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Delyon J, Michielin O. Adjuvant or neoadjuvant treatment with immune checkpoint inhibitors: re-assessing the risk-benefit ratio. Lancet Oncol 2024; 25:3-5. [PMID: 38012894 DOI: 10.1016/s1470-2045(23)00575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Julie Delyon
- Department of Dermato-oncology, AP-HP Saint-Louis Hospital, DMU ICARE, Université Paris Cité, F-75010 Paris, France; Department of Oncology, Geneva University Hospital, Genève, Switzerland.
| | - Olivier Michielin
- Department of Oncology, Geneva University Hospital, Genève, Switzerland
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2
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Delyon J, Schmauch B, Jacob Y, Battistella M, Lebbé C. Letter to the Editor re: Observational study investigating the level of support from a convolutional neural network in face and scalp lesions deemed diagnostically 'unclear' by dermatologists. Eur J Cancer 2023; 195:113394. [PMID: 37891064 DOI: 10.1016/j.ejca.2023.113394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Julie Delyon
- Department of Dermato-Oncology, AP-HP Saint-Louis Hospital, DMU ICARE, Université Paris Cité, INSERM U976 HIPI Team 1, F-75010 Paris, France.
| | | | - Yannick Jacob
- Innovation and Data Unit, IT Department, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maxime Battistella
- Department of Pathology, AP-HP Saint-Louis Hospital, Université Paris Cité, INSERM U976 HIPI Team 1, F-75010 Paris, France
| | - Céleste Lebbé
- Department of Dermato-Oncology, AP-HP Saint-Louis Hospital, DMU ICARE, Université Paris Cité, INSERM U976 HIPI Team 1, F-75010 Paris, France
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3
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Delyon J, Vallet A, Bernard-Cacciarella M, Kuzniak I, Reger de Moura C, Louveau B, Jouenne F, Mourah S, Lebbé C, Dumaz N. TERT Expression Induces Resistance to BRAF and MEK Inhibitors in BRAF-Mutated Melanoma In Vitro. Cancers (Basel) 2023; 15:cancers15112888. [PMID: 37296851 DOI: 10.3390/cancers15112888] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Because BRAF-mutated melanomas are addicted to the Mitogen Activated Protein Kinase (MAPK) pathway they show a high response rate to BRAF and MEK inhibitors. However, the clinical responses to these inhibitors are often short-lived with the rapid onset of resistance to treatment. Deciphering the molecular mechanisms driving resistance has been the subject of intense research. Recent in vitro and clinical data have suggested a link between expression of telomerase and resistance to targeted therapy in melanoma. TERT promoter mutations are the main mechanism for the continuous upregulation of telomerase in melanoma and co-occur frequently with BRAF alterations. To understand how TERT promoter mutations could be associated with resistance to targeted therapy in melanoma, we conducted translational and in vitro studies. In a cohort of V600E-BRAF-mutated melanoma patients, we showed that the TERT promoter mutation status and TERT expression tended to be associated with response to BRAF and MEK inhibitors. We demonstrated that TERT overexpression in BRAF-mutated melanoma cells reduced sensitivity to BRAF and MEK independently of TERT's telomer maintenance activity. Interestingly, inhibition of TERT reduced growth of BRAF-mutated melanoma including resistant cells. TERT expression in melanoma can therefore be a new biomarker for resistance to MAPK inhibitors as well as a novel therapeutic target.
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Affiliation(s)
- Julie Delyon
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
- Département de Dermatologie, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Anaïs Vallet
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
| | - Mélanie Bernard-Cacciarella
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
- Département de Dermatologie, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Isabelle Kuzniak
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
| | - Coralie Reger de Moura
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
- Département de Pharmacogénomique, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Baptiste Louveau
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
- Département de Pharmacogénomique, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Fanélie Jouenne
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
- Département de Pharmacogénomique, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Samia Mourah
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
- Département de Pharmacogénomique, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Céleste Lebbé
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
- Département de Dermatologie, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Nicolas Dumaz
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Université Paris Cité, Institut de Recherche Saint Louis (IRSL), F-75010 Paris, France
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Moghadam P, Herms F, Baroudjian B, Tetu P, Delyon J, Jouenne F, Boisson M, Louveau B, Mourah S, Brunet-Possenti F, Duverger L, Gounant V, Lebbé C, Basset-Seguin N. Eruptive squamous cell carcinomas following an acute skin inflammatory disease: A series of four cases. J Eur Acad Dermatol Venereol 2023; 37:e119-e121. [PMID: 35993817 DOI: 10.1111/jdv.18559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Parna Moghadam
- Dermatology Department, Université Paris-Cité, INSERM 976, Saint Louis Hospital, Paris, France
| | - Florian Herms
- Dermatology Department, Université Paris-Cité, INSERM 976, Saint Louis Hospital, Paris, France
| | - Barouyr Baroudjian
- Dermatology Department, Université Paris-Cité, INSERM 976, Saint Louis Hospital, Paris, France
| | - Pauline Tetu
- Dermatology Department, Université Paris-Cité, INSERM 976, Saint Louis Hospital, Paris, France
| | - Julie Delyon
- Dermatology Department, Université Paris-Cité, INSERM 976, Saint Louis Hospital, Paris, France
| | - Fanélie Jouenne
- Tumor Genomics and Pharmacology Department, Université Paris-Cité, INSERM UMR-S 976, Saint Louis Hospital, Paris, France
| | - Marie Boisson
- Tumor Genomics and Pharmacology Department, Université Paris-Cité, INSERM UMR-S 976, Saint Louis Hospital, Paris, France
| | - Baptiste Louveau
- Tumor Genomics and Pharmacology Department, Université Paris-Cité, INSERM UMR-S 976, Saint Louis Hospital, Paris, France
| | - Samia Mourah
- Tumor Genomics and Pharmacology Department, Université Paris-Cité, INSERM UMR-S 976, Saint Louis Hospital, Paris, France
| | - Florence Brunet-Possenti
- Virology Department, Université de Paris-Cité, INSERM UMR 1137 IAME, Bichat Hospital, Paris, France
| | - Lucie Duverger
- Pathology Department, Saint Louis Hospital, Paris, France
| | - Valérie Gounant
- Thoracic Oncology Department, Université de Paris-Cité, CIC-1425 Inserm, Bichat-Claude Bernard Hospital, Cancer Institute-AP-HP Nord, Paris, France
| | - Céleste Lebbé
- Dermatology Department, Université Paris-Cité, INSERM 976, Saint Louis Hospital, Paris, France
| | - Nicole Basset-Seguin
- Dermatology Department, Université Paris-Cité, INSERM 976, Saint Louis Hospital, Paris, France
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Lebbé C, Biard L, Delyon J, Zuber J. Managing immune checkpoint inhibition in transplant recipients. Lancet Oncol 2022; 23:969-971. [DOI: 10.1016/s1470-2045(22)00395-3] [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] [Received: 06/27/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022]
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Herms F, Baroudjian B, Delyon J, Laly P, Tetu P, Lebbe C, Basset-Seguin N. Sonidegib in the Treatment of Locally Advanced Basal Cell Carcinoma: a Retrospective Study. Acta Derm Venereol 2022; 102:adv00740. [PMID: 35604234 PMCID: PMC9574683 DOI: 10.2340/actadv.v102.1995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 01/15/2023] Open
Abstract
Sonidegib, a hedgehog pathway inhibitor, is indicated for treatment of locally advanced basal cell carcinoma, based on the results of the BOLT study. However, to date, no real-world study of sonidegib has been reported. An observational, retrospective, single-centre study (PaSoS study) was conducted. The primary objective was to evaluate the efficacy of sonidegib for treatment of locally advanced basal cell carcinoma in a real-world setting. Secondary objectives included modalities of use, tolerability, tumour evolution, and management after discontinuation. A total of 21 patients treated with sonidegib were included from March 2018 to January 2021. The median follow-up was 18.7 months and median exposure 7.0 months. Objective response (OR) rate was 81.0% (n = 17) including 6 (29%) patients with a complete response (CR). Disease control rate was 100%. First tumour response was rapid, with a median time of 2.3 months. Nine (43%) patients underwent surgery after sonidegib discontinuation, and no relapse was observed. All the patients experienced at least 1 adverse event (AE). Muscle spasms were the most frequent AE (n = 14; 67%), followed by dysgeusia (n = 8; 38%) and alopecia (n = 12; 57%). The efficacy and safety profile of sonidegib in this first-to-date real-life trial are consistent with prior results. Overall, real-world evidence corroborated sonidegib efficacy and tolerability as a first-line treatment for locally advanced basal cell carcinoma.
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Affiliation(s)
- Florian Herms
- AP-HP Department of Dermatology, Université de Paris, DMU ICARE, INSERM U976 HIPI, Team 1 Hôpital Saint-Louis, FR-75010 Paris, France.
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Abstract
Increasing the efficacy of immune checkpoint blockade therapy while mitigating toxicity is one of the major challenges in oncology research. In this issue of Cancer Cell, Hailemichael et al. provide a strong rationale for the combination of IL-6 blockade and dual inhibition of CTLA-4 and PD-1 to overcome this issue.
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Affiliation(s)
- Julie Delyon
- Department of Dermato-Oncology, AP-HP Hopital Saint-Louis; Université Paris Cité, INSERM U976 HIPI, F-75010 Paris, France.
| | - Celeste Lebbe
- Department of Dermato-Oncology, AP-HP Hopital Saint-Louis; Université Paris Cité, INSERM U976 HIPI, F-75010 Paris, France
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Pesqué L, Delyon J, Lheure C, Baroudjian B, Battistella M, Merlet P, Lebbé C, Vercellino L. Yield of FDG PET/CT for Defining the Extent of Disease in Patients with Kaposi Sarcoma. Cancers (Basel) 2022; 14:cancers14092189. [PMID: 35565319 PMCID: PMC9102885 DOI: 10.3390/cancers14092189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary The potential role of positron emission tomography/computed tomography with fluorodeoxyglucose (FDG PET/CT) for assessing the extent of Kaposi sarcoma is not well studied. We analyzed FDG PET/CTs performed on 75 patients referred to our department for Kaposi sarcoma staging or restaging. FDG PET/CTs detected most lymph nodes, bone, and muscle lesions, whereas digestive and mucous lesions could be missed. Most cutaneous lesions can be identified when whole-body FDG PET/CT (including lower limbs) is performed. Thus, a true whole-body FDG PET/CT can be recommended for staging purposes in patients with active Kaposi sarcoma and, if positive, be useful for therapeutic evaluation and follow-up. Abstract Background: Positron emission tomography/computed tomography with fluorodeoxyglucose (F-18) (FDG PET/CT) is increasingly used in Kaposi sarcoma (KS), but its value has not been assessed. Objectives: In this study, we aimed to evaluate the diagnostic accuracy of FDG PET/CT to define the extent of disease in KS. Methods: Consecutive patients with KS referred to our department for FDG PET/CT were included. The diagnostic accuracy of FDG PET/CT for cutaneous and extra-cutaneous KS staging was assessed on a per lesion basis compared to staging obtained from clinical examination, standard imaging, endoscopy, histological analyses, and follow-up. Results: From 2007 to 2017, 75 patients with FDG PET/CT were analyzed. The sensitivity and specificity of FDG PET/CT for the overall detection of KS lesions were 71 and 98%, respectively. Sensitivity and specificity were 100 and 85% for lymph nodes, 87 and 98% for bone, 87 and 100% for lungs, and 100 and 100% for muscle involvement, whereas sensitivity was only 17% to detect KS digestive involvement. The sensitivity of the diagnostic for KS cutaneous involvement increased from 73 to 88% when using a whole-body examination. Conclusion: FDG PET/CT showed good sensitivity and specificity for KS staging (digestive involvement excepted) and could be used for staging patients with active KS.
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Affiliation(s)
- Louise Pesqué
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
| | - Julie Delyon
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
| | - Coralie Lheure
- Université de Paris Cité, 75006 Paris, France;
- Department of Dermatology, Cochin University Hospital, 27, Rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Barouyr Baroudjian
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
| | - Maxime Battistella
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
- Department of Pathology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Pascal Merlet
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
- Université de Paris Cité, 75006 Paris, France;
| | - Céleste Lebbé
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
| | - Laetitia Vercellino
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
- Université de Paris, INSERM, UMR_S942 MASCOT, 75006 Paris, France
- Correspondence: ; Tel.: +33-142499411
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Oulès B, Mourah S, Baroudjian B, Jouenne F, Delyon J, Louveau B, Gruber A, Lebbé C, Battistella M. Clinicopathologic and molecular characterization of melanomas mutated for CTNNB1 and MAPK. Virchows Arch 2022; 480:475-480. [PMID: 34013383 DOI: 10.1007/s00428-021-03119-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 12/19/2022]
Abstract
Wnt/β-catenin signaling plays crucial roles in melanocyte biology and may be implicated in melanoma progression. In this study, we retrospectively examined a real-life cohort of melanomas mutated for β-catenin (CTNNB1), in association or not with a MAPK mutation (of BRAF or NRAS), and analyzed their clinical, histopathological, and molecular characteristics. Our results indicate that, regardless of the presence of a concurrent MAPK mutation, CTNNB1mut cutaneous primary melanomas display more proliferative hallmarks (increased Breslow thickness, mitotic index, and ulceration) than their CTNNB1 wild-type counterparts. Accordingly, they often progress to the metastatic stage. Furthermore, concurrent CTNNB1 and MAPK mutations do not necessarily confer a deep penetrating nevi phenotype. Altogether, this study provides evidence that CTNNB1 mutations in melanomas are associated with specific clinical and pathological features.
