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Prochazka, Katharina T.; Neumeister, Peter
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00735-zpmid: 34394761
Summary In the last few years, treatment of patients exhibiting chronic lymphocytic leukaemia has changed extensively due to advances in the development of targeted therapies. The role of immunochemotherapy has been for the most part replace and the guidelines have been modified accordingly. Herein, we give an overview on updated onkopedia guidelines, studded with updates of the landmark studies of the latest American Society of Hematology (ASH) meeting. In addition, since still crucial, recommendations concerning coronavirus disease 2019 (COVID-19) in chronic lymphocytic leukaemia patients will be covered.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00725-1
Summary At the 62nd annual meeting of the American Society of Hematology (ASH) 2020—which took place virtually for the first time—numerous clinical studies and research results were presented. The latest trends and exciting developments in the field of stem cell transplantation can be found in the following article, e. g. how transplantations with a mismatch donor can be safely performed, important studies regarding MDS and ALL patients, a promising second-line treatment in chronic GVHD, why the nutritional status and the microbiome should be part of the pre-transplant work-up and that lifelong follow-up for children and young adolescents after an allogeneic transplantation is essential.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00746-w
Summary The meeting focused in particular on new strategies such as chimeric antigen receptor (CAR)-T cells and bispecific antibodies. Updates of clinical trials regarding induction treatment in transplantable and non-transplantable status were presented. Furthermore, minimal residual disease negativity (MRD) or, in other words, a status characterized by no measurable disease, using standardized multicolor-flow cytometry or next-generation sequencing techniques becomes increasingly important as an endpoint in clinical trials. A subjectively assessed overview of the current contributions to the treatment of multiple myeloma is given here.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-020-00669-ypmid: 33362882
Summary Background Multiple myeloma (MM) is a cytogenetically heterogeneous and incurable plasma cell disease with unknown etiology. It is thought that the ABO blood groups may play a role in the etiology of many diseases. The purpose of this study is to determine whether there is a relationship between the ABO blood groups and the development of MM, clinical findings and overall survival. Methods In this single-center, retrospective and observational study, 198 patients with known blood types who diagnosed with MM between January 2012 and June 2020 were included. Results It was shown that individuals with blood group 0 had a significantly lower risk of MM (OR = 0.575, 95% confidence interval 0.416–0.794, P = 0.001). The incidence of extramedullary lesion was significantly higher in those with 0 blood group compared to other blood groups (P = 0.000). Overall survival was significantly shorter in patients with 0 blood group than those without 0 blood group (P = 0.007). Conclusion Individuals with 0 blood group had a lower risk of developing MM. It was determined that having 0 blood group is a predisposing factor for the development of extramedullary lesion in MM patients. However, it was shown that having a blood group of 0 was a very significant prognostic factor for MM patients and was associated with short OS.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00732-2
Summary The San Antonio Breast Cancer Symposium is one of the largest meetings addressing the treatment of breast cancer patients; therefore, the meeting is of high interest for breast cancer specialists from around the world. From the meeting in 2020, which was held virtually, I have picked the top three surgical abstracts to show new developments in the surgical treatment of breast cancer patients. The first abstract addresses the question of whether an axillary dissection is necessary or not, in a selected patient cohort. The results, even after a short follow-up time, could confirm the findings of the ACOZOG Z 0011 trial. The second abstract refers to the question of whether sentinel node biopsy is always mandatory in older patients with hormone-receptor-positive breast cancer. Finally, the third abstract focuses on a trial dedicated to the sentinel lymph node after neoadjuvant chemotherapy. These three abstracts show the importance of the surgical management of the axilla, under special circumstances.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00718-0
Summary Recent findings support the role of alpelisib in advanced HR-positive breast cancer harboring a PIK3CA mutation. A retrospective biomarker analysis on the intrinsic subtypes of HR-positive breast cancer reveals a subgroup that will not benefit under the addition of a CDK 4/6 inhibitor treatment. The detection of circulating tumor cells before start and during tumor treatment is associated with worse outcome in metastatic breast cancer patients.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00722-4pmid: 34221179
