memo - Magazine of European Medical Oncology

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0454-5

Kaufmann, Hannes

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0423-z

Knoebl, Paul

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0424-y

Balic, Marija

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0434-9

Hefler-Frischmuth, Katrin

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0418-9

Flow cytometry (FC) plays an important role in the diagnosis and classification of hematological disorders and can analyze a wide range of diagnostic samples. It is used in both diagnostic and follow-up testing, and is increasingly important in the detection of very small residual disease populations, i. e., minimal residual disease (MRD). Modern flow cytometers have the capability to analyze several thousands of cells per second and to identify different cell populations by evaluating the expression of specific antigens (markers) along with light scatter properties of the cells. FC can precisely differentiate between B‑ and T‑cell malignancies, between mature and precursor tumors, and among the latter, determine the myeloid or lymphatic lineage.

Westphal, Theresa; Gampenrieder, Simon; Rinnerthaler, Gabriel; Greil, Richard

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0426-9pmid: 30220923

Oligometastatic disease characterizes a distinct subgroup of metastatic breast cancer patients that might benefit from different treatment strategies to achieve long-lasting remission and potentially cure. Those long-lasting remissions are reported after locoregional treatment of the primary tumor and all metastatic sites in several case series; however, unlike other tumor entities, prospective data are lacking. Furthermore, tumor eradication by excellent systemic anticancer therapy with novel chemotherapies and targeted agents can lead to long-term survival. In addition, reactivation of the host immune defense by immuno-oncologic drugs can achieve long-lasting tumor control. So far, unfortunately, checkpoint inhibitors as monotherapy have led to responses only in a small percentage of patients with metastatic breast cancer. This short review summarizes available data on long-lasting remissions and potential cure in metastatic breast cancers. It describes and discusses data on locoregional treatment, chemo-, antibody- and immunotherapy and tries to select individual patients for whom a multidisciplinary treatment approach with curative intention might be an option to achieve long-term survival.

Pluschnig, Ursula

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0432-y

Gastrointestinal stromal tumors (GISTs) are a rare type of cancer and a heterogeneous disease. The tyrosine kinase receptors KIT and the platelet-derived growth factor receptor alpha PDGFRA are the most common mutant genes of GIST. Mutation analysis is a diagnostic standard and is crucial for drug therapy with tyrosine kinase inhibitors (TKI). About 10% of patients already have metastases at first diagnosis. R0 resection is the only curative option in GIST and is therefore the therapy for localized tumors. In case of locally advanced primary tumors, neoadjuvant therapy should be offered. Recurrent, metastatic and locally advanced disease can be treated with TKI; in select cases surgical therapy may be added. The role of surgery in metastatic disease is controversial.

Pinter, Matthias; Sieghart, Wolfgang

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0431-zpmid: 30220924

Liver resection, transplantation, and local ablation are potential curative treatment options but can only be offered to patients with early stage hepatocellular carcinoma (HCC). Patients with macrovascular tumor invasion and extrahepatic metastases are candidates for palliative systemic therapies. Achieving radiological complete response can be associated with long-term remission and excellent outcome. However, despite recent advancements in the medical treatment of advanced stage HCC, complete remission with available systemic treatment options still remains a rare event. This review summarizes data on radiological complete response to systemic therapies and discusses issues that may complicate the goal of achieving cure in advanced stage HCC.

Masel, Eva; Kreye, Gudrun

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0420-2pmid: 30220925

There is robust data that palliative care is prolonging life while there are still prejudices towards this discipline that have to be demystified. Patients, relatives and caregivers benefit from the concept of early integration of palliative care and therefore, palliative care should not be mainly regarded as end-of-life care.

