PRACTICE GUIDELINES

Adjuvant endocrine therapy in pre- and perimenopausal women with breast cancer: practice guidelines

Summary

Oestrogen receptor positive early invasive breast cancer is a common disease in pre- and perimenopausal women. Adjuvant endocrine therapy is an essential part of its treatment. Until recently, premenopausal patients were uniformly treated with tamoxifen during five years. Given the recent publication of large clinical trials showing a benefit for other treatment regimens, the BSMO Breast Cancer Task Force met on the 6th of March, 2015, to propose common guidelines for adjuvant endocrine therapy for premenopausal patients. The members agreed that low-risk patients should be treated with five to ten years of tamoxifen, while the highest-risk patients should be treated with exemestane or tamoxifen plus ovarian function suppression. Special attention should be given to patients less than 35 years at diagnosis: in this subgroup, exemestane plus ovarian function suppression is preferred to tamoxifen plus ovarian function suppression.

(BELG J MED ONCOL 2016;10(3):92–96)

The emerging role of stereotactic radiotherapy in oligometastatic cancer

Summary

Most metastatic cancer patients pass through an oligometastatic disease phase. Management of oligometastatic cancer is changing due to the increasing application of local treatments, leading to longer disease control and, in some cases, even cure. This paper discusses stereotactic radiotherapy as a progressively more effective treatment of oligometastatic cancer due to technological developments enabling the specific delivery of higher radiation doses to the tumour itself, more insight in disease-related factors influencing its effectiveness, and its potential of synergy with immunotherapy.

(BELG J MED ONCOL 2016;10(2):58–62)

Molecular diagnostics on tissue samples obtained through EBUS-TBNA: review on practice guidelines

Summary

Endobronchial ultrasonography is a minimally invasive endoscopic technique that enables a real time transbronchial needle aspiration. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) specimens have a high diagnostic accuracy in the detection of intrathoracic lymph node metastasis for a variety of malignancies. Predictive biomarker testing is gaining wide importance to tailor the treatment with the largest benefit to the patient. Endobronchial ultrasound guided transbronchial needle aspiration also results in an accurate analysis of molecular alterations (by ImmunoHistoChemistry, Fluorescence In Situ Hybridisation, or gene sequencing) provided that the endoscopist takes sufficient tumour samples and a dedicated cytopathologist is involved in the mastery of the specimens.

Endobronchial ultrasound guided transbronchial needle aspiration samples can be handled in different ways. Liquid-based cytology and smears are mostly used. The choice of the testing method should be based primarily on the nature of the sample to be tested, testing laboratory’s expertise, and available equipment. ImmunoHistoChemistry, Fluorescence In Situ Hybridisation and targeted polymerase chain reaction-based sequencing can be performed on >80% of the endobronchial ultrasound guided transbronchial needle aspiration specimens, as the latter is more sensitive in terms of limit of detection than Sanger sequencing. The next step are the next generation sequencing assays, with only 10–20 ng of DNA sample input per gene mutation, which will minimise rejected samples due to insufficient sample quantity.

(BELG J MED ONCOL 2016;10(1):15–20)

Malignant pleurisy and palliative therapy

Summary

Management of malignant pleurisy should be patient- and symptom-centred. The presence of trapped lung is the most important factor compromising the success rate of pleurodesis. Although scientific evidence is debatable, early referral for pleurodesis is advisable and thoracoscopy with talc poudrage is the treatment option of choice. The use of indwelling catheters is a novel alternative technique for specific indications.

(BELG J MED ONCOL 2015;9(7):279–85)

RAS-testing in colorectal cancer: Belgian guidelines

There is an urgent need for predictive biomarkers in several cancers. In colorectal cancers, KRAS exon 2 mutation analyses were mandatory when considering anti-epidermal growth factor antibody therapy with agents such as cetuximab or panitumumab. However, since the introduction of this testing, a cohort of patients still did not appear to benefit from this therapy. Recently, additional testing for KRAS exon 3 and 4, and NRAS considerably improved the predictive power for therapy success. Therefore, an update of the Belgian guidelines for RAS testing was urgently needed.

(BELG J MED ONCOL 2015;9(5):183–90)

Early detection of prostate cancer: the EAU versus the AUA recommendations

To present a comparison between the recommendations for early detection of prostate cancer in men without evidence of prostate cancer related symptoms, as proposed by the European Association of Urology and the American Urological Association. Prostate-specific antigen screening for prostate cancer has been and still is one of the most controversial issues in medicine. Recent guideline statements and recommendations have led to further confusion and controversy regarding the use of prostate-specific antigen testing for the early detection of prostate cancer. In this text we try to summarise the different points of view of both societies and the evidence they are based upon.

(BELG J MED ONCOL 2015;9(5):179–82)

Screening for dihydropyrimidine dehydrogenase deficiency to prevent severe fluoropyrimidine-associated toxicity

Fluoropyrimidines are the cornerstones of all currently applied regimens for the treatment of patients with cancers of the gastrointestinal tract, breast, head and neck. Dihydropyrimidine dehydrogenase plays a pivotal role in the metabolism of 5-fluorouracil and, as such, a deficiency of dihydropyrimidine dehydrogenase has been recognised as an important risk factor, predisposing patients to develop severe 5-fluorouracil associated toxicity. Screening for dihydropyrimidine dehydrogenase deficiency would not only decrease fluoropyrimidine morbidity and enhance patient quality of life but also potentially reduce costs by avoiding toxicity-related hospitalisations. Genotype and phenotype-based dosing recommendations of fluoropyrimidines propose a dose of 50% of the starting dose followed by an increase in dose in patients experiencing no or clinically tolerable toxicity, to ensure efficacy and a dose decrease in patients who do not tolerate the starting dose, to minimize toxicity.

(BELG J MED ONCOL 2015;9(3):95–8)