PRACTICE GUIDELINES

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

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)

Belgian guidelines on supportive care: Cardiotoxicity of cancer treatments

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)

PIK3CA in breast cancer: a Belgian practical testing guideline

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)

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

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

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

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)

Systemic treatment landscape and algorithm for hormone-receptor positive, HER2 negative advanced breast cancer

SUMMARY

Hormone-receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer accounts for 65% of all metastatic breast cancer (MBC) cases. With the advent of CDK4/6 inhibitors, single-agent endocrine therapy (ET) is no longer the only first-line systemic treatment option for the vast majority of patients presenting without visceral crisis. Other endocrine-based treatment options are emerging in further lines, with the goal to delay the administration of chemotherapy as long as possible. The optimal sequence of treatment is unknown. We here present a review of the available treatments and propose a treatment algorithm taking into account the latest therapeutic developments.

(BELG J MED ONCOL 2021;15(1):20-33)

Clinical management of first-line advanced triple-negative breast cancer patients

SUMMARY

Chemotherapy has represented the main treatment option for patients with advanced triple-negative breast cancer for a long time. However, due to our better understanding of tumour biology, recent clinical trials led to a change in the treatment paradigm of this disease, identifying clinically relevant subgroups with different therapeutic options. Both clinical and biological factors have become relevant and need to be considered in the treatment decision algorithm of this heterogeneous disease.

(BELG J MED ONCOL 2020;14(7):333-38)