REVIEW ONCOLOGY

Doublets in the first-line treatment of metastatic renal cell cancer with clear cell histology

SUMMARY

The treatment of mRCC has undergone a tremendous evolution in the last decades. There are data that the doublets of checkpoints inhibitors with each other or with anti-angiogenic agents improve PFS compared to sunitinib alone.

In this article, we review the different combinations and give some guidance for their use.

(BELG J MED ONCOL 2022;16(2):48–52)

Is there a place for thromboprophylaxis in cancer patients?

SUMMARY

Venous thromboembolism (VTE) is common in cancer patients. It is associated with poor outcomes and increased mortality. In fact, VTE is known as the second most common cause of mortality in cancer patients. Although the benefit of thromboprophylaxis is clear for acutely ill hospitalised cancer patients, routine prophylaxis is not recommended for all ambulatory cancer patients. The reason is the risk to treat a high proportion of patients who do not need treatment and an increased risk of major bleeding. Here we highlight the importance of adequate risk assessment models to select patients at an increased VTE risk and present pivotal trial results that form the basis for the latest international treatment guidelines related to thromboprophylaxis in cancer patients.

(BELG J MED ONCOL 2022;16(2):53–9)

Cardiotoxicity of immune-checkpoint inhibitors: A rare, yet possibly fatal complication

SUMMARY

Immune checkpoint inhibitors (ICI) represent a class of drugs that has dramatically improved survival outcomes of patients with several solid and haematological malignancies. Due to their mechanism of action, treatment-related adverse events (AEs) induced by ICI are mostly immune-related AEs, which can affect any organ, including the cardiovascular system. Immune-related cardiac AEs are rare, occurring in less than 1% of patients receiving ICI. However, they are associated with a high fatality rate compared to other AEs. Together with an increasing awareness among physicians, cardiotoxicity of ICI requires further investigation to better understand the pathophysiology of this rare but possibly fatal complication, and to improve its diagnosis and treatment. The present narrative review aimed to describe the incidence and the underlying mechanism of ICIs’ cardiotoxicity, providing key messages for clinical practice for oncologists and cardiologists on their clinical manifestations and management.

Late cardiovascular side effects of cancer treatment

SUMMARY

Thanks to the enormous progress made in cancer treatment, there are more and more cancer survivors. Oncologists are now concerned with the long-term management of patients who have recovered from their cancer. Giving them the best chance of a healthy survival is a very important issue. However, in this context, epidemiological studies and registries have revealed that the prognosis of cancer survivors is marred by the onset of more frequent and earlier cardiovascular disease. The emerging cardio-oncology discipline is seriously concerned about this issue as the number of patients potentially affected is large and growing. The task consists of identifying patients at increased risk of cardiovascular events after cancer treatment. Patients at risk are those with pre-existing cardiovascular risk factors and heart disease, and those exposed to anticancer treatment with cardiac toxicity that appears during their follow-up. Identifying those high-risk patients is possible thanks to clinical, biological and imaging monitoring. Furthermore, this monitoring allows therapeutic interventions, ranging from lifestyle recommendations to pharmacological treatment. However, several important pending questions remain, including whether cancer survivors would benefit from a more aggressive approach than that used to treat non-cancer survivor patients for the same cardiovascular problem.

(BELG J MED ONCOL 2022;16(1):11–16)

Genomics of metastatic breast cancer

SUMMARY

The purpose of this review is to highlight the recent knowledge gathered on the genomics of metastatic breast cancer (BC), together with the clinical implications. Through large sequencing efforts, the genomic profile of BC is increasingly being deciphered, with a limited number of those findings having resulted in genomicmatched treatment options. The pace at which new discoveries are made is highest in the early setting, where large samples can easily be accessed through leftover tissue of resection specimens, and smaller diagnostic biopsies are also available. In the metastatic setting however, residual tissue from clinically indicated biopsies or resections are scarce. Some efforts have been undertaken through (inter)national, institutional, clinical trial- or patient-driven initiatives. They have highlighted important differences between the genomic landscape of metastatic versus primary tumour tissues. Especially in hormone receptor positive HER2 negative (HR+/HER2-) disease, driver mutations continue to accumulate after dissemination, most of them in the ESR1 or ERBB2 genes, or in genes involved in transcription regulation, MAPK- or PI3K-signaling pathways. Importantly, the genomic landscape is not homogeneous even within one patient, and significant heterogeneity is seen on an intra-patient, inter-lesion and intra-lesion level. This poses clinical challenges, with different subclones possibly harbouring differential sensitivity to systemic treatments and single biopsies not accurately reflecting the full molecular profile. Finally, through liquid biopsies, a more complete and less invasive insight into the tumour’s characteristic could theoretically be retrieved. However, it is unclear how well these profiles correlate with the actual diversity of the different lesions. Importantly, rapid autopsy programs have been shown to enhance research on the genomics of metastatic BC, and one such program was recently launched at UZ/KU Leuven.

(BELG J MED ONCOL 2022;16(1):18–28)

When is a cancer progressive on imaging?

SUMMARY

The outcome of a cancer treatment should be adapted according to the treatment the patient is receiving and, in some instances, to the tumour type.

The different evaluation systems (RECIST 1.1, iRECIST, mRECIST, EORTC and PERCIST) have all their specific indications and rules, and they should be known by the radiologist and the oncologist.

This review focuses on the criteria to consider cancer as progressive, in relation to cancer treatment and tumour type.

(BELG J MED ONCOL 2022;16(1):29–32)

Clinical applications of circulating tumour DNA

SUMMARY

Circulating tumour DNA (ctDNA) analysis has the potential to advance precision medicine. The epidermal growth factor receptor (EGFR) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) single gene assays in plasma cell free DNA are being used for selecting patients with metastatic lung and breast cancer for treatment with EGFR and PIK3CA inhibitors, respectively. More recently, multigene assays have been approved by the Food and Drug Administration as companion diagnostics for the selection of patients that may benefit from specific targeted therapies. Moreover, ctDNA may allow a noninvasive monitoring of tumour genotype and treatment response. Potential future applications include systemic treatment of patients with ctDNA relapse and early cancer detection.

(BELG J MED ONCOL 2021;15(7):345-50)