BJMO - volume 19, issue 4, june 2025
L. Hindryckx MD, G. Catala MD, G. Grisay MD, P.-F. Petit MD, PhD
We report the case of a 68-year-old man with a history of urothelial carcinoma treated by surgery followed by adjuvant therapy with nivolumab. Anti-PD-1 therapy was discontinued after eight months due to grade 3 skin toxicity treated with oral steroids. Two months after discontinuation, the patient presented with pancytopenia associated with hyperferritinaemia, hypertriglyceridemia, and coagulopathy, notably hypofibrinogenemia. A detailed workup suggested haemophagocytic lymphohistiocytosis (HLH) as the most likely diagnosis, and intravenous therapy with high-dose steroids was initiated. After six days of treatment, severe pancytopenia and coagulopathy remained unchanged. Immunosuppressive therapy was intensified by administering tocilizumab, an anti-IL6-receptor antibody. This treatment allowed full recovery of haematological parameters in eleven days, followed by rapid steroid tapering. This case highlights the efficacy of tocilizumab for the treatment of immune checkpoint-related HLH (irHLH).
BELG J MED ONCOL 2025;19(4):157–161)
Read moreBJMO - volume 19, issue 2, march 2025
S. Gutfreund MD, A. Vandebroek MD, S. Mignon MD, A. De Vocht MD, D. Schrijvers MD, PhD
Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors are frequently used in combination with endocrine therapy for the treatment of hormone receptor positive breast cancers. This paper reports two cases of patients with digoxin intoxications due to CDK4/6 inhibitors, one involving ribociclib and the other abemaciclib. Digoxin intoxication can lead to fatal arrhythmias, highlighting the need for further research to analyse and clarify the underlying pathophysiology. It is advisable to monitor drugs with a narrow therapeutic index when prescribing CDK4/6 inhibitors. Importantly, common medication interaction checkers such as Uptodate, Medscape and WebMD do not report interactions between CDK4/6 inhibitors and digoxin.
(BELG J MED ONCOL 2025;19(2): 73–77)
Read moreBJMO - volume 19, issue 2, march 2025
L. Herman MD, A. Servais MD, N. Blétard MD, Demolin MD, G. Houbiers MD, G. Namur MD, P. Reginster MD, C. Focan MD, PhD
This report presents a rare case of bilateral tonsillar metastases originating from colorectal adenocarcinoma. The implications of pharmacokinetic testing for tailored treatment in advanced-stage metastatic disease are also briefly reviewed. This case underlines the importance of accurate histopathological assessment, multidisciplinary collaboration, and pharmacogenetics in optimising patient outcomes.
(BELG J MED ONCOL 2025;19(2):68–72)
Read moreBJMO - volume 19, issue 1, january 2025
E. Van Haute MD, D. Schrijvers MD, PhD, R. Steinkamm , K. Beel MD, PhD, An Vandebroek MD
We describe a patient with an ovarian cancer and an extensive prior treatment history presenting with abdominal pain and acute deterioration of anaemia and thrombocytopenia. Diagnosis of therapy-related myeloid neoplasm was made. Early recognition and diagnosis of therapy-related myeloid neoplasms pose an important challenge for the oncologist. They are essential in improving outcomes. A review of current insights regarding therapy-related myeloid neoplasms is provided.
(BELG J MED ONCOL 2025;19(1):27–31)
Read moreBJMO - volume 19, issue 1, january 2025
E. De Smet MA, D. Schrijvers MD, PhD, K. De Muynck MD, A. Vandebroek MD, E. De Droogh MD
This case report describes a sarcoid like reaction (SLR) in a patient with HER2-positive breast cancer undergoing treatment with trastuzumab and pertuzumab. SLRs are granulomatous reactions characterized by non-caseating epithelioid granulomas that can occur in cancer patients in response to infection, malignancy, or drugs. If found they have the potential to complicate radiological interpretations, mimic disease progression and challenge treatment evaluation. In HER2-positive breast cancer treated with trastuzumab, drug-induced SLRs have been reported, although not commonly. Clinicians should be aware of this entity, and when in doubt, tissue biopsy is needed to avoid misdiagnosis.
((BELG J MED ONCOL 2025;19(1):32–35)
Read moreBJMO - volume 19, issue 1, january 2025
L. Naert MD, S. Proost MD, A. Driessen MD, PhD, T. Vandamme MD, PhD
Jaundice in a patient with renal cell carcinoma is most frequently caused by liver metastasis and has a poor prognosis. However, multiple paraneoplastic phenomena are described in renal cell carcinoma, including a Stauffer syndrome variant with jaundice. In this case report we present the case of a woman in her 80s with jaundice in a newly diagnosed renal cell carcinoma. Hepatic metastasis was ruled out, and the differential diagnosis with the Stauffer syndrome, variant, vanishing bile duct syndrome, and hepatotoxicity was made. Due to the rapid fatal ending, it was not possible to evaluate the reversibility of the hepatic dysfunction after nephrectomy.
(BELG J MED ONCOL 2025;19(1): 36–39)
Read moreBJMO - volume 18, issue 7, november 2024
Y. Vanbiervliet MD, H. Vandekerckhove MD, N. Van Tittelboom MA, V. Neyrinck MD, V. Renard MD, S. De Waele MA
This case report discusses a 76-year-old woman with a history of epilepsy and cerebral aneurysms who underwent surgical intervention for stage III malignant melanoma and subsequently received pembrolizumab as adjuvant immunotherapy. Four weeks post-treatment initiation, she presented with unilateral ptosis and was diagnosed with a complex immune-related adverse event involving myocarditis, myositis, and myasthenia gravis, termed the triple M syndrome. The patient exhibited elevated cardiac and muscular biomarkers, deranged liver enzymes, hypothyroidism, severe aortic valve insufficiency, and decreased systolic function. Comprehensive diagnostic assessments ruled out structural abnormalities and ischaemic disease, prompting the initiation of high-dose IV corticosteroids. The patient’s clinical course involved steroid resistance, necessitating an escalation of corticosteroids and the introduction of mycophenolic acid as second-line immunosuppressive therapy. A positive evolution was observed with a resolution of ptosis and improvement of cardiac biomarkers, including troponin levels, leading to successful discharge.
(BELG J MED ONCOL 2024;18(7):279–281)
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