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Cavillon A, Pouessel D, Houédé N, Mathevet F, Dauxois JY, Chevreau C, Culine S, Delord JP, Porcher R, Filleron T. Assessing Long-term Treatment Benefits Using Complementary Statistical Approaches: An In Silico Analysis of the Phase III Keynote-045 and Checkmate-214 Immune Checkpoint Inhibitor Trials. Eur Urol 2024; 85:293-300. [PMID: 36849297 DOI: 10.1016/j.eururo.2023.02.011] [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: 09/23/2022] [Revised: 01/17/2023] [Accepted: 02/08/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND The Keynote-045 trial illustrates that the long-term benefit (LTB) of treatment does not always translate to improved progression-free survival (PFS). Milestone survival and flexible parametric survival model with cure (FPCM) have been proposed as complementary statistical approaches to more comprehensively evaluate LTBs of treatments. OBJECTIVE The current study compares milestone survival and FPCM analyses to evaluate treatment effects of immune checkpoint inhibitor (ICI) phase III trials. DESIGN, SETTING, AND PARTICIPANTS Individual patient data, from initial and follow-up analyses of Keynote-045 (urothelial cancer) and Checkmate-214 (advanced renal cell carcinoma), were reconstructed for PFS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Each trial was reanalyzed using the Cox proportional hazard regression and two complementary methods (milestone survival and FPCM) to estimate treatment impact on the LTB. RESULTS AND LIMITATIONS For each trial, there was evidence of nonproportional hazards. For the long-term analysis of the Keynote-045 trial, FPCM identified a time-dependent effect on PFS, but the Cox model found no statistical difference in PFS (hazard ratio, 0.90; 95% confidence interval, 0.75-1.08). Milestone survival and FPCM identified improvements in the LTB fractions. This was consistent with the results from the reanalysis of Keynote-045, based on the shorter follow-up, although the LTB fraction was not retained. The increase in PFS in Checkmate-214 was identified by both Cox model and FPCM. Experimental treatment-dependent improvement in the LTB fraction was demonstrated using milestone survival and FPCM. The LTB fraction estimated with FPCM was consistent with the results from the reanalysis of the shorter follow-up period. CONCLUSIONS Although ICIs show substantial shifts toward LTBs in terms of PFS, based on a conventional Kaplan-Meier or Cox model analysis, our approach provides an alternative assessment of benefit-risk ratios for new therapeutics and facilitates communicating risk to patients. Kidney patients treated with ICIs can be counseled that they are potentially cured, but future work will need to definitively validate this conclusion. PATIENT SUMMARY Although immune checkpoint inhibitor treatments show substantial shifts toward long-term benefits in terms of progression-free survival, a more rigorous attempt to quantify this shift, rather than simply using a Kaplan-Meier estimate or comparing progression-free survival curves using the classic Cox model, is warranted. Our results suggest that advanced renal cell carcinoma patients who had not received a previous treatment are functionally cured by nivolumab and ipilimumab, which is not the case for second-line urothelial carcinoma.
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Affiliation(s)
- Ana Cavillon
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud - IUCT-Oncopole, Toulouse, France
| | - Damien Pouessel
- Department of Medical Oncology, Institut Claudius Regaud - IUCT-Oncopole, Toulouse, France
| | - Nadine Houédé
- Institut de Cancérologie du Gard, CHU Nîmes, Nîmes Cedex, France
| | - Fanny Mathevet
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud - IUCT-Oncopole, Toulouse, France
| | - Jean Yves Dauxois
- Institut de Mathématiques de Toulouse, UMR 5219, Université de Toulouse, CNRS, INSA, Toulouse, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud - IUCT-Oncopole, Toulouse, France
| | - Stéphane Culine
- Department of Medical Oncology, UCOG, AP-HP, Saint-Louis Hospital, Paris, France; Paris Curie University, Paris, France
| | - Jean-Pierre Delord
- Department of Medical Oncology, Institut Claudius Regaud - IUCT-Oncopole, Toulouse, France
| | - Raphael Porcher
- Université Paris Cité, Centre de Recherche Épidémiologie et Statistiques (CRESS-UMR1153), INSERM, INRAE, Paris, France; Centre d'Épidémiologie Clinique, AP-HP, Hôtel-Dieu, Paris, France
| | - Thomas Filleron
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud - IUCT-Oncopole, Toulouse, France.
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Pfister C, Gravis G, Flechon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Soulie M, Allory Y, Harter V, Culine S. Perioperative dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin in muscle-invasive bladder cancer (VESPER): survival endpoints at 5 years in an open-label, randomised, phase 3 study. Lancet Oncol 2024; 25:255-264. [PMID: 38142702 DOI: 10.1016/s1470-2045(23)00587-9] [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: 06/08/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The optimal perioperative chemotherapy for patients with muscle-invasive bladder cancer is not defined. The VESPER (French Genito-Urinary Tumor Group and French Association of Urology V05) trial reported improved 3-year progression-free survival with dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) versus gemcitabine and cisplatin (GC) in patients who received neoadjuvant therapy, but not in the overall perioperative setting. In this Article, we report on the secondary endpoints of overall survival and time to death due to bladder cancer at 5-year follow-up. METHODS VESPER was an open-label, randomised, phase 3 trial done at 28 university hospitals or comprehensive cancer centres in France, in which adults (age ≤18 years and ≤80 years) with primary bladder cancer and histologically confirmed muscle-invasive urothelial carcinoma were randomly allocated (1:1; block size four) to treatment with dd-MVAC (every 2 weeks for a total of six cycles) or GC (every 3 weeks for a total of four cycles). Overall survival and time to death due to bladder cancer (presented as 5-year cumulative incidence of death due to bladder cancer) was analysed by intention to treat (ITT) in all randomly assigned patients. Overall survival was assessed by the Kaplan-Meier method with the treatment groups compared with log-rank test stratified for mode of administration of chemotherapy (neoadjuvant or adjuvant) and lymph node involvement. Time to death due to bladder cancer was analysed with an Aalen model for competing risks and a Fine and Gray regression model stratified for the same two covariates. Results were presented for the total perioperative population and for the neoadjuvant and adjuvant subgroups. The trial is registered with ClinicalTrials.gov, NCT01812369, and is complete. FINDINGS From Feb 25, 2013, to March 1, 2018, 500 patients were randomly assigned, of whom 493 were included in the final ITT population (245 [50%] in the GC group and 248 [50%] in the dd-MVAC group; 408 [83%] male and 85 [17%] female). 437 (89%) patients received neoadjuvant chemotherapy. Median follow-up was 5·3 years (IQR 5·1-5·4); 190 deaths at the 5-year cutoff were reported. In the perioperative setting (total ITT population), we found no evidence of association of overall survival at 5 years with dd-MVAC treatment versus GC treatment (64% [95% CI 58-70] vs 56% [50-63], stratified hazard ratio [HRstrat] 0·79 [95% CI 0·59-1·05]). Time to death due to bladder cancer was increased in the dd-MVAC group compared with in the GC group (5-year cumulative incidence of death: 27% [95% CI 21-32] vs 40% [34-46], HRstrat 0·61 [95% CI 0·45-0·84]). In the neoadjuvant subgroup, overall survival at 5 years was improved in the dd-MVAC group versus the GC group (66% [95% CI 60-73] vs 57% [50-64], HR 0·71 [95% CI 0·52-0·97]), as was time to death due to bladder cancer (5-year cumulative incidence: 24% [18-30] vs 38% [32-45], HR 0·55 [0·39-0·78]). In the adjuvant subgroup, the results were not conclusive due to the small sample size. Bladder cancer progression was the cause of death for 157 (83%) of the 190 deaths; other causes of death included cardiovascular events (eight [4%] deaths), deaths related to chemotherapy toxicity (four [2%]), and secondary cancers (four [2%]). INTERPRETATION Our results on overall survival at 5 years were in accordance with the primary endpoint analysis (3-year progression-free survival). We found no evidence of improved overall survival with dd-MVAC over GC in the perioperative setting, but the data support the use of six cycles of dd-MVAC over four cycles of GC in the neoadjuvant setting. These results should impact practice and future trials of immunotherapy in bladder cancer. FUNDING French National Cancer Institute.
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Affiliation(s)
- Christian Pfister
- Department of Urology, Charles Nicolle University Hospital, Rouen, France; Clinical Investigation Center, Onco-Urology, Inserm 1404, Rouen, France.
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, Marseille, France
| | - Aude Flechon
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | - Hakim Mahammedi
- Department of Medical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Aline Guillot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, St Priest, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, Caen, France
| | - Michel Soulie
- Department of Urology, Rangueil University Hospital, Toulouse, France
| | - Yves Allory
- Department of Pathology, Curie Institute, Saint-Cloud, France
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France
| | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Université de Paris, Paris, France
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Reignier PL, Gauthier H, Hennequin C, Aussedat Q, Xylinas E, Desgrandchamps F, Culine S, Masson-Lecomte A, Dumont C. Survival after sequential neoadjuvant chemotherapy followed by trimodal treatment or radical cystectomy for muscle-invasive bladder cancer. World J Urol 2023; 41:3249-3255. [PMID: 37410102 DOI: 10.1007/s00345-023-04506-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/01/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE to assess the respective outcomes of patients with localized muscle-invasive bladder cancer (MIBC) treated by either radical cystectomy (RC) or trimodal treatment (TMT) depending on pathological response to previous neoadjuvant chemotherapy (NAC) assessed on cystectomy specimen or post-NAC transurethral resection (TURB) specimen, respectively. PATIENT AND METHODS We retrospectively included all consecutive patients treated in one academic center with cisplatin-based NAC followed by RC or TMT for cT2-3N0M0 MIBC between 2014 and 2021. Primary endpoint was metastasis-free survival (MFS) in both treatment groups and according to pathological response to NAC. Local recurrence-free survival and conservative management failure (metastasis-free bladder-intact survival) for patients treated with TMT were assessed. RESULTS 104 patients were included, 26 treated with TMT and 78 with RC. The rate of complete pathological response was 47.4% in patients treated with RC (ypT0) and 66.7% in patients treated with TMT (ycT0). Median follow-up was 34.9 months. Four-year MFS was 72% in both treatment groups. Four-year MFS was 85% in both ypT0 RC patients and ycT0 TMT patients. ycT0 stage was associated with low rates of intravesical recurrence and conservative management failure. CONCLUSION Patients with post-NAC ycT0 stage treated with TMT have favorable oncological outcomes similar to those of ypT0 patients treated with RC. Assessment of complete histological response with TURB after NAC may help in selecting the best candidates for bladder preservation with TMT.
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Affiliation(s)
- Pierre-Louis Reignier
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Hélène Gauthier
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Christophe Hennequin
- Radiotherapy Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Quiterie Aussedat
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Urology Department, Bichat-Claude Bernard Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | | | - Stéphane Culine
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | | | - Clément Dumont
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France.
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Orlando V, Drubay D, Lavaud P, Faivre L, Lesaunier F, Delva R, Gravis G, Rolland F, Priou F, Ferrero JM, Houede N, Mourey L, Theodore C, Krakowski I, Berdah JF, Baciuchka M, Laguerre B, Fléchon A, Grosse-Goupil M, Cojean-Zelek I, Oudard S, Labourey JL, Chinet-Charrot P, Legouffe E, Lagrange JL, Linassier C, Deplanque G, Beuzeboc P, Davin JL, Martin AL, Brihoum M, Culine S, Teuff GL, Fizazi K. Very Long-Term Complete Remission Can Be Achieved in Men With High-Risk Localized Prostate Cancer and a Very High PSA Value: An Analysis of the GETUG 12 Phase 3 Trial. Clin Genitourin Cancer 2023; 21:615.e1-615.e8. [PMID: 37263910 DOI: 10.1016/j.clgc.2023.05.003] [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: 03/14/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Serum prostate specific antigen (PSA) is a well-known prognostic parameter in men with prostate cancer. The treatment of men with very high PSA values and apparently no detectable metastases is not fully established. PATIENTS AND METHODS Ancillary analysis from the GETUG 12 phase 3 trial. Patients with non-metastatic high-risk prostate cancer by bone and computerized tomography (CT) scan were randomly assigned to receive androgen deprivation therapy (ADT) and docetaxel plus estramustine or ADT alone. Relapse-free survival (RFS), clinical RFS, metastases-free survival (MFS), overall survival (OS), and prostate cancer-specific survival (PCSS) were estimated using the Kaplan-Meier method for different levels of PSA (50 ng/mL, 75 ng/mL, and 100 ng/mL). The relationship between PSA and outcomes was studied using residual-based approaches and spline functions. RESULTS The median follow-up was 12 years (range: 0-15.3). Baseline PSA (<50 ng/mL, n = 328; ≥50ng/mL, n = 85) was associated with improved RFS (P = .0005), cRFS (P = .0024), and MFS (P = .0068). The 12-year RFS rate was 46.33% (CI 40.59-51.86), 33.59% (CI 22.55-44.97), and 11.76% (1.96-31.20) in men with PSA values <50 ng/mL (n = 328), 50-100 ng/mL (n = 68), and ≥100 ng/mL (n = 17), respectively. Exploratory analyses revealed no deviation from the linear relationship assumption between PSA and the log hazard of events. CONCLUSIONS Men with apparently localized prostate cancer and a high baseline PSA value have a reasonable chance of being long-term disease-free when treated with curative intent combining systemic and local therapy.
