Articles

Highlights in respiratory oncology

BJMO - volume 14, issue 5, september 2020

J. Vansteenkiste MD, PhD, E. Wauters MD, PhD

Summary

ASCO 2020 featured the presentation of many interesting studies in the field of lung cancer. For early stage non-small cell lung cancer (NSCLC), there was a focus on adjuvant targeted therapy while for advanced NSCLC without oncogene addiction much attention went to first-line immunotherapy and to the use of novel antibody-drug conjugates. In addition to this, several trials discussed the potential of EGFR-tyrosine kinase inhibitor (TKI) combinations, the targeting of MET alterations or RET fusions and the search for EGFR exon 20 mutant selective drugs for patients with advanced NSCLC and oncogene addictions. Finally, this overview will describe important results in the field of non-metastatic and metastatic small-cell lung cancer (SCLC) as well as advances in mesothelioma.

(BELG J MED ONCOL 2020;14(5):201-8)

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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 13, issue 5, august 2019

J. Vansteenkiste MD, PhD, E. Wauters MD, PhD

In this article, the ten key messages with respect to thoracic oncology presented at ASCO 2019, are summarized.

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Will there ever be a lung cancer vaccine?

BJMO - volume 11, issue 6, october 2017

I. Delanote , B. Legius MD, E. Wauters MD, PhD, J. Vansteenkiste MD, PhD

SUMMARY

Current treatment options for advanced stage non-small cell lung cancer (NSCLC) include chemotherapy and targeted therapy. Immunotherapy is the most recent strategy to improve survival in NSCLC. Among other newly developed immunotherapeutics, all aiming to enhance and reinforce the natural ability of the immune system to fight cancer, lung cancer vaccines aim to increase the number of tumor-reactive T-cells. Although preclinical models have shown that vaccines enhance effector T-cell infiltration into the tumor, this effect has not been translated into clinical benefit in multiple, large, randomised, placebo-controlled studies. Recent understanding of cancer immunology has shown that the immunosuppressive microenvironment of NSCLC is able to inactivate the tumor-reactive T-cells generated by therapeutic vaccination.

Consequently, combining vaccination with other immunotherapeutics to reverse this immunosuppressive environment (such as anti-PD-1/PD-L1) seems to be the best way forward.

Furthermore it will be important to develop relevant biomarkers to choose the most adequate combination of immunotherapeutics for each individual patient, because of the diverse mechanisms of immunosuppression by the tumor.

(BELG J MED ONCOL 2017;11(6):255–258)

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Highlights in respiratory oncology

BJMO - volume 11, issue 4, september 2017

J. Vansteenkiste MD, PhD, E. Wauters MD, PhD

At ASCO 2017, 195 abstracts in the feld of respiratory oncology were presented (169 in 2016): 22 oral presentations (including 4 in a clinical science symposium), 24 poster discussion items, and 149 posters. In this summary, most attention will go to phase III randomized controlled trials (RCTs) and innovative data that are, or may become, relevant for the practicing clinician. As this report is only the “extract of the abstracts”, the reader is referred to the respective abstracts published in J Clin Oncol volume 35 Suppl 15, 2017 (abstracts #8500–8586 and #9000–9107 and available on-line at https://meetinglibrary.asco.org/

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Immunotherapy in lung cancer: current approach and clinical application

BJMO - volume 11, issue 9, february 2017

D. Gullentops , E. Wauters MD, PhD, J. Vansteenkiste MD, PhD

Since its start in 2009, immunotherapy with immune checkpoint inhibitors has become a hot topic in respiratory oncology. Randomized controlled trials have proven the superiority of immune checkpoint inhibitor therapy versus standard chemotherapy in advanced non-small cell lung cancer (NSCLC). PD-L1 immunohistochemistry (IHC) is so far the most commonly implemented predictive biomarker in the selection of optimal candidates for immunotherapy. Immunotherapy with pembrolizumab is approved in first-line for advanced NSCLC with a PD-L1 expression on >50% of tumor cells, and after at least one prior chemotherapy regimen in case of PD-L1 expression of >1%. Treatment with nivolumab or with atezolizumab is approved for advanced NSCLC after prior chemotherapy, irrespective of the PD-L1 status. Since PD-L1 expression does not always correlate with treatment efficacy, other biomarkers are under investigation. Tumor mutational burden (which correlates clinically with smoking status) and CD8 tumor-infiltrating lymphocytes are associated with increased responsiveness to PD-L1 inhibition, and thus are other promising predictive biomarkers. NSCLC with molecular drivers on the contrary is preferably treated with tyrosine kinase inhibitors (TKIs) rather than immunotherapy due to lower response rates, even in case of high PD-L1 expression. Immunotherapy and other therapeutic modalities (chemotherapy, radiotherapy, TKIs) might work in synergy. The results of the first prospective trials with combination therapy were recently published, and many others are to be expected.

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