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Giudici F, Pistilli B, Vaz-Luis I, Karimi M, Delaloge S, Bachelot T, Michiels S, Bardet A. Insights adjusting for non-adherence in randomized clinical trials: a reanalysis of an adjuvant trial of tamoxifen duration in early breast cancer. Br J Cancer 2023; 129:1516-1523. [PMID: 37697030 PMCID: PMC10628101 DOI: 10.1038/s41416-023-02420-w] [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: 02/14/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Several randomized clinical trials provide evidence of the survival benefit of extended adjuvant tamoxifen in women with estrogen receptor (ER)-positive early breast cancer (BC). However, non-adherence may lead to underestimate treatment effects using intention to treat (ITT) methods. We reanalyzed a randomized trial using contemporary statistical methods adjusting for non-adherence. METHODS The TAM01 study was a phase 3 trial including women with early BC, who had completed 2-3 years of adjuvant tamoxifen between 1986 and 1995. Participants were randomly assigned to continue tamoxifen up to 10 years or to discontinue the treatment at randomization. Invasive disease-free survival (iDFS) and overall survival (OS) were estimated using marginal structural models (MSM) and rank preserving structural failure time model (RPSFTM). RESULTS Of 3830 patients enrolled, 2485 were randomized to extended tamoxifen, and 1345 to treatment discontinuation. The 10-year non-adherence rate in the extended group was 27.2%. Among women with ER-positive BC (n = 2402), extended tamoxifen was associated with a 45% and 21% relative improvement in iDFS by MSM and RPSFTM, respectively (Hazard Ratio (HR), 0.55; 95% Confidence Interval (CI), 0.48-0.64 and HR, 0.79; 95%CI, 0.67-0.95, respectively), a considerable greater benefit than in the ITT analysis (HR, 0.90; 95%CI, 0.81-0.99). The OS reanalysis revealed a substantial benefit of extended tamoxifen (MSM: HR, 0.70; 95%CI, 0.59-0.83; RPSFTM: HR, 0.85; 95%CI, 0.67-1.04), compared to the ITT analyses (HR, 0.94; 95%CI, 0.84-1.07). CONCLUSION This analysis emphasizes both the importance of adherence to hormonotherapy in hormone-receptor positive early BC and the usefulness of more complex statistical analyses.
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Affiliation(s)
- Fabiola Giudici
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
| | - Ines Vaz-Luis
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, 114 Rue Edouard Vaillant, Villejuif, France
| | - Maryam Karimi
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Rue Laënnec, Lyon, France
| | - Stefan Michiels
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France.
| | - Aurelie Bardet
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
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Thomas PA, Edwards JG, Rami-Porta R, Van Schil P, Mercier O, Le Rochais JP, Falcoz PE, Meunier JP, Gkika E, Kheira H, Riesterer O, Ghigna MR, Bardet A, Le Pechoux C. The Lung ART adjuvant radiotherapy phase 3 randomized trial: Impact of quality of resection in stage IIIAN2 patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8522 Background: Lung ART is an international phase 3 trial whose main objective was to evaluate the impact of post-operative conformal radiotherapy (PORT) on disease-free survival (DFS) in patients with completely resected pathologically proven N2 non-small cell lung cancer (NSCLC), with or without neo- or adjuvant chemotherapy. Previously communicated results showed no impact of PORT on DFS. However, as quality of surgical resection and extent of lymph node dissection were expected to be critically important in the interpretation of results, surgical and pathological reports were centrally reviewed by a surgical committee. Methods: A surgical advisory committee composed of 4 expert thoracic surgeons reviewed anonymized surgical and pathological reports of all included patients. Pre-defined classification rules were defined using published guidelines from the International Association for the Study of Lung Cancer and the European Society of Thoracic Surgeons. Tumor resection was defined as complete (no residual tumor and adequate lymph node assessment), uncertain (highest mediastinal nodal station involved, incomplete nodal exploration, involved N2 removed in fragments) or incomplete (presence of residual tumor). Nodal exploration was classified as sampling, selective dissection or extensive dissection. Results: 501 patients were included in the Lung ART trial. Before surgical committee review intervention, all patients except 2 had complete resection. 496 patients’ reports were analyzed by the surgical advisory committee. The basic characteristics are specified in the following table: Conclusions: Monitoring of the quality of nodal exploration and of resection should be implemented in randomized studies evaluating peri-operative strategies in NSCLC in order to provide reliable and generalizable results. Clinical trial information: NCT00410683. [Table: see text]
