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Penel N, Mailliez A, Pannier D, Ducrocq C. [Should we take into account the informational stress of the medical oncologist?]. Bull Cancer 2024; 111:222-227. [PMID: 38199834 DOI: 10.1016/j.bulcan.2023.11.008] [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: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 01/12/2024]
Abstract
Information overload, informational stress and its deleterious consequences constitute a subject of growing interest in the way of work. This is quite well documented among anesthesiologists. Studies have also been carried out on cancer patients or on the general public in terms of cancer prevention. After having defined the concepts and the consequences, we hypothesize the presence of informational stress among medical oncologists. We illustrate this hypothesis regarding adjuvant treatment of breast cancer. Specific studies (qualitative and quantitative ones) would be particularly interesting in oncology.
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Affiliation(s)
- Nicolas Penel
- Department of Medical Oncology, Centre Oscar-Lambret, Lille, France; ULR 2694 - Metrics : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University of Lille, Lille, France.
| | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar-Lambret, Lille, France
| | - Diane Pannier
- Department of Medical Oncology, Centre Oscar-Lambret, Lille, France
| | - Christophe Ducrocq
- Faculty of Psychology, CIREL - Education and Training Sciences, Interuniversity Center for Research in Education of Lille, Lille University, Villeneuve d'Ascq, France
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Veziant J, Bouché O, Aparicio T, Barret M, El Hajbi F, Lepilliez V, Lesueur P, Maingon P, Pannier D, Quero L, Raoul JL, Renaud F, Seitz JF, Serre AA, Vaillant E, Vermersch M, Voron T, Tougeron D, Piessen G. Esophageal cancer - French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (TNCD, SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFP, RENAPE, SNFCP, AFEF, SFR). Dig Liver Dis 2023; 55:1583-1601. [PMID: 37635055 DOI: 10.1016/j.dld.2023.07.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION This document is a summary of the French intergroup guidelines regarding the management of esophageal cancer (EC) published in July 2022, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org). METHODS This collaborative work was conducted under the auspices of several French medical and surgical societies involved in the management of EC. Recommendations were graded in three categories (A, B and C), according to the level of evidence found in the literature until April 2022. RESULTS EC diagnosis and staging evaluation are mainly based on patient's general condition assessment, endoscopy plus biopsies, TAP CT-scan and 18F FDG-PET. Surgery alone is recommended for early-stage EC, while locally advanced disease (N+ and/or T3-4) is treated with perioperative chemotherapy (FLOT) or preoperative chemoradiation (CROSS regimen) followed by immunotherapy for adenocarcinoma. Preoperative chemoradiation (CROSS regimen) followed by immunotherapy or definitive chemoradiation with the possibility of organ preservation are the two options for squamous cell carcinoma. Salvage surgery is recommended for incomplete response or recurrence after definitive chemoradiation and should be performed in an expert center. Treatment for metastatic disease is based on systemic therapy including chemotherapy, immunotherapy or combined targeted therapy according to biomarkers testing such as HER2 status, MMR status and PD-L1 expression. CONCLUSION These guidelines are intended to provide a personalised therapeutic strategy for daily clinical practice and are subject to ongoing optimization. Each individual case should be discussed by a multidisciplinary team.
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Affiliation(s)
- Julie Veziant
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, University of Lille, Lille F-59000, France.
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
| | - T Aparicio
- Department of Gastroenterology and Digestive Oncology, AP-HP, Saint-Louis Hospital, Paris, France
| | - M Barret
- Gastroenterology Department, Cochin Hospital, APHP, Paris, France
| | - F El Hajbi
- Department of Oncology, Centre Oscar Lambret, Lille, France
| | - V Lepilliez
- Gastroenterology Department, Jean Mermoz Private Hospital, Ramsay Santé, Lyon, France
| | - P Lesueur
- Department of Radiation Oncology, Centre Guillaume le Conquérant, Le Havre, France
| | - P Maingon
- Department of Radiation Oncology, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - D Pannier
- Department of Oncology, Centre Oscar Lambret, Lille, France
| | - L Quero
- Department of Radiation Oncology, Saint-Louis Hospital, APHP, Paris, France
| | - J L Raoul
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - F Renaud
- Department of Pathology, La Pitié-Salpêtrière, APHP, Sorbonne University, Paris, France
| | - J F Seitz
- Department of Digestive Oncology, La Timone, Aix Marseille Université, Marseille, France
| | - A A Serre
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | | | - M Vermersch
- Medical Imaging Department, Valencienne Hospital Centre, Valencienne 59300, France
| | - T Voron
- Department of General and Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, 184 rue du faubourg Saint-Antoine, Paris 75012, France
| | - D Tougeron
- Department of Gastro-Enterology and Hepatology, Poitiers University Hospital, Poitiers, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez Hospital, CHU Lille, University of Lille, Lille F-59000, France
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Penel N, Bonvalot S, Le Deley MC, Italiano A, Tlemsani C, Pannier D, Leguillette C, Kurtz JE, Toulmonde M, Thery J, Orbach D, Dubray-Longeras P, Verret B, Bertucci F, Guillemet C, Laroche L, Dufresne A, Blay JY, Le Cesne A. Pain in desmoid-type fibromatosis: Prevalence, determinants and prognosis value. Int J Cancer 2023; 153:407-416. [PMID: 36883417 DOI: 10.1002/ijc.34493] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/03/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
The aim of this study is to evaluate the prevalence, determinants and prognostic value of pain at diagnosis in patients with desmoid-type fibromatosis (DF). We selected patients from the ALTITUDES cohort (NCT02867033), managed by surgery, active surveillance or systemic treatments, with pain assessment at diagnosis. Patients were invited to fill QLQ-C30 questionnaire and Hospital Anxiety Depression Scale. Determinants were identified using logistic models. Prognostic value on event-free survival (EFS) was evaluated using the Cox model. Overall, 382 patients were included in the current study (median age: 40.2 years; 117 men). The prevalence of pain was 36%, without significant difference according to first-line treatment (P = .18). In the multivariate analysis, pain was significantly associated with tumor size >50 mm (P = .013) and tumor site (P < .001); pain was more frequent in the neck and shoulder locations (odds ratio: 3.05 [1.27-7.29]). Pain at baseline was significantly associated with poor quality of life (P < .001), depression (P = .02), lower performance status (P = .03) and functional impairment (P = .001); we also observed a nonsignificant association with anxiety (P = .10). In the univariate analysis, baseline pain was associated with poor EFS; the 3-year EFS was 54% in patients with pain compared to 72% in those without pain. After adjustment for sex, age, size and line of treatment, pain was still associated with poor EFS (hazard ratio: 1.82 [1.23-2.68], P = .003). One third of recently diagnosed patients with DF experienced pain, especially those with larger tumors and neck/shoulder locations. Pain was associated with unfavorable EFS after adjustment for the confounders.
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Affiliation(s)
- Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
- University of Lille, CHU Lille, ULR 2694-Metrics: Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, Paris, France
| | - Marie-Cécile Le Deley
- CESP, INSERM, Paris-Saclay University, Paris-Sud University, UVSQ, Villejuif, France
- Clinical Research Department, Centre Oscar Lambret, Lille, France
| | - Antoine Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Camille Tlemsani
- Department of Medical Oncology, APHP Centre Hôpital Cochin, Université Paris Cité, Paris, France
| | - Diane Pannier
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg University Hospital, Strasbourg, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Julien Thery
- Clinical Research Department, Centre Oscar Lambret, Lille, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL Research University, Institut Curie, Paris, France
| | | | - Benjamin Verret
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - François Bertucci
- Medical Oncology Department, Institut Paoli Calmette, Marseille, France
| | - Cécile Guillemet
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Lucie Laroche
- Labelled North-West DataCenter, Centre Henri Becquerel, Rouen, France
| | - Armelle Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Axel Le Cesne
- Medical Oncology Department, Gustave Roussy, Villejuif, France
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Vano YA, Phan L, Simonaggio A, Bennamoun M, Pannier D, Chevreau C, Borchiellini D, Maillet D, Gross-Goupil M, Laguerre B, Tournigand C, Barthelemy P, Coquan E, Gravis G, Sun CM, Meylan M, Fridman WH, Sautès-Fridman C, Elaidi R, Oudard S. Overall survival (OS) and efficacy results of second-line treatment in patients (pts) with metastatic clear cell renal cell carcinoma (mRCC) treated in the randomized phase II BIONIKK trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.607] [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: 03/18/2023] Open
Abstract
