BJMO - volume 15, issue 3, may 2021
J. Heylen , N. De Moor MD, H. Janssen MD, PhD, K. Punie MD, H. Wildiers MD, PhD
A 53-year old woman previously treated for stage IIIc Her2-positive breast cancer presented to the outpatient oncology department with symptoms of holocranial headache irradiating to the neck in combination with morning sickness and vomitus. Brain CT showed multiple cerebellar metastases with signs of tonsillar herniation through the foramen magnum. Since radiotherapy was deemed unsafe given the possibility that transient increase of intracranial pressure could worsen the herniation, urgent treatment with corticosteroids and capecitabine-lapatinib was started. The metastases and peritumoral oedema initially responded well, which allowed subsequent pancranial radiotherapy after three weeks of systemic therapy. We provide a short overview of studies showing that systemic therapy can induce tumour response in brain metastases related to HER2+ positive disease.
BELG J MED ONCOL 2021;15(3):123-7
Read moreBJMO - volume 15, issue 1, january 2021
F. Derouane MD, K. Punie MD, F.P. Duhoux MD, PhD
Hormone-receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer accounts for 65% of all metastatic breast cancer (MBC) cases. With the advent of CDK4/6 inhibitors, single-agent endocrine therapy (ET) is no longer the only first-line systemic treatment option for the vast majority of patients presenting without visceral crisis. Other endocrine-based treatment options are emerging in further lines, with the goal to delay the administration of chemotherapy as long as possible. The optimal sequence of treatment is unknown. We here present a review of the available treatments and propose a treatment algorithm taking into account the latest therapeutic developments.
(BELG J MED ONCOL 2021;15(1):20-33)
Read moreBJMO - 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.
Read moreBJMO - volume 14, issue 8, december 2020
Tom Feys MBA, MSc, T. Rawson MSc, H. Wildiers MD, PhD, K. Punie MD
During the 2020 Virtual ESMO meeting, long-awaited results were presented of several important breast cancer studies. For hormone receptor positive (HR+) breast cancer, ESMO 2020 featured conflicting results on the use of CDK4/6 inhibitors in the adjuvant treatment of patients with hormone-receptor positive (HR+) early breast cancer. In HR+ metastatic breast cancer, final overall survival data were presented of the SOLAR-1 trial evaluating alpelisib in PIK3CA mutant patients. In triple negative breast cancer (TNBC), new data on immune therapy were presented. In early-stage TNBC, the addition of atezolizumab to neoadjuvant chemotherapy resulted in a significant increase in the rate of pathological complete responses (pCR). In the metastatic setting, final results of the IMpassion130 trial confirmed the benefit of atezolizumab combined with nab-paclitaxel as first-line treatment for metastatic PD-L1 positive TNBC. Unexpectedly, the IMpassion131 trial evaluating atezolizumab plus paclitaxel in first-line treatment of patients with metastatic TNBC failed to meet its primary endpoint. Finally, the phase III randomized controlled ASCENT trial identified the antibody-drug conjugate (ADC) sacituzumab govitecan as a safe and highly effective treatment option for heavily pre-treated metastatic TNBC patients.
Read moreBJMO - volume 14, issue 7, november 2020
M. Rediti MD, K. Punie MD, E. de Azambuja MD, PhD, E. Naert MD, D. Taylor MD, FP. Duhoux MD, PhD, H. Denys MD, PhD, A. Awada MD, PhD, H. Wildiers MD, PhD, M. Ignatiadis MD, PhD
Chemotherapy has represented the main treatment option for patients with advanced triple-negative breast cancer for a long time. However, due to our better understanding of tumour biology, recent clinical trials led to a change in the treatment paradigm of this disease, identifying clinically relevant subgroups with different therapeutic options. Both clinical and biological factors have become relevant and need to be considered in the treatment decision algorithm of this heterogeneous disease.
