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Lebeaud A, Antoun L, Paccard JR, Edeline J, Bourien H, Fares N, Tournigand C, Lecomte T, Tougeron D, Hautefeuille V, Viénot A, Henriques J, Williet N, Bachet JB, Smolenschi C, Hollebecque A, Macarulla T, Castet F, Malka D, Neuzillet C, Vernerey D, Boilève A, Turpin A. Management of biliary tract cancers in early-onset patients: A nested multicenter retrospective study of the ACABI GERCOR PRONOBIL cohort. Liver Int 2024. [PMID: 38588031 DOI: 10.1111/liv.15922] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND & AIMS Accumulating data has shown the rising incidence and poor prognosis of early-onset gastrointestinal cancers, but few data exist on biliary tract cancers (BTC). We aimed to analyse the clinico-pathological, molecular, therapeutic characteristics and prognosis of patients with early onset BTC (EOBTC, age ≤50 years at diagnosis), versus olders. METHODS We analysed patients diagnosed with intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and gallbladder adenocarcinoma between 1 January 2003 and 30 June 2021. Baseline characteristics and treatment were described in each group and compared. Progression-free survival, overall survival and disease-free survival were estimated in each group using the Kaplan-Meier method. RESULTS Overall, 1256 patients were included, 188 (15%) with EOBTC. Patients with EOBTC demonstrated fewer comorbidities (63.5% vs. 84.5%, p < .0001), higher tumour stage (cT3-4: 50.0% vs. 32.3%, p = .0162), bilobar liver involvement (47.8% vs. 32.1%, p = .0002), and metastatic disease (67.6% vs. 57.5%, p = .0097) compared to older. Patients with EOBTC received second-line therapy more frequently (89.5% vs. 81.0% non-EOBTC, p = .0224). For unresectable patients with BTC, median overall survival was 17.0 vs. 16.2 months (p = .0876), and median progression-free survival was 5.8 vs. 6.0 months (p = .8293), in EOBTC vs. older. In advanced stages, fewer actionable alterations were found in EOBTC (e.g., IDH1 mutations [7.8% vs. 16.6%]; FGFR2-fusion [11.7% vs. 8.9%]; p = .029). CONCLUSIONS Patients with EOBTC have a more advanced disease at diagnosis, are treated more heavily at an advanced stage but show similar survival. A distinctive molecular profile enriched for FGRF2 fusions was found.
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Affiliation(s)
| | | | - Jane-Rose Paccard
- Department of Medical Oncology and Hepatogastroenterology, Lyon University Hospital Center, Hospices Civiles de Lyon, Lyon, France
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Hélène Bourien
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Nadim Fares
- Department of Digestive Oncology, Centre Hospitalier Universitaire de Toulouse, Hôpital Rangueil, Toulouse, France
| | - Christophe Tournigand
- Department of Medical Oncology, Centre Hospitalier Universitaire Henri-Mondor, AP-HP, Creteil, France
| | - Thierry Lecomte
- Department of Gastroenterology, CHU de Tours, Hôpital Trousseau, Chambray-lès-Tours, France
| | - David Tougeron
- Department of Gastroenterology and Hepatology, CHU Poitiers, Hôpital Jean Bernard, Poitiers, France
| | - Vincent Hautefeuille
- Department of Gastroenterology, Digestive Oncology Department, CHU Amiens-Picardie - Site Nord, Amiens, France
| | - Angélique Viénot
- Department of Medical Oncology, CHU Besancon, Hôpital Jean Minjoz, Besançon, France
| | - Julie Henriques
- University of Franche-Comté, EFS, INSERM, UMR RIGHT, Besançon, France
- Methodology and Quality of Life Unit in Oncology, CHU Besançon, Besançon, France
| | - Nicolas Williet
- Department of Hepatogastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean-Baptiste Bachet
- Department of Hepato-Gastroenterology and Digestive Oncology, Groupe Hospitalier Pitié Salpetriere, Paris, France
| | - Cristina Smolenschi
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Antoine Hollebecque
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Teresa Macarulla
- Department of Gastrointestinal and Endocrine Tumor, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Florian Castet
- Department of Gastrointestinal and Endocrine Tumor, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Malka
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France
| | - Cindy Neuzillet
- Department of GI Oncology, Medical Oncology, Curie Institute, Paris, France
| | - Dewi Vernerey
- University of Franche-Comté, EFS, INSERM, UMR RIGHT, Besançon, France
- Methodology and Quality of Life Unit in Oncology, CHU Besançon, Besançon, France
| | - Alice Boilève
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Anthony Turpin
- Department of Medical Oncology, CHU Lille, Lille, France
- CNRS INSERM UMR9020-U1277, CANTHER Cancer Heterogeneity Plasticity and Resistance to Therapies, Université de Lille, Lille, France
- GERCOR, Paris, France
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2
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Gueiderikh A, Tarabay A, Abdelouahab M, Smolenschi C, Tanguy ML, Valery M, Malka D, Pudlarz T, Fuerea A, Boige V, Hollebecque A, Ducreux M, Boilève A. Pancreatic adenocarcinoma third line systemic treatments: a retrospective cohort study. BMC Cancer 2024; 24:272. [PMID: 38408958 PMCID: PMC10898186 DOI: 10.1186/s12885-024-12016-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Chemotherapy for metastatic pancreatic adenocarcinoma (PDAC) primarily relies on FOLFIRINOX (LV5FU- irinotecan - Oxaliplatine) and Gemcitabine - Nab-Paclitaxel in the first-line setting. However, second-lines remain less well-defined and there is limited data regarding third-line treatments. The objective of our study was to determine the proportion of patients advancing to third line chemotherapy, to outline the various third-line chemotherapy regimens used in routine practice and to evaluate their respective efficacy. METHODS A retrospective single-center cohort from 2010-2022 compiled baseline characteristics, treatment outcomes and survival of PDAC patients who received at least one chemotherapy line in a French tertiary-center. Overall survivals (OS) were analyzed using a Cox multivariable model. RESULTS In total, 676 patients were included, with a median follow-up time of 69.4 months, (Interquartile Range (IQR) = 72.1). Of these, 251 patients (37%) that proceeded to 3rd-line chemotherapy. The median PFS in 3rd line was 2.03 months, [CI95%: 1.83, 2.36]. The median 3rd line overall survival was 5.5 months, [CI95%: 4.8, 6.3]. In multivariable analysis erlotinib-based chemotherapy was found to be deleterious (HR=2.38, [CI95%: 1.30, 4.34], p=0.005) compared to fluoropyrimidine-based chemotherapy in terms of 3rd line overall survival while gemcitabine monotherapy showed a tendency towards negative outcomes. First and 2nd line chemotherapies sequence didn't influence 3rd line outcome. CONCLUSION In our cohort, one-third of treated patients proceeded to 3rd line chemotherapy resulting in a 5.5 months median 3rd line OS, consistent with treatments at advanced stage. Our results argue against the use of erlotinib and gemcitabine monotherapy.
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Affiliation(s)
- A Gueiderikh
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
- Université Paris Saclay, 91471, Orsay, France
| | - A Tarabay
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
| | - M Abdelouahab
- Département de statistiques, Gustave Roussy, 94800, Villejuif, France
| | - C Smolenschi
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
- Gustave Roussy, DITEP, 94800, Villejuif, France
| | - M L Tanguy
- Département de statistiques, Gustave Roussy, 94800, Villejuif, France
| | - M Valery
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
| | - D Malka
- Département d'oncologie médicale, Institut Mutualiste Montsouris, 75014, Paris, France
| | - T Pudlarz
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
| | - A Fuerea
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
| | - V Boige
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
| | - A Hollebecque
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
- Gustave Roussy, DITEP, 94800, Villejuif, France
| | - M Ducreux
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France
- Université Paris Saclay, 91471, Orsay, France
| | - A Boilève
- Département de médecine oncologique, Gustave Roussy, 94800, Villejuif, France.
- Université Paris Saclay, 91471, Orsay, France.
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3
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Loap P, El Ayachy R, Beddok A, Abbassi L, Boilève A, Deau Fischer B, Willems L, Franchi P, Bouscary D, Kirova Y. Evolution of radiotherapy techniques for mediastinal Hodgkin lymphoma: a single-center experience. Mediastinum 2023; 8:10. [PMID: 38322184 PMCID: PMC10839518 DOI: 10.21037/med-23-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/20/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
| | | | - Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Louisa Abbassi
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Alice Boilève
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Bénédicte Deau Fischer
- Department of Hematology, Assistance Publique-Hopitaux de Paris, Hopital Cochin, Paris, France
| | - Lise Willems
- Department of Hematology, Assistance Publique-Hopitaux de Paris, Hopital Cochin, Paris, France
| | - Patricia Franchi
- Department of Hematology, Assistance Publique-Hopitaux de Paris, Hopital Cochin, Paris, France
| | - Didier Bouscary
- Department of Hematology, Assistance Publique-Hopitaux de Paris, Hopital Cochin, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
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Cartry J, Bedja S, Boilève A, Mathieu JRR, Gontran E, Annereau M, Job B, Mouawia A, Mathias P, De Baère T, Italiano A, Besse B, Sourrouille I, Gelli M, Bani MA, Dartigues P, Hollebecque A, Smolenschi C, Ducreux M, Malka D, Jaulin F. Implementing patient derived organoids in functional precision medicine for patients with advanced colorectal cancer. J Exp Clin Cancer Res 2023; 42:281. [PMID: 37880806 PMCID: PMC10598932 DOI: 10.1186/s13046-023-02853-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Patient Derived Organoids (PDOs) emerged as the best technology to develop ex vivo tumor avatars. Whether drug testing on PDOs to identify efficient therapies will bring clinical utility by improving patient survival remains unclear. To test this hypothesis in the frame of clinical trials, PDO technology faces three main challenges to be implemented in routine clinical practices: i) generating PDOs with a limited amount of tumor material; ii) testing a wide panel of anti-cancer drugs; and iii) obtaining results within a time frame compatible with patient disease management. We aimed to address these challenges in a prospective study in patients with colorectal cancer (CRC). METHODS Fresh surgical or core needle biopsies were obtained from patients with CRC. PDOs were established and challenged with a panel of 25 FDA-approved anti-cancer drugs (chemotherapies and targeted therapies) to establish a scoring method ('chemogram') identifying in vitro responders. The results were analyzed at the scale of the cohort and individual patients when the follow-up data were available. RESULTS A total of 25 PDOs were successfully established, harboring 94% concordance with the genomic profile of the tumor they were derived from. The take-on rate for PDOs derived from core needle biopsies was 61.5%. A chemogram was obtained with a 6-week median turnaround time (range, 4-10 weeks). At least one hit (mean 6.16) was identified for 92% of the PDOs. The number of hits was inversely correlated to disease metastatic dissemination and the number of lines of treatment the patient received. The chemograms were compared to clinical data obtained from 8 patients and proved to be predictive of their response with 75% sensitivity and specificity. CONCLUSIONS We show that PDO-based drug tests can be achieved in the frame of routine clinical practice. The chemogram could provide clinicians with a decision-making tool to tailor patient treatment. Thus, PDO-based functional precision oncology should now be tested in interventional trials assessing its clinical utility for patients who do not harbor activable genomic alterations or have developed resistance to standard of care treatments.