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Affiliation(s)
| | - Damien Drubay
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France; Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
| | - Pernelle Lavaud
- Department of cancer medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Laura Faivre
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Remy Delva
- Institut de Cancérologie de l'Ouest, Angers, France
| | - Gwenaëlle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Frédéric Rolland
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Frank Priou
- Department of Medical Oncology, Centre Hospitalier Départemental, La Roche-sur-Yon, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Nadine Houede
- Department of Medical Oncology, Centre Hospitalier de Nimes, Nimes, France
| | - Loic Mourey
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | | | - Ivan Krakowski
- Department of Medical Oncology, Centre Alexis Vautrin, Nancy, France
| | | | - Marjorie Baciuchka
- Multidisciplinary Oncology and Therapeutic Innovations Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Isabelle Cojean-Zelek
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Stéphane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | | | | | - Eric Legouffe
- Department of Medical Oncology, Clinique Valdegour, Nîmes, France
| | - Jean-Léon Lagrange
- Department of Radiation Oncology, Hopital Henri Mondor, Université Paris Est Creteil, Créteil, France
| | - Claude Linassier
- Department of Medical Oncology, Hôpital Bretonneau, Tours, France
| | - Gaël Deplanque
- Department of Oncology, Lausanne University Hospital, Lausanne, Swiss
| | - Philippe Beuzeboc
- Oncology and Supportive Care Department, Foch Hospital, Suresnes, France
| | | | | | | | - Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | - Gwénaël Le Teuff
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France; Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
| | - Karim Fizazi
- Department of cancer medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
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Dumont C, Aregui A, Hauchecorne M, Lefèvre M, Aussedat Q, Reignier PL, Gauthier H, Hennequin C, Fossey-Diaz V, Xylinas E, Pachev A, Desgrandchamps F, Masson-Lecomte A, Culine S. Safety and efficacy of preoperative chemotherapy for muscle-invasive bladder cancer in elderly patients. World J Urol 2023; 41:2715-2722. [PMID: 37555987 DOI: 10.1007/s00345-023-04561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE This study aimed at describing the feasibility and oncological outcomes of standard cisplatin-based neoadjuvant chemotherapy (C-NAC) for muscle-invasive bladder cancer (MIBC) in patients aged ≥ 75 and assess the impact of baseline geriatric parameters. METHODS This retrospective study included patients with stage cT2-4NanyM0 MIBC aged 75 and older treated with ≥ 1 cycle of C-NAC from 2011 to 2021 at a high-volume academic center. Primary outcome was overall survival (OS). Secondary outcomes were chemotherapy feasibility (administration of ≥ 4 cycles), safety, and pathological downstaging. RESULTS Fifty-six patients were included. Median age was 79 (range 75-90). C-NAC regimen was ddMVAC in 41 patients and GC in 15. Seventy-three percent of patients received ≥ 4 cycles of C-NAC. Grade ≥ 3 toxicity was observed in 55% of patients. The febrile neutropenia rate was 7%. Thirty patients underwent cystectomy, and 13 underwent chemoradiotherapy. Three-year OS was 63%. Geriatric parameters polypharmacy, undernutrition, and age-adjusted Charlson comorbidity index ≥ 8 predicted worse OS. CONCLUSION Standard-of-care C-NAC and local treatments are feasible in selected elderly MIBC patients, with efficacy and safety findings similar to that observed in pivotal trials with younger patients. The prognostic impact of geriatric parameters underlines the need for specialized evaluation before treatment initiation.
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Affiliation(s)
- Clément Dumont
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France.
- Université Paris Cité, Paris, France.
| | - Amélie Aregui
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Mathilde Hauchecorne
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Madeleine Lefèvre
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Quiterie Aussedat
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Pierre-Louis Reignier
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Hélène Gauthier
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Christophe Hennequin
- Université Paris Cité, Paris, France
- Radiotherapy Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Virginie Fossey-Diaz
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Université Paris Cité, Paris, France
- Urology Department, Bichat-Claude Bernard Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Atanas Pachev
- Radiology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - François Desgrandchamps
- Université Paris Cité, Paris, France
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Alexandra Masson-Lecomte
- Université Paris Cité, Paris, France
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Stéphane Culine
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
- Université Paris Cité, Paris, France
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Gabriel PE, Lambert T, Dumont C, Gauthier H, Masson-Lecomte A, Culine S. [Preoperative chemotherapy for patients with upper tract urothelial carcinoma: Impact on renal function]. Prog Urol 2023; 33:446-455. [PMID: 37414668 DOI: 10.1016/j.purol.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Upper tract urothelial carcinoma (UTUC) are rare tumors with a poor prognosis. The standard treatment for localized disease is based on total nephroureterectomy (NUT) followed by platinum-based adjuvant chemotherapy for eligible patients at risk of recurrence. However, many patients have renal failure after surgery preventing chemotherapy. Thus, the place of preoperative chemotherapy (POC) is questioned with little information available about renal toxicity and efficacity. METHODS A single center retrospective study was performed on patients with UTUC who received POC. RESULTS In all, 24 patients with localized UTUC were treated with POC between 2013 and 2022. Twenty-one (91%) had secondarily NUT. In this cohort, POC did not result in degradation of median renal function (pre-POC median GFR: 70mL/min, post-POC median GFR: 77mL/min, P=0.79), unlike NUT (post-NUT median GFR: 51.5mL/min, P<0.001). In addition, the rate of complete pathological response to pathological examination was 29%. After a median follow-up of 27.4 months, the overall survival rate was 74% and the recurrence-free survival rate was 46%. CONCLUSION POC for UTUC shows a very reassuring renal toxicity profile and encouraging histological results. These data encourage prospective studies assessing its place for UTUC management. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- P-E Gabriel
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - T Lambert
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Dumont
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Cité, Paris, France
| | - H Gauthier
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Masson-Lecomte
- Université Paris-Cité, Paris, France; Service d'urologie, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - S Culine
- Service d'oncologie médicale, hôpital Saint-Louis, AP-HP-Nord, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Cité, Paris, France.
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Plais H, Dumont C, Gauthier H, Culine S. Short-course treatment after complete response to pembrolizumab in metastatic urothelial bladder cancer: a case series. Immunotherapy 2023. [PMID: 37139988 DOI: 10.2217/imt-2022-0283] [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] [Indexed: 05/05/2023] Open
Abstract
Background: The optimal duration of treatment for metastatic patients who achieve a complete response with immune checkpoint inhibitors is unknown. Methods: The outcome for six metastatic bladder cancer patients who received short course of pembrolizumab is reported. Results: A median number of seven cycles of pembrolizumab was given. After a median follow-up of 38 months, progressive disease was confirmed in three patients. All patients relapsed in lymph nodes and underwent pembrolizumab rechallenge: one achieved a complete response, another a partial response. Conclusion: Our case series paves the way for discontinuation of pembrolizumab in patients who achieve a complete response since three out of six patients remain free of disease after 3-year follow-up. Prospective studies are required to confirm our results.
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Affiliation(s)
- Henri Plais
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP Nord - Université Paris-Cité, Paris, 75010, France
| | - Clément Dumont
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP Nord - Université Paris-Cité, Paris, 75010, France
| | - Hélène Gauthier
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP Nord - Université Paris-Cité, Paris, 75010, France
| | - Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP Nord - Université Paris-Cité, Paris, 75010, France
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Frelaut M, Paillaud E, Beinse G, Scain AL, Culine S, Tournigand C, Poisson J, Bastuji-Garin S, Canoui-Poitrine F, Caillet P. External Validity of Two Scores for Predicting the Risk of Chemotherapy Toxicity Among Older Patients With Solid Tumors: Results From the ELCAPA Prospective Cohort. Oncologist 2023:7110929. [PMID: 37027521 DOI: 10.1093/oncolo/oyad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/30/2022] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Severe chemotherapy-related toxicities are frequent among older patients. The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) and the Cancer and Aging Research Group Study (CARG) score were both developed to predict these events. PATIENTS AND METHODS The objective of this study was to evaluate the scores' predictive performance in a prospective cohort, which included patients aged 70 years and older referred for a geriatric assessment prior to chemotherapy for a solid tumor. The main endpoints were grades 3/4/5 toxicities for the CARG score and grades 4/5 hematologic toxicities and grades 3/4/5 non-hematologic toxicities for the CRASH score. RESULTS A total of 248 patients were included, of which 150 (61%) and 126 (51%) experienced at least one severe adverse event as defined respectively in CARG and CRASH studies. The incidence of adverse events was not significantly greater in the intermediate and high-risk CARG groups than in the low-risk group (odds ratio (OR) [95% CI] = 0.3 [0.1-1.4] (P = .1) and 0.4 [0.1-1.7], respectively). The area under curve (AUC) was 0.55. Similarly, the incidence of severe toxicities was no greater in the intermediate-low, intermediate-high, and high-risk CRASH groups than in the low-risk CRASH group (OR [95%CI] = 1 [0.3-3.6], 1 [0.3-3.4], and 1.5 [0.3-8.1], respectively). The AUC was 0.52. The type of cancer, performance status, comorbidities, body mass index, and MAX2 index were independently associated with grades 3/4/5 toxicities. CONCLUSION In an external cohort of older patients referred for a pretherapeutic GA, the CARG and CRASH scores were poor predictors of the risk of chemotherapy severe toxicities.
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Affiliation(s)
- Maxime Frelaut
- Gustave Roussy Cancer Campus, Department of Medical Oncology, Villejuif, France
| | - Elena Paillaud
- Univ. Paris Est Créteil, Inserm U955, IMRB, Créteil, France
- AP-HP, Paris Cancer Institute CARPEM, Georges Pompidou European Hospital, Department of Geriatric Medicine, Paris, France
| | - Guillaume Beinse
- AP-HP, Cochin Hospital, Department of Clinical Oncology, Paris, France
- Cordeliers Research Center, Paris-Sorbonne University, INSERM, Team Personalized Medicine, Pharmacogenomics and Therapeutic Optimization (MEPPOT), Paris, France
| | - Anne-Laure Scain
- AP-HP, Henri Mondor Hospital, Department of Geriatric Medicine, Créteil, France
| | - Stéphane Culine
- Paris-Sorbonne University, Hemato-Immunology Research Department, CEA, Paris, France
- AP-HP, Saint-Louis Hospital, Department of Clinical Oncology, Paris, France
| | | | - Johanne Poisson
- AP-HP, Paris Cancer Institute CARPEM, Georges Pompidou European Hospital, Department of Geriatric Medicine, Paris, France
- Paris University, AP-HP, Inflammation Research Center, INSERM, UMR 1149 Paris, France
| | - Sylvie Bastuji-Garin
- Univ. Paris Est Créteil, Inserm U955, IMRB, Créteil, France
- AP-HP, Henri-Mondor Hospital, Department of Public Health, Créteil, France
| | - Florence Canoui-Poitrine
- Univ. Paris Est Créteil, Inserm U955, IMRB, Créteil, France
- AP-HP, Henri-Mondor Hospital, Department of Public Health, Créteil, France
| | - Philippe Caillet
- Univ. Paris Est Créteil, Inserm U955, IMRB, Créteil, France
- AP-HP, Paris Cancer Institute CARPEM, Georges Pompidou European Hospital, Department of Geriatric Medicine, Paris, France
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9
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Culine S, Harter V, Krucker C, Gravis G, Fléchon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Fontugne J, Allory Y, Pfister C. Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial. Cancers (Basel) 2023; 15:cancers15061742. [PMID: 36980628 PMCID: PMC10046214 DOI: 10.3390/cancers15061742] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023] Open
Abstract
Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection is the optimal treatment for patients with muscle-invasive bladder cancer. In recent years, the VESPER trial showed a statistically significant higher progression-free survival with dd-MVAC (dose dense methotrexate, vinblastine, doxorubicin, and cisplatin) compared to GC (gemcitabine and cisplatin). In the present report, we refine the characterization and outcome of patients whose cystectomy specimens were pathologically free of cancer (pathological complete response, pCR). We confirm that these patients portend a better outcome as compared to patients with invasive disease (≥pT1N0) at cystectomy. Nested variant and lymphovascular invasion were identified as adverse predictive factors of pCR. Progression-free survival probability three years after pCR on cystectomy was about 85%, regardless of the NAC regimen. A lower creatinine clearance and the delivery of less than four cycles were associated with a higher risk of relapse. Predicting the efficacy of NAC remains a major challenge. The planned analysis of molecular subtypes in the VESPER trial could help predict which patients may achieve complete response and better outcome.