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Affiliation(s)
| | | | - Ramón Rami-Porta
- Hospital Mutua de Terrassa, Thoracic Surgery Service, Terrassa, Spain
| | | | - Olaf Mercier
- Department of Thoracic Surgery, Institut d'Oncologie Thoracique, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | | | | | | | - Eleni Gkika
- Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
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Giudici F, Pistilli B, Vaz-Duarte-Luis I, Michiels S, Bardet A. Survie à long terme du traitement adjuvant par tamoxifène dans le cancer du sein précoce: nouvelles perspectives en fonction de l'adhérence. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.094] [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: 11/15/2022] Open
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Rassy E, Bardet A, Bougacha O, Gantzer L, Lekens B, Luis I, Delaloge S, André F, Michiels S, Pistilli B. 225P Impact of potential drug-drug interactions (PDDI) on adherence to endocrine therapy (ET) among patients with breast cancer (BC) in the Health Improvement Network (THIN). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.246] [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: 11/01/2022] Open
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Le Pechoux C, Pourel N, Barlesi F, Lerouge D, Antoni D, Lamezec B, Nestle U, Boisselier P, Dansin E, Paumier A, Peignaux K, Thillays F, Zalcman G, Madelaine J, Pichon E, Larrouy A, Lavole A, Argo-Leignel D, Derollez M, Faivre-Finn C, Hatton MQ, Riesterer O, Bouvier-Morel E, Dunant A, Edwards JG, Thomas PA, Mercier O, Bardet A. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial. Lancet Oncol 2022; 23:104-114. [PMID: 34919827 DOI: 10.1016/s1470-2045(21)00606-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [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] [Received: 08/15/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND In patients with non-small-cell lung cancer (NSCLC), the use of postoperative radiotherapy (PORT) has been controversial since 1998, because of one meta-analysis showing a deleterious effect on survival in patients with pN0 and pN1, but with an unclear effect in patients with pN2 NSCLC. Because many changes have occurred in the management of patients with NSCLC, the role of three-dimensional (3D) conformal PORT warrants further investigation in patients with stage IIIAN2 NSCLC. The aim of this study was to establish whether PORT should be part of their standard treatment. METHODS Lung ART is an open-label, randomised, phase 3, superiority trial comparing mediastinal PORT to no PORT in patients with NSCLC with complete resection, nodal exploration, and cytologically or histologically proven N2 involvement. Previous neoadjuvant or adjuvant chemotherapy was allowed. Patients aged 18 years or older, with an WHO performance status of 0-2, were recruited from 64 hospitals and cancer centres in five countries (France, UK, Germany, Switzerland, and Belgium). Patients were randomly assigned (1:1) to either the PORT or no PORT (control) groups via a web randomisation system, and minimisation factors were the institution, administration of chemotherapy, number of mediastinal lymph node stations involved, histology, and use of pre-treatment PET scan. Patients received PORT at a dose of 54 Gy in 27 or 30 daily fractions, on five consecutive days a week. Three dimensional conformal radiotherapy was mandatory, and intensity-modulated radiotherapy was permitted in centres with expertise. The primary endpoint was disease-free survival, analysed by intention to treat at 3 years; patients from the PORT group who did not receive radiotherapy and patients from the control group with no follow-up were excluded from the safety analyses. This trial is now closed. This trial is registered with ClinicalTrials.gov number, NCT00410683. FINDINGS Between Aug 7, 2007, and July 17, 2018, 501 patients, predominantly staged with 18F-fluorodeoxyglucose (18F-FDG) PET (456 [91%]; 232 (92%) in the PORT group and 224 (90%) in the control group), were enrolled and randomly assigned to receive PORT (252 patients) or no PORT (249 patients). At the cutoff date of May 31, 2019, median follow-up was 4·8 years (IQR 2·9-7·0). 