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Affiliation(s)
- Bénédicte Oulès
- Department of Dermatology and Centre D'investigation Clinique (CIC), Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France
- Institut Cochin, Cutaneous Biology Lab, INSERM U1016, UMR8104, Université de Paris, 75014, Paris, France
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Hospital, 75006, Paris, France
| | - Samia Mourah
- Department of Pharmacology and Tumor Genomics, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France
- Université de Paris, INSERM UMRS 976, 75010, Paris, France
| | - Barouyr Baroudjian
- Department of Dermatology and Centre D'investigation Clinique (CIC), Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France
| | - Fanélie Jouenne
- Department of Pharmacology and Tumor Genomics, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France
- Université de Paris, INSERM UMRS 976, 75010, Paris, France
| | - Julie Delyon
- Department of Dermatology and Centre D'investigation Clinique (CIC), Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France
- Université de Paris, INSERM UMRS 976, 75010, Paris, France
| | - Baptiste Louveau
- Department of Pharmacology and Tumor Genomics, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France
- Université de Paris, INSERM UMRS 976, 75010, Paris, France
| | - Aurélia Gruber
- Department of Pharmacology and Tumor Genomics, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France
- Université de Paris, INSERM UMRS 976, 75010, Paris, France
| | - Céleste Lebbé
- Department of Dermatology and Centre D'investigation Clinique (CIC), Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France
- Université de Paris, INSERM UMRS 976, 75010, Paris, France
| | - Maxime Battistella
- Université de Paris, INSERM UMRS 976, 75010, Paris, France.
- Department of Pathology, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, 75010, Paris, France.
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Cuendet MA, Gatta R, Wicky A, Gerard CL, Dalla-Vale M, Tavazzi E, Michielin G, Delyon J, Ferahta N, Cesbron J, Lofek S, Huber A, Jankovic J, Demicheli R, Bouchaab H, Digklia A, Obeid M, Peters S, Eicher M, Pradervand S, Michielin O. A differential process mining analysis of COVID-19 management for cancer patients. Front Oncol 2022; 12:1043675. [PMID: 36568192 PMCID: PMC9768429 DOI: 10.3389/fonc.2022.1043675] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
During the acute phase of the COVID-19 pandemic, hospitals faced a challenge to manage patients, especially those with other comorbidities and medical needs, such as cancer patients. Here, we use Process Mining to analyze real-world therapeutic pathways in a cohort of 1182 cancer patients of the Lausanne University Hospital following COVID-19 infection. The algorithm builds trees representing sequences of coarse-grained events such as Home, Hospitalization, Intensive Care and Death. The same trees can also show probability of death or time-to-event statistics in each node. We introduce a new tool, called Differential Process Mining, which enables comparison of two patient strata in each node of the tree, in terms of hits and death rate, together with a statistical significance test. We thus compare management of COVID-19 patients with an active cancer in the first vs. second COVID-19 waves to quantify hospital adaptation to the pandemic. We also compare patients having undergone systemic therapy within 1 year to the rest of the cohort to understand the impact of an active cancer and/or its treatment on COVID-19 outcome. This study demonstrates the value of Process Mining to analyze complex event-based real-world data and generate hypotheses on hospital resource management or on clinical patient care.
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Affiliation(s)
- Michel A. Cuendet
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, United States
| | - Roberto Gatta
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alexandre Wicky
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Camille L. Gerard
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
- The Francis Crick Institute, London, United Kingdom
| | - Margaux Dalla-Vale
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Erica Tavazzi
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Grégoire Michielin
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Julie Delyon
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Nabila Ferahta
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Cesbron
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sébastien Lofek
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Huber
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jeremy Jankovic
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rita Demicheli
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hasna Bouchaab
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michel Obeid
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Solange Peters
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Manuela Eicher
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Higher Education and Research in Health Care, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sylvain Pradervand
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Michielin
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- *Correspondence: Olivier Michielin,
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11
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Gerard CL, Delyon J, Wicky A, Homicsko K, Cuendet MA, Michielin O. Turning tumors from cold to inflamed to improve immunotherapy response. Cancer Treat Rev 2021; 101:102227. [PMID: 34656019 DOI: 10.1016/j.ctrv.2021.102227] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 01/06/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 12/30/2022]
Abstract
Immune checkpoint inhibitors have revolutionized the treatment landscape for a number of cancers over the last few decades. Nevertheless, a majority of patients still do not benefit from these treatments. Such patient-specific lack of response can be predicted, in part, from the immune phenotypes present in the tumor microenvironment. We provide a perspective on options to reprogram the tumors and their microenvironment to increase the therapeutic efficacy of immunotherapies and expand their efficacy against cold tumors. Additionally, we review data from current preclinical and clinical trials aimed at testing the different therapeutic options in monotherapy or preferably in combination with checkpoint inhibitors.
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Affiliation(s)
- C L Gerard
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland
| | - J Delyon
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland
| | - A Wicky
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland
| | - K Homicsko
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland; Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Michel A Cuendet
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland; Molecular Modelling Group, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Department of Physiology and Biophysics, Weill Cornell Medicine, NY, USA.
| | - O Michielin
- Precision Oncology Center, Lausanne University Hospital (CHUV), Switzerland; Molecular Modelling Group, Swiss Institute of Bioinformatics, Lausanne, Switzerland.
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12
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Patras M, Decullier E, Lebbé C, Delyon J, Dantal J, Legendre C, Mazloum M, Du Thanh A, Boukari F, Morelon E, Jullien D, Kanitakis J, Ducroux E. Outcome of pretransplant melanoma after solid organ transplantation: an observational study. Transpl Int 2021; 34:2154-2165. [PMID: 34519106 DOI: 10.1111/tri.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
The number of patients with a history of melanoma who are awaiting a solid organ transplantation (SOT) is increasing. Few recommendations exist on the timing to transplantation after melanoma diagnosis. The aim of this study was to assess the melanoma recurrence-free survival after pretransplant melanoma (PTM). We conducted a multicenter ambispective observational study. Organ transplant recipients (OTR) with a history of PTM and complete AJCC staging were included. Thirty-seven patients (predominantly men with a renal allograft) were included. Five melanomas were in situ, 21 stage IA, 4 stage IB, 5 stage II, and 2 stage IIIB. The median post-transplantation follow-up time was 4 years. Sixty-two percent of patients were followed up more than 2 years. Recurrence-free survival since melanoma reached 89.9%, but varied significantly according to AJCC staging (P = 0.0129). Three patients presented a recurrence. Despite the rather limited sample size and a wide range of follow-up, our findings concerning the recurrence-free survival appear reassuring for in situ and stage IA PTM; accordingly, we suggest that a waiting time to transplantation is not mandatory in patients with in situ or stage IA PTM, especially whenever SOT is urgently needed. Caution is, however, needed for patients with higher stage.
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Affiliation(s)
| | - Evelyne Decullier
- Service d'Epidémiologie et Recherches Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Céleste Lebbé
- AP-HP Dermatology, INSERM U976, Saint Louis Hospital, Université de Paris, Paris, France
| | - Julie Delyon
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Jacques Dantal
- Service de Néphrologie, Hôpital Universitaire de Nantes, Hôtel Dieu, Nantes, France
| | - Christophe Legendre
- Service de Néphrologie et Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Manal Mazloum
- Service de Néphrologie et Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Aurélie Du Thanh
- Service de Dermatologie, Hôpital Universitaire de Montpellier, Montpellier, France
| | - Feriel Boukari
- Service de Dermatologie, Hôpital Universitaire de Nice, Nice, France
| | - Emmanuel Morelon
- Service de Néphrologie, Hôpital Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Denis Jullien
- Service de Dermatologie, Hôpital Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean Kanitakis
- Service de Dermatologie, Hôpital Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Emilie Ducroux
- Service de Dermatologie, Hôpital Universitaire Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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13
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Weill A, Brunet-Possenti F, Léonard-Louis S, Delyon J, Bonniaud B, Jeudy G, Descamps V, Dinulescu M, Le Corre Y, Psimaras D, Baroudjian B, Hervier B. Myopathies inflammatoires induites par les inhibiteurs de point de contrôle immunitaire : spectre clinique et traitements. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Weill A, Le Corre Y, Brunet-Possenti F, Léonard-Louis S, Delyon J, Bonniaud B, Jeudy G, Descamps V, Dinulescu M, Psimaras D, Baroudjian B, Hervier B. Myopathies inflammatoires induites par les inhibiteurs de point de contrôle immunitaire : la reprise d’une immunothérapie est possible. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.240] [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: 10/21/2022]
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15
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Louveau B, Resche-Rigon M, Lesimple T, Da Meda L, Pracht M, Baroudjian B, Delyon J, Amini-Adle M, Dutriaux C, Reger de Moura C, Sadoux A, Jouenne F, Ghrieb Z, Vilquin P, Bouton D, Tibi A, Huguet S, Rezai K, Battistella M, Mourah S, Lebbe C. Phase I-II Open-Label Multicenter Study of Palbociclib + Vemurafenib in BRAF V600MUT Metastatic Melanoma Patients: Uncovering CHEK2 as a Major Response Mechanism. Clin Cancer Res 2021; 27:3876-3883. [PMID: 33947696 DOI: 10.1158/1078-0432.ccr-20-4050] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/16/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE In BRAF V600MUT metastatic melanoma, cyclin D-CDK4/6-INK4-Rb pathway alterations are involved in resistance to MAPK inhibitors, suggesting a clinical benefit of cyclin-dependent kinase 4 (CDK4) inhibitors. In this phase I-II study, we aimed to establish the MTD of palbociclib when added to vemurafenib. PATIENTS AND METHODS Patients with BRAF V600E/KMUT metastatic melanoma harboring CDKN2A loss and RB1 expression were included and stratified into two groups according to previous BRAF inhibitor treatment (no:strata 1; yes:strata 2). Treatment comprised palbociclib once daily for 14 days followed by a 7-day break + continuous dosing of vemurafenib. The primary endpoint was the occurrence of dose-limiting toxicity (DLT), and the secondary endpoints included the best response, survival, pharmacokinetics, and tumor molecular profiling. RESULTS Eighteen patients were enrolled, with 15 in strata 2. Characteristics at inclusion were American Joint Committee on Cancer stage IVM1c (N = 16; 88.9%), high lactate dehydrogenase (N = 9; 50.0%), and median number of previous treatments of 2. One and 5 patients experienced DLT in strata 1 and 2, respectively, defining the MTD at palbociclib 25 mg and vemurafenib 960 mg in strata 2. No significant evidence for drug-drug interactions was highlighted. The median progression-free survival was 2.8 months, and 5 (27.8%) patients showed a clinical response. The baseline differential mRNA expression analysis and in vitro data revealed the role of CHEK2 in the response to palbociclib. CONCLUSIONS Although the combination of palbociclib + fixed-dose vemurafenib did not allow an increased palbociclib dosage above 25 mg, a significant clinical benefit was achieved in pretreated patients with melanoma. An association between the transcriptomic data and clinical response was highlighted.
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Affiliation(s)
- Baptiste Louveau
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital APHP, Paris, France
- Université de Paris, INSERM U976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Saint Louis Hospital APHP, Paris, France
| | - Matthieu Resche-Rigon
- Department of Biostatistics, Saint Louis Hospital APHP, Paris, France
- Université de Paris, INSERM U1153, Saint Louis Hospital APHP, Paris, France
| | - Thierry Lesimple
- Oncodermatology Unit, Eugene Marquis Center, CHU CLCC, Rennes, France
| | - Laetitia Da Meda
- Department of Dermatology, Saint Louis Hospital APHP, Paris, France
- Centre d'Investigation Clinique (CIC 1427), Saint Louis Hospital APHP, Paris, France
| | - Marc Pracht
- Oncodermatology Unit, Eugene Marquis Center, CHU CLCC, Rennes, France
| | - Barouyr Baroudjian
- Université de Paris, INSERM U976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Saint Louis Hospital APHP, Paris, France
- Department of Dermatology, Saint Louis Hospital APHP, Paris, France
| | - Julie Delyon
- Université de Paris, INSERM U976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Saint Louis Hospital APHP, Paris, France
- Department of Dermatology, Saint Louis Hospital APHP, Paris, France
| | | | | | - Coralie Reger de Moura
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital APHP, Paris, France
| | - Aurélie Sadoux
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital APHP, Paris, France
| | - Fanélie Jouenne
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital APHP, Paris, France
- Université de Paris, INSERM U976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Saint Louis Hospital APHP, Paris, France
| | - Zineb Ghrieb
- Centre d'Investigation Clinique (CIC 1427), Saint Louis Hospital APHP, Paris, France
| | - Paul Vilquin
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital APHP, Paris, France
- Université de Paris, INSERM U976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Saint Louis Hospital APHP, Paris, France
| | | | | | | | | | - Maxime Battistella
- Université de Paris, INSERM U976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Saint Louis Hospital APHP, Paris, France
- Department of Pathology, APHP Saint Louis Hospital, Paris, France
| | - Samia Mourah
- Department of Pharmacology and Solid Tumor Genomics, Saint Louis Hospital APHP, Paris, France
- Université de Paris, INSERM U976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Saint Louis Hospital APHP, Paris, France
| | - Céleste Lebbe
- Université de Paris, INSERM U976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Saint Louis Hospital APHP, Paris, France.
