L. Duck MD

Prevention of chemotherapy-induced nausea and vomiting: Updated guidance from the BSMO supportive care task force

SUMMARY

Nausea and vomiting continue to be some of the more dreaded side effects of anticancer therapy. While advances in the prophylaxis of chemotherapy induced nausea vomiting (CINV), and guidance from international cancer societies have yielded important benefits for cancer patients, there remains an important need to further improve patient care. To address the need for a better CINV prophylaxis, and to respond to the introduction of new potentially emetogenic anticancer agents and the publication of new clinical trial data with anti-emetic agents, several international oncological societies have recently updated their guidelines for the prevention of CINV. The objective of this paper was to translate these new international recommendations to a Belgian context.

(BELG J MED ONCOL 2025;19(1):15–26)

The impact of sarcopenia in oncology Patients

SUMMARY

Sarcopenia is defined as the loss of muscle mass and strength and plays an increasingly important role in the management of oncology patients. Sarcopenia is frequently mislabelled as malnutrition or cachexia. Clinicians lack a consensus definition of easy-to-use, straightforward, reliable diagnostic tools to optimally recognise sarcopenia. This review will broadly go through the current literature in order to define sarcopenia, as well as to understand its mechanisms. Helpful diagnostic tools will be discussed, which can be used to optimise the management of patients suffering from a malignant disease. This review will also illustrate how sarcopenia is an independent negative predictive and prognostic factor regarding survival and quality of life, directly impacting toxicity and efficacy of oncological treatments.

(BELG J MED ONCOL 2022;16(6):274–8)

Corticosteroids as treatment of viral induced haemophagocytic lymphohistiocytosis in a patient with breast cancer

SUMMARY

Haemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease characterised by cytotoxic immune deregulation leading to hypercytokinaemia and macro-phage activation. Given the high mortality rate, HLH must be suspected in nonspecific situations and promptly confirmed based on 2004-HLH criteria. In adult patients, HLH is usually secondary to infection, malignancy or underlying autoimmune diseases. As treatment, paediatric protocol consists of immuno-therapy and chemotherapy, followed by a haematopoietic stem cell transplant (HSCT). In adults, individualised modified treatment is recommended because of the variable cause and severity of situation. Corticosteroids are the mainstay. We report the case of a patient with breast cancer, for whom we made the diagnosis of HLH during her neoadjuvant chemotherapy based on the 2004-HLH criteria. A viral aetiology was suspected with reactive lymphocytes found on the blood smear, and we promptly initiate treatment of dexamethasone. Our patient fully recovered both from her HLH and breast cancer.

(BELG J MED ONCOL 2021;15(4):186-91)

A case of a life-threatening toxicity following capecitabine treatment: advocacy for dihydropyrimidine dehydrogenase deficiency screening

SUMMARY

We discuss a life-threatening case of capecitabine toxicity due to the presence of a heterozygous variant on exon 14 (c.1905+1G>A, rs3918290) of the dihydropyrimidine dehydrogenase gene (DPYD). We advocate the need for dihydropyrimidine dehydrogenase deficit screening, which could become mandatory in Belgium, as in France, before any fluoropyrimidine administration to avoid cases of foreseeable toxicity.

(BELG J MED ONCOL 2020;14(4):151–4)

Appropriateness of treatment options in patients with metastatic castrationresistant prostate cancer with a focus on radium-223: outcomes of a Belgian multidisciplinary Consensus Meeting

SUMMARY

The treatment landscape for metastatic castration-resistant prostate cancer (mCRPC) has changed dramatically with the approval of a variety of therapeutic agents including abiraterone acetate, cabazitaxel, docetaxel, enzalutamide and radium-223 dichloride and the introduction of docetaxel and abiraterone acetate in combination with androgen deprivation therapy in newly diagnosed metastatic prostate cancer. Evidence on the optimal sequence of these therapies is scarce. In practice, the most appropriate treatment (sequence) depends on patient and disease characteristics. This article summarises the recommendations of a multidisciplinary group of Belgian experts in sequencing treatments for patients with mCRPC, with a focus on radium-223 dichloride.

(BELG J MED ONCOL 2019;13(6): 240–250)

Management of end-stage malignant bowel obstruction: an evidence-based review for clinical practice

SUMMARY

Malignant bowel obstruction is the clinical and imaging evidence of bowel obstruction beyond the ligament of Treitz in the setting of an incurable cancer with intraperitoneal spread. A multi-detector computed tomography scan with multiplanar reconstructions is the gold standard for diagnosis confirmation and treatment orientation. Treatment is challenging and can either be surgical, endoscopic or most likely medical. In the following manuscript, we discuss the current place of each treatment modality in end-stage malignant bowel obstruction management.

(BELG J MED ONCOL 2019;13(4):123–128)

Brain metastases: Systemic treatment approach in 2017

This review proposes to go through reasonable systemic therapy options in brain metastases, notably immune checkpoint inhibitors and oncogen-driven targeted therapies. We deliberately focus on drugs currently available in Belgium in clinical practice. In the large majority of cases, clinical trials – in particular registration trials – exclude patients with brain metastases. Therefore we have to deal with small size non-randomised phase II trials or retrospective analysis with the known caveats of highly selected patients and numerous biases.

(BELG J MED ONCOL 2018:12(3):96–102)