3-year disease-free survival was 47% (95% CI 40-54) with PORT versus 44% (37-51) without PORT, and the median disease-free survival was 30·5 months (95% CI 24-49) in the PORT group and 22·8 months (17-37) in the control group (hazard ratio 0·86; 95% CI 0·68-1·08; p=0·18). The most common grade 3-4 adverse events were pneumonitis (13 [5%] of 241 patients in the PORT group vs one [<1%] of 246 in the control group), lymphopenia (nine [4%] vs 0), and fatigue (six [3%] vs one [<1%]). Late-grade 3-4 cardiopulmonary toxicity was reported in 26 patients (11%) in the PORT group versus 12 (5%) in the control group. Two patients died from pneumonitis, partly related to radiotherapy and infection, and one patient died due to chemotherapy toxicity (sepsis) that was deemed to be treatment-related, all of whom were in the PORT group. INTERPRETATION Lung ART evaluated 3D conformal PORT after complete resection in patients who predominantly had been staged using (18F-FDG PET-CT and received neoadjuvant or adjuvant chemotherapy. 3-year disease-free survival was higher than expected in both groups, but PORT was not associated with an increased disease-free survival compared with no PORT. Conformal PORT cannot be recommended as the standard of care in patients with stage IIIAN2 NSCLC. FUNDING French National Cancer Institute, Programme Hospitalier de Recherche Clinique from the French Health Ministry, Gustave Roussy, Cancer Research UK, Swiss State Secretary for Education, Research, and Innovation, Swiss Cancer Research Foundation, Swiss Cancer League.
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Affiliation(s)
- Cecile Le Pechoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
| | - Nicolas Pourel
- Radiation Oncology, Institut Sainte Catherine, Avignon, France
| | - Fabrice Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Aix-Marseille University, Centre National de la Recherche Scientifique, Institut National des Sciences et de la Recherche Médicale, Centre de Recherche en Cancérologie de Marseille, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | - Delphine Antoni
- Department of Radiation Oncology, Centre Paul Strauss, Strasbourg, France
| | - Bruno Lamezec
- Radiation Oncology, Centre Armoricain de Radiothérapie, d'Imagerie médicale et d'Oncologie, St Brieuc, France
| | - Ursula Nestle
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Pierre Boisselier
- Department of Radiation Oncology, Centre Val d'Aurelle, Montpellier, France
| | - Eric Dansin
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Amaury Paumier
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest Centre Paul Papin, Angers, France
| | - Karine Peignaux
- Department of Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | - François Thillays
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France
| | - Gerard Zalcman
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France; Department of Thoracic Oncology, Université de Paris, Centre d'Investigation Clinique-1425-Bichat-Claude Bernard Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jeannick Madelaine
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Eric Pichon
- Department of Pneumology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Larrouy
- Radiation Oncology, Centre Specialisé Cancerologie Paris Nord, Sarcelles, France
| | - Armelle Lavole
- Department of Thoracic Oncology, Tenon University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Marc Derollez
- Pneumology, Polyclinique du Val de Sambre, Maubeuge, France
| | - Corinne Faivre-Finn
- University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Q Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich and Centre for Radiation Oncology, Cantonal Hospitals Aarau and Baden, Aarau, Switzerland
| | - Emilie Bouvier-Morel
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Ariane Dunant
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Hôpital Nord, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Institut d'Oncologie Thoracique, Marie-Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France
| | - Aurelie Bardet
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France; Oncostat Unité Mixte de Recherche 1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
