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Dinh A, Duran C, Ropers J, Bouchand F, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S, de Lastours V, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Claessens YE, Labarère J, Bedos JP, Aegerter P, Crémieux AC. Exclusive Oral Antibiotic Treatment for Hospitalized Community-Acquired Pneumonia: A Post-Hoc Analysis of a Randomized Clinical Trial. Clin Microbiol Infect 2024:S1198-743X(24)00237-4. [PMID: 38734138 DOI: 10.1016/j.cmi.2024.05.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/09/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES In this study, we aimed to assess the efficacy of different ways of administration and types of beta-lactams for hospitalized community-acquired pneumonia (CAP). METHODS In this post-hoc analysis of a RCT on patients hospitalized for CAP (PTC trial) comparing 3-day versus 8-day durations of beta-lactams, which concluded to non-inferiority, we included patients who received either amoxicillin-clavulanate (AMC) or third-generation cephalosporin (3GC) regimens, and exclusively either intravenous or oral treatment for the first 3 days (followed by either 5 days of oral placebo or AMC according to randomization). Choice of route and molecule was left to the physician in charge. The main outcome was failure at 15 days after first antibiotic intake, defined as temperature>37.9°C, and/or absence of resolution/improvement of respiratory symptoms, and/or additional antibiotic treatment for any cause. The primary outcome according to route of administration was evaluated through logistic regression. Inverse probability treatment weighting (IPTW) with a propensity score model was used to adjust for non-randomization of treatment route and potential confounders. The difference in failure rates was also evaluated among several sub-populations (AMC versus 3GC treatments, or intravenous versus oral AMC, patients with multi-lobar infection, patients aged ≥ 65 years old, and patients with CURB65 scores of 3-4). RESULTS We included 200 patients from the original trial, with 93/200 (46.5%) patients only treated with intravenous treatment and 107/200 (53.5%) patients only treated with oral therapy. Failure rate at Day 15 was not significantly different among patients treated with initial intravenous versus oral treatment (25/93 (26.9%) versus 28/107 (26.2%), aOR 0.973 (95%CI 0.519-1.823), p=0.932). Failure rates at Day 15 were not significantly different among the subgroup populations. CONCLUSIONS Among hospitalized patients with CAP, there was no significant difference in efficacy between initial intravenous and exclusive oral treatment. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, NCT01963442.
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Affiliation(s)
- Aurélien Dinh
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France; Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France.
| | - Clara Duran
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpétrière University Hospital, APHP, Paris, France
| | - Frédérique Bouchand
- Pharmacy department, Raymond-Poincaré University Hospital, APHP Paris Saclay, Garches, France
| | - Laurène Deconinck
- Infectious disease department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious disease department, Marne La Vallée Hospital, GHEF, Marne La Vallée, France
| | | | - Guillaume Mellon
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Ruxandra Calin
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | - Sabrina Makhloufi
- Infectious diseases Unit, Raymond-Poincaré University Hospital, APHP Paris Saclay University, Garches, France
| | | | | | - Jean-Emmanuel Kahn
- Internal medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal medicine, Lariboisière University Hospital, APHP, Paris, France
| | | | - Daniel Benhamou
- Pneumology department, Rouen University Hospital, Rouen, France
| | | | | | - Bertrand Renaud
- Emergency department, Cochin University Hospital, APHP, Paris, France
| | | | - José Labarère
- Quality of care unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Philippe Aegerter
- UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
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Dupuis-Girod S, Rivière S, Lavigne C, Fargeton AE, Gilbert-Dussardier B, Grobost V, Leguy-Seguin V, Maillard H, Mohamed S, Decullier E, Roux A, Bernard L, Saurin JC, Saroul N, Faure F, Cartier C, Altwegg R, Laccourreye L, Oberti F, Beaudoin M, Dhelens C, Desvignes C, Azzopardi N, Paintaud G, Hermann R, Chinet T. Efficacy and safety of intravenous bevacizumab on severe bleeding associated with hemorrhagic hereditary telangiectasia: A national, randomized multicenter trial. J Intern Med 2023; 294:761-774. [PMID: 37592715 DOI: 10.1111/joim.13714] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Bevacizumab-a humanized monoclonal antibody-has been widely used to treat patients with hereditary hemorrhagic telangiectasia (HHT), but no randomized trial has yet been conducted. METHODS This study is a double-blind multicenter randomized phase 2 trial with a 1:1 active-treatment-to-placebo ratio. We included patients over the age of 18 with a confirmed diagnosis and the need for at least four red blood cell (RBC) units transfused in the 3 months before study enrollment. Bevacizumab was administered at a dose of 5 mg/kg every 14 days with a total of six injections. The primary efficacy criterion was a decrease of at least 50% in the cumulative number of RBC units transfused in a 3-month period before and after treatment. RESULTS A total of 24 patients (12 in each group) were included and randomized at 4 different centers. In intention-to-treat analysis, 63.6% of patients (7/11) in the bevacizumab group versus 33.3% of patients (4/12) in the placebo group decreased the number of blood transfusions by at least 50% (p = 0.22). Hemoglobin levels significantly improved at 6 months in the bevacizumab versus placebo group (p = 0.02). The pharmacokinetics study revealed that patients with high exposure to bevacizumab had a significant decrease in RBC transfusions (p = 0.03). Fifty-nine adverse events were observed, 34 in the placebo arm versus 25 in the bevacizumab arm. CONCLUSION Though the present trial was underpowered, patients with HHT receiving bevacizumab required numerically fewer red blood cell transfusions than those receiving placebo, particularly those with high exposure.
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Affiliation(s)
- Sophie Dupuis-Girod
- Service de Génétique et centre de référence de la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France
- Inserm, CEA, Laboratory Biology of Cancer and Infection, Université Grenoble Alpes, Grenoble, France
| | - Sophie Rivière
- Service de Médecine Interne A, Centre Hospitalier Universitaire, Montpellier, France
| | - Christian Lavigne
- Service de médecine interne-Immunologie clinique, CHU d'Angers, Angers cedex 09, France
| | - Anne-Emmanuelle Fargeton
- Service de Génétique et centre de référence de la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France
| | | | - Vincent Grobost
- Service de Médecine Interne CHU Estaing, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Hélène Maillard
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Shirine Mohamed
- Département de Médecine interne et Immunologie Clinique, CHRU BRABOIS, Vandoeuvre-lès-Nancy, France
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- Faculté de médecine, Université Lyon 1, Lyon, France
| | - Adeline Roux
- Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- Faculté de médecine, Université Lyon 1, Lyon, France
| | | | - Jean-Christophe Saurin
- Faculté de médecine, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service d'Hépato-gastroentérologie, Hôpital E. Herriot, Lyon, France
| | - Nicolas Saroul
- CHU Clermont Ferrand, Hôpital Gabriel Montpied, Service d'ORL, Clermont-Ferrand, France
| | - Frédéric Faure
- Hospices Civils de Lyon, Hôpital E. Herriot, Service d'ORL, Lyon, France
| | - Cesar Cartier
- Service d'ORL Centre Hospitalier Universitaire, Montpellier, France
| | - Romain Altwegg
- Service Hépatogastroentérologie CHU St Eloi, Montpellier, France
| | | | - Frédéric Oberti
- Service Hépatogastroentérologie, UPRES EA 3859, Faculté de médecine, CHU Angers and Laboratoire HIFIH, Angers, France
| | - Marjolaine Beaudoin
- Service de Génétique et centre de référence de la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France
| | - Carole Dhelens
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Pharmacie à Usage Intérieur, Lyon, France
| | - Céline Desvignes
- CHRU de Tours, Plateforme Recherche, Centre Pilote de suivi Biologique des traitements par Anticorps (CePiBAc), Tours, France
- EA 4245 Transplantation, Immunologie, Inflammation (T2I), Université de Tours, Tours, France
| | | | - Gilles Paintaud
- EA 4245 Transplantation, Immunologie, Inflammation (T2I), Université de Tours, Tours, France
- Service de Pharmacologie Médicale, CHRU de Tours, Tours, France
| | - Ruben Hermann
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service d'ORL et centre de référence de la maladie de Rendu-Osler, Bron, France
| | - Thierry Chinet
- Centre Rendu-Osler, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Université de Versailles SQY, Boulogne, France
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Le TTT, Martinent G, Dupuis-Girod S, Parrot A, Contis A, Riviere S, Chinet T, Grobost V, Espitia O, Dussardier-Gilbert B, Alric L, Armengol G, Maillard H, Leguy-Seguin V, Leroy S, Rondeau-Lutz M, Lavigne C, Mohamed S, Chaussavoine L, Magro P, Seguier J, Kerjouan M, Fourdrinoy S. Development and validation of a quality of life measurement scale specific to hereditary hemorrhagic telangiectasia: the QoL-HHT. Orphanet J Rare Dis 2022; 17:281. [PMID: 35854330 PMCID: PMC9295423 DOI: 10.1186/s13023-022-02426-2] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) disease is a rare genetic disorder with symptoms and complications that can significantly affect patients’ daily lives. To date, no scale has been validated to assess the specific symptoms of this disease on the quality of life (QOL) of HHT patients. This makes it difficult for clinicians to accurately measure the quality of life of patients with HHT. The present study aims to develop and validate a QOL measurement tool specific to HHT disease: the QOL questionnaire in HHT (QoL-HHT). Methods A quantitative, non-interventional, multi-center study involving HHT patients in twenty French HHT expert centers was conducted. A calibration sample of 415 HHT patients and a validation sample of 228 HHT patients voluntarily participated in the study. Data were analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Exploratory Structural Equation Modeling (ESEM) analyses, reliability analyses, and correlational analyses. Results The EFA, CFA and ESEM results allowed us to provide evidence of the factorial structure of a questionnaire composed of 24 items measuring 6 domains of QOL: Physical limitations, social relationships, concern about bleeding, relationship with the medical profession, experience of symptoms, and concern about the evolution of the disease. Cronbach’s alpha coefficients (> 0.70) demonstrated reliable internal consistency of all the QoL-HHT scores (dimensions). The results of the test–retest provided further evidence of the reliability of the QOL-HHT scores over time. Correlational analyses provided evidence for the convergent validity of the QoL-HHT scores. Conclusions We developed a simple and quick self-assessment tool to measure quality of life specific to HHT disease. This study demonstrated reliability and validity of our QoL-HHT scores. It is a very promising tool to evaluate the impact of HHT disease on all aspects of the quality of life of HHT patients in order to offer them individualized medico-psycho-social support. Trial registration: ClinicalTrials, NCT03695874. Registered 04 October 2018, https://www.clinicaltrials.gov/ct2/show/NCT03695874 Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02426-2.
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Affiliation(s)
- Thi Thao Truc Le
- Laboratoire de Psychologie sur les Dynamiques Relationnelles et Processus Identitaires (EA 7458), Université de Bourgogne-Franche-Comté, 3 Allée des Stades Universitaires, 21000, Dijon, France
| | - Guillaume Martinent
- Laboratoire sur les Vulnérabilités et l'Innovation dans le Sport (EA 7428), Université de Lyon, Université Claude Bernard Lyon 1, 27-29 bd du 11 Novembre 1918, 69622, Villeurbanne, France
| | - Sophie Dupuis-Girod
- Service de génétique clinique, Centre de Référence pour la Maladie de Rendu-Osler, Hospices Civils de Lyon, HFME Bâtiment A1, 59 bd Pinel, 69677, Bron Cedex, France
| | - Antoine Parrot
- Service de pneumologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 rue de Chine, 75790, Paris Cedex 20, France
| | - Anne Contis
- Service de médecine interne, Hôpital Saint André, 1 rue Jean Burguet, 33000, Bordeaux, France
| | - Sophie Riviere
- Service de médecine interne, CHU de Montpellier Hôpital St Eloi, Avenue A. Fliche, 34295, Montpellier Cedex 5, France
| | - Thierry Chinet
- Consultation Maladie de Rendu-Osler, CHU Ambroise Paré, 9 av Charles de Gaulle, 92104, Boulogne Billancourt, France
| | - Vincent Grobost
- Service de médecine interne, CHU Estaing, 1 rue Lucie et Raymond Aubrac, 63100, Clermont-Ferrand, France
| | - Olivier Espitia
- Service de médecine interne - médecine vasculaire, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | | | - Laurent Alric
- Service de médecine interne, CHU Rangueil, 1 av du Pr Jean Poulhès, 31059, Toulouse Cedex 9, France
| | - Guillaume Armengol
- Service de médecine interne, CHU de Rouen Ch. Nicolle, , 1 rue de Germont, 76031, Rouen Cedex, France
| | - Hélène Maillard
- Service de médecine interne, Hôpital Huriez, 1 rue Michel Polonovski, 59037, LILLE Cedex, France
| | - Vanessa Leguy-Seguin
- Service de médecine interne, Hôpital Le Bocage, 2 Bd Maréchal de Lattre de Tassigny, BP 77908, 21079, Dijon Cedex, France
| | - Sylvie Leroy
- Service de pneumologie, CHU de Nice, 30 av de la Voie Romaine, 06002, Nice Cedex, France
| | - Murielle Rondeau-Lutz
- Service de médecine interne, CHU de Strasbourg Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Christian Lavigne
- Service de médecine interne, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex 09, France
| | - Shirine Mohamed
- Service de médecine interne, CHU de Nancy, Hôpital Brabois, Rue du Morvan, 54511, Vandoeuvre Les Nancy, France
| | - Laurent Chaussavoine
- Service de médecine vasculaire, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Pascal Magro
- Service de pneumologie, CHRU de Tours Hôpital Bretonneau, 2 bd Tonnellé, 37044, Tours Cedex 9, France
| | - Julie Seguier
- Service de médecine interne, Hôpital de La Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 05, France
| | - Mallorie Kerjouan
- Service de pneumologie, CHU de Rennes Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 09, France
| | - Sylvie Fourdrinoy
- Service de génétique clinique, Centre de Référence pour la Maladie de Rendu-Osler, Hospices Civils de Lyon, HFME Bâtiment A1, 59 bd Pinel, 69677, Bron Cedex, France.
