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Vale CL, Fisher DJ, Godolphin PJ, Rydzewska LH, Boher JM, Burdett S, Chen YH, Clarke NW, Fizazi K, Gravis G, James ND, Liu G, Matheson D, Murphy L, Oldroyd RE, Parmar MKB, Rogozinska E, Sfumato P, Sweeney CJ, Sydes MR, Tombal B, White IR, Tierney JF. Which patients with metastatic hormone-sensitive prostate cancer benefit from docetaxel: a systematic review and meta-analysis of individual participant data from randomised trials. Lancet Oncol 2023; 24:783-797. [PMID: 37414011 DOI: 10.1016/s1470-2045(23)00230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Adding docetaxel to androgen deprivation therapy (ADT) improves survival in patients with metastatic, hormone-sensitive prostate cancer, but uncertainty remains about who benefits most. We therefore aimed to obtain up-to-date estimates of the overall effects of docetaxel and to assess whether these effects varied according to prespecified characteristics of the patients or their tumours. METHODS The STOPCAP M1 collaboration conducted a systematic review and meta-analysis of individual participant data. We searched MEDLINE (from database inception to March 31, 2022), Embase (from database inception to March 31, 2022), the Cochrane Central Register of Controlled Trials (from database inception to March 31, 2022), proceedings of relevant conferences (from Jan 1, 1990, to Dec 31, 2022), and ClinicalTrials.gov (from database inception to March 28, 2023) to identify eligible randomised trials that assessed docetaxel plus ADT compared with ADT alone in patients with metastatic, hormone-sensitive prostate cancer. Detailed and updated individual participant data were requested directly from study investigators or through relevant repositories. The primary outcome was overall survival. Secondary outcomes were progression-free survival and failure-free survival. Overall pooled effects were estimated using an adjusted, intention-to-treat, two-stage, fixed-effect meta-analysis, with one-stage and random-effects sensitivity analyses. Missing covariate values were imputed. Differences in effect by participant characteristics were estimated using adjusted two-stage, fixed-effect meta-analysis of within-trial interactions on the basis of progression-free survival to maximise power. Identified effect modifiers were also assessed on the basis of overall survival. To explore multiple subgroup interactions and derive subgroup-specific absolute treatment effects we used one-stage flexible parametric modelling and regression standardisation. We assessed the risk of bias using the Cochrane Risk of Bias 2 tool. This study is registered with PROSPERO, CRD42019140591. FINDINGS We obtained individual participant data from 2261 patients (98% of those randomised) from three eligible trials (GETUG-AFU15, CHAARTED, and STAMPEDE trials), with a median follow-up of 72 months (IQR 55-85). Individual participant data were not obtained from two additional small trials. Based on all included trials and patients, there were clear benefits of docetaxel on overall survival (hazard ratio [HR] 0·79, 95% CI 0·70 to 0·88; p<0·0001), progression-free survival (0·70, 0·63 to 0·77; p<0·0001), and failure-free survival (0·64, 0·58 to 0·71; p<0·0001), representing 5-year absolute improvements of around 9-11%. The overall risk of bias was assessed to be low, and there was no strong evidence of differences in effect between trials for all three main outcomes. The relative effect of docetaxel on progression-free survival appeared to be greater with increasing clinical T stage (pinteraction=0·0019), higher volume of metastases (pinteraction=0·020), and, to a lesser extent, synchronous diagnosis of metastatic disease (pinteraction=0·077). Taking into account the other interactions, the effect of docetaxel was independently modified by volume and clinical T stage, but not timing. There was no strong evidence that docetaxel improved absolute effects at 5 years for patients with low-volume, metachronous disease (-1%, 95% CI -15 to 12, for progression-free survival; 0%, -10 to 12, for overall survival). The largest absolute improvement at 5 years was observed for those with high-volume, clinical T stage 4 disease (27%, 95% CI 17 to 37, for progression-free survival; 35%, 24 to 47, for overall survival). INTERPRETATION The addition of docetaxel to hormone therapy is best suited to patients with poorer prognosis for metastatic, hormone-sensitive prostate cancer based on a high volume of disease and potentially the bulkiness of the primary tumour. There is no evidence of meaningful benefit for patients with metachronous, low-volume disease who should therefore be managed differently. These results will better characterise patients most and, importantly, least likely to gain benefit from docetaxel, potentially changing international practice, guiding clinical decision making, better informing treatment policy, and improving patient outcomes. FUNDING UK Medical Research Council and Prostate Cancer UK.
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Affiliation(s)
- Claire L Vale
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK.
| | - David J Fisher
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Peter J Godolphin
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Larysa H Rydzewska
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | | | - Sarah Burdett
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Yu-Hui Chen
- Department of Biostatistics and Computational Biology ECOG-ACRIN Cancer Research Group, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Noel W Clarke
- Department of Surgery and Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, Paris, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Glenn Liu
- Department of Urology, Department of Medicine, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Matheson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Laura Murphy
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Robert E Oldroyd
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Ewelina Rogozinska
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Patrick Sfumato
- Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Bertrand Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Ian R White
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Jayne F Tierney
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
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Gravis G, Sfumato P, Ploussard G, Savoie PH, Durand M, Mathieu R, Rebillard X, Pignot G, Beauval JB, Ahallal Y, Vincendeau S, Guerin M, Boudin L, Crouzet S, Salem N, Vicier C, Boher JM, Marino P, Walz J. Safety and quality of life analyses of apalutamide plus active surveillance vs active surveillance alone for low, intermediate risk prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.352] [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: 03/16/2023] Open
Abstract
352 Background: Active surveillance (AS) is a standard of care for low-risk prostate cancer (PC). However, 20 to 50% of patients (pts) will ultimately require a local treatment following AS. The aim of this study is to assess whether apalutamide could decrease the proportion of pts requiring local treatment within 3 years. We report the 1-year safety and quality of life analyses. Methods: multicentric phase II study conducted in patients with low to intermediate risk PC randomized between apalutamide 6 months (240 mg/d) with AS vs AS alone. Toxicity was evaluated each month during treatment and every 3 months thereafter for both arms. Quality of life (SF12) was assessed at baseline, 6 and 12 months post enrollment. Results: Patients were randomized: 51 in apalutamide and 40 in AS arm. Only 50 pts received apalutamide (one refusal). Median age was 64 yrs (47-76), median PSA 5.9 (1.5-21.5), only 2 pts had Gleason ISUP 2, 14% had >T2, the median cancer positive cores was 14.3%. The median testosterone level was 4.7 mg/l. Only 88 were available for safety analyses (48 in apalutamide arm). Maximal grades of reported adverse events during the first year were for the experimental arm: 25%, 56%, 19% and control arm: 20%, 15% 12.5% for G1, G2, G3 respectively. In the experimental arm, grade 1/2 related adverse events (AE) were cutaneous (25%) and HTA (15%), nausea 15%, diarrhea 10%, arthralgia or musculoskeletal event 17% and anemia 6%. Attention disorders were observed in 6% and hypothyroidism in 8%. The most frequent sexual dysfunctions were erectile dysfunction observed in 29% (7.5% in AS arm), gynecomastia in 60%, loss of libido in 21%, and nipple pain in 33%. One-year post enrollment, the testosterone level was 4.86 mg/l (1.5-9.8) vs 4.6 (2-7.7) in apalutamide and AS arm, respectively. Digestive symptoms were Grade 3. Related AEs were an HTA for 2 pts, rash for 1 pt, asthenia for 1 pt, erectile dysfunction for 1 pt, and decreased libido for 1 pt. One serious related AE was reported: grade 2 cerebral ischemic attack. A reduced dose was required for 16.67% of pts and 33.3% had transient discontinuation. The treatment was stopped for toxicity in 3 pts; 94% completed the 6 months of treatment. No differences were observed in physical component summary (PCS) and mental component summary (MCS) of SF12 for treatment vs AS at 6 mo (PCS: 55.1 vs 56.4; MCS 43.4 vs 41.4) and 12 mo (PCS: 53.6 vs 54.1; MCS 44.1 vs 42.9). Conclusions: This is a large randomized study evaluating apalutamide with active surveillance vs active surveillance. No new safety issues were observed and the safety profile was consistent relative to those previously described with apalutamide and castration, no falls or fracture were observed. No detrimental effect of apalutamide on QOL was observed during and after treatment. AEs are important for pts candidates for active surveillance. Clinical trial information: NCT03088124 .
