Articles

Highlights in respiratory oncology

BJMO - volume 13, issue 8, december 2019

C. Dooms MD, PhD

ESMO 2019 featured the presentation of many interesting studies in the field of lung cancer. Much attention went to non-oncogene driven advanced stage non-small cell lung cancer (NSCLC) in which PD-(L)1 inhibitors are used in monotherapy, in combination with chemotherapy or in combination with CTLA-4 inhibitors. The results of the FLAURA, ALEX and ASCEND-7 trial demonstrated the most recent advances in oncogene-driven advanced stage NSCLC. Finally, the CASPIAN and IMpower 133 trial were the first studies to demonstrate an overall survival benefit with immunotherapy in the field of small-cell lung cancer (SCLC).

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Algorithms for molecular testing in solid tumours

BJMO - volume 13, issue 7, november 2019

Ir A. Hébrant PhD, M. Lammens MD, PhD, C. Van den Broecke MD, N. D’Haene MD, PhD, J. Van den Oord MD, PhD, A. Vanderstichele MD, PhD, A. Dendooven MD, PhD, P. Neven MD, PhD, K. Punie MD, G. Floris MD, PhD, J. Van der Meulen MD, HA. Poirel MD, PhD, C. Dooms MD, PhD, S. Rottey MD, PhD, T. Boterberg MD, PhD, L. Brochez MD, PhD, M.C. Burlacu MD, G. Costante MD, D. Creytens MD, PhD, P. De Paepe MD, PhD, R. De Pauwn MD, B. Decallonne MD, PhD, F. Dedeurwaerdere MD, H. Denys MD, PhD, L. Ferdinande MD, PhD, R. Forsyth MD, PhD, M. Garmyn MD, PhD, T. Gevaert MD, PhD, J. De Grève MD, PhD, E. Govaerts MD, E. Hauben MD, PhD, J. Kerger MD, O. Kholmanskikh Van Criekingen MD, PhD, V. Kruse MD, PhD, Y. Lalami MD, L. Lapeire MD, PhD, P. Lefesvre MD, PhD, J.P. Machiels MD, PhD, B. Maes MD, PhD, G. Martens MD, PhD, M. Remmelink MD, PhD, I. Salmon MD, PhD, R. Sciot MD, PhD, S. Tejpar MD, PhD, K. Van de Vijver MD, PhD, L. Van de Voorde MD, I. Van den Berghe MD, A. Van den Bruel MD, K. Vandecasteele MD, PhD, L. Vanwalleghem MD, K. Vermaelen MD, PhD, R. Salgado MD, PhD, E. Wauters MD, PhD, B. Weynand MD, PhD, E. Van Valckenborgh PhD, G. Raicevic PhD, M. Van den Bulcke PhD, P. Pauwels MD, PhD

SUMMARY

In order to advise the Federal Government on the reimbursement of molecular tests related to Personalised Medicine in Oncology, the Commission of Personalised Medicine (ComPerMed), represented by Belgian experts, has developed a methodology to classify molecular testing in oncology. The different molecular tests per cancer type are represented in algorithms and are annotated with a test level reflecting their relevance based on current guidelines, drug approvals and clinical data. The molecular tests are documented with recent literature, guidelines and a brief technical description. This methodology was applied on different solid tumours for which molecular testing is a clear clinical need.

(BELG J MED ONCOL 2019;13(7):286–95)

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Highlights in respiratory oncology

BJMO - volume 12, issue 4, august 2018

J. Vansteenkiste MD, PhD, C. Dooms MD, PhD

This article will briefly discuss the top stories in the field of respiratory oncology presented during the 2018 annual meeting of the American Society of Clinical Oncology (ASCO). For a complete overview of abstracts we refer to the official meeting website: https://am.asco.org.

