PRACTICE GUIDELINES

Delirium in adult cancer patients: BSMO Guidelines

BJMO - volume 16, issue 4, june 2022

C. Dumont MD, C. Fontaine MD, F. Cornélis MD, I. Clement Corral MD, J. Klastersky MD, P. Betomvuko MD, V. Verschaeve MD

SUMMARY

Delirium is frequent in cancer patients but often misdiagnosed. When severe, it causes distress not only for patients but also for families and professional caregivers. Physicians and nurses involved in the care of oncology patients should receive adequate training in the use of diagnostic tools for delirium. Identifying and reversing the underlying cause(s) of delirium are the best approaches because of the morbidity/mortality of delirium, although it is reversible most of the time. Prevention is also crucial, while pharmacological delirium management is generally not recommended in most cases. These first Belgian society of medical oncology (BSMO) guidelines aim to give a practical overview directly useful in practice.

(BELG J MED ONCOL 2022;16(4):166–75)

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Case-based illustrations of clinical flow and practical aspects of DPD-deficiency screening in Belgium

BJMO - volume 16, issue 3, may 2022

A.G. Verstraete MD, PhD, I. Borbath MD, PhD, J. Van der Meulen MD, K.B.M. Claes PhD, K.P. Geboes MD, PhD, L. Crapé MD, M. van den Eynde MD, PhD, V. Casneuf MD, V. Haufroid PhD, W. Demey MD, Y. Verheezen MD

SUMMARY

Fluoropyrimidines are frequently used as anti-cancer treatment for gastro-intestinal malignancies, breast, head and neck cancer and others. The enzyme dihydropyrimidine dehydrogenase (DPD) is crucial in the first and rate limiting enzyme step of 5-fluorouracil (5-FU) catabolism. Reduced or complete deficiency leads to severe and even fatal toxicity. The Belgian Group of Digestive Oncology (BGDO) has agreed upon a recommendation on screening for DPD deficiency before starting treatment, which was endorsed by the Belgian Society of Medical Oncology (BSMO), the College of Genetics (CG), and the Toxicological Society of Belgium and Luxembourg (BLT). This article focuses on the clinical flows and practical recommendations. Both targeted germline genotype testing and phenotyping are supported. It was suggested to use a stepwise approach, with a phenotype testing upfront because of higher sensitivity and lower societal cost. In patients with uracil levels above 14 ng/ mL, targeted germline genotype screening should follow. Fluoropyrimidines are contra-indicated in patients with complete DPD deficiency and starting dose recommendations have been validated for patients with partial deficiency.

(BELG J MED ONCOL 2022;16(3):119–24)

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Update to the Belgian follow-up guidelines for abnormal cervical screening results

BJMO - volume 16, issue 2, march 2022

B. Weynand MD, PhD, C. Bourgain MD, PhD, K. Van de Vijver MD, PhD, S. Shahebali MD, PhD

SUMMARY

The Belgian Society for Clinical Cytology elaborated updated guidelines for the follow-up of abnormal cervical cytology results in Belgium, according to a review of the literature and current reimbursement of the screening tests. A proposal for the follow-up in the setting of primary HPV screening for cervical cancer is added.

(BELG J MED ONCOL 2022;16(2):60–9)

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Belgian guidelines on supportive care: Cardiotoxicity of cancer treatments

BJMO - volume 15, issue 7, november 2021

B. von Kemp MD, On behalf of the BSMO Supportive Care Taskforce

SUMMARY

Increasing effectiveness of cancer treatments significantly improved patient survival. More treatment options are available for frailer patients. Therefore, the importance of appropriate supportive care measures increases, particularly in high-risk patients. More data concerning potentially cardiotoxic effects of cancer therapies are available, involving multiple cardiovascular side-effects. We provide an overview of available strategies to identify the patient at increased risk for cardiotoxicity, to prevent, detect and treat cardiotoxic effects of cancer treatments and to organise follow-up in patients with documented toxicity. The main focus will be left ventricular dysfunction and heart failure, but some other frequently encountered forms of toxicity will be discussed.

