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Marx T, Moore L, Talbot D, Guertin JR, Lachapelle P, Blais S, Singbo N, Simonyan D, Lavallée J, Zada N, Shahrigharahkoshan S, Huard B, Olivier P, Mallet M, Létourneau M, Lafrenière M, Archambault P, Berthelot S. Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada. BMJ Open 2024; 14:e078566. [PMID: 38670620 PMCID: PMC11057281 DOI: 10.1136/bmjopen-2023-078566] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/21/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To compare health outcomes and costs given in the emergency department (ED) and walk-in clinics for ambulatory children presenting with acute respiratory diseases. DESIGN A retrospective cohort study. SETTING This study was conducted from April 2016 to March 2017 in one ED and one walk-in clinic. The ED is a paediatric tertiary care centre, and the clinic has access to lab tests and X-rays. PARTICIPANTS Inclusion criteria were children: (1) aged from 2 to 17 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia or acute asthma. MAIN OUTCOME MEASURES The primary outcome measure was the proportion of patients returning to any ED or clinic within 3 and 7 days of the index visit. The secondary outcome measures were the mean cost of care estimated using time-driven activity-based costing and the incidence of antibiotic prescription for URTI patients. RESULTS We included 532 children seen in the ED and 201 seen in the walk-in clinic. The incidence of return visits at 3 and 7 days was 20.7% and 27.3% in the ED vs 6.5% and 11.4% in the clinic (adjusted relative risk at 3 days (aRR) (95% CI) 3.17 (1.77 to 5.66) and aRR at 7 days 2.24 (1.46 to 3.44)). The mean cost (95% CI) of care (CAD) at the index visit was $C96.68 (92.62 to 100.74) in the ED vs $C48.82 (45.47 to 52.16) in the clinic (mean difference (95% CI): 46.15 (41.29 to 51.02)). Antibiotic prescription for URTI was less common in the ED than in the clinic (1.5% vs 16.4%; aRR 0.10 (95% CI 0.03 to 0.32)). CONCLUSIONS The incidence of return visits and cost of care were significantly higher in the ED, while antibiotic use for URTI was more frequent in the walk-in clinic. These data may help determine which setting offers the highest value to ambulatory children with acute respiratory conditions.
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Affiliation(s)
- Tania Marx
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Lynne Moore
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Denis Talbot
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Jason Robert Guertin
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Philippe Lachapelle
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Sébastien Blais
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Narcisse Singbo
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - David Simonyan
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Jeanne Lavallée
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Nawid Zada
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Shaghayegh Shahrigharahkoshan
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Benoit Huard
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Pascale Olivier
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Myriam Mallet
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Mélanie Létourneau
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | | | - Patrick Archambault
- Département de médecine de famille et de médecine d'urgence, Université Laval, Québec, Québec, Canada
- Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, Québec, Canada
| | - Simon Berthelot
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine de famille et de médecine d'urgence, Université Laval, Québec, Québec, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, Québec, Canada
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Laprie A, Noel G, Chaltiel L, Truc G, Sunyach MP, Charissoux M, Magne N, Auberdiac P, Biau J, Ken S, Tensaouti F, Khalifa J, Sidibe I, Roux FE, Vieillevigne L, Catalaa I, Boetto S, Uro-Coste E, Supiot S, Bernier V, Filleron T, Mounier M, Poublanc M, Olivier P, Delord JP, Cohen-Jonathan-Moyal E. Randomized phase III trial of metabolic imaging-guided dose escalation of radio-chemotherapy in patients with newly diagnosed glioblastoma (SPECTRO GLIO trial). Neuro Oncol 2024; 26:153-163. [PMID: 37417948 PMCID: PMC10768994 DOI: 10.1093/neuonc/noad119] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) systematically recurs after a standard 60 Gy radio-chemotherapy regimen. Since magnetic resonance spectroscopic imaging (MRSI) has been shown to predict the site of relapse, we analyzed the effect of MRSI-guided dose escalation on overall survival (OS) of patients with newly diagnosed GBM. METHODS In this multicentric prospective phase III trial, patients who had undergone biopsy or surgery for a GBM were randomly assigned to a standard dose (SD) of 60 Gy or a high dose (HD) of 60 Gy with an additional simultaneous integrated boost totaling 72 Gy to MRSI metabolic abnormalities, the tumor bed and residual contrast enhancements. Temozolomide was administered concomitantly and maintained for 6 months thereafter. RESULTS One hundred and eighty patients were included in the study between March 2011 and March 2018. After a median follow-up of 43.9 months (95% CI [42.5; 45.5]), median OS was 22.6 months (95% CI [18.9; 25.4]) versus 22.2 months (95% CI [18.3; 27.8]) for HD, and median progression-free survival was 8.6 (95% CI [6.8; 10.8]) versus 7.8 months (95% CI [6.3; 8.6]), in SD versus HD, respectively. No increase in toxicity rate was observed in the study arm. The pseudoprogression rate was similar across the SD (14.4%) and HD (16.7%) groups. For O(6)-methylguanine-DNA methyltransferase (MGMT) methylated patients, the median OS was 38 months (95% CI [23.2; NR]) for HD patients versus 28.5 months (95% CI [21.1; 35.7]) for SD patients. CONCLUSION The additional MRSI-guided irradiation dose totaling 72 Gy was well tolerated but did not improve OS in newly diagnosed GBM. TRIAL REGISTRATION NCT01507506; registration date: December 20, 2011. https://clinicaltrials.gov/ct2/show/NCT01507506?cond=NCT01507506&rank=1.
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Affiliation(s)
- Anne Laprie
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Leonor Chaltiel
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Gilles Truc
- Centre Georges-François Leclerc, Dijon, France
| | | | | | - Nicolas Magne
- Institut de Cancérologie de la Loire, Saint-Priest en Jarez, France
| | | | - Julian Biau
- Centre Jean-Perrin, Clermont-Ferrand, France
| | - Soléakhéna Ken
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, RadOpt-CRCT-INSERM, Toulouse, France
| | - Fatima Tensaouti
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole & ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jonathan Khalifa
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | | | - Franck-Emmanuel Roux
- Centre Hospitalier Universitaire de Toulouse, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Laure Vieillevigne
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | | | - Sergio Boetto
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuelle Uro-Coste
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, RadOpt-CRCT-INSERM, Toulouse, France
| | - Stéphane Supiot
- Institut de Cancerologie de l’Ouest, Nantes st Herblain, France
| | - Valérie Bernier
- Institut de Cancérologie de Lorraine Centre Alexis Vautrin, Nancy, France
| | - Thomas Filleron
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Muriel Mounier
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Muriel Poublanc
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Pascale Olivier
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d’Information sur le Médicament CHU de Toulouse, Toulouse, France
| | - Jean-Pierre Delord
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
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Prioul A, Fournier D, Lefeuvre C, Duranton S, Olivier P, Blanc E, Peyro-Saint-Paul L, Ruault S, Jamet A, Mouchel C. Overview of literature monitoring practice of clinical trials vigilance units in French institutional sponsors - A study from the REVISE working group. Therapie 2023; 78:659-666. [PMID: 36906491 DOI: 10.1016/j.therap.2023.02.008] [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: 05/04/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION The evaluation of clinical trial (CT) safety is the main task of CT vigilance units. In addition to the management of adverse events, the units must review the literature to identify information that may impact the benefit-risk assessment of studies. In this survey, we investigated the literature monitoring (LM) activity of French Institutional Vigilance Units (IVU) from the working group "REflexion sur la VIgilance et la SEcurite des essais cliniques" (REVISE). MATERIAL AND METHODS We sent a questionnaire of 26 questions, divided into four themes, to the 60 IVU: (1) Presentation of the IVU and the LM activity; (2) Used sources, queries and criteria for selecting articles; (3) Valuation of the LM and (4) Practical organisation. RESULTS Of the 27 IVU that responded to the questionnaire, 85% of them carried out LM. This was mainly provided by medical staff to improve general knowledge (83%), to detect Adverse Reactions (AR) not listed in the reference documents (70%) and to detect new safety information (61%). Due to lack of time, staff, available recommendations and sources, only 21% of IVU conducted LM for all CT. On average, units reported four sources: ANSM information (96%), PubMed database (83%), EMA alerts (57%) and the subscription to APM international (48%). The LM had an impact on the CT of 57% of the IVU such as changing the conditions of a study (39%) or suspending a study (22%). DISCUSSION/CONCLUSION LM is an important but time-consuming activity with heterogeneous practices. According to the results of this survey, we proposed seven ways to improve this practice: (1) Target the highest risk CT; (2) Refine the PubMed queries; (3) Use other tools; (4) Create a decision flowchart for the selection of PubMed articles; (5) Improve training; (6) Value the activity and (7) Outsource the activity.
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Affiliation(s)
- Astrid Prioul
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France.
| | - Dorine Fournier
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
| | - Cécile Lefeuvre
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
| | - Sophie Duranton
- Direction de la recherche, unité de vigilance des essais cliniques, CHU de Poitiers, 86021 Poitiers cedex, France
| | - Pascale Olivier
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament INSERM UMR 1027, CIC 1436, CHU de Toulouse, 31059 Toulouse, France
| | - Emeline Blanc
- Direction de la recherche en santé, unité de vigilance des essais cliniques, Hospices civils de Lyon, 69229 Lyon, France
| | | | - Sophie Ruault
- Maison de la recherche clinique, CHU de Rouen, 76031 Rouen, France
| | - Aurélie Jamet
- Vigilance des essais cliniques, CHU d'Angers, 49933 Angers, France
| | - Catherine Mouchel
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
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Madi K, Flumian C, Olivier P, Sommet A, Montastruc F. Quality of reporting of adverse events in clinical trials of covid-19 drugs: systematic review. BMJ Med 2023; 2:e000352. [PMID: 37779893 PMCID: PMC10537984 DOI: 10.1136/bmjmed-2022-000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/27/2023] [Indexed: 10/03/2023]
Abstract
Objective To assess the quality of reporting of adverse events in clinical trials of covid-19 drugs based on the CONSORT (Consolidated Standards of Reporting Trials) harms extension and according to clinical trial design, and to examine reporting of serious adverse events in drug trials published on PubMed versus clinical trial summaries on ClinicalTrials.gov. Design Systematic review. Data sources PubMed and ClinicalTrials.gov registries were searched from 1 December 2019 to 17 February 2022. Eligibility criteria for selecting studies Randomised clinical trials evaluating the efficacy and safety of drugs used to treat covid-19 disease in participants of all ages with suspected, probable, or confirmed SARS-CoV-2 infection were included. Clinical trials were screened on title, abstract, and text by two authors independently. Only articles published in French and English were selected. The Cochrane risk of bias tool for randomised trials (RoB 2) was used to assess risk of bias. Results The search strategy identified 1962 randomised clinical trials assessing the efficacy and safety of drugs used to treat covid-19, published in the PubMed database; 1906 articles were excluded after screening and 56 clinical trials were included in the review. Among the 56 clinical trials, no study had a high score for quality of reporting of adverse events, 60.7% had a moderate score, 33.9% had a low score, and 5.4% had a very low score. All clinical trials with a very low score for quality of reporting of adverse events were randomised open label trials. For reporting of serious adverse events, journal articles published on PubMed under-reported 51% of serious adverse events compared with clinical trial summaries published on ClinicalTrials.gov. Conclusions In one in three published clinical trials on covid-19 drugs, the quality of reporting of adverse events was low or very low. Differences were found in the number of serious adverse events reported in journal articles versus clinical trial summaries. During the covid-19 pandemic, risk assessment of drugs in clinical trials of covid-19 drugs did not comply with good practice recommendations for publication of results. Systematic review registration European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) EUPAS45959.
