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Sebbag C, Rousset-Jablonski C, Coussy F, Ray-Coquard I, Garin C, Evrevin C, Cessot M, Labrosse J, Laot L, Darrigues L, Bobrie A, Sénéchal-Davin C, Espié M, Giacchetti S, Plu-Bureau G, Maitrot-Mantelet L, Gompel A, Santulli P, Asselain B, Hotton J, Coutant C, Guerin J, Decanter C, Mailliez A, Brain E, Dumas E, Sablone L, Seintinelles RN, Reyal F, Hamy AS. Contraception in breast cancer survivors from the FEERIC case-control study (performed on behalf of the Seintinelles research network). Breast 2022; 67:62-70. [PMID: 36630821 PMCID: PMC9982267 DOI: 10.1016/j.breast.2022.12.033] [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: 10/21/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To compare the prevalence of contraception in breast cancer (BC) patients at risk of unintentional pregnancy (i.e. not currently pregnant or trying to get pregnant) and matched controls. STUDY DESIGN The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter case-control study, including localized BC patients aged 18-43 years, matched for age and parity to cancer-free volunteer controls in a 1:2 ratio. Data were collected through online questionnaires completed on the Seintinelles research platform. RESULTS In a population of 1278 women at risk of unintentional pregnancy, the prevalence of contraception at study inclusion did not differ significantly between cases (340/431, 78.9%) and controls (666/847, 78.6%, p = 0.97). Contrarily, the contraceptive methods used were significantly different, with a higher proportion of copper IUD use in BC survivors (59.5% versus 25.0% in controls p < 0.001). For patients at risk of unintentional pregnancy, receiving information about chemotherapy-induced ovary damage at BC diagnosis (OR = 2.47 95%CI [ 1.39-4.37] and anti-HER2 treatment (OR = 2.46, 95% CI [ 1.14-6.16]) were significantly associated with the use of a contraception in multivariate analysis. CONCLUSION In this large French study, BC survivors had a prevalence of contraception use similar to that for matched controls, though almost one in five women at risk of unintentional pregnancy did not use contraception. Dedicated consultations at cancer care centers could further improve access to information and contraception counseling.
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Affiliation(s)
- Clara Sebbag
- Department of Medical Oncology, Institut Curie, Paris, France,Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France,Université Paris Cité, Paris, France
| | - Christine Rousset-Jablonski
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France,Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Isabelle Ray-Coquard
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France,Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Clémentine Garin
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France
| | - Clémence Evrevin
- Department of Medical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Marion Cessot
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Julie Labrosse
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Lucie Laot
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Lauren Darrigues
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Angélique Bobrie
- Department of Medical Oncology, Institut du cancer de Montpellier, Montpellier, France
| | | | - Marc Espié
- Sénolopole, Hôpital Saint Louis, AP-HP, Paris, France; University Paris, Paris France
| | - Sylvie Giacchetti
- Sénolopole, Hôpital Saint Louis, AP-HP, Paris, France; University Paris, Paris France
| | - Geneviève Plu-Bureau
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | | | - Anne Gompel
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | - Pietro Santulli
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | | | - Judicaël Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Charles Coutant
- Department of Surgical Oncology, Centre Georges-François Leclerc - Unicancer, Dijon, France,Clinical Research Department, Centre Georges-François Leclerc - Unicancer, Dijon, France
| | - Julien Guerin
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambert, Lille, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France
| | - Laura Sablone
- Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France
| | | | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France,Department of Surgical Oncology, Institut Curie, Paris, France,Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France,Université Paris Cité, Paris, France
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Paris, France; Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France; Department of Surgical Oncology, Institut Curie, Paris, France; Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France; Université Paris Cité, Paris, France.
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Giacchetti S, Faucheux L, Gardair C, Cuvier C, de Roquancourt A, Campedel L, Groheux D, de Bazelaire C, Lehmann-Che J, Miquel C, Cahen Doidy L, Amellou M, Madelaine I, Reyal F, Someil L, Hocini H, Hennequin C, Teixeira L, Espié M, Chevret S, Soumelis V, Hamy AS. Negative Relationship between Post-Treatment Stromal Tumor-Infiltrating Lymphocyte (TIL) and Survival in Triple-Negative Breast Cancer Patients Treated with Dose-Dense Dose-Intense NeoAdjuvant Chemotherapy. Cancers (Basel) 2022; 14:cancers14051331. [PMID: 35267639 PMCID: PMC8909288 DOI: 10.3390/cancers14051331] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Patients with triple-negative breast cancers (TNBC) have a poor prognosis unless a pathological complete response (pCR) is achieved after neoadjuvant chemotherapy (NAC). Few studies have analyzed changes in TIL levels following dose-dense dose-intense (dd-di) NAC. Patients and methods: From 2009 to 2018, 117 patients with TNBC received dd-di NAC at our institution. We aimed to identify factors associated with pre- and post-NAC TIL levels, and oncological outcomes relapse-free survival (RFS), and overall survival (OS). Results: Median pre-NAC and post-NAC TIL levels were 15% and 3%, respectively. Change in TIL levels with treatment was significantly correlated with metabolic response (SUV) and pCR. High post-NAC TIL levels were associated with a weak metabolic response after two cycles of NAC, with the presence of residual disease and nodal involvement at NAC completion. In multivariate analyses, high post-NAC TIL levels independently predicted poor RFS and poor OS (HR = 1.4 per 10% increment, 95%CI (1.1; 1.9) p = 0.014 and HR = 1.8 per 10% increment 95%CI (1.3−2.3), p < 0.0001, respectively). Conclusion: Our results suggest that TNBC patients with TIL enrichment after NAC are at higher risk of relapse. These patients are potential candidates for adjuvant treatment, such as immunotherapy, in clinical trials.
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Affiliation(s)
- Sylvie Giacchetti
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
- Correspondence:
| | - Lilith Faucheux
- ECSTRRA Team, Statistic and Epidemiologic Research Center, INSERM UMR-1153, Université de Paris, F-75010 Paris, France; (L.F.); (S.C.)
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
| | - Charlotte Gardair
- Department of Anatomopathology, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.G.); (A.d.R.); (C.M.)
| | - Caroline Cuvier
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | - Anne de Roquancourt
- Department of Anatomopathology, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.G.); (A.d.R.); (C.M.)
| | - Luca Campedel
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | - David Groheux
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
- Department of Nuclear Medicine, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | | | - Jacqueline Lehmann-Che
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
- Immunology, Biology and Histocompatibility Laboratory, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - Catherine Miquel
- Department of Anatomopathology, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.G.); (A.d.R.); (C.M.)
| | | | - Malika Amellou
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | - Isabelle Madelaine
- Department of Pharmacy, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France;
| | - Fabien Reyal
- Department of Surgery, Institut Curie, 26 rue d’Ulm, University Paris, F-75005 Paris, France;
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, 26 rue d’Ulm, University Paris, F-75005 Paris, France;
| | - Laetitia Someil
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | - Hamid Hocini
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | | | - Luis Teixeira
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
| | - Marc Espié
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
| | - Sylvie Chevret
- ECSTRRA Team, Statistic and Epidemiologic Research Center, INSERM UMR-1153, Université de Paris, F-75010 Paris, France; (L.F.); (S.C.)
- Department of Biostatistics and Medical Information, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - Vassili Soumelis
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
- Department of Anatomopathology, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.G.); (A.d.R.); (C.M.)
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, 26 rue d’Ulm, University Paris, F-75005 Paris, France;
- Department of Oncology, Institut Curie St Cloud–35 rue Dailly, St Cloud, F-92210 Paris, France
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Fornecker L, Golfier F, Grosclaude P, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard CM, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Non-genetic indications for risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. Gynécologie Obstétrique Fertilité & Sénologie 2022; 50:107-120. [PMID: 34920167 DOI: 10.1016/j.gofs.2021.12.005] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the value of performing a risk-reducting mastectomy (RRM) in the absence of a deleterious variant of a breast cancer susceptibility gene, in 4 clinical situations at risk of breast cancer. DESIGN The CNGOF Commission of Senology, composed of 26 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The Commission of Senology adhered to the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The Commission of Senology considered 8 questions on 4 topics, focusing on histological, familial (no identified genetic abnormality), radiological (of unrecognized cancer), and radiation (history of Hodgkin's disease) risk. For each situation, it was determined whether performing RRM compared with surveillance would decrease the risk of developing breast cancer and/or increase survival. RESULTS The Commission of Senology synthesis and application of the GRADE method resulted in 11 recommendations, 6 with a high level of evidence (GRADE 1±) and 5 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the Commission of Senology members on recommendations to improve practice for performing or not performing RRM in the clinical setting.
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Affiliation(s)
- Carole Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | | | | | - Gérard Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Susie Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
| | | | - Charles Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex, France.
| | - Emile Daraï
- Hôpital Tenon, service de gynécologie-obstétrique, 4, rue de la Chine, 75020 Paris, France.
| | - Yann Delpech
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France.
| | - Martha Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France.
| | - Marc Espié
- Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Luc Fornecker
- Département d'onco-hématologie, ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - François Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | | | | | - Edith Kermarrec
- Hôpital Tenon, service de radiologie, 4, rue de la Chine, 75020 Paris, France.
| | - Vincent Lavoué
- CHU, service de gynécologie, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | | | - Élisabeth Luporsi
- Oncologie médicale et oncogénétique, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château, 57085 Metz, France.
| | - Christine M Maugard
- Service de génétique oncologique clinique, unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | | | | | - Nicolas Taris
- Oncogénétique, ICANS, 17, rue Albert-Calmette, 67033 Strasbourg, France.
| | - Catherine Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - Charlotte Vaysse
- Service de chirurgie oncologique, CHU Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - Xavier Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Golfier F, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard C, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Techniques and complications of non-genetic risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. Gynecol Obstet Fertil Senol 2022; 50:121-129. [PMID: 34922037 DOI: 10.1016/j.gofs.2021.12.006] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Based on an updated review of the international literature covering the different surgical techniques and complications of risk reducing mastectomies (RRM) in non-genetic context, the Commission of Senology (CS) of the College National des Gynécologues Obstétriciens Français (CNGOF) aimed to establish recommendations on the techniques to be chosen and their implementation. DESIGN The CNGOF CS, composed of 24 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The CS adhered to and followed the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The CS considered 6 questions in 4 thematic areas, focusing on oncologic safety, risk of complications, aesthetic satisfaction and psychological impact, and preoperative modalities. RESULTS The application of the GRADE method resulted in 7 recommendations, 6 with a high level of evidence (GRADE 1±) and 1 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the CS members on recommendations for preferred surgical techniques and practical implementation.
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Affiliation(s)
- C Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - E Barranger
- Centre Antoine-Lacassagne, 36, avenue de Valombrose, 06189 Nice, France
| | | | - G Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33 000 Bordeaux, France
| | - S Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | | | - C Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr Marion, 21079 Dijon cedex, France
| | - E Daraï
- Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Y Delpech
- Centre Antoine Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - M Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France
| | - M Espié
- Hôpital St Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - F Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre Benite, France
| | - A S Hamy
- Institut Curie, 26, rue d'Ulm, 75248 Paris, France
| | - E Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - V Lavoué
- Service de gynécologie, CHU, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - M Lodi
- CHU, avenue Molière, 67200 Strasbourg, France
| | - É Luporsi
- Oncologie médicale et oncogénétique, hôpital de Mercy, CHR Metz-Thionville, 1, allée du Château, 57085 Metz, France
| | - C Maugard
- Service de génétique oncologique clinique et unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg
| | - S Molière
- Imagerie du sein, CHRU, avenue Molière 67200 Strasbourg, France
| | - J-Y Seror
- Cabinet privé, 9 ter boulevard Montparnasse, 75006 Paris, France
| | - N Taris
- Oncogénétique, ICANS, 17, rue Albert Calmette, 67033 Strasbourg, France
| | - C Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Vaysse
- Service de chirurgie oncologique, CHU de Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - X Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Favier A, Boinon D, Salviat F, Mazouni C, De Korvin B, Tunon C, Salomon AV, Doutriaux-Dumoulin I, Vaysse C, Marchal F, Boulanger L, Chabbert-Buffet N, Zilberman S, Coutant C, Espié M, Cortet M, Boussion V, Cohen M, Fermeaux V, Mathelin C, Michiels S, Delaloge S, Uzan C, Charles C. [Surgery or not on an atypical breast lesion? Taking anxiety into account in shared decision support from a prospective cohort of 300 patients]. ACTA ACUST UNITED AC 2021; 50:142-150. [PMID: 34562643 DOI: 10.1016/j.gofs.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process. METHODS Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care. RESULTS One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%). CONCLUSION Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.