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Karam C, Mansencal N, Puymirat E, Charpentier E, Palmyre A, Chinet T, El Hajjam M. Myocardial Infarction in a 29-Year-Old Woman Leads to Diagnosis and Treatment of a Rare Disease. Chest 2022; 162:e49-e52. [DOI: 10.1016/j.chest.2022.01.066] [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] [Received: 12/21/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022] Open
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Dinh A, Duran C, Ropers J, Bouchand F, Davido B, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S, de Lastours V, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Guillemot D, Renaud B, Claessens YE, Labarère J, Aegerter P, Bedos JP, Crémieux AC. Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2129566. [PMID: 34652445 PMCID: PMC8520128 DOI: 10.1001/jamanetworkopen.2021.29566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Failure of treatment is the most serious complication in community-acquired pneumonia (CAP). OBJECTIVE To assess the potential risk factors for treatment failure in clinically stable patients with CAP. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis assesses data from a randomized clinical trial on CAP (Pneumonia Short Treatment [PTC] trial) conducted from December 19, 2013, to February 1, 2018. Data analysis was performed from July 18, 2019, to February 15, 2020. Patients hospitalized at 1 of 16 centers in France for moderately severe CAP who were clinically stable at day 3 of antibiotic treatment were included in the PTC trial and analyzed in the per-protocol trial population. INTERVENTIONS Patients were randomly assigned (1:1) on day 3 of antibiotic treatment to receive β-lactam (amoxicillin-clavulanate [1 g/125 mg] 3 times daily) or placebo for 5 extra days. MAIN OUTCOMES AND MEASURES The main outcome was failure at 15 days after first antibiotic intake, defined as a temperature greater than 37.9 °C and/or absence of resolution or improvement of respiratory symptoms and/or additional antibiotic treatment for any cause. The association among demographic characteristics, baseline clinical and biological variables available (ie, at the first day of β-lactam treatment), and treatment failure at day 15 among the per-protocol trial population was assessed by univariate and multivariable logistic regressions. RESULTS Overall, 310 patients were included in the study; this secondary analysis comprised 291 patients (174 [59.8%] male; mean [SD] age, 69.6 [18.5] years). The failure rate was 26.8%. Male sex (odds ratio [OR], 1.74; 95% CI, 1.01-3.07), age per year (OR, 1.03; 95% CI, 1.01-1.05), Pneumonia Severe Index score (OR, 1.01; 95% CI, 1.00-1.02), the presence of chronic lung disease (OR, 1.85; 95% CI, 1.03-3.30), and creatinine clearance (OR, 0.99; 95% CI, 0.98-1.00) were significantly associated with failure in the univariate analysis. When the Pneumonia Severe Index score was excluded to avoid collinearity with age and sex in the regression model, only male sex (OR, 1.92; 95% CI, 1.08-3.49) and age (OR, 1.02; 95% CI, 1.00-1.05) were associated with failure in the multivariable analysis. CONCLUSIONS AND RELEVANCE In this secondary analysis of a randomized clinical trial, among patients with CAP who reached clinical stability after 3 days of antibiotic treatment, only male sex and age were associated with higher risk of failure, independent of antibiotic treatment duration and biomarker levels. Another randomized clinical trial is needed to evaluate the impact of treatment duration in populations at higher risk for treatment failure.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
- Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit, Institut Pasteur, Paris, France
| | - Clara Duran
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpétrière University Hospital, APHP, Paris, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond-Poincaré University Hospital, APHP Paris Saclay, Garches, France
| | - Benjamin Davido
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Laurène Deconinck
- Infectious Disease Department, Bichat University Hospital, APHP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious Disease Department, Marne La Vallée Hospital, Grand Hôpital de l'Est Francilien, Marne La Vallée, France
| | | | - Guillaume Mellon
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Ruxandra Calin
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | - Sabrina Makhloufi
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, Assistance Publique–Hôpitaux de Paris (APHP) Paris Saclay University, Garches, France
| | | | | | - Jean-Emmanuel Kahn
- Internal Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency Medicine, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric Department, Ambroise-Paré University Hospital, APHP Paris Saclay, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal Medicine, Lariboisière University Hospital, APHP, Paris, France
| | | | - Daniel Benhamou
- Pneumology Department, Rouen University Hospital, Rouen, France
| | | | | | - Didier Guillemot
- Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit, Institut Pasteur, Paris, France
| | - Bertrand Renaud
- Emergency Department, Cochin University Hospital, APHP, Paris, France
| | | | - José Labarère
- Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Philippe Aegerter
- UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
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Giroux Leprieur E, Hélias-Rodzewicz Z, Takam Kamga P, Costantini A, Julie C, Corjon A, Dumenil C, Dumoulin J, Giraud V, Labrune S, Garinet S, Chinet T, Emile JF. Sequential ctDNA whole-exome sequencing in advanced lung adenocarcinoma with initial durable tumor response on immune checkpoint inhibitor and late progression. J Immunother Cancer 2021; 8:jitc-2020-000527. [PMID: 32581058 PMCID: PMC7319709 DOI: 10.1136/jitc-2020-000527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite prolonged tumor response to immune checkpoint inhibitors (ICIs) for a subset of patients with advanced non-small cell lung cancer (NSCLC), a secondary resistance will occur for a majority of these patients. The understanding of late progression mechanisms with ICIs is important to improve future treatment strategies. METHODS We performed whole-exome sequencing (WES) on circulating tumor DNA and compared molecular profiles between the beginning of ICI treatment and tumor progression in patients with advanced NSCLC treated with ICIs and who had initial and prolonged tumor response with secondary progression, after at least 6 months of treatment. RESULTS We identified eight patients who experienced initial and durable tumor response, and secondary tumor progression after 6 months of treatment, with available paired blood samples (diagnosis and progression). All had lung adenocarcinoma, three had programmed-death ligand-1 expression ≥50% in immunohistochemistry and all presented low blood tumor mutational burden (bTMB). Seven patients received nivolumab in second-line or more, and one received pembrolizumab as first-line treatment. WES at progression showed clonal selection with molecular alterations of Wnt pathway-related genes, increase of copy number aberrations in cancer-related genes and loss of tumor-suppressor genes (such as PTEN) or of genes associated with immune response (such as B2M). No difference in term of bTMB was observed at progression. CONCLUSIONS This is the first study describing putative molecular mechanisms associated with late progression under ICI in lung cancer. Studies on treatment strategies adapted to these mechanisms are needed.
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Affiliation(s)
- Etienne Giroux Leprieur
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France .,Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Zofia Hélias-Rodzewicz
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Paul Takam Kamga
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France
| | - Adrien Costantini
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Catherine Julie
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Alexandre Corjon
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Simon Garinet
- Department of Molecular Biology, APHP - Hopital Europeen Georges Pompidou, Paris, France
| | - Thierry Chinet
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-François Emile
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
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7
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Dinh A, Ropers J, Duran C, Davido B, Deconinck L, Matt M, Senard O, Lagrange A, Makhloufi S, Mellon G, de Lastours V, Bouchand F, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Perronne C, Claessens YE, Labarère J, Bedos JP, Aegerter P, Crémieux AC. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial. Lancet 2021; 397:1195-1203. [PMID: 33773631 DOI: 10.1016/s0140-6736(21)00313-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shortening the duration of antibiotic therapy for patients admitted to hospital with community-acquired pneumonia should help reduce antibiotic consumption and thus bacterial resistance, adverse events, and related costs. We aimed to assess the need for an additional 5-day course of β-lactam therapy among patients with community-acquired pneumonia who were stable after 3 days of treatment. METHODS We did this double-blind, randomised, placebo-controlled, non-inferiority trial (the Pneumonia Short Treatment [PTC]) in 16 centres in France. Adult patients (aged ≥18 years) admitted to hospital with moderately severe community-acquired pneumonia (defined as patients admitted to a non-critical care unit) and who met prespecified clinical stability criteria after 3 days of treatment with β-lactam therapy were randomly assigned (1:1) to receive β-lactam therapy (oral amoxicillin 1 g plus clavulanate 125 mg three times a day) or matched placebo for 5 extra days. Randomisation was done using a web-based system with permuted blocks with random sizes and stratified by randomisation site and Pneumonia Severity Index score. Participants, clinicians, and study staff were masked to treatment allocation. The primary outcome was cure 15 days after first antibiotic intake, defined by apyrexia (temperature ≤37·8°C), resolution or improvement of respiratory symptoms, and no additional antibiotic treatment for any cause. A non-inferiority margin of 10 percentage points was chosen. The primary outcome was assessed in all patients who were randomly assigned and received any treatment (intention-to-treat [ITT] population) and in all patients who received their assigned treatment (per-protocol population). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT01963442, and is now complete. FINDINGS Between Dec 19, 2013, and Feb 1, 2018, 706 patients were assessed for eligibility, and after 3 days of β-lactam treatment, 310 eligible patients were randomly assigned to receive either placebo (n=157) or β-lactam treatment (n=153). Seven patients withdrew consent before taking any study drug, five in the placebo group and two in the β-lactam group. In the ITT population, median age was 73·0 years (IQR 57·0-84·0) and 123 (41%) of 303 participants were female. In the ITT analysis, cure at day 15 occurred in 117 (77%) of 152 participants in the placebo group and 102 (68%) of 151 participants in the β-lactam group (between-group difference of 9·42%, 95% CI -0·38 to 20·04), indicating non-inferiority. In the per-protocol analysis, 113 (78%) of 145 participants in the placebo treatment group and 100 (68%) of 146 participants in the β-lactam treatment group were cured at day 15 (difference of 9·44% [95% CI -0·15 to 20·34]), indicating non-inferiority. Incidence of adverse events was similar between the treatment groups (22 [14%] of 152 in the placebo group and 29 [19%] of 151 in the β-lactam group). The most common adverse events were digestive disorders, reported in 17 (11%) of 152 patients in the placebo group and 28 (19%) of 151 patients in the β-lactam group. By day 30, three (2%) patients had died in the placebo group (one due to bacteraemia due to Staphylococcus aureus, one due to cardiogenic shock after acute pulmonary oedema, and one due to heart failure associated with acute renal failure) and two (1%) in the β-lactam group (due to pneumonia recurrence and possible acute pulmonary oedema). INTERPRETATION Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment. These findings could allow substantial reduction of antibiotic consumption. FUNDING French Ministry of Health.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France.
| | - Jacques Ropers
- Clinical research unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Clara Duran
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Laurène Deconinck
- Infectious Disease Department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Olivia Senard
- Infectious Disease Department, Marne La Vallée Hospital, GHEF, Marne La Vallée, France
| | | | - Sabrina Makhloufi
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Guillaume Mellon
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | - Victoire de Lastours
- Internal Medicine Department, Beaujon University Hospital, AP-HP, University of Paris, Clichy, France
| | - Frédérique Bouchand
- Pharmacy, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | | | - Jean-Emmanuel Kahn
- Internal Medicine Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal Medicine Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Pneumology Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Thierry Chinet
- Pneumology Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Marion Pépin
- Geriatric Department, Ambroise Paré University Hospital, AP-HP, Paris Saclay University, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal Medicine Department, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | | | - Daniel Benhamou
- Pneumology Department, Bois-Guillaume University Hospital, Rouen, France
| | | | - Marie-Christine Dombret
- Pneumology Department, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Bertrand Renaud
- Emergency Department, Cochin University Hospital, AP-HP, Paris Centre University, Paris, France
| | - Christian Perronne
- Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP, Paris Saclay University, Garches, France
| | | | - José Labarère
- Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Philippe Aegerter
- UMRS 1169 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
| | - Anne-Claude Crémieux
- Infectious Disease Department, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
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8
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Mehlman C, Takam Kamga P, Costantini A, Julié C, Dumenil C, Dumoulin J, Ouaknine J, Giraud V, Chinet T, Emile JF, Giroux Leprieur E. Baseline Hedgehog Pathway Activation and Increase of Plasma Wnt1 Protein Are Associated with Resistance to Immune Checkpoint Inhibitors in Advanced Non-Small-Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13051107. [PMID: 33807552 PMCID: PMC7962040 DOI: 10.3390/cancers13051107] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/26/2022] Open
Abstract
Hedgehog (Hh) and Wingless-type (Wnt) pathways are associated with resistance to immune checkpoint inhibitors (ICIs) in preclinical studies. This study aimed to assess the association between expression and activation levels of Wnt and Sonic Hedgehog (Shh) pathways and resistance to ICIs in advanced NSCLC patients treated with ICI. Hh and Wnt pathways activation was assessed by immunohistochemistry (Gli1 and beta-catenin) on corresponding tumor tissues, and by plasma concentrations of Shh and Wnt (Wnt1, Wnt2 and Wnt3) at ICI introduction and at the first clinical evaluation. Sixty-three patients were included, with 36 patients (57.1%) with available tissue. Response rate was lower in Gli1+ NSCLC (20.0%) compared to Gli1 negative (Gli-) NSCLC (55.6%) (p = 0.015). Rate of primary resistance was 69.8%, vs. 31.2%, respectively (p = 0.04), and median progression-free survival (PFS) was 1.9 months (interquartile range (IQR) 1.2-5.7) vs. 6.1 months (1.6-26.0), respectively (p = 0.08). Median PFS and overall survival were shorter in case of increase of Wnt1 concentration during ICI treatment compared to other patients: 3.9 months vs. 11.2 months (p = 0.008), and 15.3 months vs. not reached (p = 0.003). In conclusion, baseline activation of Hh pathway and increase of Wnt1 concentrations during ICI treatment were associated with poor outcome in NSCLC patients treated with ICIs.
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Affiliation(s)
- Camille Mehlman
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
| | - Paul Takam Kamga
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
| | - Adrien Costantini
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Catherine Julié
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Pathology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Julia Ouaknine
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Thierry Chinet
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Jean-François Emile
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Pathology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
- Correspondence: ; Tel.: +33-149-095-802; Fax: +33-149-095-806
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9
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Costantini A, Takam Kamga P, Julie C, Corjon A, Dumenil C, Dumoulin J, Ouaknine J, Giraud V, Chinet T, Rottman M, Emile JF, Giroux Leprieur E. Plasma Biomarkers Screening by Multiplex ELISA Assay in Patients with Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors. Cancers (Basel) 2020; 13:cancers13010097. [PMID: 33396187 PMCID: PMC7795942 DOI: 10.3390/cancers13010097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 12/22/2022] Open
Abstract
Simple Summary There is an unmet need for new predictive biomarkers associated with efficacy and immune-related toxicity of immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC). In this study, we performed multiplex ELISA screening in plasma from 35 consecutive patients with advanced NSCLC treated with nivolumab or pembrolizumab, allowing large-scale screening for 48 cytokines involved in immune response and tumour proliferation. We found an association between ICIs efficacy and three cytokines: soluble hepatocyte growth factor (sHGF), soluble Fibroblast Growth Factor (sFGF) and interleukine-12 (IL-12). Moreover, TNF-α, IL-16, IL-12p40 and MCP3 were candidate biomarkers for predicting grade 3–4 immune-related toxicity. This exploratory study shows the potential role of new plasma biomarkers in advanced NSCLC treated with ICIs. Abstract Immune checkpoint inhibitors (ICIs) are commonly used in patients with advanced non-small cell lung cancer (NSCLC). An unmet need remains for new biomarkers associated with ICIs. In this study, consecutive patients with advanced NSCLC treated with nivolumab or pembrolizumab were included. Plasma at ICIs initiation was prospectively collected and a multiplex ELISA assay testing 48 cytokines and growth factors was performed. Exploratory endpoints were the association between plasma biomarkers with outcome and grade III–IV immune related adverse events (irAEs). Thirty-five patients were included. Patients without clinical benefit (n = 22) had higher pre-ICI soluble Hepatocyte Growth Factor (sHGF) (210.9 vs. 155.8 pg/mL, p = 0.010), lower pre-ICI soluble Fibroblast Growth Factor (sFGF) (4.0 vs. 4.8 pg/mL, p = 0.043) and lower pre-ICI interleukine-12 (IL-12) (1.3 vs. 2.2 pg/mL, p = 0.043) concentrations. Patients with early progression (n = 23) had higher pre-ICIs sHGF (206.2 vs. 155.8 pg/mL, p = 0.025) concentrations. Patients with low sHGF levels at ICIs initiation had longer progression-free survival and overall survival than those with high sHGF levels: respectively 2.5 vs. 8.0 months (p = 0.002), and 5.5 vs. 35.0 months (p = 0.001). TNF-α, IL-16, IL-12p40 and MCP3 were associated with high grade irAEs. This study shows the potential association between several plasma biomarkers with outcome and grade 3–4 IrAEs in advanced NSCLC treated with ICIs.