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Affiliation(s)
- Karima Madi
- CIC 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, France
| | - Clara Flumian
- CIC 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, France
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pascale Olivier
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Agnès Sommet
- CIC 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, France
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - François Montastruc
- CIC 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, France
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Pouessel D, Ken S, Gouaze-Andersson V, Piram L, Mervoyer A, Larrieu-Ciron D, Cabarrou B, Lusque A, Robert M, Frenel JS, Uro-Coste E, Olivier P, Mounier M, Sabatini U, Sanchez EH, Zouitine M, Berjaoui A, Cohen-Jonathan Moyal E. Hypofractionated Stereotactic Re-irradiation and
Anti-PDL1 Durvalumab Combination in Recurrent Glioblastoma: STERIMGLI Phase I Results. Oncologist 2023; 28:825-e817. [PMID: 37196069 PMCID: PMC10485381 DOI: 10.1093/oncolo/oyad095] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/13/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Hypofractionated stereotactic radiotherapy (hFSRT) is a salvage option for recurrent glioblastoma (GB) which may synergize anti-PDL1 treatment. This phase I study evaluated the safety and the recommended phase II dose of anti-PDL1 durvalumab combined with hFSRT in patients with recurrent GB. METHODS Patients were treated with 24 Gy, 8 Gy per fraction on days 1, 3, and 5 combined with the first 1500 mg Durvalumab dose on day 5, followed by infusions q4weeks until progression or for a maximum of 12 months. A standard 3 + 3 Durvalumab dose de-escalation design was used. Longitudinal lymphocytes count, cytokines analyses on plasma samples, and magnetic resonance imaging (MRI) were collected. RESULTS Six patients were included. One dose limiting toxicity, an immune-related grade 3 vestibular neuritis related to Durvalumab, was reported. Median progression-free interval (PFI) and overall survival (OS) were 2.3 and 16.7 months, respectively. Multi-modal deep
learning-based analysis including MRI, cytokines, and lymphocytes/neutrophil ratio isolated the patients presenting pseudoprogression, the longest PFI and those with the longest OS, but statistical significance cannot be established considering phase I data only. CONCLUSION Combination of hFSRT and Durvalumab in recurrent GB was well tolerated in this phase I study. These encouraging results led to an ongoing randomized phase II. (ClinicalTrials.gov Identifier: NCT02866747).
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Affiliation(s)
- Damien Pouessel
- Department of Medical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Re-gaud, Toulouse, France
| | - Soléakhéna Ken
- Department of Engineering and Medical Physics, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France
- INSERM UMR1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Team Radiation Optimization “RADOPT”, Toulouse, France
| | - Valérie Gouaze-Andersson
- INSERM UMR1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Team Radiation Optimization “RADOPT”, Toulouse, France
- Department of Radiation Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Lucie Piram
- INSERM UMR1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Team Radiation Optimization “RADOPT”, Toulouse, France
- Department of Radiation Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Augustin Mervoyer
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Nantes, France
| | - Delphine Larrieu-Ciron
- Department of Medical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Re-gaud, Toulouse, France
| | - Bastien Cabarrou
- Department of Biostatistics, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Marie Robert
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Nantes, France
| | | | - Emmanuelle Uro-Coste
- INSERM UMR1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Team Radiation Optimization “RADOPT”, Toulouse, France
- Department of Anatomopathology, CHU Toulouse, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Pascale Olivier
- Department of Medical and Clinical Pharmacology, Center of Pharmacovigilance and Pharmacoepidemiology, Toulouse University Hospital, Toulouse, France
| | - Muriel Mounier
- Clinical Research Unit, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France
| | - Umberto Sabatini
- Institute of Neuroradiology, University Magna Graecia, Catanzaro, Italy
| | | | - Mehdi Zouitine
- Institut de Recherche Technologique Saint Exupéry, Toulouse, France
| | - Ahmad Berjaoui
- INSERM UMR1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Team Radiation Optimization “RADOPT”, Toulouse, France
- Institut de Recherche Technologique Saint Exupéry, Toulouse, France
| | - Elizabeth Cohen-Jonathan Moyal
- INSERM UMR1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Team Radiation Optimization “RADOPT”, Toulouse, France
- Department of Radiation Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France
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Marx T, Moore L, Talbot D, Guertin JR, Lachapelle P, Blais S, Singbo N, Simonyan D, Lavallée J, Zada N, Shahrigharahkoshan S, Huard B, Olivier P, Mallet M, Létourneau M, Lafrenière M, Archambault PM, Berthelot S. A value-based comparison of the management of respiratory diseases in walk-in clinics and emergency departments. CAN J EMERG MED 2023; 25:394-402. [PMID: 37004679 DOI: 10.1007/s43678-023-00481-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/04/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES Our aim was to compare some of the health outcomes and costs associated with value of care in emergency departments (ED) and walk-in clinics for ambulatory patients presenting with an acute respiratory disease. METHODS A health records review was conducted from April 2016 through March 2017 in one ED and one walk-in clinic. Inclusion criteria were: (i) ambulatory patients at least 18 years old, (ii) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Primary outcome was the proportion of patients returning to any ED or walk-in clinic within three and seven days of the index visit. Secondary outcomes were the mean cost of care and the incidence of antibiotic prescription for URTI patients. The cost of care was estimated from the Ministry of Health's perspectives using time-driven activity-based costing. RESULTS The ED group included 170 patients and the walk-in clinic group 326 patients. The return visit incidences at three and seven days were, respectively, 25.9% and 38.2% in the ED vs. 4.9% and 14.7% in the walk-in clinic (adjusted relative risk (arr) of 4.7 (95% CI 2.6-8.6) and 2.7 (1.9-3.9)). The mean cost ($Cdn) of the index visit care was 116.0 (106.3-125.7) in the ED vs. 62.5 (57.7-67.3) in the walk-in clinic (mean difference of 56.4 (45.7-67.1)). Antibiotic prescription for URTI was 5.6% in the ED vs. 24.7% in the walk-in clinic (arr 0.2, 0.01-0.6). CONCLUSIONS This study is the first in a larger research program to compare the value of care between walk-in clinics and the ED. The potential advantages of walk-in clinics over EDs (lower costs, lower incidence of return visits) for ambulatory patients with respiratory diseases should be considered in healthcare planning.
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Affiliation(s)
- Tania Marx
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Lynne Moore
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Jason R Guertin
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
| | - Philippe Lachapelle
- Clinical and Organizational Performance Department of the CHU de Québec-Université Laval, Québec, QC, Canada
| | - Sébastien Blais
- Clinical and Organizational Performance Department of the CHU de Québec-Université Laval, Québec, QC, Canada
| | - Narcisse Singbo
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - David Simonyan
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Jeanne Lavallée
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Nawid Zada
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Shaghayegh Shahrigharahkoshan
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Benoit Huard
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Pascale Olivier
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Myriam Mallet
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Mélanie Létourneau
- Clinical and Organizational Performance Department of the CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Patrick M Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- Centre de Recherche du Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- VITAM - Centre de Recherche en Santé Durable, Université Laval, Québec, QC, Canada
| | - Simon Berthelot
- Axe Santé des Populations et Pratiques Optimales en Sante, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada.
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Grangeret J, Imbert L, Claudin M, Bros M, Bordonne M, Olivier P, Marie P, Verger A, Boursier Joppin C. La scintigraphie au Lutétium a-t-elle une place dans le suivi des traitements par 177Lu-PSMA ? Une évaluation thérapeutique multitraceurs. Médecine Nucléaire 2023. [DOI: 10.1016/j.mednuc.2023.01.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Berthelot S, Mallet M, Blais S, Moore L, Guertin JR, Boulet J, Boilard C, Fortier C, Huard B, Mokhtari A, Lesage A, Lévesque É, Baril L, Olivier P, Vachon K, Yip O, Bouchard M, Simonyan D, Létourneau M, Pineault A, Vézo A, Stelfox HT. Adaptation of time‐driven activity‐based costing to the evaluation of the efficiency of ambulatory care provided in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12778. [PMID: 35865131 PMCID: PMC9292471 DOI: 10.1002/emp2.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/20/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim of this study was: (1) to adapt the time‐driven activity‐based costing (TDABC) method to emergency department (ED) ambulatory care; (2) to estimate the cost of care associated with frequently encountered ambulatory conditions; and (3) to compare costs calculated using estimated time and objectively measured time. Methods TDABC was applied to a retrospective cohort of patients with upper respiratory tract infections, urinary tract infections, unspecified abdominal pain, lower back pain and limb lacerations who visited an ED in Québec City (Canada) during fiscal year 2015–2016. The calculated cost of care was the product of the time required to complete each care procedure and the cost per minute of each human resource or equipment involved. Costing based on durations estimated by care professionals were compared to those based on objective measurements in the field. Results Overall, 220 care episodes were included and 3080 time measurements of 75 different processes were collected. Differences between costs calculated using estimated and measured times were statistically significant for all conditions except lower back pain and ranged from $4.30 to $55.20 (US) per episode. Differences were larger for conditions requiring more advanced procedures, such as imaging or the attention of ED professionals. Conclusions The greater the use of advanced procedures or the involvement of ED professionals in the care, the greater is the discrepancy between estimated‐time‐based and measured‐time‐based costing. TDABC should be applied using objective measurement of the time per procedure.
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Affiliation(s)
- Simon Berthelot
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine familiale et de médecine d'urgence Faculté de médecine Québec Canada
| | | | | | - Lynne Moore
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine sociale et préventive Faculté de médecine Université Laval Québec Canada
| | - Jason R. Guertin
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine sociale et préventive Faculté de médecine Université Laval Québec Canada
| | | | | | | | | | | | | | | | - Laurence Baril
- CHU de Québec‐Université Laval Québec Canada
- Département de médecine familiale et de médecine d'urgence Faculté de médecine Québec Canada
| | | | | | - Olivia Yip
- CHU de Québec‐Université Laval Québec Canada
| | | | | | | | | | - Adrien Vézo
- CHU de Québec‐Université Laval Québec Canada
| | - Henry T. Stelfox
- Department of Critical Care and the O'Brien Institute for Public Health McCaig Tower University of Calgary Calgary Alberta Canada
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9
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Roussel M, Lauwers-Cances V, Macro M, Leleu X, Royer B, Hulin C, Karlin L, Perrot A, Touzeau C, Chrétien ML, Rigaudeau S, Dib M, Nicolas-Virelizier E, Escoffre-Barbe M, Belhadj K, Mariette C, Stoppa AM, Araujo C, Doyen C, Fontan J, Kolb B, Garderet L, Brechignac S, Malfuson JV, Jaccard A, Lenain P, Borel C, Hebraud B, Benbrahim O, Dorvaux V, Manier S, Augeul-Meunier K, Vekemans MC, Randriamalala E, Chaoui D, Caers J, Chaleteix C, Benboubker L, Vincent L, Glaisner S, Zunic P, Slama B, Eveillard JR, Humbrecht-Kraut C, Morel V, Mineur P, Eisenmann JC, Demarquette H, Richez V, Vignon M, Caillot D, Facon T, Moreau P, Colin AL, Olivier P, Wuilleme S, Avet-Loiseau H, Corre J, Attal M. Bortezomib and high-dose melphalan conditioning regimen in frontline multiple myeloma: an IFM randomized phase 3 study. Blood 2022; 139:2747-2757. [PMID: 35511184 DOI: 10.1182/blood.2021014635] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/28/2022] [Indexed: 12/22/2022] Open
Abstract
High-dose melphalan (HDM) and transplantation are recommended for eligible patients with multiple myeloma. No other conditioning regimen has proven to be more effective and/or safer. We previously reported in a phase 2 study that bortezomib can safely and effectively be combined with HDM (Bor-HDM), with a 32% complete response (CR) rate after transplantation. These data supported a randomized phase 3 trial. Randomization was stratified according to risk and response to induction: 300 patients were enrolled, and 154 were allocated to the experimental arm (ie, arm A) with bortezomib (1 mg/m2 intravenously [IV]) on days -6, -3, +1, and +4 and melphalan (200 mg/m2 IV) on day -2. The control arm (ie, arm B) consisted of HDM alone (200 mg/m2 IV). There were no differences in stringent CR + CR rates at day 60 posttransplant (primary end point): 22.1% in arm A vs 20.5% in arm B (P = .844). There were also no differences in undetectable minimum residual disease rates: 41.3% vs 39.4% (P = .864). Median progression-free survival was 34.0 months for arm A vs 29.6 months for arm B (adjusted HR, 0.82; 95% CI, 0.61-1.13; P = .244). The estimated 3-year overall survival was 89.5% in both arms (hazard ratio, 1.28; 95% CI, 0.62-2.64; P = .374). Sixty-nine serious adverse events occurred in 18.7% of Bor-HDM-treated patients (vs 13.1% in HDM-treated patients). The proportion of grade 3/4 AEs was similar within the 2 groups (72.0% vs 73.1%), mainly (as expected) blood and gastrointestinal disorders; 4% of patients reported grade 3/4 or painful peripheral neuropathy in arm A (vs 1.5% in arm B). In this randomized phase 3 study, a conditioning regimen with Bor-HDM did not improve efficacy end points or outcomes compared with HDM alone. The original trial was registered at www.clinicaltrials.gov as #NCT02197221.
