Belgian clinical practice guidelines for the treatment of patients with HER2-positive advanced breast cancer

BJMO - , issue ,

G. Nader-Marta MD, F.P. Duhoux MD, PhD, D. Taylor MD, T. Van den Mooter MD, H. Denys MD, PhD, J-L. Canon MD, PhD, J. Mebis MD, A. Awada MD, PhD, H. Wildiers MD, PhD, K. Punie MD, E. de Azambuja MD, PhD

HER2-targeted agents are the central component of HER2-positive metastatic breast cancer (MBC) treatment. The combination of trastuzumab, pertuzumab and a taxane is the preferred first-line regimen in most settings. For patients with disease relapse after adjuvant therapy, treatment decisions in the first-line are influenced by the treatment-free interval and the regimens used in the (neo)adjuvant setting. T-DXd has been recently established as the preferred second-line therapy. T-DM1, or the combination of tucatinib, trastuzumab and capecitabine, are reasonable third-line options, although efficacy and safety data of these regimens after prior exposure to T-DXd are lacking. In fourth and later lines, trastuzumab duocarmazine, neratinib plus capecitabine, margetuximab plus chemotherapy, lapatinibbased combinations or the continuation of trastuzumab with different chemotherapy partners are valid alternatives.


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Escalation and de-escalation strategies in early breast cancer

BJMO - volume 16, issue 3, may 2022

D. Taylor MD, K. Punie MD, E. de Azambuja MD, PhD


Early breast cancer is the most frequently diagnosed cancer among women worldwide. Different subtypes have been identified, and with them, new treatment strategies have emerged. In order to elaborate a personalised treatment, clinicians need reliable pathological and molecular disease subtyping, refined assessments of the risk of relapse, and predictive markers to estimate treatment benefit. Combining these elements allows for de-escalation in some patients and, on the contrary, identifies those who should receive more intensive therapy and serve as candidates for escalation strategies in standard practice or clinical trials. This article reviews the de-escalation and escalation strategies currently available and will explore future treatment perspectives in early breast cancer.

(BELG J MED ONCOL 2022;16(3):102–13)

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Clinical management of first-line advanced triple-negative breast cancer patients

BJMO - volume 14, issue 7, november 2020

M. Rediti MD, K. Punie MD, E. de Azambuja MD, PhD, E. Naert MD, D. Taylor MD, FP. Duhoux MD, PhD, H. Denys MD, PhD, A. Awada MD, PhD, H. Wildiers MD, PhD, M. Ignatiadis MD, PhD


Chemotherapy has represented the main treatment option for patients with advanced triple-negative breast cancer for a long time. However, due to our better understanding of tumour biology, recent clinical trials led to a change in the treatment paradigm of this disease, identifying clinically relevant subgroups with different therapeutic options. Both clinical and biological factors have become relevant and need to be considered in the treatment decision algorithm of this heterogeneous disease.

(BELG J MED ONCOL 2020;14(7):333-38)

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Should tumour infiltrating lymphocytes and PIK3Ca mutation be added as markers to the histology report for breast cancer?

BJMO - volume 11, issue 1, february 2017

P. Vuylsteke MD, J.C. Goeminne MD, S. Henry MD, V. Vanhaudenarde MD, B. Willemart MD, P. Marchettini MD, D. Taylor MD


Tumour infiltrating lymphocytes are a sign of immune mediated reaction of the host against the tumour. They are considered as a positive prognostic marker and may also have a predictive role for the use of certain therapies. The challenge remains to convert tumours with low tumour infiltrating lymphocytes into tumours with high tumour infiltrating lymphocytes in order to enhance the immune mediated effect of therapies.

PIK3Ca mutation is one of the most frequent mutations encountered in breast cancer, particularly in hormone receptor positive cancer in which it can confer resistance to hormonal therapy. Therefore, a lot of effort has been made to target the PI3K-pathway with drugs, and to find a way to predict their efficacy: some results have been achieved; in particular with the detection of PIK3Ca in circulating DNA, but many questions still remain. This article provides an overview concerning these two biomarkers, and attempts to determine whether they could be used in clinical practice today.

(BELG J MED ONCOL 2017;11(1):7–11)

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