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Moreau-Bachelard C, Robert M, Gourmelon C, Bourbouloux E, Patsouris A, Frenel JS, Campone M. Evaluating everolimus for the treatment of breast cancer. Expert Opin Pharmacother 2023:1-7. [PMID: 37183684 DOI: 10.1080/14656566.2023.2214677] [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] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Everolimus is an oral drug that inhibits mTOR with immunosuppressive and antiproliferative characteristics. It is commonly used in association with exemestane in hormone receptor (HR)-positive advanced breast cancer (ABC). AREAS COVERED The current review summarizes the publications relating to everolimus from clinical research in breast cancer. Everolimus showed treatment efficacy and an acceptable safety tolerance with prevention of side effects in Phase II/III studies. BOLERO-2 study showed a progression-free survival improvement in patients with HR-positive ABC previously treated with aromatase inhibitors (AI) and leading to its acceptance in this indication. The absence of a post CDK4/6 inhibitor (CDK4/6i.) study and the arrival of new drugs may raise questions about its current place in the therapeutic strategy. EXPERT OPINION Everolimus is relevant in the management of HR-positive ABC. Because of its efficacy, acceptable tolerability and the absence of drugs that have shown a greater benefit, it remains a second-line treatment option in HR-positive, HER2 negative (score 0) patients without BRCA mutation or visceral crisis and can be discuss with fulvestrant in second line after CDK4-6i. It is likely that within 5 years this treatment will be replaced in second line HR-positive breast cancer by new emerging treatments: drug-conjugated antibodies, tyrosine kinase inhibitors or immunotherapy in combination with chemotherapy.
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Affiliation(s)
| | - Marie Robert
- ICO Centre René Gauducheau, Oncology, Nantes, France
| | | | | | | | | | - Mario Campone
- ICO Centre René Gauducheau, Oncology, Nantes, France
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Lange M, Lefevre Arbogast S, Hardy-Léger I, Rigal O, Le Fel J, Pistilli B, Petrucci J, Lévy C, Capel A, Coutant C, Médeau L, Lerebours F, Vanlemmens L, Brion M, Bourbouloux E, Blain M, Binarelli G, Vaz-Luis I, Giffard B, Querel O, Everhard S, André F, Charles C, Dauchy S, Joly F. Cognitive change in breast cancer patients up to 2 years after diagnosis. J Natl Cancer Inst 2023; 115:322-331. [PMID: 36571503 PMCID: PMC9996221 DOI: 10.1093/jnci/djac240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/11/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Using the large nationwide French, national, multicenter, prospective cancer and toxicities (CANTO) cohort, we assessed cognitive functioning change after cancer treatments in a subgroup of breast cancer (BC) patients. METHODS We included patients with newly diagnosed invasive stage I-III BC enrolled in the CANTO substudy focused on cognitive evaluation and healthy control women matched for age and education. Episodic and working memory, executive functions, processing speed, attention, self-report cognitive difficulties (SRCD), fatigue, anxiety and depression were assessed with neuropsychological tests and self-report questionnaires before treatment (baseline) and approximately 1 (year 1) and 2 years (year 2) after diagnosis. We used linear mixed models to study changes in cognition and tested the effect of adjuvant chemotherapy. RESULTS We studied 276 localized BC patients (62% chemotherapy) compared with 135 healthy controls (HC). After adjustment, patients had lower baseline working memory, processing speed, and attention scores than HC (P ≤ .001), and the difference remained statistically significant over follow-up for working memory and processing speed. Executive function scores were similar between groups at baseline but decreased at year 1 among patients compared with HC (Pchange = .006). This decrease in chemotherapy patients was statistically significant compared with HC scores (Pchange < .001). After adjustment, SRCD were similar between BC patients and HC at baseline but increased in patients after treatment at year 1 (Pchange = .002). CONCLUSIONS Cognitive difficulties are an important concern in BC patients, starting at diagnosis. Cancer treatments induce executive function decline and SRCD, which decrease over follow-up.
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Affiliation(s)
- Marie Lange
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
- Equipe Labellisée LIGUE 2022, 14000 Caen, France
| | - Sophie Lefevre Arbogast
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
| | | | - Olivier Rigal
- Care Support Department, Centre Henri Becquerel, 76000 Rouen, France
- Medical Oncology Department, Centre Henri Becquerel, 76000 Rouen, France
| | - Johan Le Fel
- Care Support Department, Centre Henri Becquerel, 76000 Rouen, France
| | - Barbara Pistilli
- Medical Oncology Department, Gustave Roussy, 94800 Villejuif, France
| | - Jean Petrucci
- Medical Oncology Department, Institut Curie, 92210 Saint Cloud, France
| | - Christelle Lévy
- Institut Normand du Sein, Centre François Baclesse, 14000 Caen, France
| | - Aurélie Capel
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France
| | - Charles Coutant
- Medical Oncology Department, Centre Georges François Leclerc, 21000 Dijon, France
| | - Laure Médeau
- Medical Oncology Department, Centre Georges François Leclerc, 21000 Dijon, France
| | | | | | - Marine Brion
- Medical Oncology Department, Centre Oscar Lambret, 59000 Lille, France
| | - Emmanuelle Bourbouloux
- Medical Oncology Department, Institut de Cancérologie de l’Ouest, 44805/49100 Nantes/Angers, France
| | - Maxime Blain
- Medical Oncology Department, Institut de Cancérologie de l’Ouest, 44805/49100 Nantes/Angers, France
| | - Giulia Binarelli
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
| | | | - Bénédicte Giffard
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
- Normandie Univ, UNICAEN, PSL University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | | | | | - Fabrice André
- Medical Oncology Department, Gustave Roussy, 94800 Villejuif, France
| | - Cécile Charles
- Université de Bordeaux, Bordeaux Population Health Research Center, France
| | | | - Florence Joly
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
- Equipe Labellisée LIGUE 2022, 14000 Caen, France
- CHU de Caen, Medical Oncology Department, 14000 Caen, France
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Brain E, Viansone AA, Bourbouloux E, Rigal O, Ferrero JM, Kirscher S, Allouache D, D'hondt V, Savoye AM, Durando X, Duhoux FP, Venat-Bouvet L, Blot E, Canon JLR, Rollot F, Bonnefoi HR, Lemonnier J, Lacroix-Triki M, Bonnetain F, Vernerey D. Final results from a phase III randomized clinical trial of adjuvant endocrine therapy ± chemotherapy in women ≥ 70 years old with ER+ HER2- breast cancer and a high genomic grade index: The Unicancer ASTER 70s trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
500 Background: Benefit of adjuvant chemotherapy (CT) in addition to endocrine therapy (ET) remains controversial for patients (pts) aged ≥ 70 years with oestrogen receptors-positive (ER+) HER2-negative (HER2-) breast cancer (BC). In a large prospective trial, we first assessed the tumour genomic grade index (GGI) in all pts, and second, randomized pts with a high GGI between CT + ET vs. ET alone. Methods: Eligible pts were women ≥ 70 years with ER+ HER2- primary BC or isolated local relapse, irrespective of other characteristics, for whom adjuvant systemic treatment was considered. G8 score, Charlson comorbidity index (CCI) and 4-year mortality Lee score were collected at baseline. GGI was centrally performed by RT-PCR on FFPE samples. Pts with low GGI were not recommended to receive CT and were followed in an observational cohort. Pts with high (+ equivocal) GGI were randomized 1:1 to CT + ET vs. ET alone, using G8, pN and centre for stratification. Investigators chose between 3 CT regimens: 4 cycles of doxorubicin/cyclophosphamide, non-pegylated liposomal doxorubicin/cyclophosphamide or docetaxel/cyclophosphamide, given q3w with G-CSF. Standard ET consisted of 5 years of aromatase inhibitor, tamoxifen or a sequence based on tolerance. Based on CALGB 49907 results, the primary objective was to demonstrate an overall survival (OS) benefit for CT (4-year assumptions 87.5 vs 80%, HR=0.60) in the intent to treat (ITT) population. With 171 events, the trial had 90% power to demonstrate a difference with a bilateral test α=0.05. Secondary objectives included BC specific survival (BCSS), invasive disease-free survival (iDFS), event-free survival (EFS), competing events, cost-effectiveness and Q-TWiST analysis, geriatric dimensions, willingness and quality of life. Results: Between 04/2012 and 05/2016, 1,969 pts from 61 French and 12 Belgian centres were enrolled. Of them, 1,089 (55%) were randomized between CT + ET and ET alone. Median follow-up was 5.8 years at the data cut-off (17/12/2021) with 180 OS events observed. Median age was 75 (70-92), G8 score, CCI and Lee score being >14, ≤ 2, and ≤ 8 in 60%, 62% and 84% of pts, respectively. Tumours were ≥ pT2, pN+, isolated local relapses, with histological grade III, in 56%, 46%, 11% and 39% of cases, respectively. No significant OS difference was observed between arms (HR 0.85 [0.64-1.13], p=0.2538); 4-year OS was 90.5% in the CT + ET arm and 89.7% in the ET alone arm. The forest plot could not identify any subgroup deriving significant benefit from CT. ITT and per protocol analysis of secondary objectives (BCSS, iDFS, EFS) showed similar results. Conclusions: In this large phase III trial, we did not find a statistically significant OS benefit with the addition of CT to ET after surgery for ER+ HER2- BC with a high GGI. Analysis of the other outcome measures will be presented. Clinical trial information: NCT0156405.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Emmanuel Blot
- CH Bretagne Atlantique & Centre Saint Yves, Vannes, France
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Lobbedez FJ, Hardy-Léger I, Arbogast SL, Rigal O, Le Fel J, Pistilli B, Petrucci J, Lévy C, Capel A, Coutant C, Lerebours F, Vanlemmens L, Bourbouloux E, Vaz-Luis I, Martin AL, Everhard S, André F, Charles C, Dauchy S, Lange M. 125P Cognitive impairment in breast cancer patients up to 18 months after cancer treatments: The French multicentric longitudinal CANTO-Cog cohort substudy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Falandry C, Rousseau F, Mouret-Reynier MA, Tinquaut F, Lorusso D, Herrstedt J, Savoye AM, Stefani L, Bourbouloux E, Sverdlin R, D'Hondt V, Lortholary A, Brachet PE, Zannetti A, Malaurie E, Venat-Bouvet L, Trédan O, Mourey L, Pujade-Lauraine E, Freyer G. Efficacy and Safety of First-line Single-Agent Carboplatin vs Carboplatin Plus Paclitaxel for Vulnerable Older Adult Women With Ovarian Cancer: A GINECO/GCIG Randomized Clinical Trial. JAMA Oncol 2021; 7:853-861. [PMID: 33885718 DOI: 10.1001/jamaoncol.2021.0696] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Single-agent carboplatin is often proposed instead of a conventional carboplatin-paclitaxel doublet in vulnerable older patients with ovarian cancer. Such an approach could have a detrimental effect on outcomes for these patients. Objective To compare the feasibility, efficacy, and safety of single-agent carboplatin every 3 weeks, weekly carboplatin-paclitaxel, or conventional every-3-weeks carboplatin-paclitaxel in vulnerable older patients with ovarian cancer. Design, Setting, and Participants This international, open-label, 3-arm randomized clinical trial screened 447 women 70 years and older with newly diagnosed stage III/IV ovarian cancer by determining their Geriatric Vulnerability Score; 120 patients with a Geriatric Vulnerability Score of 3 or higher were stratified by country and surgical outcome. Enrollment took place at 48 academic centers in France, Italy, Finland, Denmark, Sweden, and Canada from December 11, 2013, to April 26, 2017. Final analysis database lock April 2019. Data analysis was performed from February 1 to December 31, 2019. Interventions Patients were randomized to receive 6 cycles of (1) carboplatin, area under the curve (AUC) 5 mg/mL·min, plus paclitaxel, 175 mg/m2, every 3 weeks; (2) single-agent carboplatin, AUC 5 mg/mL·min or AUC 6 mg/mL·min, every 3 weeks; or (3) weekly carboplatin, AUC 2 mg/mL·min, plus paclitaxel, 60 mg/m2, on days 1, 8, and 15 every 4 weeks. Main Outcomes and Measures The primary outcome was treatment feasibility, defined as the ability to complete 6 chemotherapy cycles without disease progression, premature toxic effects-related treatment discontinuation, or death. Results A total of 120 women were randomized. The mean and median age was 80 (interquartile range, 76-83; range, 70-94) years; 43 (36%) had a Geriatric Vulnerability Score of 4 and 13 (11%) had a Geriatric Vulnerability Score of 5; 40 (33%) had stage IV disease. During its third meeting, the independent data monitoring committee's recommendation led to the termination of the trial because single-agent carboplatin was associated with significantly worse survival. Six cycles were completed in 26 of 40 (65%), 19 of 40 (48%), and 24 of 40 (60%) patients in the every-3-weeks combination, single-agent carboplatin, and weekly combination groups, respectively. Treatment-related adverse events were less common with the standard every-3-weeks combination (17 of 40 [43%]) than single-agent carboplatin or weekly combination therapy (both 23 of 40 [58%]). Treatment-related deaths occurred in 4 patients (2 of 40 [5%] in each combination group). Conclusions and Relevance This randomized clinical trial shows that compared with every-3-weeks or weekly carboplatin-paclitaxel regimens, single-agent carboplatin was less active with significantly worse survival outcomes in vulnerable older patients with ovarian cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02001272.