607 Background: To date, no biomarker of efficacy of nivolumab+/-ipilimumab (N+/-I) or anti-VEGFR TKI has been prospectively validated in mRCC. The BIONIKK trial showed promising objective response rate (ORR) and progression-free survival (PFS) with these treatments in first line (L1) after selection by tumour molecular group. We report OS and efficacy results of the second-line (L2) treatment. Methods: BIONIKK is a French multicentre non-comparative phase II trial, randomising 199 mRCC pts to receive N (58), NI (101) or TKI (40) in L1 according to four molecular groups (ccrcc1-4). ORR and PFS were already reported. With an additional follow-up of ≥20 months, we report OS from randomization and from the start of L2, as well as ORR and PFS with a TKI in L2 by molecular group. Results: With a median follow-up of 42.1 months (40.5-45.2), 86 (43%) patients died: 27/58 (46.5%), 39/101 (39%) and 20/40 (50%) in the N, NI, and TKI arm, respectively. Median OS were 43.4 months (95%CI=31.4-NR) with N, 52.7 months (95%CI=46-NR) with NI and 38.1 months (95%CI=33.2-NR) with TKI (table). 175 (88%) patients discontinued first-line treatment, including 20 deaths, and 129 (74%) received a L2, 38/58 (65.5%), 64/101 (63%), and 27/40 (67.5%) after N, NI and TKI, respectively. The most frequent L2 received after N+/-I was a TKI in 96/102 (94%) pts, including cabozantinib in 49, sunitinib/pazopanib in 32, axitinib in 13, and lenvatinib in 2. N was the most frequent L2 after TKI, 20/27 (74%). ORR with TKI in L2 was 28.5% (10/35) after N, 39% (24/61) after NI and 80% (4/5) after TKI, with marked benefit in ccrcc2 pts (table). The mPFS with TKI in L2 was 8.2 (95%CI=6.9-19.3) after N, 11.4 (95%CI= 8.9-16.8) after NI, and 12.1 (95%CI =11.4-NR) months after TKI, with a higher benefit in ccrcc2 pts (vs. ccrcc1+4, p=0.04). Conversely, ORR and mPFS with N after TKI in ccrcc2-pts were 12.5% (2/16) and 5.4 (2.6-NR) months, respectively. Median OS L2 was reported in the table. The updated ORR and PFS in L1 will presented at the Meeting, as well as PFS2 and efficacy by TKI type in L2. Conclusions: We report for the first-time OS and L2 efficacy results by molecular group in a randomized trial. Molecular selection also has an impact on treatment efficacy in L2. These results, together with those reported in L1, can inform clinicians on the best treatment sequence in L1-2. Clinical trial information: NCT02960906 . [Table: see text]
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Affiliation(s)
- Yann-Alexandre Vano
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
| | - Letuan Phan
- ARTIC - Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hôpital Européen Georges Pompidou, AP-HP. Centre – Université Paris Cité, Paris, France
| | - Audrey Simonaggio
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
| | - Mostefa Bennamoun
- Department of Oncology, Institut Mutualiste Montsouris, Paris, France
| | - Diane Pannier
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Denis Maillet
- Department of Medical Oncology, IMMUCARE, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices de Lyon (IC-HCL); Faculté de médecine de Saint Etienne, Pierre-Bénite, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Centre Hospitalier Universitaire de Bordeaux - Hôpital Saint-André, Bordeaux, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugène - Marquis, Rennes, France
| | - Christophe Tournigand
- Department of Medical Oncology, Hôpital Henri-Mondor, AP-HP - Université de Paris Est, Créteil, France
| | - Philippe Barthelemy
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Elodie Coquan
- Department of Medical Oncology, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Universite, CRCM, Marseille, France
| | - Cheng-Ming Sun
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Maxime Meylan
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Wolf-Hervé Fridman
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Catherine Sautès-Fridman
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Réza Elaidi
- ARTIC - Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hôpital Européen Georges Pompidou, AP-HP. Centre – Université Paris Cité, Paris, France
| | - Stephane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
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Adenis A, Piessen G, Le Sourd S, Bogart E, Paumier A, Vendrely V, Glehen O, Dahan L, Simmet V, Bergeat D, Samalin E, Chauvenet M, d'Journo XB, Hiret S, Gronnier C, Baty M, Pannier D, Veziant J, Le Deley MC, Mirabel X. Trimodality therapy with carboplatin/paclitaxel (CP) or FOLFOX (FFX) for esophageal/esogastric junctional cancer (EC/EGJ): Expanded safety and efficacy data from PROTECT. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.370] [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: 01/25/2023] Open
Abstract
370 Background: When combined to preoperative radiation therapy (RT), CP and FFX regimen provide both high complete resection (R0) rate for EC/EGJ cancer (Adenis, ASCO 2022). However, it appeared that neoadjuvant chemoradiation (nCRT) with CP is associated with a severe postoperative morbidity rate higher than expected. We present here the expanded safety and efficacy analyses from the PROTECT trial. Methods: PROTECT is a randomized, phase 2 trial which included stage II/III and ECOG PS ≤2 EC or Siewert I-II EGJ cancers. Patients (pts) received FFX or CP with concurrent RT (41.4Gy, 1.8Gy, 23 fractions), followed by surgery 4-8 weeks after completion of nCRT (Messager, BMC Cancer 2016). Co-primary endpoints were proportion of R0 rate and proportion of Clavien-Dindo severe postoperative morbidity. Main secondary endpoints were nCRT and postoperative safety (NCI CTCAE v.4), DFS and OS. Results: 41/50 (82%) and 39/50 (78 %) pts received the planned chemo cycles and concurrent RT in FFX and CP arms, respectively. Grade (gr.) 3–4 AEs related to nCRT (FFX 14/50, 28%; CP 14/50, 28%) occurring in ≥5% of pts included lymphopenia (n=3, 6%; n=4, 8%), neutropenia (n=1, 2%; n=3, 6%), fatigue (n=2, 4%; n=0) and esophagitis-related to RT (n=1, 2%; n=1, 2%). No death was reported during nCRT. Surgery (FFX and CP; mini invasive: 15 and 15, hybrid: 22 and 21, open: 7 and 12) was performed in 44 and 48 pts, in FFX and CP groups, respectively. The main gr. III-V surgical complications (Clavien-Dindo scale) occurring in ≥5% of pts included esophageal fistula (n=2/43 evaluable pts, 6%; 8/48, 17%), conduit necrosis (n=2, 5%; n=1, 2%), ARDS (n=3, 7%; n=3, 6%), pleural effusion (n=3, 7%; n=4, 8%), and haemorrhage (n=0; n=3, 6%). There were no postoperative deaths. With a median follow-up of 54m, median DFS were 12.3m and 20m (HR=0.84; 95%CI: 0.52-1.35; p=0.48) and median OS were 31.7m and 45.8m (HR=0.79; 95%CI: 0.47-1.32; p=0.36) in FFX and CP arms, respectively. Prognostic factors significantly associated to DFS in univariate analysis were: R0 resection, TRG1-2 and ypT0N0 status. Conclusions: A higher than expected number of severe esophageal fistula was observed in the CP arm. We could not demonstrate a significant benefit of CP compared to FFX in terms of survival outcomes, but the study was not primarily designed to specifically address this issue. Clinical trial information: NCT02359968 .
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Affiliation(s)
- Antoine Adenis
- Institut du Cancer de Montpellier and IRCM, Université de Montpellier, Montpellier, France
| | | | | | | | - Amaury Paumier
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | | | | | | | - Emmanuelle Samalin
- Institut du Cancer de Montpellier and IRCM, Université de Montpellier, Montpellier, France
| | | | | | - Sandrine Hiret
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | - Diane Pannier
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
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Meylan M, Sun CM, Elaidi RT, Moreira M, Bougouin A, Verkarre V, Bennamoun M, Chevreau C, Borchiellini D, Barthelemy P, Pannier D, Maillet D, Gross Goupil M, Tournigand C, Braychenko E, Phan L, Oudard S, Fridman WH, Sautes-Fridman C, Vano YA. 1451MO In-situ immune markers predict nivolumab (N) +/-ipilimumab (I) efficacy in frontline metastatic clear cell renal cell carcinoma (mccRCC): Key ancillary analyses from the BIONIKK randomized trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1554] [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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Rousseau B, Bieche I, Pasmant E, Hamzaoui N, Leulliot N, Michon L, de Reynies A, Foote M, Masliah-Planchon J, Svrcek M, Cohen R, Simmet V, Augereau P, Malka D, Hollebecque A, Pouessel D, Gomez-Roca C, Guimbaud R, Bruyas A, Guillet M, Duluc M, Cousin S, de la Fourchardiere C, Rolland F, Hiret S, Saada-Bouzid E, Bouche O, Andre T, Pannier D, Hajbi FE, Oudard S, Tournigand C, Soria JC, Gerber D, Stephens D, Lamandola-Essel M, Maron SB, Diplas B, Argiles G, Krishnan A, Segal N, Cercek A, Hoog-Labouret N, Legrand F, Simon C, Lamrani-Ghaouti A, Diaz LA, Saintigny P, Chevret S, Marabelle A. Abstract CT021: PD-1 blockade in solid tumors with defects in polymerase epsilon. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct021] [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
Context: Polymerase epsilon (POLE) gene missense hotspot mutations can generate pathogenic (p) proofreading defects resulting in hypermutated genomic profiles.
Aim: Determine the prevalence, genomic consequences and immunotherapy sensitivity of advanced POLE mutated tumors according to mutation site, primary tumor and tumor mutational burden (TMB).
Results: Pan-Cancer TCGA & MSKCC databases genomic analyses found a prevalence of non-pathogenic POLE mutations (POLEnp) of 3.4% with median TMB of 11 mutations/Megabase (mt/Mb, IQR 3-34). Pathogenic POLE mutations (POLEp) prevalence was 0.4% with median TMB of 215 mt/Mb (IQR 107-324), predominantly in colorectal and endometrial cancers. Prevalence dropped to 0.1% in metastatic cancers. We assessed prospectively the efficacy of PD-1 blockade in mismatch repair proficient advanced solid tumors harboring POLE missense mutations (phase II ASCe Nivolumab trial; NCT03012581). Variants were categorized prospectively by a molecular board as POLEp, POLEnp or Variants with Unknown significance (VUS). The primary endpoint was the Overall Response Rate (ORR) at 12 weeks according to RECIST 1.1, and secondary endpoints included survival analyses according to POLE variants pathogenicity. Among 61 screened patients, 21 were eligible and 20 received Nivolumab and 19 were assessable for response (table 1). The 12-week ORR was 37% for patients harboring POLEp and VUS and resulted in major survival improvement compared to POLEnp patients (HR=0.1 ; CI95% 0.02-0.7); see results in Table 1. Among patients POLEp tumors, while higher TMB was not predictive of response, higher proportion of POLE-related mutational signature correlated with improved benefit. In silico exonucleasic POLE domain analyses confirmed that all POLEp and 2 VUS clustered in the DNA binding or the Catalytic site. Recategorizing the VUS according to the location within the exonucleasic domain improved the prediction of survival outcomes.
Impact: This study gives new insights on how DNA repair defects, mutational burden and signatures sensitize to PD-1 blockade and may offer emerging tumor agnostic biomarkers for benefit to checkpoint blockade.
