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Chevalier H, Vienot A, Lièvre A, Edeline J, El Hajbi F, Peugniez C, Vernerey D, Meurisse A, Hammel P, Neuzillet C, Borg C, Turpin A. FOLFIRINOX De-Escalation in Advanced Pancreatic Cancer: A Multicenter Real-Life Study. Oncologist 2020; 25:e1701-e1710. [PMID: 32886823 DOI: 10.1634/theoncologist.2020-0577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Our study describes the feasibility and efficacy of a first-line FOLFIRINOX (5-fluorouracil [5FU], folinic acid, irinotecan, and oxaliplatin) induction chemotherapy (CT) followed by de-escalation as a maintenance strategy for advanced pancreatic cancer. MATERIALS AND METHODS This multicenter retrospective study was conducted from January 2011 to December 2018. FOLFIRINOX de-escalation was defined as stopping oxaliplatin and/or irinotecan after at least four cycles of FOLFIRINOX, without evidence of disease progression. Maintenance schedules were fluoropyrimidine monotherapy (intravenous or oral [capecitabine]), FOLFOX (5FU, oxaliplatin), or FOLFIRI (5FU, irinotecan). Primary endpoint was overall survival (OS). Secondary endpoints were first progression-free survival (PFS1), second progression-free survival (PFS2), and toxicity. RESULTS Among 321 patients treated with FOLFIRINOX, 147 (45.8%) were included. Median OS was 16.1 months (95% confidence interval [CI], 13.7-20.3) and median PFS1 was 9.4 months (95% CI, 8.5-10.4). The preferred maintenance regimen was FOLFIRI in 66 (45%) patients versus 5FU monotherapy in 52 (35%) and FOLFOX in 25 (17%) patients. Among 118 patients who received maintenance CT with FOLFIRI or 5FU, there was no difference in PFS1 (median, 9.0 vs. 10.1 months, respectively; p = .33) or OS (median, 16.6 vs. 18.7 months; p = .86) between the two maintenance regimens. Reintroduction of FOLFIRINOX was performed in 20.2% of patients, with a median PFS2 of 2.8 months (95% CI, 2.0-22.3). The rates of grade 3-4 toxicity were significantly higher with FOLFIRI maintenance CT than with 5FU (41% vs. 22%; p = .03), especially for neuropathy (73% vs. 9%). CONCLUSION 5FU monotherapy maintenance appeared to be as effective as FOLFIRI, in a FOLFIRINOX de-escalation strategy, which is largely used in France. IMPLICATIONS FOR PRACTICE FOLFIRINOX de-escalation and maintenance is a feasible strategy in advanced pancreatic cancer that decreases chemotherapy toxicity to improve both survival and quality of life. Survivals in patients with maintenance therapy are clinically meaningful. Fluoropyrimidine monotherapy maintenance seems to be as efficient as FOLFIRI and should be a reference arm in future pancreatic cancer maintenance trials.
