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Mari R, Garnier J, Lapeyre-Prost A, Rochigneux P, Dahel Y, Caillol F, Giovannini M, Turrini O, Mitry E, Chanez B. Do we need postoperative chemotherapy after preoperative FOLFIRINOX in resected borderline or locally advanced pancreatic cancer? A retrospective analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4150 Background: Pancreatic ductal adenocarcinoma (PDAC) has poor outcome and surgical resection remains the only curative treatment. Post-operative (Post-Op) chemotherapy (CT) improves survival and FOLFIRINOX (FFX) regimen is the standard of care. Increasing number of patients with borderline resectable (BL) or locally advanced (LA) disease are treated with pre-operative (Pre-Op) CT with FFX. However, the benefit of Post-Op CT after Pre-Op FFX remains unclear. The aim of this study was to analyze the impact on survival of Post-Op CT in patients with resected BL or LA PDAC after Pre-Op FFX CT. Methods: 116 consecutive patients treated at the Institut Paoli-Calmettes comprehensive cancer center between 2014 and 2020 were retrospectively analyzed. All patients underwent pancreatectomy after Pre-Op FFX for a BL or LA PDAC. Patients who progressed or died within 3 months after surgery were excluded from the analysis. We compared median relapse-free survival (mRFS) and median overall survival (mOS) defined by time from surgery to relapse or death in patients who received or not Post-Op CT. Results: 116 patients (80% BL, 20% LA) were included: 82 received Post-Op CT (CT+) and 34 did not (CT-). The median number of Pre-Op FFX cycles was 4 in the CT+ group vs 6 in the CT- group. 24 (29.3%) patients received Post-Op FFX, 37 (45.1%) received Gemcitabine, 9 (11%) received Gemcitabine + Capecitabine, and 9 (11%) received a 5FU-based CT. Median time between surgery and first Post-Op CT cycle was 63 days. No difference in mRFS nor in mOS were found between CT+ and CT- groups: mRFS 15.0 vs 13.6 months, HR 1.1 [IC95% 0.69–1.77] and mOS 33.8 vs 36.1 months, HR 0.94 [IC95% 0.55–1.60]. Among patients with pathologic node positive disease (N+) (n = 79), mRFS was 13.9 months in the CT+ group vs 6.9 months in the CT- group (HR 0.68 [IC 0.35 – 1.19]), and mOS was 31.8 months in the CT+ group vs 16.5 months in the CT- group (HR 0.96 [IC95% 0.51-1.81]). Patients who received peri-operative (Peri-Op) FFX (n = 24) experienced longer mOS compared to patients who received Gemcitabine Post-Op CT: NR vs 33.8 months, HR 0.45 [IC95% 0.25-1.02]. Patients who received Peri-Op CT for a total of six months or more (n = 31) had increased mOS (55 vs 32 months, HR 0.61 [IC 95% 0.37- 1.11] and mRFS (16 vs 14 months HR 0.80, [IC95% 0.50 -1.31]) than patients receiving less than 6 months Peri-Op CT (n = 85) Conclusions: Post-Op CT does not clearly impact survival in BL or LA pancreatic cancer pretreated with Pre-Op FFX. We observed a trend in the N+ population for a survival benefit. Peri-Op FFX was associated with longer survival than Gemcitabine Post-Op regimen. Further randomized data are needed to assess the impact of Peri-Op FFX for these patients
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Affiliation(s)
- Roxane Mari
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
| | - Jonathan Garnier
- Digestive surgery Department, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Yanis Dahel
- Gastroenterology and Endoscopy Department, Institut Paoli-Calmettes, Marseille, France
| | - Fabrice Caillol
- Gastroenterology and Endoscopy Department, Institut Paoli-Calmettes, Marseille, France
| | - Marc Giovannini
- Gastroenterology and Endoscopy Department, Institut Paoli-Calmettes, Marseille, France
| | - Olivier Turrini
- Digestive surgery Department, Institut Paoli-Calmettes, Marseille, France
| | - Emmanuel Mitry
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
| | - Brice Chanez
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
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Hafliger E, Boccaccino A, Lapeyre-Prost A, Perret A, Gallois C, Antista M, Pilla L, Lecomte T, Scartozzi M, Soularue E, Salvatore L, Bourgeois V, Salati M, Tougeron D, Evesque L, Vaillant JN, El-Khoury R, Lonardi S, Cremolini C, Taieb J. Encorafenib plus cetuximab treatment in BRAF V600E-mutated metastatic colorectal cancer patients pre-treated with an anti-EGFR: An AGEO-GONO case series. Eur J Cancer 2022; 168:34-40. [DOI: 10.1016/j.ejca.2022.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/25/2022] [Accepted: 03/13/2022] [Indexed: 12/13/2022]