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Affiliation(s)
- Claire Falandry
- Groupe d'Investigateurs Nationaux pour l'Étude des Cancers de l'Ovaire et du sein (GINECO), Laboratoire CarMEN, INSERM U1060/INRA U1397, Université Lyon 1, INSA de Lyon, and Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | | | - Fabien Tinquaut
- GINECO and Institut de Cancérologie de la Loire, St Priest en Jarez, France
| | - Domenica Lorusso
- Multicentre Italian Trials in Ovarian cancer (MITO) and Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, and Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Jørn Herrstedt
- Nordic Society of Gynecologic Oncology (NSGO), Odense University Hospital, Odense, and Zealand University Hospital, Roskilde, Denmark
| | | | | | | | - Robert Sverdlin
- GINECO and Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | | | | | | | | | - Loïc Mourey
- GINECO and Institut Claudius Regaud, Toulouse, France
| | | | - Gilles Freyer
- GINECO and Centre Hospitalier Lyon-Sud, Lyon, France
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Jovenin N, De Boissieu P, Cailleux PÉ, Dohollou N, Stefani L, Bourbouloux E, Toledano A, Abadie-Lacourtousie S, Soffray F, Tual V, Dreno B, Farsi F, Krakowski I. Efficacité et tolérance d’une cure thermale sur la xérose cutanée cicatricelle post-chirurgie du cancer du sein suivie de radiothérapie : résultats d’un essai ouvert, randomisé et contrôlé. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.554] [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: 11/28/2022]
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Doucet L, Moreau-Bachelard C, Gourmelon C, Robert M, Berton D, Bourbouloux E, Guerin C, Blonz C, Andrieux N, Campone M, Frenel JS. Long-term outcomes of patients with HER2+ breast cancer with small-size residual disease (≤ypT1) in the absence of pathological response after trastuzumab-based neoadjuvant chemotherapy and without adjuvant T-DM1: A monocentric retrospective study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.589] [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
589 Background: The Katherine trial has shown that adjuvant T-DM1 improved invasive disease free survival (iDFS) of patients with HER2+ breast cancer who did not achieve a pathological complete response (pCR) with trastuzumab-based neoadjuvant chemotherapy (NAC). However, some subgroups may benefit less from this treatment escalation. Methods: All HER2+ breast cancer patients treated with trastuzumab-based NAC between 2006 and 2016 were retrieved from our institution’s database. Neo- or adjuvant T-DM1 was an exclusion criterion. We then selected the patients who did not achieve a pCR and analyzed the outcome (iDFS and overall survival (OS)) according to ypT, ypN and several factors analyzed in the Katherine trial. Results: Out of the 182 patients, 117 patients reached the inclusion criteria. Patient’s characteristics were similar to the trastuzumab arm of the Katherine trial. With a median follow-up of 75.4 months (29.3–149.7), 28 events (24%) occurred, among which 22 distant relapses. In univariate analysis, ≤ypT1 vs > ypT1, ypN0 vs ypN+, no capsular rupture, signs of histological response (Sataloff not D in T or N) were associated with a better iDFS. In multivariate analysis, only ypT status remained significant. Of note, patients with ≤ypT1 (ypTis, ypT0, ypTmic, ypT1) (n = 81; 69%) had an excellent outcome: 3 years (y) and 5y iDFS rates of 90% (83.6-96.8) and 88.6% (81.9-95.9) respectively. The remaining patients (n = 36; 31%) had a significantly lower 3y and 5y iDFS: 69.2% (55.6-86.2) and 59.5% (45-78.6) respectively (p = 0.0017). OS in a multivariate analysis was also improved in pts with the smaller residual and/or node negative disease (3y OS rates of 100% (100-100) vs 92.1% (85.7-99); 5y OS rates of 96% (90.7-100) vs 81.1% (71.6-91.9); p = 0.02). Conclusions: In the absence of pCR after trastuzumab-based NAC, patients with pathological response scored as ≤ypT1 (ypTis,ypT0, ypTmic, ypT1) have an excellent outcome. These patients may derive less benefit from adjuvant T-DM1.
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Affiliation(s)
| | | | - Carole Gourmelon
- Institut de Cancerologie de l'Ouest (ICO), Centre René Gauducheau, Medical Oncology Department, Saint-Herblain, France
| | - Marie Robert
- Cancer Institute of the West (ICO), Nantes, France
| | - Dominique Berton
- Groupe d'Investigateurs Nationaux pour l'Étude des Cancers Ovariens (GINECO), Institut de Cancérologie de l'Ouest (ICO) Centre René Gauducheau, Saint Herblain, France
| | | | | | | | | | - Mario Campone
- Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France
| | - Jean-Sebastien Frenel
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
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Patsouris A, Augereau P, Frenel JS, Robert M, Gourmelon C, Bourbouloux E, Berton-Rigaud D, Chevalier LM, Campone M. Benefits versus risk profile of buparlisib for the treatment of breast cancer. Expert Opin Drug Saf 2019; 18:553-562. [PMID: 31159599 DOI: 10.1080/14740338.2019.1623877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/26/2022]
Abstract
Introduction: Activation of phosphoinositide 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathways occurs in 70% of breast cancer, including PIK3CA activating mutations, PTEN loss and AKT mutation. It is associated with poor prognosis and resistance to anti-HER2 and endocrine therapy. PI3K inhibitors are promising anticancer targets that can reverse resistance to these therapies. Buparlisib (BKM-120) is an orally active pan-PI3K inhibitor evaluated in different solid tumors as monotherapy or in combination. Areas covered: This article reviews preclinical data, clinical studies that have evaluated the efficacy and safety profiles of buparlisib as a monotherapy or in combination with targeted therapy (including endocrine and anti-HER2 therapy) or cytotoxics. The authors cover completed and ongoing studies to evaluate the benefit vs risk profile of buparlisib. Expert opinion: Targeting PI3K showed efficacy in BC. Buparlisib, a pan PI3K inhibitor, presents manageable but not negligible toxicity with an activity/toxicity ratio in favor of the use of emerging second generation, α-selective PI3K inhibitors for ongoing and future trials.
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Affiliation(s)
- Anne Patsouris
- a Unité INSERM 1232, Equipe 12, CRCINA , ICO Nantes-Angers , Nantes , France
| | - Paule Augereau
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | | | - Marie Robert
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | - Carole Gourmelon
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | | | | | | | - Mario Campone
- d Unité INSERM 1232, Equipe 8 CRCINA , ICO Nantes-Angers , Nantes , France
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Falandry C, Savoye AM, Stefani L, Tinquaut F, Lorusso D, Herrstedt J, Bourbouloux E, Floquet A, Brachet PE, Zannetti A, Mouret-Reynier MA, Sverdlin R, D'hondt V, Guillem O, Cojocarasu O, Venat-Bouvet L, Rousseau F, Lortholary A, Pujade-Lauraine E, Freyer G. EWOC-1: A randomized trial to evaluate the feasibility of three different first-line chemotherapy regimens for vulnerable elderly women with ovarian cancer (OC): A GCIG-ENGOT-GINECO study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5508] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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
5508 Background: The Geriatric Vulnerability Score (GVS) combining albumin, lymphocyte count, ADL, IADL and HADS scores has been reported (Falandry C Ann Oncol 2013) to identify vulnerable elderly OC patients (pts) as those with a GVS≥3. For such pts, Carboplatin (Cb) monotherapy or weekly Cb plus paclitaxel (Pa) are often proposed as an alternative to Cb-Pa given every 3 weeks. Methods: Pts ≥70 yrs with first line FIGO stage III/IV epithelial OC were screened for GVS. Those with GVS≥3 were randomized to receive either arm A: Cb AUC5-6 + Pa 175mg/m², d1q3week or arm B: Cb AUC5-6 d1q3week or arm C:weekly Cb AUC2 + Pa 60mg/m² d1-d8-d15 q4week. Primary endpoint is treatment feasibility defined as the ability to complete 6 chemotherapy courses without disease progression, early treatment stopping due to unacceptable toxicity or death. Inclusion of 240 pts was planned. Results: Among 444 screened pts, 120 were randomized from 12/2013 to 04/2017 (armA = B = C = 40). Pts characteristics were well balanced between arms A-B-C respectively: median age (79-82-80 yrs), FIGO stage IV (32-37-27%), primary surgery (65-72-70%), absence of macroscopic residuals (CC-0) (7-5-7%), ECOG≥2 (50-50-47%). Feasibility per protocol for arms A-B-C is 65%, 47% and 60% (p = 0.15). Main reasons for treatment arrest are treatment toxicity (A:20%; B:15%; C:22.5%; p = 0.771) and disease progression (A:7.5%; B:30%; C:2%; p = 0.004). Median PFS for arm A-B-C are 12.5 mos (95%CI 10.3-15.3), 4.8 (3.8-15.3) and 8.3 (6.6-15.3), respectively (p < 0.001) and median OS for arm A-B-C is not reached (NR) (21, NR), 7.4 (5.3-NR) and 17.3 (10.8-NR), respectively (p = 0.001). At the pre-planned intermediate analysis, the IDMC recommended to prematurely close the study as survival in armB was found significantly worse and the number of potential pts required to find a significant difference between both Cb-Pa regimens (arms A&C) was out of reach. Conclusions: Compared to 3-weekly and weekly Cb-Pa regimens, Cb single agent was reported to be less active with significant worse survival outcome in vulnerable elderly pts. In this population Cb-Pa combination remains a standard. Clinical trial information: NCT02001272.