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Affiliation(s)
| | - Angélique Vienot
- Department of Medical Oncology, Besançon University Hospital, Besançon, France
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France
| | - Astrid Lièvre
- Chemistry Oncogenesis Stress Signaling (COSS), Unité Mixte de Recherche (UMR)_S 1242, Department of Gastroenterology, Rennes University Hospital
| | - Julien Edeline
- Oncology Department, Cancer Institute Eugène Marquis, Rennes 1 University
- Nutrition, Metabolism, and Cancer (NuMeCan), Institut National de la Recherche Agronomique (INRA), INSERM, Rennes 1 University, Rennes, France
| | - Farid El Hajbi
- Department of Medical Oncology, Oscar Lambret Center, Lille, France
| | - Charlotte Peugniez
- Department of Medical Oncology, Saint Vincent de Paul Hospital, Lille, France
| | - Dewi Vernerey
- Methodological and Quality of Life in Oncology Unit, EA 3181, Besançon University Hospital, Besançon, France
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France
| | - Aurélia Meurisse
- Methodological and Quality of Life in Oncology Unit, EA 3181, Besançon University Hospital, Besançon, France
| | - Pascal Hammel
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France
- Department of Digestive Oncology, Beaujon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
- University Paris 7, Denis Diderot, Clichy, France
| | - Cindy Neuzillet
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France
- Department of Medical Oncology, Curie Institute, Versailles Saint-Quentin University, Saint Cloud, France
| | - Christophe Borg
- Department of Medical Oncology, Besançon University Hospital, Besançon, France
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France
| | - Anthony Turpin
- Oncology Multidisciplinary Research Group (GERCOR), Paris, France
- Department of Medical Oncology, Lille University Hospital, Lille, France
- UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity, and Resistance to Therapies, Institut Pasteur de Lille, CNRS, INSERM, Centre Hospitalier Universitaire (CHU) Lille, Lille University, Lille, France
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Chevalier H, Vienot A, Lièvre A, Edeline J, El Hajbi F, Peugniez C, Vernerey D, Meurisse A, Hammel P, Neuzillet C, Borg C, Turpin A. FOLFIRINOX de-escalation in advanced pancreatic cancer (aPC): A multicenter real-life study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
4639 Background: FOLFIRINOX (5FU, irinotecan, and oxaliplatin) is a reference first line (L1) of chemotherapy (CT) in fit patients (Pts) with advanced pancreatic cancer (aPC). Limiting toxicities (in particular, neuropathy) are frequent and maintaining quality of life without a lack of efficacy is a crucial need. Modalities and efficacy of maintenance strategy in aPC remain scarcely studied. Our study describes the French practices of a FOLFIRINOX de-escalation and maintenance in a real-life multicentric cohort. Methods: We performed a retrospective multicentric study in 5 French centers. Pts receiving FOLFIRINOX L1 for aPC were recruited between January 2011 and December 2018. FOLFIRINOX de-escalation was defined as stopping oxaliplatin and/or irinotecan in patients without tumor progression, after at least 4 cycles of FOLFIRINOX. Maintenance schedules were oral capecitabine or intravenous (IV) 5FU, FOLFOX or FOLFIRI. Primary endpoint was overall survival (OS). Secondary endpoints were first progression-free survival (PFS1) and, in case of reintroduction of FOLFIRINOX, second progression free survival (PFS2). OS and PFS were estimated using the Kaplan-Meier method and compared using the log-rank test. Results: Among the 321 patients included, 147 (46%) received a maintenance therapy. Median age was 60.0 (53-66), 35 (24%) had locally advanced PC and 91 (62%) had metastatic PC. The median number of cycles of FOLFIRINOX was 9.0 (6.0-11.0). Median OS was 16.1 months (95%CI=13.7-20.3). Median PFS1 was 9.4 months (95%CI=8.5-10.4). The preferred maintenance regimen was FOLFIRI in 66 (45%), vs fluoropyrimidine (FP) in 52 (35%) and FOLFOX in 25 (17%). Among 118 Pts who received a maintenance CT with FP or FOLFIRI, there was no difference in PFS1 (median: 10.1 vs 9.0, respectively, p=0.33) or OS (median: 16.6 versus 18.7, p=0.86) between the 2 maintenance regimens. After progression under maintenance CT with FOLFIRI or FP, reintroduction of FOLFIRINOX was performed in 20.2% of Pts, with a median PFS2 of 2.8 months (95%CI=2.0-22.3). The rates of G3-4 toxicity were significantly higher during FOLFIRI maintenance CT than with FP (41% vs 22%, p=0.03), especially neuropathy (73% vs 9%). Conclusions: FOLFIRINOX de-escalation in aPC is largely used in France. Fluoropyrimidine maintenance chemotherapy appears to be as effective as FOLFIRI.
