REVIEW ONCOLOGY

Tumour mutational burden: a review

SUMMARY

Immunotherapeutics, like immune checkpoint blockade (ICB), have demonstrated therapeutic efficacy in a variety of human cancers. Even among the tumour types described as responsive, immunotherapy is only efficient in a minority of the patients. To maximise therapeutic benefits, a biomarker to identify ICB-responders is needed. Tumour mutational burden would correlate with the efficacy of immune checkpoint inhibitors. Clinical evidence for TMB as biomarker already exists in metastatic melanoma, non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC). In this review an update about tumour mutational burden (TMB) is given.

(BELG J MED ONCOL 2020;14(1):4–7)

Adjuvant treatment of stage III melanoma: a tabulated review of randomised phase III trials

(BELG J MED ONCOL 2020;14(1):8–12)

Update in prostate cancer 2019

SUMMARY

The prostate cancer (PCa) landscape has changed dramatically over the past few years. New paradigm-shifting data are published nearly every month. This review aims to give a brief overview of the most important publications of 2018–2019. From the ever-lasting discussion about PSA screening, with the recent publication of the CAP trial, over diagnostics where multi-parametric MRI has caused a true revolution, to hypofractionation in radiotherapy and the dramatic treatment shifts in metastatic hormone sensitive and non-metastatic castrate resistant PCa. All exciting data that will change clinical practice.

(BELG J MED ONCOL 2020;14(1):13–21)

The hype of phase II trials

SUMMARY

Many of the new drugs are registered based on phase II data and surrogate endpoints. The medical oncologist should know the limitations and dangers of such an approach. The value of phase II trials and surrogate endpoints as well as clinical meaningful results are discussed.

(BELG J MED ONCOL 2019;13(7):273–6)

Molecular-defined melanoma: Implications for clinical practice

SUMMARY

Due to the development of genome-directed therapy and standardised methods of molecular analysis, molecular diagnostics has become an important part of daily practice in clinical oncology, especially in diseases like malignant melanoma where molecular testing has therapeutic implications. Melanoma has one of the highest mutation frequency of all cancers analysed in the TGCA (The Cancer Genome Atlas) and is characterised by an enormous genetic heterogeneity.¹ The discovery of ‘driver mutations’ directly involved in melanomagenesis has led to the development of small-molecule kinase inhibitors. The emergence of BRAF and MEK inhibitors has completely changed treatment paradigm for BRAF-mutant metastatic melanoma with dramatically improvement of therapeutic outcomes. Despite high response rates, the duration of response remains limited, mainly due to the development of acquired treatment resistance. In this review the authors try to outline the importance of molecular oncology for malignant melanoma by giving an overview of the most frequent and potentially clinically relevant molecular alterations, the targeted therapies already used in clinical routine and by discussing the problem of acquired resistance and treatment strategies being developed to circumvent these obstacles.

(BELG J MED ONCOL 2019;13(7):277–85)

Low Grade Glioma: towards a personalised treatment

SUMMARY

This review is designed to help the management of low grade glioma and is based on literature regarding molecular characterisation, surgery, radiotherapy, chemotherapy and neurocognitive preservation.

(BELG J MED ONCOL 2019;13(6): 213–218)

Introducing a Castrate Resistant Prostate Cancer (CRPC) Model Care Pathway in Belgian Hospitals – towards national standardisation?

SUMMARY

Castrate-resistant prostate cancer (CRPC) is characterised by complex strategies for therapy and follow-up. In order to standardise CRPC cancer care on a national basis, an integrated care pathway was devised, based on clinical governance principles and acknowledged best practice, in order to reduce length of hospital stay, reduce costs of patient care, improve patient outcomes (e.g. Quality-of-Life, complications), etc. Therefore, a steering group of Belgian experts, consisting of medical oncologist, urologists, radiation oncologists, oncology nurses, pathologists and nuclear medicines, was assembled to discuss the need for an integrated care pathway for CRPC in Belgium. This was made possible through the financial support of Astellas Belgium. An extensive integrated care pathway was discussed with various stages, depending on the disease status of the patient. Belgian implementation could lead towards further standardisation of cancer care for CRPC patients although several important matters still have to be discussed or adapted. Further assessment and inter-hospital deliberation seems required to ensure a national implementation of the CRPC integrated care pathway.

(BELG J MED ONCOL 2019;13(6): 219–226)