Articles

Highlights in radiotherapy

BJMO - 2021, issue Special, december 2021

J. Blokken PhD, PharmD, T. Feys MBA, MSc

SABCS 2020 featured several interesting presentations in the field of radiotherapy. The PRIME 2 study investigated the impact of omitting postoperative whole breast radiotherapy in older, low-risk women with early invasive breast cancer. Outcomes of the phase III BIG 3-07/TROG 07.01 trial were also reported providing improved insights into the optimal radiation dose and fractionation schedule for non-low risk ductal carcinoma in situ of the breast. Other interesting topics included the comparison of patient and physician reports of toxicity after breast radiotherapy and the finding that radiation therapy improves survival in early-stage HER2-positive breast cancer with a high-levels of tumour infiltrating lymphocytes. Finally, we report on the results of a retrospective analysis assessing the feasibility of radiation therapy de-escalation in patients with stage I, node-negative, HER2-positive breast cancer.

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Highlights in HER2-positive breast cancer

BJMO - 2021, issue Special, december 2021

J. Blokken PhD, PharmD, T. Feys MBA, MSc

In the field of Human Epidermal Growth Factor Receptor 2 (HER2) positive early breast cancer, an interesting Subpopulation Treatment Effect Pattern Plot (STEPP) analysis of the APHINITY trial was presented at SABCS 2020. In addition, BluePrint RNA sequencing was used in an attempt to predict the benefit of adjuvant pertuzumab in this trial. Other interesting data in early HER2-positive breast cancer came from the use of neratinib as extended adjuvant therapy. In the metastatic setting, results of the PERTAIN study, the first randomised phase II trial to assess the addition of pertuzumab to trastuzumab and an aromatase inhibitor in the presence or absence of induction chemotherapy, were presented. Finally, a long list of abstracts featured results with novel HER2-directed therapies, including the antibody-drug conjugate trastuzumab deruxtecan, the tyrosine kinase inhibitor tucatinib and the investigational monoclonal antibody margetuximab.

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Immunotherapy for the treatment of triple-negative breast cancer

BJMO - 2020, issue Special, december 2020

J. Blokken PhD, PharmD, Tom Feys MBA, MSc, K. Punie MD

While immune checkpoint inhibitors (ICIs) demonstrated a convincing efficacy with durable responses in many cancer types, the single agent efficacy of ICIs in patients with advanced triple-negative breast cancer (TNBC) proved to be low. In a successful attempt to boost this clinical activity, ICIs were subsequently combined with chemotherapy in patients with metastatic TNBC. Following the positive results in the metastatic setting, ICIs are now also under evaluation in combination with neoadjuvant chemotherapy in patients with early TNBC. This review provides an overview of the results obtained with ICI in TNBC, from the disappointing results with ICI monotherapy, over the emerging data with ICI-chemotherapy combinations in the neoadjuvant setting to the pivotal, practice-changing results obtained with atezolizumab and atezolizumab in combination with chemotherapy in metastatic TNBC patients.

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The emerging role of immunotherapy in small-cell lung cancer

BJMO - 2020, issue Special, december 2020

J. Blokken PhD, PharmD, Tom Feys MBA, MSc

In contrast to the impressive improvements that were made in the treatment of patients with non-small cell lung cancer, the treatment for patients with small-cell lung cancer (SCLC) remained largely unchanged during the past three decades. More recently, however, immune checkpoint inhibitors have been gaining momentum in this setting. In Belgium, patients with extensive stage (ES) SCLC now have the choice between two effective treatment regimens combining an immune checkpoint inhibitor with chemotherapy. In addition to this, several other immunotherapy-based therapies are being scrutinised in clinical trials with ES SCLC patients.

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Synergism between CTLA-4 and PD-(L)1 inhibition: the nivolumab-ipilimumab story

BJMO - 2020, issue Special, december 2020

J. Blokken PhD, PharmD, Tom Feys MBA, MSc, P. Coulie MD, PhD

In recent years, the approval of anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and anti-programmed cell death protein 1 (PD-1) antibodies have led to significant improvements in disease outcomes for various cancers. Despite their long-term durable efficacy, the responses to immune checkpoint blockade are limited to a minority of patients. In an attempt to overcome this, the combination of CTLA-4 and PD-1 inhibitors is gaining momentum as a rational approach to improve outcomes.1 This review describes the mechanism of action of both nivolumab and ipilimumab and discusses how the combined use of both drugs leads to potential synergism. The final part of the article assesses the extent to which this theoretical synergism is translated into a clinical benefit for cancer patients.

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Immunotherapy as frontline treatment for advanced hepatocellular cancer

BJMO - 2020, issue Special, december 2020

J. Blokken PhD, PharmD, Tom Feys MBA, MSc

For more than a decade, systemic treatment of advanced hepatocellular carcinoma (HCC) remained limited to the use of the tyrosine kinase inhibitor sorafenib, with lenvatinib being a non-inferior alternative to this standard of care. Recently, however, results of the phase III IMbrave 150 trial, demonstrated that the combination of atezolizumab and bevacizumab is associated with a significantly better progression-free and overall survival than sorafenib in the frontline treatment of patients with advanced HCC. This finding will have a dramatic impact on the treatment paradigm for these patients. In addition to atezolizumab-bevacizumab, several other immunotherapy-based treatment regimens are being evaluated in the treatment of advanced HCC.

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Highlights in gynaecological cancers

BJMO - volume 14, issue 8, december 2020

T. Rawson MSc, J. Blokken PhD, PharmD, Tom Feys MBA, MSc

In this overview, the key highlights from ESMO 2020 with respect to gynaecological cancers will be discussed. In advanced endometrial cancers, data were presented on the use of letrozole in combination with palbociclib. In addition, to this, promising clinical efficacy was seen for the antibody-drug conjugate tisotumab vedotin in the treatment of patient with recurrent or metastatic cervical cancer. Also in cervical cancer, a study was presented on the optimal management of cervical cancer patients with intraoperatively detected positive pelvic lymph nodes. In ovarian cancers, several updates were presented of pivotal trials evaluating PARP inhibitors. In addition, results if the phase III INOVATYON trial indicate that platinum-based regimens should remain the standard of care for patients with recurrent ovarian cancer who experienced disease progression within six-twelve months after their last line of platinum-based therapy. Finally, results were presented of the IMagyn050 trial assessing the efficacy and safety of bevacizumab in combination with atezolizumab in the treatment of patients newly diagnosed stage III-IV ovarian cancer.

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