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Affiliation(s)
- Jérôme Cartry
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France.
| | - Sabrina Bedja
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Alice Boilève
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Jacques R R Mathieu
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Emilie Gontran
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Maxime Annereau
- Département de Pharmacie Clinique, Gustave Roussy, 94805, Villejuif, France
| | - Bastien Job
- Inserm US23, Plateforme de Bioinformatique, Gustave Roussy, 94805, Villejuif, France
| | - Ali Mouawia
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Pierre Mathias
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Thierry De Baère
- Département de Radiologie Interventionnelle, Gustave Roussy, 94805, Villejuif, France
- UFR Médecine, Université Paris-Saclay, 94270, Le Kremlin-Bicêtre, France
| | - Antoine Italiano
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Villejuif, 94805, France
- Gustave Roussy, Unité de Médecine de Précision, 94805, Villejuif, France
| | - Benjamin Besse
- Gustave Roussy, Unité de Médecine de Précision, 94805, Villejuif, France
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | | | - Maximiliano Gelli
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
- Département de Chirurgie Viscérale, Gustave Roussy, 94805, Villejuif, France
| | | | - Peggy Dartigues
- Département de Pathologie, Gustave Roussy, 94805, Villejuif, France
| | - Antoine Hollebecque
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Villejuif, 94805, France
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Cristina Smolenschi
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Villejuif, 94805, France
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Michel Ducreux
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - David Malka
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
- Département d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France
| | - Fanny Jaulin
- Inserm U-1279, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France.
- Département de Recherche, Gustave Roussy, 94800, Villejuif, France.
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5
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Valery M, Vasseur D, Fachinetti F, Boilève A, Smolenschi C, Tarabay A, Antoun L, Perret A, Fuerea A, Pudlarz T, Boige V, Hollebecque A, Ducreux M. Targetable Molecular Alterations in the Treatment of Biliary Tract Cancers: An Overview of the Available Treatments. Cancers (Basel) 2023; 15:4446. [PMID: 37760415 PMCID: PMC10526255 DOI: 10.3390/cancers15184446] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Biliary tract cancers (BTCs) are rare tumours, most often diagnosed at an unresectable stage, associated with poor prognosis, with a 5-year survival rate not exceeding 10%. Only first- and second-line treatments are well codified with the combination of cisplatin-gemcitabine chemotherapy and immunotherapy followed by 5-FU and oxaliplatin chemotherapy, respectively. Many studies have shown that BTC, and more particularly intrahepatic cholangiocarcinoma (iCCA), have a high rate of targetable somatic alteration. To date, the FDA has approved several drugs. Ivosidenib targeting IDH1 mutations, as well as futibatinib and pemigatinib targeting FGFR2 fusions, are approved for pre-treated advanced CCA. The combination of dabrafenib and trametinib are approved for BRAFV600E mutated advanced tumours, NTRK inhibitors entrectinib and larotrectinib for tumours bearing NTRK fusion and prembrolizumab for MSI-H advanced tumours, involving a small percentage of BTC in these three settings. Several other potentially targetable alterations are found in BTC, such as HER2 mutations or amplifications or KRASG12C mutations and mutations in genes involved in DNA repair mechanisms. This review aims to clarify the specific diagnostic modalities for gene alterations and to summarize the results of the main trials and developments underway for the management of advanced BTC with targetable alterations.
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Affiliation(s)
- Marine Valery
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Damien Vasseur
- Medical Biology and Pathology Department, Gustave Roussy, F-94805 Villejuif, France;
| | - Francesco Fachinetti
- Dana-Farber Institute, Lowe Center for Thoracic Oncology, Boston, MA 02215, USA;
| | - Alice Boilève
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
- Université Paris-Saclay, Gustave Roussy, Inserm Unité Dynamique des Cellules Tumorales, F-94805 Villejuif, France
| | - Cristina Smolenschi
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
- Département d’Innovation Thérapeutique, Gustave Roussy, F-94805 Villejuif, France
| | - Anthony Tarabay
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Leony Antoun
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Audrey Perret
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Alina Fuerea
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Thomas Pudlarz
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Valérie Boige
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
| | - Antoine Hollebecque
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
- Département d’Innovation Thérapeutique, Gustave Roussy, F-94805 Villejuif, France
| | - Michel Ducreux
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (A.T.); (L.A.); (A.P.); (A.F.); (T.P.); (V.B.); (A.H.); (M.D.)
- Université Paris-Saclay, Gustave Roussy, Inserm Unité Dynamique des Cellules Tumorales, F-94805 Villejuif, France
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6
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Boilève A, Faron M, Fodil-Cherif S, Bayle A, Lamartina L, Planchard D, Tselikas L, Kanaan C, Scoazec JY, Ducreux M, Italiano A, Baudin E, Hadoux J. Molecular profiling and target actionability for precision medicine in neuroendocrine neoplasms: real-world data. Eur J Cancer 2023; 186:122-132. [PMID: 37062210 DOI: 10.1016/j.ejca.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Key molecular alterations (MA) of neuroendocrine neoplasm (NEN) of various grade/primaries have been described but the applicability of molecular profiling (MP) for precision medicine in NEN remains to be demonstrated. METHODS We conducted a retrospective study of all patients with metastatic NEN who had MP on tumour tissue at Gustave Roussy. The primary objective was to assess the clinical applicability of MP by evaluating the growth modulator index (GMI) as the primary end-point. RESULTS MPs were obtained in 114 out of 156 eligible patients, including 12% NET-G1, 42% NET-G2, 13% NET-G3 and 35% neuroendocrine carcinoma (NEC). Primary sites were lung/thymus (40%), pancreas (19%), gastro-intestinal (16%), head&neck (10%), unknown (10%) and others (10%) with synchronous metastases in 61% of the patients. Most frequent MA were: MEN1 (25%), PTEN (13%), TP53 (11%) and TSC2 (9%), in neuroendocrine tumour (NET), and TP53 (50%) and RB1 (18%) in NEC. ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT) classification of these MA were: I(5%), III(20%), IV(23%), X(27%); a putative actionable MA was identified in 48% patients. Median TMB was 5.7 Mut/Mb, with 3 TMB > 10 and 1 MSI NET. No MA was found in 26% patients. Molecularly matched treatment was administered to 19 patients (4 NEC, 15 NET): immunotherapy (n = 3), tipifarnib (n = 1), NOTCHi (n = 1), EGFRi (n = 2), HER2i (n = 1) and everolimus (n = 11). Overall, 67% of patients had a clinical benefit defined as a GMI over 1.3 with a 78% disease control rate. CONCLUSION We report 48% of NEN with a putative actionable MA of which 35% received molecularly matched treatment, with a clinical benefit in 67% of the cases.
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7
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Rassy E, Le Roy F, Smolenschi C, Valéry M, Boige V, Ducreux M, Boilève A. Rechallenge After Oxaliplatin-Induced Hypersensitivity Reactions. JAMA Oncol 2023; 9:434-435. [PMID: 36701137 PMCID: PMC9880861 DOI: 10.1001/jamaoncol.2022.7136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/02/2022] [Indexed: 01/27/2023]
Abstract
This cohort study assesses the outcome of oxaliplatin desensitization for patients with gastrointestinal cancers who experienced hypersensitivity reactions after oxaliplatin infusion.
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Affiliation(s)
- Elie Rassy
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
| | - Florence Le Roy
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
- Service de Gastroentérologie, Groupe Hospitalier Bretagne Sud, Hôpital du Scorff, Lorient, France
| | | | - Marine Valéry
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
| | - Valérie Boige
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
| | - Michel Ducreux
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
- Faculté de Médecine Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Alice Boilève
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
- Faculté de Médecine Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette, France
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8
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Hilmi M, Naoun N, Boilève A, Géraud A, Bayle A, Pagès A, Aupomerol M, Rouanne M, Madec FX, Pommeret F, Massard C, Baldini C, Scotté F, Champiat S. Evaluation of supportive care needs, sexuality and quality of life in phase 1 trials: a prospective monocentric study. Support Care Cancer 2022; 30:9841-9849. [PMID: 36271944 DOI: 10.1007/s00520-022-07407-6] [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] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients enrolled in oncology phase 1 trials (ph1) usually have advanced heavily pre-treated cancers with few therapeutic options. Quality of life (QoL) is one of the key cancer-treatment outcome measures, especially in ph1, and sexuality is an important part of Qol but rarely explored. This prospective study aims to assess supportive care needs, QoL and sexuality in ph1. METHODS Between September 2020 and June 2021, we prospectively recruited patients enrolled in ph1 at Gustave Roussy in France. Supportive care needs, QoL (EORTC QLQ-C30) and sexuality (female sexual function index for women, male sexual health questionnaire [MSHQ] for men) were assessed at baseline, one, three and 5 months. We performed multivariate analyses to identify associations between clinical characteristics, QoL and quality of sexual life over time. RESULTS At baseline, we analyzed 187 patients (45% women (n = 84) and 55% men (n = 103)). Patients expressed the need for consultations in pain management, nutrition, psychology and sexology in 28%, 26%, 19% and 9%, respectively. Lower global QoL was independently associated with Royal Marsden Hospital score (p = 0.012), urogenital location tumor (p = 0.021), elevated CRP levels (p = 0.014) and pain intensity (p = 0.005). Ninety-two percent of women had sexual dysfunction. In men, a lower MSHQ score was independently associated with urogenital location tumor (p = 0.021), ECOG Performance Status (p = 0.006), comorbidity at risk (p = 0.024) and pain intensity (p = 0.004). CONCLUSIONS There are significant needs for supportive care in ph1, especially in some subgroups of patients. New models of care should be developed to improve early phase pathways.
