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Tougeron D, Dahan L, Evesque L, Le Malicot K, El Hajbi F, Aparicio T, Bouché O, Bonichon Lamichhane N, Chibaudel B, Angelergues A, Bodere A, Phelip JM, Mabro M, Kaluzinski L, Petorin C, Breysacher G, Rinaldi Y, Zaanan A, Smith D, Gouttebel MC, Perret C, Etchepare N, Emile JF, Sanfourche I, Di Fiore F, Lepage C, Artru P, Louvet C. FOLFIRI Plus Durvalumab With or Without Tremelimumab in Second-Line Treatment of Advanced Gastric or Gastroesophageal Junction Adenocarcinoma: The PRODIGE 59-FFCD 1707-DURIGAST Randomized Clinical Trial. JAMA Oncol 2024:2817120. [PMID: 38573643 DOI: 10.1001/jamaoncol.2024.0207] [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: 04/05/2024]
Abstract
Importance Efficacy of second-line chemotherapy in advanced gastric or gastrooesphageal junction (GEJ) adenocarcinoma remains limited. Ojectives To determine the efficacy of 1 or 2 immune checkpoint inhibitors combined with FOLFIRI (leucovorin [folinic acid], fluorouracil, and irinotecan) in the treatment of advanced gastric/GEJ adenocarcinoma. Design, Setting, and Participants The PRODIGE 59-FFCD 1707-DURIGAST trial is a randomized, multicenter, noncomparative, phase 2 trial, conducted from August 27, 2020, and June 4, 2021, at 37 centers in France that included patients with advanced gastric/GEJ adenocarcinoma who had disease progression after platinum-based first-line chemotherapy. Intervention Patients were randomized to receive FOLFIRI plus durvalumab (anti-programmed cell death 1 [PD-L1]) (FD arm) or FOLFIRI plus durvalumab and tremelimumab (anti-cytotoxic T-lymphocyte associated protein 4 [CTLA-4]) (FDT arm). The efficacy analyses used a clinical cutoff date of January 9, 2023. Main outcome and Measures The primary end point was progression-free survival (PFS) at 4 months according to RECIST 1.1 criteria evaluated by investigators. Results Overall, between August 27, 2020, and June 4, 2021, 96 patients were randomized (48 in each arm). The median age was 59.7 years, 28 patients (30.4%) were women and 49 (53.3%) had GEJ tumors. Four month PFS was 44.7% (90% CI, 32.3-57.7) and 55.6% (90% CI, 42.3-68.3) in the FD and FDT arms, respectively. The primary end point was not met. Median PFS was 3.8 and 5.4 months, objective response rates were 34.7% and 37.7%, and median overall survival was 13.2 and 9.5 months in the FD and FDT arms, respectively. Disease control beyond 1 year was 14.9% in the FD arm and 24.4% in the FDT arm. Grade 3 to 4 treatment-related adverse events were observed in 22 (47.8%) patients in each arm. A combined positive score (CPS) PD-L1 of 5 or higher was observed in 18 tumors (34.0%) and a tumor proportion score (TPS) PD-L1 of 1% or higher in 13 tumors (24.5%). Median PFS according to CPS PD-L1 was similar (3.6 months for PD-L1 CPS ≥5 vs 5.4 months for PD-L1 CPS <5) by contrast for TPS PD-L1 (6.0 months for PD-L1 TPS ≥1% vs 3.8 months for PD-L1 TPS <1%). Conclusions and Relevance Combination of immune checkpoint inhibitors with FOLFIRI in second-line treatment for advanced gastric/GEJ adenocarcinoma showed an acceptable safety profile but antitumor activity only in a subgroup of patients. Trial Registration ClinicalTrials.gov Identifier: NCT03959293.
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Affiliation(s)
- David Tougeron
- Department of Gastroenterology and Hepatology, Poitiers University Hospital, Poitiers, France
| | - Laetitia Dahan
- Department of Gastroenterology and Hepatology, Marseille University Hospital, Marseille, France
| | - Ludovic Evesque
- Department of Digestive Oncology, A. Lacassagne Centre, Nice, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Bourgogne Franche-Comté University, Dijon, France
| | - Farid El Hajbi
- Department of Gastroenterology and Digestive Oncology, Oscar Lambret Centre, Lille, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, Paris, France
| | - Olivier Bouché
- Department of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | | | - Benoist Chibaudel
- Department of Oncology, Franco-Britannique Hospital, Levallois, France
| | | | | | - Jean-Marc Phelip
- Department of Gastroenterology and Hepatology, Saint Etienne University Hospital, Groupe URCAS, Université Jean Monet, Saint Etienne, France
| | - May Mabro
- Department of Oncology, Foch Hospital, Suresnes, France
| | - Laure Kaluzinski
- Department of Oncology, Cherbourg-en-Cotentin Hospital, Cherbourg-en-Cotentin, France
| | - Caroline Petorin
- Department of Oncology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Gilles Breysacher
- Department of Gastroenterology and Hepatology, Colmar Hospital, Colmar, France
| | - Yves Rinaldi
- Department of Gastroenterology, Marseille European Hospital, Marseille, France
| | - Aziz Zaanan
- Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Université Paris Cité, Paris Cancer Institute CARPEM, Paris, France
| | - Denis Smith
- Department of Gastroenterology and Hepatology, Bordeaux University Hospital, Bordeaux, France
| | | | - Clément Perret
- Department of Oncology, Private Saint-Grégoire Hospital, Saint-Grégoire, France
| | | | - Jean-François Emile
- Paris-Saclay University, Versailles SQY University, EA4340-BECCOH, Assistance Publique-Hôpitaux de Paris (APHP), Ambroise-Paré Hospital, Pathology Department, Boulogne, France
| | - Ivan Sanfourche
- Department of Pathology, Poitiers University Hospital, Poitiers, France
| | - Frédéric Di Fiore
- Department of Hepatogastroenterology, Normandy University, UNIROUEN, Rouen University Hospital, Rouen, France
| | - Côme Lepage
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Bourgogne Franche-Comté University, Dijon, France
| | - Pascal Artru
- Department of Gastroenterology, Mermoz Hospital, Lyon, France
| | - Christophe Louvet
- Department of Medical Oncology, Institute Mutualiste Montsouris, Paris, France
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Gouriou C, Lemanski C, Pommier P, Le Malicot K, Saint A, Rivin Del Campo E, Evin C, Quero L, Regnault P, Baba-Hamed N, Ronchin P, Crehange G, Tougeron D, Menager-Tabourel E, Diaz O, Hummelsberger M, de la Rocherfordiere A, Drouet F, Vendrely V, Lièvre A. Management of non-metastatic anal cancer in the elderly: ancillary study of the French multicenter prospective cohort FFCD-ANABASE. Br J Cancer 2024; 130:769-776. [PMID: 38184691 PMCID: PMC10912210 DOI: 10.1038/s41416-023-02564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Standard care for non-metastatic squamous cell carcinoma of the anus (SCCA) is chemoradiotherapy, data about elderly patients are scarce. METHODS All consecutive patients treated for non-metastatic SCCA from the French multicenter FFCD-ANABASE cohort were included. Two groups were defined according to age: elderly (≥75 years) and non-elderly (<75). RESULTS Of 1015 patients, 202 (19.9%) were included in the elderly group; median follow-up was 35.5 months. Among the elderly, there were more women (p = 0.015); frailer patients (p < 0.001), fewer smokers (p < 0.001) and fewer HIV-infected (p < 0.001) than in the non-elderly group. Concomitant chemotherapy and inguinal irradiation were less frequent (p < 0.001 and p = 0.04). In the elderly group; 3-year overall survival (OS), recurrence-free survival (RFS) and colostomy-free survival (CFS) were 82.9%, 72.4% and 78.0%, respectively; complete response rate at 4-6 months was 70.3%. There were no differences between groups for all outcomes and toxicity. In multivariate analyses for the elderly, PS ≥ 2 and locally-advanced tumors were significantly associated with poor OS (HR = 3.4 and HR = 2.80), RFS (HR = 2.4 and HR = 3.1) and CFS (HR = 3.8 and HR = 3.0); and treatment interruption with poor RFS (HR = 1.9). CONCLUSION In the FFCD-ANABASE cohort, age did not influence tumor and tolerance outcomes of non-metastatic SCCA. Optimal curative treatment should be offered to elderly patients.
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Affiliation(s)
| | - Claire Lemanski
- Institut Régional du Cancer Montpellier, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Olivia Diaz
- GHM Institut Daniel Hollard Grenoble, Grenoble, France
| | | | | | - Franck Drouet
- Clinique Mutualiste de l'Estuaire St Nazaire, Saint-Nazaire, France
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Taïeb J, Bouche O, André T, Le Malicot K, Laurent-Puig P, Bez J, Toullec C, Borg C, Randrian V, Evesque L, Corbinais S, Perrier H, Buecher B, Di Fiore F, Gallois C, Emile JF, Lepage C, Elhajbi F, Tougeron D. Avelumab vs Standard Second-Line Chemotherapy in Patients With Metastatic Colorectal Cancer and Microsatellite Instability: A Randomized Clinical Trial. JAMA Oncol 2023; 9:1356-1363. [PMID: 37535388 PMCID: PMC10401392 DOI: 10.1001/jamaoncol.2023.2761] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/24/2023] [Indexed: 08/04/2023]
Abstract
Importance Only 1 randomized clinical trial has shown the superiority of immune checkpoint inhibitors in patients with deficient mismatch repair and/or microsatellite instability (dMMR/MSI) metastatic colorectal cancer (mCRC) in the first-line setting. Objectives To determine whether avelumab (an anti-programmed cell death ligand 1 antibody) improves progression-free survival (PFS) compared with standard second-line chemotherapy in patients with dMMR/MSI mCRC. Design, Setting, and Participants The SAMCO-PRODIGE 54 trial is a national open-label phase 2 randomized clinical trial that was conducted from April 24, 2018, to April 29, 2021, at 49 French sites. Patients with dMMR/MSI mCRC who experienced progression while receiving standard first-line therapy were included in the analysis. Interventions Patients were randomized to receive standard second-line therapy or avelumab every 2 weeks until progression, unacceptable toxic effects, or patient refusal. Main Outcome and Measures The primary end point was PFS according to RECIST (Response Evaluation Criteria in Solid Tumours), version 1.1, evaluated by investigators in patients with mCRC and confirmed dMMR and MSI status who received at least 1 dose of treatment (modified intention-to-treat [mITT] population). Results A total of 122 patients were enrolled in the mITT population. Median age was 66 (IQR, 56-76) years, 65 patients (53.3%) were women, 100 (82.0%) had a right-sided tumor, and 52 (42.6%) had BRAF V600E-mutated tumors. There was no difference in patients and tumor characteristics between treatment groups. No new safety concerns in either group were detected, with fewer treatment-related adverse events of at least grade 3 in the avelumab group than in the chemotherapy group (20 [31.7%] vs 34 [53.1%]; P = .02). After a median follow-up of 33.3 (95% CI, 28.3-34.8) months, avelumab was superior to chemotherapy with or without targeted agents with respect to PFS (15 [24.6%] vs 5 [8.2%] among patients without progression; P = .03). Rates of PFS rates at 12 months were 31.2% (95% CI, 20.1%-42.9%) and 19.4% (95% CI, 10.6%-30.2%) in the avelumab and control groups, respectively, and 27.4% (95% CI, 16.8%-39.0%) and 9.1% (95% CI, 3.2%-18.8%) at 18 months. Objective response rates were similar in both groups (18 [29.5%] vs 16 [26.2%]; P = .45). Among patients with disease control, 18 (75.7%) in the avelumab group compared with 9 (19.1%) in the control group had ongoing disease control at 18 months. Conclusions The SAMCO-PRODIGE 54 phase 2 randomized clinical trial showed, in patients with dMMR/MSI mCRC, better PFS and disease control duration with avelumab over standard second-line treatment, with a favorable safety profile. Trial Registration ClinicalTrials.gov Identifier: NCT03186326.
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Affiliation(s)
- Julien Taïeb
- Institut du Cancer Paris Cancer Research for Personalized Medicine, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
- Centre de Recherche des Cordeliers, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique, Sorbonne Université, Université Sorbonne Paris Cité, Université de Paris, Paris, France
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, AP-HP Centre, Université Paris Cité, Paris, France
| | - Olivier Bouche
- Department of Digestive Oncology, Centre Hospitalier Universitaire (CHU) Reims, Reims, France
| | - Thierry André
- Sorbonne Université and Hôpital Saint Antoine, INSERM 938 and Site de Recherche Intégrée sur le Cancer CURAMUS, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM Lipides Nutrition Cancer–Unité Mixte de Recherche 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Pierre Laurent-Puig
- Institut du Cancer Paris Cancer Research for Personalized Medicine, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
- Centre de Recherche des Cordeliers, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique, Sorbonne Université, Université Sorbonne Paris Cité, Université de Paris, Paris, France
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, AP-HP Centre, Université Paris Cité, Paris, France
| | - Jérémie Bez
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM Lipides Nutrition Cancer–Unité Mixte de Recherche 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Clémence Toullec
- Department of Medical Oncology, Institut du Cancer, Avignon-Provence, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Violaine Randrian
- Department of Gastroenterology and Hepatology, Poitiers University Hospital, Poitiers, France
| | - Ludovic Evesque
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - Hervé Perrier
- Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, France
| | - Bruno Buecher
- Department of Oncology, Institut Curie, Paris, France
| | - Frederic Di Fiore
- Hepatogastroenterology Department, CHU Rouen, University of Rouen Normandy, INSERM 1245, Institut de Recherche en Oncologie Group, Normandie University, Rouen, France
| | - Claire Gallois
- Institut du Cancer Paris Cancer Research for Personalized Medicine, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
- Centre de Recherche des Cordeliers, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique, Sorbonne Université, Université Sorbonne Paris Cité, Université de Paris, Paris, France
| | - Jean Francois Emile
- EA4340, Pathology Department and INSERM, Ambroise Paré Hospital, Boulogne, France
| | - Côme Lepage
- Sorbonne Université and Hôpital Saint Antoine, INSERM 938 and Site de Recherche Intégrée sur le Cancer CURAMUS, Paris, France
- Department of Digestive Oncology, University Hospital Dijon, University of Burgundy and Franche Comté, Dijon, France
| | - Farid Elhajbi
- Medical Oncology Department, Oscar Lambret Center, Lille, France
| | - David Tougeron
- Department of Gastroenterology and Hepatology, Poitiers University Hospital, Poitiers, France
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Vendrely V, Ronchin P, Minsat M, Le Malicot K, Lemanski C, Mirabel X, Etienne PL, Lièvre A, Darut-Jouve A, de la Fouchardière C, Giraud N, Breysacher G, Argo-Leignel D, Thimonnier E, Magné N, Abdelghani MB, Lepage C, Aparicio T. Panitumumab in combination with chemoradiotherapy for the treatment of locally-advanced anal canal carcinoma: Results of the FFCD 0904 phase II trial. Radiother Oncol 2023; 186:109742. [PMID: 37315583 DOI: 10.1016/j.radonc.2023.109742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND PURPOSE Standard treatment of squamous cell carcinoma of the anus (SCCA)is 5-fluorouracil (5FU) and mitomycin C (MMC) based chemoradiotherapy (CRT). This phase II study (EudraCT: 2011-005436-26) assessed the tolerance and complete response (CR) rate at 8 weeks of panitumumab (Pmab) combined with MMC-5FU-based CRT. METHODS Patients with locally advanced tumors without metastases (T2 > 3 cm, T3-T4, or N + whatever T stage) were treated with IMRT up to 65 Gy and concomitant CT according to the doses defined by a previous phase I study (MMC: 10 mg/m2; 5FU: 400 mg/m2; Pmab: 3 mg/kg). The expected CR rate was 80%. RESULTS Forty-five patients (male: 9, female: 36; median age: 60.1 [41.5-81]) were enrolled in 15 French centers. The most common related grade 3-4 toxicities observed were digestive (51.1%), hematologic (lymphopenia: 73.4%; neutropenia: 11.1%), radiation dermatitis (13.3%), and asthenia (11.1%) with RT interruption in 14 patients. One patient died because of mesenteric ischemia during the CRT, possibly related to treatment. In ITT analysis, the CR rate at 8 weeks after CRT was 66.7% [90%CI: 53.4-78.2]. Median follow-up was 43.6 months [IC 95%: 38.61-47.01]. Overall survival, recurrence-free and colostomy-free survival at 3 years were 80% [95%CI: 65.1-89], 62.2% [IC95%: 46.5-74.6] and 68.8 % [IC95%: 53.1-80.2] respectively. CONCLUSION Panitumumab in combination with CRT for locally advanced SCCA failed to meet the expected CR rate and exhibited a poor tolerance. Furthermore, late RFS, CFS, and OS did not suggest any outcome improvement to justify further clinical trials. CLINICALTRIALS gov identifier: NCT01581840.
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Affiliation(s)
- Véronique Vendrely
- Radiation Oncology Department, CHU Bordeaux, Bordeaux, France; BRIC (BoRdeaux Institute of OnCology), UMR1312, INSERM, University of Bordeaux, F-33000 Bordeaux, France.
| | | | | | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, University of Burgundy, Biostatistics, Dijon, France, EPICAD INSERM LNC-UMR 1231, Dijon, France
| | - Claire Lemanski
- Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France
| | - Xavier Mirabel
- Radiotherapy Department, Centre Oscar Lambret, Lille, France
| | | | - Astrid Lièvre
- Gastroenterology Department, Rennes University Hospital, Rennes 1 University, Inserm U1242 COSS (Chemistry Oncogenesis Stress Signaling), Rennes, France
| | | | | | - Nicolas Giraud
- Radiation Oncology Department, CHU Bordeaux, Bordeaux, France
| | | | | | | | - Nicolas Magné
- Radiotherapy and Oncology Department, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | | | - Côme Lepage
- Department of Hepato-gastroenterology, University Hospital of Dijon, Dijon, France
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, AP-HP, Paris, France
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Kim S, Vendrely V, Saint A, André T, Vaflard P, Samalin E, Pernot S, Bouché O, Zubir M, Desrame J, de la Fouchardière C, Smith D, Ghiringhelli F, Vienot A, Jacquin M, Klajer E, Nguyen T, François É, Taieb J, Le Malicot K, Vernerey D, Meurisse A, Borg C. DCF versus doublet chemotherapy as first-line treatment of advanced squamous anal cell carcinoma: a multicenter propensity score-matching study. Exp Hematol Oncol 2023; 12:63. [PMID: 37480095 PMCID: PMC10362607 DOI: 10.1186/s40164-023-00413-2] [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: 03/26/2023] [Accepted: 05/15/2023] [Indexed: 07/23/2023] Open
Abstract
Triplet DCF (docetaxel, cisplatin and 5-flurouracil) and doublet CP/CF (carboplatin and paclitaxel/cisplatin and 5-fluorouracil) regimens were prospectively evaluated in advanced squamous anal cell carcinoma (SCCA), and validated as standard treatments. Even though the high efficacy and good tolerance of DCF regimen were confirmed in 3 independent prospective trials, doublet CP regimen is still recommended in several guidelines based in its better safety profile with similar efficacy compared to CF regimen. We performed a propensity score-adjusted method with inverse probability of treatment weighted (IPTW) and matched case control (MCC) comparison among patients with metastatic or non-resectable locally advanced recurrent SCCA, treated with chemotherapy as first line regimen. The primary endpoint was the overall survival (OS), and the secondary endpoint was the progression-free survival (PFS). 247 patients were included for analysis. 154 patients received DCF and 93 patients received a doublet regimen. The median OS was 32.3 months with DCF and 18.3 months with doublet regimens (HR 0.53, 95%CI 0.38-0.74; p = 0.0001), and the median PFS was 11.2 months with DCF versus 7.6 months with doublet regimens (HR 0.53, 95%CI 0.39-0.73; p < 0.0001). The hazard ratios by IPTW and MCC analyses were 0.411 (95% CI, 0.324-0.521; p < 0.0001) and 0.406 (95% CI, 0.261-0.632; p < 0.0001) for OS, and 0.466 (95% CI, 0.376-0.576; p < 0.0001) and 0.438 (95% CI, 0.298-0.644; P < 0.0001) for PFS. The triplet DCF regimen provides a high and significant benefit in OS and PFS over doublet regimens, and should be considered as upfront treatment for eligible patients with advanced SCCA.
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Affiliation(s)
- Stefano Kim
- Clinical Investigational Center, INSERM CIC-1431, Centre Hospitalier Universitaire de Besançon, Besançon, France.
- INSERM Unit 1098, University of Bourgogne Franche-Comté, Besançon, France.
- Department of Oncology, Sanatorio Allende, Cordoba, Argentina.
| | - Véronique Vendrely
- Department of Radiation Oncology, Bordeaux University Hospital, Pessac, France
| | - Angélique Saint
- Department of Oncology, Centre Antoine Lacassagne, Nice, France
| | - Thierry André
- Sorbonne Université and Hôpital Saint Antoine, Paris, France
| | | | - Emmanuelle Samalin
- Department of Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Simon Pernot
- Department of Oncology, Institut Bergonié, Bordeaux, France
| | - Oliver Bouché
- Department of Digestive Oncology, Université de Reims Champagne Ardenne, CHU Reims, Reims, France
| | - Mustapha Zubir
- Department of Oncology, Hôpital Privé des Peupliers, Paris, France
| | - Jérôme Desrame
- Department of Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Denis Smith
- Department of Oncology, Bordeaux University Hospital, Bordeaux, France
| | | | - Angélique Vienot
- Clinical Investigational Center, INSERM CIC-1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
- INSERM Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - Marion Jacquin
- Clinical Investigational Center, INSERM CIC-1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Cancéropôle Grand-Est, Strasbourg, France
| | - Elodie Klajer
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - Thierry Nguyen
- Department of Oncology, University Hospital of Besançon, Besançon, France
- Hôpital Nord Franche Comté, Montbéliard, France
| | - Éric François
- Department of Oncology, Centre Antoine Lacassagne, Nice, France
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Université Paris-Cité, Georges Pompidou European Hospital, SIRIC CARPEM, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive (FFCD), EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Dewi Vernerey
- INSERM Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Aurélia Meurisse
- INSERM Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Clinical Investigational Center, INSERM CIC-1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
- INSERM Unit 1098, University of Bourgogne Franche-Comté, Besançon, France
- Department of Oncology, University Hospital of Besançon, Besançon, France
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Douget JEL, Taïeb J, Jacob P, Bibeau F, Malicot KL, Emile JF, de Reyniès A, Morel M, Jégou S, Lepage C, Laurent-Puig P. Abstract 5430: Improved colorectal cancer survival prediction with deep learning-based WSI analysis on PETACC8 and PRODIGE13 cohorts. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5430] [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: 04/07/2023]
Abstract
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and represents the third leading cause of cancer deaths. Robust postoperative prediction of CRC patient prognosis may prove useful to better stratify patients, guide therapeutic choices and improve clinical trial designs. Deep learning-based analysis of whole slide images (WSI) has recently proved successful at various prediction tasks, including for example survival prediction for malignant pleural mesothelioma.