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Affiliation(s)
- A Favier
- AP-HP (Assistance Publique des hôpitaux de Paris), department of gynecological and breast surgery and oncology, Pitié-Salpêtrière University Hospital, Paris, France.
| | - D Boinon
- Psycho-oncology unit, Gustave-Roussy, université Paris-Saclay, Villejuif, France; Université de Paris, LPPS, 92100 Boulogne Billancourt, France
| | - F Salviat
- Service de biostatistique et d'épidémiologie, Gustave-Roussy, Villejuif, France; CESP Inserm U1018, université Paris-Saclay, université Paris-Saclay, Villejuif, France
| | | | - B De Korvin
- Radiology center, centre Eugène-Marquis, CLCC, Rennes, France
| | - C Tunon
- Institut Bergonié, Bordeaux, France
| | - A-V Salomon
- Institut Curie, université Paris-Sciences Lettres, Inserm U934, département de médecine diagnostique et théranostique, Paris, France
| | | | - C Vaysse
- Département de chirurgie, CHU-Toulouse, institut universitaire du cancer de Toulouse-Oncopole, Toulouse, France
| | - F Marchal
- Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | - S Zilberman
- Hôpital Tenon, Sorbonne university, Paris, France
| | - C Coutant
- Centre Georges François Leclerc, Dijon, France
| | - M Espié
- University of Paris, Breast Unit, hôpital Saint-Louis, AP-HP, Paris, France
| | - M Cortet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - V Boussion
- Centre Jean-Perrin, Clermont-Ferrand, France
| | - M Cohen
- Institut Paoli Calmettes, Marseille, France
| | - V Fermeaux
- Service de pathologie, CHU Dupuytren, Limoges, France
| | - C Mathelin
- Les Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Michiels
- Service de biostatistique et d'épidémiologie, Gustave-Roussy, Villejuif, France; CESP Inserm U1018, université Paris-Saclay, université Paris-Saclay, Villejuif, France
| | | | - C Uzan
- AP-HP (Assistance Publique des hôpitaux de Paris), department of gynecological and breast surgery and oncology, Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Inserm UMR_S_938, "Cancer Biology and Therapeutics", centre de recherche Saint-Antoine (CRSA), Paris, France; Institut universitaire de cancérologie (IUC), Paris, France
| | - C Charles
- Université de Bordeaux, Bordeaux Population Health (U1219), équipe méthodes pour la recherche interventionnelle en santé des populations (MéRISP), Bordeaux, France
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Groheux D, Hindié E, Espié M, Ulaner GA. Letter to the Editor: PET/CT in Locally Advanced Breast Cancer: Time for a Guideline Change? J Natl Compr Canc Netw 2021; 19:xxx. [PMID: 34416711 DOI: 10.6004/jnccn.2021.7050] [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: 11/17/2022]
Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
| | - Elif Hindié
- Department of Nuclear Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Marc Espié
- Breast Diseases Unit, Saint-Louis Hospital, Paris, France; and
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, California
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Dent R, Oliveira M, Isakoff SJ, Im SA, Espié M, Blau S, Tan AR, Saura C, Wongchenko MJ, Xu N, Bradley D, Reilly SJ, Mani A, Kim SB. Final results of the double-blind placebo-controlled randomized phase 2 LOTUS trial of first-line ipatasertib plus paclitaxel for inoperable locally advanced/metastatic triple-negative breast cancer. Breast Cancer Res Treat 2021; 189:377-386. [PMID: 34264439 DOI: 10.1007/s10549-021-06143-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In LOTUS (NCT02162719), adding the oral AKT inhibitor ipatasertib to first-line paclitaxel for locally advanced/metastatic triple-negative breast cancer (aTNBC) improved progression-free survival (PFS; primary endpoint), with an enhanced effect in patients with PIK3CA/AKT1/PTEN-altered tumors (FoundationOne next-generation sequencing [NGS] assay). We report final overall survival (OS) results. METHODS Eligible patients had measurable previously untreated aTNBC. Patients were stratified by prior (neo)adjuvant therapy, chemotherapy-free interval, and tumor immunohistochemistry PTEN status, and were randomized 1:1 to paclitaxel 80 mg/m2 (days 1, 8, 15) plus ipatasertib 400 mg or placebo (days 1-21) every 28 days until disease progression or unacceptable toxicity. OS (intent-to-treat [ITT], immunohistochemistry PTEN-low, and PI3K/AKT pathway-activated [NGS PIK3CA/AKT1/PTEN-altered] populations) was a secondary endpoint. RESULTS Median follow-up was 19.0 versus 16.0 months in the ipatasertib-paclitaxel versus placebo-paclitaxel arms, respectively. In the ITT population (n = 124), median OS was numerically longer with ipatasertib-paclitaxel than placebo-paclitaxel (hazard ratio 0.80, 95% CI 0.50-1.28; median 25.8 vs 16.9 months, respectively; 1-year OS 83% vs 68%). Likewise, median OS favored ipatasertib-paclitaxel in the PTEN-low (n = 48; 23.1 vs 15.8 months; hazard ratio 0.83) and PIK3CA/AKT1/PTEN-altered (n = 42; 25.8 vs 22.1 months; hazard ratio 1.13) subgroups. The ipatasertib-paclitaxel safety profile was unchanged. CONCLUSIONS Final OS results show a numerical trend favoring ipatasertib-paclitaxel and median OS exceeding 2 years with ipatasertib-paclitaxel. Overall, results are consistent with the reported PFS benefit; interpretation within biomarker-defined subgroups is complicated by small sample sizes and TNBC heterogeneity.
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Affiliation(s)
- Rebecca Dent
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, 11 Hospital Crescent, Singapore, Singapore.
| | - Mafalda Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Steven J Isakoff
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Marc Espié
- Department of Medical Oncology, Breast Disease Center, Hospital Saint Louis, Paris, France
| | - Sibel Blau
- Oncology Division, Northwest Medical Specialties, Puyallup, WA, USA
| | - Antoinette R Tan
- Department of Solid Tumor and Investigational Therapeutics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Cristina Saura
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Na Xu
- Biostatistics, Genentech, Inc., South San Francisco, CA, USA
| | - Denise Bradley
- Pharma Development, Roche Products Ltd, Welwyn Garden City, UK
| | | | - Aruna Mani
- Product Development Oncology, Genentech, Inc., South San Francisco, CA, USA
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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8
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Guillerm SO, Bourstyn E, Itti R, Cahen-Doidy L, Quéro L, Labidi M, Marchand E, Lorphelin H, Giacchetti S, Cuvier C, Espié M, Teixeira L, Hennequin C. Intraoperative Radiotherapy for Breast Cancer in Elderly Women. Clin Breast Cancer 2021; 22:e109-e113. [PMID: 34154928 DOI: 10.1016/j.clbc.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/18/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate outcomes and postoperative toxicities after intraoperative radiotherapy (IORT) in elderly women. POPULATION Women older than 65 years, with infiltrating ductal breast cancer ≤3 cm, expressing estrogen receptor (ER+) without Her2 overexpression, and with negative axillary nodes. TREATMENT Treatment consisted of partial mastectomy with a sentinel lymph node biopsy (SLNB) procedure; in case of positive SLNB, IORT was cancelled. IORT consisted in a total dose of 20 Gy in 1 fraction delivered at the surface of the applicator with the Intrabeam® technique. RESULTS IORT was planned to be administered to a total of 225 patients but was cancelled for 34 patients during surgery. Thus 191 patients were analyzed; mean age was 76 years, with 57 patients (30%) >80 years. Despite inclusion criteria, 15 had lobular carcinoma and 7 were triple negative. With a median follow-up of 40 months, we observed only 1 local recurrence, located in the skin over the initial tumor. The 5-year local relapse rate was 1.7%. A wound healing delay (>15 days) was observed in 21 patients (11%). Sixty-six patients (35%) had postoperative complications, mainly grade 2, resolving within a few days. Two patients needed surgical drainage for local abscesses. Long-term (>1 year) cosmetic outcome was evaluated in 120 patients and was judged excellent or good in 102 (91%). CONCLUSION IORT can be safely given to elderly women, with a good local control rate and without major toxicities.
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Affiliation(s)
- S Ophie Guillerm
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Edwige Bourstyn
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Ramona Itti
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Laurence Cahen-Doidy
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Laurent Quéro
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Mouna Labidi
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Eva Marchand
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Henri Lorphelin
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Sylvie Giacchetti
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Caroline Cuvier
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Marc Espié
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Luis Teixeira
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France
| | - Christophe Hennequin
- Radiation Oncology Department, Saint-Louis Hospital, Paris, France; Breast Cancer Unit, Saint-Louis Hospital, Paris, France.
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de Margerie-Mellon C, Debry JB, Dupont A, Cuvier C, Giacchetti S, Teixeira L, Espié M, de Bazelaire C. Nonpalpable breast lesions: impact of a second-opinion review at a breast unit on BI-RADS classification. Eur Radiol 2021; 31:5913-5923. [PMID: 33462625 DOI: 10.1007/s00330-020-07664-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare BI-RADS classification, management, and outcome of nonpalpable breast lesions assessed both by community practices and by a multidisciplinary tumor board (MTB) at a breast unit. METHODS All nonpalpable lesions that were first assigned a BI-RADS score by community practices and then reassessed by an MTB at a single breast unit from 2009 to 2017 were retrospectively reviewed. Inter-review agreement was assessed with Cohen's kappa statistic. Changes in biopsy recommendation were calculated. The percentage of additional tumor lesions detected by the MTB was obtained. The sensitivity, AUC, and cancer rates for BI-RADS category 3, 4, and 5 lesions were computed for both reviews. RESULTS A total of 1909 nonpalpable lesions in 1732 patients were included. For BI-RADS scores in the whole cohort, a fair agreement was found (κ = 0.40 [0.36-0.45]) between the two reviews. Agreement was higher when considering only mammography combined with ultrasound (κ = 0.53 [0.44-0.62]), masses (κ = 0.50 [0.44-0.56]), and architectural distortion (κ = 0.44 [0.11-0.78]). Changes in biopsy recommendation occurred in 589 cases (31%). Ninety of 345 additional biopsies revealed high-risk or malignant lesions. Overall, the MTB identified 27% additional high-risk and malignant lesions compared to community practices. The BI-RADS classification AUCs for detecting malignant lesions were 0.66 (0.63-0.69) for community practices and 0.76 (0.75-0.78) for the MTB (p < 0.001). CONCLUSION Agreement between community practices and MTB reviews for BI-RADS classification in nonpalpable lesions is only fair. MTB review improves diagnostic performances of breast imaging and patient management. KEY POINTS • The inter-review agreement for BI-RADS classification between community practices and the multidisciplinary board was only fair (κ = 0.40). • Disagreements resulted in changes of biopsy recommendation in 31% of the lesions. • The multidisciplinary board identified 27% additional high-risk and malignant lesions compared to community practices.
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Affiliation(s)
- Constance de Margerie-Mellon
- Department of Radiology, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
| | - Jean-Baptiste Debry
- Department of Radiology, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Axelle Dupont
- Department of Biostatistics, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Caroline Cuvier
- Breast Disease Unit, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Sylvie Giacchetti
- Breast Disease Unit, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Luis Teixeira
- Breast Disease Unit, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Marc Espié
- Breast Disease Unit, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Cédric de Bazelaire
- Department of Radiology, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
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10
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Bidard FC, Jacot W, Kiavue N, Dureau S, Kadi A, Brain E, Bachelot T, Bourgeois H, Gonçalves A, Ladoire S, Naman H, Dalenc F, Gligorov J, Espié M, Emile G, Ferrero JM, Loirat D, Frank S, Cabel L, Diéras V, Cayrefourcq L, Simondi C, Berger F, Alix-Panabières C, Pierga JY. Efficacy of Circulating Tumor Cell Count-Driven vs Clinician-Driven First-line Therapy Choice in Hormone Receptor-Positive, ERBB2-Negative Metastatic Breast Cancer: The STIC CTC Randomized Clinical Trial. JAMA Oncol 2021; 7:34-41. [PMID: 33151266 DOI: 10.1001/jamaoncol.2020.5660] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The choice between chemotherapy and endocrine therapy as first-line treatment for hormone receptor-positive, ERBB2 (also known as HER2)-negative metastatic breast cancer is usually based on the presence of clinical features associated with a poor prognosis. In this setting, a high circulating tumor cell (CTC) count (≥5 CTCs/7.5 mL) is a strong adverse prognostic factor for overall survival and progression-free survival (PFS). Objective To compare the efficacy of a clinician-driven treatment choice vs a CTC-driven choice for first-line treatment. Interventions In the CTC arm, patients received chemotherapy or endocrine therapy according to the CTC count (chemotherapy if ≥5 CTCs/7.5 mL; endocrine therapy if <5 CTCs/7.5 mL), whereas in the control arm, the choice was left to the investigator. Design, Setting, and Participants In the STIC CTC randomized, open-label, noninferiority phase 3 trial, participants were randomized to a clinician-driven choice of first-line treatment or a CTC count-driven first-line treatment choice. Eligible participants were premenopausal and postmenopausal women 18 years or older diagnosed with hormone receptor-positive, ERBB2-negative metastatic breast cancer. Data were collected at 17 French cancer centers from February 1, 2012, to July 28, 2016, and analyzed June 2019 to October 2019. Main Outcome and Measures The primary end point was the investigator-assessed PFS in the per-protocol population, with a noninferiority margin of 1.25 for the 90% CI of the hazard ratio. Results Among the 755 women in the per-protocol population, the median (range) age was 63 (30-88) years [64 (30-88) years for the 377 patients allocated to the CTC arm and 63 (31-87) years for the 378 patients allocated to the standard arm]; 138 (37%) and 103 (27%) received chemotherapy, respectively. Median PFS was 15.5 months (95% CI, 12.7-17.3) in the CTC arm and 13.9 months (95% CI, 12.2-16.3) in the standard arm. The primary end point was met, with a hazard ratio of 0.94 (90% CI, 0.81-1.09). Conclusions and Relevance This randomized clinical trial found that the CTC count may be a reliable biomarker method for guiding the choice between chemotherapy and endocrine therapy as the first-line treatment in hormone receptor-positive, ERBB2-negative metastatic breast cancer. Trial Registration ClinicalTrials.gov Identifier: NCT01710605.