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Affiliation(s)
- Marc Hilmi
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris-Saclay, 94140, Villejuif, France. .,Biostatistics and Epidemiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - Natacha Naoun
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris-Saclay, 94140, Villejuif, France
| | - Alice Boilève
- Medical Oncology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Arthur Géraud
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris-Saclay, 94140, Villejuif, France.,Biostatistics and Epidemiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Arnaud Bayle
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris-Saclay, 94140, Villejuif, France.,Biostatistics and Epidemiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Arnaud Pagès
- Biostatistics and Epidemiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Marion Aupomerol
- Medical Oncology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Matthieu Rouanne
- Urology Department, Hopital Foch, Université Paris-Saclay, Suresnes, France.,Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Fanny Pommeret
- Medical Oncology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Christophe Massard
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris-Saclay, 94140, Villejuif, France
| | - Capucine Baldini
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris-Saclay, 94140, Villejuif, France.,Laboratory for Immunomonitoring in Oncology (LIO), University Paris-Saclay, Gustave Roussy Cancer Campus, Villejuif, France
| | - Florian Scotté
- Interdisciplinary Patient Pathway Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Stéphane Champiat
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Université Paris-Saclay, 94140, Villejuif, France
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9
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Ngo C, Grinda T, Boilève A, Levy A, Le-Pechoux C, Haddag L, Valent A, Lazure T, Briand S, Honoré C, Faron M, Mir O, Bahleda R, Verret B, Le Cesne A. Durable response to crizotinib in metastatic angiomatoid fibrous histiocytoma with EWSR1-CREB1 fusion and ALK overexpression. Ann Oncol 2022; 33:848-850. [PMID: 35568279 DOI: 10.1016/j.annonc.2022.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/07/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Carine Ngo
- Department of Biology and Pathology, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Thomas Grinda
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Alice Boilève
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Cecile Le-Pechoux
- Department of Radiation Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Leila Haddag
- Department of Radiology, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Alexander Valent
- Department of Biology and Pathology, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Thierry Lazure
- Department of Pathology, Bicêtre Hospital, Université Paris-Saclay, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Sylvain Briand
- Department of Orthopaedics and Traumatology, Bicêtre Hospital, Université Paris-Saclay, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Charles Honoré
- Department of Surgery, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Matthieu Faron
- Department of Surgery, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, 94800 Villejuif, France
| | - Ratio Bahleda
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Benjamin Verret
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Axel Le Cesne
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
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10
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Hilmi M, Ashton E, Delaye M, Giraud P, Neuzillet C, Spano JP, Gligorov J, Ollivier L, Rousseau A, Naoun N, Boilève A. [Goals, motivations, and difficulties of young oncology residents]. Bull Cancer 2021; 109:119-129. [PMID: 34809979 DOI: 10.1016/j.bulcan.2021.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Association for education and research of interns in oncology (AERIO) conducted a national survey of the 2020-year oncology residents promotion in the "phase socle". The objective was to collect and analyze their motivations, as well as the objectives and limitations in the life and career of the residents during this first year of residency. METHODS A questionnaire included 45 closed questions divided into 6 sections describing: the demographic characteristics of the population, the commitment of the students' and their clinical and academic expectations in the, their training, their life and career objectives, and their commitment in associative life. RESULTS Seventy-eight of 119 residents participated (66%), of which 68 (87.2%) completed the questionnaire entirely. The population was predominantly women (60%) with a median age of 24 years. The choice between medical or radiation oncology was mostly undefined (87%) and 15% of the residents considered to change their medical specialty. The average hospital work time reported was predominantly between 45 and 65hours per week (83%). Sixty-nine percent were primarily interested in clinical research. One out of two residents (52%) did not have access to their half-day of training per week. DISCUSSION This national survey made possible to analyze the perception of oncology young residents, as well as their career aspirations and their relationship to research.
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Affiliation(s)
- Marc Hilmi
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France.
| | - Elisabeth Ashton
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France
| | - Matthieu Delaye
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France
| | - Philippe Giraud
- Hôpital Européen Georges-Pompidou, université de Paris, service d'oncologie radiothérapie, 20, rue Leblanc, 75015 Paris, France; Coordination du DES d'oncologie d'Ile de France, 75020 Paris, France
| | - Cindy Neuzillet
- Institut Curie, université Versailles Saint-Quentin (UVSQ), département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Jean-Philippe Spano
- Institut universitaire de cancérologie AP-HP. Sorbonne université, service d'oncologie médicale, site Pitié-Salpêtrière, 47-83, boulevard de l'hôpital, 75013 Paris, France; Collège national des enseignants de cancérologie, 75006 Paris, France
| | - Joseph Gligorov
- Coordination du DES d'oncologie d'Ile de France, 75020 Paris, France; Collège national des enseignants de cancérologie, 75006 Paris, France; Institut universitaire de cancérologie AP-HP. Sorbonne université, Service d'oncologie médicale, site hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Luc Ollivier
- Société française des jeunes radiothérapeutes oncologues (SFJRO), 75013 Paris, France
| | - Adrien Rousseau
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France
| | - Natacha Naoun
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France
| | - Alice Boilève
- Association d'enseignement et de recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France
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11
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Boilève A, Baudin E, Hadoux J. A diffuse pruriginous erythemato-squamous rash. Endocrine 2021; 74:435-436. [PMID: 34076837 DOI: 10.1007/s12020-021-02776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/29/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alice Boilève
- Department of Endocrine Oncology, Gustave Roussy, Villejuif, 94805, France.
| | - Eric Baudin
- Department of Endocrine Oncology, Gustave Roussy, Villejuif, 94805, France
| | - Julien Hadoux
- Department of Endocrine Oncology, Gustave Roussy, Villejuif, 94805, France
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12
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Boilève A, Mathy E, Roux C, Faron M, Hadoux J, Tselikas L, Al Ghuzlan A, Hescot S, Leboulleux S, de Baere T, Lamartina L, Deschamps F, Baudin E. Combination of Mitotane and Locoregional Treatments in Low-volume Metastatic Adrenocortical Carcinoma. J Clin Endocrinol Metab 2021; 106:e4698-e4707. [PMID: 34143888 DOI: 10.1210/clinem/dgab449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 12/27/2022]
Abstract
CONTEXT European and French guidelines for ENSAT stage IV low tumor burden or indolent adrenocortical carcinoma (ACC) recommend a combination of mitotane and locoregional treatments (LRT) as first-line treatment. Nevertheless, the benefit of LRT in combination with mitotane has never been evaluated in this selected group of patients. OBJECTIVE This work aimed to evaluate the therapeutic strategy of LRT combined with mitotane in patients with low tumor burden stage IVA ACC. METHODS A retrospective chart review was performed from 2003 to 2018 of patients with stage IV ACC with 2 or fewer tumoral organs who received mitotane in our center. The primary end point was the delay between mitotane initiation and first systemic chemotherapy. Secondary end points were progression-free survival (PFS) and overall survival (OS) from mitotane initiation. Adjusted analyses were performed on the main prognostic factors. RESULTS Out of 79 included patients, 48 (61%) patients were female and the median age at stage IVA diagnosis was 49.8 years (interquartile range [IQR], 38.8-60.0 years). Metastatic sites were mainly lungs (76%) and liver (48%). Fifty-eight (73%) patients received LRT including adrenal bed radiotherapy (14 patients, 18%), surgery (37 patients, 47%), and/or interventional radiology (35 patients, 44%). Median time between mitotane initiation and first chemotherapy administration was 9 months (IQR, 4-18 months). Median PFS1 (first tumor-progression) was 6.0 months (95% CI, 4.5-8.6). Median OS was 46 months (95% CI, 41-68). PFS1, PFS2, and OS were statistically longer in the mitotane plus LRT group compared to the mitotane-only group (hazard ratio [HR] = 0.39; 95% CI, 0.22-0.68; HR = 0.35; 95% CI, 0.20-0.63; and HR = 0.27; 95% CI, 0.14-0.50, respectively). Ten (13%) patients achieved complete response (CR), all from the mitotane plus LRT group. CONCLUSION Our results endorse European and French guidelines for stage IV ACC with 2 or fewer tumor organs and favor the combination of mitotane and LRT as first-line treatment. For the first time, a significant number of CRs were observed. Prospective studies are expected to confirm these findings.
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Affiliation(s)
- Alice Boilève
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Elise Mathy
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Charles Roux
- Institut Gustave Roussy, Département de radiologie interventionnelle, Villejuif, France
| | - Matthieu Faron
- Institut Gustave Roussy, Département de chirurgie, Villejuif, France
| | - Julien Hadoux
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Lambros Tselikas
- Institut Gustave Roussy, Département de radiologie interventionnelle, Villejuif, France
| | - Abir Al Ghuzlan
- Institut Gustave Roussy, Département d'anatomopathologie, Villejuif, France
| | - Ségolène Hescot
- Institut Curie, Département de médecine oncologique, Paris, France
| | - Sophie Leboulleux
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Thierry de Baere
- Institut Gustave Roussy, Département de radiologie interventionnelle, Villejuif, France
| | - Livia Lamartina
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
| | - Frédéric Deschamps
- Institut Gustave Roussy, Département de radiologie interventionnelle, Villejuif, France
| | - Eric Baudin
- Institut Gustave Roussy, Département d'oncologie endocrinienne, Villejuif, France
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Boilève A, Smolenschi C, Fuerea A, Hollebecque A, Boige V. Metastatic hepatocellular carcinoma cured by exclusive systemic antiangiogenic therapy: Two cases along with tumor molecular profiles. Dig Liver Dis 2021; 53:1059-1061. [PMID: 34030987 DOI: 10.1016/j.dld.2021.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Alice Boilève
- Gustave Roussy, Département de médecine oncologique, F-94805, Villejuif, France; Université Paris-Saclay, France.
| | - Cristina Smolenschi
- Gustave Roussy, Département de médecine oncologique, F-94805, Villejuif, France
| | - Alina Fuerea
- Gustave Roussy, Département de médecine oncologique, F-94805, Villejuif, France
| | - Antoine Hollebecque
- Gustave Roussy, Département de médecine oncologique, F-94805, Villejuif, France; Gustave Roussy, Département d'innovations thérapeutiques et d'essais précoces, F-94805, Villejuif, France
| | - Valérie Boige
- Gustave Roussy, Département de médecine oncologique, F-94805, Villejuif, France; Université Paris-Saclay, France
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Boilève A, Lavaud P, Caron O. Germline BRCA1 Mutation and Prostate Cancer: Be Careful on Causality. Eur Urol Oncol 2021; 4:674-675. [PMID: 34154978 DOI: 10.1016/j.euo.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/29/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alice Boilève
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France.