We developed a deep learning model that predicts overall survival (OS) of CRC patients, using WSI stained with haematoxylin/eosin as input, and also evaluated the difference in prognostic power obtained when combining our model prediction with other clinical factors, namely tumor grade, sex and age. The model was trained on PETACC8 cohort, constituted of 1939 WSI from patients with stage III colon cancer. The PRODIGE13 cohort, constituted of 1155 WSI from patients with stage II and III colon and rectal cancers, was used for validation; only stage III colon cancers (N=428) were selected. Patients from both cohorts received standard chemotherapy treatment, with half of the PETACC8 population also receiving CETUXIMAB antibody treatment. Both cohorts were provided by the FFCD.
Our model first extracts information on small tiles of size 112µm from the WSI, using a deep learning network trained in a self-supervised fashion, then aggregates the information of these tiles using a Multiple Instance Learning model (MIL) at the slide level to establish the final prediction. Our model was able to predict OS from WSI, reaching a c-index of 0.63 [0.61 - 0.66] in cross-validation over the PETACC8 cohort and a c-index of 0.59 [0.53 - 0.65] when transferring the PETACC8-trained model onto the PRODIGE13 cohort. The model was also able to significantly stratify patients into high and low risk groups [HR: 2.67; p<0.0001]. We observed a significant c-index gain when combining our prediction and the pT classification in a linear Cox model as compared to pT alone, with c-index increasing from 0.61 to 0.66 (p=0.03).
Overall, we demonstrated that our model is able to robustly predict OS from WSI in stage III colon cancers and provides increased prognostic power, on top of more traditional clinical markers such as tumor grading. Further investigation of the WSI regions targeted by our model could provide valuable insights into postoperative histopathological features of prognostic significance.
Citation Format: Jean-Eudes Le Douget, Julien Taïeb, Paul Jacob, Frédéric Bibeau, Karine Le Malicot, Jean-François Emile, Aurélien de Reyniès, Mehdi Morel, Simon Jégou, Côme Lepage, Pierre Laurent-Puig. Improved colorectal cancer survival prediction with deep learning-based WSI analysis on PETACC8 and PRODIGE13 cohorts. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5430.
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Affiliation(s)
| | - Julien Taïeb
- 2Georges Pompidou European Hospital, Paris, France
| | | | - Frédéric Bibeau
- 3Centre Hospitalier Universitaire de Besançon, Besançon, France
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7
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Walter T, Lievre A, Coriat R, Malka D, Elhajbi F, Di Fiore F, Hentic O, Smith D, Hautefeuille V, Roquin G, Perrier M, Dahan L, Granger V, Sobhani I, Mineur L, Niccoli P, Assenat E, Scoazec JY, Le Malicot K, Lepage C, Lombard-Bohas C. Bevacizumab plus FOLFIRI after failure of platinum-etoposide first-line chemotherapy in patients with advanced neuroendocrine carcinoma (PRODIGE 41-BEVANEC): a randomised, multicentre, non-comparative, open-label, phase 2 trial. Lancet Oncol 2023; 24:297-306. [PMID: 36739879 DOI: 10.1016/s1470-2045(23)00001-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/26/2022] [Accepted: 01/03/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is no standard second-line treatment after platinum-etoposide chemotherapy for gastroenteropancreatic neuroendocrine carcinoma. We aimed to evaluate the efficacy of FOLFIRI plus bevacizumab, and FOLFIRI alone, in this setting. METHODS We did a randomised, non-comparative, open-label, phase 2 trial (PRODIGE 41-BEVANEC) at 26 hospitals in France. We included patients aged 18 years or older with locally advanced or metastatic gastroenteropancreatic neuroendocrine carcinoma or neuroendocrine carcinoma of unknown primary origin, documented progressive disease during or after first-line platinum-etoposide chemotherapy, and an Eastern Cooperative Oncology Group performance status of 0-2. Patients were randomly assigned (1:1; block size of three), without stratification, to receive FOLFIRI (irinotecan 180 mg/m2, calcium folinate 400 mg/m2 or levofolinate 200 mg/m2, and fluorouracil 400 mg/m2 bolus then 2400 mg/m2 over 46 h) plus bevacizumab 5 mg/kg or FOLFIRI alone, intravenously, every 2 weeks until disease progression or unacceptable toxicity. Neither patients nor investigators were masked to group assignment. The primary outcome was overall survival at 6 months after randomisation, evaluated in the modified intention-to-treat population (all enrolled and randomly assigned patients who received at least one cycle of FOLFIRI). This study is now complete and is registered with ClinicalTrials.gov, NCT02820857. FINDINGS Between Sept 5, 2017, and Feb 8, 2022, 150 patients were assessed for eligibility and 133 were enrolled and randomly assigned: 65 to the FOLFIRI plus bevacizumab group and 68 to the FOLFIRI group. 126 patients (59 in the FOLFIRI plus bevacizumab group and 67 in the FOLFIRI group) received at least one cycle of FOLFIRI and were included in the modified intention-to-treat population, 83 (66%) of whom were male and 43 (34%) were female, and the median age of the patients was 67 years (IQR 58-73). The primary tumour location was colorectal in 38 (30%) of 126 patients, pancreatic in 34 (27%), gastro-oesophageal in 22 (17%), and unknown in 23 (18%). After a median follow-up of 25·7 months (95% CI 22·0-38·2), 6-month overall survival was 53% (80% CI 43-61) in the FOLFIRI plus bevacizumab group and 60% (51-68) in the FOLFIRI group. Grade 3-4 adverse events that occurred in at least 5% of patients were neutropenia (eight [14%] patients), diarrhoea (six [10%]), and asthenia (five [8%]) in the FOLFIRI plus bevacizumab group, and neutropenia (seven [10%]) in the FOLFIRI group. One treatment-related death (ischaemic stroke) occurred in the FOLFIRI plus bevacizumab group. INTERPRETATION The addition of bevacizumab did not seem to increase the benefit of FOLFIRI with regard to overall survival. FOLFIRI could be considered as a standard second-line treatment in patients with gastroenteropancreatic neuroendocrine carcinoma. FUNDING French Ministry of Health and Roche SAS.
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Affiliation(s)
- Thomas Walter
- Department of Medical Oncology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Gastroenterology and Technologies for Health, Research Unit INSERM UMR 1052 CNRS UMR 5286, Cancer Research Center of Lyon, Lyon, France.
| | - Astrid Lievre
- Digestive Unit, Hôpital Universitaire de Pontchaillou, Rennes, France
| | - Romain Coriat
- Gastroenterology Department, Hôpital Cochin, Paris, France
| | - David Malka
- Gastrointestinal Oncology Department, Gustave Roussy, Villejuif, France
| | - Farid Elhajbi
- Oncology Department, Centre Oscar Lambret, Lille, France
| | - Fréderic Di Fiore
- Gastroenterology Department, Hôpital Universitaire de Rouen, Rouen, France
| | - Olivia Hentic
- Gastroenterology-Pancreatology Department, Hôpital Beaujon, Clichy, France
| | - Denis Smith
- Hepatogastroenterology and Digestive Oncology, Hôpital Universitaire de Bordeaux, Pessac, France
| | - Vincent Hautefeuille
- Gastroenterology and Digestive Oncology, Hôpital Universitaire d'Amiens, Amiens, France
| | - Guillaume Roquin
- Gastroenterology and Digestive Oncology, Hôpital Universitaire d'Angers, Angers, France
| | - Marine Perrier
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Robert Debré, Reims, France
| | - Laetitia Dahan
- Digestive Oncology Department, Hôpital Universitaire La Timone, Marseille, France
| | - Victoire Granger
- Hepatogastroenterology Department, Hôpital Universitaire Michallon, Grenoble, France
| | - Iradj Sobhani
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Henry Mondor, Creteil, France
| | - Laurent Mineur
- Oncology Department, Clinique Sainte-Catherine, Avignon, France
| | | | - Eric Assenat
- Medical Oncology Department, Hôpital St Eloi, Montpellier, France
| | - Jean-Yves Scoazec
- Department of Surgical and Molecular Pathology, Gustave Roussy, Villejuif, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Côme Lepage
- Gastroenterology and Digestive Oncology, Hôpital Universitaire Le Bocage, Dijon, France
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Merle P, Blanc JF, Edeline J, Le Malicot K, Allaire M, Assenat E, Guarssifi M, Bouattour M, Péron JM, Laurent-Puig P, Levrero M, Costentin C, Guiu B, Sokol H, Tougeron D, Aparicio T, Nault JC, Phelip JM. Ipilimumab with atezolizumab-bevacizumab in patients with advanced hepatocellular carcinoma: The PRODIGE 81-FFCD 2101-TRIPLET-HCC trial. Dig Liver Dis 2023; 55:464-470. [PMID: 36804053 DOI: 10.1016/j.dld.2023.01.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/23/2023]
Abstract
A substantial proportion of patients with hepatocellular carcinoma have to face up, sooner or later, to systemic therapy. The current standards as first line systemic therapies are either atezolizumab (anti-PD-L1) plus bevacizumab (anti-VEGF), or durvalumab (anti-PD-L1) plus tremelimumab (anti-CTLA-4). However, the median overall survival remains below 20 months, and a minority of patients become long-term survivors. Of interest in immune-oncology strategies for hepatocellular carcinoma, the objective response seems to be the most reliable surrogate marker of better overall survival. TRIPLET-HCC (NCT05665348) is a multicentre, randomised, open-label phase II-III trial designed to evaluate efficacy and safety of the triple combination by the addition of ipilimumab (anti-CTLA-4) to atezolizumab/bevacizumab, versus the double atezolizumab/bevacizumab combination. The main inclusion criteria are histologically proven BCLC-B/C HCC without previous systemic therapy. The primary objective of the phase II is the objective response rate in the triple arm, and OS in the triple versus double arms in the phase III. Secondary endpoints common to the phases II and III are the comparisons of progression-free survival, objective response rates, tolerance and quality of life. In addition, genetic and epigenetic studies from tissue and circulating DNA/RNA will be conducted to assess their prognostic or predictive value.
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Affiliation(s)
- Philippe Merle
- Hepatology Unit, University Hospital La Croix-Rousse, INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Lyon, France.
| | | | - Julien Edeline
- INSERM, Univ Rennes, Department of Medical Oncology, CLCC Eugène Marquis, COSS [(Chemistry Oncogenesis Stress Signaling)] - UMR_S 1242, Rennes, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Bourgogne Franche-Comté University, Dijon, France
| | - Manon Allaire
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France
| | - Eric Assenat
- Medical Oncology, St-Eloi University Hospital, Montpellier, France
| | - Meriem Guarssifi
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Bourgogne Franche-Comté University, Dijon, France
| | - Mohamed Bouattour
- AP-HP, Hôpital Universitaire Beaujon, Unité Fonctionnelle Oncologie Hépatique et Innovation Thérapeutique, Clichy France
| | - Jean-Marie Péron
- Service d'Hépato-Gastroentérologie, Hôpital Purpan, Toulouse, France
| | - Pierre Laurent-Puig
- INSERM U 775 - Faculté des Sciences Fondamentales et Biomédicales, Center Universitaire des Saints-Pères, Université des Saints Pères, Paris Descartes, Paris, France
| | - Massimo Levrero
- Hepatology Unit, University Hospital La Croix-Rousse, INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Charlotte Costentin
- Grenoble Alpes University, Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Gastroenterology, hepatology and GI oncology department, Digidune, Grenoble Alpes University Hospital, La Tronche, France
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, Montpellier, France
| | - Harry Sokol
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint-Antoine Hospital, Gastroenterology Department, Paris, France; Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France; Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, University Hospital of Poitiers, Poitiers, France
| | - Thomas Aparicio
- Service de Gastroentérologie, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
| | - Jean-Charles Nault
- AP-HP Paris Nord, Hôpital Universitaire Avicenne, Service d'hépatologie, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris Cité, team « Functional Genomics of Solid Tumors », Paris, France; Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, France
| | - Jean-Marc Phelip
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, Hôpital Nord de Saint -Etienne, Saint Priest en Jarez, France
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Salfati D, Huot M, Aparicio T, Lepage C, Taieb J, Bouché O, Boige V, Phelip JM, Dahan L, Bennouna J, Le Malicot K, Boussari O, Gornet JM. Carcinoembryonic antigen kinetics predict response to first-line treatment in metastatic colorectal cancer: Analysis from PRODIGE 9 trial. Dig Liver Dis 2023; 55:791-798. [PMID: 36725401 DOI: 10.1016/j.dld.2022.12.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/20/2022] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND To examine the relationship between carcinoembryonic antigen (CEA) kinetics and prognosis in metastatic colorectal cancer (mCRC) patients receiving first-line chemotherapy in the PRODIGE9 trial. METHODS Associations between monthly CEA measurements within 6 months since baseline and progression-free survival (PFS) were evaluated using a joint-latent class-mixed model. A validation set was used to test our prognosis model. Correlations between CEA trajectories (classes) and baseline characteristics were also investigated. RESULTS Three classes were identified. Class 1 had low baseline CEA with small variations. Class 2 had high baseline CEA with a rapid decrease reaching the same CEA level at 6 months as in class 1. Class 3 had high baseline CEA with a transient decrease followed by an increase to reach, at 6 months, the same CEA level as at baseline. Six-month PFS was significantly lower in class 3 than in classes 1 and 2 (57% vs. 91% and 93% respectively; p<0.01). Class 3 was significantly associated with ECOG 2 status, a high LDH level and non-resected primary tumor. DISCUSSION Variations in CEA kinetics correlate with prognosis in patients receiving first-line chemotherapy for mCRC. We propose here a user-friendly application to classify CEA trajectory.
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Affiliation(s)
- Delphine Salfati
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris Cité, Paris, France
| | - Margaux Huot
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Thomas Aparicio
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris Cité, Paris, France
| | - Come Lepage
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Julien Taieb
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Université de Paris, SIRIC CARPEM, Paris, France
| | - Olivier Bouché
- Department of Gastroenterology and Digestive Oncology, CHU Reims, Université de Reims Champagne-Ardenne (URCA), Reims, France
| | - Valérie Boige
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay Villejuif, France
| | - Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Laetitia Dahan
- Cancer Research Center of Marseille, CRCM, Inserm, CNRS, Paoli-Calmettes Institut, Aix-Marseille University, Marseille, France; La Timone Hospital, Marseille, France
| | | | - Karine Le Malicot
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Olayide Boussari
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Jean-Marc Gornet
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris Cité, Paris, France.
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de Rauglaudre B, Sibertin-Blanc C, Fabre A, Le Malicot K, Bennouna J, Ghiringhelli F, Taïeb J, Boige V, Bouché O, Chatellier T, Faroux R, François E, Jacquot S, Genet D, Mulot C, Olschwang S, Seitz JF, Aparicio T, Dahan L. Predictive value of vascular endothelial growth factor polymorphisms for maintenance bevacizumab efficacy in metastatic colorectal cancer: an ancillary study of the PRODIGE 9 phase III trial. Ther Adv Med Oncol 2022; 14:17588359221141307. [PMID: 36601631 PMCID: PMC9806434 DOI: 10.1177/17588359221141307] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/07/2022] [Indexed: 12/28/2022] Open
Abstract
Background Several studies have reported the impact of single nucleotide polymorphisms (SNPs) in vascular endothelial growth factor (VEGF) pathway genes on the efficacy of bevacizumab in metastatic colorectal cancer (mCRC), but results are still inconsistent. The PRODIGE 9 phase III study compared bevacizumab maintenance versus observation alone after induction chemotherapy with FOLFIRI plus bevacizumab. Objective We evaluated the impact of SNPs of VEGF-A, VEGF receptors (VEGFR-1, VEGFR-2), and hypoxia inducible factor-1α (HIF-1α) on tumor control duration (TCD), overall survival (OS), progression-free survival (PFS), and duration of first chemotherapy free-intervals (CFI). Patients and methods We included 314/491 patients from PRODIGE 9 with a DNA blood sample available. Nine SNPs were genotyped on germline DNA using real-time Polymerase Chain Reaction TaqMan TM (Thermo Fisher Scientific, Waltham, MA , USA 02451). Results In the bevacizumab arm, patients with the VEGFR-1 rs9582036 CC genotype (n = 14) had significantly longer TCD [22.4 months (95% confidence interval (CI): 14.75-not reached)] than patients with the AA or CA genotype [14.4 months (95% CI: 11.7-17.1)] (p = 0.036), whereas there was no significant difference in the observation arm. In the bevacizumab arm, no significant difference was found between the CC, and AA or CA genotype for OS [28.2 (95% CI: 18.1-42.8) versus 22.5 (95% CI: 18.6-24.6) months, p = 0.5], PFS [9.4 (95% CI: 7.2-11.3) versus 9.2 (95% CI: 8.71-10.1)], and duration of the first CFI [4.6 (95% CI: 1.6-13.3) versus 4.14 (95% CI: 0.5-29.0) months, p = 0.3]. Conclusion Among mCRC patients treated with bevacizumab maintenance, those with the VEGFR-1 rs9582036 CC genotype experienced longer TCD. The presence of this genotype may thus predict a benefit of bevacizumab maintenance in mCRC.
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Affiliation(s)
| | - Camille Sibertin-Blanc
- UMR S-910 INSERM, Génétique Médicale et
Génomique Fonctionnelle, Aix-Marseille Université, Marseille, France,Hôpital Sainte Musse, Centre Hospitalier
Intercommunal Toulon 6 La Seyne-sur-Mer, Toulon, France
| | - Aurélie Fabre
- UMR S-910 INSERM, Génétique Médicale et
Génomique Fonctionnelle, Aix-Marseille Université, Marseille, France
| | - Karine Le Malicot
- Département de Statistique, Fédération
Française de Cancérologie Digestive (FFCD), Dijon, France
| | | | | | - Julien Taïeb
- Hôpital Européen Georges Pompidou – Université
Paris-Cité, SIRIC CARPEM, Paris, France
| | - Valérie Boige
- Department of Cancer Medicine, Gustave Roussy,
Villejuif, France
| | - Olivier Bouché
- Service de Gastroentérologie et Oncologie
Digestive, CHU Reims, Reims, France
| | | | - Roger Faroux
- Centre Hospitalier les Oudairies, La
Roche-sur-Yon, France
| | | | | | | | - Claire Mulot
- CRB EPIGENETEC, Centre de Recherche des
Cordeliers, INSERM U1138 – Université de Paris, La Sorbonne, Paris,
France
| | - Sylviane Olschwang
- Hôpital Privé Clairval, Ramsay Santé,
Marseille, France Medipath, Eguilles, France
| | - Jean-François Seitz
- Hôpital la Timone, Assistance Publique
Hôpitaux de Marseille – Aix-Marseille Université, Marseille, France,UMR S-910 INSERM, Génétique Médicale et
Génomique Fonctionnelle, Aix-Marseille Université, Marseille, France
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Grancher A, Beaussire L, Manfredi S, Le Malicot K, Dutherage M, Verdier V, Mulot C, Bouché O, Phelip JM, Levaché CB, Deguiral P, Coutant S, Sefrioui D, Emile JF, Laurent-Puig P, Bibeau F, Michel P, Sarafan-Vasseur N, Lepage C, Di Fiore F. Postoperative circulating tumor DNA detection is associated with the risk of recurrence in patients resected for a stage II colorectal cancer. Front Oncol 2022; 12:973167. [PMID: 36439476 PMCID: PMC9685416 DOI: 10.3389/fonc.2022.973167] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Circulating tumor DNA (ctDNA) is reported to be promising in localized colorectal cancer (CRC). The present study aimed to retrospectively evaluate the impact of ctDNA in patients with a resected stage II CRC from the PROGIGE 13 trial with available paired tumor and blood samples. A group of recurrent patients were matched one-to-one with nonrecurrent patients according to sex, tumor location, treatment sequence, and blood collection timing. CtDNA was analyzed by digital PCR according to NGS of tumors. Disease-free survival (DFS) and overall survival (OS) were analyzed based on ctDNA, and the risks of recurrence and death were determined. A total of 134 patients were included, with 67 patients in each group. At least one alteration was identified in 115/134 tumors. Postoperative ctDNA was detected in 10/111 (9.0%) informative samples and was detected more frequently in the recurrent group (16.7% versus 1.8%; p = 0.02). The median DFS of ctDNA+ versus ctDNA- patients was 16.8 versus 54 months (p = 0.002), respectively, and the median OS was 51.3 versus 69.5 months (p = 0.03), respectively. CtDNA was associated with recurrence (ORa = 11.13, p = 0.03) and death (HRa = 3.15, p = 0.01). In conclusion, the presence of postoperative ctDNA is associated with both recurrence and survival in stage II CRC.