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Bardet A, Fraslin AM, Marghadi J, Borget I, Faron M, Honoré C, Delaloge S, Albiges L, Planchard D, Ducreux M, Hadoux J, Colomba E, Robert C, Bouhir S, Massard C, Micol JB, Ter-Minassian L, Michiels S, Auperin A, Barlesi F, Bonastre J. Impact of COVID-19 on healthcare organisation and cancer outcomes. Eur J Cancer 2021; 153:123-132. [PMID: 34153714 PMCID: PMC8213441 DOI: 10.1016/j.ejca.2021.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Changes in the management of patients with cancer and delays in treatment delivery during the COVID-19 pandemic may impact the use of hospital resources and cancer mortality. PATIENTS AND METHODS Patient flows, patient pathways and use of hospital resources during the pandemic were simulated using a discrete event simulation model and patient-level data from a large French comprehensive cancer centre's discharge database, considering two scenarios of delays: massive return of patients from November 2020 (early-return) or March 2021 (late-return). Expected additional cancer deaths at 5 years and mortality rate were estimated using individual hazard ratios based on literature. RESULTS The number of patients requiring hospital care during the simulation period was 13,000. In both scenarios, 6-8% of patients were estimated to present a delay of >2 months. The overall additional cancer deaths at 5 years were estimated at 88 in early-return and 145 in late-return scenario, with increased additional deaths estimated for sarcomas, gynaecological, liver, head and neck, breast cancer and acute leukaemia. This represents a relative additional cancer mortality rate at 5 years of 4.4 and 6.8% for patients expected in year 2020, 0.5 and 1.3% in 2021 and 0.5 and 0.5% in 2022 for each scenario, respectively. CONCLUSIONS Pandemic-related diagnostic and treatment delays in patients with cancer are expected to impact patient survival. In the perspective of recurrent pandemics or alternative events requiring an intensive use of limited hospital resources, patients should be informed not to postpone care, and medical resources for patients with cancer should be sanctuarised.
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Affiliation(s)
- Aurelie Bardet
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France.
| | - Alderic M Fraslin
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Jamila Marghadi
- Service of Medical Information, Gustave Roussy, Villejuif, France
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Matthieu Faron
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France; Department of Surgical Oncology, Gustave Roussy, Villejuif, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - David Planchard
- Department of Cancer Medicine, Thoracic Oncology Unit, Gustave Roussy, Villejuif, France
| | - Michel Ducreux
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France; INSERM U1279, Villejuif, France
| | - Julien Hadoux
- Department of Endocrinology, Imaging Department, Gustave Roussy, Villejuif, France
| | - Emeline Colomba
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Caroline Robert
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Samia Bouhir
- Department of Head and Neck Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Christophe Massard
- Department of Drug Development (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Jean-Baptiste Micol
- Department of Hematology, Gustave Roussy, Paris-Saclay University, Villejuif, France; INSERM U1287, Villejuif, France
| | | | - Stefan Michiels
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Anne Auperin
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Fabrice Barlesi
- Department of Cancer Medicine, Gustave Roussy, Paris-Saclay University, Villejuif, France; Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Julia Bonastre
- Department of Biostatistics and Epidemiology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France
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Fraslin A, Bardet A, Marghadi J, Borget I, Matthieu F, Auperin A, Michiels S, Bonastre J. Un modèle de micro-simulation à événements discrets pour estimer les impacts de l’épidémie de COVID-19 sur l’organisation des soins et la mortalité par cancer. Rev Epidemiol Sante Publique 2021. [PMCID: PMC8138911 DOI: 10.1016/j.respe.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Laurent C, Hamon M, Syrykh C, Adélaï J, Guille A, Parrens M, Dartigues P, Bardet A, Mescam L, Schiano De Colella J, Sujobert P, Besson C, Birnbaum D, Xerri L. RESISTANCE OF B‐CELL LYMPHOMAS TO CAR‐T CELL THERAPY IS ASSOCIATED WITH HISTOPHENOTYPICAL AND GENOMIC TUMOR CHANGES WHICH CAN INDUCE PROFOUND TRANS‐DIFFERENTIATION. Hematol Oncol 2021. [DOI: 10.1002/hon.190_2880] [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] [Indexed: 11/07/2022]
Affiliation(s)
| | - M. Hamon
- Hopital André Mignot Pathology Versailles France
| | | | - J. Adélaï