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Affiliation(s)
- Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
| | - Paul Takam Kamga
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
| | - Catherine Julie
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
- Department of Pathology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France;
| | - Alexandre Corjon
- Department of Pathology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France;
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
| | - Julia Ouaknine
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
| | - Martin Rottman
- Department of Microbiology, APHP—Hôpital Raymond Poincaré, 92380 Garches, France;
- UMR 1173, UVSQ, Université Paris-Saclay, 78180 Montigny-le-Bretonneux, France
| | - Jean-François Emile
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
- Department of Pathology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France;
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
- Correspondence: ; Tel.: +33-1-49-09-58-02
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Roumier M, Paule R, Vallée A, Rohmer J, Ballester M, Brun AL, Cerf C, Chabi ML, Chinet T, Colombier MA, Farfour E, Fourn E, Géri G, Khau D, Marroun I, Ponsoye M, Roux A, Salvator H, Schoindre Y, Si Larbi AG, Tchérakian C, Vasse M, Verrat A, Zuber B, Couderc LJ, Kahn JE, Groh M, Ackermann F. Tocilizumab for Severe Worsening COVID-19 Pneumonia: a Propensity Score Analysis. J Clin Immunol 2020; 41:303-314. [PMID: 33188624 PMCID: PMC7666405 DOI: 10.1007/s10875-020-00911-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Background High levels of serum interleukin-6 (IL-6) correlate with disease severity in COVID-19. We hypothesized that tocilizumab (a recombinant humanized anti-IL-6 receptor) could improve outcomes in selected patients with severe worsening COVID-19 pneumonia and high inflammatory parameters. Methods The TOCICOVID study included a prospective cohort of patients aged 16–80 years with severe (requiring > 6 L/min of oxygen therapy to obtain Sp02 > 94%) rapidly deteriorating (increase by ≥ 3 L/min of oxygen flow within the previous 12 h) COVID-19 pneumonia with ≥ 5 days of symptoms and C-reactive protein levels > 40 mg/L. They entered a compassionate use program of treatment with intravenous tocilizumab (8 mg/kg with a maximum of 800 mg per infusion; and if needed a second infusion 24 to 72 h later). A control group was retrospectively selected with the same inclusion criteria. Outcomes were assessed at D28 using inverse probability of treatment weighted (IPTW) methodology. Results Among the 96 patients included (81% male, mean (SD) age: 60 (12.5) years), underlying conditions, baseline disease severity, and concomitant medications were broadly similar between the tocilizumab (n = 49) and the control (n = 47) groups. In the IPTW analysis, treatment with tocilizumab was associated with a reduced need for overall ventilatory support (49 vs. 89%, wHR: 0.39 [0.25–0.56]; p < 0.001). Albeit lacking statistical significance, there was a substantial trend towards a reduction of mechanical ventilation (31% vs. 45%; wHR: 0.58 [0.36–0.94]; p = 0.026). However, tocilizumab did not improve overall survival (wHR = 0.68 [0.31–1.748], p = 0.338). Among the 85 (89%) patients still alive at D28, patients treated with tocilizumab had a higher rate of oxygen withdrawal (82% vs. 73.5%, wHR = 1.66 [1.17–2.37], p = 0.005), with a shorter delay before being weaned of oxygen therapy (mean 11 vs. 16 days; p < 0.001). At D28, the rate of patients discharged from hospital was higher in the tocilizumab group (70% vs. 40%, wHR = 1.82 [1.22–2.75]; p = 0.003). The levels of CRP and fibrinogen post therapy (p < 0.001 for both variables) were significantly lower in the tocilizumab group (interaction test, mixed model). Rates of neutropenia (35% vs. 0%; p < 0.001) were higher in the tocilizumab group, yet rates of infections (22% vs. 38%, p = 0.089) including ventilator-acquired pneumonia (8% vs. 26%, p = 0.022) were higher in the control group. Conclusion These data could be helpful for the design of future trials aiming to counter COVID-19-induced inflammation, especially before patients require admission to the intensive care unit. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-020-00911-6.
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Affiliation(s)
- Mathilde Roumier
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Romain Paule
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, AP-HP, Hôtel-Dieu Hospital, Paris-Descartes University, Paris, France
| | - Julien Rohmer
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Marie Ballester
- Emergency Department, Foch Hospital, F-92151, Suresnes, France
| | - Anne-Laure Brun
- Department of Radiology, Foch Hospital, F-92151, Suresnes, France
| | - Charles Cerf
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | | | - Thierry Chinet
- Department of Respiratory Medicine, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France.,Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France
| | | | - Eric Farfour
- Department of Clinical Biology & INSERM UMRS-1176, Foch Hospital, F-92151, Suresnes, France
| | - Erwan Fourn
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Guillaume Géri
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France.,INSERM UMR 1018, Villejuif, France
| | - David Khau
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Ibrahim Marroun
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Antoine Roux
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Hélène Salvator
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Yoland Schoindre
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Anne-Gaëlle Si Larbi
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | - Colas Tchérakian
- Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Marc Vasse
- Department of Clinical Biology & INSERM UMRS-1176, Foch Hospital, F-92151, Suresnes, France
| | - Anne Verrat
- Emergency Department, Foch Hospital, F-92151, Suresnes, France
| | - Benjamin Zuber
- Department of Anesthesiology and Intensive Care, Foch Hospital, F-92151, Suresnes, France
| | - Louis-Jean Couderc
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Respiratory Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Jean-Emmanuel Kahn
- Simone Veil Medical Faculty, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Department of Internal Medicine, Ambroise Paré Hospital, AP-HP, F-92100, Boulogne-Billancourt, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France
| | - Félix Ackermann
- Department of Internal Medicine, Foch Hospital, F-92151, Suresnes, France.
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11
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Mustafic H, Celebic A, Lannou S, Mallet S, Vieillard Baron A, Cekovic D, Chinet T, Giroux Leprieur E, Thomas D, Josseran L, Marie Hauguel M, Szymanski C, Dubourg O, Mansencal N. Tamponade during immune checkpoint inhibitors therapy in lung cancer: case-reports and systematic review of the literature. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Immune therapy is a new option that has revolutionized cancer therapy. Immune checkpoint inhibitors target mostly either PD-1 (Pembrolizumab, Nivolumab) or PD-L1 (Durvalumab). Immune-related cardiotoxic side effects, among them, tamponade, initially thought to be rare, seem to be increasingly cited in the literature. Moreover, tobacco smoking is linked to 80% of lung cancers. Smoking during cancer therapy may influence on radiotherapy and chemotherapy outcomes but little is known on immunotherapy.
Purpose
We aimed to review all the published cases of tamponade during immune therapy for lung cancer and to report all the cases that occurred in the University Hospital Ambroise Paré. We also wanted to highlight the possible impact of tobacco on immunotherapy.
Methods
We conducted a literature review in the PubMED database, from database inception up to 02/14/2020, with a combination of the following terms: “tamponade AND ((immune checkpoint inhibitors) OR (PD-1) OR (PD-L1))”. We also reported all the tamponade cases occurred in our hospital from the beginning of immune checkpoint inhibitors therapy existence up to 02/14/2020.
Results
Seventeen cases citing tamponade were identified in the literature to which we added 3 cases from our hospital. Mortality rate at 1 month was of 20%. Nivolumab was involved in 80%, Pembrolizumab in 10% and Durvalumab in 10%. In 75%, lung cancer was with a stage IV. Men accounted for 85% and mean age was of 62 years. Active smokers represented 85% and passive smokers existed in 5%, after diagnosis, smoking cessation was done in 10%. Tamponade occurred either shortly after the first administrations but also after several doses. Pericardial fluid cytology revealed malignant cells in half of the cases and microbiology was always negative. For all the cases, excepted for one who was directly considered as palliative, an evacuation of the pericardial fluid was done. In 45% a corticotherapy was initiated. Two cases quickly worsened after pericardial evacuation by unmasking a probable myocarditis with cardiogenic shock which needed the use of a veno-arterial extracorporeal membrane oxygenation.
Conclusions
Tamponade under immune checkpoint inhibitors therapy appears less rare than initially thought and mortality rate at one month was not negligible. The use of regular echocardiography during this immune therapy may be crucial in detecting early stages of the disease process and smoking cessation should also be advised for these patients. The prevalence of complications among all the patients both exposed to immune therapy and tobacco could not be calculated in this work (case-reports), but some recent studies may indicate survival gains of smoking cessation. Further research establishing more specific guidelines is naturally necessary in dealing with this potentially fatal effect but also in establishing the possibly additional role of smoking in the cardiotoxicity of immunotherapy.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Mustafic
- University Hospital Ambroise Pare, Department of Cardiology, Boulogne-Billancourt, France
| | - A Celebic
- University Clinical Center of Montenegro, Clinic of Oncology and Radiotherapy, Podgorica, Montenegro
| | - S Lannou
- University Hospital Ambroise Pare, Department of Cardiology, Boulogne-Billancourt, France
| | - S Mallet
- University Hospital Ambroise Pare, Department of Cardiology, Boulogne-Billancourt, France
| | - A Vieillard Baron
- University Hospital Ambroise Pare, Department of Intensive Care, Boulogne-Billancourt, France
| | - D Cekovic
- University Pierre & Marie Curie Paris VI, Paris, France
| | - T Chinet
- University Hospital Ambroise Pare, Department of Pneumology, Boulogne-Billancourt, France
| | - E Giroux Leprieur
- University Hospital Ambroise Pare, Department of Pneumology, Boulogne-Billancourt, France
| | - D Thomas
- Alliance contre le Tabac, Paris, France
| | - L Josseran
- University Hospital Raymond Poincare, Department of Public Health and Epidemiology, Garches, France
| | - M Marie Hauguel
- University Hospital Ambroise Pare, Department of Cardiology, Boulogne-Billancourt, France
| | - C Szymanski
- University Hospital Ambroise Pare, Department of Cardiology, Boulogne-Billancourt, France
| | - O Dubourg
- University Hospital Ambroise Pare, Department of Cardiology, Boulogne-Billancourt, France
| | - N Mansencal
- University Hospital Ambroise Pare, Department of Cardiology, Boulogne-Billancourt, France
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12
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Hauguel-Moreau M, Hajjam ME, De Baynast Q, Vieillard-Baron A, Lot AS, Chinet T, Mustafic H, Bégué C, Carlier RY, Geri G, Dubourg O, Beaune S, Mansencal N. Occurrence of pulmonary embolism related to COVID-19. J Thromb Thrombolysis 2020; 52:69-75. [PMID: 33025502 PMCID: PMC7538189 DOI: 10.1007/s11239-020-02292-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 11/01/2022]
Abstract
Recent reports have suggested an increased risk of pulmonary embolism (PE) related to COVID-19. The aim of this cohort study is to compare the incidence of PE during a 3-year period and to assess the characteristics of PE in COVID-19. We studied consecutive patients presenting with PE (January 2017-April 2020). Clinical presentation, computed tomography (CT) and biological markers were systematically assessed. We recorded the global number of hospitalizations during the COVID-19 pandemic and during the same period in 2018-2019. We included 347 patients: 326 without COVID-19 and 21 with COVID-19. Patients with COVID-19 experienced more likely dyspnea (p=0.04), had lower arterial oxygen saturation (p<0.001), higher C-reactive protein and white blood cell (WBC) count (p<0.0001 and p=0.001, respectively), and a significantly higher in-hospital mortality (14% versus 3.4%, p=0.04). Among COVID-19 patients, diagnosis of PE was performed at admission in 38% (n=8). COVID-19 patients with diagnosis of PE during hospitalization (n=13) had significantly more dyspnea (p=0.04), lower arterial oxygen saturation (p=0.01), less proximal PE (p=0.02), and higher heart rate (p=0.009), CT severity score (p=0.001), C-reactive protein (p=0.006) and WBC count (p=0.04). During the COVID-19 outbreak, a 97.4% increase of PE incidence was observed as compared to 2017-2019 and the proportion of hospitalizations related to PE was 3.7% versus 1.3% in 2018-2019 (p<0.0001). In conclusion, the COVID-19 pandemic leads to a dramatic increased incidence of PE. Physicians should be aware that PE may be diagnosed at admission, but also after several days of hospitalization, with a different clinical, CT and biological features of thrombotic disease.