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Affiliation(s)
| | | | | | | | | | | | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, INSERM UMR 1098, University Hospital of Besancon, Besançon, France
| | | | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | - Cindy Neuzillet
- Medical Oncology Department, Curie Institute, Versailles Saint-Quentin University, Saint Cloud, France
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Abstract
BACKGROUND Chronic lymphoedema is classically complicated by recurring episodes of cellulitis. Degeneration to the angiosarcoma form (Stewart-Treves syndrome) is much less common. It occurs mainly in the upper limbs following surgery or radiotherapy for mammary neoplasia. Herein we report a rare case of Stewart-Treves syndrome (STS) of the lower limb as a complication of congenital lymphoedema. PATIENTS AND METHODS A 69-year-old woman treated for bilateral lower-limb oedema present for 30years developed painful necrotic lesions in her left lower limb. A diagnosis of angiosarcoma was made based on biopsy of a nodular lesion. Since surgical excision was precluded by the extent of the lesions, chemotherapy was initiated with paclitaxel 175mg/m2 every 21days. The outcome was rapidly unfavourable and the patient died at her home during the third course of treatment. DISCUSSION Angiosarcoma is an extremely rare complication of primary lymphoedema; treatment is poorly codified and the prognosis is unfavourable.
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Affiliation(s)
- M-M Farhat
- Dermatologie, hôpital Saint-Vincent, Lille, France
| | - A Le Guern
- Dermatologie, hôpital Saint-Vincent, Lille, France; Université catholique de Lille, Lille, France.
| | - C Peugniez
- Université catholique de Lille, Lille, France; Hématologie-oncologie, hôpital Saint-Vincent, Lille, France
| | - F Dabouz
- Dermatologie, hôpital Saint-Vincent, Lille, France; Université catholique de Lille, Lille, France
| | - J-F Quinchon
- Université catholique de Lille, Lille, France; Laboratoire d'anatomopathologie, hôpital Saint-Vincent, Lille, France
| | - P Modiano
- Dermatologie, hôpital Saint-Vincent, Lille, France; Université catholique de Lille, Lille, France
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Turpin A, Paget-Bailly S, Ploquin A, Hollebecque A, Peugniez C, El-Hajbi F, Bonnetain F, Hebbar M. Clinical Relevance of Alternative Endpoints in Colorectal Cancer First-Line Therapy With Bevacizumab: A Retrospective Study. Clin Colorectal Cancer 2017; 17:e99-e107. [PMID: 29128267 DOI: 10.1016/j.clcc.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 09/25/2017] [Accepted: 10/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND We studied the relationship between intermediate criteria and overall survival (OS) in metastatic colorectal cancer (mCRC) patients who received first-line chemotherapy with bevacizumab. PATIENTS AND METHODS We assessed OS, progression-free survival (PFS), duration of disease control (DDC), the sum of the periods in which the disease did not progress, and the time to failure of strategy (TFS), which was defined as the entire period before the introduction of a second-line treatment. Linear correlation and regression models were used, and Prentice criteria were investigated. RESULTS With a median follow-up of 57.6 months for 216 patients, the median OS was 24.5 months (95% confidence interval [CI], 21.3-29.7). The median PFS, DDC, and TFS were 8.9 (95% CI, 8.4-9.7), 11.0 (95% CI, 9.8-12.4), and 11.1 (95% CI, 10.0-13.0) months, respectively. The correlations between OS and DDC (Pearson coefficient, 0.79 [95% CI, 0.73-0.83], determination coefficient, 0.62) and OS and TFS (Pearson coefficient, 0.79 [95% CI, 0.73-0.84], determination coefficient, 0.63) were satisfactory. Linear regression analysis showed a significant association between OS and DDC, and between OS and TFS. Prentice criteria were verified for TFS as well as DDC. CONCLUSION DDC and TFS correlated with OS and are relevant as intermediate criteria in the setting of patients with mCRC treated with a first-line bevacizumab-based regimen.
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Affiliation(s)
- Anthony Turpin
- Service d'oncologie médicale, Hôpital Claude Huriez, University Hospital, Lille, France; Université Lille Nord de France, Lille, France; CNRS-UMR8161, Institut de Biologie de Lille, Lille, France.
