REVIEW ONCOLOGY

Emerging therapies in gynaecological cancers (part 2): Endometrial cancer – Adjuvant and metastatic settings

SUMMARY

Historically, the treatment of patients with advanced and metastatic endometrial cancers (ECs) included a limited number of systemic therapeutic options. The identification of four distinct molecular subgroups through the TCGA classification has significantly improved the understanding of this disease and enabled the development of new treatments. Around 25–30% of ECs are known to have a MSI-H/MMRd status and are characterised by high PD-L1 expression and strong CD8+ T cell infiltration, explaining their remarkable sensitivity to immune checkpoint inhibitors (ICIs). Indeed, these therapies have demonstrated high response rates and significant survival benefits, redefining the standard of care in both first-line and recurrent settings. In contrast, 70–75% of ECs have a MSS/MMRp status, including a heterogeneous population and thus exhibiting more variable responses to ICIs. Furthermore, emerging approaches include the use of antibodydrug conjugates targeting proteins that are overexpressed in tumour cells and often linked to poor prognosis, such as Trop-2 and HER2. Selinexor, an exportin 1 (XPO1) inhibitor inducing nuclear accumulation of key proteins and leading to tumour cell death, is another innovative strategy.

(BELG J MED ONCOL 2025;19(4):143–150)

Global perspectives and challenges of breast cancer care in Europe

SUMMARY

Breast cancer care is a costly health issue in Europe where efficacy depends on early detection and equitable access to treatment options. Yet, inequities persist and must be addressed. With a better strategy we could do more with less, providing value-based cancer care with a focus on patient-centred research.

(BELG J MED ONCOL 2025;19(4): 151–156)

Emerging therapies in gynaecological cancers (part 1) : Locally advanced and metastatic cervical cancer

SUMMARY

Although progress has been made through screening and vaccination against human papillomavirus (HPV), locally advanced (LACC) and metastatic cervical cancer continue to present significant therapeutic challenges. Indeed, the treatment strategies have remained largely unchanged for almost twenty years. In the LACC setting, recent research has focused on improving standard treatment (chemoradiation followed by brachytherapy), including neo-adjuvant chemotherapy (INTERLACE trial) or addition of an immune checkpoint inhibitor (ICI) (ENGOT-Cx11 study). In metastatic disease, immunotherapy is also making strides, encompassing ICIs in the first-line treatment; but also, tumour-infiltrating lymphocytes (TILs) transfer and therapeutic vaccination are still in clinical trials. The antibody-drug conjugate (ADC) tisotumab vedotin has demonstrated efficacy in second- or third-line therapy, while other ADCs targeting HER2 and TROP2 are under investigation. These innovative treatments offer hope for improving survival outcomes in patients with cervical cancer.

(BELG J MED ONCOL 2025;19(3):88–95)

Clinical application of circulating tumour DNA (ctDNA) in breast cancer management

SUMMARY

In recent years, the introduction of circulating tumour DNA (ctDNA) has advanced precision medicine in breast cancer management. Progress in tumour biology and improvements in ctDNA detection assays have enabled its implementation in metastatic breast cancer, with regulatory authorities approving assays for detecting specific mutations to guide treatment selection. In early breast cancer, studies have demonstrated that ctDNA detection during follow-up after definitive treatment is associated with worse outcomes. Ongoing interventional studies are evaluating the clinical utility of ctDNA in this context. Additionally, the potential role of ctDNA in breast cancer screening is under investigation. This review discusses the current indications for ctDNA and ongoing studies in breast cancer.

(BELG J MED ONCOL 2025;19(3): 96–103)

The accuracy of PSMA PET/CT for assessing intraprostatic lesions in patients with prostate cancer: An evaluation of the PI-RADS, PRIMARY and PSMA-expression score

SUMMARY

Background: Magnetic Resonance Imaging (MRI) is advised for the diagnosis of prostate cancer (PC), and PSMA PET/CT is used for distant staging of PC. Local staging of the primary tumour with PSMA PET/CT is currently not recommended, although the primary lesion can be visualised as well. Recently, two new tumour-assessing scores were developed to optimise the diagnostic accuracy of PSMA PET/CT for the primary tumour: the PSMA-expression score and the PRIMARY score.

Objective: To evaluate the performance of PSMA PET/CT and its PRIMARY and PSMA-expression scores in the assessment of intraprostatic lesions in patients with PC. Patients and methods: This is a retrospective analysis of patients treated with radical prostatectomy for PC in a single tertiary centre between 2019 and 2022. All patients underwent preoperative prostate MRI and 18F- or 68Ga-PSMA-11 PET/CT. The medical images were pseudonymized and retrospectively assessed by two radiologists and a nuclear medicine specialist. The PSMA PET/CTs were scored according to the PSMA-expression score (PROMISE V2 framework) and the PRIMARY score. The MRIs were scored using the PI-RADS system. The accuracy of the three different scores for diagnosing high-grade PC (ISUP grade ≥3) was evaluated.

Results: The PSMA-expression score demonstrated the highest accuracy for detecting high-grade PC, with an AUC of 0.76, outperforming the PI-RADS scores from reader 1 (AUC of 0.59) and reader 2 (AUC of 0.68) and the PRIMARY score (AUC of 0.69). It had a sensitivity of 72%, a specificity of 70%, a positive predictive value of 85%, and a negative predictive value of 51%.

Conclusion: PSMA PET/CT has a promising diagnostic accuracy to detect intraprostatic lesions of high grade in patients with PC. Further validation of the PSMA PET scoring systems is warranted.

Patient summary: In this study, the performance of PSMA PET/CT (the PRIMARY and PSMA-expression scores) to detect malignant lesions in the prostate was evaluated. PSMA PET/CT and these scoring systems seem promising to detect PC and could be of interest in cases where MRI is ambiguous.

(BELG J MED ONCOL 2025;19(2):46–53)

The development of a supporting tool for professionals for adequate referral of cancer patients to supportive care services in Belgium: The Belgian Handbook for (Haemato)-Oncological Supportive Care

SUMMARY

Supportive oncological care is essential for ensuring the quality of life of cancer patients and carers. In the long-term, adequate care for survivors can lead to less severe sequelae and reduced need for medical support. Despite the advances in cancer treatment leading to increased survival rates, not all patients in Belgium have equal access to supportive care. Key hindrances include the lack of legal and practice frameworks and insufficient knowledge of available services among patients and professionals. This paper discusses the development of a supporting tool for professionals to adequately refer patients to reliable and accessible supportive care services in Belgium: The Belgian Handbook for (Haemato)-Oncological Supportive Care. The methods used in the development process are presented and discussed with regard to achieving a useful and sustainable tool.

(BELG J MED ONCOL 2025;19(2): 54–60)

Admission of patients with solid cancer in the Intensive Care Unit: Challenging situations

SUMMARY

The proportion of cancer patients considered for admission in intensive care units (ICU) gradually increased over the last decades. In this situation, it is important to avoid inappropriate management, whether through refusal of admission that could be beneficial, or through futile therapeutic escalation. In this review, we describe the factors that medical oncologists and intensive carers should discuss when considering ICU admission for cancer patients and propose a framework for decision-making based on four important concepts. Among cancer patients, data strongly suggest that the short-term prognosis is more linked to the acute pathology than to the underlying active tumour. More specifically, the impairment of more than two vital organs and the requirement of organ support are the most important factors predictive of mortality. ECOG performance status furthermore remains a crucial prognostic factor to consider. Open discussions with patients and close relatives at cancer diagnosis and during treatment are mandatory for informed decision making during an acute event.

(BELG J MED ONCOL 2025;19(1): 4–10)