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Ladoire S, Rederstorff E, Goussot V, Parnalland S, Briot N, Ballot E, Truntzer C, Ayati S, Bengrine-Lefevre L, Bremaud N, Coudert B, Desmoulins I, Favier L, Fraisse C, Fumet JD, Hennequin A, Hervieu A, Ilie S, Kaderbhai C, Lagrange A, Martin N, Mazilu I, Mayeur D, Palmier R, Simonet-Lamm AL, Vincent J, Zanetta S, Arnould L, Coutant C, Bertaut A, Ghiringhelli F. Parallel evolution and differences in seroprevalence of SARS-CoV-2 antibody between patients with cancer and health care workers in a tertiary cancer centre during the first and second wave of COVID-19 pandemic: canSEROcov-II cross-sectional study. Eur J Cancer 2022; 165:13-24. [PMID: 35189537 PMCID: PMC8806022 DOI: 10.1016/j.ejca.2022.01.005] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
Abstract
Background Patients with cancer are a population at high risk of severe infection from SARS-CoV-2. Patients with cancer regularly attend specialised healthcare centres for management and treatment, where they are in contact with healthcare workers (HCWs). Numerous recommendations target both patients with cancer and HCWs to minimise the spread of SARS-CoV-2 during these interactions. Objective To investigate the parallel evolution of the COVID-19 epidemic in these 2 populations over time, we studied the seroprevalence of anti-SARS-CoV-2 antibodies after both the first and second waves of the pandemic, and in both cancer patients and HCWs from a single specialised anti-cancer centre. Factors associated with seropositivity were identified in both populations. Methods We conducted a cross-sectional study after the second wave of the COVID pandemic in France. All participants were invited to undergo serological testing for SARS-CoV-2 and complete a questionnaire collecting data about their working conditions (for HCWs) or medical management (for patients) during this period. Results after the second wave were compared to those of a previous study among 1011 patients with cancer and 663 HCWs performed in the same centre after the first wave, using the same evaluations. Findings We included 502 HCWs and 507 patients with cancer. Seroprevalence of anti-SARS-CoV-2 antibodies was higher after the second wave than after the first wave in both HCWs (15.1% versus 1.8%; p < 0.001), and patients (4.1% versus 1.7%; p = 0.038). By multivariate analysis, the factors found to be associated with seropositivity after the second wave for HCWs were: working in direct patient care (p = 0.050); having worked in a dedicated COVID-19 unit (p = 0.0036); contact with a person with COVID-19-positive in the workplace (p = 0.0118) or outside of the workplace (p = 0.0297). Among patients with cancer, only a contact with someone who tested positive for COVID-19 was found to be significantly associated with positive serology. The proportion of reported contacts with individuals with COVID-19-positive was significantly lower among patients with cancer than among HCWs (7.6% versus 40.7%, respectively; p < 0.0001) Interpretation Between the first and second waves of the epidemic in France, the seroprevalence of anti-SARS-CoV-2 antibodies increased to a lesser extent among patients with cancer than among their HCWs, possibly due to better self-protection, notably social distancing. The risk factors for infection identified among HCWs plead in favour of numerous intra-hospital contaminations, especially for HCWs in contact with high-risk patients. This underlines the compelling need to pursue efforts to implement strict hygiene and personal protection measures (including vaccination) to protect HCWs and patients with cancer.
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Affiliation(s)
- Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France.
