J. Blokken PhD, PharmD

New oncology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J MED ONCOL 2024;18(6):248)

Gut microbiota as a novel source of biomarkers for immunotherapy in NSCLC

There is growing interest for biomarkers that allow a better selection of non-small cell lung cancer (NSCLC) patients that are likely to benefit from immunotherapy. To date, several biomarkers are under investigation, including the PD1/PL-L1 axis, the tumour mutational burden, and the gut microbiota. The gut microbiota seems interesting due to its role in cancer, cancer treatment and treatment-related toxicities. Below we briefly summarize the conditions that might influence the composition of the gut microbiota and the subsequent effect on a response to immunotherapy, immune-related adverse events, and their management in NSCLC.¹

Systemic treatment of brain metastases in oncogene-driven non-small cell lung cancer

The percentage of brain metastases at initial diagnosis ranges from 10–30% in patients with non-small cell lung cancer (NSCLC), with increasing incidence throughout the disease course. These brain metastases can cause motor dysfunction, mental dysfunction, seizures, headaches, nausea and vomiting and can thus severely hamper the patient’s quality of life. Historically, the presence of brain metastasis is a poor prognostic factor, and its control may prolong the prognosis of the patient. Brain metastases can be addressed with local therapy (such as surgery and radiotherapy), or with systemic therapy using classical anticancer drugs. Unfortunately, one of the major limitations in defining the optimal initial treatment for NSCLC patients with brain metastases is that patients with untreated brain metastases were often excluded from randomised clinical trials evaluating systemic therapies.¹ Furthermore, also a drug’s inability to penetrate the blood-brain barrier (BBB) can result in treatment resistance.² The most suitable treatment should be determined during a multidisciplinary consult and should be based on histologic type, the general condition of the patient, and the size and number of brain metastases.² This mini-review discusses the systemic management of patients with NSCLC and brain metastases, with a particular focus on patients with actionable genomic alterations.

Late-breaking session on uro-oncology

The second day of BMUC 2024 kicked off with the late-breaking session on uro-oncology. During this session, three recent clinical trials with important implications for daily clinical practice were discussed and critically interpreted. First, Prof. Piet Ost (University Hospital Ghent) walked us through the results of the GETUG-AFU18 trial. Thereafter, Dr. Marco Gizzi (Institut Roi Albert II Cliniques universitaires Saint-Luc) shared his insights on the potential caveats of the KEYNOTE-564 trial after which Dr. Alexander Giesen (University Hospitals Leuven) closed the session with a presentation on the PREVENT trial.

Supportive Care Task Force

The second day of the 2024 annual BSMO meeting kicked off with a session from the supportive care task force. First, Dr. Gary Deng (Memorial Sloan Kettering Cancer Center, United States) gave a talk on integrative medicine and how it helps cancer supportive care. Thereafter, Dr. Antonietta Iasiello (Dr. Spinedi Clinic, Orselina, Switzerland), discussed health education according to the Charter of Ottawa.

Breast Cancer Task Force

In line with the tradition, the 2024 annual BSMO meeting kicked off with a session from the Breast Cancer Task Force. Dr. Françoise Derouane (University Hospitals Leuven, Leuven) opened the session with a lecture on candidates for neoadjuvant chemotherapy in luminal disease. Thereafter, Dr. Ines Nevelsteen (University Hospitals Leuven, Leuven) discussed targeted axillary dissection after neoadjuvant chemotherapy in cN+ disease. In a third lecture, Dr. Nuria Kotecki (Institut Jules Bordet, Brussels) addressed the current challenges in the approach of brain metastases in breast cancer. Finally, Dr. Kevin Punie (GZA Hospitals Sint-Augustinus, Wilrijk) shared his knowledge and experience on how to select the optimal adjuvant endocrine therapy in early HR+ breast cancer.

Immune checkpoint inhibitor rechallenge in non-small cell lung cancer

Over the past years, immune checkpoint inhibitors (ICIs) against cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) or programmed death ligand 1 (PD-L1) have drastically changed the treatment landscape for patients with non-small cell lung cancer (NSCLC). Despite their success, a considerable proportion of patients will eventually consider ICI discontinuation due to disease progression, immune-related adverse events (irAEs) or the completion of a fixed duration course of ICIs without disease progression. Against this background, evidence is mounting that ICI retreatment could be an option for some patients. To date, however, no guidelines have been published for ICI rechallenge in lung cancer and it is still unclear which patients could benefit from a second course of ICI. In this, one needs to make a distinction between restarting the ICI without any other cancer treatment in between (retreatment) or restarting ICI after another treatment was used between the two ICI regimens (rechallenge). This is an important distinction as additional treatments may influence the homeostasis of the patients’ immune system.^1,2 This article describes some of the key elements that could influence treatment outcomes upon ICI retreatment or rechallenge and addresses potential strategies for ICI rechallenge and safety management.