memo - Magazine of European Medical Oncology

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00695-4

Marosi, Christine

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00677-6pmid: 33688378

Hassler, Marco

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00683-8

Unseld, Matthias

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00682-9

Preusser, Matthias

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00676-7

Agis, Hermine

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00687-4

Hohenegger, Martin

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00668-z

Summary Pharmacological anticancer therapy in elderly people has to account for pharmacokinetic aspects in view of age-related changes in organ function and disease-related alterations. Age-related changes in organ function might still be physiological and have to be discriminated from concomitant diseases and their pharmacotherapy. Although efficacy is retained with pharmacological anticancer therapies in elderly patients, plasma drug concentrations and the incidence of adverse reactions often increase. Thus, altered organ function in elderly will be reviewed with respect to clinically relevant outcomes. Furthermore, possible consequences of therapeutic drug monitoring will be discussed focusing on novel targeted therapies with small molecules. Examples of therapeutic drug monitoring during targeted therapies may represent an easy tool to overcome the individual pharmacokinetic situation of elderly cancer patients and may contribute to enhanced safety, when implemented in clinical routine.

Wenkstetten-Holub, Alfa; Fangmeyer-Binder, Maria; Fasching, Peter

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00657-2

Summary Comorbidity is common among cancer patients and increases with age. Comorbid conditions potentially affect treatment, therapy outcomes, and survival of people with cancer. This short review aims at presenting the prevalence of comorbidities, to illustrate their impact on elderly persons with cancer and to discuss their assessment.

Marhold, Maximilian; Topakian, Thais; Unseld, Matthias

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00637-6

Summary Geriatric assessments, nutritional counseling and monitoring of muscle health before and during therapy are of high clinical significance in the management of elderly cancer patients. Criteria, data and cut-offs characterizing cancer-related geriatric sarcopenia are sparse and no consensus about definitions exists to date. We hence highlight a need for clinical trials focusing on sarcopenia in elderly cancer patients, based on its high prevalence and potential negative consequences on therapy outcomes, mortality, quality of life and physical mobility.

Unseld, Matthias; Marosi, Christine

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00625-w

Summary Background With the aging of populations, the number of elderly persons with cancer will increase. Due to the high individuality of elderly persons and their varying patterns of resources and disabilities, cancer treatment for elderly cancer patients needs to be individually adapted. To achieve this, geriatric medicine has established the comprehensive geriatric assessment (CGA). This short review presents the evidence of feasibility and impact of CGA on cancer treatment in elderly patients, as recommended by the American Society of Clinical Oncology (ASCO) in 2018. Methods A systematic review of the literature and a Delphi Consensus with a panel of experts cooperated to compile the evidence for choosing the most adequate treatment for elderly cancer patients. Results There is evidence that CGA makes it possible to predict the occurrence of complications of chemotherapy and of health deterioration, as well as death within 1 year. Conclusion The ASCO has recognized the optimization of cancer therapy for elderly patients as a priority.

Habelsberger, Winfried

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00664-3

Summary Physical activity and exercise can have numerous positive effects on various disease- and therapy-related symptoms across the continuum of cancer disease. These include an improvement in quality of life, physical function, aerobic fitness, muscle strength and muscle mass, bone density and a reduction of insomnia, psychological distress, pain and fatigue. Although no higher fracture incidence could be found in several studies, exercise is still often considered contraindicated in patients with bone metastases due to concerns about skeletal-related events such as pathologic fractures, spinal cord compression, aggravating pain, increased mortality and higher health care costs. This short, narrative review reports general considerations about physical activity in patients with cancer. In particular, it focuses on principles, precautions and contraindications regarding exercise recommendations for patients with metastatic bone disease in order to implement safe and efficient exercise interventions.