| | - Pernelle Lavaud
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
| | - Olivier Caron
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
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15
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Boilève A, Hilmi M, Delaye M, Tijeras-Raballand A, Neuzillet C. Biomarkers in Hepatobiliary Cancers: What is Useful in Clinical Practice? Cancers (Basel) 2021; 13:2708. [PMID: 34070929 PMCID: PMC8198554 DOI: 10.3390/cancers13112708] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022] Open
Abstract
Hepatocellular carcinoma (HCC) and biliary tract cancers (BTC) exhibit a poor prognosis with 5-year overall survival rates around 15%, all stages combined. Most of these primary liver malignancies are metastatic at diagnostic, with only limited therapeutic options, relying mainly on systemic therapies. Treatment modalities are different yet partially overlapping between HCC and BTC. The complex molecular profile of BTC yields to several actionable therapeutic targets, contrary to HCC that remains the field of antiangiogenic drugs in non-molecularly selected patients. Immunotherapy is now validated in the first line in HCC in combination with bevacizumab, while clinical activity of single agent immunotherapy appears limited to a subset of patients in BTC, still poorly characterized, and combinations are currently under investigation. In this review, we provide a critical evaluation and grading of clinical relevance on (i) the main prognostic biomarkers in HCC and BTC, (ii) the main theragnostic biomarkers in both tumors, and lastly (iii) what is recommended in clinical practice.
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Affiliation(s)
- Alice Boilève
- Gustave Roussy, Département de Médecine Oncologique, 94805 Villejuif, France;
- GERCOR Group, 151 rue du Faubourg Saint-Antoine, 75011 Paris, France; (M.H.); (M.D.); (A.T.-R.)
| | - Marc Hilmi
- GERCOR Group, 151 rue du Faubourg Saint-Antoine, 75011 Paris, France; (M.H.); (M.D.); (A.T.-R.)
- Département de Médecine Oncologique, Curie Institute, 92210 Saint-Cloud, France
| | - Matthieu Delaye
- GERCOR Group, 151 rue du Faubourg Saint-Antoine, 75011 Paris, France; (M.H.); (M.D.); (A.T.-R.)
- Département de Médecine Oncologique, Curie Institute, 92210 Saint-Cloud, France
| | - Annemilaï Tijeras-Raballand
- GERCOR Group, 151 rue du Faubourg Saint-Antoine, 75011 Paris, France; (M.H.); (M.D.); (A.T.-R.)
- OncoMEGA, 75010 Paris, France
| | - Cindy Neuzillet
- GERCOR Group, 151 rue du Faubourg Saint-Antoine, 75011 Paris, France; (M.H.); (M.D.); (A.T.-R.)
- Département de Médecine Oncologique, Curie Institute, 92210 Saint-Cloud, France
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Boilève A, Hilmi M, Smolenschi C, Ducreux M, Hollebecque A, Malka D. Immunotherapy in Advanced Biliary Tract Cancers. Cancers (Basel) 2021; 13:1569. [PMID: 33805461 PMCID: PMC8036747 DOI: 10.3390/cancers13071569] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022] Open
Abstract
Biliary tract cancers are rare tumors with a poor prognosis. Two-thirds of these primary liver malignancies are diagnosed at advanced stages where therapeutic options are limited. Whereas several molecular targeted therapies emerge in biliary tract cancers, immunotherapy is still investigational, the only approved immunotherapy to date being the immune checkpoint inhibitor pembrolizumab for the small fraction of patients with microsatellite-instable tumors. In microsatellite-stable, pre-treated biliary tract cancers, single-agent immune checkpoint blockade has a limited albeit often long-lasting clinical activity in a still ill-defined subgroup of patients. The identification of predictive biomarkers will allow a better selection of patients that may benefit from immunotherapy. Combinations of immunotherapies with each other, with chemotherapy or targeted molecular therapies are being investigated in early lines of therapy, including first-line.
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Affiliation(s)
- Alice Boilève
- Département de Médecine Oncologique, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (M.D.); (A.H.)
- Université Paris-Saclay, F-91190 Saint-Aubin, France
| | - Marc Hilmi
- Département D’Innovations Thérapeutiques et D’Essais Précoces, Gustave Roussy, F-94805 Villejuif, France;
| | - Cristina Smolenschi
- Département de Médecine Oncologique, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (M.D.); (A.H.)
- Département D’Innovations Thérapeutiques et D’Essais Précoces, Gustave Roussy, F-94805 Villejuif, France;
| | - Michel Ducreux
- Département de Médecine Oncologique, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (M.D.); (A.H.)
- Université Paris-Saclay, F-91190 Saint-Aubin, France
| | - Antoine Hollebecque
- Département de Médecine Oncologique, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (M.D.); (A.H.)
- Département D’Innovations Thérapeutiques et D’Essais Précoces, Gustave Roussy, F-94805 Villejuif, France;
| | - David Malka
- Département de Médecine Oncologique, Gustave Roussy, F-94805 Villejuif, France; (A.B.); (C.S.); (M.D.); (A.H.)
- Université Paris-Saclay, F-91190 Saint-Aubin, France
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Boilève A, Verlingue L, Hollebecque A, Boige V, Ducreux M, Malka D. Rare cancer, rare alteration: the case of NTRK fusions in biliary tract cancers. Expert Opin Investig Drugs 2021; 30:401-409. [PMID: 33641556 DOI: 10.1080/13543784.2021.1896703] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: For patients with advanced/unresectable biliary tract cancers, cisplatin-gemcitabine combination is the standard first-line treatment. Beyond the first line, the therapeutic arsenal is limited with minimal benefit. Biliary tract cancers exhibit one of the highest frequencies of targetable molecular alterations across cancer types, and several targeted therapies are emerging as treatment options.Areas covered:We discuss neurotrophic tyrosine kinase receptor gene (NTRK) fusions in biliary tract cancers and the use of NTRK inhibitors (now approved in a 'cancer-agnostic' way), mechanisms of resistance, and emerging second-generation NTRK inhibitors.Expert opinion: Despite their rarity in biliary tract cancers, NTRK fusions are promising molecular targets because i) NTRK inhibitors have proven highly effective in NTRK-rearranged cancers and are now approved in a 'cancer-agnostic' way; ii) emerging second-generation NTRK inhibitors may overcome secondary resistance; iii) NTRK rearrangements will be readily detectable with the generalization of next-generation-sequencing in biliary tract cancers, including the detection of other frequent gene rearrangements, such as those involving the fibroblast growth factor receptor 2 gene (FGFR2). However, more data are necessary regarding the prevalence and characteristics of NTRK fusions in biliary tract cancers and the efficacy of NTRK inhibitors in these patients.
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Affiliation(s)
- Alice Boilève
- Département De Médecine Oncologique, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, France
| | - Loïc Verlingue
- Université Paris-Saclay, France.,Département D'innovations Thérapeutiques Et D'essais Précoces, Gustave Roussy, Villejuif, France
| | - Antoine Hollebecque
- Département De Médecine Oncologique, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, France.,Département D'innovations Thérapeutiques Et D'essais Précoces, Gustave Roussy, Villejuif, France
| | - Valérie Boige
- Département De Médecine Oncologique, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, France
| | - Michel Ducreux
- Département De Médecine Oncologique, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, France
| | - David Malka
- Département De Médecine Oncologique, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, France
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18
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Hilmi M, Boilève A, Ducousso A, Michalet M, Turpin A, Neuzillet C, Naoun N. Professional and Psychological Impacts of the COVID-19 Pandemic on Oncology Residents: A National Survey. JCO Glob Oncol 2020; 6:1674-1683. [PMID: 33151771 PMCID: PMC7713519 DOI: 10.1200/go.20.00376] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has severely affected clinical practice in oncology, leading to organizational, ethical, and medical issues. In particular, it has raised challenges in the context of competing care priorities between COVID-19 and cancer treatment. Residents on the front line face difficulties related to increasing care needs and urgent reorganization of health care systems while managing psychological stress and uncertainty. We aimed to evaluate the impact of the COVID-19 pandemic on oncology residents. METHODS AND MATERIALS We conducted a national survey (39 questions) in France among oncology and radiation therapy residents to determine the psychological impact and professional difficulties (eg, reassignment, training/research time, supervision, teleworking, management of patients) associated with the first peak of the COVID-19 pandemic. RESULTS Overall, 222 residents (medical oncologists, 61%; radiation therapists, 39%) participated in our survey, representing approximately one third of all residents and fellows in France. One third of respondents had been reassigned to a COVID-19 ward. Training and research activity decreased for 89% and 41% of respondents, respectively. Two thirds (70%) of respondents declared that they had faced ethical issues, 35% felt worried about their own health, and 23% experienced psychological distress. According to the Hospital Anxiety and Depression Scale, 32% were anxious and 17% depressed. Consumption of tobacco, psychostimulants, and alcohol increased in 31%, 24%, and 29% of respondents, respectively. CONCLUSION French oncology residents were highly affected by the first peak of the COVID-19 pandemic in terms of professional activity and psychological impact. This national survey can be used as a basis for improved management, medical reorganization, and training of residents during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Marc Hilmi
- Department of Medical Oncology, Institut Curie Saint-Cloud, Saint-Cloud, France.,Association pour l'Enseignement et la Recherche des Internes d'Oncologie, Paris, France
| | - Alice Boilève
- Association pour l'Enseignement et la Recherche des Internes d'Oncologie, Paris, France.,Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Anabelle Ducousso
- Association pour l'Enseignement et la Recherche des Internes d'Oncologie, Paris, France
| | - Morgan Michalet
- Société Française des Jeunes Oncologues Radiothérapeutes, Paris, France.,Department of Radiation Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Anthony Turpin
- Department of Medical Oncology, Centre Hôpital-Universitaire Lille, Lille, France
| | - Cindy Neuzillet
- Department of Medical Oncology, Institut Curie Saint-Cloud, Saint-Cloud, France
| | - Natacha Naoun
- Association pour l'Enseignement et la Recherche des Internes d'Oncologie, Paris, France.,Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
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19
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Boilève A, Hilmi M, Gougis P, Cohen R, Rousseau B, Blanc JF, Ben Abdelghani M, Castanié H, Dahan L, Tougeron D, Metges JP, Tournigand C, Garcia-Larnicol ML, Vernerey D, Turpin A, Neuzillet C. Triplet combination of durvalumab, tremelimumab, and paclitaxel in biliary tract carcinomas: Safety run-in results of the randomized IMMUNOBIL PRODIGE 57 phase II trial. Eur J Cancer 2020; 143:55-63. [PMID: 33279854 DOI: 10.1016/j.ejca.2020.10.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/07/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The IMMUNOBIL PRODIGE 57 trial is a non-comparative randomized phase II study assessing the efficacy and safety of the durvalumab (an anti-PD-L1) and tremelimumab (an anti-CTLA4) combination with or without weekly paclitaxel in patients with advanced biliary tract carcinoma (BTC) after failure of platinum-based chemotherapy. Taxanes have already been safely combined with immune checkpoint inhibitors in other tumors. We report results of the 20-patient safety run-in. METHODS Patients received durvalumab (1500 mg at day 1 [D1] of each cycle)/tremelimumab (75 mg at D1 for 4 cycles; Arm A) or durvalumab/tremelimumab with paclitaxel (80 mg/m2 at D1, D8, D15; Arm B) every 28 days. RESULTS Twenty patients were enrolled (Arm A/B: 10/10). There were no dose-limiting toxicities (DLTs) in Arm A. Six DLTs were observed in five patients (50%) in Arm B, meeting a stopping rule for the trial inclusions. DLTs included three serious anaphylactic reactions (with one cardiac arrest), two enterocolitis, and one infectious pneumopathy with septic shock. There were no patients with history of personal or familial auto-immune disease. CONCLUSION The safety run-in part of IMMUNOBIL PRODIGE 57 raised concerns regarding co-administration of paclitaxel with durvalumab and tremelimumab in BTC, with an unexpected increase in anaphylactic adverse events. Phase II of the study will only evaluate the durvalumab and tremelimumab combination arm. CLINICALTRIALS REGISTRATION NCT03704480.