| | - Sophie Paget-Bailly
- Unité de Méthodologie et Qualité de vie en cancérologie (INSERM U1098), University Hospital, Besançon, France
| | - Anne Ploquin
- Service d'oncologie médicale, Hôpital Claude Huriez, University Hospital, Lille, France; Université Lille Nord de France, Lille, France
| | | | - Charlotte Peugniez
- Service d'onco-hématologie, Hôpital Saint Vincent de Paul, Lille, France
| | - Farid El-Hajbi
- Service de cancérologie digestive, Centre Oscar Lambret, Lille, France
| | - Franck Bonnetain
- Unité de Méthodologie et Qualité de vie en cancérologie (INSERM U1098), University Hospital, Besançon, France
| | - Mohamed Hebbar
- Service d'oncologie médicale, Hôpital Claude Huriez, University Hospital, Lille, France; Université Lille Nord de France, Lille, France
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Kotecki N, Hiret S, Etienne PL, Penel N, Tresch E, François E, Galais MP, Ben Abdelghani M, Michel P, Dahan L, Ghiringelli F, Bedenne L, Samalin E, Piessen G, Bennouna J, Peugniez C, El Hajbi F, Clisant S, Kramar A, Mariette C, Adenis A. First-Line Chemotherapy for Metastatic Esophageal Squamous Cell Carcinoma: Clinico-Biological Predictors of Disease Control. Oncology 2016; 90:88-96. [PMID: 26784946 DOI: 10.1159/000442947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of tumor control (TC) in metastatic esophageal squamous cell carcinoma patients receiving first-line chemotherapy. METHODS A development cohort of 68 patients from a prospective multicenter trial (NCT01248299) was used to identify predictors of TC at first radiological tumor assessment and to generate a predictive score for TC. That score was applied in an independent retrospective single-center validation cohort of 60 consecutive patients. RESULTS Multivariate analysis identified three predictors of TC: body mass index ≥18.5 (OR 4.5, 95% CI 0.91-22.5), absence of bone metastasis (OR 4.6, 95% CI 0.91-23.2) and albumin ≥35 g/l (OR 3.5, 95% CI 1.0-12.1). Based on the presence or absence of these three independent prognosticators, we built a predictive model using a score from 0 to 3. In the development cohort, the TC rates were 14.3 and 78.0% and in the validation cohort 12.5 and 44.2%, for scores of 0-1 and 2-3, respectively. With negative predictive values of 85 and 88% in the development and validation cohorts, respectively, we were able to identify patients with a very low probability of TC. CONCLUSION We have developed and validated a score that can be easily determined at the bedside to predict TC in metastatic esophageal squamous cell carcinoma patients.
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Affiliation(s)
- C Peugniez
- Department of Medical Oncology, Centre Oscar Lambret, Lille Medical School of Catholic University, Lille
| | - S Cousin
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille SIRIC OncoLille Consortium, Clinical Research and Methodology Platform, Lille, France
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Stern N, Lervat C, Defachelles AS, Ryckewaert T, Marliot G, Sakji I, Peugniez C, Penel N. Risk factors for ifosfamide-related encephalopathy (IRE) in sarcoma (S) patients (pts). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e21523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Nicolas Penel
- Centre Oscar Lambret General Oncology Department, Lille, France
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Taieb S, Saada-Bouzid E, Tresch E, Ryckewaert T, Bompas E, Italiano A, Guillemet C, Peugniez C, Piperno-Neumann S, Thyss A, Maynou C, Clisant S, Penel N. Comparison of response evaluation criteria in solid tumours and Choi criteria for response evaluation in patients with advanced soft tissue sarcoma treated with trabectedin: a retrospective analysis. Eur J Cancer 2014; 51:202-9. [PMID: 25499439 DOI: 10.1016/j.ejca.2014.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 11/05/2014] [Accepted: 11/11/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND To assess the additional value of density measurement using contrast-enhancement sequences (Choi assessment) in a real-life cohort of adult soft tissue sarcoma patients treated with trabectedin. METHODS Eligibility criteria included adults (age ⩾18) treated between 01/2007 and 12/2011, with at least two trabectedin cycles after failure or intolerance to doxorubicin/ifosfamide. Baseline and first computed tomography (CT)-scans were centrally reviewed by an experienced radiologist. RESULTS The retrospective cohort consists of 134 (73 female) patients treated with trabectedin 1.5 mg/m(2) given as a 24-h infusion every 3 weeks. Patients received a median of five trabectedin cycles (range: 2-33) and the main cause of discontinuation was progressive disease (PD) (n = 105, 78.4%). Response Evaluation Criteria in Solid Tumours (RECIST) assessment was feasible in 128 (95.5%) patients, with Choi assessment performed in 92 (68.7%) patients, generally due to inadequate sequences or exclusive lung metastases. Concordance between both methods was fair (Kappa = 0.290). We identified five patients with false PD (i.e. PD according to RECIST but stable disease/partial response as per Choi). Univariate analysis did not identify any predictive factors for false PD. Median overall survival (OS) of patients with PD as per RECIST but stable disease/partial response (SD/PR) according to Choi was better than for patients with PD according to both RECIST and Choi (14 months versus 8 months; p = 0.052). CONCLUSIONS Choi assessment may identify patients with false PD who achieved improved efficacy outcomes, suggesting that trabectedin may delay tumour progression even in the case of non-dimensional response. Dual size and tumour density assessment may be more suitable to evaluate responses to trabectedin in sarcoma patients as well as to improve the decision-making strategies for the continuation of trabectedin therapy.