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Affiliation(s)
- François-Clément Bidard
- Department of Medical Oncology, Institut Curie, UVSQ and Paris-Saclay University, Saint-Cloud, France.,INSERM Center of Clinical Investigations in Biotherapies of Cancer (CIC-BT) 1428, Paris, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Montpellier University, Montpellier, France
| | - Nicolas Kiavue
- Department of Medical Oncology, Institut Curie, UVSQ and Paris-Saclay University, Saint-Cloud, France
| | - Sylvain Dureau
- Biometry Unit, Institut Curie, PSL Research University, Paris, France
| | - Amir Kadi
- Biometry Unit, Institut Curie, PSL Research University, Paris, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, UVSQ and Paris-Saclay University, Saint-Cloud, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Hugues Bourgeois
- Department of Medical Oncology, Victor Hugo Clinic, Le Mans, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, CRCM, Aix-Marseille University, Marseille, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Hervé Naman
- Department of Medical Oncology, Centre Azuréen de Cancérologie, Mougins, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Joseph Gligorov
- Department of Medical Oncology, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Marc Espié
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | - George Emile
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Université de Paris, Paris, France
| | - Sophie Frank
- Department of Medical Oncology, Institut Curie, Université de Paris, Paris, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, UVSQ and Paris-Saclay University, Saint-Cloud, France
| | - Véronique Diéras
- Formerly with Department of Medical Oncology, Institut Curie, Paris, France.,Now with Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Laure Cayrefourcq
- Laboratory of Rare Human Circulating Cells, University Medical Center of Montpellier, EA 2415, Montpellier University, Montpellier, France
| | - Cécile Simondi
- Clinical Research Department, Institut Curie, PSL Research University, Paris, France
| | - Frédérique Berger
- Biometry Unit, Institut Curie, PSL Research University, Paris, France
| | - Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells, University Medical Center of Montpellier, EA 2415, Montpellier University, Montpellier, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université de Paris, Paris, France
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11
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Bécourt S, Doucet L, Cohen-Haguenauer O, Ledoux F, Nguyen O, Campedel L, Giacchetti S, Cuvier C, Espié M, Teixeira L. Abstract P5-03-06: Comparison of clinicopathological features and outcome of breast cancer in BRCA-mutation carriers, in patients with a family history without BRCA-mutation and in patients with sporadic disease. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-03-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: BRCA1 and BRCA2 are two major susceptibility genes for breast cancer. We aimed to compare clinicopathological features and outcomes in BRCA1/2-mutation carriers patients, in patients with a family history suggesting hereditary breast cancer (HBC) without BRCA mutation (Eisinger score ≥ 5), and in patients with sporadic disease. METHODS: We retrospectively reviewed clinical and pathological data of 56 BRCA-mutation carriers (29 BRCA1, 27 BRCA2), 85 HBC patients and 70 sporadic breast cancer patients treated at Saint-Louis hospital between 1987 and 2017. Sporadic breast cancer patients were free from family history of cancer and randomly extracted from our database. We recorded age, clinicopathological features of breast tumors (tumor size, grade, nodal status, hormone receptor and c-erbB2 status), treatment type, ipsilateral relapse, contralateral breast cancer occurrence, distant metastasis and outcome (disease-free and overall survival). RESULTS: BRCA-mutated and HBC patients showed earlier age of onset of tumor (respectively 36, 42 and 40 years) than sporadic breast cancer patients (54 years, p<0.05). Relatives of HBC patients have developed significantly more different tumor-types than BRCA-mutated patient. BRCA1-mutated patients tumors were mostly triple-negative (62%, p<0,05) and grade 3 (83%, p<0,05), whereas the other groups presented mostly tumors of luminal subtype and grade 2. Of note, HBC and BRCA2-mutated patients shared similar clinical and pathological characteristics. Interestingly, HER2 overexpressed tumors were less represented in BRCA-mutated patients (4 and 10%) than in HBC and sporadic breast cancer patients (22% and 19%, p=0,06). BRCA1-mutated tumors were significantly more sensitive to chemotherapy, with a higher rate of clinicopathological complete response to neo-adjuvant chemotherapy (64%, p<0.05). BRCA1-mutated patients developed more contralateral breast cancers than sporadic breast cancer patients (p=0,01). No difference in RFS, DFMS or OS was observed between the different groups. CONCLUSION: clinicopathological characteristics and outcomes of HBC patients are similar to those of BRCA2-mutated patients. Ongoing multi-gene panel testing in this population will identify mutations in other relevant genes and provide new insights in genotype-phenotype correlation.
Citation Format: Stéphanie Bécourt, Ludovic Doucet, Odile Cohen-Haguenauer, Florence Ledoux, Olivia Nguyen, Luca Campedel, Sylvie Giacchetti, Caroline Cuvier, Marc Espié, Luis Teixeira. Comparison of clinicopathological features and outcome of breast cancer in BRCA-mutation carriers, in patients with a family history without BRCA-mutation and in patients with sporadic disease [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-03-06.
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Affiliation(s)
| | | | | | | | | | - Luca Campedel
- 3La Pitié-Salpêtrière Universitary Hospital, Paris, France
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12
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Abstract
Le traitement médical des cancers du sein s'est considérablement enrichi ces dernières années z Les indications thérapeutiques ont été affinées grâce à la classification moléculaire des cancers. La chimiothérapie restera encore pour quelques années indispensable notamment pour les cancers du sein triple négatif et surexprimant le récepteur 2 du facteur de croissance épidermique humain. De nouvelles molécules sont en développement pour contourner les mécanismes de résistance à l'hormonothérapie et en association pour en augmenter l'efficacité. L'avenir est aux thérapies ciblées qui visent les anomalies moléculaires de chaque cancer pour chaque patiente.
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Affiliation(s)
- Marc Espié
- Sénopole, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
| | - Gaëlle Douchet
- Sénopole, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
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13
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Jacot W, Cottu P, Berger F, Dubot C, Venat-Bouvet L, Lortholary A, Bourgeois H, Bollet M, Servent V, Luporsi E, Espié M, Guiu S, D'Hondt V, Dieras V, Sablin MP, Brain E, Neffati S, Pierga JY, Bidard FC. Actionability of HER2-amplified circulating tumor cells in HER2-negative metastatic breast cancer: the CirCe T-DM1 trial. Breast Cancer Res 2019; 21:121. [PMID: 31727113 PMCID: PMC6854749 DOI: 10.1186/s13058-019-1215-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this prospective phase 2 trial, we assessed the efficacy of trastuzumab-emtansine (T-DM1) in HER2-negative metastatic breast cancer (MBC) patients with HER2-positive CTC. METHODS Main inclusion criteria for screening were as follows: women with HER2-negative MBC treated with ≥ 2 prior lines of chemotherapy and measurable disease. CTC with a HER2/CEP17 ratio of ≥ 2.2 by fluorescent in situ hybridization (CellSearch) were considered to be HER2-amplified (HER2amp). Patients with ≥ 1 HER2amp CTC were eligible for the treatment phase (T-DM1 monotherapy). The primary endpoint was the overall response rate. RESULTS In 154 screened patients, ≥ 1 and ≥ 5 CTC/7.5 ml of blood were detected in N = 118 (78.7%) and N = 86 (57.3%) patients, respectively. ≥1 HER2amp CTC was found in 14 patients (9.1% of patients with ≥ 1 CTC/7.5 ml). Among 11 patients treated with T-DM1, one achieved a confirmed partial response. Four patients had a stable disease as best response. Median PFS was 4.8 months while median OS was 9.5 months. CONCLUSIONS CTC with HER2 amplification can be detected in a limited subset of HER2-negative MBC patients. Treatment with T-DM1 achieved a partial response in only one patient. TRIAL REGISTRATION NCT01975142, Registered 03 November 2013.
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Affiliation(s)
- William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France.,Montpellier University, Montpellier, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, PSL Research University, Saint Cloud, France
| | - Frederique Berger
- Biometry and Clinical Trial Promotion Units, Institut Curie, PSL Research University, Saint Cloud, France
| | - Coraline Dubot
- Department of Medical Oncology, Institut Curie, PSL Research University, Saint Cloud, France
| | | | - Alain Lortholary
- Department of Medical Oncology, Centre Catherine de Sienne, Nantes, France
| | - Hugues Bourgeois
- Department of Medical Oncology, Clinique Victor Hugo, Le Mans, France
| | - Marc Bollet
- Department of Radiation Therapy, Clinique Hartmann, Neuilly, France
| | | | - Elisabeth Luporsi
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Marc Espié
- Department of Medical Oncology, Hôpital Saint Louis, Paris, France
| | - Severine Guiu
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Veronique D'Hondt
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Veronique Dieras
- Department of Medical Oncology, Institut Curie, PSL Research University, Saint Cloud, France
| | - Marie-Paule Sablin
- Department of Medical Oncology, Institut Curie, PSL Research University, Saint Cloud, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, PSL Research University, Saint Cloud, France
| | - Souhir Neffati
- Biometry and Clinical Trial Promotion Units, Institut Curie, PSL Research University, Saint Cloud, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, PSL Research University, Saint Cloud, France.,Université Paris Descartes, Paris, France.,Laboratory of Circulating Tumor Biomarkers, Institut Curie, PSL Research University, Paris, France
| | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, PSL Research University, Saint Cloud, France. .,Université Paris Descartes, Paris, France. .,UVSQ, Paris Saclay University, Saint Cloud, France.
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14
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Bousquet G, Feugeas JP, Gu Y, Leboeuf C, Bouchtaoui ME, Lu H, Espié M, Janin A, Benedetto MD. High expression of apoptosis protein (Api-5) in chemoresistant triple-negative breast cancers: an innovative target. Oncotarget 2019; 10:6577-6588. [PMID: 31762939 PMCID: PMC6859922 DOI: 10.18632/oncotarget.27312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/26/2019] [Indexed: 11/25/2022] Open
Abstract
Anti-apoptotic protein-5 (API-5) is a survival protein interacting with the protein acinus, preventing its cleavage by caspase-3 and thus inhibiting apoptosis. We studied the effect of targeting API-5 in chemoresistant triple negative breast cancers (TNBCs), to reverse chemoresistance. 78 TNBC biopsies from patients with different responses to chemotherapy were analysed for API-5 expression before any treatment. Further studies on API-5 expression and inhibition were performed on patient-derived TNBC xenografts, one highly sensitive to chemotherapies (XBC-S) and the other resistant to most tested drugs (XBC-R). In situ assessments of necrosis, cell proliferation, angiogenesis, and apoptosis in response to anti-API-5 peptide were performed on the TNBC xenografts. Clinical analyses of the 78 TNBC biopsies revealed that API-5 was more markedly expressed in endothelial cells before any treatment among patients with chemoresistant TNBC, and this was associated with greater micro-vessel density. A transcriptomic analysis of xenografted tumors showed an involvement of anti-apoptotic genes in the XBC-R model, and API-5 expression was higher in XBC-R endothelial cells. API-5 expression was also correlated with hypoxic stress conditions both in vitro and in vivo. 28 days of anti-API-5 peptide efficiently inhibited the XBC-R xenograft via caspase-3 apoptosis. This inhibition was associated with major inhibition of angiogenesis associated with necrosis and apoptosis. API-5 protein could be a valid therapeutic target in chemoresistant metastatic TNBC.
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Affiliation(s)
- Guilhem Bousquet
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France.,INSERM, U942, F-75010, Paris, France.,Université Paris 13, Sorbonne Paris Cite, F-93000, Villetaneuse, France.,AP-HP, Hôpital Avicenne, Medical Oncology, F-93000, Bobigny, France
| | | | - Yuchen Gu
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France
| | - Christophe Leboeuf
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France.,INSERM, U942, F-75010, Paris, France
| | | | - He Lu
- INSERM, U942, F-75010, Paris, France
| | - Marc Espié
- AP-HP, Hôpital Saint-Louis, Centre des Maladies du Sein, F-75010, Université Paris Diderot, Sorbonne Paris Cité, INSERM CNRS UMR7212, Paris, France
| | - Anne Janin
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France.,INSERM, U942, F-75010, Paris, France.,AP-HP, Hôpital Saint-Louis, Laboratoire de Pathologie, F-75010, Paris, France
| | - Melanie Di Benedetto
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France.,INSERM, U942, F-75010, Paris, France.,Université Paris 13, Sorbonne Paris Cite, F-93000, Villetaneuse, France
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15
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Campedel L, Blanc-Durand P, Binasker A, Bécourt S, Ledoux F, Cuvier C, Gardair C, Teixeira L, De Roquancourt A, Lehmann Che J, Espié M, Giacchetti S. Outcome of triple negative inflammatory breast cancers (TNIBC) treated with dose dense neoadjuvant epirubicin cyclophosphmide, prognostic impact of pre and post neoadjuvant chemotherapy (NAC) tumour infiltrating lymphocytes (TIL) and post NAC lymphovascular invasion. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz241.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Pivot X, Romieu G, Debled M, Pierga JY, Kerbrat P, Bachelot T, Lortholary A, Espié M, Fumoleau P, Serin D, Jacquin JP, Jouannaud C, Rios M, Abadie-Lacourtoisie S, Venat-Bouvet L, Cany L, Catala S, Khayat D, Gambotti L, Pauporté I, Faure-Mercier C, Paget-Bailly S, Henriques J, Grouin JM. 6 months versus 12 months of adjuvant trastuzumab in early breast cancer (PHARE): final analysis of a multicentre, open-label, phase 3 randomised trial. Lancet 2019; 393:2591-2598. [PMID: 31178155 DOI: 10.1016/s0140-6736(19)30653-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/16/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2013, the interim analysis of the Protocol for Herceptin as Adjuvant therapy with Reduced Exposure (PHARE) trial could not show that 6 months of adjuvant trastuzumab was non-inferior to 12 months. Here, we report the planned final analysis based on the prespecified number of occurring events. METHODS PHARE is an open-label, phase 3, non-inferiority randomised trial of patients with HER2-positive early breast cancer comparing 6 months versus 12 months of trastuzumab treatment concomitant with or following standard neoadjuvant or adjuvant chemotherapy. The study was undertaken in 156 centres in France. Eligible patients were women aged 18 years or older with non-metastatic, operable, histologically confirmed adenocarcinoma of the breast and either positive axillary nodes or negative axillary nodes but a tumour of at least 10 mm. Participants must have received at least four cycles of a chemotherapy for this breast cancer and have started receiving adjuvant trastuzumab-treatment. Eligible patients were randomly assigned to either 6 months or 12 months of trastuzumab therapy duration between the third and sixth months of adjuvant trastuzumab. The randomisation was stratified by concomitant or sequential treatment with chemotherapy, oestrogen receptor status, and centre. The primary objective was non-inferiority in the intention-to-treat population in the 6-month group in terms of disease-free survival with a prespecified hazard margin of 1·15. This trial is registered with ClinicalTrials.gov, number NCT00381901. FINDINGS 3384 patients were enrolled and randomly assigned to either 12 months (n=1691) or 6 months (n=1693) of adjuvant trastuzumab. One patient in the 12-month group and three patients in the 6-month group were excluded, so 1690 patients in each group were included in the intention-to-treat analysis. At a median follow-up of 7·5 years (IQR 5·3-8·8), 704 events relevant to disease-free survival were observed (345 [20·4%] in the 12-month group and 359 [21·2%] in the 6-month group). The adjusted hazard ratio for disease-free survival in the 12-month group versus the 6-month group was 1·08 (95% CI 0·93-1·25; p=0·39). The non-inferiority margin was included in the 95% CI. No differences in effects pertaining to trastuzumab duration were found in any of the subgroups. After the completion of trastuzumab treatment, rare adverse events occurred over time and the safety analysis remained similar to the previously published report. In particular, we found no change in the cardiac safety comparison, and only three additional cases in which the left ventricular ejection fraction decreased to less than 50% have been reported in the 12-month group. INTERPRETATION The PHARE study did not show the non-inferiority of 6 months versus 12 months of adjuvant trastuzumab. Hence, adjuvant trastuzumab standard duration should remain 12 months. FUNDING The French National Cancer Institute.