| | - Emilie Rederstorff
- Clinical Research Center (CRC), Centre Georges François Leclerc, Dijon, France
| | - Vincent Goussot
- Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Sophie Parnalland
- Clinical Research Center (CRC), Centre Georges François Leclerc, Dijon, France
| | - Nathalie Briot
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - Elise Ballot
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges-François Leclerc Cancer Center, Dijon, France
| | - Caroline Truntzer
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges-François Leclerc Cancer Center, Dijon, France
| | - Siavoshe Ayati
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Nathalie Bremaud
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Bruno Coudert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laure Favier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Cléa Fraisse
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Jean-David Fumet
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Audrey Hennequin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Alice Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Silvia Ilie
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Courèche Kaderbhai
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Lagrange
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Nils Martin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Irina Mazilu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Didier Mayeur
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Rémi Palmier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Julie Vincent
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Sylvie Zanetta
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laurent Arnould
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Charles Coutant
- University of Burgundy-Franche Comté, France; Department of Oncologic Surgery, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Bertaut
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France
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Palmier R, Degand T, Aho S, Lepage C, Facy O, Michiels C, Manfredi S. A colonoscopy quality improvement intervention in an endoscopy unit. Sci Rep 2022; 12:817. [PMID: 35039559 PMCID: PMC8763865 DOI: 10.1038/s41598-022-04786-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
Many studies identified colonoscopy quality indicators in order to improve performance and safety. We conducted a colonoscopy improvement study. Our study was designed according to a Plan-Do-Study-Act cycle: first recording of our quality indicators and identification of shortcomings, second identification of improvement targets and implementation of new procedures, third second recording of quality indicators, fourth validation of procedures and identification of new goals. Quality indicators derived from European and French guidelines were recorded before and after our improvement actions. We were mainly interested in the quality indicators of the colonic preparation, the description of the diagnosed lesions and on the examination reports. The data of 134 patients prospectively included in January-February 2017 were compared to 133 patients included in May-June 2019, after implementation of improvement procedures, in the digestive endoscopy unit of the university hospital of Dijon, France. Our intervention, and in particular the implementation of new standardized forms, improved preparation quality: Boston Bowel Preparation Scale scores increased significantly from 7.8 to 8.2. Cecal intubation rate increased by 6%, and more adenomas were diagnosed and removed (+3.3%). Adenoma detection rate increased significantly from 26 to 42%. The completion of withdrawal time measure improved from 6.7 to 100%. Our study led to the rapid implementation of corrective actions and improved quality in our unit and in our personal practice. This quality improvement strategy could be easily implemented in every digestive endoscopy unit.
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Affiliation(s)
- Rémi Palmier
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Thibault Degand
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Serge Aho
- Département d'hygiène Hospitalière, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Côme Lepage
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Olivier Facy
- Département de Chirurgie Digestive et Oncologique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Christophe Michiels
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Sylvain Manfredi
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France. .,Hepato-Gastroenterology Unit, University Hospital, Dijon, France.
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Bellio H, Bertaut A, Hervieu A, Zanetta S, Hennequin A, Vincent J, Palmier R, Bengrine-Lefevre L, Ghiringhelli F, Fumet JD. Phase I Dose-Escalation Trial of an Innovative Chemotherapy Regimen Combining a Fractionated Dose of Irinotecan Plus Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Folinic Acid (bFOLFIRINOX-3) in Chemorefractory Metastatic Colorectal Cancer. Cancers (Basel) 2021; 13:cancers13215472. [PMID: 34771635 PMCID: PMC8582415 DOI: 10.3390/cancers13215472] [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: 09/27/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary Treatment of non-resectable metastatic colorectal cancer (mCRC) involves chemotherapy based on 5-fluorouracil, oxaliplatin and irinotecan and monoclonal antibodies targeting VEGF or EGFR. After an initial progression, it is usual to change the chemotherapy regimen and targeted therapy, with rather moderate results. Several studies have focused on the interest of using again already used molecules and rechallenge with oxaliplatin and irinotecan bi fractionation (FOLFIRI3) have previously shown efficacy in chemorefractory patients, but desynchronized triplet chemotherapy was never tested. The aim of this study