- Department of Dermatology, Saint Louis Hospital APHP, Paris, France
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16
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Ghisoni E, Wicky A, Bouchaab H, Imbimbo M, Delyon J, Gautron Moura B, Gérard CL, Latifyan S, Özdemir BC, Caikovski M, Pradervand S, Tavazzi E, Gatta R, Marandino L, Valabrega G, Aglietta M, Obeid M, Homicsko K, Mederos Alfonso NN, Zimmermann S, Coukos G, Peters S, Cuendet MA, Di Maio M, Michielin O. Late-onset and long-lasting immune-related adverse events from immune checkpoint-inhibitors: An overlooked aspect in immunotherapy. Eur J Cancer 2021; 149:153-164. [PMID: 33865201 DOI: 10.1016/j.ejca.2021.03.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionised cancer therapy but frequently cause immune-related adverse events (irAEs). Description of late-onset and duration of irAEs in the literature is often incomplete. METHODS To investigate reporting and incidence of late-onset and long-lasting irAEs, we reviewed all registration trials leading to ICI's approval by the US FDA and/or EMA up to December 2019. We analysed real-world data from all lung cancer (LC) and melanoma (Mel) patients treated with approved ICIs at the University Hospital of Lausanne (CHUV) from 2011 to 2019. To account for the immortal time bias, we used a time-dependent analysis to assess the potential association between irAEs and overall survival (OS). RESULTS Duration of irAEs and proportion of patients with ongoing toxicities at data cut-off were not specified in 56/62 (90%) publications of ICIs registration trials. In our real-world analysis, including 437 patients (217 LC, 220 Mel), 229 (52.4%) experienced at least one grade ≥2 toxicity, for a total of 318 reported irAEs, of which 112 (35.2%) were long-lasting (≥6 months) and about 40% were ongoing at a median follow-up of 369 days [194-695] or patient death. The cumulative probability of irAE onset from treatment initiation was 42.8%, 51.0% and 57.3% at 6, 12 and 24 months, respectively. The rate of ongoing toxicity from the time of first toxicity onset was 42.8%, 38.4% and 35.7% at 6, 12 and 24 months. Time-dependent analysis showed no significant association between the incidence of irAEs and OS in both cohorts (log Rank p = 0.67 and 0.19 for LC and Mel, respectively). CONCLUSIONS Late-onset and long-lasting irAEs are underreported but common events during ICIs therapy. Time-dependent survival analysis is advocated to assess their impact on OS. Real-world evidence is warranted to fully capture and characterise late-onset and long-lasting irAEs in order to implement appropriate strategies for patient surveillance and follow-up.
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Affiliation(s)
- E Ghisoni
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - A Wicky
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - H Bouchaab
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - M Imbimbo
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - J Delyon
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - B Gautron Moura
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - C L Gérard
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - S Latifyan
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - B C Özdemir
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - M Caikovski
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - S Pradervand
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - E Tavazzi
- Department of Information Engineering, University of Padova, Italy
| | - R Gatta
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - L Marandino
- Department of Oncology, University of Torino, Italy
| | - G Valabrega
- Department of Oncology, University of Torino, Italy; Candiolo Cancer Institute, FPO, IRCCS, Candiolo (TO), Italy
| | - M Aglietta
- Department of Oncology, University of Torino, Italy; Candiolo Cancer Institute, FPO, IRCCS, Candiolo (TO), Italy
| | - M Obeid
- Service Immunologie et Allergie, Lausanne University Hospital, Switzerland
| | - K Homicsko
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | | | - S Zimmermann
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - G Coukos
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - S Peters
- Department of Oncology, Lausanne University Hospital, Switzerland
| | - M A Cuendet
- Department of Oncology, Lausanne University Hospital, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland; Department of Physiology and Biophysics, Weill Cornell Medicine, New York, USA
| | - M Di Maio
- Department of Oncology, University of Torino, Italy; Medical Oncology, A.O. Ordine Mauriziano, Torino, Italy
| | - O Michielin
- Department of Oncology, Lausanne University Hospital, Switzerland; Ludwig Institute for Cancer Research, Lausanne, Switzerland.
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17
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Weill A, Delyon J, Descamps V, Deschamps L, Dinulescu M, Dupuy A, Célérier P, Nardin C, Aubin F, Le Corre Y, Heidelberger V, Maubec E, Malissen N, Longvert C, Machet L, Gounant V, Brosseau S, Bonniaud B, Jeudy G, Psimaras D, Doucet L, Lebbe C, Zalcman G, De Masson A, Baroudjian B, Leonard-Louis S, Hervier B, Brunet-Possenti F. Treatment strategies and safety of rechallenge in the setting of immune checkpoint inhibitors-related myositis: A national multicenter study. Rheumatology (Oxford) 2021; 60:5753-5764. [PMID: 33725115 DOI: 10.1093/rheumatology/keab249] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/04/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The occurrence of immune-related myositis (irM) is increasing, yet there are no therapeutic guidelines. We sought to analyze the current therapeutic strategies of irM and evaluate the outcomes of immune checkpoint inhibitors (ICI) rechallenge. METHODS We conducted a nationwide retrospective study between April 2018 and March 2020 including irM without myocardial involvement. Depending on the presence of cutaneous signs or unusual histopathological features, patients were classified into two groups: typical or atypical irM. Therapeutic strategies were analyzed in both groups. The modalities and outcomes of ICI rechallenge were reviewed. RESULTS Among the 20 patients, 16 presented typical irM. Regardless of severity, most typical irM were treated with steroid monotherapy (n = 14/16) and all had a complete response within ≤ 3 weeks. The efficacy of oral steroids for non-severe typical irM (n = 10) was the same with low-dose (≤ 0.5 mg/kg/day) or high-dose (1 mg/kg/day). Severe typical irM were successfully treated with intravenous methylprednisolone. Atypical irM (n = 4) had a less favorable evolution, including one irM-related death, and required heavy immunosuppression. ICI were safely reintroduced in 9 patients presenting a moderate (n = 6) or a severe (n = 3) irM. CONCLUSION Our data highlight that steroid monotherapy is an effective treatment for typical irM, either with prednisone or with intravenous methylprednisone pulses depending on the severity. The identification of unusual features is important in determining the initial therapeutic strategy. The outcomes of rechallenged patients are in favor of a safe reintroduction of ICI following symptom resolution and CK normalization in moderate and severe forms of irM.
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Affiliation(s)
- Amandine Weill
- Department of Dermatology, Hôpital Bichat, AP-HP, Université de Paris, Paris, France
| | - Julie Delyon
- Department of Dermatology, Hôpital Saint Louis, AP-HP, Université de Paris, Paris, France
| | - Vincent Descamps
- Department of Dermatology, Hôpital Bichat, AP-HP, Université de Paris, Paris, France
| | - Lydia Deschamps
- Department of Pathology, Hôpital Bichat, AP-HP, Université de Paris, Paris, France
| | - Monica Dinulescu
- Department of Dermatology, CHU de Rennes, Université de Rennes, Rennes, France
| | - Alain Dupuy
- Department of Dermatology, CHU de Rennes, Université de Rennes, Rennes, France
| | | | - Charlee Nardin
- Department of Dermatology, CHU de Besançon, Université de Franche Comté, Besançon, France
| | - François Aubin
- Department of Dermatology, CHU de Besançon, Université de Franche Comté, Besançon, France
| | - Yannick Le Corre
- Department of Dermatology, CHU d'Angers, Université LUNAM, Angers, France
| | - Valentine Heidelberger
- Department of Dermatology, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Eve Maubec
- Department of Dermatology, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Nausicaa Malissen
- Department of Dermatology, Hôpital La Timone, AP-HM, Université d'Aix-Marseille, Marseille, France
| | - Christine Longvert
- Department of Dermatology, Hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, France
| | - Laurent Machet
- Dermatology Department, CHRU de Tours, Université de Tours, Tours, France
| | - Valérie Gounant
- Department of Thoracic Oncology, Hôpital Bichat, AP-HP, Université de Paris, Paris, France
| | - Solenne Brosseau
- Department of Thoracic Oncology, Hôpital Bichat, AP-HP, Université de Paris, Paris, France
| | - Bertille Bonniaud
- Department of Dermatology, Hôpital universitaire de Dijon, Dijon, France
| | - Géraldine Jeudy
- Department of Dermatology, Hôpital universitaire de Dijon, Dijon, France
| | - Dimitri Psimaras
- Department of Neurology, Hôpital La Pitié Salpétrière, AP-HP, Université Sorbonne Paris Centre, Paris, France
| | - Ludovic Doucet
- Department of Oncology, Hôpital Saint Louis, AP-HP, Université 7, Paris, France
| | - Céleste Lebbe
- Department of Dermatology, Hôpital Saint Louis, AP-HP, Université de Paris, Paris, France
| | - Gérard Zalcman
- Department of Thoracic Oncology, Hôpital Bichat, AP-HP, Université de Paris, Paris, France
| | - Adèle De Masson
- Department of Dermatology, Hôpital Saint Louis, AP-HP, Université de Paris, Paris, France
| | - Barouyr Baroudjian
- Department of Dermatology, Hôpital Saint Louis, AP-HP, Université de Paris, Paris, France
| | - Sarah Leonard-Louis
- Department of Neuropathology, Hôpital La Pitié Salpétrière, AP-HP, Université Sorbonne Paris Centre, Paris, France
| | - Baptiste Hervier
- Department of Internal Medicine, Hôpital Saint Louis, AP-HP, Université de Paris, Paris, France
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18
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Gauci ML, Baroudjian B, Bédérède U, Zeboulon C, Delyon J, Allayous C, Madelaine I, Eftekhari P, Resche-Rigon M, Poté N, Paradis V, Durand F, Lebbé C, Roux O, Bouattour M. Severe immune-related hepatitis induced by immune checkpoint inhibitors: Clinical features and management proposal. Clin Res Hepatol Gastroenterol 2021; 45:101491. [PMID: 32773362 DOI: 10.1016/j.clinre.2020.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Immune-related hepatitis (IRH) occurs in 1 to 18% of immune checkpoint inhibitor (ICI)-treated patients. Steroids are usually recommended for grade≥3 IRH, but their impact on IRH resolution and patient survival remains unclear. METHODS We retrospectively analyzed a prospective cohort of 339 patients treated at Saint-Louis Hospital (Paris, France) with ICIs for advanced melanoma. Cases of grade≥3 IRH were collected and analyzed. Two groups were compared for their biological features and time for IRH resolution and survival: patients who received steroids (steroids group: SG) and patients who did not (nonsteroids group: NSG). FINDINGS Grade≥3 IRH was observed in 21 patients. Thirteen were treated with steroids (SG), and 8 were not (NSG). The median time for toxicity resolution was 49 days in SG and 24 days in NSG (P=0.62). All but one patient showed a favorable outcome. Two-year survival was 56% in SG and 54% in NSG (P=0.83). Higher transaminase (P=0.002) and bilirubin (P=0.008) and lower prothrombin (P=0.035) levels were observed in SG than in NSG. For 8 (4 SG/4 NSG) patients, ICI was resumed without any hepatitis relapse. INTERPRETATION Favorable outcomes may be achieved spontaneously and with no steroids in patients with severe IRH. Steroid initiation should be discussed in cases of high bilirubin levels and decreased prothrombin levels. ICI could be resumed without hepatitis relapse. We propose a management algorithm for grade≥3 IRH that should be validated in larger and prospective cohorts.
