REVIEW ONCOLOGY

Genetic testing in prostate cancer in clinical practice

BJMO - volume 15, issue 4, june 2021

B. De Laere PhD, K.B.M. Claes PhD, P. Ost MD, PhD, R. de Putter MD

SUMMARY

Mutations in DNA damage repair (DDR) genes are relatively common in prostate cancer (PC), and may guide therapy selection. Approximately half of somatic DDR mutations are also present in the germline and lead to a heritable cancer predisposition syndrome (CPS), which informs on future risk, prostate cancer prognosis, and therapeutic options. In germline carriers, genetic counselling is essential to help psychosocial coping and to provide pre-symptomatic testing in relatives, who upon carrier identification can opt for intensified surveillance or – in some cases – prophylactic surgery.

(BELG J MED ONCOL 2021;15(4):156-63)

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PARP inhibition and prostate cancer

BJMO - volume 15, issue 4, june 2021

L. Dirix MD

SUMMARY

Deoxyribonucleic acid (DNA) recombination between homologous chromosomes is essential in the process of meiosis as it drives genetic diversity and assures accurate segregation. In somatic cells, a substantial machinery is involved in DNA damage repair (DDR). Failure to repair DNA damage has many consequences, including cancer predisposition. Insights in DDR mechanisms and the prevalence of defects in DDR in tumours has resulted in the fundamental insight of the presence of DDR defects as a chemosensitising biomarker for alkylating agents in high-grade serous ovarian cancer, non-small-cell lung cancer and glioblastoma. Increasing the DDR defect by PARP inhibition in this context of pre-existing DDR impairment, can result in catastrophic DNA damage and cancer cell death. In patients with mCRPC and demonstrated intratumoural DDR defect, PARP inhibition represents a valuable new treatment option.

(BELG J MED ONCOL 2021;15(4):164-9)

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Genetic and molecular biology in pancreatobiliary cancers: Testing for pancreatobiliary cancer in the context of the Belgian NGS convention

BJMO - volume 15, issue 4, june 2021

A. Demols MD, PhD, A. Hébrant PhD, A. Jouret-Mourin MD, PhD, F. Dedeurwaerdere MD, F. Lambert MD, G. Martens MD, PhD, H. Antoine-Poirel MD, PhD, J-L. van Laethem MD, PhD, J. Van der Meulen PhD, J. Van Huysse MD, K. Geboes MD, PhD, K.B.M. Claes PhD, M. van den Eynde MD, PhD, N. D’Haene MD, PhD, P-J. Van Dam MD, P. Lefesvre MD, PhD, P. Pauwels MD, PhD, P. Peeters MD, R. Salgado MD, PhD, S. Metsu PhD, X. Sagaert MD

SUMMARY

Pancreatobiliary cancers (PBC) group pancreatic and biliary tract cancers and are among the cancers with the lowest survival rate. Emerging data suggest that novel biomarker-specific targeted therapies can be proposed for selected populations with survival benefit. This review summarises the scientific evidence to test for these biomarkers in order to optimise the management of pancreatobiliary cancers, within the context of the Belgian NGS convention.

(BELG J MED ONCOL 2021;15(4):170-6)

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PI3K inhibitors in medical oncology: Update on an emerging treatment Modality

BJMO - volume 15, issue 3, may 2021

A. Iabkriman MD, F.P. Duhoux MD, PhD, J. Collignon MD

SUMMARY

The phosphatidylinositol-3-kinases (PI3Ks) play a critical role in cellular metabolism and proliferation, as well as in the development of cancer. Several mutations in the genes coding for PI3Ks have been identified in a large proportion of tumours at different rates, depending on the tumour type. Therapies targeting PI3Ks have been developed in the last years and initially used in hematological malignancies. In medical oncology, a number of trials have tried to prove the efficacy of these compounds, but most of them have been confronted with very important toxicities and only a modest benefit in progression-free survival. Recent trials using more selective treatments have shown good efficacy with an acceptable toxicity profile. The aim of this article is to review the current knowledge about PI3K inhibitors, their potential use in medical oncology and their toxicities.

(BELG J MED ONCOL 2021;15(3):96-103)

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Indications and timing of neurosurgery for brain metastases in NSCLC

BJMO - volume 15, issue 3, may 2021

M. De Praeter MD

SUMMARY

Although prognosis of non-small cell lung carcinoma (NSCLC) patients with brain metastases (BMs) has improved over the last years, the overall survival remains poor. Indications for surgical resection of a single BM have been well defined in the literature: Limited and or controlled systemic disease, Karnofsky performance scale ≥70, solitary lesion larger than 3 cm, non-eloquent area of the brain and unclear pathological diagnosis. However, recent advances in surgical technique and intraoperative technologies have facilitated surgery, including surgery for multiple lesions and lesions in eloquent brain areas.1–4 With the advance of molecularly targeted therapy, selection of patients who qualify for surgery of their BMs has become even more complex.5 The purpose of this review is to determine the indications and timing of surgery for brain metastases in NSCLC.

BELG J MED ONCOL 2021;15(3):104-11

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Management of high-risk non-muscle invasive bladder cancer: adjuvant intravesical BCG therapy and alternatives

BJMO - volume 15, issue 2, march 2021

S. Bulteel BSc, T. Muilwijk MD

SUMMARY

Intravesical BCG is the standard of care in the treatment of high-risk non-muscle invasive bladder cancer as it decreases the risk of recurrence and progression. Although it has been used for more than 40 years, it is currently still superior over chemotherapy and other immunotherapies. The worldwide shortage of BCG stresses the need for alternatives of BCG, for which the only curative treatment option outside clinical studies is an early radical cystectomy.

(BELG J MED ONCOL 2021;15(2):57-62)

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Tumour-derived organoids and future clinical applications

BJMO - volume 15, issue 2, march 2021

D. Timmerman MD, PhD, I. Vergote MD, PhD, S. Dumont MD, T. Van Gorp MD, PhD

SUMMARY

Human drug research, and cancer drug research in particular, heavily relies on traditional tumour models such as 2D cell cultures and xenografts to develop and test novel therapeutics. Organoids are a novel 3D cell platform derived from stem cells, allowing to faithfully replicate human tissue in an in vitro environment, bridging the ease of use of 2D cell cultures and the biological relevance of xenografts. In this manuscript, we introduce organoids to the oncological community and demonstrate the major advantages and challenges of this exciting new technology. Cancer organoids could be the next major step in tumour research and drug development, ultimately leading to highly precise personalised medicine.

(BELG J MED ONCOL 2021;15(2):63-8)

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