences are important when making risk assessments and treatment decisions in those cases where there is doubt on the benefit of giving adjuvant chemotherapy. Taken together, gene expression profiles provide information that may be complementary to that provided by standard clinicopathological assessment in guiding decision of therapy in the adjuvant setting. These assays represent a step forward towards personalised medicine. We strongly propose to allow reimbursement of gene expression profiles in Belgium, but pragmatic and clear criteria for reimbursement should be developed with all stakeholders to avoid overconsumption.

(BELG J MED ONCOL 2016;10(4):114–122)

Adjuvant endocrine therapy in pre- and perimenopausal women with breast cancer: practice guidelines

Summary

Oestrogen receptor positive early invasive breast cancer is a common disease in pre- and perimenopausal women. Adjuvant endocrine therapy is an essential part of its treatment. Until recently, premenopausal patients were uniformly treated with tamoxifen during five years. Given the recent publication of large clinical trials showing a benefit for other treatment regimens, the BSMO Breast Cancer Task Force met on the 6th of March, 2015, to propose common guidelines for adjuvant endocrine therapy for premenopausal patients. The members agreed that low-risk patients should be treated with five to ten years of tamoxifen, while the highest-risk patients should be treated with exemestane or tamoxifen plus ovarian function suppression. Special attention should be given to patients less than 35 years at diagnosis: in this subgroup, exemestane plus ovarian function suppression is preferred to tamoxifen plus ovarian function suppression.

(BELG J MED ONCOL 2016;10(3):92–96)

Breast cancer highlights

The amount of new, clinically relevant information for breast cancer oncologists was quite limited at this meeting, but many interesting reviews and debates could be followed. Below you can read a summary of the more remarkable abstracts in the breast cancer field.

(BELG J MED ONCOL 2015;9:251–55)

Highlights in breast cancer

(BELG J MED ONCOL 2014;8(4):166–70)

Geriatric oncology in Belgium

As in other developed countries, the management of older cancer patients has become a major public health concern in Belgium owing to an increasing incidence and to other challenging specificities of this population. Since 2009, the Cancer Plan has played a leading role in the development of geriatric oncology in our country by supporting numerous pilot projects. By the year 2015, a scientific analysis of each of these projects will provide important information to the public authorities and care givers in order to organise the management of older cancer patients in an optimal way in Belgium. In this article, we describe the present landscape of geriatric oncology in Belgium focusing on epidemiological data and pilot projects supported by the Cancer Plan 2009–2011 and 2012–2015.

(BELG J MED ONCOL 2014;8(5):206–12)

Adjuvant and neoadjuvant chemotherapy regimens in breast cancer: summary from the BSMO breast cancer task force meeting

Knowledge on adjuvant and neoadjuvant chemotherapy regimens in breast cancer is increasing rapidly. Many different regimens are available: some have been compared with each other, but still many questions remain to be answered. At the breast cancer task force meeting of the Belgian Society of Medical Oncology (BSMO) in Brussels, on February 21^st 2014, 41 medical oncologists involved in breast cancer management reviewed the most important recent data. The task force discussed a framework for regimen selection in clinical practice. The authors of this paper summarised the literature and meeting discussion, highlighting controversial areas.

(BELG J MED ONCOL 2014;8(4):116–24)

How to sequence systemic therapies and radiotherapy in early breast cancer?

Breast cancer is the most common malignancy in women in the Western world. Over the last decades, the use of postoperative systemic therapies (chemotherapy, hormonal therapy, trastuzumab) and radiotherapy led to significant survival benefits for patients with early breast cancer. Although these modalities have been extensively studied and used, a major question is how these systemic therapies are optimally sequenced with radiotherapy in the adjuvant setting. This article reviews available data on how to combine systemic therapies with radiotherapy in women with early stage breast cancer, and provides recommendations that unfortunately do not reach level I evidence due to insufficient quality of available clinical data.

BELG J MED ONCOL 2014;8(3):72–80