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Berghmans T, Brandão M, Ilzkovitz M, Meert AP. [Severe complications of systemic treatment in thoracic oncology]. Rev Mal Respir 2024; 41:317-324. [PMID: 38461088 DOI: 10.1016/j.rmr.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/07/2024] [Indexed: 03/11/2024]
Abstract
Primary thoracic cancers affect a large number of patients, mainly those with lung cancer and to a lesser extent those with pleural mesothelioma and thymic tumours. Given their frequency and associated comorbidities, in patients whose mean age is high, these diseases are associated with multiple complications. This article, the last of a series dedicated to emergencies in onco-haematological patients, aims to present a clinical picture of the severe complications (side effects, immune-related adverse events) associated with systemic treatments, excluding infections and respiratory emergencies, with which general practitioners and specialists can be confronted. New toxicities are to be expected with the implementation of innovative therapeutic approaches, such as CAR-T cells, along with immunomodulators and antibody-drug conjugates.
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Affiliation(s)
- T Berghmans
- Clinique d'oncologie thoracique, institut Jules-Bordet, rue Meylemeersch 90, 1070 Bruxelles, Belgique.
| | - M Brandão
- Clinique d'oncologie thoracique, institut Jules-Bordet, rue Meylemeersch 90, 1070 Bruxelles, Belgique
| | - M Ilzkovitz
- Service de médecine interne, institut Jules-Bordet, hôpital universitaire de Bruxelles, université Libre de Bruxelles, Bruxelles, Belgique
| | - A-P Meert
- Service de médecine interne, institut Jules-Bordet, hôpital universitaire de Bruxelles, université Libre de Bruxelles, Bruxelles, Belgique
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Meert AP, Toffart AC, Picard M, Jaubert P, Gibelin A, Bauer P, Mokart D, Van De Louw A, Hatzl S, Moreno-Gonzales G, Rousseau-Bussac G, Bruneel F, Montini L, Moreau AS, Carpentier D, Seguin A, Hemelaar P, Azoulay E, Lemiale V. When targeted therapy for cancer leads to ICU admission. RETRO-TARGETICU multicentric study. Bull Cancer 2022; 109:916-924. [PMID: 35718570 DOI: 10.1016/j.bulcan.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To study prevalence of targeted therapy (TT)-related adverse events requiring ICU admission in solid tumor patients. METHODS Retrospective multicenter study from the Nine-i research group. Adult patients who received TT for solid tumor within 3 months prior to ICU admission were included. Patients admitted for TT-related adverse event were compared to those admitted for other reasons. RESULTS In total, 140 patients, median age of 63 (52-69) years were included. Primary cancer site was mostly digestive (n=27, 19%), kidney (n=27, 19%), breast (n=24, 17%), and lung (n=20, 14%). Targeted therapy was anti-VEGF/VEGFR for 27% (n=38) patients, anti-EGFR for 22% (n=31) patients, anti-HER2 for 14% (n=20) patients and anti-BRAF for 9% (n=5) patients. ICU admission was related to TT adverse events for 30 (21%) patients. The most frequent complications were interstitial pneumonia (n=7), cardiac failure (n=5), anaphylaxis (n=4) and bleeding (n=4). At ICU admission, no significant difference was found between patients admitted for a TT-related adverse event and the other patients. One-month survival rate was higher in patients admitted for TT adverse event (OR=5.733 [2.031-16.182] P<0.001). CONCLUSIONS Adverse events related to targeted therapy accounted for 20% of ICU admission in our population and carried a 16% one-month mortality. Outcome was associated with admission for TT related to adverse event, breast cancer and good performance status.