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Affiliation(s)
- Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Nord, Université de Paris Cité, Avenue Claude Vellefaux, 75010 Paris, France
- Correspondence: ; Tel.: +33-142-494-247
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, 14000 Caen, France
| | - Clémentine Krucker
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, 13009 Marseille, France
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France
| | - Christine Chevreau
- Department of Medical Oncology, ICR-IUCT Oncopole, 31100 Toulouse, France
| | - Hakim Mahammedi
- Department of Medical Oncology, Jean Perrin Cancer Center, 63011 Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Center, 35042 Rennes, France
| | - Aline Guillot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42270 St Priest en Jarez, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, 14000 Caen, France
| | - Jacqueline Fontugne
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
- Department of Pathology, Institut Curie, 92210 Saint-Cloud, France
- Université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Yves Allory
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
- Department of Pathology, Institut Curie, 92210 Saint-Cloud, France
- Université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Christian Pfister
- Department of Urology, Clinical Investigation Center, Inserm 1404, Charles Nicolle University Hospital, 76000 Rouen, France
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10
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Malka D, Girard N, Smadja DM, Chevreau C, Culine S, Lesur A, Rouzier R, Rozet F, Spano JP, Blay JY. [Prophylaxis and management of cancer-associated thrombosis: Practical issues about anticoagulant use]. Bull Cancer 2023; 110:212-224. [PMID: 36494243 DOI: 10.1016/j.bulcan.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
Cancer-associated thrombosis (CAT) is a common complication resulting from various vascular mechanisms related to cancer, antitumoral therapy and patient status, and is associated with a poor prognosis. Anticoagulants recommended for CAT treatment or prevention mainly include low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs). Regarding thromboprophylaxis, a situation for which LMWH is a preferred option due to a lower risk of hemorrhage especially in patients with unresected gastro-intestinal and genito-urinary malignancies, the identification of patients at risk is a major issue. For patients with established CAT, the main issue is the choice of the most appropriate anticoagulant therapy. Because of the convenience of oral formulation, DOACs are an attractive option, and their efficacy has been shown in randomized trials. However, such studies are limited by selection biases, which make the analyzed population not representative of the real-life setting, as for instance cancers associated with a high risk of hemorrhage, or antitumoral therapies (e.g., tyrosine kinase inhibitors) known to interact with DOACs and then modifying their bioavailability. Caution associated with DOAC use is highlighted by most updated guidelines that recommend a case-by-case-based approach. The aim of the present paper is to help the oncologists make the most appropriate decision regarding the choice of anticoagulant therapy in a context of thromboprophylaxis or established CAT management in a patient with a solid tumor. The main issues are addressed through key practical questions, the answers of which are based on the current guidelines and additional published data or expert opinions.
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Affiliation(s)
- David Malka
- Institut mutualiste Montsouris, département d'oncologie médicale, Paris, France; Université Paris-Saclay, unité dynamique des cellules tumorales INSERM U1279, Gustave Roussy, Villejuif, France.
| | - Nicolas Girard
- Institut Curie, institut du Thorax Curie-Montsouris, Paris, France
| | - David M Smadja
- Université de Paris, INSERM innovations thérapeutiques en hémostase, Paris, France; Hôpital Européen Georges-Pompidou, AP-HP, département d'hématologie, Paris, France; Réseau F-CRIN INNOVTE, Paris, France
| | | | - Stéphane Culine
- Université Paris Cité, service d'oncologie médicale, AP-HP Saint-Louis, Paris, France
| | - Anne Lesur
- Mutuelle générale éducation nationale, Nancy, France
| | - Roman Rouzier
- Centre François Baclesse, département de Chirurgie, Caen, France
| | - François Rozet
- Institut mutualiste Montsouris, département d'urologie, Paris, France
| | - Jean-Philippe Spano
- Hôpital La Pitié-Salpêtrière, service d'oncologie médicale, AP-HP-SU, IUC, Paris, France
| | - Jean-Yves Blay
- Centre Leon Bérard and UCBL1, département d'oncologie médicale, Lyon, France
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11
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Da Silva A, Fléchon A, Coquan E, Planchamp F, Culine S, Murez T, Méjean A, Pasquier D, Chevreau C, Fizazi K, Thiery-Vuilemin A, Joly F. How to improve adherence of guidelines for localized testicular cancer surveillance: A Delphi consensus study. Front Oncol 2022; 12:1036190. [PMID: 36324582 PMCID: PMC9619048 DOI: 10.3389/fonc.2022.1036190] [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: 09/04/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
Stage-I testicular germ-cell tumor (TGCT) has excellent cure rates. Surveillance is fully included in patient's management, particularly during the first years of follow-up. Surveillance guidelines differ between the academic societies, mainly concerning imaging frequency and long-term follow-up. We evaluated surveillance practice and schedules followed by French specialists and set up a DELPHI method to obtain a consensual surveillance program with an optimal schedule for patients with localized TGCT. First, an online survey on surveillance practice of stage-I TGCT based on clinical-cases was conducted among urologists, radiation-oncologists and medical-oncologists. These results were compared to ESMO/EAU and AFU guidelines. Then a panel of experts assessed surveillance proposals following a Delphi-CM. Statements were drafted after analysis of the previous survey and systematic literature review, with 2 successive rounds to reach a consensus. The study was conducted between July 2018 and May 2019. Concerning the first step: 61 participated to the survey (69% medical-oncologists, 15% urologists, 16% radiation-oncologists). About 65% of practitioners followed clinico-biological guidelines concerning 1 to 5 years of follow-up, but only 25% stopped surveillance after the 5th-year. No physician followed the EAU/ESMO guidelines of de-escalation chest imaging. Concerning the second step: 32 experts (78% medical-oncologists, 16% urologists, 6% radiation-oncologists) participated to the Delphi-CM. Thanks to Delphi-CM, a consensus was reached for 26 of the 38 statements. Experts agreed on clinico-biological surveillance modalities and end of surveillance after the 5th-year of follow-up. For seminoma, abdominal ultrasound was proposed as an option to the abdominopelvic (AP) scan for the 4th-year of follow-up. No consensus was reached regarding de-escalation of chest imaging. To conclude, the survey proved that French TGCT-specialists do not follow current guidelines. With Delphi-CM, a consensus was obtained for frequency of clinico-biological surveillance, discontinuation of surveillance after the 5th-year, stop of AP scan on the 4th-year of follow-up for seminoma. Questions remains concerning type and frequency of chest imaging.
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Affiliation(s)
| | - Aude Fléchon
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | - Elodie Coquan
- Centre François-Baclesse, Department of Medical Oncology, Caen, France
- Centre François-Baclesse, Clinical Research Unit, Caen, France
| | | | - Stéphane Culine
- Hôpital Saint-Louis, Department of Medical Oncology, Paris, France
| | - Thibaut Murez
- Hôpital Lapeyronie, Department of Urology, Montpellier, France
| | - Arnaud Méjean
- Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Department of Urology, Paris, France
| | - David Pasquier
- Centre Oscar Lambret, Department of Radiation Oncology, Lille, France
| | | | - Karim Fizazi
- Gustave Roussy, University of Paris Sud, Department of Medical Oncology, Villejuif, France
| | | | - Florence Joly
- Centre François-Baclesse, Department of Medical Oncology, Caen, France
- Centre François-Baclesse, Clinical Research Unit, Caen, France
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12
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Dumont C, Masson-Lecomte A, Desgrandchamps F, Culine S. [Testicular tumors]. Rev Prat 2022; 72:803-805. [PMID: 36511974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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13
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De Wit R, Vaughn D, Fradet Y, Fong L, Vogelzang N, Climent Duran M, Necchi A, Petrylak D, Gerritsen W, Gurney H, Quinn D, Culine S, Sternberg C, Bajorin D, Choueiri T, Xu J, Imai K, Homet Moreno B, Bellmunt J, Lee JL. 1747P Impact of prior chemotherapy (Chemo) on pembrolizumab (Pembro) response in urothelial cancer (UC): Exploratory analysis of the phase III KEYNOTE-045 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1825] [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: 11/01/2022] Open
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14
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Helal C, Lambert T, Joly BS, Dumont C, Gauthier H, Culine S. Disseminated Intravascular Coagulation with Enhanced Fibrinolysis Caused by Heart Metastasis of Bladder Urothelial Carcinoma. Case Rep Oncol 2022; 15:745-749. [PMID: 36157695 PMCID: PMC9459518 DOI: 10.1159/000523822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/17/2022] [Indexed: 11/19/2022] Open
Abstract
Heart metastases from urothelial carcinoma of the bladder have rarely been reported in the literature. We present a case complicated by symptomatic disseminated intravascular coagulation in a 67-year-old woman. A rapid and sustained recovery from hemostatic troubles was obtained following fibrinogen supplementation combined with second-line paclitaxel chemotherapy.
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Affiliation(s)
- Clara Helal
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP.Nord − Université de Paris, Paris, France
| | - Tiphaine Lambert
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP.Nord − Université de Paris, Paris, France
| | - Bérangère S. Joly
- Department of Biological Hematology, Lariboisière Hospital, AP-HP.Nord − Université de Paris, Paris, France
| | - Clément Dumont
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP.Nord − Université de Paris, Paris, France
| | - Hélène Gauthier
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP.Nord − Université de Paris, Paris, France
| | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP.Nord − Université de Paris, Paris, France
- *Stéphane Culine,
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15
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Pfister C, Harter V, Allory Y, Culine S. Reply to S. Zeng et al. J Clin Oncol 2022; 40:3094-3095. [PMID: 35704836 DOI: 10.1200/jco.22.01031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christian Pfister
- Christian Pfister, MD, PhD, Department of Urology, Charles Nicolle University Hospital, Rouen, France, Clinical Investigation Center, Onco-Urology, Inserm 1404, Rouen, France; Valentin Harter, MSc, North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France; Yves Allory, MD, PhD, Department of Pathology, Curie Institute, Saint-Cloud, France; and Stéphane Culine, MD, PhD, for the VESPER Trial Investigators, Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Faculté de Paris, Paris, France
| | - Valentin Harter
- Christian Pfister, MD, PhD, Department of Urology, Charles Nicolle University Hospital, Rouen, France, Clinical Investigation Center, Onco-Urology, Inserm 1404, Rouen, France; Valentin Harter, MSc, North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France; Yves Allory, MD, PhD, Department of Pathology, Curie Institute, Saint-Cloud, France; and Stéphane Culine, MD, PhD, for the VESPER Trial Investigators, Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Faculté de Paris, Paris, France
| | - Yves Allory
- Christian Pfister, MD, PhD, Department of Urology, Charles Nicolle University Hospital, Rouen, France, Clinical Investigation Center, Onco-Urology, Inserm 1404, Rouen, France; Valentin Harter, MSc, North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France; Yves Allory, MD, PhD, Department of Pathology, Curie Institute, Saint-Cloud, France; and Stéphane Culine, MD, PhD, for the VESPER Trial Investigators, Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Faculté de Paris, Paris, France
| | - Stéphane Culine
- Christian Pfister, MD, PhD, Department of Urology, Charles Nicolle University Hospital, Rouen, France, Clinical Investigation Center, Onco-Urology, Inserm 1404, Rouen, France; Valentin Harter, MSc, North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France; Yves Allory, MD, PhD, Department of Pathology, Curie Institute, Saint-Cloud, France; and Stéphane Culine, MD, PhD, for the VESPER Trial Investigators, Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Faculté de Paris, Paris, France
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16
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Terrisse S, Goubet AG, Ueda K, Thomas AM, Quiniou V, Thelemaque C, Dunsmore G, Clave E, Gamat-Huber M, Yonekura S, Ferrere G, Rauber C, Pham HP, Fahrner JE, Pizzato E, Ly P, Fidelle M, Mazzenga M, Costa Silva CA, Armanini F, Pinto F, Asnicar F, Daillère R, Derosa L, Richard C, Blanchard P, Routy B, Culine S, Opolon P, Silvin A, Ginhoux F, Toubert A, Segata N, McNeel DG, Fizazi K, Kroemer G, Zitvogel L. Immune system and intestinal microbiota determine efficacy of androgen deprivation therapy against prostate cancer. J Immunother Cancer 2022; 10:jitc-2021-004191. [PMID: 35296557 PMCID: PMC8928383 DOI: 10.1136/jitc-2021-004191] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 12/12/2022] Open
Abstract
Background Prostate cancer (PC) responds to androgen deprivation therapy (ADT) usually in a transient fashion, progressing from hormone-sensitive PC (HSPC) to castration-resistant PC (CRPC). We investigated a mouse model of PC as well as specimens from PC patients to unravel an unsuspected contribution of thymus-derived T lymphocytes and the intestinal microbiota in the efficacy of ADT. Methods Preclinical experiments were performed in PC-bearing mice, immunocompetent or immunodeficient. In parallel, we prospectively included 65 HSPC and CRPC patients (Oncobiotic trial) to analyze their feces and blood specimens. Results In PC-bearing mice, ADT increased thymic cellularity and output. PC implanted in T lymphocyte-depleted or athymic mice responded less efficiently to ADT than in immunocompetent mice. Moreover, depletion of the intestinal microbiota by oral antibiotics reduced the efficacy of ADT. PC reduced the relative abundance of Akkermansia muciniphila in the gut, and this effect was reversed by ADT. Moreover, cohousing of PC-bearing mice with tumor-free mice or oral gavage with Akkermansia improved the efficacy of ADT. This appears to be applicable to PC patients because long-term ADT resulted in an increase of thymic output, as demonstrated by an increase in circulating recent thymic emigrant cells (sjTRECs). Moreover, as compared with HSPC controls, CRPC patients demonstrated a shift in their intestinal microbiota that significantly correlated with sjTRECs. While feces from healthy volunteers restored ADT efficacy, feces from PC patients failed to do so. Conclusions These findings suggest the potential clinical utility of reversing intestinal dysbiosis and repairing acquired immune defects in PC patients.