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Affiliation(s)
- Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Universite, CRCM, Marseille, France
| | - Patrick Sfumato
- Paoli Calmettes Institute, Department of Clinical Research and Innovation, Statistics and Methodology Unit, Marseille, France
| | | | - Pierre-Henri Savoie
- Department of Urology, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Matthieu Durand
- Department of Urology, Pasteur University Hospital, Nice, France
| | | | | | | | - Jean-Baptiste Beauval
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, Quint Fonsegrives, France
| | - Youness Ahallal
- Department of Urology, Pasteur University Hospital, Nice, France
| | | | - Mathilde Guerin
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, CRCM, Marseille, France
| | - Laurys Boudin
- Department of Oncology, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Sebastien Crouzet
- Urology Department, Edouard Herriot Hospital, University of Lyon, Lyon, France
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | | | - Jean-Marie Boher
- Department of Clinical Research and Innovation, Statistics and Methodology Unit, Paoli-Calmettes Institute, Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes, SESSTIM, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
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Melia A, Fockens E, Sfumato P, Zemmour C, Madroszyk A, Lafforgue P, Pham T. Musculoskeletal immune-related adverse events in 927 patients treated with immune checkpoint inhibitors for solid cancer. Joint Bone Spine 2023; 90:105457. [PMID: 36116771 DOI: 10.1016/j.jbspin.2022.105457] [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: 02/05/2022] [Revised: 07/31/2022] [Accepted: 08/17/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The prevalence of the musculoskeletal immune-related adverse events (irAEs) is probably underestimated, as most studies report only severe side effects. Our aim was to describe and characterize all musculoskeletal irAEs in a large cohort of patients treated with immune checkpoint inhibitors (ICI). METHODS We conducted a retrospective study among patients who received ICI from 07/27/2014 to 05/08/2020 at the medical oncology department of the Institut Paoli-Calmettes, Marseille, France. All medical files were systemically reviewed by a rheumatologist who collected clinical features, time of occurrence, treatment regimen, irAEs management, course and outcomes. We also assessed tumor response 3 months after introduction of ICI, according to severity and treatments used to manage musculoskeletal irAEs. RESULTS Among 927 patients treated with ICI for a solid tumor, 118 patients (12.7%) presented a musculoskeletal irAE. Their median age was 66.5, 61% were male, and they mainly had a lung (57.6%) or urological cancer (27.1%). The most frequently involved ICI was an anti PD-1. Arthralgias and myalgias were the most frequent musculoskeletal irAEs (9.8%) and inflammatory rheumatic features were reported in 36 patients (3.9%) with elevated acute phase reactants and negative immunological markers. The median time of onset was 2 months (IC 95% 1.8; 2.7). Tumor response at 3 months did not differ according to musculoskeletal irAE severity, type of manifestation (arthralgias/myalgias versus inflammatory rheumatic features), pain patterns (mechanical versus inflammatory) or irAE treatments. CONCLUSION Musculoskeletal irAEs in this large cohort of patients treated with ICI were frequent (12.7%), mostly mild and well tolerated.
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Affiliation(s)
- Angélique Melia
- Department of Rheumatology, University Hospital of Marseille Sainte-Marguerite, Aix Marseille University, AP-HM, Marseille, France.
| | - Emilie Fockens
- Department of Rheumatology, University Hospital of Marseille Sainte-Marguerite, Aix Marseille University, AP-HM, Marseille, France
| | - Patrick Sfumato
- Biostatistics department, Institut Paoli-Calmettes, Marseille, France
| | | | - Anne Madroszyk
- Oncology department, Institut Paoli-Calmettes, Marseille, France
| | - Pierre Lafforgue
- Department of Rheumatology, University Hospital of Marseille Sainte-Marguerite, Aix Marseille University, AP-HM, Marseille, France
| | - Thao Pham
- Department of Rheumatology, University Hospital of Marseille Sainte-Marguerite, Aix Marseille University, AP-HM, Marseille, France
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4
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Cabarrou B, Leconte E, Sfumato P, Boher JM, Filleron T. A stratified adaptive two-stage design with co-primary endpoints for phase II clinical oncology trials. BMC Med Res Methodol 2022; 22:278. [PMID: 36289451 PMCID: PMC9608934 DOI: 10.1186/s12874-022-01748-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Given the inherent challenges of conducting randomized phase III trials in older cancer patients, single-arm phase II trials which assess the feasibility of a treatment that has already been shown to be effective in a younger population may provide a compelling alternative. Such an approach would need to evaluate treatment feasibility based on a composite endpoint that combines multiple clinical dimensions and to stratify older patients as fit or frail to account for the heterogeneity of the study population to recommend an appropriate treatment approach. In this context, stratified adaptive two-stage designs for binary or composite endpoints, initially developed for biomarker studies, allow to include two subgroups whilst maintaining competitive statistical performances. In practice, heterogeneity may indeed affect more than one dimension and incorporating co-primary endpoints, which independently assess each individual clinical dimension, would therefore appear quite pertinent. The current paper presents a novel phase II design for co-primary endpoints which takes into account the heterogeneity of a population. Methods We developed a stratified adaptive Bryant & Day design based on the Jones et al. and Parashar et al. algorithm. This two-stage design allows to jointly assess two dimensions (e.g. activity and toxicity) in two different subgroups. The operating characteristics of this new design were evaluated using examples and simulation comparisons with the Bryant & Day design in the context where the study population is stratified according to a pre-defined criterion. Results Simulation results demonstrated that the new design minimized the expected and maximum sample sizes as compared to parallel Bryant & Day designs (one in each subgroup), whilst controlling type I error rates and maintaining a competitive statistical power as well as a high probability of detecting heterogeneity. Conclusions In a heterogeneous population, this two-stage stratified adaptive phase II design provides a useful alternative to classical one and allows to identify a subgroup of interest without dramatically increasing sample size. As heterogeneity is not limited to older populations, this new design may also be relevant to other study populations such as children or adolescents and young adults or the development of targeted therapies based on a biomarker. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01748-w.
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Affiliation(s)
- Bastien Cabarrou
- grid.417829.10000 0000 9680 0846Biostatistics & Health Data Science Unit, Institut Claudius Regaud - IUCT-O, 1 avenue Irène Joliot-Curie, 31059 Cedex 9 Toulouse, France
| | - Eve Leconte
- grid.22147.320000 0001 2190 2837Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France
| | - Patrick Sfumato
- grid.418443.e0000 0004 0598 4440Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Marie Boher
- grid.418443.e0000 0004 0598 4440Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France ,grid.464064.40000 0004 0467 0503Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - Thomas Filleron
- grid.417829.10000 0000 9680 0846Biostatistics & Health Data Science Unit, Institut Claudius Regaud - IUCT-O, 1 avenue Irène Joliot-Curie, 31059 Cedex 9 Toulouse, France
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5
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Marx M, Caillol F, Sfumato P, Romero J, Ratone JP, Pesenti C, Godat S, Hoibian S, Dahel Y, Boher JM, Giovannini M. EUS-guided hepaticogastrostomy in the management of malignant biliary obstruction: Experience and learning curve in a tertiary referral center. Dig Liver Dis 2022; 54:1236-1242. [PMID: 35680522 DOI: 10.1016/j.dld.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND EUS-guided hepaticogastrostomy (EUS-HGS) is a recognized second-line strategy for biliary drainage when endoscopic retrograde cholangiopancreatography fails or is impossible. Substantial technical and procedural progress in performing EUS-HGS has been achieved. The present study wanted to analyze whether growing experience in current practice has changed patient outcomes over time. METHODS We retrospectively analyzed data from patients with malignant biliary obstruction treated by EUS-HGS between 2002 and 2018 at a tertiary referral center. RESULTS A total of 205 patients were included (104 male; mean age 68 years). Clinical success was achieved in 93% of patients with available 30-days follow-up (153), and the rate of procedure-related morbidity and mortality after one month was 18% and 5%, respectively. The cumulative sum (CUSUM) learning curve suggests a slight improvement in the rate of early complications during the second learning phase (23% vs 32%; P = 0.14; including death for any cause and intensive care). However, a significant threshold of early complications could not be determined. Recurrent biliary stent occlusion is the main cause for endoscopic reintervention (47/130; 37%). CONCLUSION The rate of procedure-related complications after EUS-HGS has improved over time. However, the overall morbidity rate remains high, emphasizing the importance of dedicated expertise, appropriate patient selection and multidisciplinary discussion.
