J. Blokken PhD, PharmD

Highlights in thoracic oncology

SUMMARY

In the field of thoracic oncology, many refinements and longer follow-up results of previously reported trials were presented during the annual ASCO 2022 meeting. Although there were no presentations of new, truly practice-changing trials, several exciting and promising data are worthwhile to mention in this highlights in thoracic oncology overview.

(Belg J Med Oncol 2022;16(5):229–35)

Congress highlights SABCS 2021

SUMMARY

The hybrid SABCS 2021 could only attract a few hundred life attendees, but like every year, several key abstracts were presented. In early stage, a meta-analysis on aromatase inhibitor versus tamoxifen in premenopausal ER+ patients showed lower recurrence with aromatase inhibitors, while the impact on overall survival remains unclear. An EBCTCG meta-analysis showed no benefit for an anthracycline-taxane adjuvant chemotherapy regimen compared to a taxane only regimen, if the taxane was given sequentially after the anthracycline, confirming the role of anthracycline-free chemotherapy regimens in a large proportion of patients with early breast cancer. In ER+ metastatic disease, the new SERD elacestrant was more potent than classical endocrine therapy after progression on first/second line endocrine therapy. Datopotamab deruxtecan is a promising new ADC targeting TROP2 with clear activity in triple negative disease. In HER2 positive disease, T-DXd displayed substantial antitumour effect on brain metastases, and pyrotinib can be added to the list of highly potent HER2 tyrosine kinase inhibitors. In patients with HER2 mutations, neratinib showed clear antitumour activity both in ER positive and triple negative metastatic breast cancer. In the surgery field, black and Hispanic women were shown to be at higher risk for breast cancer related lymphedema after axillary lymph node dissection. The Italian SINODAR-ONE trial built further on the Z0011 trial and confirmed that axillary surgery can be omitted in patients with breast cancer patients and one or two macro metastatic sentinel nodes.

(BELG J MED ONCOL 2022;16(2):79–87)

How to stage primary prostate cancer in 2022

Over the past years, next-generation imaging such as multiparametric whole body MRI and PSMA-PET/CT scans have been gaining momentum. Nonetheless, Prof. Padhani argues not to throw bone scintigraphy and CT scans (BS/ CT scans) out just yet. On the contrary, he puts BS/CT scans at the centre of patient care in men with locally advanced prostate cancer (LAPC). However, BS/ CT also comes with important limitations for which next-generation imaging (NGI) can serve as a problem solver after BS/CT scan assessments. During his talk at the BMUC 2022 meeting, Prof. Padhani emphasized the proven prognostic role of BS/CT scans, their predictive role in directing pelvic radiotherapy and for oncologic drug development. Finally, he argued that higher-quality evidence on the management and/or outcomes is needed before BS/CT scans can be substituted by NGI.¹

Belgian Multidisciplinary Immunotoxicity Board

With the increasing use of immunotherapy, more and more questions rise on the management of specific immune-related adverse events (irAEs) that are associated with these agents. Unfortunately, guidance on long-term irAE management is currently lacking and as patients with auto-immune disease or organ transplants were often excluded from clinical trials, there is also a lack of data on the use of immunotherapy in these setting. As irAEs can affect any organ system, it is not always easy to recognise and manage these adverse events in a timely manner, making multidisciplinary collaboration essential. To address these unmet needs, the Belgian Multidisciplinary Immunotoxicity Board was set up. During their talk at the BSMO annual meeting, Sandrine Aspeslagh, (MD, PhD, University Hospital Brussels, Brussels, Belgium) and Marthe Verhaert (MD, University Hospital Brussels, Brussels, Belgium) discussed the rationale, aim, and first results of this BITOX initiative.

Keynote lecture: head and neck cancer

Head and neck cancer (HNC) refers to a very heterogeneous group of tumours with different anatomic site, histology, and aetiology. The most common HNCs consist of squamous cell carcinomas of the pharynx, oral cavity, and larynx. As the selection of the best treatment option for patients with squamous cell carcinoma of the head can be difficult, Prof. Jean-Pascal Machiels (Cliniques Universitaires Saint-Luc, Brussels) gave an overview of the currently available and promising treatment combinations under investigation during a Keynote Lecture at the annual BSMO meeting.

Radiation oncology for the medical oncologist

In the multidisciplinary oncology landscape, radiation oncology is becoming increasingly important in the treatment of many cancer patients. In this light, Prof. Dr. Liv Veldeman (University Hospital Ghent, Ghent, Belgium), president of the Belgian Society for Radiotherapy and Oncology (BeSTRO), discussed the most important steps in the radiotherapy process. In addition, she shared her experience with modern radiotherapy treatments and addressed how these innovative techniques may further
improve treatment outcomes.

Clinical cancer therapy in Belgium: What not to have missed in 2021

In this article selected studies influencing therapeutic guidelines in solid tumours, as well as highlights in breast cancer, lung cancer, digestive oncology, genitourinary cancer, biomarkers, and what’s new in rare tumours/histologies are discussed.