CONGRESS HIGHLIGHTS

Highlights in breast cancer

SUMMARY

At ESMO 2024, updated results of the KEYNOTE-522 study showed for the first time overall survival (OS) benefit when adding pembrolizumab to neoadjuvant chemotherapy in patients with early-stage triplenegative breast cancer (TNBC). In addition, real-world evidence indicated that oestrogen receptor (ER)-low human epidermal growth factor receptor 2 (HER2)-negative disease treated with the neoadjuvant KEYNOTE-522 regimen achieved very high pathological complete response (pCR) rates and should preferably be treated as TNBC. Updated results from the NATALEE trial further reinforced the efficacy of combining a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor with endocrine therapy in patients with early-stage hormone receptor (HR)-positive breast cancer at risk of recurrence. Furthermore, preliminary evidence showed promising activity in patients with luminal B-like breast cancer treated with preoperative radiotherapy (RT) plus immuno-chemotherapy. Additionally, the HypoG-01 trial supports the use of hypofractionated RT (40 Gy/15 fractions in three weeks) to irradiate loco-regional nodes in patients with early-stage breast cancer. In the metastatic setting, the addition of capivasertib to first-line paclitaxel did not significantly improve survival in patients with TNBC. In addition, first-line treatment with CDK4/6 inhibitors and endocrine therapy confirmed efficacy for patients with HR-positive HER2-negative breast cancer with aggressive disease criteria compared to upfront chemotherapy. Moreover, in patients with HR-positive breast cancer, a large proportion of patients currently categorised as having tumours with an immunohistochemical (IHC) score of 0 at local testing, are HER2-low (IHC 1 or 2+) or ultralow (IHC >0 and <1) at retesting and can also benefit from trastuzumab deruxtecan (T-DXd). Finally, substantial and durable intracranial clinical activity was seen in patients with HER2-positive breast cancer with stable and active brain metastases treated with T-DXd.

(BELG J MED ONCOL 2024;18(8):294–302)

Highlights in genitourinary cancers

SUMMARY

The 2024 annual ASCO meeting offered remarkable presentations about the lastest trial updates in renal cell, bladder, testicular and prostate cancer. This article will give an overview of the key highlights in genitourinary cancers presented at ASCO 2024.

(Belg J Med Oncol 2024;18(5):206–10)

Highlights in head and neck cancer

SUMMARY

The ASCO annual meeting was held from the 31^st of May until the 4^th of June 2024 in a live and virtual format. During this Meeting, HPV vaccination shows first encouraging prevention results towards head and neck cancer incidence in young persons. Intensity-modulated proton therapy beats intensity-modulated photon therapy as definitive treatment of oropharyngeal cancer regarding toxicity profile. Promising chemotherapy-free regimens are at the horizon in first-line treatment of recurrent/metastatic HNSCC, though more studies in larger patient populations are needed. Also HPV-targeting immunotherapy is entering in the neoadjuvant and metastatic HNSCC setting, studies are running. Antibody-drug conjugates are prudently looking for a place in later-line treatment of HNSCC. Metronomic chemotherapy shows a clinically very relevant OS benefit for ECOG 2 patients. Immunotherapy is promising in the neoadjuvant and adjuvant treatment of locally advanced nasopharyngeal carcinoma. FAPI PET-CT beats ¹⁸F-FDG PET-CT as imaging for medullary thyroid carcinoma.

In this report, the most important headlines will be discussed, with comments on the clinical relevance of the different studies.

(Belg J Med Oncol 2024;18(5):181–90)

Highlights in breast cancer

SUMMARY

ASCO 2024 was, as usual, an important meeting for the oncology community.

Therapeutic innovations such as antibody-drug conjugates, new immunotherapy approaches and molecular targeted therapies were the basis of many presentations changing clinical practice or clinically of interest. In addition, cancer biology understanding, artificial intelligence and Telehealth were also on the menu.

This article summarises important reports from the breast cancer field. The basis of the selection is the following:

1. Practice-changing abstracts,
2. Clinically meaningful abstracts, and
3. Abstracts paving the way for progress.

This review will be divided into three categories:

1. Therapeutic innovations that influence outcome,
2. Escalation/de-escalation therapeutic strategies involving systemic therapies as well as loco-regional approaches, and
3. More precision in using «older» agents such as carboplatin or anthracycline.

To facilitate the reading, the classical molecular subdivision of breast cancer from luminal disease to triplenegative breast cancer to the HER2 molecular subtype was followed. With the development of the group of HER2 disease called HER2 low/ultra-low expressors, in which trastuzumab deruxtecan showed significant antitumour activity, the original molecular subtyping in three different subgroups is currently not so sharp.

(Belg J Med Oncol 2024;18(5):191–4)

Highlights in thoracic oncology

SUMMARY

This year’s ASCO was an exceptionally good year for thoracic oncology, as more than 300 abstracts on this subject, both under oral and poster form, were discussed in this meeting. Many advances were presented and extensively discussed, of which some are clearly practice changing. In this article I will try to mention the most significant one’s and briefly put them into context. Priority is clearly given to practice changing studies and will be discussed more in detail.

(Belg J Med Oncol 2024;18(5):195–200)

Highlights in gastrointestinal cancers

SUMMARY

The 2024 ASCO meeting will be remembered for the presentation of the TRANSMET trial, a study in carefully selected patients with definitely unresectable liver metastases, showing that liver transplantation is feasible and leads to better survival. We also learned that thermal ablation is a safe alternative for surgery for small liver metastases in patients with colorectal cancer. The ESOPAC trial is another important study answering a long-standing question on the optimal perioperative treatment in patients with adenocarcinoma of the oesophagus or GEJ junction.

(Belg J Med Oncol 2024;18(5):201–5)

Highlights in gynaecological cancers

SUMMARY

In the field of gynaecologic oncology, numerous studies were presented at the 2024 ASCO Annual Meeting. Several therapeutic de-escalation strategies were discussed, including the lack of benefits from lymphadenectomy in advanced ovarian cancer and from adjuvant chemotherapy in early high-risk cervical cancer. Neoadjuvant combined with adjuvant PARP inhibitors for patients with resectable recurrent ovarian tumours is a promising approach to avoid chemotherapy and enhance quality of life. Among the new treatments, mirvetuximab soravtansine for platinum-resistant ovarian cancers and selinexor for advanced or recurrent TP53 wild-type endometrial tumours are particularly promising. Additionally, several trials have explored the impact of obesity and its management in gynaecological cancers.

(Belg J Med Oncol 2024;18(5):211–5)