W. Lybaert MD

Recurrent liposarcoma in the piriform sinus in a 69-year-old patient

SUMMARY

Patient concerns: We describe the rare case of a 69-year-old man with a recurrent atypical lipomatous tumour (ALT)/well-differentiated liposarcoma (WDLS) in the left piriform sinus. The patient has a history of a dedifferentiated liposarcoma (DDLS) of the piriform sinus on the left side, which was resected in 2015 using the CO2-laser. Nine years later (2024), he presented again to the ENT department at the Antwerp University Hospital, reporting the sensation of a new mass in his throat, causing pyrosis, trouble with swallowing and weight loss. Lessons: In contrast to conventional lipomas, which are benign tumours characterised by slow to absent growth and very low to absent recurrence risk, ALTs tend to continue growing and frequently reoccur after incomplete excision. Albeit rare outside the inguinal canal and retroperitoneum, ALTs also have a chance to dedifferentiate to overt DDLS with more rapid growth and metastatic risk. Every specialist in ENT, the emergency room and maxillofacial surgery have to be aware of the risks of rapid displacement in the laryngeal region, possibly causing severe upper airway obstruction. Radical surgical resection is the preferred treatment for liposarcomas. However, the location of the tumour may sometimes prohibit complete resection without damaging surrounding tissues. Some studies report benefits from adjuvant radiotherapy, certainly in the case of high-grade DDLS. Currently, perioperative systemic therapies are available for DDLS with a high risk of recurrence, but there is no indication for systemic therapies for ALT/WDLS. Future research should focus on refining treatment strategies for liposarcomas in challenging anatomical sites and exploring the potential of targeted therapies.

(BELG J MED ONCOL 2025;19(7):327–331)

Highlights of the ENETS (European Neuroendocrine Tumour Society) congress 2025

SUMMARY

During the ENETS Conference, the long-awaited results of the phase 3 COMPETE trial were presented, with the comparison of [177Lu]Lu-edotreotide (Peptide Receptor Radionuclide Therapy = PRRT) vs. everolimus in patients with grade 1–2 gastroenteropancreatic neuroendocrine tumours (GEP NET): PRRT outperformed everolimus in terms of objective response rate and also progression-free survival. Also, an update of the phase 2 OCCLURANDOM trial showed the superiority of PRRT vs. sunitinib in a direct comparison between these two treatment modalities. Alpha-PRRT is advancing in the field of NET as a promising treatment option, with the ACTION-1 trial actively recruiting now in Belgium. NET-IMPRESS, a novel methylation-based assay to diagnose and monitor NET patients using liquid biopsies, was rewarded as the most promising basic research project during the conference and will be tested in broader patient populations. Also, the prominent presence of the patient organisations INCA/VZW NET & MEN at ENETS coincides with the rapidly growing field of treatment options in recent years for our patients with NET.

In this report, the most important headlines will be discussed, with comments on the clinical relevance of the different studies.

(BELG J MED ONCOL 2025;19(4):166–184)

Highlights of the Gastrointestinal Cancers Symposium 2025

SUMMARY

This year’s conference was organised in San Francisco from 23 till 25 January 2025, again as a hybrid event. Pan-RAS inhibition shows early, deep molecular responses in RAS-mutant pancreatic adenocarcinoma and looks very promising regarding PFS and OS in a phase 1 study. Adjuvant treatment with aspirin daily for three years reduced the recurrence rate in colorectal cancer patients with somatic alterations in the PI3K signalling pathway. Two other top stories of ASCO GI 2025 are nivolumab + ipilimumab beating nivolumab monotherapy across treatment lines in MSI-high/deficient mismatch repair (MMR) metastatic colorectal cancer and encorafenib + cetuximab + mFOLFOX6 as the new standard of care for first-line treatment of BRAF V600E-mutant colorectal cancer. The prognostic role of circulating tumour DNA (ctDNA) in colorectal cancer stage II-III is consistent between different trials and under active investigation in randomised trials. The combination of everolimus and lanreotide significantly prolonged progression-free survival compared to everolimus monotherapy as first-line treatment for grade 1 or 2 gastroenteropancreatic neuroendocrine tumours with poor prognostic features. In this report, the most important headlines will be discussed, with comments on the clinical relevance of the different studies.