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Affiliation(s)
- Murielle Roussel
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
- USMR, Centre Hospitalo-universitaire (CHU) de Toulouse, Toulouse, France
| | | | - Margaret Macro
- Centre Hospitalo-universitaire (CHU) Côte de Nacre, Caen, France
| | - Xavier Leleu
- Centre Hospitalo-universitaire (CHU) La Mileterie, INSERM CIC 1402, Poitiers, France
| | - Bruno Royer
- Centre Hospitalo-universitaire (CHU) Amiens sud, Amiens, France
- Hôpital St Louis, Paris, France
| | - Cyrille Hulin
- Centre Hospitalo-universitaire (CHU) Haut Lévêque, Bordeaux, France
| | | | - Aurore Perrot
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
- USMR, Centre Hospitalo-universitaire (CHU) de Toulouse, Toulouse, France
- Centre Hospitalo-universitaire (CHU) Côte de Nacre, Caen, France
- Centre Hospitalo-universitaire (CHU) La Mileterie, INSERM CIC 1402, Poitiers, France
- Centre Hospitalo-universitaire (CHU) Amiens sud, Amiens, France
- Centre Hospitalo-universitaire (CHU) Haut Lévêque, Bordeaux, France
- Hospices Civils de Lyon, Pierre Bénite, France
- Centre Hospitalo-universitaire (CHU), Vandoeuvre Les Nancy, France
| | - Cyrille Touzeau
- Centre Hospitalo-universitaire (CHU) Hôtel Dieu, Nantes, France
| | | | | | | | | | | | - Karim Belhadj
- Centre Hospitalo-universitaire (CHU) Henri Mondor, Créteil, France
| | | | | | - Carla Araujo
- Centre Hospitalier de la côte basque, Bayonne, France
| | - Chantal Doyen
- Centre Hospitalo-universitaire (CHU) UCL Namur site Godinne, Yvoir, Belgium
| | - Jean Fontan
- Centre Hospitalo-universitaire (CHU), Besançon, France
| | | | - Laurent Garderet
- Hôpital Saint Antoine, Paris, France
- Hematology Hôpital Avicenne, Bobigny, France
| | | | | | - Arnaud Jaccard
- Centre Hospitalo-universitaire (CHU) Dupuytren, Limoges, France
| | | | - Cécile Borel
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Benjamin Hebraud
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | | | | | | | | | | | | | | | - Jo Caers
- Hôpital Du Sart-Tilman, Liège, Belgium
| | - Carine Chaleteix
- Centre Hospitalo-universitaire (CHU) d'Estaing, Clermont-Ferrand, France
| | | | | | | | - Patricia Zunic
- Cliniques universitaires Saint-Luc, UCL, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | - Philippe Moreau
- Centre Hospitalo-universitaire (CHU) Hôtel Dieu, Nantes, France
| | - Anne-Laurène Colin
- Pharmacovigilance des essais, Centre Hospitalo-universitaire (CHU) de Toulouse, Toulouse, France
| | - Pascale Olivier
- Pharmacovigilance des essais, Centre Hospitalo-universitaire (CHU) de Toulouse, Toulouse, France
| | - Soraya Wuilleme
- Hématologie Biologique, Centre Hospitalo-universitaire (CHU) Hôtel Dieu, Nantes, France; and
| | - Hervé Avet-Loiseau
- UGM, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Université de Toulouse, UPS, Toulouse, France
| | - Jill Corre
- UGM, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Université de Toulouse, UPS, Toulouse, France
| | - Michel Attal
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
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Martin R, Vincent B, Olivier P, Marie-Agnès G, Ulricke S, François L. PO-1265 Title: DLCO decrease in a prospective cohort of VMAT-treated lung cancer patients (NCT03931356). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03229-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Groussolles M, Winer N, Sentilhes L, Biquart F, Massoud M, Vivanti AJ, Bouchghoul H, Rozenberg P, Olivier P, Desbriere R, Chauleur C, Perrotin F, Coatleven F, Fuchs F, Bretelle F, Tsatsaris V, Salomon LJ, Sananes N, Kayem G, Houflin-Debarge V, Schmitz T, Benoist G, Arnaud C, Ehlinger V, Vayssière C. Arabin pessary to prevent adverse perinatal outcomes in twin pregnancies with a short cervix: a multicenter randomized controlled trial (PESSARONE). Am J Obstet Gynecol 2022; 227:271.e1-271.e13. [PMID: 35123930 DOI: 10.1016/j.ajog.2022.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/17/2022] [Accepted: 01/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The number of twin pregnancies continues to increase worldwide as both the number of pregnancies obtained by medically assisted reproduction and age at first pregnancy keep rising. Preterm delivery is the major complication associated with twin pregnancies. The effectiveness of preventive treatments such as progesterone or cervical cerclage for women with a short cervix is doubtful in twin pregnancies. The effectivity of cervical pessaries in preventing preterm birth and its associated morbidity and mortality is also controversial. OBJECTIVE We sought to investigate if the Arabin pessary reduces adverse neonatal outcomes in twin pregnancies with a short cervix. STUDY DESIGN This open-label, multicenter, randomized controlled trial on twin pregnancies with a cervical length of <35 mm compared pessary placement at 16+0 to 24+0 weeks' gestation with standard care alone. The primary endpoint was a composite of adverse neonatal outcomes, namely peripartum or neonatal death or significant neonatal morbidity before hospital discharge, defined as at least 1 of the following complications: bronchopulmonary dysplasia, intraventricular hemorrhage grade III to IV, periventricular leukomalacia, necrotizing enterocolitis grade II or higher, culture-proven sepsis, and retinopathy requiring treatment. A sample size of 308 pregnancies was planned to ensure 80% power to compare the proportions of women with at least 1 infant with an adverse neonatal outcome. The intention-to-treat analysis after multiple imputation of missing data, was supplemented with a secondary analysis that controlled for gestational age and cervical length, both at inclusion. The primary endpoint was also compared between randomization groups in the per-protocol population, which excluded patients with prespecified major protocol violations (mostly cervical cerclage and/or progesterone after inclusion). Secondary endpoints included preterm birth, spontaneous preterm birth, and pessary side effects. RESULTS In total, 315 women were randomized to either receive a pessary (n=157) or standard management (n=158). Overall, 10.8% (34 women) of participants had a missing value for the primary endpoint, mostly (79%) because of the lack of paternal consent for neonatal data collection. In the intention-to-treat analysis, the adverse neonatal outcome occurred in 16.8% of the pessary group vs in 22.5% of the control group (risk ratio, 0.69; 95% confidence interval, 0.39-1.23; P=.210). The per-protocol analysis did not show any significant difference between groups (risk ratio, 0.78; 95% confidence interval, 0.47-1.28; P=.320). The occurrence of preterm birth or spontaneous preterm birth did not differ significantly between groups. No serious side effects were associated with pessary use. CONCLUSION Pessary use in our study did not significantly reduce adverse neonatal outcomes in twin pregnancies with a short cervix.
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Bologna S, Vander Borght T, Briere J, Ribrag V, Damaj GL, Thieblemont C, Feugier P, Peyrade F, Lebras L, Coso D, Sibon D, Bonnet C, Morschhauser F, Ghesquieres H, Becker S, Olivier P, Fabiani B, Tilly H, Haioun C, Bastie JN. EARLY POSITRON EMISSION TOMOGRAPHY RESPONSE‐ADAPTED TREATMENT IN LOCALIZED DIFFUSE LARGE B‐CELL LYMPHOMA (AAIPI=0) : RESULTS OF THE PHASE 3 LYSA LNH 09‐1B TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.5_2879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S Bologna
- Hématologie Privée Nancéienne 54 Essey lès Nancy France
| | | | - J Briere
- CHU Henri Mondor 94 Créteil France
| | - V Ribrag
- Institut Gustave Roussy 94 Villejuif France
| | | | | | - P Feugier
- CHRU Nancy 54 Vandoeuvre lès Nancy France
| | - F Peyrade
- Centre Antoine Lacassagne 06 Nice France
| | - L Lebras
- Centre Léon Berard 69 Lyon, France
| | - D Coso
- Institut Paoli Calmette 13 Marseille France
| | - D Sibon
- Hôpital Necker-Enfants Malades 75 Paris France
| | | | | | | | - S Becker
- Centre Henri Becquerel 76 Rouen France
| | - P Olivier
- CHRU Nancy 54 Vandoeuvre lès Nancy France
| | - B Fabiani
- Hopital Saint Antoine 75 Paris France
| | - H Tilly
- Centre Henry Becquerel 76 Rouen France
| | - C Haioun
- Hopital Henri Mondor 94 Créteil France
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Petitpain N, Olivier P, Crépin S, Leone E, Ouk T, Villeneuve C, Muller C, Ruault S, Jamet A, Franceschi MP, Duranton S, Gavard M. Overview of clinical trials vigilance units in French institutional sponsors - A study from the REVISE working group. Therapie 2021; 76:743-750. [PMID: 33993991 DOI: 10.1016/j.therap.2021.04.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To follow the European Directive 2001/20/EC, institutional sponsors created or reinforced their vigilance units. Since 2007, the working group "REflexion sur la VIgilance et la Sécurité des Essais" (REVISE) rallies French institutional vigilance units (IVUs) to share their experience. The group decided to elaborate a collective work to provide a real-life descriptive picture of French IVUs activities and resources over the 2011-2016 period. METHOD A questionnaire was sent to the 60 IVUs of the group. It included questions on staff and activities, such as the number of received and analyzed serious adverse events (SAEs). All results and proposals were discussed and consensus was achieved in general meeting. RESULTS/CONCLUSION The results highlight the commitment of IVU staffs at many steps of CTs, but also the frailty of some units, leading to 6 proposals intended to institutional sponsors and competent authorities for ensuring (1) IVU visibility to all actors; (2) sustainable IVU staff; (3) IVU resources adapted to sponsor's ambitions; (4) valorization of IVUs in publications; (5) recognition of IVU's value in clinical research quality; (6) involvement of IVUs in regulatory changes and their procedures of implementation.
