T. Feys MBA, MSc

Real-world treatment practices for EGFR-mutant NSCLC patients

The introduction of tyrosine kinase inhibitors (TKIs) targeting mutant epidermal growth factor receptor (EGFR) has revolutionized the treatment of patients with EGFR-mutant advanced NSCLC. In the recently published REVEAL trial, investigators assessed the current clinical practice for these patients in Belgium revealing some striking observations. In fact, one out of five EGFR-mutant advanced NSCLC patients in this study did not receive ESMO standard of care in first line. After progression on a first EGFR-TKI, Moreover, nearly 30% of patients were not tested for the presence of a T790M mutation after progression on first-line treatment with an EGFR TKI and a quarter of patients did not receive subsequent systemic treatment for NSCLC. These findings underscore the need for more diligent decision-making in the treatment of these patients in order to maximize the clinical potential of EGFR TKIs.

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

Highlights of the 23rd annual meeting of the Belgian Society of Medical Oncology (BSMO)

SUMMARY

As always, the annual meeting of the Belgian Society of Medical Oncology (BSMO) wanted to provide a platform for the dissemination of practice-changing information relevant to Oncology within Belgium. In light of the ongoing global pandemic, the 23^rd annual meeting went virtual in 2021. This did not detract from the engaging line up of presentations, with a particular emphasis on treatment breakthroughs in a variety of cancers. In addition to this, several projects with a local impact on the Belgian Oncology landscape were presented. Get up to date with the 2021 BSMO 23^rd annual meeting with these highlights.

BELG J MED ONCOL 2021;15(3):134-44

Highlights in HER2-positive breast cancer

In the field of Human Epidermal Growth Factor Receptor 2 (HER2) positive early breast cancer, an interesting Subpopulation Treatment Effect Pattern Plot (STEPP) analysis of the APHINITY trial was presented at SABCS 2020. In addition, BluePrint RNA sequencing was used in an attempt to predict the benefit of adjuvant pertuzumab in this trial. Other interesting data in early HER2-positive breast cancer came from the use of neratinib as extended adjuvant therapy. In the metastatic setting, results of the PERTAIN study, the first randomised phase II trial to assess the addition of pertuzumab to trastuzumab and an aromatase inhibitor in the presence or absence of induction chemotherapy, were presented. Finally, a long list of abstracts featured results with novel HER2-directed therapies, including the antibody-drug conjugate trastuzumab deruxtecan, the tyrosine kinase inhibitor tucatinib and the investigational monoclonal antibody margetuximab.

Highlights in luminal breast cancer

Among patients with early breast cancer (BC), approximately 75% present with a luminal tumour (HR+).¹ In addition to being the most common BC subtype, luminal BC also causes most deaths.² Interestingly, the deaths caused by this BC subtype occur over a longer period of time compared to what is seen with HER2-positive and triple negative breast cancer (TNBC).^3,4 As such, it is safe to say that luminal BC continues to be an unmet clinical need. To address this need, a long list of clinical trials are looking into novel strategies to optimize the management of patents with luminal BC. SABCS 2020 featured a plethora of abstracts discussing updates of pivotal trials in luminal breast cancer in addition to studies generating promising results with novel therapeutic agents in patients with more advanced HR+ BC.

Highlights in triple-negative breast cancer

Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer that is prone to early recurrence. In recent years, however, promising data were generated with immunotherapy-based treatment regimens in both the neoadjuvant and metastatic setting. Several updates of these studies were presented at SABCS 2020. In addition, the meeting featured several interesting abstracts discussing potential biomarkers that would facilitate a better treatment selection. In addition to immunotherapy, several novel therapeutics, including antibody-drug conjugates and targeted therapies are emerging in the treatment for patients with metastatic TNBC.

Highlights in radiotherapy

SABCS 2020 featured several interesting presentations in the field of radiotherapy. The PRIME 2 study investigated the impact of omitting postoperative whole breast radiotherapy in older, low-risk women with early invasive breast cancer. Outcomes of the phase III BIG 3-07/TROG 07.01 trial were also reported providing improved insights into the optimal radiation dose and fractionation schedule for non-low risk ductal carcinoma in situ of the breast. Other interesting topics included the comparison of patient and physician reports of toxicity after breast radiotherapy and the finding that radiation therapy improves survival in early-stage HER2-positive breast cancer with a high-levels of tumour infiltrating lymphocytes. Finally, we report on the results of a retrospective analysis assessing the feasibility of radiation therapy de-escalation in patients with stage I, node-negative, HER2-positive breast cancer.