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Affiliation(s)
- Adrien Grancher
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
- *Correspondence: Adrien Grancher,
| | - Ludivine Beaussire
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
- Department of Medical Oncology, Henri Becquerel Centre, Rouen, Rouen, France
| | - Sylvain Manfredi
- Burgundy Digestive Cancer Registry, INSERM, Lipides, Nutrition, Cancers (LNC)-UMR1231, University Bourgogne Franche-Comté, Dijon, France
| | - Karine Le Malicot
- Burgundy Digestive Cancer Registry, INSERM, Lipides, Nutrition, Cancers (LNC)-UMR1231, University Bourgogne Franche-Comté, Dijon, France
| | - Marie Dutherage
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
| | - Vincent Verdier
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
| | - Claire Mulot
- Paris University, Biology Resources Center EPIGENETEC, Paris, France
| | - Olivier Bouché
- Department of Digestive Oncology, University Hospital of Reims, Reims, France
| | - Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Charles-Briac Levaché
- Department of Radiotherapy and Medical Oncology, Polyclinique Francheville, Périgueux, France
| | - Philippe Deguiral
- Department of Gastroenterology, St Nazaire Hospital, Saint-Nazaire, France
| | - Sophie Coutant
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
| | - David Sefrioui
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
| | - Jean-François Emile
- Department of Pathology, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Pierre Laurent-Puig
- Department of Biology, Georges Pompidou Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Frédéric Bibeau
- Department of Pathology, Caen University Hospital, Caen, France
| | - Pierre Michel
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
| | - Nasrin Sarafan-Vasseur
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
| | - Côme Lepage
- Burgundy Digestive Cancer Registry, INSERM, Lipides, Nutrition, Cancers (LNC)-UMR1231, University Bourgogne Franche-Comté, Dijon, France
| | - Frederic Di Fiore
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Rouen, France
- Department of Medical Oncology, Henri Becquerel Centre, Rouen, Rouen, France
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12
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Kerckhove N, Tougeron D, Lepage C, Pezet D, Le Malicot K, Pelkowski M, Pereira B, Balayssac D. Efficacy of donepezil for the treatment of oxaliplatin-induced peripheral neuropathy: DONEPEZOX, a protocol of a proof of concept, randomised, triple-blinded and multicentre trial. BMC Cancer 2022; 22:742. [PMID: 35799138 PMCID: PMC9264497 DOI: 10.1186/s12885-022-09806-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of oxaliplatin in digestive tract cancers could induce severe peripheral neuropathy (OIPN) decreasing the quality of life of patients and survivors. There is currently, no univocal treatment for these peripheral neuropathies. Donepezil, a reversible inhibitor of cholinesterase, used to treat Alzheimer’s disease and dementia, is reported to have a good safety profile in humans, and preclinical data have provided initial evidence of its effectiveness in diminishing neuropathic symptoms and related comorbidities in OIPN animal models. Methods The DONEPEZOX trial will be a proof-of-concept, randomised, triple-blinded, and multicentre study. It will be the first clinical trial evaluating the efficacy and safety of donepezil for the management of OIPN. Adult cancer survivors with OIPN that report sensory neuropathy according to QLQ-CIPN20 sensory score (equivalence of a grade ≥ 2), at least 6 months after the end of an oxaliplatin-based chemotherapy will be included. Eighty patients will be randomly assigned to receive either donepezil or placebo over 16 weeks of treatment. The primary endpoint will be the rate of responders (neuropathic grade decreases according to the QLQ-CIPN20 sensory score) in the donepezil arm. The severity of OIPN will be assessed by the QLQ-CIPN20 sensory scale before and after 16 weeks of treatment. The comparison versus the placebo arm will be a secondary objective. The other secondary endpoints will be tolerance to donepezil, the severity and features of OIPN in each arm before and after treatment, related-comorbidities and quality of life. Fleming’s one-stage design will be used for sample size estimation. This design yields a type I error rate of 0.0417 and power of 91% for a responder rate of at least 30% in donepezil arm. A total of 80 randomized patients is planned. Discussion This study will allow, in the case of positive results, to initiate a phase 3 randomized and placebo-controlled (primary endpoint) clinical study to assess the therapeutic interest of donepezil to treat OIPN. Trial registration NCT05254639, clincialtrials.gov, Registered 24 February 2022.
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Affiliation(s)
- Nicolas Kerckhove
- UMR 1107 NEURODOL, service de pharmacologie médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, 63000, Clermont-Ferrand, France.
| | - David Tougeron
- Service d'Hépato gastroentérologie, CHU Poitiers, 86000, Poitiers, France
| | - Côme Lepage
- Service d'Hépatogastroentérologie et oncologie digestive, CHU Dijon, Université de Bourgogne, Dijon, France.,UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France
| | - Denis Pezet
- Service de chirurgie digestive, U1071, M2iSH, USC-INRA 2018, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, INRA, 63000, Clermont-Ferrand, France
| | - Karine Le Malicot
- UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France.,Fédération Francophone de Cancérologie Digestive (FFCD), 21079, Dijon, France
| | - Manon Pelkowski
- UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France.,Fédération Francophone de Cancérologie Digestive (FFCD), 21079, Dijon, France
| | - Bruno Pereira
- Direction de la recherche clinique et de l'innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - David Balayssac
- UMR 1107 NEURODOL, service de pharmacologie médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, 63000, Clermont-Ferrand, France.,Direction de la recherche clinique et de l'innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
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13
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Canton C, Boussari O, Boulin M, Le Malicot K, Taieb J, Dahan L, Lopez A, Lepage C, Bachet JB. Impact of G-CSF Prophylaxis on Chemotherapy Dose-Intensity, Link Between Dose-Intensity and Survival in Patients with Metastatic Pancreatic Adenocarcinoma. Oncologist 2022; 27:e571-e579. [PMID: 35289915 PMCID: PMC9255980 DOI: 10.1093/oncolo/oyac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In metastatic pancreatic adenocarcinoma, few data are available on the use of granulocyte-colony stimulating factor (G-CSF) prophylaxis and its impact on dose-intensity (DI), or the link between DI and progression-free survival (PFS). This study assessed the impact of G-CSF prophylaxis on the DI received by patients and the relationship between full DI and PFS according to chemotherapy regimens. PATIENTS AND METHODS Patients from three first-line randomized phase II clinical trials were included in this retrospective cohort. G-CSF prophylaxis groups were identified and balanced according to baseline characteristics using a propensity score. Patients were classified into 2 treatment groups (FOLFIRINOX vs FOLFIRI/nab-paclitaxel (NAB)). DI was a binary variable (full/reduced). Adverse events were defined using NCI-CTCAE v4.0. RESULTS Of the 498 patients, 154 (31%) were in "prophylaxis" group; 179 (36%) were treated by FOLFIRINOX and 319 (64%) by FOLFIRI/NAB. In FOLFIRINOX group, G-CSF prophylaxis was significantly associated with a higher rate of full DI (OR, 5.07; 95% CI, 1.52-16.90; P < .01) while in FOLFIRI/NAB group, it was significantly associated with a lower rate of full DI (OR, 0.23; 95% CI, 0.06-0.83; P = .03). Full DI was associated with a non-significant increase in PFS (FOLFIRINOX group: HR 0.83; 95% CI, 0.59-1.16; P = .27; FOLFIRI/NAB group: HR 0.84; 95% CI, 0.63-1.11; P = .22). CONCLUSION Granulocyte-colony stimulating factor prophylaxis was associated with a higher rate of full DI with FOLFIRINOX. Full DI was associated with a non-significant increase in PFS. These results need to be confirmed prospectively.
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Affiliation(s)
- Clémence Canton
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Dijon, Dijon, France
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
| | - Olayidé Boussari
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Mathieu Boulin
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Department of Pharmacy, University Hospital of Dijon, Dijon, France
| | - Karine Le Malicot
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
- Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Julien Taieb
- Department of Hepato-Gastroenterology, Georges Pompidou European Hospital, Carpem, Sorbonne Paris City, Paris Descartes University, Paris, France
| | - Laetitia Dahan
- Department of Hepato-Gastroenterology and Digestive Oncology, La Timone, AMU, Marseille, France
| | - Anthony Lopez
- Department of Hepato-Gastroenterology, University Hospital Nancy-Brabois, Nancy, France
| | - Come Lepage
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Dijon, Dijon, France
- EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche-Comté, Dijon, France
| | - Jean-Baptiste Bachet
- Department of Hepato-Gastroenterology, Pitié-Salpêtrière Hospital, Paris, France
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14
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Randrian V, Pernot S, Le Malicot K, Catena V, Baumgaertner I, Tacher V, Forestier J, Hautefeuille V, Tabouret-Viaud C, Gagnaire A, Mitry E, Guiu B, Aparicio T, Smith D, Dhomps A, Tasu JP, Perdrisot R, Edeline J, Capron C, Cheze-Le Rest C, Emile JF, Laurent-Puig P, Bejan-Angoulvant T, Sokol H, Lepage C, Taieb J, Tougeron D. FFCD 1709-SIRTCI phase II trial: Selective internal radiation therapy plus Xelox, Bevacizumab and Atezolizumab in liver-dominant metastatic colorectal cancer. Dig Liver Dis 2022; 54:857-863. [PMID: 35610167 DOI: 10.1016/j.dld.2022.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
Immune checkpoint inhibitors (ICI) have high efficacy in metastatic colorectal cancer (mCRC) with microsatellite instability (MSI) but not in microsatellite stable (MSS) tumour due to the low tumour mutational burden. Selective internal radiation therapy (SIRT) could enhance neoantigen production thus triggering systemic anti-tumoral immune response (abscopal effect). In addition, Oxalipatin can induce immunogenic cell death and Bevacizumab can decrease the exhaustion of tumour infiltrating lymphocyte. In combination, these treatments could act synergistically to sensitize MSS mCRCs to ICI SIRTCI is a prospective, multicentre, open-label, phase II, non-comparative single-arm study evaluating the efficacy and safety of SIRT plus Xelox, Bevacizumab and Atezolizumab (anti-programmed death-ligand 1) in patients with liver-dominant MSS mCRC. The primary objective is progression-free survival at 9 months. The main inclusion criteria are patients with MSS mCRC with liver-dominant disease, initially unresectable disease and with no prior oncologic treatment for metastatic disease. The trial started in November 2020 and has included 10 out of the 52 planned patients.
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Affiliation(s)
- Violaine Randrian
- Service d'Hépato-gastroentérologie, CHU de Poitiers et Université de Poitiers, Poitiers 86021, France
| | - Simon Pernot
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Vittorio Catena
- Department of Radiology, Institut Bergonié, Bordeaux, France
| | | | - Vania Tacher
- University of Paris Est Créteil, Unité INSERM 955, Equipe 18, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil F-94010, France
| | - Julien Forestier
- Department of Medical Oncology, Hôpital Edouard Herriot, Lyon Cedex 03 69437, France
| | - Vincent Hautefeuille
- Department of Hepato-Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens, France
| | - Claire Tabouret-Viaud
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | - Alice Gagnaire
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, BP 87900 21079 Dijon, EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - Emmanuel Mitry
- Medical Oncology Department, Paoli-Calmettes Institut, Marseille, France
| | - Boris Guiu
- Hôpital St-Eloi (CHU Montpellier), Université de Montpellier, Montpellier, France
| | - Thomas Aparicio
- AP-HP, Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, 1 avenue Claude Vellefaux, Université de Paris, Paris F-75010, France
| | - Denis Smith
- Service d'Oncologie médicale, Haut-Lévèque Hospital, CHU Bordeaux, Bordeaux, France
| | - Anthony Dhomps
- Nuclear Medicine, University Hospital of Lyon, Pierre Bénite, France
| | - Jean-Pierre Tasu
- Radiology Department, University Hospital Centre Poitiers, Poitiers, France; LATIM, INSERM UMR 1101, Université de Brest, CHU Morvan, 2 avenue FOCH, 29 609 Brest cedex, France
| | - Rémy Perdrisot
- Nuclear Medicine, Poitiers University Hospital, Poitiers France
| | - Julien Edeline
- Medical Oncology, Centre Eugène Marquis, Rennes 35000, France
| | - Claude Capron
- Service d'immunologie, AP-HP, Hôpital Ambroise Paré, Paris, France
| | - Catherine Cheze-Le Rest
- LATIM, INSERM UMR 1101, Université de Brest, CHU Morvan, 2 avenue FOCH, 29 609 Brest cedex, France; Nuclear Medicine, Poitiers University Hospital, Poitiers France
| | - Jean-François Emile
- Department of Pathology, APHP-Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Pierre Laurent-Puig
- Department of Biology, Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | | | - Harry Sokol
- Sorbonne Université, INSERM UMRS-938, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Gastroentérologie, Paris, Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas and Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - Come Lepage
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, BP 87900 21079 Dijon, EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - Julien Taieb
- Service de Gastroentérologie et d'Oncologie Digestive, Hôpital Européen George Pompidou, Université de Paris, AP-HP, Paris, France
| | - David Tougeron
- Service d'Hépato-gastroentérologie, CHU de Poitiers et Université de Poitiers, Poitiers 86021, France.
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15
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Legoux JL, Faroux R, Barrière N, Le Malicot K, Tougeron D, Lorgis V, Guerin-Meyer V, Bourgeois V, Malka D, Aparicio T, Baconnier M, Lebrun Ly V, Egreteau J, Khemissa Akouz F, Lepage C, Boige V. Aflibercept-LV5FU2 as first-line treatment of non-resectable metastatic colorectal cancers: Results of the FOLFA randomized phase II trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3555] [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
3555 Background: Previous trials have demonstrated that bevacizumab and fluoropyrimidine combination is effective and well-tolerated in older patients (pts) with non-aggressive unresectable metastatic colorectal cancer. We evaluated in this trial safety and efficacy of aflibercept and infusional 5-fluorouracil/folinic acid (LV5FU2 regimen) combination versus LV5FU2 alone in older pts, asymptomatic and/or frail, deemed unsuitable for doublet cytotoxic chemotherapy. Methods: The main eligibility criteria for this randomized phase II trial were age ≥ 65 and WHO performance status < 2. Randomization was stratified according to thymidylate synthase (TS)- 5’UTR germline polymorphism. Common (also called simplified) LV5FU2 regimen was preceded or not by aflibercept (4mg/kg). The primary endpoint was the 6-month progression-free survival (PFS) rate, achieved if > 40% in the experimental arm. Secondary objectives were safety, quality of life, overall survival (OS), and the prognostic impact of TS -5’UTR polymorphism. Results: 117 patients (pts) were included, 59 in arm A (5FU-aflibercept), 58 in arm B (5FU alone), of median age 81 years (range 67-91; > 75 years: 81%). RAS/ BRAF status (available in 112 pts [96%]) was mutated in 49% and 7%, respectively. The 6-month PFS was 54% in both arms (same 90% CI 42-65). The disease control rate was 83% in arm A and 87% in arm B. The median OS was 21.8 months in arm A and 25.1 months in arm B. The toxicities were more common in arm A: at least 1 grade 3-4 toxicity > 2 in 82% versus (vs) 58.2% pts, hypertension grade > 3 in 42% vs 18% pts, proteinuria (any grade) in 51% vs 11% pts, dysphonia (grade < 3) in 19% vs 2%, 1 colic perforation in arm A. Treatment delays for toxicities were required for 4% of the 753 courses in arm A vs 2% of the 780 courses in arm B , 5FU bolus suppression was decided for 29.8% pts vs 20% (arm A vs arm B), median 29 days vs 73 days after the first course (arm A vs B), without difference in the doses of infusional 5FU. A second and third line of treatment were received in 41% and 14% of pts in arm A vs 67% and 29% of pts in arm B, respectively. The TS 5’UTR polymorphism (3R3R vs 2R2R or 2R3R) had no impact on PFS or OS. Regarding the quality of life (QLQ C30 score), the difference of overall health score was on average -6.39 (SD = 26.68) in arm A vs -4.91 (SD = 27.15) in arm B, and was very similar in all components. The median time to definitive deterioration in quality of life was 15 months (95% CI: 9-22.8) in arm A vs 9.6 (95% CI: 5.1-19.4) in arm B. Conclusions: FOLFA trial meets is primary endpoint with 53.6% of 6-month PFS with LV5FU2-aflibercept. Nevertheless, as compared with LV5FU2 alone we observed no increase in PFS or OS and more toxicities. These results do not argue for an evaluation of LV5FU2-aflibercept combination in a randomized phase III trial. Clinical trial information: EudraCT 2014-001837-10.
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Affiliation(s)
| | | | | | | | | | | | | | | | - David Malka
- Digestive Oncology, Gustave Roussy, Villejuif, France
| | - Thomas Aparicio
- Department of Gastroenterology, Hôpital Saint Louis, AP-HP, Paris, France
| | | | | | | | | | - Come Lepage
- Dijon University Hospital, INSERM U1231, Dijon, France
| | - Valérie Boige
- Digestive Oncology, Gustave Roussy, Villejuif, France
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16
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Tougeron D, Dahan L, El Hajbi F, Le Malicot K, Evesque L, Aparicio T, Bouché O, Bonichon-Lamichhane N, Chibaudel B, Angelergues A, Bordere A, Phelip JM, Mabro M, Artru P, Louvet C. The PRODIGE 59-DURIGAST trial: A randomized phase II study evaluating FOLFIRI plus durvalumab and FOLFIRI plus durvalumab plus tremelimumab in second-line treatment of patients with advanced gastric or gastro-esophageal junction adenocarcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4036 Background: Efficacy of 2nd line chemotherapy in advanced gastric/gastro-oesphageal junction (GEJ) adenocarcinoma remains limited. No study up until now has evaluated the efficacy of immune checkpoint inhibitors combined with chemotherapy as 2ndline treatment of advanced gastric/GEJ adenocarcinoma. Methods: DURIGAST PRODIGE 59 is a randomized, multicenter, phase II study designed to assess the efficacy and safety of the combination of FOLFIRI plus durvalumab (anti-PD-L1 until progression) (FD) versus FOLFIRI plus durvalumab and tremelimumab (anti-CTLA-4 for 4 cycles) (FDT). Key eligibility criteria included advanced gastric/GEJ adenocarcinoma, platinum-based first-line chemotherapy and ECOG performance status (PS) 0 or 1. Patients were randomized in a 1:1 ratio to FD versus FDT. The primary endpoint is progression-free survival (PFS) at 4 months, which was expected to be 70% (H0:50%). With an α risk of 5%, a power of 85% and 5% of non-evaluable patients, 47 evaluable patients are needed by arm. Secondary endpoints included safety, overall survival (OS) and quality of life. Results: Between August 2020 and June 2021, 96 patients were randomized, 48 in each arm. The median age was 59.7 years, 30.4% were women and 66.3% ECOG PS 1. All in all, 22.8% had HER2+ tumors and 4.3% dMMR/MSI tumors. The 4-month PFS were 44.7% [90%CI: 32.3–57.7] and 57.8% [90%CI: 44.5–70.3] in the FD and FDT arms, respectively. Primary endpoint was not met. Median PFS were 3.8 and 5.9 months, disease control rates 68.9% and 73.8% and median OS not reached and 10.1 months in FD and FDT arms, respectively. Eight patients in FDT arm had tremelimumab re-introduction at progression. Twenty-one patients, 8 in FD arm and 13 in FDT arm, are still being treated with a median duration of treatment of 7.8 and 10.9 months. All in all, 50.0% and 47.8% of patients experienced at least one grade 3-4 adverse events related to the treatment (neutropenia: 13.0 vs 21.7%, anemia: 10.9 vs 6.5%, diarrhea: 2.2 vs 8.7% and vomiting: 6.5 vs 10.9%), in FD and FDT arms, respectively. In both arms there was no clinically significant deterioration of quality of life superior to 10 points according to EORTC QLQ-C30 global health status. Conclusions: The DURIGAST PRODIGE 59 trial demonstrates an acceptable safety profile of immune checkpoint inhibitors plus FOLFIRI in 2nd line treatment for advanced gastric/GEJ adenocarcinoma. FDT combination demonstrates a clinically relevant efficacy never before achieved with a median PFS of 6 months and should be evaluated in a phase III trial. Updated results including PFS according to centralized review and PD-L1 status will be presented during ASCO meeting. Clinical trial information: NCT03959293.
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Affiliation(s)
- David Tougeron
- Gastroenterology Department, Poitiers University Hospital, Poitiers, France
| | - Laetitia Dahan
- Hepato-Gastroenterology and Oncology Department, University Hospital la Timone, Marseille, France
| | | | | | | | - Thomas Aparicio
- Department of Gastroenterology, Hôpital Saint Louis, AP-HP, Paris, France
| | | | | | - Benoist Chibaudel
- Hospital Franco-Britannique, Fondation Cognacq-Jay, Medical Oncology, Levallois-Perret, France
| | | | | | | | | | | | - Christophe Louvet
- Medical Oncology Department, Institut Mutualiste Montsouris, Paris, France
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17
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Boisteau E, François E, Aparicio T, Le Malicot K, Boulahssass R, Lecomte T, Laurent-Puig P, Guiu B, Paillaud E, Galais MP, Lopez-Trabada Ataz D, Tougeron D, Dourthe LM, Guimbaud R, Samalin E, Moreau M, Louvet C, Lepage C, Lièvre A. SOCRATE-PRODIGE 55 trial: A randomized phase II study to evaluate second-line ramucirumab alone or with paclitaxel in older patients with advanced gastric cancer. Dig Liver Dis 2022; 54:747-754. [PMID: 35351371 DOI: 10.1016/j.dld.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patients ≥ 70 years old constitute 40% of patients with advanced gastric cancer (GC). Ramucirumab plus Paclitaxel is a therapeutic option validated in the second-line treatment of advanced GC, but as older patients are at higher risk of severe toxicity, due to comorbidities and/or frailty, we aimed to evaluate second-line Ramucirumab alone or combined with Paclitaxel in terms of overall survival (OS) and quality of life (QoL) in patients ≥ 70 years-old with advanced GC. METHODS In this multicenter, randomized, open-label, non-comparative, prospective phase II clinical trial, the main inclusion criteria are: patients ≥ 70 years old, with advanced GC having progressed after first-line chemotherapy or in the six months following the last administration of adjuvant chemotherapy, with WHO performance status <2. They are randomized to receive either ramucirumab alone (arm A) or ramucirumab plus Paclitaxel (arm B). The primary endpoint is 6-month OS and QoL evaluated with the EORTC QLQ-ELD14 questionnaire. The secondary endpoints include other parameters of QoL, time to definitive deterioration (TTDD) in QoL and TTDD in autonomy, treatment toxicities, other parameters of survival and disease control, identification of geriatric and nutritional prognostic scores and predictive factors of treatment safety and efficacy. OS of 60% is expected at 6 months (H0:40%). Using a Simon-minimax design, with one-sided α risk of 2% and 80% power for OS, and considering 5% lost to follow-up, it is necessary to randomize 56 patients in each arm. PERSPECTIVES As older patients are at higher risk of chemotherapy toxicity, ramucirumab alone could be an interesting alternative to Paclitaxel plus ramucirumab, as a second-line therapy for patients ≥ 70 years old with advanced GC, and needs to be evaluated.
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Affiliation(s)
- Emeric Boisteau
- Service des Maladies de l'Appareil Digestif, INSERM U1242, CHU de Rennes, CHU Pontchaillou, Université de Rennes 1, Rennes Cedex9 35033, France
| | - Eric François
- Service d'Oncologie, Center Antoine Lacassagne, Nice, France
| | - Thomas Aparicio
- Service de Gastroentérologie, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
| | - Karine Le Malicot
- FFCD EPICAD INSERM LNC-UMR 1231, Université de Bourgogne Franche-Comté Dijon, France
| | | | - Thierry Lecomte
- Service d'Hépato-Gastroentérologie, CHU de Tours, Tours, France; INSERM UMR 1069, "Nutrition, Croissance et Cancer", Université de Tours, France
| | - Pierre Laurent-Puig
- INSERM U 775 - Faculté des Sciences Fondamentales et Biomédicales, Center Universitaire des Saints-Pères, Université des Saints Pères, Paris Descartes, Paris, France
| | - Boris Guiu
- Département de Radiologie, CHU St-Eloi, Montpellier, France
| | - Elena Paillaud
- Hôpital Européen Georges Pompidou, Service de Gériatrie, APHP, Paris Cancer Institute CARPEM, Paris 75015, France
| | | | | | - David Tougeron
- Service d'Hépato-gastroentérologie, CHU de Poitiers, La Milétrie, et l'Université de Poitiers, Poitiers, France
| | | | - Rosine Guimbaud
- Département d'Oncologie Médicale, Pôle Digestif, CHU Toulouse, Toulouse, France
| | - Emmanuelle Samalin
- Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Marie Moreau
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France
| | - Christophe Louvet
- Service d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France
| | - Côme Lepage
- Service d'Hépato-gastroentérologie, CHU de Dijon, Dijon, France
| | - Astrid Lièvre
- Service des Maladies de l'Appareil Digestif, INSERM U1242, CHU de Rennes, CHU Pontchaillou, Université de Rennes 1, Rennes Cedex9 35033, France.
