1
|
Assenat E, de la Fouchardière C, Portales F, Ychou M, Debourdeau A, Desseigne F, Iltache S, Fiess C, Mollevi C, Mazard T. Sequential first-line treatment with nab-paclitaxel/gemcitabine and FOLFIRINOX in metastatic pancreatic adenocarcinoma: GABRINOX phase Ib-II controlled clinical trial. ESMO Open 2021; 6:100318. [PMID: 34837745 PMCID: PMC8637474 DOI: 10.1016/j.esmoop.2021.100318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nab-paclitaxel/gemcitabine (AG) and FOLFIRINOX (FFX) are promising drugs in metastatic pancreatic cancer (MPC). This study evaluated a new first-line sequential treatment (AG followed by FFX) in MPC that might overcome resistance to primary therapy and delay tumor progression. PATIENTS AND METHODS Patients with histologically/cytologically confirmed MPC were included in a multicentric trial receiving AG (day 1, 8 and 15) followed by FFX (day 29 and 43). In phase Ib, three dose-levels were tested for maximum tolerated dose (MTD) and recommended phase II dose. In phase II, the main outcome was the objective response rate (ORR) and secondarily safety, progression-free survival (PFS) and overall survival (OS). RESULTS In phase Ib, we included 33 patients (31 assessable) of median age 61.0 years (range 42-75 years) and represented by 54.8% males. Five dose-limiting toxicities were reported without any death. The main grade 3/4 toxicities were neutropenia with spontaneous resolution (35.5%/32.3%), venous thromboembolism (grade 3: 22.6%) and thrombopenia (grade 3: 29.0%), while the MTD was not reached. In phase II, we included 58 patients of median age 60 years (range 34-72 years), 50% males and with Eastern Cooperative Oncology Group stage score 0 and 1 of 37.9% and 62.1%, respectively. They received a median of 4 (1-9) cycles in 8.5 months (0.5-19.8 months). The ORR was 64.9% [95% confidence interval (CI) 51.1% to 77.1%], and neurotoxicity was remarkably low. The main grade 3-4 toxicities were venous thromboembolism, thrombopenia, neutropenia/febrile neutropenia, nausea, diarrhea, weight loss and asthenia without any death. Tumor response was complete in 3.5% and partial in 61.4%, while disease was stable in 19.3% and progressive in 15.8% of patients. The median PFS was 10.5 months (95% CI 6.0-12.5 months) and median OS was 15.1 months (95% CI 10.6-20.1 months). CONCLUSION Sequential AG and FFX showed acceptable toxicity as first-line treatment with no limiting neurotoxicity, while high response rate and survival justify randomized trials.
Collapse
Affiliation(s)
- E Assenat
- Medical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France; CHU Montpellier, University of Montpellier, Montpellier, France.
| | | | - F Portales
- Medical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - M Ychou
- Medical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, University of Montpellier, Montpellier, France
| | - A Debourdeau
- CHU Montpellier, University of Montpellier, Montpellier, France
| | - F Desseigne
- Medical Oncology Department, Léon Bérard Centre, Lyon, France
| | - S Iltache
- CHU Montpellier, University of Montpellier, Montpellier, France
| | - C Fiess
- Medical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France; Clinical Research and Innovation Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - C Mollevi
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique (IDESP), INSERM UMR UA 11, University of Montpellier, Montpellier, France
| | - T Mazard
- Medical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, University of Montpellier, Montpellier, France
| |
Collapse
|
2
|
Heudel P, Chabaud S, Perol D, Flechon A, Fayette J, Combemale P, Tredan O, Desseigne F, de la Fouchardiere C, Boyle H, Perol M, Bachelot T, Cassier P, Avrillon V, Terret C, Michallet AS, Neidhardt-Berard EM, Nicolas-Virelizier E, Dufresne A, Belhabri A, Brahmi M, Lebras L, Nicolini F, Sarabi M, Rey P, Bonneville-Levard A, Rochefort P, Provensal AM, Eberst L, Assaad S, Swalduz A, Saintigny P, Toussaint P, Guillermin Y, Castets M, Coutzac C, Meeus P, Dupré A, Durand T, Crochet H, Fervers B, Gomez F, Rivoire M, Gregoire V, Claude L, Chassagne-Clement C, Pilleul F, Mognetti T, Russias B, Soubirou JL, Lasset C, Chvetzoff G, Mehlen P, Beaupère S, Zrounba P, Ray-Coquard I, Blay JY. Immune checkpoint inhibitor treatment of a first cancer is associated with a decreased incidence of second primary cancer. ESMO Open 2021; 6:100044. [PMID: 33516148 PMCID: PMC7844579 DOI: 10.1016/j.esmoop.2020.100044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background Second primary cancers (SPCs) are diagnosed in over 5% of patients after a first primary cancer (FPC). We explore here the impact of immune checkpoint inhibitors (ICIs) given for an FPC on the risk of SPC in different age groups, cancer types and treatments. Patients and methods The files of the 46 829 patients diagnosed with an FPC in the Centre Léon Bérard from 2013 to 2018 were analyzed. Structured data were extracted and electronic patient records were screened using a natural language processing tool, with validation using manual screening of 2818 files of patients. Univariate and multivariate analyses of the incidence of SPC according to patient characteristics and treatment were conducted. Results Among the 46 829 patients, 1830 (3.9%) had a diagnosis of SPC with a median interval of 11.1 months (range 0-78 months); 18 128 (38.7%) received cytotoxic chemotherapy (CC) and 1163 (2.5%) received ICIs for the treatment of the FPC in this period. SPCs were observed in 7/1163 (0.6%) patients who had received ICIs for their FPC versus 437/16 997 (2.6%) patients receiving CC and no ICIs for the FPC versus 1386/28 669 (4.8%) for patients receiving neither CC nor ICIs for the FPC. This reduction was observed at all ages and for all histotypes analyzed. Treatment with ICIs and/or CC for the FPC are associated with a reduced risk of SPC in multivariate analysis. Conclusion Immunotherapy with ICIs alone and in combination with CC was found to be associated with a reduced incidence of SPC for all ages and cancer types. From 2013 to 2018, 3.9% of the 46 829 patients diagnosed with a first cancer presented with an SPC. Treatment of the first cancer with ICIs was associated with a major reduction of SPC. CC given for an FPC was also associated with a lower magnitude of reduction of SPC. There were no SPC in cancer patients treated with ICIs in the localized phase of their first cancer.
Collapse
Affiliation(s)
- P Heudel
- Centre Léon Bérard, Lyon, France
| | | | - D Perol
- Centre Léon Bérard, Lyon, France
| | | | | | | | - O Tredan
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - H Boyle
- Centre Léon Bérard, Lyon, France
| | - M Perol
- Centre Léon Bérard, Lyon, France
| | - T Bachelot
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - C Terret
- Centre Léon Bérard, Lyon, France
| | | | | | | | - A Dufresne
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | - M Brahmi
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - L Lebras
- Centre Léon Bérard, Lyon, France
| | - F Nicolini
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - M Sarabi
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - P Rey
- Centre Léon Bérard, Lyon, France
| | | | | | | | - L Eberst
- Centre Léon Bérard, Lyon, France
| | - S Assaad
- Centre Léon Bérard, Lyon, France
| | | | - P Saintigny
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - M Castets
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - C Coutzac
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - P Meeus
- Centre Léon Bérard, Lyon, France
| | - A Dupré
- Centre Léon Bérard, Lyon, France
| | - T Durand
- Centre Léon Bérard, Lyon, France
| | | | | | - F Gomez
- Centre Léon Bérard, Lyon, France
| | - M Rivoire
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - L Claude
- Centre Léon Bérard, Lyon, France
| | | | - F Pilleul
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | | | | | - C Lasset
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - P Mehlen
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - S Beaupère
- Centre Léon Bérard, Lyon, France; Unicancer, Paris, France
| | | | - I Ray-Coquard
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - J-Y Blay
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France; Unicancer, Paris, France.