POLE variant pathogenicity All(N=21) POLEnp(N=5) VUS(N=4) POLEp(N=12) Age, years ± SD 57 ± 16 64 ± 10 56 ± 16 54 ± 17 Sex, Male (%) 12 (57) 5 (100) 2 (50) 5 (42) PS (ECOG)=1 (%) 16 (75) 4 (80) 2 (50) 10 (83) Primary tumor Colorectal 9 (43) 2 (40) 2 (50) 5 (42) Endometrial 6 (29) 0 (0) 0 (0) 6 (50) Gastric 2 (9) 2 (40) 0 (0) 0 (0) Glial 1 (5) 0 (0) 0 (0) 1 (8) Biliary tract 1 (5) 0 (0) 1 (25) 0 (0) Pancreas 2 (9) 1 (20) 1 (25) 0 (0) Number of previous treatments 2.4 ± 2 5 ± 2 1.8 ± 1 1.5 ± 1 TMB (mt/Mb, Min-Max)(N=16) 36.2 (2-385) 5 (4-9) 3 (2-4) 114 (25-385) ORR at 12 weeks (CR+PR) 37%(N=7/19) 0%(N=0/5) 50%(N=2/4) 46%(5/10) DCR at 12 weeks (CR+PR+SD) 58%(N=11/19) 0%(N=0/5) 75%(N=3/4) 80%(8/10) Median Progresssion-Free survival (months) 5.6 2.3 10.3vs POLEnp: HR=0.2 IC95% 0.1-0.7 Median Overall Survival (months) 9.1 5.0 Not Reachedvs POLEnp:HR=0.1 IC95% 0.02-0.7
Citation Format: Benoît Rousseau, Ivan Bieche, Eric Pasmant, Nadim Hamzaoui, Nicolas Leulliot, Lucas Michon, Aurelien de Reynies, Mike Foote, Julien Masliah-Planchon, Magali Svrcek, Romain Cohen, Victor Simmet, Paule Augereau, David Malka, Antoine Hollebecque, Damien Pouessel, Carlos Gomez-Roca, Rosine Guimbaud, Amandine Bruyas, Marielle Guillet, Muriel Duluc, Sophie Cousin, Christelle de la Fourchardiere, Frederic Rolland, Sandrine Hiret, Esma Saada-Bouzid, Olivier Bouche, Thierry Andre, Diane Pannier, Farid El Hajbi, Stephane Oudard, Christophe Tournigand, Jean-Charles Soria, Drew Gerber, Dennis Stephens, Michelle Lamandola-Essel, Steven B Maron, Bill Diplas, Guillem Argiles, Asha Krishnan, Neil Segal, Andrea Cercek, Nathalie Hoog-Labouret, Frederic Legrand, Clotide Simon, Assia Lamrani-Ghaouti, Luis A. Diaz, Pierre Saintigny, Sylvie Chevret, Aurelien Marabelle. PD-1 blockade in solid tumors with defects in polymerase epsilon [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT021.
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Affiliation(s)
| | | | - Eric Pasmant
- 3Service de Génétique et Biologie Moléculaires, Hôpital Cochin, Paris, France
| | - Nadim Hamzaoui
- 3Service de Génétique et Biologie Moléculaires, Hôpital Cochin, Paris, France
| | - Nicolas Leulliot
- 4Cibles Thérapeutiques et Conception de Médicaments, CNRS UMR8015, Université de Paris, UFR de Pharmacie de Paris, Paris, France
| | - Lucas Michon
- 5Department of Translational Medicine, Centre Léon Bérard, Lyon, France
| | | | - Mike Foote
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Victor Simmet
- 7Institut de Cancérologie de l'Ouest, Angers, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sandrine Hiret
- 14Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | | | | | | | | | | | | | - Drew Gerber
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Bill Diplas
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Asha Krishnan
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil Segal
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Luis A. Diaz
- 1Memorial Sloan Kettering Cancer Center, New York, NY
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8
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Rousseau B, Bieche I, Pasmant E, Hamzaoui N, Leulliot N, Michon L, de Reynies A, Attignon V, Foote MB, Masliah-Planchon J, Svrcek M, Cohen R, Simmet V, Augereau P, Malka D, Hollebecque A, Pouessel D, Gomez-Roca C, Guimbaud R, Bruyas A, Guillet M, Grob JJ, Duluc M, Cousin S, de la Fouchardiere C, Flechon A, Rolland F, Hiret S, Saada-Bouzid E, Bouche O, Andre T, Pannier D, El Hajbi F, Oudard S, Tournigand C, Soria JC, Champiat S, Gerber DG, Stephens D, Lamendola-Essel MF, Maron SB, Diplas BH, Argiles G, Krishnan AR, Tabone-Eglinger S, Ferrari A, Segal NH, Cercek A, Hoog-Labouret N, Legrand F, Simon C, Lamrani-Ghaouti A, Diaz LA, Saintigny P, Chevret S, Marabelle A. PD-1 Blockade in Solid Tumors with Defects in Polymerase Epsilon. Cancer Discov 2022; 12:1435-1448. [PMID: 35398880 PMCID: PMC9167784 DOI: 10.1158/2159-8290.cd-21-0521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/26/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
Abstract
Missense mutations in the polymerase epsilon (POLE) gene have been reported to generate proofreading defects resulting in an ultramutated genome and to sensitize tumors to checkpoint blockade immunotherapy. However, many POLE-mutated tumors do not respond to such treatment. To better understand the link between POLE mutation variants and response to immunotherapy, we prospectively assessed the efficacy of nivolumab in a multicenter clinical trial in patients bearing advanced mismatch repair-proficient POLE-mutated solid tumors. We found that only tumors harboring selective POLE pathogenic mutations in the DNA binding or catalytic site of the exonuclease domain presented high mutational burden with a specific single-base substitution signature, high T-cell infiltrates, and a high response rate to anti-PD-1 monotherapy. This study illustrates how specific DNA repair defects sensitize to immunotherapy. POLE proofreading deficiency represents a novel agnostic biomarker for response to PD-1 checkpoint blockade therapy. SIGNIFICANCE POLE proofreading deficiency leads to high tumor mutational burden with high tumor-infiltrating lymphocytes and predicts anti-PD-1 efficacy in mismatch repair-proficient tumors. Conversely, tumors harboring POLE mutations not affecting proofreading derived no benefit from PD-1 blockade. POLE proofreading deficiency is a new tissue-agnostic biomarker for cancer immunotherapy. This article is highlighted in the In This Issue feature, p. 1397.
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Affiliation(s)
- Benoit Rousseau
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ivan Bieche
- Department of Genetics, Institut Curie, Paris, France
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université de Paris, CARPEM, Paris, France
| | - Eric Pasmant
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université de Paris, CARPEM, Paris, France
- Fédération de Génétique et Médecine Génomique, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
| | - Nadim Hamzaoui
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université de Paris, CARPEM, Paris, France
- Fédération de Génétique et Médecine Génomique, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
| | - Nicolas Leulliot
- Cibles Thérapeutiques et Conception de Médicaments, CNRS UMR8015, Université de Paris, UFR de Pharmacie de Paris, Paris, France
| | - Lucas Michon
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Aurelien de Reynies
- Université de Paris, Centre de Recherche des Cordeliers, UMRS1138, AP-HP, SeqOIA-IT, Paris, France
| | | | - Michael B. Foote
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Magali Svrcek
- Pathology department, Saint Antoine Hospital
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, F-75012 Paris, France
| | - Romain Cohen
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, F-75012 Paris, France
- Medical Oncology Department, Hôpital Saint-Antoine, Paris, France
| | - Victor Simmet
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest (ICO), Angers, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest (ICO), Angers, France
| | - David Malka
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antoine Hollebecque
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Damien Pouessel
- Department of Medical Oncology, Institut Claudius Regaud / IUCT Oncopole, Toulouse, France
| | - Carlos Gomez-Roca
- Department of Medical Oncology, Institut Claudius Regaud / IUCT Oncopole, Toulouse, France
| | | | - Amandine Bruyas
- Department of Medical Oncology, Hôpital de la Croix-Rousse, Lyon, France
| | - Marielle Guillet
- Department of Gastroenterology and Digestive Oncology, Hôpital de la Croix-Rousse, Lyon, France
| | | | - Muriel Duluc
- Dermatology and Oncology, Hôpital de la Timone, Marseille, France
| | | | | | - Aude Flechon
- Department of medical Oncology, Centre Leon Berard, Lyon, France
| | - Frederic Rolland
- Department of Medical Oncology, ICO Institut de Cancerologie de l’Ouest René Gauducheau, Saint-Herblain, France
| | - Sandrine Hiret
- Department of Medical Oncology, ICO Institut de Cancerologie de l’Ouest René Gauducheau, Saint-Herblain, France
| | - Esma Saada-Bouzid
- Medical Oncology, Centre Anticancer Antoine Lacassagne, Nice, France
| | - Olivier Bouche
- Gastroenterology and Digestive Oncology, CHU de Reims - Hôpital Robert Debré, Reims, France
| | - Thierry Andre
- Medical Oncology Department, Hôpital Saint-Antoine, Paris, France
| | | | | | - Stephane Oudard
- Oncology, Hopital Europeen Georges Pompidou, AP-HP, Paris, France
| | | | - Jean-Charles Soria
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Stephane Champiat
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Drew G. Gerber
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dennis Stephens
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Steven B. Maron
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bill H. Diplas
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guillem Argiles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Asha R. Krishnan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Anthony Ferrari
- Platform of Bioinformatics Gilles Thomas-Synergie Lyon Cancer, Centre Léon Bérard, Lyon
| | - Neil H. Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Frederic Legrand
- Research and Innovation, Institut National du Cancer, Boulogne-Billancourt, France
| | | | | | - Luis A. Diaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pierre Saintigny
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Department of medical Oncology, Centre Leon Berard, Lyon, France
| | | | - Aurelien Marabelle
- Département d’Innovation Thérapeutique et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
- U1015 & CIC1428, Institut national de la santé et de la recherche médicale (INSERM), Villejuif, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicetre, France
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9
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Tredan O, Pouessel D, Penel N, Chabaud S, Gomez-Roca CA, Pannier D, Brahmi M, Fabbro M, Garcia ME, Larrieu-Ciron D, Ray-Coquard IL, Viala M, Italiano A, Cassier PA, Dufresne A, Attignon V, Treilleux I, Viari A, Pérol D, Blay JY. Increasing targeted therapy options for patients with relapsed cancer with broader somatic gene panel analysis from the primary tumor: The Profiler02 randomized phase II trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3130] [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
3130 Background: PROFILER-02 is a multicenter randomized prospective study comparing the proportion of metastatic cancer patients (pts) with Targeted Agent (TA) recommendation provided by large NGS panel (FOne panel, 324 genes) vs home 87-gene NGS panel (CTRL) (PMID 30865223). Methods: Adult pts with advanced/metastatic cancer during 1st or 2nd line of therapy without known targetable gene alteration were eligible and randomized (1:1) to FOne vs CTRL panel. Both panels were performed for each patient. The randomization arm defined the first panel reviewed by dedicated Molecular Tumor Board (MTB) at disease progression while the 2nd panel remained blinded. The primary objective was the pts rate with at least one TA recommendation by the MTB using either FOne or CTRL panel. The study was designed in order to detect difference in proportions of 10% between the two panels. A sample size of 289 pts with both panels were requested to show this difference with an expected proportion of discordant pairs of 20% using a McNemar's test with 98% power and 5% two-sided significance level. Secondary endpoints included number of pts receiving at least one TA, progression free survival (PFS) and overall survival (OS). Results: From June 2017 to June 2019, among the 339 included pts 171 and 168 pts were randomized in FOne or CTRL panels’ first use, respectively. Median age was 57 years [19.0 - 85.0]; 54.9% were female. The median time from randomization to first MTB was 7.62 months [range 0.80 - 48.1]. Among the 339 pts, 147 pts (43.4%) had no TA recommendation, 108 pts (31.9%) had at least one TA recommendation according to both panels, 67 pts (19.8%) had one or more TA recommendation according to FOne panel only and 17 pts (5%) according to CTRL panel only (McNemar p < 0.001). At the time of the analysis, 51/339 (15%) pts started recommended treatment: 27 pts (8%) with TA recommendation from both panels, 21 pts (6.2%) from FOne only and 3 pts (0.3%) from CTRL only. Main initiated TA were PARP inh. (FOne n = 12; CTRL n = 9), PI3K/AKT/mTOR inh. (FOne n = 10; CTRL n = 9) and immunotherapy (ICI) (FOne n = 7; CTRL n = 0). Median PFS following first MTB were 3.2 months (95% CI 2.5-3.8) and 2.6 months (95% CI 2.0-3.8), median OS were 8.7 months (95% CI 6.6-10.8) and 8.4 months (95% CI 6.4-9.7), in the FOne and CTRL arm, respectively. Conclusions: Larger NGS panel including Tumor Mutational Burden increased the number of recommended options (TA and ICI), as well as the number of treatment initiation. Clinical trial information: NCT03163732.