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Affiliation(s)
| | | | | | - Fabien Tinquaut
- GINECO Statistician - Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | - Domenica Lorusso
- MITO and Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Jorn Herrstedt
- Nordic Society of Gynecologic Oncology (NSGO) and Odense University Hospital, Odense, Denmark
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Robert M, Frenel JS, Bourbouloux E, Berton Rigaud D, Patsouris A, Augereau P, Gourmelon C, Campone M. Pertuzumab for the treatment of breast cancer. Expert Rev Anticancer Ther 2019; 20:85-95. [PMID: 30884986 DOI: 10.1080/14737140.2019.1596805] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Pertuzumab, a humanized monoclonal antibody that binds the human epidermal growth factor receptor 2 (HER2), inhibits the heterodimerization of HER2 with other HER receptors. It has been approved both by the Food and Drug Administration and the European Medicine Agency in the metastatic, neoadjuvant and adjuvant setting.Areas covered: This review analyses and discusses preclinical and clinical studies of pertuzumab in breast cancer. In this article, we review the status of pertuzumab, the completed and ongoing trials, and its safety.Expert opinion: Pertuzumab is a key drug for the treatment of HER2-positive metastatic or early breast cancer. However, it is imperative to identify patients that will need dual-targeting and mechanisms of resistance. Moreover, the value of pertuzumab beyond progression needs to be evaluated.
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Affiliation(s)
- Marie Robert
- Medical Oncology, Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France
| | - Jean-Sébastien Frenel
- Medical Oncology, Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France
| | - Emmanuelle Bourbouloux
- Medical Oncology, Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France
| | | | - Anne Patsouris
- Medical Oncology, Institut de Cancérologie de l'Ouest, Paul Papin, Angers, France
| | - Paule Augereau
- Medical Oncology, Institut de Cancérologie de l'Ouest, Paul Papin, Angers, France
| | - Carole Gourmelon
- Medical Oncology, Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France
| | - Mario Campone
- Medical Oncology, Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France.,Medical Oncology, Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Nantes, France
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Robert M, Frenel JS, Bourbouloux E, Berton Rigaud D, Patsouris A, Augereau P, Gourmelon C, Campone M. Pharmacokinetic drug evaluation of abemaciclib for advanced breast cancer. Expert Opin Drug Metab Toxicol 2019; 15:85-91. [DOI: 10.1080/17425255.2019.1559816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marie Robert
- Medical Oncology, Institut de Cancérologie de l’Ouest, René Gauducheau, St Herblain, France
| | - Jean-Sébastien Frenel
- Medical Oncology, Institut de Cancérologie de l’Ouest, René Gauducheau, St Herblain, France
| | - Emmanuelle Bourbouloux
- Medical Oncology, Institut de Cancérologie de l’Ouest, René Gauducheau, St Herblain, France
| | | | - Anne Patsouris
- Medical Oncology, Institut de Cancérologie de l’Ouest, Paul Papin, Angers, France
| | - Paule Augereau
- Medical Oncology, Institut de Cancérologie de l’Ouest, Paul Papin, Angers, France
| | - Carole Gourmelon
- Medical Oncology, Institut de Cancérologie de l’Ouest, René Gauducheau, St Herblain, France
| | - Mario Campone
- Medical Oncology, Institut de Cancérologie de l’Ouest, René Gauducheau, St Herblain, France
- Medical Oncology, Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), France
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Robert M, Frenel JS, Bourbouloux E, Berton Rigaud D, Patsouris A, Augereau P, Gourmelon C, Campone M. Efficacy of buparlisib in treating breast cancer. Expert Opin Pharmacother 2017; 18:2007-2016. [PMID: 29169282 DOI: 10.1080/14656566.2017.1410139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Breast cancer is the most frequent cancer in women. Despite a decline in breast cancer mortality, prognosis of advanced breast cancer remains poor. In a desperate need to improve breast cancer outcomes, newer agents that target molecular pathways are being tested. Deregulation of the phosphoinositide 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) is frequently found in breast cancer. This can lead to resistance of endocrine therapy and anti-HER2 therapies. Targeting this pathway may restore sensitivity to these compounds. Buparlisib (BKM-120) is an orally active pan-PI3K inhibitor evaluated in different tumor types. Areas covered: Buparlisib is one of the most investigated PI3K inhibitors. Preclinical and clinical studies of buparlisib in breast cancer are analyzed and discussed. This article reviews the status of buparlisib, completed and ongoing trials, and its safety. Expert opinion: PI3K inhibitors show promising results in breast cancer. However, we raise a number of issues including the identification of biomarkers to predict treatment response and strategies to counteract resistance. Moreover, its toxicity profile could limit its extensive use.
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Affiliation(s)
- Marie Robert
- a Department of Medical Oncology , Institut de Cancérologie de l'Ouest, René Gauducheau , St. Herblain , France
| | - Jean-Sébastien Frenel
- a Department of Medical Oncology , Institut de Cancérologie de l'Ouest, René Gauducheau , St. Herblain , France
| | - Emmanuelle Bourbouloux
- a Department of Medical Oncology , Institut de Cancérologie de l'Ouest, René Gauducheau , St. Herblain , France
| | - Dominique Berton Rigaud
- a Department of Medical Oncology , Institut de Cancérologie de l'Ouest, René Gauducheau , St. Herblain , France
| | - Anne Patsouris
- b Department of Medical Oncology , Institut de Cancérologie de l'Ouest, Paul Papin , Angers , France
| | - Paule Augereau
- b Department of Medical Oncology , Institut de Cancérologie de l'Ouest, Paul Papin , Angers , France
| | - Carole Gourmelon
- b Department of Medical Oncology , Institut de Cancérologie de l'Ouest, Paul Papin , Angers , France
| | - Mario Campone
- a Department of Medical Oncology , Institut de Cancérologie de l'Ouest, René Gauducheau , St. Herblain , France.,c Nantes and Angers , Centre de Recherche en Cancérologie Nantes-Angers (CRNA) , France
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Bourgeois H, Grudé F, Solal-Céligny P, Dupuis O, Voog E, Ganem G, Denis F, Zinger M, Juhel-Voog L, Lafond C, Maillart P, Capitain O, Delva R, Soulié P, Abadie-Lacourtoisie S, Guérin-Meyer V, Morin-Meschin M, Commer J, Gangler A, d’Aillières B, Zannetti A, Bourbouloux E, Berton-Rigault D, Lebouvier-Sadot S, Kaassis M, Baudon J, Lam Y, Bizieux A, Marcq M, Edeline J, Le Du F, Lefeuvre C, Deguiral P, Delecroix V, Blot E, Egreteau J, Goudier M, Lamy R, Ferec M, Artignan X, Corbinais S, Morel H, Hardy-Bessard A, Alleaume C, Naudeix E, Cojocarasu O, Metges J, Riché C, Gamelin E, Déniel-Lagadec D, Marhuenda F, Ingrand P, Douillard J. Clinical validation of a prognostic tool in a population of outpatients treated for incurable cancer undergoing anticancer therapy: PRONOPALL study. Ann Oncol 2017; 28:1612-1617. [DOI: 10.1093/annonc/mdx172] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 12/25/2022] Open
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Augereau P, Patsouris A, Bourbouloux E, Gourmelon C, Abadie Lacourtoisie S, Berton Rigaud D, Soulié P, Frenel JS, Campone M. Hormonoresistance in advanced breast cancer: a new revolution in endocrine therapy. Ther Adv Med Oncol 2017; 9:335-346. [PMID: 28529550 PMCID: PMC5424863 DOI: 10.1177/1758834017693195] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 03/29/2016] [Accepted: 01/16/2017] [Indexed: 11/17/2022] Open
Abstract
Endocrine therapy is the mainstay of treatment of estrogen-receptor-positive (ER+) breast cancer with an overall survival benefit. However, some adaptive mechanisms in the tumor emerge leading to the development of a resistance to this therapy. A better characterization of this process is needed to overcome this resistance and to develop new tailored therapies. Mechanisms of resistance to hormone therapy result in activation of transduction signal pathways, including the cell cycle regulation with cyclin D/CDK4/6/Rb pathway. The strategy of combined hormone therapy with targeted agents has shown an improvement of progression-free survival (PFS) in several phase II or III trials, including three different classes of drugs: mTOR inhibitors, PI3K and CDK4/6 inhibitors. A recent phase III trial has shown that fulvestrant combined with a CDK 4/6 inhibitor doubles PFS in aromatase inhibitor-pretreated postmenopausal ER+ breast cancer. Other combinations are ongoing to disrupt the interaction between PI3K/AKT/mTOR and cyclin D/CDK4/6/Rb pathways. Despite these successful strategies, reliable and reproducible biomarkers are needed. Tumor genomics are dynamic over time, and blood-based biomarkers such as circulating tumor DNA represent a major hope to elucidate the adaptive mechanisms of endocrine resistance. The optimal combinations and biomarkers to guide this strategy need to be determined.
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Affiliation(s)
- Paule Augereau
- Department of Medical Oncology, Institut cancerologie de l'ouest site Paul Papin, 15 rue Andre Bocquel 49055 Angers Cedex 02, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut cancerologie de l'ouest site Paul Papin, France
| | - Emmanuelle Bourbouloux
- Department of Medical Oncology, Institut cancerologie de l'ouest site René Gauducheau, Saint Herblain, France
| | - Carole Gourmelon
- Department of Medical Oncology, Institut cancerologie de l'ouest site René Gauducheau, Saint Herblain, France
| | | | - Dominique Berton Rigaud
- Department of Medical Oncology, Institut cancerologie de l'ouest site René Gauducheau, Saint Herblain, France
| | - Patrick Soulié
- Department of Medical Oncology, Institut cancerologie de l'ouest site Paul Papin, France
| | - Jean Sebastien Frenel
- Department of Medical Oncology, Institut cancerologie de l'ouest site René Gauducheau, Saint Herblain, France
| | - Mario Campone
- Department of Medical Oncology, Institut cancerologie de l'ouest site Paul Papin, France Department of Medical Oncology, Institut cancerologie de l'ouest site René Gauducheau, Saint Herblain, France
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Frenel JS, Bally O, Bourbouloux E, Berton-Rigaud D, Campone M, Bachelot T, Heudel PÉ. [Trastuzumab emtansine in the systemic treatment of HER-2-positive breast cancer brain metastases]. Bull Cancer 2016; 103:507-10. [PMID: 26992855 DOI: 10.1016/j.bulcan.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jean-Sébastien Frenel
- Institut de cancérologie de l'Ouest, département d'oncologie médicale, 44800 Saint-Herblain, France
| | - Olivia Bally
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France
| | - Emmanuelle Bourbouloux
- Institut de cancérologie de l'Ouest, département d'oncologie médicale, 44800 Saint-Herblain, France
| | - Dominique Berton-Rigaud
- Institut de cancérologie de l'Ouest, département d'oncologie médicale, 44800 Saint-Herblain, France
| | - Mario Campone
- Institut de cancérologie de l'Ouest, département d'oncologie médicale, 44800 Saint-Herblain, France
| | - Thomas Bachelot
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France
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Dubot C, Bourbouloux E, Mir O, Kirscher S, Rigal O, Ferrero JM, Cure H, Blot E, Allouache D, Cottu P, Romieu G, Lefeuvre C, Malaurie E, Tubiana-Mathieu N, Lacroix-Triki M, Rollot F, Peyro-Saint-Paul H, Orsini C, Bonnetain F, Brain E. Abstract OT3-3-02: ASTER 70s UNICANCER phase III trial: Can a genomic prognosticator help tailoring adjuvant systemic treatment for luminal breast carcinoma in elderly women? Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-ot3-3-02] [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
The benefit of adjuvant chemotherapy (CT) added to hormonal therapy (HT) compared with HT alone remains debated for women >70 with ER+ HER2- breast cancer (BC). Selection of valid indications might be improved by the use of better prognosticator. This trial compares the impact of both strategies on overall survival (OS) according to Genomic Grade (GG).
