D. Schrijvers MD, PhD

The benefit of anticancer drugs

SUMMARY

New anticancer drugs are continuously developed and show statistically significant differences compared to the standard treatment. However, their clinical impact is not always shown. In this review, two systems to evaluate the meaningful clinical benefit are discussed: the ESMO-MCBS, developed by ESMO, and the ASCO value framework, proposed by ASCO. Both systems evaluate clinical meaningful effects of new anticancer drugs based on available clinical research, and grade them according to the system they developed. Whereas the ESMO-MCBS is a tool directed to guide development and health care system professionals, the ASCO value framework is a tool to help the medical oncologist and the patient to make an informed decision in relation to the value of a new treatment, including costs.

(BELG J MED ONCOL 2022;16(7):355–9)

Elevated CA-15.3 in a patient with megaloblastic anaemia: A red herring in breast cancer follow-up

SUMMARY

The cancer antigen 15.3 (CA-15.3) is an important tumour marker for the evaluation of patients with a history of breast cancer. An increase of CA-15.3 can be a sign of breast cancer recurrence and warrants further investigation. However, CA-15.3 is not specific and can be elevated in several oncological and benign conditions. This case describes a megaloblastic anaemia due to folic acid deficiency and elevated CA-15.3 in a patient with a history of breast cancer. No signs of breast cancer recurrence were found, and serum CA-15.3 levels normalised after supplementation of folic acid. Benign causes of CA-15.3 elevation should be considered when evaluating a patient with a history of breast cancer.

(BELG J MED ONCOL 2022;16(6):360–2)

Giant cell tumour of the jaw: Long-term treatment with denosumab in two patients

SUMMARY

Giant cell tumour of the bone (GCTB) is an uncommon primary bone tumour with rare metastatic potential. Giant cell tumour of the jaw (GCTJ) is histologically similar to GCTB with comparable treatment options. Denosumab, a human monoclonal antibody working as a RANKL inhibitor is recommended for treating patients with unresectable giant cell tumours. However, data on long-term efficacy and toxicity (e.g. osteonecrosis of the jaw) remains scarce, especially in GCTJ. This article presents two cases of patients with a GCTJ who were treated with denosumab for over eight years with excellent disease control and without significant toxicity.

(BELG J MED ONCOL 2022;16(6):300–2)

Mazabraud’s Syndrome in association with other benign soft tissue tumours: A case report

SUMMARY

Mazabraud’s Syndrome is a rare benign disorder characterised by the association of two hallmark entities: fibrous dysplasia (FD) and intramuscular myxomas (IM). The aetiology of the disease is unclear, but molecular research of FD and IM points in the direction of post-zygotic mutations in the guanine nucleotide binding protein, alpha stimulating (GNAS) gene, which activates a trophic cascade leading to aberrant cellular proliferation. Although the diagnosis of Mazabraud’s Syndrome is rare, showing a prevalence lower than 1/1,000,000, it should be suspected in every patient presenting with FD and IM. These patients should get a bone scintigraphy and a magnetic resonance imaging (MRI) of the affected anatomical area. Other imaging techniques, such as positron emission tomography-computed tomography (PET-CT), may have additional value. Finally, the patients should perform a biopsy of the IM to confirm the diagnosis. The treatment includes bisphosphonates for FD, and surgery is reserved only for severe cases with persistent pain, deformity, fracture, or risk for a pathological fracture. Asymptomatic IM should be treated conservatively, but symptomatic lesions can be surgically excised. Follow-up is useful since malignant transformation of FD and recurrence of IM after excision are reported in the literature.

(BELG J MED ONCOL 2022;16(4):187–90)

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)

Doublets in the first-line treatment of metastatic renal cell cancer with clear cell histology

SUMMARY

The treatment of mRCC has undergone a tremendous evolution in the last decades. There are data that the doublets of checkpoints inhibitors with each other or with anti-angiogenic agents improve PFS compared to sunitinib alone.

In this article, we review the different combinations and give some guidance for their use.

(BELG J MED ONCOL 2022;16(2):48–52)

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)