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Affiliation(s)
- Sophie Taieb
- Radiology Department, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
| | - Esma Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, 33 Avenue Valombrose, 06100 Nice, France.
| | - Emmanuelle Tresch
- Biostatistics and Methodology Unit, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille cedex , France.
| | - Thomas Ryckewaert
- Medical Oncology Department, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
| | - Emmanuelle Bompas
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Boulevard Jacques Monod, 44805 Saint Herblain cedex, France.
| | - Antoine Italiano
- Medical Oncology Department, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France.
| | - Cécile Guillemet
- Medical Oncology Department, Centre Henri Becquerel, Rue d'Amiens, 76000 Rouen, France.
| | - Charlotte Peugniez
- Medical Oncology Department, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France.
| | | | - Antoine Thyss
- Medical Oncology Department, Centre Antoine Lacassagne, 33 Avenue Valombrose, 06100 Nice, France.
| | - Carlos Maynou
- Orthopedics Unit A, University Hospital, Hôpital Roger Salengro, 59035 Lille cedex, France.
| | - Stéphanie Clisant
- Clinical Research Unit, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France; Clinical Resarch and Methodological Platform, SIRIC OncoLille, Lille, France.
| | - Nicolas Penel
- Medical Oncology Department, Centre Oscar Lambret, 3 rue Combemale, 59020 Lille cedex, France; Clinical Resarch and Methodological Platform, SIRIC OncoLille, Lille, France.
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Taieb S, Saada E, Tresch E, Ryckewaert T, Bompas E, Italiano A, Guillemet C, Peugniez C, Piperno-Neumann S, Thyss A, Clisant S, Cassar A, Nommay D, Penel N. Choi Vs. Recist Assessment of Tumor Response in a Retrospective Analysis of Patients (Pts) Receiving Trabectedin (T) for Advanced Soft Tissue Sarcomas (Asts). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.31] [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: 11/12/2022] Open
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Adenis A, Bennouna J, Galais MP, Tresch E, Francois E, Etienne PL, Ben Abdelghani M, Michel P, Seitz JF, Conroy T, Ghiringhelli F, Bedenne L, Samalin E, Piessen G, Hiret S, Peugniez C, Herin H, Clisant S, Kramar A, Mariette C. Predictors of disease control in patients treated with platinum-based chemotherapies for metastatic squamous-cell esophageal cancer: First results of the e-DIS trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.95] [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
95 Background: There is little evidence that chemotherapy (CT) impacts on outcome of patients with MSEC. We designed an ongoing randomized phase 2 trial to detect a progression-free survival benefit of CT continuation over CT discontinuation in disease-controlled and ECOG≤2 patients at 6 weeks after an initial CT treatment. The aim of the present study was to identify predictors of disease control at 6 weeks (DC6wkx) in MSEC patients receiving platinum-based CTs as first-line treatment for metastatic disease. Methods: Among 68/70 evaluable patients included between 1/2011 and 7/2013 who received at least 1 CT cycle, 58 were evaluable for disease assessment at 6 weeks. Ten patients were not evaluable (early death: 4, patient’s decision: 2, concomitant disease 1, early progressive disease 1, other