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3
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Lapeyre-Prost A, Perkins G, Vallee M, Pozet A, Tougeron D, Maillet M, Locher C, Dreanic J, Legoux JL, Lièvre A, Lecaille C, Sabate JM, Mary F, Bonnetain F, Jaulmes-Bouillot H, Behal F, Landi B, Taieb J. Chemotherapy use in end-of-life digestive cancer patients: a retrospective AGEO observational study. Clin Res Hepatol Gastroenterol 2021; 45:101709. [PMID: 33930588 DOI: 10.1016/j.clinre.2021.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of chemotherapy (CT) near the end-of-life (EOL) is an important issue in oncology since it could degrade quality of life. CT near EOL is still poorly studied, with no dedicated study in gastrointestinal (GI) cancer patients. AIM To analyze in GI cancer patients the factors associated with the use of CT within 3- and 1-month before patients' death. METHODS AND PARTICIPANTS All consecutive patients who died from a GI cancer in 10 French tertiary care hospitals during 2014 were included in this retrospective study. Clinical, demographical and biological data were collected and compared between patients receiving or not CT within 3- and 1-month before death. Variables associated with overall survival (OS) was also determined using of univariate and multivariate analyses with a Cox model. RESULTS Four hundred and thirty-seven patients with a metastatic GI cancer were included in this study. Among them, 293 pts (67.0%) received CT within 3-months before death, and 121 pts (27.7%) received CT within 1-month before death. Patients receiving CT within 3-months before death were significantly younger (median age: 65.5 vs 72.8 years, p < 0.0001), with a better PS (PS 0 or 1: 53.9 vs 29.3%, p < 0.0001) and a higher albumin level (median: 32.8 vs 31.0 g/L, p = 0.048). Similar results were found for CT within 1 month before death. Palliative care team intervention was less frequent in patients who received CT in their last month of life (39.7% vs 51.3%, p = 0.02). In multivariate analysis, median OS from diagnosis was shorter in the group receiving CT within 1-month before death (HR = 0.59; 95% CI [0.48-0.74]). CONCLUSION In GI-cancer patients, CT is administered within 3- and 1-month before death, in two and one third of patients, respectively. Patients receiving CT within 1-month before death, had more aggressive disease with poor OS. Palliative care team intervention was associated with less administration of CT in the last month of life. These results highlight the need to better anticipate the time to stop CT treatment in the end-of-life and the importance of an active collaboration between oncology and palliative care teams.
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Affiliation(s)
- Alexandra Lapeyre-Prost
- Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Geraldine Perkins
- Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Marie Vallee
- Oncology Department, Poitiers University Hospital, Poitiers, France
| | - Astrid Pozet
- Methodology and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France
| | - David Tougeron
- Gastroenterology Department, Poitiers University Hospital, Poitiers, France
| | - Marianne Maillet
- Department of Gastroenterology, St-Louis Hospital, AP-HP, Paris, France
| | - Christophe Locher
- Department of Gastroenterology, General Hospital of Meaux, Meaux, France
| | - Johann Dreanic
- Department of Gastroenterology, Cochin Hospital, AP-HP, Paris, France
| | - Jean-Louis Legoux
- Department of Gastroenterology and Digestive Oncology, Centre Hospitalier Regional, Orléans, France
| | - Astrid Lièvre
- Department of Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud, France; Department of Gastroenterology, Rennes University Hospital, Rennes 1 University, Rennes, France
| | - Cedric Lecaille
- Department of Gastroenterology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Jean-Marc Sabate
- Department of Gastroenterology, Louis Mourier Hospital, AP-HP, Colombes, France
| | - Florence Mary
- Gastroenterology and Digestive Oncology, CHU Avicenne, AP-HP, Bobigny, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France
| | | | - Florence Behal
- Palliative Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Bruno Landi
- Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Julien Taieb
- Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France.