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Affiliation(s)
- Olivier Tredan
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - Damien Pouessel
- Department of Medical Oncology & Clinical Research Unit, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse (IUCT-Oncopôle), Toulouse, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | - Sylvie Chabaud
- Department of Clinical Research, Centre Léon Bérard, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | - Armelle Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Valéry Attignon
- Platform of Cancer Genomics, Centre Léon Bérard, Lyon, France
| | | | - Alain Viari
- Platform of Bioinformatics Gilles-Thomas, Centre Léon Bérard, Lyon, France
| | - David Pérol
- Department of Clinical Research, Centre Léon Bérard, Lyon, France
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10
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Ducreux M, Parzy A, Ben Abdelghani M, Martin-Babau J, Tougeron D, Botsen D, Taieb J, Pannier D, Khemissa F, Viaud J, Villing A, Bouche O, Peytier A, Alexandre H, Garic F, Tanguy ML, Bachet JB. 508TiP PRODIGE 68 - UCGI 38 - SOREGATT: A randomized phase II study comparing the sequences of regorafenib (reg) and trifluridine/tipiracil (t/t) after failure of standard therapies in patients (pts) with metastatic colorectal cancer (mCRC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1027] [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: 11/30/2022] Open
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11
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Hammoudi A, Marliot G, Cucchi M, Mahi N, Pannier D, Leblanc E, Mirabel X, Ceugnart L, Robin YM, Lartigau E, Penel N. Impact of the COVID-19 pandemic on clinical activity during the lockdown in North France: A single center experience. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e13594] [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
e13594 Background: During the French COVID-19 pandemic, clinical activity for cancer care has declined and modified the management of patients in cancer institute. France has imposed two national lockdowns of the population (from March 17 to May 11 and from October 30 to December 15 2020). We evaluate the impact of the lockdown period in North France on clinical activity. Methods: We measured and compared key-indicators of clinical activity between different periods: 2019 versus 2020; before and during the first and second lockdown. Results are given as percentage of changes with 95% confidence interval (CI). Results: The comparative analysis between 2019 and 2020 showed that most clinical activities except hospitalizations (-0.0% [-0.2; +0.1%] has changed. There was a significant increase in overall treated patients (+0.4% [+0.3; +0.5], telemedicine +99.9% [+99.4; +99.7], MRI (+8.8% [+8.2; +9.5], ambulatory chemotherapy (+3.5% [+3.3; +3.8]), number of chemotherapies prepared (+2.0 [+.1.9; +2.2]) and admission in palliative care unit (+15.3%, [+10.8; +19.8]). On the contrary, a significant decrease in treated patients aged > 65 years old (-6.4% [-6.9; -5.9]), incidence rate (-3.1% [-3.6; -2.7]), multidisciplinary team meeting on patient assessment (-3.1% [-3.5;-2.5]), pathology reports (-2.9% (-3.3;-2.6]), radiotherapy (-4.6% [-4.7;-4.4]) and surgery (-6.7% [-7.4;-5.6]) were observed. In 2020, before and during the first lockdown all key-indicators declined except telemedicine (+40,400%) and admission in palliative care unit (+35.5% [+31.0-+49.7]). During the first lockdown, key-indicators decreased from -63.0% [-70.3-59.2] for outpatient visits to -5.1% [-7.0-3.8] for chemotherapy. The impact caused by the second lockdown was non-significant compared to the first one since all key-indicators has increased during the second lockdown: from +23.8% [+22.2; +25.5] for radiotherapy to +76.6% [+72.5; +79.5] for the management of new cases. Conclusions: Dramatic changes occurred in 2020 during the COVID-19-related lockdown compared to 2019. An Increase in chemotherapy treatment and admission on palliative care unit and a decrease in surgery and radiotherapy strongly suggests that the clinical activity was changed in 2020 compared to 2019. This was in line with the reduction of cancer screening in 2020. The impact of the first lockdown on clinical activities was higher compared to the second one. These observations should be investigated further in order to better understand the effects of a pandemic-related lockdown on cancer care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Eric Lartigau
- Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
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12
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Aelbrecht-Meurisse C, Ryckewaert T, Pannier D, Gamblin V, Garcia V, Aelbrecht S, Penel N. [Withholding or withdrawing life-sustaining treatments in acute oncology situations: History and regulatory aspects in France]. Bull Cancer 2021; 108:415-423. [PMID: 33678409 DOI: 10.1016/j.bulcan.2020.11.020] [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: 07/02/2020] [Revised: 10/28/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
The management of oncology patients, especially hospitalized patients, can lead to almost daily discussions regarding therapeutic limitations. Here, we review the history and propose a summary of the texts framing the notion of "withholding and withdrawing life-sustaining treatment" in oncology practice in France. This decision is regulated by the Claeys-Léonetti Law of February 2, 2016 recommending a collegial discussion and its documentation in the medical record. The decision to withhold or withdraw life-sustaining treatments is the subject of discussion between the patient, his physicians and his family and may take place at any time during his management. The work of intensive-care physicians provides many useful recommendations for acute oncology situations, however articles specific for oncology practice are scarce; this is a topic that oncologists must take up.
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Affiliation(s)
| | - Thomas Ryckewaert
- Centre Oscar Lambret, département d'oncologie médicale, 3, rue Frédéric Combemale, 59000 Lille, France
| | - Diane Pannier
- Centre Oscar Lambret, département d'oncologie médicale, 3, rue Frédéric Combemale, 59000 Lille, France
| | - Vincent Gamblin
- Centre Oscar Lambret, département de soins palliatifs, 3, rue Frédéric Combemale, 59000 Lille, France
| | - Vincent Garcia
- Centre Oscar Lambret, département d'anesthésie-réanimation, 3, rue Frédéric Combemale, 59000 Lille, France
| | - Stéphane Aelbrecht
- EHPAD Les Myosotis, 160, rue Augustin Tirmont, 59283 Raimbeaucourt, France
| | - Nicolas Penel
- Centre Oscar Lambret, département d'oncologie médicale, 3, rue Frédéric Combemale, 59000 Lille, France
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Gehenne L, Christophe V, Eveno C, Carnot A, Turpin A, Pannier D, Piessen G, Lelorain S. Creating scripted video-vignettes in an experimental study on two empathic processes in oncology: Reflections on our experience. Patient Educ Couns 2021; 104:654-662. [PMID: 32938562 DOI: 10.1016/j.pec.2020.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 08/10/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aims were to: (1) apply the guidelines to develop and test the validity of video-vignettes manipulating empathy and context in oncology; (2) compare lay people's and patients' assessments of validity; (3) reflecting on our experiment METHODS: Guidelines were followed: (1) deciding whether video-vignettes were appropriate; (2) developing a valid script; (3) designing valid manipulations; (4) converting the scripted consultations into videos. One hundred sixteen lay people and 46 cancer patients filled in the Video Engagement Scale, the CARE, and ad hoc questionnaires on realism and emotions. RESULTS The video-vignettes are valid for experimental use. Differences appeared in the emotions participants reported. The empathic processes were successfully manipulated and perceived. Lay people's and patients' assessments were equivalent, except for video-vignettes in neutral consultations. Participants' comments on nonverbal behavior, camera perspective, scripts and empathy assessment were reported. CONCLUSION Patients' assessments are impacted by their personal experiences. Researchers should control for this in analogue patient studies. PRACTICE IMPLICATIONS Based on this experience, we reflect on: (1) adopting congruent nonverbal behavior throughout the video-vignettes; (2) alternating camera perspectives; (3) avoiding the sole use of written scripts; (4) using quantitative and qualitative analysis to validate scripts and video-vignettes.