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Affiliation(s)
- Marie Hauguel-Moreau
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France. .,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France. .,AP-HP, Hôpital Universitaire Ambroise Paré, Service de Cardiologie et des Maladies Vasculaires, 9 avenue Charles de Gaulle, 92100, Boulogne, France. .,ACTION Study Group, Paris, France.
| | - Mostafa El Hajjam
- Department of Radiology, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France.,INSERM U 1179, Handicap Neuromusculaire, UVSQ Paris-Saclay, Garches, France
| | - Quentin De Baynast
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Antoine Vieillard-Baron
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France.,Intensive Care Unit, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Anne-Sophie Lot
- Department of medical information, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, Ambroise Paré Hospital, APHP, UVSQ, Boulogne-Billancourt, France.,EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100, Boulogne-Billancourt, France
| | - Hazrije Mustafic
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France.,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Céline Bégué
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Robert Yves Carlier
- Department of Radiology, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France.,INSERM U 1179, Handicap Neuromusculaire, UVSQ Paris-Saclay, Garches, France
| | - Guillaume Geri
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France.,Intensive Care Unit, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Olivier Dubourg
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France.,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Sébastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France.,FHU SEPSIS IFrancenserm UMR 1144, Université́ Paris Centre, Paris, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France.,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
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13
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El Hajjam M, Mekki A, Palmyre A, Eyries M, Soubrier F, Bourgault Villada I, Ozanne A, Carlier RY, Chinet T. RASA1 phenotype overlaps with hereditary haemorrhagic telangiectasia: two case reports. J Med Genet 2020; 58:645-647. [PMID: 32900839 DOI: 10.1136/jmedgenet-2019-106792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 11/04/2022]
Abstract
Background We report two cases of RASA1-related capillary malformation-arteriovenous malformation (CM-AVM1) syndrome mimicking hereditary haemorrhagic telangiectasia (HHT).Methods and results A 28-year-old man, previously embolised for cerebral arteriovenous malformations (AVMs), presented with epistaxis and typical nasal telangiectasias of HHT. CT scan revealed a large portocaval shunt. The second patient was a 9-year-old girl presenting with cyanosis and several mucocutaneous telangiectasias, similar to those observed in typical cases of HHT. CT scan revealed a huge and complex pulmonary AVM of the right lower lobe and a hepatic AVM within the left lobe. HHT diagnosis was considered possible according to the Curaçao criteria for the two patients, with at least two criteria for each. Genetic tests did not find any mutation in the three classic genes (Endoglin, Activin receptor-like kinase 1 or Mothers against decapentaplegic homolog 4), but identified in both cases an RASA1 mutation, known to cause CM-AVM1 syndrome.Conclusions Pulmonary AVM and portocaval shunt, usually encountered in HHT, have not yet been described in the CM-AVM1 syndrome. RASA1 screening may be considered in case of HHT suspicion, particularly when mutations are not found in the usually affected genes.
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Affiliation(s)
- Mostafa El Hajjam
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France.,DMU Smart Imaging, AP-HP, Boulogne-Billancourt, France.,Medical Imaging department, APHP, Boulogne-Billancourt, France
| | - Ahmed Mekki
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France .,DMU Smart Imaging, AP-HP, Garches, France.,Medical Imaging department, APHP, Garches, France
| | - Aurelien Palmyre
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Genetics, AP-HP, Boulogne-Billancourt, Île-de-France, France
| | - Melanie Eyries
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Genetics, Groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, Île-de-France, France
| | - Florent Soubrier
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Genetics, Groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, Île-de-France, France
| | - Isabelle Bourgault Villada
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Department of Dermatology, AP-HP, Boulogne-Billancourt, France
| | - Augustin Ozanne
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Department of Interventional Neuroradiology, Bicêtre Teaching Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Robert Yves Carlier
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Paris-Saclay University, DMU Smart Imaging, Medical Imaging Department, Raymond Poincaré Teaching Hospital, Garches, France; INSERM U 1179, University of Versailles Saint-Quentin-en-Yvelines (UVSQ) Paris-Saclay, Paris, France
| | - Thierry Chinet
- Hereditary Hemorrhagic Telangiectasia Center of Paris, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Department of Respiratory Diseases and Thoracic Oncology, AP-HP, Boulogne-Billancourt, Île-de-France, France
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14
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Greffe S, Espinasse F, Duran C, Labrune S, Sirol M, Mantalvan B, Gramer MC, Babulle C, Do Rosario G, Vauvillier Q, Huet A, Van der Heidjen A, Tysebaert J, Kramarz LF, Rabes JP, Pellissier G, Chinet T, Moreau F, Rouveix E. [Nasopharyngeal carriage of SARS-CoV-2 among health personnel with symptoms suggestive of COVID-19 in a University Hospital in the Paris suburbs]. Rev Med Interne 2020; 41:510-516. [PMID: 32680715 PMCID: PMC7342041 DOI: 10.1016/j.revmed.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/08/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023]
Abstract
Introduction Une consultation dédiée aux professionnels de santé symptomatiques a été ouverte au début de l'épidémie de COVID-19, afin de répondre aux besoins spécifiques de cette population. L'objectif de ce travail était d'estimer la fréquence du portage nasopharyngé du SARS-Cov-2 chez les personnels de santé symptomatiques suspects de COVID-19, et de déterminer les facteurs associés à ce portage. Méthodes Étude descriptive des caractéristiques cliniques et épidémiologiques des consultants, conduite du 5 mars au 17 avril 2020. Le recueil des données cliniques et des résultats du test RT-PCR a été conduit à l'aide de formulaires standardisés. Résultats Des 522 consultants, 308 exerçaient à l'Hôpital et 214 à l'extérieur. Ils avaient des formes bénignes de COVID-19 et des signes cliniques non spécifiques à l'exception de l'agueusie/anosmie, significativement plus fréquente chez ceux avec RT-PCR positive. Le taux de positivité de la RT-PCR était globalement de 38 %, sans différence significative selon la profession, supérieur chez les consultants extérieurs (47 % versus 31 %). À l'hôpital, ce taux était significativement moindre pour les personnels symptomatiques des secteurs de soins, comparé aux personnels des plateaux techniques et laboratoires (24 %, versus 45 %, p = 0,006 et 54 %, p < 0,001, respectivement), mais ne différait pas entre personnels des unités COVID et des autres secteurs de soins (30 % versus 28 %). Parmi les consultants extérieurs, les taux de positivité des personnels des EHPAD et des libéraux (53 % et 55 % respectivement) étaient plus du double de celui du personnel soignant hospitalier (24 %, p < 0,001). Conclusions Ces données confirment l'impact fort du COVID-19 sur les professionnels de santé. Les taux de positivité plus élevés chez les professionnels symptomatiques exerçant en dehors de l'hôpital, comparativement à ceux exerçant à l'hôpital, pourraient s'expliquer en partie par une pénurie en équipements de protection et par des difficultés d'accès au diagnostic virologique, qui étaient plus importants en dehors de l'hôpital quand l'épidémie a commencé.
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Affiliation(s)
- S Greffe
- Service de médecine interne, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - F Espinasse
- Equipe opérationnelle d'hygiène, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - C Duran
- Service de médecine interne, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - S Labrune
- Service de pneumologie, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - M Sirol
- Service de radiologie, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - B Mantalvan
- Service de rhumatologie, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - M C Gramer
- Equipe opérationnelle d'hygiène, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - C Babulle
- Service de médecine interne, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - G Do Rosario
- Service de médecine interne, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - Q Vauvillier
- UFR Simone Veil-Santé, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - A Huet
- UFR Simone Veil-Santé, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - A Van der Heidjen
- UFR Simone Veil-Santé, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - J Tysebaert
- UFR Simone Veil-Santé, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - L F Kramarz
- Service de direction, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - J-P Rabes
- UFR Simone Veil-Santé, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France; Service de biochimie et Génétique Moléculaire, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - G Pellissier
- GERES, UFR de Médecine Bichat, 16 rue Henri Huchard, 75018 Paris, France
| | - T Chinet
- Service de pneumologie, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France; UFR Simone Veil-Santé, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - F Moreau
- Service de biochimie et Génétique Moléculaire, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France
| | - E Rouveix
- Service de médecine interne, CHU Ambroise Paré, GH Paris Saclay, Assistance Publique Hôpitaux de Paris (APHP), France; UFR Simone Veil-Santé, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Saclay, 2 avenue de la Source de la Bièvre, 78180 Montigny-Le-Bretonneux, France; GERES, UFR de Médecine Bichat, 16 rue Henri Huchard, 75018 Paris, France.
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15
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Suehs CM, Zysman M, Chenivesse C, Burgel PR, Couturaud F, Deslee G, Berger P, Raherison C, Devouassoux G, Brousse C, Roche N, Molimard M, Chinet T, Devillier P, Chanez P, Kessler R, Didier A, Martinat Y, Le Rouzic O, Bourdin A. Prioritising outcomes for evaluating eosinophil-guided corticosteroid therapy among patients with acute COPD exacerbations requiring hospitalisation: a Delphi consensus study. BMJ Open 2020; 10:e035811. [PMID: 32611741 PMCID: PMC7332193 DOI: 10.1136/bmjopen-2019-035811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Presently, those outcomes that should be prioritised for chronic obstructive pulmonary disease (COPD) exacerbation studies remain unclear. In order to coordinate multicentre studies on eosinophilia-driven corticosteroid therapy for patients hospitalised for acute exacerbation of COPD (AECOPD), we aimed to find consensus among experts in the domain regarding the prioritisation of outcomes. DESIGN A modified Delphi study was proposed to recognised COPD experts. Two brainstorming questionnaires were used to collect potential outcomes. Four subsequent rounds of questionnaires were used to rank items according to a six-point Likert scale for their importance in the protocol, as well as for being the primary outcome. Priority outcome criteria were predefined as those for which ≥70% of experts indicated that the outcome was essential for interpreting study results. SETTING COPD exacerbation management in France. PARTICIPANTS 34 experts recommended by the French Language Pulmonology Society were invited to participate. Of the latter, 21 experts participated in brainstorming, and 19 participated in all four ranking rounds. RESULTS 105 outcomes were ranked. Two achieved consensus as candidate primary outcomes: (1) treatment failure defined as death from any cause or the need for intubation and mechanical ventilation, readmission because of COPD or intensification of pharmacologic therapy, and (2) the time required to meet predefined discharge criteria. The 10 secondary priority outcomes included survival, time with no sign of improvement, episodes of hospitalisation, exacerbation, pneumonia, mechanical or non-invasive ventilation and oxygen use, as well as comorbidities during the initial hospitalisation. CONCLUSIONS This Delphi consensus project generated and prioritised a great many outcomes, documenting current expert views concerning a diversity of COPD endpoints. Among the latter, 12 reached consensus as priority outcomes for evaluating the efficacy of eosinophil-driven corticosteroid therapy in AECOPD inpatients. STUDY REGISTRATION The eo-Delphi project/protocol was registered on 23 January 2018 at https://osf.io/4ahqw/.
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Affiliation(s)
| | - Maéva Zysman
- Maladies Respiratoires, Pôle Cardiothoracique, CHU Haut-Lévèque, Bordeaux, France
- Centre de Recherche Cardio-thoracique de Bordeaux, INSERM U1045, Univ. Bordeaux, Bordeaux, France
| | - Cécile Chenivesse
- Pneumologie et Immuno-Allergologie, CHU Lille, Univ. Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Pierre-Régis Burgel
- Respiratory Medicine, Cochin Hospital (APHP), University Paris Descartes (INSERM U1016 Institut Cochin), Université de Paris, Paris, France
| | - F Couturaud
- Internal Medicine and Chest Diseases, EA3878, CIC-INSERM1412, Brest University Hospital Centre, Brest University, Brest, France
| | - Gaëtan Deslee
- Pulmonary Medicine, INSERM U1250, University Hospital of Reims, Reims, France
| | - Patrick Berger
- Centre de Recherche Cardio-thoracique de Bordeaux, INSERM U1045, Univ. Bordeaux, Bordeaux, France
- Exploration Fonctionnelle Respiratoire, CIC 1401, CHU Bordeaux, Bordeaux, France
| | - Chantal Raherison
- Bordeaux Population Health Research Center, U1219 BPH - Inserm - Université de Bordeaux, Bordeaux, France
| | - Gilles Devouassoux
- Pneumologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon et Université Claude Bernard Lyon 1, EA7426, Lyon, France
| | | | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital (APHP), University Paris Descartes (INSERM U1016 Institut Cochin), Université de Paris, Paris, France
| | | | - Thierry Chinet
- Pneumologie et Oncologie Thoracique, CHU Ambroise Paré, AP-HP, Université de Versailles SQY, Saint-Quentin-en-Yvelines, France
| | - Philippe Devillier
- Airway Diseases, UPRES EA 220, Foch hospital, University Paris-Saclay, Suresnes, France
| | - Pascal Chanez
- Respiratory Diseases, AP-HM, INSERM, INRA, C2VN Aix Marseille Université, Marseille, France
| | - Romain Kessler
- Pneumologie, Fédération de médecine translationnelle, Université de Strasbourg, Strasbourg, France
| | - Alain Didier
- Pôle des Voies Respiratoires, Hôpital Larrey, CHU de Toulouse et Université Paul Sabatier, Toulouse, France
| | | | - Olivier Le Rouzic
- Pneumologie et Immuno-Allergologie, CHU Lille, Univ. Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - A Bourdin
- Maladies Respiratoires, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, INSERM, CNRS, CHU Montpellier, Montpellier, France
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Gridelli C, Ciuleanu T, Domine M, Szczesna A, Bover I, Cobo M, Kentepozidis N, Zarogoulidis K, Kalofonos C, Kazarnowisz A, Korozan M, de Las Penas R, Majem M, Chella A, Griesinger F, Bournakis E, Sadjadian P, Kotsakis A, Chinet T, Syrigos KN, Correale P, Gallou C, Jamet JM, Vetsika EK, Kosmatopoulos K, Georgoulias V. Clinical activity of a htert (vx-001) cancer vaccine as post-chemotherapy maintenance immunotherapy in patients with stage IV non-small cell lung cancer: final results of a randomised phase 2 clinical trial. Br J Cancer 2020; 122:1461-1466. [PMID: 32210365 PMCID: PMC7217860 DOI: 10.1038/s41416-020-0785-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 08/13/2019] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 12/30/2022] Open
Abstract
Background The cancer vaccine Vx-001, which targets the universal tumour antigen TElomerase Reverse Transcriptase (TERT), can mount specific Vx-001/TERT572 CD8 + cytotoxic T cells; this immune response is associated with improved overall survival (OS) in patients with advanced/metastatic non-small cell lung cancer (NSCLC). Methods A randomised, double blind, phase 2b trial, in HLA-A*201-positive patients with metastatic, TERT-expressing NSCLC, who did not progress after first-line platinum-based chemotherapy were randomised to receive either Vx-001 or placebo. The primary endpoint of the trial was OS. Results Two hundred and twenty-one patients were randomised and 190 (101 and 89 patients in the placebo and the Vx-001 arm, respectively) were analysed for efficacy. There was not treatment-related toxicity >grade 2. The study did not meet its primary endpoint (median OS 11.3 and 14.3 months for the placebo and the Vx-001, respectively; p = 0.86) whereas the median Time to Treatment Failure (TTF) was 3.5 and 3.6 months, respectively. Disease control for >6months was observed in 30 (33.7%) and 26 (25.7%) patients treated with Vx-001 and placebo, respectively. There was no documented objective CR or PR. Long lasting TERT-specific immune response was observed in 29.2% of vaccinated patients who experienced a significantly longer OS compared to non-responders (21.3 and 13.4 months, respectively; p = 0.004). Conclusion Vx-001 could induce specific CD8+ immune response but failed to meet its primary endpoint. Subsequent studies have to be focused on the identification and treatment of subgroups of patients able to mount an effective immunological response to Vx-001. Clinical trial registration NCT01935154
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Affiliation(s)
| | | | | | | | | | - Manuel Cobo
- Hospital Regional Universitario Málaga, Instituto de Investigaciones Biomédicas (IBIMA), Málaga, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Athanasios Kotsakis
- Dpt of Medical Oncology, University General Hospital of Larissa, Larissa, Greece
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Sellier J, Karam C, Beauchet A, Dallongeville A, Binsse S, Blivet S, Bourgault-Villada I, Charron P, Chinet T, Eyries M, Fagnou C, Lesniak J, Lesur G, Lucas J, Nicod-Tran A, Ozanne A, Palmyre A, Soubrier F, El Hajjam M, Lacombe P. Higher prevalence of splenic artery aneurysms in hereditary hemorrhagic telangiectasia: Vascular implications and risk factors. PLoS One 2020; 15:e0226681. [PMID: 31971937 PMCID: PMC6977744 DOI: 10.1371/journal.pone.0226681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 12/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Splenic artery aneurysm (SAA) is a rare but potentially fatal condition. Rupture results in 25% mortality up to 75% in pregnant women with 95% fetal mortality. Brief reports suggest an increased risk of developing SAA in patients with HHT. METHODS We analyzed enhanced multidetector CT data in 186 HHT patients matched (gender and ± 5 year old) with 186 controls. We screened for SAA and recorded diameter of splenic and hepatic arteries and hepatic, pancreatic and splenic parenchymal involvements. We determined by univariate and multivariate analysis, the relationship with age, sex, genetic status, cardiovascular risk factors (CVRF) and visceral involvement. RESULTS SAA concerned 24.7% of HHT patients and 5.4% of controls, p<0.001. Factors associated with increased risk of SAA in HHT were female gender (p = 0.04, OR = 2.12, IC 95% = 1.03-4.50), age (p = 0.0003, OR = 1.04, 95% CI = 1.02-1.06) and pancreatic parenchymal involvement (p = 0.04, OR = 2.13, 95% CI = 1.01-4.49), but not type of mutation, hepatic or splenic parenchymal involvements, splenic size or splenic artery diameter or CVRF. CONCLUSIONS We found a 4.57 higher rate of SAA in HHT patients without evidence of splenic high output related disease or increased CVRF. These results suggest the presence of a vascular intrinsic involvement. It should lead to screening all HHT patients for SAA. The vasculopathy hypothesis could require a change in management as screening of all systemic arteries and even the aorta and to further research in the field.
