REVIEW ONCOLOGY

Integration of oncology and palliative care: summary of the Lancet Oncology Commission paper

SUMMARY

An international collaboration between 30 experts in oncology, palliative care, public health and psycho-oncology provided opportunities and guidelines on how to achieve full integration based on current findings of palliative care research in a Lancet Oncology Commission paper. This review provides a summary of this commission paper in which an overview is given of the different levels of palliative care and which elements of patient-centred care are crucial in the provision of optimal integrated palliative care. Due to the increase in incidence and prevalence of patients living with advanced cancer and associated care needs, palliative care should be seen as an essential component of comprehensive care throughout the life course and disease trajectory. If cure is not achievable, a combined tumour-directed approach and patient-centred approach is needed. We need to rethink and reorganise the delivery of oncology and palliative care to improve treatment and promote collaboration at the appropriate levels of care. Palliative care needs to be implemented in cancer care plans and in clinical care pathways. To guide patients and their family through the healthcare system and improve their health care outcomes, a multidisciplinary team approach is needed in which primary, secondary and tertiary palliative care providers can collaborate and communicate and in which patients can be referred to tertiary palliative care if needed.

(BELG J MED ONCOL 2020;14(2):47–55)

Tumour mutational burden: a review

SUMMARY

Immunotherapeutics, like immune checkpoint blockade (ICB), have demonstrated therapeutic efficacy in a variety of human cancers. Even among the tumour types described as responsive, immunotherapy is only efficient in a minority of the patients. To maximise therapeutic benefits, a biomarker to identify ICB-responders is needed. Tumour mutational burden would correlate with the efficacy of immune checkpoint inhibitors. Clinical evidence for TMB as biomarker already exists in metastatic melanoma, non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC). In this review an update about tumour mutational burden (TMB) is given.

(BELG J MED ONCOL 2020;14(1):4–7)

Adjuvant treatment of stage III melanoma: a tabulated review of randomised phase III trials

(BELG J MED ONCOL 2020;14(1):8–12)

Update in prostate cancer 2019

SUMMARY

The prostate cancer (PCa) landscape has changed dramatically over the past few years. New paradigm-shifting data are published nearly every month. This review aims to give a brief overview of the most important publications of 2018–2019. From the ever-lasting discussion about PSA screening, with the recent publication of the CAP trial, over diagnostics where multi-parametric MRI has caused a true revolution, to hypofractionation in radiotherapy and the dramatic treatment shifts in metastatic hormone sensitive and non-metastatic castrate resistant PCa. All exciting data that will change clinical practice.

(BELG J MED ONCOL 2020;14(1):13–21)

The hype of phase II trials

SUMMARY

Many of the new drugs are registered based on phase II data and surrogate endpoints. The medical oncologist should know the limitations and dangers of such an approach. The value of phase II trials and surrogate endpoints as well as clinical meaningful results are discussed.

(BELG J MED ONCOL 2019;13(7):273–6)

Molecular-defined melanoma: Implications for clinical practice

SUMMARY

Due to the development of genome-directed therapy and standardised methods of molecular analysis, molecular diagnostics has become an important part of daily practice in clinical oncology, especially in diseases like malignant melanoma where molecular testing has therapeutic implications. Melanoma has one of the highest mutation frequency of all cancers analysed in the TGCA (The Cancer Genome Atlas) and is characterised by an enormous genetic heterogeneity.¹ The discovery of ‘driver mutations’ directly involved in melanomagenesis has led to the development of small-molecule kinase inhibitors. The emergence of BRAF and MEK inhibitors has completely changed treatment paradigm for BRAF-mutant metastatic melanoma with dramatically improvement of therapeutic outcomes. Despite high response rates, the duration of response remains limited, mainly due to the development of acquired treatment resistance. In this review the authors try to outline the importance of molecular oncology for malignant melanoma by giving an overview of the most frequent and potentially clinically relevant molecular alterations, the targeted therapies already used in clinical routine and by discussing the problem of acquired resistance and treatment strategies being developed to circumvent these obstacles.

(BELG J MED ONCOL 2019;13(7):277–85)

Low Grade Glioma: towards a personalised treatment

SUMMARY

This review is designed to help the management of low grade glioma and is based on literature regarding molecular characterisation, surgery, radiotherapy, chemotherapy and neurocognitive preservation.

(BELG J MED ONCOL 2019;13(6): 213–218)