M. Peeters MD, PhD

Highlights of the European Neuroendocrine Tumour Society Congress

SUMMARY

The first World NET Forum brought together leading scientists in the neuroendocrine tumour (NET) field to present their cutting-edge research to inspire other scientists and clinicians. This meeting focused mainly on models in NET research, NET tumour biology, as well as therapeutic and diagnostic advances. This article discusses some of the most relevant and promising studies.

(BELG J MED ONCOL 2022;16(6):310–22)

Capecitabine and folic acid: A lethal combination?

SUMMARY

5-Fluorouracil (5-FU) and its prodrug capecitabine are widely used and generally well-tolerated chemotherapeutic agents. Although leucovorin, a derivative of folic acid, is routinely used to potentiate the effect of 5-FU, there seems to be little to no awareness about a similar interplay between capecitabine and folic acid, a commonly used supplement. This study presents a case in which a high concentration of folic acid led to fatal capecitabine-related toxicity, with the aim to raise awareness on the interaction between folic acid supplementation and 5-FU/capecitabine treatment toxicity.

(BELG J MED ONCOL 2022;16(2):74–8)

Highlights in digestive oncology

The 2021 edition of ESMO was held virtually between the 16th and 21st of September 2021. The main goal of this overview is to highlight the most striking abstracts in the field of digestive oncology for daily clinical practice. First, the upper gastro-intestinal tract tumours will be discussed, followed by an overview of the congress highlights related to cancers of the lower gastro-intestinal tract.

(BELG J MED ONCOL 2021;15(5):415–20)

Paving the way for immunotherapy in pancreatic cancer by exploring a novel combination immunotherapy consisting of a CD40 agonist and interleukin-15

SUMMARY

Pancreatic Ductal Adenocarcinoma (PDAC) has the worst 5-year survival of all cancer types. Treatment options for these patients are limited and consist mainly of chemotherapy. However, the unique tumour microenvironment with its dense, fibrotic shield causes resistance to current and novel therapies. Tackling this stromal shield is therefore deemed crucial for making progress in PDAC treatment. We investigated in this thesis the potential of Natural Killer (NK) cells to address this high medical need. Firstly, our systematic review revealed strong evidence of their importance in PDAC and how the tumour renders them into a suppressed and less functional state. Based on this information, we sought to stimulate NK cells in such way that they attack both tumour and surrounding stroma. We show that, upon stimulation with IL-15, NK cells are capable of killing both pancreatic cancer and stellate cells, the drivers of the stromal reaction, in a contact-dependant manner. Increased expression of NKG2D and TIM-3 receptors was partially responsible for this enhanced killing. Furthermore, in our search to potentiate IL-15 stimulation, we combined this with an immune priming CD40 agonist and demonstrated profound anti-tumour effects and prolonged survival in PDAC mouse models. Increased intra-tumoral cytotoxic T cells, NK cells and reduced T regulatory cells combined with increased cross-presenting dendritic cells in the tumour draining lymph nodes are the main effectors of the observed anti-tumour effects. Summarised, our data provide a strong rationale for NK cell-driven cancer immunotherapy where immune stimulation is combined with immune priming. Initiation of an early-phase clinical trials with this novel combination immunotherapy for PDAC patients is warranted.

BELG J MED ONCOL 2021;15(3):128-31

Tissue is the issue

SUMMARY

Multimodal therapy, including preoperative chemoradiotherapy followed by total mesorectal excision, has become the standard treatment for patients with locoregionally advanced rectal cancer.¹ We report on a 54- year old female patient with rectal adenocarcinoma cT3N0M0, who was treated with neoadjuvant chemo-radiotherapy (capecitabine 825 mg/m² BID 5 days/week + 45 Gy in 25 fractions) followed by total mesorectal excision and adjuvant capecitabine for six months. Eleven weeks after the start of adjuvant capecitabine, she presented with dyspnoea, non-productive cough, shortness of breath, chest wall pain, and decrease of physical activity, for which she was admitted to the Antwerp University Hospital (UZA) in Edegem. Computed tomography (CT) revealed pulmonary emboli, enlarged mediastinal and hilar lymph nodes, and multiple micronodules in both lungs. Radiologic findings were suggestive of metastatic lymph nodules and numerous pulmonary metastases. However, pathological diagnosis showed nude granulomas without necrosis without evidence of tumour. Our case illustrates that sarcoid-like lesions may mimic lung metastases in cancer patients being treated with chemotherapy and that tissue still remains the issue.

(BELG J MED ONCOL 2021;15(1):40-3)

Highlights in digestive oncology

The annual ESMO meeting was held virtually between 19^th and 21^st September 2020 and covered many interesting abstracts in the field of digestive oncology. In this overview, our main aim was to highlight the data that are most relevant for daily clinical practice. This year, we will discuss the results according to the traditional division in upper and lower gastro-intestinal tract tumours.

Multimodality treatment approach for rectal cancer

SUMMARY

Rectal cancer treatment constitutes a complex exercise. With the exception of very early and metastatic disease were surgery and palliative chemotherapy are respectively the backbone treatment modalities, the optimal treatment strategy for rectal cancer remains a subject of active debate. Different therapeutic options, including local and systemic approaches like different surgical techniques, radiation therapy, chemoradiotherapy and chemotherapy in different sequences and settings are commonly combined in clinical practice. This multimodal treatment strategy improved survival and reduced local recurrence, but the optimal way to combine the different modalities represents a subject of active research. In the coming paragraphs we attempt to answer some of the most important questions, in our opinion, regarding multimodality treatment approach for rectal cancer through a systematic review of the literature.

(BELG J MED ONCOL 2020;14(7):311-20)