- IPC, Predictive Oncology/ CRCM Inserm CNRS AMU Marseille France
| | - A. Guille
- CRCM Predictive oncology Marseille France
| | - M. Parrens
- Hopital haut‐Lévéque, Pathology Bordeaux France
| | | | - A. Bardet
- Institut Paoli‐Calmettes pathology Marseille France
| | - L. Mescam
- Institut Paoli‐Calmettes pathology Marseille France
| | | | - P. Sujobert
- CHU Lyon‐Sud, Hématology Pierre‐Bénite France
| | - C. Besson
- Hopital André Mignot Pathology Versailles France
| | | | - L. Xerri
- Institut Paoli‐Calmettes pathology Marseille France
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Vigouret-Viant L, Legoupil C, Bardet A, Laurent C, Ducreux M, Laurent S, Mateus C, Dauchy S, Blot F. Development of an aid to decision-making form (ADF) integrated into a major institutional program in oncology: A tool to support care goal identification. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18646 Background: For cancer patients, life-threatening complications may be difficult to anticipate, leading to complex medical decision-making processes. Since 2015, the Gustave Roussy Cancer Center has implemented a major institutional program including a Decision-Aid Form (ADF), outlining the anticipation of appropriate care for patient in case of worsening evolution. Methods: Between January and May 2017, all patients transferred from Site 1 to Site 2 of the hospital were prospectively included. In this study, we assessed the acceptability of the ADF, its using and its impact on the patient’s becoming. Results: Out of 206 patients included, 89.3% had an ADF. The planned stratification of care was notified in practically all cases. Conversely, the involvement of the palliative care team was notified in only 29% of the ADF. The value of the WHO/ECOG Performance Status was limited, varying between physicians. Finally, the field “information for patients and relatives” was insufficiently completed. Although a possible transfer to Intensive Care Unit was initially proposed in two-thirds of the patients, the majority (76%) of the 35 patients experiencing an acute event received exclusive medical or palliative care. The level of therapeutic commitment suggested by the ADF was never upgraded, and often revised towards less aggressive care, and especially without excess mortality for the patients who were initially designated to be eligible for intensive care. Moreover, the patient's survival at 6 months seems to be correlated with the anticipated level of care recorded on the FAD (Log-rank P value < 0,0001). Conclusions: The results of our study suggest that setting up a care stratification file in advance is possible in a French cultural setting and it could be helpful for clarifying prognosis assessment. To achieve complete acculturation, our extensive institutional program remains a cornerstone for the development of advance care planning. Since 2017, this program has widely spreaded ADF which is now integrated into the electronic medical record. Each physician can complete and modify the patient's ADF at any stage of the patient's disease course.
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Affiliation(s)
- Laurence Vigouret-Viant
- Gustave Roussy Cancer Campus, Palliative Care Unit, Interdisciplinary Cancer Pathway Department, Villejuif, France
| | | | | | | | | | - Sophie Laurent
- Gustave Roussy Cancer Campus, Interdisciplinary Cancer Pathway Department, Villejuif, France
| | - Christine Mateus
- Gustave Roussy Cancer Campus, Palliative Care Unit, Interdisciplinary Cancer Pathway Department, Villejuif, France
| | | | - François Blot
- Gustave Roussy Cancer Campus, Interdisciplinary Cancer Pathway Department, Villejuif, France
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Moukasse Y, Pourel N, Lerouge D, Faivre-Finn C, Ramella S, Edwards J, Van Schil P, Rami-Porta R, Thomas P, Bardet A, Le Pechoux C. PH-0280: Quality of surgery and RT in stage IIIN2 NSCLC: Insights from the Lung Adjuvant Radiotherapy trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00304-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pistilli B, Ferreira A, Combarel D, Paci A, Havas J, Pradon C, Bardet A, Di Meglio A, Menvielle G, Fasse L, Cottu P, Lerebours F, Coutant C, Lesur A, Chopin N, Everhard S, Delaloge S, Michiels S, André F, Luis IV. 167MO Longitudinal evaluation of serum assessed non-adherence to tamoxifen (TAM) among premenopausal patients (pts) in the prospective multicenter CANTO cohort. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.289] [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: 11/24/2022] Open