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Affiliation(s)
- Anne-Pascale Meert
- Institut Jules-Bordet, université Libre de Bruxelles (ULB), service de médecine interne, soins intensifs et urgences oncologiques, Brussels, Belgium
| | | | - Muriel Picard
- Institut universitaire du cancer de Toulouse-Oncopole, CHU de Toulouse, Intensive Care Unit, Toulouse, France
| | - Paul Jaubert
- AP-HP Cochin, Intensive care unit, Paris, France
| | | | - Philippe Bauer
- Mayo Clinic, Pulmonary and Critical Care Medicine, Rochester, MN, USA
| | - Djamel Mokart
- Institut Paoli-Calmette, réanimation polyvalente et département d'anesthésie et de réanimation, Marseille, France
| | - Andry Van De Louw
- Pennsylvania State University, Division of Pulmonary and Critical Care, Hershey, PA, USA
| | - Stefan Hatzl
- Medical University of Graz, Department of Internal Medicine, Graz, Austria
| | | | | | | | - Luca Montini
- Intensive Care Unit, Department of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Amelie Seguin
- Hôtel Dieu-HME, University Hospital of Nantes, Medical Intensive Care Unit, Nantes, France
| | - Pleun Hemelaar
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, The Netherlands
| | - Elie Azoulay
- AP-HP Saint-Louis, Intensive Care Unit, Paris, France
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Qingjie Fuzheng Granule suppresses lymphangiogenesis in colorectal cancer via the VEGF-C/VEGFR-3 dependent PI3K/AKT pathway. Biomed Pharmacother 2021; 137:111331. [PMID: 33578235 DOI: 10.1016/j.biopha.2021.111331] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
SCOPE To investigate the effect of Qingjie Fuzheng Granule (QFG) on lymphangiogenesis and lymphatic metastasis in colorectal cancer. METHODS The effects of QFG on the expression and secretion of vascular endothelial growth factor-C (VEGF-C) in HCT-116 cells were investigated both in vitro and in vivo. HCT-116 cells were treated with different concentrations (0.2, 0.5, and 1.0 mg/mL) of QFG. The VEGF-C expression level was determined using RT-qPCR and western blotting, and the VEGF-C concentration in supernatant was measured by ELISA. Tumor xenograft models of HCT-116 cells were generated using BALB/c nude mice, and the mice were randomly divided into a control group (gavaged with normal saline) and QFG group (gavaged with 2 g/kg QFG). The effect of QFG on tumor growth was evaluated by comparing the volume and weight of tumors between two groups. Immunohistochemistry (IHC) and RT-qPCR were performed to detect the expression levels of VEGF-C, vascular endothelial growth factor receptor 3 (VEGFR-3), and LYVE-1 (lymphatic vessel endothelial hyaluronan receptor 1). ELISA was performed to measure the concentration of serum VEGF-C. TMT proteomics technology and Reactome pathway analysis were used to explore the mechanism of QFG inhibiting lymphangiogenesis in tumor. The VEGF-C (5 ng/mL)-stimulated human lymphatic endothelial cell (HLEC) model was conducted to evaluate the effect of QFG on lymphangiogenesis in vitro. The model cells were treated with different concentrations (0.2, 0.5, and 1.0 mg/mL) of QFG. Cell viability was then determined using an MTT assay. The cell migration, invasion, and tube-formation ability were analyzed using transwell migration, matrigel invasion and tube formation assays, respectively. The underlying mechanism was uncovered, the levels of VEGFR-3, matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), p-PI3K/PI3K, p-AKT/AKT and p-mTOR/ mTOR were detected using western blotting. RESULTS QFG significantly reduced VEGF-C expression and secretion in HCT-116 cells. QFG evidently suppressed in vivo tumor growth and the expression of VEGF-C, VEGFR-3, and LYVE-1. The serum VEGF-C level was also reduced by QFG. Moreover, TMT proteomics technology and Reactome pathway analysis identified 95 differentially expressed protein and multiple enriched pathway about matrix metalloproteinase and extracellular matrix, which is direct associate with lymphangiogenesis. In vitro experiment, QFG inhibited the viability, migration, invasion and tube formation of HLECs. Additionally, QFG reduced the VEGFR-3, MMP-2, MMP-9 expression levels, and the p-PI3K/PI3K, p-AKT/AKT, p-mTOR/ mTOR ratios. CONCLUSION QFG can exert its effect on both tumor cells and HLECs, exhibiting ani- lymphangiogenesis in colorectal cancer via the VEGF-C/VEGFR-3 dependent PI3K/AKT pathway pathway.
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Factors associated with survival of patients with solid Cancer alive after intensive care unit discharge between 2005 and 2013. BMC Cancer 2021; 21:9. [PMID: 33402107 PMCID: PMC7786972 DOI: 10.1186/s12885-020-07706-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022] Open
Abstract
Background At intensive care unit (ICU) admission, the issue about prognosis of critically ill cancer patients is of clinical interest, especially after ICU discharge. Our objective was to assess the factors associated with 3- and 6-month survival of ICU cancer survivors. Methods Based on the French OutcomeRea™ database, we included solid cancer patients discharged alive, between December 2005 and November 2013, from the medical ICU of the university hospital in Grenoble, France. Patient characteristics and outcome at 3 and 6 months following ICU discharge were extracted from available database. Results Of the 361 cancer patients with unscheduled admissions, 253 (70%) were discharged alive from ICU. The main primary cancer sites were digestive (31%) and thoracic (26%). The 3- and 6-month mortality rates were 33 and 41%, respectively. Factors independently associated with 6-month mortality included ECOG performance status (ECOG-PS) of 3–4 (OR,3.74; 95%CI: 1.67–8.37), metastatic disease (OR,2.56; 95%CI: 1.34–4.90), admission for cancer progression (OR,2.31; 95%CI: 1.14–4.68), SAPS II of 45 to 58 (OR,4.19; 95%CI: 1.76–9.97), and treatment limitation decision at ICU admission (OR,4.00; 95%CI: 1.64–9.77). Interestingly, previous cancer chemotherapy prior to ICU admission was independently associated with lower 3-month mortality (OR, 0.38; 95%CI: 0.19–0.75). Among patients with an ECOG-PS 0–1 at admission, 70% (n = 66) and 61% (n = 57) displayed an ECOG-PS 0–2 at 3- and 6-months, respectively. At 3 months, 74 (55%) patients received anticancer treatment, 13 (8%) were given exclusive palliative care. Conclusions Factors associated with 6-month mortality are almost the same as those known to be associated with ICU mortality. We highlight that most patients recovered an ECOG-PS of 0–2 at 3 and 6 months, in particular those with a good ECOG-PS at ICU admission and could benefit from an anticancer treatment following ICU discharge. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07706-3.