| |
Collapse
|
3
|
Bonnet E, Mastier C, Lardy-Cléaud A, Rochefort P, Sarabi M, Guibert P, Cattey-Javouhey A, Desseigne F, de La Fouchardière C. FOLFIRINOX in patients with peritoneal carcinomatosis from pancreatic adenocarcinoma: a retrospective study. ACTA ACUST UNITED AC 2019; 26:e466-e472. [PMID: 31548814 DOI: 10.3747/co.26.4903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Peritoneal carcinomatosis (pcm) in metastatic pancreatic ductal adenocarcinomas (mpdac) is frequently encountered in day-to-day practice, but rarely addressed in the literature. The objective of the present study was to describe the management and outcome of patients diagnosed with pcm. Methods Data for all consecutive patients with mpdac treated in our centre between 1 January 2014 and 31 August 2015 were analyzed retrospectively. Computed tomography imaging was centrally reviewed by a dedicated radiologist to determine the date of pcm diagnosis. Results The analysis included 48 patients. Median age in the group was 61 years, and 41 patients had an Eastern Cooperative Oncology Group performance status (ecog ps) of 0-1. All patients presented with pcm either synchronously (group 1) or metachronously (group 2). Those groups differed significantly by baseline ecog ps and neutrophil-to-lymphocyte ratio (nlr), with ecog ps being poorer and nlr being higher in group 1. In addition to pcm, the main sites of metastasis were liver (62.5%) and lungs (31.3%). First-line chemotherapy in 36 patients (75%) was folfirinox (fluorouracil-irinotecan-leucovorin-oxaliplatin). The median overall survival for the entire population was 10.81 months [95% confidence interval (ci): 7.16 months to 14.16 months]; it was 13.17 months (95% ci: 5.9 months to 15.4 months) for patients treated with folfirinox. Median overall survival was 7.13 months (95% ci: 4.24 months to 10.41 months) for patients in group 1 and 14.34 months (95% ci: 9.79 months to 19.91 months) for patients in group 2, p = 0.1296. Conclusions Compared with other metastatic sites, synchronous pcm seems to be a poor prognostic factor. It could be more frequently associated with a poor ecog ps and a nlr greater than 5 in this group of patients. In patients with mpdac and pcm, either synchronous or metachronous, folfirinox remains an efficient regimen.
Collapse
Affiliation(s)
- E Bonnet
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - C Mastier
- Radiology Department, Centre Léon Bérard, Lyon, France
| | - A Lardy-Cléaud
- Clinical Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - P Rochefort
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - M Sarabi
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - P Guibert
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | | | - F Desseigne
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | | |
Collapse
|
4
|
Trédan O, Wang Q, Pissaloux D, Cassier P, de la Fouchardière A, Fayette J, Desseigne F, Ray-Coquard I, de la Fouchardière C, Frappaz D, Heudel PE, Bonneville-Levard A, Fléchon A, Sarabi M, Guibert P, Bachelot T, Pérol M, You B, Bonnin N, Collard O, Leyronnas C, Attignon V, Baudet C, Sohier E, Villemin JP, Viari A, Boyault S, Lantuejoul S, Paindavoine S, Treillleux I, Rodriguez C, Agrapart V, Corset V, Garin G, Chabaud S, Pérol D, Blay JY. Molecular screening program to select molecular-based recommended therapies for metastatic cancer patients: analysis from the ProfiLER trial. Ann Oncol 2019; 30:757-765. [PMID: 30865223 DOI: 10.1093/annonc/mdz080] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Antitumor activity of molecular-targeted agents is guided by the presence of documented genomic alteration in specific histological subtypes. We aim to explore the feasibility, efficacy and therapeutic impact of molecular profiling in routine setting. PATIENTS AND METHODS This multicentric prospective study enrolled adult or pediatric patients with solid or hematological advanced cancer previously treated in advanced/metastatic setting and noneligible to curative treatment. Each molecular profile was established on tumor, relapse or biopsies, and reviewed by a molecular tumor board (MTB) to identify molecular-based recommended therapies (MBRT). The main outcome was to assess the incidence rate of genomic mutations in routine setting, across specific histological types. Secondary objectives included a description of patients with actionable alterations and for whom MBRT was initiated, and overall response rate. RESULTS Four centers included 2579 patients from February 2013 to February 2017, and the MTB reviewed the molecular profiles achieved for 1980 (76.8%) patients. The most frequently altered genes were CDKN2A (N = 181, 7%), KRAS (N = 177, 7%), PIK3CA (N = 185, 7%), and CCND1 (N = 104, 4%). An MBRT was recommended for 699/2579 patients (27%), and only 163/2579 patients (6%) received at least one MBRT. Out of the 182 lines of MBRT initiated, 23 (13%) partial responses were observed. However, only 0.9% of the whole cohort experienced an objective response. CONCLUSION An MBRT was provided for 27% of patients in our study, but only 6% of patients actually received matched therapy with an overall response rate of 0.9%. Molecular screening should not be used at present to guide decision-making in routine clinical practice outside of clinical trials.This trial is registered with ClinicalTrials.gov, number NCT01774409.
Collapse
Affiliation(s)
- O Trédan
- Departments of Medical Oncology, University Claude Bernard
| | - Q Wang
- Translational Research and Innovation
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - B You
- Department of Medical Oncology, Lyon Sud Hospital Center, CITOHL, Institute of Cancerology, Hospices Civils de Lyon (IC-HCL), Lyon; Faculty of Medicine-Lyon Sud, EMR UCBL/HCL 3738, University of Lyon 1, Oullins
| | - N Bonnin
- Department of Medical Oncology, Lyon Sud Hospital Center, CITOHL, Institute of Cancerology, Hospices Civils de Lyon (IC-HCL), Lyon
| | - O Collard
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez
| | - C Leyronnas
- Department of Medical Oncology, Mutualist Hospital Group, Grenoble
| | | | - C Baudet
- Synergie Lyon Cancer, Bio-Informatics Platform
| | - E Sohier
- Synergie Lyon Cancer, Bio-Informatics Platform
| | | | - A Viari
- Synergie Lyon Cancer, Bio-Informatics Platform
| | - S Boyault
- Translational Research and Innovation
| | | | | | | | - C Rodriguez
- BioPathology, Léon Bérard Cancer center, Lyon
| | - V Agrapart
- Department of Clinical Research and Innovation, Léon Bérard Cancer Center, Lyon, France
| | - V Corset
- Department of Clinical Research and Innovation, Léon Bérard Cancer Center, Lyon, France
| | - G Garin
- Department of Clinical Research and Innovation, Léon Bérard Cancer Center, Lyon, France
| | - S Chabaud
- Department of Clinical Research and Innovation, Léon Bérard Cancer Center, Lyon, France
| | - D Pérol
- Department of Clinical Research and Innovation, Léon Bérard Cancer Center, Lyon, France
| | - J-Y Blay
- Departments of Medical Oncology, University Claude Bernard.
