Articles

Highlights in respiratory oncology

BJMO - volume 14, issue 5, september 2020

J. Vansteenkiste MD, PhD, E. Wauters MD, PhD

Summary

ASCO 2020 featured the presentation of many interesting studies in the field of lung cancer. For early stage non-small cell lung cancer (NSCLC), there was a focus on adjuvant targeted therapy while for advanced NSCLC without oncogene addiction much attention went to first-line immunotherapy and to the use of novel antibody-drug conjugates. In addition to this, several trials discussed the potential of EGFR-tyrosine kinase inhibitor (TKI) combinations, the targeting of MET alterations or RET fusions and the search for EGFR exon 20 mutant selective drugs for patients with advanced NSCLC and oncogene addictions. Finally, this overview will describe important results in the field of non-metastatic and metastatic small-cell lung cancer (SCLC) as well as advances in mesothelioma.

(BELG J MED ONCOL 2020;14(5):201-8)

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Highlights in respiratory oncology

BJMO - volume 13, issue 5, august 2019

J. Vansteenkiste MD, PhD, E. Wauters MD, PhD

In this article, the ten key messages with respect to thoracic oncology presented at ASCO 2019, are summarized.

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Highlights in respiratory oncology

BJMO - volume 12, issue 4, august 2018

J. Vansteenkiste MD, PhD, C. Dooms MD, PhD

This article will briefly discuss the top stories in the field of respiratory oncology presented during the 2018 annual meeting of the American Society of Clinical Oncology (ASCO). For a complete overview of abstracts we refer to the official meeting website: https://am.asco.org.

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Second-line treatment of non-small cell lung cancer adenocarcinoma patients not harbouring an oncogene driver mutation anno 2017–2018: A consensus group meeting

BJMO - volume 12, issue 2, march 2018

P-E. Baugnée , L. Bosquée MD, PhD, C. Compère MD, N. D’Haene MD, PhD, I. Demedts , D. Galdermans MD, P. Germonpré , M. Gustin , V. Ninane MD, PhD, S. Ocak , P. Pauwels MD, PhD, T. Pieters MD, PhD, A. Sadowska MD, A. Sibille MD, V. Surmont MD, PhD, J. Vansteenkiste MD, PhD

Summary

The treatment landscape for patients with advanced non-small cell lung cancer, who do not harbour an oncogenic driver abnormality, has changed dramatically over the last years. Second-generation antiangiogenic agents, such as nintedanib and ramucirumab, and particularly PD-1/PD-L1 inhibitors, such as nivolumab, pembrolizumab and atezolizumab have shown to prolong survival in pretreated non-small cell lung cancer patients. Immune checkpoint inhibition in the treatment of advanced non-small cell lung cancer comes with the promise of durable responses in responding patients. Nevertheless, one must appreciate that the average response rate seen with these PD-1/PD-L1 targeting agents is only about 20%. While PD-L1 testing may be used as an enrichment biomarker, a substantial proportion of patients still do not benefit from these agents. They could benefit from alternative therapeutic options, including novel anti-angiogenic agents. In this paper, a treatment algorithm is proposed that aims to optimise the second-line treatment choice for patients with lung adenocarcinoma, based on the available clinical data.

(BELG J MED ONCOL 2018;12(2):61–66)

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Will there ever be a lung cancer vaccine?

BJMO - volume 11, issue 6, october 2017

I. Delanote , B. Legius MD, E. Wauters MD, PhD, J. Vansteenkiste MD, PhD

SUMMARY

Current treatment options for advanced stage non-small cell lung cancer (NSCLC) include chemotherapy and targeted therapy. Immunotherapy is the most recent strategy to improve survival in NSCLC. Among other newly developed immunotherapeutics, all aiming to enhance and reinforce the natural ability of the immune system to fight cancer, lung cancer vaccines aim to increase the number of tumor-reactive T-cells. Although preclinical models have shown that vaccines enhance effector T-cell infiltration into the tumor, this effect has not been translated into clinical benefit in multiple, large, randomised, placebo-controlled studies. Recent understanding of cancer immunology has shown that the immunosuppressive microenvironment of NSCLC is able to inactivate the tumor-reactive T-cells generated by therapeutic vaccination.

Consequently, combining vaccination with other immunotherapeutics to reverse this immunosuppressive environment (such as anti-PD-1/PD-L1) seems to be the best way forward.

Furthermore it will be important to develop relevant biomarkers to choose the most adequate combination of immunotherapeutics for each individual patient, because of the diverse mechanisms of immunosuppression by the tumor.

(BELG J MED ONCOL 2017;11(6):255–258)

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Therapy-orienting testing of EGFR inhibitor-resistant non-small cell lung cancer

BJMO - volume 11, issue 5, september 2017

C. Dooms MD, PhD, B. Colinet MD, I. Demedts , N. D’Haene MD, PhD, V. Ninane MD, PhD, T. Pieters MD, PhD, J. Vansteenkiste MD, PhD, B. Weynand MD, PhD, P. Pauwels MD, PhD

SUMMARY

Somatic sensitising mutations in the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) are detected in approximately 10% of patients with advanced non-squamous non-small cell lung cancer (NSCLC). EGFR tyrosine kinase inhibitors (EGFR-TKIs) are the first-line treatment option for patients with an actionable EGFR mutation. Despite initial responses, the majority of patients progress within one to two years after EGFR-TKIs treatment initiation.

The most common mechanism of resistance is the development of an additional EGFR-T790M mutation in exon 20, found in 50–60% of EGFR-mutant NSCLC patients who were rebiopsied on EGFR-TKI treatment. Phase II and III trials with osimertinib, a third-generation EGFR-TKI, demonstrated an objective response rate (ORR) of 60–70% and median progression-free survival (mPFS) of 10–11 months in EGFR-T790M-positive tumours.

A tissue biopsy of a progressing lesion for confirmation of histology and molecular characterisation is a critical consideration. However, a repeat tissue biopsy is not possible for every patient. Therefore, a liquid biopsy can be considered for EGFR-T790M mutation testing. Indeed, clinical trials testing osimertinib have shown similar clinical outcomes (ORR and mPFS on osimertinib) in patients with T790M-positive plasma versus T790M-positive tumour tissue.

Osimertinib clearly expands relapse treatment options for advanced stage EGFR-mutant NSCLC. Testing for EGFR-T790M at acquired resistance should become a standard component of patient care in EGFR-mutant tumours. In this manuscript, we propose and discuss two possible clinical diagnostic algorithms that could be used for the therapy-orienting testing of EGFR-TKI-resistant NSCLC patients. Tissue and liquid biopsies involve challenges in terms of specific clinical role, safety, logistics, and cost.

(BELG J MED ONCOL 2017;11(5):226–233)

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Highlights in respiratory oncology

BJMO - volume 11, issue 4, september 2017

J. Vansteenkiste MD, PhD, E. Wauters MD, PhD

At ASCO 2017, 195 abstracts in the feld of respiratory oncology were presented (169 in 2016): 22 oral presentations (including 4 in a clinical science symposium), 24 poster discussion items, and 149 posters. In this summary, most attention will go to phase III randomized controlled trials (RCTs) and innovative data that are, or may become, relevant for the practicing clinician. As this report is only the “extract of the abstracts”, the reader is referred to the respective abstracts published in J Clin Oncol volume 35 Suppl 15, 2017 (abstracts #8500–8586 and #9000–9107 and available on-line at https://meetinglibrary.asco.org/

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