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Affiliation(s)
- Mariola Marx
- Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland.
| | - Fabrice Caillol
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Patrick Sfumato
- Dept. Clin Res and Invest, Biostat and Methodolo Unit, Paoli-Calmettes Institute, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Juan Romero
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | | | - Christian Pesenti
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Sébastien Godat
- Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
| | - Solène Hoibian
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Yanis Dahel
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
| | - Jean Marie Boher
- Dept. Clin Res and Invest, Biostat and Methodolo Unit, Paoli-Calmettes Institute, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Marc Giovannini
- Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France
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6
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Vale CL, Fisher D, Godolphin P, Rydzewska LH, Boher JM, Burdett S, Chen YH, Gravis G, James ND, Liu G, Murphy L, Parmar MKB, Rogozinska E, Sfumato P, Sweeney C, Sydes MR, Tombal BF, White IR, Tierney JF. Defining more precisely the effects of docetaxel plus ADT for men with mHSPC: Meta-analysis of individual participant data from randomized trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5070 Background: Adding docetaxel to androgen deprivation therapy(ADT) improves survival in metastatic, hormone-sensitive prostate cancer (mHSPC), but uncertainty remains about who benefits most. To investigate this thoroughly and reliably, the STOPCAP M1 collaborationconducted a meta-analysis of individual participant data (IPD) from relevant trials. Methods: Methods were included in a registered protocol ( CRD42019140591 ). Updated IPD from the GETUG-15, CHAARTED and STAMPEDE trials were harmonised and checked. The main outcomes were overall survival (OS), progression-free survival (PFS) and failure-free survival (FFS). Overall pooled effects were estimated using intention-to-treat, 2-stage, fixed-effect meta-analysis, adjusted for age, PSA, Gleason sum score, performance status, and timing of metastatic disease (missing covariate values imputed), with 1-stage and random-effects sensitivity analyses. We assessed subgroup effects using 2-stage, fixed-effect meta-analysis of within-trial interactions, adjusted for the same covariates. We based these on PFS to maximise power, and OS whenever interactions were found. To explore multiple subgroup interactions, and to derive subgroup-specific absolute treatment effects, we used 1-stage, flexible parametric modelling and standardisation. Results: We obtained IPD for all 2261 men randomised, with median FU of 6 years (all patients). There were clear relative benefits of docetaxel on OS (HR = 0.79, 95% CI 0.70 to 0.88, p<0.0001), PFS (HR = 0.70, 95% CI 0.63 to 0.77, p<0.0001) and FFS (HR = 0.64, 95% CI 0.58 to 0.71, p<0.0001). With evidence of non-proportional hazards, we also estimated 5-year absolute differences: OS 10% (95% CI 6 to 15%), PFS 9% (95% CI 5 to 13%) and FFS 9% (95% CI 6 to 12%). The relative effect of docetaxel on PFS differed by volume of metastases (interaction p=0.027; high volume HR = 0.60, 95% CI 0.52 to 0.68; low volume HR = 0.78, 95% CI 0.64 to 0.94), and timing of metastatic disease (interaction p=0.077; synchronous HR = 0.67, 95% CI 0.60 to 0.75; metachronous HR = 0.89, 95% CI 0.67 to 1.18). OS results were similar. When metastatic disease volume and timing were combined, docetaxel appeared to improve PFS and OS for all men, except those with low volume, metachronous disease (Table). Conclusions: This IPD meta-analysis provides the most detailed assessment of the effects of docetaxel for mHSPC, and suggests that men with low volume, metachronous disease should be managed differently to those with other types of metastatic disease. [Table: see text]
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Affiliation(s)
| | - David Fisher
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | | | | | - Sarah Burdett
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | - Gwenaelle Gravis
- Institut Paoli-Calmettes Aix-Mareseille Université, Marseille, France
| | | | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Laura Murphy
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | | | | | - Christopher Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Bertrand F. Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium
| | - Ian R White
- MRC Clinical Trials Unit at UCL, London, United Kingdom
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Sabatier R, Vicier C, Garnier S, Guille A, Carbuccia N, Isambert N, Dalenc F, Robert M, Levy C, Pakradouni J, Adelaïde J, Chaffanet M, Sfumato P, Mamessier E, Bertucci F, Goncalves A. Circulating tumor DNA predicts efficacy of a dual AKT/p70S6K inhibitor (LY2780301) plus paclitaxel in metastatic breast cancer: plasma analysis of the TAKTIC phase IB/II study. Mol Oncol 2022; 16:2057-2070. [PMID: 35122700 PMCID: PMC9120890 DOI: 10.1002/1878-0261.13188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
The phosphatidylinositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathway is frequently activated in HER2-negative breast cancer and may play a role in taxane resistance. The phase IB/II TAKTIC trial (NCT01980277) has shown that combining a dual AKT and p70 ribosomal protein S6 kinase (p70S6K) inhibitor (LY2780301) taken orally with weekly paclitaxel in HER2-negative advanced breast cancer is feasible, with preliminary evidence of efficacy. We wanted to explore whether circulating tumor DNA (ctDNA) may be a surrogate marker of treatment efficacy in this setting. Serial plasma samples were collected and cell-free DNA was sequenced using low-coverage whole-genome sequencing, and analysis was completed with droplet digital PCR for some patients with driver mutations. Baseline tumor fraction (TF) and TF after 7 weeks on treatment were compared to progression-free survival (PFS) and overall response rate. We also explored circulating copy number alterations associated with treatment failure. Of the 51 patients enrolled in the TAKTIC trial, at least one plasma sample was available for 44 cases (96 time points). All patients with tumor TP53, PI3KCA or AKT1 mutations harbored at least one of these alterations in plasma. TF at inclusion was correlated to PFS (6m-PFS was 92% for ctDNAneg patients vs 68% for ctDNApos cases; HR=3.45, 95%CI [1.34-8.90], p=0.007). ctDNA status at week 7 was not correlated to prognosis. Even though most circulating copy number alterations were conserved at disease progression, some genomic regions of interest were altered in post-progression samples. In conclusions, ctDNA detection at baseline was associated with shorter PFS in patients included in the TAKTIC trial. Plasma-based copy number analysis may help to identify alterations involved in resistance to treatment.
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Affiliation(s)
- Renaud Sabatier
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM-Predictive Oncology laboratory, Marseille, France.,Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille, France
| | - Cécile Vicier
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille, France
| | - Séverine Garnier
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM-Predictive Oncology laboratory, Marseille, France
| | - Arnaud Guille
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM-Predictive Oncology laboratory, Marseille, France
| | - Nadine Carbuccia
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM-Predictive Oncology laboratory, Marseille, France
| | - Nicolas Isambert
- Drug Development Department, Centre Georges François Leclerc, Dijon, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, CRCT, Inserm, Toulouse, France
| | - Marie Robert
- Institut de Cancérologie de l'Ouest-René Gauducheau, Saint-Herblain, France
| | - Christelle Levy
- Centre François Baclesse, Department of Medical Oncology, Caen, France
| | - Jihane Pakradouni
- Depatment of Clinical Research and Innovation, Institut Paoli-Calmettes, Marseille, France
| | - José Adelaïde
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM-Predictive Oncology laboratory, Marseille, France
| | - Max Chaffanet
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM-Predictive Oncology laboratory, Marseille, France
| | - Patrick Sfumato
- Depatment of Clinical Research and Innovation, Institut Paoli-Calmettes, Marseille, France
| | - Emilie Mamessier
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille, France
| | - François Bertucci
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM-Predictive Oncology laboratory, Marseille, France.,Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille, France
| | - Anthony Goncalves
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM-Predictive Oncology laboratory, Marseille, France.,Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, Department of Medical Oncology, Marseille, France
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8
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Bertucci F, Gonçalves A, Guille A, Adelaïde J, Garnier S, Carbuccia N, Billon E, Finetti P, Sfumato P, Monneur A, Pécheux C, Khran M, Brunelle S, Mescam L, Thomassin-Piana J, Poizat F, Charafe-Jauffret E, Turrini O, Lambaudie E, Provansal M, Extra JM, Madroszyk A, Gilabert M, Sabatier R, Vicier C, Mamessier E, Chabannon C, Pakradouni J, Viens P, André F, Gravis G, Popovici C, Birnbaum D, Chaffanet M. Prospective high-throughput genome profiling of advanced cancers: results of the PERMED-01 clinical trial. Genome Med 2021; 13:87. [PMID: 34006291 PMCID: PMC8132379 DOI: 10.1186/s13073-021-00897-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/27/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The benefit of precision medicine based on relatively limited gene sets and often-archived samples remains unproven. PERMED-01 (NCT02342158) was a prospective monocentric clinical trial assessing, in adults with advanced solid cancer, the feasibility and impact of extensive molecular profiling applied to newly biopsied tumor sample and based on targeted NGS (t-NGS) of the largest gene panel to date and whole-genome array-comparative genomic hybridization (aCGH) with assessment of single-gene alterations and clinically relevant genomic scores. METHODS Eligible patients with refractory cancer had one tumor lesion accessible to biopsy. Extracted tumor DNA was profiled by t-NGS and aCGH. We assessed alterations of 802 "candidate cancer" genes and global genomic scores, such as homologous recombination deficiency (HRD) score and tumor mutational burden. The primary endpoint was the number of patients with actionable genetic alterations (AGAs). Secondary endpoints herein reported included a description of patients with AGA who received a "matched therapy" and their clinical outcome, and a comparison of AGA identification with t-NGS and aCGH versus whole-exome sequencing (WES). RESULTS Between November 2014 and September 2019, we enrolled 550 patients heavily pretreated. An exploitable complete molecular profile was obtained in 441/550 patients (80%). At least one AGA, defined in real time by our molecular tumor board, was found in 393/550 patients (71%, two-sided 90%CI 68-75%). Only 94/550 patients (17%, 95%CI 14-21) received an "AGA-matched therapy" on progression. The most frequent AGAs leading to "matched therapy" included PIK3CA mutations, KRAS mutations/amplifications, PTEN deletions/mutations, ERBB2 amplifications/mutations, and BRCA1/2 mutations. Such "matched therapy" improved by at least 1.3-fold the progression-free survival on matched therapy (PFS2) compared to PFS on prior therapy (PFS1) in 36% of cases, representing 6% of the enrolled patients. Within patients with AGA treated on progression, the use of "matched therapy" was the sole variable associated with an improved PFS2/PFS1 ratio. Objective responses were observed in 19% of patients treated with "matched therapy," and 6-month overall survival (OS) was 62% (95%CI 52-73). In a subset of 112 metastatic breast cancers, WES did not provide benefit in term of AGA identification when compared with t-NGS/aCGH. CONCLUSIONS Extensive molecular profiling of a newly biopsied tumor sample identified AGA in most of cases, leading to delivery of a "matched therapy" in 17% of screened patients, of which 36% derived clinical benefit. WES did not seem to improve these results. TRIAL REGISTRATION ID-RCB identifier: 2014-A00966-41; ClinicalTrials.gov identifier: NCT02342158 .