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Affiliation(s)
- Safae Terrisse
- INSERM U1015, Gustave Roussy, Villejuif, France.,Medical Oncology, Hôpital Saint-Louis, Paris, France
| | | | - Kousuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
| | | | | | | | | | - Emmanuel Clave
- Institut de Recherche de Paris, INSERM UMRS-1160, Université de Paris, Paris, France
| | | | | | | | | | | | - Jean-Eudes Fahrner
- INSERM U1015, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Saint-Aubin, France
| | | | - Pierre Ly
- INSERM U1015, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | - Romain Daillère
- Gustave Roussy, Villejuif, France.,EverImmune Gustave Roussy Cancer Center, Villejuif, France
| | - Lisa Derosa
- INSERM U1015, Gustave Roussy, Villejuif, France.,Center of Clinical Investistigations in Biotherapies of Cancer (CICBT), Villejuif, France
| | | | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Bertrand Routy
- Département de Médicine, CHUM, Montreal, Québec, Canada.,CRCHUM, Montreal, Québec, Canada
| | - Stéphane Culine
- Medical Oncology, Hôpital Saint-Louis, Paris, France.,Université de Paris, Paris, France
| | - Paule Opolon
- Department of Biology and Medical Pathology, Gustave Roussy, Villejuif, France
| | | | | | - Antoine Toubert
- Institut de Recherche Saint Louis, INSERM U1160, Université de Paris, Paris, France.,Laboratoire d'immunologie et d'histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - Douglas G McNeel
- Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Karim Fizazi
- Université Paris-Saclay, Saint-Aubin, France.,Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Guido Kroemer
- Gustave Roussy, Villejuif, France .,Sorbonne Université INSERM U1138, Université de Paris, Paris, France
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus, Villejuif, France .,Université Paris-Saclay Faculté de Médecine, Le Kremlin-Bicetre, France
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17
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Pfister C, Gravis G, Fléchon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Soulié M, Allory Y, Harter V, Culine S. Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin or Gemcitabine and Cisplatin as Perioperative Chemotherapy for Patients With Nonmetastatic Muscle-Invasive Bladder Cancer: Results of the GETUG-AFU V05 VESPER Trial. J Clin Oncol 2022; 40:2013-2022. [PMID: 35254888 DOI: 10.1200/jco.21.02051] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The optimal perioperative chemotherapy regimen for patients with nonmetastatic muscle-invasive bladder cancer is not defined. PATIENTS AND METHODS Between February 2013 and March 2018, 500 patients were randomly assigned in 28 French centers and received either six cycles of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) once every 2 weeks or four cycles of gemcitabine and cisplatin (GC) once every 3 weeks before surgery (neoadjuvant group) or after surgery (adjuvant group). We report the primary end point of the GETUG-AFU V05 VESPER trial (ClinicalTrials.gov identifier: NCT01812369): progression-free survival (PFS) at 3 years. Secondary end points were time to progression and overall survival. RESULTS Four hundred thirty-seven patients (88%) received neoadjuvant chemotherapy; 60% of patients received the planned six cycles in the dd-MVAC arm, 84% received four cycles in the GC arm, and thereafter, 91% and 90% of patients underwent surgery, respectively. Organ-confined response (< ypT3N0) was observed more frequently in the dd-MVAC arm (77% v 63%, P = .001). In the adjuvant group, 40% of patients received six cycles in the dd-MVAC arm, and 81% of patients received four cycles in the GC arm. For all patients in the clinical trial, 3-year PFS was improved in the dd-MVAC arm, but the study did not meet its primary end point (3-year rate: 64% v 56%, hazard ratio [HR] = 0.77 [95% CI, 0.57 to 1.02], P = .066); nevertheless, the dd-MVAC arm was associated with a significantly longer time to progression (3-year rate: 69% v 58%, HR = 0.68 [95% CI, 0.50 to 0.93], P = .014). In the neoadjuvant group, PFS at 3 years was significantly higher in the dd-MVAC arm (66% v 56%, HR = 0.70 [95% CI, 0.51 to 0.96], P = .025). CONCLUSION In the VESPER trial, dd-MVAC improved 3-years PFS over GC. In the neoadjuvant group, a better bladder tumor local control and a significant improvement in 3-year PFS were observed in the dd-MVAC arm.
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Affiliation(s)
- Christian Pfister
- Department of Urology, Charles Nicolle University Hospital, Rouen, France.,Clinical Investigation Center, Onco-Urology, Inserm 1404, Rouen, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, Marseille, France
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | - Hakim Mahammedi
- Department of Medical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Aline Guillot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, St Priest, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, Caen, France
| | - Michel Soulié
- Department of Urology, Rangueil University Hospital, Toulouse, France
| | - Yves Allory
- Department of Pathology, Curie Institute, Saint-Cloud, France
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France
| | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Faculté de Paris, France
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18
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Boudou-Rouquette P, de Moura A, Martinez-Tapia C, Serrano AG, Chahwakilian A, Jouinot A, Ulmann G, Orvoën G, Chambraud C, Durand JP, Caillet P, Goldwasser F, Paillaud E, Canouï-Poitrine F, Aregui A, Baronn M, Bringuier M, Bouvard E, Caillet P, Cosqueric G, Corsin L, Cudennec T, Chahwakilian A, Djender A, Dupuydupin E, Ebadi N, Fossey-Diaz V, Gisselbrecht M, Goldstein C, Gonzalez B, Laurent M, Leguen J, Lefevre M, Lazarovici-Nagera C, Lorisson E, Massias J, Mebarki S, Orvoen G, Pamoukdjian F, Scain AL, de Lempdes GR, Rollot-Trad F, Varnier G, Vincent H, Paillaud E, Raynaud-Simon A, Boudou-Rouquette P, Brain E, Culine S, Frelaut M, Ghebriou D, Gligorov J, Lopez-Trabada-Ataz SHD, Mir O, Tournigand C, Aparicio T, Touboul C, Lagrange JL, Benyahia S, Bonhomme S, Mota A, Philocles G, Ouakinine C, Audureau E, Bastuji-Garin S, Canouï-Poitrine F, Loriot MA, Natella PA, Martinez-Tapia C, Reinald N, Rello S, Lafage M, Allain M, Chambraud C, Baudin A, Bobin M, Canovas J, Chaoui S, Iratni L, Garrigou S, Lacour S, Mabungu H, Morisset L, Saadaoui B. Energy expenditure profiles and the risk of early limiting toxicity in older patients with cancer: The ELCAPA-25 prospective cohort survey. Clin Nutr 2022; 41:1073-1082. [DOI: 10.1016/j.clnu.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 12/31/2022]
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19
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Pfister C, Culine S. [Comment to "Administration de chimiothérapie né-adjuvante pour tumeur de vessie infiltrant le muscle en vie réelle : les urologues encore trop frileux ?" M. Such, A. Lavolle, M.B. Popelin, C. Thibault, E. Fontaine, C. Dariane, S. Oudard, A. Mejean, M.O. Timsit, F. Audenet. Progrès en Urologie (2021) 31, 332-339]. Prog Urol 2022; 32:3-5. [PMID: 34702636 DOI: 10.1016/j.purol.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- C Pfister
- Service urologie, CHU de Rouen, Rouen, France
| | - S Culine
- Service oncologie, AP-HP Saint-Louis, Paris, France
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20
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Pfister C, Gravis G, Flechon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Soulié M, Allory Y, Harter V, Culine S. Dose dense methotrexate, vinblastine, doxorubicin et cisplatin (DD-MVAC) versus gemcitabine et cisplatin (GC) comme chimiothérapie péri-opératoire dans le cancer de vessie localisé infiltrant le muscle. résultats de la phase III GETUG/AFU vesper V05. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Pfister C, Gravis G, Flechon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Soulie M, Allory Y, Harter V, Culine S. 652O Dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC) as perioperative chemotherapy for patients with muscle-invasive bladder cancer (MIBC): Results of the GETUG/AFU VESPER V05 phase III trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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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22
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Martinez Chanza N, Carnot A, Barthelemy P, Casert V, Sautois B, Van den Brande J, Vanhaudenarde V, Staudacher L, Seront E, Culine S, Gizzi M, Gil T, Paesmans M, Kotecki N, Ignatiadis M, Albisinni S, Fantoni J, Tricard T, Roumeguere T, Awada A. 659MO Avelumab (A) as the basis of neoadjuvant chemotherapy (NAC) regimen in platinum eligible and ineligible patients (pts) with non-metastatic muscle invasive bladder cancer (NM-MIBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.055] [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: 11/29/2022] Open
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23
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Naoun N, Le Teuff G, Pagliaro L, Fléchon A, Mardiak J, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard JC, Malhaire J, Linassier C, Reckova M, Nenan S, Culine S, Fizazi K. 713P Assessment of bleomycin pulmonary toxicity in men with poor-prognosis non-seminomatous germ-cell tumors treated in the GETUG 13 phase III trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.109] [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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24
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Delaye M, Benderra MA, Deforceville L, Larghero J, Parquet N, Culine S, Grazziotin-Soares D, Lotz JP. High-dose Chemotherapy in Germ Cell Cancer Patients With Brain Metastases: Experience of an Expert Center. Am J Clin Oncol 2021; 44:423-428. [PMID: 34081032 DOI: 10.1097/coc.0000000000000836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Germ cell tumor (GCT) patients with brain metastases (BM) have a poor prognosis and high risk of treatment failure. Optimal therapies for these patients remain controversial. The aim of this study was to report the outcomes of all GCT patients with BM treated with high-dose chemotherapy (HDCT) in our French expert center for GCT. METHODS We carried out a retrospective study of 35 GCT patients with BM who were treated from 2003 to 2019 with HDCT, followed by infusions of autologous peripheral blood hematopoietic stem cells. RESULTS The overall survival at 2 years was 36.9% (95% confidence interval, 19.7-54). The median overall survival was 12 months and the median progression-free survival was 8 months. No variables were associated with better survival in the univariable analysis. Among the 35 patients included in our study, 31 completed HDCT and 4 stopped treatments after mobilization. Eleven patients (11) showed favorable responses (complete, partial, or stable disease) to HDCT and 20 patients died of disease progression (17) or toxicities (3). Among the 11 patients with favorable responses to HDCT, 8 (72.7%) had metachronous BM, mostly isolated. The majority of these patients did not receive local treatment at diagnosis or at relapse. CONCLUSIONS Together, our study reveals that GCT patients can experience long-term survival even in the presence of BM. Metachronous BM can also be cured with HDCT even in the absence of local treatment. Biological and radiologic responses to mobilization could be a predictor of favorable responses to HDCT.
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Affiliation(s)
- Matthieu Delaye
- Department of Medical Oncology and Cellular Therapy, Hospital Tenon
| | | | | | | | | | - Stéphane Culine
- Department of Medical Oncology, Hospital Saint-Louis (Public Assistance - Paris Hospitals, AP-HP)
| | - Daniele Grazziotin-Soares
- Department of Medical Oncology and Cellular Therapy, Hospital Tenon
- Alliance for Cancer Research, Tenon Hospital
| | - Jean-Pierre Lotz
- Department of Medical Oncology and Cellular Therapy, Hospital Tenon
- University Cancer Institute (IUC), Sorbonne University, Paris, France
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25
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Khalifa J, Supiot S, Pignot G, Hennequin C, Blanchard P, Pasquier D, Magné N, de Crevoisier R, Graff-Cailleaud P, Riou O, Cabaillé M, Azria D, Latorzeff I, Créhange G, Chapet O, Rouprêt M, Belhomme S, Mejean A, Culine S, Sargos P. Recommendations for planning and delivery of radical radiotherapy for localized urothelial carcinoma of the bladder. Radiother Oncol 2021; 161:95-114. [PMID: 34118357 DOI: 10.1016/j.radonc.2021.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Curative radio-chemotherapy is recognized as a standard treatment option for muscle-invasive bladder cancer (MIBC). Nevertheless, the technical aspects for MIBC radiotherapy are heterogeneous with a lack of practical recommendations. METHODS AND MATERIALS In 2018, a workshop identified the need for two cooperative groups to develop consistent, evidence-based guidelines for irradiation technique in the delivery of curative radiotherapy. Two radiation oncologists performed a review of the literature addressing several topics relative to radical bladder radiotherapy: planning computed tomography acquisition, target volume delineation, radiation schedules (total dose and fractionation) and dose delivery (including radiotherapy techniques, image-guided radiotherapy (IGRT) and adaptive treatment modalities). Searches for original and review articles in the PubMed and Google Scholar databases were conducted from January 1990 until March 2020. During a meeting conducted in October 2020, results on 32 topics were presented and discussed with a working group involving 15 radiation oncologists, 3 urologists and one medical oncologist. We applied the American Urological Association guideline development's method to define a consensus strategy. RESULTS A consensus was obtained for all 34 except 4 items. The group did not obtain an agreement on CT enhancement added value for planning, PTV margins definition for empty bladder and full bladder protocols, and for pelvic lymph-nodes irradiation. High quality evidence was shown in 6 items; 8 items were considered as low quality of evidence. CONCLUSION The current recommendations propose a homogenized modality of treatment both for routine clinical practice and for future clinical trials, following the best evidence to date, analyzed with a robust methodology. The XXX group formulates practical guidelines for the implementation of innovative techniques such as adaptive radiotherapy.
