J. Blokken PhD, PharmD

Breast cancer task force

In line with the tradition, the 2023 annual BSMO meeting kicked off with a session from the Breast Cancer Task Force. Prof. Evandro de Azambuja (Institut Jules Bordet, Brussels) opened the session with a lecture on the extended use of adjuvant endocrine therapy and the impact of recent insights on clinical practice. Thereafter, Dr. Donatienne Taylor (Clinique Sainte-Elisabeth CHU UCL Namur, Namur) discussed the antibodydrug conjugate landscape in advanced breast cancer. Finally, Dr. Caroline Duhem (Centre Hospitalier de Luxembourg, Luxemburg) shared her knowledge and experiences with the emerging adjuvant treatment escalation options in early HR+/HER2- breast cancer

Advances in local therapy for patients with early-stage breast cancer

During SABCS 2022, several abstracts were dedicated to advances in local therapy for patients with earlystage breast cancer (BC). A first trial assessed the impact of breast conserving therapy on local recurrence in patients with multiple ipsilateral BC. Next, the OPBC-04/EUBREAST-06/OMA study evaluated the oncological outcomes following sentinel lymph node biopsy or targeted axillary dissection after downstaging with neoadjuvant chemotherapy. In addition to this, POLAR was identified as a genomic classifier that is not only prognostic for locoregional recurrence but also predictive for a benefit of radiotherapy. Finally, hypofractionated regimens of radiotherapy were studied

HER2-low breast cancer: a separate entity?

About 60% of breast cancers traditionally categorised as HER2-negative in fact express low levels of HER2 (defined as tumours with HER2 IHC expression 1+ or 2+ without HER2 gene amplification). Last year, the DESTINY-Breast04 trial demonstrated notable efficacy of the HER2 antibody-drug conjugate trastuzumab deruxtecan (T-DXd), in patients whose tumours are not conventionally HER2+, but defined as HER2-low. As a result, HER2-low has become a clinically relevant HER2 status among patients with breast cancer, warranting a better understanding of this disease entity. As such, it was no surprise to see that at SABCS 2022, a special session was entirely devoted to HER2-low disease. Below, some key presentations of this session are summarized.

Highlights in HER2-positive breast cancer

For patients with early-stage Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer (BC), the most important data presented at SABCS 2022 consisted of the final results of the phase III PEONY study. Results of this trial add to the existing body of evidence demonstrating the benefit of the pertuzumabtrastuzumab-docetaxel regimen in patients with HER2-positive early breast cancer (EBC). In the metastatic setting, trastuzumab deruxtecan (T-DXd) was once again the center of the attention with the presentation of data from the DESTINY-Breast02, DESTINY-Breast03 and ROSET-BM trials. Finally, several studies assessed the possibility of chemotherapy-free regimens for the treatment of HER2-positive, hormone receptor (HR)- positive metastatic BC.

The KRAS oncogene: a long and winding road to druggability

The Kirsten rat sarcoma viral oncogene homolog (KRAS) is mutated in about a quarter of all human cancers and is at the centre of several pathways involved in tumorigenesis. As such, novel therapeutic strategies that can target this oncoprotein are potentially extremely valuable. However, since its discovery as on oncogene, almost four decades have gone by without any major breakthrough in the therapeutic targeting of mutant KRAS. In recent years, however, we are finally witnessing a paradigm shift with the discovery of druggable pockets on KRAS and the clinical activity of covalent KRAS^G12C inhibitors such as sotorasib and adagrasib.

Highlights in thoracic oncology

SUMMARY

In the field of thoracic oncology, many refinements and longer follow-up results of previously reported trials were presented during the annual ASCO 2022 meeting. Although there were no presentations of new, truly practice-changing trials, several exciting and promising data are worthwhile to mention in this highlights in thoracic oncology overview.

(Belg J Med Oncol 2022;16(5):229–35)

How to stage primary prostate cancer in 2022

Over the past years, next-generation imaging such as multiparametric whole body MRI and PSMA-PET/CT scans have been gaining momentum. Nonetheless, Prof. Padhani argues not to throw bone scintigraphy and CT scans (BS/ CT scans) out just yet. On the contrary, he puts BS/CT scans at the centre of patient care in men with locally advanced prostate cancer (LAPC). However, BS/ CT also comes with important limitations for which next-generation imaging (NGI) can serve as a problem solver after BS/CT scan assessments. During his talk at the BMUC 2022 meeting, Prof. Padhani emphasized the proven prognostic role of BS/CT scans, their predictive role in directing pelvic radiotherapy and for oncologic drug development. Finally, he argued that higher-quality evidence on the management and/or outcomes is needed before BS/CT scans can be substituted by NGI.¹