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Affiliation(s)
- Alice Boilève
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France; GERCOR, Paris, France
| | - Marc Hilmi
- GERCOR, Paris, France; Department of Medical Oncology, Institut Curie - Site Saint Cloud, Versailles Saint-Quentin University, Paris Saclay University, Saint-Cloud, France
| | - Paul Gougis
- Department of Pharmacology Sorbonne Université, INSERM, CIC-1901 Paris-Est, CLIP(2) Galilée, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Romain Cohen
- GERCOR, Paris, France; Department of Medical Oncology, Sorbonne Université, Assistance-Publique - Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France
| | - Benoît Rousseau
- GERCOR, Paris, France; Department of Medicine, Solid Tumor Division, Mortimer B. Zuckerman Research Center, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jean-Frédéric Blanc
- Department of Hepato-Gastro-Enterology and Digestive Oncology, Hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | | | - Hélène Castanié
- Institut de Cancérologie Catherine de Sienne, L'Hôpital Privé Du Confluent, Nantes, France
| | - Laëtitia Dahan
- Department of Digestive Oncology, Centre Hospitalo-Universitaire La Timone, Marseille, France
| | - David Tougeron
- Department of Hepato-Gastro-Enterology, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
| | - Jean-Philippe Metges
- Centre Hospitalo-Universitaire Brest-Institut de Cancerologie et D'Hematologie, Brest, France
| | - Christophe Tournigand
- Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, University Paris Est Créteil, Créteil, France
| | | | - Dewi Vernerey
- GERCOR, Paris, France; Unité de Méthodologie et de Qualité de Vie en Cancérologie (INSERM UMR 1098), CHU Besançon, Besançon, France
| | - Anthony Turpin
- GERCOR, Paris, France; Department of Medical Oncology, Centre Hospitalo-Universitaire Lille, Lille, France
| | - Cindy Neuzillet
- GERCOR, Paris, France; Department of Medical Oncology, Institut Curie - Site Saint Cloud, Versailles Saint-Quentin University, Paris Saclay University, Saint-Cloud, France.
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20
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Boilève A, Dufresne A, Chamseddine A, Nassif E, Dumont S, Brahmi M, Adam J, Rouleau E, Karanian M, Haddad V, Faron M, Honoré C, Meeus P, Le Cesne A, Blay JY, Mir O. Outcomes of patients with metastatic gastrointestinal stromal tumors (GIST) treated with multi-kinase inhibitors other than imatinib as first-line treatment. ESMO Open 2020; 5:e001082. [PMID: 33246932 PMCID: PMC7703411 DOI: 10.1136/esmoopen-2020-001082] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Background Imatinib is the standard first-line therapy in metastatic gastrointestinal stromal tumours (GIST). Investigational multi-kinase inhibitors (MKIs) such as nilotinib, dasatinib or masitinib have been tested as first-line therapies in phase II/III studies. This might theoretically result either in increased survival or in early emergence of resistance to approved MKIs. Methods To assess whether using MKIs other than imatinib in first line decreases imatinib efficacy in second line for patients with GIST, a retrospective chart review was performed from 2005 to 2011 in two French tertiary centres of patients with GIST who received investigational MKIs (in phase II/III trials) as first-line treatment, followed by imatinib as second line. Results Of 46 patients, (55% women, median age 55 years (range 24–81)), 22 (47%) had a KIT exon 11 mutation, 1 a KIT exon 9 mutation (2%), 1 a PDGFRA D842V mutation (2%). Out of 46 patients, 21 (46%) received masitinib, 17 (37%) received dasatinib and 8 (17%) received nilotinib as first-line treatment with a median progression-free survival of 18.0 months (95% CI: 8.5 to 25.5). Median time to imatinib failure was 19.7 months (95% CI: 13.5 to 29.0). Median time to second relapse was 48.7 months (95% CI: 31.2 to 72.0). Median overall survival from time of initial metastasis diagnosis was 5.7 years (95% CI: 4.5 to 7.4). Conclusions Patients with GIST who received investigational MKIs as first-line treatment and imatinib as second line had a time to second relapse longer than that observed historically with imatinib in first line, suggesting that using MKIs other than imatinib in first line does not decrease the efficacy of subsequent treatment lines.
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Affiliation(s)
| | | | | | - Elise Nassif
- Sarcoma Group, Centre Léon Bérard, Lyon, Rhône-Alpes, France
| | - Sarah Dumont
- Sarcoma Group, Gustave Roussy, Villejuif, France
| | - Medhi Brahmi
- Sarcoma Group, Centre Léon Bérard, Lyon, Rhône-Alpes, France
| | - Julien Adam
- Sarcoma Group, Gustave Roussy, Villejuif, France
| | | | - Marie Karanian
- Sarcoma Group, Centre Léon Bérard, Lyon, Rhône-Alpes, France
| | | | | | | | - Pierre Meeus
- Sarcoma Group, Centre Léon Bérard, Lyon, Rhône-Alpes, France
| | | | - Jean-Yves Blay
- Sarcoma Group, Centre Léon Bérard, Lyon, Rhône-Alpes, France
| | - Olivier Mir
- Sarcoma Group, Gustave Roussy, Villejuif, France
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21
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Boilève A, Gavaud A, Grignano E, Franck N, Carlotti A, Mira JP, Bouscary D, Jozwiak M. Acute and fatal cephalosporin-induced autoimmune haemolytic anaemia. Br J Clin Pharmacol 2020; 87:2152-2156. [PMID: 33075171 DOI: 10.1111/bcp.14612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022] Open
Abstract
We report the case of an 82-year old male patient admitted in our medical intensive care unit for diffuse skin lesions, 3 days after the onset of ceftriaxone for bilateral pneumonia without microbiological documentation. The patient concomitantly exhibited diffuse skin lesions compatible with livedo and neurological and haemodynamic failure. Biological analysis revealed acute haemolytic anaemia. Warming of patient, red blood-cells transfusion and high-doses corticosteroids were initiated and ceftriaxone was stopped. Despite these therapeutics, the patient exhibited multiple organ failure and died. The main suspected triggering factor of this acute and fatal haemolytic anaemia was ceftriaxone administration considering: (i) the delay between cephalosporin administration and symptoms; (ii) the worsening of livedo and acrocyanosis a few hours after meningeal ceftriaxone doses; and (iii) fatal evolution. Cephalosporin-induced autoimmune haemolytic anaemia is a rare and serious cause of livedo that should be suspected in patients exhibiting livedo and acute haemolytic anaemia within hours/days following cephalosporin administration.
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Affiliation(s)
- Alice Boilève
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France
| | - Ariane Gavaud
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de Médecine Intensive Réanimation, Paris, France.,Université de Paris, Paris, France
| | - Eric Grignano
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France.,Université de Paris, Paris, France
| | - Nathalie Franck
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de Dermatologie, Paris, France
| | - Agnès Carlotti
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Anatomo-Pathologie, Paris, France
| | - Jean-Paul Mira
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de Médecine Intensive Réanimation, Paris, France.,Université de Paris, Paris, France
| | - Didier Bouscary
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France.,Université de Paris, Paris, France
| | - Mathieu Jozwiak
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de Médecine Intensive Réanimation, Paris, France
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22
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Boilève A, Grignano E, Bouscary D, Fourquet A, Deau-Fischer B, Kirova Y. Relapsed, Refractory, or Advanced Hodgkin Lymphoma: A Single-Center Experience. Clin Lymphoma Myeloma Leuk 2020; 21:e27-e31. [PMID: 32933880 DOI: 10.1016/j.clml.2020.08.015] [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] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the treatment and outcomes of patients with relapsed, refractory, or advanced Hodgkin lymphoma treated with consolidation or salvage radiotherapy. PATIENTS AND METHODS We studied all patients diagnosed with this profile treated by radiotherapy in our center between 2006 and 2019. RESULTS A total of 33 patients who received external-beam radiotherapy for advanced (21%), relapsed (52%), or refractory (24%) Hodgkin lymphoma were studied. Median [interquartile range] age was 25 [22-38] years, with 11 women (33%). The follow-up after first-line treatment was 28 [10-53] months. Number of chemotherapy lines received before radiotherapy was 3 [1-4]. Fourteen patients (42%) had undergone autologous stem-cell transplantation before radiotherapy, and 2 patients were treated by radiotherapy alone. Nine patients (27%) were treated by involved-field radiotherapy, 17 (52%) by involved-site radiotherapy, 5 (17%) by involved-node radiotherapy, and 2 by other volumes. The acute toxicity profile was favorable, with grade 1 radiodermatitis (33%) or dysphagia (30%). Overall, 21 patients (64%) experienced prolonged complete response and 12 experienced relapse (36%) after radiotherapy. Median disease-free survival was 68.8 months. CONCLUSIONS External-beam radiotherapy should be considered an effective treatment modality for advanced, relapsed, or refractory Hodgkin lymphoma as part of a multimodal approach.
