Articles

Case-based illustrations of clinical flow and practical aspects of DPD-deficiency screening in Belgium

BJMO - volume 16, issue 3, may 2022

L. Crapé MD, K.P. Geboes MD, PhD, V. Casneuf MD, A.G. Verstraete MD, PhD, K.B.M. Claes PhD, M. van den Eynde MD, PhD, I. Borbath MD, PhD, Y. Verheezen MD, W. Demey MD, J. Van der Meulen MD, V. Haufroid PhD

SUMMARY

Fluoropyrimidines are frequently used as anti-cancer treatment for gastro-intestinal malignancies, breast, head and neck cancer and others. The enzyme dihydropyrimidine dehydrogenase (DPD) is crucial in the first and rate limiting enzyme step of 5-fluorouracil (5-FU) catabolism. Reduced or complete deficiency leads to severe and even fatal toxicity. The Belgian Group of Digestive Oncology (BGDO) has agreed upon a recommendation on screening for DPD deficiency before starting treatment, which was endorsed by the Belgian Society of Medical Oncology (BSMO), the College of Genetics (CG), and the Toxicological Society of Belgium and Luxembourg (BLT). This article focuses on the clinical flows and practical recommendations. Both targeted germline genotype testing and phenotyping are supported. It was suggested to use a stepwise approach, with a phenotype testing upfront because of higher sensitivity and lower societal cost. In patients with uracil levels above 14 ng/ mL, targeted germline genotype screening should follow. Fluoropyrimidines are contra-indicated in patients with complete DPD deficiency and starting dose recommendations have been validated for patients with partial deficiency.

(BELG J MED ONCOL 2022;16(3):119–24)

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Systemic therapies in neuroendocrine tumours

BJMO - volume 15, issue 7, november 2021

I. Borbath MD, PhD

SUMMARY

Neuroendocrine neoplasms (NENs) are a heterogeneous family of tumours of increasing incidence and concern. The appropriate systemic therapy to apply in advanced/metastatic setting needs to be validated after a multidisciplinary meeting, because of the many characteristics to consider, such as stage (TNM), histological grade (Grade 1 to 3), functional imaging (FDG-PET) and somatostatin-receptor imaging (SRI), primary organ of origin, hormone-induced clinical symptoms, tumour bulk and of course general condition of the patient. Here, systemic therapies, including somatostatin analogues (SSA), targeted therapies, chemotherapy and peptide receptor radioligand therapy (PRRT) and excluding loco-regional therapies such as selective internal radiation therapy, are discussed for the treatment of advanced/metastatic neuroendocrine carcinomas (NEC), neuroendocrine tumours (NET) from pancreatic origin (PanNET) or small intestinal origin (SI-NET).

(BELG J MED ONCOL 2021;15(7):351-6)

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Highlights of the Gastrointestinal Cancers Symposium 2021

BJMO - volume 15, issue 6, october 2021

W. Lybaert MD, A. Demols MD, PhD, I. Dero MD, I. Borbath MD, PhD, J. Collignon MD

SUMMARY

The annual Gastrointestinal Cancers Symposium was held from 15 till 17 January 2021 in a virtual format. During this meeting, evolving immunotherapy options were shown in the upper digestive tractus, already presented at ESMO 2020. Besides immunotherapy, also the total neoadjuvant treatment approach (TNT) in rectal cancer reached sufficient attention, changing our current standard of practice in 2021. Targeted therapies for different gastrointestinal (GI) tumour locations showed promising results, paving the way for more personalised medicine.

In this report, the most important headlines will be discussed, with comments on the clinical relevance of the different studies.

(BELG J MED ONCOL 2021;15(6):331-9)

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