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Affiliation(s)
- Lucie Gehenne
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.
| | - Véronique Christophe
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France; Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France
| | - Aurélien Carnot
- Department of General Oncology, Centre Oscar Lambret, Lille, France
| | - Anthony Turpin
- Department of Medical Oncology, University of Lille, Claude Huriez University Hospital, Lille, France; University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Diane Pannier
- Department of General Oncology, Centre Oscar Lambret, Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France; Jean-Pierre Aubert Research Center, Neurosciences and Cancer, University of Lille, IMR-S 1172-JPArc, Lille, France
| | - Sophie Lelorain
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.
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14
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Penel N, Ryckewaert T, Pannier D. Deleterious effect of ifosfamide in leiomyosarcoma: Convergence of weak signals. Cancer 2020; 126:4614-4615. [DOI: 10.1002/cncr.33111] [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: 05/26/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Nicolas Penel
- Medical Oncology Department Oscar Lambret Center Lille France
- Lille University School of Medicine Lille France
| | | | - Diane Pannier
- Medical Oncology Department Oscar Lambret Center Lille France
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15
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Vano Y, Elaidi R, Bennamoun M, Chevreau C, Borchiellini D, Pannier D, Maillet D, Gross-Goupil M, Tournigand C, Laguerre B, Barthélémy P, Joly F, Gravis G, Caruso S, Sun CM, Verkarre V, Fridman WH, Zucman-Rossi J, Sautès-Fridman C, Oudard S. LBA25 Results from the phase II biomarker driven trial with nivolumab (N) and ipilimumab or VEGFR tyrosine kinase inhibitor (TKI) in naïve metastatic kidney cancer (m-ccRCC) patients (pts): The BIONIKK trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2254] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Broyelle A, Bimbai AM, Carnot A, Pannier D, Makhloufi S, Ryckewaert T, Penel N, Oudard S. Docetaxel (DOC) versus new androgen receptor-targeted agent (ART) in metastatic castrate-resistant prostate cancer (mCRPC) patients (pts) having received abiraterone (ABI) or enzalutamide (ENZA) as first-line (L1). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.109] [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
109 Background: The main treatments for mCRPC are 2 new ART (ABI, ENZA) and 2 taxanes [doctaxel (DOC) and Cabazitaxel]. The optimal sequence is currently not defined. An increasing number of pts are first treated with one of ART. In this population, data about efficacy of 2nd line (L2) are spare. We designed a retrospective study to evaluate activity of DOC vs ART in mCRPC pts treated with ART as L1 therapy. Methods: In this observational cohort study, we included all consecutive pts with ENZA or ABI as L1 for chemo-naïve mCRPC. We measured PFS and OS during both L1 & L2. To compare the efficacy of DOC versus ART as L2, we measured Growth Modulation Index (GMI=Time To progression with L2/TTP with L1) and we used Cox model to compare PFS/OS in both arm, in both univariate & multivariate analysis using propensity score. Results: We included 175 pts, including 75 treated ENZA and 100 with ABI as L1. 69 (39%) pts received DOC and 30 (17%) pts received ART as L2; 76 (43%) did not receive L2. Median follow-up was 36 months (CI95%: 30.4 - 40). From the starting of L1, PFS was 13.0 months (CI95% 11.0 – 15.0), OS was 34.5 months (CI95%: 28.7 – 38.6). There was no difference between ENZA and ABI in PFS and OS (p=0.684). From the start of L2, the median PFS was 6.0 months (CI95%: 5.0 – 6.6) and the median OS was 18.0 months (CI95%: 13.9 – 21.4). We found a significant benefit in PFS for DOC vs ART in L2 (6.7 months vs 4.0 months, HR 0.60 [CI95%: 0.31 – 0.96], p=0.03). This benefit did not reach the level of significance in OS (19.5 months vs 12.0 months, HR 0.60 [CI95%: 0.35 – 1.03], p=0.1). ECOG-PS and time of castration resistance were associated with OS in multivariable analysis and then used in propensity score. After adjustment to both parameters, we found no difference in PFS (p=0.2) and OS (p=0.1) in pts receiving DOC vs ART as L2. Only 56% of pts received L2. Probability for GMI being >1.33 was not significantly different between DOC (19%) and ART (13%), p=0.099. Conclusions: ABI and ENZA are similarly active in L1 mCRPC. In univariate analysis, L2 with DOC seemed more active than ART. However this benefit was not retained after adjustment to propensity score.
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Affiliation(s)
| | | | | | | | | | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
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Strobbe G, Pannier D, Sakji I, Villain A, Feutry F, Marliot G. Advantages of everolimus therapeutic drug monitoring in oncology when drug-drug interaction is suspected: A case report. J Oncol Pharm Pract 2020; 26:1743-1749. [PMID: 32070198 DOI: 10.1177/1078155220904761] [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] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Drug interactions involving everolimus are fairly well known because of its common use, primarily as an immunosuppressant. Several recommendations regarding therapeutic drug monitoring are also available for the use of everolimus-based immunosuppression regimens. However, everolimus use in oncology differs substantially, particularly because of the high doses involved. Therapeutic drug monitoring, although sometimes necessary, is not recommended as a routine in oncology. Thus, it was deemed inapplicable due to the lack of clear recommendations. CASE REPORT Here, we present a case where a patient was prescribed everolimus for renal cell carcinoma. The patient benefitted from a pharmaceutical consultation prior to treatment initiation, and a drug interaction with verapamil was suspected.Management and outcome: Therapeutic drug monitoring of everolimus was proposed. Based on the everolimus values reported in the literature, trough plasma concentration in the patient was greatly increased. The patient was then diagnosed with grade 4 oral mucositis, thereby requiring temporary suspension of everolimus treatment. Management of adverse effects was performed through multiple medicated mouthwashes. DISCUSSION Therapeutic drug monitoring for everolimus is important for potential drug interactions or the occurrence of severe adverse events. In such cases, dose adjustments should be managed according to everolimus plasma concentrations. Clear oncological recommendations regarding plasma everolimus thresholds are required for a successful follow-up of the patient's condition and to ensure adequate response to treatment.
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Affiliation(s)
| | - Diane Pannier
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Ilyes Sakji
- Service of Pharmacy, Centre Oscar Lambret, Lille, France
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Albiges L, Pouessel D, Beylot-Barry M, Bens G, Pannier D, Gavoille C, Oudard S, Chevret S, Hoog Labouret N, Legrand F, Simon C, Lamrani-Ghaouti A, Escudier B, Marabelle A, Flechon A. Nivolumab in metastatic nonclear cell renal cell carcinoma: First results of the AcSe prospective study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
699 Background: AcSe Nivolumab (N), is a non-randomised, open-label, multicentric study to investigate the efficacy and safety of nivolumab monotherapy in patients (pts) with specific rare cancers (NCT03012581). We report on the non-clear cell renal cell carcinoma (RCC) cohort. Methods: Primary endpoint was objective response rate (ORR) at 12 weeks according to RECIST1.1. All pts receives N at 240mg IV every 2 weeks. Secondary endpoints included progression free survival (PFS), overall survival (OS), best response, and safety. Results: Between 07/2017 and 02/2019, 50 pts have been enrolled across 13 institutions. Median age was 61.4 years old, 70% were male. ECOG PS was 0, 1, 2, in 29%, 63% and 8% of pts respectively. Histological types were papillary (pRCC) type 2 (41%), chromophobe (18%), pRCC type I (10%), pRCC unclassified (8%), collecting duct carcinoma (CDC) (8%), and others (including predominant sarcomatoid, renal medullary carcinoma, MITF associated RCC, unclassified RCC). N was used in first line in 16%, second line in 54% and third line or beyond in 30%. IMDC risk group was 14%, 70% and 16% for good, intermediate and poor risk respectively. With a median follow up of 10.4 months (mo), 42 pts had discontinued N. The 12 weeks-ORR was 6% (3 PR), with stable disease in 49% and PD in 44% of pts. The best ORR was 10%. Median PFS was 3.9 mo (IC95% [2.9; 8.3]). At time of analysis, 25 pts (50%) had died and 12-months OS rate was 47.7% (IC95% [33.5; 67.8]). Overall, 31 pts (62%) have presented at least one grade ≥ 3 AE. No new safety signal with N was reported. 12 weeks-ORR and best ORR according to distinct histology are presented in table 1. Pts with PR were 1pRCC type 2, 1pRCC type 1, 1 CDC, 1 MITF RCC and 1 unclassified. Conclusions: We report the first prospective study of N single agent in non-clear cell RCC. N demonstrates limited activity in a pretreated and heterogeneous non- clear cell RCC population. Interestingly 1/4 CDC developed PR while no response was noted in chromophobe RCC. Clinical trial information: NCT03012581. [Table: see text]
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Affiliation(s)
- Laurence Albiges
- Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Marie Beylot-Barry
- Dermatology, Hôpital Saint-André, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | | | - Céline Gavoille
- Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | | | | | | | | | | | | | | | - Aurelien Marabelle
- Gustave Roussy, Université Paris-Saclay, Département d’Innovation Thérapeutique et d’Essais Précoces, Villejuif, France
| | - Aude Flechon
- Departement of Medical Oncology, Centre Léon Bérard, Lyon, France
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Pannier D, Cordoba A, Ryckewaert T, Robin YM, Penel N. Hormonal therapies in uterine sarcomas, aggressive angiomyxoma, and desmoid-type fibromatosis. Crit Rev Oncol Hematol 2019; 143:62-66. [DOI: 10.1016/j.critrevonc.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022] Open
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20
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Turpin A, Genin M, Hebbar M, Occelli F, Lanier C, Vasseur F, Descarpentries C, Pannier D, Ploquin A. Spatial heterogeneity of KRAS mutations in colorectal cancers in northern France. Cancer Manag Res 2019; 11:8337-8344. [PMID: 31571990 PMCID: PMC6750880 DOI: 10.2147/cmar.s211119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/04/2019] [Accepted: 07/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background Somatic mutations in the KRAS gene are the most common oncogenic mutations found in human cancers. However, no clinical features have been linked to KRAS mutations in colorectal cancer [CRC]. Purpose In this study, we attempted to identify the potential geographical population clusters of KRAS mutations in CRC patients in northern France. Patients and methods All patients with CRC who were identified to have KRAS mutations between 2008 and 2014 at the Regional Molecular Biology Platform at Lille University Hospital were included. 2,486 patients underwent a KRAS status available, with 40.9% of CRC with KRAS mutations in northern France. We retrospectively collected demographic and geographic data from these patients. The proportions of KRAS mutation were smoothed to take into account the variability related to low frequencies and spatial autocorrelation. Geographical clusters were searched using spatial scan statistical models. Results A mutation at KRAS codon 12 or 13 was found in 1,018 patients [40.9%]. We report 5 clusters of over-incidence but only one elongated cluster that was statistically significant [Cluster 1; proportion of KRAS mutation among CRC: 0.4570; RR=1.29; P=0.0314]. We made an ecological study which did not highlight a significant association between KRAS mutations and the distance to the Closest Waste Incineration Plant, and between KRAS mutations and The French Ecological Deprivation Index but few socio-economic and environmental data were available. Conclusion There was a spatial heterogeneity and a greater frequency of KRAS mutations in some areas close to major highways and big cities in northern France. These data demand deeper epidemiological investigations to identify environmental factors such as air pollution as key factors in the occurrence of KRAS mutations.