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Affiliation(s)
| | | | | | | | | | | | | | - Marc Espié
- University Hospital Saint-Louis, Paris, France
| | | | | | | | | | - Maria Rios
- Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France
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17
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El Bouchtaoui M, Do Cruzeiro M, Leboeuf C, Loisel-Ferreira I, Fedronie C, Ferreira C, Ait El Far R, Ziol M, Espié M, Falgarone G, Cassinat B, Kiladjian JJ, Feugeas JP, Janin A, Bousquet G. A Constitutional Activating MET Mutation Makes the Genetic Link between Malignancies and Chronic Inflammatory Diseases. Clin Cancer Res 2019; 25:4504-4515. [DOI: 10.1158/1078-0432.ccr-18-3261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/16/2019] [Accepted: 04/15/2019] [Indexed: 11/16/2022]
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18
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Hamy AS, Tury S, Wang X, Gao J, Pierga JY, Giacchetti S, Brain E, Pistilli B, Marty M, Espié M, Benchimol G, Laas E, Laé M, Asselain B, Aouchiche B, Edelman M, Reyal F. Celecoxib With Neoadjuvant Chemotherapy for Breast Cancer Might Worsen Outcomes Differentially by COX-2 Expression and ER Status: Exploratory Analysis of the REMAGUS02 Trial. J Clin Oncol 2019; 37:624-635. [PMID: 30702971 DOI: 10.1200/jco.18.00636] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The overexpression of cyclooxygenase 2 (COX-2) gene, also known as prostaglandin-endoperoxide synthase 2 ( PTGS2), occurs in breast cancer, but whether it affects response to anticox drugs remains unclear. We investigated the relationships between PTGS2 expression, celecoxib use during neoadjuvant chemotherapy (NAC), and both event-free survival (EFS) and overall survival (OS). MATERIALS AND METHODS We analyzed a cohort of 156 patients with human epidermal growth factor receptor 2 -negative breast cancer from the REMAGUS02 (ISRCTN Registry No. 10059974) trial with pretreatment PTGS2 expression data. Patients were treated by sequential NAC (epirubicin plus cyclophosphamide followed by docetaxel with or without celecoxib). Experimental validation was performed on breast cancer cell lines. The Cancer and Leukemia Group B (CALGB) 30801 ( ClinicalTrials.gov identifier: NCT01041781) trial that tested chemotherapy with or without celecoxib in patients with lung cancer served as an independent validation cohort. RESULTS After 94.5 months of follow-up, EFS was significantly lower in the celecoxib group (hazard ratio [HR], 1.7; 95% CI, 1 to 2.88; P = .046). A significant interaction between PTGS2 expression and celecoxib use was detected ( Pinteraction = .01). In the PTGS2-low group (n = 100), EFS was lower in the celecoxib arm (HR, 3.01; 95% CI, 1.45 to 6.24; P = .002) than in the standard treatment arm. Celecoxib use was an independent predictor of poor EFS, distant relapse-free survival, and OS. Celecoxib in addition to docetaxel enhanced cell viability in PTGS2-low cell lines but not in PTGS2-high cell lines. In CALGB 30801, a trend toward poorer progression-free survival was observed in the patients with low urinary metabolite of prostaglandin E2 who received celecoxib (HR = 1.57; 95% CI, 0.87 to 2.84; P = .13). CONCLUSION Celecoxib use during chemotherapy adversely affected survival in patients with breast cancer, and the effect was more marked in PTGS2-low and/or estrogen receptor-negative tumors. COX-2 inhibitors should preferably be avoided during docetaxel use in patients with breast cancer who are undergoing NAC.
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Affiliation(s)
| | - Sandrine Tury
- 1 Institut Curie, Université Paris Descartes, Paris, France
| | - Xiaofei Wang
- 2 Alliance Statistics and Data Center, Durham, NC
| | - Junheng Gao
- 2 Alliance Statistics and Data Center, Durham, NC
| | | | - Sylvie Giacchetti
- 3 Hôpital Saint Louis (APHP), Université Paris Diderot, Paris, France
| | - Etienne Brain
- 1 Institut Curie, Université Paris Descartes, Paris, France
| | | | - Michel Marty
- 3 Hôpital Saint Louis (APHP), Université Paris Diderot, Paris, France
| | - Marc Espié
- 3 Hôpital Saint Louis (APHP), Université Paris Diderot, Paris, France
| | | | - Enora Laas
- 1 Institut Curie, Université Paris Descartes, Paris, France
| | - Marick Laé
- 1 Institut Curie, Université Paris Descartes, Paris, France
| | | | | | | | - Fabien Reyal
- 1 Institut Curie, Université Paris Descartes, Paris, France
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19
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Campedel L, Assoun S, Bécourt S, Nguyen O, Ledoux F, Doucet L, Espié M, Teixeira L. Toxicités sévères des immunothérapies du cancer. Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’immunothérapie représente une avancée récente et importante en cancérologie. Les inhibiteurs de checkpoints immunitaires, ciblant les protéines PD-1, PD-L1 et CTLA-4, sont les thérapies les plus prometteuses et sont utilisés dans la prise en charge de plusieurs cancers. Les toxicités associées à ces traitements sont généralement moins fréquentes et moins graves que celles associées aux chimiothérapies et à la plupart des thérapies ciblées. Cependant, il existe un certain nombre de toxicités spécifiques de ce type de traitement, qui peuvent parfois être sévères et dont les plus fréquentes sont les toxicités pulmonaire, digestive, endocrinienne et cutanée. Dans cette mise au point, nous reviendrons sur la fréquence, le mécanisme et les principes de traitement des différentes toxicités sévères associées à l’immunothérapie.
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20
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Espié M, Moley-Massol I, Zernik N, Debiais D, Diéras V. Metastatic Breast Cancer: Patient Journey, Patient Needs, and Expectations: Results of the RÉALITÉS National Survey. ONCOLOGIE 2018. [DOI: 10.3166/onco-2018-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Jacquinot Q, Paget-Bailly S, Fumoleau P, Romieu G, Pierga JY, Espié M, Lortholary A, Nabholtz JM, Mercier CF, Pauporté I, Henriques J, Pivot X. Fluctuation of the left ventricular ejection fraction in patients with HER2-positive early breast cancer treated by 12 months of adjuvant trastuzumab. Breast 2018; 41:1-7. [PMID: 29913374 DOI: 10.1016/j.breast.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/02/2018] [Accepted: 06/02/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cardiac toxicity with a decrease of the left ventricular ejection fraction (LVEF) is the main side effect induced by trastuzumab. This study reports the fluctuation of LVEF over the 12 months of adjuvant trastuzumab in PHARE trial (NCT00381901). METHODS LVEF assessment was performed every 3 months while patients received trastuzumab and after completion of treatment over the first 2 years and then every 6 months afterwards. The fluctuations of LVEF over time were described and a logistic regression model was performed investigating associated factors to LVEF perfect recovery at baseline value. RESULTS A total of 1631 patients who received 12 months of trastuzumab from PHARE trial, were considered in the analysis. A total of 13 881 LVEF measurements were assessed. Baseline mean LVEF was 66.08% (standard error (SE): 0.15) and the mean relative LVEF decrease observed at 12-month was 3.61% (SE: 0.31). No clinical characteristic was significantly associated to LVEF fluctuation. After completion of trastuzumab, the relative difference progressively disappeared with beyond 30 months a relative difference value of 0.08% (SE: 0.42). Nevertheless, at 30 months, 48.53% of patients with available measures (379/781) did not fully recover their baseline LVEF value. CONCLUSION The LVEF decreased during treatment with trastuzumab and rose up after the completion of treatment without coming back to the initial values for a substantial subset. These results would suggest investigating some strategies aimed to improve the ability to achieve a full recovery.
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Affiliation(s)
- Quentin Jacquinot
- UPFR des Sports, Université de Bourgogne Franche-Comté, Besançon, France; EA 3920: Marqueurs pronostiques et facteurs de régulation des pathologies cardiaques et vasculaires, CHU Jean-Minjoz, Besançon, France.
| | - Sophie Paget-Bailly
- INSERM UMR 1098: Unité de méthodologie et de qualité de vie en cancérologie, CHU Jean-Minjoz, Besançon, France.
| | | | | | | | - Marc Espié
- Hôpital Universitaire Saint-Louis, Paris, France.
| | | | | | | | | | - Julie Henriques
- INSERM UMR 1098: Unité de méthodologie et de qualité de vie en cancérologie, CHU Jean-Minjoz, Besançon, France.
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22
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Groheux D, Biard L, Lehmann-Che J, Teixeira L, Bouhidel FA, Poirot B, Bertheau P, Merlet P, Espié M, Resche-Rigon M, Sotiriou C, de Cremoux P. Tumor metabolism assessed by FDG-PET/CT and tumor proliferation assessed by genomic grade index to predict response to neoadjuvant chemotherapy in triple negative breast cancer. Eur J Nucl Med Mol Imaging 2018; 45:1279-1288. [DOI: 10.1007/s00259-018-3998-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/21/2018] [Indexed: 12/18/2022]
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23
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Cortes J, Perez-Garcia J, Levy C, Gómez Pardo P, Bourgeois H, Spazzapan S, Martínez-Jañez N, Chao TC, Espié M, Nabholtz J, Gonzàlez Farré X, Beliakouski V, Román García J, Holgado E, Campone M. Open-label randomised phase III trial of vinflunine versus an alkylating agent in patients with heavily pretreated metastatic breast cancer. Ann Oncol 2018; 29:881-887. [DOI: 10.1093/annonc/mdy051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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de Cremoux P, Biard L, Poirot B, Bertheau P, Teixeira L, Lehmann-Che J, Bouhidel FA, Merlet P, Espié M, Resche-Rigon M, Sotiriou C, Groheux D. 18FDG-PET/CT and molecular markers to predict response to neoadjuvant chemotherapy and outcome in HER2-negative advanced luminal breast cancers patients. Oncotarget 2018; 9:16343-16353. [PMID: 29662649 PMCID: PMC5893244 DOI: 10.18632/oncotarget.24674] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/26/2018] [Indexed: 11/25/2022] Open
Abstract
Background The efficacy of neoadjuvant chemotherapy regimens in advanced luminal breast cancer patients is difficult to predict. Intrinsic properties of breast tumors, including altered gene expression profile and dynamic evaluation of metabolic properties of tumor cells using positron emission tomography/computed tomography (PET/CT) of tumor cells, have been identified to guide patient's prognosis. The aim of this study is to determine if both analyses may improve the prediction of response to neoadjuvant chemotherapy in ER-positive / HER2-negative breast cancers (BCs) patients. Methods We used metabolic PET parameters, at diagnosis and after two cycles of chemotherapy and proliferation gene expression profile on biopsy at diagnosis, in particular, the genomic grade index (GGI) analyzed by reverse transcription and quantitative polymerase chain reaction (RT-qPCR). The pathological response was the surrogate endpoint. Results The change of FDG uptake between baseline PET and interim PET after 2 cycles of neoadjuvant chemotherapy (ΔSUVmax) was highly associated with pCR (p=0.008). We also observed an ability of P53 mutated status (p=0.042), in addition to histological grade (p=0. 0004), and PR expression (p=0.01) to predict pCR in ER-positive BCs, whereas no proliferation marker predicted pCR (P=0.39 for GGI). Finally, only ΔSUVmax was significantly associated with event free survival (p=0.047). Conclusions Our results confirm the predictive and prognostic value of tumor ΔSUVmax in ER-positive /HER2-negative advanced BCs patients. These findings can be helpful to select high-risk patients within trials investigating novel treatment strategies.
