REVIEW ONCOLOGY

Photobiomodulation and gynaecological cancer therapy-related complications: What is known?

SUMMARY

Cancer treatment options are steadily improving, but the resulting side effects remain a significant burden. Some of these adverse events can occur in the genitourinary system and often lack a comprehensive management approach. Photobiomodulation therapy (PBM) uses visible or (near)-infrared light to stimulate tissue regeneration. This narrative review discusses the most common cancer therapy-related adverse events in the genitourinary sphere, the causative factors, their current treatment options, and the possible use of PBM in their management strategies. The findings suggest that PBM has the potential to be effective in the treatment of gynaecological cancer therapy-related complications, but further research is required.

(BELG J MED ONCOL 2024;18(1):4–9)

Update metastatic cutaneous melanoma: Increasing the therapeutic armamentarium

SUMMARY

Systemic treatment for irresectable or metastatic malignant melanoma has transformed over the past decade. For patients harbouring a BRAF V600 mutation, two standard treatment options exist, namely targeted therapy or anti-PD1 based therapy. For all other patients, immune checkpoint blockade based on monoclonal antibodies against anti-PD1 is considered the standard-of-care. Combination therapy with other checkpoint blockers such as anti-CTLA4 or anti-LAG3 are characterised by an improved outcome but are also associated with higher toxicity – which in case of the anti-PD1/anti-CTLA4 combination can be considerable. Up to date, patient selection for either monotherapy or combination therapy is largely based on patients’ demographics. Recent data suggest that treatment naïve patients with a BRAF V600 mutation have a better outcome when combination therapy with anti-CTLA4/anti-PD1 is given in first-line and BRAF/MEK inhibitory therapy is postponed to second-line. Patients who have exhausted their standard-of-care options should be included in a clinical trial and most scientific activity is evolving in the field of the immunotherapy refractory setting. A staggering number of different targets engaged in increasingly diverse subpopulations of immune effector- and regulator cells including the tumoral and stromal compartment are being explored in both the pre-clinical and clinical setting. These efforts will undoubtedly pave the way for the next transformation in the treatment of patients with malignant melanoma.

(BELG J MED ONCOL 2024;18(1):10–16)

Discussing sexuality-related issues with breast cancer patients: When and how?

SUMMARY

The improvements in breast cancer treatment have resulted in an increased survival rate and a growing number of breast cancer survivors. These survivors have to learn to cope with the side effects of breast cancer treatment. These side effects often have an important impact on patient’s general and sexual well-being. In clinical care, sexual side effects are often un(der)recognised because physicians and patients experience barriers to discussing sexuality-related issues. It is, nevertheless, important and relevant to discuss sexuality during the various stages of (breast) cancer treatment. For young women at the start of breast cancer treatment, fertility-related questions may arise. During the different phases of breast cancer treatment, sexual functioning and sexual experience may be altered by the physical, psychosocial, and relational impact of breast cancer diagnosis and treatment. This article aimed to highlight easy-to-use methods to discuss sexuality proactively for any healthcare provider involved in the care of the cancer patient. Mentioning sexuality in the early stages of (breast) cancer treatment and addressing sexual sequelae of breast cancer diagnosis and treatment can significantly improve patients’ quality of life.

(BELG J MED ONCOL 2023;17(7):252–8)

The Belgian Virtual Tumourbank: Residual tumour samples with high quality data

SUMMARY

The Belgian Virtual Tumourbank (BVT) network has been set up in order to facilitate the search for samples scattered among eleven Belgian tumour biobanks that collect and store residual human tumour samples locally. To achieve this, the central database (BVTr) collects patient, technical and oncological data of human residual samples stored locally in a harmonised and standardised way. In parallel, the catalogue (BVTc) enables researchers to trace the samples required for their oncology research. The implementation of automatic and manual data quality control steps guarantees a high quality of associated data from residual tumour samples and associated materials. This article presents the results of a new quality control study on breast sample data and the possibilities for researchers searching for samples. The BVT catalogue is a valuable source of information for oncology research. The ultimate goal is to promote multidisciplinary cancer research to benefit all cancer patients.

