BJMO - 2022, issue Targeted Therapy Special, november 2022
T. Feys MBA, MSc, P. Pauwels MD, PhD
In recent years, the number of approved targeted therapies for patients with advanced non-small-cell lung cancer (NSCLC) has steadily increased, making an efficient and effective molecular profiling of paramount importance in the management of NSCLC patients. To ensure that patients receive the most appropriate treatment, broad upfront molecular testing including both established and new targetable alterations should nowadays be routine practice in the diagnostic work-up of newly diagnosed patients with advanced NSCLC. Specifically for Belgium, ComPerMed guidelines recommend to test the mutational status of EGFR, KRAS and BRAF, screen for MET exon 14 skipping mutations and look for the presence of genetic fusions/rearrangements involving ALK, ROS1, RET, and NTRK1-3. These biomarkers should be analyzed in all patients with non-squamous NSCLC and in selected NSCLC patients with a squamous histology (i.e., never smokers, very young patients). Given the multitude of biomarkers that need to be tested, multigene testing using next generation sequencing (NGS) has gradually replaced sequential single gene testing as the preferred molecular screening tool in NSCLC. In fact, combined DNA/RNA NGS is now considered to be the most reliable and efficient approach for comprehensive detection of all approved and emerging biomarkers in advanced NSCLC (excluding PD-L1 detection). Both tissue samples as cytology specimens can be used for these NGS analyses as long as they contain a sufficient percentage of neoplastic cells and are processed in a way that safeguards nucleic acid integrity. In Belgium, a program is in place offering reimbursed DNA/RNA NGS testing to NSCLC patients through a network of 10 reference centers.
Read moreBJMO - 2022, issue Targeted Therapy Special, november 2022
T. Feys MBA, MSc
Next-generation sequencing (NGS) is increasingly replacing single gene assays in the screening for therapeutic biomarkers in patients with NSCLC. While NGS has the clear advantage that it can detect all targetable oncogenic driver alterations simultaneously, this technique does come with the risk for a longer turnaround time, in part as a result of the centralized way in which this testing is often organized. However, with a delayed test result, you risk that some patients with a high disease burden miss the opportunity to be treated with a specific targeted therapy, or even die before the NGS result comes in. To mitigate this risk, it may be interesting to adopt a rapid PCR-based testing strategy for selected oncogenic driver mutations in parallel to broad NGS testing.
Read moreBJMO - 2022, issue Targeted Therapy Special, november 2022
T. Feys MBA, MSc
Antibody-drug conjugates (ADCs) combine the high specificity of monoclonal antibodies with the high anti-tumor activity of small molecular cytotoxic payloads. In 2013, the human epidermal growth factor receptor 2 (HER2)-targeted ADC ado-trastuzumab emtansine (T-DM1) entered the treatment arsenal for patients with metastatic breast cancer (BC), making it the first ADC to be approved for the treatment of a solid tumor. The pace of ADC development for solid tumors has since increased dramatically, with currently more than 100 ADCs being investigated in clinical trials. Specifically in breast cancer, there are now 3 EMA-approved ADCs: T-DM1, trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG). This article will briefly touch upon the key components and mode of action of ADCs after which the clinical experience with the EMA-approved ADCs in breast cancer will be discussed.
Read moreBJMO - 2022, issue Targeted Therapy Special, november 2022
J. Blokken PhD, PharmD, T. Feys MBA, MSc
The Kirsten rat sarcoma viral oncogene homolog (KRAS) is mutated in about a quarter of all human cancers and is at the centre of several pathways involved in tumorigenesis. As such, novel therapeutic strategies that can target this oncoprotein are potentially extremely valuable. However, since its discovery as on oncogene, almost four decades have gone by without any major breakthrough in the therapeutic targeting of mutant KRAS. In recent years, however, we are finally witnessing a paradigm shift with the discovery of druggable pockets on KRAS and the clinical activity of covalent KRASG12C inhibitors such as sotorasib and adagrasib.
Read moreBJMO - 2022, issue SPECIAL, february 2022
J. Blokken PhD, PharmD, T. Feys MBA, MSc
The breast cancer task force session of the Belgian Society of Medical Oncology (BSMO) annual meeting reviewed the most important recent data on advanced HER2-positive breast cancer and triple negative breast cancer (TNBC). First, Dr. Eline Naert (University Hospital Ghent) discussed the treatment algorithm for advanced HER2-positive breast cancer anno 2022. Prof. Francois Duhoux (UCLouvain) subsequently addressed the current and emergent treatment options for patients with early or locoregional advanced triple-negative breast cancer. Finally, Prof. Christos Sotiriou (Institut Jules Bordet) closed the session by further dissecting the TNBC heterogeneity through molecular profiling and special transcriptomics.
Read moreBJMO - 2022, issue SPECIAL, february 2022
A. Enguita PhD, T. Feys MBA, MSc
Next-Generation Sequencing (NGS) significantly changed cancer management, allowing the identification of different oncogenic drivers and the subsequent approval of many targeted agents. An overview of the Belgian reimbursement situation and drug access in this setting was given during the molecular tests in oncology session of the Belgian Society of Medical Oncology (BSMO) annual meeting. First, Prof. Brigitte Maes (Jessa Hospital, Hasselt) walked us through the current NGS situation in
Belgium with a discussion of the achievements and challenges of the BALLETT study. Subsequently, Dr. Kevin Punie (Leuven University Hospital, Leuven) discussed the current strategy, tasks and challenges of the molecular tumour board (MTB). Finally, Pr. Lore Decoster (University Hospital Brussel), Dr. Wim Demey (Klina General Hospital, Brasschaat) and Dr. Joëlle Collignon (CHU de Liège, Liège) addressed the reimbursements of drugs in lung, gastro-oesophageal, biliary and pancreatic cancer.
BJMO - 2022, issue SPECIAL, february 2022
J. Blokken PhD, PharmD, T. Feys MBA, MSc
During the supportive care task force meeting, the BSMO supportive care task force introduced three clinical trials they would like to set up in the near future. In addition, new BSMO guidelines on extravasation and anaemia were presented after which the session was closed by Dr. Christel Fontaine (UZ Brussel) with a status update on the supportive care task force activities over the past year.
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