REVIEW ONCOLOGY

Depression as an early manifestation of pancreatic cancer

SUMMARY

Ever since the early 1930’s, an association between pancreatic cancer and depression has been noticed. The prevalence of depression is higher in patients with pancreatic cancer than it is in patients with other abdominal neoplasms, and psychiatric symptoms often precede somatic symptoms. Despite further research on this co-occurrence, the true mechanism of interaction is still not clear. Knowing what it is that forms the biological link between depression and the pancreatic tumour, could be of great importance to the future diagnostic and therapeutic workup of these patients.

Different theories are proposed. Plausible are the depression being induced through cytokines more specifically IL-6, alterations in the tryptophan-kynurenine, glutamate and serotonin pathways, and antibodies disturbing brain functioning directly or through serotonin. Depression causing cancer is also possible, but to date of unknown importance in pancreatic cancer. All this information brought together makes depressive symptoms of diagnostic importance in pancreatic cancer. The insights pave the way for the development of targeted therapies, hopefully to be implemented in clinical practice in the future.

(BELG J MED ONCOL 2017;11(5):212–217)

A multidisciplinary rehabilitation program for breast cancer patients

PURPOSE

The aim of this paper is to evaluate the effectiveness of a multidisciplinary rehabilitation program in the treatment of breast cancer survivors in an outpatient rehabilitation clinic.

PATIENTS AND METHODS

Eighty seven breast cancer patients began a rehabilitation program based on physical exercise. Baseline parameters were compared for patients who had received chemotherapy (YES=66) and patients who had not received chemotherapy (NO=21). Data on physical fitness, body mass index and lean mass, quality of life and Beck’s Depression Inventory in breast cancer patients were compared before (T0) and after (T1) a 16-week, twice-weekly standardised rehabilitation program.

RESULTS

At baseline, there were no statistical differences for all parameters between patients who had received chemotherapy and those who had not. Sixty one out of eighty seven patients completed the program. There was a significant increase in physical fitness parameters, at 50 Watt HR (p=0.038) with lactic acid (p=0.020) decreased and at 75 Watt HR (p=0.010) with LA (p=0.001) decreased. Body mass index did not change significantly (p=0.239) but there was a strong correlation with increase in lean mass (p<0.001). Quality of life and Beck’s Depression Inventory improved significantly (p<0.001) and there was a correlation between improvement in quality of life and improvement in submaximal physical fitness (p=0.005).

CONCLUSION

This analysis shows correlations between the statistically significant benefit of a multidisciplinary rehabilitation program on physical fitness, depression symptoms and quality of life.

(BELG J MED ONCOL 2017;11(5):218–225)

Aspects of carcinogenesis applied to prostate cancer

SUMMARY

The characteristics of carcinogenesis are discussed in relation to prostate cancer. Some of these are already used as treatment targets in daily clinical practice, while in some, medications proved to be ineffective to interfere with these mechanisms of carcinogenesis.

Currently, treatments that have shown efficacy are addressing the mechanism of sustained proliferative activity, while there are some indications that immune modulation and agents interfering with DNA repair may play a role in the treatment of prostate cancer.

Other aspects of carcinogenesis need more study in patients with prostate cancer to show a benefit and they must be the scope of future research.

(BELG J MED ONCOL 2017;11(3):87–91)

Extracellular vesicles to diagnose and treat cancer

SUMMARY

Extracellular vesicles transfer lipids, nucleic acids and membrane-associated as well as intraluminal proteins between cells to maintain homeostasis and regulate physiological functions. This communication system is hijacked in cancer. Tumour-derived extracellular vesicles enter the circulation and carry targeting motifs and unique messages for cell-type specific instruction of distant ecosystems to foster metastasis. In this review we focus on how extracellular vesicles provide new opportunities for the diagnosis and treatment of cancer. Quantification and characterisation of tumour-derived extracellular vesicles obtained by liquid biopsy may enable the diagnosis and prognosis of cancer patients. Interference with extracellular vesicle biogenesis and implementation of extracellular vesicles as cancer vaccines or drug delivery vehicles opens up therapeutic potential to treat cancer.

(BELG J MED ONCOL 2017;11(3):92–105)

Premedication strategy for paclitaxel, still an unsolved question after 30 years

SUMMARY

Background: For paclitaxel administered 3-weekly, the Food and Drug Administration recommends the use of premedication with dexamethasone 20 mg orally twelve and six hours prior to paclitaxel, histamine–1 and –2 antagonists 30–60 minutes prior to paclitaxel, to prevent hypersensitivity reactions. There are no guidelines for the use of premedication when paclitaxel is given weekly.

Material and methods: MEDLINE was searched using the keywords premedication, dexamethasone, paclitaxel and hypersensitivity in November 2016. Articles were surveyed for additional citations.

Results: We retrieved 28 papers, of which sixteen on prospective trials (four on weekly, nine on 3-weekly paclitaxel). Using a dexamethasone tapering regimen in patients without hypersensitivity reactions after the first weekly paclitaxel administration, hypersensitivity reactions were reported in 1.0%, 2.3% and 5.7% of patients. In five single arm studies, intravenous dexamethasone 20 mg was administered prior to 3-weekly paclitaxel. Hypersensitivity reaction rates varied between 0–15%. Hypersensitivity reaction rates in sequential cohorts, in a single centre, with an intravenous or oral dexamethasone regimen were 14.5% and 5.4%, respectively (p=0.07). In a randomised trial there was no significant difference between an intravenous and oral dexamethasone regimen prior to 3-weekly paclitaxel administration.

Conclusions: Tapering of dexamethasone or no premedication at all seems to be safe in patients without hypersensitivity reactions after the first weekly administration of paclitaxel. Substitution of oral dexamethasone by a single intravenous administration immediately prior to 3-weekly paclitaxel was associated with a higher risk of hypersensitivity reactions, until 17,9%.

(BELG J MED ONCOL 2017;11(2):46–55)

Highlights in oncology 2016

SUMMARY

Every year brings new knowledge and insights that help to direct research that ultimately leads to improved care for patients with cancer. This report, which is based on the clinical cancer advances 2017 article published by the American Society of Clinical Oncology, reviews the most important advances made in the different fields of oncology that are most likely to impact daily clinical practice.¹ Over the last few years, immunotherapy has become a new treatment option for patients with a growing number of cancer types. Building on the initial successes with immunotherapy, a key next step is to understand why currently fewer than half of patients benefit from immunotherapy and why the benefit, if it occurs, may be short lived. In 2016, several reports revealed early insights into patient and cancer characteristics that might predict whether immunotherapy could work well in an individual patient. Many studies also assess whether combining immunotherapy with other cancer treatments might extend the potential of this new group of therapies.

A second part of this report focuses on targeted therapies. The research into cancer biology is propelling rapid development of novel treatments targeting the key molecules that allow cancers to grow and spread. In 2016, this strategy resulted in new targeted therapies for patients with advanced lung, breast, and kidney cancer, as well as several hard-to-treat forms of blood cancer. In addition to this, new molecular technologies are emerging that can quickly pinpoint molecular changes in the tumour or free-floating cancer DNA in the blood.

(BELG J MED ONCOL 2017; 11(2):37–45)

Robot-assisted radical prostatectomy, an update of the current evidence

SUMMARY

Robot-assisted radical prostatectomy has become standard-of-care in most centres of excellence in the treatment of prostate cancer. Recent literature shows a reduced complication risk, reduced transfusion need, shorter hospitalisation and functional and oncological benefit in comparison with open radical prostatectomy. Long term follow-up data and large randomised clinical trails are currently lacking.

(BELG J MED ONCOL 2017;11(1):4–6)