PHARMACOTHERAPY

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

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)

Neoadjuvant treatment considerations in HER2-positive breast cancer patients

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)

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

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)

Optimal systemic treatment for advanced hepatocellular carcinoma: current clinical evidence and new insights based on tumour immunobiology

SUMMARY

Advanced hepatocellular carcinoma, known for its dismal prognosis, is a disease that is challenging to treat. For almost a decade, sorafenib was the only available treatment. However, the last two to three years have witnessed a true revolution in systemic treatment options for this lethal disease. Several targeted therapies with mostly anti-angiogenic properties have been developed and immunotherapy has made its entrance into the field. Furthermore, a growing understanding of the molecular pathways involved in hepatocarcinogenesis and new insights in tumour-immunobiology have led to the development of rational combination therapies, showing very promising results in a myriad of ongoing clinical trials. Here we review the latest developments and discuss the main consequences for clinical practice.

(BELG J MED ONCOL 2020;14(7):339-46)

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

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)

Biosimilars in oncology – Part I: The principles of biosimilars

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)

Precision therapy in pancreaticobiliary cancers: molecular testing for all?

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)