PRACTICE GUIDELINES

An update on the management of metastatic clear-cell renal cell carcinoma: the BSMO expert panel recommendations

BJMO - volume 14, issue 2, march 2020

A. Verbiest MD, B. Beuselinck MD, PhD, B. Delafontaine MD, C. De Backer MD, C. Gennigens MD, C. Vulsteke MD, PhD, G. Pelgrims MD, G. Van Lancker MD, L. D’Hondt MD, PhD, M. Strijbos MD, PhD, N. Martínez Chanzá MD, On behalf of the BSMO Uro-Oncology Task Force Group , P. Debruyne MD, PhD, S. Rottey MD, PhD, T. Gil MD

SUMMARY

The management of recurrent or metastatic renal cell carcinoma is evolving fast, with new therapeutic options becoming available that may improve the outcome of patients. In this paper, recent evolutions are discussed and recommendations are made regarding the management of renal cell carcinoma in a Belgian context.

(BELG J MED ONCOL 2020;14(2):56–70)

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Algorithms for molecular testing in solid tumours

BJMO - volume 13, issue 7, november 2019

A. Dendooven MD, PhD, A. Hébrant PhD, A. Van den Bruel MD, A. Vanderstichele MD, PhD, B. Decallonne MD, PhD, B. Maes MD, PhD, B. Weynand MD, PhD, C. Dooms MD, PhD, C. Van den Broecke MD, D. Creytens MD, PhD, E. Govaerts MD, E. Hauben MD, PhD, E. Van Valckenborgh PhD, E. Wauters MD, PhD, F. Dedeurwaerdere MD, G. Costante MD, G. Floris MD, PhD, G. Martens MD, PhD, G. Raicevic PhD, H. Denys MD, PhD, HA. Poirel MD, PhD, I. Salmon MD, PhD, I. Van den Berghe MD, J. De Grève MD, PhD, J. Kerger MD, PhD, J. Van den Oord MD, PhD, J. Van der Meulen PhD, J.P. Machiels MD, PhD, K. Punie MD, PhD, K. Van de Vijver MD, PhD, K. Vandecasteele MD, PhD, K. Vermaelen MD, PhD, L. Brochez MD, PhD, L. Ferdinande MD, PhD, L. Lapeire MD, PhD, L. Van de Voorde MD, L. Vanwalleghem MD, M. Garmyn MD, PhD, M. Lammens MD, PhD, M. Remmelink MD, PhD, M. Van den Bulcke PhD, M.C. Burlacu MD, N. D’Haene MD, PhD, O. Kholmanskikh Van Criekingen MD, PhD, P. De Paepe MD, PhD, P. Lefesvre MD, PhD, P. Neven MD, PhD, P. Pauwels MD, PhD, R. De Pauwn MD, R. Forsyth MD, PhD, R. Salgado MD, PhD, R. Sciot MD, PhD, S. Rottey MD, PhD, S. Tejpar MD, PhD, T. Boterberg MD, PhD, T. Gevaert MD, PhD, V. Kruse MD, PhD, Y. Lalami MD

SUMMARY

In order to advise the Federal Government on the reimbursement of molecular tests related to Personalised Medicine in Oncology, the Commission of Personalised Medicine (ComPerMed), represented by Belgian experts, has developed a methodology to classify molecular testing in oncology. The different molecular tests per cancer type are represented in algorithms and are annotated with a test level reflecting their relevance based on current guidelines, drug approvals and clinical data. The molecular tests are documented with recent literature, guidelines and a brief technical description. This methodology was applied on different solid tumours for which molecular testing is a clear clinical need.

(BELG J MED ONCOL 2019;13(7):286–95)

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State of the art in the treatment of soft tissue sarcomas

BJMO - volume 13, issue 6, october 2019

C. Gennigens MD, G. Jerusalem MD, PhD

SUMMARY

Soft tissue sarcomas represent 75% of all sarcomas and constitute a group of more than 50 different histological subtypes, with an even greater number of molecular subtypes. Localised STSs are generally treated by surgery followed, or preceded, by radiotherapy and according to criteria linked with the risk of local recurrence. Metastatic STSs are principally treated by systemic treatments such as chemotherapy and targeted drugs. The most important drugs used are doxorubicin, ifosfamide, dacarbazine, gemcitabine/docetaxel, eribulin and trabectedin; but also pazopanib. The place of localised treatments (surgery, radiotherapy, radiofrequency, etc.) in this setting is reserved for oligometastatic disease. A multidisciplinary approach is mandatory, with centralisation of all cases in reference centres, as early as at the time of clinical diagnosis of a suspected sarcoma. This ‘centralised’ approach, for this rare and complex disease, has an impact on the oncologic outcomes (quality of resection and overall survival) of patients.