Summary One year into the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, the 2020 San Antonio Breast Cancer Symposium (SABCS) was another large congress held in a virtual format. Despite these circumstances, clinically relevant data were presented, and this short review focuses on developments in the fields of triple-negative breast cancer (TNBC) and metastatic HER2-positive breast cancer. A quality-of-life (QoL) analysis from IMPassion031 showed that adding atezolizumab to neoadjuvant chemotherapy was not associated with a detrimental effect on QoL, while the burden of treatment-induced side effects increased with each cycle of neoadjuvant therapy in both treatment arms. KEYNOTE-355 evaluated the addition of pembrolizumab to chemotherapy as first-line treatment in metastatic TNBC (mTNBC); a significant improvement of progression-free survival (PFS) was reported in the pembrolizumab arm. At the 2020 SABCS, results with respect to different chemotherapy backbones were reported and the benefit of pembrolizumab was maintained irrespective of the type of taxane. Disappointingly, the phase III IPATunity130 study could not confirm a PFS improvement with the AKT inhibitor ipatasertib when added to paclitaxel as first-line treatment in mTNBC. A biomarker analysis from the phase III ASCENT study showed that the antibody–drug conjugate sacituzumab govitecan was superior to chemotherapy by investigator’s choice independent of Trop‑2 expression and BRCA mutation status. In HER2-positive breast cancer, the PRECIOUS trial suggested a small albeit significant benefit with reinduction of pertuzumab in later treatment lines in patients progressing on prior dual HER2-blockade in the first- or second-line setting. The HER2-specific tyrosine kinase inhibitor tucatinib when added to trastuzumab and capecitabine was shown to improve PFS and overall survival (OS) over trastuzumab and capecitabine alone in pretreated patients in the randomized HER2CLIMB trial; this benefit was apparently independent of hormone-receptor expression. An update from the DESTINY-Breast01 trial reported a median PFS of 19.4 months with trastuzumab deruxtecan in heavily pretreated patients. Finally, an analysis from the PERTAIN trial with > 6 years median follow-up showed excellent OS in patients with luminal B/HER2-positive receiving first-line trastuzumab/pertuzumab in combination with endocrine therapy suggesting that chemotherapy-free treatment is an option in highly selected patients.
Gampenrieder, Simon Peter; Rinnerthaler, Gabriel; Greil, Richard
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00726-0
Summary The three top abstracts at the 2020 virtual San Antonio Breast Cancer Symposium regarding hormone-receptor-positive early breast cancer, from our point of view, were the long-awaited results from PenelopeB and RxPONDER as well as the data from the ADAPT trial of the West German Study Group. PenelopeB failed to show any benefit by adjuvant palbociclib when added to standard endocrine therapy in patients without pathologic complete response after neoadjuvant chemotherapy. RxPONDER demonstrated that postmenopausal patients with early hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2−) breast cancer, 1–3 positive lymph nodes and an Oncotype DX Recurrence Score of less than 26 can safely be treated with endocrine therapy alone. In contrast, in premenopausal women with positive nodes, adjuvant chemotherapy plays still a role even in case of low genomic risk. Whether the benefit by chemotherapy is mainly an indirect endocrine effect and if ovarian function suppression would be similarly effective, is still a matter of debate. The HR+/HER2− part of the ADAPT umbrella trial investigated the role of a Ki-67 response to a short endocrine therapy before surgery in addition to Oncotype DX—performed on the pretreatment biopsy—to identify low-risk patients who can safely forgo adjuvant chemotherapy irrespective of menopausal status.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00723-3
Summary Chronic myeloid leukemia is nowadays associated with a good prognosis and an excellent life expectancy. However, certain levels of responses have to be achieved with the various available tyrosine kinase inhibitors at certain time points during the treatment otherwise adequate diagnostic and therapeutic actions have to be initiated. This paper will focus on these issues.
Azizi, Amedeo A.; Gojo, Johannes; Peyrl, Andreas
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00736-y
Summary In recent years, novel insight into molecular mechanisms has allowed the identification of drug targets for various pediatric brain tumors. The aim of this article is to give an overview of new treatment options in neurofibromatosis type 1 (NF1), novel tyrosine kinase inhibitors that target oncogenic gene fusions in pediatric brain tumors, and antiangiogenesis as promising therapy especially in recurrent medulloblastoma.
