J-F. Baurain MD, PhD

Guidance for the prevention and treatment of venous thromboembolism in cancer patients

Summary

Venous thrombosis is a common complication in cancer patients and thromboembolism is the second most common cause of death. Several practice guidelines provide recommendations for the management of cancer-associated thrombosis. However, these guidelines do not sufficiently cover commonly encountered clinical challenges. With this expert panel, consisting of medical oncologists, haematologists, internists and thrombosis specialists, we aimed to develop a practical Belgian guidance for adequate prevention and treatment of cancer-associated thrombosis that covered several challenging situations encountered in daily clinic. This paper discusses the following topics: type and treatment duration of anticoagulant therapy, recurrent VTE despite anticoagulation, anticoagulation in case of renal impairment, liver disease and thrombocytopenia, the role of anti-Xa monitoring, central venous catheter-associated thrombosis, the position of direct oral anticoagulants and thromboprophylaxis, both in ambulatory and hospitalised patients. For an overview of the recommendations formulated by the expert panel, we refer to the key messages for clinical practice in this article.

(BELG J MED ONCOL 2016;10(7):249–255)

How immune checkpoint inhibition reshaped advanced melanoma

Cutaneous melanoma has long been one of the most aggressive forms of cancer, with limited treatment options and a very dismal prognosis. However, in recent years new strategies for treating melanoma have been introduced that significantly improve the outlook for patients with this challenging disease. One of the most important advances has been the development of immunotherapy. The better understanding of the role of the immunological system in tumor control has paved the way for strategies to enhance the immune response against cancer cells. Monoclonal antibodies (mAbs) against the immune checkpoints cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed cell death protein 1 (PD-1) and its ligand (PD-L1) have demonstrated high activity in melanoma and other tumors. This has marked a new era in the treatment of metastatic melanoma and much research is now ongoing with other checkpoint inhibitors and investigating combinations of agents targeting different immune checkpoints.

Adjuvant treatment for uterine cancers, a review of the current evidence

Summary

To date, the main treatment of loco-regional uterine cancer is surgery. The benefit of adjuvant treatment depends on the subtype of cancer, stage, and risk factors. We describe here the current evidence-based data supporting the administration of adjuvant treatment after surgery, with a focus on chemotherapy.

(BELG J MED ONCOL 2016;10(2):63–68)

Highlights in melanoma

(BELG J MED ONCOL 2015;9:132–8)

Thrombo-embolic events in cancer patients with impaired renal function

Venous thromboembolism is a frequent cause of mortality and morbidity in patients with malignancy. Thrombosis is one of the leading causes of death in patients with malignancy after cancer itself. As such, prompt recognition and treatment of venous thromboembolism are required in order to reduce the risk of venous thromboembolism-related mortality. This report reviews the interrelationship between cancer, renal insufficiency and venous thromboembolism. The working group behind this review article concludes that low molecular weight heparins decrease the risk of recurrent venous thrombosis in cancer patients without increasing major bleeding complications. Low molecular weight heparins are therefore recommended as first line antithrombotic treatment in cancer patients with a clear clinical benefit. In patients with renal dysfunction, who are at increased risk of bleeding and of thrombotic complications, preference should be given to unfractionated heparin or a low molecular weight heparin with a mean molecular weight such as tinzaparin, having less risk of plasma accumulation and offering the possibility to maintain full therapeutic dose.

(BELG J MED ONCOL 2015;9(2):53–60)

Highlights in melanoma

(BELG J MED ONCOL 2014;8(4):136–42)

Practice guidelines in the management of uveal melanoma

Summary

Uveal melanoma is a rare oncological disease. This incidence has remained stable for the past 50 years. There is no survival difference depending on the type of ocular treatment (enucleation versus radiotherapy versus tumour resection). Brachytherapy (Ru-106, I-125) presently remains the most common method for treating uveal melanoma. Despite adequate and early local treatment, half of the patients will develop metastatic recurrence with an average of 2.5 years after initial diagnosis. Clinical and histological prognostic factors have been identified, but some studies suggest that inactivation of BAP1 by chromosomal deletion or mutation is a key event driving metastasis development. Presently, no adjuvant treatment prevents those metastatic relapses. Nearly 90% of patients who relapse have only liver metastases. The median survival of those patients is about four months. Numerous trials evaluating the interest of exclusive liver treatment have failed to demonstrate an increase in survival, except surgery for solitary liver metastasis. Chemotherapy with dacarbazine remains the standard treatment of metastatic patients. New treatments targeting the signal transduction pathways or aiming at the stimulation of the immune system are under development.

(BELG J MED ONCOL 2013;7:20–26)