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Affiliation(s)
- François Bertucci
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France.
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France.
| | - Anthony Gonçalves
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Arnaud Guille
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - José Adelaïde
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Séverine Garnier
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Nadine Carbuccia
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Emilien Billon
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Pascal Finetti
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Patrick Sfumato
- Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Audrey Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Christophe Pécheux
- Department of Medical genetics, Hôpital Timone Enfants, AP-HM, Marseille, France
| | - Martin Khran
- Department of Medical genetics, Hôpital Timone Enfants, AP-HM, Marseille, France
- Aix-Marseille University, Inserm, U1251-MMG, Marseille Medical Genetics, Marseille, France
| | - Serge Brunelle
- Department of Imaging, Institut Paoli-Calmettes, Marseille, France
| | - Lenaïg Mescam
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France
| | | | - Flora Poizat
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France
| | | | - Olivier Turrini
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Magali Provansal
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Marc Extra
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anne Madroszyk
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Marine Gilabert
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Cécile Vicier
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Emilie Mamessier
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Christian Chabannon
- Biobank, Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Jihane Pakradouni
- Department of Clinical Research and Innovation, Institut Paoli-Calmettes, Marseille, France
| | - Patrice Viens
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Fabrice André
- Department of Medical Oncology, Gustave Roussy Cancer Campus, UMR981 Inserm, Villejuif, France
- Paris Sud University, Orsay, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Cornel Popovici
- Department of Oncogenetics, Institut Paoli-Calmettes, Marseille, France
| | - Daniel Birnbaum
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Max Chaffanet
- Laboratory of Predictive Oncology, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, Aix-Marseille University, 232 Boulevard Sainte-Marguerite, 13009, Marseille, France
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Le Floch AC, Eisinger F, D'Incan E, Rey J, Charbonnier A, Caymaris L, Stoler M, Mancini J, Boher JM, Sfumato P, Vey N. Corrigendum to "Socioeconomic deprivation is associated with decreased survival in patients with acute myeloid leukemia" [Cancer Epidemiol. 66 (2020) 101699]. Cancer Epidemiol 2020; 69:101832. [PMID: 33067156 DOI: 10.1016/j.canep.2020.101832] [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: 11/28/2022]
Affiliation(s)
| | - François Eisinger
- Aix-Marseille University, Marseille, France; Département d'Anticipation et de Suivi du Cancer DASC, Institut Paoli-Calmettes, Marseille, France
| | - Evelyne D'Incan
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Jérôme Rey
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Aude Charbonnier
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | | | - Marion Stoler
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Julien Mancini
- Aix-Marseille University, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" Group, Hop Timone, BIOSTIC, Marseille, France
| | - Jean-Marie Boher
- Clinical Trial Office and Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Patrick Sfumato
- Clinical Trial Office and Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Norbert Vey
- Hematology Department, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, Marseille, France.
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Regnier P, DE Luca V, Brunelle S, Sfumato P, Walz J, Rybikowski S, Maubon T, Branger N, Fakhfakh S, Durand M, Gravis G, Pignot G. Impact of sarcopenia status of muscle-invasive bladder cancer patients on kidney function after neoadjuvant chemotherapy. Minerva Urol Nephrol 2020; 73:215-224. [PMID: 32083413 DOI: 10.23736/s2724-6051.20.03616-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy (RC). The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and RC for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC or surgery. METHODS Between 2012 and 2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers. We defined severe sarcopenia as SMI <50 cm2/m2 for men and SMI <35 cm2/m2 for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models. RESULTS According to the SMI, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients' characteristics between sarcopenic and non-sarcopenic patients were not significantly different except for BMI (P<0.001). Among patients non-sarcopenic before NAC, nine (25.7%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (P=0.02). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (P=0.01 and P=0.03, respectively). CONCLUSIONS We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.
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Affiliation(s)
- Pierre Regnier
- Department of Urology, Nice University Hospital, University of Nice Sophia Antipolis, Nice, France
| | - Valeria DE Luca
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | - Serge Brunelle
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | - Patrick Sfumato
- Department of Biostatistics, Paoli-Calmettes Institute, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | | | - Thomas Maubon
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Nicolas Branger
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Sami Fakhfakh
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Matthieu Durand
- Department of Urology, Nice University Hospital, University of Nice Sophia Antipolis, Nice, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Géraldine Pignot
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France -
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11
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Regnier P, DE Luca V, Brunelle S, Sfumato P, Walz J, Rybikowski S, Maubon T, Branger N, Fakhfakh S, Durand M, Gravis G, Pignot G. Impact of sarcopenia status of muscle-invasive bladder cancer patients on kidney function after neoadjuvant chemotherapy. Minerva Urol Nephrol 2020. [PMID: 32083413 DOI: 10.23736/s0393-2249.20.03616-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy (RC). The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and RC for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC or surgery. METHODS Between 2012 and 2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers. We defined severe sarcopenia as SMI <50 cm2/m2 for men and SMI <35 cm2/m2 for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models. RESULTS According to the SMI, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients' characteristics between sarcopenic and non-sarcopenic patients were not significantly different except for BMI (P<0.001). Among patients non-sarcopenic before NAC, nine (25.7%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (P=0.02). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (P=0.01 and P=0.03, respectively). CONCLUSIONS We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.
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Affiliation(s)
- Pierre Regnier
- Department of Urology, Nice University Hospital, University of Nice Sophia Antipolis, Nice, France
| | - Valeria DE Luca
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | - Serge Brunelle
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | - Patrick Sfumato
- Department of Biostatistics, Paoli-Calmettes Institute, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | | | - Thomas Maubon
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Nicolas Branger
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Sami Fakhfakh
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Matthieu Durand
- Department of Urology, Nice University Hospital, University of Nice Sophia Antipolis, Nice, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Géraldine Pignot
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France -
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12
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Sfumato P, Filleron T, Giorgi R, Cook RJ, Boher JM. Goftte: A R package for assessing goodness-of-fit in proportional (sub) distributions hazards regression models. Comput Methods Programs Biomed 2019; 177:269-275. [PMID: 31319955 DOI: 10.1016/j.cmpb.2019.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 05/05/2019] [Accepted: 05/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE In this paper, we introduce a new R package goftte for goodness-of-fit assessment based on cumulative sums of model residuals useful for checking key assumptions in the Cox regression and Fine and Gray regression models. METHODS Monte-Carlo methods are used to approximate the null distribution of cumulative sums of model residuals. To limit the computational burden, the main routines used to approximate the null distributions are implemented in a parallel C++ programming environment. Numerical studies are carried out to evaluate the empirical type I error rates of the different testing procedures. The package and the documentation are available to users from CRAN R repositories. RESULTS Results from simulation studies suggested that all statistical tests implemented in goftte yielded excellent control of the type I error rate even with modest sample sizes with high censoring rates. CONCLUSIONS As compared to other R packages goftte provides new useful method for testing functionals, such as Anderson-Darling type test statistics for checking assumptions about proportional (sub-) distribution hazards. Approximations for the null distributions of test statistics have been validated through simulation experiments. Future releases will provide similar tools for checking model assumptions in multiplicative intensity models for recurrent data. The package may help to spread the use of recent advocated goodness-of-fit techniques in semiparametric regression for time-to-event data.