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Affiliation(s)
- Nadine Petitpain
- Service de pharmacologie clinique, toxicologie, unité de vigilance des essais cliniques, Centre régional de pharmacovigilance, CHRU de Nancy, bâtiment de biologie et de biopathologie, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Pascale Olivier
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament INSERM UMR 1027, CIC 1436, faculté de médecine, centre hospitalier universitaire, 31059 Toulouse, France
| | - Sabrina Crépin
- Service de pharmacologie, toxicologie et pharmacovigilance, unité de vigilance des essais cliniques, CHU de Limoges, 87000 Limoges, France
| | - Emanuela Leone
- Unité de vigilance des essais cliniques, Hôpital Foch, 92151 Suresnes, France
| | - Thavarak Ouk
- Cellule vigilance, direction de la recherche et de l'innovation, CHU de Lille, 59045 Lille, France
| | - Claire Villeneuve
- Service de pharmacologie, toxicologie et pharmacovigilance, unité de vigilance des essais cliniques, CHU de Limoges, 87000 Limoges, France
| | - Charlotte Muller
- Vigilance des essais cliniques, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France
| | - Sophie Ruault
- Maison de la recherche clinique, CHU de Rouen, 76031 Rouen, France
| | - Aurélie Jamet
- Vigilance des essais cliniques, CHU d'Angers, 49933 Angers, France
| | - Marie-Paule Franceschi
- Direction de la recherche, des partenariats hospitalo-universitaires et internationaux, CHU de Nîmes, Université de Montpellier, 30029 Nîmes, France
| | - Sophie Duranton
- Direction de la recherche, unité de vigilance des essais cliniques, CHU de Poitiers, 86021 Poitiers cedex, France
| | - Marylaure Gavard
- Cellule de vigilance des essais cliniques-délégation à la recherche clinique et à l'innovation - CHU de Grenoble-Alpes, 38043 Grenoble, France
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Bouhanick B, Delchier MC, Lagarde S, Boulestreau R, Conil C, Gosse P, Rousseau H, Lepage B, Olivier P, Papadopoulos P, Trillaud H, Cremer A. Radiofrequency ablation for adenoma in patients with primary aldosteronism and hypertension: ADERADHTA, a pilot study. J Hypertens 2021; 39:759-765. [PMID: 33196558 PMCID: PMC7969174 DOI: 10.1097/hjh.0000000000002708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy and the feasibility of radiofrequency ablation to treat aldosterone-producing adenomas. METHODS In an open prospective bicentric pilot study, patients with hypertension on ambulatory blood pressure measurement, a primary aldosteronism, an adenoma measuring less than 4 cm, and confirmation of lateralization by adrenal venous sampling were recruited. The primary endpoint, based on ABPM performed at 6 months after the radiofrequency ablation, was a daytime SBP/DBP less than 135/85 mmHg without any antihypertensive drugs or a reduction of at least 20 mmHg for SBP or 10 mmHg for DBP. RESULTS Thirty patients have been included (mean age = 51 ± 11 years; 50% women). Mean baseline daytime SBP and DBP were 144 ± 19 / 95 ± 15 mmHg and 80% received at least two antihypertensive drugs. At 6 months: 47% (95% CI 28-66) of patients reached the primary endpoint, mean daytime SBP and DBP were 131 ± 14 (101-154)/87 ± 10 (71-107) mmHg; 43% of them did not take any antihypertensive drug and 70% of them did not take potassium supplements. Few complications were recorded: four cases of back pain at day 1 postablation; three limited pneumothoraxes, which resolved spontaneously; one lesion of a polar renal artery. CONCLUSION Radiofrequency ablation for hypertensive patients with aldosterone-producing adenomas seems to be an emerging promising alternative to surgery. Its efficacy and its feasibility have to be confirmed in a larger sample of patients.
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Affiliation(s)
| | | | | | | | | | - Philippe Gosse
- Service de Cardiologie/HTA, Hôpital Saint André, CHU Bordeaux
| | | | | | - Pascale Olivier
- Service de Pharmacologie Médicale et Clinique, Pharmacovigilance, CHU Toulouse
| | | | - Hervé Trillaud
- Service d’imagerie diagnostique et interventionnelle, CHU Bordeaux, France
| | - Antoine Cremer
- Service de Cardiologie/HTA, Hôpital Saint André, CHU Bordeaux
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Mourey L, Le Louedec F, Ravaud A, Paludetto MN, Digue L, Gomez-Roca CA, Valentin T, Balardy L, Olivier P, Cabarrou B, Filleron T, Chatelut E. VOTRAGE study: Phase I dose-escalation study of pazopanib in unfit older patients. J Geriatr Oncol 2021; 12:759-764. [PMID: 33715996 DOI: 10.1016/j.jgo.2021.02.006] [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: 10/20/2020] [Revised: 12/18/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pazopanib is a tyrosine kinase inhibitor given at the approved dose of 800 mg orally once daily (OD), but often requiring individual dose adjustment due to toxicity. Limited data is available to guide prescription in older patients especially the unfit according to geriatric assessment. PATIENTS AND METHODS VOTRAGE is a 3 + 3 dose-escalation, open-label phase I trial of continuous OD oral administration of pazopanib to evaluate safety, PK and PD data in unfit older patients with advanced solid tumors. The primary objective was to determine the maximum tolerated dose (MTD). PK data were compared with those obtained in younger adult patients in a population PK analysis. RESULTS Eighteen patients with a median age of 82.5 years (range 75-91) were included in three dosing cohorts (400, 600, and 800 mg daily). Three dose-limiting toxicities (DLT) were observed in five patients at 800 mg and one DLT at 600 mg in six evaluable patients. MTD was defined as level 2 dose (600 mg). Individual oral clearance was not correlated with age. A relationship was observed between the occurrence of DLT and pazopanib plasma exposure. Decreased oral bioavailability of pazopanib when given with proton-pump inhibitors was confirmed in this group of patients. CONCLUSION We recommend performing geriatric assessment in patients older than 75 and starting pazopanib at 600 mg per day in unfit older patients. Therapeutic drug monitoring appears very helpful in this population.
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Affiliation(s)
- Loïc Mourey
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France.
| | - Félicien Le Louedec
- Laboratory of Phamacology, Institut Claudius Regaud, IUCT-Oncopole, and CRCT, Université de Toulouse, Inserm, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Alain Ravaud
- Department of Medical Oncology, Saint André CHU Hospital, 1, rue Jean Burguet, 33000 Bordeaux, France
| | - Marie-Noëlle Paludetto
- Pharmacy Department, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France et Cancer Research Center of Toulouse (CRCT), INSERM UMR1037, University of Toulouse, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Laurence Digue
- Department of Medical Oncology, Saint André CHU Hospital, 1, rue Jean Burguet, 33000 Bordeaux, France
| | - Carlos Alberto Gomez-Roca
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Thibaud Valentin
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Laurent Balardy
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Toulouse University Hospital Purpan, place du Docteur Joseph Baylac, 31300 Toulouse, France
| | - Pascale Olivier
- Department of Clinical and Medical Pharmacology and regional pharmacovigilance center, Toulouse University Hospital, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Bastien Cabarrou
- Department of Biostatistics, Institut Claudius Regaud, IUCT-Oncopole, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud, IUCT-Oncopole, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - Etienne Chatelut
- Laboratory of Phamacology, Institut Claudius Regaud, IUCT-Oncopole, and CRCT, Université de Toulouse, Inserm, 1, avenue Irène Joliot-Curie, 31059 Toulouse, France
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16
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Chevreau C, Massard C, Flechon A, Delva R, Gravis G, Lotz JP, Bay JO, Gross-Goupil M, Fizazi K, Mourey L, Paci A, Guitton J, Thomas F, Lelièvre B, Ciccolini J, Moeung S, Gallois Y, Olivier P, Culine S, Filleron T, Chatelut E. Multicentric phase II trial of TI-CE high-dose chemotherapy with therapeutic drug monitoring of carboplatin in patients with relapsed advanced germ cell tumors. Cancer Med 2021; 10:2250-2258. [PMID: 33675184 PMCID: PMC7982623 DOI: 10.1002/cam4.3687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 11/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background High‐dose chemotherapy (HDCT) with TI‐CE regimen is a valid option for the treatment of relapsed advanced germ cell tumors (GCT). We report a phase II trial with therapeutic drug monitoring of carboplatin for optimizing area under the curve (AUC) of this drug. Methods Patients with unfavorable relapsed GCT were treated according to TI‐CE regimen: two cycles combining paclitaxel and ifosfamide followed by three cycles of HD carboplatin plus etoposide administered on 3 days. Carboplatin dose was adapted on day 3 based on carboplatin clearance (CL) at day 1 in order to reach a target AUC of 24 mg.min/mL per cycle. The primary endpoint was the complete response (CR) rate. Results Eighty‐nine patients who received HDCT were included in the modified intent‐to‐treat (mITT) analysis. Measured mean AUC was 24.4 mg.min/mL per cycle (22.4 and 26.8 mg.min/mL for 10th and 90th percentiles). Thirty‐five (44.3%) patients achieved a CR with or without surgery of residual masses and 20 patients achieved a partial response with negative tumor markers. With a median follow‐up of 44 months (m), median PFS was 12.3 m (95% CI: 7.5–25.9) and OS was 46.3 m (95% CI: 18.6–not reached). For high‐ and very high‐risk patients, according to the International Prognostic Score at first relapse or treated after at least one salvage treatment (n = 51), 2‐year PFS rate was 41.1%. Conclusion The rates of complete and favorable responses were clinically relevant in this very poor risk population. Individual monitoring of carboplatin plasma concentration permitted to control more accurately the target AUC and avoided both underexposure and overexposure to the drug.
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Affiliation(s)
| | | | | | - Rémy Delva
- Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France
| | | | | | | | | | | | - Loïc Mourey
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - Jérôme Guitton
- Laboratoire de Pharmacologie Toxicologie, CHU, Lyon, France
| | - Fabienne Thomas
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.,Cancer Research Center of Toulouse (CRCT),, Université Paul Sabatier, Toulouse, France
| | | | | | - Sotheara Moeung
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.,Cancer Research Center of Toulouse (CRCT),, Université Paul Sabatier, Toulouse, France
| | - Yohan Gallois
- Service d'Otoneurologie et ORL Pédiatrique, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | | | | | | | - Etienne Chatelut
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.,Cancer Research Center of Toulouse (CRCT),, Université Paul Sabatier, Toulouse, France
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17
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Montfort A, Filleron T, Virazels M, Dufau C, Milhès J, Pagès C, Olivier P, Ayyoub M, Mounier M, Lusque A, Brayer S, Delord JP, Andrieu-Abadie N, Levade T, Colacios C, Ségui B, Meyer N. Combining Nivolumab and Ipilimumab with Infliximab or Certolizumab in Patients with Advanced Melanoma: First Results of a Phase Ib Clinical Trial. Clin Cancer Res 2020; 27:1037-1047. [PMID: 33272982 DOI: 10.1158/1078-0432.ccr-20-3449] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE TNF blockers can be used to manage gastrointestinal inflammatory side effects following nivolumab and/or ipilimumab treatment in patients with advanced melanoma. Our preclinical data showed that anti-TNF could promote the efficacy of immune checkpoint inhibitors. PATIENTS AND METHODS TICIMEL (NTC03293784) is an open-label, two-arm phase Ib clinical trial. Fourteen patients with advanced and/or metastatic melanoma (stage IIIc/IV) were enrolled. Patients were treated with nivolumab (1 mg/kg) and ipilimumab (3 mg/kg) combined to infliximab (5 mg/kg, N = 6) or certolizumab (400/200 mg, N = 8). The primary endpoint was safety and the secondary endpoint was antitumor activity. Adverse events (AEs) were graded according to the NCI Common Terminology Criteria for Adverse Events and response was assessed following RECIST 1.1. RESULTS Only one dose-limiting toxicity was observed in the infliximab cohort. The two different combinations were found to be safe. We observed lower treatment-related AEs with infliximab as compared with certolizumab. In the certolizumab cohort, one patient was not evaluable for response. In this cohort, four of eight patients exhibited hepatobiliary disorders and seven of seven evaluable patients achieved objective response including four complete responses (CRs) and three partial responses (PRs). In the infliximab cohort, we observed one CR, two PRs, and three progressive diseases. Signs of activation and maturation of systemic T-cell responses were seen in patients from both cohorts. CONCLUSIONS Our results show that both combinations are safe in human and provide clinical and biological activities. The high response rate in the certolizumab-treated patient cohort deserves further investigations.
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Affiliation(s)
- Anne Montfort
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Thomas Filleron
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Mathieu Virazels
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Carine Dufau
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Jean Milhès
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Cécile Pagès
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
| | - Pascale Olivier
- Service de Pharmacologie médicale et clinique, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur le médicament du CHU de Toulouse, Toulouse, France
| | - Maha Ayyoub
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Muriel Mounier
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Amélie Lusque
- Methodology, biostatistics and clinical operations, Institut Claudius Regaud, IUCT-O, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
| | - Stéphanie Brayer
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
| | - Jean-Pierre Delord
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Nathalie Andrieu-Abadie
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
| | - Thierry Levade
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
- Laboratoire de Biochimie, Institut Fédératif de Biologie, CHU Purpan, Toulouse, France
| | - Céline Colacios
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Bruno Ségui
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France.
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Nicolas Meyer
- INSERM UMR 1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France.
