The strategic plan for paediatric cancer treatment and clinical research development in Belgium

BJMO - volume 13, issue 1, february 2019

A. van Damme , B. De Moerloose MD, PhD, B. Brichard MD, PhD, A. Ferster MD, D. Heenen , G. Laureys , K. Norga , C. Piette MD, PhD, J. van der Werff ten Bosch , A. Uyttebroeck MD, PhD

Childhood cancer can be cured in a good proportion of patients, but outcome rates are still unsatisfactory for specific cancer types and for resistant or relapsed disease. Collaborative clinical research is required for further outcome improvement as well as easier access for children to innovative treatments. Moreover, clinical care standards and clinical research infrastructure in Belgium should be optimised and structurally financed to reach the level proposed by international professional and scientific organisations. In this strategic plan, obstacles are analysed, and solutions for improved childhood cancer care and clinical research in Belgium are proposed.

(BELG J MED ONCOL 2019;13(1):21–26)

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Blood sampling at home: a pilot project

BJMO - volume 12, issue 5, september 2018

D. Schrijvers MD, PhD, L. van Asch , A. Van Goethem MD, E. Heylen , P. de Schouwer , S. van Eeckhout , V. Verheyen

Haematological and biochemical parameters are two of the important factors for safely administering oncological medication. These values should be available to the oncologist prior to administration of anticancer drugs in order to decide if they can be administered safely or if a dose reduction or postponement is necessary. In this project, the possibility of a blood sampling at home by a home care organisation 48–72 hours before the patient’s contact with the oncologist was evaluated to ensure that these parameters were available at the moment of consultation and to integrate these results in the patient electronic file.

From January 9, 2017, until April 30, 2017, 418 blood samplings were performed at home. Problems were not frequently encountered (4.7% of blood samplings). The pros and cons of this project are discussed. This project demonstrates that blood sampling at home is feasible and that the oncologist receives the required parameters in due time to ensure safe prescription and administration of anticancer medication.

(BELG J MED ONCOL 2018;12(5):247–251)

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Lung cancer screening programs: black or white?

BJMO - volume 11, issue 5, september 2017

E. Bustamante , C. Soza-Ried PhD, MSc, C. Rolfo MD, PhD, L.E. Raez , V. Domínguez MD , E.S. Santos , C. Caglevic MD


Lung cancer is a frequent malignancy worldwide with a high mortality rate. Most patients are diagnosed in advanced or metastatic stages that are not amenable to curative treatments, resulting in a poor overall survival rate. Screening programs could provide a solution to this problem, but it is unclear whether the great cost and possible risks that patients must face justify their implementation for lung cancer. This manuscript aims to show the published evidence related to screening programs for lung cancer and the importance and challenges of developing such programs in Latin America.

(BELG J MED ONCOL 2017;11(5):242–248)

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Characterisation of toll-like receptors gene expression in breast cancer

BJMO - volume 11, issue 2, march 2017

M. Mariñas , P. Valdiviezo BSc, C.H. Saravia BSc, F. Vallenas MD, PhD, L. Bravo MD, MSc, J. M. Araujo BSc, D. Bretel MD, R. Velazco BSc, H. L. Gómez MD, PhD, J. A. Pinto MSc


Toll-like receptors are key players of the innate immunity that recognise foreign patterns and have been related to cancer aggressiveness in several cancers, including breast cancer. Previously, TLR4 was associated with resistance to taxanes in breast cancer model.

Objective: The aim of this work was to characterise the expression of toll-like receptors in breast cancers and evaluate them as predictive and prognostic biomarkers.

Methods: A publicly available dataset of breast cancer in the neoadjuvant setting profiled with the Affymetrix platform H133A (GSE25066) was evaluated. Expression levels were log2 transformed and median centred. Toll-like receptors gene expression (TLR1-TLR9) was associated with clinical features and prognosis of breast cancer in terms of distant metastasis-free survival. Using levels of expression of genes involved in TLR4 signalling we developed a prognostic signature.