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Affiliation(s)
- P Sfumato
- Institut Paoli-Calmettes, Biostatistics Unit, Marseille, France
| | - T Filleron
- Institut Claudius Regaud-IUCT-O, Biostatistics Unit, Toulouse, France
| | - R Giorgi
- Hopital Timone, BioSTIC, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - R J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - J M Boher
- Institut Paoli-Calmettes, Biostatistics Unit, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.
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Regnier P, De Luca V, Brunelle S, Sfumato P, Walz J, Rybikowski S, Maubon T, Branger N, Fakhfakh S, Durand M, Gravis G, Pignot G. Impact of sarcopenia on kidney function during neoadjuvant chemotherapy and post cystectomy complications in patients treated for localized muscle-invasive bladder cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
387 Background: Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy. The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and radical cystectomy for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC and surgery. Methods: Between January 2012 and December2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 M0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers blinded to patient’s status. We defined severe sarcopenia as SMI < 50 cm2/m2 for men and SMI < 35 cm2/m2 for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models. Results: According to the SMI cut offs, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients’ characteristics between sarcopenic and non-sarcopenic patients were not significantly different except for BMI (p < 0.001). Among patients non-sarcopenic before NAC, 9 (19.1%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (OR 3.01; 95% CI 1.13–8.05; p = 0.02). There was a trend towards a higher rate of stage 3B kidney failure (GFR < 45 mL/min/1.73m2) after NAC in sarcopenic patients (OR 2.79; 95% CI 0.70–11.1) but the difference was not statistically significant (p = 0.14). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications ≤90 days (p = 0.01 and p = 0.02 respectively). Conclusions: We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.
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Sabatier R, Charafe-Jauffret E, Pierga JY, Curé H, Lambaudie E, Houvenaeghel G, Ginestier C, Sfumato P, Extra JM, Gonçalves A. Abstract P2-10-02: AVASTEM – Stem cells inhibition by bevacizumab in combination with neoadjuvant chemotherapy for locally advanced breast cancers: A prospective proof of concept randomized phase II trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-10-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Preclinical works have suggested that conventional cytotoxic chemotherapies may increase the number of cancer stem cells. Angiogenesis inhibition has been described in vitro to have an impact on stem cells proliferation. We developed a proof of concept clinical trial to explore Bevacizumab-chemotherapy activity on breast cancer stem cells for patients treated in the neoadjuvant setting.
Patients and Methods. Breast cancer patients requiring preoperative chemotherapy were included in this open-label, randomized, prospective, multicentre phase II trial. All received FEC-docetaxel combination for a maximum of 8 cycles, and patients randomized in the experimental arm received concomitant Bevacizumab (15 mg/kg Q3W). The primary endpoint was to describe aldehyde dehydrogenase (ALDH1, identified by immunohistochemistry) positive tumour cells rate before treatment and after the 4th cycle. Secondary objectives included safety, pathological complete response (pCR) rate, disease-free survival (DFS), relapse-free survival (RFS), and overall survival (OS).
Results. Seventy-five patients were included from March 2010 to July 2012, including 50 in the experimental arm. More than 80% of patients received all planned chemotherapy cycles. ALDH1 expression could be assessed both before treatment and after the fourth cycle of chemotherapy for 32 patients. The absence of a significant increase (> 5%) in ALDH1+ cells rate after chemotherapy was demonstrated in the Bevacizumab arm (n=19, Median=-0.125, one-sided 95%CI=[-∞-0], p=0.001).Yet, the same was observed in the control arm (n=13, Median=-0.25, one-sided 95%CI=[-∞-0],, p=0.006). Grade 3 or 4 adverse events, including haematological, digestive, and cutaneous disorders, were observed for 94% of the patients in the experimental arm and 88% in the control arm. A non-significant increase in pCR was observed in the Bevacizumab arm (OR=2.24, 95CI [0.77-6.54], p=0.14), but survival was not improved (OS: p=0.89 for the whole cohort; DFS: p=0.45; and RFS: p=0.68 for non-metastatic cases) . ALDH1 status at inclusion was not correlated to efficacy.
Conclusions. We observed that the rate of ALDH1+ tumour cells did not increase after Bevacizumab-based chemotherapy. However, as similar results were observed with chemotherapy only, Bevacizumab impact on breast cancer stem cells cannot be confirmed.
Citation Format: Sabatier R, Charafe-Jauffret E, Pierga J-Y, Curé H, Lambaudie E, Houvenaeghel G, Ginestier C, Sfumato P, Extra J-M, Gonçalves A. AVASTEM – Stem cells inhibition by bevacizumab in combination with neoadjuvant chemotherapy for locally advanced breast cancers: A prospective proof of concept randomized phase II trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-10-02.
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Affiliation(s)
- R Sabatier
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - E Charafe-Jauffret
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - J-Y Pierga
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - H Curé
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - E Lambaudie
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - G Houvenaeghel
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - C Ginestier
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - P Sfumato
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - J-M Extra
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - A Gonçalves
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
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Cabarrou B, Sfumato P, Mourey L, Leconte E, Balardy L, Martinez A, Delord JP, Boher JM, Brain E, Filleron T. Addressing heterogeneity in the design of phase II clinical trials in geriatric oncology. Eur J Cancer 2018; 103:120-126. [PMID: 30223225 DOI: 10.1016/j.ejca.2018.07.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/12/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cancer in the elderly is a major public issue. However, older patients have long been debarred from clinical trials. There is a high unmet medical need for specific trials addressing oncology strategies adapted to older patients' conditions. While randomised phase III trials remain the gold standard, they usually require large numbers of patients. In this perspective, late single-arm phase II trials assessing treatment feasibility might prove a good alternative. However, it is essential to take into account the heterogeneity in an ageing population characterised by frailty. Standard parallel phase II studies in defined frail and non-frail populations also require a high number of patients. Used in molecular subtyping and treatment effect heterogeneity, stratified adaptive designs can improve statistical performance, but they have never been used in geriatric oncology. This report describes their potential benefits and useful applications as compared with standard designs. METHODS In a heterogeneous population, stratified adaptive designs allowed us to select subgroups of interest in two stages. Operational characteristics were evaluated through simulations of clinical trials under different scenarios. RESULTS Simulations showed that the use of stratified adaptive designs can efficiently minimise both the number of patients to be included and accrual duration with competitive statistical power and high heterogeneity detection rate at interim analysis. CONCLUSION Compared with classical phase II designs, stratified adaptive phase II trial methodology offers a promising approach to improve clinical research in geriatric oncology. These designs may also be efficient in other populations such as children or adolescents and young adults.
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Affiliation(s)
- Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - Patrick Sfumato
- Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Loïc Mourey
- Medical Oncology Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - Eve Leconte
- TSE-R, Université Toulouse 1 Capitole, Toulouse, France
| | - Laurent Balardy
- Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Jean-Pierre Delord
- Medical Oncology Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - Jean-Marie Boher
- Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France; Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - Etienne Brain
- Medical Oncology Department, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Thomas Filleron
- Biostatistics Unit, Institut Claudius Regaud-IUCT-O, Toulouse, France.
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Cabarrou B, Sfumato P, Leconte E, Boher JM, Filleron T. Designing phase II clinical trials to target subgroup of interest in a heterogeneous population: A case study using an R package. Comput Biol Med 2018; 100:239-246. [PMID: 30055524 DOI: 10.1016/j.compbiomed.2018.06.034] [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: 03/14/2018] [Revised: 06/21/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022]
Abstract
Phase II trials that evaluate target therapies based on a biomarker must be well designed in order to assess anti-tumor activity as well as clinical utility of the biomarker. Classical phase II designs do not deal with this molecular heterogeneity and can lead to an erroneous conclusion in the whole population, whereas a subgroup of patients may well benefit from the new therapy. Moreover, the target population to be evaluated in a phase III trial may be incorrectly specified. Alternative approaches are proposed in the literature that make it possible to include two subgroups according to biomarker status (negative/positive) in the same study. Jones, Parashar and Tournoux et al. propose different stratified adaptive two-stage designs to identify a subgroup of interest in a heterogeneous population that could possibly benefit from the experimental treatment at the end of the first or second stage. Nevertheless, these designs are rarely used in oncology research. After introducing these stratified adaptive designs, we present an R package (ph2hetero) implementing these methods. A case study is provided to illustrate both the designs and the use of the R package. These stratified adaptive designs provide a useful alternative to classical two-stage designs and may also provide options in contexts other than biomarker studies.