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Affiliation(s)
- Alice Boilève
- Département de radiothérapie, Institut Curie, Paris, France.
| | - Eric Grignano
- Département d'hématologie Clinique, Hôpital Cochin, Paris, France
| | - Didier Bouscary
- Département d'hématologie Clinique, Hôpital Cochin, Paris, France
| | - Alain Fourquet
- Département de radiothérapie, Institut Curie, Paris, France
| | | | - Youlia Kirova
- Département de radiothérapie, Institut Curie, Paris, France
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23
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Hilmi M, Boilève A, Ducousso A, Michalet M, Turpin A, Neuzillet C, Naoun N. Abstract PO-033: Professional and psychological impact of COVID-19 pandemic on medical and radiation oncology residents: Results of a national survey. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-po-033] [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: 11/16/2022]
Abstract
Abstract
Background: The COVID-19 pandemic deeply impacted clinical practices in oncology leading to organizational, ethical, and medical issues. It has raised challenges in a context of competing care priorities between COVID-19 and cancer treatment. Residents and fellows were in the front line and had to face difficulties related to increasing care needs and urgent reorganization of the health care system while managing stress and uncertainty.
Methods: We conducted a national survey (39 questions) in France among all oncology and radiation therapy residents to describe psychological impact and difficulties encountered by residents (i.e., reassignment, training/research time, supervision, teleworking, management of patients) during the COVID-19 pandemic.
Results: Overall, 222 residents (oncologists: 61% and radiation therapists: 39%) participated in our survey (representing around one third of all residents and fellows in France). Reassignment in COVID-19 wards involved 32% of respondents. Training and research activity were decreased for 89% and 41% of respondents, respectively. 70% have been confronted with ethical issues, 35% felt worried about their health, and 23% experienced psychological distress. According to the Hospital Anxiety and Depression Scale, 32% were anxious and 17% depressive. Consumption of tobacco, psychostimulants, and alcohol was increased in 45%, 40%, and 24%, respectively.
Conclusion: French oncology residents were highly impacted by the COVID-19 pandemic in terms of training and emotions. This national survey can be used as a basis for improved management, medical reorganization, and training of residents during the COVID-19 pandemic, especially when further waves are not excluded.
Citation Format: Marc Hilmi, Alice Boilève, Anabelle Ducousso, Morgan Michalet, Anthony Turpin, Cindy Neuzillet, Natacha Naoun. Professional and psychological impact of COVID-19 pandemic on medical and radiation oncology residents: Results of a national survey [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-033.
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Affiliation(s)
| | | | | | | | | | | | - Natacha Naoun
- 6Institut de Cancérologie de Lorraine, Nancy, France
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24
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Boilève A, Stoclin A, Barlesi F, Varin F, Suria S, Rieutord A, Blot F, Netzer F, Scotté F. COVID-19 management in a cancer center: the ICU storm. Support Care Cancer 2020; 28:5037-5044. [PMID: 32734394 PMCID: PMC7392620 DOI: 10.1007/s00520-020-05658-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
A novel coronavirus, SARS-CoV-2, was first reported as a respiratory illness in December 2019 in Wuhan, China. Since then, the World Health Organization (WHO) Emergency Committee declared a global health. COVID-19 has now spread worldwide and is responsible of more than 472,216 persons, out of 9,100,090 officially diagnosed worldwide since 23 of June. In the context of cancer patients, COVID-19 has a severe impact, regarding pulmonary infection but also cancer treatments in this fragile and immunocompromised population, and ICU admission for cancer patients in the context of COVID-19 requires ethical and clinical consideration. In our cancer center, intensivists, oncologists, pharmacists, and hospital administrators had to prepare for a substantial increase in critical care bed capacity (from 10 ICU beds, 6 medical intensive care beds, and 12 surgical intensive care beds, bed capacity was increased to 28 medical intensive care beds with ventilating capacity) and to adapt infrastructure (i.e., ICU beds), supplies (i.e., drugs, ventilators, protective materials), and staff (i.e., nurses and medical staff). Overall, thirty-three COVID-19 patients were admitted in our ICU, 17 cancer-free and 16 with cancer, and 23 required mechanical ventilation, resulting in 4 deaths (of them two patients with cancer). We report here management of a dedicated intensive care unit of a cancer center during the COVID-19 infection pandemic, considering resource allocation and redistribution of healthcare workers.
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Affiliation(s)
- Alice Boilève
- Medical Oncology Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France.
| | - Annabelle Stoclin
- Intensive Care Unit, Gustave Roussy Cancer Campus, Villejuif, France.,Interdisciplinary Cancer Course Department (DIOPP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Fabrice Barlesi
- Medical Oncology Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France
| | - Florent Varin
- Department of Anesthesia, Gustave Roussy Cancer Campus, Villejuif, France
| | - Stéphanie Suria
- Department of Anesthesia, Gustave Roussy Cancer Campus, Villejuif, France
| | - André Rieutord
- Pharmacy Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - François Blot
- Intensive Care Unit, Gustave Roussy Cancer Campus, Villejuif, France.,Interdisciplinary Cancer Course Department (DIOPP), Gustave Roussy Cancer Campus, Villejuif, France
| | - Florence Netzer
- Pharmacy Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Florian Scotté
- Interdisciplinary Cancer Course Department (DIOPP), Gustave Roussy Cancer Campus, Villejuif, France
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25
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Boilève A, Kuhnowski F, Cassou-Mounat T, Jehanno N, Kirova Y. Hodkgin lymphoma concomitant of tuberculosis, a therapeutic challenge for multidisciplinary management. Cancer Radiother 2020; 24:335-339. [PMID: 32444284 DOI: 10.1016/j.canrad.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 11/18/2022]
Abstract
Hodgkin lymphoma (HL) is a disease characterized by a high curability rate, and the treatment benefit-risk balance must be carefully addressed to achieve complete disease control with low risk of long-term toxicities. Most patients are treated with a combination of chemotherapy and radiotherapy, after disease staging and response to treatment evaluated by FDG PET/CT. We report the case of a 28-year-old patient concomitantly diagnosed of a Hodgkin lymphoma and active tuberculosis. Initial staging was difficult due to pulmonary and abdominal tuberculosis localization that induced FDG PET/CT hypermetabolism. Anti-tuberculosis treatment was first started, allowing secondary an early accurate Hodgkin lymphoma staging by FDG PET/CT. The patient was then treated by chemotherapy and radiotherapy. Helical TomoTherapy® was used with involved site (IS) irradiation volume was performed to decrease the high doses to organs-at-risk (OAR), especially lungs in this context of tuberculosis.
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Affiliation(s)
- A Boilève
- Department of Radiation Oncology, Institut Curie, 25, rue d'Ulm, 75005 Paris, France.
| | - F Kuhnowski
- Department of Hematology, Institut Curie, Paris, France
| | - T Cassou-Mounat
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - N Jehanno
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - Y Kirova
- Department of Radiation Oncology, Institut Curie, 25, rue d'Ulm, 75005 Paris, France; University of Versailles, St Quentin, France
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26
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Boilève A, Thomas L, Lillo-Le Louët A, Gaboriau L, Chouchana L, Ducreux M, Malka D, Boige V, Hollebecque A, Hillaire-Buys D, Jozwiak M. 5-Fluorouracil-induced hyperammonaemic encephalopathy: A French national survey. Eur J Cancer 2020; 129:32-40. [PMID: 32120273 DOI: 10.1016/j.ejca.2020.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND 5-Fluorouracil (5-FU)-induced hyperammonaemic encephalopathy is a rare but serious 5-FU adverse drug reaction (ADR). Given the growing number of cancers treated with 5-FU and the paucity of data regarding this ADR, we performed a retrospective national survey to better characterise 5-FU-induced hyperammonaemic encephalopathy. PATIENTS AND METHODS Since inception of the French pharmacovigilance database, we identified all patients who experienced 5-FU-induced hyperammonaemic encephalopathy. Variables regarding demographics, characteristics, management and outcome of patients were collected. RESULTS From 1986 to 2018, 30 patients were included. 5-FU-induced hyperammonaemic encephalopathy started 2 [1-4] days after 5-FU infusion onset. Most common neurological disorders were consciousness impairment, seizures and confusion. hyperammonaemia tended to be higher in patients with the lowest Glasgow score and admitted in intensive care unit (ICU) compared to non-ICU patients (250 [133-522] versus 139 [68-220] μmol/L respectively, p = NS). Dihydropyrimidine dehydrogenase deficiency was found in 27% of tested patients (n = 3/11). Encephalopathy-induced mortality was 17%, 57% of patients were admitted in ICU and 70% had a complete neurological recovery within 5 [2-10] days. A 5-FU rechallenge was considered in 14 (67%) patients with neurological recovery and a relapse was observed in 57% of them. No 5-FU-induced hyperammonaemic encephalopathy relapse was observed as long as 5-FU rechallenge was performed with decreased 5-FU dosage. CONCLUSION We report the largest cohort of 5-FU-induced hyperammonaemic encephalopathy cases so far. This ADR should be suspected and ammonaemia measured in all patients experiencing neurological disorders after 5-FU administration. In patients with complete neurological recovery, a 5-FU rechallenge could be cautiously considered.
