PHARMACOTHERAPY

The benefit of anticancer drugs

BJMO - volume 16, issue 7, november 2022

D. Schrijvers MD, PhD

SUMMARY

New anticancer drugs are continuously developed and show statistically significant differences compared to the standard treatment. However, their clinical impact is not always shown. In this review, two systems to evaluate the meaningful clinical benefit are discussed: the ESMO-MCBS, developed by ESMO, and the ASCO value framework, proposed by ASCO. Both systems evaluate clinical meaningful effects of new anticancer drugs based on available clinical research, and grade them according to the system they developed. Whereas the ESMO-MCBS is a tool directed to guide development and health care system professionals, the ASCO value framework is a tool to help the medical oncologist and the patient to make an informed decision in relation to the value of a new treatment, including costs.

(BELG J MED ONCOL 2022;16(7):355–9)

Read more

Vascular malformations: Repurposing the role of anti-cancer targeted molecular inhibitors

BJMO - volume 16, issue 6, october 2022

A. van Damme MD, PhD, E. Seront MD, PhD, L. Boon MD, PhD, M. Vikkula MD, PhD, V. Dekeuleneer MD

SUMMARY

Vascular malformations are rare diseases that result from anomalies in the angiogenesis process. They are subdivided into capillary, lymphatic, venous, arteriovenous, and mixed malformations, according to the type of affected vessels. Until a few years ago, therapeutic options were limited to sclerotherapy and/or surgery, but these treatments are rarely curative or not feasible. Most vascular malformations are caused by inherited or somatic mutations in various genes. These mutations are similar to oncogenic mutations detected in cancer, leading to hyperactivity of important signalling pathways, including MAPK and PI3K/AKT/mTOR cascades. This article highlights the role of targeted molecular inhibitors as therapies for vascular anomalies via repurposing of anticancer drugs.

(BELG J MED ONCOL 2022;16(6):293–99)

Read more

Current treatment patterns of advanced hormone receptor-positive, HER2-negative breast cancer in Belgium

BJMO - volume 16, issue 4, june 2022

A. Awada MD, PhD, G. Jerusalem MD, PhD, K. Detournay DVM , K. Punie MD

SUMMARY

Several treatment guidelines exist for hormone receptor-positive/HER2-negative advanced breast cancer (HR+/HER2- aBC), but various factors influence their local implementation. We performed a 3-round Delphi methodbased study in search of a consensus regarding HR+/HER2- aBC management in Belgian practice. Panel questionnaires included questions related to treatment patterns, drug-drug interactions (DDIs) and side-effect management (SEM). A consensus threshold of 75% was applied. The results were evaluated for concordance with the ABC5 guidelines. Treatment patterns in HR+/HER2- aBC reached moderate to high consensus among Belgian oncologists and showed high concordance with ABC5 guidelines. A CDK4/6 inhibitor is the preferred first-line treatment, combined with an aromatase inhibitor or with fulvestrant in the endocrine-sensitive and -resistant setting, respectively. Alpelisib-fulvestrant is the preferred second-line treatment in presence of a PIK3CA-activating mutation. Some practices regarding DDI and SEM needed further discussion before reaching consensus highlighting the need for additional training and incorporation of these topics in guidelines.

(BELG J MED ONCOL 2022;16(4):176–86)

Read more

Neoadjuvant therapy for resectable and borderline resectable pancreatic cancer: Is radiotherapy worthwhile?

BJMO - volume 15, issue 3, may 2021

B. Groot-Koerkamp MD, PhD, E. Versteijne MD, G. van Tienhoven MD, PhD, J.W. de Groot MD, PhD

SUMMARY

For resectable pancreatic cancer, (RPC) or borderline resectable pancreatic cancer (BRPC) the standard treatment is surgery followed by adjuvant chemotherapy. There is a worldwide ongoing discussion on the benefit of neoadjuvant treatment instead of adjuvant treatment for these patients. Interpretation and comparison of studies is hard because of a difference in patient selection between studies about these two strategies. Reporting by intention to treat and randomised clinical trials are essential.

In the first decade of the 21st century, many studies and reviews suggested superiority of the neoadjuvant approach in RPC and BRPC for patients with resected pancreatic cancer. Several reviews also suggested an advantage by intention to treat. The first two randomised trials failed due to lack of accrual, and the third discontinued because of changed standard regimens. Since 2018, two randomised trials were published and one presented. A meta-analysis of these six RCTs, four of which with neoadjuvant chemoradiotherapy, and all with gemcitabine based regimens, revealed that with neoadjuvant treatment overall survival improved compared to upfront surgery for both RPC and BRPC. Since local control and pathological factors such as pN classification and R0 resection rate are invariably better after neoadjuvant treatment, radiotherapy probably plays an important role.

