SPECIAL

High-risk non-muscle invasive bladder cancer: What are the options?

Non-muscle invasive bladder cancer (NMIBC) makes up about 75% of all bladder cancers. Unfortunately, the majority of patients with NMIBC will experience a disease recurrence and a substantial proportion of them (~20–25%) will progress to muscle-invasive disease. Patients with high-risk NMIBC represent a particularly challenging patient group that is confronted with an increased 5-year risk of recurrence (up to 80 %) and progression (up to 50 %).¹ At BMUC 2020, an entire session was dedicated to the different treatment options for these patients: Dr. Tim Muilwijk (University Hospitals Leuven, Leuven, Belgium) discussed BCG therapy, Prof. Dr. Joan Palou Redorta (Fundació Puigvert, Barcelona, Spain) talked about the potential of early cytoreductive therapy, Prof. Dr. Anthony Zietman (Massachusetts General Hospital, Boston, USA) made a case for the use of radiotherapy in high-risk NMIBC patients and Prof. Dr. Yohann Loriot (Gustave Roussy Cancer Campus, Paris, France) provided an overview of the data generated with targeted therapy in this setting.

What is new in renal cell carcinoma?

Over the course of 2020, updates were presented of several pivotal randomised controlled trials in renal cell carcinoma (RCC). During the 2020 annual BMUC meeting, Prof. Dr. Axel Bex (UCL Division of Surgery and Interventional Science, London, UK. The Netherlands Cancer Institute, Amsterdam, The Netherlands) provided an overview of the most important novelties in the field of RCC and gave us a look into the future.

Poster Awards

Out of the fourteen posters submitted to the BMUC contest session, the board selected three posters based on their high-quality work. Award winners were given the opportunity to discuss their work in a short oral presentation at the BMUC 2020 meeting. In addition, Guillaume Grisay (Jolimont Hospital, Haine Saint-Paul, Belgium) was selected as a fourth winner by voting from the audience for his poster on the ‘Impact of modern imaging tools on management of prostate cancer, a single centre evaluation’.

Congress highlights 2020

In line with the tradition, the BMUC scientific committee asked a urologist, a radiation oncologist and a medical oncologist to summarise the top stories that were presented during the large urology and oncology meetings of the previous year. In addition, this year’s Congress Highlights also included presentations discussing congress highlights in imaging and genomics.

What’s new for patients with oncogenedriven non-small-cell lung cancer?

Summary

Over the last decades, the comprehensive molecular characterization of non-small-cell lung cancer (NSCLC) has expanded our understanding of the cellular origins and molecular pathways affected in this lung cancer subtype. Many of these genetic alterations represent potential therapeutic targets for which new drugs are constantly under development. As such, targeted therapy has emerged as the therapeutic cornerstone for patients with oncogene-driven advanced NSCLC. This personalized treatment strategy not only improved the treatment outcomes compared to traditional chemotherapy, it also had a significant impact on the quality of life of patients. Nowadays, targeted agents directed against epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase rearrangements have become standard therapy for patients harbouring these genetic aberrations. In addition to this, targeted agents directed against other, more rare, genetic aberrations (e.g. ROS1, NTRK, MET, RET, etc.) have generated promising results and several of these agents will enter the NSCLC treatment arsenal in the near future. This article provides an overview of key studies in patients with oncogene-driven NSCLC that were presented in the past year.

First-line immunotherapy for patients with advanced NSCLC: where do we stand?

Summary

Over the last decades we have witnessed substantial progress in the first-line treatment of patients with advanced non-small-cell lung cancer (NSCLC). While several targeted therapies entered the therapeutic arena for patients harbouring oncogenic driver mutations, the treatment for patients with non-oncogene driven NSCLC remained largely chemotherapy based. In recent years however, also the treatment paradigm for these patients underwent a transformation. In fact, convincing data generated by a long list of randomized trials, established immune checkpoint inhibition as a new therapeutic strategy for an ever-growing proportion of NSCLC patients. Within a couple of years immune checkpoint blockade moved from the second line setting to first-line therapy and broadened its scope from advanced to locally advanced NSCLC. As such, it turned the first-line treatment of advanced NSCLC into a competitive battlefield of crucial importance. Currently, three immunotherapeutic strategies have proven their worth in the first line treatment of patients with advanced, non-oncogene driven NSCLC: the use of PD-(L)1 inhibitors in monotherapy, combining PD-(L)1 inhibitors with chemotherapy, and combining PD-(L)1 inhibitors with other immune checkpoint inhibitors (mainly anti CTLA-4). In this article we will review the most recent clinical data generated with these three therapeutic strategies and provide updates on the biomarkers that can guide the choice for one of these options in the individual patient.

Biomarkers for immune checkpoint inhibition

Summary

Immune checkpoint inhibitors are effective in restoring the T-cell mediated immune response and can achieve a deep and durable response in a small subset of cancer patients. As only 15% to 25% of the patients with advanced NSCLC will benefit from immunotherapy, a predictive biomarker is required to select patients who will potentially respond. To date, the most intensively studied potential biomarkers consist of the programmed death ligand 1 (PD-L1) expression, the tumour mutational burden (TMB) and the tumour micro-environment (TME), each with its own advantages and challenges. This article will briefly describe each of these biomarkers and will touch upon the relationship between certain genetic modifiers and a response to immunotherapy.