REVIEW ONCOLOGY

Pancreatic cancer: Where are we now and where are we going?

SUMMARY

Pancreatic cancer is one of the deadliest cancer types. Incidence rates are on the rise in the Western world, transforming it into one of the most common causes of cancer-related death. Pancreatic adenocarcinoma is the most frequently encountered type and diagnosis often occurs in an advanced stage, hence when curative treatment is no longer an option. Current management strategies are based on the tumour stage and resectability as well as patient characteristics, and should be discussed by a multidisciplinary tumour board. In patients with resectable disease, surgery followed by adjuvant therapy is the golden standard. Neoadjuvant strategies are currently gaining popularity, especially for borderline resectable disease. In the advanced setting, treatment with combination chemotherapy has only modestly improved overall survival. The field of personalised medicine is rapidly evolving and slowly trying to find its way into the classically defined treatment paradigm of pancreatic cancer. In this article, we aim to provide an overview of the current treatment options and highlight future developments.

(BELG J MED ONCOL 2021;15(1):11-9)

Cancer incidence in Belgium, 2004-2017

SUMMARY

Cancer incidence in Belgium – just as worldwide – is increasing, essentially attributable to an ageing and growing population. The aim of this study is to describe the incidence of different cancers in Belgium based on the most recent data, reaching to the year 2017. When comparing Belgium to Europe, Belgium is ranked within the top ten European countries as for overall cancer incidence rates. In particular, Belgian breast cancer incidence rates are among the highest in Europe. The cumulative risk of developing cancer before the age of 75 years in Belgium is currently 34% in males, compared to 28% in females. This discrepancy between both sexes is expected to diminish further as the overall cancer risk in males tends to decline while a gradual increase is observed in females. The most frequently occurring tumour types in Belgium remained unchanged over the last decade (i.e. lung- and colorectal cancer in both sexes, prostate cancer in males and breast cancer in females) and they represent the major part (54%) of the overall cancer incidence. However, different tendencies in cancer risk are observed for the individual tumour types, also explaining the opposite evolution of overall cancer risk in males in comparison to females.

(BELG J MED ONCOL 2021;15(1):4-10)

Multimodality treatment approach for rectal cancer

SUMMARY

Rectal cancer treatment constitutes a complex exercise. With the exception of very early and metastatic disease were surgery and palliative chemotherapy are respectively the backbone treatment modalities, the optimal treatment strategy for rectal cancer remains a subject of active debate. Different therapeutic options, including local and systemic approaches like different surgical techniques, radiation therapy, chemoradiotherapy and chemotherapy in different sequences and settings are commonly combined in clinical practice. This multimodal treatment strategy improved survival and reduced local recurrence, but the optimal way to combine the different modalities represents a subject of active research. In the coming paragraphs we attempt to answer some of the most important questions, in our opinion, regarding multimodality treatment approach for rectal cancer through a systematic review of the literature.

(BELG J MED ONCOL 2020;14(7):311-20)

Early detection and diagnosis of prostate cancer in well informed men: the way forward for Europe

SUMMARY

As 107,000 men died of prostate cancer in Europe in 2018, this is not an indolent disease. It is responsible for >10% of all male cancer deaths. Most men are not aware that it is possible to have asymptomatic prostate cancer and are uninformed about the existence and value of the PSA blood test. Early detection of prostate cancer reduces the mortality rate and can be easily cured without unbearable side effects and at a rather low price. Advanced cancer is less amenable for cure, with substantial side effects and a significant reduction in quality of life, and has a high chance of becoming metastatic and castrate-resistant. Treatment of this late stage disease is costly and prolongs life with on average only two years. Most importantly, the quality of life of these men is poor. The arguments against PSA testing are focused on issues related to over-diagnosis and overtreatment. These arguments have led in some countries to a decrease in testing, which in turn has led to an increase in too late diagnosis. In this paper, we present the results of clinical trials on early detection, the risks and benefits of early detection using PSA testing, and a way forward for the EU Cancer Plan using the current EAU scientific guidance on early detection as a basis. We conclude that PSA can now be used in a more clever fashion to ensure that men are diagnosed early enough to be able to prevent meaningful clinical disease, increase quality of life, and reduce costs for healthcare systems.

