REVIEW ONCOLOGY

Late cardiovascular side effects of cancer treatment

SUMMARY

Thanks to the enormous progress made in cancer treatment, there are more and more cancer survivors. Oncologists are now concerned with the long-term management of patients who have recovered from their cancer. Giving them the best chance of a healthy survival is a very important issue. However, in this context, epidemiological studies and registries have revealed that the prognosis of cancer survivors is marred by the onset of more frequent and earlier cardiovascular disease. The emerging cardio-oncology discipline is seriously concerned about this issue as the number of patients potentially affected is large and growing. The task consists of identifying patients at increased risk of cardiovascular events after cancer treatment. Patients at risk are those with pre-existing cardiovascular risk factors and heart disease, and those exposed to anticancer treatment with cardiac toxicity that appears during their follow-up. Identifying those high-risk patients is possible thanks to clinical, biological and imaging monitoring. Furthermore, this monitoring allows therapeutic interventions, ranging from lifestyle recommendations to pharmacological treatment. However, several important pending questions remain, including whether cancer survivors would benefit from a more aggressive approach than that used to treat non-cancer survivor patients for the same cardiovascular problem.

(BELG J MED ONCOL 2022;16(1):11–16)

Genomics of metastatic breast cancer

SUMMARY

The purpose of this review is to highlight the recent knowledge gathered on the genomics of metastatic breast cancer (BC), together with the clinical implications. Through large sequencing efforts, the genomic profile of BC is increasingly being deciphered, with a limited number of those findings having resulted in genomicmatched treatment options. The pace at which new discoveries are made is highest in the early setting, where large samples can easily be accessed through leftover tissue of resection specimens, and smaller diagnostic biopsies are also available. In the metastatic setting however, residual tissue from clinically indicated biopsies or resections are scarce. Some efforts have been undertaken through (inter)national, institutional, clinical trial- or patient-driven initiatives. They have highlighted important differences between the genomic landscape of metastatic versus primary tumour tissues. Especially in hormone receptor positive HER2 negative (HR+/HER2-) disease, driver mutations continue to accumulate after dissemination, most of them in the ESR1 or ERBB2 genes, or in genes involved in transcription regulation, MAPK- or PI3K-signaling pathways. Importantly, the genomic landscape is not homogeneous even within one patient, and significant heterogeneity is seen on an intra-patient, inter-lesion and intra-lesion level. This poses clinical challenges, with different subclones possibly harbouring differential sensitivity to systemic treatments and single biopsies not accurately reflecting the full molecular profile. Finally, through liquid biopsies, a more complete and less invasive insight into the tumour’s characteristic could theoretically be retrieved. However, it is unclear how well these profiles correlate with the actual diversity of the different lesions. Importantly, rapid autopsy programs have been shown to enhance research on the genomics of metastatic BC, and one such program was recently launched at UZ/KU Leuven.

(BELG J MED ONCOL 2022;16(1):18–28)

When is a cancer progressive on imaging?

SUMMARY

The outcome of a cancer treatment should be adapted according to the treatment the patient is receiving and, in some instances, to the tumour type.

The different evaluation systems (RECIST 1.1, iRECIST, mRECIST, EORTC and PERCIST) have all their specific indications and rules, and they should be known by the radiologist and the oncologist.

This review focuses on the criteria to consider cancer as progressive, in relation to cancer treatment and tumour type.

(BELG J MED ONCOL 2022;16(1):29–32)

Clinical applications of circulating tumour DNA

SUMMARY

Circulating tumour DNA (ctDNA) analysis has the potential to advance precision medicine. The epidermal growth factor receptor (EGFR) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) single gene assays in plasma cell free DNA are being used for selecting patients with metastatic lung and breast cancer for treatment with EGFR and PIK3CA inhibitors, respectively. More recently, multigene assays have been approved by the Food and Drug Administration as companion diagnostics for the selection of patients that may benefit from specific targeted therapies. Moreover, ctDNA may allow a noninvasive monitoring of tumour genotype and treatment response. Potential future applications include systemic treatment of patients with ctDNA relapse and early cancer detection.

(BELG J MED ONCOL 2021;15(7):345-50)

Systemic therapies in neuroendocrine tumours

SUMMARY

Neuroendocrine neoplasms (NENs) are a heterogeneous family of tumours of increasing incidence and concern. The appropriate systemic therapy to apply in advanced/metastatic setting needs to be validated after a multidisciplinary meeting, because of the many characteristics to consider, such as stage (TNM), histological grade (Grade 1 to 3), functional imaging (FDG-PET) and somatostatin-receptor imaging (SRI), primary organ of origin, hormone-induced clinical symptoms, tumour bulk and of course general condition of the patient. Here, systemic therapies, including somatostatin analogues (SSA), targeted therapies, chemotherapy and peptide receptor radioligand therapy (PRRT) and excluding loco-regional therapies such as selective internal radiation therapy, are discussed for the treatment of advanced/metastatic neuroendocrine carcinomas (NEC), neuroendocrine tumours (NET) from pancreatic origin (PanNET) or small intestinal origin (SI-NET).

(BELG J MED ONCOL 2021;15(7):351-6)

Future perspectives and opportunities to improve the treatment of brain metastases in solid tumours: Brainstorm program – an initiative from the Oncodistinct network

SUMMARY

Patients with central nervous system (CNS) metastases have a poor prognosis, which is generally worse than in those with disease only outside the CNS. Treatment options for CNS metastases are still limited and suboptimal. New systemic therapies such as targeted therapies and immunotherapy have emerged for different cancers and differences in survival of patients with CNS metastases by tumour subtype have been observed. A better knowledge on the evolving epidemiology and biology of CNS metastases are key elements in the development of new treatment strategies whereby the identification of promising therapeutic targets for new compounds may play an important role in improving patient outcome. This article will provide a general overview of the recent improvement in systemic therapies for CNS metastases, highlighting perspectives to improve the management of CNS metastases and introduce the BrainStorm program- an innovative research program from the Oncodistinct network aiming to overcome the challenges of CNS metastases.

(BELG J MED ONCOL 2021;15(7):357-61)

The value of population-based databases to evaluate long-term patient outcomes: A multicentric research project in older patients with cancer

SUMMARY

The use of population-based data is a relatively accessible and cost-effective approach to study long-term outcomes in oncology. Also in older patients with cancer, longer-term outcome studies are limited and population-based data could help address this gap. Under the lead of UZ Leuven and the Belgian Cancer Registry (BCR), a national study was initiated to explore the association between the general health status of older patients with cancer as assessed by geriatric screening and assessment, and long-term outcomes as captured by population-based data. To this extent, data previously gathered within the context of a multicentre clinical study will be linked with three population-based databases: cancer registration data from BCR, healthcare reimbursement data from InterMutualistic Agency and hospital discharge data from Technical Cell. The major advantage of these population-based data is their longitudinal nature, which allows to follow a (sub)population across several years. The downside is their lack of clinical information. One way to partially overcome this limitation is to supplement population-based data with primary study data to investigate more clinically relevant outcomes. Although often scientifically interesting and appealing, coupling with population-based data demands intensive administrative efforts including an authorisation demand at the Information Security Committee. During the whole process, special attention should be given to privacyrelated aspects of the use and linkage of these data to ensure confidentiality.

BELG J MED ONCOL 2021;15(7):362-6)