T. Feys MBA, MSc

Highlights in gynaecological cancers

The highlights in gynecologic cancers from ASCO 2019 include data on the outcome of chemotherapy or PARP inhibitors as monotherapy or combination therapy in (elderly) patients with ovarian cancer, as well as results of immune checkpoint blockade in patients with advanced or recurrent endometrial cancer with or without a mismatch repair deficiency. Novel findings in (early-stage) cervical cancer include the efficacy and safety of neoadjuvant chemotherapy followed by surgery vs. chemoradiation, and of minimally invasive hysterectomy compared to open radical hysterectomy.

Highlights of the Post-ASCO Genitourinary regional tour 2019

SUMMARY

The 2019 annual American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium was held from February 14-16 in San Francisco. The Belgian Multidisciplinary Meeting on Urological Cancers (BMUC) organised a post-ASCO GU regional tour during which the highlights of the 2019 ASCO GU meeting were discussed. This tour featured four different meetings in four locations in Belgium: Namur, Ghent, Nivelles and Paal. This summary will specifically report on the meeting held in Ghent during which prof. dr Piet Ost (Ghent University Hospital) and prof. dr Sylvie Rottey (Ghent University Hospital) gave a summary of the most important advances in the treatment of prostate, bladder and renal cancer.

(BELG J MED ONCOL 2019;13(3):109–114)

New oncology reimbursements in Belgium

Overview of Belgian reimbursement news

(BELG J MED ONCOL 2019;13(3):115–116)

Highlights from the 2018 annual meeting of the San Antonio Breast Cancer Symposium (SABCS)

SUMMARY

From the 4–8th of December, the San Antonio Riverwalk again formed the background of the most important breast cancer congress in the world. This report will summarise eight top stories presented during the 2018 San Antonio Breast Cancer Symposium (SABCS). For a more complete overview of studies presented at the meeting, we refer to the congress website www.sabcs.org.

(BELG J MED ONCOL 2019;13(2):66–71)

Radiotherapy in the lung cancer immuno-oncology era

ABSTRACT

Radiotherapy not only allows us to selectively target the tumour, it also interacts with the tumor microenvironment and consequently the host’s immune system. Theoretically this can lead to an in situ vaccination and trigger so-called abscopal responses, away from the irradiated site. Unfortunately, these are rarely seen the clinic. Over the past years, both preclinical and clinical studies demonstrated synergistic effects of radiation in combination with several types of immunotherapy. However, the optimal dose and fractionation of radiation therapy as well as the optimal combination and sequence of radiotherapy and immunotherapy still needs to be determined.

Chimeric antigen receptor T-cells: is the success in haematological malignancies translatable to solid tumours?

SUMMARY

Chimeric antigen receptor (CAR) T-cell therapy is a new cancer immunotherapy targeting specific cell surface antigens. This type of adoptive cell immunotherapy has been a breakthrough in the treatment of aggressive B-cell lymphoma and B-cell precursor acute lymphoblastic leukaemia (ALL) and is currently being studied in other cancer types, including multiple myeloma and chronic lymphocytic leukaemia. With the unprecedented success of CAR T cells in haematological malignancies, a growing number of (pre)clinical studies are focusing on translating this treatment to solid tumours. However, response rates to CAR T-cell therapy have so far been much less favourable in non-haematologic malignancies, mainly due to a paucity of unique tumour target antigens, limited CAR T-cell trafficking to tumour sites, tumour heterogeneity, antigen loss, the presence of an immune suppressive tumour microenvironment and recognition of normal cells expressing the targeted antigen. A broad range of strategies is currently being explored to overcome these hurdles. For example, TCR-CAR-T hybrids have been developed that can also target intracellular antigens which broadens the potential scope of the CAR-T cell strategy. This article reviews completed and ongoing CAR T-cell trials in solid tumours and discusses the strategies to improve the efficacy of this treatment modality in solid tumours, including accelerated production flows. CAR-T’s might very well be the upcoming major advance in cancer treatment.

Immunotherapy for locally advanced unresectable non-small cell lung cancer

The progress that has been made in the last decades in the treatment of stage IV non-small cell lung cancer (NSCLC) has overall not been translated in the curative setting of stage I to III disease. In fact, the list of failed clinical trials aimed at improving the cure rates in this setting is long. The recent successes with immune checkpoint inhibition in stage IV NSCLC formed the basis to also study these agents in the curative setting. The first clinical trials to yield results in this setting evaluate immune checkpoint inhibition as consolidation treatment following chemoradiotherapy in locally advanced, unresectable NSCLC. The PACIFIC trial demonstrated that consolidation therapy with PD-L1 inhibitor durvalumab significantly prolongs both the progression-free (PFS) and overall survival (OS) compared to placebo in patients with disease control after chemoradiotherapy for stage III unresectable NSCLC. These findings have recently led to the EMA indication of durvalumab as a treatment of locally advanced, unresectable NSCLC patients whose tumors express PD-L1 on ≥1% of tumor cells and whose disease has not progressed following platinum-based chemoradiation therapy. In addition to this, recent phase II data show that consolidation pembrolizumab following concurrent chemoradiotherapy substantially prolongs the time to metastasis or death in patients with inoperable stage III NSCLC. Finally, the phase II ETOP NICOLAS trial demonstrated that the addition of nivolumab to concurrent chemoradiotherapy is safe and tolerable in stage III NSCLC with promising efficacy signals. Together all these data support the further exploration of immune checkpoint inhibition in the curative NSCLC setting. Several trials are currently ongoing, including studies on the potential of adjuvant immune checkpoint inhibition in stage II and IIIA disease and trials in the pre-operative setting.