Following surgery, ∼2,000 patients (Pts) will have a GG performed centrally on FFPE specimens by RT-PCR. Those with a high risk (high or equivocal GG) will be randomized to HT alone vs CT+HT. Pts with a low GG will be followed as an observational cohort.
OS (all deaths) is the primary endpoint. Secondary objectives include competing events, cost-effectiveness and Q-TWiST analysis, geriatric dimension, willingness and health-related quality of life including specific ELD15. Translational research will focus on prognostic biomarkers and pharmacogenetics.
Statistical design: sample size based on 4-year OS benefit favouring CT (87.5 vs 80%; HR 0.60); bilateral test α=0.05, β=0.20; 129 events expected in 700 randomized Pts enrolled over 4 years.
From 04/12-05/14, 67 centres in France and Belgium have included 990 Pts aged 70-92.
Only 31 GG evaluations were not performed (tumour blocks not available, 14; consent withdrawal or central pathology review discordance, 7 each; treatment choice, 3). In the main recruiting site, the study was not proposed to 20% of pre-screened Pts mostly because of team choice (50%) and inclusion criteria (25%). Amongst those informed, 66% accepted to participate. Median time to get GG information was 17 days (11-25) from sending tumour sample to providing the information to patient.
Of 932 cases with GG report, 374 (40%), 187 (20%) and 362 (39%) were low, equivocal and high GG respectively; 9 tests (1%) failed for technical reasons. The proportion of high-risk tumours (high/equivocal GG 59%) is similar to that observed in general BC populations (40% to 60%) and only 21 of high-risk cases were not randomized (consent withdrawal, 6; treatment choice, 5; laboratory values, 4; tumour phenotype not confirmed or distant metastasis, 3 each).
With 75% of target recruitment in < 2 years, we confirm the feasibility of such innovative multicentre program in an usually underserved population. This might help to better select adjuvant strategy in the elderly BC population and to avoid jeopardising any benefit if stymied by uncontrolled side effects.
Citation Format: Coraline Dubot, Emmanuelle Bourbouloux, Olivier Mir, Sylvie Kirscher, Olivier Rigal, Jean-Marc Ferrero, Herve Cure, Emmanuel Blot, Djelila Allouache, Paul Cottu, Gilles Romieu, Claudia Lefeuvre, Emmanuelle Malaurie, Nicole Tubiana-Mathieu, Magali Lacroix-Triki, Florence Rollot, Hélène Peyro-Saint-Paul, Christine Orsini, Franck Bonnetain, Etienne Brain. ASTER 70s UNICANCER phase III trial: Can a genomic prognosticator help tailoring adjuvant systemic treatment for luminal breast carcinoma in elderly women? [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr OT3-3-02.
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Dubot C, Bourbouloux E, Mir O, Kirscher S, Rigal O, Ferrero JM, Curé H, Blot E, Allouache D, Cottu P, Romieu G, Lefeuvre C, Malaurie E, Tubiana-Mathieu N, Lacroix-Triki M, Rollot F, Peyro-Saint-Paul H, Orsini C, Bonnetain F, Brain E. ASTER 70s UNICANCER phase III Trial: Can a genomic prognosticator help tailoring adjuvant systemic treatment for luminal breast carcinoma in elderly women? J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dubot C, Tazi Y, Bourbouloux E, Kirscher S, Rigal O, Abadie-Lacourtoisie S, Ferrero J, Curé H, Blot E, Allouache D, Romieu G, Cottu P, Malaurie E, Terret C, Lacroix MT, Rollot F, Paul HPS, Orsini C, Bonnetain F, Brain E. Aster 70S Unicancer Phase III Trial : Adjuvant Treatment for Women Over 70 with Luminal Breast Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bourgeois HP, Solal-Celigny P, Capitain O, Bourbouloux E, Baudon J, Marcq M, Boucher E, Delecroix V, Blot E, Ferec MARC, Egreteau J, Artignan X, Corbinais S, Alleaume C, Cojocarasu O, Hardy-Bessard AC, Naudeix E, Berger V, Ingrand P, Grude F. Assessing 2-month clinical prognosis in patients with solid tumors: Final results of PRONOPALL study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Marie Marcq
- Centre Hospitalier, La Roche-sur-Yon, France
| | | | - Valérie Delecroix
- Pôle Hospitalier Mutualiste de St Nazaire Polyclinique de l'Océan, SAINT NAZAIRE, France
| | | | | | | | | | | | | | | | | | | | | | | | - Francoise Grude
- Observatory of Cancer Bretagne Pays de la Loire, Angers, France
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Dubot C, Bourbouloux E, Tazi Y, Cure H, Ferrero JM, Romieu G, Rigal O, Allouache D, Abadie-Lacourtoisie S, Kirscher S, Ladoire S, Malaurie E, Blot E, Rollot F, Terret C, Baffert S, Lacroix-Triki M, Falandry C, Poggionovo C, Peyro Saint Paul HP, Orsini C, Latouche A, Bonnetain F, Girre V, Brain E. Abstract OT3-1-10: ASTER 70s (UNICANCER phase III trial): Is personalized adjuvant treatment for women over 70 with luminal breast cancer the way to go? Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot3-1-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The question of the additional benefit of adjuvant chemotherapy (CT) compared to hormonal therapy alone (HT) for women >70 with ER+ / HER2- breast cancer (BC) and aggressive characteristics is still unsolved. This trial compares the impact of both strategies on overall survival (OS).
Trial design
Following surgery, ∼2,000 patients will have a Genomic Grade (GG) centrally performed on FFPE specimens. Those with a high or equivocal GG will be randomized HT alone vs HT+CT. Patients with low GG will be followed as an observational cohort. The study, on-going in France since April 2012, has been recently activated in Belgium.
Eligibility criteria
Any ER+ HER2- BC after complete surgery, M0, any pT or pN. Normal organ functions. No specific BC treatment before surgery. Contralateral BC, invasive BC after ductal carcinoma in situ and isolated local invasive relapse when adjuvant systemic treatment is considered are all eligible. Multifocal or bilateral are eligible according to focus with worst GG. The G8 screening tool is used as stratification criteria for randomization.
Specific aims
OS (all deaths) is the primary endpoint. Secondary objectives include competing events, cost-effectiveness and Q-TWiST analysis, geriatric dimension, acceptability/willingness and health-related quality of life including specific ELD15. The Lee's 4-year mortality score is calculated. Translational research will focus on prognostic biomarkers and pharmacogenetic, investigating also the impact of treatments on putative ageing biomarkers as CRAMP, stathmin, EF-1α and chitinase and telomeres length.
Statistical methods
Sample size based on 4-year OS (87.5 vs 80%), bilateral test, α = 0.05, β = 0.20 and HR = 0.60.
In total, 129 events are expected, requiring 340 patients/arm. Considering those lost to follow-up, ∼700 patients in total should be included (5 extra patients/year).
Present accrual and target accrual
As of May 2013, 43 centres have included 406 Patients aged 70-88.
Only 14 GG evaluations were not performed for the following reasons: Patients consent withdrawal (n = 3), tumour block not available for the GG test (n = 5), CT not a treatment option anymore (patients or investigator's decision) (n = 2) or tumour status (ER+/HER2-) not confirmed by central review (n = 4). 8 GG evaluations are on-going.
Of 384 cases with GG report, 160 (42%), 151 (39%) and 65 (17%) were respectively GG-1 (low risk), GG-3 (high risk) and GG-EQ (equivocal); 8 (2%) tests failed for technical reasons. The proportion of high GG in the study (53%) is similar to those observed in previous studies in general BC populations (40% to 60%).
Of 216 GG-3/-EQ cases, 4 were not randomized because of distant metastases detected during extensive work-up (n = 3) and Patient refusal of CT treatment before randomization (n = 1). Five randomizations are on-going.
GG determination was obtained in 384 leading to randomization in 207, totalizing so far 30% of the projected recruitment for the primary objective. This confirms the feasibility of such multicentre strategic program with an innovative prognostic signature in the elderly BC population.
Contact information
c-orsini@unicancer.fr.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT3-1-10.
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Affiliation(s)
- C Dubot
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - E Bourbouloux
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - Y Tazi
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - H Cure
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - J-M Ferrero
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - G Romieu
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - O Rigal
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - D Allouache
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - S Abadie-Lacourtoisie
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - S Kirscher
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - S Ladoire
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - E Malaurie
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - E Blot
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - F Rollot
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - C Terret
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - S Baffert
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - M Lacroix-Triki
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - C Falandry
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - C Poggionovo
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - HP Peyro Saint Paul
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - C Orsini
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - A Latouche
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - F Bonnetain
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - V Girre
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
| | - E Brain
- Hôpital René Huguenin / Institut Curie, Saint-Cloud, France; ICO - Centre René Gauducheau, Nantes, France; Institut Gustave Roussy, Villejuif, France; Institut Jean Godinot, Reims, France; Centre Antoine-Lacassagne, Nice, France; Institut Régional du Cancer Montpellier/Val d'Aurelle - Paul Lamarque, Montpellier, France; Centre Henri Becquerel, Rouen, France; Centre François Baclesse, Caen, France; Institut de Cancérologie de L'Ouest -site Paul Papin, Angers, France; Institut Sainte Catherine, Avignon, France; Centre Georges-François Leclerc, Dijon, France; CHI de Créteil, Creteil, France; CH Bretagne Atlantique, Vannes, France; Centre Saint-Yves, Vannes, France; Institut Curie - Hôpital Claudius Regaud, Paris, France; Centre Léon Bérard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Centre Hospitalier Lyon Sud, Lyon, France; Qiagen Marseille SA, Marseille, France; UNICANCER, Paris, France; CNAM, Paris, France; CHU Besançon, Besancon, France; CHD de Vendée, La Roche sur Yon, France
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Melichar B, DeMichele A, Adenis A, Bourbouloux E, Tan-Chiu E, Niu H, Schusterbauer C, Dansky Ullmann C, Zhang B, Benaim E. Abstract PD5-5: Phase 2 study of single agent MLN8237 (alisertib), an investigational aurora A kinase (AAK) inhibitor, in patients (pts) with relapsed/refractory breast cancer (BrC). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-pd5-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: AAK, a key mitotic regulator, is frequently amplified/overexpressed across a spectrum of tumors, including BrC. AAK overexpression is associated with poor prognosis. MLN8237 is an oral selective AAK inhibitor under evaluation in pts with advanced cancer as a single agent and in combination therapy. A phase 1/2 study (NCT01045421) evaluated MLN8237 in pts with different solid tumors; phase 2 data for the Brc cohort are presented.
Methods: Females aged ≥18 y with relapsed/refractory BrC including HR+, HER2+ and triple-negative histological subtype, ECOG PS 0–1, measurable disease by RECIST v1.1 and ≤4 prior cytotoxic chemotherapy regimens (not including adjuvant, neo-adjuvant; no limitation on prior hormonal or HER2 targeted, immunological or biological agents) were enrolled. Symptomatic brain metastases were excluded (treated stable metastasis allowed). A Simon's optimal 2-stage design was used; 20 pts were initially enrolled, expansion proceeded if ≥2 objective responses were observed in these response-evaluable pts. Pts received MLN8237 50 mg BID for 7 days in 21-day cycles. Primary objective: overall response rate (ORR). Secondary objectives: safety, duration of response (DOR) and progression-free survival (PFS). An exploratory study was performed to assess clinical responses in relation to candidate biomarker dysregulation (mutation, amplification, and deletion) in banked tumor specimens.