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Affiliation(s)
- Anthony Turpin
- Medical oncology unit, Hôpital Claude Huriez, F-59000 Lille, France.,Lille University Medical School, Université Lille Nord de France, Lille, France.,University Lille, CNRS, Institut Pasteur de Lille, UMR 8161 - Mechanisms of Tumorigenesis and Target Therapies, F-59021 Lille, France
| | - Michael Genin
- EA 2694-Santé Publique: épidémiologie et qualité des soins, University Lille, CHU Lille, 59000 Lille, France
| | - Mohamed Hebbar
- Medical oncology unit, Hôpital Claude Huriez, F-59000 Lille, France.,Lille University Medical School, Université Lille Nord de France, Lille, France
| | - Florent Occelli
- EA 4483 - Impact de l'environnement chimique sur la santé humaine, University of Lille, 59000 Lille, France
| | - Caroline Lanier
- EA 4483 - Impact de l'environnement chimique sur la santé humaine, University of Lille, 59000 Lille, France
| | - Francis Vasseur
- EA 2694-Santé Publique: épidémiologie et qualité des soins, University Lille, CHU Lille, 59000 Lille, France
| | - Clotilde Descarpentries
- Division of Biochemistry and Molecular Biology, Oncology and Molecular Genetics Laboratory, CHU Lille, Lille, France
| | - Diane Pannier
- Department of Medical Oncology, Centre Oscar Lambret, Lille, F-59000, France
| | - Anne Ploquin
- Medical oncology unit, Hôpital Claude Huriez, F-59000 Lille, France
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Strobbe G, Pannier D, Villain A, Feutry F, Marliot G. First-time prescription of enzalutamide in a patient treated with fluindione and digoxin: serial drug interactions. Acta Oncol 2019; 58:1167-1169. [PMID: 31032691 DOI: 10.1080/0284186x.2019.1606936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Diane Pannier
- b Medical Oncology Department , Centre Oscar Lambret , Lille , France
| | | | - Frédéric Feutry
- a Service of Pharmacy , Centre Oscar Lambret , Lille , France
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El Ali Z, Rottey S, Barthelemy P, Kotecki N, VAN Paemel R, Devrient D, Awada A, Gil T, Pannier D, Ryckewaert T, Waisse W, Clavier JB, Penel N, Vermassen T. Brain Metastasis and Renal Cell Carcinoma: Prognostic Scores Assessment in the Era of Targeted Therapies. Anticancer Res 2019; 39:2993-3002. [PMID: 31177140 DOI: 10.21873/anticanres.13431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/08/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022]
Abstract
AIM This study aimed at exploring several brain metastatic prognostic scores in patients with renal cell carcinoma. PATIENTS AND METHODS We retrospectively analyzed data of 93 metastatic renal cell carcinoma patients who were diagnosed with brain metastases between October 2005 and July 2016 who received targeted therapy. Potential prognostic factors (RTOG RPA, BS-BM, and a newly developed score CERENAL) were analyzed. RESULTS A total of 75 patients received targeted therapy. All scores showed prognostic value in progression-free survival after first-line treatment with CERENAL being the sole independent prognostic factor associated with improved duration of first-line treatment. Both RTOG RPA and CERENAL were potential prognosticators for overall survival, whereas only the CERENAL score was associated with prolonged disease-specific survival. CONCLUSION Several prognostic scores can be useful to predict survival of patients with brain metastases from renal cancer, especially the newly developed CERENAL score.
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Affiliation(s)
- Ziad El Ali
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Philippe Barthelemy
- Medical Oncology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nuria Kotecki
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Department of General Oncology, Centre Oscar Lambret, Lille, France
| | - Ruben VAN Paemel
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Daniel Devrient
- Radiotherapy Department, Jules Bordet Institute, Brussels, Belgium
| | - Ahmad Awada
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Gil
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Diane Pannier
- Department of General Oncology, Centre Oscar Lambret, Lille, France
| | | | - Waissi Waisse
- Radiation Oncology Department, Comprehensive Cancer Center Paul Strauss, Strasbourg, France
| | - Jean-Baptiste Clavier
- Radiation Oncology Department, Comprehensive Cancer Center Paul Strauss, Strasbourg, France
| | - Nicolas Penel
- Department of General Oncology, Centre Oscar Lambret, Lille, France
| | - Tijl Vermassen
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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Ploquin A, Genin M, Hebbar M, Occelli F, Lanier C, Decarpentries C, Pannier D, Turpin A. Spatial heterogeneity of KRAS mutations in colorectal cancers: A population-based study in northern France. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15101] [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
e15101 Background: Somatic mutations in the KRAS gene are present in about 40% of tumors from colorectal cancer (CRC) patients and are associated with a resistance to anti-EGFR therapies. However, no clinical features have been linked to KRAS mutations in CRC. In this study, we attempted to identify the potential geographical population clusters of KRAS mutations in CRC patients in northern France. Methods: All patients with CRC who were identified to have KRAS mutations performed by pyrosequencing between 2008 and 2014 at the Regional Molecular Biology Platform at Lille University Hospital were included. We retrospectively collected demographic and geographic data from these patients. The proportions of KRAS mutation were smoothed to take into account the variability related to low frequencies and spatial autocorrelation. Geographical clusters were searched using spatial scan statistical models. Then, we made an ecological study. Results: 2,486 patients underwent a KRAS status available. A mutation of KRAS codon 12 or 13 performed by pyrosequencing was found in 1,018 patients (40.9%). We report 5 clusters of over-incidence but only one elongated cluster that was statistically significant ranging from the city of Tourcoing to the city of Marquion (Cluster 1; smoothed proportion of KRAS mutation: 0.4570; RR = 1.29; p = 0.0314). The ecological study did not highlight a significant association between KRAS mutations and the distance to the Closest Waste Incineration Plant , and between KRAS mutations and The French Ecological Deprivation Index. There was a greater frequency of KRAS mutations in some areas close to major highways and big cities in northern France. Conclusions: There is a spatial heterogeneity of KRAS codon 12 or 13 mutations in CRC in northern France. These data demand deeper epidemiological investigations to identify environmental factors such as air pollution as key factors in the occurrence of KRAS mutations.
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Affiliation(s)
| | - Michael Genin
- EA 2694-Santé Publique: Épidémiologie Et Qualité Des Soins, Lille, France
| | | | - Florent Occelli
- EA 4483-Impact De L'environnement Chimique Sur La Santé Humaine, Lille, France
| | - Caroline Lanier
- EA 4483-Impact De L'environnement Chimique Sur La Santé Humaine, Lille, France
| | - Clotilde Decarpentries
- Division of Biochemistry and Molecular Biology, Oncology and Molecular Genetics Laboratory, Lille, France
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Durand B, Decanter G, Jafari M, Tessier W, Robin Y, Renaud A, Amor MBH, Basson L, Pannier D, Ryckewaert T, Penel N, Largo AC. EP-1604 Feasibility of preoperative radiotherapy in localized sarcoma of the limb:a single center experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32024-9] [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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Pannier D, Adenis A, Bogart E, Dansin E, Clisant-Delaine S, Decoupigny E, Lesoin A, Amela E, Ducornet S, Meurant JP, Le Deley MC, Penel N. Once weekly paclitaxel associated with a fixed dose of oral metronomic cyclophosphamide: a dose-finding phase 1 trial. BMC Cancer 2018; 18:775. [PMID: 30064401 PMCID: PMC6069824 DOI: 10.1186/s12885-018-4678-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary aim of this trial was to determine the recommended phase II dose (RP2D) of weekly paclitaxel (wP) administered in combination with oral metronomic cyclophosphamide (OMC). METHODS Patients ≥ 18 years of age with refractory metastatic cancers were eligible if no standard curative measures existed. Paclitaxel was administered IV weekly (D1, D8, D15; D1 = D28) in combination with a fixed dose of OMC (50 mg twice a day). A 3 + 3 design was used for dose escalation of wP (40 to 75 mg/m2) followed by an expansion cohort at RP2D. Dose-limiting toxicity (DLT) was defined over the first 28-day cycle as grade ≥ 3 non-hematological or grade 4 hematological toxicity (NCI-CTCAE v4.0) or any toxicity leading to a dose reduction. RESULTS In total, 28 pts. (18 in dose-escalation phase and 10 in expansion cohort) were included, and 16/18 pts. enrolled in the dose-escalation phase were evaluable for DLT. DLT occurred in 0/3, 1/6 (neuropathy), 0/3 and 2/4 pts. (hematological toxicity) at doses of 40, 60, 70 and 75 mg/m2 of wP, respectively. The RP2D of wP was 70 mg/m2; 1/10 patients in the expansion phase had a hematological DLT. At RP2D (n = 14), the maximal grade of drug-related adverse event was Gr1 in three patients, Gr2 in six patients, Gr3 in one patient and Gr4 in one patient (no AE in three patients). At RP2D, a partial response was observed in one patient with lung adenocarcinoma. CONCLUSION The combination of OMC and wP resulted in an acceptable safety profile, warranting further clinical evaluation. TRIAL REGISTRATION TRN: NCT01374620 ; date of registration: 16 June 2011.