| |
Collapse
|
5
|
Aparicio T, Ducreux M, Faroux R, Barbier E, Manfredi S, Lecomte T, Etienne PL, Bedenne L, Bennouna J, Phelip JM, François E, Michel P, Legoux JL, Gasmi M, Breysacher G, Rougier P, De Gramont A, Lepage C, Bouché O, Seitz JF, Adenis A, Alessio A, Aouakli A, Azzedine A, Bedjaoui A, Bidault A, Blanchi A, Botton A, Cadier-Lagnes A, Fatisse A, Gagnaire A, Gilbert A, Gueye A, Hollebecque A, Lemaire A, Mahamat A, Marre A, Patenotte A, Rotenberg A, Roussel A, Thirot-Bidault A, Votte A, Weber A, Zaanan A, Dupont-Gossart A, Villing A, Queuniet A, Coudert B, Denis B, Garcia B, Lafforgue B, Landi B, Leduc B, Linot B, Paillot B, Rhein B, Winkfield B, Barberis C, Becht C, Belletier C, Berger C, Bineau C, Borel C, Brezault C, Buffet C, Cornila C, Couffon C, De La Fouchardière C, Giraud C, Lecaille C, Lepere C, Lobry C, Locher C, Lombard-Bohas C, Paoletti C, Platini C, Rebischung C, Sarda C, Vilain C, Briac-Levaché C, Auby D, Baudet-Klepping D, Bechade D, Besson D, Cleau D, Festin D, Gargot D, Genet D, Goldfain D, Luet D, Malka D, Peré-Vergé D, Pillon D, Sevin-Robiche D, Smith D, Soubrane D, Tougeron D, Zylberait D, Carola E, Cuillerier E, Dorval Danquechin E, Echinard E, Janssen E, Maillard E, Mitry E, Norguet-Monnereau E, Suc E, Terrebonne E, Zrihen E, Pariente E, Almaric F, Audemar F, Bonnetain F, Desseigne F, Dewaele F, Di Fiore F, Ghiringhelli F, Husseini F, Khemissa F, Kikolski F, Morvan F, Petit-Laurent F, Riot F, Subtil F, Zerouala-Boussaha F, Caroli-Bosc F, Boilleau-Jolimoy G, Bordes G, Cavaglione G, Coulanjon G, Deplanque G, Gatineau-Saillant G, Goujon G, Medinger G, Roquin G, Brixi-Benmansour H, Castanie H, Lacroix H, Maechel H, Perrier H, Salloum H, Senellart H, Baumgaertner I, Cumin I, Graber I, Trouilloud I, Boutin J, Butel J, Charneau J, Cretin J, Dauba J, Deguiral J, Egreteau J, Ezenfis J, Forestier J, Goineau J, Lacourt J, Lafon J, Martin J, Meunier J, Moreau J, Provencal J, Taieb J, Thaury J, Tuaillon J, Vergniol J, Villand J, Vincent J, Volet J, Bachet J, Barbare J, Souquet J, Grangé J, Dor J, Paitel J, Jouve J, Raoul J, Cheula J, Gornet J, Sabate J, Vantelon J, Vaillant J, Aucouturier J, Barbieux J, Herr J, Lafargue J, Lagasse J, Latrive J, Plachot J, Ramain J, Robin J, Spano J, Douillard J, Beerblock K, Bouhier-Leporrier K, Slimane Fawzi K, Cany L, Chone L, Dahan L, Gasnault L, Rob L, Stefani L, Wander L, Baconnier M, Ben Abdelghani M, Benchalal M, Blasquez M, Carreiro M, Charbit M, Combe M, Duluc M, Fayolle M, Gignoux M, Giovannini M, Glikmanas M, Mabro M, Mignot M, Mornet M, Mousseau M, Mozer M, Pauwels M, Pelletier M, Porneuf M, Ramdani M, Schnee M, Tissot M, Zawadi M, Clavero-Fabri M, Gouttebel M, Kaminsky M, Galais M, Abdelli N, Barrière N, Bouaria N, Bouarioua N, Delas N, Gérardin N, Hess-Laurens N, Stremsdoerfer N, Berthelet O, Boulat O, Capitain O, Favre O, Amoyal P, Bergerault P, Burtin P, Cassan P, Chatrenet P, Chiappa P, Claudé P, Couzigou P, Feydy P, Follana P, Geoffroy P, Godeau P, Hammel P, Laplaige P, Lehair P, Martin P, Novello P, Pantioni P, Pienkowski P, Pouderoux P, Prost P, Ruszniewski P, Souillac P, Texereau P, Thévenet P, Haineaux P, Benoit R, Coriat R, Lamy R, Mackiewicz R, Beorchia S, Chaussade S, Hiret S, Jacquot S, Lavau Denes S, Montembault S, Nahon S, Nasca S, Nguyen S, Oddou-Lagraniere S, Pesque-Penaud S, Fratte S, Chatellier T, Mansourbakht T, Morin T, Walter T, Boige V, Bourgeois V, Derias V, Guérin-Meyer V, Hautefeuille V, Jestin Le Tallec V, Lorgis V, Quentin V, Sebbagh V, Veuillez V, Adhoute X, Coulaud X, Becouarn Y, Coscas Y, Courouble Y, Le Bricquir Y, Molin Y, Rinaldi Y, Lam Y, Ladhib Z. Overweight is associated to a better prognosis in metastatic colorectal cancer: A pooled analysis of FFCD trials. Eur J Cancer 2018; 98:1-9. [DOI: 10.1016/j.ejca.2018.03.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
|
6
|
Cassier P, de la Fouchardiere C, Guibert P, Pissaloux D, Pacaux C, Terret C, Eberst L, Sarabi M, Attignon V, Wang Q, Corset V, Perol D, Blay JY, Desseigne F. Actionable molecular alterations in advanced biliary tract carcinomas: Preliminary data from the ProfiLER program (NCT01774409). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
7
|
Assenat E, Fouchardiere C, Mollevi C, Samalin E, Portales F, Desseigne F, Carenco C, Dupuy M, Lopez-Martinez E, Fiess C, Mazard T, Ychou M. Gabrinox: A phase I-II of nab-paclitaxel plus gemcitabine followed by folfirinox in metastatic pancreatic adenocarcinoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
8
|
Mineur L, Deplanque G, Desseigne F, Moureau-Zabotto L, Boulat O, Jalali K, Smith D, Obled S, Belkacemi M. P-284 NESC Multicenter phase II trial in the Preoperative Treatment of gastric adenocarcinoma consisting of chemotherapy using docetaxel-cisplatin-5FU + lenograstim followed by chemoradiation (RTCT) based 5FU and oxaliplatin and surgery. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Kramar A, Paule B, Burtin P, Tougeron D, Desseigne F, Dourthe L, Wallet J, Etienne PL, Mineur L, Becuwe C, Maes P, Dauba J, Michel P, Hollebecque A, Linot B, Morere J, Fouchardiere CDL, Phelip J, Andre T, Adenis A. 2090 Prognostic score (REGOSCORE) for survival after Regorafenib (RE) treatment for patients (pts) with pretreated metastatic colorectal cancer (mCRC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31012-7] [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: 11/27/2022]
|
10
|
Jiang X, Pissaloux D, De La Fouchardiere C, Desseigne F, Wang Q, Fondrevelle M, Cassier P, Seigne C, Perol D, Ray-Coquard I, Le Cesne A, Penel N, Tredan O, Blay J. 209 The sum of gains and losses of genes encoding for protein tyrosine kinase targets predicts response to multi-kinase inhibitor treatment. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30097-1] [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: 10/22/2022]
|
11
|
Beji H, De La Fouchardière C, Desseigne F, Thiesse P, Richioud B, Pilleul F. Thrombocytopenia due to hypersplenism in oncological disease: partial splenic embolization during palliative treatment. Diagn Interv Imaging 2015; 96:383-6. [PMID: 25737395 DOI: 10.1016/j.diii.2014.08.005] [Citation(s) in RCA: 4] [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] [Received: 03/25/2014] [Revised: 08/21/2014] [Accepted: 08/27/2014] [Indexed: 12/14/2022]
Abstract
Hypersplenism is excess activity of the spleen, resulting in peripheral pancytopenia that predominates in platelet cell lines. Pancytopenia can be limited by reducing the volume of the functional spleen. However, in patients in very poor general condition, a splenectomy may not be possible, due to the risks of surgery and postoperative infection. Another therapeutic alternative in these patients is to reduce the volume of the spleen by super selective percutaneous splenic embolization. We report three cases of peripheral thrombocytopenia due to hypersplenism with a platelet count between 60,000 and 80,000/mm(3), which made it impossible to continue or start a chemotherapy protocol in these patients. For these patients, super selective partial embolization of the splenic parenchyma, with uncharged microspheres (250 microns) quickly resulted in a platelet count above 150,000/mm(3) so that chemotherapy could be continued or initiated.
Collapse
Affiliation(s)
- H Beji
- Service de radiologie interventionnelle, centre de lutte contre le cancer Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France.
| | - C De La Fouchardière
- Service d'oncologie digestive, centre de lutte contre le cancer Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - F Desseigne
- Service d'oncologie digestive, centre de lutte contre le cancer Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - P Thiesse
- Service de radiologie interventionnelle, centre de lutte contre le cancer Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - B Richioud
- Service de radiologie interventionnelle, centre de lutte contre le cancer Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - F Pilleul
- Service de radiologie interventionnelle, centre de lutte contre le cancer Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| |
Collapse
|
12
|
Tougeron D, Desseigne F, Etienne P, Dourthe L, Mineur L, Paule B, Hollebecque A, Tresch E, Spaeth D, Michel P, Dauba J, Laplaige P, Borg C, Bechade D, Clisant S, Phelip J, De Fouchardiere C, André T, Adenis A. Rebecca: a Large Cohort Study of Regorafenib (Reg) in the Real-Life Setting in Patients (Pts) Previously Treated for Metastatic Colorectal Cancer (Mcrc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
13
|
Belbarka R, Fadoukheir Z, Delafouchardiere C, Desseigne F, Errihani H. An unusual presentation of pancreatic cancer: Muscular metastasis. Indian J Cancer 2014; 51:369-370. [PMID: 25494141 DOI: 10.4103/0019-509x.146714] [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: 11/04/2022]
Affiliation(s)
- R Belbarka
- Department of Medical Oncology, Centre Oncology-Hematology, Cadi Ayad University, Marrakech, Morocco
| | | | | | | | | |
Collapse
|
14
|
Bidard FC, Huguet F, Louvet C, Mineur L, Bouché O, Chibaudel B, Artru P, Desseigne F, Bachet JB, Mathiot C, Pierga JY, Hammel P. Circulating tumor cells in locally advanced pancreatic adenocarcinoma: the ancillary CirCe 07 study to the LAP 07 trial. Ann Oncol 2013; 24:2057-61. [PMID: 23676420 DOI: 10.1093/annonc/mdt176] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic carcinoma is one of the leading causes of cancer-related mortality. At the time of diagnosis, 30% of patients present with a locally advanced pancreatic carcinoma (LAPC). As circulating tumor cells (CTCs) count may be a surrogate of the cancer metastatic abilities, CTC detection rates and prognostic value were studied in a prospective cohort of LAPC patients. PATIENTS AND METHODS An LAP07 international multicenter randomized study assesses in patients whose LAPC is controlled after 4 months of chemotherapy whether chemoradiotherapy could increase survival versus continuation of chemotherapy. A subgroup of patients included in the LAP07 trial was screened for CTCs (CellSearch®) before the start of the chemotherapy and after 2 months of treatment. Patient characteristics and survival were obtained prospectively and were correlated with CTC detection. RESULTS Seventy-nine patients were included. One or more CTCs/7.5 ml were detected in 5% of patients before treatment and in 9% of patients after 2 months of treatment (overall detection rate: 11% of patients). CTC positivity was associated with poor tumor differentiation (P = 0.04), and with shorter overall survival (OS) in multivariable analysis (RR = 2.5, P = 0.01), together with anemia. CONCLUSIONS The evaluation of micrometastatic disease using CTC detection appears as a promising prognostic tool in LAPC patients.