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Therapy-orienting testing of EGFR inhibitor-resistant non-small cell lung cancer

BJMO - volume 11, issue 5, september 2017

C. Dooms MD, PhD, B. Colinet MD, I. Demedts , N. D’Haene MD, PhD, V. Ninane MD, PhD, T. Pieters MD, PhD, J. Vansteenkiste MD, PhD, B. Weynand MD, PhD, P. Pauwels MD, PhD

SUMMARY

Somatic sensitising mutations in the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) are detected in approximately 10% of patients with advanced non-squamous non-small cell lung cancer (NSCLC). EGFR tyrosine kinase inhibitors (EGFR-TKIs) are the first-line treatment option for patients with an actionable EGFR mutation. Despite initial responses, the majority of patients progress within one to two years after EGFR-TKIs treatment initiation.

The most common mechanism of resistance is the development of an additional EGFR-T790M mutation in exon 20, found in 50–60% of EGFR-mutant NSCLC patients who were rebiopsied on EGFR-TKI treatment. Phase II and III trials with osimertinib, a third-generation EGFR-TKI, demonstrated an objective response rate (ORR) of 60–70% and median progression-free survival (mPFS) of 10–11 months in EGFR-T790M-positive tumours.

A tissue biopsy of a progressing lesion for confirmation of histology and molecular characterisation is a critical consideration. However, a repeat tissue biopsy is not possible for every patient. Therefore, a liquid biopsy can be considered for EGFR-T790M mutation testing. Indeed, clinical trials testing osimertinib have shown similar clinical outcomes (ORR and mPFS on osimertinib) in patients with T790M-positive plasma versus T790M-positive tumour tissue.

Osimertinib clearly expands relapse treatment options for advanced stage EGFR-mutant NSCLC. Testing for EGFR-T790M at acquired resistance should become a standard component of patient care in EGFR-mutant tumours. In this manuscript, we propose and discuss two possible clinical diagnostic algorithms that could be used for the therapy-orienting testing of EGFR-TKI-resistant NSCLC patients. Tissue and liquid biopsies involve challenges in terms of specific clinical role, safety, logistics, and cost.

(BELG J MED ONCOL 2017;11(5):226–233)

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Molecular diagnostics on tissue samples obtained through EBUS-TBNA: review on practice guidelines

BJMO - volume 10, issue 1, february 2016

C. Dooms MD, PhD, B. Weynand MD, PhD, S. Vander Borght PhD, L. Vliegen MSc, E. Verbeken MD, PhD, J. Vansteenkiste MD, PhD, P. Vandenberghe MD, PhD

Summary

Endobronchial ultrasonography is a minimally invasive endoscopic technique that enables a real time transbronchial needle aspiration. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) specimens have a high diagnostic accuracy in the detection of intrathoracic lymph node metastasis for a variety of malignancies. Predictive biomarker testing is gaining wide importance to tailor the treatment with the largest benefit to the patient. Endobronchial ultrasound guided transbronchial needle aspiration also results in an accurate analysis of molecular alterations (by ImmunoHistoChemistry, Fluorescence In Situ Hybridisation, or gene sequencing) provided that the endoscopist takes sufficient tumour samples and a dedicated cytopathologist is involved in the mastery of the specimens.

Endobronchial ultrasound guided transbronchial needle aspiration samples can be handled in different ways. Liquid-based cytology and smears are mostly used. The choice of the testing method should be based primarily on the nature of the sample to be tested, testing laboratory’s expertise, and available equipment. ImmunoHistoChemistry, Fluorescence In Situ Hybridisation and targeted polymerase chain reaction-based sequencing can be performed on >80% of the endobronchial ultrasound guided transbronchial needle aspiration specimens, as the latter is more sensitive in terms of limit of detection than Sanger sequencing. The next step are the next generation sequencing assays, with only 10–20 ng of DNA sample input per gene mutation, which will minimise rejected samples due to insufficient sample quantity.

(BELG J MED ONCOL 2016;10(1):15–20)

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Malignant pleurisy and palliative therapy

BJMO - volume 9, issue 7, december 2015

J. Yserbyt MD, C. Dooms MD, PhD

Summary

Management of malignant pleurisy should be patient- and symptom-centred. The presence of trapped lung is the most important factor compromising the success rate of pleurodesis. Although scientific evidence is debatable, early referral for pleurodesis is advisable and thoracoscopy with talc poudrage is the treatment option of choice. The use of indwelling catheters is a novel alternative technique for specific indications.

(BELG J MED ONCOL 2015;9(7):279–85)

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