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Affiliation(s)
- Diane Pannier
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Antoine Adenis
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Emilie Bogart
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Eric Dansin
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | | | - Emilie Decoupigny
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Anne Lesoin
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Eric Amela
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France
| | - Sandrine Ducornet
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Jean-Pierre Meurant
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France.,INSERM CESP Oncostat Team, Paris-Sud, Paris-Saclay University, Orsay, France
| | - Nicolas Penel
- Medical Oncology Department, Centre Oscar Lambret, 3, rue F Combemale, 59020, Lille Cedex, France. .,Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France. .,Medical School, Lille-Nord-de-France University, EA2694 Research Unit, Lille, France.
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Hutt E, Da Silva A, Bogart E, Le Lay-Diomande S, Pannier D, Delaine-Clisant S, Le Deley MC, Adenis A. Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: a randomised phase III trial. BMJ Open 2018; 8:e015904. [PMID: 29362244 PMCID: PMC5786132 DOI: 10.1136/bmjopen-2017-015904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Palliative care (PC) has usually been offered at the end-of-life stage, although the WHO recommends providing PC as early as possible in the course of the disease. A recent study has shown that early PC (EPC) provides a more meaningful effect on quality of life and, surprisingly, on overall survival (OS) than standard treatment for patients with metastatic lung cancer. Whether EPC benefits also apply to patients with metastatic upper gastrointestinal (GI) cancers is unknown. METHODS AND ANALYSIS EPIC is a randomised phase III trial comparing EPC plus standard oncologic care versus standard oncologic care in patients with metastatic upper GI cancers. Its primary objective is to evaluate the efficacy of EPC in terms of OS. Its secondary objectives are to assess the effects of EPC on patient-reported outcomes (quality of life, depression and anxiety) and the effect of EPC on the number of patients receiving chemotherapy in their last 30 days of life. Assuming an exponential distribution of survival time, 381 deaths are required to ensure an 80% power for an absolute difference of 10% in 1 year OS rates (40% vs 50.3%, HR=0.75; log rank test two-sided alpha=5%), leading to a planned sample size of 480 patients enrolled over 3 years and a final analysis at 4 years. The main analysis will be performed on the intent-to-treat dataset. ETHICS AND DISSEMINATION This study was approved by the 'Comité de Protection des Personnes Nord-Ouest I' (4 April 2016), complies with the Helsinki declaration and French laws and regulations and follows the International Conference on Harmonisation E6 (R1) Guideline for Good Clinical Practice. The trial results, even if they are inconclusive, will be presented at international oncology congresses and published in peer-reviewed journals. TRIAL REGISTRATION NUMBERS EudraCT: 2015-A01943-46; Pre-results. NCT02853474.
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Affiliation(s)
- Emilie Hutt
- Department of Gastrointestinal Oncology, Centre Oscar Lambret, Lille, France
| | | | - Emilie Bogart
- Methodology and Biostatistic Unit, Centre Oscar Lambret, Lille, France
| | | | - Diane Pannier
- Department of Gastrointestinal Oncology, Centre Oscar Lambret, Lille, France
| | | | - Marie-Cécile Le Deley
- Methodology and Biostatistic Unit, Centre Oscar Lambret, Lille, France
- CESP, INSERM, Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Antoine Adenis
- Department of Gastrointestinal Oncology, Centre Oscar Lambret, Lille, France
- Catholic University, Lille, France
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Hutt E, Da silva A, Pannier D, Bogart E, El-Hajbi F, Villet S, Clisant S, Le Deley MC, Adenis A. Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: Phase III EPIC trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pannier D, Adenis A, Tresch-Bruneel E, Bogart E, El Hajbi F, Dansin E, Kotecki N, Ceugnart L, Ryckewaert T, Delaine SC, Lauridant Philippin G, Lesoin A, Ducornet S, Vanseymortier M, Decoupigny E, Le Deley MC, Penel N. Paclitaxel once weekly (wP) combined with fixed dose of oral metronomic cyclophosphamide (OMC): A dose-escalating phase I trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e14015] [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
e14015 Background: OMC, as continuous administration of low doses of chemotherapy acts as direct cytotoxic as well as antiangiogenetic agent. wP also induces antiangiogenic effects in mouse models. The aims of this trial were to determine the recommended Phase 2 dose (RP2D) of wP given in combination with OMC, and estimate activity and safety of the combination. Methods: Methods This is a single-center, phase 1 trial. Patients (pts) > 18 years with refractory metastatic cancers were eligible if no standard curative measures existed. Paclitaxel was administered IV weekly (D1, D8, D15; D1 = D28) in combination with a fixed dose of OMC (50mg x2/day). A 3+3 design was used for Dose-Escalation of wP (40 mg/m² to 75 mg/m²), followed by an expansion cohort at RP2D. The primary endpoint was the dose-limiting toxicity (DLT), defined as grade > 3 non-hematological or grade 4 hematological toxicity (NCI-CTCAE v4.0) occurring in the first 28 days, or any toxicity leading to a dose reduction. Results: 28 pts (18 in dose-escalation phase and 10 in expansion cohort) were included between May 2011 and December 2013. The sex ratio was 2:1, the median age was 54.5 (range, 26-67); the most common primary tumors were colorectal cancers (n = 9), sarcomas (n = 4), Head & Neck (n = 3). 16/18 pts enrolled in the dose-escalation phase were evaluable for DLT. DLT occurred in 0/3, 1/6 (neuropathy), 0/3 and 2/4 pts (hematological toxicity) at dose 40, 60, 70 and 75 mg/m² of wP, respectively. The RP2D of wP was 70 mg/m2; 1/10 pts in the expansion phase had an hematological DLT. At RP2D (n = 14), the maximal grade of adverse events (AE), regardless of causality, was Gr2 in 3 pts, Gr3 in 7 pts, Gr4 in 3 pts and Gr5 in 1 pt; the maximal grade of treatment-related AE was Gr1 in 1 pt, Gr2 in 8 pts, Gr3 in 3 pts and Gr4 in 1 pt (no AE in 1 pt). At RP2D, the median PFS was 2.8 mo and Growth Modulation index was ≥1.33 in 4/14 pts (29%). There was 1 objective response (1/14; 7%): 1 pt with lung adenocarcinoma achieved a partial response. Conclusions: The combination of OMC and wP resulted in an acceptable safety profile. Further evaluation of this combination with wP at 70mg/m² could be warranted in a phase 2 trial. Clinical trial information: NCT01374620.
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Pannier D, Philippin-Lauridant G, Baranzelli MC, Bertin D, Bogart E, Delprat V, Villain G, Mattot V, Bonneterre J, Soncin F. High expression levels of egfl7 correlate with low endothelial cell activation in peritumoral vessels of human breast cancer. Oncol Lett 2016; 12:1422-1428. [PMID: 27446447 PMCID: PMC4950557 DOI: 10.3892/ol.2016.4791] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 05/24/2016] [Indexed: 12/15/2022] Open
Abstract
Tumor blood vessels participate in the immune response against cancer cells and we previously used pre-clinical models to demonstrate that egfl7 (VE-statin) promotes tumor cell evasion from the immune system by repressing endothelial cell activation, preventing immune cells from entering the tumor mass. In the present study, the expression levels of egfl7 and that of ICAM-1 as a marker of endothelium activation, were evaluated in peritumoral vessels of human breast cancer samples. Breast cancer samples (174 invasive and 30 in situ) from 204 patients treated in 2005 were immunostained for CD31, ICAM-1 and stained for egfl7 using in situ hybridization. The expression levels of ICAM-1 and egfl7 were assessed in peritumoral areas using semi-quantitative scales. There was a strong and significant inverse correlation between the expression of ICAM-1 and that of egfl7 in CD31+ blood vessels. When the ICAM-1 score increased, the egfl7 score reduced significantly (P=0.004), and vice-versa (Cuzick's test for trend across ordered groups). In order to determine which gene influenced the other gene between egfl7 and ICAM-1, the expression levels of either gene were modulated in endothelial cells. Egfl7 regulated ICAM-1 expression while ICAM-1 had no effects on egfl7 expression in the same conditions. Altogether, these results provide further results that egfl7 serves a regulatory role in endothelial cell activation in relation to immune infiltration and that it is a potential therapeutic target to consider for improving anticancer immunotherapies.