was to evaluate the safety and efficacy of a new regimen so-called: FOLFIRINOX-3 bevacizumab in chemorefractory metastatic colorectal cancer. Abstract The care of metastatic colorectal cancers is based on combination chemotherapies including 5-fluorouracil, oxaliplatin, irinotecan, and monoclonal antibodies targeting the epidermal growth factor receptor or vascular endothelial growth factor. The regimen is determined based on the patient’s molecular biology and general condition. Irinotecan bifractionation showed efficacy in chemorefractory patients in a previous study, FOLFIRI-3, but a desynchronized triplet has never been tested. The aim of bFOLFIRINOX-3 is to determine the safety, tolerance, and efficacy of a new regimen (FOLFIRINOX-3 bevacizumab) in chemorefractory patients. The aim of this study was to evaluate the safety and efficacy of FOLFIRINOX-3 bevacizumab in chemorefractory metastatic colorectal cancer (mCRC). A standard phase I, “3 + 3” design study was performed. The standard protocol comprised simplified FOLFOX 4 (folinic acid 400 mg/m2), 5-fluorouracil (a 400 mg/m2 bolus followed by 2400 mg/m2 for 46 h), oxaliplatin (85 mg/m2) and irinotecan (administered before and after 5-fluorouracil infusion), plus bevacizumab (5 mg/kg). In a “3 + 3” design, three different doses of irinotecan were tested: 60, 70 and 90 mg/m2. The primary endpoint was the maximum tolerable dose (MTD) of irinotecan. The secondary endpoints included the objective response (at 8 and 16 weeks) according to the RECIST 1.1 criteria and progression free survival. Thirteen patients were enrolled, and twelve patients were finally evaluated for dose-limiting toxicity (DLT). The dose level defined was 70 mg/m2 irinotecan. A total of three DLTs were observed (grade 3 diarrhea): two DLTs at the 90 mg/m2 dose level and one at the 70 mg/m2 dose level. The most frequently described adverse events were asthenia (93%), diarrhea (77%), nausea (62%) and peripheral sensory neuropathy (46%). The most frequent biological event was thrombopenia (54%). Regarding efficacy, among the 11 evaluable patients, no progression was observed at 8 weeks, and the partial response rate was 18.2%. At 16 weeks, a partial response rate of 27.3% was observed, and five patients had a stable disease. The new regimen of bFOLFIRINOX-3 with irinotecan at 70 mg/m2 was well tolerated. In chemorefractory patients, this protocol shows a high response rate.
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Affiliation(s)
- Hélène Bellio
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
- Correspondence: (H.B.); (J.-D.F.)
| | - Aurélie Bertaut
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Alice Hervieu
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Sylvie Zanetta
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Audrey Hennequin
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Julie Vincent
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Rémi Palmier
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Leila Bengrine-Lefevre
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - François Ghiringhelli
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
- UMR INSERM 1231, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France
| | - Jean-David Fumet
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
- Correspondence: (H.B.); (J.-D.F.)
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Ladoire S, Goussot V, Redersdorff E, Cueff A, Ballot E, Truntzer C, Ayati S, Bengrine-Lefevre L, Bremaud N, Coudert B, Desmoulins I, Favier L, Fraisse C, Fumet JD, Hanu R, Hennequin A, Hervieu A, Ilie S, Kaderbhai C, Lagrange A, Martin N, Mazilu I, Mayeur D, Palmier R, Simonet-Lamm AL, Vincent J, Zanetta S, Arnould L, Coutant C, Bertaut A, Ghiringhelli F. Seroprevalence of SARS-CoV-2 among the staff and patients of a French cancer centre after first lockdown: The canSEROcov study. Eur J Cancer 2021; 148:359-370. [PMID: 33780664 PMCID: PMC7914029 DOI: 10.1016/j.ejca.2021.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 01/08/2023]
Abstract
Background In view of the potential gravity of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection for patients with cancer, epidemiological data are vital to assess virus circulation among patients and staff of cancer centres. We performed a prospective study to investigate seroprevalence of SARS-CoV-2 antibodies among staff and patients with cancer at a large cancer centre, at the end of the period of first national lockdown in France and to determine factors associated with the risk of SARS-CoV-2 infection. Methods After the first lockdown, all medical and non-medical staff, as well as all patients attending the medical oncology department were invited to undergo serological testing for SARS-CoV-2 between 11 May and 30 June 2020. All participants were also invited to complete a questionnaire collecting data about their living and working conditions, and for patients, medical management during lockdown. Findings A total of 1,674 subjects (663 staff members, 1011 patients) were included. Seroprevalence was low in both staff (1.8%) and patients (1.7%), despite more features of high risk for severe forms among patients. None of the risk factors tested in our analysis (working or living conditions, comorbidities, management characteristics during lockdown) was found to be statistically associated with seroprevalence in either staff or patients. There was no significant difference in the proportion of symptomatic and asymptomatic subjects between staff and patients. Only fever, loss of smell, and loss of taste were significantly more frequent among seropositive patients, in both staff and patients. Interpretation We report very low seroprevalence of antibodies against SARS-CoV-2 in the staff (caregiving and non-caregiving) and patients of a large cancer care centre in which strict hygiene, personal protection, and social distancing measures were implemented.