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Affiliation(s)
- Marie-Léa Gauci
- AP-HP, Département de Dermatologie, Hôpital Saint-Louis, Paris, France; INSERM U976, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Barouyr Baroudjian
- AP-HP, Département de Dermatologie, Hôpital Saint-Louis, Paris, France; INSERM U976, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Ulysse Bédérède
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; AP-HP, Service de Biostatistiques, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France
| | - Charlotte Zeboulon
- AP-HP, Département de Dermatologie, Hôpital Saint-Louis, Paris, France; INSERM U976, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Julie Delyon
- AP-HP, Département de Dermatologie, Hôpital Saint-Louis, Paris, France; INSERM U976, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Clara Allayous
- AP-HP, Département de Dermatologie, Hôpital Saint-Louis, Paris, France; INSERM U976, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Isabelle Madelaine
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; AP-HP, Service de Pharmacologie,Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France
| | - Pirayeh Eftekhari
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; AP-HP, Centre Régional de Pharmacovigilance, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Fernand Widal Hospital Paris, Paris, France
| | - Matthieu Resche-Rigon
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; AP-HP, Service de Biostatistiques, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France
| | - Nicolas Poté
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; AP-HP, Département d'Anatomopathologie, Hôpital Beaujon Clichy, Clichy, France; INSERM UMR 1149, Paris, France
| | - Valerie Paradis
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; AP-HP, Département d'Anatomopathologie, Hôpital Beaujon Clichy, Clichy, France; INSERM UMR 1149, Paris, France
| | - François Durand
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; INSERM UMR 1149, Paris, France; AP-HP, Service d'Hépatologie et Réanimation Hépatique, Pôle des maladies de l'appareil digestif, Hôpital Beaujon, Clichy, France
| | - Céleste Lebbé
- AP-HP, Département de Dermatologie, Hôpital Saint-Louis, Paris, France; INSERM U976, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | - Olivier Roux
- Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; AP-HP, Service d'Hépatologie et Réanimation Hépatique, Pôle des maladies de l'appareil digestif, Hôpital Beaujon, Clichy, France
| | - Mohamed Bouattour
- AP-HP, Département d'Oncologie Digestive, Pôle des maladies de l'appareil digestif, Hôpital Beaujon, Clichy, France.
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- AP-HP, Département de Dermatologie, Hôpital Saint-Louis, Paris, France; INSERM U976, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France; AP-HP, Service de Biostatistiques, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France; AP-HP, Centre Régional de Pharmacovigilance, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Fernand Widal Hospital Paris, Paris, France; AP-HP, Département d'Anatomopathologie, Hôpital Beaujon Clichy, Clichy, France; INSERM UMR 1149, Paris, France; AP-HP, Service d'Hépatologie et Réanimation Hépatique, Pôle des maladies de l'appareil digestif, Hôpital Beaujon, Clichy, France; AP-HP, Département d'Oncologie Digestive, Pôle des maladies de l'appareil digestif, Hôpital Beaujon, Clichy, France
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Delyon J, Zuber J, Dorent R, Poujol-Robert A, Peraldi MN, Anglicheau D, Lebbe C. Immune Checkpoint Inhibitors in Transplantation-A Case Series and Comprehensive Review of Current Knowledge. Transplantation 2021; 105:67-78. [PMID: 32355121 DOI: 10.1097/tp.0000000000003292] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Cancer is a leading cause of morbidity and deaths in solid organ transplant recipients. In immunocompetent patients, cancer prognosis has been dramatically improved with the development of immune checkpoint inhibitors (ICI), as programmed cell death protein 1/programmed death-ligand 1 and cytotoxic T lymphocyte-associated antigen 4 inhibitors, that increase antitumor immune responses. ICI has been developed outside of the scope of transplantation because of the theoretical risk of graft rejection, which has later been confirmed by the publication of several cases and small series. The use of ICI became unavoidable for treating advanced cancers including in organ transplant patients, but their management in this setting remains highly challenging, as to date no strategy to adapt the immunosuppression and to prevent graft rejection has been defined. In this article, we report a monocentric series of 5 solid organ transplant recipients treated with ICI and provide a comprehensive review of current knowledge of ICI management in the setting of solid organ transplantation. Strategies warranted to increase knowledge through collecting more exhaustive data are also discussed.
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Affiliation(s)
- Julie Delyon
- Department of Dermatology, AP-HP Hôpital Saint Louis, Université de Paris, INSERM U976, Team 1, HIPI, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Université de Paris, Paris, France
| | - Richard Dorent
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Armelle Poujol-Robert
- Department of Hepatology, AP-HP, Hôpital Saint-Antoine, UPMC University, Paris, France
| | - Marie-Noelle Peraldi
- Department of Nephrology, AP-HP Hôpital Saint Louis, Université de Paris, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Université de Paris, Paris, France
| | - Celeste Lebbe
- Department of Dermatology, AP-HP Hôpital Saint Louis, Université de Paris, INSERM U976, Team 1, HIPI, Paris, France
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20
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Nguyen TT, Gapihan G, Tetu P, Pamoukdjian F, El Bouchtaoui M, Lebœuf C, Feugeas JP, Paris J, Baroudjian B, Delyon J, Mourah S, Lebbé C, Janin A, Bousquet G, Battistella M. Increased risk of brain metastases among patients with melanoma and PROM2 expression in metastatic lymph nodes. Clin Transl Med 2020; 10:e198. [PMID: 33377645 PMCID: PMC7711084 DOI: 10.1002/ctm2.198] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Thuy Thi Nguyen
- INSERM U942, Universités de Paris et Sorbonne Paris Nord, Bobigny, France.,AP-HP Hôpital Avicenne, Oncologie Médicale, Bobigny, France.,Medical Oncology Department A, National Cancer Hospital, Hanoi, Vietnam
| | - Guillaume Gapihan
- INSERM U942, Universités de Paris et Sorbonne Paris Nord, Bobigny, France.,Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Pauline Tetu
- Dermatologie, AP-HP Hôpital Saint Louis, Paris, France
| | - Frédéric Pamoukdjian
- INSERM U942, Universités de Paris et Sorbonne Paris Nord, Bobigny, France.,Médecine Gériatrique, AP-HP Hôpital Avicenne, Bobigny, France.,Université Sorbonne Paris Nord, Cardiovascular Markers in Stressed Conditions, MASCOT, Bobigny, France
| | | | - Christophe Lebœuf
- INSERM U942, Universités de Paris et Sorbonne Paris Nord, Bobigny, France
| | - Jean-Paul Feugeas
- INSERM U722, Paris, France.,Université de Franche-Comté, Besançon, France
| | - Justine Paris
- INSERM U942, Universités de Paris et Sorbonne Paris Nord, Bobigny, France
| | | | - Julie Delyon
- Dermatologie, AP-HP Hôpital Saint Louis, Paris, France.,INSERM U976, Paris, France
| | - Samia Mourah
- Hôpital Saint-Louis, Université de Paris, Paris, France.,INSERM U976, Paris, France.,Solid Tumor Genomic Department, AP-HP, Hôpital Saint Louis, Paris, France
| | - Céleste Lebbé
- Hôpital Saint-Louis, Université de Paris, Paris, France.,Dermatologie, AP-HP Hôpital Saint Louis, Paris, France.,INSERM U976, Paris, France
| | - Anne Janin
- INSERM U942, Universités de Paris et Sorbonne Paris Nord, Bobigny, France.,Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Guilhem Bousquet
- INSERM U942, Universités de Paris et Sorbonne Paris Nord, Bobigny, France.,AP-HP Hôpital Avicenne, Oncologie Médicale, Bobigny, France.,Université Sorbonne Paris Nord, Cardiovascular Markers in Stressed Conditions, MASCOT, Bobigny, France
| | - Maxime Battistella
- Hôpital Saint-Louis, Université de Paris, Paris, France.,INSERM U976, Paris, France.,Laboratoire de Pathologie, AP-HP Hôpital Saint-Louis, Paris, France
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21
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Benajiba L, Lambert J, La Selva R, Cochereau D, Baroudjian B, Roux J, Le Goff J, Basset-Seguin N, Pages C, Battistella M, Delyon J, Lebbé C. Évolution clinique et prise en charge thérapeutique du sarcome de Kaposi classique et endémique. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.197] [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]
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22
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Tetu P, Sirven-Villaros L, Cuzzubbo S, Ursu R, Baroudjian B, Delyon J, Nataf F, De Margerie-Mellon C, Basset-Seguin N, Allayous C, Lefevre W, Carpentier A, Lebbé C. Impact des nouveaux traitements systémiques et de la radiothérapie cérébrale concomitante dans la prise en charge des patients présentant un mélanome avec atteinte leptoméningée. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.486] [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]
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23
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Tetu P, Baroudjian B, Delyon J, Basset-Seguin N, Allayous C, Oriano B, Lebbé C. Facteurs pronostiques et prédictifs associés au traitement par nivolumab et ipilimumab chez les patients présentant un mélanome métastatique. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Delyon J, Resche-Rigon M, Renaud M, Le Goff J, Dalle S, Heidelberger V, Da Meda L, Allain V, Toullec L, Mourah S, Carcelain G, Caillat-Zucman S, Battistella M, Lebbe C. Essai de phase 2 multicentrique évaluant le pembrolizumab dans la maladie de Kaposi classique ou endémique. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.041] [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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25
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Jouenne F, Louveau B, Têtu P, Sadoux A, Gruber A, Lopes E, Delyon J, Serror K, Marco O, Da Meda L, Ndiaye A, Lermine A, Dumaz N, Battistella M, Baroudjian B, Lebbe C, Mourah S. Développement d’un panel « Next Generation Sequencing » ciblé en vue d’améliorer la prise en charge des patients atteints de mélanome. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Oulès B, Mourah S, Baroudjian B, Jouenne F, Delyon J, Louveau B, Gruber A, Lebbe C, Battistella M. Les mélanomes mutés CTNNB1 : description clinique, histologique et génétique. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Louveau B, Jouenne F, Têtu P, Sadoux A, Gruber A, Lopes E, Delyon J, Serror K, Marco O, Da Meda L, Ndiaye A, Lermine A, Dumaz N, Battistella M, Baroudjian B, Lebbe C, Mourah S. A Melanoma-Tailored Next-Generation Sequencing Panel Coupled with a Comprehensive Analysis to Improve Routine Melanoma Genotyping. Target Oncol 2020; 15:759-771. [PMID: 33151472 DOI: 10.1007/s11523-020-00764-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tumor molecular deciphering is crucial in clinical management. Pan-cancer next-generation sequencing panels have moved towards exhaustive molecular characterization. However, because of treatment resistance and the growing emergence of pharmacological targets, tumor-specific customized panels are needed to guide therapeutic strategies. OBJECTIVE The objective of this study was to present such a customized next-generation sequencing panel in melanoma. METHODS Melanoma patients with somatic molecular profiling performed as part of routine care were included. High-throughput sequencing was performed with a melanoma tailored next-generation sequencing panel of 64 genes involved in molecular classification, prognosis, theranostic, and therapeutic resistance. Single nucleotide variants and copy number variations were screened, and a comprehensive molecular analysis identified clinically relevant alterations. RESULTS Four hundred and twenty-one melanoma cases were analyzed (before any treatment initiation for 94.8% of patients). After bioinformatic prioritization, we uncovered 561 single nucleotide variants, 164 copy number variations, and four splice-site mutations. At least one alteration was detected in 368 (87.4%) lesions, with BRAF, NRAS, CDKN2A, CCND1, and MET as the most frequently altered genes. Among patients with BRAFV600 mutated melanoma, 44.5% (77 of 173) harbored at least one concurrent alteration driving potential resistance to mitogen-activated protein kinase inhibitors. In patients with RAS hotspot mutated lesions and in patients with neither BRAFV600 nor RAS hotspot mutations, alterations constituting potential pharmacological targets were found in 56.9% (66 of 116) and 47.7% (63 of 132) of cases, respectively. CONCLUSIONS Our tailored next-generation sequencing assay coupled with a comprehensive analysis may improve therapeutic management in a significant number of patients with melanoma. Updating such a panel and implementing multi-omic approaches will further enhance patients' clinical management.
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Affiliation(s)
- Baptiste Louveau
- Department of Pharmacology and Solid Tumor Genomics, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France.,Université de Paris, Paris, France.,INSERM UMR-S 976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Paris, France
| | - Fanélie Jouenne
- Department of Pharmacology and Solid Tumor Genomics, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France.,Université de Paris, Paris, France.,INSERM UMR-S 976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Paris, France
| | - Pauline Têtu
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Sadoux
- Department of Pharmacology and Solid Tumor Genomics, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Aurélia Gruber
- Department of Pharmacology and Solid Tumor Genomics, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Eddie Lopes
- Department of Pharmacology and Solid Tumor Genomics, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Julie Delyon
- Université de Paris, Paris, France.,INSERM UMR-S 976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Paris, France.,Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kevin Serror
- Department of Plastic, Reconstructive and Esthetic Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Oren Marco
- Department of Plastic, Reconstructive and Esthetic Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laetitia Da Meda
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aminata Ndiaye
- MOABI-APHP Bioinformatics Platform-WIND-DSI, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alban Lermine
- MOABI-APHP Bioinformatics Platform-WIND-DSI, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Dumaz
- INSERM UMR-S 976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Paris, France
| | - Maxime Battistella
- Université de Paris, Paris, France.,INSERM UMR-S 976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Paris, France.,Department of Pathology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Barouyr Baroudjian
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Céleste Lebbe
- Université de Paris, Paris, France.,INSERM UMR-S 976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Paris, France.,Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samia Mourah
- Department of Pharmacology and Solid Tumor Genomics, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France. .,Université de Paris, Paris, France. .,INSERM UMR-S 976, Team 1, Human Immunology Pathophysiology and Immunotherapy (HIPI), Paris, France.