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Affiliation(s)
- Alice Boilève
- Département de Médecine Oncologique, Institut Gustave Roussy, Villejuif, France.
| | - Laure Thomas
- Centre Régional de PharmacoVigilance, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris-Est, Hôpital Henri Mondor, Créteil, France
| | - Agnès Lillo-Le Louët
- Centre Régional de PharmacoVigilance, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, Hôpital Européen Georges Pompidou, Paris, France
| | - Louise Gaboriau
- Centre Régional de PharmacoVigilance, Hôpital Universitaire de Lille, Lille, France
| | - Laurent Chouchana
- Centre Régional de PharmacoVigilance, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, Hôpital Cochin, Paris, France
| | - Michel Ducreux
- Département de Médecine Oncologique, Institut Gustave Roussy, Villejuif, France; Université Paris-Saclay, Villejuif, France
| | - David Malka
- Département de Médecine Oncologique, Institut Gustave Roussy, Villejuif, France
| | - Valérie Boige
- Département de Médecine Oncologique, Institut Gustave Roussy, Villejuif, France
| | - Antoine Hollebecque
- Département de Médecine Oncologique, Institut Gustave Roussy, Villejuif, France
| | - Dominique Hillaire-Buys
- Centre Régional de PharmacoVigilance, Hôpital Universitaire de Montpellier, Montpellier France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris-Centre, Hôpital Cochin, Paris, France
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Herrscher H, Boilève A, Lindner V, Barthélémy P, Hutt É, Pierard L, Kurtz JE, Rioux-Leclercq N, Lang H, Malouf GG. [MiT family translocation renal cell carcinomas: Natural history, molecular features and multidisciplinary management]. Bull Cancer 2020; 107:272-280. [PMID: 32044098 DOI: 10.1016/j.bulcan.2019.11.010] [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] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Abstract
MiT family translocation renal cell carcinomas (tRCC) represent a rare subtype of renal cell carcinomas. These tumors have been introduced for the first time in the World Health Classification (WHO) classification of kidney cancers in 2004. tRCC are characterized by reccurent translocations involving members of the MiT family transcription factors, mainly TFE3 and TFEB. The estimated incidence of these tumors is ∼1-5 % among all renal cell carcinomas, with female prodominance. tRCC were initially described in children, and the spectrum has been expanded over time to encompass adolescents and adults. TFE3- and TFEB-rearranged RCC harbor characteristic clinicopathological and immunohistochemical features and fluorescent hybridization in situ is considered the gold standard for their diagnosis, although it has some limitations especially when the partners are located in the vicinity of TFE3. Nephron-sparing surgery is an efficient treatment of localized cases when achievable. In metastatic setting, targeted agents and immunotherapy showed modest efficacy, with response rates and median overall survival inferior to those observed in clear-cell renal cell carcinomas. Management of tRCC necessite a multidisciplinary team and accrual in clinical trials have to be encouraged when possible. Novel biological insights are urgently awaited to better understand the mechanisms associated with kidney oncogenesis in this setting, and ultimately help to identify therapeutic targets.
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Affiliation(s)
- Hugo Herrscher
- Hôpitaux universitaires de Strasbourg, service d'oncologie médicale, 67200 Strasbourg, France
| | - Alice Boilève
- Institut Gustave-Roussy, département de médecine, 67200 Villejuif, France
| | - Véronique Lindner
- Hôpitaux universitaires de Strasbourg, département de pathologie, 67200 Strasbourg, France
| | - Philippe Barthélémy
- Hôpitaux universitaires de Strasbourg, service d'oncologie médicale, 67200 Strasbourg, France
| | - Émilie Hutt
- Hôpitaux universitaires de Strasbourg, service d'oncologie médicale, 67200 Strasbourg, France
| | - Laure Pierard
- Hôpitaux universitaires de Strasbourg, service d'oncologie médicale, 67200 Strasbourg, France
| | - Jean-Emmanuel Kurtz
- Hôpitaux universitaires de Strasbourg, service d'oncologie médicale, 67200 Strasbourg, France
| | - Nathalie Rioux-Leclercq
- Université de Rennes, service d'anatomie et cytologie pathologiques, Centre Hospitalier Universitaire de Rennes, IRSET, 67200 Rennes, France
| | - Hervé Lang
- Hôpitaux universitaires de Strasbourg, service d'urologie, 35033 Strasbourg, France
| | - Gabriel G Malouf
- Hôpitaux universitaires de Strasbourg, service d'oncologie médicale, 67200 Strasbourg, France.
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Boilève A, Maillard A, Wagner M, Dromain C, Laurent C, Dupont Bierre E, Le Sourd S, Audemar F, Ulusakarya A, Guerin-Meyer V, Smisth D, Pezzella V, De Baere T, Goere D, Gelli M, Taieb J, Boige V. Treatment intensification with hepatic arterial infusion chemotherapy in patients with liver-only colorectal metastases still unresectable after systemic induction chemotherapy - a randomized phase II study -- SULTAN UCGI 30/PRODIGE 53 (NCT03164655)- study protocol. BMC Cancer 2020; 20:74. [PMID: 32000724 PMCID: PMC6990591 DOI: 10.1186/s12885-020-6571-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Approximately 40% of colorectal cancer patients will develop colorectal liver metastases (CRLM). The most effective approach to increase long-term survival is CRLM complete resection. Unfortunately, only 10-15% of CRLM are initially considered resectable. The objective response rates (ORR) after current first-line systemic chemotherapy (sys-CT) regimens range from 40 to 80% and complete resection rates (CRR) range from 25 to 50% in patients with initially unresectable CRLM. When CRLM patients are not amenable to complete resection after induction of sys-CT, ORRs obtained with second-line sys-CT are much lower (between 10 and 30%) and consequently CRRs are also low (< 10%). Hepatic arterial infusion (HAI) oxaliplatin may represent a salvage therapy in patients with CRLM unresectable after one or more sys-CT regimens with ORRs and CRRs up to 60 and 30%, respectively. This study is designed to evaluate the efficacy of an intensification strategy based on HAI oxaliplatin combined with sys-CT as a salvage treatment in patients with CRLM unresectable after at least 2 months of first-line induction sys-CT. OBJECTIVES AND ENDPOINTS OF THE PHASE II STUDY Our main objective is to investigate the efficacy, in term of CRR (R0-R1), of treatment intensification in patients with liver-only CRLM not amenable to curative-intent resection (and/or ablation) after at least 2 months of induction sys-CT. Patients will receive either HAI oxaliplatin plus systemic FOLFIRI plus targeted therapy (i.e. anti-EGFR antibody or bevacizumab) or conventional sys-CT plus targeted therapy (i.e. anti-EGFR or antiangiogenic antibody). Secondary objectives are to compare: progression-free survival, overall survival, objective response rate, depth of response, feasibility of delivering HAI oxaliplatin including HAI catheter-related complications, and toxicity (NCI-CTCAE v4.0). METHODS This study is a multicenter, randomized, comparative phase II trial (power, 80%; two-sided alpha-risk, 5%). Patients will be randomly assigned in a 1:1 ratio to receive HAI oxaliplatin combined with systemic FOLFIRI plus targeted therapy (experimental arm) or the best sys-CT plus targeted therapy on the basis of their first-line prior sys-CT history and current guidelines (control arm). One hundred forty patients are required to account for non-evaluable patients. TRIAL REGISTRATION ClinicalTrials.gov, (NCT03164655). Trial registration date: 11th May 2017.
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Affiliation(s)
- Alice Boilève
- Department of Medical Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France.
| | - Aline Maillard
- Department of statistics and epidemiology, Villejuif, France.,Centre for Research in Epidemiology and Population Health (team 2), INSERM U1018, Paris-Saclay University, Villejuif, France
| | - Mathilde Wagner
- Department of radiology, CHU Pitié Salpétrière, Paris, France
| | - Clarisse Dromain
- Department of radiology, Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland
| | - Christophe Laurent
- Department of hepatogastroenterology, Hôpital Haut Levêque, Pessac, France
| | - Eric Dupont Bierre
- Department of digestive surgery, CHP Saint Grégoire, Saint-Grégoire, France
| | - Samuel Le Sourd
- Department of medical oncology, Centre Eugène-Marquis, Rennes, France
| | - Franck Audemar
- Department of hepatogastroenterology, Centre hospitalier Côte Basque, Bayonne, France
| | - Ayhan Ulusakarya
- Department of medical oncology, Hôpital Paul Brousse, Villejuif, France
| | | | - Denis Smisth
- Department of hepatogastroenterology, Hôpital Haut Levêque, Pessac, France
| | | | - Thierry De Baere
- Department of interventional radiology, Gustave Roussy, Villejuif, France
| | - Diane Goere
- Department of Surgical Oncology, Hôpital Saint Louis, Paris, France
| | | | - Julien Taieb
- Department of digestive oncology, Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
| | - Valérie Boige
- Department of Medical Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
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Boilève A, Contejean A, Barreau S, Sourdeau É, Friedrich C, Kosmider O, Burroni B, Dupin N, Lheure C, Rossignol J, Bouscary D, Grignano É. Mastocytosis onset in a patient with treated hairy cell leukemia: Just a coincidence? Blood Cells Mol Dis 2019; 81:102392. [PMID: 31794934 DOI: 10.1016/j.bcmd.2019.102392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022]
Abstract
Mastocytosis is a mast cell disease caused by functionally defective infiltrating mast cells and CD34+ mast cell precursors. The heterogeneous group of mast cell disorders is categorized into five variants in the updated 2017 World Health Organization (WHO) classification among those systemic mastocytosis with an associated neoplasm (SM-AHN). Except for myeloid neoplasia, lymphoproliferative disorders associated to SM-AHN are more scarce. Here, we report the second case ever described of associated mastocytosis and hairy-cell disease. A 38-year-old female patient without any specific medical history was diagnosed a hairy cell leukemia and BRAFV600E mutation was found in hairy cells. Since purine-analogs were avoided to prevent prolonged myelosuppression, she was treated with vemurafenib and rituximab. Despite early discontinuation due to vemurafenib-induced agranulocytosis, a partial response was observed. Strikingly, bone marrow biopsy performed one month after vemurafenib discontinuation revealed a nodular infiltration by 30% tumoral mastocytes. Along with elevated tryptase level, KITD816V mutation on mastocytes and clinical exam, the patient was diagnosed with systemic mastocytosis with an associated hematological neoplasm (SM-AHN). No BRAFV600E mutation was found on mastocytes. The physiopathology of this association is not known and might be only a coincidence or a common genetic driver mutation enhancing mast and hairy cells.