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18
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Christou N, Bergen ES, Canton C, Le Malicot K, Di Bartolomeo M, Galli F, Galli F, Labianca R, Shi Q, Alberts SR, Goldberg RM, Lepage C, Sinicrope FA, Taieb J. Impact of diabetes and metformin use on recurrence and outcome in stage II–III colon cancer patients—A pooled analysis of three adjuvant trials. Eur J Cancer 2022; 166:100-111. [DOI: 10.1016/j.ejca.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/21/2022] [Accepted: 02/05/2022] [Indexed: 12/30/2022]
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19
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Pietrasz D, Wang-Renault S, Taieb J, Dahan L, Postel M, Durand-Labrunie J, Le Malicot K, Mulot C, Rinaldi Y, Phelip JM, Doat S, Blons H, de Reynies A, Bachet JB, Taly V, Laurent-Puig P. Prognostic value of circulating tumour DNA in metastatic pancreatic cancer patients: post-hoc analyses of two clinical trials. Br J Cancer 2021; 126:440-448. [PMID: 34811505 DOI: 10.1038/s41416-021-01624-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The prognostication of metastatic pancreatic adenocarcinoma (mPDAC) patients remains uncertain, mainly based on carbohydrate antigen 19-9 (CA19-9), with limited utility. Circulating tumour DNA (ctDNA) has been suggested as a prognostic factor, but its added value has been poorly explored. The objective was to determine whether ctDNA is an independent factor for the prognostication of mPDAC. DESIGN Translational study based on two prospective collections of plasma samples of mPDAC patients naïve for chemotherapy. One used as a test series and the other as validation series coming from two randomised trials (Prodige 35 and Prodige 37). CtDNA was assessed by digital droplet PCR targeting two methylated markers (HOXD8 and POU4F1) according to a newly developed and validated method. Univariate and multivariate analyses were performed according to ctDNA status. RESULTS Of 372 plasma samples available, 354 patients were analyzed for survival. In the validation series, 145 of 255 patients were found ctDNA positive (56.8%), Median PFS and OS were 5.3 and 8.2 months in ctDNA-positive and 6.2 and 12.6 months in ctDNA-negative patients, respectively. ctDNA positivity was more often associated with young age, high CA19-9 level and neutrophils lymphocytes ratio. In multivariate analysis including these previous markers, ctDNA was confirmed as an independent prognostic marker for PFS (adjusted hazard ratio (HR) 1.5, CI 95% [1.03-2.18], p = 0.034) and OS (HR 1.62, CI 95% [1.05-2.5], p = 0.029). CONCLUSIONS In this first ctDNA assessment in a large series of mPDAC derived from clinical trials, ctDNA was detectable in 56.8% of patients and confirmed as an independent prognostic marker.
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Affiliation(s)
- Daniel Pietrasz
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France.,Assistance Publique-Hopitaux de Paris Hôpital Paul-Brousse, Centre Hépato-Biliaire, Université Paris-Saclay, 94800, Villejuif, France
| | - Shufang Wang-Renault
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France
| | - Julien Taieb
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France.,Institut du Cancer Paris Carpem, APHP.Centre -Université de Paris, Hopital Européen Georges Pompidou, Assistance Publique Hopitaux de Paris, Paris, France
| | - Laetitia Dahan
- Hepato-Gastroenterology and Oncology Department, University Hospital la Timone, Marseille, France
| | - Mathilde Postel
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France
| | - Jerome Durand-Labrunie
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive (FFCD); EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Claire Mulot
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France.,Biological resources center-EPIGENETEC BB-0033-00055, Paris, France
| | - Yves Rinaldi
- Gastroenterology Departement, Hôpital Européen, Marseille, France
| | | | - Solene Doat
- Gastroenterology and Digestive Oncology Department, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France
| | - Hélène Blons
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France.,Institut du cancer Paris Carpem; APHP.Centre-Université de Paris, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Aurelien de Reynies
- Programme Cartes d'Identité des Tumeurs, Ligue Nationale Contre le Cancer, Paris, France
| | - Jean-Baptiste Bachet
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France.,Gastroenterology and Digestive Oncology Department, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC University, Paris, France
| | - Valérie Taly
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France.
| | - Pierre Laurent-Puig
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, CNRS SNC 5096, Paris, France. .,Institut du cancer Paris Carpem; APHP.Centre-Université de Paris, Assistance Publique - Hopitaux de Paris, Paris, France.
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20
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Dahan L, Williet N, Le Malicot K, Phelip JM, Desrame J, Bouché O, Petorin C, Malka D, Rebischung C, Aparicio T, Lecaille C, Rinaldi Y, Turpin A, Bignon AL, Bachet JB, Seitz JF, Lepage C, François E. Randomized Phase II Trial Evaluating Two Sequential Treatments in First Line of Metastatic Pancreatic Cancer: Results of the PANOPTIMOX-PRODIGE 35 Trial. J Clin Oncol 2021; 39:3242-3250. [PMID: 34288696 DOI: 10.1200/jco.20.03329] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Metastatic pancreatic cancer (mPC) still harbors a dismal prognosis. Our previous trial (PRODIGE 4-ACCORD 11) demonstrated the superiority of 6-month chemotherapy with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) over gemcitabine for overall survival. The high limiting oxaliplatin-related neurotoxicity supports the evaluation of an oxaliplatin stop-and-go strategy and a sequential strategy in mPC. METHODS In this phase II study, patients were randomly assigned to receive either 6 months of FOLFIRINOX (arm A), 4 months of FOLFIRINOX followed by leucovorin plus fluorouracil maintenance treatment for controlled patients (arm B), or a sequential treatment alternating gemcitabine and fluorouracil, leucovorin, and irinotecan every 2 months (arm C). The primary end point was progression-free survival at 6 months. RESULTS Between January 2015 and November 2016, 276 patients (mean age: 63 years; range: 40-76 years) were enrolled (A: 91, B: 92, and C: 90). Grade 3 or 4 neurotoxicity occurred in 10.2% of patients in arm A and 19.8% in arm B. The median ratio of received dose/targeted dose of oxaliplatin was 83% in arm A and 92% in arm B. The 6-month progression-free survival was 47.1% in A, 42.9% in B, and 34.1% in C. The median overall survival was 10.1 months in arm A, 11.2 in arm B, and 7.3 in arm C. Median survival without deterioration in quality-of-life scores was higher in the maintenance arm (11.4 months) than in arms A and C (7.2 and 7.5 months, respectively). CONCLUSION Maintenance with leucovorin plus fluorouracil appears to be feasible and effective in patients with mPC controlled after 4 months of induction chemotherapy with FOLFIRINOX. Severe neurotoxicity was higher in the maintenance therapy arm, probably because of the higher cumulative dose of oxaliplatin.
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Affiliation(s)
- Laetitia Dahan
- Department of Digestive Oncology, La Timone, Aix Marseille Université, Marseille, France
| | - Nicolas Williet
- Hepatogastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Karine Le Malicot
- Biostatistics Department, Fédération Francphone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche Comté, Dijon, France
| | - Jean-Marc Phelip
- Hepatogastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jérôme Desrame
- Cancerology Institute, Jean-Mermoz Private Hospital, Lyon, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
| | - Caroline Petorin
- Hepatogastroenterology Department, Estaing University Hospital, Clermont Ferrand, France
| | - David Malka
- Cancerology Department, Gustave Roussy Institute, Villejuif, France
| | | | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, Paris, France
| | - Cédric Lecaille
- Cancerology Department, Bordeaux Nord Polyclinic, Bordeaux, France
| | - Yves Rinaldi
- Hepatogastroenterology Department, European Hospital of Marseille, Marseille, France
| | - Anthony Turpin
- Department of Medical Oncology, University Lille, CNRS UMR9020, Inserm UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, CHU Lille, Lille, France
| | - Anne-Laure Bignon
- Hepatogastroenterology Department, University Hospital of Caen, Caen, France
| | - Jean-Baptiste Bachet
- Sorbonne University, UPMC, IUC, Paris 6, Hepato-Gastroenterology and Digestive Oncology Department, Pitié Salpêtrière Hospital, Paris, France
| | - Jean-François Seitz
- Department of Digestive Oncology, La Timone, Aix Marseille Université, Marseille, France
| | - Come Lepage
- Hepatogastroenterology and Cancerology Department, Dijon Bourgogne Hospital, Dijon, France.,Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche Comté, Dijon, France
| | - Eric François
- Cancerology Department, Antoine Lacassagne Centre, Nice, France
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21
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Terlizzi M, Buscail E, Boussari O, Adgié S, Leduc N, Terrebonne E, Smith D, Blanc JF, Lapuyade B, Laurent C, Chiche L, Belleannée G, Le Malicot K, Trouette R, Pouypoudat C, Vendrely V. Neoadjuvant treatment for borderline resectable pancreatic adenocarcinoma is associated with higher R0 rate compared to upfront surgery. Acta Oncol 2021; 60:1114-1121. [PMID: 34197269 DOI: 10.1080/0284186x.2021.1944662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neoadjuvant treatment (NAT) is debated for borderline resectable pancreatic cancer (BRPC). This retrospective study assessed the impact of NAT on R0 rate and survival for BRPC patients in comparison with upfront surgery (US). MATERIAL AND METHODS Between 2010 and 2017 patient records for all consecutive patients treated for BRPC according to NCCN 2017 were reviewed. The endpoints analysed were R0 rate, recurrence-free-survival (RFS) and overall survival (OS). RESULTS Seventy-nine patients were included: 63 (79.7%) patients received NAT and 16 (20.3%) were upfront operated. NAT consisted in FOLFIRINOX (median cycles: 5, range 4-8) followed by chemoradiation (n = 55, 87.3%, median dose: 54 Gy). Thirty-nine (61.9%) patients had resection. R0 rate was higher in the NAT group considering a margin clearance of 0 mm (94.9%) or 1 mm (89.7%) compared to the US group (68.8% and 43.8% respectively). In the whole population, median RFS was 12.6 [95%CI: 10.5-22.1] in the NAT group vs 7.7 [95%CI: 4.4-14] months in the US group (p < 0.01). Median OS was 29.0 [95%CI: 23.5-63.1] and 27.2 [95%CI: 11.6-38.8] months in the NAT and US groups respectively (p = 0.06). In operated patients the NAT group achieved better RFS and OS than the US group (p < 0.01 for both). In multivariate analysis NAT, surgical resection and age <65 (p < 0.01 for both) were prognostic of RFS. NAT, surgical resection and adjuvant chemotherapy were prognostic of OS (p < 0.05 for all). In operated patients (n = 55) multivariate analysis showed that N1 status was associated with decreased RFS; age < 65 and NAT were associated with a longer RFS. Receiving a NAT, an adjuvant chemotherapy and achieving a ypT0-1N0 status were associated with better OS. NAT was well tolerated with 14.3% grade ≥ 3 toxicities. CONCLUSION NAT permitted a high R0 rate with a 0- or 1-mm clearance margin and was associated with better RFS and OS for patients with BRPC.
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Affiliation(s)
- Mario Terlizzi
- Service de Radiothérapie, CHU Bordeaux, Bordeaux, France
| | | | | | - Sarah Adgié
- Service de Radiothérapie, CHU Bordeaux, Bordeaux, France
| | - Nicolas Leduc
- Service de Radiothérapie, CHU Bordeaux, Bordeaux, France
| | - Eric Terrebonne
- Service d’Oncologie Médicale, CHU Bordeaux, Bordeaux, France
| | - Denis Smith
- Service d’Oncologie Médicale, CHU Bordeaux, Bordeaux, France
| | | | - Bruno Lapuyade
- Département d’Imagerie Médicale, CHU Bordeaux, Bordeaux, France
| | | | | | | | | | | | | | - Véronique Vendrely
- Service de Radiothérapie, CHU Bordeaux, Bordeaux, France
- Département de Chirurgie, CHU Bordeaux, Bordeaux, France
- Département de Biostatistiques, FFCD, Dijon, France
- Service d’Oncologie Médicale, CHU Bordeaux, Bordeaux, France
- Département d’Imagerie Médicale, CHU Bordeaux, Bordeaux, France
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22
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Voron T, Karoui M, Lo Dico R, Malicot KL, Espin E, Cianchi F, Jürgen W, Buggenhout A, Bruzzi M, Denimal F, Cazelles A, Douard R, Lepage C, Taieb J. Impact of laparoscopy on oncological outcomes after colectomy for stage III colon cancer: A post-hoc multivariate analysis from PETACC8 European randomized clinical trial. Dig Liver Dis 2021; 53:1034-1040. [PMID: 34112615 DOI: 10.1016/j.dld.2021.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In colon cancer (CC), surgery remains the mainstay of treatment with curative intent. Despite several clinical trials comparing open and laparoscopic approaches, data on long-term outcomes for stage III CC are lacking. METHODS This post-hoc analysis of the European PETACC8 randomized phase 3 trial included patients from 340 sites between December 2005 and November 2009, with long follow-up (median 7.56 years). Patients were randomly assigned to FOLFOX or FOLFOX+cetuximab after colonic resection. The surgical approach was left to the referring surgeon's discretion. RESULTS Among 2555 patients included, 1796 (70.29%) were operated on by open surgery and 759 (29.71%) by laparoscopy. The 5-year OS rate was better after laparoscopic resection (85.4%, 95%CI 82.5-87.7) than after open surgery (80.2%, 95%CI 78.2-82.0; p = 0.002). The 5-year DFS rate was also better after laparoscopy (p = 0.016). However, in multivariate analysis using a propensity matching, the surgical approach was not found to be an independent prognostic factor for OS or DFS. OS (p = 0.0243) and DFS (p = 0.035) were increased after laparoscopic surgery in KRAS/BRAF WT sub-group CONCLUSION: We showed that laparoscopic resection has comparable long-term outcomes to open surgery in patients with stage III CC. For those with RAS and BRAF WT CC, laparoscopic colectomy may favorably impact survival.
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Affiliation(s)
- Thibault Voron
- Sorbonne Université, Department of Digestive and General Surgery, Saint Antoine Hospital, Paris, France
| | - Mehdi Karoui
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France.
| | - Réa Lo Dico
- Université de Paris, Department of Digestive Surgery, Saint Louis Hospital, AP-HP, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, Faculty of Medecine, Dijon, France; EPICAD INSERM UMR LNC 1231, University of Burgundy Franche Comté, Dijon France
| | - Eloy Espin
- Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Weitz Jürgen
- Department of Visceral, Thoracic and Vascular surgery, University Hospital Carl Gustav Carus of the Technical University Dresden, Germany
| | - Alexis Buggenhout
- Department of surgical gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Matthieu Bruzzi
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Fabrice Denimal
- Department of Digestive Surgery, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | - Antoine Cazelles
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Richard Douard
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Come Lepage
- EPICAD INSERM UMR LNC 1231, University of Burgundy Franche Comté, Dijon France; HepatoGastroenterology and Digestive oncology department, University hospital Dijon, University of Burgundy and Franche Comté, FFCD, EPICAD INSERM LNC-UMR 1231, Dijon, France
| | - Julien Taieb
- Université de Paris, Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
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23
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Ghazi A, Le Corre D, Pilati C, Taieb J, Aparicio T, Didelot A, Dedhar S, Mulot C, Le Malicot K, Djouadi F, de Reynies A, Launay JM, Laurent-Puig P, Mouillet-Richard S. Prognostic value of the PrP C-ILK-IDO1 axis in the mesenchymal colorectal cancer subtype. Oncoimmunology 2021; 10:1940674. [PMID: 34249475 PMCID: PMC8244775 DOI: 10.1080/2162402x.2021.1940674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 10/24/2022] Open
Abstract
The CMS4 mesenchymal subtype of colorectal cancer (CRC) is associated with poor prognosis and resistance to treatment. The cellular prion protein PrPC is overexpressed in CMS4 tumors and controls the expression of a panel of CMS4-specific genes in CRC cell lines. Here, we sought to investigate PrPC downstream pathways that may underlie its role in CMS4 CRC. By combining gene set enrichment analyses and gain and loss of function approaches in CRC cell lines, we identify the integrin-linked kinase ILK as a proximal effector of PrPC that mediates its control on the CMS4 phenotype. We further leveraged three independent large CRC cohorts to assess correlations in gene expression pattern with patient outcomes and found that ILK is overexpressed in CMS4 mesenchymal tumors and confers a poor prognosis, especially when combined with high expression of the PrPC encoding gene PRNP. Of note, we discovered that the PrPC-ILK signaling axis controls the expression and activity of the tryptophan metabolizing enzyme indoleamine 2,3 dioxygenase IDO1, a key player in immune tolerance. In addition, we monitored alterations in the levels of tryptophan and its metabolites of the kynurenine pathway in the plasma of metastatic CRC patients (n = 325) and we highlight their prognostic value in combination with plasma PrPC levels. Thus, the PrPC-ILK-IDO1 axis plays a key role in the mesenchymal subtype of CRC. PrPC and IDO1-targeted strategies may represent new avenues for patient stratification and treatment in CRC.
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Affiliation(s)
- Alexandre Ghazi
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Delphine Le Corre
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Camilla Pilati
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Julien Taieb
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Department of Gastroenterology and GI Oncology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, AP-HP, Hôpital Saint-Louis, Université de Paris, Université Paris Diderot, Paris, France
| | - Audrey Didelot
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Shoukat Dedhar
- Genetics Unit, Integrative Oncology, BC Cancer, Vancouver, Canada
| | - Claire Mulot
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, Epicad Inserm, Université de Bourgogne et and Franche Comté, Dijon, France
| | - Fatima Djouadi
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Aurélien de Reynies
- Programme carte d'identité des tumeurs, Ligue Nationale Contre Le Cancer, Paris, France
| | - Jean-Marie Launay
- AP-HP Service de Biochimie, INSERM U942 Lariboisière Hospital, Paris, France.,Pharma Research Department, F. Hoffmann-La-Roche Ltd., Basel, Switzerland
| | - Pierre Laurent-Puig
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,Department of Biology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Sophie Mouillet-Richard
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
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24
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Marisa L, Blum Y, Taieb J, Ayadi M, Pilati C, Le Malicot K, Lepage C, Salazar R, Aust D, Duval A, Blons H, Taly V, Gentien D, Rapinat A, Selves J, Mouillet-Richard S, Boige V, Emile JF, de Reyniès A, Laurent-Puig P. Intratumor CMS Heterogeneity Impacts Patient Prognosis in Localized Colon Cancer. Clin Cancer Res 2021; 27:4768-4780. [PMID: 34168047 PMCID: PMC8974433 DOI: 10.1158/1078-0432.ccr-21-0529] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/10/2021] [Revised: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE The consensus molecular subtypes (CMS) represent a significant advance in the understanding of intertumor heterogeneity in colon cancer. Intratumor heterogeneity (ITH) is the new frontier for refining prognostication and understanding treatment resistance. This study aims at deciphering the transcriptomic ITH of colon cancer and understanding its potential prognostic implications. EXPERIMENTAL DESIGN We deconvoluted the transcriptomic profiles of 1,779 tumors from the PETACC8 trial and 155 colon cancer cell lines as weighted sums of the four CMSs, using the Weighted In Silico Pathology (WISP) algorithm. We assigned to each tumor and cell line a combination of up to three CMS subtypes with a threshold above 20%. RESULTS Over 55% of tumors corresponded to mixtures of at least two CMSs, demonstrating pervasive ITH in colon cancer. Of note, ITH was associated with shorter disease-free survival (DFS) and overall survival, [HR, 1.34; 95% confidence interval (CI; 1.12-1.59), 1.40, 95% CI (1.14-1.71), respectively]. Moreover, we uncovered specific combinations of CMS associated with dismal prognosis. In multivariate analysis, ITH represents the third parameter explaining DFS variance, after T and N stages. At a cellular level, combined WISP and single-cell transcriptomic analysis revealed that most colon cancer cell lines are a mixture of cells falling into different CMSs, indicating that ITH may correspond to distinct functional statuses of colon cancer cells. CONCLUSIONS This study shows that CMS-based transcriptomic ITH is frequent in colon cancer and impacts its prognosis. CMS-based transcriptomic ITH may correspond to distinct functional statuses of colon cancer cells, suggesting plasticity between CMS-related cell populations. Transcriptomic ITH deserves further assessment in the context of personalized medicine.