Collapse
Affiliation(s)
- F C Bidard
- Department of Medical Oncology, Institut Curie, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Samalin E, Bouche O, Thezenas S, Frangois E, Adenis A, Bennouna J, Taieb J, Desseigne F, Laurent-Puig P, Ychou M. 6091 POSTER Final Results of a Multicentre Phase II Trial Assessing Sorafenib in Combination With Irinotecan as 2nd or Later-line Treatment in Metastatic Colorectal Cancer (mCRC) Patients With KRas Mutated Tumours (mt) (NEXIRI). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71736-1] [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]
|
16
|
Michel P, Breysacher G, Desseigne F, Dahan L, Petorin C, Moussata D, Grenier J, Nguyen S, Viret F, Carrere N, Mariette C, Garnier Tixidre C, Bouhier Leporrier K, Galais M, Fein F, Iwanicki- Caron I, Maillard E, Dousset B, Mornex F, Bedenne L. FOLFIRI followed by radiochemotherapy and surgery in locally advanced gastric cancer: FFCD 0308 phase II trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4108] [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
|
17
|
Ychou M, Bouche O, Thézenas S, Francois E, Adenis A, Bennouna J, Taïeb J, Desseigne F, Seitz J, Conroy T, Galais M, Crapez E, Poujol S, Bibeau F, Laurent-Puig P, Samalin E. Final results of a multicenter phase II trial assessing sorafenib (S) in combination with irinotecan (i) as second- or later-line treatment in metastatic colorectal cancer (mCRC) patients (pts) with KRAS-mutated tumors (mt; NEXIRI). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
18
|
Derbel O, Limem S, Tassy L, Desseigne F, Rivoire M, Meeus P, Peyrat P, Stella M, Martel-Lafay I, De La Fouchardiere C. Clinical experience with neuroendocrine rectal tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.611] [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
611 Background: Carcinoids are heterogeneous neuroendocrine tumors with malignant potential. The rectum is the third most common location for gastrointestinal carcinoids after small bowel and colon. Due to their rarity, the characteristics and behavior of this unusual malignancy remain unclear. Methods: Retrospective review of the clinicopathologic features of patients treated for carcinoid tumors of the rectum. Results: A single institute's tumor registry was retrospectively queried, identifying nine patients with rectal carcinoid tumors over a 10-year period. The mean age at diagnosis was 57.6 years. Four of the nine patients were female. Presenting symptoms included abdominal pain in five patients, rectal bleeding in two patients and a change in bowel habits in one patient. As previously reported, no patient had symptoms consistent with carcinoid syndrome. The rectal tumor size was > 2 cm in five patients. The rectal tumor was located in the lower third of the rectum in three cases (< 5 cm from anal verge) whereas three were in the middle third (6-11 cm) and two in the upper third (11-15 cm). Four of the tumors were well differentiated tumors (grade 1), 1 was atypical carcinoid or moderately differentiated tumors (grade 2), and 4 were poorly differentiated tumors (grade 3) according to the SEER. Initially, 5/9 patients had distant metastasis. As an initial site of metastasis, the liver was the most common site (4/5 patients, 80%). Five patients underwent surgical treatment of their rectal tumor, two with endoscopic transanal resection whereas 3 patients had a low anterior resection (LAR). Three patients received chemotherapy treatment only in the metastatic setting and one patient received chemotherapy and radiotherapy as palliative treatment. Of the nine patients, five had progressive disease after initial treatment. With a median follow-up of 14 months, the overall survival of the entire population was 13.4 months. Conclusions: Neuroendocrine carcinomas of rectum are uncommon. Only small rectal carcinoids can be safely managed and surgery represents the treatment that can offer a greater chance of survival to these patients. Larger primary tumors have a high tendency to spread early. They are associated with aggressive behavior, resistance to chemotherapy and poor prognosis. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | - S. Limem
- Centre Léon Bérard, Lyon, France
| | - L. Tassy
- Centre Léon Bérard, Lyon, France
| | | | | | - P. Meeus
- Centre Léon Bérard, Lyon, France
| | | | | | | | | |
Collapse
|
19
|
Samalin E, Afchain P, Thézenas S, Abbas F, Romano O, Guimbaud R, Bécouarn Y, Desseigne F, Edeline J, Mitry E, Bouché O, Adenis A, Aparicio T, Dorval E, Kramar A, Ychou M. Efficacy of irinotecan in combination with 5-fluorouracil (FOLFIRI) for metastatic gastric or gastroesophageal junction adenocarcinomas (MGA) treatment. Clin Res Hepatol Gastroenterol 2011; 35:48-54. [PMID: 21634054 DOI: 10.1016/j.gcb.2010.06.010] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The most commonly used schedules are 5-FU in combination with CDDP with or without epirubicin (ECF) or docetaxel (TCF) in treatment of MGA patients (pts), independently of HER status. We evaluated the efficacy of FOLFIRI regimen in a large retrospective series of MGA pts. METHODS Two hundred and twelve pts from 13 French centers were treated with at least one cycle of FOLFIRI (irinotecan 180 mg/m2 intravenous (i.v.) over 90 minutes on day 1 with folinic acid (FA) 400mg/m2 i.v. over two hours followed by 5-FU 400mg/m2 i.v. bolus then 5- FU 2400 mg/m2 continuous infusion over 46 hours on day 1, repeated every 14 days). Primary tumour sites were 120 (58%) stomach and 92 (42%) gastroesophageal junction. FOLFIRI was administered as first-line in 137 (65%) pts and as later-line in 75 (35%) pts for MGA. RESULTS There was no difference between chemonaive and not chemonaive pts treated as firstline in terms of response rate 37% (95% CI: 25-50) vs 44% (95% CI: 21-69), median PFS, 6.7 (95% CI: 5.5-9.9) vs 5.3 months (95% CI: 3.6-6.9) (P = 0.25), and OS, 13.1 (95% CI: 11.7-18.7) vs 8.8 months (95% CI: 7.3—15.6) (P = 0.19), respectively. There was no difference between pts treated as second or later-line in terms of response rate 20% (95% CI: 8-39) vs 22% (95% CI: 6-48), median PFS, four months (95% CI: 2.8-5.4) vs 3.5 months (95% CI: 2.3-4.5) (P = 0.56), and OS, 10.4 months (95% CI: 5.4-14.4) vs 5.3 months (95% CI: 3.5-11.3) (P = 0.58), respectively. The global grade 3-4 toxicities were: diarrhea 11%, vomiting 9%, neutropenia 18%, febril neutropenia 4% (one toxic death). CONCLUSIONS This retrospective study confirms the activity and good tolerance of FOLFIRI regimen in MGA as first-line as well as later-line.