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Affiliation(s)
- Alice Boilève
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France.
| | - Adrien Contejean
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France; Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France
| | - Sylvain Barreau
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - Élise Sourdeau
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - Chloé Friedrich
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - Olivier Kosmider
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - Barbara Burroni
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'anatomopathologie, Paris, France
| | - Nicolas Dupin
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de dermatologie, Paris, France
| | - Coralie Lheure
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de dermatologie, Paris, France
| | - Julien Rossignol
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service d'Hématologie Clinique, Paris, France
| | - Didier Bouscary
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France; Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France
| | - Éric Grignano
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France; Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France
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Boilève A, Carlo MI, Barthélémy P, Oudard S, Borchiellini D, Voss MH, George S, Chevreau C, Landman-Parker J, Tabone MD, Chism DD, Amin A, Bilen MA, Bosse D, Coulomb-L'hermine A, Su X, Choueiri TK, Tannir NM, Malouf GG. Immune checkpoint inhibitors in MITF family translocation renal cell carcinomas and genetic correlates of exceptional responders. J Immunother Cancer 2018; 6:159. [PMID: 30591082 PMCID: PMC6307255 DOI: 10.1186/s40425-018-0482-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/13/2018] [Indexed: 01/05/2023] Open
Abstract
Background Microphthalmia Transcription Factor (MITF)family translocation renal cell carcinoma (tRCC) is a rare RCC subtype harboring TFE3/TFEB translocations. The prognosis in the metastatic (m) setting is poor. Programmed death ligand-1 expression was reported in 90% of cases, prompting us to analyze the benefit of immune checkpoint inhibitors (ICI) in this population. Patients and methods This multicenter retrospective study identified patients with MITF family mtRCC who had received an ICI in any of 12 referral centers in France or the USA. Response rate according to RECIST criteria, progression-free survival (PFS), and overall survival (OS) were analyzed. Genomic alterations associated with response were determined for 8 patients. Results Overall, 24 patients with metastatic disease who received an ICI as second or later line of treatment were identified. Nineteen (82.6%) of these patients had received a VEGFR inhibitor as first-line treatment, with a median PFS of 3 months (range, 1–22 months). The median PFS for patients during first ICI treatment was 2.5 months (range, 1–40 months); 4 patients experienced partial response (16,7%) and 3 (12,5%) had stable disease. Of the patients whose genomic alterations were analyzed, two patients with mutations in bromodomain-containing genes (PBRM1 and BRD8) had a clinical benefit. Resistant clones in a patient with exceptional response to ipilimumab showed loss of BRD8 mutations and increased mutational load driven by parallel evolution affecting 17 genes (median mutations per gene, 3), which were enriched mainly for O-glycan processing (29.4%, FDR = 9.7 × 10− 6). Conclusions MITF family tRCC is an aggressive disease with similar responses to ICIs as clear-cell RCC. Mutations in bromodomain-containing genes might be associated with clinical benefit. The unexpected observation about parallel evolution of genes involved in O-glycosylation as a mechanism of resistance to ICI warrants exploration.
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Affiliation(s)
- A Boilève
- Department of Medical Oncology, Hôpital Universitaire Pitié-Salpétrière, Paris, France
| | - M I Carlo
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - P Barthélémy
- Service d'Hématologie et d'Oncologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - S Oudard
- Oncology Department, European Georges Pompidou Hospital, René Descartes University, Paris, France.,Association pour la Recherche sur les Thérapeutiques Innovantes en Cancérologie, Paris, France.,U790 PARCC, European Georges Pompidou Hospital, René Descartes University, Paris, France
| | | | - M H Voss
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - S George
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - C Chevreau
- IUCT-Oncopole, Institut Claudius-Regaud, Toulouse, France
| | - J Landman-Parker
- Service d'Hématologie et d'Oncologie Pédiatrique, Hopital Armand-Trousseau, Paris, France
| | - M-D Tabone
- Service d'Hématologie et d'Oncologie Pédiatrique, Hopital Armand-Trousseau, Paris, France
| | - D D Chism
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Amin
- Carolinas Healthcare System, Levine Cancer Institute, Charlotte, NC, USA
| | - M A Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - D Bosse
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Xiaoping Su
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - T K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Gabriel G Malouf
- Department of Medical Oncology, Hôpital Universitaire Pitié-Salpétrière, Paris, France. .,Service d'Hématologie et d'Oncologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France. .,Department of Functional Genomics and Cancer, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France. .,Department of Hematology and Oncology, Centre Hospitalier Universitaire de Strasbourg, 1, Place de l'Hôpital, 67000, Strasbourg, France.
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Assoun S, Benderra MA, Géraud A, Bayle A, Boilève A, Grazziotin-Soares D, Lotz JP. Congrès de l’association américaine de recherche contre le cancer — AACR 2018. ONCOLOGIE 2018. [DOI: 10.3166/onco-2018-0011] [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: 11/20/2022]
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Boilève A, Osman D, Marthey L, Carbonnel F, Jozwiak M. Drug-induced coma after chemotherapy in intensive care unit: How to make the right diagnosis? J Neurol Sci 2018; 392:137-138. [PMID: 30059846 DOI: 10.1016/j.jns.2018.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Alice Boilève
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France; Inserm, UMR S_999, Univ Paris-Sud, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France.
| | - David Osman
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France; Inserm, UMR S_999, Univ Paris-Sud, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France
| | - Lysiane Marthey
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service d'hépato-gastro-entérologie, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France
| | - Franck Carbonnel
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service d'hépato-gastro-entérologie, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France
| | - Mathieu Jozwiak
- Hôpitaux universitaires Paris-Sud, Hôpitaux de Paris, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France; Inserm, UMR S_999, Univ Paris-Sud, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94270, France
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Boilève A, Senovilla L, Vitale I, Lissa D, Martins I, Métivier D, van den Brink S, Clevers H, Galluzzi L, Castedo M, Kroemer G. Immunosurveillance against tetraploidization-induced colon tumorigenesis. Cell Cycle 2013; 12:473-9. [PMID: 23324343 DOI: 10.4161/cc.23369] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Circumstantial evidence suggests that colon carcinogenesis can ensue the transient tetraploidization of (pre-)malignant cells. In line with this notion, the tumor suppressors APC and TP53, both of which are frequently inactivated in colon cancer, inhibit tetraploidization in vitro and in vivo. Here, we show that-contrarily to their wild-type counterparts- Tp53 (-/-) colonocytes are susceptible to drug-induced or spontaneous tetraploidization in vitro. Colon organoids generated from tetraploid Tp53 (-/-) cells exhibit a close-to-normal morphology as compared to their diploid Tp53 (-/-) counterparts, yet the colonocytes constituting these organoids are characterized by an increased cell size and an elevated expression of the immunostimulatory protein calreticulin on the cell surface. The subcutaneous injection of tetraploid Tp53 (-/-) colon organoids led to the generation of proliferating tumors in immunodeficient, but not immunocompetent, mice. Thus, tetraploid Tp53 (-/-) colonocytes fail to survive in immunocompetent mice and develop neoplastic lesions in immunocompromised settings only. These results suggest that tetraploidy is particularly oncogenic in the context of deficient immunosurveillance.
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Senovilla L, Vitale I, Martins I, Tailler M, Pailleret C, Michaud M, Galluzzi L, Adjemian S, Kepp O, Niso-Santano M, Shen S, Mariño G, Criollo A, Boilève A, Job B, Ladoire S, Ghiringhelli F, Sistigu A, Yamazaki T, Rello-Varona S, Locher C, Poirier-Colame V, Talbot M, Valent A, Berardinelli F, Antoccia A, Ciccosanti F, Fimia GM, Piacentini M, Fueyo A, Messina NL, Li M, Chan CJ, Sigl V, Pourcher G, Ruckenstuhl C, Carmona-Gutierrez D, Lazar V, Penninger JM, Madeo F, López-Otín C, Smyth MJ, Zitvogel L, Castedo M, Kroemer G. An immunosurveillance mechanism controls cancer cell ploidy. Science 2012; 337:1678-84. [PMID: 23019653 DOI: 10.1126/science.1224922] [Citation(s) in RCA: 332] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cancer cells accommodate multiple genetic and epigenetic alterations that initially activate intrinsic (cell-autonomous) and extrinsic (immune-mediated) oncosuppressive mechanisms. Only once these barriers to oncogenesis have been overcome can malignant growth proceed unrestrained. Tetraploidization can contribute to oncogenesis because hyperploid cells are genomically unstable. We report that hyperploid cancer cells become immunogenic because of a constitutive endoplasmic reticulum stress response resulting in the aberrant cell surface exposure of calreticulin. Hyperploid, calreticulin-exposing cancer cells readily proliferated in immunodeficient mice and conserved their increased DNA content. In contrast, hyperploid cells injected into immunocompetent mice generated tumors only after a delay, and such tumors exhibited reduced DNA content, endoplasmic reticulum stress, and calreticulin exposure. Our results unveil an immunosurveillance system that imposes immunoselection against hyperploidy in carcinogen- and oncogene-induced cancers.
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Jemaà M, Galluzzi L, Kepp O, Boilève A, Lissa D, Senovilla L, Harper F, Pierron G, Berardinelli F, Antoccia A, Castedo M, Vitale I, Kroemer G. Preferential killing of p53-deficient cancer cells by reversine. Cell Cycle 2012; 11:2149-58. [PMID: 22592527 DOI: 10.4161/cc.20621] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Reversine is a small synthetic molecule that inhibits multiple mitotic kinases, including MPS1 as well as Aurora kinase A and B (AURKA and AURKB). Here, we investigated the effects of reversine on p53-deficient vs p53-proficient cancer cells. We found that low doses (~0.5 µM) of reversine, which selectively inhibit MPS1 and hence impair the spindle assembly checkpoint, kill human TP53 (-/-) colon carcinoma cells less efficiently than their wild-type counterparts. In sharp contrast, high doses (~5 µM) of reversine induced hyperploidization and apoptosis to a much larger extent in TP53 (-/-) than in TP53 (+/+) cells. Such a selective cytotoxicity could not be reproduced by the knockdown of MPS1, AURKA and AURKB, neither alone nor in combination, suggesting that it involves multiple (rather than a few) molecular targets of reversine. Videomicroscopy-based cell fate profiling revealed that, in response to high-dose reversine, TP53 (-/-) (but not TP53 (+/+) ) cells undergo several consecutive rounds of abortive mitosis, resulting in the generation of hyperpolyploid cells that are prone to succumb to apoptosis upon the activation of mitotic catastrophe. In line with this notion, the depletion of anti-apoptotic proteins of the BCL-2 family sensitized TP53 (-/-) cells to the toxic effects of high-dose reversine. Moreover, the knockdown of BAX or APAF-1, as well as the chemical inhibition of caspases, limited the death of TP53 (-/-) cells in response to high-dose reversine. Altogether, these results suggest that p53-deficient cells are particularly sensitive to the simultaneous inhibition of multiple kinases, including MPS1, as it occurs in response to high-dose reversine.
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