Results: Expression of TLR1, TLR2 and TLR5 were enriched in the basal subtype. Toll-like receptors expressions were not related with pathologic complete response. The univariate analysis identified to TLR1 (HR=5.9; 95%CI: 1.7–20.9; P=0.006), TLR4 (HR=10.9; 95%CI: 2.5–46.8; P=0.001) and TLR6 (HR=6.4; 95%CI: 1.7–23.2; P=0.005) statistically related with the distant recurrence-free survival. Due to the relevance of TLR4, we evaluated 37 genes involved in its pathway. The dataset was divided into discovery and validation cohorts. The multivariate analysis with the stepwise method selected five genes that were independent prognostic factors. Using the regression coefficients, we developed a prognostic signature: (0.279xIRAK1 + –0.421xIRF3 + –0.548xNFKB1 + 0.404xNEMO + 0.336xTRIMS). The prognostic signature was able to identify patients at different risk in the validation cohort.

Conclusion: Although toll-like receptors are not related to pathologic complete response, TLR4 signalling pathway is related to the outcome in neoadjuvant chemotherapy with anthracyclines and taxanes.

(BELG J MED ONCOL 2017;11(2):68–74)

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MicroRNA as predictive biomarkers for drug resistance and sensitivity in colorectal cancer

BJMO - volume 11, issue 1, february 2017

G. Li PhD, A. Cavazzoni PhD, E. Giovannetti MD, PhD, M. A. Barbera MD, G. Frega MD, G. Biasco MD, I. Garajová MD, PhD


Despite significant improvement in anticancer treatment options, many patients are resistant or develop secondary resistance to anticancer agents, highlighting the necessity for seeking novel predictive markers for drug resistance. Piling evidence has identified miRNAs as predictive markers for resistance/sensitivity to chemotherapy and anti-VEGF/anti-EGFR monoclonal antibody therapy in colorectal cancer patients. In this review, we summarise the current knowledge of the role of miRNAs as possible response predictors to current anticancer treatments for metastatic colorectal cancer patients.

(BELG J MED ONCOL 2017;11(1):18–25)

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Feasibility of an interactive, real time data collecting tool during everolimus treatment: a clinical experience

BJMO - volume 10, issue 1, february 2016

M. Rasschaert MD, K. Papadimitriou MD, I. Van Brussel PhD, J. Ravelingien MSc, R. Remmen MD, PhD, M. Peeters MD, PhD



Oncologists and patients alike are faced with increasing challenges when managing a growing number of new anticancer agents with their specific and complex toxicities. Integrating electronic systems when monitoring patients offers the opportunity to collect data and interact in real time.


To test the feasibility and applicability of an interactive data collecting tool in an outpatient setting. To evaluate the interaction between patients and caregivers.

Materials and methods:

Within a community based clinical program for patients using everolimus, we designed a pilot study using an electronic device, uploaded with a program to stimulate the compliance of patients to treatment and preventive measures. The Coach also screened for mucositis and for other adverse events (AE); and offered advice when AE’s were detected.


Between March and September 2014, 34 patients were enrolled in this pilot study. Eight patients dropped out of the study (due to reluctance in three, to age in two, general conditions in two and logistic defect in one patient). Mean follow up time was six weeks (range two to twelve weeks). Compliance to the device was evaluated in twenty patients and 16/20 (80%) committed to ≥ 60% of registrations. Treatment related AE’s, illness or technical problems posed no barriers to compliance. Toxicity data was collected in 26 patients (92% women, median age of 63 yr). Mucositis was registered in 50% of patients. First registration of AE was documented at day seventeen. In retrospect, earlier laser therapy for everolimus induced mucositis leads to fast relief and less lengthy laser treatments.


The use of a real time data collecting tool (Remecoach) is feasible. The compliance to the device is high and resulted in early detection of everolimus induced mucositis. This approach to patient management can contribute to early toxicity management while improving treatment compliance.

(BELG J MED ONCOL 2016;10(1):29–34)

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