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Affiliation(s)
- Jacques Sellier
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Carma Karam
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
- * E-mail:
| | - Alain Beauchet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Axel Dallongeville
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Stephen Binsse
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Sandra Blivet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Isabelle Bourgault-Villada
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Philippe Charron
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Thierry Chinet
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Mélanie Eyries
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Carole Fagnou
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Jérome Lesniak
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Gilles Lesur
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Jérome Lucas
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Agnès Nicod-Tran
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Augustin Ozanne
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Aurélien Palmyre
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Florent Soubrier
- Pitié-Salpêtrière Hospital, Department of Genetics, AP-HP, Paris, France
| | - Mostafa El Hajjam
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
| | - Pascal Lacombe
- Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, University of Versailles-Saint Quentin en Yvelines, France
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Caillaud D, Annesi-Maesano I, Bourin A, Chinet T, Colette A, De Blay F, Dixsaut G, Housset B, Kleinpeter J, Malherbe L, Roussel I, Dalphin JC, Charpin D. [Outdoor pollution and its effects on lung health in France. Expert document from the Groupe Pathologies pulmonaires professionnelles environnementales et iatrogéniques (PAPPEI) of the Société de pneumologie de langue française (SPLF)]. Rev Mal Respir 2019; 36:1150-1183. [PMID: 31676143 DOI: 10.1016/j.rmr.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D Caillaud
- Service de pneumologie, CHU Clermont-Ferrand, Inra, université Clermont Auvergne, 63000 Clermont-Ferrand, France.
| | - I Annesi-Maesano
- Sorbonne universités, UPMC Univ Paris 06, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMR S 1136), épidémiologie des maladies allergiques et respiratoires, faculté de médecine Saint-Antoine, 75012 Paris, France
| | - A Bourin
- Sciences de l'atmosphère et génie de l'environnement, IMT, Lille, 59650 Douai, France
| | - T Chinet
- Service de pneumologie et oncologie thoracique, CHU Ambroise-Paré, université de Versailles SQY, 92100 Boulogne-Billancourt, France
| | - A Colette
- Unité de modélisation atmosphérique et de cartographie environnementale, INERIS, 60550 Verneuil-en-Halatte, France
| | - F De Blay
- Pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, Fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg , France
| | - G Dixsaut
- Service de physiologie explorations fonctionnelles, hôpital Cochin Hôtel Dieu et Fondation du Souffle contre les maladies respiratoires, 75014 Paris, France
| | - B Housset
- Service de pneumologie et pathologie professionnelle, centre hospitalier intercommunal de Créteil, département hospitalo-universitaire A-TVB, unité Inserm 955, Institut santé travail Paris-Est, université Paris-Est, 94000 Créteil, France
| | - J Kleinpeter
- Association agréée de Surveillance de la qualité de l'Air de la région Grand Est (ATMO Grand Est), 5, rue de Madrid, 67300 Schiltigheim, France; Association de surveillance de la pollution atmosphérique en Alsace (ASPA), 5, rue de Madrid, 67300 Schiltigheim, France
| | - L Malherbe
- Unité de modélisation atmosphérique et de cartographie environnementale, INERIS, 60550 Verneuil-en-Halatte, France
| | - I Roussel
- Faculté de Lille, 59000 Lille, France
| | - J-C Dalphin
- Service de pneumologie, CHU de Besançon, UMR CNRS 6249 chrono-environnement, université de Franche-Comté, 25000 Besançon, France
| | - D Charpin
- Unité de pneumologie, groupe hospitalier de la Timone, Aix-Marseille université et Association pour la prévention de la pollution atmosphérique, 13000 Marseille, France
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Mehlman C, Cadranel J, Lacave R, Rousseau-Bussac G, Pujals A, Girard N, Bieche I, Gounant V, Théou-Anton N, Friard S, Trédaniel J, Blons H, Dujon C, Duchemann B, Schischmanoff PO, Chinet T, Giroux Leprieur E. Efficacy of osimertinib and histomolecular profile at progression in EGFR-mutated lung cancer. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa370] [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: 11/05/2022]
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Mehlman C, Cadranel J, Rousseau-Bussac G, Lacave R, Pujals A, Girard N, Callens C, Gounant V, Théou-Anton N, Friard S, Trédaniel J, Blons H, Dujon C, Duchemann B, Schischmanoff PO, Chinet T, Giroux Leprieur E. Resistance mechanisms to osimertinib in EGFR-mutated advanced non-small-cell lung cancer: A multicentric retrospective French study. Lung Cancer 2019; 137:149-156. [PMID: 31600593 DOI: 10.1016/j.lungcan.2019.09.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The understanding of histo-molecular mechanisms associated with resistance to osimertinib is a critical step to define the optimal treatment strategy in advanced EGFR-mutated Non-Small-Cell-Lung-Cancer (NSCLC). MATERIALS AND METHODS We performed a multicentric retrospective analysis on a cohort of consecutive patients treated with osimertinib for an advanced EGFR-mutated NSCLC and collected histo-molecular data from plasma and tumor samples at the time of progression. Next-generation sequencing (NGS) was performed for all samples. Best Overall Response Rate (ORR), Progression Free Survival (PFS), Overall Survival (OS) and data on treatment post-progression efficacy were also collected. RESULTS Two-hundred and twenty-six patients were included from 9 Academic French Hospitals between April 2015-October 2018. Osimertinib was given in second-line or more in 219 patients (97%). Best ORR was 52% and best central nervous system ORR was 56%. Median PFS and OS were 9.5 months (IQR 4.0-17.2) and 24 months (IQR 12.4-NR) respectively. At the time of analysis, 150 patients (66%) had tumor progression. Among them, 73 contributive samples (56 tumor biopsies) were available. The most frequent molecular alterations were C797S mutation (n = 9 (13%)) and MET amplification (n = 8 (11%)). Histologic transformation occurred in 5 patients (9% of tumor biopsies). In T790M + NSCLC, loss of T790 M occurred in 68% of cases. Median PFS and OS with treatment beyond progression were 6.0 months (IQR 2.0-10.4) and 15.1 months (IQR 6.7-NR) respectively and longer in case of osimertinib continuation beyond progression. CONCLUSION We confirmed the efficacy of osimertinib in patients with advanced EGFR mutation positive NSCLC. At progression, the most frequent molecular alterations were MET amplification and C797S mutation.
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Affiliation(s)
- Camille Mehlman
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, EA 4340 BECCOH, UVSQ, Paris Saclay University, Boulogne-Billancourt, France
| | - Jacques Cadranel
- Chest Department-Thoracic Oncology Expert Center, AP-HP, Groupe Hospitalier HUEP, Hopital Tenon, Paris, France, and Sorbonne University, Paris, France
| | | | - Roger Lacave
- Department of Solide Tumours Genetic, AP-HP, Groupe Hospitalier HUEP, Tenon Hospital, Paris, France, and Sorbonne University, Paris, France
| | - Anaïs Pujals
- Department of Pathology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Nicolas Girard
- Thorax Institute, Institute Curie and PSL University, Paris, France
| | | | - Valérie Gounant
- Thoracic Oncology Department, University Hospital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Nathalie Théou-Anton
- Genetics Department, University Hospital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Sylvie Friard
- Pneumology Department, Foch Hospital, Suresnes, France
| | - Jean Trédaniel
- Pneumology Department, Saint-Joseph Hospital, Paris, France
| | - Hélène Blons
- Molecular Biology Department, Georges Pompidou European Hospital, AP- HP, Paris, France and INSERM UMR-S1147, CNRS SNC 5014, Saints-Pères Research Center, Paris-Descartes University, Sorbonne Paris Cité University, Paris, France
| | - Cécile Dujon
- Pneumology Department, André Mignot Hospital, Le Chesnay, France
| | - Boris Duchemann
- Oncology Department, Avicenne Hospital, AP-HP, Bobigny, France and Paris XIII University, Sorbonne Paris Cité, Paris, France and Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, Villejuif, France
| | - Pierre Olivier Schischmanoff
- Department of Molecular Oncogenetics, Avicenne Hospital, AP-HP, Bobigny, France and INSERM UMR U978/Paris XIII University, Sorbonne Paris Cité University, Paris, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, EA 4340 BECCOH, UVSQ, Paris Saclay University, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, EA 4340 BECCOH, UVSQ, Paris Saclay University, Boulogne-Billancourt, France.
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Costantini A, Takam Kamga P, Dumenil C, Chinet T, Emile JF, Giroux Leprieur E. Plasma Biomarkers and Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer: New Tools for Better Patient Selection? Cancers (Basel) 2019; 11:cancers11091269. [PMID: 31470546 PMCID: PMC6769436 DOI: 10.3390/cancers11091269] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for patients with non-small cell lung cancer (NSCLC). Although some patients can experience important response rates and improved survival, many others do not benefit from ICIs developing hyper-progressive disease or immune-related adverse events. This underlines the need to select biomarkers for ICIs use in order to better select patients. There is currently no universally validated robust biomarker for daily use of ICIs. Programmed death-ligand 1 (PD-L1) or tumor mutational burden (TMB) are sometimes used but still have several limitations. Plasma biomarkers are a promising approach in ICI treatment. This review will describe the development of novel plasma biomarkers such as soluble proteins, circulating tumor DNA (ctDNA), blood TMB, and blood microbiome in NSCLC patients treated with ICIs and their potential use in predicting response and toxicity.
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Affiliation(s)
- Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Paul Takam Kamga
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
- Department of Pathology, APHP-Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France.
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France.
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Ouaknine Krief J, Helly de Tauriers P, Dumenil C, Neveux N, Dumoulin J, Giraud V, Labrune S, Tisserand J, Julie C, Emile JF, Chinet T, Giroux Leprieur E. Role of antibiotic use, plasma citrulline and blood microbiome in advanced non-small cell lung cancer patients treated with nivolumab. J Immunother Cancer 2019; 7:176. [PMID: 31292005 PMCID: PMC6621972 DOI: 10.1186/s40425-019-0658-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent data suggested a role of gut microbiota and antibiotic use on immune checkpoint inhibitors efficacy. We aimed to evaluate the impact of early use of antibiotic (EUA), blood microbiome and plasmatic citrulline (marker of the intestinal barrier) on nivolumab efficacy in non-small cell lung cancer (NSCLC). METHODS We included all consecutive patients with advanced NSCLC treated with nivolumab in our Department between 2014 and 2017. Blood microbiome was analyzed at month (M) M0 and M2. Citrulline rates were evaluated at M0, M2, M4 and M6. RESULTS Seventy-two patients were included (EUA in 42%). Overall survival (OS) was longer without EUA (median 13.4 months) than with EUA (5.1 months, p = 0.03). Thirty-five patients (49%) had plasma samples available. High citrulline rate (≥20 μM) at M0 was associated with tumor response (p = 0.084) and clinical benefit (nivolumab > 6 months) (p = 0.002). Median progression-free survival (PFS) was 7.9 months (high citrulline) vs 1.6 months (low citrulline) (p < 0.0001), and median OS were respectively non reached vs 2.2 months (p < 0.0001). Patients with EUA had lower median citrulline rates at M0: 21 μM (IQR 15.0-30.8) vs 32 μM (IQR 24.0-42.0) without EUA (p = 0.044). The presence of specific bacterial DNA in blood at M0 was associated with response and clinical benefit (Peptostreptococcae, Paludibaculum, Lewinella) or with tumor progression (Gemmatimonadaceae). Multivariate analyses on PFS and OS confirmed the prognostic role of citrulline and blood microbiome. CONCLUSIONS EUA is associated with shorter OS with nivolumab and lower citrulline rates. Plasma citrulline and blood microbiome appear to be promising predictive factors of nivolumab efficacy.