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Affiliation(s)
- Diane Pannier
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France; Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | - Géraldine Philippin-Lauridant
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France; Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | | | - Delphine Bertin
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France
| | - Emilie Bogart
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France
| | - Victor Delprat
- Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | - Gaëlle Villain
- Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | - Virginie Mattot
- Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
| | - Jacques Bonneterre
- Senology Department, Oscar Lambret Center, Université de Lille, 59020 Lille, France
| | - Fabrice Soncin
- Institut Pasteur de Lille, Centre National de la Recherche Scientifique UMR8161, Université de Lille, 59000 Lille, France
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Pannier D, Lauridant G, Baranzelli M, Bogart E, Bonneterre J, Soncin F. 246 Blood vessel endothelial activation, egfl7 expression, and inflammatory infiltrate in breast cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30132-0] [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: 11/30/2022]
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Dumont A, Pannier D, Ducoulombier A, Tresch E, Chen J, Kramar A, Révillion F, Peyrat JP, Bonneterre J. ERCC1 and CYP1B1 polymorphisms as predictors of response to neoadjuvant chemotherapy in estrogen positive breast tumors. Springerplus 2015; 4:327. [PMID: 26180747 PMCID: PMC4493257 DOI: 10.1186/s40064-015-1053-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 11/16/2022]
Abstract
Purpose Neoadjuvant chemotherapy (NCT) using anthracyclines and taxanes is a standard treatment for locally advanced breast cancer. Efficacy of NCT is however variable among patients and predictive markers are expected to guide the selection of patients who will benefit from NCT. A promising approach stand with polymorphisms located in genes encoding drug transporters, drug metabolizing enzymes and target genes which can affect drug efficacy. Our study investigated the potential of 37 polymorphisms to predict response to NCT in breast cancer. Methods 118 women with breast adenocarcinoma were treated with FEC100 and taxotere. Genotyping was performed on germline DNA using the BioMark platform (Fluidigm). Pathological complete response (pCR) according to Sataloff criteria was correlated to clinical characteristics and genotypes using univariate and multivariate analyses. Results 25 patients (21.2%) reached complete pathologic response. pCR rate is increased in SBRIII (p = 0.009), ER negative (p = 0.005) and triple negative (p = 0.006) tumors. pCR rate is significantly increased for patients carrying at least one variant allele for BRCA1, ERCC1 or SLCO1B3, and for patients homozygous for CYP1B1. The combination of ERCC1 and CYP1B1 polymorphisms is a potential predictor of NCT response in breast cancer (pCR rate reached 50 vs 21.2% for unselected patients), and particularly in ER + breast cancer subtype where pCR rate reached 41.2 vs 13.5% for unselected patients. Conclusions This study is the first to report ERCC1, BRCA1 and SLCO1B3 as markers of response to NCT in breast cancer. ERCC1/CYP1B1 combination might be of particular interest to predict response to NCT in breast cancer and particularly to help NCT indication for ER+ breast tumors. Electronic supplementary material The online version of this article (doi:10.1186/s40064-015-1053-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aurélie Dumont
- Laboratoire d'Oncologie Moléculaire Humaine, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
| | - Diane Pannier
- Département de Sénologie, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
| | - Agnès Ducoulombier
- Département de Sénologie, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
| | - Emmanuelle Tresch
- Unité de Méthodologie et Biostatistique, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
| | - Jinying Chen
- Laboratoire d'Oncologie Moléculaire Humaine, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
| | - Andrew Kramar
- Unité de Méthodologie et Biostatistique, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
| | - Françoise Révillion
- Laboratoire d'Oncologie Moléculaire Humaine, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
| | - Jean-Philippe Peyrat
- Laboratoire d'Oncologie Moléculaire Humaine, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
| | - Jacques Bonneterre
- Département de Sénologie, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307, 59020 Lille Cedex, France
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Ducoulombier A, Dumont A, Tresch E, Chen J, Pannier D, Revillion F, Bonneterre J, Peyrat JP. Association of ERCC1 (rs11615) and DNASE2B (rs3738573) polymorphisms with pathologic complete response to neoadjuvant chemotherapy for HER2-overexpressing breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.536] [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
536 Background: Pathological complete response (pCR) is the main prognostic factor after preoperative chemotherapy. Predictive factors of pCR are mainly histological type, hormonal status, HER2 overexpression. Single nucleotide polymorphisms (SNP) in genes encoding drug transporters, drug metabolizing enzymes and target genes can affect drug efficacy and may explain therapeutic failures. The aim of the study was to identify SNPs associated with pCR in breast cancer (BC) patients (PTS) with HER-2 overexpression and treated with sequential neoadjuvant chemotherapy. Methods: Among PTS treated with NCT and included between 2007 and 2012, 46 PTS had HER-2 overexpressing BC, mostly ductal carcinoma (91.3%), greater than or equal to T2 (97.7%) and N1 (65.2%).91.3% of PTS received 3 FEC 100 - 3 Taxotere and 18 cycles of trastuzumab (3-18). Genotyping of 46 SNPs was performed on germline DNA using real time PCR. pCR was correlated with clinicopathologic features and genotypes using logistic regression. Results: pCR was evaluable for 45 PTS according to Sataloff criteria: pCR rate was 40% (95% CI 25.7-55.7%) and was significantly associated with hormonal status: 60.9% in negative hormone receptor tumors and 18.2% in positive hormone receptor tumors (p = 0.004). Four SNPs were significantly associated with pCR. All patients homozygotes CC for ERCC1-rs11615 respond to NCT (p=0.024). The response rate was higher for patients homozygotes TT for NQO2-rs1143684 (59.1%; p=0.018), PTS carrying one or two C allele for DNASE2B-rs3738573 (50%; p=0.025) and PTS carrying one or two C allele for MDR1-rs1045642(51.5%; p=0.012). Conclusions: In this pilot study 4 SNPs were significantly associated with pCR and may be useful to predict response to NCT (Anthracyclines/Taxanes/Trastuzumab regimen) for HER-2 overexpressing breast tumors. Moreover, DNASE2B-rs3738573 and ERCC1-rs11615, two polymorphisms located in genes involved in DNA reparation, have never been described as predictive markers for BC neoadjuvant chemotherapy. (The first 3 authors contributed equally to this work.)
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Pannier D, Dumont A, Tresch E, Chen J, Ducoulombier A, Revillion F, Bonneterre J, Peyrat JP. Single nucleotide polymorphisms to predict for neoadjuvant chemotherapy in breast cancer according to estrogen receptor (ER) status. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.544] [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
544 Background: Neoadjuvant chemotherapy (NCT) using anthracyclines and taxanes is a standard treatment for locally advanced breast cancer and pathologic complete response (pCR) is a major prognostic factor for survival. Gene polymorphisms have been identified as modulators of chemotherapy response. Our study investigated constitutional variants of genes associated with a change in the response to neoadjuvant chemotherapy using taxanes and/or anthracyclines in patients with breast adenocarcinoma. Methods: From November 2007 to January 2012, 118 women with breast adenocarcinoma histologically proven, with no Her2 surexpression, receiving or having received a neoadjuvant chemotherapy with taxanes and/or anthracyclines were included in the study. NCT associated 3 FEC100 then 3 Docetaxel every 21 days. Genotyping of 46 SNPs was performed on germline DNA using real time PCR. pCR was correlated to clinical characteristics and genotypes using univariate logistic regression. Results: 21.2% had a pCR according to Sataloff classification. pCR is increased in SBRIII (p=0.009), estrogen receptor negative (p=0.005) and triple negative (p=0.006) tumors. 7 SNP are significantly associated with pCR in ER+ breast tumors (pCR=13.5%). Among these SNP, pCR is increased for patients carrying almost one G allele for SLCO1B3-rs11045585 (pCR=28.6%; p=0.032), for homozygotes GG for SHTM1-rs1979277 (pCR=24.3%, p=0.006) and for homozygotes CC for CYP1B1-rs1056836 (pCR=25.7%; p=0.003). Moreover, 4 SNPs are significantly associated with pCR in ER- breast tumors: ERCC1-rs11615 (carriers of almost one C allele: pCR=50%; p=0.030), CD24-rs52812045 (Homozygotes CC pCR=56.3%, p=0.033), CYP2B6-rs2279343(carriers of one or two G allele: pCR=52.6%; p=0.046) and GSTP1-rs1695 (carriers of one or two G allele: pCR=48%; p=0.050). Conclusions: Besides ER status, polymorphisms could be useful markers to predict response to anthracyclines/taxanes NCT in breast cancer. Furthermore, this work is the first describing ERCC1-rs11615, SLCO1B3-rs11045585 and SHTM1-rs1979277 as new potential genetic markers for NCT in breast cancer. (The first 3 authors contributed equally to this work.)
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Le Rhun E, Taillibert S, Zairi F, Pannier D, Boulanger T, Andre C, Cazin JL, Dubois F, Bonneterre J, Chamberlain MC. Prolonged survival of patients with breast cancer-related leptomeningeal metastases. Anticancer Res 2013; 33:2057-2063. [PMID: 23645756] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND/AIM Prolonged overall survival (OS) has been reported for selected patients with leptomeningeal metastases (LM). The management and treatment of such patients is poorly-described. We report our experience on breast cancer (BC)-associated LM and patients with prolonged survival. PATIENTS AND METHODS Eleven patients with BC and LM had an OS >12 months in which treatment is described. RESULTS Combined intra-cerebro spinal fluid (CSF) and systemic treatment were administered until disease progression or toxicity in all but two patients. Involved-field radiotherapy was administered to two patients. Median OS in this selected cohort following LM diagnosis, was 21.0 (range=13-33.3) months. CONCLUSION Prolonged OS but also prolonged responses can be observed in BC with LM. An individualized and multi-disciplinary approach is advised for the management of these patients.
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Affiliation(s)
- Emilie Le Rhun
- Breast unit, Department of Medical Oncology, Oscar Lambret Center, Lille Cedex, France.
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Turpin A, Pannier D, Zairi F, Cazin JL, Bonneterre J, Le Rhun É. Intérêt d’un traitement intrathécal de seconde ligne par thiotepa dans les atteintes méningées de cancer du sein. Rev Neurol (Paris) 2012. [DOI: 10.1016/j.neurol.2012.01.182] [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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Pannier D, Caty A, Hysi I, Bouchindhomme B, Copin MC, Porte H, Dansin E. [Pleuro-pulmonary metastases from a malignant mesothelioma of the tunica vaginalis]. Rev Mal Respir 2011; 28:1155-7. [PMID: 22123142 DOI: 10.1016/j.rmr.2011.05.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 05/06/2011] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Mesothelioma is a malignant tumour of the serous membranes that principally affects the pleura. Peritoneal, pericardial and tunica vaginalis mesothelioma are very rare. CASE REPORT We report the case of a 65-year-old male with malignant mesothelioma of the tunica vaginalis (MTV). He presented with several local recurrences and, five years after the initial surgery, with pulmonary nodules and a pleural effusion. Pleural biopsies confirmed epithelioid mesothelioma. A diagnosis of pleuro-pulmonary metastases from previous malignant MTV was made. CONCLUSIONS Malignant MTV is a rare and aggressive tumor with frequent local recurrences and, rarely, visceral metastases. This case report emphasizes the difficulties of the differential diagnosis between pleural mesothelioma and pleural metastases from MTV. The lack of any treatment for metastatic malignant MTV is discussed.
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Affiliation(s)
- D Pannier
- Département de cancérologie générale, CLCC Oscar-Lambret, 3, rue Frédérique-Combenate, 59020 Lille cedex, France
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