BJMO - volume 18, issue 1, february 2024
L. van Zuylen MD, PhD, J. van Esch MD, PhD, S. Kobes , I. van Voorthuizen , W. van der Geugten MSc, M. Slager MSc, L. de Jong MSc, L. Tulner MD, A. Rothengatter-Ophof MD, T. Efthymiou MD, M. Tenk MD, M.S. Vos MD, PhD, I. Rietkerk MSc, I. van Trigt MSc, E. Lemmens-Sauter , A. de Graeff MD, PhD
The guideline ‘Care in the dying phase’ of 2010 has been revised by a committee consisting of members mandated by several scientific, professional and patient organisations. For every module, the literature search (up to 2014) of the guideline ‘Care of dying adults in the last days of life’ from the National Institute for Health and Care Excellence (NICE) has been used. Based on a bottleneck analysis, several scientific questions were formulated with regard to marking the dying phase, the use of opioids for dyspnoea or pain, prevention and treatment of death rattle, and artificial hydration. Other parts of the guidelines were revised consensus-based. In this paper, a summary of the most important recommendations of the guideline is given.
(BELG J MED ONCOL 2024;18(1):17–23)
Read moreBJMO - volume 17, issue 4, june 2023
A. Verbiest MD, PhD, M. Baldewijns MD, PhD, B. Beuselinck MD, PhD, P. Debruyne MD, PhD, C. Gennigens MD, PhD, G. Pelgrims MD, T. Roumeguère MD, PhD, E. Seront MD, PhD, N. Sundahl MD, PhD, S. Rottey MD, PhD
The management of renal cell carcinoma is evolving rapidly. Here, the BSMO expert panel discusses recent advances focusing on systemic therapies, and provides guidelines adapted to the Belgian context.
(BELG J MED ONCOL 2023;17(4):118–27)
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No authors
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)
Read moreBJMO - volume 16, issue 7, november 2022
S. Verbeke MD, PhD, S. Verschuere MD, PhD, M-D. Martín-Martinez MD, B. Lelie MD, L. Libbrecht MD, PhD, M. Baldewijns MD, PhD, S. Rorive MD, PhD, G. Beniuga MD, J. Eben MD, M-A. van Caillie MD, N. D’Haene MD, PhD, C. Gabriel MD, F. Dedeurwaerdere MD, Ir A. Hébrant PhD, H.L. Gijs , K.B.M. Claes PhD, D. De Maeseneer MD, B. Tombal MD, PhD, P. Pauwels MD, PhD
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)
Read moreBJMO - volume 16, issue 6, october 2022
G. Nader-Marta MD, F.P. Duhoux MD, PhD, D. Taylor MD, T. Van den Mooter MD, H. Denys MD, PhD, J-L. Canon MD, J. Mebis MD, A. Awada MD, PhD, H. Wildiers MD, PhD, K. Punie MD, E. de Azambuja MD, PhD
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)
Read moreBJMO - volume 16, issue 4, june 2022
V. Verschaeve MD, I. Clement Corral MD, C. Dumont MD, P. Betomvuko MD, F. Cornélis MD, C. Fontaine MD, J. Klastersky MD
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)
Read moreBJMO - volume 16, issue 3, may 2022
L. Crapé MD, K.P. Geboes MD, PhD, V. Casneuf MD, A.G. Verstraete MD, PhD, M. van den Eynde MD, PhD, I. Borbath MD, PhD, Y. Verheezen MD, W. Demey MD, J. Van der Meulen MD, V. Haufroid PhD
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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