Licht, Thomas; Keilani, Mohammad; Crevenna, Richard

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00688-3

Summary Many cancer patients are cured from their malignant tumor, but may suffer from long-term, chemotherapy-induced peripheral neuropathy. This frequent and often disabling condition results from treatment with anticancer drugs including microtubulin-targeting agents such as taxanes, vinca alkaloids, and some immunotoxins; platinum compounds; certain proteasome inhibitors like bortezomib; and immunomodulatory drugs such as thalidomide. Moreover, immune checkpoint inhibitors can cause an autoimmune-mediated peripheral neuropathy. Neuropathic symptoms include pain, numbness, tingling, or cold hypersensitivity in the hands and feet, as well as motor weakening or disorders of the autonomous nerve system. Medical treatment is often unsatisfactory. First-line options include antidepressants like duloxetine, venlafaxine or amitriptyline, and antineuropathic drugs like gabapentin or pregabalin. In addition, topical therapies with capsaicin or lidocaine have been applied. In severe cases, medication with tramadol or opioids may be required for painful paresthesia. Physiotherapy, sensory integrative occupational therapy, and various physical agents can be helpful. The course of disease, however, is usually protracted, and the symptoms generally gradually decrease. In this short overview, we describe medical and physical treatment options for chemotherapy-induced peripheral neuropathy.

Crevenna, Richard; Palma, Stefano; Licht, Thomas

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00686-5

Summary Cancer prehabilitation uses the pretreatment time period to prevent a treatment-related functional decline and its subsequent consequences, and therefore occurs between the time of cancer diagnosis and the beginning of acute cancer treatment. This intervention has been shown to improve functional status, physical and psychological health outcomes and decrease overall health care costs. Currently there are several unimodal and one multimodal cancer prehabilitation regimens. Unimodal cancer prehabilitation includes exercise only, and multimodal cancer prehabilitation regimens are combinations of different interventions such as exercise, patient information and education, nutrition, psychologic counseling such as psycho-oncology, smoking cessation and reduction of alcohol consumption. Both approaches have the goal to improve physical capacity and mental health and to enable cancer patients to cope with the upcoming stress of the specific cancer-related treatment they need. Furthermore, cancer prehabilitation can support cancer patients to better participate in cancer rehabilitation after cancer treatment and maintain their ability to engage in premorbid activities. A growing body of scientific evidence confirms the importance of cancer prehabilitation. Further research is needed to study effectiveness and efficiency as well as clinical aspects of unimodal and multimodal cancer prehabilitation interventions.

Portela Millinger, Filipe; Fellinger, Matthäus

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00641-w

Summary Delirium is commonly seen in palliative care. It usually develops over a short period of time and is characterized by a disturbance of attention and awareness. As delirium is associated with increased mortality, prevention and early identification of this severe neurocognitive disorder is of high clinical relevance. This paper provides a brief overview of risk factors, preventive measures, current screening and diagnostic procedures, as well as nonpharmacological and pharmacological treatment options of delirium in the palliative care setting.

Köstenberger, Markus; Likar, Rudolf

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00685-6

Summary In addition to other distressing symptoms, palliative patients often suffer from very severe pain. For this reason, a precise pain diagnosis is necessary in order to be able to initiate the necessary therapeutic measures. Pain therapy includes the medications specified in the World Health Organization (WHO) analgesic ladder as well as various supportive measures.

Bartsch, Rupert

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00674-9pmid: 33520003

Summary The 2020 Annual Meeting of the American Society of Clinical Oncology (ASCO) was held in a virtual format due to the ongoing SARS-CoV‑2 pandemic. Despite these unique circumstances, results of several interesting studies in the field of breast cancer (BC) were reported. While overall survival data are still missing, KEYNOTE-355 suggests significant activity of pembrolizumab when added to first-line chemotherapy in metastatic triple-negative breast cancer. TBCRC 048 evaluated the role of olaparib in homologous recombination deficient tumours due to genomic alterations other than germline BRCA1/2 mutations; clinically relevant activity was reported in patients with germline PALB2 and somatic BRCA1/2 mutations. In HER2-positive early stage disease, different strategies of chemotherapy de-escalation are under investigation, but the optimal approach is still not well defined. Updated results from the HER2CLIMB trial show that the third-generation HER2 tyrosine-kinase inhibitor tucatinib in combination with trastuzumab and capecitabine is the new standard-of-care for pretreated patients with HER2-positive metastatic BC with active brain metastases. Results from BYLieve supports the notion that the combination of endocrine therapy with the PIK3Ca inhibitor alpelisib is a reasonable treatment approach in hormone-receptor positive/HER2-negative BC after prior CDK4/6-inhibitor therapy. Finally, the ECOG-ACRIN 2108 trial failed to show a benefit for early surgery of the primary tumour in patients with metastatic BC.