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Monier PA, Chrusciel J, Ecarnot F, Bruera E, Sanchez S, Barbaret C. Duration of palliative care involvement and cancer care aggressiveness near the end of life. BMJ Support Palliat Care 2020:bmjspcare-2020-002641. [PMID: 33355165 DOI: 10.1136/bmjspcare-2020-002641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/05/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Previous studies have found an association between aggressive cancer care and lower quality end of life. Despite international recommendations, late or very late referral to palliative care seems frequent. This study aimed to evaluate the association between the duration of involvement of a palliative care team (PCT), and aggressive cancer care, and to identify factors associated with aggressive cancer care. METHODS We performed an observational retrospective study in a single academic teaching hospital. In total, 561 inpatients with solid tumours or haematological malignancies were included. Patients followed by a PCT for at least 1 month before death were classified in the palliative care group. Aggressive cancer care was defined as: hospitalisations and/or a new line of chemotherapy within the last month of life, location of death, the use of chemotherapy in the last 2 weeks and hospice admissions within the last 3 days of life. RESULTS Among the 561 patients, 241 (43%) were referred to the PCT; 89 (16%) were followed by the PCT for a month or more before death. In the last 2 weeks of life, 124 (22%) patients received chemotherapy, 110 (20%) died in an acute care unit. At least one criterion of aggressive cancer care was found in 395 patients overall (71%). Aggressive cancer care was significantly less frequent when the PCT referral occurred >1 month before death (p<0.0001). CONCLUSION More studies are needed to understand reasons for late referrals despite international recommendations encouraging integrative palliative care. ETHICS APPROVAL The study was approved by the Grenoble Teaching Hospital ethics committee, and by the CNIL (French national commission for data privacy; Commission Nationale de l'Informatique et des Libertés) under the number 1987785 v 0. Due to ethical and legal restrictions, data are only available on request.
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Affiliation(s)
- Pierre Antoine Monier
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Jan Chrusciel
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, Besancon, France
- EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephane Sanchez
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Cecile Barbaret
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
- Laboratoire ThEMAS (Techniques pour l'évaluation et la Modélisation des Actions de Santé) TIMC-IMAG (Technique de l'Ingénierie Médicale et de la Compléxité-Informatique, Mathématiques et Applications, Grenoble), Grenoble, France
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Pinsolle J, Terzi N, Ferrer L, Giaj Levra M, Toffart AC, Moro-Sibilot D. Les avancées dans la prise en charge des cancers bronchopulmonaires : ce qui change pour le réanimateur. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le cancer bronchopulmonaire (CBP) est la première cause de mortalité par cancer en France et dans le monde, mais son pronostic tend à s’améliorer depuis une dizaine d’années grâce à de nouvelles classes de traitements : l’immunothérapie et les thérapies ciblées. L’immunothérapie stimule le système immunitaire afin d’engendrer une réponse antitumorale. Ces molécules peuvent être prescrites chez la plupart des patients avec un CBP non à petites cellules (CBNPC) métastatique et entraînent parfois des réponses tumorales majeures et durables pouvant dépasser les 24 mois. Toutefois, cette efficacité concerne entre 20 et 50 % des patients selon la ligne de traitement. Les thérapies ciblées sont des traitements oraux visant les cellules tumorales porteuses d’anomalies génétiques spécifiques (addictions oncogéniques) et intéressent moins de 15 % des patients avec CBNPC, majoritairement les non-fumeurs. Les deux principales sont les mutations du gène de l’epithelial growth factor receptor (EGFR) et les réarrangements d’anaplastic lymphoma kinase (ALK). Ces anomalies peuvent être diagnostiquées en quelques jours, parfois sur un prélèvement sanguin (biopsie liquide pour détecter les mutations EGFR). Les thérapies ciblées améliorent la survie globale des patients dont la médiane dépasse les 30 mois. Toutefois, ces deux classes de traitement entraînent des toxicités spécifiques, fréquentes mais souvent bénignes. Les hospitalisations en réanimation des patients porteurs de CBNPC sont croissantes. L’amélioration du pronostic de ces patients est à prendre en compte lors de la discussion d’admission en réanimation sans conduire à des prises en charge déraisonnables.
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