(BELG J MED ONCOL 2021;15(7):367-73)

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PIK3CA in breast cancer: a Belgian practical testing guideline

BJMO - volume 15, issue 6, october 2021

Ir A. Hébrant PhD, G. Broeckx MD, I. Vanden Bempt PhD, J. Van Huysse MD, K. Van de Vijver MD, PhD, N. D’Haene MD, PhD, P. Aftimos MD, P. Neven MD, PhD, P. Pauwels MD, PhD

SUMMARY

The PI3K/AKT pathway plays an important role in the oncogenesis of breast cancer. Activating mutations in PI3K, more specifically in the p110α catalytic unit of the class IA PI3K isoform (encoded by the PIK3CA gene), lead to an increased conversion of phosphatidylinositol-4,5-biphosphate (PIP2) to phosphatidylinositol-3,4,5-triphosphate (PIP3) inducing a cell signalling cascade for cell proliferation and cell survival. PIK3CA mutations are found in 20–32% of all breast cancers (BC), particularly in hormone sensitive (HR+) BC. In breast cancer, activation of the PI3K pathway coexists with the activation of the oestrogen receptor pathway. Inhibition of one of these pathways may lead to compensatory activation of the other pathway. Therefore, mono-therapy with PI3K inhibitors has limited activity in HR+ BC. On the other hand, this explains the efficacy of a PI3K/ER dual blockade. This dual blockade is researched in the phase III SOLAR-1 trial. In the PIK3CA-mutated cohort of this study, there is an improved outcome for patients with advanced or metastatic HR+ HER2- BC, harbouring activating hotspot mutations in PIK3CA and previously treated with an aromatase inhibitor and no more than one line of endocrine therapy for MBC, who received fulvestrant (a selective oestrogen receptor degrader) and alpelisib (a p110α-isoform specific inhibitor) in comparison to the patients that received fulvestrant and placebo. Based on these results, a medical need program for alpelisib in a heavily pre-treated setting and an amendment were approved by the EMA and the Belgian FAMHP. Supporting this data, we propose the mutational analysis of PIK3CA, preferably by next generation sequencing on FFPE tumour material, in advanced or metastatic HR+ HER2- BC, previously treated with three lines of systemic therapy.

(BELG J MED ONCOL 2021;15(6):304-14)

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Guidelines for the detection of NTRK fusions. A report from the Belgian Molecular Pathology Working Group

BJMO - volume 15, issue 3, may 2021

Ir A. Hébrant PhD, B. Weynand MD, PhD, C. Galant MD, F. Dedeurwaerdere MD, G. Broeckx MD, I. Vanden Bempt PhD, J. Van Huysse MD, K. Van de Vijver MD, PhD, N. D’Haene MD, PhD, P. Pauwels MD, PhD

(BELG J MED ONCOL 2021;15(3):112-6)

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Practical guidelines in axillary management after neo-adjuvant chemotherapy in breast cancer patients

BJMO - volume 15, issue 2, march 2021

A.-S. Vliegen MD, C. Thywissen MD, G. Orye MD, J. Mebis MD, K. Van Baelen MD, L. Noé MD, L. Vansteelant MD, M. Drijkoningen MD, PhD, N. Van den Rul MD, S. Marquette MD

SUMMARY

In clinical practice, the diversity in the surgical management of the axilla after neo-adjuvant chemotherapy (NACT) for node positive patients is huge. Given the morbidity of axillary lymph node dissection (ALND), a trend to perform a less invasive technique is seen in both literature and clinical practice. There are three major techniques: 1) sentinel lymph node biopsy (SLNB), 2) guided removal of lymph nodes that were positive prior to NACT, and 3) Targeted Axillary Dissection (TAD) which is a combination of the previous two techniques. Criteria for patients eligible for these techniques vary widely and oncological safety cannot always be guaranteed. With this report, we aim to introduce TAD in a safe way into the clinical practice.

(BELG J MED ONCOL 2021;15(2):69-74)

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