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Affiliation(s)
- Patricia de Cremoux
- Molecular Oncology Unit, Saint-Louis Hospital, Paris, France.,University Paris-Diderot, Sorbonne Paris Cité, INSERM/CNRS UMR944/7212, Paris, France
| | - Lucie Biard
- Department of Biostatistics, Saint-Louis Hospital, Paris, France.,University Paris-Diderot, Sorbonne Paris Cité, INSERM UMR 1153 ECSTRA team, Paris, France
| | - Brigitte Poirot
- Molecular Oncology Unit, Saint-Louis Hospital, Paris, France
| | - Philippe Bertheau
- Department of Pathology, Saint-Louis Hospital, Paris, France.,University Paris-Diderot, Sorbonne Paris Cité, INSERM UMR-S-1165, Paris, France
| | - Luis Teixeira
- University Paris-Diderot, Sorbonne Paris Cité, INSERM/CNRS UMR944/7212, Paris, France.,Breast Diseases Unit, Saint-Louis Hospital, Paris, France
| | - Jacqueline Lehmann-Che
- Molecular Oncology Unit, Saint-Louis Hospital, Paris, France.,University Paris-Diderot, Sorbonne Paris Cité, INSERM/CNRS UMR944/7212, Paris, France
| | | | - Pascal Merlet
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
| | - Marc Espié
- University Paris-Diderot, Sorbonne Paris Cité, INSERM/CNRS UMR944/7212, Paris, France.,Breast Diseases Unit, Saint-Louis Hospital, Paris, France
| | - Matthieu Resche-Rigon
- Department of Biostatistics, Saint-Louis Hospital, Paris, France.,University Paris-Diderot, Sorbonne Paris Cité, INSERM UMR 1153 ECSTRA team, Paris, France
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - David Groheux
- University Paris-Diderot, Sorbonne Paris Cité, INSERM/CNRS UMR944/7212, Paris, France.,Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
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25
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Bousquet G, El Bouchtaoui M, Sophie T, Leboeuf C, de Bazelaire C, Ratajczak P, Giacchetti S, de Roquancourt A, Bertheau P, Verneuil L, Feugeas JP, Espié M, Janin A. Targeting autophagic cancer stem-cells to reverse chemoresistance in human triple negative breast cancer. Oncotarget 2018; 8:35205-35221. [PMID: 28445132 PMCID: PMC5471047 DOI: 10.18632/oncotarget.16925] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 03/21/2017] [Accepted: 03/29/2017] [Indexed: 01/16/2023] Open
Abstract
There is growing evidence for the role of cancer stem-cells in drug resistance, but with few in situ studies on human tumor samples to decipher the mechanisms by which they resist anticancer agents.Triple negative breast cancer (TNBC) is the most severe sub-type of breast cancer, occurring in younger women and associated with poor prognosis even when treated at a localized stage.We investigated here the relationship between complete pathological response after chemotherapy and breast cancer stem-cell characteristics in pre-treatment biopsies of 78 women with triple negative breast carcinoma (TNBC).We found that chemoresistance was associated with large numbers of breast cancer stem-cells, and that these cancer stem-cells were neither proliferative nor apoptotic, but in an autophagic state related to hypoxia. Using relevant pharmacological models of patient-derived TNBC xenografts, we further investigated the role of autophagy in chemoresistance of breast cancer stem-cells. We demonstrated that hypoxia increased drug resistance of autophagic TNBC stem-cells, and showed that molecular or chemical inhibition of autophagic pathway was able to reverse chemoresistance.Our results support breast cancer stem-cell evaluation in pre-treatment biopsies of TNBC patients, and the need for further research on autophagy inhibition to reverse resistance to chemotherapy.
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Affiliation(s)
- Guilhem Bousquet
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,INSERM, Paris, France.,Université Paris 13, Villetaneuse, France.,AP, HP, Avicenne, Service Oncologie, Paris, France
| | | | | | - Christophe Leboeuf
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,INSERM, Paris, France
| | - Cédric de Bazelaire
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,INSERM, Paris, France.,AP HP Hôpital Saint-Louis, Service Radiologie, Paris, France
| | - Philippe Ratajczak
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,INSERM, Paris, France
| | | | - Anne de Roquancourt
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,INSERM, Paris, France.,AP HP Hôpital Saint-Louis, Service Pathologie, Paris, France
| | - Philippe Bertheau
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,INSERM, Paris, France.,AP HP Hôpital Saint-Louis, Service Pathologie, Paris, France
| | - Laurence Verneuil
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,INSERM, Paris, France
| | | | - Marc Espié
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,AP HP Hôpital Saint-Louis, Centre Maladies Sein, Paris, France
| | - Anne Janin
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire Pathologie, Paris, France.,INSERM, Paris, France.,AP HP Hôpital Saint-Louis, Service Pathologie, Paris, France
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Debourdeau P, Espié M, Chevret S, Gligorov J, Elias A, Dupré PF, Desseaux K, Kalidi I, Villiers S, Giachetti S, Frere C, Farge D. Incidence, risk factors, and outcomes of central venous catheter-related thromboembolism in breast cancer patients: the CAVECCAS study. Cancer Med 2017; 6:2732-2744. [PMID: 28980454 PMCID: PMC5673948 DOI: 10.1002/cam4.1201] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/16/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022] Open
Abstract
Previous epidemiologic studies investigating central venous catheter (CVC)‐related venous thromboembolism (CRT) were conducted in heterogenous cancer populations and data in breast cancer (BC) remain limited. To investigate the Doppler ultrasound (DUS)‐CRT incidence, risk factors and outcomes in BC, we designed a prospective, multicenter cohort of nonmetastatic invasive BC patients undergoing insertion of a CVC for chemotherapy. All patients underwent double‐blind DUS before, 7, 30, and 90 days after CVC insertion and a 6 months clinical follow‐up. Symptomatic DUS‐CRT were treated by anticoagulants. D‐Dimers, thrombin generation, and platelet‐derived microparticles were measured before and 2 days after CVC placement. In DUS‐CRT patients, a nested case–control study analyzed the role of thrombophilia. Among 524 patients, the DUS‐CRT (14 symptomatic, 46 asymptomatic) cumulative probability was 9.6% at 3 months and 11.5% at 6 months (overall incidence rate: 2.18/100 patient‐months). Ten/14 symptomatic DUS‐CRT were detected on double‐blind DUS before the clinical symptoms, and 3/14 had a simultaneous pulmonary embolism. No clinical thrombotic event subsequently occurred in untreated asymptomatic DUS‐CRT. Age >50 years (OR, 1.80; 95% CI, 1.01–3.22), BMI >30 kg/m² (OR, 2.64; 95% CI, 1.46–4.76) and comorbidities (OR, 2.05; 95% CI, 1.18–3.56) were associated with DUS‐CRT. No biomarkers was found to predict DUS‐CRT. In multivariate analysis, BMI >30 kg/m² (OR, 2.66; 95%CI, 1.46–4.84) and lobular carcinoma histology (OR, 2.56; 95%CI, 1.32–4.96) remained the only significant DUS‐CRT risk factors. Thrombophilia did not account for DUS‐CRT. Only clinical parameters identified high risk DUS‐CRT patients who may be considered for thromboprophylaxis.
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Affiliation(s)
| | - Marc Espié
- Breast Cancer Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,University Paris Diderot, Paris, France
| | - Sylvie Chevret
- University Paris Diderot, Paris, France.,Biostatistic Department and Medical Informatics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joseph Gligorov
- Medical Oncology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Francilian Breast Intergroup, APREC, IUC-UPMC Sorbonne University, Paris, France
| | - Antoine Elias
- Department of Vascular Medicine, Sainte Musse Hospital, Toulon, France
| | | | - Kristell Desseaux
- University Paris Diderot, Paris, France.,Biostatistic Department and Medical Informatics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Issa Kalidi
- Department of Biology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stephane Villiers
- Department of Anesthesiology and Reanimation, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvie Giachetti
- Breast Cancer Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,University Paris Diderot, Paris, France
| | - Corinne Frere
- Department of Haematology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, UMR_S 1166, Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Paris, France
| | - Dominique Farge
- University Paris Diderot, Paris, France.,Internal Medicine Unit: Autoimmune and Vascular Diseases, UF 04, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France
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Espié M, Bécourt S, Ledoux F. Cancer lobulaire infiltrant : épidémiologie, histoire naturelle, principes thérapeutiques. Imagerie de la Femme 2017. [DOI: 10.1016/j.femme.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Kim SB, Dent R, Im SA, Espié M, Blau S, Tan AR, Isakoff SJ, Oliveira M, Saura C, Wongchenko MJ, Kapp AV, Chan WY, Singel SM, Maslyar DJ, Baselga J. Ipatasertib plus paclitaxel versus placebo plus paclitaxel as first-line therapy for metastatic triple-negative breast cancer (LOTUS): a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Oncol 2017; 18:1360-1372. [PMID: 28800861 DOI: 10.1016/s1470-2045(17)30450-3] [Citation(s) in RCA: 341] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The oral AKT inhibitor ipatasertib is being investigated in cancers with a high prevalence of PI3K/AKT pathway activation, including triple-negative breast cancer. The LOTUS trial investigated the addition of ipatasertib to paclitaxel as first-line therapy for triple-negative breast cancer. METHODS In this randomised, placebo-controlled, double-blind, phase 2 trial, women aged 18 years or older with measurable, inoperable, locally advanced or metastatic triple-negative breast cancer previously untreated with systemic therapy were recruited from 44 hospitals in South Korea, the USA, France, Spain, Taiwan, Singapore, Italy, and Belgium. Enrolled patients were randomly assigned (1:1) to receive intravenous paclitaxel 80 mg/m2 (days 1, 8, 15) with either ipatasertib 400 mg or placebo once per day (days 1-21) every 28 days until disease progression or unacceptable toxicity. Randomisation was by stratified permuted blocks (block size of four) using an interactive web-response system with three stratification criteria: previous (neo)adjuvant therapy, chemotherapy-free interval, and tumour PTEN status. The co-primary endpoints were progression-free survival in the intention-to-treat population and progression-free survival in the PTEN-low (by immunohistochemistry) population. This ongoing trial is registered with ClinicalTrials.gov (NCT02162719). FINDINGS Between Sept 2, 2014, and Feb 4, 2016, 166 patients were assessed for eligibility and 124 patients were enrolled and randomly assigned to paclitaxel plus ipatasertib (n=62) or paclitaxel plus placebo (n=62). Median follow-up was 10·4 months (IQR 6·5-14·1) in the ipatasertib group and 10·2 months (6·0-13·6) in the placebo group. Median progression-free survival in the intention-to-treat population was 6·2 months (95% CI 3·8-9·0) with ipatasertib versus 4·9 months (3·6-5·4) with placebo (stratified hazard ratio [HR] 0·60, 95% CI 0·37-0·98; p=0·037) and in the 48 patients with PTEN-low tumours, median progression-free survival was 6·2 months (95% CI 3·6-9·1) with ipatasertib versus 3·7 months (1·9-7·3) with placebo (stratified HR 0·59, 95% CI 0·26-1·32, p=0·18). The most common grade 3 or worse adverse events were diarrhoea (14 [23%] of 61 ipatasertib-treated patients vs none of 62 placebo-treated patients), neutrophil count decreased (five [8%] vs four [6%]), and neutropenia (six [10%] vs one [2%]). No colitis, grade 4 diarrhoea, or treatment-related deaths were reported with ipatasertib. One treatment-related death occurred in the placebo group. Serious adverse events were reported in 17 (28%) of 61 patients in the ipatasertib group and nine (15%) of 62 patients in the placebo group. INTERPRETATION Progression-free survival was longer in patients who received ipatasertib than in those who received placebo. To our knowledge, these are the first results supporting AKT-targeted therapy for triple-negative breast cancer. Ipatasertib warrants further investigation for the treatment of triple-negative breast cancer. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Marc Espié
- Breast Disease Center, Hospital Saint Louis, Paris, France
| | - Sibel Blau
- Northwest Medical Specialties and Division of Oncology, University of Washington, Washington, WA, USA
| | - Antoinette R Tan
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | | | - Mafalda Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Cristina Saura
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Amy V Kapp
- Genentech Inc, South San Francisco, CA, USA
| | - Wai Y Chan
- Genentech Inc, South San Francisco, CA, USA
| | | | - Daniel J Maslyar
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - José Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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29
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Guillerm S, Bourstyn E, Itti R, Fumagalli I, Martin V, Cahen-Doidy L, Quero L, Giacchetti S, Cuvier C, Espié M, Hennequin C. EP-1150: Preliminary results of Intra-Operative RadioTherapy in old women with good prognostic features. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31586-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Giacchetti S, Hamy AS, Delaloge S, Brain E, Berger F, Sigal-Zafrani B, Mathieu MC, Bertheau P, Guinebretière JM, Saghatchian M, Lerebours F, Mazouni C, Tembo O, Espié M, Reyal F, Marty M, Asselain B, Pierga JY. Long-term outcome of the REMAGUS 02 trial, a multicenter randomised phase II trial in locally advanced breast cancer patients treated with neoadjuvant chemotherapy with or without celecoxib or trastuzumab according to HER2 status. Eur J Cancer 2017; 75:323-332. [PMID: 28279941 DOI: 10.1016/j.ejca.2017.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The REMAGUS-02 multicenter randomised phase II trial showed that the addition to neoadjuvant chemotherapy (NAC) of trastuzumab in patients with localised HER2-positive breast cancer (BC) increased the pathological complete response (pCR) rate and that the addition of celecoxib in HER2-negative cases did not increase the pCR rate. We report here the long-term follow-up results for disease-free survival (DFS) and overall survival (OS). PATIENTS AND METHODS From 2004 to 2007, 340 stage II-III BC patients were randomly assigned to receive neoadjuvant EC-T (four cycles of epirubicin-cyclophosphamide followed by four cycles of docetaxel) +/- celecoxib in HER2-negative cases (n = 220) and ± trastuzumab in HER2-positive cases (n = 120). From September 2005, all patients with HER2-positive BC received adjuvant T (n = 106). RESULTS Median follow-up was nearly 8 years (94.4 months, 20-127 m). In the HER2-negative subgroup, addition of celecoxib was not associated with a DFS benefit. Favourable factors were smaller tumour size, expression of progesterone receptor status (PgR) and pCR. In the HER2-positive population, neoadjuvant trastuzumab was not associated with a DFS benefit. Axillary pCR was the only prognostic factor associated with DFS in this group [HR = 0.44, 95% CI = 0.2-0.97], p = 0.035]. To note, DFS and OS were significantly higher in the HER2-positive than in HER2-negative BC patients (HR = 0.58 [0.36-0.92], p = 0.021). CONCLUSION Celecoxib combined with NAC provided neither pCR nor survival benefit in patients with HER2-negative BC. Absence of PgR is a major prognostic factor. Neoadjuvant trastuzumab increased pCR rates without translation into a DFS or OS benefit compared with adjuvant trastuzumab only. Axillary pCR could be a more relevant surrogate of survival than in the breast in HER2-positive population. A retrospective comparison shows that patients with HER2-positive tumours have a better outcome than HER2-negative BC patients showing the impact of trastuzumab on the natural history of BC.
