A. Awada MD, PhD

Systemic chemotherapy regimens in early breast cancer patients: updated recommendations from the BSMO breast cancer task force

SUMMARY

Since the publication from the Belgian Society of Medical Oncology breast cancer task force in 2014 in the Belgian Journal of Medical Oncology, new information has become available on optimal chemotherapy regimens for early breast cancer patients. On February 24^th, 2017, 37 medical oncologists involved in breast cancer management reviewed the most important scientific data on this topic. The authors of this paper summarised the findings, and sent a questionnaire to the members asking for their input. This paper summarises the consensus of this exercise.

(BELG J MED ONCOL 2017;11(8):375–379)

Guidance for the prevention and treatment of venous thromboembolism in cancer patients

Summary

Venous thrombosis is a common complication in cancer patients and thromboembolism is the second most common cause of death. Several practice guidelines provide recommendations for the management of cancer-associated thrombosis. However, these guidelines do not sufficiently cover commonly encountered clinical challenges. With this expert panel, consisting of medical oncologists, haematologists, internists and thrombosis specialists, we aimed to develop a practical Belgian guidance for adequate prevention and treatment of cancer-associated thrombosis that covered several challenging situations encountered in daily clinic. This paper discusses the following topics: type and treatment duration of anticoagulant therapy, recurrent VTE despite anticoagulation, anticoagulation in case of renal impairment, liver disease and thrombocytopenia, the role of anti-Xa monitoring, central venous catheter-associated thrombosis, the position of direct oral anticoagulants and thromboprophylaxis, both in ambulatory and hospitalised patients. For an overview of the recommendations formulated by the expert panel, we refer to the key messages for clinical practice in this article.

(BELG J MED ONCOL 2016;10(7):249–255)

Progressive multifocal leukoencephalopathy mimicking cerebral metastases in a patient treated for nasopharyngeal carcinoma

Summary

Progressive multifocal leukoencephalopathy is a rare demyelinating condition caused by reactivated JC polyomavirus. This disease occurs mainly in the context of immunodeficiency, usually from human immunodeficiency virus.We report a case of 67 years old patient, treated for metastatic nasopharyngeal epidermoid carcinoma with three lines of chemotherapy, admitted for deterioration of performance status and neurological symptoms represented by agitation, cognitive decline complicated by loss of consciousness, after receiving three cycles of carboplatin-docetaxel. Cerebral imaging had strongly suspected brain metastases given to the context of metastatic neoplasm in progression but cerebrospinal fluid was positive for JC-BK Polyomavirus. Unfortunately, evolution was marked by rapid clinical deterioration leading to death. We report this case in order to underline the rarity of this disease, clinico-radiological features, especially misleading appearance with cerebral metastases, risk factors and prognosis.

(BELG J MED ONCOL 2016;10(7):276–280)

Adjuvant endocrine therapy in pre- and perimenopausal women with breast cancer: practice guidelines

Summary

Oestrogen receptor positive early invasive breast cancer is a common disease in pre- and perimenopausal women. Adjuvant endocrine therapy is an essential part of its treatment. Until recently, premenopausal patients were uniformly treated with tamoxifen during five years. Given the recent publication of large clinical trials showing a benefit for other treatment regimens, the BSMO Breast Cancer Task Force met on the 6th of March, 2015, to propose common guidelines for adjuvant endocrine therapy for premenopausal patients. The members agreed that low-risk patients should be treated with five to ten years of tamoxifen, while the highest-risk patients should be treated with exemestane or tamoxifen plus ovarian function suppression. Special attention should be given to patients less than 35 years at diagnosis: in this subgroup, exemestane plus ovarian function suppression is preferred to tamoxifen plus ovarian function suppression.

(BELG J MED ONCOL 2016;10(3):92–96)

Thrombo-embolic events in cancer patients with impaired renal function

Venous thromboembolism is a frequent cause of mortality and morbidity in patients with malignancy. Thrombosis is one of the leading causes of death in patients with malignancy after cancer itself. As such, prompt recognition and treatment of venous thromboembolism are required in order to reduce the risk of venous thromboembolism-related mortality. This report reviews the interrelationship between cancer, renal insufficiency and venous thromboembolism. The working group behind this review article concludes that low molecular weight heparins decrease the risk of recurrent venous thrombosis in cancer patients without increasing major bleeding complications. Low molecular weight heparins are therefore recommended as first line antithrombotic treatment in cancer patients with a clear clinical benefit. In patients with renal dysfunction, who are at increased risk of bleeding and of thrombotic complications, preference should be given to unfractionated heparin or a low molecular weight heparin with a mean molecular weight such as tinzaparin, having less risk of plasma accumulation and offering the possibility to maintain full therapeutic dose.

(BELG J MED ONCOL 2015;9(2):53–60)

Adjuvant and neoadjuvant chemotherapy regimens in breast cancer: summary from the BSMO breast cancer task force meeting

Knowledge on adjuvant and neoadjuvant chemotherapy regimens in breast cancer is increasing rapidly. Many different regimens are available: some have been compared with each other, but still many questions remain to be answered. At the breast cancer task force meeting of the Belgian Society of Medical Oncology (BSMO) in Brussels, on February 21^st 2014, 41 medical oncologists involved in breast cancer management reviewed the most important recent data. The task force discussed a framework for regimen selection in clinical practice. The authors of this paper summarised the literature and meeting discussion, highlighting controversial areas.

(BELG J MED ONCOL 2014;8(4):116–24)

Stratified Medicine: a call for action

(BELG J MED ONCOL 2013;7:15–19)