BJMO - 2024, issue 4, june 2024
A. Janssens MD, PhD, C. Lambert MD, PhD
Chemotherapy-induced thrombocytopenia (CIT) is a common complication of cancer treatment that poses a severe clinical burden to patients with solid or haematologic malignancies. As this thrombocytopenia can present a barrier to continue chemotherapy at full dose and on schedule, it can hamper the patient’s longterm oncologic outcomes. Despite the clinical challenges related to CIT, there are currently no available agents approved by the FDA or EMA for the treatment or prevention of CIT. However, treatment with thrombopoietin receptor agonists (TPO-RAs) may increase platelet counts and benefit the safe administration of full-dose chemotherapy without dose delays. This not only reduces the patient’s bleeding risks, but also benefits the long-term oncologic outcomes. To date, most evidence for the use of TPO-RAs in the setting of CIT come from trials with romiplostim.
(BELG J MED ONCOL 2024;18(4):132–40)
Read moreBJMO - 2024, issue 4, june 2024
K. Punie MD, G. Jerusalem MD, PhD, I. Deleu MD, A. Gombos MD, T. Feys MBA, MSc, F.P. Duhoux MD, PhD
HER2 overexpression has been a therapeutic target in breast cancer (BC) for many years and the development of anti-HER2 therapies has markedly improved the outcome of patients exhibiting high levels of HER2 expression. In this, the HER2 status of patients was traditionally defined in a binary fashion, in which patients with high levels of HER2 expression were classified as HER2-positive, while all the rest were denominated as HER2-negative. Despite being classified as HER2-negative; the majority of these BCs do express some level of HER2. Until recently, however, these low levels of HER2 expression did not have any therapeutic implications. This has changed with the publication of the DESTINY-Breast04 (DB-04) study in which trastuzumab deruxtecan (T-DXd) was shown to significantly improve the progression-free (PFS) and overall survival (OS) of patients with HER2-low metastatic BC. These findings require a recalibration of the treatment paradigm for patients with advanced BC. Furthermore, the increased interest in HER2-low BC led to questions on the biology, epidemiology, heterogeneity, and prognostic relevance of HER2-low disease and confronts physicians with the challenge of incorporating the treatment of HER2-low disease in the rapidly evolving treatment landscape for patients with hormone-receptor-positive (HR+) and triple-negative BC (TNBC).
(BELG J MED ONCOL 2024;18(4):141–51)
Read moreBJMO - 2024, issue 3, may 2024
E. Landeloos MD
Immune checkpoint inhibitors have become the standard of care in previously untreated melanoma, reaching a median overall survival exceeding three years. While particularly successful in some, a significant portion of patients will never obtain treatment benefit. Over a decade of research has revealed a complex and dynamic interaction between a myriad of cancer-intrinsic and -extrinsic factors driving immune evasion, which emerge during tumour formation and shift early during treatment. In this review, we discuss primary resistance mechanisms to immune checkpoint inhibition in melanoma, and consider predictive biomarkers and their potential clinical implications.
(BELG J MED ONCOL 2024;18(3):75–81
Read moreBJMO - 2024, issue 3, may 2024
H. Van Poppel MD, PhD, M.J. Roobol PhD, L.D. Venderbos PhD, P. Basu MD, PhD, A. Chandran MD, PhD, R. van den Bergh MD, PhD, V. Vasilyeva , E. Briers PhD, PRAISE-U Consortium
Prostate cancer (PCa) is a significant health challenge for men globally and is the number two cancer-related killer of men in Northern and Western Europe. Over the years, researchers have conducted several randomised trials in order to assess the impact of screening for PCa on disease-specific mortality. Historical screening trials mainly relied on relatively simple protocols that used fixed prostate-specific antigen (PSA) thresholds and/or digital rectal examination for the indication to perform a biopsy. Current PCa screening practices across European Union (EU) member states vary in approaches and implementations. However, opportunistic PCa screening, which is associated with no significant decrease in mortality but a risk of overdiagnosis, is still prevalent. In 2022, the EU Council published updated recommendations, which incorporated PCa screening and encouraged evidence-based and person-centred cancer screening programmes. In alignment with these guidelines, the PRAISE-U project is committed to rationalising PCa screening in Europe.
(BELG J MED ONCOL 2024;18(3):82–8)
Read moreBJMO - volume 18, issue 2, march 2024
D. Schrijvers MD, PhD, S. Mignon MD, M. Brands MD, S. van Roy MD, S. De Schepper MD, N. Van Bruaene MD, D. Nevens MD, PhD, N. Meireson MD
Head and neck cancer is a complex cancer that involves multiple disciplines (surgery, radiotherapy, systemic therapy). The timely start of surgery and radiotherapy is of utmost importance since the time between the start of treatment is related to overall survival. A delay in surgery increases overall mortality by 6%, while a delay in radiotherapy increases overall mortality by 9%. In this article, the importance of a short time to start treatment in patients with head and neck cancer is discussed.
(BELG J MED ONCOL 2024;18(2):46–8)
Read moreBJMO - volume 18, issue 1, february 2024
M. Claes MSc, E. Vandaele MSc, J. Robijns PhD, J. Mebis MD
Cancer treatment options are steadily improving, but the resulting side effects remain a significant burden. Some of these adverse events can occur in the genitourinary system and often lack a comprehensive management approach. Photobiomodulation therapy (PBM) uses visible or (near)-infrared light to stimulate tissue regeneration. This narrative review discusses the most common cancer therapy-related adverse events in the genitourinary sphere, the causative factors, their current treatment options, and the possible use of PBM in their management strategies. The findings suggest that PBM has the potential to be effective in the treatment of gynaecological cancer therapy-related complications, but further research is required.
(BELG J MED ONCOL 2024;18(1):4–9)
Read moreBJMO - volume 18, issue 1, february 2024
Y. Van Herck MD, O. Bechter MD, PhD
Systemic treatment for irresectable or metastatic malignant melanoma has transformed over the past decade. For patients harbouring a BRAF V600 mutation, two standard treatment options exist, namely targeted therapy or anti-PD1 based therapy. For all other patients, immune checkpoint blockade based on monoclonal antibodies against anti-PD1 is considered the standard-of-care. Combination therapy with other checkpoint blockers such as anti-CTLA4 or anti-LAG3 are characterised by an improved outcome but are also associated with higher toxicity – which in case of the anti-PD1/anti-CTLA4 combination can be considerable. Up to date, patient selection for either monotherapy or combination therapy is largely based on patients’ demographics. Recent data suggest that treatment naïve patients with a BRAF V600 mutation have a better outcome when combination therapy with anti-CTLA4/anti-PD1 is given in first-line and BRAF/MEK inhibitory therapy is postponed to second-line. Patients who have exhausted their standard-of-care options should be included in a clinical trial and most scientific activity is evolving in the field of the immunotherapy refractory setting. A staggering number of different targets engaged in increasingly diverse subpopulations of immune effector- and regulator cells including the tumoral and stromal compartment are being explored in both the pre-clinical and clinical setting. These efforts will undoubtedly pave the way for the next transformation in the treatment of patients with malignant melanoma.
(BELG J MED ONCOL 2024;18(1):10–16)
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