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Affiliation(s)
- Sylvie Giacchetti
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France.
| | - Anne-Sophie Hamy
- Institut Curie, PSL Research University, Translational Research Department, INSERM, U932 Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory (RT2Lab), Paris, France
| | - Suzette Delaloge
- Medical Oncology Department, Gustave Roussy, Cancer Center Villejuif, France
| | - Etienne Brain
- Medical Oncology Department, Institut Curie, Saint Cloud, Paris, France
| | | | | | | | - Philippe Bertheau
- AP-HP, Hôpital Saint-Louis, Pathology Department, University Paris Diderot, Paris, France
| | | | - Mahasti Saghatchian
- Medical Oncology Department, Gustave Roussy, Cancer Center Villejuif, France
| | | | - Chafouny Mazouni
- Department of Surgery, Gustave Roussy, Cancer Center Villejuif, France
| | - Olivier Tembo
- Center for Therapeutic Innovations in Oncology and Haematology (CITOH), APHP, Hôpital Saint-Louis, Paris, France
| | - Marc Espié
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France
| | - Fabien Reyal
- Institut Curie, PSL Research University, Translational Research Department, INSERM, U932 Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory (RT2Lab), Paris, France; Department of Surgery, Institut Curie, Paris, France
| | - Michel Marty
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, 75475 Paris, France; Center for Therapeutic Innovations in Oncology and Haematology (CITOH), APHP, Hôpital Saint-Louis, Paris, France
| | | | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, Saint Cloud, Paris, France; Université Paris Descartes, Sorbonne Paris Cite, Paris, France
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31
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Groheux D, Martineau A, Teixeira L, Espié M, de Cremoux P, Bertheau P, Merlet P, Lemarignier C. 18FDG-PET/CT for predicting the outcome in ER+/HER2- breast cancer patients: comparison of clinicopathological parameters and PET image-derived indices including tumor texture analysis. Breast Cancer Res 2017; 19:3. [PMID: 28057031 PMCID: PMC5217422 DOI: 10.1186/s13058-016-0793-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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: 08/29/2016] [Accepted: 12/06/2016] [Indexed: 12/21/2022] Open
Abstract
Background This study investigated the value of some clinicopathological parameters and 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) indices, including textural features, to predict event-free survival (EFS) in estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) locally advanced breast cancer (BC) patients. Methods FDG-PET/CT indices and clinicopathological parameters were assessed before neoadjuvant chemotherapy (NAC). After completion of chemotherapy, all patients had breast surgery with axillary lymph node dissection, followed by radiation therapy and endocrine therapy for 5 years. EFS was estimated using the Kaplan-Meier method. A Cox proportional hazard regression model was used for multivariate analysis. Results One hundred forty-three consecutive patients with stage II–III ER+/HER2- BC and without distant metastases at baseline PET were included. High standardized uptake values (SUVs), were associated with shorter EFS (HR = 3.51, P < 0.01 for SUVmax; HR = 2.76, P = 0.02 for SUVmean; and HR = 4.40 P < 0.01 for SUVpeak). Metabolically active tumor volume (MATV, HR = 3.47, P < 0.01) and total lesion glycolysis (TLG, HR = 3.10, P < 0.01) were also predictive of EFS. Homogeneity was not predictive (HR = 2.27, P = 0.07) and entropy had weak prediction (HR = 2.89, P = 0.02). Among clinicopathological parameters, EFS was shorter in progesterone receptor (PR)-negative tumor (vs. PR-positive tumor; HR = 3.25, P < 0.01); histology was predictive of EFS (lobular vs. ductal invasive carcinoma; HR = 3.74, P = 0.01) but not tumor grade (grade 3 vs. grade 1–2; HR = 1.64, P = 0.32). Pathological complete response after NAC was not correlated to the risk of relapse. Three parameters remained significantly associated with EFS in multivariate analysis. MATV (HR = 1.01, P < 0.01), progesterone receptor expression (HR = 2.90, P = 0.03) and tumor histology (HR = 3.80, P = 0.02). Conclusions Baseline PET parameters measured before neoadjuvant treatment have prognostic values in ER+/HER2- locally advanced breast cancer patients. After multivariate analysis, metabolically active tumor volume remains significant while textural analysis of PET images is not of added value. Considering histopathological parameters, our study shows that patients with PR-negative or lobular invasive tumor have poorer prognosis than patients with PR-positive or ductal carcinoma, respectively.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France. .,University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France.
| | | | - Luis Teixeira
- University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France.,Breast Diseases Unit, Saint-Louis Hospital, Paris, France
| | - Marc Espié
- University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France.,Breast Diseases Unit, Saint-Louis Hospital, Paris, France
| | - Patricia de Cremoux
- University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France.,Department of Biochemistry, Saint-Louis Hospital, Paris, France
| | | | - Pascal Merlet
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
| | - Charles Lemarignier
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France.,University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France
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32
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Luporsi E, Toledano A, Spaeth D, Scotté F, Espié M, Perot S, Duvillié L, Pithois Merli I, Bugat R. Use of iron sucrose and red blood cell transfusions in anaemic cancer patients in France (OncoFer study). Support Care Cancer 2016; 25:973-982. [PMID: 27915456 DOI: 10.1007/s00520-016-3489-3] [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: 06/15/2016] [Accepted: 11/07/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE This report describes the results of an observational, retrospective cohort study, evaluating the use of iron sucrose (IS) and red blood cell (RBC) transfusions in patients with cancer in routine clinical practice in France. A parallel investigated cohort treated with ferric carboxymaltose (FCM) has been reported earlier. METHODS Data of patients with a solid tumour or haematological malignancy who have received IS or an RBC transfusion during 2010 from 3 months prior (M-3) to 3 months post first treatment (M+3) were analysed. RESULTS Data from 46 patients who had received IS (400 mg median total iron dose) and 357 patients who had received RBC transfusions as first treatment (baseline) were included. Median haemoglobin levels improved from 9.9 g/dL (interquartile range 9.2; 11.0 g/dL) at baseline to 12.4 g/dL (11.4; 13.1 g/dL) at M+3 in IS-treated patients and from 8.2 g/dL (7.8; 8.8 g/dL) at baseline to 10.1 g/dL (8.8; 11.1 g/dL) in transfused patients. An erythropoiesis-stimulating agent was given to 54.3 and 28.9% of patients in the IS and the RBC transfusion groups, respectively, resulting in slightly better mean haemoglobin increase in both groups (2.4 vs 1.5 g/dL and 2.0 vs 1.6 g/dL, respectively). No severe nor serious adverse reaction and no hypersensitivity reactions were reported. CONCLUSION Both IS and RBC transfusions effectively increased Hb levels in patients with cancer. IS was safe and well tolerated in this population. Considering prior reported results with FCM, using FCM may reduce ESA dose requirements and the required number of infusions.
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Affiliation(s)
- Elisabeth Luporsi
- Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France.
- Oncologue médical, Biostatisticien, Généticien, PMSI Oncomed, Coordination réseau lorrain GENECAL, Institut de Cancérologie de Lorraine Alexis Vautrin, Avenue de Bourgogne, F 54511, Vandoeuvre-Les-Nancy, France.
| | | | | | | | | | | | | | | | - Roland Bugat
- Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
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Soria JC, Bastian G, Bolotine L, Calais G, Céraline J, de Cremoux P, Espié M, Karayan-Tapon L, Laprie A, Mazeron JJ, Négrier S, Roché H. [Academic carriers in oncology and radiotherapy: Explanations for the readers of Bulletin du Cancer]. Bull Cancer 2016; 103:719-29. [PMID: 27561824 DOI: 10.1016/j.bulcan.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jean-Charles Soria
- Gustave-Roussy, université Paris-Saclay, département d'innovation thérapeutique et essais précoces (DITEP), 94805 Villejuif, France
| | | | - Lina Bolotine
- Institut de cancérologie de Lorraine, université de Lorraine, 54511 Vandœuvre-les-Nancy, France
| | - Gilles Calais
- Hôpital Bretonneau, clinique d'oncologie et de radiothérapie (CORAD), CHU de Tours, 37000 Tours France
| | - Jocelyn Céraline
- Hôpitaux universitaires de Strasbourg, université de Strasbourg, 67091 Strasbourg, France
| | | | - Marc Espié
- Hôpital Saint-Louis, AP-HP, université Paris-Diderot, 75010 Paris, France
| | - Lucie Karayan-Tapon
- CHRU de Poitiers La Milétrie, faculté de médecine, université de Poitiers, laboratoire de cancérologie biologique, 86021 Poitiers, France
| | - Anne Laprie
- Institut Claudius-Regaud, IUCT-oncopole, université Paul-Sabatier, 31059 Toulouse, France
| | | | - Sylvie Négrier
- Centre Léon-Bérard, université de Lyon, 69008 Lyon, France
| | - Henri Roché
- Institut Claudius-Regaud, IUCT-oncopole, université Paul-Sabatier, 31059 Toulouse, France.
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Cochereau D, Da Costa S, Le Maignan C, Gauthier H, Cochereau J, Espié M, Giacchetti S, Teixeira L. [Intrathecal methotrexate in breast cancer meningeal carcinomatosis - Experience with a new administration schedule]. Bull Cancer 2016; 103:444-54. [PMID: 26987841 DOI: 10.1016/j.bulcan.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/06/2016] [Accepted: 02/08/2016] [Indexed: 12/30/2022]
Abstract
Methotrexate represents the standard intrathecal treatment of breast cancer meningeal carcinomatosis. However, its optimal schedule remains undefined. The aim of the present study was to evaluate results obtained with the methotrexate schedule used in Saint-Louis hospital (Paris). Patients followed in Saint-Louis hospital for breast cancer and who received intrathecal methotrexate were included in this retrospective monocentric study. Intrathecal treatment received contained methotrexate 12 mg/day (days: 1-5) and then 15 mg/week until progression or toxicity. Between 2003 and 2015, 41 patients were included. Primitive tumours were RH+/HER2-, HER2+ and triple-negative in respectively 66%, 14%, 5% and 15% of patients, 22% of them had meningeal carcinomatosis as metastatic disease initial manifestation. Objective response rate was 54%, median overall survival was 4.0 mois [CI 95%: 3-7.3] and 1-year survival rate was 15.2% (11.4%, 50% et 0% in RH+/HER2-, HER2+ and triple-negative subgroups; HR=0.45 [0.21-0.97] between HER2+ and RH+/HER2-). In univariate analysis, prognostic factors were brain involvement (p=0.049), initial cerebrospinal fluid protein level (p=0.0002) and concomitant systemic treatment received (p=0.049). This intrathecal methotrexate schedule demonstrates a similar median overall survival as the one obtained with a dose-dense schedule and an improved quality of life. Nevertheless, as the objective response and 1-year survival rates are slightly inferior, a dose-dense schedule remains still preferred in HER2+ patients or in those harboring a mainly meningeal progression.
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Affiliation(s)
- Delphine Cochereau
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Sabrina Da Costa
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Christine Le Maignan
- AP-HP, hôpital Saint-Louis, service d'oncologie médicale, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Hélène Gauthier
- AP-HP, hôpital Saint-Louis, service d'oncologie médicale, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Jérôme Cochereau
- CHRU, hôpital Gui-de-Chauliac, service de neurochirurgie, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - Marc Espié
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, UFR de médecine, 75890 Paris cedex 18, France
| | - Sylvie Giacchetti
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Luis Teixeira
- AP-HP, hôpital Saint-Louis, centre des maladies du sein, 1, avenue Claude-Vellefaux, 75010 Paris, France; AP-HP, hôpital Saint-Louis, service d'oncologie médicale, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, UFR de médecine, 75890 Paris cedex 18, France
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Giacchetti S, De Roquancourt A, Groheux D, Piron P, Lehmann-che J, Cuvier C, Resche-rigon M, Albiter M, Roche B, Frank S, Hamy AS, Teixeira L, Marty M, Lalloum M, Espié M. Abstract P1-14-08: Prediction of pathological response (pCR) to neoadjuvant dose dense and intense cyclophosphamide and anthracycline in a prospective series of triple negative locally advanced breast cancers (TNLABC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Stage II-III TNBC retains a poor outcome despite high chemosensitivity. Patients (pts) with pCR after neoadjuvant chemotherapy have a good prognosis whereas non-responding pts have a 25-40% risk of distant relapse at 5 years. pCR is thus a major goal in TNBC. We previously reported that TNLABC benefit the most of dose dense dose intense cyclophosphamide (C)-epirubicin (E) (S.Giacchetti; BJC, 2014)
Aim: To confirm these results prospectively and analyze the predictive factors of response to high dose chemotherapy in TNBC.
Patients and methods: From january 2009 to april 2015 non inflammatory TNLABC received high dose C (1200 mg/m2 d1 qw 2) with E (75 mg/m2/ d1 qw2) for 6 cycles. The pts had a breast biopsy with frozen tissue. We performed molecular studies: qRT-PCR for AR, FOXA1, PI3K and FASAY technic for p53 mutation.The percentage of stromal Tumor-infiltrating lymphocytes (TILs) was also evaluated by two independent pathologists and assessed as a continuous variable. A18F-FDG PET/CT was performed initially and after 2 courses of chemotherapy and the metabolic answer assessed as a variation of the tumor uptake (ΔSUVmax). We report here the pathological complete response (pCR) (absence of infiltrative carcinomas in the breast and in the lymph nodes) and the factors associated with pCR.
Results: The characteristics of the 74 pts are listed in table 1. The median age is 48 years old, 48 pts (65.8%) are premenopausal and 79% did not have any family history of breast cancers. TIL was divided in 3 groups < 10 % (26 pts, 40 %); 10-50 % (30 pts, 46 %) > 50% (9 pts, 14 %). Pathological response was assessed in 66 pts, one pt progressed during chemotherapy and 6 pts did not undergo surgery yet. 28 pts were in pCR (42.4 %). With a median follow up of 25 months, 13 pts (17.8 %) progressed and 8 (11%) died.
