T. Feys MBA, MSc

Abemaciclib: an important weapon in the treatment arsenal for patients with hormone-receptor positive, HER2- breast cancer

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2024;18(5):221–2)

The current treatment landscape for patients with HER2-low metastatic breast cancer

SUMMARY

HER2 overexpression has been a therapeutic target in breast cancer (BC) for many years and the development of anti-HER2 therapies has markedly improved the outcome of patients exhibiting high levels of HER2 expression. In this, the HER2 status of patients was traditionally defined in a binary fashion, in which patients with high levels of HER2 expression were classified as HER2-positive, while all the rest were denominated as HER2-negative. Despite being classified as HER2-negative; the majority of these BCs do express some level of HER2. Until recently, however, these low levels of HER2 expression did not have any therapeutic implications. This has changed with the publication of the DESTINY-Breast04 (DB-04) study in which trastuzumab deruxtecan (T-DXd) was shown to significantly improve the progression-free (PFS) and overall survival (OS) of patients with HER2-low metastatic BC. These findings require a recalibration of the treatment paradigm for patients with advanced BC. Furthermore, the increased interest in HER2-low BC led to questions on the biology, epidemiology, heterogeneity, and prognostic relevance of HER2-low disease and confronts physicians with the challenge of incorporating the treatment of HER2-low disease in the rapidly evolving treatment landscape for patients with hormone-receptor-positive (HR+) and triple-negative BC (TNBC).

(BELG J MED ONCOL 2024;18(4):141–51)

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2024;18(4):176)

Systemic treatment of brain metastases in oncogene-driven non-small cell lung cancer

The percentage of brain metastases at initial diagnosis ranges from 10–30% in patients with non-small cell lung cancer (NSCLC), with increasing incidence throughout the disease course. These brain metastases can cause motor dysfunction, mental dysfunction, seizures, headaches, nausea and vomiting and can thus severely hamper the patient’s quality of life. Historically, the presence of brain metastasis is a poor prognostic factor, and its control may prolong the prognosis of the patient. Brain metastases can be addressed with local therapy (such as surgery and radiotherapy), or with systemic therapy using classical anticancer drugs. Unfortunately, one of the major limitations in defining the optimal initial treatment for NSCLC patients with brain metastases is that patients with untreated brain metastases were often excluded from randomised clinical trials evaluating systemic therapies.¹ Furthermore, also a drug’s inability to penetrate the blood-brain barrier (BBB) can result in treatment resistance.² The most suitable treatment should be determined during a multidisciplinary consult and should be based on histologic type, the general condition of the patient, and the size and number of brain metastases.² This mini-review discusses the systemic management of patients with NSCLC and brain metastases, with a particular focus on patients with actionable genomic alterations.

Gut microbiota as a novel source of biomarkers for immunotherapy in NSCLC

There is growing interest for biomarkers that allow a better selection of non-small cell lung cancer (NSCLC) patients that are likely to benefit from immunotherapy. To date, several biomarkers are under investigation, including the PD1/PL-L1 axis, the tumour mutational burden, and the gut microbiota. The gut microbiota seems interesting due to its role in cancer, cancer treatment and treatment-related toxicities. Below we briefly summarize the conditions that might influence the composition of the gut microbiota and the subsequent effect on a response to immunotherapy, immune-related adverse events, and their management in NSCLC.¹

TROP-2-targeted antibody-drug conjugates for NSCLC: Integrating a new therapeutic option

There continues to be a large unmet medical need for non-small cell lung cancer (NSCLC) patients in whom immunotherapy and chemotherapy have failed.¹ Several studies have suggested that antibody-drug conjugates (ADCs) hold promise for the treatment of these patients. This mini-review will briefly summarise the available data on the use of TROP-2 directed ADCs in this setting.