T. Feys MBA, MSc

Belgian Multidisciplinary Immunotoxicity Board

With the increasing use of immunotherapy, more and more questions rise on the management of specific immune-related adverse events (irAEs) that are associated with these agents. Unfortunately, guidance on long-term irAE management is currently lacking and as patients with auto-immune disease or organ transplants were often excluded from clinical trials, there is also a lack of data on the use of immunotherapy in these setting. As irAEs can affect any organ system, it is not always easy to recognise and manage these adverse events in a timely manner, making multidisciplinary collaboration essential. To address these unmet needs, the Belgian Multidisciplinary Immunotoxicity Board was set up. During their talk at the BSMO annual meeting, Sandrine Aspeslagh, (MD, PhD, University Hospital Brussels, Brussels, Belgium) and Marthe Verhaert (MD, University Hospital Brussels, Brussels, Belgium) discussed the rationale, aim, and first results of this BITOX initiative.

Keynote lecture: head and neck cancer

Head and neck cancer (HNC) refers to a very heterogeneous group of tumours with different anatomic site, histology, and aetiology. The most common HNCs consist of squamous cell carcinomas of the pharynx, oral cavity, and larynx. As the selection of the best treatment option for patients with squamous cell carcinoma of the head can be difficult, Prof. Jean-Pascal Machiels (Cliniques Universitaires Saint-Luc, Brussels) gave an overview of the currently available and promising treatment combinations under investigation during a Keynote Lecture at the annual BSMO meeting.

Highlights in breast cancer

At this year’s annual meeting of the European Society of Medical Oncology (ESMO) experts shared some game-changing data for the treatment of breast cancer (BC). In advanced HER2+ metastatic breast cancer m(BC), the DESTINY-Breast03 trial performed a head-to-head comparison of T-DM1 and trastuzumab deruxtecan (T-Dxd) following initial treatment with trastuzumab and a taxane, showing a major PFS benefit for T-DXd without major toxicity issues, establishing T-DXd as the new standard of care in this setting. In luminal breast cancer, the final analysis of the GIM-4 study supports the use of 7 years instead of 5 years adjuvant endocrine therapy in postmenopausal patients with hormone receptor positive (HR+)/HER2- early BC. For advanced stage HR+/HER2- BC, the MONALEESA-2 study shows >1y OS benefit when adding the CDK4/6 inhibitor ribociclib to letrozole as first-line treatment. Finally, in triple negative breast cancer (TNBC), the phase III BrighTNess study showed that addition of carboplatin to neoadjuvant chemotherapy provides long term EFS benefit. In metastatic TNBC, OS data of KEYNOTE-355 further support the use of first-line pembrolizumab plus chemotherapy in advanced PD-L1+ TNBC.

(BELG J MED ONCOL 2021;15(8):390–7)

Highlights in respiratory oncology

At this year’s ESMO meeting, much of the attention in the field of lung cancer went to early-stage nonsmall cell lung cancer (NSCLC) with interesting results from the Lung Art, COAST, GEMSTONE-301 and IMpower010 trials. For metastatic NSCLC, immunotherapy again walked away with much of the attention. In addition to this, several studies investigated the potential of combining anti-EGFR and anti-angiogenic agents, while others investigated novel targeted agents, including trastuzumab deruxtecan, poziotinib, plinabulin and datopotamab deruxtecan. Finally, we will highlight the most interesting results in other thoracic malignancies, including malignant pleural mesothelioma, extensive-stage small cell lung cancer, thymoma and thymic carcinoma.

(BELG J MED ONCOL 2021;15(8):406–14)

Highlights in gynaecological oncology

The 2021 annual ESMO meeting featured several presentations with the potential to shift the standard of care in gynaecological cancers. In cervical cancer, Keynote-826 identified pembrolizumab + chemotherapy (with or without bevacizumab) as a potential new standard of care for patients with persistent, recurrent, or metastatic cervical cancer. In addition, also the antibody drug conjugate tisotumab vedotin showed encouraging and durable anti-tumour activity in this setting. In the field of the ovarian cancer, PARP inhibition again walked away with most of the attention, but also the glucocorticoid receptor modulator relacorilant and combination therapy with the immune checkpoint inhibitor atezolizumab and bevacizumab yielded interesting data. Also for patients with advanced endometrial cancer, ESMO 2021 proved to be of interest, with important updates on the use of pembrolizumab in this setting.

(BELG J MED ONCOL 2021;15(8):428–35)

Integrating immunotherapy in the treatment paradigm for early-stage non-small cell lung cancer

Immune checkpoint inhibition (ICI) marked the start of a new era in the treatment of advanced non-small cell lung cancer (NSCLC), inducing a durable response in a substantial proportion of patients. The success of ICI in the advanced setting spurred interest to also examine the potential of this treatment modality in patients with early-stage NSCLC. The first success story in this respect came from the phase III PACIFIC trial, establishing consolidation therapy with durvalumab after chemoradiation as the new standard of care for patients with inoperable, locally advanced NSCLC. More recently, ICI also yielded promising results in patients with resectable NSCLC. In fact, the IMpower010 trial showed that adjuvant atezolizumab after 4-cycles of platinumbased chemotherapy significantly improves the disease-free survival (DFS) compared to best supportive care in patients with stage II-IIIA NSCLC. In addition to this, other studies suggest that neoadjuvant treatment with ICI might result in substantial major pathologic response and pathologic complete response rates, and high rates of R0 resection without a significant delay in the time to surgery.

Immune checkpoint inhibition: a game-changer in the treatment of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is a thoracic malignancy that is characterized by a very dismal prognosis. Patients with MPM face a large unmet medical need, with almost no therapeutic advances over the last decade. Recently, however, an important step was made in the management of these patients with the registration of immune checkpoint inhibition (ICI) as a new treatment option for treatment-naïve patients with unresectable MPM. Here we summarize the available evidence supporting the use of ICI in MPM. In addition, the article will address remaining issues such as treatment sequencing and optimal first-line treatment selection.