memo - Magazine of European Medical Oncology

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0498-1

Egle, Alexander

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0489-2

Pircher, Andreas

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0495-4

Hilbe, Wolfgang; Pircher, Andreas

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0496-3

Sillaber, Alois

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0484-7

Kranewitter, Wolfgang

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0479-4

Next-generation sequencing allows the simultaneous interrogation of a large number of genomic targets and is therefore highly suitable for situations, in which mutations in many different genes may have a clinical impact. This short educational discusses the process from the sample to the reported mutations and the limits of the method.

Jaeger, Johannes; Jaeger, Thomas; Feistritzer, Clemens

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0483-8

Venous thrombosis and pulmonary embolism are common complications in patients with active cancer. For many years low molecular weight heparins (LMWH) have been the preferred treatment option for cancer patients, because of their superiority over vitamin K antagonists, which bear high risk of interaction and unsatisfactory anticoagulation. With the introduction of direct oral anticoagulants (DOAC) a second oral treatment option appeared. However, recommendations for the use of DOACs in the treatment of cancer-associated venous thromboembolic events were only given recently. DOAC possess a different side effect profile regarding drug/drug interactions. Recent publications revealed a slightly increased risk for non major bleedings compared to LMWH, and caution is advised when used in patients with gastrointestinal tract malignancies, especially upper gastro-intestinal tract malignancies. This review depicts actual considerations for anticoagulation in cancer patients to provide a rational for clinicians before treatment initiation.

Özdemir, Seray; Iltar, Utku; Salim, Ozan; Yücel, Orhan; Erdem, Ramazan; Turhan, Özge; Undar, Levent

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-018-0468-zpmid: 32218873

Fuereder, Thorsten

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0493-6

Immuno-oncology and in particular checkpoint inhibitor (CPI) treatment has become a novel promising cancer therapy strategy in recent years. However, still a minority of patients respond to checkpoint blockade. Primary and secondary resistance to CPI is a challenge in the daily clinical routine. Combination strategies have been tested in various clinical trials in order to address this issue. Data available from these trials indicate improved activity depending on the tumor type. This review article focuses on the molecular background for resistance to CPI, gives an overview of current clinical data of CPI combination studies and points out potential strategies to overcome CPI resistance depending on the immune phenotype.

Absenger, Gudrun

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0488-3

The most common driver mutation in non-small cell lung cancer (NSCLC) is found within the tyrosine kinase domain of the epidermal growth factor receptor (EGFR). It commonly affects younger, female, and non-smoking patients. To date, there are five approved tyrosine kinase inhibitors (TKIs) for the treatment of EGFR-mutated NSCLC: erlotinib, gefitinib, the second-generation TKI afatinib and dacomitinib, and the third-generation TKI osimertinib. Sequencing TKI treatment or starting with osimertinib first are reasonable treatment strategies. Nevertheless, patients develop resistance to these TKIs, which can be primary or acquired. Primary resistance includes resistance mutations such as EGFR insertion 20, acquired resistance comprises the development of resistance mutations, activation of bypass signaling, or histological transformation into small cell lung cancer.

Culig, Zoran

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0503-8

Advanced stage prostate cancer is frequently treated with androgen receptor antagonists. Improvement in patients’ survival has been achieved with the anti-androgen enzalutamide. However, there may be an increasing number of point mutations of the androgen receptor during therapy. In addition, ligand-independent activation of truncated androgen receptors may occur during anti-hormonal therapy. In prostate cancer, there is also an increased expression of coactivators and decreased expression of corepressors, thus, contributing to the disease progression. Stromal factors such as interleukins also contribute to therapy resistance. Although preclinical studies with anti-interleukin-6 antibodies opened new possibilities for treatment of prostate cancer, clinical trials have not demonstrated a survival benefit. Increased expression of glucocorticoid receptor has also been associated with advanced prostate cancer. Thus, one can consider the administration of glucocorticoid receptor antagonists in addition to anti-androgens. Stem cells have been described either after androgen treatment or androgen ablation or as a consequence of long-term use of drugs. Taken together, multiple experimental studies provided evidence on the mechanisms that limit usefulness of anti-androgens in prostate cancer.

Seeber, Andreas; Perathoner, Alexander; Kocher, Florian

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0486-5

The approval of imatinib for the treatment of patients with gastrointestinal stromal tumor has (GIST) revolutionized the treatment in the adjuvant setting and metastatic disease. Imatinib is an inhibitor of the receptor tyrosine kinases KIT and platelet-derived growth factor receptor (PDGFR), which are constitutively activated in most cases of GIST. Even though substantial survival improvements have been observed with imatinib, primary or secondary resistance to imatinib represents a major challenge in the treatment of GIST. This short review focusses on treatment strategies to overcome resistance and provides an overview of promising new agents currently evaluated for imatinib-refractory disease.