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Affiliation(s)
- B Cabarrou
- Institut Claudius Regaud-IUCT-O. Biostatistics Unit, Toulouse, France
| | - P Sfumato
- Institut Paoli Calmettes. Biostatistics Unit, Marseille, France
| | | | - J M Boher
- Institut Paoli Calmettes. Biostatistics Unit, Marseille, France; Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - T Filleron
- Institut Claudius Regaud-IUCT-O. Biostatistics Unit, Toulouse, France.
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Annede P, Mailleux H, Sfumato P, Ferré M, Autret A, Varela Cagetti L, Macagno A, Fau P, Chargari C, Tallet A, Resbeut M, Zemmour C, Gonzague L, Boher JM. Multivariate normal tissue complication probability modeling of vaginal late toxicity after brachytherapy for cervical cancer. Brachytherapy 2018; 17:922-928. [PMID: 30061056 DOI: 10.1016/j.brachy.2018.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 03/26/2018] [Revised: 05/22/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore the best variables combination for a predictive model of vaginal toxicity in cervical cancer patients undergoing brachytherapy (BT). METHODS AND MATERIALS Clinical and 3-dimensional dosimetric parameters were retrospectively extracted from an institutional database of consecutive patients undergoing intracavitary BT after external beam radiation therapy from 2006 to 2013 for a cervical cancer. A least absolute shrinkage and selection operator selection procedure in Cox's proportional hazards regression model was performed to select a set of relevant predictors for a multivariate normal tissue complication probability model of Grade ≥2 vaginal late toxicity. Outcomes reliability was internally assessed by bootstrap resampling method. RESULTS One hundred sixty-nine women were included in the present study with a median followup time of 3.8 years (interquartile range [IQR], 1.9-5.6 years). The 2 years and 5 years cumulative incidence rates of Grade ≥2 late vaginal toxicity were 19.9% and 27.5%, respectively. Among 31 metrics and six clinical factors extracted, the optimal model included two dosimetric variables: V70Gy and D5% (the percentage volume that received a dose greater or equal to 70 Gy and the minimum dose given to the hottest 5% volume, respectively). Area under the ROC curve at 2 and 5 years of followup were 0.85 and 0.91, respectively. Regarding internal validation, median area under the ROC curve of bootstrap predictions was 0.83 (IQR, 0.78-0.88) and 0.89 (IQR, 0.85-0.93) at 2 and 5 years of followup, respectively. CONCLUSIONS A multivariate normal tissue complication probability model for severe vaginal toxicity based on two dosimetric variables (V70Gy and D5%) provides reliable discrimination capability in a cohort of cervical cancer treated with external beam radiation therapy and BT.
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Affiliation(s)
- Pierre Annede
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France; Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France.
| | - Hugues Mailleux
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Patrick Sfumato
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France
| | - Marjorie Ferré
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Aurélie Autret
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France
| | | | - Alban Macagno
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Pierre Fau
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Cyrus Chargari
- Radiotherapy Department, Gustave Roussy, Villejuif, France; Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Agnès Tallet
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Michel Resbeut
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Christophe Zemmour
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France
| | - Laurence Gonzague
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Jean-Marie Boher
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France
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Marino P, Sfumato P, Joly F, Fizazi K, Oudard S, Culine S, Habibian M, Boher JM, Gravis G. Q-TWiST analysis of patients with metastatic castrate naive prostate cancer treated by androgen deprivation therapy with or without docetaxel in the randomised phase III GETUG-AFU 15 trial. Eur J Cancer 2017; 84:27-33. [DOI: 10.1016/j.ejca.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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Cabarrou B, Sfumato P, Mourey L, Leconte E, Balardy L, Delord J, Boher J, Filleron T. Comment prendre en compte l’hétérogénéité dans le schéma des essais cliniques de phase II en oncogériatrie ? Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Boudin L, Chabannon C, Sfumato P, Sabatier R, Bertucci F, Tarpin C, Provansal M, Houvenaeghel G, Lambaudie E, Tallet A, Resbeut M, Charafe-Jauffret E, Calmels B, Lemarie C, Boher JM, Extra JM, Viens P, Gonçalves A. [Impact of Her2 and BRCA1/2 status in high-dose chemotherapy and autologous stem cells transplantation in the treatment of breast cancer: The Institut Paoli Calmettes' experience]. Bull Cancer 2017; 104:332-343. [PMID: 28214007 DOI: 10.1016/j.bulcan.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/30/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies evaluating chemotherapy high dose chemotherapy with autologous haematopoietic stem cell transplantation (HDC-ACSH) in the treatment of metastatic (MBC), locally advanced (LABC) and inflammatory (IBC) breast cancer have in common lack of biomarker information, in particular the HER2 status. PATIENTS AND METHODS All consecutive female patients treated for breast cancer with HDC and AHSCT at Institut Paoli Calmettes between 2003 and 2012 were included. Patients were categorized in three subtypes based on hormonal receptor (HR) and HER2 status of the primary tumor: luminal, (HR+/HER2-), HER2 (HER2+, any HR) and triple negative (TN) (HER2- and HR-). The main objective was the analysis of overall survival (OS) according to the IHC subtypes. RESULTS Three hundred and seventy-seven patients were included. For MBC, the TN subtype appeared to have the worst prognosis with a median OS of 19.68 months (95 % CI 11.76-44.4) compared to 44.64 months (95 % CI 40.32-67.56) for the luminal subtype and a median OS not reached for the HER2 subtype (P<0.01). For IBC, HER2 subgroup appeared to have the best prognosis with a 5-year OS of 89 % (95 % CI 64-97) compared to 57 % (95 % CI 33-76) for the TN subgroup (HR 5.38, 95 % CI 1.14-25.44; P=0.034). For CSLA, luminal subgroup appeared to have the best prognosis with a 5-year OS of 92 % (95 % CI 71-98) against 75 % (95 % CI 46-90) for HER 2 subtype and 70 % (95 %CI 97-88) for TN subtype (P=0.301). CONCLUSION The HDC-ACSH does not change the prognosis value of IHC subtype in breast cancer patients.
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Affiliation(s)
- Laurys Boudin
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France
| | - Christian Chabannon
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Institut Paoli-Calmettes, centre de thérapie cellulaire, département de biologie du cancer, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Centre d'investigations cliniques en biothérapies, Inserm CBT-1409, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Patrick Sfumato
- Institut Paoli-Calmettes, biostatistiques, département de la recherche clinique et de l'innovation (DRCI), 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Renaud Sabatier
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France; Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France
| | - François Bertucci
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France; Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France
| | - Carole Tarpin
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France
| | - Magali Provansal
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France
| | - Gilles Houvenaeghel
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France; Institut Paoli-Calmettes, département de chirurgie oncologique, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Eric Lambaudie
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France; Institut Paoli-Calmettes, département de chirurgie oncologique, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Agnes Tallet
- Institut Paoli-Calmettes, département de radiothérapie, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Michel Resbeut
- Institut Paoli-Calmettes, département de radiothérapie, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Emmanuelle Charafe-Jauffret
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France; Institut Paoli-Calmettes, biopathologie, département de biologie du cancer, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Boris Calmels
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Institut Paoli-Calmettes, centre de thérapie cellulaire, département de biologie du cancer, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Centre d'investigations cliniques en biothérapies, Inserm CBT-1409, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Claude Lemarie
- Institut Paoli-Calmettes, centre de thérapie cellulaire, département de biologie du cancer, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Centre d'investigations cliniques en biothérapies, Inserm CBT-1409, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Jean-Marie Boher
- Institut Paoli-Calmettes, biostatistiques, département de la recherche clinique et de l'innovation (DRCI), 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Jean-Marc Extra
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France
| | - Patrice Viens
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France; Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France
| | - Anthony Gonçalves
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France; Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France.
