T. Feys MBA, MSc

Highlights in gynaecological cancers

The 2022 annual meeting of the European Society of Medical Oncology (ESMO) was a grand cru when it comes to ovarian cancer, with the presentation of long-term data of several pivotal studies evaluating firstline maintenance therapy with a PARP inhibitor. Also, in the recurrent ovarian cancer setting, there was some interesting PARP news. In addition to this, ESMO featured the presentation of multiple studies evaluating checkpoint inhibitors in the management of ovarian cancer, endometrium and cervical cancer.

(Belg J Med Oncol 2022;16(8):380–6)

Highlights in breast cancer

The 2022 annual ESMO meeting featured a plethora of interesting presentations in the field of breast cancer (BC). In the hormone-sensitive setting, data were presented on the effect of extending adjuvant aromatase inhibitor therapy in patients with early-stage disease. In the metastatic setting, interesting updates were presented with CDK4/6 inhibitors, while other abstracts reported the potential of selective oestrogen receptor modulators or degraders. In addition, updated results were presented for the TROPiCS-02 study evaluating the antibody-drug conjugate sacituzumab govitecan in pre-treated patients with HR+/HER2− metastatic breast cancer. Finally, metronomic treatment with vinorelbine plus cyclophosphamide and capecitabine proved to be another feasible treatment strategy in this setting. In triple-negative breast cancer (TNBC), (neo)adjuvant data with pembrolizumab were presented together with emerging results on the use of the anti-CD73 agent oleclumab in patients with advanced TNBC. We are very grateful to Prof. Hans Wildiers and Dr. Kevin Punie for their help in making the abstract selection for this article.

(Belg J Med Oncol 2022;16(8):387–94)

Highlights in lung cancer

The 2022 annual ESMO meeting again featured a long list of interesting lung cancer-related abstracts, ranging from long-term updates of pivotal studies to preliminary data of studies assessing novel treatment strategies for lung cancer. This article will give an overview of the key highlights in lung cancer presented during this meeting. We are grateful to Prof. Lore Decoster, from the University Hospital Brussels, for helping us I selecting the abstracts for this overview and for providing her expert opinion on the different studies.

(Belg J Med Oncol 2022;16(8):395–403)

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2022;16(8):421)

Immunotherapy for non-metastatic non-small-cell lung cancer: available data and future perspectives

Over the last decade, immune checkpoint inhibition (ICI) has dramatically changed the treatment landscape for patients with metastatic non-small-cell lung cancer (NSCLC). The success of ICI-based therapy in the metastatic setting fed the interest to also evaluate the potential of immunotherapy in earlier NSCLC disease stages. This article will provide a brief overview of the available, practice-changing data with ICI-based therapy in the neoadjuvant and adjuvant treatment for patients with early-stage NSCLC. Recently, these data led to the EMA approval of atezolizumab as monotherapy in the adjuvant treatment of selected early-stage NSCLC patients. In addition, EMA approval is currently also being sought for the combination of nivolumab and chemotherapy as neoadjuvant therapy for patients with resectable NSCLC. In addition to the results in the (neo)adjuvant setting, this article will also address the clinical basis for ICI-based therapy in unresectable,locally-advanced NSCLC.

The evolving role of immunotherapy in the treatment paradigm for patients with small-cell lung cancer

Small cell lung cancer (SCLC) accounts for about 15% of all lung cancer cases and is characterized by an aggressive disease course and a particularly poor prognosis. For decades, the best available systemic therapy for patients with extensive-stage (ES) SCLC consisted of platinum-etoposide chemotherapy. In recent years, however, extensive-stage (ES) SCLC has become the second thoracic malignancy in which immune checkpoint inhibition (ICI) proved to prolong the survival of patients. In fact, the phase III CASPIAN and IMpower133 studies showed that the addition of respectively durvalumab and atezolizumab to chemotherapy significantly prolongs the overall survival (OS) of patients with ES-SCLC. The results of these studies quickly established chemo-immunotherapy as the preferred initial treatment for these patients. Nevertheless, the benefit provided by ICI remains to be limited to a proportion of patients and most patients eventually relapse. Therefore, innovative treatment strategies and ICI-based combinations are currently under investigation to further improve the prognosis of patients with ES-SCLC. In addition, studies are looking into the potential of ICI in patients with limited stage (LS) disease.

Immune checkpoint inhibition for pancreatic cancer: is there light at the end of the tunnel?

Pancreatic adenocarcinoma (PDAC) continues to be one of the most lethal cancers. In recent years, immunotherapy using immune checkpoint inhibitors (ICIs) resulted in dramatic clinical benefits in many solid tumor types. However, PDAC patients are yet to experience the potential benefits of this treatment strategy. This article will provide a brief overview of the available data obtained with ICI-based treatments in patients with advanced PDAC. These studies illustrate that PDACs are inherently immune-cold tumors who are largely refractory to ICI-based therapy in clinical trials. Understanding and overcoming the current failures of immunotherapy through elucidating resistance mechanisms and developing novel therapeutic approaches are essential to harness the potential durable benefits of immune-modulating therapy in this setting.