H. Wildiers MD, PhD

Immune checkpoint inhibition in triple negative breast cancer: targeting Achilles’ heel?

Triple negative breast cancers pose an important challenge both for patients and their clinicians due to their aggressive disease course, poor long-term survival and lack of effective systemic treatment options. Recent scientific advances show that the adaptive immune system harbors the intrinsic capacity to eradicate cancer, generally through mechanisms that involve cytotoxic T-cells. Immune checkpoint inhibition boosts the host-anti-tumor response in many solid tumors, including breast cancer. However, cancer cells acquire ways to evade immunosurveillance and intra-tumoral T-cells are often functionally impaired, resulting in overt clinical cancer. Interestingly, the efficacy of immune checkpoint inhibition appears to correlate with tumor immunogenicity and the tumor mutational burden. Triple negative breast cancer has the highest tumor mutational burden of all breast cancer subtypes and therefore is believed to be the most immunogenic subtype. For this reason, clinical trials to date mainly focus on this specific subtype. Here, we review the accumulating evidence for immune checkpoint blockade in triple negative breast cancer.

Highlights in breast cancer

During ESMO 2018 an entire presidential session was dedicated to breast cancer. In addition to exciting immuno-oncology data in the treatment of triple negative breast cancer (TNBC), this session featured the presentation of the overall survival (OS) data of the phase III PALOMA-3 trial, evaluating the alpha-specific PI3K-inhibitor alpelisib in PI3KCA-mutant advanced breast cancer, and results of a clinical trial demonstrating improved outcomes when adding a histone deacetylase (HDAC) inhibitor to exemestane in hormone-receptor positive advanced breast cancer. In early breast cancer it was further demonstrated that non-compliance with adjuvant endocrine treatment is an under-appreciated and under-reported problem. In addition, the HOBOE-2 adds to the evidence that adjuvant bisphosphonates also improve the disease-free survival (DFS) in premenopausal luminal breast cancer patients who have received ovarian function suppression combined with an aromatase inhibitor. Finally, a subgroup analysis of the ShortHER trial suggests that for low- and intermediate risk cancer HER2-positive early breast cancer, 9 weeks of trastuzumab might be non-inferior to the standard 1-year treatment duration. However, the interpretation of this trial is challenging and as such, one year of trastuzumab should remain the standard for now.

Prevention of chemotherapy-induced nausea and vomiting: Belgian antiemetic treatment options anno 2018

Summary

Chemotherapy-induced nausea and vomiting remains an important adverse effect of treatment in daily clinical practice. Recently, new data on combinations of antiemetic agents became available for the prevention of acute and delayed nausea/vomiting in patients receiving highly and moderately emetogenic chemotherapy. As a result, the leading international cancer societies updated their antiemesis guidelines. This text aims at providing guidance regarding these new regimens in the prophylaxis of chemotherapy-induced nausea and vomiting, with a particular focus on highly emetogenic chemotherapy.

(BELG J MED ONCOL 2018;12(2):51–60)

O.01 IDENTIFICATION, CLINICAL CHARACTERISTICS AND TREATMENT OUTCOMES OF SOMATIC HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2 (HER2) MUTATIONS IN METASTATIC BREAST CANCER PATIENTS

Immune checkpoint inhibition in triple negative breast cancer: targeting Achilles’ heel?

Triple negative breast cancers pose an important challenge both for patients and their clinicians due to their aggressive disease course, poor long-term survival and lack of effective systemic treatment options. Recent scientific advances show that the adaptive immune system harbors the intrinsic capacity to eradicate cancer, generally through mechanisms that involve cytotoxic T-cells. Immune checkpoint inhibition boosts the host-anti-tumor response in many solid tumors, including breast cancer. However, cancer cells acquire ways to evade immunosurveillance and intra-tumoral T-cells are often functionally impaired, resulting in overt clinical cancer. Interestingly, the efficacy of immune checkpoint inhibition appears to correlate with tumor immunogenicity and the tumor mutational burden. Triple negative breast cancer has the highest tumor mutational burden of all breast cancer subtypes and therefore is believed to be the most immunogenic subtype. For this reason, clinical trials to date mainly focus on this specific subtype. Here, we review the accumulating evidence for immune checkpoint blockade in triple negative breast cancer.

Quality management for systemic treatment of breast cancer

Summary

Limited literature is available about quality management in systemic treatment of breast cancer patients. Professionals are the key players in the identification and interpretation of quality indicators. The Belgian Society of Medical Oncology takes the lead in the field of quality management of systemic treatment for cancer, especially breast cancer. A narrow collaboration with the Belgian Cancer Registry will allow benchmarking. The results will be presented and discussed between peers of the society. This should lead to better outcomes for all Belgian centres. All Belgian Society of Medical Oncology members are called for active participation

(BELG J MED ONCOL 2018;12(1):15–21)

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)