PRACTICE GUIDELINES

Therapy-orienting testing of BRCA1 and BRCA2 germline mutations in women with ovarian cancer

With the aim to optimally position poly-(adenosine diphosphate-ribose) polymerase inhibitors in the treatment of ovarian cancer, a panel of Belgian Experts came to a national multidisciplinary consensus: (i) germline BRCA1/2 testing should be indicated for all women with high-grade serous epithelial ovarian cancer, who are in good general condition (i.e. eligible for systemic treatment with low toxicity); BRCA1/2 mutation detection ratios being about 15–20% in this group; (ii) as the finding of a BRCA1/2 germline mutation has therapeutic implications in ovarian cancer patients, the request for therapy-orienting testing should be made as soon as possible during the course of first-line treatment. Pre-test genetic counselling is important because positive testing has implications for both the patients and their relatives, and the nature of the discussions depends on whether they take place in a therapeutic or familial context. The organisation of consultations should be coordinated in a collaborative effort between clinical geneticists, and gynaecological and medical oncologists, keeping in mind that ‘fast-track’ pre-test genetic counselling and short turnaround times are required for patients for whom the test results will have a therapeutic impact. Offering germline BRCA1/2 testing to all patients with high-grade serous epithelial ovarian cancer who are eligible for systemic treatment with low toxicity will lead to a limited increase in the number of patients eligible for this test in Belgium.

(BELG J MED ONCOL 2015;9(2):65–70)

Management and systemic treatment of clear cell metastatic renal cell carcinoma: BSMO expert panel recommendations

Almost 30% of patients with renal cell cancer present initially with advanced stage IV disease. In the past decade, the management of the metastatic renal cell cancer has been revolutionised by the knowledge of its molecular biology and development of targets against vascular endothelial growth factor and mammalian target of rapamycin pathways. In this paper we present recommendations based on a thorough review of available guidelines and data from the phase III randomised controlled trials that evaluated new agents in patients with advanced metastatic renal cancer.
(BELG J MED ONCOL 2015;9(1):16–24)

Penile cancer practice guidelines

We present a condensed version of the ESMO clinical practice guidelines on penile cancer.¹

Penile cancer is an uncommon but ominous disease. In the last few years there has been a shift towards penile-preserving techniques, because besides local control, an important aim of surgery is to preserve the functionality and sexual function of the penis. This has an important impact on the patient’s self-esteem, quality of life and general mental health. Despite the rarity of the disease we gradually achieve more insight in the proper staging and treatment of this malignancy.

(BELG J MED ONCOL 2014;8(5):213–6)

Update of the Belgian guidelines for HER2 testing in breast cancer

This update of the Belgian guidelines for HER2 testing is based on the updated recommendations recently published by the American Society of Clinical Oncology and the College of American Pathologists.^1–3

(BELG J MED ONCOL 2014;8(4):109–15)

New medical treatments in thyroid cancer

Thyroid cancers are rare diseases and include types that range from indolent localised differentiated carcinomas to fulminant and lethal anaplastic disease. Until recently, treatment options for advanced or metastatic radio-iodine refractory thyroid cancer were limited. Recently kinase inhibitors targeting angiogenesis and other pathways have shown promising activity.

(BELG J MED ONCOL 2014;8(3):81–6)

How to sequence systemic therapies and radiotherapy in early breast cancer?

Breast cancer is the most common malignancy in women in the Western world. Over the last decades, the use of postoperative systemic therapies (chemotherapy, hormonal therapy, trastuzumab) and radiotherapy led to significant survival benefits for patients with early breast cancer. Although these modalities have been extensively studied and used, a major question is how these systemic therapies are optimally sequenced with radiotherapy in the adjuvant setting. This article reviews available data on how to combine systemic therapies with radiotherapy in women with early stage breast cancer, and provides recommendations that unfortunately do not reach level I evidence due to insufficient quality of available clinical data.

BELG J MED ONCOL 2014;8(3):72–80

The ideal cervical cancer screening recommendation for Belgium, an industrialised country in Europe

Cervical cancer should be a historical disease, why are we not succeeding! The prophylactic vaccination will reduce cervical cancer by almost 80% in Belgium. Cervical cancer screening should therefore continue in order to prevent the remaining 20%. The currently used Pap cytology test misses 50% of all clinically significant precancers and cancers at the time of testing. The test should remain but the analysis should be altered. The screening should be modified based on our knowledge of human papillomavirus as a causal factor. Instead of looking for cell abnormality one should look for the presence of human papillomavirus. Then, depending on the test, only two to ten percent of all relevant lesions are missed. The introduction of the vaccination should lead to the reintroduction of the screening based on human papillomavirus. This will lead to a considerable reduction in morbidity and mortality, allow longer screening intervals and be more cost-effective. More for less should be the driving force in cervical cancer screening if we want to be successful.

(BELG J MED ONCOL 2014;8(2):44–51)