J.F. Baurain MD, PhD

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)

Highlights in melanoma

(BELG J MED ONCOL 2014;8(4):136–42)

Practice guidelines in the management of uveal melanoma

Summary

Uveal melanoma is a rare oncological disease. This incidence has remained stable for the past 50 years. There is no survival difference depending on the type of ocular treatment (enucleation versus radiotherapy versus tumour resection). Brachytherapy (Ru-106, I-125) presently remains the most common method for treating uveal melanoma. Despite adequate and early local treatment, half of the patients will develop metastatic recurrence with an average of 2.5 years after initial diagnosis. Clinical and histological prognostic factors have been identified, but some studies suggest that inactivation of BAP1 by chromosomal deletion or mutation is a key event driving metastasis development. Presently, no adjuvant treatment prevents those metastatic relapses. Nearly 90% of patients who relapse have only liver metastases. The median survival of those patients is about four months. Numerous trials evaluating the interest of exclusive liver treatment have failed to demonstrate an increase in survival, except surgery for solitary liver metastasis. Chemotherapy with dacarbazine remains the standard treatment of metastatic patients. New treatments targeting the signal transduction pathways or aiming at the stimulation of the immune system are under development.

(BELG J MED ONCOL 2013;7:20–26)

Targeted therapies in melanoma

The incidence of melanoma has increased continuously these last decades. Fortunately, cure is possible in most cases thanks to diagnosis at an early stage. Nevertheless, in some instances, melanoma is diagnosed at later stages and in other cases relapses occur. Moreover, melanoma is the deadliest cutaneous cancer and more importantly the most common origin of death due to cancer in young people. Thankfully though, hope for these patients has been increasing during the past three decades with the increased insight in the underlying oncogenic mutations. This progress has opened up new perspectives for etiological targeted therapies. This review will focus on the recent advances in melanoma treatment. (BELG J MED ONCOL 2012;6:194–200)

The 6th International Conference on Thrombosis and Haemostasis Issues in Cancer

It has become a tradition to hold the biennial International Conference on Thrombosis and Haemostasis Issues in Cancer (ICTHIC) in Bergamo. Bergamo is a quiet town in Northern Italy located on a hilltop beyond the Alps. Over 700 physicians with different backgrounds but the same interest attended the meeting this year from April 20th to April 22nd. The meeting provides a unique opportunity for reviewing the different molecular and clinical findings on thrombosis and haemostasis issues in cancer and for updating the guidelines on prophylaxis and treatment of Venous Thrombo-Embolic Events (VTE) in cancer patients. This congress report covers several key topics: duration of prophylaxis in cancer patients undergoing surgery, prevention in medical cancer patients, type and duration of VTE treatment in cancer patients, place of the newer anti-thrombotic agents in cancer patients and survival advantage of Low-Weight Molecular Heparins (LWMH). (BELG J MED ONCOL 2012;6:140–143)