BJMO - volume 19, issue 4, june 2025
C. Gennigens MD, PhD, A. Lebeau PhD
Historically, the treatment of patients with advanced and metastatic endometrial cancers (ECs) included a limited number of systemic therapeutic options. The identification of four distinct molecular subgroups through the TCGA classification has significantly improved the understanding of this disease and enabled the development of new treatments. Around 25–30% of ECs are known to have a MSI-H/MMRd status and are characterised by high PD-L1 expression and strong CD8+ T cell infiltration, explaining their remarkable sensitivity to immune checkpoint inhibitors (ICIs). Indeed, these therapies have demonstrated high response rates and significant survival benefits, redefining the standard of care in both first-line and recurrent settings. In contrast, 70–75% of ECs have a MSS/MMRp status, including a heterogeneous population and thus exhibiting more variable responses to ICIs. Furthermore, emerging approaches include the use of antibodydrug conjugates targeting proteins that are overexpressed in tumour cells and often linked to poor prognosis, such as Trop-2 and HER2. Selinexor, an exportin 1 (XPO1) inhibitor inducing nuclear accumulation of key proteins and leading to tumour cell death, is another innovative strategy.
(BELG J MED ONCOL 2025;19(4):143–150)
Read moreBJMO - volume 19, issue 3, may 2025
C. Gennigens MD, PhD, A. Lebeau PhD
Although progress has been made through screening and vaccination against human papillomavirus (HPV), locally advanced (LACC) and metastatic cervical cancer continue to present significant therapeutic challenges. Indeed, the treatment strategies have remained largely unchanged for almost twenty years. In the LACC setting, recent research has focused on improving standard treatment (chemoradiation followed by brachytherapy), including neo-adjuvant chemotherapy (INTERLACE trial) or addition of an immune checkpoint inhibitor (ICI) (ENGOT-Cx11 study). In metastatic disease, immunotherapy is also making strides, encompassing ICIs in the first-line treatment; but also, tumour-infiltrating lymphocytes (TILs) transfer and therapeutic vaccination are still in clinical trials. The antibody-drug conjugate (ADC) tisotumab vedotin has demonstrated efficacy in second- or third-line therapy, while other ADCs targeting HER2 and TROP2 are under investigation. These innovative treatments offer hope for improving survival outcomes in patients with cervical cancer.
(BELG J MED ONCOL 2025;19(3):88–95)
Read moreBJMO - volume 18, issue 5, september 2024
C. Gennigens MD, PhD, A. Lebeau PhD
In the field of gynaecologic oncology, numerous studies were presented at the 2024 ASCO Annual Meeting. Several therapeutic de-escalation strategies were discussed, including the lack of benefits from lymphadenectomy in advanced ovarian cancer and from adjuvant chemotherapy in early high-risk cervical cancer. Neoadjuvant combined with adjuvant PARP inhibitors for patients with resectable recurrent ovarian tumours is a promising approach to avoid chemotherapy and enhance quality of life. Among the new treatments, mirvetuximab soravtansine for platinum-resistant ovarian cancers and selinexor for advanced or recurrent TP53 wild-type endometrial tumours are particularly promising. Additionally, several trials have explored the impact of obesity and its management in gynaecological cancers.
(Belg J Med Oncol 2024;18(5):211–5)
Read moreBJMO - volume 18, issue 2, march 2024
C. Gennigens MD, PhD, S. Altintas MD, PhD, J-F. Baurain MD, PhD, H. Denys MD, PhD, S. Henry MD, I. Vergote MD, PhD, T. Van Gorp MD, PhD
Over the past decade, immune checkpoint inhibitors (ICI) emerged as a new therapeutic pillar across a broad range of cancer types. An important characteristic of patients responding to ICI-based therapy consists of a high mutational burden in the tumours. In line with this, patients with microsatellite instability-high or mismatch repair-deficient (MSI-H/dMMR) endometrial cancer (EC) proved to be particularly sensitive to ICI, leading to the approval of anti-PD-1 antibodies for patients with MSI-H/dMMR ≥2nd line recurrent setting. Responses to single-agent ICI have also been reported in a small proportion of patients with microsatellite stable (MSS) EC. However, a high unmet need remains for these patients. More recently, several phase III randomised controlled trials showed that adding an ICI to standard chemotherapy significantly delays the disease progression in patients with primary advanced or recurrent MSI-H/dMMR EC, but also, to a lesser extent, in MMR proficient (p)/MSS EC. This article will briefly review the available clinical trial data with ICI-based therapies in EC and will assess how this treatment modality could be integrated into the Belgian treatment paradigm for these patients.
