REVIEW ONCOLOGY

Optimal management of pancreatic cancer: current standards and challenges for improving care and research

Summary

Pancreatic cancer is one of the most lethal cancers and will become the second leading cause of cancer-death; despite some progress in management, median survival remains around 24 months in resected disease, fifteen months in locally advanced non resectable disease and twelve months in metastatic setting. Two backbone regimens, folfirinox and gemcitabine-abraxane are nowadays used in routine practice, mainly in metastatic disease but are now investigated in both adjuvant and neo-adjuvant therapy. Neoadjuvant therapy, although requiring robust proof of definite efficacy, is more frequently used for borderline resectable tumours with promising results; moreover, it offers a unique window to integrate care and research by assessing new drugs in translational platforms. Molecular biology (multiomics) and imaging (radionomics) will also permit and promote a more comprehensive use of new drugs, including immune-oncological ones and strategies and select the best patients for precision medicine, the ultimate goal being to improve this poor outcome. This review covers the current standard and best practice in the different sub-entities of pancreatic cancer and opens perspectives in new therapeutic challenges.

(BELG J MED ONCOL 2018;12(2):39–45)

Fertility preservation in breast cancer patients

Summary

Fertility issues are a major concern for young patients diagnosed with breast cancer. This review focuses on the importance of taking treatment-related ovarian function and fertility decline into consideration by offering appropriate pre-treatment counselling. Fertility preservation options, including oocyte or embryo vitrification, cryopreservation of ovarian tissue, and administration of gonadotropin-releasing hormone analogues should be discussed before starting chemotherapy. We outline the advantages and disadvantages of each technique and review recent data on their efficacy and safety.

(BELG J MED ONCOL 2018;12(1):4–8)

Breast cancer and pregnancy-related issues

Summary

Breast cancer and pregnancy-related issues are important areas of concern for young women. Prior pregnancies and breastfeeding may impact the risk of developing breast cancer and its biologic features. Nowadays, thanks to major advances in oncology practice, breast cancer patients have excellent survival outcomes; hence, survivorship issues including the possibility to constitute a family after treatment are of crucial importance. Furthermore, considering the current trend of delaying childbearing, an increased awareness should be paid towards the possibility of breast cancer diagnosis during pregnancy. Despite increased amounts of data available and consensus guidelines having been published on these topics, it should be noted that current recommendations rely on limited evidence. Hence, further research efforts are needed to obtain more conclusive considerations in this regard.

This review article focuses on the link between reproductive behaviour, infertility treatments and the risk of developing breast cancer, the management of patients diagnosed with breast tumour during pregnancy, as well as the concerns of a pregnancy in survivors with prior history of breast malignancy.

(BELG J MED ONCOL 2018;12(1):9–14)

Liquid biopsy in breast cancer: challenges and opportunities

SUMMARY

Despite the use of effective loco-regional and systemic treatment approaches, many women with early-stage breast cancer still relapse and die of their disease. The early detection of small micrometastatic lesions that are currently undetectable by imaging procedures may potentially increase the chances to prevent the development of incurable metastatic disease. In patients with advanced disease, biological features of the tumour can change between the primary lesion and the metastases. However, in routine clinical practice, due to the difficulty of performing a biopsy of the recurrent lesions, treatment choices are often based on the biological features of the primary tumour. Moreover, one sample from a single metastatic lesion at a specific time point cannot capture the spatial and temporal intra-tumour heterogeneity of metastatic disease. Circulating-based biomarkers (i.e. ‘liquid biopsy’) such as circulating tumour cells and circulating tumour DNA are non-invasive biomarkers that have been developed to overcome the limitations of currently available tools in both the early and metastatic settings. In this manuscript, we review the current state of the art on circulating tumour cells and circulating tumour DNA in breast cancer focusing on their potential clinical utility as prognostic biomarkers, as tools to detect minimal residual disease, and to guide and monitor response and resistance to administered anticancer therapies.

(BELG J MED ONCOL 2017;11(8):357–363)

The role of photobiomodulation therapy in the care of cancer patients: review of the literature

SUMMARY

Photobiomodulation therapy is based on the application of visible and/or (near-)infrared light on the target tissue. We performed a review of 34 articles on the use of photobiomodulation therapy in the management of cancer related lymphoedema, oral mucositis, radiodermatitis, chemotherapy-induced peripheral neuropathy, osteonecrosis of the jaw, and xerostomia/hyposalivation. The findings suggest that photobiomodulation therapy is a promising option for the management of these cancer therapy-related side effects.

(BELG J MED ONCOL 2017;11(8):364–374)

Will there ever be a lung cancer vaccine?

SUMMARY

Current treatment options for advanced stage non-small cell lung cancer (NSCLC) include chemotherapy and targeted therapy. Immunotherapy is the most recent strategy to improve survival in NSCLC. Among other newly developed immunotherapeutics, all aiming to enhance and reinforce the natural ability of the immune system to fight cancer, lung cancer vaccines aim to increase the number of tumor-reactive T-cells. Although preclinical models have shown that vaccines enhance effector T-cell infiltration into the tumor, this effect has not been translated into clinical benefit in multiple, large, randomised, placebo-controlled studies. Recent understanding of cancer immunology has shown that the immunosuppressive microenvironment of NSCLC is able to inactivate the tumor-reactive T-cells generated by therapeutic vaccination.

Consequently, combining vaccination with other immunotherapeutics to reverse this immunosuppressive environment (such as anti-PD-1/PD-L1) seems to be the best way forward.

Furthermore it will be important to develop relevant biomarkers to choose the most adequate combination of immunotherapeutics for each individual patient, because of the diverse mechanisms of immunosuppression by the tumor.

(BELG J MED ONCOL 2017;11(6):255–258)

Leptomeningeal carcinomatosis from solid tumours: a systematic review of the literature

SUMMARY

Leptomeningeal carcinomatosis (LC), or neoplastic meningitis, is a disastrous complication of advanced cancer. This disease occurs in approximately 5% of patients with solid tumour and results from the dissemination of tumour cells from the cerebral spinal fluid (CSF) flow throughout the entire central nervous system (CNS). LC is characterized by multiple and fluctuant neurologic symptoms and signs. Useful tests for the diagnosis include magnetic resonance imaging (MRI) and CSF analysis. Unfortunately, the diagnosis remains challenging due to pleomorphic symptoms and false negative results of diagnostic procedures. For most patients, the aim of the treatment is to control symptoms, by using targeted radiotherapy and corticosteroids. More aggressive therapeutic approaches, such as intrathecal (IT) or systemic chemotherapy, should be restricted to highly selected and good-risk patients. Moreover, only few randomized clinical trials are available in the field and studies using more recent targeted therapies or immunotherapy should always be considered in these patients, as outcome with standard of care is disappointing.

(BELG J MED ONCOL 2017;11(6):259–264)