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Affiliation(s)
- Laetitia Marisa
- Programme Cartes d'Identité des Tumeurs, Ligue Nationale Contre le Cancer, Paris, France
| | - Yuna Blum
- Programme Cartes d'Identité des Tumeurs, Ligue Nationale Contre le Cancer, Paris, France
| | - Julien Taieb
- Institut du cancer Paris CARPEM, AP-HP, European Georges Pompidou Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, CNRS SNC 5096, Sorbonne Université, Université de Paris, Paris, France
| | - Mira Ayadi
- Programme Cartes d'Identité des Tumeurs, Ligue Nationale Contre le Cancer, Paris, France
| | - Camilla Pilati
- Centre de Recherche des Cordeliers, INSERM, CNRS SNC 5096, Sorbonne Université, Université de Paris, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, INSERM, Université de Bourgogne et Franche Comté, Dijon, France
| | - Côme Lepage
- Fédération Francophone de Cancérologie Digestive, INSERM, Université de Bourgogne et Franche Comté, Dijon, France.,Hepatogastroenterology and Digestive Oncology department, CHU Dijon, Dijon, France
| | - Ramon Salazar
- Catalan Institute of Oncology (IDIBELL), Universitat de Barcelona, CIBERONC, Spanish Gastrointestinal Tumors TTD Group, Barcelona, Spain
| | - Daniela Aust
- Institute for Pathology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alex Duval
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, Equipe Instabilité des Microsatellites et Cancer, équipe labellisé par la Ligue Nationale contre le Cancer, Paris, France
| | - Hélène Blons
- Institut du cancer Paris CARPEM, AP-HP, European Georges Pompidou Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, CNRS SNC 5096, Sorbonne Université, Université de Paris, Paris, France
| | - Valérie Taly
- Centre de Recherche des Cordeliers, INSERM, CNRS SNC 5096, Sorbonne Université, Université de Paris, Paris, France
| | - David Gentien
- Curie Institute, PSL Research University, Translational Research Department, Genomics Platform, Paris, France
| | - Audrey Rapinat
- Curie Institute, PSL Research University, Translational Research Department, Genomics Platform, Paris, France
| | - Janick Selves
- Centre de Recherche en Cancérologie de Toulouse, INSERM, Université Toulouse III, Department of Pathology, CHU Toulouse, Toulouse, France
| | - Sophie Mouillet-Richard
- Centre de Recherche des Cordeliers, INSERM, CNRS SNC 5096, Sorbonne Université, Université de Paris, Paris, France
| | - Valérie Boige
- Centre de Recherche des Cordeliers, INSERM, CNRS SNC 5096, Sorbonne Université, Université de Paris, Paris, France.,Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-François Emile
- Department of Pathology, AP-HP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Aurélien de Reyniès
- Programme Cartes d'Identité des Tumeurs, Ligue Nationale Contre le Cancer, Paris, France.,Corresponding Authors: Pierre Laurent-Puig, UMR-S1138, Université Paris Descartes, 15 rue de l'Ecole de Médecine, Paris 75006, France. Phone: 336-0843-7691; E-mail: ; and Aurélien de Reyniès,
| | - Pierre Laurent-Puig
- Institut du cancer Paris CARPEM, AP-HP, European Georges Pompidou Hospital, Paris, France.,Centre de Recherche des Cordeliers, INSERM, CNRS SNC 5096, Sorbonne Université, Université de Paris, Paris, France.,Corresponding Authors: Pierre Laurent-Puig, UMR-S1138, Université Paris Descartes, 15 rue de l'Ecole de Médecine, Paris 75006, France. Phone: 336-0843-7691; E-mail: ; and Aurélien de Reyniès,
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25
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Breton C, Aparicio T, Le Malicot K, Ducreux M, Lecomte T, Bachet JB, Taieb J, Legoux JL, De Gramont A, Bennouna J, Bouché O, Boussari O, Manfredi S, Gornet JM. Predictive factors of severe early treatment-related toxicity in patients receiving first-line treatment for metastatic colorectal cancer: Pooled analysis of 2190 patients enrolled in Fédération Francophone de Cancérologie Digestive (FFCD) trials. Eur J Cancer 2021; 153:40-50. [PMID: 34130228 DOI: 10.1016/j.ejca.2021.04.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/25/2021] [Indexed: 11/29/2022]
Abstract
AIM Few studies have explored the association between baseline characteristics and the occurrence of early toxicities in patients treated with first-line chemotherapy for metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Individual patient data of 2190 patients enrolled in 10 prospective FFCD (Fédération Francophone de Cancérologie Digestive) trials were analysed. Severe early toxicity was defined as the occurrence of grade ≥III toxicity within 3 months after initiation of chemotherapy (ET3). RESULTS Patients received monotherapy based on 5-FU (n = 1068), a cytotoxic doublet (n = 395) or tritherapy with a cytotoxic doublet plus anti-VEGF agent or a cytotoxic triplet (n = 727). The patients received 5-FU (100%), Irinotecan (39.6%), Oxaliplatin (13.4%), Bevacizumab (29.6%) or Aflibercept (1.8%). ET3 occurred in 244 patients (22.8%) with monotherapy, 248 patients (62.8%) with doublet and 392 patients (53.9%) with tritherapy. The most frequent ET3s were related to biological abnormalities and/or gastrointestinal, general and vascular disorders. The prognostic factors for the occurrence of an ET3 in multivariate analysis were a performance status of 2 rather than 0-1 (OR 2.57; 95% CI [1.16, 5.73]; p = 0.02), tritherapy versus monotherapy (OR 2.31; 95% CI [0.84, 6.33]; p = 0.02), alkaline phosphatase > 300 UI/l (OR 3.07; 95% CI [1.79, 5.27]; p < 0.001) and non-resected primary tumour versus resection (OR 1.59; 95% CI [1.06, 2.39]; p = 0.02). Median overall survival in patients without ET3 was significantly longer than that in patients with ET3 (HR 0.87; 95% CI [0.80-0.96]; p = 0.004). CONCLUSION ET3 is frequent whatever the treatment regimen and is associated with certain baseline characteristics. The clinical impact of ET3 on prognosis in mCRC warrants further investigation.
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Affiliation(s)
- Clémence Breton
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Thomas Aparicio
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Karine Le Malicot
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Michel Ducreux
- Gustave Roussy Cancer Campus, Villejuif, Université Paris-Saclay, France
| | - Thierry Lecomte
- Hôpital universitaire de Tours, Université de Tours, Tours, France
| | - Jean-Baptiste Bachet
- Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Julien Taieb
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Université de Paris, SIRIC CARPEM, Paris, France
| | | | | | - Jaafar Bennouna
- Hôpital universitaire de Nantes, Université de Nantes, Nantes, France
| | - Olivier Bouché
- Hôpital universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Olayide Boussari
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Sylvain Manfredi
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Jean-Marc Gornet
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France.
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26
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Salvatore L, Bria E, Sperduti I, Hinke A, Hegewisch-Becker S, Aparicio T, Le Malicot K, Boige V, Koeberle D, Baertschi D, Dietrich D, Tortora G, Arnold D. Bevacizumab as maintenance therapy in patients with metastatic colorectal cancer: A meta-analysis of individual patients' data from 3 phase III studies. Cancer Treat Rev 2021; 97:102202. [PMID: 33838596 DOI: 10.1016/j.ctrv.2021.102202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/14/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The real impact of bevacizumab maintenance as single agent in metastatic colorectal cancer (mCRC) remains unclear. SAKK-41/06 and PRODIGE-9 failed to demonstrate the non-inferiority and superiority of bevacizumab versus no maintenance, respectively, while AIO-KRK-0207 showed the non-inferiority of maintenance bevacizumab versus bevacizumab and fluoropyrimidines for time to strategy failure. METHODS Bibliography electronic databases (PubMed, MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials) were searched for English published clinical trials prospectively randomizing mCRC patients to receive bevacizumab maintenance or not after first-line chemotherapy plus bevacizumab. Individual patients' data (IPD) were provided by investigators for all included trials. Primary end-points were progression-free survival (PFS) and overall survival (OS), both from the start of induction and maintenance. Univariate and multivariate analyses for PFS and OS were performed. RESULTS Three phase III studies - PRODIGE-9, AIO-KRK-0207 and SAKK-41/06 - were included. Considering the different timing of randomization, IPD of patients not progressed during induction and starting maintenance phase entered the analysis. 909 patients were included, 457 (50%) received bevacizumab maintenance. Median PFS from induction start was 9.6 and 8.9 months in bevacizumab group versus no maintenance group, respectively (HR 0.78; 95%CI: 0.68-0.89; p < 0.0001). Subgroups analysis for PFS showed a significant interaction according for RAS status (p = 0.048), with a maintenance benefit limited to RAS wild-type patients. No difference in terms of OS was observed. CONCLUSIONS Despite the statistically significant PFS improvement for bevacizumab maintenance, the absolute benefit appears limited. Subgroup analysis shows a differential effect of bevacizumab maintenance in favor of RAS wild-type patients. Considering these results, maintenance therapy with fluoropyrimidine with or without bevacizumab remains the first option. Single agent bevacizumab maintenance can be considered in selected cases, such as cumulative toxicity or patient's refusal, in particular for RAS wild-type patients.
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Affiliation(s)
- Lisa Salvatore
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Universita' Cattolica del Sacro Cuore, Rome, Italy.
| | - Emilio Bria
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, APHP, Université de Paris, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM UMR LNC 1231, Dijon, France
| | - Valérie Boige
- Department of Oncologic Medicine, Gustave Roussy, Villejuif, France
| | | | | | | | - Giampaolo Tortora
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
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Sinicrope FA, Chakrabarti S, Laurent-Puig P, Huebner L, Smyrk TC, Tabernero J, Mini E, Goldberg RM, Zaanan A, Folprecht G, Van Laethem JL, Le Malicot K, Shi Q, Alberts SR, Taieb J. Prognostic variables in low and high risk stage III colon cancers treated in two adjuvant chemotherapy trials. Eur J Cancer 2020; 144:101-112. [PMID: 33341444 DOI: 10.1016/j.ejca.2020.11.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/15/2020] [Accepted: 11/07/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stratification of patients with stage III colon cancer into low (T1-3N1) and high (T4 and/or N2) risk groups is used to guide the duration of adjuvant chemotherapy. We determined the relative contribution of clinical and molecular features to survival by risk group. MATERIALS & METHODS Stage III colon cancer (N = 5337) patients from two adjuvant trials of FOLFOX ± cetuximab [N0147 (Alliance), PETACC-8] were risk grouped, then subgrouped by clinical features and molecular variables [KRAS and BRAF/mismatch repair (MMR) combined variable]. Distributions of disease-free survival (DFS), overall survival (OS), and survival after recurrence (SAR) were estimated. In multivariable Cox models, backward elimination was performed for analysis of candidate predictors of outcomes. Relative contributions of model-selected variables to outcomes by risk group were calculated using χ2. RESULTS Among low risk tumours, mutant KRAS and male gender were significantly associated with poorer OS multivariately. In high risk tumours, significantly poorer OS was observed for right sidedness and for mutant KRAS and BRAFV600E/pMMR, subgroups. Specifically, BRAFV600E/pMMR (OS: HR = 1.75; 95% CI: 1.36-2.24; Padj<.0001) and right- versus left-sidedness were associated with significantly poorer DFS, OS (HR = 1.56; 95% CI: 1.31-1.83; Padj<.0001), and SAR (HR = 1.64; 95% CI: 1.37-1.95; Padj<.0001). Poor prognosis of mutant KRAS for DFS and OS was similar among risk groups. BRAF/MMR and sidedness were associated with poorer SAR in both low and high risk tumours. Age, gender, and KRAS were the top three relative contributors to DFS and OS among low risk tumours; sidedness ranked first for DFS and OS, and second to BRAF/MMR for SAR among high risk tumours. CONCLUSION Sidedness and BRAF/MMR contributed the most to survival outcomes among high risk tumours and should be interpreted in the context of risk group.
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Affiliation(s)
- Frank A Sinicrope
- Department of Oncology, Mayo Clinic and Mayo Comprehensive Cancer Center, Rochester, MN, USA.
| | - Sakti Chakrabarti
- Department of Oncology, Mayo Clinic and Mayo Comprehensive Cancer Center, Rochester, MN, USA
| | - Pierre Laurent-Puig
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Luke Huebner
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Thomas C Smyrk
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), UVic, IOB-Quiron, Barcelona, Spain
| | - Enrico Mini
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Richard M Goldberg
- Department of Medicine, West Virginia University Cancer Center, Morgantown, WV, USA
| | - Aziz Zaanan
- Department of Gastroenterology and GI Oncology, Sorbonne Paris Cité, Université Paris Descartes, Hopital Européen Georges Pompidou, Paris, France
| | - Gunnar Folprecht
- First Medical Department, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Karine Le Malicot
- Department of Statistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM, France
| | - Qian Shi
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Steven R Alberts
- Department of Oncology, Mayo Clinic and Mayo Comprehensive Cancer Center, Rochester, MN, USA
| | - Julien Taieb
- Department of Gastroenterology and GI Oncology, Sorbonne Paris Cité, Université Paris Descartes, Hopital Européen Georges Pompidou, Paris, France
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28
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Lapeyre-Prost A, Pernot S, Sigrand J, Le Malicot K, Mary F, Aparicio T, Dahan L, Caroli-Bosc FX, Lecomte T, Doat S, Marthey L, Desrame J, Lepage C, Taieb J. Aflibercept in Combination With FOLFIRI as First-line Chemotherapy in Patients With Metastatic Colorectal Cancer (mCRC): A Phase II Study (FFCD 1302). Clin Colorectal Cancer 2020; 19:285-290. [DOI: 10.1016/j.clcc.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 01/18/2023]
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Taïeb J, Benhaim L, Laurent Puig P, Le Malicot K, Emile JF, Geillon F, Tougeron D, Manfredi S, Chauvenet M, Taly V, Lepage C, André T. "Decision for adjuvant treatment in stage II colon cancer based on circulating tumor DNA:The CIRCULATE-PRODIGE 70 trial". Dig Liver Dis 2020; 52:730-733. [PMID: 32482534 DOI: 10.1016/j.dld.2020.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/21/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adjuvant treatment for stage II colon cancer remains debated. Finding a tool to select patients at risk for disease recurrence may help the clinical decision. Circulating tumor DNA (ctDNA) has been reported recently as a potential predictive marker for disease recurrence. We thus aim to test its ability to better select stage II colon cancer patients for adjuvant therapy. METHODS This national, phase III trial (NCT00002019-000935-15) conducted in more than 100 centers in France, plans to screen around 2640 patients in order to randomize (2:1; minimization method) 198 ctDNA positive patients. Patients aged 18 to 75 years with ECOG performance status ≤1 with R0 surgical resection of a pT3-T4aN0 colon or high rectum adenocarcinoma will be randomized within 63 days after curative-intent surgery, to adjuvant mFOLFOX6 (oxaliplatin 85 mg/m², leucovorin 400 mg/m², and 5-FU bolus 400 mg/m2 then 5FU Continuous infusion 2.4 g/m²) every two weeks for 12 cycles or observation. Patients will be followed for maximum 7 years. A gain of 17.5% in 3-yr disease free survival (DFS) is expected (42.5% in the experimental arm vs. 25% in the control arm; HR:0.62; α, 5% [two-sided log-rank test]; 1-β, 80%). Secondary endpoints include 2-yr DFS, overall survival, and toxicity. Recruitement began End of January 2020.
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Affiliation(s)
- Julien Taïeb
- Department of gastroenterology and GI Oncology, Georges-Pompidou European Hospital, AP-HP; Sorbonne Paris cité, Université de Paris, Paris, France.
| | - Léonor Benhaim
- Département de chirurgie viscérale oncologique, Gustave Roussy, Villejuif, France
| | - Pierre Laurent Puig
- Pole biologie, Hospital European George Pompidou, Paris, Île-de-France, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive; EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | | | - Flore Geillon
- Fédération Francophone de Cancérologie Digestive; EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - David Tougeron
- Gastroenterology Department and Medical Oncology Department, Poitiers University Hospital, Poitiers, France
| | - Sylvain Manfredi
- Fédération Francophone de Cancérologie Digestive; EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France; Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, Paris, France
| | - Marion Chauvenet
- Department of Gastroenterology, Groupement hospitalier Sud, Hospices civils de Lyon, Pierre Bénite, France
| | - Valerie Taly
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, Paris, France
| | - Côme Lepage
- Fédération Francophone de Cancérologie Digestive; EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France; Department of digestive oncology University hospital Dijon; University of Burgundy and Franche Comté, Dijon, France; Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université de Paris, Equipe labellisée Ligue Nationale contre le cancer, Paris, France
| | - Thierry André
- Sorbonne Université and Hôpital Saint Antoine, Paris, France
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Niogret J, Limagne E, Thibaudin M, Blanc J, Bertaut A, Le Malicot K, Rinaldi Y, Caroli-Bosc FX, Audemar F, Nguyen S, Sarda C, Lombard-Bohas C, Locher C, Carreiro M, Legoux JL, Etienne PL, Baconnier M, Porneuf M, Aparicio T, Ghiringhelli F. Baseline Splenic Volume as a Prognostic Biomarker of FOLFIRI Efficacy and a Surrogate Marker of MDSC Accumulation in Metastatic Colorectal Carcinoma. Cancers (Basel) 2020; 12:cancers12061429. [PMID: 32486421 PMCID: PMC7352427 DOI: 10.3390/cancers12061429] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Predictive biomarkers of response to chemotherapy plus antiangiogenic for metastatic colorectal cancer (mCRC) are lacking. The objective of this study was to test the prognostic role of splenomegaly on baseline CT scan. Methods: This study is a sub-study of PRODIGE-9 study, which included 488 mCRC patients treated by 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) and bevacizumab in first line. The association between splenic volume, and PFS and OS was evaluated by univariate and multivariable Cox analyses. The relation between circulating monocytic Myeloid derived suppressor cells (mMDSC) and splenomegaly was also determined. Results: Baseline splenic volume > 180 mL was associated with poor PFS (median PFS = 9.2 versus 11.1 months; log-rank p = 0.0125), but was not statistically associated with OS (median OS = 22.6 versus 28.5 months; log-rank p = 0.1643). The increase in splenic volume at 3 months had no impact on PFS (HR 0.928; log-rank p = 0.56) or on OS (HR 0.843; log-rank p = 0.21). Baseline splenic volume was positively correlated with the level of baseline circulating mMDSC (r = 0.48, p-value = 0.031). Conclusion: Baseline splenomegaly is a prognostic biomarker in patients with mCRC treated with FOLFIRI and bevacizumab, and a surrogate marker of MDSC accumulation.
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Affiliation(s)
- Julie Niogret
- Department of Medical Oncology, Georges François Leclerc Cancer Center-UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France;
- Department of Medical Oncology, University of Burgundy-Franche-Comté, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France;
- INSERM U1231, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France
- Platform of Transfer in Cancer Biology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (E.L.); (M.T.)
| | - Emeric Limagne
- Platform of Transfer in Cancer Biology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (E.L.); (M.T.)
| | - Marion Thibaudin
- Platform of Transfer in Cancer Biology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (E.L.); (M.T.)
| | - Julie Blanc
- Methodology, Data-Management, and Biostatistics Unit, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (J.B.); (A.B.)
| | - Aurelie Bertaut
- Methodology, Data-Management, and Biostatistics Unit, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (J.B.); (A.B.)
| | - Karine Le Malicot
- Department of Medical Oncology, University of Burgundy-Franche-Comté, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France;
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM U1231, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France
| | - Yves Rinaldi
- Department of Hepato-Gastroenterology, European Hospital, 6 Rue Désirée Clary, 13003 Marseille, France;
| | | | - Franck Audemar
- Department of Gastroenterology, Côte Basque Hospital Center, 13 Avenue de l’Interne Jacques Loeb, 64100 Bayonne, France;
| | - Suzanne Nguyen
- Department of Medical Oncology, Hospital Center, 4 Boulevard Hauterive, 64000 Pau, France;
| | - Corinne Sarda
- Department of Medical Oncology, Saintonge Hospital Center, 11 Boulevard Ambroise Paré, 17100 Saintes, France;
| | - Catherine Lombard-Bohas
- Department of Medical Oncology, Edouard Herriot Hospital, HCL, 5 Place d’Arsonval, 69003 Lyon, France;
| | - Christophe Locher
- Department of Gastroenterology, Est-Francilien Great Hospital, 6-8 Rue Saint-Fiacre, 77100 Meaux, France;
| | - Miguel Carreiro
- Department of Medical Oncology and Internal medicine, Hospital Center, 100 Rue Léon Cladel, 82000 Montauban, France;
| | - Jean-Louis Legoux
- Department of Hepato-Gastroenterology and Digestive Oncology, Regional Hospital Center, 14 Avenue de l’Hôpital, 45100 Orléans, France;
| | - Pierre-Luc Etienne
- Department of Medical Oncology, CARIO, Côtes d’Armor Private Hospital, 10 Rue François Jacob, 22190 Plerin, France;
| | - Mathieu Baconnier
- Department of Hepato-Gastroenterology, Annecy Genevois Hospital Center, 1 Avenue de l’Hôpital, 74374 Pringy, France;
| | - Marc Porneuf
- Department of Medical Oncology and Hematology, Yves Le Foll Hospital Center, 10 Rue Marcel Proust, 22000 Saint-Brieuc, France;
| | - Thomas Aparicio
- Department of Gastroenterology, University Hospital Center Saint Louis, APHP, 1 Avenue Claude Vellefaux, 75010 Paris, France;
| | - Francois Ghiringhelli
- Department of Medical Oncology, Georges François Leclerc Cancer Center-UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France;
- Department of Medical Oncology, University of Burgundy-Franche-Comté, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France;
- INSERM U1231, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France
- Platform of Transfer in Cancer Biology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue Professeur Marion, 21000 Dijon, France; (E.L.); (M.T.)
- Correspondence:
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Blangero Y, Rabilloud M, Laurent-Puig P, Le Malicot K, Lepage C, Ecochard R, Taieb J, Subtil F. The area between ROC curves, a non-parametric method to evaluate a biomarker for patient treatment selection. Biom J 2020; 62:1476-1493. [PMID: 32346912 DOI: 10.1002/bimj.201900171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/26/2019] [Accepted: 01/10/2020] [Indexed: 12/19/2022]
Abstract
Treatment selection markers are generally sought for when the benefit of an innovative treatment in comparison with a reference treatment is considered, and this benefit is suspected to vary according to the characteristics of the patients. Classically, such quantitative markers are detected through testing a marker-by-treatment interaction in a parametric regression model. Most alternative methods rely on modeling the risk of event occurrence in each treatment arm or the benefit of the innovative treatment over the marker values, but with assumptions that may be difficult to verify. Herein, a simple non-parametric approach is proposed to detect and assess the general capacity of a quantitative marker for treatment selection when no overall difference in efficacy could be demonstrated between two treatments in a clinical trial. This graphical method relies on the area between treatment-arm-specific receiver operating characteristic curves (ABC), which reflects the treatment selection capacity of the marker. A simulation study assessed the inference properties of the ABC estimator and compared them with other parametric and non-parametric indicators. The simulations showed that the estimate of the ABC had low bias, power comparable to parametric indicators, and that its confidence interval had a good coverage probability (better than the other non-parametric indicator in some cases). Thus, the ABC is a good alternative to parametric indicators. The ABC method was applied to data of the PETACC-8 trial that investigated FOLFOX4 versus FOLFOX4 + cetuximab in stage III colon adenocarcinoma. It enabled the detection of a treatment selection marker: the DDR2 gene.
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Affiliation(s)
- Yoann Blangero
- Service de Biostatistique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
| | - Muriel Rabilloud
- Service de Biostatistique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
| | - Pierre Laurent-Puig
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de génétique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM UMR-S 1147, Paris, France
| | | | - Côme Lepage
- Fédération Francophone de Cancérologie Digestive, Dijon, France.,Hépato-gastroentérologie et cancérologie digestive, Centre hospitalier universitaire Dijon Bourgogne, Dijon, France.,INSERM U 866, Dijon, France
| | - René Ecochard
- Service de Biostatistique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
| | - Julien Taieb
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Chirurgie digestive générale et cancérologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Fabien Subtil
- Service de Biostatistique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
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32
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Reichling C, Taieb J, Derangere V, Klopfenstein Q, Le Malicot K, Gornet JM, Becheur H, Fein F, Cojocarasu O, Kaminsky MC, Lagasse JP, Luet D, Nguyen S, Etienne PL, Gasmi M, Vanoli A, Perrier H, Puig PL, Emile JF, Lepage C, Ghiringhelli F. Artificial intelligence-guided tissue analysis combined with immune infiltrate assessment predicts stage III colon cancer outcomes in PETACC08 study. Gut 2020; 69:681-690. [PMID: 31780575 PMCID: PMC7063404 DOI: 10.1136/gutjnl-2019-319292] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Diagnostic tests, such as Immunoscore, predict prognosis in patients with colon cancer. However, additional prognostic markers could be detected on pathological slides using artificial intelligence tools. DESIGN We have developed a software to detect colon tumour, healthy mucosa, stroma and immune cells on CD3 and CD8 stained slides. The lymphocyte density and surface area were quantified automatically in the tumour core (TC) and invasive margin (IM). Using a LASSO algorithm, DGMate (DiGital tuMor pArameTErs), we detected digital parameters within the tumour cells related to patient outcomes. RESULTS Within the dataset of 1018 patients, we observed that a poorer relapse-free survival (RFS) was associated with high IM stromal area (HR 5.65; 95% CI 2.34 to 13.67; p<0.0001) and high DGMate (HR 2.72; 95% CI 1.92 to 3.85; p<0.001). Higher CD3+ TC, CD3+ IM and CD8+ TC densities were significantly associated with a longer RFS. Analysis of variance showed that CD3+ TC yielded a similar prognostic value to the classical CD3/CD8 Immunoscore (p=0.44). A combination of the IM stromal area, DGMate and CD3, designated 'DGMuneS', outperformed Immunoscore when used in estimating patients' prognosis (C-index=0.601 vs 0.578, p=0.04) and was independently associated with patient outcomes following Cox multivariate analysis. A predictive nomogram based on DGMuneS and clinical variables identified a group of patients with less than 10% relapse risk and another group with a 50% relapse risk. CONCLUSION These findings suggest that artificial intelligence can potentially improve patient care by assisting pathologists in better defining stage III colon cancer patients' prognosis.
