T. Feys MBA, MSc

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.

Sustained survival benefit with tremelimumab and durvalumab as first line treatment for patients with advanced hepatocellular carcinoma: 4-year data from the phase III HIMALAYA trial

Combining EGFR-TKIs and chemotherapy in patients with advanced non-small cell lung cancer: time for a new standard of care?

The introduction of tyrosine kinase inhibitors (TKIs) that specifically target mutant EGFR marked the start of the personalized medicine revolution in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Nowadays, osimertinib has become the standard of care first line treatment in this setting. However, also with this third generation EGFR-TKI, patients will eventually relapse, underscoring the need for alternative treatment strategies that can prevent or delay treatment resistance. In this respect, several studies assessing first- and second-generation EGFR-TKIs indicated a benefit of combining these agents with chemotherapy in patients with EGFR-mutant NSCLC. More recently, data from the phase III FLAURA-2 study showed a statistically significant and clinically meaningful improvement in progression-free survival with the first line combination of osimertinib and platinum-pemetrexed over osimertinib monotherapy, with a manageable safety profile. This mini review provides an overview of the clinical data with EGFR-TKI plus chemotherapy combinations in the treatment of patients with previously untreated, advanced EGFR-mutant NSCLC, with particular attention for the FLAURA-2 data.