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Boudin L, Gonçalves A, Sabatier R, Moretta J, Sfumato P, Asseeva P, Livon D, Bertucci F, Extra JM, Tarpin C, Houvenaeghel G, Lambaudie E, Tallet A, Resbeut M, Sobol H, Charafe-Jauffret E, Calmels B, Lemarie C, Boher JM, Viens P, Eisinger F, Chabannon C. Highly favorable outcome in BRCA-mutated metastatic breast cancer patients receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 52:498. [PMID: 28092355 DOI: 10.1038/bmt.2016.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Boudin L, Gonçalves A, Sfumato P, Sabatier R, Bertucci F, Tarpin C, Provansal M, Houvenaeghel G, Lambaudie E, Tallet A, Resbeut M, Charafe-Jauffret E, Calmels B, Lemarie C, Boher JM, Extra JM, Viens P, Chabannon C. Prognostic impact of hormone receptor- and HER2-defined subtypes in inflammatory breast cancer treated with high-dose chemotherapy: a retrospective study. J Cancer 2016; 7:2077-2084. [PMID: 27877223 PMCID: PMC5118671 DOI: 10.7150/jca.15797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/05/2016] [Indexed: 11/05/2022] Open
Abstract
Purpose: Studies examining high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDC-AHSCT) strategies in inflammatory breast cancer (IBC), showed encouraging results in terms of disease-free survival (DFS), and overall survival (OS). The lack of data regarding HER2 status in all of these studies prevented any prognostic analysis involving breast cancer subtypes. Methods: All consecutive female patients treated for IBC with HDC and AHSCT at Institut Paoli-Calmettes between 2003 and 2012 were included. Since 2005, trastuzumab was included in initial treatment. Patient, tumor and treatment characteristics were collected. Patients were categorized in three subtypes based on hormonal receptor (HR) and HER2 status of the primary tumor: Luminal, (HR+/HER2-), HER2 (HER2+, any HR), and triple negative (TN) (HER2- and HR-). The main objective was the analysis of OS according to the IHC subtypes. Results: Sixty-seven patients were included. Eleven patients received trastuzumab. Median follow up was 80.04 months (95% CI 73.2-88.08). Five-year OS and DFS for the whole population patients were 74% (95% CI 61-83) and 65 % (95% CI 52-75), respectively. OS differed across subtypes (p=0.057) : HER2 subgroup appeared to have the best prognosis with a 5-year OS of 89% (95% CI 64-97) compared to 57% (95% CI 33-76) for the TN subgroup (HR 5.38, 95% CI 1.14-25.44; p=0.034). Conclusions: In IBC patients receiving HDC-AHSCT, OS favorably compares with data available in the literature on similar groups of patients. TN patients carried the least favourable OS and HER2 patients, half of them also receiving trastuzumab, had the best outcome. These findings provide additional information and options for patients with IBC and who could potentially benefit of HDC-AHSCT.
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Affiliation(s)
- Laurys Boudin
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Département d'Oncologie médicale, Hôpital d'Instruction des Armées Sainte Anne, Toulon, 83000, France
| | - Anthony Gonçalves
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France
| | - Patrick Sfumato
- Biostatistiques, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Renaud Sabatier
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France
| | - François Bertucci
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France
| | - Carole Tarpin
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France
| | - Magali Provansal
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France
| | - Gilles Houvenaeghel
- Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France.; Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, F -13273, France
| | - Eric Lambaudie
- Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France.; Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, F -13273, France
| | - Agnes Tallet
- Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Michel Resbeut
- Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Emmanuelle Charafe-Jauffret
- Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France.; Biopathologie, Département de Biologie du Cancer Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Boris Calmels
- Département d'Oncologie médicale, Hôpital d'Instruction des Armées Sainte Anne, Toulon, 83000, France.; Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, F-13273, France.; Centre d'Investigations Cliniques en Biothérapies, Inserm CBT-1409, Marseille, F-13009, France
| | - Claude Lemarie
- Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, F-13273, France.; Centre d'Investigations Cliniques en Biothérapies, Inserm CBT-1409, Marseille, F-13009, France
| | - Jean-Marie Boher
- Biostatistiques, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Jean-Marc Extra
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France
| | - Patrice Viens
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France
| | - Christian Chabannon
- Aix-Marseille Université, Marseille, F-13284, France.; Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, F-13273, France.; Centre d'Investigations Cliniques en Biothérapies, Inserm CBT-1409, Marseille, F-13009, France
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Boudin L, Chabannon C, Sabatier R, Bertucci F, Sfumato P, Tarpin C, Provansal M, Houvenaegel G, Lambaudie E, Tallet A, Michel R, Charafe-Jauffret E, Calmels B, Lemarie C, Jean-Marie B, Extra JM, Viens P, Gonçalves A. High-dose chemotherapy for inflammatory breast cancer: impact of immunohistochemical status on survival outcome. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Houvenaeghel G, Boher JM, Reyal F, Cohen M, Garbay JR, Classe JM, Rouzier R, Giard S, Faure C, Charitansky H, Tunon de Lara C, Daraï E, Hudry D, Azuar P, Gimbergues P, Villet R, Sfumato P, Lambaudie E. Impact of completion axillary lymph node dissection in patients with breast cancer and isolated tumour cells or micrometastases in sentinel nodes. Eur J Cancer 2016; 67:106-118. [PMID: 27640137 DOI: 10.1016/j.ejca.2016.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/21/2016] [Accepted: 08/04/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Omission of completion axillary lymph node dissection (ALND) is a standard practice in patients with breast cancer (BC) and negative sentinel nodes (SNs) but has shown insufficient evidence to be recommended in those with SN invasion. METHODS A retrospective analysis of a cohort of patients with BC and micrometastases (Mic) or isolated tumour cells (ITCs) in SN. Factors associated with ALND were identified, and patients with ALND were matched to patients without ALND. Overall survival (OS) and recurrence-free survival (RFS) were estimated in the overall population, in Mic and in ITC cohorts. FINDINGS Among 2009 patients analysed, 1390 and 619 had Mic and ITC in SN, respectively. Factors significantly associated with ALND were SN status, histological type, age, number of SN harvested and absence of adjuvant chemotherapy. After a median follow-up of 60.4 months, ALND omission was independently associated with reduced OS (hazard ratio [HR] 2.41, 90 confidence interval [CI] 1.36-4.27, p = 0.0102), but not with increased RFS (HR 1.21, 90 CI 0.74-2.0, p = 0.52) in the overall population. In matched patients, the increased risk of death in case of ALND omission was found only in the Mic cohort (HR 2.88, 90 CI 1.46-5.69), not in the ITC cohort. The risk of recurrence was also significantly increased in the subgroup of matched Mic patients (HR 1.56, 90 CI 0.90-2.73). INTERPRETATION A separate analysis of Mic and ITC groups, matched for the determinants of ALND, suggested that patients with Mic had increased recurrence rates and shorter OS when ALND was not performed. Our results are consistent with those of previous studies for patients with ITC but not for those with Mic. Randomised controlled clinical trials are still warranted to show with a high level of evidence if ALND can be safely omitted in patients with micrometastatic disease in SN.
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Affiliation(s)
- G Houvenaeghel
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, France.
| | - J M Boher
- Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009, France; Aix-Marseille University, Unité Mixte de Recherche S912, Institut de Recherche pour le Développement, 13385, Marseille, France
| | - F Reyal
- Institut Curie, 26 rue d'Ulm, 75248, Paris, France
| | - M Cohen
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France
| | - J R Garbay
- Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France
| | - J M Classe
- Institut René Gauducheau, Site hospitalier Nord, St Herblain, France
| | - R Rouzier
- Centre René Huguenin, 35 rue Dailly, Saint Cloud, France
| | - S Giard
- Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France
| | - C Faure
- Centre Léon Bérard, 28 rue Laennec, Lyon, France
| | - H Charitansky
- Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France
| | | | - E Daraï
- Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - D Hudry
- Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France
| | - P Azuar
- Hôpital de Grasse, Chemin de Clavary, Grasse, France
| | - P Gimbergues
- Centre Jean Perrin, 58 rue Montalembert, Clermont Ferrand, France
| | - R Villet
- Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, Paris, France
| | - P Sfumato
- Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009, France; Aix-Marseille University, Unité Mixte de Recherche S912, Institut de Recherche pour le Développement, 13385, Marseille, France
| | - E Lambaudie
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France
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25
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Boudin L, Gonçalves A, Sabatier R, Moretta J, Sfumato P, Asseeva P, Livon D, Bertucci F, Extra JM, Tarpin C, Houvenaeghel G, Lambaudie E, Tallet A, Resbeut M, Sobol H, Charafe-Jauffret E, Calmels B, Lemarie C, Boher JM, Viens P, Eisinger F, Chabannon C. Highly favorable outcome in BRCA-mutated metastatic breast cancer patients receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2016; 51:1082-6. [PMID: 27042835 DOI: 10.1038/bmt.2016.82] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 01/04/2023]
Abstract
Breast cancer carrying BRCA mutation may be highly sensitive to DNA-damaging agents. We hypothesized a better outcome for BRCA-mutated (BRCA(mut)) metastatic breast cancer (MBC) patients receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HDC AHSCT) versus unaffected BRCA (BRCA wild type; (BRCA(wt))) or patients without documented BRCA mutation (BRCA untested (BRCA(ut))). All female patients treated for MBC with AHSCT at Institut Paoli-Calmettes between 2003 and 2012 were included. BRCA(mut) and BRCA(wt) patients were identified from our institutional genetic database. Overall survival (OS) was the primary end point. A total of 235 patients were included. In all, 15 patients were BRCA(mut), 62 BRCA(wt) and 149 BRCA(ut). In multivariate analyses, the BRCA(mut) status was an independent prognostic factor for OS (hazard ratio (HR): 3.08, 95% confidence interval (CI): 1.10-8.64, P=0.0326) and PFS (HR: 2.52, 95% CI :1.29-4.91, P=0.0069). In this large series of MBC receiving HDC AHSCT, we report a highly favorable survival outcome in the subset of patients with documented germline BRCA mutations.