Collapse
Affiliation(s)
- E Samalin
- CRLC Val d'Aurelle, 208, rue des Apothicaires, 34298 Montpellier cedex 5, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Conroy T, Desseigne F, Ychou M, Ducreux M, Bouche O, Guimbaud R, Becouarn Y, Montoto-Grillot C, Gourgou-Bourgade S, Adenis A. Randomized phase III trial comparing FOLFIRINOX (F: 5FU/leucovorin [LV], irinotecan [I], and oxaliplatin [O]) versus gemcitabine (G) as first-line treatment for metastatic pancreatic adenocarcinoma (MPA): Preplanned interim analysis results of the PRODIGE 4/ACCORD 11 trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4010] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
21
|
Ray-Coquard I, Dussart S, Goillot C, Mayeur D, Debourdeau P, Ghesquieres H, Bachelot T, Le Cesne A, Anglaret B, Agostini C, Guastalla JP, Lancry L, Biron P, Desseigne F, Blay JY. A risk model for severe anemia to select cancer patients for primary prophylaxis with epoetin α: a prospective randomized controlled trial of the ELYPSE study group. Ann Oncol 2009; 20:1105-12. [DOI: 10.1093/annonc/mdn750] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Rivoire M, Thezenas S, Rebischung C, Viret F, Guimbaud R, Francois E, Ducreux M, Quenet F, Desseigne F, Ychou M. Preliminary results of a randomized phase II trial comparing standard bi-therapy versus three intensified chemotherapy regimens as treatment for patients with non resectable liver metastases from colorectal cancer (LMCRC). (METHEP). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Afchain P, Samalin E, Thezenas S, Abbas F, Romano O, Guimbaud R, Becouarn Y, Desseigne F, Mitry E, Ychou M. Efficacy of irinotecan in combination with 5-fluorouracil (FOLFIRI) in metastatic gastric adenocarcinoma (MGA). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15539] [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
|
24
|
Ychou M, Viret F, Kramar A, Desseigne F, Mitry E, Guimbaud R, Delpero JR, Rivoire M, Quénet F, Portier G, Nordlinger B. Tritherapy with fluorouracil/leucovorin, irinotecan and oxaliplatin (FOLFIRINOX): a phase II study in colorectal cancer patients with non-resectable liver metastases. Cancer Chemother Pharmacol 2007; 62:195-201. [PMID: 17901955 DOI: 10.1007/s00280-007-0588-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [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: 06/08/2007] [Accepted: 09/01/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the rate of R(0) resection of liver metastases achieved after chemotherapy with FOLFIRINOX. PATIENTS AND METHODS Patients with histologically proven primary colorectal cancer and bidimensionally measurable liver metastasis, not fully resectable based on technical inability to achieve R(0) resection, but potentially resectable after tumor reduction, were given FOLFIRINOX: oxaliplatin 85 mg/m(2), irinotecan 180 mg/m(2), leucovorin 400 mg/m(2), bolus fluorouracil 400 mg/m(2) and fluorouracil 46-h continuous IV infusion 2,400 mg/m(2), every 2 weeks for a maximum of 12 cycles. RESULTS Thirty-four patients were enrolled. Response rate before surgery was 70.6% (95%CI: 52.5-84.9). Twenty-eight patients (82.4%) underwent hepatic resection and nine achieved R(0) resection [26.5% (95% CI: 12.9-44.4%)]. The rate of clinical complete remission after surgery was 79.4%. Two-year overall survival was 83%. The most frequent grade 3 or 4 toxicities were neutropenia (64.8%), diarrhea (29.4%), fatigue (23.5%), abdominal cramps (14.7%), neuropathy and nausea (11.8% each), and AST/ALT elevation (14.7/11.8%). Only one patient experienced febrile neutropenia, four patients withdrew due to toxicity and no toxic death was observed. CONCLUSION FOLFIRINOX, with an acceptable toxicity profile, shows a high response rate in liver metastases from colorectal cancer. The rate of hepatic resection in patients initially not resectable, is attractive and warrants further assessment of this regimen in randomized studies compared to standard regimens.
Collapse
Affiliation(s)
- M Ychou
- Centre Régional de Lutte contre le Cancer Val d'Aurelle, 208 rue des apothicaires, 34298, Montpellier cedex 05, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Delord JP, Bennouna J, Artru P, Perrier H, Husseini F, Desseigne F, François E, Faroux R, Smith D, Piedbois P, Naman H, Douillard JY, Bugat R. Phase II study of UFT with leucovorin and irinotecan (TEGAFIRI): first-line therapy for metastatic colorectal cancer. Br J Cancer 2007; 97:297-301. [PMID: 17637682 PMCID: PMC2360336 DOI: 10.1038/sj.bjc.6603889] [Citation(s) in RCA: 15] [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] [Indexed: 01/24/2023] Open
Abstract
This phase II trial was performed to evaluate the efficacy and tolerability of oral tegafur-uracil (UFT) with leucovorin (LV) combined with intravenous (i.v.) irinotecan every 3 weeks (TEGAFIRI) as first-line treatment for patients with metastatic colorectal cancer (mCRC). Patients received oral UFT 250 mg m(-2) day(-1) and LV 90 mg day(-1) in three divided daily doses for 14 days followed by a 1-week rest and i.v. irinotecan 250 mg m(-2) as a 90-min infusion every 3 weeks. Tumour responses, assessed every two cycles using RECIST criteria, were reviewed by an independent review committee. In 52 evaluable patients, the best overall response rate was 33% (95% confidence intervals (CI) 20-47%; 1 complete and 16 partial responses). The median time to progression was 5.4 months (95% CI 3.02-7.52 months) and median overall survival was 14.9 months (11.73-17.97 months). A total of 307 cycles were administered, with a median number of five cycles per patient (range: 1-10). The most common grade 3/4 toxicities were neutropenia (25% of patients), diarrhoea (22%), vomiting (11%) and anaemia (11%). The TEGAFIRI regimen is a feasible, well-tolerated and convenient treatment option for patients with non-resectable mCRC.
Collapse
Affiliation(s)
- J-P Delord
- Institut Claudius Regaud, 20-24 rue du Pont saint Pierre, Toulouse 31052, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Ychou M, Desseigne F, Guimbaud R, Ducreux M, Bouché O, Bécouarn Y, Adenis A, Montoto-Grillot C, Luporsi E, Conroy T. Randomized phase II trial comparing folfirinox (5FU/leucovorin [LV], irinotecan [I] and oxaliplatin [O]) vs gemcitabine (G) as first-line treatment for metastatic pancreatic adenocarcinoma (MPA). First results of the ACCORD 11 trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4516] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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
4516 Background: In a phase II trial of Folfirinox (F) in 35 MPA patients (pts), we reported a 26% response rate and median survival of 9.5 months (mo) with quality of life improvement (Conroy, JCO 2005). The aim of this phase II trial was to compare the response rate and safety of F vs G in pts with MPA. Methods: Chemotherapy-naïve pts aged 18–75 years with histologically or cytologically confirmed measurable MPA were randomized to receive G (1,000 mg/m2 IV weekly x 7 for 8 weeks [wks] then weekly x 3 out of 4 wks) or F (O 85mg/m2 d1 + I 180mg/m2 d1 + LV 400mg/m2 d1 followed by 5FU 400mg/m2 bolus d1 and 2,400 mg/m2 46h continuous infusion biweekly). Patients were stratified by centre, performance status (ECOG 0 versus 1), and primary tumor location (head vs other). Primary endpoint was response rate. Results: From 01/05 to 11/06, all planned 88 pts (44 per arm) were enrolled. Median age was 56 yrs [35–76]. Currently, safety data for 81 pts (41F/40G) and efficacy data for 65 pts (31F/34G) are available (17 too early). One pt was ineligible in arm F. Two pts, one in each arm, did not receive protocol therapy. Median number of wks on treatment was 18 (F) and 7 (G). No toxic death occurred. Main grade 3–4 toxicities (arm F vs G) were G3 neutropenia (32%/17.5), G4 neutropenia (19.5%/0), G3–4 thrombocytopenia (12%/0), G3 vomiting (17%/2.5), G3 transaminases (0%/15) and G3–4 fatigue (27%/15).Confirmed partial responses (PR) rates (F/G) were 38.7% (12/31) and 11.7 % (4/34) according to the investigators and median duration of response was 6,3 and 4,6 mo. PR and stable disease (SD) were documented for 21/31 evaluable pts in arm F and expert review confirmed 13 PR (41.9 %) and 6 SD (19.3%). Conclusions: Folfirinox induces a response rate > 30% with manageable toxicity in ECOG 0–1 pts with MPA. According to these interim results, this trial will continue as a phase III study. Updated results will be presented at the meeting. Supported by a PHRC 2004 grant from the French Ministry of Health. [Table: see text]
Collapse
Affiliation(s)
- M. Ychou
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - F. Desseigne
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - R. Guimbaud
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - M. Ducreux
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - O. Bouché
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - Y. Bécouarn
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - A. Adenis
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - C. Montoto-Grillot
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - E. Luporsi
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| | - T. Conroy
- Centre Val d’Aurelle, Montpellier, France; Centre Leon Berard, Lyon, France; Institut Claudius Regaud, Toulouse, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier R. Debré, Reims, France; Institut Bergonié, Bordeaux, France; Centre Oscar Lambret, Lille, France; FNCLCC, Paris, France; Centre Alexis Vautrin, Nancy, France
| |
Collapse
|
27
|
Carrie C, De La Fouchardière C, Perol D, Negrier S, Desseigne F, Meeus P, Labrosse H, Martel Lafay I. Daily irinotecan and concomitant radiotherapy for locally advanced pancreatic cancer: Feasibility and MTD. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15124] [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
