BJMO - volume 11, issue 6, october 2017
I. Delanote , B. Legius MD, E. Wauters MD, PhD, J. Vansteenkiste MD, PhD
Current treatment options for advanced stage non-small cell lung cancer (NSCLC) include chemotherapy and targeted therapy. Immunotherapy is the most recent strategy to improve survival in NSCLC. Among other newly developed immunotherapeutics, all aiming to enhance and reinforce the natural ability of the immune system to fight cancer, lung cancer vaccines aim to increase the number of tumor-reactive T-cells. Although preclinical models have shown that vaccines enhance effector T-cell infiltration into the tumor, this effect has not been translated into clinical benefit in multiple, large, randomised, placebo-controlled studies. Recent understanding of cancer immunology has shown that the immunosuppressive microenvironment of NSCLC is able to inactivate the tumor-reactive T-cells generated by therapeutic vaccination.
Consequently, combining vaccination with other immunotherapeutics to reverse this immunosuppressive environment (such as anti-PD-1/PD-L1) seems to be the best way forward.
Furthermore it will be important to develop relevant biomarkers to choose the most adequate combination of immunotherapeutics for each individual patient, because of the diverse mechanisms of immunosuppression by the tumor.
(BELG J MED ONCOL 2017;11(6):255–258)
Read moreBJMO - volume 11, issue 6, october 2017
P. Frères MD, C. Gennigens MD, PhD, D. Martin MD, PhD, G. Jerusalem MD, PhD
Leptomeningeal carcinomatosis (LC), or neoplastic meningitis, is a disastrous complication of advanced cancer. This disease occurs in approximately 5% of patients with solid tumour and results from the dissemination of tumour cells from the cerebral spinal fluid (CSF) flow throughout the entire central nervous system (CNS). LC is characterized by multiple and fluctuant neurologic symptoms and signs. Useful tests for the diagnosis include magnetic resonance imaging (MRI) and CSF analysis. Unfortunately, the diagnosis remains challenging due to pleomorphic symptoms and false negative results of diagnostic procedures. For most patients, the aim of the treatment is to control symptoms, by using targeted radiotherapy and corticosteroids. More aggressive therapeutic approaches, such as intrathecal (IT) or systemic chemotherapy, should be restricted to highly selected and good-risk patients. Moreover, only few randomized clinical trials are available in the field and studies using more recent targeted therapies or immunotherapy should always be considered in these patients, as outcome with standard of care is disappointing.
(BELG J MED ONCOL 2017;11(6):259–264)
Read moreBJMO - volume 11, issue 5, september 2017
T. Geukens MD, J. Verheezen MD
Ever since the early 1930’s, an association between pancreatic cancer and depression has been noticed. The prevalence of depression is higher in patients with pancreatic cancer than it is in patients with other abdominal neoplasms, and psychiatric symptoms often precede somatic symptoms. Despite further research on this co-occurrence, the true mechanism of interaction is still not clear. Knowing what it is that forms the biological link between depression and the pancreatic tumour, could be of great importance to the future diagnostic and therapeutic workup of these patients.
Different theories are proposed. Plausible are the depression being induced through cytokines more specifically IL-6, alterations in the tryptophan-kynurenine, glutamate and serotonin pathways, and antibodies disturbing brain functioning directly or through serotonin. Depression causing cancer is also possible, but to date of unknown importance in pancreatic cancer. All this information brought together makes depressive symptoms of diagnostic importance in pancreatic cancer. The insights pave the way for the development of targeted therapies, hopefully to be implemented in clinical practice in the future.
(BELG J MED ONCOL 2017;11(5):212–217)
Read moreBJMO - volume 11, issue 5, september 2017
E. Joos MD, N. Vanhauter , A. De Smedt MD, PhD
The aim of this paper is to evaluate the effectiveness of a multidisciplinary rehabilitation program in the treatment of breast cancer survivors in an outpatient rehabilitation clinic.
Eighty seven breast cancer patients began a rehabilitation program based on physical exercise. Baseline parameters were compared for patients who had received chemotherapy (YES=66) and patients who had not received chemotherapy (NO=21). Data on physical fitness, body mass index and lean mass, quality of life and Beck’s Depression Inventory in breast cancer patients were compared before (T0) and after (T1) a 16-week, twice-weekly standardised rehabilitation program.
