J. Blokken PhD, PharmD

Immune checkpoint inhibitor rechallenge in non-small cell lung cancer

Over the past years, immune checkpoint inhibitors (ICIs) against cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) or programmed death ligand 1 (PD-L1) have drastically changed the treatment landscape for patients with non-small cell lung cancer (NSCLC). Despite their success, a considerable proportion of patients will eventually consider ICI discontinuation due to disease progression, immune-related adverse events (irAEs) or the completion of a fixed duration course of ICIs without disease progression. Against this background, evidence is mounting that ICI retreatment could be an option for some patients. To date, however, no guidelines have been published for ICI rechallenge in lung cancer and it is still unclear which patients could benefit from a second course of ICI. In this, one needs to make a distinction between restarting the ICI without any other cancer treatment in between (retreatment) or restarting ICI after another treatment was used between the two ICI regimens (rechallenge). This is an important distinction as additional treatments may influence the homeostasis of the patients’ immune system.^1,2 This article describes some of the key elements that could influence treatment outcomes upon ICI retreatment or rechallenge and addresses potential strategies for ICI rechallenge and safety management.

Journal Scan

In this section of the BJMO, we aim to provide a snapshot of pivotal studies published in recent issues of the most important international journals focusing on oncology. Importantly, the selection of the studies discussed here is the sole responsibility of the publisher and was not influenced by third parties. Do you miss an important study, or did you read a hidden jewel that deserves to be shared with your colleagues? Please, let us know (editor@bjmo.be) and we will make sure to include it in the journal scan section of the next BJMO issue.

(BELG J MED ONCOL 2023;17(7):271–4)

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2023;17(7):275)

Perioperative immunotherapy for resectable non-small cell lung cancer

Historically, surgery, with or without chemotherapy, has been the standard of care for patients with earlystage non-small cell lung cancer (NSCLC). When chemotherapy was used, a platinum-based doublet regimen has been the long-standing standard adjuvant treatment for resected patients with stage II-III disease. However, the clinical benefit that can be gained with adjuvant chemotherapy is limited, with a five-year overall survival (OS) benefit of only 5%. Moreover, despite surgery and adjuvant chemotherapy, most patients with early-stage NSCLC eventually die from disease recurrence.¹ In an attempt to improve on this, several clinical trials have assessed the potential impact of integrating immunotherapy into the neoadjuvant and adjuvant treatment algorithm for patients with early-stage NSCLC.

The management of nivolumab plus cabozantinib in the frontline treatment of advanced renal cell carcinoma

Over the past decade, we have witnessed a paradigm shift in the first-line treatment of patients with advanced or metastatic clear cell renal cell carcinoma (RCC). Nowadays, the preferred first-line treatment for these patients consists of a combination of an immune checkpoint inhibitor (ICI) with a tyrosine kinase inhibitor, or dual ICI therapy. With a minimal follow-up of three years, the pivotal CheckMate 9ER trial demonstrated the superior survival and response benefits of combination therapy with cabozantinib and nivolumab over sunitinib as first-line therapy for advanced RCC patients. However, effective management strategies to deal with potential adverse events are key to maintain tolerability with cabozantinib and nivolumab treatment.

Molecularly matched targeted therapy for advanced cholangiocarcinoma

Cholangiocarcinoma (CCA) is the second most common primary liver cancer and accounts for approximately 10–15% of all primary liver cancers. CCA is subdivided into intrahepatic CCA (iCCA), arising from bile ductules proximal to the second-order bile ducts; perihilar CCA (pCCA), arising in the right and/or left hepatic duct and/or at their junction; and distal CCA (dCCA), arising from the epithelium distal to the insertion of the cystic duct. pCCA and dCCA are collectively referred to extrahepatic CCA (eCCA). For patients with early-stage CCA, the treatment usually consists of a surgical resection followed by adjuvant chemotherapy, while systemic chemotherapy is the standard first-line treatment for patients with advanced stage disease. However, given the fact that nearly 40% of patients with biliary tract cancer harbour genetic alterations which are potential targets for precision medicine, molecular analysis should be carried out before or during firstline therapy to evaluate options for second and higher lines of treatment as early as possible in advanced disease.¹ This review aims to discuss the most promising therapeutic molecular targets for CCA and the targeted agents that are available in this setting.

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2023;17(6):245)