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Affiliation(s)
- Julia Ouaknine Krief
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Pierre Helly de Tauriers
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Nathalie Neveux
- Department of Biochemistry, APHP – Hopital Cochin, Paris, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Julie Tisserand
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Catherine Julie
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Department of Pathology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Department of Pathology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
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de Picciotto C, El Hajjam M, Karam C, Chinet T, Bonay M. Pulmonary gas exchange in hereditary hemorrhagic telangiectasia patients with liver arteriovenous malformations. Respir Res 2019; 20:137. [PMID: 31272464 PMCID: PMC6611029 DOI: 10.1186/s12931-019-1106-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/20/2019] [Indexed: 01/25/2023] Open
Abstract
Background The severity of Hereditary Hemorrhagic Telangiectasia (HHT) disease is generally related to vascular visceral involvement represented by arteriovenous malformations (AVMs). Pulmonary function tests (PFTs) remain normal in HHT patients without Pulmonary AVMs (PAVMs) and respiratory comorbidity. The aim of our study was to compare the diffusing capacity of the lung for carbon monoxide (DLCO) and nitric oxide (DLNO) and its 2 components: the pulmonary capillary blood volume (Vc) and the alveolar-capillary membrane conductance (Dm), in HHT patients with PAVMs, PAVMs and liver AVMs (LAVMs), LAVMs without PAVM, no PAVM and LAVM, and controls. Methods Sixty one consecutive adult patients (HHT without PAVM and LAVM: n = 7; HHT with PAVMs: n = 8; HHT with PAVMs and LAVMs: n = 25; HHT with LAVMs: n = 21) and controls matched for age and sex ratio without respiratory, heart and liver pathology (n = 15) were non-invasively evaluated using PFTs, combined DLCO/DLNO, arterial blood gas at rest, contrast echocardiography and enhanced computed tomography scan of the liver and chest the day of pulmonary function testing. Results We found that patients with LAVMs but without PAVMs exhibited increased Vc/Dm ratio. Interestingly, HHT patients with hepatic artery enlargement showed higher Vc/Dm ratio than HHT patients with normal hepatic artery diameter. Conclusion Vc/Dm ratio may have practical impact in HHT patients’ management to detect precociously the occurrence of LVAMs. However, further studies are needed to assess the accuracy and potential prognostic value of pulmonary gas exchange measurements in HHT patients with LVAMs.
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Affiliation(s)
- Carole de Picciotto
- Service de Physiologie-Explorations Fonctionnelles Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), 92104 Boulogne cedex, Boulogne, France.,HHT center Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), Boulogne, France
| | - Mostafa El Hajjam
- HHT center Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), Boulogne, France.,Service de Radiologie Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), Boulogne, France
| | - Carma Karam
- HHT center Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), Boulogne, France.,Service de Cardiologie Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), Boulogne, France
| | - Thierry Chinet
- HHT center Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), Boulogne, France.,Service de Pneumologie Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), Boulogne, France
| | - Marcel Bonay
- Service de Physiologie-Explorations Fonctionnelles Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), 92104 Boulogne cedex, Boulogne, France. .,HHT center Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris (AP-HP) Boulogne, France et Université de Versailles Saint Quentin (UVSQ), Boulogne, France.
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Dacosta-Noble P, Costantini A, Dumenil C, Dumoulin J, Helly de Tauriers P, Giraud V, Labrune S, Emile JF, Alvarez JC, Chinet T, Giroux Leprieur E. Positive plasma cotinine during platinum-based chemotherapy is associated with poor response rate in advanced non-small cell lung cancer patients. PLoS One 2019; 14:e0219080. [PMID: 31260495 PMCID: PMC6602197 DOI: 10.1371/journal.pone.0219080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Patients with advanced non-small cell lung cancer (NSCLC) are most of the time treated with a first-line cytotoxic chemotherapy. Tobacco use is responsible for 90% of lung cancer. The aim of this study was to evaluate the impact of smoking continuation during first-line chemotherapy on tumor response in advanced-stage NSCLC. MATERIALS AND METHODS All patients with an advanced-stage NSCLC (IIIb or IV), treated with first-line platinum-based chemotherapy in our Department between June 2013 and July 2017 were included. Smoking status was assessed at inclusion by self-report, then at the tumor assessment consultation after 2 months of treatment, by both self-report and plasmatic cotinine measurement. Chemotherapy response, progression-free survival (PFS), overall survival (OS) and stage 3-4 toxicity were registered. RESULTS Ninety-seven patients were included: 8 (8%) declared to be non-smokers, 56 (58%) current smokers and 33 (34%) former smokers at diagnosis. At the first tumor evaluation, 24 (25%) self-reported as active smokers and 73 (75%) as non-smokers; overall response rate (ORR) was respectively 38% and 48% (p = 0.373). Fifty-four patients had a plasmatic cotinine evaluation at the first tumor evaluation. Seventeen patients (32%) had a positive cotinine rate (median 108ng/mL, IQR 31-236). Six patients (35%) had positive cotinine rate whereas declaring to be non-smokers at the first tumor evaluation. ORR was 18% in case of positive cotinine rate, and 57% when negative (p = 0.007). Regardless of the method for smoking status evaluation, PFS, OS and grade 3-4 toxicities were similar between smoker and non-smoker patients at the first tumor evaluation. CONCLUSION Smoking continuation during platinum-based chemotherapy, reflected by positive plasma cotinine rate, was associated with a poor ORR.
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Affiliation(s)
- Philippine Dacosta-Noble
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Pierre Helly de Tauriers
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Centre de Ressources Biologiques, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-Claude Alvarez
- AP-HP, Hôpital Raymond Poincaré, Service de Pharmacologie Toxicologie, INSERM U-1173, UVSQ, Université Paris-Saclay, Garches, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- * E-mail:
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Girodon E, Cazeneuve C, Lebargy F, Chinet T, Costes B, Ghanem N, Martin J, Lemay S, Scheid P, Housset B, Bignon J, Goossens M. CFTR Gene Mutations in Adults with Disseminated Bronchiectasis. Eur J Hum Genet 2019. [DOI: 10.1159/000484750] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ouaknine J, Helly De Tauriers P, Dumenil C, Neveux N, Dumoulin J, Giraud V, Labrune S, Tisserand J, Emile J, Chinet T, Giroux Leprieur E. Impact de l’antibiothérapie précoce, de la citrulline plasmatique, du microbiome sanguin chez les patients traités par nivolumab pour un cancer bronchique non à petites cellules de stade avancé. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.038] [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: 11/25/2022]
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Ouaknine J, Helly De Tauriers P, Dumenil C, Neveux N, Dumoulin J, Giraud V, Labrune S, Tisserand J, Emile J, Chinet T, Giroux Leprieur E. MA10.03 Plasmatic Evaluation of the Intestinal Barrier and Blood Microbiota, and Antibiotic Use in Non-Small Cell Lung Cancer Patients Treated with Nivolumab. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Costantini A, Julie C, Dumenil C, Hélias-Rodzewicz Z, Dumoulin J, Giraud V, Labrune S, Chinet T, Emile JF, Giroux-Leprieur E. Predictive role of plasmatic biomarkers in advanced non-small cell lung cancer (NSCLC) treated with nivolumab (nivo). Lung Cancer 2018. [DOI: 10.1183/13993003.congress-2018.oa3302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Purpose This study was performed to examine acute exacerbation of COPD (AECOPD) during pulmonary rehabilitation (PR) and the usefulness of multidimensional indices (MIs) to predict AECOPD at enrolment in PR. Patients and methods A 4-week PR program (PRP) was implemented for 125 consecutive patients with COPD. At baseline and PRP completion, we recorded the FEV1, 6-minute walk test, peak work rate at cardiopulmonary testing, modified Medical Research Council score, and COPD Assessment Test (CAT) score. The risk of AECOPDs at baseline was assessed using the body mass index, airway obstruction, dyspnea, Exercise capacity (BODE), dyspnea, obstruction, smoking, exacerbation (DOSE), and score to predict short-term risk of COPD exacerbations (SCOPEX) MIs. Results Thirty-two episodes of AECOPD occurred. The COPD status was worse in patients with than without AECOPD at baseline (lower FEV1, 6-minute walk test, and peak work rate; higher modified Medical Research Council and CAT scores). The sensitivities of the BODE, DOSE, and SCOPEX MIs to predict the occurrence of AECOPD during PRP were 78.1%, 21.9%, and 84.4%, and the specificities were 73.6%, 87.1%, and 51.6%, respectively. Conclusion The BODE and SCOPEX MIs help to predict the exacerbation risk during PR.
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Affiliation(s)
- Bertrand Herer
- Pulmonary Rehabilitation Unit, Pulmonary Department, Centre Hospitalier De Bligny, Briis sous Forges, France
| | - Thierry Chinet
- Pneumology Unit, Hôpital A. Paré, Boulogne-Billancourt, France
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30
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Dumenil C, Massiani MA, Dumoulin J, Giraud V, Labrune S, Chinet T, Giroux Leprieur E. Clinical factors associated with early progression and grade 3-4 toxicity in patients with advanced non-small-cell lung cancers treated with nivolumab. PLoS One 2018; 13:e0195945. [PMID: 29684049 PMCID: PMC5912777 DOI: 10.1371/journal.pone.0195945] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/03/2018] [Indexed: 02/08/2023] Open
Abstract
Introduction The prognosis of advanced non-small-cell lung cancer (NSCLC) has been improved by development of immune checkpoint inhibitors (ICIs) such as nivolumab for second-line treatment. As phase III trials include only selected patients, we here investigated the clinical factors associated with efficacy and safety of nivolumab in ‘real life’ patients with advanced NSCLC. Methods Clinical and histological characteristics, therapies and survival data of all consecutive patients with advanced NSCLC included prospectively and treated by nivolumab in two French academic hospitals between February 2015 and December 2016 were examined. Results Sixty-seven patients were included, mostly male (69%), current or former smokers (87%) with PS <2 (73%). Median age was 68.5 years and 42% were aged ≥70 years. According to uni- and multi-variate analyses, only PS 2 (OR = 0.17, 95% CI 0.03–0.99, p = 0.049) and number of previous treatment lines (OR = 0.33, 95% CI 0.13–0.85, p = 0.022) were significantly negatively associated with tumor control. Worse progression-free survival (PFS) was significantly associated with PS 2 (HR = 5.17, 95% CI 1.99–13.43, p = 0.001) and use of steroids (HR = 3.27, 95% CI 1.39–7.69, p = 0.006). Worse overall survival was associated with symptomatic brain metastasis (HR = 3.15, 95% CI 1.23–8.85, p = 0.029). Treatment-related adverse events occurred in 47 patients (70%), symptomatic brain metastasis being significantly associated with Grade ≥3 toxicity (OR = 8.13, 95% CI 1.21–55.56, p = 0.031). Age and nutritional status were not associated with response, PFS, OS or toxicity. Conclusion Our results suggest that nivolumab is not beneficial or safe for patients with PS 2 and symptomatic brain metastases.
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Affiliation(s)
- Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Marie-Ange Massiani
- Department of Medical Oncology, René Huguenin Hospital, Curie Institute, Saint-Cloud, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
- EA4340, University of Versailles Saint-Quentin-en-Yvelines, Paris-Saclay University, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
- EA4340, University of Versailles Saint-Quentin-en-Yvelines, Paris-Saclay University, Boulogne-Billancourt, France
- * E-mail:
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Costantini A, Julie C, Dumenil C, Hélias-Rodzewicz Z, Tisserand J, Dumoulin J, Giraud V, Labrune S, Chinet T, Emile JF, Giroux Leprieur E. Predictive role of plasmatic biomarkers in advanced non-small cell lung cancer treated by nivolumab. Oncoimmunology 2018; 7:e1452581. [PMID: 30221046 PMCID: PMC6136870 DOI: 10.1080/2162402x.2018.1452581] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/17/2022] Open
Abstract
Immune checkpoint inhibitors, as nivolumab, are used in advanced non-small cell lung cancer (NSCLC). However, no associated biomarker is validated in clinical practice with this drug. We investigated herein immune-related blood markers in patients with advanced NSCLC treated with nivolumab. Plasma of 43 consecutive patients were prospectively collected at time of the diagnosis of cancer, at the initiation of nivolumab and at the first tumour evaluation (2 months). Concentrations of PD-L1 (sPD-L1), soluble PD-L2 (sPD-L2), Interleukine-2 (sIl-2), Interferon-gamma (sIFN-γ), and Granzyme B (sGranB) were quantified by ELISA. Cell free RNA was quantified by Reverse Transcriptase -PCR), and plasmatic microRNAs (miRNAs) were evaluated by targeted sequencing. Expression of PD-L1 on tumour biopsies was performed by immunohistochemistry using E13LN. High sPD-L1 at 2 months and increase of sPD-L1 concentrations were associated with poor response and absence of clinical benefit (nivolumab treatment less than 6 months). The variation of sPD-L1 concentrations were confirmed by RNA quantification. sPD-L1 concentrations were not correlated with PD-L1 expression on corresponding tumour samples. Low sGranB at nivolumab initiation was also associated with poor response. High sPD-L1 and low sGranB were associated with poor progression-free survival (PFS) and overall survival (OS). Low sPD-L2, low sIl-2 and high sIFN-γ were associated with grade 3-4 toxicities. Finally, miRNA screening showed that patients with clinical benefit (n = 9) had down-expression of miRNA-320b and -375 compared to patients with early progression at 2 months (n = 9). In conclusion, our results highlight the interest of circulating biomarkers in patients treated with nivolumab.
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Affiliation(s)
- Adrien Costantini
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Catherine Julie
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Pathology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Coraline Dumenil
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Zofia Hélias-Rodzewicz
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Pathology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Julie Tisserand
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Pathology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Violaine Giraud
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Sylvie Labrune
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Thierry Chinet
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Pathology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
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Giroux Leprieur E, Herbretau G, Dumenil C, Julie C, Giraud V, Labrune S, Dumoulin J, Tisserand J, Emile JF, Blons H, Chinet T. Circulating tumor DNA evaluated by Next-Generation Sequencing is predictive of tumor response and prolonged clinical benefit with nivolumab in advanced non-small cell lung cancer. Oncoimmunology 2018; 7:e1424675. [PMID: 29721388 DOI: 10.1080/2162402x.2018.1424675] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 01/05/2023] Open
Abstract
Nivolumab is an anti-PD1 antibody, given in second-line or later treatment in advanced non-small cell lung cancer (NSCLC). The objective of this study was to describe the predictive value of circulating tumor DNA (ctDNA) on the efficacy of nivolumab in advanced NSCLC. We prospectively included all consecutive patients with advanced NSCLC treated with nivolumab in our Department between June 2015 and October 2016. Plasma samples were obtained before the first injection of nivolumab and at the first tumor evaluation with nivolumab. ctDNA was analyzed by Next-Generation Sequencing (NGS), and the predominant somatic mutation was followed for each patient and correlated with tumor response, clinical benefit (administration of nivolumab for more than 6 months), and progression-free survival (PFS). Of 23 patients, 15 had evaluable NGS results at both times of analysis. ctDNA concentration at the first tumor evaluation and ctDNA change correlated with tumor response, clinical benefit and PFS. ROC curve analyses showed good diagnostic performances for tumor response and clinical benefit, both for ctDNA concentration at the first tumor evaluation (tumor response: positive predictive value (PPV) at 100.0% and negative predictive value (NPV) at 71.0%; clinical benefit: PPV at 83.3% and NPV 77.8%) and the ctDNA change (tumor response: PPV 100.0% and NPV 62.5%; clinical benefit: PPV 100.0% and NPV 80.0%). Patients without ctDNA concentration increase >9% at 2 months had a long-term benefit of nivolumab. In conclusion, NGS analysis of ctDNA allows the early detection of tumor response and long-term clinical benefit with nivolumab in NSCLC.