At baseline, there were no statistical differences for all parameters between patients who had received chemotherapy and those who had not. Sixty one out of eighty seven patients completed the program. There was a significant increase in physical fitness parameters, at 50 Watt HR (p=0.038) with lactic acid (p=0.020) decreased and at 75 Watt HR (p=0.010) with LA (p=0.001) decreased. Body mass index did not change significantly (p=0.239) but there was a strong correlation with increase in lean mass (p<0.001). Quality of life and Beck’s Depression Inventory improved significantly (p<0.001) and there was a correlation between improvement in quality of life and improvement in submaximal physical fitness (p=0.005).
This analysis shows correlations between the statistically significant benefit of a multidisciplinary rehabilitation program on physical fitness, depression symptoms and quality of life.
(BELG J MED ONCOL 2017;11(5):218–225)
Read moreBJMO - volume 11, issue 3, may 2017
D. Schrijvers MD, PhD, T. Debacker MD
The characteristics of carcinogenesis are discussed in relation to prostate cancer. Some of these are already used as treatment targets in daily clinical practice, while in some, medications proved to be ineffective to interfere with these mechanisms of carcinogenesis.
Currently, treatments that have shown efficacy are addressing the mechanism of sustained proliferative activity, while there are some indications that immune modulation and agents interfering with DNA repair may play a role in the treatment of prostate cancer.
Other aspects of carcinogenesis need more study in patients with prostate cancer to show a benefit and they must be the scope of future research.
(BELG J MED ONCOL 2017;11(3):87–91)
Read moreBJMO - volume 11, issue 3, may 2017
J. Tulkens , L. Lippens PhD, G. Vergauwen , S. Jeurissen MD, B. Dhondt MD, H. Denys MD, PhD, A. Hendrix PhD
Extracellular vesicles transfer lipids, nucleic acids and membrane-associated as well as intraluminal proteins between cells to maintain homeostasis and regulate physiological functions. This communication system is hijacked in cancer. Tumour-derived extracellular vesicles enter the circulation and carry targeting motifs and unique messages for cell-type specific instruction of distant ecosystems to foster metastasis. In this review we focus on how extracellular vesicles provide new opportunities for the diagnosis and treatment of cancer. Quantification and characterisation of tumour-derived extracellular vesicles obtained by liquid biopsy may enable the diagnosis and prognosis of cancer patients. Interference with extracellular vesicle biogenesis and implementation of extracellular vesicles as cancer vaccines or drug delivery vehicles opens up therapeutic potential to treat cancer.
(BELG J MED ONCOL 2017;11(3):92–105)
Read moreBJMO - volume 11, issue 2, march 2017
Tom Feys MBA, MSc
Every year brings new knowledge and insights that help to direct research that ultimately leads to improved care for patients with cancer. This report, which is based on the clinical cancer advances 2017 article published by the American Society of Clinical Oncology, reviews the most important advances made in the different fields of oncology that are most likely to impact daily clinical practice.1 Over the last few years, immunotherapy has become a new treatment option for patients with a growing number of cancer types. Building on the initial successes with immunotherapy, a key next step is to understand why currently fewer than half of patients benefit from immunotherapy and why the benefit, if it occurs, may be short lived. In 2016, several reports revealed early insights into patient and cancer characteristics that might predict whether immunotherapy could work well in an individual patient. Many studies also assess whether combining immunotherapy with other cancer treatments might extend the potential of this new group of therapies.
A second part of this report focuses on targeted therapies. The research into cancer biology is propelling rapid development of novel treatments targeting the key molecules that allow cancers to grow and spread. In 2016, this strategy resulted in new targeted therapies for patients with advanced lung, breast, and kidney cancer, as well as several hard-to-treat forms of blood cancer. In addition to this, new molecular technologies are emerging that can quickly pinpoint molecular changes in the tumour or free-floating cancer DNA in the blood.
(BELG J MED ONCOL 2017; 11(2):37–45)
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