Pezzullo, Giovanna; Ugga, Lorenzo; Cuocolo, Renato; Perillo, Teresa; D’Amico, Alessandra
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00720-6
Summary Primary diffuse leptomeningeal melanomatosis is a rare and very aggressive neoplasm with only 6 pediatric cases reported so far. Recognizing this condition is unfortunately difficult due to the nonspecific clinical presentation. Nevertheless, imaging may help in a timely diagnosis that can better direct the management of these patients, especially in the light of the rapidly ominous course of the pathology. We describe three cases of pediatric primary diffuse leptomeningeal melanomatosis and review the literature regarding this entity, focusing on computed tomography and magnetic resonance imaging findings.
Salzer, Elisabeth; Hutter, Caroline
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00743-z
Summary Cancer remains the leading cause of death from disease among children beyond the age of one. Survival of pediatric patients with cancer has dramatically improved over the last decades but some tumors remain almost intractable and relapse is still associated with an infaust prognosis. Despite the heterogeneity of pediatric malignancies, most treatments include the same set of generic therapies. Optimizing delivery of conventional therapeutics has been the driving force behind continuous improvements but further escalation of conventional therapy is unlikely to improve outcomes. The limited success of targeted drugs in pediatric cancer patients, originally developed for cancers in adults, can be connected to the different etiology of tumors in children versus adults. In addition, many pediatric cancers lack reliable biomarkers, cannot be studied in large cohorts and only few available therapies target abberations specific for certain pediatric cancers. These observations have led to the establishment of pediatric precision-medicine programs. The major goal of these programs is to identify patient-tailored molecular treatment plans that will eventually improve quality of life and survival. Despite the initial euphemism, the impact of actionable matched treatments and the most adequate value-based genomics strategies are not yet well established. A non-competitive collaborative model based on pediatric cancer priorities and strong collaboration between academia, pharmaceutical companies and regulators is needed. In the near future, clinical trials need to focus on biologically defined patient subsets, in an even smaller patient population. A major collaborative effort between all associated groups will be necessary to ensure success of pediatric precision cancer medicine.
Fischmeister, Gustav; Riedl, David; Sanio, Gabriele; Bogendorfer, Thomas; Holzner, Bernhard; Rumpold, Gerhard; Nickels, Alain; Licht, Thomas; Sperl, Wolfgang
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00729-x
Summary Until 2018 only adults had access to rehabilitation in Austria, but since then 5 centers for pediatric rehabilitation with different indications have been established with the goal of improving the health of sick children and young adults. The pediatric rehabilitation center “Leuwaldhof”, which is located south of Salzburg, is the only pediatric oncologic rehabilitation center in Austria. It offers rehabilitation and recovery for pediatric patients who suffered from malignancies, as well as for their families and siblings, but also for acute or chronic disease in metabolism or digestion. Cancer and its treatment significantly decrease the quality of life (QoL) of pediatric patients and their families. Families often have to split up during the months of chemotherapy if there are siblings in the family and very often it is the mother who stays with the sick child in the hospital. To facilitate recovery for the families in these difficult times, interdisciplinary and family-oriented inpatient rehabilitation has recently been implemented in Austria. To evaluate the improvements during the rehabilitation, the QoL of the patients and families has been routinely assessed since the opening of the center. In a specifically designed ‘life app’, patients and families complete the Pediatric Quality of Life Inventory (PedsQL; generic score and cancer module) before and after rehabilitation on their own electronic devices. Data of 98 patients and 124 parents between June 2018 and December 2019 show significant improvements in QoL. Our goal is to support the children and their families to help them return to normal life. Our results show rehabilitation helps achieve this important goal.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00734-0pmid: 34422121
Summary Human metapneumovirus (HMPV) causes a flu-like disease in humans. Most infections occur in early childhood, but reinfections during life are common. The clinical course of these infections are usually mild and do not require hospitalization. However, this is not the case for older and/or comorbid patients, especially if lymphoma is a concurrent disease. Here, we report on a case of an 81-year-old man, who suffered from chronic lymphocytic leukemia. During the first coronavirus disease (COVID) wave, he was admitted to the emergency department with respiratory symptoms. Initially, he was suspected as having SARS-CoV‑2 infection, but a broad diagnostic approach revealed a HMPV infection. The patient showed remarkable, bilateral pulmonary infiltrates and worsened within a few days. Consequently, he had to be admitted to the intensive care unit, where he was mechanically ventilated. Clinically, the patient worsened further and died on day 5 after admission. Severe HMPV infections are rare. However, patients suffering from hematological diseases are at high risk, which is exemplified in this case report.