(BELG J MED ONCOL 2023;17(6):206–10)

Rethinking the reimbursement of innovative medicines in oncology: Looking beyond overall survival

SUMMARY

The oncological treatment landscape is evolving at a very rapid pace with a continuous stream of novel treatment options. To fully leverage these therapeutic advances in clinical practice it is important to facilitate a rapid access to innovative anticancer drugs for patients. Specifically for Belgium, the delay from EMA approval to reimbursement for anticancer drugs is very long, with an average of almost 600 days, and a substantial proportion of innovative drugs never make it to the patient. The stringent focus of the Belgian Commission for Reimbursement of Medicines (CRM) on overall survival (OS) data in reimbursement decisions is believed to be an important contributor to this situation. However, the ever-increasing pace at which new anticancer therapies are being developed in combination with an earlier detection of cancer will make it increasingly difficult to present mature OS data at the time of regulatory approval in the years to come. As such, there is an urgent need for a debate with the regulators to consider more readily available endpoints in their reimbursement assessments. In fact, when a strong treatment effect is seen on an intermediate endpoint such as disease-free or progression-free survival, a benefit in OS is quite likely. As such, our reimbursement system needs to be adapted to better align with the scientific progress in oncology. In this, a temporary reimbursement decision based on intermediate endpoints could give Belgian patients earlier access to promising lifesaving medicines. In this, we as oncologists, including specialists in haematology, respiratory oncology, and gastrointestinal cancer, strongly encourage the CRM to use the grading provided by the ESMO magnitude of clinical benefit scale to evaluate the clinical added value of future cancer treatments. This will not only facilitate a faster patient access to innovative therapies, but will also help policy-makers in advancing ‘accountability for reasonableness’ in their resource allocation deliberations.

(BELG J MED ONCOL 2023;17(6):211–5)

Individualising radiation therapy decisions in breast cancer patients based on tumour-infiltrating lymphocytes and genomic biomarkers

SUMMARY

Radiation therapy (RT) has long been fundamental for the curative treatment of breast cancer. While substantial progress has been made in the anatomical and technological precision of RT delivery, and some approaches to de-escalate or omit RT based on clinic-pathologic features have been successful, there remain substantial opportunities to refine individualised RT based on tumour biology. A major area of clinical and research interest is to ascertain the individualised risk of loco-regional recurrence to direct treatment decisions regarding escalation and de-escalation of RT. Patient-tailored treatment with RT is considerably lagging behind compared with the massive progress made in the field of personalised medicine that currently mainly applies to decisions on the use of systemic therapy or targeted agents.

Herein we review select literature surrounding the use of tumour genomic biomarkers and biomarkers of the immune system, including tumour-infiltrating lymphocytes (TILs), within the management of breast cancer, specifically as they relate to progress in moving toward analytically validated and clinically tested biomarkers utilised in RT.

(Belg J Med Oncol 2023;17(6):216–29)

Neutrophil extracellular traps and circulating tumour cells

SUMMARY

Cancer is a leading cause of morbidity and mortality worldwide. The process of metastasis involves many steps, with circulating tumour cells (CTCs) playing an essential role. This literature review examines the role of neutrophil extracellular traps (NETs) in the survival and implantation of CTCs in secondary organs. CTCs get to secondary organs primarily through the bloodstream and can then extravasate into the parenchyma of these organs. NETs are formed by various stimuli, including cancer. They can occur in primary tumours, but are most commonly present in metastatic tumour sites. They make the blood vessels of both primary organs and secondary organs more permeable, allowing CTCs to enter the bloodstream and extravasate from the bloodstream into the secondary organs, respectively. NETs also protect CTCs from degradation by the immune system and can trap CTCs in the microvasculature of secondary organs, allowing CTCs to be more numerous in the vasculature before entering these organs. This contributes to the formation of micrometastases and, subsequently, macrometastases. It also appears that this metastatic cascade is more easily initiated after surgery of the primary tumour, due to an increase in inflammation and, thus, increased formation of NETs. NETs can also awaken dormant tumour cells, which promotes metastasis as well. In short, NETs play an important role in the different stages of the life cycle of CTCs. Treatments against NETs may, therefore, offer important advances in fighting cancer.

(BELG J MED ONCOL 2023;17(4):112–7)