REVIEW ONCOLOGY

Real-world evidence for implementation of new drugs

SUMMARY

Randomised clinical trials are still the gold standard when it comes to the development of new drugs. There are, however, important limitations to trials. Such as, patients included in clinical trials are often not representative of the general population, which limits the applicability of trial results in clinical practice. In this article, the advantages and disadvantages of observational data are discussed. For example, observational data are generally more representative of the general population and can include large numbers of patients. However, there are important biases that should be considered when performing observational studies. Of these, so-called ‘confounding by indication’ is the most important form of bias, which means that reasons for certain treatment allocations are also associated with outcomes of treatment, which can disrupt the analyses. In summary, real-world data can add to clinical trials, but bias in these studies cannot be completely resolved. For this reason, clinical trials remain essential and should attempt to use less stringent inclusion criteria in order to improve the generalisability of their results.

(BELG J MED ONCOL 2023;17(1):11–4)

The role of radiation therapy in pancreatic cancer management

SUMMARY

Treatment of pancreatic ductal adenocarcinoma (PDAC) has been the subject of controversy for decades. At the centre of this controversy is radiation therapy. Since PDAC is considered a systemic disease, the role of radiation therapy is debated. However, most of the available evidence is blurred by suboptimal radiation doses, less effective chemotherapy regimens and abandoned radiotherapy techniques. This article reviewed the available literature and discussed the changes in radiation therapy that have taken place over the past decade.

(BELG J MED ONCOL 2022;16(7):328–35)

Radiotherapy for metastatic colorectal cancer: When is it worth it?

SUMMARY

Colorectal cancer is a prevalent cancer in Belgium. Unfortunately, many of these patients will develop metastases at some point in their disease. However, given the new therapeutic options, the prognosis of these patients is better than before. Local ablation of metastases is among these therapeutic options. This concept of metastasis-directed therapy (MDT) is generally accepted for oligometastatic disease. It can be accomplished by a multitude of techniques, including surgery, radiofrequency and microwave ablation, but also radiotherapy (RT). This review addressed the rationale and application of RT within this context.

(BELG J MED ONCOL 2022;16(7):336–42)

Tailoring systemic treatment after neoadjuvant chemotherapy in patients with early breast cancer

SUMMARY

Neoadjuvant treatments in patients with breast cancer provide the opportunity for a direct evaluation of treatment effect on tumour size, allow higher rates of conservative surgery and give the chance to tailor systemic treatments after surgery. Patients who achieve a pathological complete response experience better long-term survival, compared to those with residual disease after the completion of neoadjuvant therapy, and those with residual invasive disease at surgery may benefit from additional post-neoadjuvant treatment strategies. Some systemic post-neoadjuvant treatments for patients with residual disease at surgery are already approved in clinical practice (i.e., capecitabine for patients with triple-negative breast cancer, or T-DM1 for patients with HER2-positive disease), and several new strategies are currently under evaluation. The present review discusses the available evidence for the implementation of systemic post-neoadjuvant treatment strategies into clinical practice for patients with early breast cancer, shading light on the pitfalls and limitations of different studies, and summarising data on novel promising treatment strategies that are being explored in clinical trials.

(BELG J MED ONCOL 2022;16(6):262–73)

The impact of sarcopenia in oncology Patients

SUMMARY

Sarcopenia is defined as the loss of muscle mass and strength and plays an increasingly important role in the management of oncology patients. Sarcopenia is frequently mislabelled as malnutrition or cachexia. Clinicians lack a consensus definition of easy-to-use, straightforward, reliable diagnostic tools to optimally recognise sarcopenia. This review will broadly go through the current literature in order to define sarcopenia, as well as to understand its mechanisms. Helpful diagnostic tools will be discussed, which can be used to optimise the management of patients suffering from a malignant disease. This review will also illustrate how sarcopenia is an independent negative predictive and prognostic factor regarding survival and quality of life, directly impacting toxicity and efficacy of oncological treatments.

(BELG J MED ONCOL 2022;16(6):274–8)

Lung cancer screening in 2022: How should we screen optimally?

SUMMARY

On the brink of the implementation of lung cancer screening, the road from a controlled clinical trial to the real world is long, winding and not without hurdles. The latter will be addressed to come to an optimal lung cancer screening environment in Belgium.

(BELG J MED ONCOL 2022;16(6):279–86)

Bone health in cancer

Bone health is an important factor in the quality of life of cancer patients. Complications of impaired bone health can impact the quality of life and the survival of these patients. Every oncologist should look at problems of bone health such as osteoporosis and complications related to patient characteristics, the oncological disease and the cancer treatment. Complications should be prevented and, if they occur, adequately treated.

(BELG J MED ONCOL 2022;16(4):161–5)