Articles

Radium-223 in metastatic castration-resistant prostate cancer: a single centre experience

BJMO - volume 13, issue 1, february 2019

D. Schrijvers MD, PhD, A. Baitar , T. Debacker MD, F. van Acker MD

Radium-223 is one of the treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC), based on the ALSYMPCA trail, a large randomised study.

In this retrospective study, the experience with radium-223 in patients with mCRPC, treated in a single centre, is reported in relation to the number of cycles of radium-223 given; reason of discontinuing radium-223 treatment, overall survival according to radium-223 treatments received; next treatment and interval to next treatment after discontinuing radium-223.

The Kaplan-Meier method was used to describe overall survival, and the log-rank was used to compare different groups.

Thirty-eight patients were analysed. A total of 26 patients (68.4%) completed all six cycles of radium-223, while twelve patients (31.6%) stopped treatment earlier. The reasons for discontinuing treatment early were progressive disease during treatment with radium-223 (four patients); myelotoxicity (one patient, who was previously treated for a small cell carcinoma of the ureter with six cycles of carboplatinum); intercurrent death due to non-prostate cancer-related diseases (four patients); patient refusal (one patient); complication due to co-morbid condition (one patient). And, one patient who stopped treatment after five cycles was lost to follow up.

Patients who completed all six cycles had a median survival time of 27.4 months (95% CI: 16.4-non applicable [NA; because the upper confidence limit never reaches the 50% survival]); and patients who completed one to four cycles 9.0 months (95% CI: 4.6-NA, log rank test: p<0.001).

Of the 26 patients who completed all six cycles, sixteen patients started another line of treatment for mCRPC after a median time of 30.0 weeks (95% CI: 18.1-NA) after the last injection of radium-223.

Radium-223 is an appropriate treatment for patients with mCRPC with a median overall survival of 27.4 months and a drug-free interval of 30 weeks after six cycles of radium-223.

(BELG J MED ONCOL 2019;13(1):16–20)

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Immuno-oncology in transitional cell Carcinoma

BJMO - volume 12, issue 5, september 2018

D. Schrijvers MD, PhD, T. Debacker MD

Immunotherapy has been used in the treatment of localised, high-risk transitional cell carcinoma. Bacillus of Calmette-Guérin therapy is a standard treatment for patients with non-invasive transitional cell carcinoma with bad prognostic factors (high-grade pTa; carcinoma in situ) and early stage invasive bladder cancer (pT1) after transurethral resection of the bladder. Recently, based on phase II trials, atezolizumab, an inhibitor of PD-L1, and nivolumab, an inhibitor of PD1, have been registered for the treatment of patients with metastatic transitional cell carcinoma progressing after a platinum-based chemotherapy for metastatic disease. Pembrolizumab, a monoclonal antibody against programmed death receptor-1 was registered based on a phase III trial in this setting resulting in a survival benefit compared to second-line chemotherapy. Predictive markers are being explored for a better patient selection for the treatment of transitional cell carcinoma.

(BELG J MED ONCOL 2018;12(5):218–222)

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Aspects of carcinogenesis applied to prostate cancer

BJMO - volume 11, issue 3, may 2017

D. Schrijvers MD, PhD, T. Debacker MD

SUMMARY

The characteristics of carcinogenesis are discussed in relation to prostate cancer. Some of these are already used as treatment targets in daily clinical practice, while in some, medications proved to be ineffective to interfere with these mechanisms of carcinogenesis.

Currently, treatments that have shown efficacy are addressing the mechanism of sustained proliferative activity, while there are some indications that immune modulation and agents interfering with DNA repair may play a role in the treatment of prostate cancer.

Other aspects of carcinogenesis need more study in patients with prostate cancer to show a benefit and they must be the scope of future research.

(BELG J MED ONCOL 2017;11(3):87–91)

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Incidental finding of prostate cancer in patients treated with benign prostatic hyperplasia (BPH)

BJMO - volume 9, issue 3, july 2015

D. Schrijvers MD, PhD, N. Toussaint MD, C. Goor MD, T. Debacker MD

In this case report we describe the incidental finding of prostate cancer in a patient undergoing a transurethral prostate resection for benign prostatic hyperplasia and discuss the diagnostic and treatment approach of this patient group.

(BELG J MED ONCOL 2015;9(3):104–6)

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Biomarkers and genomics in prostate cancer

BJMO - volume 8, issue 4, september 2014

D. Schrijvers MD, PhD, T. Debacker MD

Biomarkers and genomics are making their entrance in daily clinical practice in many tumour types. In prostate cancer, their use is relatively limited. This article reviews biomarkers and genomics used in different clinical settings such as screening, diagnosis, prognosis, prediction and surrogate endpoints for overall survival and shows an unmet need in prostate cancer.

(BELG J MED ONCOL 2014;8(4):104–8)

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