PHARMACOTHERAPY

Precision therapy in pancreaticobiliary cancers: molecular testing for all?

BJMO - volume 14, issue 6, october 2020

A. Demols MD, PhD, J.L. van Laethem MD, PhD, L. Mans

SUMMARY

Pancreaticobiliary cancers remain challenging to be treated due to aggressive biology and heterogeneous molecular patterns. Chemotherapy remains the backbone therapy, with two lines available in each cancer. Using targeted therapies in unselected populations has led to complete failure while currently used immunotherapy with anti-PD1 can only be active in instable tumours (MSI-High), a rare condition in these cancers. As recently reported, targeting specific genes in pancreaticobiliary cancers may significantly improve tumour control and offer new ways to manage them, in addition to conventional chemotherapies usually proposed in front line. Consequently, it is now more and more recommended to perform genetic and genomic testing of these tumours, searching for new druggable targets. Dedicated trials focusing on such enriched populations are currently ongoing.

(BELG J MED ONCOL 2020;14(6):274-9)

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Biosimilars in oncology – Part I: The principles of biosimilars

BJMO - volume 14, issue 6, october 2020

AG. Vulto , E. Moorkens , L. Barbier , T. Barcina Lacosta , Y. Vandenplas

SUMMARY

Equally safe and effective alternatives to biological reference products, biosimilars, can lead to lowered treatment costs and higher patient access. With the arrival of biosimilars in the treatment of cancer (i.e., trastuzumab, rituximab, bevacizumab), it is important that oncologists gain confidence to adopt biosimilars in clinical practice. This article, the first in a series of two, emphasizes the need for biosimilars to create a competitive and sustainable biologicals market, highlights key concepts of the regulatory approval pathway of biosimilars, explains what key challenges biosimilars are facing, and what actions have been undertaken in Belgium to increase their use. We conclude with some recommendations.

(BELG J MED ONCOL 2020;14(6):280-5)

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Biosimilars in Oncology – Part II: Considerations about the clinical use of oncology biosimilars

BJMO - volume 14, issue 6, october 2020

AG. Vulto , E. Moorkens , L. Barbier , T. Barcina Lacosta , Y. Vandenplas

SUMMARY

Biosimilars are equally safe and effective treatment options compared to their biological reference products, and can lower treatment costs and increase patient access to necessary medicines. Biosimilars in oncology have been integrated in cancer care, with the availability of supportive care biosimilars (epoetin and filgrastim) for over a decade. With the arrival of monoclonal antibody (mAb) biosimilars (trastuzumab, rituximab and bevacizumab), this article provides an up to date overview of the biosimilars available in oncology, while explaining clinical considerations important for prescribers, highlighting the need for in-depth understanding among oncologists about biosimilars and discussing the experience with oncology biosimilars in Europe and Belgium.

(BELG J MED ONCOL 2020;14(6):286-92)

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Optimal treatment of metastatic gastric and gastro-oesophageal junction adenocarcinoma

BJMO - volume 14, issue 4, june 2020

A. De Cuyper MD, J. Siplet MD, M. van den Eynde MD, PhD

SUMMARY

Standard of care for advanced and metastatic gastric and gastro-oesophageal junction adenocarcinoma relies on palliative systemic therapy that can improve both survival and quality of life of patients. In first-line, platinum – fluoropyrimidine-based doublet (combined with trastuzumab for HER2/neu positive tumours) or triplet chemotherapy regimen (mainly combining a taxane) is now standard option. For fit patients, a secondline with taxane and/or ramucirumab or irinotecan monotherapy, is an option. Latest studies showed interest for new treatments such as immune checkpoint inhibitors (anti-PD-1) or trifluridine/tipiracil in some situations.

(BELG J MED ONCOL 2020;14(4):146–50)

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Adjuvant chemotherapy of colon cancer: 3 versus 6 months

BJMO - volume 13, issue 6, october 2019

B. Van den Heuvel MD, C. Debeuckelaere MD, H. Prenen MD, PhD, K. Papadimitriou MD, L. Triest MD, M. Peeters MD, PhD, M. Rasschaert MD, T. Vandamme MD

Summary

For over a decade, oxaliplatin-based adjuvant chemotherapy has been the gold standard for resected early colon cancer. Oxaliplatin is known to cause polyneuropathy, which affects quality of life dramatically. In recent years, there has not been any progress in the development of novel agents to replace oxaliplatin as adjuvant therapy. Consequently, there is a growing interest to investigate whether a shorter course of chemotherapy is sufficient. This article will discuss the history of adjuvant treatment in early-resected colon cancer, the toxicity of oxaliplatin, the results from the IDEA meta-analysis and future prospects.

(BELG J MED ONCOL 2019;13(6):234–239)

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Appropriateness of treatment options in patients with metastatic castrationresistant prostate cancer with a focus on radium-223: outcomes of a Belgian multidisciplinary Consensus Meeting

BJMO - volume 13, issue 6, october 2019

B. Tombal MD, PhD, D. Schrijvers MD, PhD, E. Seront MD, PhD, K. Goffin MD, PhD, L. Duck MD, M. Gizzi MD, N. Withofs MD, PhD, P. Ost MD, PhD, S. Joniau MD, PhD, S. Rottey MD, PhD, T. Roumeguère MD, PhD

SUMMARY

The treatment landscape for metastatic castration-resistant prostate cancer (mCRPC) has changed dramatically with the approval of a variety of therapeutic agents including abiraterone acetate, cabazitaxel, docetaxel, enzalutamide and radium-223 dichloride and the introduction of docetaxel and abiraterone acetate in combination with androgen deprivation therapy in newly diagnosed metastatic prostate cancer. Evidence on the optimal sequence of these therapies is scarce. In practice, the most appropriate treatment (sequence) depends on patient and disease characteristics. This article summarises the recommendations of a multidisciplinary group of Belgian experts in sequencing treatments for patients with mCRPC, with a focus on radium-223 dichloride.

(BELG J MED ONCOL 2019;13(6): 240–250)

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Interventions in non-metastatic castration-resistant prostate cancer: earlier seems better

BJMO - volume 13, issue 4, june 2019

D. Schrijvers MD, PhD

SUMMARY

Patients with non-metastatic castration-resistant prostate cancer benefit from an early treatment in terms of metastasis-free survival. Three drugs were compared with placebo in large randomised trials (SPARTAN, PROSPER, ARAMIS) and all showed an improvement in median metastasis-free survival. They differ in some of the secondary endpoints and side effects. This article discusses the results and the impact for patients with non-metastatic castration-resistant prostate cancer.

(BELG J MED ONCOL 2019;13(4):129–131)

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