memo - Magazine of European Medical Oncology

Niedersüß-Beke, Dora

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00605-0

SummaryThe field of uro-oncology has become more and more important in the past 3 years. ESMO 2019 once again had more highlights in this growing field of medical oncology. The 2019 ESMO annual meeting was an outstanding conference, especially in uro-oncology. Trials with potential for changing the standard of care and novel therapy approaches were presented in bladder cancer and renal cell carcinoma.

Effenberger, Maria; Tilg, Herbert

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00597-x

SummaryThe intestinal microbiota seems to play a key role in many gastrointestinal, pancreatic and liver disorders. Dysbiosis, a substantial alteration in the intestinal microbiome, is associated with chronic liver disease (CLD) compared to healthy individuals. These findings were shown in several preclinical and clinical studies and were most distinct in the stage of cirrhosis. The pathogenesis of hepatocellular carcinoma (HCC) and its underlying diseases is still not completely understood: Bacteria and related metabolites and pro-inflammatory signals may be involved. Several animal and human studies have focused on the role of intestinal microbiota in HCC. Here a key role of the intestinal microbiota in the pathogenesis could be addressed, whereby the abundance of pro-inflammatory intestinal species is increased. Additionally, some studies could demonstrate a decrease of butyrate-producing species and other species known for their anti-inflammatory potential. Furthermore, multiple preclinical studies could demonstrate that the intestinal microbiota is a key player in hepatocarcinogenesis. The intestinal microbiota seems to interact with the central pathways of hepatocarcinogenesis.

Grassi, Massimiliano; Spagnoletti, Andrea; Puccini, Alberto

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00598-w

SummarySoft tissue sarcomas are rare diseases that encompass a very heterogeneous group of tumors with diverse pathology and clinically overlapping characteristics. Although some treatment options may be used across different subtypes, each is characterized by specific features and may benefit more from specific approaches. In such a rare and peculiar group of diseases, it is rather important to define the best strategy to prolong survival and improve the quality of life of the patients. Although anthracycline-based chemotherapy remains a milestone in the first-line setting, in recent years novel targeted and immune therapies have been developed and more tailored strategies are possible. For these reasons, every case should be discussed in a multidisciplinary board that includes all specialists involved in the treatment of these patients, since the combination of systemic and local treatments can often be proposed. In this short review, we present the state of the art and offer future perspectives for the management of soft tissue sarcomas.

Thaler, Martin; Khosravi, Ismail

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00595-z

SummaryBone sarcomas are rare, representing only 0.2% of all diagnosed cancers. Incidence is higher in children and adolescents, but bone sarcomas are still numerically outnumbered by benign bone tumors in this patient cohort. This article summarizes the management of treatment for bone sarcomas. Systemic therapy, surgical therapy, and radiotherapy are presented. Osteosarcoma, chondrosarcoma, and Ewing sarcoma are among the most frequently occurring bone sarcomas in all age groups. In recent decades, multimodal treatment of these rare entities has increased disease-free survival for these patients. As malignant primary bone tumors are rare cancers, and since management is complex, the standard of treatment should be performed by reference centers. If possible, wide en-bloc resection of the bone sarcoma should be performed. The role of radiotherapy in osteosarcoma and chondrosarcoma is limited, but Ewing sarcoma is a radiation-responsive tumor. In primary bone sarcomas, the efficacy of chemotherapy varies according to histological type. Prognosis is poor in patients with osteosarcoma or Ewing’s sarcoma if surgery without neoaqdjuvant chemotherapy is performed. Despite advances in surgical, medical, and radiation therapy, few significant positive changes in overall survival have been observed in patients with these diseases in recent decades.

Amann, A.

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00603-2

SummaryThis article summarizes important highlights regarding gastrointestinal cancer at the 2019 ESMO annual meeting. The choice of the abstracts was based on a personal view with a focus on different tumor entities of the gastrointestinal tract. Precision-medicine-guided therapy for cancer entities was one of the main topics at this year’s ESMO. Furthermore, circulating tumor DNA (ctDNA) by performing liquid biopsy was again another hot topic, especially in guiding adjuvant chemotherapy in stage III colorectal cancer (CRC) patients. Finally, hope was stirred up again for immunotherapy in the indication of first-line treatment in nonresectable hepatocellular cancer (HCC). In summary, the astonishing progress in new drugs that has been made in recent years is still ongoing and will lead to better treatment for cancer patients.

Bartl, Thomas; Paspalj, Valentina; Grimm, Christoph

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00606-z

SummarySince the introduction of poly-ADP-ribose polymerase (PARP) inhibitor therapy for epithelial ovarian cancer (EOC) patients, testing for aberrations of homologous recombination (HR) repair as a predictive biomarker of therapy response has become an area of particular clinical interest. As HR represents a crucial repair pathway of otherwise possibly lethal DNA double strand breaks, its deficiency triggers a phenotypic behavior of tumor cells resulting in the accumulation of genetic damage. PARP inhibitors target this emerging genomic instability by fostering DNA strand breaks. Whereas testing for mutations of the tumor-suppressor genes BRCA 1 and BRCA 2 as a pivotal part of the HR apparatus has entered clinical routine, approximately 30% more high-grade EOC patients harbor aberrations of the HR pathway other than BRCA mutations and may therefore respond to PARP inhibition therapy. In recent years, several double-blind, placebo-controlled trials investigating sizeable patient cohorts have reported positive results of PARP inhibitor therapy response in HR-positive patient subgroups. Therefore, introducing HR testing in both the primary and recurrent setting as a biomarker for PARP inhibitor response may expand the range of patients who may profit from this therapeutic option beyond BRCA-mutated tumors.