(BELG J MED ONCOL 2019;13(6): 227–233)

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Prostate-specific antigen screening

BJMO - volume 13, issue 3, may 2019

N. Mottet MD, PhD

SUMMARY

Prostate cancer is the third cause of death in developed countries, suggesting a role for systematic screening. However, no country has considered this policy yet. On the contrary, an individual early diagnostic process based on a risk adapted strategy is now considered. In an informed patient with at least fifteen years of life expectancy, the process starts at 45 years of age in a man at risk. Otherwise, it starts at 50 years of age. While already based on a prostate-specific antigen test and a digital rectal examination, the MRI as well as risk calculators or biological tests might be helpful to avoid unnecessary biopsy. However, it must be remembered that finding a tumour does not mean a systematic treatment.

(BELG J MED ONCOL 2019;13(3):93–97)

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The potential of proton therapy in oesophageal cancer treatment

BJMO - volume 13, issue 1, february 2019

K. Haustermans , M. Lambrecht MD, PhD, M. Thomas

Radiotherapy has become the standard of care in the curative treatment of locally advanced oesophageal cancer. Advanced radiotherapy techniques, such as intensity-modulated radiotherapy, can reduce doses to normal tissues resulting in lower toxicities and an improved outcome. The unique physical features of proton beam therapy has tremendous potential to further spare organs at risk. Besides the clear dosimetric advantages of proton beam therapy in oesophageal cancer, there is evidence that supports a clinical benefit. However, results from prospective randomised trials are awaited. To maximise the cost-effectiveness of this new technology, patient selection for proton beam therapy using validated multifactorial normal tissue complication probability models is suggested. However, this requires international collaboration to prospectively collect data of patients treated with proton beam therapy.

(BELG J MED ONCOL 2019;13(1):11–15)

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Belgian consensus guidelines for prostate core needle biopsy reporting

BJMO - volume 12, issue 6, october 2018

B. Lelie MD, B. Weynand MD, PhD, C. Mattelaer MD, E. Lerut MD, PhD, J. Eben , L. Libbrecht MD, PhD, L. Martinez , M-A. van Caillie , M. Baldewijns MD, PhD, M. Lammens MD, PhD, S. Rorive MD, PhD, S. Verbeke , S. Verschuere MD, PhD, T. Gevaert MD, PhD

The Belgian Working Group on Uropathology has agreed upon a dataset for prostate core needle biopsy reporting, based on existing international guidelines, recent scientific insights, national survey analysis and panel discussion, with the focus on a user- and receptor-friendly format. This dataset should encourage standardised structured reporting of prostate biopsies in the Belgian healthcare system, aiming to improve the quality of individual pathology reports and to provide real benefit for the clinical management of patients and secondary users. Therefore the Belgian Working Group on Uropathology recommends implementing this dataset in each Belgian pathology lab, in close consultation with the entire clinical team involved in the treatment of the prostate cancer patient.

(BELG J MED ONCOL 2018;12(6):279–286)

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PD-L1 Testing for Non-Small Cell Lung Cancer: Belgian Guidelines

BJMO - volume 12, issue 5, september 2018

A. Jouret-Mourin MD, PhD, B. Weynand MD, PhD, D. Hoton MD, F. Dome MD, J. van Dorpe MD, PhD, K. Dhaene MD, PhD, M. Remmelink MD, PhD, N. D’Haene , P. Pauwels MD, PhD

In recent years, the outcome of patients with non-small cell lung cancer (NSCLC) has improved thanks to the development of targeted therapies. Currently, the introduction of immunotherapy for lung cancer patients offers new treatment opportunities. The pathologist is now asked to provide the most accurate possible diagnosis in association with theranostic information in order to provide the best therapeutic option. For immunotherapy, programmed death receptor ligand 1 (PD-L1) status is, at the present, the required biomarker for patient stratification, at least in first line treatment. Different international societies have already underlined the importance of guidelines for managing samples of non-small cell lung cancer NSCLC. With the goal of adapting these international recommendations to the Belgian landscape, Belgian guidelines were published in 2016. This update integrates immunotherapy into the previously published guidelines.

(BELG J MED ONCOL 2018;12(5):233–238)

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