(BELG J MED ONCOL 2024;18(2):49–59)
Read moreBJMO - volume 17, issue 8, december 2023
C. Gennigens MD, PhD, A. Enguita PhD, T. Feys MBA, MSc
The 2023 annual ESMO meeting featured several presentations with the potential to reshape the standard of care in gynaecological cancers. New approaches emerged as promising treatments in cervical cancer, such as chemoradiotherapy combined with induction chemotherapy or pembrolizumab in patients with newly diagnosed locally advanced cervical cancer, or the antibody-drug conjugate tisotumab vedotin in the recurrent or metastatic setting. In addition, several trials further solidified the efficacy and safety of combining immunotherapy (durvalumab, atezolizumab, dostarlimab or pembrolizumab) with chemotherapy, in the treatment of advanced or recurrent mismatch repair deficient (MMRd) endometrial cancer. In contrast, the combination of atezolizumab plus chemotherapy followed by niraparib maintenance failed to demonstrate clinical benefits in patients with recurrent ovarian cancer.
(Belg J Med Oncol 2023;17(8):298–303)
Read moreBJMO - volume 17, issue 4, june 2023
A. Verbiest MD, PhD, M. Baldewijns MD, PhD, B. Beuselinck MD, PhD, P. Debruyne MD, PhD, C. Gennigens MD, PhD, G. Pelgrims MD, T. Roumeguère MD, PhD, E. Seront MD, PhD, N. Sundahl MD, PhD, S. Rottey MD, PhD
The management of renal cell carcinoma is evolving rapidly. Here, the BSMO expert panel discusses recent advances focusing on systemic therapies, and provides guidelines adapted to the Belgian context.
(BELG J MED ONCOL 2023;17(4):118–27)
Read moreBJMO - volume 17, issue 2, march 2023
C. Gennigens MD, PhD, H. Denys MD, PhD, S. Altintas MD, PhD, J. Kerger MD, J-F. Baurain MD, PhD, V. Bours MD, PhD, S. Henry MD, K. Van de Vijver MD, PhD, D. Lambrechts PhD, I. Vergote MD, PhD
Epithelial ovarian cancer (EOC) is the most frequent form of OC, a disease with a poor prognosis and high lethality, as most patients are diagnosed at advanced stages. To successfully battle EOC, it is crucial to identify reliable biomarkers and use personalised therapies in patient subgroups. A common feature of high-grade serous and endometrioid OC is homologous recombination repair deficiency (HRD), which frequently stems from the inactivation of the breast cancer susceptibility (BRCA) genes. Poly-(adenosine diphosphate [ADP])-ribose polymerase inhibitors (PARPi) were, therefore, developed for their lethality against HRD tumour cells. While patients with non-HRD tumours may also benefit from PARPi therapy in the recurrent EOC setting, recent phase III trials on newly diagnosed advanced-stage EOC have shown that PARPi treatment benefit is greater in patients with HRD tumours. These findings open new avenues for the use of PARPi as maintenance therapy in HRD-positive patients who had received first-line chemotherapy. This manuscript provides recommendations for Belgian physicians on how to approach HRD testing and incorporate it into treatment decisions of patients with newly diagnosed advanced-stage EOC.
(BELG J MED ONCOL 2023;17(2):38–45)
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