Fuereder, Thorsten

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00679-4

Summary At the ASCO 2020 virtual meeting, multiple clinically relevant studies were presented addressing open questions in the head and neck cancer field: Are de-escalation strategies feasible in low risk patients? What is the appropriate platinum dose in combination with radiotherapy in high-risk patients suffering from locally advanced disease? Is immunotherapy the first line standard of care for all patient in the recurrent/metastatic setting? This article summarizes the most significant head and neck cancer studies presented at the ASCO 2020 virtual meeting and discusses the data in the context of the current literature.

Horvath, Lena; Pircher, Andreas

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00673-2pmid: 33456617

Summary In this article we summarize our personal non-small cell lung cancer (NSCLC) highlights of the virtual ASCO 2020 meeting, covering developments in early and advanced-stage NSCLC. Until recently early stage NSCLC patients were treated independently of their genetic profile. Now the ADAURA study proved that postoperative osimertinib significantly prolongs disease-free survival compared to standard chemotherapy in EGFR-mutated NSCLC , underlining the high efficacy of targeted therapies in early stages. In advanced-stage disease, of course immunotherapy (IO) was at the center of attention. Final analysis of KEYNOTE-189 (pembrolizumab plus chemotherapy versus chemotherapy alone) and 3‑year update of CheckMate 227 (nivolumab plus ipilimumab versus standard chemotherapy) proved the long-term overall survival benefit of IO combinations in the first-line setting independent of PD-L1 status. The innovative CheckMate 9LA study demonstrated rapid disease control with limited-course chemotherapy plus IO doublet, while sparing chemotoxicity and may soon become a new clinical treatment choice. Moreover, the phase II CITYSCAPE trial presented significant response rates of the TIGIT-inhibitor tiragolumab plus atezolizumab in PD-L1 positive NSCLC. For HER2-mutated patients a highly effective drug conjugate trastuzumab deruxtecan was presented in a phase II study, extending targeted agents in genetically driven NSCLC. Altogether, ASCO 2020 could excite with inspiring new data for an optimized and more individualized NSCLC treatment regimen, contributing to a better outcome for both early and late-stage diseased patients and continuing to decrease lung cancer mortality.

Pichler, Renate; Tulchiner, Gennadi; Bektic, Jasmin

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00667-0

Summary The aim of this short review is to summarize “clinical practice changing” abstracts about genitourinary cancers from this year’s ASCO Annual Meeting. The phase 3 JAVELIN Bladder 100 trial showed astonishing overall survival (OS) data up to 22 months in metastatic urothelial carcinoma (mUC), using a novel gold standard in the first-line setting of mUC—immunotherapy maintenance with avelumab after response to platinum-based chemotherapy. In the first-line treatment of metastatic RCC (mRCC), two phase 2 trials (OMNIVORE and HCRN GU16-260) evaluated the efficacy of a novel sequential strategy, nivolumab monotherapy followed by ipilimumab rescue if nonresponse to nivolumab, confirming that this therapeutic concept is less effective as upfront combination treatment. Finally, updated 24-month progression-free survival (PFS) and OS rates of the KEYNOTE-426 are presented, showing efficacy most in intermediate- and poor-risk patients for the combination pembrolizumab plus axitinib compared with sunitinib. According to the impressive data from the HERO trial, the US Food and Drug Administration granted relugolix priority review as the first oral GNRH receptor antagonist in advanced prostate cancer. Moreover, 18F‑DCFPyL-PET/CT is a promising diagnostic tool for biochemical recurrence as the CONDOR trial confirmed diagnostic superiority of PyL-PET/CT compared with conventional imaging in detecting occult metastasis even in low PSA values. In nonmetastatic castration-resistant prostate cancer (nmCRPC), final OS data of ARAMIS, PROSPER and SPARTAN evaluating efficacy and safety of second-generation antiandrogens versus placebo were presented. In patients with mCRPC progressing after docetaxel, 177Lu-PSMA-617 demonstrated improved rates of 50% reduction in PSA relative to cabazitaxel (TheraP study).

