BJMO - volume 13, issue 8, december 2019
J. Blokken PhD, PharmD, T. Feys MBA, MSc, K. Punie MD, PhD
The 2019 edition of the annual ESMO meeting proved to be a grand cru when it comes to breast cancer studies. In early triple negative breast cancer (TNBC), the KEYNOTE-522 trial demonstrated a significant improvement of pathological complete response rate with the addition of pembrolizumab to neoadjuvant chemotherapy, irrespective of PD-L1 status. In addition to this, the prognostic value of tumour-infiltrating lymphocytes was confirmed in a pooled analysis of patients with TNBC who did not received adjuvant chemotherapy. In the field of metastatic breast cancer, much attention went to overall survival data that were presented for the CDK4/6-inhibitors ribociclib and abemaciclib in combination with fulvestrant (MONALEESA-3, MONARCH 2). Interesting results of the phase III BROCADE3 trial were presented in which the addition of the PARP inhibitor veliparib to carboplatin and paclitaxel was evaluated in patients with advanced HER2-negative breast cancer and a germline BRCA mutation. Regarding checkpoint inhibitors in metastatic TNBC, a read-out of a phase III trial with pembrolizumab compared to standard chemotherapy in second- and third-line was presented, as well as important translational data on different immunohistochemical PD-L1 assays from IMpassion130. Finally, two oral presentations focused on the use of CDK4/6-inhibitors in different combination regimens in metastatic HER2-positive breast cancer (MonarcHER) and in TNBC.
Read moreBJMO - volume 13, issue 7, november 2019
A. Hébrant PhD, M. Lammens MD, PhD, C. Van den Broecke MD, N. D’Haene MD, PhD, J. Van den Oord MD, PhD, A. Vanderstichele MD, PhD, A. Dendooven MD, PhD, P. Neven MD, PhD, K. Punie MD, PhD, G. Floris MD, PhD, J. Van der Meulen PhD, HA. Poirel MD, PhD, C. Dooms MD, PhD, S. Rottey MD, PhD, T. Boterberg MD, PhD, L. Brochez MD, PhD, M.C. Burlacu MD, G. Costante MD, D. Creytens MD, PhD, P. De Paepe MD, PhD, R. De Pauwn MD, B. Decallonne MD, PhD, F. Dedeurwaerdere MD, H. Denys MD, PhD, L. Ferdinande MD, PhD, R. Forsyth MD, PhD, M. Garmyn MD, PhD, T. Gevaert MD, PhD, J. De Grève MD, PhD, E. Govaerts MD, E. Hauben MD, PhD, J. Kerger MD, PhD, O. Kholmanskikh Van Criekingen MD, PhD, V. Kruse MD, PhD, Y. Lalami MD, L. Lapeire MD, PhD, P. Lefesvre MD, PhD, J.P. Machiels MD, PhD, B. Maes MD, PhD, G. Martens MD, PhD, M. Remmelink MD, PhD, I. Salmon MD, PhD, R. Sciot MD, PhD, S. Tejpar MD, PhD, K. Van de Vijver MD, PhD, L. Van de Voorde MD, I. Van den Berghe MD, A. Van den Bruel MD, K. Vandecasteele MD, PhD, L. Vanwalleghem MD, K. Vermaelen MD, PhD, R. Salgado MD, PhD, E. Wauters MD, B. Weynand MD, PhD, E. Van Valckenborgh PhD, G. Raicevic PhD, M. Van den Bulcke PhD, P. Pauwels MD, PhD
In order to advise the Federal Government on the reimbursement of molecular tests related to Personalised Medicine in Oncology, the Commission of Personalised Medicine (ComPerMed), represented by Belgian experts, has developed a methodology to classify molecular testing in oncology. The different molecular tests per cancer type are represented in algorithms and are annotated with a test level reflecting their relevance based on current guidelines, drug approvals and clinical data. The molecular tests are documented with recent literature, guidelines and a brief technical description. This methodology was applied on different solid tumours for which molecular testing is a clear clinical need.
(BELG J MED ONCOL 2019;13(7):286–95)
Read moreBJMO - volume 13, issue 2, march 2019
A. Hébrant PhD, K. Punie MD, PhD, F.P. Duhoux MD, PhD, C. Colpaert MD, PhD, G. Floris MD, PhD, K. Lambein MD, PhD, P. Neven MD, PhD, M. Berlière MD, PhD, R. Salgado MD, PhD, M. Chintinne MD, PhD, K. Dahan MD, PhD, S. Dedeurwaerdere MD, J. De Grève MD, PhD, A. de Leener MD, PhD, H. Denys MD, PhD, R. de Putter MD, PhD, L. Desmyter PhD, M. Baldewijns MD, PhD, D. Feret MD, C. Fontaine MD, C. Galant MD, PhD, P. Hilbert PhD, J. Janssens MD, PhD, D. Larsimont MD, PhD, P. Lefesvre MD, PhD, T. Sticca PhD, M-D. Tkint de Roodenbeke MD, G. Van Den Eynden MD, PhD, I. Vanden Bempt PhD, C. Van den Broecke MD, I. Vandernoot MD, C. Sotiriou MD, PhD, J. van Dorpe MD, PhD, H.A. Poirel MD, PhD, E. Van Valckenborgh PhD, G. Raicevic PhD, M. Van den Bulcke PhD, P. Aftimos MD
In order to advise the Federal Government on all matters related to personalised medicine in oncology, including the reimbursement of molecular tests, the Commission of Personalized Medicine (ComPerMed) has applied, for the breast tumours, the same methodology as previously applied for the digestive tumours. Meaning, the different molecular tests, represented in the shape of algorithms, are annotated with test levels — which aim to reflect their relevance based on current available data and to define the reimbursement — and are documented with recent literature, guidelines and a brief technical description.
(BELG J MED ONCOL 2019;13(2):40–45)
Read moreBJMO - , issue ,
V. Geldhof , K. Punie MD, PhD, H. Wildiers MD, PhD
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.
Read moreBJMO - volume 12, issue 8, december 2018
H. Wildiers MD, PhD, T. Feys MBA, MSc, K. Punie MD, PhD
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.
Read moreBJMO - volume 12, issue 2, march 2018
W. Lybaert MD, P. Clement MD, PhD, K. Punie MD, PhD, J. Mebis MD, PhD, M. Renard , H. Wildiers MD, PhD
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)
Read moreBJMO - volume 12, issue 9, february 2018
V. Geldhof , K. Punie MD, PhD, H. Wildiers MD, PhD
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.
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