15124 Background: To determine the maximal tolerated dose (MTD) of daily irinotecan with radiotherapy (RT) in patients (pts) with locally advanced adenocarcinoma of the pancreas. Methods: Between 09/2000 and 05/2006, 30 pts with histologically proved adenocarcinoma of pancreas were included in this prospective phase I/II study. Irinotecan was administrated daily, 1 hour before RT session. Doses were escalated by increment of 2 mg/m2 every 3 patients for an initial dose of 6 mg/m2/day. RT was delivered at 2 Gy per session, 5 fractions per week to a total dose of 50 Gy to the doses tumor volume. Primary endpoint was toxicity; secondary endpoints were tumor objective response (OR) defined as complete or partial response, secondary operability and overall survival (OS). Inoperability was assessed by surgeon. All images were reviewed by a radiologist. OR rates were compared using the Fisher’s exact test. Results: 30 pts were entered over 6 years through 7 dose levels from 6 mg/m2/day. Sex ratio was 1:1, median age was 58 years (range 33–71), Karnofsky score was ≥ 90 in 93%. Current median follow-up is 45 months. No dose limiting toxicity was yet observed (last level 18 mg/m2/day). Three patients experienced grade 3 toxicity at level 1 (ulcer perforation), level 6 (nausea, vomiting and abdominal pain), and level 7 (nausea, vomiting and hypokaliemia), respectively. OR rates were 33% at 4 weeks. 3/13 pts (23%) included within the 3 first levels (= 10 mg/m2/day) experienced an OR at 4 weeks, versus 7/17 (41%) in the levels > 10 mg/m2/day (P = 0.44). 3 pts underwent surgery because of control tumor. Median OS was 13 months (95% CI 11–14) with 24 patient’s death. One patient is in complete remission since 21 months. Conclusions: Maximal tolerated dose is not yet reached. Despite response rate is not the main aim of the study, results suggest that RT combined with a higher daily level of irinotecan could be associated with a better tumor control. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- C. Carrie
- Centre Leon Berard, Lyon, France; Clinique Prostestante, Caluire, France
| | | | - D. Perol
- Centre Leon Berard, Lyon, France; Clinique Prostestante, Caluire, France
| | - S. Negrier
- Centre Leon Berard, Lyon, France; Clinique Prostestante, Caluire, France
| | - F. Desseigne
- Centre Leon Berard, Lyon, France; Clinique Prostestante, Caluire, France
| | - P. Meeus
- Centre Leon Berard, Lyon, France; Clinique Prostestante, Caluire, France
| | - H. Labrosse
- Centre Leon Berard, Lyon, France; Clinique Prostestante, Caluire, France
| | - I. Martel Lafay
- Centre Leon Berard, Lyon, France; Clinique Prostestante, Caluire, France
| |
Collapse
|
28
|
Bennouna J, Faroux R, François E, Ligeza C, El Hannani C, Perrier H, Jacob J, Desseigne F, Perrocheau G, Douillard JY. CETUFTIRI, a new combination of UFT with leucovorin (LV), irinotecan, and cetuximab as first-line treatment for patients (pts) with unresectable metastatic colorectal cancer (mCRC): Preliminary results from a multicenter phase II trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4087] [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
4087 Background: A phase II study (ASCO 2004) established that the combination of UFT (tegafur-uracil) with LV and irinotecan (TEGAFIRI) could be safely administered to pts with unresectable mCRC, with an objective response rate (ORR) of 34% and a median time to progression (TTP) of 5.7 months. We initiated CETUFTIRI, a phase II study, to evaluate the efficacy and tolerability of cetuximab added to TEGAFIRI in chemonaïve pts with unresectable mCRC. Methods: Patients in this single-stage study were aged =18 years, with histologically or cytologically confirmed, bidimensionally measurable mCRC, ECOG performance status 0 or 1, and adequate bone marrow, renal, and hepatic function. EGFR expression was not an inclusion criterion. Treatment consisted of UFT 250 mg/m2/day d1–14, LV 90 mg/day d1–14, and irinotecan 250 mg/m2 d1 every 3 weeks, plus cetuximab 400 mg/m2 week 1 then 250 mg/m2 weekly thereafter. The primary endpoint was ORR and the planned sample size was 61 pts. The study is now closed to accrual. Results: To date, 48 patients are evaluable for safety and 31 are evaluable for efficacy. Patient characteristics (n=48): median age 65 years (range 45–84 years); ECOG PS 0/1: 73/27%; male 65%; tumor sites: colon 69%; rectum 17%; junction 14%; liver metastasis 83%; lung metastasis 46%; other 27%. Adverse events per patient (n=48) after a total of 230 cycles were: grade G3 mucositis 10%; G3/4 neutropenia 10%; G3 nausea/vomiting 8%; G3 asthenia 6%; febrile neutropenia 6%; G3 hypokalemia 6%; G3/4 anemia 4%; G3 diarrhea 2%; acne-like rash G1/2 50% (G3 4%); infusion- related reaction to cetuximab 6%. Two of 31 evaluable pts had a complete response and 11 had a partial response, for an ORR of 42%; 5 pts had stable disease (16%) and 11 pts had progressive disease (35.5%). An independent radiologist review is planned for all 61 pts included up to December 2006. Conclusions: The CETUFTIRI combination seems to have an acceptable toxicity profile with an attractive objective response rate in the first-line treatment of pts with mCRC. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- J. Bennouna
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - R. Faroux
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - E. François
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - C. Ligeza
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - C. El Hannani
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - H. Perrier
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - J. Jacob
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - F. Desseigne
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - G. Perrocheau
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| | - J. Y. Douillard
- Centre Rene Gauducheau, St. Herblain, France; Centre Hospitalier La Roche Sur Yon, La Roche Sur Yon, France; Centre Antoine Lacassagne, Nice, France; Centre Etienne Dolet, Saint-Nazaire, France; Centre Hospitalier Chateaubriand, Chateaubriand, France; Hôpital Saint- Joseph, Marseille, France; Centre Francois Baclesse, caen, France; Centre Leon Berard, Lyon, France
| |
Collapse
|
29
|
Martel-Lafay I, Desseigne F, Perol D, Kaemmerlen P, Meeus P, Labrosse H, Meunier P, Peyrat P, Vincent B, Negrier S, Carrie C. Phase I/II study of daily irinotecan as radiation sensitizer for locally advanced pancreatic cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I. Martel-Lafay
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - F. Desseigne
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - D. Perol
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - P. Kaemmerlen
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - P. Meeus
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - H. Labrosse
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - P. Meunier
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - P. Peyrat
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - B. Vincent
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - S. Negrier
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| | - C. Carrie
- Ctr Leon Berard, Lyon, France; Clin Protestante, Lyon, France; Hosp de Villefranche sur Saone, Villefranche sur Saone, France; Hosp d’Albertville, Albertville, France
| |
Collapse
|
30
|
Ychou M, Gourgou S, Desseigne F, Debrigode C, Mineur L, Chalbos P, Duffour J. Multicenter phase II study using increasing dose of irinotecan (CPT11) combined with simplified LV5FU regimen in metastatic colorectal cancer (MCRC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Ychou
- CRLC, Montpellier, France; CRLC, Lyon, France; CHU, Nı̂mes, France; Clinique St Catherine, Avignon, France
| | - S. Gourgou
- CRLC, Montpellier, France; CRLC, Lyon, France; CHU, Nı̂mes, France; Clinique St Catherine, Avignon, France
| | - F. Desseigne
- CRLC, Montpellier, France; CRLC, Lyon, France; CHU, Nı̂mes, France; Clinique St Catherine, Avignon, France
| | - C. Debrigode
- CRLC, Montpellier, France; CRLC, Lyon, France; CHU, Nı̂mes, France; Clinique St Catherine, Avignon, France
| | - L. Mineur
- CRLC, Montpellier, France; CRLC, Lyon, France; CHU, Nı̂mes, France; Clinique St Catherine, Avignon, France
| | - P. Chalbos
- CRLC, Montpellier, France; CRLC, Lyon, France; CHU, Nı̂mes, France; Clinique St Catherine, Avignon, France
| | - J. Duffour
- CRLC, Montpellier, France; CRLC, Lyon, France; CHU, Nı̂mes, France; Clinique St Catherine, Avignon, France
| |
Collapse
|
31
|
Trillet-Lenoir V, Freyer G, Kaemmerlen P, Fond A, Pellet O, Lombard-Bohas C, Gaudin JL, Lledo G, Mackiewicz R, Gouttebel MC, Moindrot H, Boyer JD, Chassignol L, Stremsdoerfer N, Desseigne F, Moreau JM, Hedelius F, Moraillon A, Chapuis F, Bleuse JP, Barbier Y, Heilmann MO, Valette PJ. Assessment of tumour response to chemotherapy for metastatic colorectal cancer: accuracy of the RECIST criteria. Br J Radiol 2002; 75:903-8. [PMID: 12466256 DOI: 10.1259/bjr.75.899.750903] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Evaluation of tumour size modifications in response to treatment is a critical issue in the management of advanced malignancies. In 1981, the World Health Organization (WHO) established guidelines for tumour response assessment. These WHO1981 criteria were recently simplified in a revised version, named RECIST (Response Evaluation Criteria in Solid Tumours), which uses unidimensional instead of bidimensional measurements, a reduced number of measured lesions, withdrawal of the progression criteria based on isolated increase of a single lesion, and different shrinkage threshold for definitions of tumour response and progression. In order to validate these new guidelines, we have compared results obtained with both classifications in a prospective series of 91 patients receiving chemotherapy for metastatic colorectal cancer. Data from iterative tomographic measurements were fully recorded and reviewed by an expert panel. The overall response and progression rates according to the WHO1981 criteria were 19% and 58%, respectively. Using RECIST criteria, 16 patients were reclassified in a more favourable subgroup, the overall response rate being 28% and the progression rate 45% (non-weighted kappa concordance test 0.72). When isolated increase of a single measurable lesion is not taken into account for progression with the WHO1981 criteria, only 7 patients were reclassified and the kappa test was satisfying, i.e. > or =0.75, for the whole population as well as for each of the responding and progressive subgroups. Since it provides concordant results with a simplified method, the use of RECIST criteria is recommended for evaluation of treatment efficacy in clinical trials and routine practice.
