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
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)Read more
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
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)Read more
BJMO - volume 10, issue 6, september 2016
G. Reychler PhD, G. Haag , G. Caty MD, PhD, T. Pieters MD, PhD
Cancers can benefit from physical activity. Most evidences concern breast, prostate and colorectal cancers. Literature about lung cancer and exercise is scarce. However lung cancer is frequent all around the world. The aim of this review was to summarise the knowledge on effects of exercise in lung cancer patients. The benefit of physical activity as a preventive strategy was also analysed.
We systematically searched for studies published between 2008 and 2013. Used key words were lung cancer, physical activity, quality of life, fatigue, functional performance, exercise, rehabilitation, treatment, prevention, complication. The following databases were reviewed: PubMed, ScienceDirect, Chest, Cochrane, SportDiscus and WHO. Eligibility criteria were availability of full texts in English or in French. Studies were classified in four categories: exercises as prevention, in preoperative period, during treatment and after treatment.
Positive effects of exercise were globally demonstrated on physical and psychological outcomes in the four categories. Benefits of exercise were particularly observed for supervised program. Home exercise program benefits were less convincing.
Even if physical activity and exercise programs can be beneficial in prevention, during and after the treatment of lung cancer, the heterogeneity of the literature is too large to reach a conclusion about their place in the treatment.
(BELG J MED ONCOL 2016;10(6):199–206)Read more