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28
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Haddad N, Delyon J, Trabelsi Messai S, Herms F, Leccia MT, Lebbe C, Whitney J, Bhatia S, Basset-Seguin N. Clinical response to immune checkpoint inhibition in patients with advanced skin cancers receiving concurrent ruxolitinib therapy for haematological malignancy. Br J Dermatol 2020; 184:564-566. [PMID: 33058221 DOI: 10.1111/bjd.19604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- N Haddad
- Department of Dermatology, AP-HP Saint-Louis Hospital, Paris, France
| | - J Delyon
- Department of Dermatology, AP-HP Saint-Louis Hospital, Paris, France.,Department of Dermatology, Université de Paris VII Diderot, Sorbonne Université Cité, Paris, France.,INSERM HIPI, Université de Paris VII Diderot, Sorbonne Université Cité, Paris, France
| | | | - F Herms
- Department of Dermatology, AP-HP Saint-Louis Hospital, Paris, France
| | - M T Leccia
- Dermatology Department, CHU de Grenoble, Grenoble, France
| | - C Lebbe
- Department of Dermatology, AP-HP Saint-Louis Hospital, Paris, France.,Department of Dermatology, Université de Paris VII Diderot, Sorbonne Université Cité, Paris, France.,INSERM HIPI, Université de Paris VII Diderot, Sorbonne Université Cité, Paris, France
| | - J Whitney
- Department of Medicine/Medical Oncology, University of Washington, Seattle, WA, USA
| | - S Bhatia
- Department of Medicine/Medical Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - N Basset-Seguin
- Department of Dermatology, AP-HP Saint-Louis Hospital, Paris, France.,Department of Dermatology, Université de Paris VII Diderot, Sorbonne Université Cité, Paris, France.,INSERM HIPI, Université de Paris VII Diderot, Sorbonne Université Cité, Paris, France
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29
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Delyon J, Porcher R, Battistella M, Meyer N, Adamski H, Bertucci F, Guillot B, Jouary T, Leccia MT, Dalac S, Mortier L, Ghrieb Z, Da Meda L, Vicaut E, Pedeutour F, Mourah S, Lebbe C. A Multicenter Phase II Study of Pazopanib in Patients with Unresectable Dermatofibrosarcoma Protuberans. J Invest Dermatol 2020; 141:761-769.e2. [PMID: 32956651 DOI: 10.1016/j.jid.2020.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 01/13/2023]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a soft-tissue sarcoma characterized by a high risk of local infiltration. The identification of the COL1A1-PDGFB t(17;22) translocation activating the PDGF pathway led to the use of imatinib in unresectable DFSP, with a response rate of 36-80%. Pazopanib is a multitarget tyrosine kinase inhibitor approved for soft-tissue sarcomas. We conducted a phase II study of patients with unresectable DFSP to evaluate the efficacy and safety of pazopanib. Patients received 800 mg of pazopanib daily. The primary endpoint was the objective response rate defined as the reduction of the largest diameter of the tumor by ≥30% at 6 months or at surgery. A total of 23 patients, including one pretreated with imatinib, were enrolled. With a median follow-up of 6.2 months (interquartile range = 5.6-7.8 months), five patients (22%, 95% confidence interval = 7-22%) had a partial response to pazopanib. The best objective response rate was 30% (95% confidence interval = 13-53%) using Response Evaluation Criteria in Solid Tumors. One patient with metastatic DFSP previously treated with imatinib died after 2.4 months. Nine patients (39%) discontinued the treatment owing to adverse events. Pharmacodynamics analyses of tumor samples were conducted: the enrichment of EGF and the EGFR-associated gene panel was associated with resistance, suggesting that EGFR-targeted therapies could be a therapeutic option to explore in DFSP. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01059656.
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Affiliation(s)
- Julie Delyon
- Team 1, HIPI, INSERM U976, Université de Paris, Paris, France; Department of Dermatology, Hôpital Saint-Louis AP-HP, Paris, France.
| | - Raphael Porcher
- CRESS-UMR1153, INSERM, INRA, Université de Paris, Paris, France; Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Maxime Battistella
- INSERM U976, Université de Paris, Paris, France; Pathology department, Hopital Saint-Louis AP-HP, Paris, France
| | - Nicolas Meyer
- Dermatologie, Institut Universitaire du Cancer et CHU de Toulouse, Toulouse, France; INSERM UMR 1037-CRCT, Toulouse, France
| | - Henri Adamski
- Department of Dermatology, Rennes University Hospital, Rennes, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Bernard Guillot
- Department of Dermatology, Montpellier University Hospital, Montpellier, France
| | - Thomas Jouary
- Department of Dermatology, Hôpital François Mitterrand, Pau, France
| | | | - Sophie Dalac
- Department of Dermatology, CHU Dijon Bourgogne, Dijon, France
| | - Laurent Mortier
- Department of Dermatology, INSERM U1189, CHU Lille, University of Lille, Lille, France
| | - Zineb Ghrieb
- Centre d'Investigations Cliniques (CIC-1427), Hôpital Saint-Louis AP-HP, Paris, France
| | - Laetitia Da Meda
- Department of Dermatology, Hôpital Saint-Louis AP-HP, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, Paris, France
| | - Florence Pedeutour
- Laboratory of Solid Tumors Genetics, Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284/INSERM U1081, Nice University Hospital affiliated, Nice University Côte d'Azur, Nice, France
| | - Samia Mourah
- INSERM U976, Laboratoire de Pharmacogénomique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Celeste Lebbe
- Team 1, HIPI, INSERM U976, Université de Paris, Paris, France; Department of Dermatology, Hôpital Saint-Louis AP-HP, Paris, France
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30
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Tétu P, Sirven-Villaros L, Cuzzubbo S, Ursu R, Baroudjian B, Delyon J, Nataf F, De Margerie-Mellon C, Allayous C, Lefevre W, Carpentier AF, Lebbé C. Impact of New Systemic Treatment and Radiotherapy in Melanoma Patients with Leptomeningeal Metastases. Cancers (Basel) 2020; 12:cancers12092635. [PMID: 32947841 PMCID: PMC7564430 DOI: 10.3390/cancers12092635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Although the recent years have seen incredible progress in the treatment of advanced melanoma including brain metastases, the survival of melanoma patients with leptomeningeal disease (LM) is still poor. There are currently only a handful of reports suggesting that BRAF and MEK inhibitors, or immune checkpoint inhibitors, may induce survival benefit in advanced melanoma patients with LM. The objective of this study was to gain a better understanding of patients, disease characteristics, and therapeutics interventions in LM melanoma patients in the era of new systemic treatment and radiosurgery. This study demonstrated that new treatment modalities appear to be promising new treatment options for melanoma LM, and need to be tested in larger prospective studies. A subset of patients are long-term survivors, and factors associated with improved survival such as low serum LDH level may be identified. Abstract Importance: Few data are available on patients with leptomeningeal disease (LM) from melanoma treated with new systemic therapies. Objective: To gain a better understanding of patients, disease characteristics, and therapeutic interventions in melanoma patients with LM in the era of new systemic treatment. Design: Clinical characteristics, treatments, and survival of melanoma patients diagnosed with LM, isolated or associated with brain metastases, were collected. The Cox regression model assessed the influence of patient and melanoma characteristics on survival. Setting: Monocentric, retrospective, real-life cohort of patients with LM from melanoma. Participants: All patients followed up at Saint-Louis University Hospital and diagnosed with LM between December 2013 and February 2020 were included. For each patient identified, a central review by dermato-oncologist and neuro-oncologist experts was performed to confirm the diagnosis of LM. Exposure: Impact of new systemic therapies and radiotherapy. Results: Among the 452 advanced melanoma patients followed at St Louis Hospital between 2013 and 2020, 41 patients with LM from melanoma were identified. Among them, 29 patients with a diagnosis of LM “confirmed” or “probable” after central neuro-oncologists reviewing were included. Nineteen patients had known melanoma brain metastases at LM diagnosis. Among the 27 patients treated with systemic therapy, 17 patients were treated with immunotherapy, 5 patients received targeted therapy, 1 was treated with chemotherapy, and 4 patients were treated with anti-PD-1 in combination with BRAF inhibitor. The median overall survival (OS) from LM diagnosis was 5.1 months. Median OS was 7.1 months for the 9 patients receiving systemic therapy combined with radiotherapy, and 3.2 months for the 20 patients not receiving combined radiotherapy. Elevated serum lactate dehydrogenase (LDH) (HR 1.44, 95% CI 1.09–1.90, p < 0.01) and presence of neurological symptoms at LM diagnosis (HR 2.96, 95% CI 1.25–6.99, p = 0.01) were associated with poor survival. At the time of data analysis, five patients were still alive with a median follow-up of 47.4 months and had persistent complete response. Conclusion: Targeted therapy and immunotherapy are promising new treatment options in LM from melanoma that can increase overall survival, and may induce long lasting remission in some patients.
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Affiliation(s)
- Pauline Tétu
- Assitance Publique des Hôpitaux de Paris Dermatology, Department of Dermatology, Hôpital Saint-Louis, 75010 Paris, France; (B.B.); (J.D.); (C.A.); (W.L.); (C.L.)
- INSERM U976, Paris 7 Diderot University, 75475 Paris, France
- Correspondence: ; Tel.: +33-658720475; Fax: +33-142384310
| | - Lila Sirven-Villaros
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, 75010 Paris, France; (L.S.-V.); (S.C.); (R.U.); (A.F.C.)
| | - Stefania Cuzzubbo
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, 75010 Paris, France; (L.S.-V.); (S.C.); (R.U.); (A.F.C.)
| | - Renata Ursu
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, 75010 Paris, France; (L.S.-V.); (S.C.); (R.U.); (A.F.C.)
| | - Barouyr Baroudjian
- Assitance Publique des Hôpitaux de Paris Dermatology, Department of Dermatology, Hôpital Saint-Louis, 75010 Paris, France; (B.B.); (J.D.); (C.A.); (W.L.); (C.L.)
- INSERM U976, Paris 7 Diderot University, 75475 Paris, France
| | - Julie Delyon
- Assitance Publique des Hôpitaux de Paris Dermatology, Department of Dermatology, Hôpital Saint-Louis, 75010 Paris, France; (B.B.); (J.D.); (C.A.); (W.L.); (C.L.)
- INSERM U976, Paris 7 Diderot University, 75475 Paris, France
| | - François Nataf
- Department of Neurosurgery, Groupement Hospitalo-Universitaire-PARIS, Hôpital Sainte-Anne Paris, 75014 Paris, France;
| | - Constance De Margerie-Mellon
- INSERM UMR 1149, Université de Paris, F-75018 Paris, France;
- Radiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, F-75010 Paris, France
| | - Clara Allayous
- Assitance Publique des Hôpitaux de Paris Dermatology, Department of Dermatology, Hôpital Saint-Louis, 75010 Paris, France; (B.B.); (J.D.); (C.A.); (W.L.); (C.L.)
- INSERM U976, Paris 7 Diderot University, 75475 Paris, France
| | - Wendy Lefevre
- Assitance Publique des Hôpitaux de Paris Dermatology, Department of Dermatology, Hôpital Saint-Louis, 75010 Paris, France; (B.B.); (J.D.); (C.A.); (W.L.); (C.L.)
- INSERM U976, Paris 7 Diderot University, 75475 Paris, France
| | - Antoine F. Carpentier
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, 75010 Paris, France; (L.S.-V.); (S.C.); (R.U.); (A.F.C.)
| | - Céleste Lebbé
- Assitance Publique des Hôpitaux de Paris Dermatology, Department of Dermatology, Hôpital Saint-Louis, 75010 Paris, France; (B.B.); (J.D.); (C.A.); (W.L.); (C.L.)
- INSERM U976, Paris 7 Diderot University, 75475 Paris, France
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Mourad N, Lourenço N, Delyon J, Eftekhari P, Bertheau P, Allayous C, Ballon A, Pagès C, Allez M, Lebbé C, Baroudjian B. Severe gastrointestinal toxicity of MEK inhibitors. Melanoma Res 2020; 29:556-559. [PMID: 31095035 DOI: 10.1097/cmr.0000000000000618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Gastrointestinal toxicities of MEK inhibitors in melanoma patients are frequent. In clinical trials, the most common digestive adverse events were nausea, vomiting, and diarrhoea. However, severe toxicities such as colitis and gastrointestinal perforation, some with fatal outcomes, have been reported. These rare but severe adverse events are not well described. We performed a retrospective analysis of all patients with stage IV and unresectable stage III melanoma treated with a MEK inhibitors at Saint-Louis Hospital, Paris, between 1 August 2013 and 15 October 2018. Among 119 patients exposed to MEK inhibitors, 78 were treated with trametinib, 19 with cobimetinib, four with binimetinib, and 18 patients with two different MEK inhibitors at separate times. All grade digestive adverse events were observed in 39 (32.7%) patients. Grade 3 and 4 adverse events occurred in 6 (5%) patients: 2 (1.7%) developed perforations, 3 (2.5%) had colitis and 1 (0.8%) had grade 4 diarrhoea. These adverse events were all reversible following a permanent discontinuation of the MEK inhibitors, or a temporary interruption followed by resumption at a dose lower than conventional posology. There were no fatal outcomes; however one patient had a permanent ileostomy. The mechanism underlying these toxicities is not well known. Clinicians should be aware of such toxicities.