Results: As of April, 2013, 53 pts were enrolled: median age was 60 y (range 33–81), median of 4 cycles (range 1–21). 49 pts (92%) were response-evaluable (HR+, n = 26; HER2+, n = 9; triple negative, n = 14). 33% of pts received treatment for ≥6 months (HR+, n = 11 [69%]; HER2+, n = 3 [19%]; triple negative, n = 2 [12%]). ORR (all pts) was 18% and median PFS was 5.42 months. Efficacy data per subgroup are shown in the table. All 53 pts were included in the safety population; drug-related adverse events (AEs) were reported in 51 pts (96%), most frequent were neutropenia (55%), alopecia (49%) and diarrhea (45%). 38 pts (72%) had grade ≥3 drug-related AEs, including neutropenia (49%), leukopenia (21%) and febrile neutropenia (4%). G-CSF use was 32%. 2 pts (4%) discontinued due to AEs (sepsis [grade 4], n = 1; neutropenia [grade 3], n = 1); no on-study deaths were reported. Treatment is ongoing in 3 HR+ pts. Whole-exome sequencing of selected tumor samples was completed. Correlative analysis is ongoing to identify potential genetic markers/mutated pathways associated with clinical response. Preliminary results will be presented.
Conclusions: MLN8237 appears to have a generally manageable toxicity profile and shows signs of single agent antitumor activity in pts with heavily pretreated (different molecular subgroups) of relapsed/refractory BrC supporting further evaluation of MLN8237 in this tumor type in different combination strategies.
Efficacy HR+ (n = 26)HER2+ (n = 9)Triple-negative (n = 14)Best response,%ORR (PR)23227Stable disease653336Progressive disease124457Median DOR, months4.2-*-**Median PFS, months7.94.11.5*2 events, **1 event
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD5-5.
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Affiliation(s)
- B Melichar
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - A DeMichele
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - A Adenis
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - E Bourbouloux
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - E Tan-Chiu
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - H Niu
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - C Schusterbauer
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - C Dansky Ullmann
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - B Zhang
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
| | - E Benaim
- Fakultní Nemocnice Olomouc – Onkologická Klinika, Olomouc, Czech Republic; University of Pennsylvania, Philadelphia, PA; Centre Oscar Lambret, Lille Cedex, France; Institut de Cancérologie de l'Ouest, Nantes, France; Plantation - Florida Cancer Research Institute (Florida Cancer Care), Plantation, FL; Millennium: The Takeda Oncology Company, Cambridge, MA
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Bourbouloux E, Tazi Y, Cure H, Ferrero JM, RIgal O, Romieu G, Rollot-trad F, Lacroix-triki M, Peyro-saint-paul H, Orsini C, Bonnetain F, Brain E. Adjuvant chemotherapy for luminal breast cancer in elderly women: Feasibility of the ongoing ASTER 70S gerico UNICANCER phase III trial. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.066] [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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23
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Caron O, Frébourg T, Bourbouloux E, Bonadona V, Mari V, Maugard C, Eisinger F, Barouk-Simonet E, Gauthier-Villars M, Tinat J, Nogues C, Dugast C, Canale S, Guillemeau C, Benusiglio PR, Brugieres L. Evaluation of whole body MRI for early detection of cancers in subjects with germ-line TP53 mutation (Li-Fraumeni syndrome). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps1607] [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] [Indexed: 11/20/2022] Open
Abstract
TPS1607 Background: The TP53 germline mutation carriers have a huge increase of cancer risk. The cancer spectrum is particularly broad (breast, sarcoma, brain tumour, leukaemia, …). The clinical management of these people is challenging, mainly concerning sarcoma screening. Moreover, some data let speculate that normal cells of these carriers are particular hypersensitive to X-rays. Among major breakthroughs in radiology, whole-body MRI (WBMRI) may contribute to TP53 carriers surveillance. In order to update the french guidelines on Li-Fraumeni families management, the LIFSCREEN study ( NCT01464086 ) was designed to assess its usefulness in France. Methods: This open, randomized, multicentric trial will evaluate the efficacy and tolerability of two screening schemes, avoiding irradiating exams. In the standard arm, people undergo clinical exam, abdominal sonography, brain MRI, Complete Blood Count, breast MRI, breast sonography, depending on the age) at inclusion, Month 12, Month 24, and a study visit at Month 36. In the experimental arm, people included undergo the same scheme, completed by a diffusion WBMRI at M0, M12, M24. At each round, quality of life and psychological impact will be assessed by self-questionnaires and semi-structured qualitative interviews. In an ancillary study, serums will be collected at each step. Subjects meeting these criteria are eligible: any TP53 germline mutation carrier, with or without personal cancer history, aged >5 and <71. A hundred people will be enrolled and randomized. The primary objective is to assess the efficiency of each scheme, evaluated by the cancer incidence at 3 years. Notably, sensitivity and specificity of each exam will be studied. As a secondary objective, the acceptability of each scheme will be assessed by quality of life / psychological questionnaires interpretation (SF-36, HADS, TAS 20, CBCL, CDI, R-CMAS, depending on subject’s age). Recruitment began in December, 2011. To date, 32 patients have been enrolled on 8 french study sites. The study will soon be implemented in another 12 sites. This academic study is, to our knowledge, the first randomized trial on this topic, and supported by the french “Ligue contre le cancer.” Clinical trial information: NCT01464086.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Julie Tinat
- Centre Hospitalier Universitaire, Rouen, France
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24
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Boureau AS, Bourbouloux E, Retornaz F, Berrut G, de Decker L. Effect of burden of comorbidity on optimal breast cancer treatment in older adults. J Am Geriatr Soc 2013; 60:2368-70. [PMID: 23231558 DOI: 10.1111/jgs.12013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Campone M, Isambert N, Bourbouloux E, Roché H, Bonneterre J, Milano G, Fumoleau P. A phase I study of vinflunine in combination with capecitabine in patients with metastatic breast cancer previously treated with anthracyclines and taxanes. Cancer Chemother Pharmacol 2011; 69:871-9. [DOI: 10.1007/s00280-011-1767-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/13/2011] [Indexed: 10/16/2022]
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26
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Bourgeois H, Traore S, Maillard P, Marcq M, Boucher E, Bourbouloux E, Baudon J, Mussault P, Ingrand P, Grude F. 3621 POSTER Assessing 2-month Clinical Prognosis in Patients With Solid Tumours – Final Results of PRONOPALL Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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27
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Redjimi N, Duperrier-Amouriaux K, Raimbaud I, Luescher I, Dojcinovic D, Classe JM, Berton-Rigaud D, Frenel JS, Bourbouloux E, Valmori D, Ayyoub M. NY-ESO-1-specific circulating CD4+ T cells in ovarian cancer patients are prevalently T(H)1 type cells undetectable in the CD25+ FOXP3+ Treg compartment. PLoS One 2011; 6:e22845. [PMID: 21829534 PMCID: PMC3146491 DOI: 10.1371/journal.pone.0022845] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 06/30/2011] [Indexed: 11/18/2022] Open
Abstract
Spontaneous CD4(+) T-cell responses to the tumor-specific antigen NY-ESO-1 (ESO) are frequently found in patients with epithelial ovarian cancer (EOC). If these responses are of effector or/and Treg type, however, has remained unclear. Here, we have used functional approaches together with recently developed MHC class II/ESO tetramers to assess the frequency, phenotype and function of ESO-specific cells in circulating lymphocytes from EOC patients. We found that circulating ESO-specific CD4(+) T cells in EOC patients with spontaneous immune responses to the antigen are prevalently T(H)1 type cells secreting IFN-γ but no IL-17 or IL-10 and are not suppressive. We detected tetramer(+) cells ex vivo, at an average frequency of 1:25,000 memory cells, that is, significantly lower than in patients immunized with an ESO vaccine. ESO tetramer(+) cells were mostly effector memory cells at advanced stages of differentiation and were not detected in circulating CD25(+)FOXP3(+)Treg. Thus, spontaneous CD4(+) T-cell responses to ESO in cancer patients are prevalently of T(H)1 type and not Treg. Their relatively low frequency and advanced differentiation stage, however, may limit their efficacy, that may be boosted by immunogenic ESO vaccines.
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MESH Headings
- Adenocarcinoma, Clear Cell/immunology
- Adenocarcinoma, Clear Cell/metabolism
- Adenocarcinoma, Mucinous/immunology
- Adenocarcinoma, Mucinous/metabolism
- Adult
- Aged
- Antigens, Neoplasm/immunology
- Antigens, Neoplasm/metabolism
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- Cystadenocarcinoma, Serous/immunology
- Cystadenocarcinoma, Serous/metabolism
- Female
- Forkhead Transcription Factors/metabolism
- Humans
- Interleukin-10/metabolism
- Interleukin-17/metabolism
- Interleukin-2 Receptor alpha Subunit/metabolism
- Lymphocyte Count
- Major Histocompatibility Complex
- Membrane Proteins/immunology
- Membrane Proteins/metabolism
- Middle Aged
- Ovarian Neoplasms/immunology
- Ovarian Neoplasms/metabolism
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Th1 Cells/immunology
- Th1 Cells/metabolism
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Affiliation(s)
- Nassima Redjimi
- Institut National de la Santé et de la Recherche Médicale, Unité 892, CLCC René Gauducheau, Saint Herblain, France
| | - Karine Duperrier-Amouriaux
- Institut National de la Santé et de la Recherche Médicale, Unité 892, CLCC René Gauducheau, Saint Herblain, France
| | - Isabelle Raimbaud
- Institut National de la Santé et de la Recherche Médicale, Unité 892, CLCC René Gauducheau, Saint Herblain, France
| | - Immanuel Luescher
- Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Epalinges, Switzerland
| | - Danijel Dojcinovic
- Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Epalinges, Switzerland
| | - Jean-Marc Classe
- Department of Surgery, CLCC René Gauducheau, Saint Herblain, France
| | | | | | | | - Danila Valmori
- Institut National de la Santé et de la Recherche Médicale, Unité 892, CLCC René Gauducheau, Saint Herblain, France
- Faculty of Medicine, University of Nantes, Nantes, France
- * E-mail: (MA); (DV)
| | - Maha Ayyoub
- Institut National de la Santé et de la Recherche Médicale, Unité 892, CLCC René Gauducheau, Saint Herblain, France
- * E-mail: (MA); (DV)
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28
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Bourgeois HP, Traoré S, Solal-Celigny P, Dupuis O, Maillart P, Capitain O, Delva R, Soulie P, Marcq M, Boucher E, Ganem G, Bourbouloux E, Baudon J, Kaassis M, Zinger M, Lafond C, Berger V, Mussault P, Ingrand P, Grude F. Assessing 2-month clinical prognosis in patients with solid tumors: First results of PRONOPALL study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Campone M, Berton-Rigaud D, Bourbouloux E, Sophie S, Zanetti A, Frenel JS. [Her2 positive breast cancer: practices]. Bull Cancer 2011; 98:154-163. [PMID: 21591301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The molecular classification of Perou and Sørlie breast tumors has to streamline, systematize and make effective use of targeted therapies against specific molecular subtypes, including breast HER2 positive. Trastuzumab and lapatinib are currently the two therapies targeting HER2, which have demonstrated their effectiveness in clinical practice. This literature review aims to make the data points on pertinent and useful data for physicians in daily.