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Pistilli B, Paci A, Ferreira AR, Di Meglio A, Poinsignon V, Bardet A, Menvielle G, Dumas A, Pinto S, Dauchy S, Fasse L, Cottu PH, Lerebours F, Coutant C, Lesur A, Tredan O, Soulie P, Vanlemmens L, Jouannaud C, Levy C, Everhard S, Arveux P, Martin AL, Dima A, Lin NU, Partridge AH, Delaloge S, Michiels S, André F, Vaz-Luis I. Serum Detection of Nonadherence to Adjuvant Tamoxifen and Breast Cancer Recurrence Risk. J Clin Oncol 2020; 38:2762-2772. [PMID: 32568632 PMCID: PMC7430219 DOI: 10.1200/jco.19.01758] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [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: 01/13/2023] Open
Abstract
PURPOSE Nonadherence to long-term treatments is often under-recognized by physicians and there is no gold standard for its assessment. In breast cancer, nonadherence to tamoxifen therapy after surgery constitutes a major obstacle to optimal outcomes. We sought to evaluate the rate of biochemical nonadherence to adjuvant tamoxifen using serum assessment and to examine its effects on short-term, distant disease-free survival (DDFS). PATIENTS AND METHODS We studied 1,177 premenopausal women enrolled in a large prospective study (CANTO/NCT01993498). Definition of biochemical nonadherence was based on a tamoxifen serum level < 60 ng/mL, assessed 1 year after prescription. Self-reported nonadherence to tamoxifen therapy was collected at the same time through semistructured interviews. Survival analyses were conducted using an inverse probability weighted Cox proportional hazards model, using a propensity score based on age, staging, surgery, chemotherapy, and center size. RESULTS Serum assessment of tamoxifen identified 16.0% of patients (n = 188) below the set adherence threshold. Patient-reported rate of nonadherence was lower (12.3%). Of 188 patients who did not adhere to the tamoxifen prescription, 55% self-reported adherence to tamoxifen. After a median follow-up of 24.2 months since tamoxifen serum assessment, patients who were biochemically nonadherent had significantly shorter DDFS (for distant recurrence or death, adjusted hazard ratio, 2.31; 95% CI, 1.05 to 5.06; P = .036), with 89.5% of patients alive without distant recurrence at 3 years in the nonadherent cohort versus 95.4% in the adherent cohort. CONCLUSION Therapeutic drug monitoring may be a useful method to promptly identify patients who do not take adjuvant tamoxifen as prescribed and are at risk for poorer outcomes. Targeted interventions facilitating patient adherence are needed and have the potential to improve short-term breast cancer outcomes.
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Affiliation(s)
| | - Angelo Paci
- Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Faculté de Pharmacie, Saint-Aubin, France
| | - Arlindo R Ferreira
- Institut Gustave Roussy, Villejuif, France.,INSERM-Unit 981, Villejuif, France.,Fundacao Champalimaud, Lisbon, Portugal
| | - Antonio Di Meglio
- Institut Gustave Roussy, Villejuif, France.,INSERM-Unit 981, Villejuif, France
| | | | - Aurelie Bardet
- Institut Gustave Roussy, Villejuif, France.,INSERM-Unit 1018, Villejuif, France
| | - Gwenn Menvielle
- Institut Pierre Louis d'Epidemiologie et de Santé Publique, Paris, France
| | - Agnes Dumas
- INSERM-Unit 1018, Villejuif, France.,UMR-Unit 1123, Paris, France.,Université Paris Diderot UFR de Médecine, Paris, France
| | - Sandrine Pinto
- Institut Pierre Louis d'Epidemiologie et de Santé Publique, Paris, France
| | | | - Leonor Fasse
- Institut Gustave Roussy, Villejuif, France.,Université Paris Decartes, Paris, France
| | | | | | | | - Anne Lesur
- Institut de Cancerologie de Lorraine, Nancy, France
| | | | - Patrick Soulie
- Institut de Cancerologie de L'Ouest, Saint Herblain, France
| | | | | | - Christelle Levy
- Centre Francois Baclesse Centre Lutte Contre le Cancer, Caen, France
| | | | - Patrick Arveux
- INSERM-Unit 1018, Villejuif, France.,Georges-Francois Leclerc Centre, Dijon, France
| | | | | | | | | | | | - Stefan Michiels
- Institut Gustave Roussy, Villejuif, France.,INSERM-Unit 1018, Villejuif, France
| | - Fabrice André
- Institut Gustave Roussy, Villejuif, France.,INSERM-Unit 981, Villejuif, France
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Moukasse Y, Pourel N, Lerouge D, Padovani L, Faivre-Finn C, Ramella S, Bardet A, Auzac G, Le Péchoux C. Contrôle qualité de la radiothérapie postopératoire des carcinomes bronchiques non à petites cellules de stade III avec envahissement N2 : une première étape importante dans l’étude multicentrique de phase III Lung Adjuvant Radiotherapy Trial (Lung ART-IFCT 0503). Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.013] [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: 10/26/2022]