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Affiliation(s)
- Nadim Mourad
- APHP, Oncodermatology Unit, Dermatology Department
| | | | - Julie Delyon
- APHP, Oncodermatology Unit, Dermatology Department
| | | | | | | | - Alice Ballon
- APHP, Oncodermatology Unit, Dermatology Department
| | - Cécile Pagès
- APHP, Oncodermatology Unit, Dermatology Department
| | | | - Céleste Lebbé
- APHP, Oncodermatology Unit, Dermatology Department.,Paris Diderot University, INSERM U976, Paris, France
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32
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Calvani J, Elia R, Battistella M, Delyon J, Vivier-Chicoteau J, Gornet JM, Lebbé C, Baroudjian B, Bertheau P. [An unusual digestive complication under anti-PD-1 (pembrolizumab)]. Ann Pathol 2020; 40:320-323. [PMID: 32107038 DOI: 10.1016/j.annpat.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/23/2019] [Accepted: 02/03/2020] [Indexed: 01/03/2023]
Abstract
The most commonly reported pattern of anti-PD-1 induced colitis is an active colitis characterized by neutrophilic inflammation and prominent apoptosis. On the other hand, reports of collagenous colitis (which is a microscopic colitis) are exceptional. In this report, we describe an unusual case of anti-PD1-associated collagenous colitis in a 76-year-old man, treated with pembrolizumab for a stage IV cutaneous melanoma. Fourteen months after the start of pembrolizumab, the patient developed a grade 3 diarrhea (up to 9 stools per day) associated with profound hypokalemia. No bacterial, viral or parasitological infectious agents were found from stool analysis. The rectosigmoidoscopy showed colonic diffuse congestion with no ulceration. Systematic biopsies were performed during endoscopy. Histologically, the fragments analyzed revealed a moderately thickened subepithelial collagen layer (20-30μm thick) associated with a mild mixed inflammatory infiltrate within the lamina propria. There were no granuloma lesions, ulcerations or viral inclusion bodies. The patient was initially successfully treated with corticosteroids (prednisone) and temporary interruption of pembrolizumab. However, during corticosteroids tapering, a relapse was observed. The treatment was switched to budesonide, leading to a complete and definitive resolution of diarrhea. To date, budesonide has been stopped and pembrolizumab has not been restarted. Currently, there is a bone progression treated by radiotherapy alone. In case of a more important progression, a systemic treatment will be secondarily discussed.
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Affiliation(s)
- Julien Calvani
- Département de pathologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Rémie Elia
- Département de pathologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Maxime Battistella
- Département de pathologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; Inserm U976, Paris, France; Groupe PATIO, partage d'expérience autour des toxicités des immunothérapies en oncologie, hôpital Saint-Louis, Paris, France
| | - Julie Delyon
- Inserm U976, Paris, France; Groupe PATIO, partage d'expérience autour des toxicités des immunothérapies en oncologie, hôpital Saint-Louis, Paris, France; Département de dermatologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Justine Vivier-Chicoteau
- Département de gastroentérologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Marc Gornet
- Département de gastroentérologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Céleste Lebbé
- Inserm U976, Paris, France; Groupe PATIO, partage d'expérience autour des toxicités des immunothérapies en oncologie, hôpital Saint-Louis, Paris, France; Département de dermatologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Barouyr Baroudjian
- Groupe PATIO, partage d'expérience autour des toxicités des immunothérapies en oncologie, hôpital Saint-Louis, Paris, France; Département de dermatologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Philippe Bertheau
- Département de pathologie, université de Paris, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; Inserm U976, Paris, France
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Huynh S, Mortier L, Dutriaux C, Maubec E, Boileau M, Dereure O, Leccia MT, Arnault JP, Brunet-Possenti F, Aubin F, Dreno B, Beylot-Barry M, Lebbe C, Lefevre W, Delyon J. Combined Therapy with Anti-PD1 and BRAF and/or MEK Inhibitor for Advanced Melanoma: A Multicenter Cohort Study. Cancers (Basel) 2020; 12:cancers12061666. [PMID: 32585901 PMCID: PMC7352575 DOI: 10.3390/cancers12061666] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/29/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022] Open
Abstract
Despite significant progress in melanoma survival, therapeutic options are still needed in case of progression under immune checkpoint inhibitors (ICI), and resistance to targeted therapies (TT) in BRAF-mutated melanomas. This study aimed to assess the safety of combined ICI and TT as a rescue line in real-life clinical practice. We conducted a study within the prospective French multicentric MelBase cohort, including patients treated with a combination of anti-PD1 (pembrolizumab/nivolumab) and BRAF inhibitor (BRAFi: dabrafenib/vemurafenib) and/or MEK inhibitors (MEKi: trametinib/cobimetinib) for BRAF mutated or wild-type advanced melanoma. Fifty-nine patients were included: 30% received the triple combination, 34% an anti-PD1 and BRAFi, and 36% an anti-PD1 and MEKi. Grade 3-4 adverse events occurred in 12% of patients. Permanent discontinuation or dose reduction of one of the treatments for toxicity was reported in 14% and 7% of patients, respectively. In the BRAF wild-type subgroup, treatment with MEKi and anti-PD1 induced a tumor control rate of 83% and median progression-free survival of 7.1 months. The combination of anti-PD1 and BRAFi and/or MEKi was a safe rescue line for advanced melanoma patients previously treated with ICI/TT. The benefit of these combinations, specifically anti-PD1 and MEKi in BRAF wild-type melanoma patients, needs to be prospectively studied.
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Affiliation(s)
- Sandra Huynh
- Dermatology Department, AP-HP Hôpital Saint-Louis, 75010 Paris, France; (S.H.); (C.L.); (W.L.)
| | - Laurent Mortier
- Service de Dermatologie, Universite de Lille, Inserm U1189, CHU de Lille, 59000 Lille, France;
| | - Caroline Dutriaux
- Department of Dermatology, Bordeaux Universitary Hospital, 33000 Bordeaux, France; (C.D.); (M.B.-B.)
| | - Eve Maubec
- Dermatology Department, AP-HP Hôpital Avicenne, Université Paris 13, 93000 Bobigny, France;
| | - Marie Boileau
- Service de Dermatologie, Universite de Lille, CHU de Lille, 59000 Lille, France;
| | - Olivier Dereure
- Department of Dermatology, University of Montpellier, 34090 Montpellier, France;
| | | | | | | | - Francois Aubin
- Dermatology Department, Hôpital Jean Minjoz, 25000 Besançon, France;
| | - Brigitte Dreno
- Dermatology Department, CHU de Nantes, 44000 Nantes, France;
| | - Marie Beylot-Barry
- Department of Dermatology, Bordeaux Universitary Hospital, 33000 Bordeaux, France; (C.D.); (M.B.-B.)
| | - Celeste Lebbe
- Dermatology Department, AP-HP Hôpital Saint-Louis, 75010 Paris, France; (S.H.); (C.L.); (W.L.)
- INSERM U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), Université de Paris, F-75010 Paris, France
| | - Wendy Lefevre
- Dermatology Department, AP-HP Hôpital Saint-Louis, 75010 Paris, France; (S.H.); (C.L.); (W.L.)
| | - Julie Delyon
- Dermatology Department, AP-HP Hôpital Saint-Louis, 75010 Paris, France; (S.H.); (C.L.); (W.L.)
- INSERM U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), Université de Paris, F-75010 Paris, France
- Correspondence:
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Arangalage D, Pavon AG, Hugelshofer S, Desgraz B, Tzimas G, Delyon J, Muller O, Obeid M, Ribi C, Michielin O, Özdemir BC, Monney P. [Cardiotoxicity of immune checkpoint inhibitors used in cancer treatment]. Rev Med Suisse 2020; 16:1165-1168. [PMID: 32496706] [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: 06/11/2023]
Abstract
Immune checkpoint inhibitors (ICI) have revolutionized the field of oncology, by reshaping the prognosis of many cancers and are progressively becoming the standard of care. One of the costs of these advances is the emergence of a new spectrum of immune-related adverse events (irAEs), of which cardiovascular irAEs are particularly feared. ICI-induced myocarditis is often a diagnostic challenge because of the vast heterogeneity of clinical presentations, and it is associated with a high mortality rate of around 50%. The present article summarizes the cardiac manifestations, the diagnostic strategy and the therapeutic management of patients with ICI-induced myocarditis used in the treatment of cancer.
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Affiliation(s)
| | | | | | | | | | | | - Olivier Muller
- Service de cardiologie, CHUV, 1011 Lausanne
- Université de Lausanne (UNIL), 1015 Lausanne
| | - Michel Obeid
- Université de Lausanne (UNIL), 1015 Lausanne
- Service d'immunologie et d'allergie, CHUV, 1011 Lausanne
| | - Camillo Ribi
- Université de Lausanne (UNIL), 1015 Lausanne
- Service d'immunologie et d'allergie, CHUV, 1011 Lausanne
| | - Olivier Michielin
- Département d'oncologie, CHUV, 1011 Lausanne
- Université de Lausanne (UNIL), 1015 Lausanne
| | | | - Pierre Monney
- Service de cardiologie, CHUV, 1011 Lausanne
- Université de Lausanne (UNIL), 1015 Lausanne
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Ghisoni E, Wicky AM, Latifyan S, Mederos Alfonso NN, Özdemir BC, Cuendet MA, Imbimbo M, Marandino L, Delyon J, Gerard CL, Tavazzi E, Gatta R, Valabrega G, Aglietta M, Obeid M, Coukos G, Peters S, Di Maio M, Bouchaab H, Michielin O. Long-lasting, irreversible and late-onset immune-related adverse events (irAEs) from immune checkpoint inhibitors (ICIs): A real-world data analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15095 Background: ICIs are effective in many tumors, but can cause severe irAEs, with potential long-term impact. Description of irAEs in literature is often insufficient, especially in terms of irAEs duration, and in terms of incidence of late-onset events. Namely, duration of irAEs and proportion of patients (pts) with toxicity still ongoing at data cut-off were not specified in 52 (89.6%) of 58 publications of trials leading to ICIs approval by US FDA and/or EMA up to August 2019. Real-world data are urgently needed to integrate this information. Methods: We retrieved the medical charts of all pts affected by lung cancer (LC) and melanoma (Mel) treated consecutively with approved ICIs at the Centre Hospitalier Universitaire Vaudoise (CHUV) from Jan 2012 to Dec 2019. We collected the following data: treatment setting, ICIs received, duration of each treatment, incidence of any irAEs of grade (G) ≥ 2 (according to CTCAE v5.0), time to onset and duration of irAEs. Pts with follow-up (FU) ≤ 28 days were excluded. Results: 345 pts were included (166 LC, 179 Mel), for a total of 455 ICIs treatment lines. 33 pts (7%, all with Mel) were treated in the adjuvant setting, while all the others were treated for advanced disease. 228 pts (50%) received anti-PD1, 43 (9%) anti-PD-L1, 56 (12%) anti-CTLA-4, 100 (22%) ICI-ICI combinations and 28 (6%) ICI–chemotherapy combinations. Median FU was 369 days (range 29-2903). Median duration of treatment was 71 days (range 1-1625). 196 pts (57%) experienced at least 1 G≥2 irAE for a total of 277 irAEs (22% skin, 18% gastro-intentinal [GI], 13% pneumonitis, 12% thyroid disorders, 11% hyphophisitis and 8% hepatitis). With 122/277 (44%) irAEs still on-going at our data cut-off, median duration of irAEs was 98 days; 104/277 irAEs (37%) lasted more than 6 month, of them 89% were considered irreversible. Out of 76 pts still on ICIs treatment at 6 months, incidence of G≥2 irAE with onset after 6 months was 51% (26% pneumonitis, 26% endocrine disorders, 15% skin disorders, 8% hepatitis and GI). Out of 32 pts still on ICIs treatment at 12 months, incidence of G≥2 irAE with onset after 12 months was 41% (38% pneumonitis, 23% endocrine and 15% skin disorders, 8% hepatitis and GI). Conclusions: Our real-world analysis shows that long-lasting and late-onset irAEs represent an important issue during ICIs treatment. A better description of toxicities in clinical trials is needed to allow a proper evaluation of treatment value and the impact on patients' quality of life.