reasons: 2). Baseline demographic, clinical, biological, and tumor characteristics were tested for prediction of DC6wkx. Significant variables for DC6wkx were identified with the chi-squared test and logistic regression. Results: Baseline patients characteristics were as follows: median age: 61.5yo; male: 57/68; ECOG 0/1/2: 13/42/13; metachronous/synchronous MSEC: 38/30; number of metastatic sites 1/2/>2: 35/20/13; metastatic location: lung 36, liver 23, bone 11, nodes 37, other 11; prior exposure to CT: 37/68; time from previous CT exposure: ≤ 6m 6/37, 6-12m 14/37, > 12m 17/37; gr>2 dysphagia (Atkinson) 19/67; BMI<18.5kg/m²: 13/68. Current CTs were FU-CDDPq3w 2/68, LV5FU2-CDDPq2w 15/68, FOLFOX 51/68, and patients received the following number of cycles 1/2/>2: 5/7/54. DC6wkx rate was 65.7%, with 16/68 PR (23.5%) and 28/68 SD (42.2%). Albumin (p<0.01), BMI (p<0.02), bone metastases (p<0.005), gender (p<0.047) and ECOG status (p<0.05) were predictive of DC6wkx. Normal or overweight BMI, grade 0 albumin, and no bone metastases, were predictive of DC6wkx in multivariate analysis. Conclusions: DC at 6 wks was 65.7% in MSEC receiving platinum-based CTs as first line treatment for metastatic disease. Normal or overweight BMI, normal albumin, and the absence of bone metastasis were significant predictors of DC6wkx in this prospective phase 2 trial. Clinical trial information: NCT01248299.
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Affiliation(s)
| | - Jaafar Bennouna
- Institut de Cancerologie de l’Ouest-site René Gauducheau, Nantes, France
| | | | | | | | | | | | - Pierre Michel
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | | | | | | | - Laurent Bedenne
- Federation Francophone de Cancerologie Digestive, Dijon, France
| | | | - Guillaume Piessen
- Department of Surgical Oncology, University Hospital of Lille, Lille, France
| | - Sandrine Hiret
- Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | | | | | | | - Andrew Kramar
- Unite de Methodologie et Biostatistique, Centre Oscar Lambret, Lille, France
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Ferte C, Romano O, Mariette C, Bourgeois V, Peugniez C, Lindet C, Ladrat L, Triboulet JP, Hebbar M. FOLFIRI chemotherapy in patients with advanced non resectable esophageal or junctional adenocarcinoma: a pilot study. J Chemother 2012; 23:358-61. [PMID: 22233821 DOI: 10.1179/joc.2011.23.6.358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In this prospective pilot study, we assessed the efficacy and safety of the FOLFIRI regimen (irinotecan 180 mg/m², leucovorin 200 mg/m² d1 followed by bolus 400 mg/m² 5-fluorouracil (5-FU) and by a 46-h 2400 mg/m² 5-FU infusion, every 2 weeks) in patients with advanced esophageal or junctional adenocarcinoma. Twenty-nine patients were included. A complete response was obtained in 2 patients, a partial response in 7 patients (objective response rate 31.0%). Stable disease was obtained in 13 patients (disease control rate 75.9%). The median progression-free and overall survivals were 5.9 and 8.6 months, respectively. One patient died from chemotherapy-related diarrhea after one cycle but this patient presented concomitant disease progression with cerebral metastases. We observed one additional grade 4 diarrhea, one grade 3 vomiting, and two grade 3 neutropenias. To conclude, FOLFIRI regimen appears quite active, with an acceptable safety profile in patients with advanced esophageal or junctional adenocarcinoma.