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Affiliation(s)
- Mario Campone
- Institut du cancer Nantes-Atlantiques, centre René-Gauducheau, Saint-Herblain, France.
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30
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Frenel JS, Leux C, Pouplin L, Ferron G, Berton Rigaud D, Bourbouloux E, Dravet F, Jaffre I, Classe JM. Oxaliplatin-based hyperthermic intraperitoneal chemotherapy in primary or recurrent epithelial ovarian cancer: A pilot study of 31 patients. J Surg Oncol 2011; 103:10-6. [PMID: 21031424 DOI: 10.1002/jso.21732] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The feasibility and safety of oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) associated with cytoreductive surgery (CRS) was assessed in patients with peritoneal carcinomatosis resulting from primary advanced or relapsing epithelial ovarian cancer (EOC). METHODS Thirty-one patients received neoadjuvant platin-based chemotherapy followed by oxaliplatin-based HIPEC associated with CRS as consolidation of primary therapy (n = 19) or for relapsing disease (n = 12). Grade 3/4 complications were recorded according to National Cancer Institute definitions. RESULTS Median peritoneal carcinomatosis index (PCI) was 2.7 after neoadjuvant chemotherapy. Mean duration of surgery was 352 min (range 105-614) and median hospital stay was 11 days (range 6-87). Grade 3 toxicity was observed in nine patients: five required repeat surgery, two an invasive procedure, four rehospitalization, and three a return to the ICU. No grade 4 toxicity occurred, excepted one hypokalemia. Median progression-free survival (PFS) for primary advanced EOC was 13.2 months and 1-year PFS was 59.3%. Median PFS for relapsing patients was 14.3 months and 1-year PFS was 54.4%. CONCLUSION CRS with oxaliplatin-based HIPEC is feasible and relatively safe in recurrent and primary EOC. HIPEC after neoadjuvant chemotherapy reduces the PCI and decreases the number of surgical procedures and morbidity. Further evaluations of this procedure are required to assess the survival benefits.
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Affiliation(s)
- Jean Sebastien Frenel
- Department of Medical Oncology, Institut de Cancérologie Nantes Atlantique CRLCC René Gauducheau, Boulevard Jacques Monod, Nantes Cedex/Saint-Herblain, France.
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31
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Brain EGC, Mertens C, Girre V, Rousseau F, Blot E, Abadie S, Uwer L, Bourbouloux E, Van Praagh-Doreau I, Mourey L, Kirscher S, Laguerre B, Fourme E, Luneau S, Genève J, Debled M. Impact of liposomal doxorubicin-based adjuvant chemotherapy on autonomy in women over 70 with hormone-receptor-negative breast carcinoma: A French Geriatric Oncology Group (GERICO) phase II multicentre trial. Crit Rev Oncol Hematol 2010; 80:160-70. [PMID: 21035352 DOI: 10.1016/j.critrevonc.2010.10.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 08/27/2010] [Accepted: 10/04/2010] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Breast cancer is a disease of ageing. Functional independence in elderly patients, measured with the Katz activities of daily living (ADL) scale, predicts overall survival and the need for welfare support. Few prospective studies have examined the feasibility of adjuvant chemotherapy and its impact on autonomy in women over 70 years of age with high-risk breast cancer. This multicentre phase II trial was designed to assess the impact of adjuvant anthracycline-based chemotherapy on these patients' autonomy. DESIGN AND METHODS In a two-stage Fleming design, women aged ≥70 years with histologically proven hormone-receptor-negative early breast cancer and a significant risk of recurrence (pN+ or "high risk" pN0) received 4 cycles of nonpegylated liposomal doxorubicin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) every 3 weeks postoperatively, on an outpatient basis. The primary endpoint was the change in the ADL score during chemotherapy. Secondary endpoints include comprehensive geriatric, quality-of-life and acceptability assessments, tolerability, and long-term outcome. The results for the primary endpoint and other scales at completion of adjuvant chemotherapy are reported here, while long-term follow-up is not yet complete. RESULTS Forty patients (median age 75 [70-82]) were enrolled between February 2006 and November 2007. Chemotherapy had no deleterious impact on ADL, cognition, mental status, or the frequency of comorbidities. In contrast, the number of patients at risk of malnutrition, based on the Mini Nutritional Assessment, more than doubled between baseline and the end of chemotherapy, rising from 15% to 38%. Quality-of-life deteriorated in terms of social and role functioning, likely owing to fatigue, loss of appetite, nausea and vomiting. Treatment acceptability was good. The main adverse effect was neutropenia, 15% of the patients experiencing febrile neutropenia. No cardiac toxicity or toxic deaths occurred. CONCLUSION This study demonstrates the feasibility of an adjuvant chemotherapy regimen combining nonpegylated liposomal doxorubicin and cyclophosphamide in fit elderly women <85 years with breast cancer. Although chemotherapy had an impact on social and role functioning, autonomy was not impaired and toxicity was acceptable. Special attention should be paid to nutritional status before and after treatment.
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32
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Isambert N, Campone M, Bourbouloux E, Drouin M, Major A, Yin W, Loadman P, Capizzi R, Grieshaber C, Fumoleau P. Evaluation of the safety of C-1311 (SYMADEX) administered in a phase 1 dose escalation trial as a weekly infusion for 3 consecutive weeks in patients with advanced solid tumours. Eur J Cancer 2010; 46:729-34. [DOI: 10.1016/j.ejca.2009.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 12/01/2009] [Indexed: 11/16/2022]
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Abstract
Lapatinib is an oral, small-molecule, dual kinase inhibitor that targets both HER2 and the EGF receptor. Lapatinib was approved in June 2008 in Europe for the treatment of advanced HER2-positive breast cancer. Promising results in trastuzumab-refractory metastatic breast cancer were obtained from Phase I, II and III studies in combination with chemotherapy. Diarrhea and rash are the most common side-effects and are mostly moderate and treatable. Cardiac toxicity occurs rarely and mostly as an asymptomatic and reversible decrease of left ventricular ejection fraction. Unlike trastuzumab, some data show that lapatinib could cross the blood-brain barrier, with some evidence of activity in treating or preventing brain metastases. Its evaluation is actively ongoing, in combination with trastuzumab and in the adjuvant setting.
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Affiliation(s)
- J-S Frenel
- Oncologie Médicale, Institut Regional du Cancer Nantes Atlantique CRLCC René Gauducheau, Bd Jacques Monod 44805 Nantes Cedex/Saint-Herblain, France.
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34
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Frenel J, Classe J, Dravet F, Leux C, Rigaud DB, Bourbouloux E. 8038 Oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) in primary or recurrent epithelial ovarian cancer: a pilot study of 31 patients. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71560-5] [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: 11/27/2022] Open
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35
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Abadie S, Capitain O, Delva R, Maillart P, Soulié P, Bourbouloux E, Levy C, Delozier T, Campone M, Morin Meschin M, Delecroix V, Ollivier J, Boux de Casson F, Poirier A, Berger V, Fumoleau P, Gamelin E. A multicenter phase II trial of weekly paclitaxel (wPC) and epirubicin (E) in first line metastatic breast cancer (MBC) and pronostic impact of VEGF level. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-6122] [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
Abstract #6122
Background : wPC and E are effective in the treatment of MBC. The main objective was to determine the efficacy of combined induction with wPC and E followed by consolidation with wPC. Secondary objective were to determine tolerance survivals and characterize antiangiogenic PC activity and predictive values of plasmatic neurotrophic and endothelial factors, in terms of neurotoxicity and efficacy.
 Methods : patients (pts) with RECIST measurable metastasis were recruited from april 2004 to may 2006 : ages (18-75 y) PS≤2, prior neoadjuvant adjuvant chemotherapy (NA-A CT) was permited if >6 month. 3 cycles [wPC 80 mg/m² (D1, D8, D15, reinduction D28) and epirubicine 100 mg/m² D15], were followed by wPC (no week rest). VEGF, IL6, IL6SR, BDNF were measured in plasma at baseline and C2. Evaluation was performed after 3 induction cycles and every 3 month. A Simon optimal two-stage design was performed with 13 objective responses, allowing to accrue 25 more patients (28 responses expected).
 Results : 54 patients: median age 58.5 (30-75); 81% had surgery, 53.7% radiotherapy and 40.7% had NA-A CT, 46.3% hormonotherapy. Metastatic sites were nodes (36) lung (36) liver (28) bone (23). 100% PC and 90% E dose were administered at C2 and C3. 49 patients were evaluable for response; 3 patients withdrawn for taxol hypersensitivity, 1 early death (GIII asthenia and dyspnea), 1 investigator's decision. ITT analysis was performed: 33 responses (ORR: 61 %) Median OS was 30 months. During induction, 16 grade III, 27 grade IV and 3 febrile neutropenia were reported. There were 13 serious adverse events.
 Consolidation was mainly associated with neurotoxicity n=28 (20pts), GIII (n=1; 3.6%) GIV (n=1; 3.6%), astenia n=26 (18pts) ), GIII n=1; 3.8% GIV n=1; 3.8%and onycholysis n=15 (13pts) ), GIII n=2 ; 13.4% GIV n=1; 6.7%.
 High initial VEGF plasma levels were correlated with poor survival s (PFS, OS) with an univariate cox model (OR=1.954, 95%CI 0.944-4.043, p=0.071 ; HR 4.437, 95%CI 1.731-11.371, p=0.0019). Thresholds were determined. No correlation were observed between neurotoxicity and IL6, IL6SR and BDNF plasma levels.
 Conclusion : Despite the significant but manageable haematologic toxicity, PC + E showed a high efficacy. VEGF plasma levels are predictive of the outcome and should be tested as antiangiogenic drugs targeting factors.This work was supported in part by BMS.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6122.
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Affiliation(s)
- S Abadie
- 1 Oncology, Centre Paul Papin, Angers, France
| | - O Capitain
- 1 Oncology, Centre Paul Papin, Angers, France
| | - R Delva
- 1 Oncology, Centre Paul Papin, Angers, France
| | - P Maillart
- 1 Oncology, Centre Paul Papin, Angers, France
| | - P Soulié
- 1 Oncology, Centre Paul Papin, Angers, France
| | | | - C Levy
- 3 Oncology, Centre François Baclesse, Caen, France
| | - T Delozier
- 3 Oncology, Centre François Baclesse, Caen, France
| | - M Campone
- 2 Oncology, Centre René Gauducheau, Nantes, France
| | | | - V Delecroix
- 2 Oncology, Centre René Gauducheau, Nantes, France
| | - J Ollivier
- 3 Oncology, Centre François Baclesse, Caen, France
| | | | - A Poirier
- 1 Oncology, Centre Paul Papin, Angers, France
| | - V Berger
- 1 Oncology, Centre Paul Papin, Angers, France
| | - P Fumoleau
- 4 Oncology, Centre Georges-François Leclerc, Dijon, France
| | - E Gamelin
- 1 Oncology, Centre Paul Papin, Angers, France
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Campone M, Levy V, Bourbouloux E, Berton Rigaud D, Bootle D, Dutreix C, Zoellner U, Shand N, Calvo F, Raymond E. Safety and pharmacokinetics of paclitaxel and the oral mTOR inhibitor everolimus in advanced solid tumours. Br J Cancer 2009; 100:315-21. [PMID: 19127256 PMCID: PMC2634724 DOI: 10.1038/sj.bjc.6604851] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Everolimus displays antiproliferative effects on cancer cells, yields antiangiogenic activity in established tumours, and shows synergistic activity with paclitaxel in preclinical models. This study assessed the safety and the pharmacokinetic interactions of everolimus and paclitaxel in patients with advanced malignancies. Everolimus was dose escalated from 15 to 30 mg and administered with paclitaxel 80 mg m−2 on days 1, 8, and 15 every 28 days. Safety was assessed weekly, and dose-limiting toxicity (DLT) was evaluated in cycle 1. A total of 16 patients (median age 54.5 years, range 33–69) were entered; 11 had prior taxane therapy for breast (n=5), ovarian (n=3), and vaginal cancer (n=1) or angiosarcoma (n=2). Grade 3 neutropenia in six patients met the criteria for DLT in two patients receiving everolimus 30 mg weekly. Other drug-related grade 3 toxicities were leucopenia, anaemia, thrombocytopenia, stomatitis, asthenia, and increased liver enzymes. Tumour stabilisation reported in 11 patients exceeded 6 months in 2 patients with breast cancer. Everolimus showed an acceptable safety profile at the dose of 30 mg when combined with weekly paclitaxel 80 mg m−2, warranting further clinical investigation.