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Affiliation(s)
- Eleonora Ghisoni
- Department of Oncology, University of Lausanne; Ludwig Institute for Cancer Research, Lausanne, Switzerland; Department of Oncology, University of Torino, Italy., Lausanne, Switzerland
| | - Alexandre M Wicky
- Department of Oncology, University of Lausanne, Lausanne, Switzerland
| | - Sofiya Latifyan
- Department of Oncology, University of Lausanne, Lausanne, Switzerland, Lausanne, Switzerland
| | | | - Berna C. Özdemir
- Department of Oncology, University of Lausanne, Lausanne, Switzerland, Lausanne, Switzerland
| | - Michel A Cuendet
- Ludwig Institute for Cancer Research, Lausanne, Switzerland, Swiss Institute of Bioinformatics, Lausanne, Switzerland, Department of Physiology and Biophysics, Weill Cornell Medicine, New York, USA, Lausanne, Switzerland
| | - Martina Imbimbo
- Department of Oncology, University of Lausanne, Lausanne, Switzerland, Lausanne, Switzerland
| | - Laura Marandino
- Department of Oncology, University of Turin, Candiolo Cancer Institute-FPO-IRCCS, Candiolo (TO), Italy
| | - Julie Delyon
- Ludwig Institute for Cancer Research, Lausanne, Switzerland
| | - Camille Lea Gerard
- Center of Personalized Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Erica Tavazzi
- Lausanne University Hospital, Switzerland, Departement of Information Engineering, University of Padova, Italy, Lausanne, Switzerland
| | - Roberto Gatta
- Center of Personalized Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, Italy. Candiolo Cancer Institute, FPO - IRCCS - Str. Prov.le 142, km. 3,95, 10060 Candiolo (TO), Italy, Torino, Italy
| | | | - Michel Obeid
- Immunology and Allergy Service, CHUV, Lausanne, Switzerland, Lausanne, Switzerland
| | - George Coukos
- Department of Oncology, University of Lausanne, Ludwig Institute for Cancer Research, Lausanne, Switzerland, Lausanne, Switzerland
| | - Solange Peters
- Lausanne University Hospital (CHUV), Lausanne University, Lausanne, Switzerland
| | - Massimo Di Maio
- Department of Oncology, A.O. Ordine Mauriziano Hospital, University of Turin, Turin, Italy
| | - Hasna Bouchaab
- Department of Oncology, University of Lausanne, Lausanne, Switzerland, Lausanne, Switzerland
| | - Olivier Michielin
- Center of Personalized Oncology, Lausanne University Hospital (CHUV), Switzerland, Molecular Modeling Group, Swiss Institute of Bioinformatics, Lausanne, Switzerland
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Gerard CL, Tavazzi E, Gatta R, Delyon J, Cuendet MA, Michielin O. A process mining approach to real-world advanced melanoma treatments. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22040] [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
e22040 Background: Process Mining (PM) is an emerging discipline with promising potential in oncology, which offers a time-oriented perspective on the clinical events that define the patient’s (pts) path of care, from diagnosis to follow-up. PM enables us to 1) build unsupervised models that automatically discover frequent patterns and detect unexpected behaviors, and 2) show the pts flow through predefined models, allowing quantitative assessments of conformance/divergence between reality and expected behaviors or medical guidelines. Methods: We explored the potential of PM to analyze treatments in a real-world melanoma cohort of 212 advanced melanoma pts treated with tyrosine kinase inhibitors (TKI), chemotherapy, or immunotherapy (IO) since 2010. 44% of pts are BRAF mutated, 24% NRAS mutated, and 16% WT. Using PM, we characterize the sequences of treatment according to type of drugs, order and timing of consecutive lines. We use kernel density estimations, Fisher or Wilcoxon tests to assess differences between groups. As main endpoint we assess the overall survival (OS) with respect to specific patterns of care followed by the pts using Kaplan-Meier analysis with log-rank test. Results: This approach provides important self-consistency checks for data and reveals the most frequent treatment sequences, and the associated outcome. The 324 administered treatments, characterized in terms of type and occurrence, are: TKI (23%), antiCTLA4 + antiPD1 (22%), antiPD1 (21%), and antiCTLA4 (20%). The overall 3-year OS is 56.9% (95% CI: 49.2 – 65.8). We identified 50 distinct patterns, which can be further aggregated into relevant cohorts to provide real-world answers to medical questions. Among others, we probed the influence of treatment order: IO single (any BRAF status), IO → TKI, TKI → IO (see table). Preliminary results suggest that pts treated with TKI → IO had shorter OS despite balance prognostic factors to IO → TKI group. IO → TKI provides short-term benefits with 1.5-year OS similar to IO alone, but degraded 3-year OS. Conclusions: The PM approach enables fast and efficient visual inspection of the data, emphasizing treatment sequences over time and allowing stratification at different levels. More population attributes and outcomes will be included to further characterize treatment sequences and provide real-world insights into future personalized care options. [Table: see text]
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Affiliation(s)
- Camille Lea Gerard
- Center of Personalized Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Erica Tavazzi
- Lausanne University Hospital, Switzerland, Departement of Information Engineering, University of Padova, Italy, Lausanne, Switzerland
| | - Roberto Gatta
- Center of Personalized Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Julie Delyon
- Center of Personalized Oncology, Lausanne University Hospital (CHUV), Switzerland, Lausanne, Switzerland
| | - Michel A Cuendet
- Center of Personalized Oncology, Lausanne University Hospital (CHUV), Switzerland, Molecular Modeling Group, Swiss Institute of Bioinformatics, Lausanne, Switzerland, Department of Phy, Lausanne, Switzerland
| | - Olivier Michielin
- Center of Personalized Oncology, Lausanne University Hospital (CHUV), Switzerland, Molecular Modeling Group, Swiss Institute of Bioinformatics, Lausanne, Switzerland
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Tétu P, Delyon J, André J, Reger de Moura C, Sabbah M, Ghanem GE, Battistella M, Mourah S, Lebbé C, Dumaz N. FGF2 Induces Resistance to Nilotinib through MAPK Pathway Activation in KIT Mutated Melanoma. Cancers (Basel) 2020; 12:cancers12051062. [PMID: 32344828 PMCID: PMC7281633 DOI: 10.3390/cancers12051062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
KIT is a bona fide oncogene in a subset of melanoma and, ex vivo, KIT inhibitors are very efficient at killing KIT-mutant melanoma cell lines. However, KIT-mutant melanoma tumors tend to show a de novo resistance in most cases and a limited duration of response when response is achieved. We performed pharmacodynamic studies on patients with KIT-mutated melanoma treated with nilotinib, which suggested that the FGF2 axis may be a mechanism of resistance in this subset of melanoma. Using several melanoma cell lines, which are dependent on oncogenic KIT, we showed that although KIT inhibition markedly decreased cell viability in melanoma cell lines with distinct KIT mutations, this effect was lessened in the presence of FGF2 due to inhibition of BIM expression by MAPK pathway activation. Addition of a MEK inhibitor reversed the FGF2-driven resistance for all KIT mutants. We confirmed the expression of FGF2 and activation of MEK-ERK in melanoma patients using in situ data from a clinical trial. Therefore, the combined inhibition of KIT with FGFR or MEK may be a next-step effective clinical strategy in KIT-mutant melanoma.
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Affiliation(s)
- Pauline Tétu
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Département de Dermatologie, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Julie Delyon
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Département de Dermatologie, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Jocelyne André
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Institut de Recherche Saint Louis (IRSL), Université de Paris, F-75010 Paris, France
| | - Coralie Reger de Moura
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Institut de Recherche Saint Louis (IRSL), Université de Paris, F-75010 Paris, France
- Département de Pharmacogénomique, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Malak Sabbah
- Laboratory of Oncology and Experimental Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, 1000 Brussels, Belgium
| | - Ghanem E Ghanem
- Laboratory of Oncology and Experimental Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, 1000 Brussels, Belgium
| | - Maxime Battistella
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Institut de Recherche Saint Louis (IRSL), Université de Paris, F-75010 Paris, France
- Département de Pathologie, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Samia Mourah
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Institut de Recherche Saint Louis (IRSL), Université de Paris, F-75010 Paris, France
- Département de Pharmacogénomique, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
| | - Céleste Lebbé
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Département de Dermatologie, Hôpital Saint Louis, AP-HP, F-75010 Paris, France
- Institut de Recherche Saint Louis (IRSL), Université de Paris, F-75010 Paris, France
| | - Nicolas Dumaz
- INSERM, U976, Team 1, Human Immunology Pathophysiology & Immunotherapy (HIPI), F-75010 Paris, France
- Institut de Recherche Saint Louis (IRSL), Université de Paris, F-75010 Paris, France
- Correspondence: ; Tel.: +33-01-53-72-20-85
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38
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Dupré A, Michot JM, Schoeffler A, Frumholtz L, Baroudjian B, Delyon J, Lebbe C, Lambotte O. Haemophagocytic lymphohistiocytosis associated with immune checkpoint inhibitors: a descriptive case study and literature review. Br J Haematol 2020; 189:985-992. [PMID: 32243578 DOI: 10.1111/bjh.16630] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Anastasia Dupré
- Service de Médecine Interne et d'Immunologie Clinique, AP-HP Université Paris-Saclay, Hôpital Bicêtre, Villejuif, France
| | - Jean-Marie Michot
- Département d'Innovation Thérapeutique et d'Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | | | - Laure Frumholtz
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
| | - Barouyr Baroudjian
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
| | - Julie Delyon
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France.,Dermatologie, Université de Paris, INSERM U976, AP-HP, Saint Louis Hospital, France
| | - Céleste Lebbe
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France.,Dermatologie, Université de Paris, INSERM U976, AP-HP, Saint Louis Hospital, France
| | - Olivier Lambotte
- Service de Médecine Interne et d'Immunologie Clinique, AP-HP Université Paris-Saclay, Hôpital Bicêtre, Villejuif, France.,Centre de recherche en Immunologie des infections virales et des maladies auto-immunes, Université Paris-Saclay, Inserm, CEA, Le Kremlin Bicêtre, France
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39
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Geoffroy PA, Delyon J, Strullu M, Dinh AT, Duboc H, Zafrani L, Etienne I, Lejoyeux M, Ceccaldi PF, Plaisance P, Peyre H. Standardized Patients or Conventional Lecture for Teaching Communication Skills to Undergraduate Medical Students: A Randomized Controlled Study. Psychiatry Investig 2020; 17:299-305. [PMID: 32200607 PMCID: PMC7176569 DOI: 10.30773/pi.2019.0258] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/27/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The conduct of a medical interview is a challenging skill, even for the most qualified physicians. Since a training is needed to acquire the necessary skills to conduct an interview with a patient, we compared role-play with standardized patients (SP) training and a conventional lecture for the acquisition of communications skills in undergraduate medical students. METHODS An entire promotion of third year undergraduate medical students, who never received any lessons about communications skills, were randomized into 4 arms: 1) SP 2 months before the testing of medical communications skills (SP); 2) conventional lecture 2 months before the testing (CL); 3) two control groups (CG) without any intervention, tested either at the beginning of the study or two months later. Students were blindly assessed by trained physicians with a modified 17-items Calgary-Cambridge scale. RESULTS 388 students (98.7%) participated. SP performed better than CL, with significant statistical differences regarding 5 skills: the use of open and closed questions, encouraging patient responses, inviting the patient to clarify the missing items, encouraging of the patient's emotions, and managing the time and the conduct of the interview. The SP group specifically improved communications skills between the SP training and testing sessions regarding 2 skills: the use of open and closed questions and encouraging patient responses. No improvements in communications skills were observed in CG between the two time points, ruling out a possible time effect. CONCLUSION Role-play with standardized patients appears more efficient than conventional lecture to acquire communication skills in undergraduate medical students.