Currently, more effective treatments are available, in particular FOLFIRINOX and gemcitabine + nab-paclitaxel are considered the best available chemotherapeutic schedules and stereotactic body radiotherapy (SBRT) is superior to conventional radiotherapy. Future studies should investigate the role of FOLFIRINOX or gemcitabine plus nab-paclitaxel combined with SBRT.

BELG J MED ONCOL 2021;15(3):117-22

Read more

Reactivations of prior infections in cancer patients treated with immunosuppressive/immunomodulatory treatments

BJMO - volume 15, issue 2, march 2021

D. Schrijvers MD, PhD

SUMMARY

Prior infections may reactivate in cancer patients receiving immunosuppressive/immunomodulatory treatments. Depending on the severity of the immune suppression, chemoprophylaxis may be necessary and is recommended in Herpes simplex virus- and Herpes zoster virus-seropositive patients undergoing allogenous hematologic stem cell transplantation and in solid cancer patients with Hepatitis B surface antigen or hepatitis B core antibody seropositivity.

For other infections, a low threshold for performing diagnostic testing of potential viral or tuberculosis infections should be used should be used in daily clinical practice in order to prevent severe morbidity or mortality.

(BELG J MED ONCOL 2021;15(2):75-8)

Read more

Neoadjuvant treatment considerations in HER2-positive breast cancer patients

BJMO - volume 15, issue 1, january 2021

E. de Azambuja MD, PhD, R. Saúde-Conde MD, S. Cristóvão-Ferreira MD, PhD

SUMMARY

HER2-positive breast cancer was considered an aggressive subtype with a worse prognosis, but the development of anti-HER2 agents changed this paradigm. In the last years, the treatment of early HER2 breast cancer patients faced several improvements. Different anti-HER2 targeted drugs, like trastuzumab, pertuzumab, lapatinib, and TDM-1 used in advanced disease started to be included in multimodal curative strategies. Further, the presence of complete pathological response to neoadjuvant treatments started to be used as a surrogate outcome and led to the development of post-neoadjuvant strategies. Here, we summarise the neoadjuvant and post-neoadjuvant treatments of HER2-positive breast cancer according to the best evidence, reviewing the pharmacological aspects of HER2 targeted agents.

(BELG J MED ONCOL 2021;15(1):4-10)

Read more

BELFIGO – A retrospective observational study to evaluate the treatment patterns of mCRPC patients in Belgium treated with radium-223

BJMO - volume 14, issue 7, november 2020

A. Sacré MD, A. Van den Eeckhaut MD, D. Schrijvers MD, PhD, E. Seront MD, PhD, F. Jamar MD, PhD, I. Billiet MD, J. Deferme , K. Goffin MD, PhD, N. Mahy MD, P. De Wil MD, R. Bierlaire , Sofie Willems MD, V. Vanhaudenarde MD

SUMMARY

BELFIGO is a national retrospective chart review that aimed to assess the sequencing and application of radium-223 (Ra-223) within routine clinical practice, and evaluate the use of Ra-223 in monotherapy. The collection of data was primarily used to describe the proportion of Belgian metastatic Castration Resistant Prostate Cancer patients receiving one-four versus five-six Ra-223 injections, and the potentially associated patient characteristics. In total, 164 patients from eleven centres in Belgium were included and analysed in this study. Hundred-thirteen patients (69%) completed five-six injections of Ra-223. There was a trend that patients with a lower Eastern Cooperative Oncology Group Performance Status score, lower extent of disease on bone scan, alkaline phosphatase at baseline < 140 U/L and lactate dehydrogenase at baseline <250 U/L showed a higher chance of completing the six cycles of Ra-223. Median overall survival was estimated at 6.9 months for the patients having received one-four injections and 23.8 months for patients who completed five-six injections of Ra-223. More than 70% of patients received at least one treatment line after Ra-223, mainly enzalutamide, docetaxel or abiraterone acetate. These results show that the life-prolonging targeted alpha-therapy Ra-223 does not preclude the start of subsequent lines of treatment and that its use in an earlier line results, in a higher probability of reaching five-six doses. Patients with less advanced disease are more likely to complete five-six injections and tend to have a higher median overall survival.

(BELG J MED ONCOL 2020;14(7):347-54)

Read more
X