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Affiliation(s)
- Cynthia Reichling
- Département d'hépato-gastroentérologie et en oncologie digestive, Hôpital du Bocage, Dijon, Bourgogne-Franche-Comté, France
| | - Julien Taieb
- Service d'hépato-gastroentérologie, Hopital Europeen Georges Pompidou, Paris, France
| | - Valentin Derangere
- Plateforme de recherche biologique en oncologie, Georges-Francois Leclerc Centre, Dijon, Bourgogne-Franche-Comté, France
| | - Quentin Klopfenstein
- Plateforme de recherche biologique en oncologie, Georges-Francois Leclerc Centre, Dijon, Bourgogne-Franche-Comté, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, Hôpital du Bocage, Dijon, Bourgogne-Franche-Comté, France
| | - Jean-Marc Gornet
- Département d'hépato-gastroentérologie, Hospital Saint-Louis, Paris, Île-de-France, France
| | - Hakim Becheur
- Département d'hépato-gastroentérologie, Hôpital Bichat Claude-Bernard, Paris, Île-de-France, France
| | - Francis Fein
- Département d'hépato-gastroentérologie, CHU Besancon, Besancon, France
| | - Oana Cojocarasu
- Département d'onco-hématologie, Le Mans Universite, Le Mans, Pays de la Loire, France
| | - Marie Christine Kaminsky
- Département d'oncologie médicale, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Lorraine, France
| | - Jean Paul Lagasse
- Département d'hépato-gastroentérologie et en oncologie digestive, Orleans University, Orleans, France
| | - Dominique Luet
- Département d'hépato-gastroentérologie et en oncologie digestive, CHU Angers, Angers, Pays de la Loire, France
| | - Suzanne Nguyen
- Service d'Oncologie Médicale, CH Pau, Pau, Aquitaine-Limousin-Poitou, France
| | - Pierre-Luc Etienne
- Service d'Oncologie Médicale, Hospital Centre Saint Brieuc, Saint Brieuc, Bretagne, France
| | - Mohamed Gasmi
- Département d'hépato-gastroentérologie, Assistance Publique Hopitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Andre Vanoli
- Département d'oncologie médicale, Clinique Sainte Marthe, Dijon, Bourgogne, France
| | - Hervé Perrier
- service d'oncologie, Hopital Saint Joseph, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Pierre-Laurent Puig
- pole biologie, Hospital European George Pompidou, Paris, Île-de-France, France
| | | | - Come Lepage
- Département d'hépato-gastroentérologie et en oncologie digestive, Hôpital du Bocage, Dijon, Bourgogne-Franche-Comté, France
| | - François Ghiringhelli
- Département d'oncologie médicale, Georges-Francois Leclerc Centre, Dijon, Bourgogne-Franche-Comté, France
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33
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Dohan A, Gallix B, Guiu B, Le Malicot K, Reinhold C, Soyer P, Bennouna J, Ghiringhelli F, Barbier E, Boige V, Taieb J, Bouché O, François E, Phelip JM, Borel C, Faroux R, Seitz JF, Jacquot S, Ben Abdelghani M, Khemissa-Akouz F, Genet D, Jouve JL, Rinaldi Y, Desseigne F, Texereau P, Suc E, Lepage C, Aparicio T, Hoeffel C. Early evaluation using a radiomic signature of unresectable hepatic metastases to predict outcome in patients with colorectal cancer treated with FOLFIRI and bevacizumab. Gut 2020; 69:531-539. [PMID: 31101691 DOI: 10.1136/gutjnl-2018-316407] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [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: 03/13/2018] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The objective of this study was to build and validate a radiomic signature to predict early a poor outcome using baseline and 2-month evaluation CT and to compare it to the RECIST1·1 and morphological criteria defined by changes in homogeneity and borders. METHODS This study is an ancillary study from the PRODIGE-9 multicentre prospective study for which 491 patients with metastatic colorectal cancer (mCRC) treated by 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) and bevacizumab had been analysed. In 230 patients, computed texture analysis was performed on the dominant liver lesion (DLL) at baseline and 2 months after chemotherapy. RECIST1·1 evaluation was performed at 6 months. A radiomic signature (Survival PrEdiction in patients treated by FOLFIRI and bevacizumab for mCRC using contrast-enhanced CT TextuRe Analysis (SPECTRA) Score) combining the significant predictive features was built using multivariable Cox analysis in 120 patients, then locked, and validated in 110 patients. Overall survival (OS) was estimated with the Kaplan-Meier method and compared between groups with the logrank test. An external validation was performed in another cohort of 40 patients from the PRODIGE 20 Trial. RESULTS In the training cohort, the significant predictive features for OS were: decrease in sum of the target liver lesions (STL), (adjusted hasard-ratio(aHR)=13·7, p=1·93×10-7), decrease in kurtosis (ssf=4) (aHR=1·08, p=0·001) and high baseline density of DLL, (aHR=0·98, p<0·001). Patients with a SPECTRA Score >0·02 had a lower OS in the training cohort (p<0·0001), in the validation cohort (p<0·0008) and in the external validation cohort (p=0·0027). SPECTRA Score at 2 months had the same prognostic value as RECIST at 6 months, while non-response according to RECIST1·1 at 2 months was not associated with a lower OS in the validation cohort (p=0·238). Morphological response was not associated with OS (p=0·41). CONCLUSION A radiomic signature (combining decrease in STL, density and computed texture analysis of the DLL) at baseline and 2-month CT was able to predict OS, and identify good responders better than RECIST1.1 criteria in patients with mCRC treated by FOLFIRI and bevacizumab as a first-line treatment. This tool should now be validated by further prospective studies. TRIAL REGISTRATION Clinicaltrial.gov identifier of the PRODIGE 9 study: NCT00952029.Clinicaltrial.gov identifier of the PRODIGE 20 study: NCT01900717.
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Affiliation(s)
- Anthony Dohan
- Radiologie A, Assistance Publique - Hôpitaux de Paris, Cochin Hospital, Paris, France.,Medical School, Université de Paris, Paris, France.,Radiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Benoit Gallix
- Radiology, McGill University Health Centre, Montreal, Quebec, Canada.,IRCAD, Institut Hospitalo-Universitaire, Strasbourg, France.,Medical School, Université de Strasbourg, Strasbourg, France
| | - Boris Guiu
- Radiology, Hopital Saint-Eloi, Montpellier, Languedoc-Roussillon, France.,Medical School, Université de Montpellier, Montpellier, France
| | - Karine Le Malicot
- Biostatistics, FFCD, Dijon, France.,EPICAD, INSERM LNC-UMR 1231, University of Burgundy and Franche-Comté, Dijon, France
| | - Caroline Reinhold
- Radiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Philippe Soyer
- Radiologie A, Assistance Publique - Hôpitaux de Paris, Cochin Hospital, Paris, France.,Medical School, Université de Paris, Paris, France
| | - Jaafar Bennouna
- Gastroenterology and Digestive Oncology, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | | | - Emilie Barbier
- Biostatistics, FFCD, Dijon, France.,EPICAD, INSERM LNC-UMR 1231, University of Burgundy and Franche-Comté, Dijon, France
| | - Valérie Boige
- Oncologic Medicine, Institut Gustave Roussy, Villejuif, France
| | - Julien Taieb
- Medical School, Université de Paris, Paris, France.,Hepatogastroenterology and GI Oncology, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Olivier Bouché
- Gastrointestinal Oncology Unit, CHU Reims, Reims, France
| | - Eric François
- Pôle de Médecine, Centre Antoine-Lacassagne, Nice, France
| | - Jean-Marc Phelip
- Hepatogastroenterology, Saint Etienne University Hospital, Hôpital Nord, Saint Priest en Jarez, France
| | | | - Roger Faroux
- Gastroenterology, Hospital of La Roche sur Yon, La Roche sur Yon, France
| | - Jean-Francois Seitz
- Hepatogastroenterology and Oncology, Hopital de la Timone, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Stéphane Jacquot
- Oncology, Centre de Cancérologie du Grand Montpellier, Montpellier, France
| | | | | | - Dominique Genet
- Medical Oncology, Clinique Francois Chenieux, Limoges, France
| | - Jean Louis Jouve
- Hepatogastroenterology, University Hospital Le Bocage, Dijon, France
| | - Yves Rinaldi
- Digestive Oncology, Hopital Européen, Marseilles, France
| | | | - Patrick Texereau
- Gastroenterology, Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, Aquitaine, France
| | - Etienne Suc
- Medical oncology, Clinique Saint Jean de Languedoc, Toulouse, Midi-Pyrénées, France
| | - Come Lepage
- EPICAD, INSERM LNC-UMR 1231, University of Burgundy and Franche-Comté, Dijon, France.,Hepatogastroenterology, University Hospital Le Bocage, Dijon, France
| | - Thomas Aparicio
- Medical School, Université de Paris, Paris, France.,Gastroenterology and Digestive Oncology Department, Assistance Publique - Hôpitaux de Paris, Saint-Louis Hospital, Paris, France
| | - Christine Hoeffel
- Radiology, Hopital Maison Blanche, Reims, Champagne-Ardenne, France.,CRESTIC, Université de Reims, Reims, URCA, France
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34
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Zaanan A, Shi Q, Taieb J, Alberts SR, Meyers JP, Smyrk TC, Julie C, Zawadi A, Tabernero J, Mini E, Goldberg RM, Folprecht G, Van Laethem JL, Le Malicot K, Sargent DJ, Laurent-Puig P, Sinicrope FA. Clinical Outcomes in Patients With Colon Cancer With Microsatellite Instability of Sporadic or Familial Origin Treated With Adjuvant FOLFOX With or Without Cetuximab: A Pooled Analysis of the PETACC8 and N0147 Trials. JCO Precis Oncol 2020; 4:1900237. [PMID: 32923882 PMCID: PMC7446392 DOI: 10.1200/po.19.00237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The microsatellite instability (MSI) or deficient mismatch repair (dMMR) phenotype is usually regarded as a single biologic entity, given the absence of comparative analyses regarding prognosis and response to chemotherapy between sporadic and familial dMMR cancers. PATIENTS AND METHODS Patients with stage III colon cancers were randomly assigned to FOLFOX (leucovorin, fluorouracil, and oxaliplatin) with or without cetuximab in 2 large adjuvant phase III trials (N = 5,577). Among patients with MSI and KRAS exon 2 wild-type (WT) tumors, the prognostic and predictive impacts of sporadic versus familial dMMR cancers and BRAF V600E mutational status were determined. Multivariable Cox proportional hazards models were used to assess disease-free survival (DFS) by treatment arm, adjusting for age, sex, tumor grade, Eastern Cooperative Oncology Group performance status, pT/pN stage, and primary tumor location. RESULTS Among patients with MSI status with complete data for dMMR mechanism analysis (n = 354), 255 (72%) had sporadic (BRAF mutation and/or MLH1 methylation) and 99 (28%) had familial tumors (BRAF WT and unmethylated MLH1 or loss of MSH2/MSH6/PMS2 protein expression). A large proportion of dMMR sporadic tumors were mutated for BRAF (n = 200). In patients treated with FOLFOX, DFS did not differ statistically by dMMR mechanism, whereas in patients treated with FOLFOX plus cetuximab, those with sporadic tumors had worse DFS than those with familial cancers (multivariable hazard ratio, 2.69; 95% CI, 1.02 to 7.08; P = .04). Considering the predictive utility, the interaction between treatment and dMMR mechanism was significant (P = .03). Furthermore, a nonsignificant trend toward a deleterious effect of adding cetuximab to FOLFOX was observed in patients with BRAF-mutant but not BRAF WT tumors. CONCLUSION The addition of cetuximab to adjuvant FOLFOX was associated with shorter DFS in patients with sporadic dMMR colon cancer. Additional studies are needed to validate these results in metastatic disease.
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Affiliation(s)
- Aziz Zaanan
- Department of Medicine, Mayo Clinic,
Rochester, MN,Department of Gastroenterology and
Digestive Oncology, European Georges Pompidou Hospital, Assistance Publique
Hôpitaux de Paris (APHP), Paris, France,Aziz Zaanan, MD, PhD, Department of Gastroenterology and
Digestive Oncology, European Georges Pompidou Hospital, Paris Descartes
University, Paris, France; e-mail:
| | - Qian Shi
- Alliance Statistics and Data Center, Mayo
Clinic, Rochester, MN
| | - Julien Taieb
- Centre de Recherche des Cordeliers,
INSERM, Sorbonne Université, Université Paris Descartes,
Université Paris Diderot, Université Sorbonne Paris Cité,
Paris, France,Department of Gastroenterology and
Digestive Oncology, European Georges Pompidou Hospital, Assistance Publique
Hôpitaux de Paris (APHP), Paris, France
| | | | | | - Thomas C. Smyrk
- Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN
| | - Catherine Julie
- Department of Pathology, Ambroise
Paré Hospital, APHP, Boulogne-Billancourt, France,Versailles Saint-Quentin-en-Yvelines
University, Boulogne-Billancourt, France
| | - Ayman Zawadi
- Radiotherapy Unit, Departmental Hospital
Center, La Roche-Sur-Yon, France
| | - Josep Tabernero
- Medical Oncology Department, Vall
d‘Hebron University Hospital, Barcelona, Spain,Vall d‘Hebron Institute of
Oncology, University of Vic, IOB-Quiron, Barcelona, Spain
| | - Enrico Mini
- Section of Clinical Pharmacology and
Oncology, Department of Health Sciences, University of Florence, Florence,
Italy,DENOTHE Excellence Center, University of
Florence, Florence, Italy
| | | | - Gunnar Folprecht
- First Medical Department, University
Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Karine Le Malicot
- Department of Statistics,
Fédération Francophone de Cancérologie Digestive, Dijon,
France
| | | | - Pierre Laurent-Puig
- Centre de Recherche des Cordeliers,
INSERM, Sorbonne Université, Université Paris Descartes,
Université Paris Diderot, Université Sorbonne Paris Cité,
Paris, France,Department of Biology, European Georges
Pompidou Hospital, APHP, Paris, France
| | - Frank A. Sinicrope
- Department of Medicine, Mayo Clinic,
Rochester, MN,Mayo Comprehensive Cancer Center,
Rochester, MN
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Zaanan A, Shi Q, Taieb J, Alberts SR, Meyers JP, Smyrk TC, Julie C, Zawadi A, Tabernero J, Mini E, Goldberg RM, Folprecht G, Van Laethem JL, Le Malicot K, Sargent DJ, Laurent-Puig P, Sinicrope FA. Role of Deficient DNA Mismatch Repair Status in Patients With Stage III Colon Cancer Treated With FOLFOX Adjuvant Chemotherapy: A Pooled Analysis From 2 Randomized Clinical Trials. JAMA Oncol 2019; 4:379-383. [PMID: 28983557 DOI: 10.1001/jamaoncol.2017.2899] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance The prognostic impact of DNA mismatch repair (MMR) status in stage III colon cancer patients receiving FOLFOX (folinic acid, fluorouracil, and oxaliplatin) adjuvant chemotherapy remains controversial. Objective To determine the association of MMR status with disease-free survival (DFS) in patients with stage III colon cancer treated with FOLFOX. Design, Setting, and Participants The evaluated biomarkers for MMR status were determined from prospectively collected tumor blocks from patients treated with FOLFOX in 2 open-label, phase 3 randomized clinical trials: NCCTG N0147 and PETACC8. The studies were conducted in general community practices, private practices, and institutional practices in the United States and Europe. All participants had stage III colon adenocarcinoma. They were enrolled in NCCTG N0147 from February 2004 to November 2009 and in PETACC8 from December 2005 to November 2009. Interventions Patients in the clinical trials were randomly assigned to receive 6 months of chemotherapy with FOLFOX or FOLFOX plus cetuximab. Only those patients treated with FOLFOX alone were included in the present study. Main Outcomes and Measures Association of MMR status with DFS was analyzed using a stratified Cox proportional hazards model. Multivariable models were adjusted for age, sex, tumor grade, pT/pN stage, tumor location, ECOG (Eastern Cooperative Oncology Group) performance status, and BRAF V600E mutational status. Results Among 2636 patients with stage III colon cancer treated with FOLFOX, MMR status was available for 2501. Of these, 252 (10.1%) showed deficient MMR status (dMMR; 134 women, 118 men; median age, 59 years), while 2249 (89.9%) showed proficient MMR status (pMMR; 1020 women, 1229 men; median age, 59 years). The 3-year DFS rates in the dMMR and pMMR groups were 75.6% and 74.4%, respectively. By multivariate analysis, patients with dMMR phenotype had significantly longer DFS than those with pMMR (adjusted hazard ratio, 0.73; 95% CI, 0.54-0.97; P = .03). Conclusions and Relevance The deficient MMR phenotype remains a favorable prognostic factor in patients with stage III colon cancer receiving FOLFOX adjuvant chemotherapy. Trial Registration clinicaltrials.gov Identifier: NCT00079274 for the NCCTG N0147 trial and EudraCT identifier: 2005-003463-23 for the PETACC8 trial.
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Affiliation(s)
- Aziz Zaanan
- Departments of Medicine and Oncology, Mayo Clinic and Mayo Comprehensive Cancer Center, Rochester, Minnesota.,Paris Descartes University, Sorbonne Paris Cité, France.,Department of Gastroenterology and Digestive Oncology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Qian Shi
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Julien Taieb
- Paris Descartes University, Sorbonne Paris Cité, France.,Department of Gastroenterology and Digestive Oncology, European Georges Pompidou Hospital, APHP, Paris, France
| | | | - Jeffrey P Meyers
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Thomas C Smyrk
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Catherine Julie
- Department of Pathology, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France.,Versailles Saint-Quentin-en-Yvelines University, Boulogne-Billancourt, France
| | - Ayman Zawadi
- Radiotherapy Unit, Departemental Hospital Center, La Roche Sur Yon, France
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrico Mini
- Section of Internal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Gunnar Folprecht
- First Medical Department, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Karine Le Malicot
- Department of Statistics, Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - Daniel J Sargent
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Pierre Laurent-Puig
- Paris Descartes University, Sorbonne Paris Cité, France.,UMR-S 1147, INSERM, Paris, France.,Department of Biology, European Georges Pompidou Hospital, APHP, Paris, France
| | - Frank A Sinicrope
- Departments of Medicine and Oncology, Mayo Clinic and Mayo Comprehensive Cancer Center, Rochester, Minnesota
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36
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Le Corre D, Ghazi A, Balogoun R, Pilati C, Aparicio T, Martin-Lannerée S, Marisa L, Djouadi F, Poindessous V, Crozet C, Emile JF, Mulot C, Le Malicot K, Boige V, Blons H, de Reynies A, Taieb J, Ghiringhelli F, Bennouna J, Launay JM, Laurent-Puig P, Mouillet-Richard S. The cellular prion protein controls the mesenchymal-like molecular subtype and predicts disease outcome in colorectal cancer. EBioMedicine 2019; 46:94-104. [PMID: 31377347 PMCID: PMC6710984 DOI: 10.1016/j.ebiom.2019.07.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 02/08/2023] Open
Abstract
Background Comprehensive transcriptomic analyses have shown that colorectal cancer (CRC) is heterogeneous and have led to the definition of molecular subtypes among which the stem-cell, mesenchymal-like group is associated with poor prognosis. The molecular pathways orchestrating the emergence of this subtype are incompletely understood. In line with the contribution of the cellular prion protein PrPC to stemness, we hypothesize that deregulation of this protein could lead to a stem-cell, mesenchymal-like phenotype in CRC. Methods We assessed the distribution of the PrPC-encoding PRNP mRNA in two large CRC cohorts according to molecular classification and its association with patient survival. We developed cell-based assays to explore the impact of gain and loss of PrPC function on markers of the mesenchymal subtype and to delineate the signalling pathways recruited by PrPC. We measured soluble PrPC in the plasmas of 325 patients with metastatic CRC and probed associations with disease outcome. Findings We found that PRNP gene expression is enriched in tumours of the mesenchymal subtype and is associated with poor survival. Our in vitro analyses revealed that PrPC controls the expression of genes that specify the mesenchymal subtype through the recruitment of the Hippo pathway effectors YAP and TAZ and the TGFß pathway. We showed that plasma levels of PrPC are elevated in metastatic CRC and are associated with poor disease control. Interpretation Our findings define PrPC as a candidate driver of the poor-prognosis mesenchymal subtype of CRC. They suggest that PrPC may serve as a potential biomarker for patient stratification in CRC. Funding Grant support was provided by the following: Cancéropôle Ile de France (grant number 2016-1-EMERG-36-UP 5-1), Association pour la Recherche sur le Cancer (grant number PJA 20171206220), SATT Ile de France Innov (grant number 415) as well as INSERM.
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Affiliation(s)
- Delphine Le Corre
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Alexandre Ghazi
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Ralyath Balogoun
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Camilla Pilati
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, AP-HP, Hôpital Saint-Louis, Université Paris Diderot, F-75010 Paris, France
| | - Séverine Martin-Lannerée
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Laetitia Marisa
- Programme "Cartes d'Identité des Tumeurs", Ligue Nationale Contre le Cancer, F-75013 Paris, France
| | - Fatima Djouadi
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Virginie Poindessous
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Carole Crozet
- Institut de Médecine Régénératrice et de Biothérapie (I.M.R.B.), Université de Montpellier UMR-1183, Centre Hospitalo-Universitaire de Montpellier, F-34000 Montpellier, France
| | - Jean-François Emile
- Department of Pathology, AP-HP, Hôpital Ambroise Paré, F-92100 Boulogne-Billancourt, France
| | - Claire Mulot
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Université de Bourgogne et and Franche Comté, F-21000 Dijon, France
| | - Valérie Boige
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France; Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, F-94800 Villejuif, France
| | - Hélène Blons
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France; Department of Biology, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Aurélien de Reynies
- Programme "Cartes d'Identité des Tumeurs", Ligue Nationale Contre le Cancer, F-75013 Paris, France
| | - Julien Taieb
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France; Department of Gastroenterology and GI Oncology, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre Georges-François Leclerc, F-21000 Dijon, France
| | - Jaafar Bennouna
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, F-44800 Saint-Herblain, France
| | - Jean-Marie Launay
- Department of Biochemistry and Molecular Biology, INSERM U942, AP-HP, Hôpital Lariboisière, Université Paris Descartes, F-75010 Paris, France; Pharma Research Department, F. Hoffmann-La-Roche Ltd., CH-4070 Basel, Switzerland
| | - Pierre Laurent-Puig
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France; Department of Biology, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Sophie Mouillet-Richard
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006 Paris, France.
