PRACTICE GUIDELINES

Belgian consensus guidelines for prostate core needle biopsy reporting

The Belgian Working Group on Uropathology has agreed upon a dataset for prostate core needle biopsy reporting, based on existing international guidelines, recent scientific insights, national survey analysis and panel discussion, with the focus on a user- and receptor-friendly format. This dataset should encourage standardised structured reporting of prostate biopsies in the Belgian healthcare system, aiming to improve the quality of individual pathology reports and to provide real benefit for the clinical management of patients and secondary users. Therefore the Belgian Working Group on Uropathology recommends implementing this dataset in each Belgian pathology lab, in close consultation with the entire clinical team involved in the treatment of the prostate cancer patient.

(BELG J MED ONCOL 2018;12(6):279–286)

PD-L1 Testing for Non-Small Cell Lung Cancer: Belgian Guidelines

In recent years, the outcome of patients with non-small cell lung cancer (NSCLC) has improved thanks to the development of targeted therapies. Currently, the introduction of immunotherapy for lung cancer patients offers new treatment opportunities. The pathologist is now asked to provide the most accurate possible diagnosis in association with theranostic information in order to provide the best therapeutic option. For immunotherapy, programmed death receptor ligand 1 (PD-L1) status is, at the present, the required biomarker for patient stratification, at least in first line treatment. Different international societies have already underlined the importance of guidelines for managing samples of non-small cell lung cancer NSCLC. With the goal of adapting these international recommendations to the Belgian landscape, Belgian guidelines were published in 2016. This update integrates immunotherapy into the previously published guidelines.

(BELG J MED ONCOL 2018;12(5):233–238)

Opportunities and challenges in oncology and molecular testing: the Belgian strategy

Summary

Molecular diagnostics in cancer aiming at improving diagnosis, prognosis and treatment are constantly exposed to new opportunities and challenges. The Belgian Commission of Personalised Medicine (ComPer-Med) has been created to advise the Federal Government on all matters related to personalised medicine in oncology, including the reimbursement of molecular tests. Here, we propose the Belgian strategy for molecular testing within a scientific based framework and its implementation in the Belgian healthcare system. For each tested biomarker a clinical test level is attached, which is key to establish the relevance of the test and to define the reimbursement.

(BELG J MED ONCOL 2018;12(2):46–50)

Prevention of chemotherapy-induced nausea and vomiting: Belgian antiemetic treatment options anno 2018

Summary

Chemotherapy-induced nausea and vomiting remains an important adverse effect of treatment in daily clinical practice. Recently, new data on combinations of antiemetic agents became available for the prevention of acute and delayed nausea/vomiting in patients receiving highly and moderately emetogenic chemotherapy. As a result, the leading international cancer societies updated their antiemesis guidelines. This text aims at providing guidance regarding these new regimens in the prophylaxis of chemotherapy-induced nausea and vomiting, with a particular focus on highly emetogenic chemotherapy.

(BELG J MED ONCOL 2018;12(2):51–60)

Second-line treatment of non-small cell lung cancer adenocarcinoma patients not harbouring an oncogene driver mutation anno 2017–2018: A consensus group meeting

Summary

The treatment landscape for patients with advanced non-small cell lung cancer, who do not harbour an oncogenic driver abnormality, has changed dramatically over the last years. Second-generation antiangiogenic agents, such as nintedanib and ramucirumab, and particularly PD-1/PD-L1 inhibitors, such as nivolumab, pembrolizumab and atezolizumab have shown to prolong survival in pretreated non-small cell lung cancer patients. Immune checkpoint inhibition in the treatment of advanced non-small cell lung cancer comes with the promise of durable responses in responding patients. Nevertheless, one must appreciate that the average response rate seen with these PD-1/PD-L1 targeting agents is only about 20%. While PD-L1 testing may be used as an enrichment biomarker, a substantial proportion of patients still do not benefit from these agents. They could benefit from alternative therapeutic options, including novel anti-angiogenic agents. In this paper, a treatment algorithm is proposed that aims to optimise the second-line treatment choice for patients with lung adenocarcinoma, based on the available clinical data.

(BELG J MED ONCOL 2018;12(2):61–66)

Systemic chemotherapy regimens in early breast cancer patients: updated recommendations from the BSMO breast cancer task force

SUMMARY

Since the publication from the Belgian Society of Medical Oncology breast cancer task force in 2014 in the Belgian Journal of Medical Oncology, new information has become available on optimal chemotherapy regimens for early breast cancer patients. On February 24^th, 2017, 37 medical oncologists involved in breast cancer management reviewed the most important scientific data on this topic. The authors of this paper summarised the findings, and sent a questionnaire to the members asking for their input. This paper summarises the consensus of this exercise.

(BELG J MED ONCOL 2017;11(8):375–379)

The ION-Ghent guidelines for the management of immune related adverse events (irAE’s)

SUMMARY

Checkpoint inhibitors targeting CTLA4, PD1 and PD-L1 have become a part of the daily clinical practice in the management of stage IV melanoma, renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC) and Hodgkin-lymphoma patients. While these agents can elicit strong anti-tumour immune responses, they can also generate immune related adverse events, which can become life threatening if not detected and managed promptly. At the University Hospital Ghent, we created a working group of organ specialists with specific experience in dealing with immune related adverse events. This initiative is part of ION (Immuno-Oncology-Network) Ghent. In this paper we would like to share our institutional guidelines for the clinical care of patients treated with checkpoint-inhibitors with the Belgian Oncology Community.

(BELG J MED ONCOL 2017;11(6):265–276)