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Affiliation(s)
- Jonathan Khalifa
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de l'Ouest, Nantes Saint-Herblain, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | | | - Pierre Blanchard
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - David Pasquier
- Department of Radiotherapy, Centre Oscar Lambret, Lille, France
| | - Nicolas Magné
- Department of Radiotherapy, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | | | - Pierre Graff-Cailleaud
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - Olivier Riou
- Department of Radiotherapy, Institut du Cancer de Montpellier, France
| | | | - David Azria
- Department of Radiotherapy, Institut du Cancer de Montpellier, France
| | - Igor Latorzeff
- Department of Radiotherapy, Clinique Pasteur, Toulouse, France
| | | | - Olivier Chapet
- Department of Radiotherapy, Hospices Civils de Lyon, France
| | - Morgan Rouprêt
- Department of Urology, Hôpital Pitié-Salpétrière, APHP Sorbonne Université, Paris, France
| | - Sarah Belhomme
- Department of Medical Physics, Institut Bergonié, Bordeaux, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France.
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26
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Courcier J, Dalban C, Laguerre B, Ladoire S, Barthélémy P, Oudard S, Joly F, Gravis G, Chevreau C, Geoffrois L, Deluche É, Rolland F, Topart D, Culine S, Négrier S, Mahammedi H, Tantot F, Jamet A, Escudier B, Flippot R, Albigès L. Primary Renal Tumour Response in Patients Treated with Nivolumab for Metastatic Renal Cell Carcinoma: Results from the GETUG-AFU 26 NIVOREN Trial. Eur Urol 2021; 80:325-329. [PMID: 34103181 DOI: 10.1016/j.eururo.2021.05.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022]
Abstract
Primary tumour response may impact therapeutic strategies in metastatic renal cell carcinoma (mRCC) but remains unknown in the era of immune checkpoint inhibitors. We aimed to describe the response of the primary tumour in patients who did not undergo upfront cytoreductive nephrectomy (uCN) and were treated with nivolumab in the GETUG-AFU-26 NIVOREN phase 2 trial. Primary tumour response was prospectively assessed, as well as the overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). Among 720 patients, 111 did not undergo uCN, mainly patients with intermediate (45%) and poor (49%) International mRCC Database Consortium (IMDC) risk. In the 111 patients, nivolumab was used in the second line for 63% of patients and the third line or more for 37%, with an ORR of 16% (95% confidence interval [CI] 1025%); with a median follow-up of 24.5 mo (95% CI 21.6-27.1), median PFS was 2.7 mo (95% CI 2.5-4.0) and median OS was 15.9 mo (95% CI 9.5-19.8). A total of 67 patients had an evaluable primary renal lesion, four of whom (6%) experienced shrinkage of more than 30%. Overall, patients who did not undergo uCN had adverse baseline characteristics and nivolumab activity against the primary tumour was limited. PATIENT SUMMARY: In this report, we observed that nivolumab was associated with a limited response of the primary tumour in previously treated patients with metastatic kidney cancer.
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Affiliation(s)
- Jean Courcier
- Department of Urology, UPEC-Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | | | | | | | - Stéphane Oudard
- Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Gwénaëlle Gravis
- Medical Oncology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | | | - Lionel Geoffrois
- Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | - Delphine Topart
- Department of Medical Oncology, Montpellier University Hospital, Hôpital Saint Eloi, Montpellier, France
| | - Stéphane Culine
- Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Antoine Jamet
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Bernard Escudier
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Ronan Flippot
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Laurence Albigès
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France.
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27
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Beyer J, Collette L, Sauvé N, Daugaard G, Feldman DR, Tandstad T, Tryakin A, Stahl O, Gonzalez-Billalabeitia E, De Giorgi U, Culine S, de Wit R, Hansen AR, Bebek M, Terbuch A, Albany C, Hentrich M, Gietema JA, Negaard H, Huddart RA, Lorch A, Cafferty FH, Heng DYC, Sweeney CJ, Winquist E, Chovanec M, Fankhauser C, Stark D, Grimison P, Necchi A, Tran B, Heidenreich A, Shamash J, Sternberg CN, Vaughn DJ, Duran I, Bokemeyer C, Patrikidou A, Cathomas R, Assele S, Gillessen S. Survival and New Prognosticators in Metastatic Seminoma: Results From the IGCCCG-Update Consortium. J Clin Oncol 2021; 39:1553-1562. [PMID: 33729863 PMCID: PMC8099394 DOI: 10.1200/jco.20.03292] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The classification of the International Germ-Cell Cancer Collaborative Group (IGCCCG) has been a major advance in the management of germ-cell tumors, but relies on data of only 660 patients with seminoma treated between 1975 and 1990. We re-evaluated this classification in a database from a large international consortium.
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Affiliation(s)
- Jörg Beyer
- Department of Medical Oncology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Nicolas Sauvé
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Gedske Daugaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Darren R Feldman
- Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Medical College of Cornell University, New York, NY
| | - Torgrim Tandstad
- The Cancer Clinic, St Olavs University Hospital and Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexey Tryakin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation.,Research Institute of Oncology at Bashkir State Medical University, Ufa, Russian Federation
| | - Olof Stahl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Enrique Gonzalez-Billalabeitia
- Servicio de Oncologia Medica, Hospital Universitario 12 de Octubre, Madrid, Spain.,Universidad Catolica San Antonio de Murcia, UCAM, Murcia, Spain
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy and the Italian Germ Cell Cancer Group (IGG), Italy
| | - Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Faculté de Paris, Paris, France
| | - Ronald de Wit
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Marko Bebek
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Angelika Terbuch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Costantine Albany
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | | | - Helene Negaard
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.,Department of Urology, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Fay H Cafferty
- Medical Research Council Clinical Trials Unit at University College London (UCL), London, United Kingdom
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Eric Winquist
- Division of Medical Oncology, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | | | - Daniel Stark
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Peter Grimison
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, Australia
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Current affiliation: Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Cora N Sternberg
- Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy. Current affiliation: Englander Institute for Precision Medicine, Weill Cornell Medicine, New York-Presbyterian, New York, NY
| | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla and IDIVAL, Santander, Spain
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Patrikidou
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland. Current affiliation: Sarah Cannon Research Institute and UCL Cancer Institute, London, United Kingdom
| | - Richard Cathomas
- Division of Oncology/Hematology, Cantonal Hospital Graubunden, Chur, Switzerland
| | - Samson Assele
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland.,Universita della Svizzera Italiana, Lugano, Switzerland.,University of Manchester, Manchester, United Kingdom
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28
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Chevreau C, Massard C, Flechon A, Delva R, Gravis G, Lotz JP, Bay JO, Gross-Goupil M, Fizazi K, Mourey L, Paci A, Guitton J, Thomas F, Lelièvre B, Ciccolini J, Moeung S, Gallois Y, Olivier P, Culine S, Filleron T, Chatelut E. Multicentric phase II trial of TI-CE high-dose chemotherapy with therapeutic drug monitoring of carboplatin in patients with relapsed advanced germ cell tumors. Cancer Med 2021; 10:2250-2258. [PMID: 33675184 PMCID: PMC7982623 DOI: 10.1002/cam4.3687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 11/07/2020] [Indexed: 12/02/2022] Open
Abstract
Background High‐dose chemotherapy (HDCT) with TI‐CE regimen is a valid option for the treatment of relapsed advanced germ cell tumors (GCT). We report a phase II trial with therapeutic drug monitoring of carboplatin for optimizing area under the curve (AUC) of this drug. Methods Patients with unfavorable relapsed GCT were treated according to TI‐CE regimen: two cycles combining paclitaxel and ifosfamide followed by three cycles of HD carboplatin plus etoposide administered on 3 days. Carboplatin dose was adapted on day 3 based on carboplatin clearance (CL) at day 1 in order to reach a target AUC of 24 mg.min/mL per cycle. The primary endpoint was the complete response (CR) rate. Results Eighty‐nine patients who received HDCT were included in the modified intent‐to‐treat (mITT) analysis. Measured mean AUC was 24.4 mg.min/mL per cycle (22.4 and 26.8 mg.min/mL for 10th and 90th percentiles). Thirty‐five (44.3%) patients achieved a CR with or without surgery of residual masses and 20 patients achieved a partial response with negative tumor markers. With a median follow‐up of 44 months (m), median PFS was 12.3 m (95% CI: 7.5–25.9) and OS was 46.3 m (95% CI: 18.6–not reached). For high‐ and very high‐risk patients, according to the International Prognostic Score at first relapse or treated after at least one salvage treatment (n = 51), 2‐year PFS rate was 41.1%. Conclusion The rates of complete and favorable responses were clinically relevant in this very poor risk population. Individual monitoring of carboplatin plasma concentration permitted to control more accurately the target AUC and avoided both underexposure and overexposure to the drug.
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Affiliation(s)
| | | | | | - Rémy Delva
- Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France
| | | | | | | | | | | | - Loïc Mourey
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - Jérôme Guitton
- Laboratoire de Pharmacologie Toxicologie, CHU, Lyon, France
| | - Fabienne Thomas
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.,Cancer Research Center of Toulouse (CRCT),, Université Paul Sabatier, Toulouse, France
| | | | | | - Sotheara Moeung
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.,Cancer Research Center of Toulouse (CRCT),, Université Paul Sabatier, Toulouse, France
| | - Yohan Gallois
- Service d'Otoneurologie et ORL Pédiatrique, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | | | | | | | - Etienne Chatelut
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France.,Cancer Research Center of Toulouse (CRCT),, Université Paul Sabatier, Toulouse, France
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Thureau S, Marchesi V, Vieillard MH, Perrier L, Lisbona A, Leheurteur M, Tredaniel J, Culine S, Dubray B, Bonnet N, Asselain B, Salleron J, Faivre JC. Efficacy of extracranial stereotactic body radiation therapy (SBRT) added to standard treatment in patients with solid tumors (breast, prostate and non-small cell lung cancer) with up to 3 bone-only metastases: study protocol for a randomised phase III trial (STEREO-OS). BMC Cancer 2021; 21:117. [PMID: 33541288 PMCID: PMC7863429 DOI: 10.1186/s12885-021-07828-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/21/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stereotactic Body Radiation Therapy (SBRT) is an innovative modality based on high precision planning and delivery. Cancer with bone metastases and oligometastases are associated with an intermediate or good prognosis. We assume that prolonged survival rates would be achieved if both the primary tumor and metastases are controlled by local treatment. Our purpose is to demonstrate, via a multicenter randomized phase III trial, that local treatment of metastatic sites with curative intent with SBRT associated of systemic standard of care treatment would improve the progression-free survival in patients with solid tumor (breast, prostate and non-small cell lung cancer) with up to 3 bone-only metastases compared to patients who received systemic standard of care treatment alone. METHODS This is an open-labeled randomized superiority multicenter phase III trial. Patients with up to 3 bone-only metastases will be randomized in a 1:1 ratio.between Arm A (Experimental group): Standard care of treatment & SBRT to all bone metastases, and Arm B (Control group): standard care of treatment. For patients receiving SBRT, radiotherapy dose and fractionation depends on the site of the bone metastasis and the proximity to critical normal structures. This study aims to accrue a total of 196 patients within 4 years. The primary endpoint is progression-free survival at 1 year, and secondary endpoints include Bone progression-free survival; Local control; Cancer-specific survival; Overall survival; Toxicity; Quality of life; Pain score analysis, Cost-utility analysis; Cost-effectiveness analysis and Budget impact analysis. DISCUSSION The expected benefit for the patient in the experimental arm is a longer expectancy of life without skeletal recurrence and the discomfort, pain and drastic reduction of mobility and handicap that the lack of local control of bone metastases eventually inflicts. TRIALS REGISTRATION ClinicalTrials.gov NCT03143322 Registered on May 8th 2017. Ongoing study.