(BELG J MED ONCOL 2020;14(7):321-6)

Lessons learned after two decades of international academic clinical research in breast cancer: 2019 JC Heuson Memorial Lecture

SUMMARY

The Breast International Group (BIG), founded in 1999, is the umbrella organisation harnessing the efforts and supporting the activities of its nearly 60 national and international cooperative group members worldwide. BIG’s collaborative research model provides academic leadership in industry-sponsored randomised clinical trials. Some of these trials have successfully led to the rapid registration of new anticancer drugs with a significant impact on breast cancer mortality, such as the HERA trial, which contributed to the registration of adjuvant trastuzumab in many countries around the world in less than four years. BIG also supports clinical trials sponsored by its academic member groups and facilitates collaboration between international researchers and the US cooperative groups: the SOFT and TEXT trials evaluating adjuvant endocrine therapies for 5,738 premenopausal women are an example of such a collaboration, which has helped clarify which women can be safely treated with tamoxifen and which women are best served by a combination of tamoxifen or an aromatase inhibitor with an LHRH agonist. BIG is most proud of its ambitious purely ‘academic’ initiatives: namely MINDACT and AURORA.

MINDACT, which was recently updated at a median follow-up of 8.7 years on its 6,693 enrolled patients, most of whom had hormone receptor positive/HER2 negative (HR+ HER2−) early breast cancer, continues to demonstrate the clinical utility of a low risk 70 gene signature for foregoing adjuvant chemotherapy in the presence of a high clinical risk (and no more than three positive nodes) in women older than 50 years. In younger women, a clinically relevant chemotherapy benefit of about 5% has emerged and should be part of informed shared decision-making. AURORA is an ongoing European effort at elucidating the clonal evolution of breast cancer towards the development of lethal metastasis: with close to 1,000 women with metastatic breast cancer already enrolled, it aims at the integration of multiple genomic analyses with high quality clinical data, longitudinal sampling and a biobank. Its impact could be improved treatment strategies and personalisation in the years to come.

(BELG J MED ONCOL 2020;14(7):327-32)

Management of Mucinous Ovarian Cancer in 2020: literature survey

SUMMARY

In this article the authors reviewed literature regarding mucinous ovarian carcinoma (MOC), which represents a special challenge as a rare ovarian tumour (about 3%) with unique clinical characteristics as compared to serous ovarian carcinoma (SOC). MOC is mostly diagnosed at an early stage and is generally associated with an excellent prognosis. However, later stages usually remain resistant to medical treatment, with early deaths occurring. Overall, advanced MOC patients seem 2.3 times more likely to die of their tumour as compared to SOC patients. Anatomo-pathological diagnosis and distinguishing between primary and metastasised MOC remains difficult and sometimes inconclusive, despite the contribution of immunohistochemistry (IHC) and/or molecular biology. The preservation of fertility is currently conceivable in younger patients with an early stage disease.

(BELG J MED ONCOL 2020;14(6):246-53)

Locally advanced rectal cancer: What is the best perioperative strategy?

SUMMARY

The treatment for locally advanced rectal cancer involves a multidisciplinary approach in which total mesorectal excision usually is preceeded by (chemo)radiotherapy. Depending on risk factors, adjuvant chemotherapy is frequently applied. Preoperative short course radiotherapy and chemoradiotherapy result in high local control rates. However, the high risk on systemic relapse and the appealing concept of organ preservation urge researchers to explore alternative perioperative strategies. This review provides an overview of the established role of preoperative short course radiotherapy and chemoradiotherapy, as well as the evidence so far for short course radiotherapy with delayed surgery, induction chemotherapy and for neoadjuvant chemotherapy without radiotherapy.

(BELG J MED ONCOL 2020;14(6):254-62)