P. Ost MD, PhD

Genetic testing in prostate cancer in clinical practice

SUMMARY

Mutations in DNA damage repair (DDR) genes are relatively common in prostate cancer (PC), and may guide therapy selection. Approximately half of somatic DDR mutations are also present in the germline and lead to a heritable cancer predisposition syndrome (CPS), which informs on future risk, prostate cancer prognosis, and therapeutic options. In germline carriers, genetic counselling is essential to help psychosocial coping and to provide pre-symptomatic testing in relatives, who upon carrier identification can opt for intensified surveillance or – in some cases – prophylactic surgery.

(BELG J MED ONCOL 2021;15(4):156-63)

Boosting anticancer immunity with radiotherapy

SUMMARY

Preclinical and early clinical data indicate that stereotactic body radiotherapy (SBRT) could work synergistically with checkpoint inhibitors and increase response rates. Given the potential synergistic effect between both treatments, the associated toxicity might also be increased. We conducted two phase I trials combining SBRT with ipilimumab (n=13) or pembrolizumab (n=18) in metastatic/inoperable melanoma and metastatic urothelial carcinoma respectively. To evaluate the effect of SBRT timing, patients were randomised to either sequential or concurrent SBRT in the latter trial. To assess early efficacy, a phase II trial of SBRT and nivolumab was conducted in metastatic/inoperable melanoma (n=20). Our data shows that SBRT combined with ipilimumab, nivolumab or pembrolizumab is safe and might increase efficacy in a subset of patients.

(BELG J MED ONCOL 2020;14(1):28–30)

Introducing a Castrate Resistant Prostate Cancer (CRPC) Model Care Pathway in Belgian Hospitals – towards national standardisation?

SUMMARY

Castrate-resistant prostate cancer (CRPC) is characterised by complex strategies for therapy and follow-up. In order to standardise CRPC cancer care on a national basis, an integrated care pathway was devised, based on clinical governance principles and acknowledged best practice, in order to reduce length of hospital stay, reduce costs of patient care, improve patient outcomes (e.g. Quality-of-Life, complications), etc. Therefore, a steering group of Belgian experts, consisting of medical oncologist, urologists, radiation oncologists, oncology nurses, pathologists and nuclear medicines, was assembled to discuss the need for an integrated care pathway for CRPC in Belgium. This was made possible through the financial support of Astellas Belgium. An extensive integrated care pathway was discussed with various stages, depending on the disease status of the patient. Belgian implementation could lead towards further standardisation of cancer care for CRPC patients although several important matters still have to be discussed or adapted. Further assessment and inter-hospital deliberation seems required to ensure a national implementation of the CRPC integrated care pathway.

(BELG J MED ONCOL 2019;13(6): 219–226)

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)

O.03 DETECTION OF AR PERTURBATIONS IN CIRCULATING TUMOUR CELLS AND CELL-FREE DNA FROM PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER PREDICTS RESISTANCE TO ENDOCRINE THERAPY

The ION-Ghent guidelines for the management of immune related adverse events (irAE’s)

SUMMARY

Checkpoint inhibitors targeting CTLA4, PD1 and PD-L1 have become a part of the daily clinical practice in the management of stage IV melanoma, renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC) and Hodgkin-lymphoma patients. While these agents can elicit strong anti-tumour immune responses, they can also generate immune related adverse events, which can become life threatening if not detected and managed promptly. At the University Hospital Ghent, we created a working group of organ specialists with specific experience in dealing with immune related adverse events. This initiative is part of ION (Immuno-Oncology-Network) Ghent. In this paper we would like to share our institutional guidelines for the clinical care of patients treated with checkpoint-inhibitors with the Belgian Oncology Community.

(BELG J MED ONCOL 2017;11(6):265–276)

O.01 Circulating Tumour Cells and Survival in Abiraterone- and Enzalutamide-treated Patients with Castration-Resistant Prostate Cancer