- Equipe Labellisée Fondation ARC pour la recherche sur le cancer, Toulouse, France
- Institut Universitaire du Cancer (IUCT-O), Toulouse, France
- Université Toulouse III - Paul Sabatier, Toulouse, France
- Service d'Oncodermatologie, IUCT-O, CHU de Toulouse, Toulouse, France
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18
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Conte C, Rousseau V, Vert C, Montastruc F, Montastruc J, Durrieu G, Olivier P. Adverse drug reactions of statins in children and adolescents: a descriptive analysis from VigiBase, the WHO global database of individual case safety reports. Fundam Clin Pharmacol 2020; 34:518-520. [DOI: 10.1111/fcp.12542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/13/2020] [Accepted: 01/30/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Cécile Conte
- Faculté de Médecine Laboratoire de Pharmacologie Médicale et Clinique F‐31000 Toulouse France
- Service de Pharmacologie Médicale et Clinique Centre de Pharmacovigilance de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU F‐31000 Toulouse France
- UMR 1027 Inserm‐Université de Toulouse 31000 Toulouse France
| | - Vanessa Rousseau
- Service de Pharmacologie Médicale et Clinique Centre de Pharmacovigilance de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU F‐31000 Toulouse France
- UMR 1027 Inserm‐Université de Toulouse 31000 Toulouse France
| | - Charlotte Vert
- Service de Pharmacologie Médicale et Clinique Centre de Pharmacovigilance de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU F‐31000 Toulouse France
| | - François Montastruc
- Faculté de Médecine Laboratoire de Pharmacologie Médicale et Clinique F‐31000 Toulouse France
- Service de Pharmacologie Médicale et Clinique Centre de Pharmacovigilance de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU F‐31000 Toulouse France
- UMR 1027 Inserm‐Université de Toulouse 31000 Toulouse France
| | - Jean‐Louis Montastruc
- Faculté de Médecine Laboratoire de Pharmacologie Médicale et Clinique F‐31000 Toulouse France
- Service de Pharmacologie Médicale et Clinique Centre de Pharmacovigilance de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU F‐31000 Toulouse France
- UMR 1027 Inserm‐Université de Toulouse 31000 Toulouse France
| | - Geneviève Durrieu
- Faculté de Médecine Laboratoire de Pharmacologie Médicale et Clinique F‐31000 Toulouse France
- Service de Pharmacologie Médicale et Clinique Centre de Pharmacovigilance de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU F‐31000 Toulouse France
| | - Pascale Olivier
- Faculté de Médecine Laboratoire de Pharmacologie Médicale et Clinique F‐31000 Toulouse France
- Service de Pharmacologie Médicale et Clinique Centre de Pharmacovigilance de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU F‐31000 Toulouse France
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19
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Lafaurie M, Olivier P, Khouri C, Atzenhoffer M, Bihan K, Durrieu G, Montastruc JL. Myocardial infarction and ischemic stroke with vasoconstrictors used as nasal decongestant for common cold: a French pharmacovigilance survey. Eur J Clin Pharmacol 2019; 76:603-604. [PMID: 31858187 DOI: 10.1007/s00228-019-02807-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/25/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Margaux Lafaurie
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC 1436, UMR 1027, Faculté de Médecine, Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | - Pascale Olivier
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC 1436, UMR 1027, Faculté de Médecine, Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Charles Khouri
- Centre Régional de Pharmacovigilance, Centre Hospitalier Universitaire Grenoble Alpes, INSERM UMR 1042-HP2, Université Grenoble Alpes, Grenoble, France
| | - Marina Atzenhoffer
- Service Hospitalo-Universitaire de Pharmaco-Toxicologie, Centre Régional de Pharmacovigilance, Hospices Civils de Lyon, Lyon, France
| | - Kévin Bihan
- Service de Pharmacologie, Centre Régional de Pharmacovigilance, Hôpital Pitié-Salpêtrière, Paris, France
| | - Geneviève Durrieu
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC 1436, UMR 1027, Faculté de Médecine, Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CIC 1436, UMR 1027, Faculté de Médecine, Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Pouessel D, Mervoyer A, Larrieu-Ciron D, Cabarrou B, Robert M, Frenel J, Olivier P, Mounier M, Cohen-Jonathan Moyal E. OS4.4 Hypofractionated stereotactic radiotherapy and anti-PDL1 Durvalumab combination in recurrent glioblastoma: Results of the phase I part of the phase I/II STERIMGLI trial. Neuro Oncol 2019; 21:iii10-iii11. [PMCID: PMC6795045 DOI: 10.1093/neuonc/noz126.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Abstract
BACKGROUND
Glioblastoma (GBM) remains a lethal disease with inevitable local relapse and no standard treatment. Re-irradiation by hypofractionated stereotactic radiotherapy (hFSRT) is an option of treatment with tolerable safety, but needs improvement in term of efficacy. Radiotherapy (RT) causes immunogenic tumor cell death but also induces PDL1 and PD1 expression on tumors and immune cells, potentially evoking resistance to RT. Pre-clinical studies combining hFSRT with an anti-PD-1 antibody in GBM have shown increased efficacy of the combination. Clinical studies also show encouraging results when checkpoint inhibitors have been combined with high dose RT. We hypothesized that combining the anti PD-L1 Durvalumab (Durva) with hFSRT will be an effective regimen for patients with recurrent GBM. We designed a phase I/II clinical trial studying the combination of hFSRT with Durva for recurrent GBM≤35 mm diameter. Results of the phase I are presented.
MATERIAL AND METHODS
Patients were included from February 2017 to October 2017.
A standard 3 + 3 de-escalation design was used. Patients were treated by hFSRT 24 Gy, 8 Gy/fraction at 80% isodose, every other day, combined with Durva infusion 1500mg first dose (Level 1) or 750 mg (Level -1) delivered on the last hFSRT day followed by 1500 mg Durva infusion every four weeks until relapse. The schema was defined as safe if one patient or less among 6 presents a dose limiting toxicity (DLT). Brain MRI was performed before RT and then every 8 weeks until relapse. Tumor assessment was performed according to RANO criteria.
RESULTS
Among the 6 patients (3 methylated MGMT, 3 unmethylated MGMT; all wild type IDH) included at the level 1, all completed the hFSRT course, only one had a DLT which was an immune related grade 3 vestibular neuritis. At the time of analysis (24/01/19), all the patients had a local tumor progression, 4 were still alive. Local progression free interval (LPFI) ranges from 2.1 to 8.1 months. Interestingly the 2 patients who presented a pseudo-progression had a prolonged LPFI (5.7 and 8.1 months) compared to the other patients. All the patients except these 2 patients had a lymphopenia at inclusion. PDL-1 expression varied from 0 to 70% in the primary tumor.
CONCLUSION
Combining three 8 Gy fractions of hFSRT with 1500 mg Durvalumab on the 3rd fraction hFSRT and every 4 weeks for recurrent GBM is well tolerated justifying exploration of its efficacy in the phase II which is currently in interim analysis
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Affiliation(s)
- D Pouessel
- Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - A Mervoyer
- Institut de Cancerologie de l’Ouest, Saint Herblain, France
| | | | - B Cabarrou
- Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - M Robert
- Institut de Cancerologie de l’Ouest, Saint Herblain, France
| | - J Frenel
- Institut de Cancerologie de l’Ouest, Saint Herblain, France
| | - P Olivier
- Centre Régional de Pharmacovigilance, Toulouse, France
| | - M Mounier
- Institut Claudius Regaud-IUCT-O, Toulouse, France
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Hampton P, Richardson D, Brown S, Goodhead C, Montague K, Olivier P. Usability testing of MySkinSelfie: a mobile phone application for skin self-monitoring. Clin Exp Dermatol 2019; 45:73-78. [PMID: 31021009 DOI: 10.1111/ced.13995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2019] [Indexed: 12/01/2022]
Abstract
Teledermatology generally involves doctors taking images of patients; however, patients increasingly want to own or have easy access to their health data. MySkinSelfie ( http://myskinselfie.com) is a mobile phone application (app) designed to improve the quality, consistency and accessibility of patient-held photos, and was developed to give patients the ability to generate and hold their own skin images to help guide their skin care. This study assessed the usability of this app in a cohort of patients attending a National Health Service Dermatology clinic. Patients were asked to use the app but were not given specific tasks to achieve. Of the 102 patients recruited, 32 downloaded the app and registered an account, 21 took at least one photo (median 5, range 1-103) and 19 completed the usability questionnaire. The majority of questionnaire respondents found the app easy to use but were more neutral on whether it really helped them to manage their skin problem. MySkinSelfie has been shown to be easy to use. Self-monitoring of skin problems may be useful for a subset of patients, and this is likely to depend on diagnosis, age and other patient factors.
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Affiliation(s)
- P Hampton
- Department of Dermatology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - D Richardson
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - S Brown
- Department of Dermatology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - C Goodhead
- Department of Dermatology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - K Montague
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - P Olivier
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
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22
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Clapes V, Rousseau V, Despas F, Montastruc JL, Olivier P. Adverse Drug Reactions Involving Protein Kinase Inhibitors: A French Pharmacovigilance Database Study Comparing Safety in Younger and Older Patients (≥ 75 years) with Cancer. Pharmaceut Med 2019; 33:21-27. [DOI: 10.1007/s40290-018-0259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Mourey L, Ravaud A, Digue L, Cabarrou B, Gomez-Roca C, Valentin T, Olivier P, Fabre A, Mounier M, Balardy L, Filleron T. VOTRAGE study pazopanib in a population of “frail” elderly patients after geriatric assessment: A phase I study with geriatric criteria. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Larrieu-Ciron D, Peyraga G, Pouessel D, Mervoyer A, Cabarrou B, Attal J, Robert M, Olivier P, Mounier M, Cohen-Jonathan Moyal E. P01.094 Hypofractionnated Stereotactic Radiation Therapy and Durvalumab combination in recurrent Glioblastoma (GBM): Results of the phase I part of the phase I/II STERIMGLI trial. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.136] [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: 11/13/2022] Open
Affiliation(s)
| | - G Peyraga
- Institut Claudius Régaud, Toulouse, France
| | - D Pouessel
- Institut Claudius Régaud, Toulouse, France
| | - A Mervoyer
- Institut René Gauducheau, Nantes, France
| | | | - J Attal
- Institut Claudius Régaud, Toulouse, France
| | - M Robert
- Institut René Gauducheau, Nantes, France
| | | | - M Mounier
- Institut Claudius Régaud, Toulouse, France
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Pouessel D, Mervoyer A, Larrieu-Ciron D, Cabarrou B, Attal J, Robert M, Frenel JS, Olivier P, Poublanc M, Mounier M, Moyal E. Hypofractionnated stereotactic radiotherapy and anti-PDL1 durvalumab combination in recurrent glioblastoma: Results of the phase I part of the phase I/II STERIMGLI trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Augustin Mervoyer
- Institut de Cancérologie de l'Ouest - René Gauducheau, Radiation Therapy Department, Saint-Herblain, France
| | | | | | | | - Marie Robert
- Cancer Institute of the West (ICO), Nantes, France
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Perez C, Olivier P, Lortal B, Duranton S, Montastruc JL, Colin AL, Toulza E, Becker M, Hamy L, Crepin S, Roussillon C, Gimbert A, Petitpain N, Salvo F. Detection of drug safety signals from clinical trials data: Role of SUSARs. Pharmacol Res 2018; 131:218-223. [PMID: 29444478 DOI: 10.1016/j.phrs.2018.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/08/2018] [Accepted: 02/08/2018] [Indexed: 02/01/2023]
Abstract
One of the main goals of safety management in clinical trials is to detect suspected unexpected serious adverse reactions (SUSARs). The unexpectedness concerns the nature, frequency or severity of an adverse reaction. Drug safety signals could thus be retrieved, and a study was performed to investigate whether SUSARs allow signal detection in pharmacovigilance. Data from six academic safety units were collected from 2005 to 2016. Characteristics of SUSARs were analysed and signals were identified i) by evaluating the presence of other causes, ii) by assessing the summary of product characteristics (SPC), iii) by searching for specific safety information in Pubmed and health agencies, and iv) by investigating the narrative of each case. Pharmacological plausibility was evaluated by compatible mechanism of reaction and time-to-onset. During the study period, 211 SUSARs were collected. They mostly concerned general disorders (26.1%) and protein kinase inhibitors (24.6%). After eliminating SUSARs with other causes or those considered as expected, 50 SUSARs (23.7%), involving a total of 115 drug-reaction pairs, concerned potential safety signals. Among these pairs, 12 (10.4%) were considered as pharmacologically plausible. This study indicates that one quarter of SUSARs collected in academic clinical trials refers to potential safety signals, especially for oncologic drugs. One tenth of drug-reaction pairs was considered to have a pharmacological plausibility and could merit further evaluation. This is the first study suggesting that SUSARs could be a source of safety signals and that their routine analysis should be complementary to spontaneous reporting.
