The year 2017 was particularly rich in new developments in the field pertaining to coagulation disorders, be they thrombotic or hemorrhagic. Several studies further confirmed the role of direct oral anticoagulants (DOACs) at reduced dose levels for the secondary prevention of venous thromboembolic disease. These same agents will likely replace low molecular weight heparins (LMWHs) in cancer patients with antecedents of venous thromboembolism. A specific and extensively validated antidote is already available for dabigatran (idarucizumab). While awaiting the validation of specific antidotes for factor Xa anticoagulants, prothrombin complex concentrates (PCCs) have been shown to be effective, even at reduced dose levels, in patients requiring rapid reversibility of anticoagulation induced by an anti-Xa agent. In the hemophilia setting, the development of a bispecific antibody mimicking the action of FVIII (emicizumab), along with the first successes of gene therapy for hemophilia A open revolutionary perspectives as to the management of this rare disease.
Jean-François Baurain, François Duhoux, Astrid De Cuyper, Frank Cornélis, Jean-Pascal Machiels, Thierry PietersPublished in the journal : February 2018Category : Oncologie
2017 was again a great year for oncologists, as the efficacy of new promising drugs and treatment modalities could be confirmed, thus improving the prognosis of our patients. Since we cannot describe all highlights here, we decided to focus on some major advances. Immunotherapy with anti-PD-1/PD-L1 antibodies has become a standard of care in many metastatic patients, with a long-term survival benefit reported for some of them (yet it is too early to talk about cure). However, the administration of these antibodies is associated with a very specific auto-immune toxicity that may have serious or even fatal consequences if not recognized and treated early. Moreover, the range of available targeted therapies is continuously growing, with the advent of new therapeutic classes, such as the CDK 4/6 and PARP inhibitors. Thanks to our better understanding of the mechanisms underlying resistance to targeted therapies, news drugs have been developed (e.g. osimertinib) and have proved able to overcome the resistance observed with the first-generation tyrosine kinase inhibitors in lung cancer. There is also a trend toward decreasing the aggressiveness of chemotherapeutic regimens. All these treatments are available at the King Albert II Cancer Institute, along with new treatments that are currently being investigated and might become the standard of care of tomorrow.
Marie-Christiane Vekemans, Eric Van Den Neste, Sarah BaillyPublished in the journal : February 2018Category : Onco-Hématologie
The landscape of Multiple Myeloma treatments is rapidly evolving, with more and more potent therapeutic options. The most exciting news are probably those regarding a new class of therapies targeting the B-cell maturation antigen (BCMA) via different mechanisms. CAR T-cells as well as antibody-drug conjugates targeting this antigen have yielded very promising results. This next-generation MM treatments will probably lead to a paradigm shift from purely “survival-focused” to “quality of-life-focused”. Biomarkers of minimal residual disease (MRD) and molecular/cytogenetic techniques will undoubtedly be of great help in redefining treatment goals and selecting appropriate treatments. Treating MM in earlier stages will also impact the way we consider this disease today. The management of chronic lymphocytic leukemia has evolved tremendously over the past years, notably due to the efficacy of new oral therapies and the increased consideration of prognostic factors.
Emmanuel Costa, Tevi Morel Lawson, Julie Lelotte, Edward Fomekong, Geraldo Vaz, Nicolas Whenham, Laurette Renard, Christian RaftopoulosPublished in the journal : February 2018Category : Neurochirurgie
Glioblastoma (GBM) is the most aggressive primary tumor of the central nervous system (CNS), and our study sought to identify the characteristics of patients with prolonged overall survival (OS). To this end, we reviewed the records of 127 patients who underwent surgery in our center for GBM between January 2002 and November 2011. We then identified those patients with prolonged survival (>3years). The characteristics of all these patients and their tumors were analyzed, and the anatomic pathological diagnosis was reviewed by a second anatomical pathologist. Of these 127 patients, 101 (79.6%) underwent excisional surgery, with 12 of these surviving longer than 36 months. The GBM diagnosis was confirmed in 11 (11%) patients (F/M: 4.5; mean age: 50 years (31-68); mean Karnofsky preoperative: 82%). The average survival of these 11 patients was 74 months (36-150); seven patients (63.6%) underwent complete resection, three (27.3%) almost complete resection, and the last one (9.1%) partial resection. Only two (18.8%) patients exhibited an IDH1 mutation. Seven (63.6%) patients benefited from a complete Stupp protocol. Eight of these patients had poor prognostic factors regarding prolonged survival (age, low Karnofsky score, or unmutated IDH). In conclusion, for any patient who develops a GBM, there is some hope that survival may be prolonged, even in the presence of poor prognosticators.
