BJMO - volume 17, issue 2, march 2023
C. Gennigens MD, PhD, H. Denys MD, PhD, S. Altintas MD, PhD, J. Kerger MD, J-F. Baurain MD, PhD, V. Bours MD, PhD, S. Henry MD, K. Van de Vijver MD, PhD, D. Lambrechts PhD, I. Vergote MD, PhD
Epithelial ovarian cancer (EOC) is the most frequent form of OC, a disease with a poor prognosis and high lethality, as most patients are diagnosed at advanced stages. To successfully battle EOC, it is crucial to identify reliable biomarkers and use personalised therapies in patient subgroups. A common feature of high-grade serous and endometrioid OC is homologous recombination repair deficiency (HRD), which frequently stems from the inactivation of the breast cancer susceptibility (BRCA) genes. Poly-(adenosine diphosphate [ADP])-ribose polymerase inhibitors (PARPi) were, therefore, developed for their lethality against HRD tumour cells. While patients with non-HRD tumours may also benefit from PARPi therapy in the recurrent EOC setting, recent phase III trials on newly diagnosed advanced-stage EOC have shown that PARPi treatment benefit is greater in patients with HRD tumours. These findings open new avenues for the use of PARPi as maintenance therapy in HRD-positive patients who had received first-line chemotherapy. This manuscript provides recommendations for Belgian physicians on how to approach HRD testing and incorporate it into treatment decisions of patients with newly diagnosed advanced-stage EOC.
(BELG J MED ONCOL 2023;17(2):38–45)
Read moreBJMO - volume 17, issue 2, march 2023
C. Isnard-Bagnis MD, PhD, J. Nortier MD, PhD, C. Vulsteke MD, PhD, C. Hermans MD, PhD, S. Treille De Grandsaigne MD, P. Clement MD, PhD, A. Awada MD, PhD
Chronic kidney disease (CKD) and cancer are intertwined in many ways. In fact, cancer can cause CKD either directly or indirectly through the treatment adverse effects, while CKD may conversely be a risk factor for cancer. According to the Belgian Renal Insufficiency and Anticancer Medications (BIRMA) study, 64% of patients with cancer had a glomerular filtration rate (GFR) <90 ml/min/1.73m2 and 16% of them presented with a mildly to severely decreased GFR (i.e.; <30 ml/min/1.73m2 or 30–60 ml/min/1.73m2). As many anticancer drugs are predominantly excreted in the urine, tailoring the drug dose to the renal function of the individual patient is a crucial consideration. Furthermore, patients with cancer and CKD are also at an increased risk of thrombosis. Therefore, safe and effective drugs for the treatment and prevention of thrombotic events are necessary.
(BELG J MED ONCOL 2023;17(2):46–51)
Read moreBJMO - volume 17, issue 1, january 2023
B. Depreitere MD, PhD, S. Schelfaut MD, F. Sinnaeve MD, H. Wafa MD, M. Lambrecht MD, PhD, M. Christiaens MD, PhD, M. Delforge MD, PhD, F.J. Sherida H. Woei-A-Jin MD, PhD, P. Brys MD, M. Renard MD, R. Sciot MD, PhD, J-F. Daisne MD, PhD
Primary bone tumours of the spine are relatively rare when compared to metastatic lesions and haematopoietic neoplasms. This often results in misdiagnosis leading to a high incidence of inadvertent intralesional surgery, which is associated in many cases with worse progression-free survival and overall survival. Based on evidence and consensus, a protocol was designed at the University Hospitals Leuven, intended to guide all possibly involved caregivers in different clinical situations. The protocol raises awareness of potentially suspicious situations and provides expert input to avoid unfortunate decisions, even in situations with alarming neurological deficits.
(BELG J MED ONCOL 2023;17(1):4–10)
Read moreBJMO - volume 17, issue 1, january 2023
N.A. de Glas MD, M.G. Derks MD, F. van den Bos MD, M. Slingerland MD, J.E. Portielje MD, PhD
Randomised clinical trials are still the gold standard when it comes to the development of new drugs. There are, however, important limitations to trials. Such as, patients included in clinical trials are often not representative of the general population, which limits the applicability of trial results in clinical practice. In this article, the advantages and disadvantages of observational data are discussed. For example, observational data are generally more representative of the general population and can include large numbers of patients. However, there are important biases that should be considered when performing observational studies. Of these, so-called ‘confounding by indication’ is the most important form of bias, which means that reasons for certain treatment allocations are also associated with outcomes of treatment, which can disrupt the analyses. In summary, real-world data can add to clinical trials, but bias in these studies cannot be completely resolved. For this reason, clinical trials remain essential and should attempt to use less stringent inclusion criteria in order to improve the generalisability of their results.
(BELG J MED ONCOL 2023;17(1):11–4)
Read moreBJMO - volume 16, issue 7, november 2022
I. Joye MD, PhD, S. Vanderkam MD, N. Meireson MD, R. Weytjens MD
Treatment of pancreatic ductal adenocarcinoma (PDAC) has been the subject of controversy for decades. At the centre of this controversy is radiation therapy. Since PDAC is considered a systemic disease, the role of radiation therapy is debated. However, most of the available evidence is blurred by suboptimal radiation doses, less effective chemotherapy regimens and abandoned radiotherapy techniques. This article reviewed the available literature and discussed the changes in radiation therapy that have taken place over the past decade.
(BELG J MED ONCOL 2022;16(7):328–35)
Read moreBJMO - volume 16, issue 7, november 2022
P. Populaire MD, S. Isebaert PhD, K. Haustermans MD, PhD
Colorectal cancer is a prevalent cancer in Belgium. Unfortunately, many of these patients will develop metastases at some point in their disease. However, given the new therapeutic options, the prognosis of these patients is better than before. Local ablation of metastases is among these therapeutic options. This concept of metastasis-directed therapy (MDT) is generally accepted for oligometastatic disease. It can be accomplished by a multitude of techniques, including surgery, radiofrequency and microwave ablation, but also radiotherapy (RT). This review addressed the rationale and application of RT within this context.
(BELG J MED ONCOL 2022;16(7):336–42)
Read moreBJMO - volume 16, issue 6, october 2022
E. Agostinetto MD, V. Debien MD, G. Nader-Marta MD, D. Martins-Branco MD, E. de Azambuja MD, PhD
Neoadjuvant treatments in patients with breast cancer provide the opportunity for a direct evaluation of treatment effect on tumour size, allow higher rates of conservative surgery and give the chance to tailor systemic treatments after surgery. Patients who achieve a pathological complete response experience better long-term survival, compared to those with residual disease after the completion of neoadjuvant therapy, and those with residual invasive disease at surgery may benefit from additional post-neoadjuvant treatment strategies. Some systemic post-neoadjuvant treatments for patients with residual disease at surgery are already approved in clinical practice (i.e., capecitabine for patients with triple-negative breast cancer, or T-DM1 for patients with HER2-positive disease), and several new strategies are currently under evaluation. The present review discusses the available evidence for the implementation of systemic post-neoadjuvant treatment strategies into clinical practice for patients with early breast cancer, shading light on the pitfalls and limitations of different studies, and summarising data on novel promising treatment strategies that are being explored in clinical trials.
(BELG J MED ONCOL 2022;16(6):262–73)
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