(BELG J MED ONCOL 2025;19(3): 114–128)

ESMO NET (Neuroendocrine Tumours) Report 2024: Two breakthrough studies changing the future treatment algorithm of NET

SUMMARY

During the ESMO Conference in Barcelona in 2024, two important phase 3 studies in the field of neuro-endocrine tumours (NET) that were presented earlier this year were updated and also published subsequently. The NETTER-2 trial is shifting [177Lu]Lu-DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) to the first-line treatment setting of patients with advanced, well-differentiated grade 2 and grade 3 gastro-enteropancreatic (GEP) NET; the CABINET trial is adding cabozantinib as targeted systemic therapy for previously treated, progressive advanced extrapancreatic and pancreatic NET.

In this report, these two practice-changing NET trials will be discussed in depth, with comments on the clinical relevance and the outstanding questions.

(BELG J MED ONCOL 2025;19(2):78–82)

Vaccination recommendations for patients with solid tumours in 2024–2025 in Belgium

SUMMARY

In recent years, our armamentarium for oncological diseases has rapidly evolved; treatment modalities include surgery, radiotherapy, chemotherapy, targeted therapy, hormonal treatments, immunotherapy, and recently the antibody-drug conjugates (ADC). All these treatments have more or less consequences for the immune system of our patients, above the cancer itself, which causes a state of immunosuppression.

(BELG J MED ONCOL 2025;19(2):61–62)

Head and Neck Cancer Highlights

SUMMARY

The ASCO Annual Meeting was held from 30 May till 3 June 2025 in a live and virtual format. During the meeting, two potentially practice-changing phase 3 studies were presented in the field of head and neck squamous cell carcinoma (HNSCC): perioperative pembrolizumab in KEYNOTE-689 for resectable locally advanced (LA) HNSCC, with a tremendous absolute benefit in median event-free survival (EFS) of twenty months, irrespective of the PD-L1 Combined Positive Score (CPS); on the contrary, nivolumab solely given adjuvant for resected HNSCC with higher-risk features in the NIVOPOSTOP study, with an absolute three-year disease-free survival (DFS) difference of 10% and also irrespective of PD-L1 CPS. Where this benefit was attributable in KEYNOTE-689 to diminishing distant metastases, the advantage in NIVOPOSTOP was due to lesser locoregional recurrences. Overall survival results are immature in both trials. These 2 trial results will surely influence our discussions case by case in the near future during the Multidisciplinary Tumour Board. In the adjuvant setting of HNSCC, phase 1 data on tumour-informed vaccination are looking very promising, going forward to phase 2. Cemiplimab, and not pembrolizumab, reached a statistically and clinically meaningful DFS benefit as adjuvant treatment for locally advanced cutaneous squamous cell carcinoma after surgery and radiotherapy. Neoadjuvant pembrolizumab + dabrafenib/trametinib gives the best shot when operation is the scope for BRAFV600E-mutated anaplastic thyroid cancer. After years of slow progression in the head and neck cancer arena, this ASCO meeting gave an exciting boost for our daily clinical practice! In this report, the most important headlines will be discussed, with comments on the clinical relevance of the different studies.

(BELG J MED ONCOL 2025;19(5):218–234)

Highlights in head and neck cancer

SUMMARY

The ESMO congress was held from 13–17th of September 2024, in a live and virtual format. During this congress, the promising combination of eftilagimod alpha and pembrolizumab as a chemotherapy-sparing regimen in first-line treatment of recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) shows puzzling, but rather disappointing results at first analysis. Since adjuvant atezolizumab after concomitant chemoradiotherapy failed to improve results in locally advanced HNSCC, all eyes are now on the phase III JADE study in the same setting with dostarlimab. Neoadjuvant chemotherapy is an effective intervention that could improve organ preservation in patients with T3 and T4a nasal and paranasal sinus squamous cell carcinoma. Chemotherapy and androgen deprivation therapy (ADT) present equivalent results in androgen receptor (AR)-expressing salivary gland tumours, and trastuzumab deruxtecan enters as an efficacious new treatment line in this rare tumour type. In this report, the most important headlines will be discussed, with comments on the clinical relevance of the different studies.

(BELG J MED ONCOL 2024;18(8):317–324)