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Affiliation(s)
- Sébastien Thureau
- Radiation Oncology & Medical Physics Department, Henri-Becquerel Comprehensive Cancer Center, rue d'Amiens, F-76 000, Rouen, France. .,EA4108 QuantIf Litis, University of Rouen, 22 boulevard Gambetta, 76000, Rouen, France.
| | - Vincent Marchesi
- Academic Radiation Oncology & Brachytherapy Department, Lorraine Institute of Cancerology - Alexis-Vautrin Comprehensive Cancer Center, 6 avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Marie-Hélène Vieillard
- Rheumatology Department, University Hospital of Lille, 2 avenue Oscar Lambret, 59 000, Lille, France
| | - Lionel Perrier
- UMR CNRS 5824, Léon Bérard Comprehensive Cancer Center, 28 rue laennec, 69 373, Lyon, France
| | - Albert Lisbona
- Academic Radiation Oncology & Brachytherapy Department, Institut de Cancérologie de l'Ouest - René Gauducheau Comprehensive Cancer Center, Boulevard Professeur Jacques Monod, 44805, Saint-Herblain, France
| | - Marianne Leheurteur
- Medical Oncology Department, Henri-Becquerel Comprehensive Cancer Center, rue d'Amiens, 76000, Rouen, France
| | - Jean Tredaniel
- Pneumology Department, University Hospital of Paris (Groupe hospitalier Paris Saint-Joseph), 185 Rue Raymond Losserand, 75014, Paris, France
| | - Stéphane Culine
- Medical Oncology Department, University Hospital of Paris (Saint-Louis Hospital), 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University, 16 rue Huchard, 75018, Paris, France
| | - Bernard Dubray
- Radiation Oncology & Medical Physics Department, Henri-Becquerel Comprehensive Cancer Center, rue d'Amiens, F-76 000, Rouen, France.,EA4108 QuantIf Litis, University of Rouen, 22 boulevard Gambetta, 76000, Rouen, France
| | - Naïma Bonnet
- Unicancer, 101, rue de Tolbiac, F-75654, Paris, France
| | | | - Julia Salleron
- Biostatistics Department, Institut de Cancérologie de Lorraine - Alexis-Vautrin Comprehensive Cancer Center, 6 avenue de Bourgogne, F-54519, Vandœuvre-lès-Nancy, France
| | - Jean-Christophe Faivre
- Academic Radiation Oncology & Brachytherapy Department, Lorraine Institute of Cancerology - Alexis-Vautrin Comprehensive Cancer Center, 6 avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
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Landre T, Des Guetz G, Chouahnia K, Fossey-Diaz V, Culine S. Immune Checkpoint Inhibitors for Patients Aged ≥ 75 Years with Advanced Cancer in First- and Second-Line Settings: A Meta-Analysis. Drugs Aging 2021; 37:747-754. [PMID: 32681403 DOI: 10.1007/s40266-020-00788-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The impact of aging on the effectiveness of immune checkpoint inhibitors (ICIs) remains controversial, and little is known on the subject in adults aged ≥ 75 years. OBJECTIVE The objective of this comprehensive meta-analysis was to assess the efficacy of ICIs in patients aged ≥ 75 years. METHODS We performed a meta-analysis of published randomized controlled trials concerning ICIs (as monotherapy or in combination) versus standard therapy in patients with advanced solid tumors between January 2010 and January 2020. We compared overall survival between older (aged ≥ 75 years) and younger (< 75 years) patients. Hazard ratios (HRs) and 95% confidence intervals (CIs) were collected and pooled. The secondary endpoint focused on the impact of the use of ICIs in first- and second-line settings. RESULTS In total, 15 phase III studies evaluating anti-programmed cell death 1 (anti-PD-1) (nivolumab or pembrolizumab), anti-programmed cell death ligand 1 (anti-PD-L1) (atezolizumab or avelumab), or anti-cytotoxic T lymphocyte antigen 4 (anti-CTLA-4) (ipilimumab) therapies were included. Enrolled patients had non-small-cell lung cancer, renal cell carcinoma, melanoma, head and neck squamous cell carcinoma, or gastric cancer. Eight studies assessed treatment in the first-line setting and seven in the second-line setting. The median age was 64 years, with 906 patients aged ≥ 75 years (552 in first line, 354 in second line) and 8741 were aged < 75 years (4992 in first line, 3749 in second line). In the first-line setting, HRs for death were 0.78 (95% CI 0.61-0.99) in patients aged ≥ 75 years versus 0.84 (95% CI 0.71-1.00) in those aged < 75 years. In the second-line setting, HRs for death were 1.02 (95% CI 0.77-1.36) in patients aged ≥ 75 years versus 0.68 (95% CI 0.61-0.75) in those aged < 75 years, with a statistically significant difference observed between subgroups (p = 0.009 for interaction). CONCLUSIONS ICIs appear to be effective in patients aged ≥ 75 years. However, the survival benefit is mainly observed in first-line treatment and remains unclear in the second-line setting.
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Affiliation(s)
- Thierry Landre
- Geriatric Oncology Coordination Unit, UCOG 93, APHP, HUPSSD, Université Sorbonne Paris Nord, Sevran, France.
| | - Gaetan Des Guetz
- Oncology Department, CH Delafontaine, Université de Limoges, St Denis, France
| | - Kader Chouahnia
- Oncology Department, APHP, Avicenne, HUPSSD, Université Sorbonne Paris Nord, Bobigny, France
| | - Virginie Fossey-Diaz
- Geriatric Department, UCOG Paris Nord, AP-HP, Bretonneau Hospital, 23 Rue Joseph de Maistre, 75018, Paris, France
| | - Stéphane Culine
- Department of Medical Oncology, UCOG Paris Nord, AP-HP, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University, 5 Rue Thomas Mann, 75013, Paris, France
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Pfister C, Gravis G, Flechon A, Soulie M, Guy L, Laguerre B, Mottet N, Joly F, Allory Y, Harter V, Culine S. Essai GETUG/AFU-V05 VESPER phase III randomisée de chimiothérapie périopératoire (schéma MVAC dose-dense ou GC) dans le cancer de vessie infiltrant localisé. Résultats sur la toxicité de la chimiothérapie et la réponse histologique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Courcier J, Dalban C, Laguerre B, Ladoire S, Barthélémy P, Oudard S, Joly F, Gravis Mescam G, Chevreau C, Geoffrois L, Deluche E, Rolland F, Topart D, Culine S, Négrier S, Mahammedi H, Tantot F, Escudier B, Flippot R, Albiges L. 712P Primary tumour response in patients treated with nivolumab for metastatic renal cell carcinoma (mRCC): Results of the GETUG-AFU 26 NIVOREN trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jamelot M, Pressat-Laffouilhere T, Baciarello G, Dumont C, Bonnet C, Fizazi K, Culine S. 648P Abiraterone and dexamethasone in castration-resistant prostate cancer: Biological response after switch or rechallenge. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.907] [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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Grivas P, Balar A, Vuky J, de Wit R, Vogelzang N, Choueiri T, Bajorin D, Castellano Gauna D, Gerritsen W, Gurney H, Quinn D, Culine S, Fradet Y, Saadatpour A, Loboda A, Ma J, Rajasagi M, Godwin J, Moreno B, Bellmunt J. 744P Association between gene expression signatures (sigs) and pembrolizumab (pembro) efficacy in patients (pts) with advanced urothelial cancer (UC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.816] [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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Pfister C, Gravis G, Fléchon A, Soulié M, Guy L, Laguerre B, Mottet N, Joly F, Allory Y, Harter V, Culine S. Randomized Phase III Trial of Dose-dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin, or Gemcitabine and Cisplatin as Perioperative Chemotherapy for Patients with Muscle-invasive Bladder Cancer. Analysis of the GETUG/AFU V05 VESPER Trial Secondary Endpoints: Chemotherapy Toxicity and Pathological Responses. Eur Urol 2020; 79:214-221. [PMID: 32868138 DOI: 10.1016/j.eururo.2020.08.024] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Perioperative chemotherapy (neoadjuvant or adjuvant) has been developed to increase overall survival for nonmetastatic muscle-invasive bladder cancer (MIBC). Retrospective studies or prospective phase II trials have been reported to use dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC). As dd-MVAC has shown higher response rates in metastatic disease, better efficacy is expected in the perioperative setting. OBJECTIVE We designed a randomized phase III trial to compare the efficacy of dd-MVAC or GC in MIBC perioperative (neoadjuvant or adjuvant) setting. DESIGN, SETTING AND PARTICIPANTS A total of 500 patients were randomized from February 2013 to March 2018 in 28 centers and received either six cycles of dd-MVAC every 2 wk or four cycles of GC every 3 wk. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint (progression-free survival at 3 yr) was not reported. We focused on secondary endpoints: chemotherapy toxicity and pathological responses. RESULTS AND LIMITATIONS In the neoadjuvant group, 218 patients received dd-MVAC and 219 received GC. Of the patients, 60% received six cycles in the dd-MVAC arm and 84% received four cycles in the GC arm; 199 (91%) and 198 (90%) patients underwent surgery, respectively. Complete pathological response (ypT0pN0) was observed in 84 (42%) and 71 (36%) patients, respectively (p=0.2). An organ-confined status (<ypT3pN0) was obtained in 154 (77%) and 124 (63%) patients, respectively (p=0.001). In the adjuvant group, 40% of patients received six cycles in the dd-MVAC arm and 60% received four cycles in the GC arm. Most of Common Terminology Criteria for Adverse Events (CTCAE) grade ≥3 toxicities concerned hematological toxicities, reported for 129 (52%) patients in the dd-MVAC group and 134 (55%) patients in the GC group. Gastrointestinal (GI) grade ≥3 disorders were more frequently observed in the dd-MVAC arm (p=0.003), as well as asthenia of grade ≥3 (p<0.001). CONCLUSIONS The toxicity of dd-MVAC was manageable with more severe asthenia and GI side effects than that of GC in perioperative chemotherapy. A higher local control rate (complete pathological response, tumor downstaging, or organ confined) was observed in the dd-MVAC arm (p=0.021). However, such data have to be confirmed on progression-free survival, with primary endpoint data expected in mid-2021. PATIENT SUMMARY The authors have designed a randomized phase III controlled study comparing the efficacy of gemcitabine and cisplatin, and dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) in patients for whom chemotherapy has been decided, before or after radical cystectomy. Higher toxicity regarding asthenia and gastrointestinal side effects along with a better bladder control rate were observed in the dd-MVAC arm. However, such data have to be confirmed on progression-free survival, with primary endpoint data expected in mid-2021.
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Affiliation(s)
- Christian Pfister
- Department of Urology, Charles Nicolle University Hospital, Rouen, France; Clinical Investigation Center, Inserm 1404, Onco-Urology, Rouen, France.
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, Marseille, France
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Michel Soulié
- Department of Urology, Rangueil University Hospital, Toulouse, France
| | - Laurent Guy
- Department of Urology, Montpied University Hospital, Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Marquis Cancer Center, Rennes, France
| | - Nicolas Mottet
- Department of Urology, Nord University Hospital, Saint-Etienne, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, Caen, France
| | - Yves Allory
- Department of Pathology, Institut Curie, Saint-Cloud, France; Department of Pathology, Foch Hospital, Suresnes, France
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France
| | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis-APHP, Faculté de Paris, France
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Fradet Y, Bellmunt J, Vaughn DJ, Lee JL, Fong L, Vogelzang NJ, Climent MA, Petrylak DP, Choueiri TK, Necchi A, Gerritsen W, Gurney H, Quinn DI, Culine S, Sternberg CN, Nam K, Frenkl TL, Perini RF, de Wit R, Bajorin DF. Randomized phase III KEYNOTE-045 trial of pembrolizumab versus paclitaxel, docetaxel, or vinflunine in recurrent advanced urothelial cancer: results of >2 years of follow-up. Ann Oncol 2020; 30:970-976. [PMID: 31050707 PMCID: PMC6594457 DOI: 10.1093/annonc/mdz127] [Citation(s) in RCA: 285] [Impact Index Per Article: 71.3] [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] [Indexed: 12/14/2022] Open
Abstract
Background Novel second-line treatments are needed for patients with advanced urothelial cancer (UC). Interim analysis of the phase III KEYNOTE-045 study showed a superior overall survival (OS) benefit of pembrolizumab, a programmed death 1 inhibitor, versus chemotherapy in patients with advanced UC that progressed on platinum-based chemotherapy. Here we report the long-term safety and efficacy outcomes of KEYNOTE-045. Patients and methods Adult patients with histologically/cytologically confirmed UC whose disease progressed after first-line, platinum-containing chemotherapy were enrolled. Patients were randomly assigned 1 : 1 to receive pembrolizumab [200 mg every 3 weeks (Q3W)] or investigator’s choice of paclitaxel (175 mg/m2 Q3W), docetaxel (75 mg/m2 Q3W), or vinflunine (320 mg/m2 Q3W). Primary end points were OS and progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1) by blinded independent central radiology review (BICR). A key secondary end point was objective response rate per RECIST v1.1 by BICR. Results A total of 542 patients were enrolled (pembrolizumab, n = 270; chemotherapy, n = 272). Median follow-up as of 26 October 2017 was 27.7 months. Median 1- and 2-year OS rates were higher with pembrolizumab (44.2% and 26.9%, respectively) than chemotherapy (29.8% and 14.3%, respectively). PFS rates did not differ between treatment arms; however, 1- and 2-year PFS rates were higher with pembrolizumab. The objective response rate was also higher with pembrolizumab (21.1% versus 11.0%). Median duration of response to pembrolizumab was not reached (range 1.6+ to 30.0+ months) versus chemotherapy (4.4 months; range 1.4+ to 29.9+ months). Pembrolizumab had lower rates of any grade (62.0% versus 90.6%) and grade ≥3 (16.5% versus 50.2%) treatment-related adverse events than chemotherapy. Conclusions Long-term results (>2 years’ follow-up) were consistent with those of previously reported analyses, demonstrating continued clinical benefit of pembrolizumab over chemotherapy for efficacy and safety for treatment of locally advanced/metastatic, platinum-refractory UC. Trial registration ClinicalTrials.gov: NCT02256436.