Wieser, Verena; Marth, Christian

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0478-5

Ovarian cancer (OC) is the foremost lethal gynaecologic malignancy and among the top five deadliest cancers in women. Current treatment comprises a combination therapy of surgery, platinum-based chemotherapy and anti-vascular endothelial growth factor (VEGF) antibodies. However, patients typically experience a disease relapse within two years. Recurrent OC is incurable and resistance to platins and anti-VEGF treatment is a major determinant of prognosis. Understanding the molecular mechanisms that contribute to tumour metastasis and chemoresistance are essential to improve patient outcome and especially survival. In a current OC model, tumour metastasis and chemoresistance critically depend on the biology of cancer stem cells (CSCs). Recent studies also suggest that intratumour heterogeneity is the main cause of treatment failure due to chemoresistance. Furthermore, the proinflammatory tumour microenvironment seems to contribute to metastasis and chemoresistance. Despite an improved understanding of the complex interplay between classical mechanisms of drug inactivation or efflux, clonal selection and the tumour microenvironment, mechanisms of resistance in human OC are poorly understood. This review summarises current concepts in the treatment of OC, mechanisms of resistance to chemotherapy and angiogenic inhibitors and approaches to overcome drug resistance.

Kauffmann-Guerrero, Diego; Schindler, Andreas; Tufman, Amanda; Syunyaeva, Zulfiya; Pfluger, Thomas; Huber, Rudolf; Berger, Frank; Kahnert, Kathrin

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0497-2

Neuberger, Manfred

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0485-6

Reasons for high smoking prevalence in Europe compared to Australia and North America are low prices of tobacco adjusted for purchasing power and poor smoke-free legislation and enforcement in Central and Eastern Europe. High rates of passive smoking in Czechia, Slovakia, Poland and Austria are associated with weak implementation of smoke-free public rooms, especially in the hospitality industry. In 2018 Austria cancelled the smoking ban in all bars and restaurants and continued to allow access to minors, while Hungary since 2012 showed remarkable success by limiting supply of cigarettes and by banning access of minors to tobacco shops. Even more advanced are Western European countries because of lower affordability of cigarettes, ban of smoking rooms and tobacco advertising, plain packaging and public information campaigns. Smoking cessation services across Europe make use of quitlines, provide internet counseling and apps for self-help. Cooperation with physicians should be improved and could help oncologists to combine cancer screening with smoking cessation. Cancer therapy is more successful after smoking cessation.

Asshoff, Malte; Weiss, Günter; Tancevski, Ivan

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0501-x

The benefits of screening programs are highly dependent on risk group definition. This is especially true for lung cancer screening. Results from the National Lung Cancer Screening Trial (NLST) and the NELSON trial (Dutch/Belgian randomised lung cancer screening trial) demonstrated that lung cancer screening using low-dose CT scans results in reduction of cancer-related mortality. This article gives a short overview on participant selection in the NLST and NELSON trials, and on current evidence for implementation of multivariable risk prediction models.

Widmann, Gerlig

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0490-9

Implementation of lung cancer screening is a challenge for radiology. The present short review summarizes major requirements which are needed to ensure high rates of diagnostic accuracy and appropriate protocols for follow-up and invasive work-up. Standardization of procedures, structured reporting, assessment of quality metrics, close multidisciplinary collaboration, and continuous education are essential. Additional quantification of coronary artery calcium and emphysema may provide synergistic medical benefits for a lung cancer screening programme.

Ng, Caecilia; Maier, Herbert; Augustin, Florian

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0502-9

Results from lung cancer screening trials are promising and show improved survival of lung cancer patients, mainly due to a shift in tumor stages at the time of detection. More lung nodules for histopathologic workup and earlier tumor stages translate into more patients and work load for thoracic surgical units. This article provides a view on lung cancer screening from a thoracic surgeon’s perspective.

Kocher, Florian; Pall, Georg

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0492-7

With the release of the survival results from the NELSON lung cancer screening trial there is now additional evidence that low-dose computed tomography (LDCT) screening leads to a reduction of lung cancer mortality in high-risk individuals. These results clearly show that LDCT screening has to be implemented in daily routine. However some questions like the most efficient screening intervals, duration of screening or the most appropriate participant selection are still not finally answered. This article provides a view on lung cancer screening from an oncologist’s perspective.

Chaturvedi, Abhishek; Faisal, Muhammad; Khattab, Ahmed; Devine, Joan; Mewawalla, Prerna

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0487-4

Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive inflammation and immune activation.  The syndrome can be triggered by multiple events that disrupt immune homeostasis, including infection, autoimmune diseases, and lymphoma. Although more common in children—which might indicate a genetic cause—HLH can occur in patients of any age. The most common presenting features of HLH are fever, cytopenia, hepatitis, and splenomegaly. Other features include neurologic abnormalities such as altered mental status, seizures, and ataxia. It is a reactive process of antigen-presenting macrophages and CD8+ T‑cell activation and migration. In addition, abnormalities in the action or number of natural killer cells have been observed. Direct cytotoxicity from T cells, along with elevated levels of pro-inflammatory cytokines and interleukins, plays a role in the generation of excessive inflammation that leads to organ dysfunction. We present the case of a 61-year-old female patient with a past history of recurrent self-limiting episodes of fever that occurred two to three times every autumn for the past 11 years. The meticulous thought process that led to her diagnosis with HLH and marginal zone lymphoma is discussed.

Chaturvedi, Abhishek; Faisal, Muhammad; Khattab, Ahmed; Devine, Joan; Mewawalla, Prerna

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0494-5

Correction to:

Abdelhafeez, Ahmed; Ibrahim, Wael; Elsherief, Wessam

2019 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-019-0471-z