Tschann, Peter; Rauch, Stephanie; Girotti, Paolo; Rumpold, Holger; Königsrainer, Ingmar

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0415-z

Bartsch, Rupert; Bergen, Elisabeth; Galid, Arik

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0421-1pmid: 30220926

Preoperative administration of chemotherapy is a widespread treatment approach in early stage breast cancer whenever chemotherapy is indicated in principle. In addition, neoadjuvant treatment is today regarded as the preferred way of delivering systemic therapy in triple-negative and HER2-positive breast cancer. While preoperative chemotherapy allows for disease downstaging and increases breast conservation rates, achieving pathologic complete remission (pCR) is usually regarded as the most pertinent aim as pCR predicts for improved long-term outcome in high-risk breast cancer subtypes. A multitude of clinical trials therefore have focused on strategies to increase pCR rates. This short review summarizes outcomes of selected studies investigating the addition of further chemotherapeutic drugs or biologically targeted agents to standard regimens and provides an overview of novel strategies currently under clinical evaluation.

Bartsch, Rupert; Bergen, Elisabeth

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0430-0pmid: 30220927

In the areas of chemotherapy, targeted therapy and immunotherapy, several interesting and clinically relevant data were presented at the 2017 San Antonio Breast Cancer Symposium (SABCS). This short review focuses on dose-dense and/or sequential administration of adjuvant chemotherapy, provides an update on targeted therapies for HER2-positive and triple-negative breast cancer and summarizes new results in the field of immunotherapy.

Rinnerthaler, Gabriel; Gampenrieder, Simon; Greil, Richard

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0433-xpmid: 30220928

This article reviews the clinically most relevant presentations at the San Antonio Breast Cancer Symposium (SABCS) 2017 on the topics lifestyle factors, hormone receptor-positive advanced disease, liquid biopsies, and prognosis.

Fitzal, Florian

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0403-3pmid: 30220929

This year there were three interesting oral presentations and several posters presenting important new data regarding local therapy (surgery and radiotherapy) as well as radiological aspects. This minireview is a personal view of the clinically most relevant data in this respect with the following conclusions: A micrometastasis is no indication for axillary dissection. The number of involved sentinel lymph nodes predicts non-sentinel lymph node metastasis and should be taken into account regarding omitting axillary dissection. Neoadjuvant chemotherapy reduces the risk of non-sentinel lymph node metastasis. A 2 mm margin shows an optimal rate of local recurrences after breast conservation. The question of the correct definition for an R0 resection after neoadjuvant therapy remains open. We should omit radiotherapy for women with low risk ductal carcinoma in situ (DCIS) below 2.5 cm in size and pT1a G1 after breast conservation. Risk of finding invasive cancer after having a B3 biopsy is very low depending on the type of lesion, thus, questioning the surgical approach of some of these entities. The use of magnetic resonance imaging is a standard procedure before and after neoadjuvant therapy. Data regarding correlation between complete radiologic response (rCR) with pathologic complete response (pCR) and real tumor size are rare. For women with micrometastases or isolated tumor cells in the sentinel node postmastectomy radiotherapy has little benefit. After neoadjuvant therapy only women with ypN2 had a significant benefit of postmastectomy radiotherapy for local, disease-free and overall survival.

Bago-Horvath, Zsuzsanna

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0427-8pmid: 30220930

The 40th International San Antonio Breast Cancer Symposium offered a multifaceted platform for the presentation of several innovative therapeutic approaches. The results of these preclinical and clinical studies provided insight into the development of novel therapy concepts from the laboratory bench to the bedside of breast cancer patients. One main focus of last year’s symposium was the search for synergisms and opportunities for collaboration between basic research scientists and investigators in drug development. Highlights of these topics included preclinical data on selective estrogen receptor covalent antagonists (SERCAs), the discovery of immune-modulating effects of demethylating agents as well as the exact characterization and risk assessment of BRCA2 mutations of previously unknown significance. Pathological advances aimed at the molecular understanding of intratumoral heterogeneity and the evolution of lobular breast cancer. Beyond preclinical discoveries at the molecular level, clinical studies provided evidence on the duration of adjuvant bisphosphonate treatment and the use of the EndoPredict multigenomic assay to predict response to neoadjuvant chemo- and endocrine therapy. The SUCCESS A study reported that the prolonged adjuvant administration of zoledronic acid for 5 years did not improve patient survival after chemotherapy. A translational analysis of the ABCSG 34 trial revealed that the EndoPredict multigenomic assay could identify patients who do not benefit from neoadjuvant endocrine or chemotherapy. These recent advances are likely to promote individualized breast cancer care.

