PHARMACOTHERAPY

KCE, a key actor in cancer care

Summary

This article presents an overview of the work of the Belgian Health Care Knowledge Centre in the field of cancer.

(BELG J MED ONCOL 2016;10(1):21–28)

The role of docetaxel in prostate cancer

Docetaxel has shown to improve survival and quality of life in patients with castration-resistant prostate cancer. Its place as first-line treatment in this population is challenged by new hormonal treatments, but it still has a place in this setting. Its role in metastatic hormone-sensitive prostate cancer is becoming clearer and docetaxel may be offered to selected patients. In localised high-risk prostate cancer the place of docetaxel remains to be determined.

(BELG J MED ONCOL 2015;9(5):191–93)

Pan-HER inhibitors

The human epidermal growth factor receptor family is composed of four tyrosine kinase receptors (HER-1 or EGFR, HER-2, HER-3 and HER-4). Human epidermal growth factor receptor pathways play a critical role in human cancer and are involved in tumour proliferation, apoptosis, angiogenesis, and cell migration/invasion. Pan-HER inhibitors such as afatinib, dacomitinib, and neratinib induce irreversible inhibition of all the dimers formed by the human epidermal growth factor receptor family. In clinical practice, only afatinib is approved by the Food and Drug Administration for the first-line treatment of patients with metastatic non-small cell lung cancer whose tumours have epidermal growth factor receptor exon 19 deletions or exon 21 (L858R) substitution mutations. Today, those molecules are still in development and their activity and safety investigated in clinical trials. The most common adverse effects of the pan-HER inhibitors are diarrhoea and skin toxicity.

(BELG J MED ONCOL 2015;9(3):99–103)

The role of immunotherapy in colorectal cancer

Colorectal cancer is one of the most prevalent types of cancer worldwide and a leading cause of cancer related mortality. Although chemo- and radiation therapy can improve survival rates, it is imperative to integrate more advanced treatment options; therefore, rationally designed immunotherapeutic strategies are being explored as adjuvant treatment. In this review, we will discuss the study design and results of the clinical trials that have been conducted in colorectal cancer patients using autologous and allogeneic tumour cell vaccines, peptide vaccines, viral vector based vaccines, dendritic cell based vaccines, and antibody-based immunotherapy as well as some future recommendations.

(BELG J MED ONCOL 2015;9(1):25–30)

Adjuvant and neoadjuvant chemotherapy regimens in breast cancer: summary from the BSMO breast cancer task force meeting

Knowledge on adjuvant and neoadjuvant chemotherapy regimens in breast cancer is increasing rapidly. Many different regimens are available: some have been compared with each other, but still many questions remain to be answered. At the breast cancer task force meeting of the Belgian Society of Medical Oncology (BSMO) in Brussels, on February 21^st 2014, 41 medical oncologists involved in breast cancer management reviewed the most important recent data. The task force discussed a framework for regimen selection in clinical practice. The authors of this paper summarised the literature and meeting discussion, highlighting controversial areas.

(BELG J MED ONCOL 2014;8(4):116–24)

Morphine derivatives

Morphine, and derivatives, remain the cornerstone of cancer pain management. They share the same clinical spectrum but exhibit different pharmacological profiles. Some derivatives have specificity regarding pain control (i.e. neuropathic pain) potency or toxicity. The interest of having different opioids relies in part on inter-individual genetic variability (in terms of metabolism or receptor affinity). The specificity of breakthrough pain syndrome is considered. Because of various available converting ratio, a simplified converting table is proposed.

(BELG J MED ONCOL 2014;8(1):9–13)

Attacking the androgen receptor pathway in prostate cancer

Summary

Since the 1940’s the androgen receptor has been the main target for systemic therapy in prostate cancer. Classic hormonal therapy aims at lowering serum testosterone levels or block the androgen receptor ligand-binding domain. Despite disease progression, castration-resistant prostate cancer remains predominantly androgen-driven as novel secondary hormonal therapy with abiraterone acetate or enzalutamide has demonstrated increased overall survival. Promising androgen synthesis inhibitors (orteronel, galeterone), androgen receptor inhibitors (ARN-509, EPI-001, AZD3514) and heat-shock protein modulators are under investigation. Given the upcoming arsenal of systemic therapies and the molecular heterogeneity of castration-resistant prostate cancer, patient-tailored therapy strategies are being explored.

(BELG J MED ONCOL 2013;7(3):111–8)