Mirela Morisca-Gavriliu, Michel P. Hermans, Dominique Maiter, Vanessa PreumontPublished in the journal : February 2018Category : Diabétologie
Insulin FIASP (for “fast-acting insulin aspart”) is a new original insulin formulation that combines insulin aspart and two excipients, namely a vitamin (niacinamide) and an aminoacid (L-arginine), designed to increase the initial insulin absorption rate following subcutaneous injection, thereby promoting an earlier anti-hyperglycemic effect after meals. Its efficacy and safety profiles have been studied in the Onset clinical trial program. These first clinical studies have shown that using FIASP is associated with improved early post-prandial glycemic control compared to aspart alone in Type 1 and Type 2 diabetic subjects. It is expected that insulin FIASP will soon be available in Belgium.
Marie Baeck, Caroline Colmant, Laurence de Montjoye, Pierre-Dominique Ghislain, Anne Herman, Bernard Leroy, Chloé Algoet, Alison Coster, Liliane Marot, Isabelle TrommePublished in the journal : February 2018Category : Dermatology
The world of biologicals continues to rapidly evolve, whilst diversifying in terms of therapeutic targets, available molecules, and indications. Notably, the way to manage severe atopic dermatitis will substantially change in 2018 following the introduction of dupilumab, an anti-IL-4 and IL-13, with considerable efficacy in Phase III clinical studies. In addition, rituximab was demonstrated to be associated with clinical remission in many patients with pemphigus.
The first total hip prostheses were implanted more than 40 years ago. Over the past 10 years, so-called "mini-invasive" surgeries have emerged, enabling patient's muscle mass to be preserved. This type of surgery is associated with a faster functional recovery and shorter hospital stay. Five years ago, we implemented a clinical course on arthroplasty, titled "Optimal Recovery", at the Cliniques Universitaires Saint-Luc. This protocol seeks to optimize the care of patients throughout their care journey, ensuring that standardized procedures be applied as much as possible. Patients benefit from two information sessions, one individual and one group session, and receive an information leaflet, in order to be actively included in the care process, which reduces their stress. Minimally-invasive surgical techniques, along with the adaptation of pre-, intra- and postoperative protocols, including postoperative analgesia and rehabilitation techniques, have likewise been developed in this setting. Implementing this type of care strategy has been associated with a reduction in both hospital stay and postoperative transfusion rates. The good results thereby observed enable bilateral arthroplasty to be performed at the same time, without any significant impact on either duration of the operation or functional recovery.
Charles Lebrun-Lambeau, Alexandre Stouffs, Victoria Van Regemorter, Philippe Dubois, Thierry Pirotte, Michel Van Dyck, Christine Watremez, Mona Momeni, Cristel Sanchez TorresPublished in the journal : February 2018Category : Anesthesiology
Progress in anesthesia in recent years has not been abrupt but rather progressive. Although there was no real innovation in 2017, we have seen some progress in our practices, due to a better understanding of anatomy, physiology and pharmacology, associated with better intraoperative monitoring. All this now contributes to increased safety throughout the perioperative period.
In patients with type 2 diabetes, sulfonylureas are a therapeutic option as dual antihyperglycemic therapy following metformin failure or as a tritherapy approach.
Stéphanie Olivier, Marie Baeck, Anne Herman, Liliane Marot, Laurence de MontjoyePublished in the journal : January 2018Category : Dermatology
Paucibacillary leprosy generally occurs as one or several hypopigmented macules with sensory loss. Given the small number of Hansen’s bacilli in these lesions, neither the skin smear nor the pathology is able to bring out bacilli. Diagnosis is therefore mainly based on clinical manifestation in association with a compatible granulomatous histopathology.