Fauser, Josia; Köck, Stefan; Gunsilius, Eberhard; Chott, Andreas; Peer, Andreas; Ditlbacher, Adelheid; Fritsche, Gernot; Joannidis, Michael; Wolf, Dominik; Pircher, Andreas
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00701-9pmid: 33824685
Summary HLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00702-8
Summary Multidrug resistance of bacterial pathogens is an increasing problem wordwide, especially treatment of multidrug resistant (MDR) gramnegative bacteria is challenging. In the recent past, several new antibiotics as well as new betalactamase inhibitors have been introduced. These novel drugs are valuable new tools for the therapy of infectious complications in cancer patients once there is a high risk for infections due to multidrug-resistant pathogens. While it is necessary to start empirical antibiotic therapy immediately, novel antibiotics only provide benefits in certain situations, depending on the underlying pathogens. Thus, these new antibiotics are best used guided by microbiological testing, since the exact mechanism of resistance determines susceptibility or resistance to certain antibiotics. For empirical therapy, previous culture results and/or colonization with MDR pathogens can help to choose from conventional antibiotics or novel drugs. In clinical practice, optimal antibiotic therapy can be achieved by close collaboration of specialists in hematooncology, infectious diseases and microbiology.
Mayrhofer, Karl; Hilbe, Wolfgang
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00721-5
Summary We report a patient with pretreated recurrent diffuse large B-cell lymphoma who was admitted to our ward due to emesis, headache and fatigue. Radiologic workup inlcuding brain magnetic resonance imaging showed no abnormalities but consecutively carried out lumbar puncture due to persistent headache reveiled cryptococcus neoformans meningitis. Treatment consisted of intravenous liposomal amphotericin B followed by maintenance therapy with fluconazole. Disease characteristics and therapy of cryptococcal meningitis are reviewed in this article.
Chaari, Anis; Turak, Esraa; Nashaat, Mark; Aboayana, Islam; Kauts, Vipin
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00705-5
Summary Mucormycosis is a rare but potentially life-threatening disease. Common risk factors include diabetic ketoacidosis, malignancies and bone marrow transplant. In patients with hematological malignancies mucormycosis often occurs in a context of neutropenia and/or following chemotherapy. We report a case of sphenoidal mucormycosis in a patient with large B‑cell lymphoma. This complication happened before any chemotherapy. The patient had normal neutrophils count and his diabetes was well controlled. Clinical course and management are discussed along with a review of the literature.
Steinbrecher, Oskar; Brodowicz, Thomas; Lamm, Wolfgang
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00728-y
Summary Osteosarcomas are rare malignant bone tumors, most frequently occurring in children as well as adolescents and young adults. Therapy of initially localized disease consists of neoadjuvant chemotherapy followed by surgical resection and adjuvant chemotherapy. Osteosarcomas often present relapses, most commonly lung metastases. Treatment of isolated lung metastasis most commonly includes surgical resection. The correct adjuvant treatment option is still under investigation. In this manuscript we describe the clinical course of an osteosarcoma patient and give a review of the literature regarding current standard treatment for localized as well as pulmonary metastatic disease.
Meischl, Tobias; Tamandl, Dietmar; Pinter, Matthias
2021 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-021-00730-4
Summary We report an unusual case of a cirrhotic patient with two different types of hepatic lesions: Eventually, the patient was diagnosed with hepatocellular carcinoma and hepatic splenosis. Possible diagnostic strategies and the differentiation between these two entities are discussed.