Collapse
Affiliation(s)
- V Trillet-Lenoir
- Department of Medical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Ychou M, Raoul JL, Desseigne F, Borel C, Caroli-Bosc FX, Jacob JH, Seitz JF, Kramar A, Hua A, Lefebvre P, Couteau C, Merrouche Y. High-dose, single-agent irinotecan as first-line therapy in the treatment of metastatic colorectal cancer. Cancer Chemother Pharmacol 2002; 50:383-91. [PMID: 12439596 DOI: 10.1007/s00280-002-0506-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [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: 01/31/2002] [Accepted: 07/08/2002] [Indexed: 11/28/2022]
Abstract
PURPOSE The efficacy and safety of single-agent, high-dose irinotecan (CPT-11, Campto) 500 mg/m(2) every 3 weeks were investigated as first-line treatment for advanced colorectal cancer (CRC). PATIENTS AND METHODS Patients were enrolled into the study to receive a first cycle of therapy with irinotecan at a dose of 350 mg/m(2) every 3 weeks, which could be escalated to 500 mg/m(2) for the second and subsequent cycles depending on toxicity. Efficacy, safety and pharmacokinetics were determined in the intent to treat (ITT) population and the high-dose population (i.e. patients who had received at least three cycles of irinotecan, the second and third at 500 mg/m(2)). RESULTS Of 49 patients enrolled into the study (ITT population), 31 (63%) received at least three cycles of treatment with cycles 2 and 3 at an irinotecan dose of 500 mg/m(2) (the high-dose population). The response rates (RR) for the ITT and high-dose populations were 24.5% and 35.5%, respectively. The main grade 3/4 toxicities per cycle in the ITT and high-dose populations were neutropenia 22% and 17%, febrile neutropenia 5% and 3%, and diarrhoea 12% and 7%, respectively. The pharmacokinetics of irinotecan and its metabolite SN-38 were investigated in 31 patients in cycle 1 and 22 patients in cycle 2. Irinotecan clearance and SN-38 exposure were not sufficiently correlated with toxicity in cycle 1 to identify patients for dose increase in subsequent cycles. The exposure to irinotecan and SN-38 increased in proportion to dose from 350 to 500 mg/m(2). CONCLUSION These results suggest that high-dose irinotecan can be safely administered as first-line monotherapy to approximately two-thirds of patients who present with advanced CRC following a selective first cycle.
Collapse
Affiliation(s)
- M Ychou
- CRLC Val d'Aurelle, 31 Rue de la croix verte, 34298 Montpellier cedex 05, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
André T, Bensmaine MA, Louvet C, François E, Lucas V, Desseigne F, Beerblock K, Bouché O, Carola E, Merrouche Y, Morvan F, Dupont-André G, de Gramont A. Multicenter phase II study of bimonthly high-dose leucovorin, fluorouracil infusion, and oxaliplatin for metastatic colorectal cancer resistant to the same leucovorin and fluorouracil regimen. J Clin Oncol 1999; 17:3560-8. [PMID: 10550155 DOI: 10.1200/jco.1999.17.11.3560] [Citation(s) in RCA: 219] [Impact Index Per Article: 8.8] [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: 11/20/2022] Open
Abstract
PURPOSE To evaluate the objective tumor response rates and toxicities of leucovorin (LV) plus fluorouracil (5-FU) cancer regimen combined with oxaliplatin (85 mg/m(2)) every 2 weeks on metastatic colorectal cancer patients with documented proof of progression while on bimonthly LV and 5-FU alone. PATIENTS AND METHODS One hundred patients were enrolled onto this study and 97 received the study drugs between October 1995 and December 1996. Eighty-nine patients were eligible for per-protocol efficacy analysis with documented proof of progression on one of the following two treatments: LV 500 mg/m(2) and continuous 5-FU infusion 1.5 to 2 g/m(2)/22 hours, days 1 through 2 every 2 weeks (FOLFUHD); or LV 200 mg/m(2), bolus 5-FU 400 mg/m(2), and continuous 5-FU infusion 600 mg/m(2)/22 hours, days 1 through 2 every 2 weeks (LV5FU2). In our study, 40 patients received FOLFUHD + 85 mg/m(2) of oxaliplatin day 1 (FOLFOX3) and 57 patients received LV5FU2 + 85 mg/m(2) of oxaliplatin day 1 (FOLFOX4). RESULTS Of the 97 patients treated, 20 partial responses were observed (FOLFOX3/4: response rate, 20.6%; 95% confidence interval, 13% to 31.1%; FOLFOX3: response rate,18.4%; FOLFOX4: response rate, 23.5%). For patients treated with FOLFOX3/4, the median response duration for was 7.5 months, and the major toxicities were peripheral neuropathy and neutropenia. The incidence of grade 3 (National Cancer Institute common toxicity criteria) peripheral neuropathy was 20.6%; whereas the overall incidence of grade 3 to 4 neutropenia was 27.8%, 15%, and 36.9% for FOLFOX3/4, FOLFOX3, and FOLFOX4, respectively (P =.02). From the start of treatment, median progression-free survival was 4. 7, 4.6, and 5.1 months for FOLFOX3/4, FOLFOX3, FOLFOX4, respectively, and median overall survival was 10.8, 10.6, and 11.1 months, respectively. CONCLUSION This phase II study of oxaliplatin at 85 mg/m(2) in combination with bimonthly LV plus 5-FU in patients with colorectal cancer resistant to LV plus 5-FU alone confirms the enhanced antitumor activity of oxaliplatin in combination with 5-FU.
Collapse
Affiliation(s)
- T André
- Hôpital Tenon, Clinique du Mont Louis, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Taieb S, Vaillant E, Pommier P, Bonvoisin S, Desseigne F, Morignat E, Gerard JP, Mornex F. [Curative treatment of non-metastatic esophageal cancer: concomitant chemoradiotherapy and high-dose-rate endoluminal curietherapy boost]. Gastroenterol Clin Biol 1999; 23:1048-54. [PMID: 10592877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the feasibility, toxicity, and efficacy of a curative combination of chemo-radiotherapy with high-dose-rate brachytherapy (HDRB) in patients with non metastatic esophageal cancer. PATIENTS AND METHODS Fifty-two patients with esophageal carcinoma were treated with > 50 Gy external irradiation, concomitant chemotherapy (5FU-CDDP) followed by HDRB delivering 12.5 Gy (6-20) as a boost. Twelve patients were stage I, 20 stage IIa, 5 stage IIb, and 13 stage III, 1 Tis, 1 stage N unknown. Surgery was not indicated for medical reasons. RESULTS The response rate was 96%, with complete response rate 85%. The 1-, 3-, 5-year overall survival rates were 78%, 33%, and 22% respectively. A local failure occurred in 32%, and distant metastasis in 16%. Severe (grade 3, 4) acute toxicity occurred in 6 cases, severe late toxicity in 2 cases and there was 1 toxic death. Tumoral length > or = 5 cm and stage IIa, IIb and III versus stage 1 indicated poor prognosis. CONCLUSION This regimen is feasible and well tolerated. The 5-year overall survival is 22%, but the local failure rate is still very high. These results are encouraging and will be prospectively evaluated with currently ongoing randomized trial.