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Affiliation(s)
- Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Guillaume Herbretau
- INSERM UMR-S1147, CNRS SNC 5014, Saints-Pères Research Center, 45 rue des Saints-Pères Paris-Descartes University, Sorbonne Paris Cité University, Paris, France.,Department of Molecular Biology, Georges Pompidou European Hospital, 20 rue Leblanc, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Catherine Julie
- EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.,Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Julie Tisserand
- EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.,Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.,Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Hélène Blons
- INSERM UMR-S1147, CNRS SNC 5014, Saints-Pères Research Center, 45 rue des Saints-Pères Paris-Descartes University, Sorbonne Paris Cité University, Paris, France.,Department of Molecular Biology, Georges Pompidou European Hospital, 20 rue Leblanc, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
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Costantini A, Julie C, Dumenil C, Hélias-Rodzewicz Z, Dumoulin J, Giraud V, Labrune S, Chinet T, Émile J, Giroux-Leprieur E. Rôle pronostique et prédictif du PD-L1 plasmatique dans les cancers bronchiques non à petites cellules de stade avancé traités par nivolumab. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.127] [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: 10/18/2022]
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Guilhem A, Fargeton AE, Simon AC, Duffau P, Harle JR, Lavigne C, Carette MF, Bletry O, Kaminsky P, Leguy V, Lerolle N, Roux D, Lambert M, Chinet T, Bonnet D, Dupuis-Girod S, Rivière S. Intra-venous bevacizumab in hereditary hemorrhagic telangiectasia (HHT): A retrospective study of 46 patients. PLoS One 2017; 12:e0188943. [PMID: 29190827 PMCID: PMC5708634 DOI: 10.1371/journal.pone.0188943] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/15/2017] [Indexed: 12/25/2022] Open
Abstract
Background Bevacizumab, an anti-VEGF monoclonal antibody, has recently emerged as a new option for severe forms of hereditary hemorrhagic telangiectasia (HHT). Its utilization in this orphan disease has rapidly spread despite the lack of randomized trials and international guidelines. The objective of this study is to report the main clinical data (baseline characteristics, dose schedule, efficacy, adverse events and deaths) of HHT patients treated by intravenous bevacizumab in France. Methods Retrospective observational study of HHT patients treated with bevacizumab for a severe form of the disease in the 14 centers of the French HHT network. Results Forty-six patients (median age: 68 years) were treated between March 2009 and May 2015. Ten patients were treated for high output cardiac failure, 20 patients for severe hemorrhages and 16 for both indications. The standard protocol (6 infusions of 5mg/kg every 2 weeks) was initially used in 89% of the cases but diverse strategies were subsequently applied. A clinical improvement was noted by the referent physician for 74% of the patients with a median effect’s duration of 6 months. Wound healing complications led to 2 amputations. Arthralgia/arthritis and arterial hypertension occurred in 5 patients each. One third of the patients were dead at the time of the final update, coherently with age and the poor prognosis of these highly symptomatic patients. Conclusion Intravenous bevacizumab seems to provide a clinical benefice in severe HHT patients. Precautions concerning wound healing and vascular pathologies must be respected. Prospective double blinded versus placebo trials are needed.
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Affiliation(s)
- Alexandre Guilhem
- Médecine Interne - Maladies Multi-Organiques, Hôpital Saint Eloi, Montpellier, France
- * E-mail:
| | - Anne-Emmanuelle Fargeton
- Service de Génétique - Centre de Référence National Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | | | - Pierre Duffau
- Service de Médecine Interne et Immunologie Clinique, Hôpital Saint-André, Bordeaux, France
| | - Jean-Robert Harle
- Département de Médecine Interne, Hôpital de la Timone, Marseille, France
| | - Christian Lavigne
- Médecine Interne et Maladies Vasculaires, CHU d’Angers, Angers, France
| | | | - Olivier Bletry
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Pierre Kaminsky
- Service de Médecine Interne, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France
| | - Vanessa Leguy
- Service de Médecine Interne et Immunologie Clinique, Hôpital François Mitterrand, Dijon, France
| | | | | | - Marc Lambert
- Service de Médecine Interne, Hôpital Huriez, Lille, France
| | - Thierry Chinet
- Service de Pneumologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Delphine Bonnet
- Service de Médecine Interne du Pôle digestif, CHU Purpan, Toulouse, France
| | - Sophie Dupuis-Girod
- Service de Génétique - Centre de Référence National Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | - Sophie Rivière
- Médecine Interne - Maladies Multi-Organiques, Hôpital Saint Eloi, Montpellier, France
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Wang L, Dumenil C, Julié C, Giraud V, Dumoulin J, Labrune S, Chinet T, Emile JF, He B, Giroux Leprieur E. Molecular characterization of circulating tumor cells in lung cancer: moving beyond enumeration. Oncotarget 2017; 8:109818-109835. [PMID: 29312651 PMCID: PMC5752564 DOI: 10.18632/oncotarget.22651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/20/2017] [Indexed: 12/30/2022] Open
Abstract
Molecular characterization of tumor cells is a key step in the diagnosis and optimal treatment of lung cancer. However, analysis of tumor samples, often corresponding to small biopsies, can be difficult and does not accurately reflect tumor heterogeneity. Recent studies have shown that isolation of circulating tumor cells (CTCs) is feasible in non-small cell lung cancer patients, even at early disease stages. The amount of CTCs corresponds to the metastatic potential of the tumor and to patient prognosis. Moreover, molecular analyses, even at the single-cell level, can be performed on CTCs. This review describes the technologies currently available for detecting and capturing CTCs, the potential for downstream molecular diagnostics, and the clinical applications of CTCs isolated from lung cancer patients as screening, prognostic, and predictive tools. Main limitations of CTCs are also discussed.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Catherine Julié
- Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340 "Biomarqueurs en Cancérologie et Onco-Hématologie" UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340 "Biomarqueurs en Cancérologie et Onco-Hématologie" UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Jean-François Emile
- Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340 "Biomarqueurs en Cancérologie et Onco-Hématologie" UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Biao He
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340 "Biomarqueurs en Cancérologie et Onco-Hématologie" UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
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Palmyre A, Eyries M, Senat MV, Ozanne A, Staraci S, Dufour P, Chinet T, Lacombe P, Soubrier F, Charron P. Prenatal molecular diagnosis in RASA1
-related disease. Prenat Diagn 2017; 37:1261-1264. [DOI: 10.1002/pd.5165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/04/2017] [Accepted: 09/29/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Aurélien Palmyre
- Service de Génétique, Hôpital Ambroise Paré; Assistance Publique Hôpitaux de Paris; Boulogne-Billancourt France
- Centre de compétence pour la maladie de Rendu Osler; Hôpital Ambroise Paré; Boulogne-Billancourt France
| | - Mélanie Eyries
- Département de Génétique & ICAN, Hôpital Pitié-Salpêtrière; Assistance Publique Hôpitaux de Paris; Paris France
| | - Marie-Victoire Senat
- Service Gynécologie Obstétrique, Hôpital Bicêtre; Assistance Publique Hôpitaux de Paris; Paris France
| | - Augustin Ozanne
- Service de Neuroradiologie Interventionnelle; GHU Paris-Sud - Hôpital de Bicêtre, Assistance Publique Hôpitaux de Paris; Paris France
- Centre de compétence pour la maladie de Rendu Osler; Hôpital Ambroise Paré; Boulogne-Billancourt France
| | - Stéphanie Staraci
- Service de Génétique, Hôpital Ambroise Paré; Assistance Publique Hôpitaux de Paris; Boulogne-Billancourt France
- Département de Génétique & ICAN, Hôpital Pitié-Salpêtrière; Assistance Publique Hôpitaux de Paris; Paris France
| | - Philippe Dufour
- Service Maternité et suites de naissances; Hôpital Jeanne de Flandre, CHRU de Lille; Lille France
| | - Thierry Chinet
- Service de Pneumologie et Oncologie Thoracique; Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris; Boulogne-Billancourt France
- Centre de compétence pour la maladie de Rendu Osler; Hôpital Ambroise Paré; Boulogne-Billancourt France
| | - Pascal Lacombe
- Service d'Imagerie Diagnostique et Interventionnelle; Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris; Boulogne-Billancourt France
- Centre de compétence pour la maladie de Rendu Osler; Hôpital Ambroise Paré; Boulogne-Billancourt France
| | - Florent Soubrier
- Département de Génétique & ICAN, Hôpital Pitié-Salpêtrière; Assistance Publique Hôpitaux de Paris; Paris France
| | - Philippe Charron
- Service de Génétique, Hôpital Ambroise Paré; Assistance Publique Hôpitaux de Paris; Boulogne-Billancourt France
- Département de Génétique & ICAN, Hôpital Pitié-Salpêtrière; Assistance Publique Hôpitaux de Paris; Paris France
- Centre de compétence pour la maladie de Rendu Osler; Hôpital Ambroise Paré; Boulogne-Billancourt France
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Rotenberg C, Bonay M, El Hajjam M, Blivet S, Beauchet A, Lacombe P, Chinet T. Effect of pulmonary arteriovenous malformations on the mechanical properties of the lungs. BMC Pulm Med 2017; 17:64. [PMID: 28420371 PMCID: PMC5395778 DOI: 10.1186/s12890-017-0411-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary arteriovenous malformations (PAVMs) are present in approximately 15-50% individuals with hereditary hemorrhagic telangiectasia (HHT). They may be isolated but more often are multiple. The goal of this study was to evaluate the influence of PAVMs on lung mechanical properties. METHODS We reviewed the files of all adult patients (age ≥ 18 years) referred to our Center for evaluation of HHT between 2005 and 2013. The diagnosis of HHT was based on the Curacao criteria and/or the presence of a pathogenic mutation. Exclusion criteria included: chronic cardiac or lung disease (i.e. asthma or COPD), suspicion of pulmonary hypertension on echocardiography, current or past smoking (>10 pack-years), history of thoracic surgery, previous treatment of PAVMs by embolotherapy, lung infection or thromboembolic disease in the past 3 months, pregnancy and obesity (BMI > 30 kg/m2). Chest high resolution CT-scan and pulmonary function tests were performed the same day in all patients as part of our routine work-up. RESULTS One hundred and fifty five patients with HHT were included (age: 44.4 ± 16.7 yrs - mean ± SD -; males: 39%). Eighty eight patients had no PAVM, 45 had 1-3 PAVMS and 22 had at least 4 PAVMs. Thirty eight patients had unilateral PAVMs and 29 bilateral PAVMs. We found no statistical relationship between the number, the size and the laterality of PAVMs and results of lung flows and volumes. CONCLUSION We found no evidence that PAVMs have a significant influence on lung mechanical properties as measured using routine pulmonary function tests in adult patients with HHT, even in case of numerous, macroscopic or bilateral malformations.
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Affiliation(s)
- Cécile Rotenberg
- Consultation Pluridisciplinaire Maladie de Rendu Osler, Université de Versailles SQY, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Marcel Bonay
- Consultation Pluridisciplinaire Maladie de Rendu Osler, Université de Versailles SQY, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Mostafa El Hajjam
- Consultation Pluridisciplinaire Maladie de Rendu Osler, Université de Versailles SQY, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Sandra Blivet
- Consultation Pluridisciplinaire Maladie de Rendu Osler, Université de Versailles SQY, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Alain Beauchet
- Consultation Pluridisciplinaire Maladie de Rendu Osler, Université de Versailles SQY, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Pascal Lacombe
- Consultation Pluridisciplinaire Maladie de Rendu Osler, Université de Versailles SQY, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Thierry Chinet
- Consultation Pluridisciplinaire Maladie de Rendu Osler, Université de Versailles SQY, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
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Dinh A, Dumoulin J, Duran C, Davido B, Lagrange A, Benhamou D, Dombret M, Renaud B, Claessens Y, Labarère J, Philippe B, Boitiaux J, Bedos J, Ropers J, Chinet T, Crémieux A. Peut-on traiter les patients, avec comorbidités, hospitalisés pour pneumonies communautaires par 3jours de bétalactamines ? Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dupuis-Girod S, Ambrun A, Decullier E, Fargeton AE, Roux A, Bréant V, Colombet B, Rivière S, Cartier C, Lacombe P, Chinet T, Blivet S, Blondel JH, Gilbert-Dussardier B, Dufour X, Michel J, Harle JR, Dessi P, Faure F. Effect of Bevacizumab Nasal Spray on Epistaxis Duration in Hereditary Hemorrhagic Telangectasia: A Randomized Clinical Trial. JAMA 2016; 316:934-42. [PMID: 27599328 DOI: 10.1001/jama.2016.11387] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Epistaxis is the most frequent and disabling manifestation of hereditary hemorrhagic telangiectasia (HHT). The efficacy of intravenous bevacizumab (an anti-vascular endothelial growth factor monoclonal antibody) for epistaxis has been shown. However, the efficacy of intranasal bevacizumab has yet to be evaluated. OBJECTIVE To evaluate the efficacy of 3 different doses of bevacizumab administered as a nasal spray in a repeated manner for the duration of nosebleeds in patients with HHT. DESIGN, SETTING, AND PARTICIPANTS Randomized, multicenter, placebo-controlled, phase 2/3 clinical trial with dose selection at an intermediate analysis and prespecified stopping rules (nonbinding stopping for futility). Patients aged 18 years or older with a diagnosis of HHT were recruited from 5 French centers from April 2014 to January 2015 with a 6-month follow-up after the end of treatment. Participants had a history of self-reported nosebleeds with a monthly duration of more than 20 minutes in at least the 3 months prior to inclusion corroborated by epistaxis grids completed during the same preinclusion period. INTERVENTIONS Eighty consecutive HHT patients were randomized and treated in the phase 2 study, with 4 parallel groups in a 1:1:1:1 ratio. One group received placebo (n = 21); the other 3 received bevacizumab nasal spray. Each bevacizumab group received a different dose of the drug (25 mg [n = 20], 50 mg [n = 20], or 75 mg [n = 19] per treatment) in 3 doses 14 days apart for a total treatment duration of 4 weeks, resulting in a total dose of 75 mg, 150 mg, and 225 mg in each treatment group. MAIN OUTCOMES AND MEASURES Mean monthly epistaxis duration for 3 consecutive months immediately after the end of the treatment. RESULTS Of the 80 patients who were randomized (mean age, 60.47 [SD, 10.61] years; 37 women [46.25%]), 75 completed the study. Mean monthly epistaxis duration measured at 3 months was not significantly different in the 59 patients receiving bevacizumab in comparison with the placebo group (P = .57) or between the bevacizumab groups. The mean monthly epistaxis duration was 259.2 minutes (95% CI, 82.1-436.3 minutes) in the 25-mg group, 244.0 minutes (95% CI, 81.8-406.2 minutes) in the 50-mg group, 215.0 minutes (95% CI, 102.8-327.2 minutes) in the 75-mg group, and 200.4 minutes (95% CI, 109.3-291.5 minutes) in the placebo group. Toxicity was low and no severe adverse events were reported. This study was terminated prior to phase 3 for treatment futility after interim analysis on the recommendations of an independent data monitoring committee. CONCLUSIONS AND RELEVANCE In patients with HHT, a bevacizumab nasal spray treatment of 3 administrations at 14-day intervals with doses of 25 mg, 50 mg, or 75 mg per spray, compared with a placebo, did not reduce monthly epistaxis duration in the 3 consecutive months immediately after the end of treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02106520.