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Affiliation(s)
- Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France.
| | - Vincent Goussot
- Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Emilie Redersdorff
- Clinical Research Center (CRC), Centre Georges François Leclerc, Dijon, France
| | - Adele Cueff
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - Elise Ballot
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges, François Leclerc Cancer Center, Dijon, France
| | - Caroline Truntzer
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges, François Leclerc Cancer Center, Dijon, France
| | - Siavoshe Ayati
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Nathalie Bremaud
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Bruno Coudert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laure Favier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Cléa Fraisse
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Jean-David Fumet
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Roxana Hanu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Audrey Hennequin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Alice Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Silvia Ilie
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Courèche Kaderbhai
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Lagrange
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Nils Martin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Irina Mazilu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Didier Mayeur
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Rémi Palmier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Julie Vincent
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Sylvie Zanetta
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laurent Arnould
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Charles Coutant
- University of Burgundy-Franche Comté, France; Department of Oncologic Surgery, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Bertaut
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France
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5
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Dolat M, Macaire P, Goirand F, Vincent J, Hennequin A, Palmier R, Bengrine-Lefevre L, Ghiringhelli F, Royer B, Schmitt A. Association of 5-FU Therapeutic Drug Monitoring to DPD Phenotype Assessment May Reduce 5-FU Under-Exposure. Pharmaceuticals (Basel) 2020; 13:ph13110416. [PMID: 33238487 PMCID: PMC7700344 DOI: 10.3390/ph13110416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
In order to limit 5-fluorouracil (5-FU) toxicity, some health agencies recommend evaluating dihydropyrimidine dehydrogenase (DPD) deficiency before any 5-FU treatment introduction. In our study, we investigated relationships between 5-FU clearance and markers of DPD activity such as uracilemia (U), dihydrouracilemia (UH2)/U ratio, or genotype of the gene encoding DPD (DPYD). All patients with gastrointestinal cancers who received 5-FU-based regimens form March 2018 to June 2020 were included in our study. They routinely benefited of a pre-therapeutic DPYD genotyping and phenotyping. During 5-FU infusion, blood samples were collected to measure 5-FU steady-state concentration in order to adapt 5-FU doses at the following cycles. A total of 169 patients were included. Median age was 68 (40–88) years and main primary tumor sites were colorectal (40.8%) and pancreas (31.4%), metastatic in 76.3%. 5-FU was given as part of FOLFIRINOX (44.4%), simplified FOLFOX-6 (26.6%), or docetaxel/FOLFOX-4 (10.6%). Regarding DPD activity, median U and UH2/U were, respectively, 10.8 ng/mL and 10.1, and almost 15% harbored a heterozygous mutation. On the range of measured U and UH2/U, no correlation was observed with 5-FU clearance. Moreover, in patients with U < 16 ng/mL, 5-FU exposure was higher than in other patients, and most of them benefited of dose increase following 5-FU therapeutic drug monitoring (TDM). If recent guidelines recommend decreasing 5-FU dose in patients harboring U ≥ 16 ng/mL, our study highlights that those patients are at risk of under-exposure and that 5-FU TDM should be conducted in order to avoid loss of efficacy.
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Affiliation(s)
- Marine Dolat
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - Pauline Macaire
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
- INSERM U1231, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Françoise Goirand
- Laboratoire de Pharmacologie/Toxicologie, CHU de Dijon, 21000 Dijon, France;
| | - Julie Vincent
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - Audrey Hennequin
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - Rémi Palmier
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - Leïla Bengrine-Lefevre
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - François Ghiringhelli
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
- INSERM U1231, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Bernard Royer
- Laboratoire de Pharmacologie Clinique, CHU Jean-Minjoz, 3, Boulevard Alexandre-Fleming, 25030 Besançon, France;
- INSERM, EFS BFC, UMR1098, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Université Bourgogne Franche-Comté, 25000 Besançon, France
| | - Antonin Schmitt
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
- INSERM U1231, University of Burgundy Franche-Comté, 21000 Dijon, France
- Correspondence:
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