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Affiliation(s)
- L Boudin
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France
| | - A Gonçalves
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France.,Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France
| | - R Sabatier
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France.,Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France
| | - J Moretta
- Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - P Sfumato
- Biostatistiques, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, France
| | - P Asseeva
- Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - D Livon
- Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - F Bertucci
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France.,Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France
| | - J-M Extra
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France
| | - C Tarpin
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France
| | - G Houvenaeghel
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, France
| | - E Lambaudie
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, France
| | - A Tallet
- Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, France
| | - M Resbeut
- Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, France
| | - H Sobol
- Aix-Marseille Université, Marseille, France.,Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - E Charafe-Jauffret
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Biopathologie, Département de Biologie du Cancer Institut Paoli-Calmettes, Marseille, France
| | - B Calmels
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France.,Centre d'Investigations Cliniques en Biothérapies, Marseille, France
| | - C Lemarie
- Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France.,Centre d'Investigations Cliniques en Biothérapies, Marseille, France
| | - J-M Boher
- Biostatistiques, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, France
| | - P Viens
- Département d'Oncologie Médicale, Institut Paoli-Calmettes (IPC), Marseille, France.,Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France
| | - F Eisinger
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Département d'Anticipation et de Suivi du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - C Chabannon
- Centre de Recherches en Cancérologie de Marseille (CRCM), Marseille, France.,Aix-Marseille Université, Marseille, France.,Biopathologie, Département de Biologie du Cancer Institut Paoli-Calmettes, Marseille, France.,Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France
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El Cheikh J, Sfumato P, Sobh M, Fegueux N, Mohty M, Vigouroux S, Beguin Y, Yakoub-Agha I, Socié G, Cornillon J, Mercier M, Bay JO, Blaise D, Michallet M, Peffault de Latour R. Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen for elderly patients (60 years and older) with hematologic malignancies using unrelated donors: a retrospective study from the French society for stem cell transplantation (SFGM-TC). Haematologica 2016; 101:e262-5. [PMID: 26992946 DOI: 10.3324/haematol.2015.139345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jean El Cheikh
- Hematology and Oncology Bone Marrow Transplantation Program, American University of Beirut, Medical Center Beirut, Lebanon
| | - Patrick Sfumato
- Clinical Trial Office and Biostatistics Unit, Paoli Calmettes Institute, Marseille, France
| | - Mohamad Sobh
- Hematology Department, University Hospital Center, Lyon, France
| | - Nathalie Fegueux
- Hematology Department, University Hospital Center, Montpellier, France
| | - Mohamad Mohty
- Hematology and cellular therapy unit, AP-HP, Université Paris 6, Hôpital Saint Antoine, Paris, France
| | - Stephane Vigouroux
- Hematology Department, Haut-Leveque Hospital and Bordeaux University Hospital Center, Pessac, France
| | - Yves Beguin
- Hematology department, Centre Hospitalier Universitaire de Liège, Liège University, Liège, Belgium
| | | | - Gerard Socié
- Hematology and cellular therapy unit, AP-HP, Hôpital Saint Louis, Paris, France
| | - Jerome Cornillon
- Hematology Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Melanie Mercier
- Hematology Department, University Hospital Center, Angers, France
| | | | - Didier Blaise
- Hematology Department, transplantation unit, Paoli Calmettes Institute, Marseille, France
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27
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Gravis G, Chanez B, Derosa L, Beuselinck B, Barthelemy P, Laguerre B, Brachet PE, Joly F, Escudier B, Harrison DJ, Laird A, Vasudev N, Ralph C, Larkin J, Lote H, Salem N, Walz J, Thomassin J, Sfumato P, Stewart GD, Boher JM. Effect of glandular metastases on overall survival of patients with metastatic clear cell renal cell carcinoma in the antiangiogenic therapy era. Urol Oncol 2015; 34:167.e17-23. [PMID: 26670200 DOI: 10.1016/j.urolonc.2015.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 04/08/2015] [Revised: 09/11/2015] [Accepted: 10/26/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Glandular metastases (GMs) (pancreas, breast, parotid, thyroid, or contralateral adrenal) are rare in metastatic clear cell renal cell carcinoma (mccRCC). In a multicenter study we have assessed outcome from mccRCC with or without GMs. PATIENTS AND METHODS Patients with mccRCC and GM or non-GM (NGM) at first presentation of mccRCC, treated at 9 European centers (5 French, 3 UK, and 1 Belgian centers) between January 2004 and October 2013, were retrospectively analyzed. Association between overall survival (OS) and site of metastases was assessed using the log-rank test for univariate analysis and the chi-square test for multivariable Cox regression. RESULTS In all, 138 patients with GM mccRCC and 420 with NGM mccRCC were included; 37.2% patients with GM had Memorial Sloan-Kettering Cancer Center (MSKCC)-favorable risk vs. 18% NGM patients; 10.7% patients with GM had MSKCC-poor risk vs. 27% NGM patients (P<0.0001). Median interval from metastases to treatment was 4.2 months (range: 0-221.3mo). Median OS was 61.5 months (51.4-81.6mo) for GM and 37.4 months (31.3-42mo) for NGM (hazard ratio [HR] = 1.7; 95% CI = 1.3-2.2, P<0.001). In univariate OS analysis, age, delay between initial diagnosis and metastases, MSKCC, bone/lung metastases, and GM or NGM group were significant parameters (P<0.001). In multivariate analysis, adjusted according to MSKCC risk group, NGM vs. GM was a strong prognostic factor (HR = 1.4; 95% CI = 1.0-1.8, P=0.026); bone or liver metastases were also significant (HR = 1.3; 95% CI = 1.1-1.7, P<0.02; HR = 1.4; 95% CI = 1.1-1.7, P<0.02, respectively). Even in patients without bone or liver metastases, GM status was significant (HR = 1.8; 95% CI = 1.2-2.7, P<0.004). CONCLUSIONS This large retrospective study shows that the presence of at least 1 GM site in development of mccRCC was associated with a significantly longer OS. The presence of GMs vs. NGM disease was an independent prognostic factor for survival irrespective of the presence or absence of bone or liver metastases. This finding could affect daily practice in which patients with mccRCC and GMs should receive more aggressive treatment with a potential for long-term survival. The causal mechanisms for this improved prognosis in GM mccRCC would be evaluated in translational studies.
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Affiliation(s)
- Gwenaelle Gravis
- Medical Oncology, Institut Paoli-Calmettes Marseille, Aix-Marseille Université, Marseille, France.
| | - Brice Chanez
- Medical Oncology, Institut Paoli-Calmettes Marseille, Aix-Marseille Université, Marseille, France
| | - Lisa Derosa
- Medical Oncology, Institut Gustave-Roussy, Villejuif, France
| | | | | | | | | | - Florence Joly
- Medical Oncology, Centre François Baclesse, Caen, France
| | | | | | - Alexander Laird
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Naveen Vasudev
- Department of Medical Oncology, St James׳s Institute of Oncology, Leeds, UK
| | - Christy Ralph
- Department of Medical Oncology, St James׳s Institute of Oncology, Leeds, UK
| | - James Larkin
- The Royal Marsden Hospital, Fulham Road, London, UK
| | - Hazel Lote
- The Royal Marsden Hospital, Fulham Road, London, UK
| | - Naji Salem
- Radiotherapy Department, Institut Paoli-Calmettes, Marseille, France
| | - Jochen Walz
- Urological Department, Institut Paoli-Calmettes, Marseille, France
| | - Jeanne Thomassin
- Biopathology Department, Institut Paoli-Calmettes, Marseille, France
| | - Patrick Sfumato
- Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France
| | - Grant D Stewart
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Jean Marie Boher
- Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France
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Sfumato P, Boher JM, Cabarrou B, Blaise D, Filleron T, Kramar A. Estimation de la prévalence d’un état à partir d’un modèle de Markov, comparaison avec la méthode de référence. Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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