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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Standard of care in 2021 for patients with ovarian cancer in Belgium

BJMO - volume 15, issue 6, october 2021

I. Vergote MD, PhD, H. Denys MD, PhD, J. De Grève MD, PhD, C. Gennigens MD, PhD, K. Van de Vijver MD, PhD, J. Kerger MD, P. Vuylsteke MD, J-F. Baurain MD, PhD


Ovarian cancer is often diagnosed at an advanced stage, which is associated with worse survival outcomes and more limited therapeutic options. Over the last years, knowledge regarding the molecular features of ovarian cancer has advanced considerably, enabling the development of several options for diagnosis and treatment in a patient-tailored approach. Identification of homologous recombination deficiency (such as mutations of the BRCA1 and BRCA2 genes, or genomic instability) affecting DNA repair, has become essential in guiding treatment decisions, especially after the development of targeted agents. Therapeutic decisions take into consideration the cancer subtype, its molecular features and disease stage. Fundamental principles of good treatment for women with ovarian cancer include debulking surgery (to reduce the tumour to no residual disease whenever possible), along with appropriate systemic treatment (chemotherapy and targeted agents). To aid Belgian physicians in developing the best individual medical strategies for patients with primary and recurrent ovarian cancer, we present here standard of care applicable in Belgium, that also includes recently developed targeted agents and currently applicable reimbursement criteria.

(BELG J MED ONCOL 2021;15(6):286-91)

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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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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


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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Molecular test algorithms for breast tumours

BJMO - volume 13, issue 2, march 2019

Ir A. Hébrant PhD, K. Punie MD, F.P. Duhoux MD, PhD, C. Colpaert MD, PhD, G. Floris MD, PhD, K. Lambein MD, PhD, P. Neven MD, PhD, M. Berlière MD, PhD, R. Salgado MD, PhD, M. Chintinne MD, PhD, K. Dahan MD, PhD, S. Dedeurwaerdere MD, J. De Grève MD, PhD, A. de Leener MD, PhD, H. Denys MD, PhD, R. de Putter MD, L. Desmyter PhD, M. Baldewijns MD, PhD, D. Feret MD, C. Fontaine MD, C. Galant MD, P. Hilbert PhD, J. Janssens MD, PhD, D. Larsimont MD, PhD, P. Lefesvre MD, PhD, T. Sticca PhD, M-D. Tkint de Roodenbeke MD, G. Van Den Eynden MD, PhD, I. Vanden Bempt PhD, C. Van den Broecke MD, I. Vandernoot MD, C. Sotiriou MD, PhD, J. van Dorpe MD, PhD, H.A. Poirel MD, PhD, E. Van Valckenborgh PhD, G. Raicevic PhD, M. Van den Bulcke PhD, P. Aftimos MD


In order to advise the Federal Government on all matters related to personalised medicine in oncology, including the reimbursement of molecular tests, the Commission of Personalized Medicine (ComPerMed) has applied, for the breast tumours, the same methodology as previously applied for the digestive tumours. Meaning, the different molecular tests, represented in the shape of algorithms, are annotated with test levels — which aim to reflect their relevance based on current available data and to define the reimbursement — and are documented with recent literature, guidelines and a brief technical description.

(BELG J MED ONCOL 2019;13(2):40–45)

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Four case reports of arterial thromboembolism and cisplatin administration

BJMO - volume 12, issue 3, may 2018

S. De Keukeleire MSc, T. De Beule , H. Denys MD, PhD, S. De Waele , Wim Duthoy MD, V. Renard MD

Cisplatin is one of the frequently used chemotherapeutic agents. Common side effects such as vomiting, nephrotoxicity, ototoxicity and neurotoxicity are well known, though Cisplatin is also thought to activate destructive processes in blood vessels, including all types of arteries. Not only can it cause long-term cardiovascular complications (myocardial infarction, hypertension, and stroke), but also such complications during or shortly after its systemic administration. In a significant portion of patients, with up to 9% in some studies, thromboembolic events are encountered.1,2 In most of the cases, this concerns a venous thromboembolic event, though arterial thromboembolic events should not be neglected as it predicts a bad prognosis and significantly increased mortality risk, especially in cancer patients receiving other prothrombotic chemotherapies or when certain comorbidities are present that enhance the risk of thromboembolism.3 During a short period, we encountered four patients with arterial thromboembolic events while receiving Cisplatin-based therapy, of which three patients had a renal infarction. It should be noted that each patient had a different type of malignancy and Cisplatin was administered in combination with other therapeutic agents.

(BELG J MED ONCOL 2018:12(3):125–129)

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Extracellular vesicles to diagnose and treat cancer

BJMO - volume 11, issue 3, may 2017

J. Tulkens , L. Lippens , G. Vergauwen , S. Jeurissen MD, B. Dhondt MD, H. Denys MD, PhD, A. Hendrix PhD


Extracellular vesicles transfer lipids, nucleic acids and membrane-associated as well as intraluminal proteins between cells to maintain homeostasis and regulate physiological functions. This communication system is hijacked in cancer. Tumour-derived extracellular vesicles enter the circulation and carry targeting motifs and unique messages for cell-type specific instruction of distant ecosystems to foster metastasis. In this review we focus on how extracellular vesicles provide new opportunities for the diagnosis and treatment of cancer. Quantification and characterisation of tumour-derived extracellular vesicles obtained by liquid biopsy may enable the diagnosis and prognosis of cancer patients. Interference with extracellular vesicle biogenesis and implementation of extracellular vesicles as cancer vaccines or drug delivery vehicles opens up therapeutic potential to treat cancer.

(BELG J MED ONCOL 2017;11(3):92–105)

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