J. De Grève MD, PhD

Mixed adenoneuroendocrine carcinoma (MANEC) of the colon: molecular pathogenesis and treatment

We present the case of a 30-year-old male patient with a high grade neuroendocrine carcinoma and an adenocarcinoma developed in a tubulovillous adenoma of the colon, with diffuse liver metastasis. He underwent a right hemicolectomy and received four courses of postoperative chemotherapy with cisplatin and etoposide, followed by high dose chemotherapy with autologous stem cell support. After this treatment there was a complete biochemical and radiological remission. Now, 48 months after diagnosis the patient is alive and in unmaintained complete remission. The occurrence of a high grade neuroendocrine carcinoma in a low grade colon adenocarcinoma without any intermediate phenotypes was intriguing. Comparative exome sequencing of DNA from the malignant components revealed six somatic changes in cancer consensus genes. In both tumours, we detected mutations in APC and KRAS, as well as in BCL9 and FOXP1. Only in the neuroendocrine carcinoma component did we find a mutation in SMARCA4. All mutations were absent in germ-line DNA. The finding of several identical somatic mutations in both components in the subsequent exome sequencing supports a clonal relationship between the neuroendocrine carcinoma and the synchronous adenocarcinoma. We suggest that a mutation in SMARCA4A may be responsible for the abrupt transition to the aggressive neuroendocrine phenotype.

(BELG J MED ONCOL 2015;9(1):31–34)

Developmental therapeutics at ESMO 2014

(BELG J MED ONCOL 2014;8(4):177–9)

Concerning a previously published Introduction

(BELG J MED ONCOL 2013;7:3-7)

The 35^th San Antonio Breast Cancer Symposium

Summary

From December 4^th-8^th 2012, San Antonio, Texas, was again transformed into the world’s capital in the fight against breast cancer. The 2012 CTRC-AACR San Antonio Breast Cancer Symposium (SABCS) was a joint presentation of the Cancer Therapy & Research Center at the University of Texas Health Science Center at San Antonio, the American Association for Cancer Research, and the Baylor College of Medicine. This years’ meeting drew nearly 8,000 participants from over 90 countries and again proved to be the number one breast cancer meeting in the world. This report does not aim to summarise the entire meeting but discusses the key highlights of the meeting.

(BELG J MED ONCOL 2013;7:31–33)

Highlights in Oncology 2012

Summary

2012 has been a rich year in progress on cancer care. Many studies highlighted this year capitalised on the growing insight into the complexity of cancer to develop sophisticated treatment approaches, including combinations of targeted drugs for difficult-to-treat cancers and expanded use of targeted drugs to multiple forms of cancer sharing the same genetic alteration. This article is based on the clinical cancer advances 2012 article published by the American Society of Clinical Oncology and lists the most important advances made in the different fields of oncology that are most likely to impact daily clinical practice.¹

(BELG J MED ONCOL 2013;7:10–14)

Stratified Medicine: a call for action

(BELG J MED ONCOL 2013;7:15–19)

The changing role of the axillary dissection in the treatment of breast cancer

The aim of this article is to highlight the recent changes in the surgical approach of the axilla in breast cancer patients. Axillary staging is dominated by the sentinel lymph node (SLN) biopsy, which is now widely practiced in clinically node negative patients. Most authors believe a SLN biopsy may even be performed in patients with a large or multifocal tumour, before neo-adjuvant systemic therapy, during pregnancy, after prior excisional biopsy and after prior mantle field radiotherapy of the breast. Intra-operative assessment of the SLN is recommended as it can identify half of all positive lymph nodes. It is generally accepted that it is safe to omit an axillary lymph node dissection (ALND) in patients with a negative SLN or with only isolated tumour cells (<0.2 mm) in the SLN. Moreover, in a subset of patients with a micro-/macrometastasis in the SLN it might not be necessary to perform a completion of ALND. We suggest to accept the option of omitting completion of ALND in frail patients with a positive sentinel lymph node on final pathology OR in these patients with, on final pathology, one or two positive SLNs AND a grade I or II tumour smaller than 4 cm AND adjuvant radiotherapy on the whole breast or chest wall. In conclusion, an increasingly tailored surgical approach is guiding the management of the axilla for women with early breast cancer. (BELG J MED ONCOL 2012;6:87–95)