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Sinicrope FA, Huebner LJ, Laurent-Puig P, Smyrk TC, Tabernero J, Mini E, Goldberg RM, Folprecht G, Zaanan A, Le Malicot K, Shi Q, Alberts SR, Taieb J. Relative contribution of clinical and molecular features to outcome within low and high risk T and N groups in stage III colon cancer (CC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
3520 Background: Duration of adjuvant FOLFOX or CAPOX for stage III CC is being guided by pt stratification into low (T1-3N1) and high (T4 or N2) risk groups based on the IDEA study. We determined the relative contributions of clinical and molecular features for prediction of time-to-recurrence (TTR) and survival after recurrence (SAR) within each risk group. Methods: Stage III CC (N=5,430) from 2 trials of adjuvant FOLFOX ± cetuximab with similar outcome by study arm [NCCTG N0147 (Alliance), PETACC-8] were used. Tumors were analyzed for mismatch repair (dMMR vs pMMR), mutations in KRAS (exon 2) and BRAFV600E. Median pt follow-up was 83.4 months. Relative contributions to predicting outcome were assessed using χ2 (Harrell’s rms) based on multivariable (MV) Cox models. Results: N (50.8%) and T (31.8%) stage were the top two contributors to prediction of TTR which supports risk grouping. High risk (n=2566) vs low risk (n=2774) pts had poorer TTR (HR 2.7, 95% CI, 2.4-3.0) and SAR [HR 1.6 (1.4-1.9)], both p<.0001. TTR: KRAS contributed the most to predicting TTR among high (58.6%) and low (51.1%) risk pts (Table). Contribution of MMR (16%) to predicting TTR was limited to low risk pts. Contribution of BRAFV600E to TTR was nearly 3-fold increased in high vs low risk pts. SAR: BRAFV600E contributed the most to predicting SAR, especially in high vs low risk pts (2-fold increase). Tumor sidedness and performance status (PS) were key contributors to SAR, but not TTR. MV associations: TTR: low risk, KRAS [HR 1.7 (1.4-2.3], MMR [HR 0.55 (.35-.87), gender (M/F) [HR 1.3 (1.0-1.5)], all p<.04]; high risk: BRAF [HR 1.3 (1.1-1.7)], sidedness (R vs L) [HR 1.14 (1.0-1.3)], KRAS [HR 1.4 (1.2-1.6)], all p<.04]. SAR: BRAF, sidedness, PS (all p<.05). Conclusions: KRAS mutation was the strongest predictor of shorter TTR in both risk groups whereas BRAFV600E was the primary driver of SAR, especially in high risk pts. Support: U10CA180821, U10CA180882, U24CA196171; BMS, Pfizer, Sanofi. NCT00079274.[Table: see text]
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Affiliation(s)
| | | | | | | | - Josep Tabernero
- Vall d’Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Enrico Mini
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Aziz Zaanan
- Department of Medical Oncology, Saint Antoine Hospital, UPMC University Paris 06, Paris, France
| | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
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Salvatore L, Bria E, Sperduti I, Hinke A, Hegewisch-Becker S, Aparicio T, Le Malicot K, Boige V, Koeberle D, Baertschi D, Dietrich D, Tortora G, Arnold D. Bevacizumab (BV) maintenance (M) after first-line chemotherapy (CT) plus BV for metastatic colorectal cancer (mCRC) patients (pts): A meta-analysis of individual pts data (IPD) from three phase III studies. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3550 Background: Although CAIRO3 and AIO KRK 0207 trials demonstrated the benefit of BV + fluoropyrimidine as a M regimen after induction CT + BV, the role of BV alone is not clear. Indeed, SAKK 41/06 and PRODIGE 9 trials failed to demonstrate the superiority of BV alone vs no M, while AIO KRK 0207 showed the non-inferiority of BV alone vs combo M. Thus, in order to evaluate the magnitude of the eventual benefit of M with BV alone vs no M, an IPD meta-analysis was performed. Methods: Trials whereas mCRC pts were prospectively randomized to receive BV M or not were considered eligible. Primary end-points were PFS and OS, both from the start of induction and M. Univariate and multivariate analyses for PFS and OS were performed, with the following variables: baseline ECOG PS; age ( > vs ≤ 65 years); RAS and BRAF status; LDH and CEA baseline level; RR (PR or CR vs SD) during induction; induction CT (oxa- vs iri-based); resected primary tumor; primary tumor side; synchronous vs metachronous; adjuvant treatment; number (N) of metastatic sites; liver-only disease. Results: IPD of 1,064 pts enrolled in the PRODIGE 9, AIO KRK 0207 and SAKK 41/06 trials were collected. Considering the different timing of randomization in PRODIGE 9 (at the start of induction) vs AIO KRK 0207 and SAKK 41/06 (at the start of M), IPD of pts not progressed during induction and starting M phase entered the analysis. 909 pts were included, 457 (50%) received BV M. Median PFS from induction start was 9.6 and 8.9 months in BV group vs no M group, respectively (HR 0.78; 95%CI: 0.68-0.89; p < 0.0001). At the multivariate PFS analysis, BV M, resected primary tumor, N of metastatic sites and liver-only disease were significant. No difference in terms of OS between the 2 groups was observed. Conclusions: This is the first IPD meta-analysis investigating the role of BV alone M vs no M after first-line induction CT+BV in mCRC pts. Despite the significant PFS improvement in favor of BV M, the absolute benefit appears limited, and without a clear clinical relevance. On these bases, a predictive nomogram to identify pts most likely to benefit from BV M is under evaluation and will be presented during the Congress.
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Affiliation(s)
- Lisa Salvatore
- Oncologia Medica, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Roma, Italy
| | - Emilio Bria
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Isabella Sperduti
- Bio-Statistics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | | | - Valerie Boige
- Digestive Oncology, Gustave Roussy, Villejuif, France
| | | | | | | | | | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg AK Altona, Hamburg, Germany
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Zaanan A, Shi Q, Taieb J, Alberts SR, Meyers JP, Smyrk TC, Julié C, Zawadi A, Tabernero J, Mini E, Goldberg RM, Folprecht G, VAN Laethem JL, Le Malicot K, Sargent DJ, Laurent-Puig P, Sinicrope FA. Is the predictive and prognostic impact of sporadic and familial microsatellite instable stage III colon cancer different? A pooled analysis of the PETACC8 and NCCTG N0147 (Alliance) trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3583] [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
3583 Background: The Microsatellite instability (MSI) or deficient mismatch repair (dMMR) phenotype is usually taken as a single biological entity whereas no data are available concerning prognosis and response to chemotherapy between sporadic and familial dMMR cases. Methods: Resected KRAS exon 2 wild-type (WT) tumor stage III colon cancers (N = 4596) from patients (pts) randomly assigned to FOLFOX +/- cetuximab in two adjuvant large phase III trials were prospectively analyzed for MSI status and dMMR mechanism (sporadic vs familial). Stratified Cox models were used to assess prognostic and predictive values of dMMR mechanism by treatment arms, adjusting for age, gender, tumor grade, ECOG PS, pT/pN stage and primary tumor location. Results: Among dMMR patients with complete data for dMMR mechanism analysis (N = 354), there were 255 (72%) sporadic ( BRAF mutated or WT with MLH1 methylation) and 99 (28%) familial (loss of MSH2 or MSH6, or loss MLH1 with BRAF WT and unmethylated MLH1) cases. A large proportion of dMMR sporadic cases were mutated for BRAF (n = 200; 80%). In pts treated with FOLFOX, the disease-free survival (DFS) was not statistically different by dMMR mechanism, while for pts treated with FOLFOX + cetuximab, the sporadic cases did worse than familial cases (DFS; adjusted (adj) HR, 2.69; 95% CI, 1.02-7.08; P= 0.04). Considering the predictive value, a deleterious effect of adding cetuximab to FOLFOX was observed in sporadic (DFS; adjHR, 1.68; 95% CI, 1.01-2.79; P= 0.04) but not in familial dMMR pts (interaction P value regarding treatment effect = 0.03). Furthermore, a non-significant trend to a deleterious effect of adding cetuximab to FOLFOX was observed in BRAF mutant (DFS; adjHR, 1.66; 95% CI, 0.95-2.92; P= 0.07) but not in BRAF WT pts. Conclusions: The addition of cetuximab to FOLFOX was associated with reduced DFS in patients with sporadic dMMR cases. Further studies including the methylator phenotype (CIMP) analysis are needed to validate these results. Clinical trial information: NCT00265811 and NCT00079274.
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Affiliation(s)
- Aziz Zaanan
- Hopital Européen Georges Pompidou, Paris, France
| | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
| | | | | | | | - Catherine Julié
- Ambroise Paré Hospital and Versailles Saint-Quentin-en-Yvelines University, Boulogne-Billancourt, France
| | - Ayman Zawadi
- Radiothérapie, Centre Hospitalier Départemental, La Roche Sur Yon, France
| | - Josep Tabernero
- Vall d’Hebron University Hospital and Institute of Oncology, Barcelona, Spain
| | - Enrico Mini
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
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Aparicio T, Ronchin P, Bazire L, Le Malicot K, Lemanski C, Mirabel X, Etienne PL, Lièvre A, Cacheux W, Darut-Jouve A, De La Fouchardiere C, Breysacher G, Argo Leignel D, Tessier A, Magne N, Ben Abdelghani M, Lepage C, Vendrely V. Anti-epidermal growth factor receptor therapy in combination with chemoradiotherapy for the treatment of locally advanced anal canal carcinoma: Results of a phase II study with panitumumab (FFCD 0904). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3570 Background: Standard treatment of anal squamous cell carcinoma is 5-fluorouracil (5FU) and mitomycin C (MMC) based chemoradiotherapy (CRT). This phase II study studied the tolerance and complete response (CR) rate at 8 weeks of panitumumab (Pmab) combined with MMC-5FU based CRT. Methods: Patients with locally advanced tumor without metastases (Stage T2, T3 or T4, whatever N stage; Stage N1-N3 whatever T stage) were treated with two RT periods (45Gy in 5 weeks and a boost of 20Gy in 2 weeks) with concomitant CT sessions of 5FU/MMC at RT weeks 1 and 5. Pmab was administered on RT weeks 1, 3, 5 and 7 according to the doses defined by a previous phase 1.study (MMC: 10 mg/m² at J1 and J29; 5FU: 400 mg/m² from J1 to J4 and from J29 to J32, Pmab: 3mg/kg). The expected rate of CR at 8 weeks to continue in phase III was 80%. Results: Forty-five patients (male: 9 (20%), female: 36 (80%); median age: 60.1 [41.5-81]) were enrolled in 15 French centers. All patients but one completed the CRT. Median duration of CRT was 52 days [30-76].Fourteen patients had a RT interruption because of toxicity. Most common related grade 3-4 toxicities observed were digestive (51.1%), hematologic (lymphopenia: 73.4%; neutropenia: 11.1%), radiation dermatitis (28.8%) and asthenia (11.1%). On patient died because of mesenteric ischemia during the CRT (total dose: 36 Gy). In ITT analysis, the CR rate at 8 weeks after CRT was 66.7% [90%CI: 53.4-78.2]. Median follow-up was 16.2 months [14.1-18.2]. Overall survival, recurrence-free and colostomy-free survival at one year were 94.6% [95%CI: 75.8-98.7], 72.2% [95%CI: 55.0-83.7] and 78.2% [95%CI: 60.6 – 88.6] respectively. Six (13%) patients had a colostomy with abdomino-perineal amputation due to a tumour recurrence. Conclusions: Despite an acceptable tolerance, panitumumab in combination with CRT for locally advanced anal cancer failed to meet the expected CR rate to justify further clinical trials. Clinical trial information: NCT01581840.
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Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | | | - Louis Bazire
- Institut Curie-Radiotherapy Department, Paris, France
| | | | - Claire Lemanski
- Radiation Oncology, Montpellier Val d'Aurelle Cancer Institute, Montpellier, France
| | | | | | | | - Wulfran Cacheux
- Institut Curie-Medical Oncology Department, Saint-Cloud, France
| | | | | | | | | | | | - Nicolas Magne
- Lucien Neuwirth Cancer Institute, Saint-Priest-En-Jarez, France
| | | | - Come Lepage
- Dijon University Hospital, INSERM U1231, Dijon, France
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Eveno C, Adenis A, Bouche O, Le Malicot K, Hautefeuille V, Faroux R, Thirot Bidault A, Egreteau J, Meunier B, Mabro M, Carrere N, Barriere N, Ben Abdelghani M, Mauvais F, Di Fiore F, Malka D, Manfredi S, Piessen G. Adjuvant chemotherapy versus perioperative chemotherapy (CTx) for resectable gastric signet ring cell (SRC) gastric cancer: A multicenter, randomized phase II study (PRODIGE 19). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4019 Background: The incidence of SRC gastric cancers is markedly increasing in Western countries. SRC cancers may harbor intrinsic resistance to chemotherapy (CTx) leaving many clinicians unsure of the benefits of delaying surgery to pursue a neoadjuvant approach. The primary objective of this study was to assess whether upfront surgery plus adjuvant CTx would provide enough survival benefit for study in a phase III trial when compared to perioperative CTx. Methods: Patients with stage IB-III SRC gastric cancer were randomly assigned to receive upfront surgery plus adjuvant CTx (epirubicin, cisplatin and 5-fluorouracil [ECF regimen], 6 cycles; experimental arm [SurgFirst]) or perioperative CTx (ECF, 3 cycles before and 3 cycles after surgery; control arm [CTxFirst]). Randomization (1:1) was stratified by tumor stage, tumor location, performance status and center. The primary endpoint was overall survival (OS) at 2 years (OS2; target (H1): OS2 > 26%). Results: 83 eligible patients were included in 27 centers from 11/12 to 09/16 (median age, 61 years (range: 32-80 years); male, 59%; ECOG PS 0-1, 99%). Results were (CTxFirst/SurgFirst): full completion of CTx, 87%/77%; surgical resection, 82.5%/90%; major postoperative complications (Clavien Dindo III-IV), 24%/23%; R0 resection rate, 88%/78%; OS2, 60%/53.5%; and median OS, 39/28 months (exploratory hazard ratio, 0.71 [95%CI: 0.40-2.64]). Conclusions: This trial met its primary endpoint (OS2 > 26% in the experimental arm). With OS2 rates > 50%, both CTx modalities deserve further evaluation in Phase III studies in stage IB-III SRC gastric cancer. Clinical trial information: NCT01717924.
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Affiliation(s)
| | | | | | | | | | - Roger Faroux
- Centre Hospitalier Departemental Les Oudairies, La Roche-Sur-Yon, France
| | | | | | | | | | - Nicolas Carrere
- Department of Digestive Surgery, Purpan University Hospital, Toulouse, France
| | | | | | | | - Frédéric Di Fiore
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | - David Malka
- Gustave Roussy, Université Paris-Saclay, Département de Médecine Oncologique, Villejuif, France
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Pietrasz D, Wang-Renault S, Dahan L, Taieb J, Le Malicot K, Rinaldi Y, Doat S, Phelip JM, Taly V, Bachet JB, Laurent-Puig P. Methylated circulating tumor DNA (Met-DNA) as an independent prognostic factor in metastatic pancreatic adenocarcinoma (mPAC) patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
4136 Background: Circulating tumor DNA has emerged as prognostic biomarker in oncology. Many different genes can be mutated within a tumor, complicating procedures, even with highly sensitive next-generation sequencing (NGS). DNA methylation in promotor of specific genes is an early key epigenetic change during oncogenesis. Specific methylated genes could be a potential relevant cancer biomarker that may substitute for NGS panels. The aim of this study was to assess the prognostic value of Met-DNA in mPAC. Methods: Prognostic value of Met-DNA was assessed in a prospective cohort (PLAPAN) of mPAC (training cohort), correlated with NGS, then in two prospective independent validation cohorts from two randomized phase II trials (PRODIGE 35 and 37). Plasma samples were collected before chemotherapy on EDTA-coated tubes. Met-DNA was quantified using two specific markers of pancreatic DNA methylation by digital droplet PCR and correlated with prospectively registered patient (pts) characteristics and oncologic outcomes (progression free survival (PFS) and overall survival (OS)). Results: 330 patients (pts) were enrolled. 60% (n = 58) of the 96 pts of the training cohort had at least one Met-DNA marker. The correlation with NGS assessment was R = 0.93 (Pearson; p < 0.001). 59.5% (n = 100/168) and 59% (n = 39/66) of pts had detectable Met-DNA in the 2 validation cohorts. In the training cohort, Met-DNA was correlated with poor OS (HR = 1.82; 95%CI 1.07-2.42; p = 0.026). In validation cohorts, Met-DNA was a prognostic factor of PFS (HR = 1.62; 95%CI 1.17-2.25, p = 004) and OS (HR = 1.79; 95%CI 1.28-2.49, p < 0.001) in PRODIGE 35, as in PRODIGE 37: PFS HR = 1.79 (95%CI 1.07-2.99; p = 0.026) and OS HR = 2.08 (95%CI [1.18-3.68], p = 0.01), respectively. In multivariate analysis adjusted on gender, age, CA19-9 > 40UI.mL, treatment arm, number of metastatic sites and stratified on center, Met-DNA was independently associated with poor OS in both trials: HR = 1.81 (95%CI 1.10-2.98; p = 0.02) and HR = 3.62 (95%CI: 1.32-9.93; p = 0.01). Conclusions: This study demonstrates that Met-DNA is a strong independent prognostic factor in mPAC. These results argue for patient’s stratification on ctDNA status for further randomized trials. Clinical trial information: NCT02827201 and NCT02352337.
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Affiliation(s)
| | | | | | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
| | | | | | - Solene Doat
- University Hospital Pitie Salpetriere APHP, Paris, France
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Reichling C, Taieb J, Derangere V, Le Malicot K, Emile JF, Gornet JM, Becheur H, Fein F, Cojocarasu O, Kaminsky MC, Lagasse JP, Luet D, Nguyen S, Etienne PL, Gasmi M, Vanoli A, Perrier H, Klopfenstein Q, Lepage C, Ghiringhelli F. Combination of tissues analysis and immune infiltrate in localized colon cancer using artificial intelligence in PETACC8 study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3574 Background: We used artificial intelligence to perform tissue classification and count CD3 and CD8 in each subclass and determined their role in outcome prediction in PETACC8 cohort of stage III colon cancer treated with FOLFOX or FOLFOX plus cetuximab. Methods: We developed artificial intelligence aimed to detect tumor, healthy mucosa, stroma and immune cells on whole slide of CD3 and CD8 staining. The invasive margin (IM) was also automatically determined. Using a lasso algorithm, the software was able to detect digital parameters within the tumor core (TC) which were related to patients’ outcome (variable called DGMate for DiGital tuMor pArameTErs). CD3 and CD8 lymphocytes density were also quantified automatically by the software in TC and at IM. Associations with disease-free survival (DFS) were evaluated by multivariable Cox regression adjusting for age, T/N stage, sidedness, KRAS/BRAF, DNA mismatch repair (MMR). Results: On 1220 samples collected, data could be generated for 1018 patients. We observed that a high IM stromal area and a high DGMate were associated with a poorer DFS [HR 5.65 (95% CI, 2.34, 13.67), p < 0.0001; HR 2.72 (95% IC, 1.92, 3.85), p<0.001 respectively for the continuous variable]. A higher density of CD3+ TC, CD3+ IM and CD8+ TC were significantly associated with a longer DFS (HR 0.75 (95% IC, .66, .87), p<0.0001; HR 0.78 (95% IC, .68, .88), p<0.0001; HR 0.83 (95% IC, .71, .96), p=0.01). All these immune variables were significantly correlated with each other. ANOVA test demonstrated that CD3+ TC gave a similar prognostic value compared to the classical CD3/CD8 immunoscore (p=0.44). The combination of IM stromal area, DGMate and CD3 outperformed the classical CD3/CD8 immunoscore to estimate patients’ prognosis (C-index= 0.601 vs 0.578, p-value=0.04). Adding this new variable to classical clinical prognostic parameters we generated a nomogram which predicted the risk of relapse of stage III colon cancer with a stronger predictive value compared to clinical parameters or the immunoscore. Conclusions: We propose a new fully automated method of whole slide analysis using a software based on artificial intelligence which classify tissue and determine tumor and immune parameters on one single slide stained with CD3 antibody. This valuable strategy outperforms immunoscore and clinical outcome prediction models.