Knöbl, Paul

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0429-6pmid: 30220931

Thrombotic thrombocytopenic purpura (TTP) is a clearly defined entity of the thrombotic microangiopathies (TMA), a heterogeneous group of disorders characterized by microangiopathic hemolytic anemia with red cell fragmentation, thrombocytopenia and organ dysfunction due to disturbed microcirculation. TTP is characterized by a severe deficiency of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13), an enzyme responsible for physiological cleavage of von Willebrand factor (VWF). Organ dysfunction can be severe and life-threatening, and immediate start of appropriate therapy is necessary to avoid permanent damage or death. Until recently, therapeutic options were limited to symptomatic measures, which were not standardized or based on high scientific evidence. In recent years, not only considerable progress has been made in better diagnosis of TTP, but also new therapeutic strategies have been established. Initial treatment is still based on plasma exchange and symptomatic measures to protect organ function, but new concepts (immunosuppression, targeted anti-VWF or anti-complement therapy, replacement with recombinant enzymes) have recently demonstrated impressive advantages.

Trojnár, Eszter; Szilágyi, Ágnes; Mikes, Bálint; Csuka, Dorottya; Sinkovits, György; Prohászka, Zoltán

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-017-0380-y

Thrombotic microangiopathies (TMAs) are rare but life-threatening disorders characterized by microvascular hemolytic anemia and acute thrombocytopenia with or without organ damage. The term TMA covers various subgroups of diseases, the pathogenesis of which is briefly summarized in this review. As highlighted here, complement activation may represent an important amalgamating process in all of these conditions, since it is able to link together activation and damage of multiple involved cell types, such as endothelial cells, platelets, and neutrophils.

Cario, Holger

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0402-4

Hemoglobinopathies represent the most frequent monogenic disorders worldwide. Migration during recent years led to a profoundly increasing number of patients in countries where the indigenous population has not been affected. This short review will give an overview on etiology, pathogenesis, clinical features, diagnostics, and treatment of the most relevant hemoglobinopathies, i.e., the thalassemias and sickle cell disease.

Bohn, Jan-Paul; Steurer, Michael

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0428-7pmid: 30220932

Immune thrombocytopenia (ITP) is an acquired autoimmune phenomenon resulting in low platelet count and increased bleeding risk. Goals of upfront management include prompt control of severe bleeding—which is rare—as well as induction and maintenance of a hemostatic platelet count. Thus, optimal management of ITP patients is often challenging and requires a highly individualized approach. Many patients may not suffer significant bleeding despite severe thrombocytopenia and the risk of toxicity associated with treatment may outweigh its benefit. Most patients treated with standard first-line regimen of glucocorticoids achieve an initial response. However, the rate of long-term remission remains low and multiple lines of therapy are often required. Current investigations aim at defining the subgroup of patients at risk of relapse and providing intensified risk-balanced induction regimens to improve long-term disease control.

Sepulveda, Ilson; Ulloa, J.; Spencer, M.; Vera, Paulo; Rivas-Rodriguez, Francisco; Puentes, Ricardo

2018 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0419-8

We present the case of a 65-year-old woman with sublingual adenoid cystic carcinoma (ACC). Computed tomography (CT) sialography revealed an expansive process in the left sublingual gland accompanied with ipsilateral submandibular salivary duct obstruction. The head and neck tumor board recommended surgical and radiotherapy treatment. Presently, the patient is disease-free with no visible complications or signs of recurrence.