Jeryczynski, Georg; Krauth, Maria-Theresa

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00630-z

Summary Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant hematological condition arising from B‑cells, characterized by the presence of monoclonal immunoglobulin production, also known as paraprotein. It is found in up to 3% of individuals over the age of 50 years. The overall progression rate is low at around 1% per year, with most patients progressing to multiple myeloma (MM). Other diseases that may arise from MGUS include non-Hodgkin lymphomas, Waldenström macroglobulinemia, amyloid light-chain (AL) amyloidosis, POEMS (polyneuropathy, organomegaly, endocrinopathy, M‑protein, skin changes), cryoglobulinemia, monoclonal gammopathy of renal significance (MGRS), and additional paraprotein-driven diseases. Every case of monoclonal gammopathy warrants careful investigation to rule out the presence of a malignant form. In recent years, paraprotein-associated conditions such as MGRS have been increasingly recognized. Accurate diagnosis and work-up of these cases require a multidisciplinary approach, and it is paramount to accurately distinguish them from true MGUS in order to prevent end-organ damage. Follow-up of MGUS should be lifelong; however, a risk-adapted approach involving the primary care setting is recommended.

Krauth, Maria T.; Agis, Hermine

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00689-2

Summary AL amyloidosis (AL) and monoclonal gammopathy of renal significance (MGRS) are both paraprotein-associated diseases. Both entities are based on a monoclonal paraprotein produced by a clonal plasma-cell population like in monoclonal gammopathy of undetermined significance (MGUS) or by a B-cell population like in low grade lymphoma. Per definition MGUS and low-grade lymphoma do not require treatment. But in rare cases the monoclonal M‑gradient acts as a “toxic” protein inducing severe multimodal organ damage as in AL and MGRS. Urgent treatment is indicated in AL and in MGRS to avoid irreparable loss of organ function or death. No treatment is currently approved in Europe for AL or MGRS. On January 15, 2021 the US Food and Drug Administration approved the monoclonal anti-CD38 antibody for treatment of AL. To minimize the serum M‑gradient concentration, a clone directed therapy as in multiple myeloma or B‑cell malignancies treatment regimens can be applied. In AL, an additional treatment option is under investigation. These special drugs are directed against the typical amyloid-fibrils responsible for deposition formation. An additional and important consideration in this special field of rare diseases is the option of organ transplantation in particular kidney transplantation in MGRS. All these treatment modalities are addressed in this article.

Binder, Christina; Duca, Franz

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00678-5

Summary Cardiac amyloidosis is caused by deposition of abnormally folded proteins (amyloid). The most common forms of amyloidosis which present with cardiac involvement are light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). Even with novel treatments emerging, the prognosis of these patients remains poor once amyloid deposits in the heart. Therefore, knowledge on clinical and imaging features of cardiac amyloidosis is crucial to make an early diagnosis and improve patient outcomes. This article reviews the most important diagnostic findings of cardiac amyloidosis and gives an overview on the therapeutic management of these patients, including supportive-, device- and disease-specific drug therapies focusing on AL amyloidosis.

Reiter, Thomas; Nackenhorst, Maja

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00671-4

Summary Monoclonal gammopathy of renal significance (MGRS) encompasses a group of kidney disorders in which a monoclonal immunoglobulin secreted by a B cell or plasma cell clone causes renal damage, without meeting hematological criteria for malignancy. The underlying disorder in patients with MGRS is generally consistent with monoclonal gammopathy of undetermined significance (MGUS). Because of the wide spectrum of MGRS-associated diseases, defined through the location and mechanism of renal injury, it is often challenging to establish the right diagnosis. Kidney biopsy must be considered early; hence, close cooperation between hematologist and nephrologists is crucial in diagnosis and treatment from the beginning to prevent irreversible organ damage. Anti B‑cell or plasma-cell clone directed therapy with cytostatic or immunomodulatory agents can save and ameliorate renal function significantly. This is underlined by the fact that, untreated, MGRS-associated disease shows early recurrence in patients after kidney transplantation.