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Affiliation(s)
| | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
| | - Valentin Derangere
- Research Platform in Biological Oncology, Center GF Leclerc, Dijon, France
| | | | - Jean Francois Emile
- Service d’Anatomie Pathologique Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | | | | | | | | | | | | | | | | | | | | | - Andr Vanoli
- Clinique Sainte Marie, Chalons Sur Saone, France
| | | | | | - Come Lepage
- Dijon University Hospital, INSERM U1231, Dijon, France
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Aparicio T, Ghiringhelli F, Boige V, Le Malicot K, Taieb J, Bennouna J. Reply to M. Mo et al. J Clin Oncol 2018; 36:2452-2453. [DOI: 10.1200/jco.2018.78.9669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas Aparicio
- Thomas Aparicio, Saint Louis Hospital, Assistance Publique–Hôpitaux de Paris, and Université Paris 7, Sorbonne Paris-Cité, Paris Diderot University, Paris, France; Francois Ghiringhelli, Centre Georges-François Leclerc, Dijon, France; Valerie Boige, Gustave Roussy, Villejuif, France; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive, Dijon, France; Julien Taieb, Sorbonne Paris-Cité, Paris Descartes University, and Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris,
| | - Francois Ghiringhelli
- Thomas Aparicio, Saint Louis Hospital, Assistance Publique–Hôpitaux de Paris, and Université Paris 7, Sorbonne Paris-Cité, Paris Diderot University, Paris, France; Francois Ghiringhelli, Centre Georges-François Leclerc, Dijon, France; Valerie Boige, Gustave Roussy, Villejuif, France; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive, Dijon, France; Julien Taieb, Sorbonne Paris-Cité, Paris Descartes University, and Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris,
| | - Valerie Boige
- Thomas Aparicio, Saint Louis Hospital, Assistance Publique–Hôpitaux de Paris, and Université Paris 7, Sorbonne Paris-Cité, Paris Diderot University, Paris, France; Francois Ghiringhelli, Centre Georges-François Leclerc, Dijon, France; Valerie Boige, Gustave Roussy, Villejuif, France; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive, Dijon, France; Julien Taieb, Sorbonne Paris-Cité, Paris Descartes University, and Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris,
| | - Karine Le Malicot
- Thomas Aparicio, Saint Louis Hospital, Assistance Publique–Hôpitaux de Paris, and Université Paris 7, Sorbonne Paris-Cité, Paris Diderot University, Paris, France; Francois Ghiringhelli, Centre Georges-François Leclerc, Dijon, France; Valerie Boige, Gustave Roussy, Villejuif, France; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive, Dijon, France; Julien Taieb, Sorbonne Paris-Cité, Paris Descartes University, and Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris,
| | - Julien Taieb
- Thomas Aparicio, Saint Louis Hospital, Assistance Publique–Hôpitaux de Paris, and Université Paris 7, Sorbonne Paris-Cité, Paris Diderot University, Paris, France; Francois Ghiringhelli, Centre Georges-François Leclerc, Dijon, France; Valerie Boige, Gustave Roussy, Villejuif, France; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive, Dijon, France; Julien Taieb, Sorbonne Paris-Cité, Paris Descartes University, and Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris,
| | - Jaafar Bennouna
- Thomas Aparicio, Saint Louis Hospital, Assistance Publique–Hôpitaux de Paris, and Université Paris 7, Sorbonne Paris-Cité, Paris Diderot University, Paris, France; Francois Ghiringhelli, Centre Georges-François Leclerc, Dijon, France; Valerie Boige, Gustave Roussy, Villejuif, France; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive, Dijon, France; Julien Taieb, Sorbonne Paris-Cité, Paris Descartes University, and Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris,
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Taieb J, Kourie HR, Emile JF, Le Malicot K, Balogoun R, Tabernero J, Mini E, Folprecht G, Van Laethem JL, Mulot C, Bouché O, Aparicio T, Michel P, Thaler J, Bridgewater J, Van Cutsem E, Perkins G, Lepage C, Salazar R, Laurent-Puig P. Association of Prognostic Value of Primary Tumor Location in Stage III Colon Cancer With RAS and BRAF Mutational Status. JAMA Oncol 2018; 4:e173695. [PMID: 29167892 DOI: 10.1001/jamaoncol.2017.3695] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance We know of no data on the prognostic value of primary tumor location (PTL) according to BRAF, RAS, and microsatellite instability (MSI) status in patients who have undergone resection for colon cancer (CC) and have been treated with current standard adjuvant chemotherapy. Objective To determine the prognostic and predictive value of PTL according to BRAF, RAS, and MSI status in patients with stage III CC receiving adjuvant treatment with FOLFOX (folinic acid [leucovorin calcium], fluorouracil, and oxaliplatin) with or without cetuximab. Design, Setting, and Participants This post hoc analysis included patients with available tumor blocks of resected stage III colon adenocarcinoma who participated in the Pan-European Trials in Alimentary Tract Cancer (PETACC)-8 phase 3 randomized trial. Among the 2559 patients who underwent randomization, 1900 were screened by next-generation sequencing, which showed that 1869 had full information concerning PTL. We categorized primary tumor site as located proximal (right) or distal (left) to the splenic flexure. Main Outcomes and Measures The associations between PTL (right- vs left-sided) and disease-free survival (DFS), survival after relapse (SAR), and overall survival (OS) were assessed by Cox models and adjusted for clinical and pathological features, treatment, and MSI, BRAF, and RAS status. Results Among the 1869 patients (1056 [57%] male; mean [SD] age, 59.4 [9.5] years) with full molecular data analyzed, 755 (40%) had a right-sided tumor, 164 (10%) had MSI, 942 (50%) had RAS mutations, and 212 (11%) had BRAF mutations. Right-sided tumor location was not prognostic for DFS in the whole population but was associated with a shorter SAR (hazard ratio [HR], 1.54; 95% CI, 1.23-1.93; P = .001) and OS (HR, 1.25; 95% CI, 1.02-1.54; P = .03). When looking at DFS in the different molecular subgroups, we found similar results for microsatellite-stable tumors and tumors with MSI; a better DFS in right-sided vs left-sided tumors in patients with RAS mutations (HR, 0.80; 95% CI, 0.64-1.00; P = .046); and a worse DFS in right-sided vs left-sided tumors in patients with RAS and BRAF double wild type (HR, 1.39; 95% CI, 1.01-1.92; P = .04). These results were found independently of the treatment received, and no beneficial effect of cetuximab on DFS or OS was observed in left-sided tumors. Conclusions and Relevance Although right-sided tumor location is associated with poor survival in patients with metastatic CC as previously reported, the association with disease recurrence appears to vary for patients with stage III CC and RAS or BRAF mutations vs those with double wild type.
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Affiliation(s)
- Julien Taieb
- Sorbonne Paris Cité, Université Paris Descartes, Department of Hepatogastroenterology and GI Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | - Hampig Raphael Kourie
- Sorbonne Paris Cité, Université Paris Descartes, Department of Hepatogastroenterology and GI Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France
| | - Ralyath Balogoun
- Université Paris Descartes, Sorbonne Paris Cité, France.,Assistance Publique-Hôpitaux de Paris, Department of Biology, Hôpital Européen Georges Pompidou, INSERM UMR-S1147, Paris, France
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), CIBERONC, Universitat Autònoma de Barcelona, Spanish Gastrointestinal Tumours TTD Group, Barcelona, Spain
| | - Enrico Mini
- Section of Internal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gunnar Folprecht
- Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Claire Mulot
- Université Paris Descartes, Sorbonne Paris Cité, France.,Assistance Publique-Hôpitaux de Paris, Department of Biology, Hôpital Européen Georges Pompidou, INSERM UMR-S1147, Paris, France
| | - Olivier Bouché
- Department of Hepato-Gastroenterology, Reims University Hospital, Reims, France
| | - Thomas Aparicio
- Gastroenterology Department, CHU Saint Louis, Assistance Publique-Hôpitaux de Paris and Université Paris 7, Sorbonne Paris Cité, Paris, France
| | - Pierre Michel
- Department of Gastroenterology, Rouen University Hospital, University of Rouen, Rouen, France
| | - Josef Thaler
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - John Bridgewater
- UCL Cancer Institute, University College London, London, England
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Géraldine Perkins
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Come Lepage
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France.,Hepato-Gastroenterology Department, Dijon University Hospital and INSERM U 866, Dijon, France
| | - Ramon Salazar
- Catalan Institute of Oncology (IDIBELL), Universitat de Barcelona, CIBERONC, Spanish Gastrointestinal Tumours TTD Group, Barcelona, Spain
| | - Pierre Laurent-Puig
- Université Paris Descartes, Sorbonne Paris Cité, France.,Assistance Publique-Hôpitaux de Paris, Department of Biology, Hôpital Européen Georges Pompidou, INSERM UMR-S1147, Paris, France
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46
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Gallois C, Taieb J, Le Corre D, Le Malicot K, Tabernero J, Mulot C, Seitz JF, Aparicio T, Folprecht G, Lepage C, Mini E, Van Laethem JL, Emile JF, Laurent-Puig P. Prognostic Value of Methylator Phenotype in Stage III Colon Cancer Treated with Oxaliplatin-based Adjuvant Chemotherapy. Clin Cancer Res 2018; 24:4745-4753. [PMID: 29921730 DOI: 10.1158/1078-0432.ccr-18-0866] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/19/2018] [Accepted: 06/13/2018] [Indexed: 01/11/2023]
Abstract
Purpose: There are conflicting results concerning the prognostic value of the CpG island methylator phenotype (CIMP) in patients with nonmetastatic colon cancer. We studied this phenotype in stage III colon cancer characterized for mismatch repair (MMR), RAS, and BRAF status, and treated with adjuvant FOLFOX-based regimen.Experimental Design: Tumor samples of 1,907 patients enrolled in the PETACC-8 adjuvant phase III trial were analyzed. The method used was methylation-specific PCR, where CIMP+ status was defined by methylation of at least 3 of 5 following genes: IGF2, CACNA1G, NEUROG1, SOCS1, and RUNX3 Association between CIMP status and overall survival (OS), disease-free survival (DFS), and survival after recurrence (SAR), was assessed by Cox model adjusted for prognostic factors and treatment arm (FOLFOX4 ± cetuximab).Results: CIMP status was successfully determined in 1,867 patients (97.9%): 275 (14.7%) tumors were CIMP+ Compared with CIMP- patients, CIMP+ patients were more frequently older (P = 0.002), females (P = 0.04), with right-sided (P < 0.0001), grade 3-4 (P < 0.0001), pN2 (P = 0.001), dMMR (P < 0.0001), BRAF mutated (P < 0.0001), and RAS wild-type (P < 0.0001) tumors. In multivariate analysis, CIMP+ status was associated with shorter OS [HR, 1.46; 95% confidence interval (CI), 1.02-1.94; P = 0.04] and SAR [HR, 1.76; 95% CI, 1.20-2.56; P < 0.0004]; but not DFS [HR, 1.15; 95% CI, 0.86-1.54; P = 0.34]. A nonsignificant trend of detrimental effect of cetuximab was observed in patients with CIMP+ tumors for OS, DFS, and SAR.Conclusions: In a large cohort of well-defined patients with stage III colon cancer, CIMP+ phenotype is associated with a shorter OS and SAR but not to DFS. Clin Cancer Res; 24(19); 4745-53. ©2018 AACR.
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Affiliation(s)
- Claire Gallois
- Department of Gastroenterology and Digestive Oncology, Institut National de la Santé et de le Recherche Médicale (INSERM) U1147; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris Descartes University, Paris, France
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Paris Descartes University; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Delphine Le Corre
- Department of Gastroenterology and Digestive Oncology, Institut National de la Santé et de le Recherche Médicale (INSERM) U1147; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris Descartes University, Paris, France
| | | | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Claire Mulot
- Department of Gastroenterology and Digestive Oncology, Institut National de la Santé et de le Recherche Médicale (INSERM) U1147; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris Descartes University, Paris, France
| | - Jean-François Seitz
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone; Aix-Marseille University, Marseille, France
| | - Thomas Aparicio
- Assistance Publique-Hôpitaux de Paris, Gastroenterology and Digestive Oncology Department, Hôpital Saint-Louis; Paris Diderot University, Paris, France
| | - Gunnar Folprecht
- 1st Medical Department, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Côme Lepage
- Fédération Francophone de Cancérologie Digestive, Dijon, France.,Hepato-gastroenterology and Digestive Oncology, Centre Hospitalier Universitaire de Dijon, EPICAD INSERM LNC-UMR 1231, University of Burgundy, Franche-Comté, France
| | - Enrico Mini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Jean-François Emile
- Pathological Department, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne, France
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Dahan L, Phelip JM, Le Malicot K, Williet N, Desrame J, Volet J, Petorin C, Malka D, Rebischung C, Aparicio T, Lecaille C, Rinaldi Y, Turpin A, Bignon AL, Bachet JB, Seitz JF, Lepage C, Francois E. FOLFIRINOX until progression, FOLFIRINOX with maintenance treatment, or sequential treatment with gemcitabine and FOLFIRI.3 for first-line treatment of metastatic pancreatic cancer: A randomized phase II trial (PRODIGE 35-PANOPTIMOX). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4000] [Citation(s) in RCA: 36] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - David Malka
- Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | - Cedric Lecaille
- Department of Gastroenterology, Polyclinique Nord Aquitaine, Bordeaux, France
| | | | | | | | | | | | - Come Lepage
- CHU Le Bocage HGE, INSERM U1231, Dijon, France
| | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Michel P, Boige V, Andre T, Aparicio T, Bachet JB, Dahan L, Guimbaud R, Lepage C, Manfredi S, Tougeron D, Taieb J, Selves J, Le Malicot K, Di Fiore F, Maillard E. Aspirin versus placebo in stage III or high-risk stage II colon cancer with PIK3CA mutation: A French randomised double-blind phase III trial (PRODIGE 50-ASPIK). Dig Liver Dis 2018; 50:305-307. [PMID: 29402752 DOI: 10.1016/j.dld.2017.12.023] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 12/11/2022]
Abstract
Oxaliplatin-based adjuvant chemotherapy is standard of care for radically resected stage III colon cancer and an accepted option for high-risk stage II. Two recent retrospective studies strongly suggested that low-dose aspirin used (100 mg/d) after surgical resection of colorectal cancer with a PIK3CA mutation could act as a targeted therapy with a major protective effect on the risk of recurrence. We propose a double-blind randomized phase III study to evaluate aspirin (100 mg/d during 3 years or until recurrence) versus placebo. Main inclusion criteria are patients aged 18 or 20, stage III or high risk stage II. The primary endpoint of the study is 3-year disease-free survival (DFS). Hypotheses are to improve 3-years DFS from placebo: 72% to aspirin: 83% (HR = 0.56). 94 events and 264 patients with PIK3CA mutation are required. The secondary endpoints are DFS at 5 years, the overall survival rate at 5 years, grade 3-4 severe bleeding.
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Affiliation(s)
- Pierre Michel
- Normandie Univ, UNIROUEN, Inserm 1245, IRON Group, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France.
| | - Valerie Boige
- Department of Oncologic Medicine, Gustave Roussy, Villejuif, France
| | - Thierry Andre
- Department of Medical Oncology, Saint Antoine Hospital, Université Pierre et Marie Curie, Paris, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, University Paris 7, Sorbonne Paris Cité, Paris, France
| | - Jean Baptiste Bachet
- Department of Hepato-Gastroenterology and Digestive Oncology, Hôpital de la Pitié Salpetrière, APHP, University Paris 6, Paris, France
| | - Laetitia Dahan
- Department of Digestive Oncology, Aix-Marseille University-Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Rosine Guimbaud
- Department of Medical Oncology, University Hospital Toulouse, Paul Sabatier University, Toulouse, France
| | - Côme Lepage
- Department of Hepatogastroenterology and Oncology Digestive, Burgundy Franche-Conté University, INSERM LNC UMR 1231 EPICAD, University Hospital of Dijon, Dijon, France
| | - Sylvain Manfredi
- Department of Hepatogastroenterology and Oncology Digestive, Burgundy Franche-Conté University, INSERM LNC UMR 1231 EPICAD, University Hospital of Dijon, Dijon, France
| | - David Tougeron
- Gastroenterology Department of Hepatogastroenterology, Poitiers University Hospital, Poitiers, France
| | - Julien Taieb
- Department of Digestive Oncology, Université Paris Descartes, Hôpital Européen Georges Pompidou, Paris, France
| | - Janick Selves
- Department of Pathology, University Hospital Toulouse, Paul Sabatier University, Toulouse, France
| | - Karine Le Malicot
- French Federation of Digestive Oncology (FFCD), INSERM LCN UMR 1231 EPICAD, Dijon, France
| | - Frederic Di Fiore
- Normandie Univ, UNIROUEN, Inserm 1245, IRON Group, Department of Hepato-Gastroenterology, Rouen University Hospital, Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Emilie Maillard
- French Federation of Digestive Oncology (FFCD), INSERM LCN UMR 1231 EPICAD, Dijon, France
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Aparicio T, Ghiringhelli F, Boige V, Le Malicot K, Taieb J, Bouché O, Phelip JM, François E, Borel C, Faroux R, Dahan L, Jacquot S, Genet D, Khemissa F, Suc E, Desseigne F, Texereau P, Lepage C, Bennouna J. Bevacizumab Maintenance Versus No Maintenance During Chemotherapy-Free Intervals in Metastatic Colorectal Cancer: A Randomized Phase III Trial (PRODIGE 9). J Clin Oncol 2018; 36:674-681. [DOI: 10.1200/jco.2017.75.2931] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose Conflicting results are reported for maintenance treatment with bevacizumab during chemotherapy-free intervals (CFI) in metastatic colorectal cancer after induction chemotherapy. Patients and Methods In this open-label, phase III, randomized controlled trial, we compared the tumor control duration (TCD) observed with bevacizumab maintenance and with no treatment (observation) during CFI subsequent to induction chemotherapy with 12 cycles of fluorouracil, leucovorin, and irinotecan plus bevacizumab. After disease progression, the induction regimen was repeated for eight cycles, followed by a new CFI. Results From March 2010 to July 2013, 491 patients were randomly assigned. Disease progression or death occurred during induction chemotherapy in 85 patients (17%); 261 patients (53%) had at least one reinduction, 107 (22%) had two reinductions, and 56 (11%) had three or more reinductions. The median TCD was 15 months in both groups; the median progression-free survival (PFS) from randomization was 9.2 and 8.9 months in the maintenance group and observation groups, respectively. The TCD observed in both groups was higher compared with the TCD hypotheses of the trial. The median overall survival (OS) was 21.7 and 22.0 months in the maintenance and observation groups, respectively. In the per-protocol population, defined as patients with at least one reinduction after the first progression, the median duration of the first CFI was 4.3 months in both arms; the median TCD was 17.8 and 23.3 months ( P = .339), the median PFS was 9.9 and 9.5 months, and the median OS was 27.6 and 28.5 months in the maintenance and observation groups, respectively. Multivariable analysis revealed that female gender, WHO performance status ≥ 2, and unresected primary tumors were associated with a shorter TCD. Conclusion Bevacizumab maintenance monotherapy did not improve TCD, CFI duration, PFS, or OS.
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Affiliation(s)
- Thomas Aparicio
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Francois Ghiringhelli
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Valérie Boige
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Karine Le Malicot
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Julien Taieb
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Olivier Bouché
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Jean-Marc Phelip
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Eric François
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Christian Borel
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Roger Faroux
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Laetitia Dahan
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Stéphane Jacquot
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Dominique Genet
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Faiza Khemissa
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Etienne Suc
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Françoise Desseigne
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Patrick Texereau
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Come Lepage
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
| | - Jaafar Bennouna
- Thomas Aparicio, Centre Hospitalier Universitaire (CHU) Saint Louis, Assistance Public Hôpitaux de Paris (APHP), and Université Paris 7, Sorbonne Paris Cité; Julien Taieb, Hôpital Européen Georges Pompidou, Paris; Francois Ghiringhelli, Centre Georges-François Leclerc; Karine Le Malicot, Fédération Francophone de Cancérologie Digestive; Come Lepage, CHU Le Bocage, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche (UMR) 1231, Dijon; Valérie Boige, Institut Gustave Roussy,
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50
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Walter T, Malka D, Hentic O, Lombard-Bohas C, Le Malicot K, Smith D, Ferru A, Assenat E, Cadiot G, Lievre A, Kurtz JE, Dahan L, Dubreuil O, Hautefeuille V, Lepere C, Gangloff A, Elhajbi F, Coriat R, Roquin G, Bouarioua N, Granger V, Scoazec JY, Lepage C. Evaluating bevacizumab in combination with FOLFIRI after the failure of platinum-etoposide regimen in patients with advanced poorly differentiated neuroendocrine carcinoma: The PRODIGE 41-BEVANEC randomized phase II study. Dig Liver Dis 2018; 50:195-198. [PMID: 29258812 DOI: 10.1016/j.dld.2017.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Patients with gastroenteropancreatic (GEP), metastatic or locally advanced, non-resectable, grade 3 poorly-differentiated neuroendocrine carcinoma (NEC) are treated with cisplatin (or carboplatin)-etoposide in first-line palliative chemotherapy (CT1). However, nearly all patients will develop resistance and there is no standard second-line treatment. AIM PRODIGE 41-BEVANEC is an academic randomized, phase II study designed to evaluate the efficacy of bevacizumab in combination with FOLFIRI after failure of CT1 in unknown primary NEC and GEP-NEC. MATERIALS AND METHODS The main eligibility criteria are age ≥18 years, metastatic (synchronous or metachronous) or locally advanced, non-resectable, grade 3 GEP-NEC, and documented progressive disease during or after CT1 therapy. RESULTS A total of 124 patients will be randomly assigned (1:1) to receive either 5 mg/kg bevacizumab with FOLFIRI, or FOLFIRI alone, every 14 days until disease progression or unacceptable toxicity. The hypothesis is to demonstrate a 6-month overall survival for at least 50% of the patients in bevacizumab arm versus 35% in the control arm (FOLFIRI alone). Secondary endpoints are objective response, response duration, progression-free survival, toxicity, and biochemical response. CONCLUSION The study is currently opened in France (NCT02820857). The first patient was randomized on September 6, 2017.
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Affiliation(s)
- Thomas Walter
- Department of Medical Oncology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
| | - David Malka
- Gastrointestinal Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - Olivia Hentic
- Gastroenterology-Pancreatology Department, Beaujon Hospital, PMAD, Clichy, France
| | - Catherine Lombard-Bohas
- Department of Medical Oncology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Denis Smith
- Hepatogastroenterology and Digestive Oncology Department, Haut-Lévèque, University Hospital of Bordeaux, Pessac, France
| | - Aurélie Ferru
- Pôle régional de cancérologie, University Hospital of Poitiers, Poitiers, France
| | - Eric Assenat
- Medical Oncology Department, University Hospital St Eloi, Montpellier, France
| | - Guillaume Cadiot
- Department of Hepatogastroenterology and Digestive Oncology, Robert Debré Hospital, University Hospital of Reims, Reims, France
| | - Astrid Lievre
- Service des maladies de l'appareil digestif, University Hospital of Pontchaillou, Rennes, France
| | - Jean-Emmanuel Kurtz
- Oncology Department, Nouvel Hospital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Laetitia Dahan
- Digestive Oncology Department, University Hospital Timone, Marseille, France
| | - Olivier Dubreuil
- Hepatogastroenterology and Digestive Oncology Department, Pitié Salpêtrière Hospital, Paris, France
| | - Vincent Hautefeuille
- Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens, France
| | | | - Alice Gangloff
- Gastroenterology Department, University Hospital of Rouen, Rouen, France
| | - Farid Elhajbi
- Oncology Department, Oscar Lambret Center, Lille, France
| | - Romain Coriat
- Gastroenterology Department, Cochin Hospital, Paris, France
| | - Guillaume Roquin
- Gastroenterology & Digestive Oncology, University Hospital of Angers, Angers, France
| | - Nadia Bouarioua
- Service de gastroentérologie et oncologie digestive, hôpital Nord, Saint Priest en Jarez, France
| | - Victoire Granger
- Hepatogastroenterology Department, Michallon Hospital, University Hospital of Grenoble, Grenoble, France
| | - Jean-Yves Scoazec
- Gustave Roussy Cancer Campus, Department of Surgical and Molecular Pathology, Villejuif Cedex, France; Université Paris Saclay, Université Paris Sud XI, Faculté de Médecine de Bicêtre, Le Kremlin-Bicêtre, France
| | - Côme Lepage
- Gastrointestinal Oncology Department, Gustave Roussy Institute, Villejuif, France; Gastroenterology & Digestive Oncology, University Hospital Le Bocage, Dijon, France
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