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Affiliation(s)
- C Ferte
- Department of Medical Oncology, University Hospital, Lille, France
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Peugniez C, Vennin P, Adenis A. Long-term survival for pancreatic cancer: a matter of hope, courage, or genetics? Gastrointest Cancer Res 2011; 4:67. [PMID: 21673878 PMCID: PMC3109884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Peugniez C, Fournier C, Guerin-Meyer V, Berger S, Gasnault L, Girault C, Rad E, Lam Y, Maes P, Adenis A. A randomized cross-over trial comparing single-agents capecitabine (C) and UFT plus leucovorin (LV) in patients (Pts) with advanced colorectal cancer (CRC): Preliminary data of a patient preference study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.558] [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
558 Background: Oral fluoropyrimidines such as C and UFT plus LV (U) are widely used pro-drugs dedicated to the care of CRC. Although their toxicity profile may slightly differ, no direct comparison between these treatments has been done as both molecules are converted into fluorouracil. To help the physicians to choose between C and U, we initiated this randomized cross-over trial aimed to assess patient's preference. Methods: Pts with advanced CRC received either a first cycle of C (1,250mg/m2 x 2/d for 14 days, q3 wks) or a first cycle of U (UFT 300mg/m2/d plus LV 75 mg/d in 3 divided doses every 8 hrs for 28 days, repeated at 35-day intervals). Patients were randomized to receive C at cycle 1 followed by U (arm A) or U at cycle 1 followed by C (arm B). After 2 cycles, pts were asked which treatment they preferred. Treatment was then continued with the chosen regimen. Preferences rates are presented with 95% confidence intervals and the two groups are compared with the chi-squared test. Results: 89 pts were enrolled from 10/2005 to 6/2010. Treatment arms were well balanced for baseline characteristics: male 57%; median age 66 years; PS 0-1 81%. Most of the pts were heavily pretreated (0/1/2/ and >2 previous chemotherapy lines: 6/2/15/66). 64 (arm A: 35, arm B: 29)/89 pts received at least 2 cycles of chemotherapy and were evaluable for preference. At cycle 1, 21% and 43% of the pts presented at least 1 severe toxic event with C and U, respectively. Pts with U at cycle 1 presented more likely with severe fatigue and anorexia. There was 1 toxic death under C (gr. 3 diarrhea, gr.4 neutropenia) at cycle 1. Overall, 66% (95%CI: 52-77%) of evaluable pts expressed preference for C, and there was a statistically significant difference between arms A and B (p<0.02) with more pts preferring C in arm A: 79% (95%CI: 61-91%), as compared to arm B: 50% (95%CI: 31-79%). Conclusions: Pts with advanced CRC preferred C over U, especially when given during the first cycle. No significant financial relationships to disclose.
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Affiliation(s)
- C. Peugniez
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - C. Fournier
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - V. Guerin-Meyer
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - S. Berger
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - L. Gasnault
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - C. Girault
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - E. Rad
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - Y. Lam
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - P. Maes
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
| | - A. Adenis
- Centre Oscar Lambret, Lille, France; Centre Paul Papin, Angers, France; Noroncomed Network, Lille, France; Centre Hospitalier de Cholet, Cholet, France
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Peugniez C, Fantoni S, Leroyer A, Skrzypczak J, Duprey M, Bonneterre J. Return to work after treatment for breast cancer: single-center experience in a cohort of 273 patients. Ann Oncol 2010; 21:2124-2125. [PMID: 20841323 DOI: 10.1093/annonc/mdq556] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - J Bonneterre
- Centre Oscar Lambret; CHRU Lille; Université Lille 2, CHRU Lille; Université de Lille Nord de France, Lille, France
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Fantoni SQ, Peugniez C, Duhamel A, Skrzypczak J, Frimat P, Leroyer A. Factors related to return to work by women with breast cancer in northern France. J Occup Rehabil 2010; 20:49-58. [PMID: 19902340 DOI: 10.1007/s10926-009-9215-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Earlier diagnosis and better treatment have increased the survival rates of breast cancer patients. This warrants research on return to work of cancer survivors, especially about subjective factors because they affect the mental desire to return to work. Moreover, knowledge in this issue is very limited in France. OBJECTIVES This study aims to explore the objective and subjective factors that affect whether and when women with breast cancer return to work. METHODS 379 women with breast cancer aged 18-60 years who were working at the time of diagnosis responded to a 45 item questionnaire. The questionnaire had personal characteristics, disease-related characteristics and work-related ones. Multivariate logistic regressions were run to determine the association of these factors and return to work and time until return to work. RESULTS During a median follow-up of 36 months, 82.1% of the 379 women who had worked before their diagnosis returned to work after a median sick leave of 10.8 months. Older age, lower educational level, chemotherapy, radiotherapy, lymphoedema, psychological or organizational self-perceived constraints related to their former job, and the lack of moral support from work colleagues both limited and delayed return to work. CONCLUSION The resumption of work by women with breast cancer depends on many factors, not all of them medical. The self-perceived factors must be considered: first to help support these women during their sick leave, while taking into account elements that may hinder early return to work; second to initiate a work resumption support process which takes into account both the person and her environment.