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Affiliation(s)
- Christelle Perez
- Direction de la recherche et Clinique et de l'Innovation, Unité de Sécurité et Vigilance de la Recherche Clinique, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Pascale Olivier
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament INSERM UMR 1027, CIC 1436, Centre Hospitalier Universitaire, Faculté de Médecine, F-31059, Toulouse, France
| | - Barbara Lortal
- Institut Bergonié, Vigilance des Essais Cliniques, F-33076, Bordeaux Cedex, France
| | - Sophie Duranton
- Direction de la Recherche, Unité de Vigilance des essais cliniques, CHU de Poitiers, F-86021, Poitiers Cedex, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament INSERM UMR 1027, CIC 1436, Centre Hospitalier Universitaire, Faculté de Médecine, F-31059, Toulouse, France
| | - Anne-Laurène Colin
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament INSERM UMR 1027, CIC 1436, Centre Hospitalier Universitaire, Faculté de Médecine, F-31059, Toulouse, France
| | - Emilie Toulza
- Institut Bergonié, Vigilance des Essais Cliniques, F-33076, Bordeaux Cedex, France
| | - Madlyne Becker
- Service de Pharmacologie Clinique et de Toxicologie, Centre Régional de Pharmacovigilance, CHRU de Nancy, F-54035, Nancy Cedex, France
| | - Laura Hamy
- Direction de la Recherche, Unité de Vigilance des essais cliniques, CHU de Poitiers, F-86021, Poitiers Cedex, France
| | - Sabrina Crepin
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, Unité de vigilance des essais cliniques, France CHU de Limoges, F-87000, Limoges, France
| | - Caroline Roussillon
- Direction de la recherche et Clinique et de l'Innovation, Unité de Sécurité et Vigilance de la Recherche Clinique, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Anne Gimbert
- Direction de la recherche et Clinique et de l'Innovation, Unité de Sécurité et Vigilance de la Recherche Clinique, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Nadine Petitpain
- Service de Pharmacologie Clinique et de Toxicologie, Centre Régional de Pharmacovigilance, CHRU de Nancy, F-54035, Nancy Cedex, France
| | - Francesco Salvo
- Direction de la recherche et Clinique et de l'Innovation, Unité de Sécurité et Vigilance de la Recherche Clinique, CHU de Bordeaux, F-33000, Bordeaux, France; Univ. Bordeaux, INSERM U1219, Pharmacoepidemiology Team, F-33000, Bordeaux, France.
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Massabeau C, Khalifa J, Filleron T, Modesto A, Bigay-Gamé L, Plat G, Dierickx L, Aziza R, Rouquette I, Gomez-Roca C, Mounier M, Delord JP, Toulas C, Olivier P, Chatelut E, Mazières J, Cohen-Jonathan Moyal E. Continuous Infusion of Cilengitide Plus Chemoradiotherapy for Patients With Stage III Non-Small-cell Lung Cancer: A Phase I Study. Clin Lung Cancer 2017; 19:e277-e285. [PMID: 29221762 DOI: 10.1016/j.cllc.2017.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/18/2017] [Accepted: 11/10/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Because of our previous preclinical results, we conducted a phase I study associating the specific αvβ3/αvβ5 integrin inhibitor cilengitide, given as a continuous infusion, with exclusive chemoradiotherapy for patients with stage III non-small-cell lung cancer. PATIENTS AND METHODS A standard 3+3 dose escalation design was used. Cilengitide was given as a continuous infusion (dose levels of 12, 18, 27, and 40 mg/h), starting 2 weeks before and continuing for the whole course of chemoradiotherapy (66 Gy combined with platinum/vinorelbine), and then at a dose of 2000 mg twice weekly in association with chemotherapy. 2-Deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography (PET) and computed tomography scans were performed before and after the first 2 weeks of cilengitide administration and then every 3 months. RESULTS Of the 14 patients included, 11 were evaluable for evaluation of the dose-limiting toxicities (DLTs). One DLT, a tracheobronchial fistula, was reported with the 40 mg/h dose. No relevant adverse events related to cilengitide were observed overall. At the PET evaluation 2 months after chemoradiotherapy, 4 of 9 patients had a complete response and 4 had a partial response. The median progression-free and overall survival was 14.4 months (95% confidence interval [CI], 8.4 to not reached) and 29.4 months (95% CI, 11.73 to not reached), respectively. CONCLUSION Cilengitide, given continuously with chemoradiotherapy, showed acceptable toxicity and gave encouraging clinical results.
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Affiliation(s)
- Carole Massabeau
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France.
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Anouchka Modesto
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Laurence Bigay-Gamé
- Department of Pneumology, Centre Hospitalo-Universitaire Larrey, Toulouse, France
| | - Gavin Plat
- Department of Pneumology, Centre Hospitalo-Universitaire Larrey, Toulouse, France
| | - Lawrence Dierickx
- Department of Imaging/Nuclear Medicine, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Richard Aziza
- Department of Imaging/Nuclear Medicine, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Isabelle Rouquette
- Department of Pathology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Carlos Gomez-Roca
- Department of Medical Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Muriel Mounier
- Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Jean-Pierre Delord
- Department of Medical Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France; Université Paul Sabatier, Toulouse, France; INSERM U1037, Centre de Recherche Contre le Cancer de Toulouse, Toulouse, France
| | - Christine Toulas
- INSERM U1037, Centre de Recherche Contre le Cancer de Toulouse, Toulouse, France
| | - Pascale Olivier
- Vigilance des Essais Cliniques, de la recherche et de l'innovation du Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Etienne Chatelut
- Université Paul Sabatier, Toulouse, France; INSERM U1037, Centre de Recherche Contre le Cancer de Toulouse, Toulouse, France; Laboratoire de Pharmacologie, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Julien Mazières
- Department of Pneumology, Centre Hospitalo-Universitaire Larrey, Toulouse, France; Université Paul Sabatier, Toulouse, France; INSERM U1037, Centre de Recherche Contre le Cancer de Toulouse, Toulouse, France
| | - Elizabeth Cohen-Jonathan Moyal
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France; Université Paul Sabatier, Toulouse, France; INSERM U1037, Centre de Recherche Contre le Cancer de Toulouse, Toulouse, France
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Olivier P, Van Melkebeke D, Honoré PJ, Defreyne L, Hemelsoet D. Cerebral vasospasm in acute porphyria. Eur J Neurol 2017; 24:1183-1187. [DOI: 10.1111/ene.13347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/22/2017] [Indexed: 01/22/2023]
Affiliation(s)
- P. Olivier
- Ghent University Hospital; Ghent Belgium
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Chevreau C, Massard C, Flechon A, Delva R, Gravis G, Lotz JP, Bay JO, Gross-Goupil M, Fizazi K, Mourey L, Thomas F, Filleron T, Olivier P, Culine S, Chatelut E. Phase II trial of TI-CE high dose chemotherapy (HDCT) with drug monitoring for individual carboplatin dosing in patients with relapsed advanced germ cell tumors: A multicentric prospective GETUG trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
401 Background: HDCT is a valid option of treatment for relapsed advanced GCTs pts. The results of the TICE regimen as salvage therapy in poor risk pts demonstrated a 50% complete response (CR) but with very high variability of measured carboplatin area under the curve (AUC) (between 10.9-36.7 for target AUC = 24 mg.min/mL). We initiated a phase II trial of TICE with therapeutic drug monitoring (TDM) for individual carboplatin dosing in order to target the 3-day AUC to 24 mg/min/mL. Methods: Were included pts with unfavorable relapsed GCTs , secondarily classified according to the International Prognostic Factors Study Group. Pts were treated according the TICE regimen with two cycles combining paclitaxel and ifosfamide followed by three cycles HDCT: carboplatin plus etoposide with stem cell support. Carboplatin dose was adapted on day 3 based on carboplatin clearance (Cl) at day 1, in order to reach the target AUC. The primary endpoint was the CR rate (cCR sCR pCR). A Simon Minimax design was performed using the following hypothesis: p0 = 50%, p1 = 65 α = 5%, β = 10%. Results: Between 03/2009 and 11/2015 101 pts were accrued, 60 pts were treated in first relapse (34 classified as high and very high-risk) and 41 in 2ndor more relapse. 72 pts (71%) received the whole treatment, 12 pts (10%) did not receive any cycle of HDCT. 29pts (26%) stopped treatment earlier, 8 for toxicity. Three pts died on treatment. 35/79 (44.3%) evaluable pts achieved a CR. 19 pts (24%) presented a PRm-. The mean observed carboplatin AUC was 24.5 mg.min/mL (between 18.9 and 28.8) at C1.Following TDM, the modification of the total carboplatin dose during C1 was comprised between -33% and +44%, showing the benefit of TDM in comparison with individual dosing based only on carboplatin Cl predicted according to patient’s renal characteristics. Conclusions: The CR rate observed in this very poor prognosis population was 44.3% and 69.6% CR + PRm-. Carboplatin dose individualization based on TDM allowed to reach more accurately the target AUC compared to previous reports. Clinical trial information: NCT00864318.
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Affiliation(s)
| | | | | | - Remy Delva
- Institut de Cancerologie de l'Ouest, Angers, France
| | - Gwenaelle Gravis
- Medical Oncology, Institut Paoli Calmette, Hopital de Jour, Marseille, France
| | | | - Jacques-Olivier Bay
- Centre Jean Perrin and Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Karim Fizazi
- Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Loic Mourey
- Institut Claudius Regaud - IUCT-O, Toulouse, France
| | | | - Thomas Filleron
- Institut Universitaire du Cancer - Oncopole, Toulouse, France
| | | | - Stephane Culine
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
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Merlin JL, Rauch P, Leufflen L, Salleron J, Harlé A, Olivier P, Marchal F. Abstract P2-01-30: Limited effectiveness of patent blue dye in addition to isotope scanning for identification of sentinel lymph nodes: Cross-sectional real-life study in 1024 breast cancer patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-01-30] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- J-L Merlin
- Institut de Cancérologie de Lorraine, Nancy, France; Université de Lorraine, Nancy, France; CNRS UMR7039 CRAN, Vandoeuvre les Nancy, France; CHU, Nancy, France
| | - P Rauch
- Institut de Cancérologie de Lorraine, Nancy, France; Université de Lorraine, Nancy, France; CNRS UMR7039 CRAN, Vandoeuvre les Nancy, France; CHU, Nancy, France
| | - L Leufflen
- Institut de Cancérologie de Lorraine, Nancy, France; Université de Lorraine, Nancy, France; CNRS UMR7039 CRAN, Vandoeuvre les Nancy, France; CHU, Nancy, France
| | - J Salleron
- Institut de Cancérologie de Lorraine, Nancy, France; Université de Lorraine, Nancy, France; CNRS UMR7039 CRAN, Vandoeuvre les Nancy, France; CHU, Nancy, France
| | - A Harlé
- Institut de Cancérologie de Lorraine, Nancy, France; Université de Lorraine, Nancy, France; CNRS UMR7039 CRAN, Vandoeuvre les Nancy, France; CHU, Nancy, France
| | - P Olivier
- Institut de Cancérologie de Lorraine, Nancy, France; Université de Lorraine, Nancy, France; CNRS UMR7039 CRAN, Vandoeuvre les Nancy, France; CHU, Nancy, France
| | - F Marchal
- Institut de Cancérologie de Lorraine, Nancy, France; Université de Lorraine, Nancy, France; CNRS UMR7039 CRAN, Vandoeuvre les Nancy, France; CHU, Nancy, France
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Mukherjee JM, Lindsay C, Mukherjee A, Olivier P, Shao L, King MA, Licho R. Improved frame-based estimation of head motion in PET brain imaging. Med Phys 2017; 43:2443. [PMID: 27147355 DOI: 10.1118/1.4946814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Head motion during PET brain imaging can cause significant degradation of image quality. Several authors have proposed ways to compensate for PET brain motion to restore image quality and improve quantitation. Head restraints can reduce movement but are unreliable; thus the need for alternative strategies such as data-driven motion estimation or external motion tracking. Herein, the authors present a data-driven motion estimation method using a preprocessing technique that allows the usage of very short duration frames, thus reducing the intraframe motion problem commonly observed in the multiple frame acquisition method. METHODS The list mode data for PET acquisition is uniformly divided into 5-s frames and images are reconstructed without attenuation correction. Interframe motion is estimated using a 3D multiresolution registration algorithm and subsequently compensated for. For this study, the authors used 8 PET brain studies that used F-18 FDG as the tracer and contained minor or no initial motion. After reconstruction and prior to motion estimation, known motion was introduced to each frame to simulate head motion during a PET acquisition. To investigate the trade-off in motion estimation and compensation with respect to frames of different length, the authors summed 5-s frames accordingly to produce 10 and 60 s frames. Summed images generated from the motion-compensated reconstructed frames were then compared to the original PET image reconstruction without motion compensation. RESULTS The authors found that our method is able to compensate for both gradual and step-like motions using frame times as short as 5 s with a spatial accuracy of 0.2 mm on average. Complex volunteer motion involving all six degrees of freedom was estimated with lower accuracy (0.3 mm on average) than the other types investigated. Preprocessing of 5-s images was necessary for successful image registration. Since their method utilizes nonattenuation corrected frames, it is not susceptible to motion introduced between CT and PET acquisitions. CONCLUSIONS The authors have shown that they can estimate motion for frames with time intervals as short as 5 s using nonattenuation corrected reconstructed FDG PET brain images. Intraframe motion in 60-s frames causes degradation of accuracy to about 2 mm based on the motion type.