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Affiliation(s)
- M Campone
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
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Debled M, Girre V, Mertens C, Blot E, Rousseau F, Abadie S, Uwer L, Bourbouloux E, Fourme E, Gouttenoire F, Brain E. Doxorubin-based adjuvant chemotherapy for elderly patients with hormone receptors negative breast carcinoma: a French geriatric oncology group (GERICO) phase II multicentric program. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Marchand V, Graveleau J, Lanctin-Garcia C, Bourbouloux E, Bridji B, Resche I, Kraeber-Bodéré F, Rousseau C. A rare gynecological case of paraneoplastic cerebellar degeneration discovered by FDG-PET. Gynecol Oncol 2007; 105:545-7. [PMID: 17368524 DOI: 10.1016/j.ygyno.2007.01.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 01/17/2007] [Accepted: 01/20/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND PET/CT may be particularly useful to detect the primary cancer in paraneoplastic cerebellar degeneration (PCD) with anti-Yo which is most commonly associated with breast, ovarian and other gynecological cancers. CASE A 60-year-old woman developed a PCD associated with anti-Yo antibodies in serum and cerebrospinal fluid. Conventional imaging was negative. FDG-PET showed an abnormal hot spot in the right ovarian area associated with lombo aortic lymph nodes. The diagnosis was confirmed by surgery as an ovarian adenocarcinoma. CONCLUSION In this case report, FDG-PET played a crucial role in detecting the unknown primary tumor in a patient with PCD.
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Affiliation(s)
- V Marchand
- Nuclear Medicine Division, Cancer Center, Neurology Unit, University Hospital, Saint-Herblain-Nantes, France.
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Rousseau C, Devillers A, Sagan C, Ferrer L, Bridji B, Campion L, Ricaud M, Bourbouloux E, Doutriaux I, Clouet M, Berton-Rigaud D, Bouriel C, Delecroix V, Garin E, Rouquette S, Resche I, Kerbrat P, Chatal JF, Campone M. Monitoring of early response to neoadjuvant chemotherapy in stage II and III breast cancer by [18F]fluorodeoxyglucose positron emission tomography. J Clin Oncol 2006; 24:5366-72. [PMID: 17088570 DOI: 10.1200/jco.2006.05.7406] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study aimed to assess prospectively the efficacy of sequential [18F]fluorodeoxyglucose positron emission tomography (FDG PET) to evaluate early response to neoadjuvant chemotherapy in stage II and III breast cancer patients. PATIENTS AND METHODS Images were acquired with a PET/computed tomography scanner in 64 patients after administration of FDG (5 MBq/kg) at baseline and after the first, second, third, and sixth course of chemotherapy. Ultrasound and mammography were used to assess tumor size. Decrease in the standardized uptake value (SUV) with PET was compared with the pathologic response. RESULTS Surgery was performed after six courses of chemotherapy and pathologic analysis revealed gross residual disease in 28 patients and minimal residual disease in 36 patients. Although SUV data did not vary much in nonresponders (based on pathology findings), they decreased markedly to background levels in 94% (34 of 36) of responders. When using 60% of SUV at baseline as the cutoff value, the sensitivity, specificity, and negative predictive value of FDG PET were 61%, 96%, and 68% after one course of chemotherapy, 89%, 95%, and 85% after two courses, and 88%, 73%, and 83% after three courses, respectively. The same parameters with ultrasound (US) and mammography were 64%, 43%, and 55%, and 31%, 56%, and 45%, respectively. Assessment of tumor response with US or mammography was never significant whatever the cutoff. CONCLUSION Pathologic response to neoadjuvant chemotherapy in stage II and III breast cancer can be predicted accurately by FDG PET after two courses of chemotherapy.
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Affiliation(s)
- Caroline Rousseau
- Nuclear Medicine Unit, René Gauducheau Cancer Center, Saint Herblain, France
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Campone M, Cortes-Funes H, Vorobiof D, Martin M, Slabber CF, Ciruelos E, Bourbouloux E, Mendiola C, Delgado FM, Colin C, Aslanis V, Fumoleau P. Vinflunine: a new active drug for second-line treatment of advanced breast cancer. Results of a phase II and pharmacokinetic study in patients progressing after first-line anthracycline/taxane-based chemotherapy. Br J Cancer 2006; 95:1161-6. [PMID: 17031408 PMCID: PMC2360552 DOI: 10.1038/sj.bjc.6603347] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
To evaluate the single agent activity, pharmacokinetics and tolerability of the novel tubulin targeted agent vinflunine (VFL) (320 mg m−2 q 21 days) as second-line chemotherapy in patients with metastatic breast carcinoma (MBC). All patients had disease progression after anthracycline/taxane (A/T) therapy. They could have received a nonanthracycline adjuvant treatment and subsequently received a first-line A/T combination for advanced/metastatic disease; or relapsed >6 months after completion of adjuvant A/T therapy and were subsequently treated with the alternative agent; or relapsed within 6 months from an adjuvant A/T combination. Objective response was documented in 18 of 60 patients enrolled (RR: 30% (95% confidence interval (CI): 18.9–43.2%)). Among the responders, seven patients had relapsed during a period of <3 months from taxane-based regimen yielding a RR of 33.3%. The median duration of response was 4.8 months (95% CI: 4.2–7.2), median progression-free survival was 3.7 months (95% CI: 2.8–4.2) and median overall survival was 14.3 months (95% CI: 9.2–19.6). The most frequent adverse event was neutropenia (grade 3 in 28.3% and grade 4 in 36.7% of patients). No febrile neutropenia was observed. Fatigue (grade 3 in 16.7% of patients) and constipation (grade 3 in 11.7% of patients) were also common; these were non-cumulative and manageable permitting achievement of a good relative dose intensity of 93.5%. Vinflunine is an active agent with acceptable tolerance in the management of MBC patients previously treated with (A/T)-based regimens. These encouraging phase II results warrant further investigation of this novel agent in combination with other active agents in this setting or in earlier stages of disease.
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Affiliation(s)
- M Campone
- Centre René Gauducheau, 44805 Saint Herblain, France
| | | | - D Vorobiof
- Sandton Oncology Centre, Sandton, South Africa
| | - M Martin
- Hospital Universitario San Carlos, Madrid, Spain
| | - C F Slabber
- Pretoria Academic Hospital, Pretoria, South Africa
| | - E Ciruelos
- Hospital 12 de Octubre, 28041 Madrid, Spain
| | - E Bourbouloux
- Centre René Gauducheau, 44805 Saint Herblain, France
| | - C Mendiola
- Hospital 12 de Octubre, 28041 Madrid, Spain
| | - F M Delgado
- Institut de Recherche Pierre Fabre, 92654 Boulogne-Billancourt, France
| | - C Colin
- Institut de Recherche Pierre Fabre, 92654 Boulogne-Billancourt, France
| | - V Aslanis
- Institut de Recherche Pierre Fabre, 92654 Boulogne-Billancourt, France
| | - P Fumoleau
- Centre René Gauducheau, 44805 Saint Herblain, France
- Centre GF Leclerc, Département d'Oncologie Médicale, 1 rue du Pr. Marion 21079 DIJON Cedex, France; E-mail:
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Campone M, Isambert N, Bourbouloux E, Maury S, Monin-Baroille P, Berille J, Fumoleau P. Phase I dose-escalation study of a novel antitumor agent, SR271425, administered intravenously in split doses (d1–d2–d3) in patients with refractory solid tumors. Cancer Chemother Pharmacol 2006; 59:689-95. [PMID: 17031647 DOI: 10.1007/s00280-006-0349-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 09/04/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND SR271425 is a novel DNA-binding cytotoxic agent with a broad spectrum of antitumor activity in preclinical models,across a variety of the schedule of administration. In toxicological studies, it has been reported to prolong QTc proportionally to C (max). In order to circumvent this C (max)-related QTc prolongation, 5 phase I studies were initiated to investigate 1-h, 24-h, weekly, and split iv infusions. This phase I study assessed a split-dose regimen (a 1-h infusion on each of Days 1 to 3, repeated every 3 weeks) to establish the dose limiting toxicities (DLT), to recommended a phase II dose, and to characterize PK/PD. METHODS Patient with advanced solid tumors, adequate bone marrow, hepatic, renal function and on specific cardiac criteria were eligible and "3 + 3" design was used for dose escalation. That dose escalation was guided by PK data, toxicities observed and information from other ongoing phase I studies with SR271425. SR271425 plasma levels (PK samples) were measured using a validated LC-MS/MS method. Careful monitoring of ECGs was done, and ECGs were read centrally. RESULTS Three centers enrolled 19 heavily pretreated patients to six dose levels, from 75 to 450 mg/m(2)/day (i.e., 225-1,350 mg/m(2)/cycle): 12 males and 7 females. Median age 56. Median ECOG, PS = 1. Main tumor types were brain, breast, gynecological, and urological. Patients received a median of 2 cycles (range: 1-6). NCI-CTC Grade 1-2 toxicities included nausea, vomiting, asthenia, rash, and yellow skin discoloration. No DLTs were reported, and there were no dose-limiting prolongations of QTc. Both C (end) and AUC increased in a dose-related manner, with no evidence of accumulation between Day 1 and Day 3, consistent with the mean (+/-SD) terminal elimination half-life of 5.11 +/- 1.21 h. Stable disease was observed in five cases. CONCLUSION Split doses allow high cumulative exposure to SR271425 without significant toxicity, especially without QTc prolongation. MTD was not reached due to the early termination of the SR271425 program by the sponsor.
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Affiliation(s)
- M Campone
- CLCC R.Gauducheau, St-Herblain-Nantes, Nantes, France.