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Lapeyre-Prost A, Pernot S, Sigrand J, Le Malicot K, Mary F, Aparicio T, Dahan L, Caroli-Bosc FX, Lecomte T, Doat S, Marthey L, Desrame J, Lepage C, Taieb J. Aflibercept in Combination With FOLFIRI as First-line Chemotherapy in Patients With Metastatic Colorectal Cancer (mCRC): A Phase II Study (FFCD 1302). Clin Colorectal Cancer 2020; 19:285-290. [DOI: 10.1016/j.clcc.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 01/18/2023]
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Taieb J, Lapeyre-Prost A, Laurent Puig P, Zaanan A. Exploring the best treatment options for BRAF-mutant metastatic colon cancer. Br J Cancer 2019; 121:434-442. [PMID: 31353365 PMCID: PMC6738120 DOI: 10.1038/s41416-019-0526-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/05/2019] [Accepted: 06/19/2019] [Indexed: 12/18/2022] Open
Abstract
The BRAFV600E mutation is a well-accepted poor prognostic factor in patients with metastatic colorectal cancer (mCRC), as it confers Ras-independent stimulation of the extracellular signal-regulated kinase/mitogen-activated protein kinase pathway involved in proliferation, migration, angiogenesis and the suppression of apoptosis. Analysis of the potential predictive value of BRAF for treatment efficacy is inherently confounded by this known prognostic impact. Currently, approved therapeutic strategies for patients with BRAF-mutant (BRAF-mt) mCRC are suboptimal, and uncertainty exists regarding how to best treat these patients. Based on the available evidence, it is currently not possible to confirm the superiority of any available treatment options cited in European Society for Medical Oncology and National Comprehensive Cancer Network guidelines (that is, doublet or triplet chemotherapy regimens plus anti-vascular endothelial growth factor or anti-epidermal growth factor receptors), even if triplet chemotherapy plus bevacizumab is the most accepted standard regimen. In this review, we highlight still-emerging strategies that could be deployed to combat BRAF-mt mCRC, including triplet chemotherapy plus available biologic agents, rationally derived combinations of targeted agents and immunotherapy. While it is clear that the needs of patients with BRAF-mt mCRC are currently unmet, we are cautiously optimistic that the recently renewed research interest in these patients will yield clinically relevant insights and therapeutic strategies.
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Affiliation(s)
- Julien Taieb
- Sorbonne Paris-Cité, Paris Descartes University, Assistance Publique Hôpitaux de Paris (APHP), Gastro-enterology and GI Oncology Department, Georges Pompidou European Hospital, Paris, France.
- INSERM UMR-S1138, CNRS SNC5014, Paris Descartes University, Equipe labellisée Ligue Nationale contre le Cancer, Paris, France.
| | - Alexandra Lapeyre-Prost
- Sorbonne Paris-Cité, Paris Descartes University, Assistance Publique Hôpitaux de Paris (APHP), Gastro-enterology and GI Oncology Department, Georges Pompidou European Hospital, Paris, France
| | - Pierre Laurent Puig
- INSERM UMR-S1138, CNRS SNC5014, Paris Descartes University, Equipe labellisée Ligue Nationale contre le Cancer, Paris, France
- Sorbonne Paris Cité, Paris Descartes University, Assistance Publique Hôpitaux de Paris, Department of Biology, Georges Pompidou European Hospital, Paris, France
| | - Aziz Zaanan
- Sorbonne Paris-Cité, Paris Descartes University, Assistance Publique Hôpitaux de Paris (APHP), Gastro-enterology and GI Oncology Department, Georges Pompidou European Hospital, Paris, France
- INSERM UMR-S1138, CNRS SNC5014, Paris Descartes University, Equipe labellisée Ligue Nationale contre le Cancer, Paris, France
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6
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Lapeyre-Prost A, Pernot S, Sigrand J, Mary F, Le Malicot K, Aparicio T, Dahan L, Caroli-Bosc FX, Lecomte T, Racine Doat S, Marthey L, Desrame J, Lepage C, Taieb J. Aflibercept in combination with irinotecan, fluorouracil and leucovorin (FOLFIRI) as first-line chemotherapy in metastatic colorectal cancer (mCRC) patients: A phase II multicentric study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Hirsch L, Palle J, Lapeyre-Prost A, Pernot S, Voron T, Tartour E, Taieb J, Terme M. Immunomodulatory effect of hepatocyte growth factor on monocytes in human gastric cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy268.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Abstract
The evidence that the immune system, when rightly stimulated, can eradicate cancer cells, combined with the latest knowledge about antitumor immunity, has led to recent progress in cancer immunotherapy. While infiltration of tumors with immune cells is described in advanced stage colorectal cancer (CRC), the first data concerning the clinical efficacy of immune-targeted therapies in CRC patients were disappointing. The evidence of tumor responses in CRC patients with microsatellite instability treated with immune checkpoint blockers has renewed the interest for research in the field of CRC immunotherapy. In this article, we briefly review the role of T lymphocytes infiltrating CRC tumors in order to introduce a brief history of CRC immunotherapy and then current trials involving immune-based strategies and particularly immune checkpoint blockers.