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Affiliation(s)
- J M Mukherjee
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - C Lindsay
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | | | - P Olivier
- Philips Medical Systems, Cleveland, Ohio 44143
| | - L Shao
- ViewRay, Oakwood Village, Ohio 44146
| | - M A King
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - R Licho
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts 01655
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O'Brien JT, Gallagher P, Stow D, Hammerla N, Ploetz T, Firbank M, Ladha C, Ladha K, Jackson D, McNaney R, Ferrier IN, Olivier P. A study of wrist-worn activity measurement as a potential real-world biomarker for late-life depression. Psychol Med 2017; 47:93-102. [PMID: 27667663 PMCID: PMC5197921 DOI: 10.1017/s0033291716002166] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 12/03/2022]
Abstract
BACKGROUND Late-life depression (LLD) is associated with a decline in physical activity. Typically this is assessed by self-report questionnaires and, more recently, with actigraphy. We sought to explore the utility of a bespoke activity monitor to characterize activity profiles in LLD more precisely. METHOD The activity monitor was worn for 7 days by 29 adults with LLD and 30 healthy controls. Subjects underwent neuropsychological assessment and quality of life (QoL) (36-item Short-Form Health Survey) and activities of daily living (ADL) scales (Instrumental Activities of Daily Living Scale) were administered. RESULTS Physical activity was significantly reduced in LLD compared with controls (t = 3.63, p < 0.001), primarily in the morning. LLD subjects showed slower fine motor movements (t = 3.49, p < 0.001). In LLD patients, activity reductions were related to reduced ADL (r = 0.61, p < 0.001), lower QoL (r = 0.65, p < 0.001), associative learning (r = 0.40, p = 0.036), and higher Montgomery-Åsberg Depression Rating Scale score (r = -0.37, p < 0.05). CONCLUSIONS Patients with LLD had a significant reduction in general physical activity compared with healthy controls. Assessment of specific activity parameters further revealed the correlates of impairments associated with LLD. Our study suggests that novel wearable technology has the potential to provide an objective way of monitoring real-world function.
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Affiliation(s)
- J. T. O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - P. Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
| | - D. Stow
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - N. Hammerla
- Open Lab, Newcastle University, Newcastle upon Tyne, UK
| | - T. Ploetz
- Open Lab, Newcastle University, Newcastle upon Tyne, UK
| | - M. Firbank
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - C. Ladha
- Open Lab, Newcastle University, Newcastle upon Tyne, UK
| | - K. Ladha
- Open Lab, Newcastle University, Newcastle upon Tyne, UK
| | - D. Jackson
- Open Lab, Newcastle University, Newcastle upon Tyne, UK
| | - R. McNaney
- Open Lab, Newcastle University, Newcastle upon Tyne, UK
| | - I. N. Ferrier
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - P. Olivier
- Open Lab, Newcastle University, Newcastle upon Tyne, UK
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Blum A, Gondim-Teixeira P, Gabiache E, Roche O, Sirveaux F, Olivier P, Coudane H, Raymond A, Louis M, Grandhaye M, Meyer JB, Mainard D, Molé D. Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm. Diagn Interv Imaging 2016; 97:735-47. [PMID: 27452630 DOI: 10.1016/j.diii.2016.07.001] [Citation(s) in RCA: 16] [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: 05/24/2016] [Accepted: 07/01/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several imaging modalities can be used to diagnose complications of hip prosthesis placement. Despite progress in these imaging techniques, there are, as yet, no guidelines as to their respective indications. METHODS We formed a panel of experts in fields related to prosthesis imaging (radiology, nuclear medicine, orthopedic surgery) and conducted a review of the literature to determine the value of each modality for diagnosing complications following hip replacement. RESULTS Few recent studies have investigated the benefits related to the use of the latest technical developments, and studies comparing different methods are extremely rare. CONCLUSIONS We have developed a diagnostic tree based on the characteristics of each imaging technique and recommend its use. Computed topography was found to be the most versatile and cost-effective imaging solution and therefore a key tool for diagnosing the complications of hip replacement surgery.
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Affiliation(s)
- A Blum
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - P Gondim-Teixeira
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - E Gabiache
- Service de médecine nucléaire, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - O Roche
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - F Sirveaux
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - P Olivier
- Service de médecine nucléaire, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - H Coudane
- Chirurgie traumatologique et arthroscopique de l'appareil locomoteur (ATOL), CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | | | - A Raymond
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Louis
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Grandhaye
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - J-B Meyer
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - D Mainard
- Chirurgie orthopédique et traumatologique (COT), CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - D Molé
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
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Olivier P, Gimbert A, Colin AL, Salvo F, Becker M, Marty V, Montastruc JL, Petitpain N. Serious adverse drug events related to non-investigational drugs in academic clinical trials: another source of safety data for risk assessment? Br J Clin Pharmacol 2016; 82:1069-75. [PMID: 27276241 DOI: 10.1111/bcp.13035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 12/01/2022] Open
Abstract
AIMS Sponsors of clinical trials have to analyze serious adverse events (SAEs). Both sponsors and investigators determine the relationship between the investigational medicinal product, the investigational device or procedure and SAEs. SAEs related to another cause, such as a non-investigational medicinal product (NIMP), do not have clear pharmacovigilance reporting requirements. The aim of this study was to evaluate the amount and the nature of NIMP-related SAEs recorded by three French academic sponsors and to propose pharmacovigilance requirements for these cases. METHODS This was a retrospective descriptive study including all cases of NIMP-related SAEs occurring in clinical trials and reported to three academic sponsors between January 2009 and October 2014. RESULTS Among 5870 cases of SAEs, 300 (5%) were related to a NIMP in 50 clinical trials. Involved NIMPs were mainly antithrombotics, cytostatics and immunosuppressants. Some of these drugs were currently followed by a risk management plan (e.g. rivoxaban). The most frequent NIMP-related SAEs were neurological, gastrointestinal and infectious disorders. Seven NIMP-related SAEs were known as 'rare' or 'very rare' and two were 'unlabelled'. CONCLUSIONS As far as we know, this is the first study to focus about NIMP-related SAEs occurring in clinical trials. This work highlights the potential high quality source of safety data via NIMP-related SAE collection. Globally, we propose that NIMP-related SAEs occurring in clinical trials should systematically be notified to the pharmacovigilance system of the concerned country. Clearer procedures of interactions between safety units of academic sponsors and pharmacovigilance systems are needed to allow an effective recording of NIMP-related SAEs.
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Affiliation(s)
- Pascale Olivier
- Service de Pharmacologie médicale et clinique, Centre Midi-Pyrénées de Pharmacovigilance, d'informations sur le médicament et de Pharmacoépidémiologie du CHU de Toulouse, Faculté de Médecine, 37 allées Jules Guesde, 31000, TOULOUSE. .,Vigilance des essais cliniques, Direction de la Recherche et de l'Innovation du CHU de Toulouse, 2 rue Viguerie, 31059, Toulouse Cedex.
| | - Anne Gimbert
- Valerie MARTY and Francesco SALVO Direction de la Recherche Clinique et de l'Innovation Unité de sécurité et de vigilance - Département promotion interne, Direction Générale des hôpitaux de Bordeaux, 12 rue Dubernat, 33 404, Talence cedex
| | - Anne-Laurène Colin
- Vigilance des essais cliniques, Direction de la Recherche et de l'Innovation du CHU de Toulouse, 2 rue Viguerie, 31059, Toulouse Cedex
| | - Francesco Salvo
- Valerie MARTY and Francesco SALVO Direction de la Recherche Clinique et de l'Innovation Unité de sécurité et de vigilance - Département promotion interne, Direction Générale des hôpitaux de Bordeaux, 12 rue Dubernat, 33 404, Talence cedex.,INSERM, UMR1219, Bordeaux Population Health Research Center, Pharmacoepidemiology team, University of Bordeaux, Bordeaux
| | - Madlyne Becker
- Centre Régional de Pharmacovigilance de Lorraine, Laboratoire de Pharmacologie Clinique et de Toxicologie Hôpital Central, 29 avenue du Maréchal de Lattre de Tassigny CO 60034, 54035, Nancy cedex
| | - Valérie Marty
- Valerie MARTY and Francesco SALVO Direction de la Recherche Clinique et de l'Innovation Unité de sécurité et de vigilance - Département promotion interne, Direction Générale des hôpitaux de Bordeaux, 12 rue Dubernat, 33 404, Talence cedex
| | - Jean-Louis Montastruc
- Service de Pharmacologie médicale et clinique, Centre Midi-Pyrénées de Pharmacovigilance, d'informations sur le médicament et de Pharmacoépidémiologie du CHU de Toulouse, Faculté de Médecine, 37 allées Jules Guesde, 31000, TOULOUSE
| | - Nadine Petitpain
- Centre Régional de Pharmacovigilance de Lorraine, Laboratoire de Pharmacologie Clinique et de Toxicologie Hôpital Central, 29 avenue du Maréchal de Lattre de Tassigny CO 60034, 54035, Nancy cedex
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Aptel S, Lecocq-Teixeira S, Olivier P, Regent D, Gondim Teixeira P, Blum A. Multimodality evaluation of musculoskeletal sarcoidosis: Imaging findings and literature review. Diagn Interv Imaging 2016; 97:5-18. [DOI: 10.1016/j.diii.2014.11.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/23/2014] [Accepted: 11/06/2014] [Indexed: 10/23/2022]
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François C, Olivier P, Rouillier M, Leduc-Gaudet J, Bradette F, St-Pierre D. Etiology of Excessive Lipid Accumulation in Pre-Myocyte Cells. Can J Diabetes 2015. [DOI: 10.1016/j.jcjd.2015.01.285] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Faivre J, Charra-Brunaud C, Peiffert D, Olivier P, Guillemin F, Desandes E. Impact des facteurs cliniques et dosimétriques sur le contrôle local de la curiethérapie utérovaginale intracavitaire de bas débit de dose pulsé dans les cancers du col de l’utérus : résultat d’une cohorte de l’institut de cancérologie de Lorraine. Cancer Radiother 2014. [DOI: 10.1016/j.canrad.2014.07.044] [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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Couturier O, Rousseau C, Pierga JY, Berriolo-Riedinger A, Alberini JL, Girault S, Fumoleau P, Brain E, Abadie-Lacourtoisie S, Vera P, Liehn JC, Olivier P, Uwer L, Cachin F, Sagan C, Bouchet F, Lebas N, Mesleard C, Fourme E, Martin AL, Lovinfosse P, Lacœuille F, Campone M. Abstract P4-01-05: 3’-deoxy-3’-[18F]fluoro-thymidine (18F-FLT) positron emission tomography (PET): An accurate and effective tool for assessing tumor response in breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-01-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives : A French multicenter study was promoted by the national French cancer federation (Unicancer R&D) to assess the potential of [18F]FLT (positron emission tomography (PET) biomarker of proliferation)to manage breast cancer neoadjuvant chemotherapy (NAC). The main objective was to compare changes in tumor [18F]FLT uptake to histopathological changes induced by NAC, assuming an arrest of tumor growth related to the effectiveness of NAC.