Agis, Hermine; Krauth, Maria T.

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00675-8

Summary Immunoglobulin light chain (AL) amyloidosis is a rare and underdiagnosed life-threatening systemic disease, primarily caused by insoluble depositions of misfolded monoclonal light chains. The monoclonal light chain paraprotein originates from a small clonal B‑cell or a clonal plasma cell population. If left undetected the paraprotein can induce a number of complications based on organ damage. The most dangerous and life-threatening organ dysfunction emerges from cardiac involvement. Thus, patients overall survival depends on early detection. Establishing the correct diagnosis and clear characterization of the amyloid-forming protein, staging, risk assessment and treatment are crucial and depend on a highly experienced interdisciplinary, multiprofessional team.

Böhm, Alexandra

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00644-7

Summary Treatment of patients with light-chain amyloidosis (AL amyloidosis) has changed over the last 20 years, and early mortality rates have decreased with prolongation of survival. However, many patients are not cured with conventional therapy. Therefore, all patients should be assessed at diagnosis to determine eligibility for autologous stem cell transplantation (ASCT) since high-dose melphalan and ASCT have been shown to induce long-term hematologic and clinical responses with treatment-related mortality (TRM) <5%. Earlier diagnosis, improvement of supportive care, and deeper remissions with recently available first-line therapy have substantially reduced TRM. However, procedures and experience in complex AL amyloidosis patients still vary between transplant centers because a multidisciplinary team is necessary for an individual risk-adapted approach.

Doleschal, Bernhard; Popper, Ulrich

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-021-00684-7

Summary Recent advances in molecular diagnostics classify Langerhans cell histiocytosis as an orphan disease strongly dependent on alterations in MAP kinase pathway, most prominently BRAF V600E mutation. Molecular targeted therapy with vemurafenib often leads to long-term remission. Efforts to expand therapeutic approaches include MEK inhibition or modulation of cellular senescence.

Reyad, Mona; Abdel-Aziz, Sherin; Saleh, Layla M.; El-Ghlban, Samah; El Tantawy El Sayed, Ibrahim; Abdel-ghaffar, Hasan

2021 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-020-00665-2

Summary Background Acute lymphoblastic leukemia (ALL), characterized by overproduction and accumulation of immature lymphoid cells in bone marrow and peripheral blood, is the most common malignancy in children. NOTCH signaling is suggested to be a key event in hematological malignancies and appears to be a major oncogenic trigger in leukemia. Several studies on NOTCH target gene (HES‑1, p21 and c‑Myc) expression evaluated the correlation between these genes in AML (acute myeloid leukemia), but this relationship has not yet been clarified in ALL. Therefore, we aimed to study the expression of these genes in our Egyptian patients with ALL to obtain more information. Patients and methods RNA was extracted from peripheral blood mononuclear cells (PBMNCs) of 91 pediatric ALL patients (49 B-cell acute lymphoblastic leukemia [B-ALL] and 42 T-cell acute lymphoblastic leukemia [T-ALL]) and 52 healthy controls. The expression levels were determined by quantitative real-time polymerase chain reaction (qRT-PCR). Results Median p21 and HES1 expressions were down regulated, while c‑Myc expression was up-regulated in B‑ALL cases (p < 0.001, p = 0.008, p < 0.001, respectively) and in T‑ALL cases (p = 0.049, p = 0.015, p < 0.001, respectively) when compared to the control group. Median HES1 expression was down regulated, in B‑ALL cases compared to T‑ALL cases (p = 0.002), while P21 and c‑Myc did not differ significantly between B‑ALL and T‑ALL cases. Conclusion P21 expression showed a significant positive correlation with HES1 expression and c‑Myc showed nonsignificant negative correlations with p21 and HES1, thus, suggesting that HES1 may affect ALL cells through the HES1–p21 pathway. Patients with over expressed c‑Myc had worse survival than patients with low expression which suggested it is a risk predictor.