T. Feys MBA, MSc

Highlights in breast cancer

At this year’s annual meeting of the European Society of Medical Oncology (ESMO) experts shared some game-changing data for the treatment of breast cancer (BC). In advanced HER2+ metastatic breast cancer m(BC), the DESTINY-Breast03 trial performed a head-to-head comparison of T-DM1 and trastuzumab deruxtecan (T-Dxd) following initial treatment with trastuzumab and a taxane, showing a major PFS benefit for T-DXd without major toxicity issues, establishing T-DXd as the new standard of care in this setting. In luminal breast cancer, the final analysis of the GIM-4 study supports the use of 7 years instead of 5 years adjuvant endocrine therapy in postmenopausal patients with hormone receptor positive (HR+)/HER2- early BC. For advanced stage HR+/HER2- BC, the MONALEESA-2 study shows >1y OS benefit when adding the CDK4/6 inhibitor ribociclib to letrozole as first-line treatment. Finally, in triple negative breast cancer (TNBC), the phase III BrighTNess study showed that addition of carboplatin to neoadjuvant chemotherapy provides long term EFS benefit. In metastatic TNBC, OS data of KEYNOTE-355 further support the use of first-line pembrolizumab plus chemotherapy in advanced PD-L1+ TNBC.

(BELG J MED ONCOL 2021;15(8):390–7)

Highlights in respiratory oncology

At this year’s ESMO meeting, much of the attention in the field of lung cancer went to early-stage nonsmall cell lung cancer (NSCLC) with interesting results from the Lung Art, COAST, GEMSTONE-301 and IMpower010 trials. For metastatic NSCLC, immunotherapy again walked away with much of the attention. In addition to this, several studies investigated the potential of combining anti-EGFR and anti-angiogenic agents, while others investigated novel targeted agents, including trastuzumab deruxtecan, poziotinib, plinabulin and datopotamab deruxtecan. Finally, we will highlight the most interesting results in other thoracic malignancies, including malignant pleural mesothelioma, extensive-stage small cell lung cancer, thymoma and thymic carcinoma.

(BELG J MED ONCOL 2021;15(8):406–14)

Highlights in gynaecological oncology

The 2021 annual ESMO meeting featured several presentations with the potential to shift the standard of care in gynaecological cancers. In cervical cancer, Keynote-826 identified pembrolizumab + chemotherapy (with or without bevacizumab) as a potential new standard of care for patients with persistent, recurrent, or metastatic cervical cancer. In addition, also the antibody drug conjugate tisotumab vedotin showed encouraging and durable anti-tumour activity in this setting. In the field of the ovarian cancer, PARP inhibition again walked away with most of the attention, but also the glucocorticoid receptor modulator relacorilant and combination therapy with the immune checkpoint inhibitor atezolizumab and bevacizumab yielded interesting data. Also for patients with advanced endometrial cancer, ESMO 2021 proved to be of interest, with important updates on the use of pembrolizumab in this setting.

(BELG J MED ONCOL 2021;15(8):428–35)

Integrating immunotherapy in the treatment paradigm for early-stage non-small cell lung cancer

Immune checkpoint inhibition (ICI) marked the start of a new era in the treatment of advanced non-small cell lung cancer (NSCLC), inducing a durable response in a substantial proportion of patients. The success of ICI in the advanced setting spurred interest to also examine the potential of this treatment modality in patients with early-stage NSCLC. The first success story in this respect came from the phase III PACIFIC trial, establishing consolidation therapy with durvalumab after chemoradiation as the new standard of care for patients with inoperable, locally advanced NSCLC. More recently, ICI also yielded promising results in patients with resectable NSCLC. In fact, the IMpower010 trial showed that adjuvant atezolizumab after 4-cycles of platinumbased chemotherapy significantly improves the disease-free survival (DFS) compared to best supportive care in patients with stage II-IIIA NSCLC. In addition to this, other studies suggest that neoadjuvant treatment with ICI might result in substantial major pathologic response and pathologic complete response rates, and high rates of R0 resection without a significant delay in the time to surgery.

Immune checkpoint inhibition: a game-changer in the treatment of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is a thoracic malignancy that is characterized by a very dismal prognosis. Patients with MPM face a large unmet medical need, with almost no therapeutic advances over the last decade. Recently, however, an important step was made in the management of these patients with the registration of immune checkpoint inhibition (ICI) as a new treatment option for treatment-naïve patients with unresectable MPM. Here we summarize the available evidence supporting the use of ICI in MPM. In addition, the article will address remaining issues such as treatment sequencing and optimal first-line treatment selection.

Immune checkpoint inhibition in kidney transplant recipients

Over the last years, immune checkpoint inhibition (ICI) emerged as an important therapeutic modality across a variety of cancer types. However, kidney and other solid organ transplant recipients (SOTR) have systematically been excluded from those trials, mainly due to concerns for organ rejection and the use of immunosuppressive therapy in these patients. As a result, little is known about the safety and efficacy of ICI in this setting. Given the increased cancer risk in kidney transplant recipients, with an overrepresentation of certain cancer types for which ICI has become the new standard of care, this represents an important data gap. Based on the scanty data available in the literature, one can conclude that the tumoral response rate to ICI among SOTR suffering from cancer is in line with what is seen in the general cancer population. However, this comes at the cost of an increased risk of allograft rejection and graft loss. This article will briefly discuss the increased cancer risk among kidney transplant recipients after which the available data on the use of ICIs in kidney transplant recipients (KTR) will be summarized, with a particular focus on treatment efficacy and risk factors associated with allograft rejection.

Immunotherapy for gastro-oesophageal cancers

Over the last decade, immunotherapy has become increasingly important as a treatment modality for various solid tumors. Unfortunately, the development of immunotherapy in the treatment of gastro-oesophageal malignancies has been lagging behind. More recently, however, impressive advancements have been made with immune checkpoint inhibitors in gastro-oesophageal cancers, with a long list of clinical trials yielding promising, and potentially practice changing results. This review provides an overview of the topline results of these studies.