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Affiliation(s)
- Alexandra Lapeyre-Prost
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Sorbonne Paris Cité. 56 rue Leblanc, 75015 Paris, France
| | - Magali Terme
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Sorbonne Paris Cité. 56 rue Leblanc, 75015 Paris, France
| | - Simon Pernot
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Sorbonne Paris Cité. 56 rue Leblanc, 75015 Paris, France
- Université Paris-Descartes, Sorbonne Paris Cité, Service d'hépatogastroentérologie et d'oncologie digestive, Hôpital Européen Georges Pompidou, AP-HP Paris, France
| | - Elie Marcheteau
- SeleXel, Centre Pierre Potier, 31106 Toulouse Cedex 1, France
- INSERM U1037, CRCT (Cancer Research Center of Toulouse), 2 Avenue Hubert Curien, 31100 Toulouse, France
| | - Anne-Laure Pointet
- Université Paris-Descartes, Sorbonne Paris Cité, Service d'hépatogastroentérologie et d'oncologie digestive, Hôpital Européen Georges Pompidou, AP-HP Paris, France
| | - Thibault Voron
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Sorbonne Paris Cité. 56 rue Leblanc, 75015 Paris, France
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, AP-HP Paris, France
| | - Eric Tartour
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Sorbonne Paris Cité. 56 rue Leblanc, 75015 Paris, France
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, AP-HP Paris, France
| | - Julien Taieb
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Sorbonne Paris Cité. 56 rue Leblanc, 75015 Paris, France
- Université Paris-Descartes, Sorbonne Paris Cité, Service d'hépatogastroentérologie et d'oncologie digestive, Hôpital Européen Georges Pompidou, AP-HP Paris, France
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Abstract
The ability of tumor cells to escape tumor immunosurveillance contributes to cancer development. Factors produced in the tumor microenvironment create "tolerizing" conditions and thereby help the tumor to evade antitumoral immune responses. VEGF-A, already known for its major role in tumor vessel growth (neoangiogenesis), was recently identified as a key factor in tumor-induced immunosuppression. In particular, VEGF-A fosters the proliferation of immunosuppressive cells, limits T-cell recruitment into tumors, and promotes T-cell exhaustion. Antiangiogenic therapies have shown significant efficacy in patients with a variety of solid tumors, preventing tumor progression by limiting tumor-induced angiogenesis. VEGF-targeting therapies have also been shown to modulate the tumor-induced immunosuppressive microenvironment, enhancing Th1-type T-cell responses and increasing tumor infiltration by T cells. The immunomodulatory properties of VEGF-targeting therapies open up new perspectives for cancer treatment, especially through strategies combining antiangiogenic drugs with immunotherapy. Preclinical models and early clinical studies of these combined approaches have given promising results.
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Affiliation(s)
- A Lapeyre-Prost
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Paris, France
| | - M Terme
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Paris, France.
| | - S Pernot
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Paris, France; Service d'hépatogastroentérologie et d'oncologie digestive, Hôpital Européen Georges Pompidou, Paris, France
| | - A-L Pointet
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Paris, France; Service d'hépatogastroentérologie et d'oncologie digestive, Hôpital Européen Georges Pompidou, Paris, France
| | - T Voron
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Paris, France; Service de chirurgie digestive, Hôpital Européen Georges Pompidou, Paris, France
| | - E Tartour
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Paris, France; Service d'immunologie biologique. Hôpital Européen Georges Pompidou, Paris, France
| | - J Taieb
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris-Descartes, Paris, France; Service d'hépatogastroentérologie et d'oncologie digestive, Hôpital Européen Georges Pompidou, Paris, France.
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Lapeyre-Prost A, Perkins G, Vallee M, Pozet A, Tougeron D, Maillet M, Locher C, Dreanic J, Legoux J, Lievre A, Lecaille C, Sabate JM, Mary F, Bonnetain F, Jaulmes-Bouillot H, Landi B, Taieb J. End of life (EOL) chemotherapy (CT) in gastro-intestinal (GI) cancer patients (pts): A retrospective AGEO study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw384.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Lapeyre-Prost A, Clément O, Lotfalizadeh E, Boussaud V, Diehl JL. Hepatic vein thrombosis associated with segmental hypo-attenuation in the liver: an unusual complication of a haemodialysis catheter. Intern Emerg Med 2015; 10:531-2. [PMID: 25573620 DOI: 10.1007/s11739-014-1182-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 12/20/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Alexandra Lapeyre-Prost
- Medical Intensive Care Unit and Inserm UMR-S1140, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
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