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Affiliation(s)
- Y Fradet
- Department of Surgery/Urology, CHU de Québec-Université Laval, Québec City, Canada.
| | - J Bellmunt
- Department of Medical Oncology, PSMAR-IMIM Research Institute, Barcelona, Spain and Harvard Medical School University, Boston, USA
| | - D J Vaughn
- Department of Medical Oncology, Abramson Cancer Center, Perelman Center for Advanced Medicine, Philadelphia, USA
| | - J L Lee
- Department of Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - L Fong
- Department of Medicine and Urology, University of California San Francisco, San Francisco
| | - N J Vogelzang
- Department of Medical Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, USA
| | - M A Climent
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - D P Petrylak
- Division of Medical Oncology, Smilow Cancer Hospital at Yale University, New Haven
| | - T K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - W Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Gurney
- Department of Medical Oncology, Westmead Hospital and Macquarie University, Sydney, NSW, Australia
| | - D I Quinn
- Department of Medical Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, USA
| | - S Culine
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | - C N Sternberg
- Department of Medical Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York-Presbyterian, New York
| | - K Nam
- Department of Medical Oncology, Merck & Co., Inc., Kenilworth, USA
| | - T L Frenkl
- Department of Medical Oncology, Merck & Co., Inc., Kenilworth, USA
| | - R F Perini
- Department of Medical Oncology, Merck & Co., Inc., Kenilworth, USA
| | - R de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D F Bajorin
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
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Pfister C, Gravis G, Flechon A, Soulie M, Guy L, Laguerre B, Mottet N, Joly F, Allory Y, Harter V, Culine S. Randomized phase III trial of dose-dense MVAC or GC as perioperative chemotherapy for muscle-invasive urothelial bladder cancer (MIUBC): Preliminary results of the GETUG/AFU V05 VESPER trial on toxicity and pathological responses. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Oudard S, Latorzeff I, Caty A, Miglianico L, Sevin E, Hardy-Bessard AC, Delva R, Rolland F, Mouret L, Priou F, Beuzeboc P, Gravis G, Linassier C, Gomez P, Voog E, Muracciole X, Abraham C, Banu E, Ferrero JM, Ravaud A, Krakowski I, Lagrange JL, Deplanque G, Zylberait D, Bozec L, Houede N, Culine S, Elaidi R. Effect of Adding Docetaxel to Androgen-Deprivation Therapy in Patients With High-Risk Prostate Cancer With Rising Prostate-Specific Antigen Levels After Primary Local Therapy: A Randomized Clinical Trial. JAMA Oncol 2020; 5:623-632. [PMID: 30703190 DOI: 10.1001/jamaoncol.2018.6607] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Androgen-deprivation therapy (ADT) plus docetaxel is the standard of care in hormone-naive metastatic prostate cancer but is of uncertain benefit in a nonmetastatic, high-risk prostate cancer setting. Objective To assess the benefit of ADT plus docetaxel in patients presenting with rising prostate-specific antigen (PSA) levels after primary local therapy and high-risk factors but no evidence of metastatic disease. Design, Setting, and Participants This open-label, phase 3, randomized superiority trial comparing ADT plus docetaxel vs ADT alone enrolled patients from 28 centers in France between June 4, 2003, and September 25, 2007; final follow-up was conducted April 12, 2017, and analysis was performed May 2 to July 31, 2017. Patients had undergone primary local therapy for prostate cancer, were experiencing rising PSA levels, and were considered to be at high risk of metastatic disease. Stratification was by prior local therapy and PSA-level doubling time (≤6 vs >6 months), and intention-to-treat analysis was used. Interventions Patients were randomly assigned to receive ADT (1 year) plus docetaxel, 70 mg/m2 (every 3 weeks [6 cycles]), or ADT alone (1 year). Main Outcomes and Measures The primary outcome was PSA progression-free survival (PSA-PFS). Secondary end points were PSA response, radiologic PFS, overall survival, safety, and quality of life. Results Overall, 254 patients were randomized (1:1) to the trial; median age, 64 years in the ADT plus docetaxel arm, 66 years in the ADT alone arm. At a median follow-up of 30.0 months, the median PSA-PFS was 20.3 (95% CI, 19.0-21.6) months in the ADT plus docetaxel arm vs 19.3 (95% CI, 18.2-20.8) months in the ADT alone arm (hazard ratio [HR], 0.85; 95% CI, 0.62-1.16; P = .31). At a median follow-up of 10.5 years, there was no significant between-arm difference in radiologic PFS (HR, 1.03; 95% CI, 0.74-1.43; P = .88). Overall survival data were not mature. The most common grade 3 or 4 hematologic toxic effects in the ADT plus docetaxel arm were neutropenia (60 of 125 patients [48.0%]), febrile neutropenia (10 [8.0%]), and thrombocytopenia (4 [3.0%]). There was no significant between-arm difference in overall quality of life. Conclusions and Relevance Compared with ADT alone, combined ADT plus docetaxel therapy with curative intent did not significantly improve PSA-PFS in patients with high-risk prostate cancer and rising PSA levels and no evidence of metastatic disease. Trial Registration French Health Products Safety Agency identifier: 030591; ClinicalTrials.gov identifier: NCT00764166.
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Affiliation(s)
- Stéphane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | - Igor Latorzeff
- Department of Oncology Radiotherapy, Clinique Pasteur, Toulouse, France
| | - Armelle Caty
- Department of Medical Oncology, Centre Galilée, Hôpital Privé la Louvière, Lille, France
| | - Laurent Miglianico
- Department of Oncology Radiotherapy, Centre Hospitalier Privé St Grégoire, Rennes, France
| | - Emmanuel Sevin
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Remy Delva
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Angers, France
| | - Frédéric Rolland
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, St Herblain, France
| | - Loic Mouret
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Franck Priou
- Department of Medical Oncology, Centre Hospitalier de Vendée, La Roche sur Yon, France
| | | | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Claude Linassier
- Department of Medical Oncology, Centre Hospitalier Bretonneau, Tours, France
| | - Philippe Gomez
- Department of Oncology Radiotherapy, Centre Joliot Curie, Rouen, France
| | - Eric Voog
- Department of Medical Oncology, Clinique Victor Hugo, Institut Inter-régional de Cancérologie, Le Mans, France
| | - Xavier Muracciole
- Department of Oncology Radiotherapy, Hôpital de la Timone, Marseille, France
| | - Christine Abraham
- Department of Medical Oncology, Centre Hospitalier Versailles André Mignot, Le Chesnay, France
| | - Eugeniu Banu
- Department of Medical Oncology, Cancer Institute Ion Chiricuta, Cluj-Napoca, Romania
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Alain Ravaud
- Department of Medical Oncology, Hôpital St Andre, Bordeaux, France
| | - Ivan Krakowski
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre Les Nancy, France
| | | | - Gaël Deplanque
- Department of Medical Oncology, Fondation Hopital St Joseph, Paris, France
| | - David Zylberait
- Department of Medical Oncology, Centre Hospitalier de Compiegne, Compiegne, France
| | - Laurence Bozec
- Department of Medical Oncology, Hôpital Foch, Suresnes, France
| | - Nadine Houede
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Stéphane Culine
- Department of Medical Oncology, Hôpital St Louis, Paris, France
| | - Reza Elaidi
- Association pour la Recherche sur les Thérapeutiques Innovantes en Cancérologie, Paris, France
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Pfister C, Harter V, Allory Y, Radvanyi F, Culine S. Design of a randomized controlled phase III study of dose dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC) as peri-operative chemotherapy for patients with locally advanced transitional cell cancer of the bladder. The French GETUG/AFU V05 VESPER trial. Contemp Clin Trials Commun 2020; 17:100536. [PMID: 32083220 PMCID: PMC7025084 DOI: 10.1016/j.conctc.2020.100536] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 09/05/2019] [Revised: 01/17/2020] [Accepted: 01/26/2020] [Indexed: 11/25/2022] Open
Abstract
The main objective of the French GETUG/AFU V05 VESPER randomized phase III study was to assess the efficacy of dd-MVAC and GC in term of progression-free survival in patients for whom chemotherapy has been decided, before or after surgery. A total of 500 patients have been randomized in 28 reference centers. Inclusion criteria were urothelial carcinoma without neuro-endocrine variant, disease defined by a T2, T3 or T4a N0 (pelvic lymph node ≤ 10 mm on CT scan) M0 staging for patients receiving neoadjuvant chemotherapy or pT3 or pT4 or pN+ and M0 for patients receiving adjuvant chemotherapy. Secondary endpoints include overall survival, safety, response rate. The peri-operative chemotherapy schedule was experimental arm dd-MVAC for a total of 6 cycles versus standard arm GC 4 cycles. The toxicity was evaluated according to NCI CTCAE (v 4.0). The progression-free survival rate will be estimated at 3 years by the Kaplan-Meier method. All the patients will be followed for 5 years. The last patient was randomized in March 2018 and the primary endpoint results are expected for mid-2021. As the dd-MVAC schedule is associated with higher response rates in metastatic disease, the real question today is to confirm such benefit in the peri-operative setting, taking also in consideration the chemotherapy toxicity. Tomorrow, the challenge may be the best chemotherapy and immunotherapy association, the authors hope that final Vesper Trial results will help to determine the gold standard chemotherapy.
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Affiliation(s)
- Christian Pfister
- Department of Urology, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, Inserm 6204, Onco-Urology, Rouen, France
| | - Valentin Harter
- Department of Biostatistics, Baclesse Unicancer Center, Caen, France
| | - Yves Allory
- Department of Pathology, Institut Curie, Saint-Cloud, France
| | | | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis, APHP, Paris, France
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Horwich A, Babjuk M, Bellmunt J, Bruins HM, De Reijke TM, De Santis M, Gillessen S, James N, Maclennan S, Palou J, Powles T, Ribal MJ, Shariat SF, Van Der Kwast T, Xylinas E, Agarwal N, Arends T, Bamias A, Birtle A, Black PC, Bochner BH, Bolla M, Boormans JL, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Compérat E, Crabb S, Culine S, De Bari B, DeBlok W, De Visschere PJL, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne V, Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmüller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo V, Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Carmen Mir M, Moschini M, Mostafid H, Müller AC, Müller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, Oyen WJG, Pacheco-Figueiredo L, Pappot H, Patel MI, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk RJ, Smits A, Stenzl A, Thalmann GN, Tombal B, Turkbey B, Vahr Lauridsen S, Valdagni R, Van Der Heijden AG, Van Poppel H, Vartolomei MD, Veskimäe E, Vilaseca A, Vives Rivera FA, Wiegel T, Wiklund P, Williams A, Zigeuner R, Witjes JA. EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees†. Ann Oncol 2019; 30:1697-1727. [PMID: 31740927 PMCID: PMC7360152 DOI: 10.1093/annonc/mdz296] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. SETTING Online Delphi survey and consensus conference. PARTICIPANTS The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.
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Affiliation(s)
- A Horwich
- Emeritus Professor, The Institute of Cancer Research, London, UK; Emeritus Professor, The Institute of Cancer Research, London, UK.
