BJMO - volume 14, issue 2, march 2020
B. Delafontaine MD, C. De Backer MD, B. Beuselinck MD, PhD, P. Debruyne MD, PhD, L. D’Hondt MD, PhD, C. Gennigens MD, T. Gil MD, C. Vulsteke MD, PhD, N. Martinez Chanza MD, A. Verbiest MD, M. Strijbos MD, PhD, G. Van Lancker MD, G. Pelgrims MD, S. Rottey MD, PhD, On behalf of the BSMO Uro-Oncology Task Force Group
The management of recurrent or metastatic renal cell carcinoma is evolving fast, with new therapeutic options becoming available that may improve the outcome of patients. In this paper, recent evolutions are discussed and recommendations are made regarding the management of renal cell carcinoma in a Belgian context.
(BELG J MED ONCOL 2020;14(2):56–70)
Read moreBJMO - volume 13, issue 2, march 2019
A. Awada MD, PhD, J.F. Baurain MD, PhD, P. Clement MD, PhD, P. Hainaut MD, PhD, S. Holbrechts MD, PhD, K. Jochmans MD, PhD, V. Mathieux MD, PhD, J. Mebis MD, PhD, M. Strijbos MD, PhD, C. Vulsteke MD, PhD, T. Vanassche MD, PhD, P. Verhamme MD, PhD
Cancer patients are at an increased risk of venous thromboembolism (VTE). The current standard initial treatment of an acute episode of VTE in cancer patients consists of the administration of three to six months of subcutaneous low molecular weight heparin (LMWH) at a dose adjusted to the body weight. The efficacy and safety profile of LMWHs are well established, but a drawback of these agents is that they require daily subcutaneous administration. In addition, they are mainly cleared through the kidneys, and their use in patients with severe renal insufficiency may require dose reduction or monitoring of the anti-Xa activity. To address the issues with LMWH, several direct oral anticoagulants (DOAC) have been developed for the treatment of VTE. In contrast to LMWHs and vitamin K antagonist, DOACs directly interfere with thrombin or activated factor X (FXa). DOACs have now become standard treatment options in the general management of VTE, but until recently, there were no results of clinical trials specifically assessing the role of DOACs in the treatment of cancer-associated thrombosis. Recently, the Hokusai VTE cancer study and preliminary data from the Select-D trial demonstrated that DOACs are non-inferior to LMWH in preventing recurrent VTE. However, both studies also show that this comes at the cost of an increased rate of both major and clinically-relevant non-major bleeding. Especially in the subgroup of patients with gastrointestinal cancer, the benefit in VTE recurrence with the DOAC seems to be outbalanced by a significantly increased bleeding risk. Based on the available results, DOACs might represent an interesting alternative for LMWH in certain subgroups of patients, but with an important list of exceptions. It seems reasonable not to use DOACs in patients with a high bleeding risk, and especially in patients with gastrointestinal cancer, DOACs should not be the first-line choice. In summary, while LMWHs are currently the standard of care in the acute management of cancer-associated thrombosis, the advent of DOACs is welcomed for patients at a low bleeding risk who are in need of long-term anticoagulation.
(BELG J MED ONCOL 2019;13(2):46–53)
Read moreBJMO - volume 12, issue 7, november 2018
A. Awada MD, PhD, J.F. Baurain MD, PhD, P. Clement MD, PhD, P. Hainaut MD, PhD, S. Holbrechts MD, PhD, K. Jochmans MD, PhD, V. Mathieux MD, PhD, J. Mebis MD, PhD, M. Strijbos MD, PhD, C. Vulsteke MD, PhD, T. Vanassche MD, PhD, P. Verhamme MD, PhD
Unprovoked venous thromboembolism (VTE) may be the earliest sign of malignancy, and as a result, screening for occult cancer in these patients has become routine practice. However, the elaborateness of this screening is subject to debate and varies between medical centres. This study’s expert panel, consisting of oncologists and thrombosis specialists, aimed to develop a practical Belgian guidance for adequate cancer screening in patients with unprovoked VTE. In summary, comprehensive non-invasive cancer screening consisting of a medical history assessment, physical examinations, basic blood tests and a chest X-ray is sufficient to pick up the vast majority of occult cancers. When specific abnormalities are picked up by the battery of tests in the comprehensive non-invasive cancer screening, more extensive screening using CT scans are recommended. Routine CT screening in all patients presenting with an unprovoked VTE does not provide a significant clinical benefit and should not be routinely performed. In the presence of specific risk factors (e.g., older age, smoking history, previous VTE), physicians are advised to be more vigilant. Finally, given the significant anxiety that cancer screening may cause to patients, accurate and clear patient communication is key. A complete list of guidance statements is provided at the end of the article.
(BELG J MED ONCOL 2018;12(7):326–329)
Read moreBJMO - volume 12, issue 7, november 2018
C. Vulsteke MD, PhD, M. del Pilar Ortega Arevalo , Ir C. Mouton MBA, K. Stam , R. Goethals , F. Ameye , C. Populaire , M. Peeters MD, PhD, P. Verdonck
Keeping up with the rising amount of clinical data, guidelines and approvals of new antineoplastic drugs is a major challenge for every oncologist. Artificial intelligence promises to address this and to revolutionise health care and cancer treatment. What is the current state of artificial intelligence for the oncologist, and is it ready for prime time? In this article, the current, available tools of artificial intelligence are highlighted, which try to take a privileged role in the daily practice of the oncologist.
(BELG J MED ONCOL 2018;12(7)330–333)
Read moreBJMO - volume 10, issue 7, november 2016
A. Awada MD, PhD, J.F. Baurain MD, PhD, P. Clement MD, PhD, P. Hainaut MD, PhD, S. Holbrechts MD, PhD, J-M. Hougardy , K. Jochmans MD, PhD, V. Mathieux MD, PhD, J. Mebis MD, PhD, M. Strijbos MD, PhD, C. Vulsteke MD, PhD, P. Verhamme MD, PhD
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)
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