Methods : 97 patients (age 48.6 +/- 10.2 y.) were included in 13 nuclear medicine centers. All patients were eligible to anthracycline-based NAC for a de novo unifocal breast cancer (ductal n = 84, lobular = 11, other type = 2; stage II n = 75, stage III n = 21 et stage IV n = 1). 90 patients underwent a baseline PET before the onset of NAC (PET1) and a final PET after the end of NAC and before surgery (PET3). PET acquisitions were performed 60±7min after FLT injection. SUVmax (maximum standardized uptake value), SUVpeak (1 cm3 ROI including pixel max) and SUV41 (isocontour 41% of pixel max) were computed. Changes in SUV on PET3 vs PET1 were analyzed in relation to histopathological findings at the end of NAC (Sataloff criteria).
Results : Tumor FLT uptake decreased markedly between TEP1 and TEP3 (SUVmax = 6.2±4.8 vs 1.3±1.2 respectively; SUVpeak = 4.6±3.2 vs 0.9±0.9; SUV41 = 3.6±2.8 vs 0.8±0.7). Total or near-total therapeutic effect (grade A) were obtained in 20 patients, more than 50% therapeutic effect but less than total or near-total effect (grade B) in 37 patients, less than 50% therapeutic effect but visible effect (grade C) in 22 patients, or no therapeutic effect (grade D) in 11 patients. SUVmax decreased dramatically (87.5%) to background levels in all patients with a complete response (grade A). Overall, changes in SUV differed depending on the type of histological response (p<0.01) i.e. SUVmax changes were more pronounced as pathological responses were good: 61% for grade D; 65.7% grade C and 69.8% grade B. The same results were obtained with the two other SUV types.
Conclusions : Pathologic response to NAC in breast cancer can be assessed accurately by FLT.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-05.
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Affiliation(s)
- O Couturier
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - C Rousseau
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - J-Y Pierga
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - A Berriolo-Riedinger
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - J-L Alberini
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - S Girault
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - P Fumoleau
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - E Brain
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - S Abadie-Lacourtoisie
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - P Vera
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - J-C Liehn
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - P Olivier
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - L Uwer
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - F Cachin
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - C Sagan
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - F Bouchet
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - N Lebas
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - C Mesleard
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - E Fourme
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - A-L Martin
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - P Lovinfosse
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - F Lacœuille
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
| | - M Campone
- Centre Hospitalier Universitaire, Angers, France; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Institut Curie, Paris, France; Centre Georges-François Leclerc, Dijon, France; Insitut Curie, Saint Cloud, France; Institut de Cancérologie de l'Ouest, Angers, France; Centre Henri Becquerel, Rouen, France; Institut Jean Godinot, Reims, France; Centre Hospitalier Universitaire, Nancy, France; Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire, Saint Herblain, France; R&D Unicancer, Paris, France
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Dubray B, Mezzani-Saillard S, Édet-Sanson A, Ménard JF, Modzelewski R, Thureau S, Meyer ME, Jalali K, Bardet S, M’Vondo CM, Houzard C, Mornex F, Olivier P, Faure G, Rousseau C, Mahé MA, Gomez P, Brenot-Rossi I, Salem N, Vera P. La SUVmax (standard uptake value maximale) mesurée en cours de radiothérapie pour cancer bronchique non à petites cellules est prédictive de la survie sans récidive à un an : étude prospective et multicentrique. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.06.009] [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: 10/26/2022]
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Louvel G, Olivier P, Gillet N, Rodrigues C, De Crevoisier R. 18F-FDG PET As A Predictor Of Survival In Radiotherapy For Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Leseur J, Louvel G, Devillers A, Olivier P, Gillet N, Rodrigues C, Williaume D, Arango JO, Garin E, De Crevoisier R. 2000 ORAL Prognostic Value of Metabolic Response Assessed by 18F-FDG PET During Radiotherapy for Cervix and Head and Neck Carcinoma. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70958-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Oldrini G, Geoffrois L, Olivier P, Henrot P, Blum A. [Metastatic paraganglioma. Answer to May e-quid]. ACTA ACUST UNITED AC 2011; 92:739-43. [PMID: 21819919 DOI: 10.1016/j.jradio.2011.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 03/18/2011] [Indexed: 11/28/2022]
Affiliation(s)
- G Oldrini
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Lattre-de-Tassigny, 54000 Nancy, France
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Berthet S, Olivier P, Montastruc JL, Lapeyre-Mestre M. Drug safety of rosiglitazone and pioglitazone in France: a study using the French PharmacoVigilance database. BMC Clin Pharmacol 2011; 11:5. [PMID: 21609444 PMCID: PMC3119167 DOI: 10.1186/1472-6904-11-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 05/24/2011] [Indexed: 11/10/2022]
Abstract
Background Thiazolidinediones (TZDs), rosiglitazone (RGZ) and pioglitazone (PGZ) are widely used as hypoglycemic drugs in patients with type 2 diabetes mellitus. The aim of our study was to investigate the profile of adverse drug reactions (ADRs) related to TZDs and to investigate potential risk factors of these ADRs. Methods Type 2 diabetic patients were identified from the French Database of PharmacoVigilance (FPVD) between 2002 and 2006. We investigated ADR related to TZD, focusing on 4 ADR: edema, heart failure, myocardial infarction and hepatitis corresponding to specific WHO-ART terms. Results Among a total of 99,284 adult patients in the FPVD, 2295 reports concerned type 2 diabetic patients (2.3% of the whole database), with 161 (7%) exposed to TZDs. The frequency of edema and cardiac failure was significantly higher with TZDs than in other patients (18% and 7.4% versus 0.8% and 0.1% respectively, p < 0.001) whereas the frequency of hepatitis was similar (5.9% versus 4%, NS). A multiple logistic regression model taking into account potential confounding factors (age, gender, drug exposure and co-morbidities) found that TZD exposure remained associated with heart failure and edema, but not with hepatitis or myocardial infarction. Conclusions Thiazolidinediones exposure is associated with an increased risk of edema and heart failure in patients with type 2 diabetes even when recommendations for use are respected. In contrast, the risk of hepatic reactions and myocardial infarction with this class of drugs seems to be similar to other hypoglycemic agents.
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Affiliation(s)
- Stephanie Berthet
- Unité INSERM 1027, Equipe de Pharmacoépidémiologie, Université de Toulouse, Toulouse, France
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Abstract
AIM To determine the post-marketing safety profile of avocado-soybean unsaponifiables since their commercialization in France until 2008. METHODS We used data provided by French spontaneous reporting system via the network of National Pharmacovigilance centres. We analysed all suspected adverse drug reactions (ADRs) concerning avocado-soybean unsaponifiables (ASU) reported between 1978 and 2008 and notified in the French Pharmacovigilance Database. RESULTS We kept 117 ADRs concerning 117 patients (mean age 65.5 years, 72% female). ADRs (35.9%) were "serious" (resulted in hospitalisation or prolonged it). No death was reported. In most of cases, causality of ASU was "possible" and others drugs were also suspected. The most frequently reported ADRs were cutaneous (32.5% of all ADRs, with eczemas or urticaria), hepatic (16.2%, mostly hepatocellular injuries) and gastrointestinal (12%, with 9 cases of colitis and/or diarrhea) ADRs. In these cases, dechallenge of ASU allowed rapid regression of symptoms. Others significant ADRs were coagulation and platelet (6.8%), neurological (6%) and metabolic or nutritional (4.3%) disorders. DISCUSSION-CONCLUSION This Pharmacovigilance analysis of ASU notified since their commercialisation in France highlights the diversity of ADRs with several class-organ involved. Cutaneous, hepatic and gastro-intestinal disorders were the most frequently reported ADRs. Since ASU is largely prescribed in France, incidence of their ADRs seems to be "very rare" (although we did not take into account the part of under-notification). These safety data should be discussed in the light of the poor expected clinical benefit of ASU in rheumatology (low "Service Medical Rendu") or in stomatology (insufficient "Service Medical Rendu").
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Affiliation(s)
- Pascale Olivier
- Centre hospitalier universitaire de Toulouse, centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, service de pharmacologie clinique, 31000 Toulouse, France.
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Montastruc JL, Charlotte Danton A, Durrieu G, Lacroix I, Olivier P, Sommet A, Senard JM. Neuropathy as a potential complication of levodopa use in Parkinson's disease: A Pharmacological and Pharmacovigilance point of view. Mov Disord 2010; 25:660-1. [DOI: 10.1002/mds.22878] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zender HO, Olivier P, Genné D. [Acute community-acquired bacterial meningitis in adults]. Rev Med Suisse 2009; 5:1968-1974. [PMID: 19908635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Bacterial meningitis in adults is fatal in 20% of patients and leads to sequels in 30%. The clinical presentation includes two of the following four symptoms and signs: fever, headache, stiff neck, altered mental status. The essential ancillary test is the analysis of the cerebrospinal fluid. Sometimes, the lumbar puncture is not feasible or deferred (brain computer tomography), requiring antibiotics and corticosteroids early. 80% of bacterial meningitis are secondary to pneumococcus or meningococcus. Empirical antibiotics must be given as soon as possible and provide coverage for these both bacteria. Corticosteroids are also recommended for some meningitis. A score can predict the evolution. Preventive measure must be taken for close contacts of a patient with a meningococcal meningitis.
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Affiliation(s)
- H O Zender
- Service des soins intensifs, Département de médecine cantonal, Hôpital neuchâtelois-La Chaux-de-Fonds, Rue de Chasseral 20, 2300 La Chaux-de-Fonds.
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Sénéclauze-Seguin V, Olivier P, Jeanine O, Christiane W, Israël N. The impact of obesity on implantation rates and the outcomes of first trimester pregnancies after assisted reproductive treatment. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Baud O, Olivier P, Vottier G, Pham H, Mercier JC, Loron G. Effet du NO inhalé sur le poumon et le cerveau en développement. Arch Pediatr 2009; 16 Suppl 1:S1-8. [DOI: 10.1016/s0929-693x(09)75295-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Olivier P, Bertrand L, Tubery M, Lauque D, Montastruc JL, Lapeyre-Mestre M. Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey. Drugs Aging 2009; 26:475-82. [PMID: 19591522 DOI: 10.2165/00002512-200926060-00004] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Several studies have been conducted to determine the frequency and characteristics of adverse drug reactions (ADRs) in elderly populations, focusing on those leading to hospital admission. However, most of these studies have been limited in their ability to assess risk factors, particularly the renal status of patients. Thus, the aim of this prospective study was to assess the incidence of ADRs and associated factors leading to hospital admissions in the elderly population. METHODS All patients aged > or =65 years admitted to the Toulouse University Hospital through the Emergency Department during four non-consecutive weeks in 2002-3 were included in this study except for patients in ambulatory care or admitted for intentional overdoses. The characteristics of patients admitted for a suspected ADR were compared with those of patients admitted for other reasons. RESULTS The incidence of hospital admissions for ADRs was 8.37 per 100 admissions (95% CI 6.52, 10.52), corresponding to 66 patients with ADRs among 789 admissions. The most important factors associated with ADRs were the number of drugs being taken (odds ratio [OR] 1.18; 95% CI 1.08, 1.29), self-medication (OR 2.34; 95% CI 1.18, 4.66), use of antithrombotics (Anatomic Therapeutic and Chemical [ATC] classification B01; OR 2.26; 95% CI 1.33, 3.88) and use of antibacterial drugs (ATC J01; OR 4.04; 95% CI 1.50, 10.83). Surprisingly, exposure to drugs for acid-related disorders was associated with a low risk of ADRs (OR 0.26; 95% CI 0.09, 0.76). CONCLUSION A significant incidence of ADRs leading to hospital admissions was found among elderly people. Our study showed that there is a need to increase the availability of information for the general public concerning potential ADRs due to self-medication and for prescribers concerning ADRs due to drug-drug interactions and polypharmacy.
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Affiliation(s)
- Pascale Olivier
- Unit of Pharmacoepidemiology, University of Toulouse, Toulouse, France
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