| | - M Babjuk
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - J Bellmunt
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Harvard Medical School, Boston, USA
| | - H M Bruins
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - T M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - M De Santis
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Charité University Hospital, Berlin, Germany
| | - S Gillessen
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen; University of Bern, Bern, Switzerland
| | - N James
- University Hospitals Birmingham NHS Foundation Trust, Birmingham; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
| | - S Maclennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - J Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Powles
- The Royal Free NHS Trust, London; Barts Cancer Institute, Queen Mary University of London, London, UK
| | - M J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - S F Shariat
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - T Van Der Kwast
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris; Paris Descartes University, Paris, France
| | - N Agarwal
- Huntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, USA
| | - T Arends
- Urology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, Nijmegen, The Netherlands
| | - A Bamias
- 2nd Propaedeutic Dept of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - A Birtle
- Division of Cancer Sciences, University of Manchester, Manchester; Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK
| | - P C Black
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - B H Bochner
- Department of Urology, Weill Cornell Medical College, New York; Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Bolla
- Emeritus Professor of Radiation Oncology, Grenoble - Alpes University, Grenoble, France
| | - J L Boormans
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - A Briganti
- Department of Urology, Urological Research Institute, Milan; Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - I Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - M Burger
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - D Castellano
- Medical Oncology Department, 12 de Octubre University Hospital (CIBERONC), Madrid, Spain
| | - R Cathomas
- Department Innere Medizin, Abteilung Onkologie und Hämatologie, Kantonsspital Graubünden, Chur, Switzerland
| | - A Chiti
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy
| | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - E Compérat
- Department of Pathology, Tenon Hospital, HUEP, Paris; Sorbonne University, Paris, France
| | - S Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - S Culine
- Department of Cancer Medicine, Hôpital Saint Louis, Paris
| | - B De Bari
- Radiation Oncology Department, Centre Hospitalier Régional Universitaire "Jean Minjoz" of Besançon, INSERM UMR 1098, Besançon, France; Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - W DeBlok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J L De Visschere
- Department of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Ghent
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - K Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - J L Dominguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Bologna, Italy
| | - V Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
| | - M Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - J J Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Gakis
- Department of Urology and Paediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Würzburg, Germany
| | - B Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - P Gontero
- Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy
| | - B Grubmüller
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D E Hansel
- Department of Urology, University of California, San Diego Pathology, La Jolla, USA
| | - A Hartmann
- Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - D Hayne
- Department of Urology, UWA Medical School, University of Western Australia, Perth, Australia
| | - A M Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - V Hernandez
- Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - H Herr
- Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - K Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Centre for Cancer Treatment, London, UK
| | - J Huguet
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - R Jones
- Institute of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A M Kamat
- Department of Urology - Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, USA
| | - V Khoo
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medicine, University of Melbourne, Melbourne; Monash University, Melbourne, Australia
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - S Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - S Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - P C Lara
- Department of Oncology, Hospital Universitario San Roque, Canarias; Universidad Fernando Pessoa, Canarias, Spain
| | - A Leliveld
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - V Løgager
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - A Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Y Loriot
- Département de Médecine Oncologique, Gustave Roussy, INSERM U981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - R Meijer
- UMC Utrecht Cancer Center, MS Oncologic Urology, Utrecht, The Netherlands
| | - M Carmen Mir
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - M Moschini
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - H Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - A-C Müller
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - C R Müller
- Cancer Treatment Centre, Sorlandet Hospital, Kristiansand, Norway
| | - J N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - A Necchi
- Department of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy
| | - Y Neuzillet
- Department of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - J R Oddens
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Osanto
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - W J G Oyen
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - L Pacheco-Figueiredo
- Department of Urology, Centro Hospitalar São João, Porto; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - M I Patel
- Department of Urology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - B R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam
| | - K Plass
- EAU Guidelines Office, Arnhem, The Netherlands
| | - M Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - M Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - J Richenberg
- Department of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton; Brighton and Sussex Medical School, Brighton, UK
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - F Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - J E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York, USA
| | - M Rouprêt
- Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - O Rouvière
- Hospices Civils de Lyon, Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Lyon; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - C Salembier
- Department of Radiation Oncology, Europe Hospitals Brussels, Brussels, Belgium
| | - A Salminen
- Department of Urology, University Hospital of Turku, Turku, Finland
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - S Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne; Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - A Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - R J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Smits
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - A Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - G N Thalmann
- Department of Urology, Inselspital, Bern University Hospital, Berne, Switzerland
| | - B Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | - B Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, USA
| | - S Vahr Lauridsen
- Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - R Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - H Van Poppel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - M D Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - E Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - A Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - F A Vives Rivera
- Clinica HematoOncologica Bonadona Prevenir, Universidad Metropolitana, Clinica Club de Leones, Barranquilla, Colombia
| | - T Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - P Wiklund
- Icahn School of Medicine, Mount Sinai Health System, New York City, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - A Williams
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - R Zigeuner
- Department of Urology, Medizinische Universität Graz, Graz, Austria
| | - J A Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen
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Necchi A, Fradet Y, Bellmunt J, de Wit R, Lee JL, Fong L, Vozelgang N, Climent M, Petrylak D, Choueiri T, Gerritsen W, Gurney H, Quinn D, Culine S, Sternberg C, Nam K, Frenkl T, Godwin J, Bajorin D, Vaughn D. Three-year follow-up from the phase III KEYNOTE-045 trial: Pembrolizumab (Pembro) versus investigator’s choice (paclitaxel, docetaxel, or vinflunine) in recurrent, advanced urothelial cancer (UC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fizazi K, Maillard A, Penel N, Baciarello G, Allouache D, Daugaard G, Van de Wouw A, Soler G, Vauleon E, Chaigneau L, Janssen R, Losa Gaspa F, Morales Barrera R, Balana C, Tosi D, Chauffert B, Schnabel C, Martineau G, Culine S, Borget I. A phase III trial of empiric chemotherapy with cisplatin and gemcitabine or systemic treatment tailored by molecular gene expression analysis in patients with carcinomas of an unknown primary (CUP) site (GEFCAPI 04). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abstract
Combining quality and quantity of life is one of the challenges of geriatric oncology This requires early diagnosis and a full medical, psychological and social assessment of the patient. The aim of this assessment is to take a global approach to the patient's care management, to take into consideration his or her own opinion and to define a suitable treatment. Once the treatment has been established, the setting up of follow-up care for any comorbidities and symptoms, as well as the putting in place of help where needed, can help to improve quality of life.
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Affiliation(s)
- Amélie Aregui
- Hôpitaux Bichat, Bretonneau, Saint-Louis, Ucog Paris-Nord, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10, France.
| | - Rachida Qabbal
- Hôpitaux Bichat, Bretonneau, Saint-Louis, Ucog Paris-Nord, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10, France
| | - Stéphane Culine
- Hôpitaux Bichat, Bretonneau, Saint-Louis, Ucog Paris-Nord, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10, France; Service d'oncologie médicale, Hôpital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; Service d'oncologie médicale, Hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Virginie Fossey Diaz
- Hôpitaux Bichat, Bretonneau, Saint-Louis, Ucog Paris-Nord, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10, France; Service de gériatrie et de soins palliatifs, Hôpital Bretonneau, AP-HP, 23, rue Joseph-de-Maistre, 75018 Paris, France
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Flippot R, Dalban C, Laguerre B, Borchiellini D, Gravis G, Négrier S, Chevreau C, Joly F, Geoffrois L, Ladoire S, Mahammedi H, Rolland F, Gross-Goupil M, Deluche E, Priou F, Laramas M, Barthélémy P, Narciso B, Houedé N, Culine S, Oudard S, Chenot M, Tantot F, Chabaud S, Escudier B, Albiges L. Safety and Efficacy of Nivolumab in Brain Metastases From Renal Cell Carcinoma: Results of the GETUG-AFU 26 NIVOREN Multicenter Phase II Study. J Clin Oncol 2019; 37:2008-2016. [PMID: 31194611 DOI: 10.1200/jco.18.02218] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Nivolumab is standard of care for patients with metastatic clear cell renal cell carcinoma (ccRCC) after failure of antiangiogenic therapies, but its activity on brain metastases from ccRCC remains unknown, because these patients were excluded from pivotal studies. We aimed to assess the activity of nivolumab in this population. METHODS The GETUG-AFU 26 NIVOREN phase II trial assessed the activity and safety of nivolumab in patients with metastatic ccRCC who failed vascular endothelial growth factor-directed therapies (ClinicalTrials.gov identifier: NCT03013335). Patients with asymptomatic brain metastases were prospectively identified and underwent dedicated brain evaluation. Two cohorts were constituted: cohort A comprised patients with previously untreated brain metastases, and cohort B comprised patients whose brain metastases underwent prior therapy. The primary end point was intracranial response rate in cohort A. RESULTS Seventy-three patients with brain metastases were included: 39 in cohort A and 34 in cohort B. Intracranial response rate was 12% in cohort A; no objective response was reported in patients with brain lesions that were multiple or larger than 1 cm. Median intracranial progression-free survival was 2.7 months (95% CI, 2.3 to 4.6 months) in cohort A and 4.8 months (95% CI, 3.0 to 8.0 months) in cohort B, with adjusted hazard ratio of 2.04 (95% CI, 1.08 to 3.83). Overall survival rate at 12 months was 67% (95% CI, 49.6% to 79.1%) in cohort A and 59% (95% CI, 40.6% to 73.2%) in cohort B. Most patients in cohort A (72%) needed subsequent focal brain therapy. Nivolumab was well tolerated, with no unexpected toxicity. CONCLUSION Nivolumab activity is limited in patients with untreated brain metastases from ccRCC. Brain imaging and focal therapy should be considered before immune checkpoint inhibitors in patients with metastatic ccRCC.
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Affiliation(s)
- Ronan Flippot
- 1Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Frank Priou
- 14Centre Hospitalier de Vendée, La Roche sur Yon, France
| | | | | | | | | | - Stéphane Culine
- 19Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Oudard
- 20Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Bernard Escudier
- 1Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Laurence Albiges
- 1Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
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Khayi F, Lafarge L, Terret C, Albrand G, Falquet B, Culine S, Gourgou S, Ducher M, Bourguignon L. Prediction of docetaxel toxicity in older cancer patients: a Bayesian network approach. Fundam Clin Pharmacol 2019; 33:679-686. [DOI: 10.1111/fcp.12476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/28/2019] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fouzy Khayi
- Hospices Civils de Lyon Hôpital Pierre Garraud 136 rue du commandant Charcot 69005 Lyon France
| | - Laurent Lafarge
- Hospices Civils de Lyon Hôpital Pierre Garraud 136 rue du commandant Charcot 69005 Lyon France
| | - Catherine Terret
- Department of Medical Oncology Centre Léon Bérard 28 Prom. Léa et Napoléon Bullukian 69008 Lyon France
| | - Gilles Albrand
- Hospices Civils de Lyon Centre Hospitalier Lyon Sud 165 Chemin du Grand Revoyet 69310 Pierre‐Bénite France
| | - Benoit Falquet
- Hospices Civils de Lyon Hôpital Pierre Garraud 136 rue du commandant Charcot 69005 Lyon France
| | - Stéphane Culine
- Department of Medical Oncology AP‐HP Hôpital Saint‐Louis 1 Avenue Claude Vellefaux 75010 Paris France
- Paris‐Diderot University Paris France
| | - Sophie Gourgou
- Institut du cancer de Montpellier unité de biométrie, 208, avenue des Apothicaires 34298 Montpellier France
- Université de Montpellier 163, rue Auguste‐Broussonnet 34090 Montpellier France
| | - Michel Ducher
- Hospices Civils de Lyon Hôpital Pierre Garraud 136 rue du commandant Charcot 69005 Lyon France
- EMR 3738 Faculté de médecine Lyon‐sud Université Lyon 1 69310 Pierre‐Bénite Lyon France
| | - Laurent Bourguignon
- Hospices Civils de Lyon Hôpital Pierre Garraud 136 rue du commandant Charcot 69005 Lyon France
- UMR CNRS 5558 Laboratoire de Biométrie et Biologie Évolutive Université Lyon 1 69100 Villeurbanne Lyon France
- ISPB – Faculté de pharmacie Université Lyon 1 8 Avenue Rockefeller 69008 Lyon France
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Dumont C, Gauthier H, Bonnet C, Culine S. Understanding chemotherapy-induced changes in bladder cancer biology: a necessary step towards tailored treatment in cisplatin-refractory disease. Transl Androl Urol 2019; 8:S116-S118. [PMID: 31143685 DOI: 10.21037/tau.2018.12.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Clément Dumont
- Department of Medical Oncology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène Gauthier
- Department of Medical Oncology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clément Bonnet
- Department of Medical Oncology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Marret G, Doucet L, Hennequin C, Fizazi K, Culine S. Abiraterone in metastatic castration-resistant prostate cancer: Efficacy and safety in unselected patients. Cancer Treat Res Commun 2018; 17:37-42. [PMID: 30347333 DOI: 10.1016/j.ctarc.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Abiraterone acetate (AA), an androgen biosynthesis inhibitor, is now a standard of care for men with metastatic, castration-sensitive and castration-resistant prostate cancer (mCRPC). Data exploring real-world toxicity and outcomes are scarce. METHODS Retrospective study on unselected patients with mCRPC on AA plus steroids. RESULTS 93 patients were included in the study. Median duration of treatment by AA was 7.5 months (95% CI 5.7-12) among the 58 patients pretreated with chemotherapy, versus 12.7 months ( 95% CI 8.2-35.9) among the 33 chemo-naive patients. Median survivals would reach 13.4 months (95% CI 10.2-19.1) and 36.4 months (95% CI 24.7-41.5) respectively. Rates of hypokalemia, peripheral edema, hypertension, cardiac failure, and overall survival assessments in patients with and without prior chemotherapy were similar to that previously reported in phase 3 randomized trials. The median survival time without adverse event of special interest was 7.5 months for hypokalemia and hypertension, and 5.3 months for liver-function test abnormalities (it was not reached for cardiac disorders). CONCLUSION Our findings provide further evidence for the survival benefits of AA with a low frequency of additional adverse events among unselected patients. In patients who have not developed hypokalemia or a transaminase increase within 7.5 and 5.3 months respectively, a lighter systematic monitoring may be considered.
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Affiliation(s)
- Grégoire Marret
- Department of Cancer Medicine, Hôpital Saint Louis, Paris, France.
| | - Ludovic Doucet
- Department of Cancer Medicine, Hôpital Saint Louis, Paris, France.
| | | | - Karim Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Saclay, Villejuif, France.
| | - Stéphane Culine
- Department of Cancer Medicine, Hôpital Saint Louis, Paris, France.
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Bellucci A, Nevoret C, De Bazelaire C, Oudard S, Teixeira L, Defrance R, Huet T, Pierre L, Doppler V, Medioni J, Culine S, Fournier L. Prognostic value of response according to tumour growth rate in a phase I trial on vaccine therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.048] [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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Bellmunt J, de Wit R, Vaughn D, Fradet Y, Lee J, Fong L, Vogelzang N, Climent M, Petrylak D, Choueiri T, Necchi A, Gerritsen W, Gurney H, Quinn D, Culine S, Sternberg C, Jensen E, Frenkl T, Perini R, Bajorin D. Impact of prognostic factors and risk groups on overall survival (OS) in patients treated with pembrolizumab vs investigator’s choice chemotherapy for advanced urothelial cancer (UC): Post hoc analysis of KEYNOTE-045. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.110] [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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Fizazi K, Carmel A, Joly F, Delva R, Gravis G, Rolland F, Priou F, Ferrero JM, Houede N, Mourey L, Theodore C, Krakowski I, Berdah JF, Baciuchka Palmaro M, Laguerre B, Flechon A, Ravaud A, Brihoum M, Culine S, Le Teuff G. Updated results of GETUG-12, a phase III trial of docetaxel-based chemotherapy in high-risk localized prostate cancer, with a 12-year follow-up. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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