Collapse
Affiliation(s)
- S Taieb
- Département de Radiothérapie-Oncologie EA643, Centre Hospitalier Lyon Sud, Pierre-Bénite
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Wang Q, Lasset C, Desseigne F, Saurin JC, Maugard C, Navarro C, Ruano E, Descos L, Trillet-Lenoir V, Bosset JF, Puisieux A. Prevalence of germline mutations of h MLH1 , h MSH2 , h PMS1 , h PMS2 , and h MSH6 genes in 75 French kindreds with nonpolyposis colorectal cancer. Hum Genet 1999. [DOI: 10.1007/s004390051067] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Wang Q, Lasset C, Desseigne F, Saurin JC, Maugard C, Navarro C, Ruano E, Descos L, Trillet-Lenoir V, Bosset JF, Puisieux A. Prevalence of germline mutations of hMLH1, hMSH2, hPMS1, hPMS2, and hMSH6 genes in 75 French kindreds with nonpolyposis colorectal cancer. Hum Genet 1999; 105:79-85. [PMID: 10480359 DOI: 10.1007/s004399900064] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [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: 01/16/2023]
Abstract
Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome characterized by familial predisposition to colorectal carcinoma and extracolonic cancers of the gastrointestinal, urological, and female reproductive tracts. This dominant disorder is caused by germline defects in one of at least five DNA mismatch repair (MMR) genes: hMLH1, hMSH2, hPMS1, hPMS2, and hMSH6 (GTBP). Germline mutations of hMSH2 and hMLH1 are also frequently identified in families not fulfilling all the Amsterdam criteria, thereby demonstrating that the involvement of these genes is not confined to typical HNPCC. To evaluate the respective involvement of the various MMR genes in typical and incomplete HNPCC syndromes, we have performed an analysis of the hMLH1, hMSH2, hPMS1, hPMS2, and hMSH6 genes in a large series of French kindreds (n=75) with colorectal tumors and/or aggregation of extracolonic cancers belonging to the HNPCC spectrum. Mutational analysis has been performed in all families, without preselection for the tumor phenotype. We have detected 26 pathogenic germline mutations of the hMLH1 and hMSH2 genes and several novel variants of the hPMS1, hPMS2, and hMSH6 genes. Our data confirm that, regardless of the type of families and the tumor phenotype, hPMS1, hPMS2, and hMSH6 germline mutations are rare in familial aggregation of colorectal cancers. Furthermore, they suggest that the presence of multiple primary malignancies in a single individual and the observation of extracolonic tumors in relatives of a colorectal cancer patient should be included among the guidelines for referring patients for genetic testing.
Collapse
Affiliation(s)
- Q Wang
- Département d'Oncologie Fondamentale et Appliquée, INSERM Unité 453, Centre Léon Bérard, Lyon, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Wang Q, Lasset C, Desseigne F, Frappaz D, Bergeron C, Navarro C, Ruano E, Puisieux A. Neurofibromatosis and early onset of cancers in hMLH1-deficient children. Cancer Res 1999; 59:294-7. [PMID: 9927034] [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: 02/10/2023]
Abstract
Hereditary nonpolyposis colon cancer is a common hereditary disorder caused by the germ-line mutations of DNA mismatch repair (MMR) genes, especially hMLH1 and hMSH2. We report here the first identification of human compounds with a homozygous inactivation of a MMR gene. In a typical hereditary nonpolyposis colon cancer family, MMR-deficient children conceived from matings between heterozygotes for a hMLH1 deleterious mutation exhibited clinical features of de novo neurofibromatosis type I and early onset of extracolonic cancers. This observation demonstrates that MMR deficiency is compatible with human development but may lead to mutations during embryogenesis. On the basis of clinical symptoms observed in MMR-deficient children, we speculate that the neurofibromatosis type 1 gene is a preferential target for such alterations.
Collapse
Affiliation(s)
- Q Wang
- Unité d'Oncologie Moléculaire, Institut National de la Santé et de la Recherche Médicale, Centre Léon Bérard, Lyon, France
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Taieb S, Vaillant E, Morignat E, Bonvoisin S, Pommier P, Desseigne F, Gérard JP, Mornex F. P62 Traitement à visée curative du cancer de l'œsophage non métastatique. Cancer Radiother 1998. [DOI: 10.1016/s1278-3218(98)80135-2] [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: 10/18/2022]
|
39
|
Wang Q, Desseigne F, Lasset C, Saurin JC, Navarro C, Yagci T, Keser I, Bagci H, Luleci G, Gelen T, Chayvialle JA, Puisieux A, Ozturk M. Germline hMSH2 and hMLH1 gene mutations in incomplete HNPCC families. Int J Cancer 1997; 73:831-6. [PMID: 9399661 DOI: 10.1002/(sici)1097-0215(19971210)73:6<831::aid-ijc11>3.0.co;2-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/05/2023]
Abstract
Hereditary non-polyposis colon cancer (HNPCC) is a common hereditary disease characterized by a predisposition to an early onset of colorectal cancer. The majority of the HNPCC families carry germline mutations of either hMSH2 or hMLH1 genes, whereas germline mutations of hPMS1 and hPMS2 genes have rarely been observed. Almost all of the germline mutations reported so far concern typical HNPCC families. However, there are families that display aggregations of colon cancer even though they do not fulfil all HNPCC criteria (incomplete HNPCC families) as well as sporadic cases of early onset colon cancers that could be related to germline mutations of these genes. Therefore, we screened germline mutations of hMSH2 and hMLH1 genes in 3 groups of patients from France and Turkey: typical HNPCC (n = 3), incomplete HNPCC (n = 9) and young patients without apparent familial history (n = 7). By in vitro synthesis of protein assay, heteroduplex analysis and direct genomic sequencing, we identified 1 family with hMSH2 mutation and 5 families with hMLH1 mutations. Two of the 3 HNPCC families (66%) displayed hMLH1 germline mutations. Interestingly, 4 of 9 families with incomplete HNPCC (44%) also displayed mutations of hMSH2 or hMLH1 genes. In contrast, no germline mutation of these genes was found in 7 young patients. Our results show that germline mutations of hMSH2 and hMLH1 genes contribute to a significant fraction of familial predisposition to colon cancer cases that do not fulfil all diagnostic criteria of HNPCC.
Collapse
Affiliation(s)
- Q Wang
- Laboratoire d'Oncologie Moléculaire, Unité INSERM 453, Centre Léon Bérard, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
André T, Bensmaÿne M, Louvet C, Lucas V, Beerblock K, Desseigne F, François E, Merrouche Y, Bouché O, Morvan F, Carola E, de Gramont A. Addition of oxaliplatin (Eloxatine®, LOHP) to the same leucovorin (LV) and 5 fluorouracil (5FU) bimonthly regimens after progression in patients (pts) with metastatic colorectal cancer (MCRC): Preliminary report. Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)85355-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
41
|
Affiliation(s)
- P Bachmann
- Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | | | | | | | | | | |
Collapse
|
42
|
Mornex F, Saurin J, Bohas C, Descos F, Desseigne F, Lambert R. 416 Intensive concurrent chemoradiation in advanced esophageal carcinoma. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95669-w] [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: 11/16/2022]
|
43
|
Martel I, Mornex F, Desseigne F, Carrie C, Rivoire M, Kaemmerlen P, Lacroze M, Rebattu P, Merrouche Y. 741 Brain metastases in colorectal cancer: An unusual metastatic site. Report of 15 cases treated with radiotherapy. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95990-n] [Citation(s) in RCA: 3] [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: 10/27/2022]
|
44
|
Mion F, Desseigne F, Napoleon B, Berger F, Lambert R. Failure of endoscopic detection of a de novo carcinoma of the colon in a patient with adenomatous polyps. Gastrointest Endosc 1992; 38:703-6. [PMID: 1473675 DOI: 10.1016/s0016-5107(92)70570-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- F Mion
- Digestive Diseases, Department Hospital E. Herriot, Lyon, France
| | | | | | | | | |
Collapse
|
45
|
Desseigne F, Carrère J. [Mothers who kill their children]. Ann Med Psychol (Paris) 1974; 2:238-48. [PMID: 4447288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|