T. Feys MBA, MSc

Highlights in gynaecological cancers

SUMMARY

The 2023 annual ESMO meeting featured several presentations with the potential to reshape the standard of care in gynaecological cancers. New approaches emerged as promising treatments in cervical cancer, such as chemoradiotherapy combined with induction chemotherapy or pembrolizumab in patients with newly diagnosed locally advanced cervical cancer, or the antibody-drug conjugate tisotumab vedotin in the recurrent or metastatic setting. In addition, several trials further solidified the efficacy and safety of combining immunotherapy (durvalumab, atezolizumab, dostarlimab or pembrolizumab) with chemotherapy, in the treatment of advanced or recurrent mismatch repair deficient (MMRd) endometrial cancer. In contrast, the combination of atezolizumab plus chemotherapy followed by niraparib maintenance failed to demonstrate clinical benefits in patients with recurrent ovarian cancer.

(Belg J Med Oncol 2023;17(8):298–303)

Highlights in breast cancer

SUMMARY

At ESMO 2023, updated results of monarchE and NATALEE further reinforced the efficacy and safety of combining a CDK4/6 inhibitor with endocrine therapy (ET) in patients with early-stage hormone receptor positive (HR+) breast cancer (BC). In addition to this, the CheckMate 7FL and KEYNOTE-756 studies demonstrated a potential clinical benefit of adding an immune checkpoint inhibitor to neoadjuvant chemotherapy and adjuvant ET in this setting. In early-stage triple negative breast cancer (TNBC), updated results of the KEYNOTE-522 study confirmed the benefit of perioperative pembrolizumab, while the NeoTRiP trial, assessing the addition of atezolizumab to neoadjuvant chemotherapy, did not show a significant benefit in event-free survival (EFS). In metastatic disease, promising results were obtained with new selective oestrogen receptor degraders (SERD) and antibody-drug conjugates (ADC). In addition, results of a real-world study indicate that patients with HER2-/ER-low disease should preferably be treated as TNBC.

(Belg J Med Oncol 2023;17(8):304–12)

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2023;17(8):323–4)

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2023;17(7):275)

Perioperative immunotherapy for resectable non-small cell lung cancer

Historically, surgery, with or without chemotherapy, has been the standard of care for patients with earlystage non-small cell lung cancer (NSCLC). When chemotherapy was used, a platinum-based doublet regimen has been the long-standing standard adjuvant treatment for resected patients with stage II-III disease. However, the clinical benefit that can be gained with adjuvant chemotherapy is limited, with a five-year overall survival (OS) benefit of only 5%. Moreover, despite surgery and adjuvant chemotherapy, most patients with early-stage NSCLC eventually die from disease recurrence.¹ In an attempt to improve on this, several clinical trials have assessed the potential impact of integrating immunotherapy into the neoadjuvant and adjuvant treatment algorithm for patients with early-stage NSCLC.

Immunotherapy for the treatment of gastric cancer

In recent years, immunotherapy has become a vital part of the treatment algorithm for patients with advanced gastric cancer (AGC). Initially, immunotherapy-based regimens proved their worth in (heavily) pre-treated patients. More recently, however, immune-checkpoint inhibitors (ICIs) were also introduced in the first-line treatment of advanced gastric cancer. This article provides a brief overview of the clinical trials that form the rationale for this immunotherapy-shift in the management of gastric cancer.

Immune checkpoint inhibitor rechallenge in non-small cell lung cancer

Over the past years, immune checkpoint inhibitors (ICIs) against cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) or programmed death ligand 1 (PD-L1) have drastically changed the treatment landscape for patients with non-small cell lung cancer (NSCLC). Despite their success, a considerable proportion of patients will eventually consider ICI discontinuation due to disease progression, immune-related adverse events (irAEs) or the completion of a fixed duration course of ICIs without disease progression. Against this background, evidence is mounting that ICI retreatment could be an option for some patients. To date, however, no guidelines have been published for ICI rechallenge in lung cancer and it is still unclear which patients could benefit from a second course of ICI. In this, one needs to make a distinction between restarting the ICI without any other cancer treatment in between (retreatment) or restarting ICI after another treatment was used between the two ICI regimens (rechallenge). This is an important distinction as additional treatments may influence the homeostasis of the patients’ immune system.^1,2 This article describes some of the key elements that could influence treatment outcomes upon ICI retreatment or rechallenge and addresses potential strategies for ICI rechallenge and safety management.