PRACTICE GUIDELINES

Practical guidance for molecular testing in metastatic prostate cancer: A Belgian perspective

BJMO - , issue ,

No authors

SUMMARY

The recent approval of the poly(ADP-ribose) polymerase (PARP) inhibitor olaparib for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) harbouring pathogenic variants of BRCA2 or BRCA1 marks the start of molecularly guided precision medicine in prostate cancer. In parallel with this approval comes the need to embed molecular diagnostics in the clinical management of patients with mCRPC. To date, however, there are no established protocols in Belgium for the use of mutation testing in this setting. This article will therefore provide practical guidance for sample preparation and handling, pre-analytic processing, and pathogenic variant analysis in mCRPC. Across the different phases of this process, a multidisciplinary approach involving urologists, oncologists, radiologists, pathologists, molecular biologists, technicians, nurses, and geneticists will be key to safeguard adequate sample selection to perform molecular analyses at the time of metastatic disease. It will also facilitate high-quality molecular testing with a minimal failure rate. Only by optimising this process will physicians be able to adequately select mCRPC patients that are most likely to benefit from PARP inhibition, or other future targeted therapies, allowing to use these agents in the correct patient groups.

(BELG J MED ONCOL 2022;16(7):343–54)

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Practical guidance for molecular testing in metastatic prostate cancer: A Belgian perspective

BJMO - volume 16, issue 7, november 2022

Ir A. Hébrant PhD, B. Lelie MD, B. Tombal MD, PhD, C. Gabriel MD, D. De Maeseneer MD, F. Dedeurwaerdere MD, G. Beniuga MD, H.L. Gijs , J. Eben MD, K.B.M. Claes PhD, L. Libbrecht MD, PhD, M-A. van Caillie MD, M-D. Martín-Martinez MD, M. Baldewijns MD, PhD, N. D’Haene MD, PhD, P. Pauwels MD, PhD, S. Rorive MD, PhD, S. Verbeke MD, PhD, S. Verschuere MD, PhD

SUMMARY

The recent approval of the poly(ADP-ribose) polymerase (PARP) inhibitor olaparib for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) harbouring pathogenic variants of BRCA2 or BRCA1 marks the start of molecularly guided precision medicine in prostate cancer. In parallel with this approval comes the need to embed molecular diagnostics in the clinical management of patients with mCRPC. To date, however, there are no established protocols in Belgium for the use of mutation testing in this setting. This article will therefore provide practical guidance for sample preparation and handling, pre-analytic processing, and pathogenic variant analysis in mCRPC. Across the different phases of this process, a multidisciplinary approach involving urologists, oncologists, radiologists, pathologists, molecular biologists, technicians, nurses, and geneticists will be key to safeguard adequate sample selection to perform molecular analyses at the time of metastatic disease. It will also facilitate high-quality molecular testing with a minimal failure rate. Only by optimising this process will physicians be able to adequately select mCRPC patients that are most likely to benefit from PARP inhibition, or other future targeted therapies, allowing to use these agents in the correct patient groups.

(BELG J MED ONCOL 2022;16(7):343–54)

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Belgian clinical practice guidelines for the treatment of patients with HER2-positive advanced breast cancer

BJMO - volume 16, issue 6, october 2022

A. Awada MD, PhD, D. Taylor MD, E. de Azambuja MD, PhD, F.P. Duhoux MD, PhD, G. Nader-Marta MD, H. Denys MD, PhD, H. Wildiers MD, PhD, J-L. Canon MD, J. Mebis MD, PhD, K. Punie MD, T. Van den Mooter MD

SUMMARY

HER2-targeted agents are the central component of HER2-positive metastatic breast cancer (MBC) treatment. The combination of trastuzumab, pertuzumab and a taxane is the preferred first-line regimen in most settings. For patients with disease relapse after adjuvant therapy, treatment decisions in the first-line are influenced by the treatment-free interval and the regimens used in the (neo)adjuvant setting. T-DXd has been recently established as the preferred second-line therapy. T-DM1, or the combination of tucatinib, trastuzumab and capecitabine, are reasonable third-line options, although efficacy and safety data of these regimens after prior exposure to T-DXd are lacking. In fourth and later lines, trastuzumab duocarmazine, neratinib plus capecitabine, margetuximab plus chemotherapy, lapatinib-based combinations or the continuation of trastuzumab with different chemotherapy partners are valid alternatives.

(BELG J MED ONCOL 2022;16(6): 287–92)

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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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