Table 1: Patients characteristics and pCR according to tumor features and metabolic responseCharacteristicsNumber of pts (%)N of pts evaluated for pCRpCR (%)OR [IC 95%]p-valueTumor size T2363519 (54)10.04T337319 (29)0.34 [0.12 ; 0.96]Nodal status N0363315 (46)10.62N1/N2/N3 24/11/33313 (39)0.78 [0.29 ; 2.07]Histological grade: 2660 (0) 0.04*3676028 (47)TILs <10 %26 (40)2510 (40)10.02610-50 %30 (46)267 (27)0.55 [0.17 ; 1.80]≥ 509 (14)9 7 (78)5.25 [0.90 ; 30.62]P53 Mutated54 (89)5121 (41)10.43WT7 (12)53 (60)2.14 [0.33; 13.96]AR Negative43 (83)4318 (42)10.46Positive 9 (17)95 (56)1.74 [0.41 ; 7.38]FOXA1 Negative40 (77)4015 (38)10.08Positive 12 (23)128 (60) 3.33 [0.86 ; 12.99]Molecular Apocrine8 (17)85 (63)10.19TN38 (83)3814 (37)0.35 [0.07 ; 1.69]PI3K Non mutated44 (88)4419 (43)10.75Mutated6 (12)63 (50)1.31 [0.24 ; 7.26]SUVmax at 2 courses0.0001< 70 %27 (53)221 (5)1≥ 70 %24 (47)2318 (78)79.2 [8.48 ; 739.82]* Measured with a Fisher Test
Tumor size, tumor grade, percentage of TILs, the change in 18F-fluorodeoxyglucose tumor uptake (ΔSUVmax) were significantly associated with pCR at univariate analysis. Only one factor remained significant at multivariate analysis, the ΔSUVmax, OR: 0.04 [0.007- 0.27], p = 0.0008.
Conclusion: In this prospective phase III trial we confirm the efficacy of a dose dense EC in TNBC. The metabolic response evaluated with 18 F-FDG PET/CT is a strong and reliable predictor of pCR and could allow an early change of treatment for the non responders. A clinical trial is planned to test this strategy.
Citation Format: Giacchetti S, De Roquancourt A, Groheux D, Piron P, Lehmann-che J, Cuvier C, Resche-rigon M, Albiter M, Roche B, Frank S, Hamy A-S, Teixeira L, Marty M, Lalloum M, Espié M. Prediction of pathological response (pCR) to neoadjuvant dose dense and intense cyclophosphamide and anthracycline in a prospective series of triple negative locally advanced breast cancers (TNLABC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-08.
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Affiliation(s)
- S Giacchetti
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - A De Roquancourt
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - D Groheux
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - P Piron
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - J Lehmann-che
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - C Cuvier
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - M Resche-rigon
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - M Albiter
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - B Roche
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - S Frank
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - A-S Hamy
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - L Teixeira
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - M Marty
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - M Lalloum
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
| | - M Espié
- Breast Disease Unit, Hôpital Saint Louis, Paris, France; Hôpital Saint Louis, Paris, France; Biochemistry Department, Paris, France; Department of Biostatistics, Paris, France; Department of Radiology, Paris, France; Institut Curie, Paris, France
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Groheux D, Biard L, Giacchetti S, Teixeira L, Hindié E, Cuvier C, Vercellino L, Merlet P, de Roquancourt A, de Cremoux P, Resche-Rigon M, Espié M. 18F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen. J Nucl Med 2015; 57:536-43. [DOI: 10.2967/jnumed.115.163907] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/23/2015] [Indexed: 02/01/2023] Open
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Cortés J, Dieras V, Ro J, Barriere J, Bachelot T, Hurvitz S, Le Rhun E, Espié M, Kim SB, Schneeweiss A, Sohn JH, Nabholtz JM, Kellokumpu-Lehtinen PL, Taguchi J, Piacentini F, Ciruelos E, Bono P, Ould-Kaci M, Roux F, Joensuu H. Afatinib alone or afatinib plus vinorelbine versus investigator's choice of treatment for HER2-positive breast cancer with progressive brain metastases after trastuzumab, lapatinib, or both (LUX-Breast 3): a randomised, open-label, multicentre, phase 2 trial. Lancet Oncol 2015; 16:1700-10. [PMID: 26596672 DOI: 10.1016/s1470-2045(15)00373-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with advanced HER2-positive breast cancer frequently develop CNS metastases. The metastases that progress after brain radiotherapy and HER2-targeted systemic therapy are a difficult therapeutic challenge. We aimed to assess the efficacy and safety of afatinib, an irreversible blocker of the ErbB protein family, alone or combined with vinorelbine, compared with treatment of the investigator's choice in women with HER2-positive breast cancer with progressive brain metastases during or after treatment with trastuzumab, lapatinib, or both. METHODS We did this randomised, open-label, multicentre, phase 2 trial in 40 hospitals in Canada, Finland, France, Germany, Italy, Spain, South Korea, and the USA. Women older than 18 years with histologically confirmed HER2-overexpressing breast cancer and CNS recurrence or progression as determined by Response Evaluation Criteria in Solid Tumors (RECIST version 1.1) during or after treatment with trastuzumab, lapatinib, or both, were eligible. We randomly assigned patients (1:1:1) centrally to afatinib 40 mg orally once per day, afatinib 40 mg per day plus intravenous vinorelbine 25 mg/m(2) once per week, or investigator's choice of treatment in cycles of 3 weeks until disease progression, patient withdrawal, or unacceptable toxicity. Treatment assignment was not masked for clinicians or patients, but the trial team was masked until database lock to reduce bias. The primary endpoint, assessed in the intention-to-treat population, was patient benefit at 12 weeks, defined by an absence of CNS or extra-CNS disease progression, no tumour-related worsening of neurological signs or symptoms, and no increase in corticosteroid dose. Safety was assessed in all patients who received at least one dose of a study drug. This completed trial is registered with ClinicalTrials.gov, number NCT01441596. FINDINGS Between Dec 22, 2011, and Feb 12, 2013, we screened 132 patients, of whom 121 were eligible and randomly assigned to treatment: 40 to afatinib alone, 38 to afatinib plus vinorelbine, and 43 to investigator's choice. All patients discontinued study treatment before the data collection cutoff on Oct 16, 2014. Patient benefit was achieved in 12 (30·0%; 95% CI 16·6-46·5) patients given afatinib alone (difference vs investigator's choice: -11·9% [95% CI -32·9 to 9·7], p=0·37), 13 (34·2%; 19·6-51·4) given afatinib plus vinorelbine (difference vs investigator's choice: -7·6% [-28·9 to 14·2], p=0·63), and 18 (41·9%; 27·0-57·9) given investigator's choice. The most common treatment-related grade 3 or 4 adverse events were diarrhoea (seven [18%] of 40 patients in the afatinib only group vs nine [24%] of 37 patients in the afatinib plus vinorelbine group vs two [5%] of 42 patients in the investigator's choice group) and neutropenia (none vs 14 [38%] vs four [10%]). INTERPRETATION Patient benefit with afatinib-containing treatments was not different from that in patients given investigator's choice of treatments; however, adverse events were frequent and afatinib-containing treatments seemed to be less well tolerated. No further development of afatinib for HER2-positive breast cancer is currently planned. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Javier Cortés
- Vall d'Hebron Institute of Oncology, Barcelona, Spain and Ramon y Cajal University Hospital, Madrid, Spain.
| | | | - Jungsil Ro
- National Cancer Center, Goyang-si, Republic of Korea
| | | | | | | | - Emilie Le Rhun
- Centre Oscar Lambret, Lille, France; University Hospital, Lille, France
| | | | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany
| | - Joo Hyuk Sohn
- Severance Hospital, Sinchon-dong, Seodaemun-gu, Seoul, South Korea
| | | | | | | | | | - Eva Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Petri Bono
- Comprehensive Cancer Center, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | | | - Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
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Tournaire M, Devouche E, Espié M, Asselain B, Levadou A, Cabau A, Dunbavand A, Grosclaude P, Epelboin S. Cancer Risk in Women Exposed to Diethylstilbestrol in Utero. Therapie 2015; 70:433-41. [DOI: 10.2515/therapie/2015030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/16/2015] [Indexed: 11/20/2022]
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Groheux D, Majdoub M, Sanna A, de Cremoux P, Hindié E, Giacchetti S, Martineau A, de Roquancourt A, Merlet P, Visvikis D, Resche-Rigon M, Hatt M, Espié M. Early Metabolic Response to Neoadjuvant Treatment: FDG PET/CT Criteria according to Breast Cancer Subtype. Radiology 2015; 277:358-71. [PMID: 25915099 DOI: 10.1148/radiol.2015141638] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate parameters based on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging that are best correlated with pathologic complete response (PCR) in human epidermal growth factor receptor type 2 (HER2)-positive cancer and triple-negative breast cancer (TNBC) and with partial or complete response in ER-positive/HER2-negative breast cancer. MATERIALS AND METHODS This study was approved by institutional review board with waivers of informed written consent and included consecutive patients treated by neoadjuvant chemotherapy. Five PET examination-derived parameters were tested: standard uptake value (SUV) maximum (SUV(max)), peak (SUV(peak)), and mean (SUV(mean)), metabolically active tumor volume, and total lesion glycolysis (TLG). Absolute values at baseline PET, at PET imaging after two cycles of chemotherapy, and variation (ie, change) were measured. Correlations with pathologic response (Wilcoxon rank-sum test) and predictive power assessed (area under the curve [AUC] on the basis of receiver operating characteristic analysis) were examined. RESULTS Included were 169 consecutive patients (mean age, 50 years). PCR was more frequent in HER2-positive tumors (16 of 33 patients [48.5%]) and TNBCs (20 of 54 patients [37%]) than in ER positive/HER2-negative tumors (four of 82 [4.9%]) (P < .001). Among patients with ER-positive/HER2-negative cancers, 33 patients had partial response. In TNBC, best association with PCR was obtained with change in SUV(max) (AUC, 0.86) or change in TLG (AUC, 0.88). In HER2-positive phenotype, absolute SUV(max) (or SUV(peak)) values at PET imaging after two cycles of chemotherapy (AUC for each cycle, 0.93) were better correlated with PCR than change in SUV(max) (AUC, 0.78; P = .11) or change in TLG (AUC, 0.62; P = .005). Regarding ER-positive/HER2-negative cancers, change in SUV(max) or change in TLG (AUC, 0.75) were parameters best correlated with partial or complete response. Baseline SUV(max) was higher in lymph nodes than in primary tumor in 31 patients. Findings were similar considering the site with highest FDG uptake. CONCLUSION Quantitative indexes of tumor glucose use that are best correlated with pathologic response vary by phenotype: change in SUV(max) or TLG are most adequate for TNBCs and ER-positive/ HER2-negative cancers and absolute SUV(max) after two cycles of chemotherapy for HER2-positive breast cancers.
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Affiliation(s)
- David Groheux
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Mohamed Majdoub
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Alice Sanna
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Patricia de Cremoux
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Elif Hindié
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Sylvie Giacchetti
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Antoine Martineau
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Anne de Roquancourt
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Pascal Merlet
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Dimitris Visvikis
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Matthieu Resche-Rigon
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Mathieu Hatt
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Marc Espié
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
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Groheux D, Sanna A, Majdoub M, de Cremoux P, Giacchetti S, Teixeira L, Espié M, Merlet P, de Roquancourt A, Visvikis D, Hatt M, Resche-Rigon M, Hindié E. Baseline Tumor 18F-FDG Uptake and Modifications After 2 Cycles of Neoadjuvant Chemotherapy Are Prognostic of Outcome in ER+/HER2− Breast Cancer. J Nucl Med 2015; 56:824-31. [DOI: 10.2967/jnumed.115.154138] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/10/2015] [Indexed: 11/16/2022] Open
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Nikpayam M, Uzan C, Rivera S, Delaloge S, Cahen-Doidy L, Giacchetti S, Espié M, Groheux D. Impact of radical surgery on outcome in locally advanced breast cancer patients without metastasis at the time of diagnosis. Anticancer Res 2015; 35:1729-1734. [PMID: 25750335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM In the era of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG-PET/CT), more patients are being diagnosed with N3M0 disease. The objective of this study was to assess the prognostic impact of radical lymph node surgery (RLNS) in patients with locally advanced breast cancer classified as lymph node N3 disease according to the American Joint Committee on Cancer (AJCC) 2002 in whom there is no known distant metastasis and in the context of multimodal therapy. PATIENTS AND METHODS This was a two-Center retrospective study that included patients with breast cancer classified as N3M0 after (18)FDG-PET/CT assessment. We reviewed the clinical characteristics, surgical treatment and oncological outcomes of those patients. RESULTS Thirty-nine patients fulfilled the inclusion criteria. Multimodal treatment included neo-adjuvant chemotherapy (n=34), adjuvant radiotherapy (n=33), adjuvant chemotherapy (n=18) or neo- or adjuvant hormone therapy (n=17). Surgical treatment was not homogeneous. Eight patients had undergone RLNS and 31 conventional axillary lymph node dissection (CD). There was no significant difference in median overall survival between the RLNS group and the CD group (32 months (28-36) vs. 49 months (42-56) respectively (p=0.25)). The overall recurrence rate was 23%. Out of the 8 patients who had under gone RLNS, three had relapsed (two with distant metastases and one local). CONCLUSION RLNS was not proven to be beneficial in our study. In order to guide surgical management for these patients, PET/CT and magnetic resonance imaging (MRI) could be of interest, therefore a pilot study to improve reproducible surgical management would be of interest.
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Affiliation(s)
- Maryam Nikpayam
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Catherine Uzan
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Sofia Rivera
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | | | - Marc Espié
- Department of Breast Diseases, Saint Louis, Paris, France
| | - David Groheux
- Department of Nuclear Imaging, Saint Louis, Paris, France
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Coussy F, Teixeira L, Giacchetti S, Cuvier C, Hocini H, Espié M. [New targeted therapies in breast cancer]. Gynecol Obstet Fertil 2014; 42:787-794. [PMID: 25442825 DOI: 10.1016/j.gyobfe.2014.09.007] [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] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/20/2014] [Indexed: 06/04/2023]
Abstract
Trastuzumab improves care of patients with HER2+ breast cancer and allows a major gain in terms of survival. T-DM1 and pertuzumab are two new treatments, which give very encouraging results in metastatic breast cancer. Their place in neo-adjuvant and adjuvant setting still remains to be defined. Bevacizumab have its place in metastatic breast cancer. In adjuvant setting, results are disappointing and in neo-adjuvant setting, we need more studies on subgroups, which can benefit more. Development of the PARP inhibitors was slowed down by recent negative results in metastatic breast cancer but studies continue with more targeted patient's. Finally, everolimus, inhibitor of mTOR, allows to by pass the hormono-resistance in metastatic phase. Its toxicity must be taken into account in particular in adjuvant setting.