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Perez AM, Bardet A, Lacroix-Triki M, Riet F, Mathieu M, Deutsch E, Michiels S, Rivera S. OC-0153 Immune infiltrate modulation induced by preoperative radiotherapy in breast cancer patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30573-0] [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: 11/29/2022]
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Kandel M, Allayous C, Dalle S, Mortier L, Dalac Rat S, Dutriaux C, Leccia MT, Guillot B, Saiag P, Lacour JP, Legoupil D, Brunet-Possenti F, Dreno B, Ballon A, Bardet A, Michiels S, Lebbe C, Borget I. Assessment of quality of life in patients with metastatic melanoma in real clinical practice in France. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.045] [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: 11/13/2022] Open
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Mateus C, Dréno B, Lebbé C, Ouidad Z, Meyer N, Adrian G, Mehdi M, Bardet A, Moreau M, Duval-Modeste AB. Cobimétinib associé au vémurafénib dans le traitement du mélanome non résécable ou métastatique : données de l’autorisation temporaire d’utilisation. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.266] [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: 11/26/2022]
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Meyer N, Anne-Bénédicte DM, Dreno B, Lebbe C, Zehou O, Gorana A, Mouri M, Bardet A, Moreau M, Mateus C. Cobimetinib plus vemurafenib to treat unresectable or metastatic melanoma: Data from the French temporary authorization for use. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pentousis D, Toussaint M, Zheng H, Favereau X, Guerin Y, Bardet A, Maribas P, Corcos T. Conservative management for an extensive type A aortic dissection complicating coronary angioplasty. J Invasive Cardiol 2000; 12:320-3. [PMID: 10859720] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Aortic dissection is a recognized, though rare complication of percutaneous revascularization procedures. We report a case of an extensive type A dissection that occurred during an attempt to recanalize a chronic total occlusion of a right coronary artery. The patient was treated conservatively and was followed for 36 months, during which he remained well. We conclude that, even though surgery remains the preferred option, conservative management could also be considered in certain patients.
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Affiliation(s)
- D Pentousis
- Department of Interventional Cardiology, Clinique Turin, 9 rue de Turin, 75008, Paris, France
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Kartun P, Bardet A, Duprey J, Macrez C, Lubetzki J. [A phonomecanographic test of hyperthyroidism]. Nouv Presse Med 1976; 5:1735-8. [PMID: 958878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Systolic intervals may be studied by phonomechanography. This provides data regarding the function of the left ventricle. In the absence of any problem of intraventricular conduction or valvular lesion, such information is particularly valuable. Thyroxine impregnation, whetHer active directly and/or by catecholamine hypersecretion, results in cardiac hyperkinesia which is reflected not only by tachycardia but also a shortening penetration time and contraction of the ventricular muscle. This shows itself within systole as a change in the relation between the duration of the pre-ejection phase (PPE) and the ejection phase. The first decreases whilst the second remains normal and their ratio changes, PPE/E changes from a normal value of 0.34 +/- 0.04 to 0.25 +/- 0.03. These tests are not only of value in diagnosis but also make it possible to observe the effects of treatment. It is certain that a true phonomechanographic syndrome of cardiac hyperkinesia may be described. The commonest, though not the only, aetiology is hyperthyroidism.
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Kartun P, Bardet A, Duprey J, Macrez C, Lubetzki J. [Study of systolic intervals in hyperthyroidism without cardiac complications]. Arch Mal Coeur Vaiss 1973; 66:877-89. [PMID: 4200948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Py J, Bardet A. [Phonocardiography of mitral stenosis. Diastolic murmur. 3rd sound and initial jerk of the murmur. 2nd pulmonary sound. Apex systolic souffles]. Arch Mal Coeur Vaiss 1966; 59:917-38. [PMID: 4960825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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