Richtig, Erika

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00593-1

SummaryThe therapeutic landscape of advanced and metastatic melanoma has changed dramatically in the last ten years. Targeted therapies as well as checkpoint inhibitors and oncolytic viruses have launched a broad revolution within this field. First presented at ASCO 2011, changes in melanoma treatment giving “light at the end of the tunnel” have also changed the treatment of many other tumor entities. So oncologists all over the world can offer their patients these treatment options with higher efficacy than we ever had. But despite all optimism we are still losing about half of our patients with metastatic melanoma along the way. In this short review the therapeutic landscape of advanced melanoma is described.

Arnold, Christoph Reinhold; Mangesius, Julian; Jäger, Robert; Ganswindt, Ute

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00594-0

SummaryNeoadjuvant chemoradiotherapy is a well-established standard treatment for locally advanced rectal cancer and has led to a remarkable improvement in local control. However, distant recurrences still pose a notable threat and local failure, albeit increasingly rare, can lead to unfavorable clinical situations. In this short review, we discuss three promising new strategies to improve rectal cancer treatment: total neoadjuvant therapy, short course radiotherapy, and immune checkpoint inhibitors.

Reichinger, Andreas; Rumpold, Holger

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00607-y

SummaryApproximately 20% of locoregional colorectal carcinoma (CRC) relapse after standard of care treatment. Therefore, it is necessary to personalize our adjuvant strategies and define this subgroup, which remains at high risk after treatment. Circulating tumour DNA (ctDNA) is cell-free DNA from apoptotic cancer cells, which carries the whole genome information of the primary tumour and has emerged as good candidate to guide our therapy decisions in the future. It was shown that high levels of ctDNA after adjuvant chemotherapy is a poor prognostic factor. Moreover, it was presented at ESMO 2019 in Barcelona that patients with advanced colorectal carcinomas and ctDNA-positive samples after surgery had a significantly decreased 2‑year disease-free survival in comparison to ctDNA-negative patients. That means, ctDNA could be a tool to select this high-risk subgroup in advanced CRC in order to prolong or intensify adjuvant chemotherapy and to avoid insufficient treatment.

Putzer, Daniel; Schullian, Peter; Eberle, Gernot; Bale, Reto Josef

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00600-5

SummaryMinimally invasive thermal ablation techniques are an integral part of international treatment guidelines in hepatocellular carcinoma (HCC). Due to highly effective local tumor control in nonresectable liver tumors with a relatively low rate of morbidity and mortality, thermal ablation even challenges the surgical approach as the first-line treatment in selected patients. Ablation outcome is largely dependent on the size and location of the HCC as well as on the applied ablation technique and image guidance. The creation of a sufficient ablation margin (A0 ablation in analogy to R0 resection) is prerequisite to assure low recurrence rates. In large tumors, tumor-free margins can be achieved only by overlapping ablation zones, which can be accomplished using stereotactic multiprobe ablation techniques (stereotactic radiofrequency ablation [SRFA], stereotactic microwave ablation [SMWA], stereotactic irreversible electroporation [SIRE]) in combination with 3D trajectory planning and image fusion for intraoperative evaluation of treatment results.

Schwameis, Richard; Paspalj, Valentina; Kranawetter, Marlene; Polterauer, Stephan

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00596-y

SummarySurgery is a cornerstone of treatment in patients with ovarian cancer. In primary disease, patients should be carefully selected to undergo either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery. The aim of every debulking surgery is complete tumour resection. Whilst thorough evaluation of the iliac and para-aortic lymph nodes is important, systematic lymphadenectomy may be omitted when lymph nodes seem unsuspicious. To date, surgical outcome seems to remain the most important prognostic factor in the treatment of patients with ovarian cancer and therefore patients should only be treated in high-volume centres that are able to perform complex multidisciplinary surgery. The role of debulking surgery in recurrent disease has yet to be defined.

Koelblinger, Peter

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00602-3

SummaryFor years, interferon alpha was the sole option in the adjuvant treatment of patients with completely resected melanoma with lymph node metastases and a high risk of disease recurrence, albeit being associated with a relatively low efficacy combined with significant toxicities. After the advent of immunotherapy and targeted therapy in locally advanced or metastatic melanoma at the beginning of the last decade, these therapeutic approaches have meanwhile also shown superior efficacy compared to previously used treatments or observation in the context of adjuvant therapy. Hence, adjuvant targeted or anti-PD1-antibody-based immunotherapy was incorporated into routine clinical practice to reduce the risk of tumor recurrence in affected patients in early 2018. Moreover, modern melanoma therapies are increasingly being investigated in a neoadjuvant setting in analogy to other solid malignancies. Considering the promising results reported so far, neoadjuvant immunotherapy might potentially become the treatment of choice in high-risk melanoma patients with macrometastatic disease in the near future.

Marhold, Maximilian; Topakian, Thaïs

2020 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00599-9

SummaryHomologous repair deficiency is a clinically relevant molecular aberration in prostate cancer. The goal of this short review is to summarize the study landscape of treatments targeting these aberrations through discussion of the most relevant clinical trials. Due to its shortness, this review does not claim to be exhaustive and a major focus is being laid on PARP inhibitors in clinical development for prostate cancer.