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Affiliation(s)
- F Coussy
- Centre des maladies du sein, hôpital St-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - L Teixeira
- Centre des maladies du sein, hôpital St-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot 7, 10, avenue de Verdun, 75010 Paris, France
| | - S Giacchetti
- Centre des maladies du sein, hôpital St-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Cuvier
- Centre des maladies du sein, hôpital St-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - H Hocini
- Centre des maladies du sein, hôpital St-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Espié
- Centre des maladies du sein, hôpital St-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot 7, 10, avenue de Verdun, 75010 Paris, France
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Quéro L, Taright N, Guillerm S, Michaud S, Selz J, Ménard J, Espié M, Maylin C, Hennequin C. Boost par curiethérapie ambulatoire de haut débit de dose dans le traitement conservateur du cancer du sein : résultats à 10ans chez 621 patientes. Cancer Radiother 2014. [DOI: 10.1016/j.canrad.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Frank S, Dupont A, Porcher R, De Roquancourt A, Teixeira L, Espié M, Cuvier C. Ductal Carcinoma in Situ (Dcis) Treated By Mastectomy, or Local Excision with or Without Radiotherapy: a Retrospective Study About 608 Women. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Groheux D, Hindié E, Marty M, Espié M, Rubello D, Vercellino L, Bousquet G, Ohnona J, Toubert ME, Merlet P, Misset JL. ¹⁸F-FDG-PET/CT in staging, restaging, and treatment response assessment of male breast cancer. Eur J Radiol 2014; 83:1925-33. [PMID: 24985086 DOI: 10.1016/j.ejrad.2014.05.037] [Citation(s) in RCA: 13] [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] [Received: 03/01/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Male breast cancer (BC) is a rare disease, with patterns different from those found in women. Most tumors are detected at more advanced stages than in women. The aim of this study was to analyze the performance of [18F]fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in staging, restaging, and therapy response assessment. METHODS We performed a systematic analysis in the database of Saint-Louis Hospital to identify male patients with BC referred for PET/CT. (18)F-FDG-PET/CT findings considered suspicious for malignancy were compared to biopsy results, further work-up and/or patient follow-up of at least 6 months. Performances of (18)F-FDG-PET/CT were compared to that of conventional imaging (CI) using the McNemar test. The impact of PET/CT on management was evaluated. RESULTS During 6 consecutive years, among 12,692 (18)F-FDG-PET/CT oncology studies, 30 were performed in 15 men with BC: 7 examinations for initial staging, 11 for restaging, and 12 for response assessment. Tumors profile was ER+ and one had HER2 overexpression. PET/CT sensitivity, specificity, positive predictive value, negative predictive value and accuracy to detect distant metastases were 100%, 67%, 86%, 100% and 89%, respectively. PET/CT was more informative than CI in 40% of studies (p=0.03; 95% confidence interval: 3.26 - 40%). Findings from (18)F-FDG-PET/CT led to modification in the planned treatment in 13/30 cases (43%). CONCLUSION Although all the tumors were ER+, primary lesions and metastases were diagnosed with high sensitivity. (18)F-FDG-PET/CT seems to be a powerful imaging method to perform staging, restaging and treatment response assessment in male patients with BC.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Doctoral School of Biology and Biotechnology, University Institute of Hematology, University of Paris VII, Paris, France.
| | - Elif Hindié
- Department of Nuclear Medicine, Haut-Lévêque Hospital, CHU Bordeaux, University Bordeaux-Segalen, Bordeaux, France
| | - Michel Marty
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France; Centre for Therapeutic Innovation, Saint-Louis Hospital, Paris, France
| | - Marc Espié
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France
| | - Domenico Rubello
- Department of Nuclear Medicine, Santa Maria della Misericordia, Rovigo Hospital, Rovigo, Italy
| | - Laetitia Vercellino
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Doctoral School of Biology and Biotechnology, University Institute of Hematology, University of Paris VII, Paris, France
| | - Guilhem Bousquet
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France; INSERM U728, University Institute of Hematology, University of Paris VII, Paris, France
| | - Jessica Ohnona
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
| | | | - Pascal Merlet
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Doctoral School of Biology and Biotechnology, University Institute of Hematology, University of Paris VII, Paris, France
| | - Jean-Louis Misset
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France
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Abstract
Because of its prevalence, breast cancer is a major public health problem although its prognosis has improved as a result of early screening and improvement in treatments. We now no longer refer to breast cancer in the singular, but to breast cancers, which have different prognoses and treatments depending on their molecular profile.
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Affiliation(s)
- M Espié
- Department of Medical Oncology, Breast Diseases Center, Saint-Louis Hospital, Paris Public Hospitals Health Service, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
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Groheux D, Hindié E, Giacchetti S, Hamy AS, Berger F, Merlet P, de Roquancourt A, de Cremoux P, Marty M, Hatt M, Espié M. Early assessment with 18F-fluorodeoxyglucose positron emission tomography/computed tomography can help predict the outcome of neoadjuvant chemotherapy in triple negative breast cancer. Eur J Cancer 2014; 50:1864-71. [PMID: 24841218 DOI: 10.1016/j.ejca.2014.04.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/06/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In patients with triple-negative breast cancer (TNBC), pathology complete response (pCR) to neoadjuvant chemotherapy (NAC) is associated with improved prognosis. This prospective study was designed and powered to investigate the ability of interim (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG-PET/CT) to predict pathology outcomes to NAC early during treatment. PATIENTS AND METHODS Consecutive TNBC women underwent (18)FDG-PET/CT at baseline and after two courses of NAC. Maximum standardised uptake value (SUV(max)) in the primary tumour and lymph nodes at each examination and the evolution (ΔSUV(max)) between the two scans were measured. NAC was continued irrespective of PET results. Correlations between PET parameters and pathology response, and between PET parameters and event-free survival (EFS), were examined. RESULTS Fifty patients without distant metastases were enroled. At completion of NAC, surgery showed pCR in 19 patients, while 31 had residual tumour. Mean follow-up was 30.3 months. Thirteen patients, all with residual tumour, experienced relapse. Of all assessed clinical, biological and PET parameters, ΔSUV(max) in the primary tumour was the most predictive of pathology results (p<0.0001; Mann-Whitney-U test) and EFS (p=0.02; log rank test). A threshold of 42% decrease in SUV was identified because it offered the best accuracy in predicting EFS. There were 32 metabolic responders (⩾ 42% decrease in SUV(max)) and 18 non-responders. Within responders, the pCR rate was 59% and the 3-year EFS 77.5%. In non-responders, the pCR rate was 0% and the 3-year EFS 47.1%. CONCLUSION Interim (18)FDG can early predict the inefficacy of NAC in TNBC patients. It shows promise as a potential contributory biomarker in these patients.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; B2T, Doctoral School, IUH, University of Paris VII, France.
| | - Elif Hindié
- Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, France
| | - Sylvie Giacchetti
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France
| | - Anne-Sophie Hamy
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France; Department of Biostatistics, Institut Curie, Paris, France
| | | | - Pascal Merlet
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; B2T, Doctoral School, IUH, University of Paris VII, France
| | | | | | - Michel Marty
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France; Centre for Therapeutic Innovation, Saint Louis Hospital, Paris, France
| | | | - Marc Espié
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France
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Kramar A, Bachelot T, Madrange N, Pierga JY, Kerbrat P, Espié M, Fumoleau P, Pauporté I, Khayat D, Romieu G, Pivot X. Trastuzumab duration effects within patient prognostic subgroups in the PHARE trial. Ann Oncol 2014; 25:1563-70. [PMID: 24827132 DOI: 10.1093/annonc/mdu177] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND At 42.5 months of median follow-up, PHARE failed to show that 6 was non-inferior to 12 months of adjuvant trastuzumab. From the results of PHARE, questions remain regarding whether the magnitude of benefit derived from 1 year is sufficient to justify its systematic use for different patient subgroups. METHODS Treatment effects were evaluated according to various tumour characteristics, and the multivariate Cox proportional hazards regression models were carried out on metastases-free survival (MFS) in the 12 months control arm. A prognostic score was defined providing the identification of patient categories with similar risks. The 6-month arm was used as a validation set in order to test for heterogeneity. This study is registered at clinicaltrials.gov, number NCT00381901. RESULTS A total of 261 metastatic events were observed and four prognostic groups were defined: very low, low, intermediate and high risk in the 12-month arm. The corresponding 3-year MFS rates were 98.3%, 95.8%, 90.4% and 78.4% in the four prognostic groups, respectively. In the 6-month arm, the 3-year MFS rates were 98.3%, 94.2%, 85.7% and 74.8% in the four prognostic groups, respectively. CONCLUSION In the very low-risk group, the potential absolute benefit of standard duration of trastuzumab was small enough to indicate that optimal standard treatment might be clinically questionable. On the other hand, the 3-year metastasis occurrence rates strongly support the need for a search of a more efficient treatment in the low-, intermediate- and high-risk groups.
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Affiliation(s)
- A Kramar
- Methdology and Biostatistics Unit, Centre Oscar Lambret, Lille
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - N Madrange
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - J-Y Pierga
- Department of Medical Oncology, Institut Curie, Paris
| | - P Kerbrat
- Department of Medical Oncology, Centre Eugene Marquis, Rennes
| | - M Espié
- Department of Medical Oncology, University Hospital Saint-Louis, Paris
| | - P Fumoleau
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - I Pauporté
- French National Cancer Institut, Boulogne-Billancourt
| | - D Khayat
- Department of Medical Oncology, University Hospital Pitié Salpetrière, Paris
| | - G Romieu
- Department of Medical Oncology, Val d'Aurelle Institut Régional du Cancer, Montpellier
| | - X Pivot
- Department of Medical Oncology, University Hospital Besancon, Besancon, France
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Espié M, Frank S. [The post-cancer period, a conceptual and epidemiological approach]. Soins 2014:26-29. [PMID: 24761513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The post-cancer period constitutes a growing issue due to increased cancer incidence and the improvements in treatments. There are numerous related concepts: survivor, remission, cure, etc. The consequences of the disease on the reprisal of a social and family life must be taken into account.
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50
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Giacchetti S, Porcher R, Lehmann-Che J, Hamy AS, de Roquancourt A, Cuvier C, Cottu PH, Bertheau P, Albiter M, Bouhidel F, Coussy F, Extra JM, Marty M, de Thé H, Espié M. Long-term survival of advanced triple-negative breast cancers with a dose-intense cyclophosphamide/anthracycline neoadjuvant regimen. Br J Cancer 2014; 110:1413-9. [PMID: 24569467 PMCID: PMC3960631 DOI: 10.1038/bjc.2014.81] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 10/17/2013] [Revised: 01/14/2014] [Accepted: 01/20/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Triple-negative (TN) breast cancers exhibit major initial responses to neoadjuvant chemotherapy, but generally have a poor outcome. Because of the lack of validated drug targets, chemotherapy remains an important therapeutic tool in these cancers. METHODS We report the survival of two consecutive series of 267 locally advanced breast cancers (LABC) treated with two different neoadjuvant regimens, either a dose-dense and dose-intense cyclophosphamide-anthracycline (AC) association (historically called SIM) or a conventional sequential association of cyclophosphamide and anthracycline, followed by taxanes (EC-T). We compared pathological responses and survival rates of these two groups and studied their association with tumours features. RESULTS Although the two regimens showed equivalent pathological complete response (pCR) in the whole population (16 and 12%), the SIM regimen yielded a non-statistically higher pCR rate than EC-T (48% vs 24%, P=0.087) in TN tumours. In the SIM protocol, DFS was statistically higher for TN than for non-TN patients (P=0.019), although we showed that the TN status was associated with an increased initial risk of recurrence in both regimens. This effect gradually decreased and after 2 years, TN was associated with a significantly decreased likelihood of relapse in SIM-treated LABC (hazard ratio (HR)=0.25 (95% CI: 0.07-0.86), P=0.028). CONCLUSIONS AC dose intensification treatment is associated with a very favourable long-term survival rate in TN breast cancers. These observations call for a prospective assessment of such dose-intense AC-based regimens in locally advanced TN tumours.
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Affiliation(s)
- S Giacchetti
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, Paris 75475, France
| | - R Porcher
- AP-HP, Hôpital Saint-Louis, Biostatistic Department, Paris 75475, France
| | - J Lehmann-Che
- 1] AP-HP, Hôpital Saint-Louis, Molecular Biology Department, Paris 75475, France [2] INSERM/CNRS/University Paris Diderot UMR 944/7212, Paris 75475, France
| | - A-S Hamy
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, Paris 75475, France
| | - A de Roquancourt
- 1] AP-HP, Hôpital Saint-Louis, Pathology Department, Paris 75475, France [2] University Paris Diderot, UMR-S-728 INSERM, Paris 75475, France
| | - C Cuvier
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, Paris 75475, France
| | - P-H Cottu
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, Paris 75475, France
| | - P Bertheau
- 1] AP-HP, Hôpital Saint-Louis, Pathology Department, Paris 75475, France [2] University Paris Diderot, UMR-S-728 INSERM, Paris 75475, France
| | - M Albiter
- AP-HP, Hôpital Saint-Louis, Radiology Department, Paris 75475, France
| | - F Bouhidel
- 1] AP-HP, Hôpital Saint-Louis, Pathology Department, Paris 75475, France [2] University Paris Diderot, UMR-S-728 INSERM, Paris 75475, France
| | - F Coussy
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, Paris 75475, France
| | - J-M Extra
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, Paris 75475, France
| | - M Marty
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, Paris 75475, France
| | - H de Thé
- 1] AP-HP, Hôpital Saint-Louis, Molecular Biology Department, Paris 75475, France [2] INSERM/CNRS/University Paris Diderot UMR 944/7212, Paris 75475, France
| | - M Espié
- AP-HP, Hôpital Saint-Louis, Breast Disease Unit, University Paris Diderot, Paris 75475, France
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