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Isambert N, Campone M, Bourbouloux E, Drouin M, Major A, Loadman P, Capizzi R, Grieshaber C, Fumoleau P. Evaluation of the safety of C-1311 administered in a phase I dose-escalation trial as a weekly infusion for 3 consecutive weeks in patients with advanced solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.2069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
2069 Background: C-1311 is the most active member of a new series of anti-cancer agents, the imidazoacridinones, specially designed compounds developed from research on the structure-activity relationships of other cancer therapies such as the anthracenediones (e.g. mitoxantrone) and the anthracyclines (e.g. doxorubicin). This first-in-man clinical trial was designed to assess the safety profile of C-1311 and determine the recommended dose upon weekly administration for 3 consecutive weeks, within a 28-day cycle. Methods: Patients with advanced solid tumors refractory to conventional therapy were enrolled. The dose escalation scheme was divided into 2 phases: an initial accelerated phase of cohorts of 1 patient at doubling doses and a modified Fibonacci phase of cohorts of 3 pts at 25–33% dose increments. The maximum tolerated dose (MTD) was defined as the dose at which 2/3 or 2/6 pts experienced a dose-limiting toxicity (DLT). The recommended dose (RD) was defined as the dose level below the MTD, confirmed by expansion of the cohort to 9 pts. Results: 16 pts received doses of 15, 30, 60, 120, 240, 480 and 640 mg/m2/wk. The 2 pts treated at 640 mg/m2 experienced a DLT (grade 3 neutropenia preventing the administration of the 2nd and 3rd dose of the first cycle respectively). The RD was defined as 480 mg/m2/wk (cohort of 9 pts). Six additional pts were treated at the RD in an extension study in which one of the first 2 doses was given orally. Overall, 2 serious adverse events have been reported as possibly drug-related, both consisting of post-infusion fever without evidence of infection, resolving within 24 hours. Transient neutropenia was the only recurring grade 3 or 4 drug-related adverse event (AE). Grade 1 or 2 AEs most commonly reported as drug-related were nausea, asthenia, vomiting and diarrhea. Stable disease was observed in 3 patients with advanced malignancy. One pt had a stable course over > 8 cycles, and two had stable courses over 4 cycles. Plasma drug concentrations were linear and proportional to dose. Conclusions: The recommended phase 2 dose of 480 mg/m2, weekly × 3 q 28 days, offers a predictable safety profile and excellent tolerability. [Table: see text]
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Affiliation(s)
- N. Isambert
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
| | - M. Campone
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
| | - E. Bourbouloux
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
| | - M. Drouin
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
| | - A. Major
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
| | - P. Loadman
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
| | - R. Capizzi
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
| | - C. Grieshaber
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
| | - P. Fumoleau
- Centre François Leclerc, Dijon, France; Centre René Gauducheau, St. Herblain, France; Xanthus Life Sciences, Montreal, PQ, Canada; University of Bradford, Bradford, United Kingdom; Xanthus Life Sciences, Cambridge, MA
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Bourbouloux E, Campone M, Vermorken JB, Martin M, Sessa C, Perotti A. Phase I study of intravenous (IV) milataxel in adult patients with advanced malignant tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.2037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
2037 Background: M (TL139, MAC-321) is a novel taxane with activity in human xenograft models against tumors resistant to paclitaxel. The maximum tolerated dose (MTD) when given IV every 3 weeks was 35 mg/m2. The current study was designed to determine if the dose intensity of M could be increased by a weekly IV schedule. Methods: The primary objective of the study was to determine the maximum tolerated dose (MTD), the dose limiting toxicity (DLT) and the recommended dose (RD) for phase II. Secondary objectives were pharmacokinetic (PK)/pharmacodynamic (PD) parameters of M given IV weekly and a preliminary estimate of efficacy in an expanded cohort at the RD. Key pt eligibility criteria included in adult pts with refractory malignant tumors, ECOG PS <3 and adequate hematologic, hepatic and renal function. Patients were not allowed concurrent strong inhibitors of cytochrome p450 3A4. Dose escalation was based on Fibonacci method. At the RD, additional pts with tumors that typically respond to taxane treatment were added. PK data were obtained on day 1 and 15. Results: A total of 32 pts were treated, 15 (6 females, 9 males) in the dose escalation part and 17 (15 females, 2 males) in the MTD confirmation part. The median number of doses was 11 (range 1–18). In the dose escalation phase, 3, 4, and 3 pts were treated at 8, 12, and 16 mg/m2 IV weekly without DLT. At 20 mg/m2, 2 of 5 pts developed DLT (1 pt - myalgia and neuropathy, 1 pt grade 4 neutropenia > 5 days in duration). The RD was 16 mg/m2 weekly. 17 more pts were treated at the RD. The most frequent grade 3 or 4 adverse events were asthenia (19%), nausea (9%), parethesia (9%) and neuropathy (9%). Of the 10 pts with breast cancer who were evaluable for response, one had a PR. Another breast cancer pt with a PR was a protocol violation and was not evaluable. In 20 pts at the MTD, the Tmax was 4 hr, the Cmax was 51.97 ng/mL, AUC 2711 ng*hr/mL, and the Vss was 1496 L/m2. Conclusions: Milataxel had an RD of 16 mg/m2 IV per week. Objective responses were observed in pts with metastatic breast cancer. No significant financial relationships to disclose.
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Affiliation(s)
- E. Bourbouloux
- Centre René Gauducheau, St. Herblain, France; University Hospital, Antwerp, Belgium; Hospital Clinico Universitario San Carlos, Madrid, Spain; Ospedale San Giovani, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milan, Italy
| | - M. Campone
- Centre René Gauducheau, St. Herblain, France; University Hospital, Antwerp, Belgium; Hospital Clinico Universitario San Carlos, Madrid, Spain; Ospedale San Giovani, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milan, Italy
| | - J. B. Vermorken
- Centre René Gauducheau, St. Herblain, France; University Hospital, Antwerp, Belgium; Hospital Clinico Universitario San Carlos, Madrid, Spain; Ospedale San Giovani, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milan, Italy
| | - M. Martin
- Centre René Gauducheau, St. Herblain, France; University Hospital, Antwerp, Belgium; Hospital Clinico Universitario San Carlos, Madrid, Spain; Ospedale San Giovani, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milan, Italy
| | - C. Sessa
- Centre René Gauducheau, St. Herblain, France; University Hospital, Antwerp, Belgium; Hospital Clinico Universitario San Carlos, Madrid, Spain; Ospedale San Giovani, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milan, Italy
| | - A. Perotti
- Centre René Gauducheau, St. Herblain, France; University Hospital, Antwerp, Belgium; Hospital Clinico Universitario San Carlos, Madrid, Spain; Ospedale San Giovani, Bellinzona, Switzerland; Istituto Nazionale dei Tumori, Milan, Italy
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Rousseau C, Bourbouloux E, Campion L, Fleury N, Bridji B, Chatal JF, Resche I, Campone M. Brown fat in breast cancer patients: analysis of serial 18F-FDG PET/CT scans. Eur J Nucl Med Mol Imaging 2006; 33:785-91. [PMID: 16596378 DOI: 10.1007/s00259-006-0066-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Accepted: 12/12/2005] [Indexed: 12/31/2022]
Abstract
PURPOSE It has recently been suggested that FDG accumulation in the brown adipose tissue varies as a function of age, sex and outdoor temperature. The aim of this study was to assess changes in FDG uptake in brown fat in patients based on serial PET/CT scans and to compare our results with previous findings. METHODS Early response to neoadjuvant chemotherapy in 33 female breast cancer patients was assessed by FDG PET. Five PET/CT scans were performed for each patient. PET/CT images were analysed retrospectively. PET scans were considered positive when diffuse, symmetrical, abnormal "USA" (uptake in supraclavicular area) fat was detected. RESULTS A total of 163 PET images were analysed. Seventy-four PET scans (45%) revealed abnormal FDG uptake in the supraclavicular area. These foci were present on uncorrected and attenuation-corrected images. FDG uptake was identical on all five scans in only five patients. No significant relationship was found between abnormal FDG uptake and outdoor temperature, age or time interval between chemotherapy and PET. Abnormal FDG uptake in the neck seemed to predominantly occur in patients with a low body mass index (p<0.05). Most significant changes in the PET/CT scan results were observed during chemotherapy with docetaxel (p<0.05). When observed, bilateral uptake in the neck was more intense than background uptake (p<0.00001). CONCLUSION This study shows that FDG uptake in the neck varies as a function of time, that it is unrelated to age or outdoor temperature, and that bilateral uptake is generally intense.
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Affiliation(s)
- C Rousseau
- Nuclear Medicine Unit, René Gauducheau Cancer Center, Boulevard Monod, 44805 Nantes-Saint Herblain, France.
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Campone M, Fumoleau P, Bourbouloux E, Kerbrat P, Roché H. Taxanes in adjuvant breast cancer setting: which standard in Europe? Crit Rev Oncol Hematol 2005; 55:167-75. [PMID: 16039867 DOI: 10.1016/j.critrevonc.2005.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2004] [Revised: 03/30/2005] [Accepted: 04/19/2005] [Indexed: 11/20/2022] Open
Abstract
The clinical studies of cooperators groups (trials CALGB 9344, NSABP-B-28, BCIRG 001, PACS01 and CALGB 9741) demonstrated, in the adjuvant breast cancer setting, that taxanes (paclitaxel and docetaxel) improved both disease free and overall survival (trials CALGB 9344, BCIRG 001 and PACS 01). However, the debate remains open in Europe. Less than 50% of the expert present at the last St. Gallen Conference recommended the use of taxanes in adjuvant setting. The reasons for this are primarily related to the fact that the comparator arms of cooperators group (AC, FAC and FEC 100) are considered by some Europe groups as being less effective than the European standards (chemotherapy (CMF) and Epirubicine-CMF). Many questions remain unanswered, including whether the use of taxanes should be sequential or concomitant, and which population would benefit from such a treatment: patients with hormone-receptor negative disease and/or the HER-2 positive tumors?
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Affiliation(s)
- Mario Campone
- Centre René Gauducheau, Boulevard Jacques Monod, 44 805 Nantes Cedex/Saint Herblain, France.
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Fumoleau P, Campone M, Isambert N, Maury S, Monin-Baroille P, Bourbouloux E, Schackleton G, de Braud F, Berille J, Dujardin F. A phase-I dose-escalation study of SR271425 administered intravenously in split doses (d1-d2-d3) in patients with refractory solid tumors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. Fumoleau
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - M. Campone
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - N. Isambert
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - S. Maury
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - P. Monin-Baroille
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - E. Bourbouloux
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - G. Schackleton
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - F. de Braud
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - J. Berille
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
| | - F. Dujardin
- Ctr G-F Leclerc, Dijon, France; CRLCC Nantes Atlantique, St-Herblain Cedex, France; Sanofi-Aventis, Alnwick, United Kingdom; Inst Europeo Di Oncologia, Milano, Italy; Sanofi-Aventis, Chilly-Mazarin, France
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Campone M, Bourbouloux E, Fumoleau P. [Cardiac dysfunction induced by trastuzumab]. Bull Cancer 2004; 91 Suppl 3:166-73. [PMID: 15899624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Trastuzumab combined to chemotherapy had demonstrated significant improvement of time to progression and survival in metastatic breast cancer patient overexpressing HER-2. Cardiac toxicity was an unexpected side effect. The incidence of cardiac dysfunction was dependent on prior or current anthracycline exposure. The mechanism of action involved for this cardiac toxicity is unclear. We discuss in this article the incidence, the physiopathology, the risk factors, the predictive factors and the patient management and on cardiotoxicity of trastuzumab.
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Affiliation(s)
- Mario Campone
- Centre René-Gauducheau, Boulevard Jacques-Monod, 44805 Nantes Cedex.
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48
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Campone M, Levy V, Delecroix V, Bourbouloux E, Bootle D, Tanaka C, Shand N, Calvo F, Raymond E. 359 Phase Ib and pharmacokinetic studies of Everolimus (RAD001), a novel oral mTOR-inhibitor, with paclitaxel in patients with advanced solid tumors. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80366-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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