(BELG J MED ONCOL 2020;14(7):333-38)
Read moreBJMO - volume 13, issue 8, december 2019
J. Blokken PhD, PharmD, Tom Feys MBA, MSc, K. Punie MD
The 2019 edition of the annual ESMO meeting proved to be a grand cru when it comes to breast cancer studies. In early triple negative breast cancer (TNBC), the KEYNOTE-522 trial demonstrated a significant improvement of pathological complete response rate with the addition of pembrolizumab to neoadjuvant chemotherapy, irrespective of PD-L1 status. In addition to this, the prognostic value of tumour-infiltrating lymphocytes was confirmed in a pooled analysis of patients with TNBC who did not received adjuvant chemotherapy. In the field of metastatic breast cancer, much attention went to overall survival data that were presented for the CDK4/6-inhibitors ribociclib and abemaciclib in combination with fulvestrant (MONALEESA-3, MONARCH 2). Interesting results of the phase III BROCADE3 trial were presented in which the addition of the PARP inhibitor veliparib to carboplatin and paclitaxel was evaluated in patients with advanced HER2-negative breast cancer and a germline BRCA mutation. Regarding checkpoint inhibitors in metastatic TNBC, a read-out of a phase III trial with pembrolizumab compared to standard chemotherapy in second- and third-line was presented, as well as important translational data on different immunohistochemical PD-L1 assays from IMpassion130. Finally, two oral presentations focused on the use of CDK4/6-inhibitors in different combination regimens in metastatic HER2-positive breast cancer (MonarcHER) and in TNBC.
Read moreBJMO - volume 13, issue 7, november 2019
Ir A. Hébrant PhD, M. Lammens MD, PhD, C. Van den Broecke MD, N. D’Haene MD, PhD, J. Van den Oord MD, PhD, A. Vanderstichele MD, PhD, A. Dendooven MD, PhD, P. Neven MD, PhD, K. Punie MD, G. Floris MD, PhD, J. Van der Meulen MD, HA. Poirel MD, PhD, C. Dooms MD, PhD, S. Rottey MD, PhD, T. Boterberg MD, PhD, L. Brochez MD, PhD, M.C. Burlacu MD, G. Costante MD, D. Creytens MD, PhD, P. De Paepe MD, PhD, R. De Pauwn MD, B. Decallonne MD, PhD, F. Dedeurwaerdere MD, H. Denys MD, PhD, L. Ferdinande MD, PhD, R. Forsyth MD, PhD, M. Garmyn MD, PhD, T. Gevaert MD, PhD, J. De Grève MD, PhD, E. Govaerts MD, E. Hauben MD, PhD, J. Kerger MD, O. Kholmanskikh Van Criekingen MD, PhD, V. Kruse MD, PhD, Y. Lalami MD, L. Lapeire MD, PhD, P. Lefesvre MD, PhD, J.P. Machiels MD, PhD, B. Maes MD, PhD, G. Martens MD, PhD, M. Remmelink MD, PhD, I. Salmon MD, PhD, R. Sciot MD, PhD, S. Tejpar MD, PhD, K. Van de Vijver MD, PhD, L. Van de Voorde MD, I. Van den Berghe MD, A. Van den Bruel MD, K. Vandecasteele MD, PhD, L. Vanwalleghem MD, K. Vermaelen MD, PhD, R. Salgado MD, PhD, E. Wauters MD, PhD, B. Weynand MD, PhD, E. Van Valckenborgh PhD, G. Raicevic PhD, M. Van den Bulcke PhD, P. Pauwels MD, PhD
In order to advise the Federal Government on the reimbursement of molecular tests related to Personalised Medicine in Oncology, the Commission of Personalised Medicine (ComPerMed), represented by Belgian experts, has developed a methodology to classify molecular testing in oncology. The different molecular tests per cancer type are represented in algorithms and are annotated with a test level reflecting their relevance based on current guidelines, drug approvals and clinical data. The molecular tests are documented with recent literature, guidelines and a brief technical description. This methodology was applied on different solid tumours for which molecular testing is a clear clinical need.
(BELG J MED ONCOL 2019;13(7):286–95)
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