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Affiliation(s)
- Sophie Quinton Fantoni
- Department of Occupational Medicine, CHRU Lille, Université Lille 2, 1 Avenue Oscar Lambret, Lille Cedex, France.
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Peugniez C, Peugniez C, Fantoni S, Leroyer A, Leroyer A, Skrypczak J, Duprey M, Bonneterre J, Bonneterre J. Return to Work after Treatment for Breast Cancer: Single Center Experience in a Cohort of 273 Patients. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1060] [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: An increasing number of patients (pts) are treated for breast cancer during professional life. The aim of this study was to assess medical as well as socio-professional factors impacting on the likelihood of patients to return to work after treatment.Patients and methods: 1067 pts who were less than 60 years of age, and surgically treated in our institution between January 1, 2004 and December 31, 2005 received a questionnaire with medical, sociodemographic and professional items. An answer was obtained in 586 cases. After excluding in situ carcinoma, local relapses, bilateral tumors and pts without professional activity before treatment, 273 were evaluable. All the clinical files of these patients were reviewed. We studied return to work qualitatively (by univariate, then multivariate logistic regression) and quantitatively, by measuring time until return to work (by log-rank and then multivariate Cox model).Results: Overall, 79.8% of the patients returned to work after a median delay of 11.5 months. In the multivariate analysis, the factors affecting the return to work were: age (p<.0001), particularly pts >55 years returning to work in 58% of cases vs more than 80% in younger ones, education level (p<.001), colleagues support (p<.001), chemotherapy (p<.05), lymphedema (p<.01), and the physical (p=.01) and psychological constraints of the job (p<.01). Surprisingly, local pain with ankylosis of the shoulder was significant only in the univariate analysis (p<.0001). In the multivariate analysis, the factors affecting the delay between treatment and return to work were very similar: age (p<.01), education level (p<.0001), colleagues support (p<.0001), chemotherapy (p<0001), lymphedema (p<.01), and the professional constraints of the job (p<.0001). No significant difference was observed according to type of surgery, tumorectomy vs mastectomy, sentinel lymph node vs axillary clearance, radiation therapy or not, hormonotherapy or not.Conclusion: in our study, 80% of the pts with a professional activity before treatment returned to work; the factors affecting the return to work as well as its delay were: medical (chemotherapy and lymphedema), demographic (age) and socioprofessional (education level, which induces differences in the socio-professional groups, constraints of the job, colleagues support). We could not find any influence of the other treatments such as radiotherapy or hormonotherapy.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1060.
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Affiliation(s)
- C. Peugniez
- 1Faculté de Médecine de Lille - UDSL - Universitié Lille Nord de France, France
| | | | - S. Fantoni
- 3Centre Hospitaliers Régional Universitaire de Lille, France
| | - A. Leroyer
- 1Faculté de Médecine de Lille - UDSL - Universitié Lille Nord de France, France
| | - A. Leroyer
- 3Centre Hospitaliers Régional Universitaire de Lille, France
| | - J. Skrypczak
- 3Centre Hospitaliers Régional Universitaire de Lille, France
| | - M. Duprey
- 3Centre Hospitaliers Régional Universitaire de Lille, France
| | - J. Bonneterre
- 1Faculté de Médecine de Lille - UDSL - Universitié Lille Nord de France, France
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Peugniez C, Coche-Dequéant B, Leblond P, Lacornerie T, Lartigau É. CyberKnife® et tumeurs de l’enfant : à propos de cinq cas. Cancer Radiother 2009. [DOI: 10.1016/j.canrad.2009.08.032] [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: 11/25/2022]
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