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Affiliation(s)
- Pierre A Geoffroy
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,Department of Psychiatry and Addiction Medicine, AP-HP, Hopital Bichat-Claude Bernard, Paris, France.,NeuroDiderot, Inserm, Paris University, Paris, France
| | - Julie Delyon
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,Université de Paris; INSERM U976, Team 1, HIPI, Paris, France.,Department of Dermatology, AP-HP Hôpital Saint Louis, Paris, France
| | - Marion Strullu
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,Service d'hémato-Immunologie Pédiatrique, Hôpital Robert Debré, AP-HP, Paris, France
| | - Alexy Tran Dinh
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,Department of Anesthesiology and Critical Care Medicine, AP-HP, University Hospital Bichat-Claude Bernard, Paris, France
| | - Henri Duboc
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,INSERM U1149, Centre de Recherche sur l'Inflammation, Université Paris Diderot, Paris, France.,Department of Gastroenterology, Louis Mourier Hospital, AP-HP, Paris, France
| | - Lara Zafrani
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,INSERM U976, HIPI, Paris, France.,Department of Intensive Care Medicine, AP-HP Hôpital Saint Louis, Paris, France
| | - Isabelle Etienne
- iLumens Diderot Simulation Health Center, Paris University, Paris, France
| | - Michel Lejoyeux
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,Department of Psychiatry and Addiction Medicine, AP-HP, Hopital Bichat-Claude Bernard, Paris, France
| | - Pierre-François Ceccaldi
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,HUPNVS, Paris University, Beaujon Hospital, Department of Obstetrics and Gynecology, Clichy, France
| | - Patrick Plaisance
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,Department of Emergency Medicine, Lariboisière University Hospital, AP-HP, Paris, France
| | - Hugo Peyre
- iLumens Diderot Simulation Health Center, Paris University, Paris, France.,Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Paris, France
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Galezowski A, Delyon J, Le Cleach L, Guégan S, Ducroux E, Alanio A, Lastennet D, Moguelet P, Dadban A, Leccia MT, Le Pelletier F, Francès C, Lebbé C, Barete S. Deep cutaneous fungal infections in solid-organ transplant recipients. J Am Acad Dermatol 2020; 83:455-462. [PMID: 31931081 DOI: 10.1016/j.jaad.2019.12.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Deep cutaneous fungal infections (DCFIs) are varied in immunosuppressed patients, with few data for such infections in solid-organ transplant recipients (s-OTRs). OBJECTIVE To determine DCFI diagnostic characteristics and outcome with treatments in s-OTRs. METHODS A 20-year retrospective observational study in France was conducted in 8 primary dermatology-dedicated centers for s-OTRs diagnosed with DCFIs. Relevant clinical data on transplants, fungal species, treatments, and outcomes were analyzed. RESULTS Overall, 46 s-OTRs developed DCFIs (median delay, 13 months after transplant) with predominant phaeohyphomycoses (46%). Distribution of nodular lesions on limbs and granulomatous findings on histopathology were helpful diagnostic clues. Treatments received were systemic antifungal therapies (48%), systemic antifungal therapies combined with surgery (28%), surgery alone (15%), and modulation of immunosuppression (61%), leading to complete response in 63% of s-OTRs. LIMITATIONS Due to the retrospective observational design of the study. CONCLUSIONS Phaeohyphomycoses are the most common DCFIs in s-OTRs. Multidisciplinary teams are helpful for optimal diagnosis and management.
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Affiliation(s)
- Agnès Galezowski
- Unit of Dermatology, DMU3ID, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Julie Delyon
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Institut National de la Santé et de la Recherche Médicale U976, Université de Paris Paris, France
| | - Laurence Le Cleach
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Paris-Est Créteil Val de Marne-Paris 12 University, Créteil, France
| | - Sarah Guégan
- Department of Dermatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Emilie Ducroux
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Alexandre Alanio
- Department of Parasitology-Mycology, Saint-Louis Hospital, AP-HP, Université de Paris Paris, France; Unit of Molecular Mycology, Centre National de la Recherche Scientifique Unité Mixte de Recherche 2000, Institut Pasteur, Paris, France
| | - Diane Lastennet
- Unit of Public Health, Department of Biostatistics, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | | | - Ali Dadban
- Department of Dermatology, Amiens University Hospital, Amiens, France
| | | | | | - Camille Francès
- Department of Dermatology, DMU3ID, Tenon Hospital, AP-HP, Paris, France
| | - Céleste Lebbé
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Institut National de la Santé et de la Recherche Médicale U976, Université de Paris Paris, France
| | - Stéphane Barete
- Unit of Dermatology, DMU3ID, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
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41
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Reger de Moura C, Vercellino L, Jouenne F, Baroudjian B, Sadoux A, Louveau B, Delyon J, Serror K, Goldwirt L, Merlet P, Bouquet F, Battistella M, Lebbé C, Mourah S. Intermittent Versus Continuous Dosing of MAPK Inhibitors in the Treatment of BRAF-Mutated Melanoma. Transl Oncol 2019; 13:275-286. [PMID: 31874374 PMCID: PMC6931208 DOI: 10.1016/j.tranon.2019.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/08/2019] [Indexed: 02/02/2023] Open
Abstract
The development of BRAF and MEK inhibitors (BRAFi/MEKi) has led to major advances in melanoma treatment. However, the emergence of resistance mechanisms limits the benefit duration and a complete response occurs in less than 20% of patients receiving BRAFi ± MEKi. In this study, we evaluated the impact of an intermittent versus continuous dosing schedule of BRAF/MEK inhibition in a melanoma model mildly sensitive to a BRAF inhibitor. The combination of a BRAFi with three different MEKi was studied with a continuous or intermittent dosing schedule in vivo, in a xenografted melanoma model and ex vivo using histoculture drug response assays (HDRAs) of patient-derived xenografts (PDX). To further understand the underlying molecular mechanisms of therapeutic efficacy, a biomarker pharmacodynamic readout was evaluated. An equal impact on tumor growth was observed in monotherapy or bitherapy regimens whether we used continuous and intermittent dosing schedules, with no significant differences in biomarkers expression between the treatments. The antitumoral effect was mostly due to modulations of expression of cell cycle and apoptotic mediators. Moreover, ex vivo studies did not show significant differences between the dosing schedules. In this context, our preclinical and pharmacodynamic results converged to show the similarity between intermittent and continuous treatments with either BRAFi or MEKi alone or with the combination of both.
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Affiliation(s)
- Coralie Reger de Moura
- Université de Paris, Inserm, UMR_S976, Paris, France; Department of Pharmacogenomics, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Fanélie Jouenne
- Université de Paris, Inserm, UMR_S976, Paris, France; Department of Pharmacogenomics, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Aurélie Sadoux
- Université de Paris, Inserm, UMR_S976, Paris, France; Department of Pharmacogenomics, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Baptiste Louveau
- Université de Paris, Inserm, UMR_S976, Paris, France; Department of Pharmacogenomics, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Julie Delyon
- Department of Dermatology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Kevin Serror
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Lauriane Goldwirt
- Université de Paris, Inserm, UMR_S976, Paris, France; Department of Pharmacogenomics, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Pascal Merlet
- Department of Nuclear Medicine, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Maxime Battistella
- Department of Pathology, Hôpital Saint-Louis, AP-HP, Paris, France; Université de Paris, Inserm, UMR_S1165, Paris, France
| | - Céleste Lebbé
- Université de Paris, Inserm, UMR_S976, Paris, France; Department of Dermatology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Samia Mourah
- Université de Paris, Inserm, UMR_S976, Paris, France; Department of Pharmacogenomics, Hôpital Saint-Louis, AP-HP, Paris, France.
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42
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Del Regno L, Louveau B, Battistella M, Sadoux A, Baroudjian B, Delyon J, Serror K, Allayous C, Lebbe C, Mourah S, Jouenne F. Clinical significance of BRAF/NRAS concurrent mutations in a clinic-based metastatic melanoma cohort. Br J Dermatol 2019; 182:1281-1283. [PMID: 31675434 DOI: 10.1111/bjd.18641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- L Del Regno
- Institute of Dermatology, Catholic University - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B Louveau
- INSERM, UMR_S976, Paris, France.,Université de Paris, Paris, France.,Department of Pharmacogenomics, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - M Battistella
- INSERM, UMR_S976, Paris, France.,Université de Paris, Paris, France.,Department of Pathology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - A Sadoux
- Department of Pharmacogenomics, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - B Baroudjian
- INSERM, UMR_S976, Paris, France.,Department of Dermatology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - J Delyon
- INSERM, UMR_S976, Paris, France.,Université de Paris, Paris, France.,Department of Dermatology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - K Serror
- General Surgery, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - C Allayous
- INSERM, UMR_S976, Paris, France.,Department of Dermatology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - C Lebbe
- INSERM, UMR_S976, Paris, France.,Université de Paris, Paris, France.,Department of Dermatology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - S Mourah
- INSERM, UMR_S976, Paris, France.,Université de Paris, Paris, France.,Department of Pharmacogenomics, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
| | - F Jouenne
- INSERM, UMR_S976, Paris, France.,Université de Paris, Paris, France.,Department of Pharmacogenomics, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475, Paris cedex 10, France
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43
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Louveau B, Resche-Rigon M, Lesimple T, Pracht M, Baroudjian B, Delyon J, Jouenne F, Amini-Adle M, Dutriaux C, Da Meda L, Ghrieb Z, Bouton D, Tibi A, Huguet S, Reizai K, Battistella M, Mourah S, Lebbé C. Étude de phase I-II multicentrique en ouvert évaluant le palbociclib en association au vémurafénib chez des patients atteints d’un mélanome métastatique BRAFV600 muté avec perte de CDKN2A et expression de RB1. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.029] [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: 11/17/2022]
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44
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Roelens M, De Masson A, Battistella M, Mourah S, Estevez MJ, Delyon J, Herms F, Ram-Wolff C, Lebbé C, Bagot M, Moins-Teisserenc H. Compartiments immuns malins, T bénins conventionnels et régulateurs chez 36 patients traités par mogamulizumab pour CTCL avancé. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.142] [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]
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45
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Herms F, Delyon J, Baroudjian B, De Masson A, Bagot M, Lebbé C, Basset-Seguin N. Traitement des carcinomes épidermoïdes cutanés métastatiques et localement avancés par cémiplimab : étude prospective monocentrique. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.093] [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: 10/25/2022]
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46
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Delyon J, Battistella M, Baroudjian B, Le Maignan C, Madelaine I, Vercellino L, Lebbé C. Maladie de Paget extra-mammaire associée à un carcinome indifférencié à composante neuroendocrine anal traité par anti-PD1. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.239] [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: 10/25/2022]
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47
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Wisniewski M, Baroudjian B, Granier S, Lorenzo D, Gournant V, Lourenco N, Lebbé C, Delyon J, Hammel P. Pancréatites et immunothérapie : réalité et causes ? Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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48
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Delyon J, Bizot A, Battistella M, Madelaine I, Vercellino L, Lebbé C. PD-1 blockade with nivolumab in endemic Kaposi sarcoma. Ann Oncol 2019; 29:1067-1069. [PMID: 29324995 DOI: 10.1093/annonc/mdy006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- J Delyon
- Dermatology Department, AP-HP Hôpital Saint Louis, Paris, France; Université Paris VII Diderot, Sorbonne Paris Cité, Paris, France; INSERM U976, Paris, France.
| | - A Bizot
- Dermatology Department, AP-HP Hôpital Saint Louis, Paris, France
| | - M Battistella
- Université Paris VII Diderot, Sorbonne Paris Cité, Paris, France; Pathology Department, AP-HP Hôpital Saint Louis, Paris, France; INSERM U1165, AP-HP Hôpital Saint Louis, Paris, France
| | - I Madelaine
- Department of Pharmacy, AP-HP Hôpital Saint Louis, Paris, France
| | - L Vercellino
- Department of Nuclear Medicine, AP-HP Hôpital Saint Louis, Paris, France
| | - C Lebbé
- Dermatology Department, AP-HP Hôpital Saint Louis, Paris, France; Université Paris VII Diderot, Sorbonne Paris Cité, Paris, France; INSERM U976, Paris, France
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49
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Delyon J, Lourenço N, Vu LT, Allayous C, Baroudjian B, Lebbe C. Recurrence of Immune-Mediated Colitis Upon Immune Checkpoint Inhibitor Resumption: Does Time Matter? J Clin Oncol 2019; 37:3563-3564. [PMID: 31596635 DOI: 10.1200/jco.19.01891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Julie Delyon
- Julie Delyon, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France; Nelson Lourenço, MD; Lan-Trang Vu, PhD; Clara Allayous, PhD; and Barouyr Baroudjian, MD, Hôpital Saint-Louis, Paris, France; and Celeste Lebbe, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France
| | - Nelson Lourenço
- Julie Delyon, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France; Nelson Lourenço, MD; Lan-Trang Vu, PhD; Clara Allayous, PhD; and Barouyr Baroudjian, MD, Hôpital Saint-Louis, Paris, France; and Celeste Lebbe, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France
| | - Lan-Trang Vu
- Julie Delyon, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France; Nelson Lourenço, MD; Lan-Trang Vu, PhD; Clara Allayous, PhD; and Barouyr Baroudjian, MD, Hôpital Saint-Louis, Paris, France; and Celeste Lebbe, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France
| | - Clara Allayous
- Julie Delyon, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France; Nelson Lourenço, MD; Lan-Trang Vu, PhD; Clara Allayous, PhD; and Barouyr Baroudjian, MD, Hôpital Saint-Louis, Paris, France; and Celeste Lebbe, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France
| | - Barouyr Baroudjian
- Julie Delyon, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France; Nelson Lourenço, MD; Lan-Trang Vu, PhD; Clara Allayous, PhD; and Barouyr Baroudjian, MD, Hôpital Saint-Louis, Paris, France; and Celeste Lebbe, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France
| | - Celeste Lebbe
- Julie Delyon, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France; Nelson Lourenço, MD; Lan-Trang Vu, PhD; Clara Allayous, PhD; and Barouyr Baroudjian, MD, Hôpital Saint-Louis, Paris, France; and Celeste Lebbe, MD, PhD, Hôpital Saint-Louis, Paris, France, and Université de Paris, Paris, France
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Beaziz J, Battistella M, Delyon J, Maignan CL, Marco O, Kérob D, Laurent CP, Da Meda L, Farges C, Basset-Seguin N, Lebbe C, Baroudjian B. Long-term outcome of neoadjuvant tyrosine kinase inhibitors (TKI) in locally advanced dermatofibrosarcoma protuberans (DFSP). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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