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Affiliation(s)
- Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence sur la maladie de Rendu-Osler, Bron, France2Université de Lyon, Faculté de médecine, Université Lyon 1, Lyon, France
| | - Alexis Ambrun
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'ORL, Lyon, France
| | - Evelyne Decullier
- Hospices Civils de Lyon, pôle IMER, Lyon, France5Université Lyon 1, Lyon, France
| | - Anne-Emmanuelle Fargeton
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence sur la maladie de Rendu-Osler, Bron, France2Université de Lyon, Faculté de médecine, Université Lyon 1, Lyon, France
| | - Adeline Roux
- Hospices Civils de Lyon, pôle IMER, Lyon, France
| | - Valentine Bréant
- Hospices Civils de Lyon, Pharmacie, Hôpital Louis Pradel, Bron, France
| | - Bettina Colombet
- Hospices Civils de Lyon, Pharmacie, Hôpital Louis Pradel, Bron, France
| | - Sophie Rivière
- Service de Médecine Interne A, Centre Hospitalier Universitaire, Montpellier, France
| | - César Cartier
- Service d'ORL, Centre Hospitalier Universitaire, Montpellier, France
| | - Pascal Lacombe
- Hôpital Ambroise Paré, Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, Boulogne, France
| | - Thierry Chinet
- Hôpital Ambroise Paré, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, Boulogne, France
| | - Sandra Blivet
- Hôpital Ambroise Paré, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, Boulogne, France
| | - Jean-Hugues Blondel
- Hôpital Ambroise Paré, Service d'ORL, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, Boulogne, France
| | | | | | - Justin Michel
- Hôpital de la conception, CHU de Marseille, Service de médecine interne, Marseille, France
| | - Jean-Robert Harle
- Hôpital de la conception, CHU de Marseille, Service de médecine interne, Marseille, France
| | - Patrick Dessi
- Hôpital la Timone, CHU de Marseille, Service d'ORL, Marseille, France
| | - Frédéric Faure
- Hospices Civils de Lyon, Hôpital E. Herriot, Service d'ORL, Lyon, France
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Chinet T. How to follow-up patients with hereditary haemorrhagic telangiectasia and suspected pulmonary arteriovenous malformations. Eur Respir J 2016; 47:1618-21. [DOI: 10.1183/13993003.00340-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 02/20/2016] [Indexed: 11/05/2022]
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Mussat E, Giraud V, Julie C, Chinet T, Leprieur EG. Fatal Haemoptysis Associated with Dramatic Response to Crizotinib in an ALK-Rearranged Lung Adenocarcinoma. J Clin Diagn Res 2016; 10:XD01-XD03. [PMID: 27134984 DOI: 10.7860/jcdr/2016/17805.7428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
The presence of an ALK (Anaplastic Lymphoma Kinase) rearrangement is a rare molecular feature in Non-Small Cell Lung Carcinoma (NSCLC), and concerns mainly non- or light smokers, young patients, with adenocarcinoma histological type. These tumours are particularly sensitive to Alk-targeted therapies, as crizotinib. Crizotinib is usually well-tolerated. We report a case of fatal haemoptysis associated with dramatic response to crizotinib in a patient with an ALK-rearranged lung adenocarcinoma. The patient presented a mediastinal invasion with tracheal involvement and compression of the right pulmonary artery. The initial evolution under crizotinib was good with tumour response. At 6 weeks of crizotinib the patient presented a massive haemoptysis with a tracheobronchial fistula and pneumomediastinum. She died of acute respiratory failure. Our case is the first to report a fatal effect of crizotinib associated with tumour necrosis and good tumour response on a massive mediastinal infiltration. Precautions are recommended with the use of crizotinib in proximal lung tumours with vascular invasion.
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Affiliation(s)
- Elodie Mussat
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Violaine Giraud
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Catherine Julie
- Faculty, Department of Pathology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Thierry Chinet
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France. EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France. EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
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Abstract
Background COPD is a frequent but underdiagnosed disease whose diagnosis relies on the spirometric demonstration of bronchial obstruction. Spirometry use by general practitioners could represent the first line in COPD diagnosis. Objective Because duration of spirometry is retarding its development in primary care, we decided to measure the time it requires in the primary-care context in France. Methods Ten volunteer general practitioners were trained during two 3-hour theoretical and practical continuing education sessions. Then, from October 2013 to May 2014, they included patients without any known respiratory disease but at risk of developing COPD (age: ≥40 years, smoker: ≥20 pack-years). The duration of spirometry and its quality were evaluated according to the following acceptability criteria: 1) expiration ≥6 seconds or reaching a plateau; 2) good start with an early peak flow, curve peaked on top and not flat; 3) no artifacts; and 4) reproducibility criteria, ie, forced expiratory volume in 1 second and forced vital capacity differences between the two best spirometry curves ≤0.15 L. Quality of the spirograms was defined as optimal when all the criteria were met and acceptable when all the criteria were satisfied except the reproducibility criterion, otherwise, it was unacceptable. Results For the 152 patients included, the 142 assessable spirometries lasted for 15.2±5.9 minutes. Acceptability criteria 1–3, respectively, were satisfied for 90.1%, 89.4%, and 91.5% of patients and reproducibility criterion 4 for 56.3%. Quality was considered optimal for 58.5% of the curves and acceptable for 30.2%. Conclusion The duration of spirometry renders it poorly compatible with the current primary-care practice in France other than for dedicated consultations. Moreover, the quality of spirometry needs to be improved.
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Affiliation(s)
- Violaine Giraud
- AP-HP, Department of Pneumology and Thoracic Oncology, Ambroise-Paré Hospital, Paris, France; UEFR Paris île-de-France Ouest, Versailles Saint Quentin-en-Yvelines University, Paris, France
| | - Alain Beauchet
- Public Health Department, Unité de Recherche Clinique, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France
| | | | - Thierry Chinet
- AP-HP, Department of Pneumology and Thoracic Oncology, Ambroise-Paré Hospital, Paris, France; UEFR Paris île-de-France Ouest, Versailles Saint Quentin-en-Yvelines University, Paris, France
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Chinet T, Dumoulin J, Honore I, Braun JM, Couderc LJ, Febvre M, Mangiapan G, Maurer C, Serrier P, Soyez F, Terrioux P, Jebrak G. [The place of inhaled corticosteroids in COPD]. Rev Mal Respir 2016; 33:877-891. [PMID: 26831345 DOI: 10.1016/j.rmr.2015.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 11/25/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Clinical trials have provided some evidence of a favorable effect of inhaled corticosteroids on the frequency of exacerbations and on the quality of life of patients with chronic obstructive pulmonary disease (COPD). In contrast, ICS have little or no impact on lung function decline and on mortality. STATE OF THE ART Inhaled corticosteroids are recommended only in a minority of COPD patients, those with severe disease and repeated exacerbations and probably those with the COPD and asthma overlap syndrome. However, surveys indicate that these drugs are inappropriately prescribed in a large population of patients with COPD. Overtreatment with inhaled corticosteroids exposes these patients to an increased risk of potentially severe side-effects such as pneumonia, osteoporosis, and oropharyngeal candidiasis. Moreover, it represents a major waste of health-care spending. CONCLUSION Primary care physicians as well as pulmonologists should be better aware of the benefits as well as the side-effects and costs of inhaled corticosteroids.
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Affiliation(s)
- T Chinet
- Service de pneumologie et oncologie thoracique, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, université de Versailles SQY, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - J Dumoulin
- Service de pneumologie et oncologie thoracique, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, université de Versailles SQY, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - I Honore
- Service de pneumologie, hôpital Cochin, 75679 Paris cedex 14, France
| | - J-M Braun
- Service de pneumologie, hôpital Cochin, hôpitaux universitaires Paris-Centre, site Val-de-Grâce, 75005 Paris, France
| | - L-J Couderc
- Service de pneumologie et UPRES EA 220 92150, hôpital Foch, Suresnes, France
| | - M Febvre
- Service de pneumologie, hôpital Tenon, 75020 Paris, France
| | - G Mangiapan
- Service de pneumologie, CHIC de Créteil, 94000 Créteil, France
| | - C Maurer
- Service de pneumologie, centre hospitalier Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - P Serrier
- Service de pneumologie, hôpital Cochin, 75679 Paris cedex 14, France
| | - F Soyez
- Hôpital privé d'Antony, 92160 Antony, France
| | - P Terrioux
- Service de médecine interne, centre hospitalier de Coulommiers, 77120 Coulommiers, France
| | - G Jebrak
- Service de pneumologie B et de transplantations pulmonaires, hôpital Bichat-Claude-Bernard, 75877 Paris cedex 18, France
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Nathan N, Giraud V, Picard C, Nunes H, Dastot-Le Moal F, Copin B, Galeron L, De Ligniville A, Kuziner N, Reynaud-Gaubert M, Valeyre D, Couderc LJ, Chinet T, Borie R, Crestani B, Simansour M, Nau V, Tissier S, Duquesnoy P, Mansour-Hendili L, Legendre M, Kannengiesser C, Coulomb-L'Hermine A, Gouya L, Amselem S, Clement A. GermlineSFTPA1mutation in familial idiopathic interstitial pneumonia and lung cancer. Hum Mol Genet 2016; 25:1457-67. [DOI: 10.1093/hmg/ddw014] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/14/2016] [Indexed: 01/18/2023] Open
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Soyez F, Ninot G, Herkert A, Phin Huyn S, Prosper M, Chinet T, Housset B, Chouaid C, Roche N. [Validation of an evaluation questionnaire for COPD acute exacerbations (Exascore)]. Rev Mal Respir 2015; 33:17-24. [PMID: 26518257 DOI: 10.1016/j.rmr.2015.09.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 10/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early identification of acute exacerbations of COPD facilitates better care. This study was designed to validate a short questionnaire (Exascore) developed to help patients, relatives and carers to diagnose acute exacerbations. METHOD We first addressed content validity that allowed the elaboration of two questionnaires, one assessing the current status and the other stable status (transition). The second step tested their construction validity, reproducibility and concomitant validity among 126 COPD patients aged 64.4±9.9 years. They included 56 presenting with an exacerbation and 70 in stable state, of whom 57 completed the questionnaire a second time after 7 days. The diagnosis of exacerbation and assessment of severity (gold standard) were established by the treating respiratory physician and confirmed by two independent experts. RESULTS Factorial analyses established a "current status" questionnaire comprising 8 items and 2 dimensions. Cronbach's alpha coefficients were satisfactory, 0.867 for "respiratory impact", 0.886 for "psychosocial impact" and 0.886 for the total score. Concomitant validity and reproducibility were also adequate. The transition questionnaire did not obtain convincing psychometric results. CONCLUSIONS The "current status" Exascore questionnaire satisfies psychometric quality criteria while being usable in clinical practice. It helps in diagnosing acute exacerbations and assessing their intensity. Further studies will need to test the adequacy of proposed thresholds, the factorial structure of the score in healthcare professionals and patients' relatives, and its predictive power.
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Affiliation(s)
- F Soyez
- Unité de pathologie thoracique, hôpital privé d'Antony, 1, rue Velpeau, 92160 Antony, France.
| | - G Ninot
- EA4556, plateforme CEPS, université de Montpellier, 34000 Montpellier, France
| | - A Herkert
- Unité de pathologie thoracique, hôpital privé d'Antony, 1, rue Velpeau, 92160 Antony, France
| | - S Phin Huyn
- Pneumologie, CHI Robert-Ballanger, 93600 Aulnay-sous-Bois, France
| | | | - T Chinet
- Pneumologie, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 92100 Boulogne, France
| | - B Housset
- Pneumologie, CHI de Créteil, 94000 Créteil, France; Équipe 4, IMRB U955, université Paris-Est - Créteil, 94000 Créteil, France
| | - C Chouaid
- Pneumologie, CHI de Créteil, 94000 Créteil, France; Équipe 4, IMRB U955, université Paris-Est - Créteil, 94000 Créteil, France
| | - N Roche
- Pneumologie et soins intensifs respiratoires, groupe hospitalier Cochin - site Val-de-Grâce, Assistance publique-Hôpitaux de Paris, 75014 Boulogne, France; EA2511, université Paris Descartes, 75006 Paris, France
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Giraud V, Longvert C, Houlle-Crepin S, Danel C, Labrune S, Camus P, Saiag P, Chinet T. Relapsing pneumonitis due to two distinct inhibitors of the MAPK/ERK pathway: report of a case. BMC Cancer 2015; 15:732. [PMID: 26481107 PMCID: PMC4612419 DOI: 10.1186/s12885-015-1754-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Received: 12/08/2014] [Accepted: 10/09/2015] [Indexed: 11/22/2022] Open
Abstract
Background BRAF and MEK are component of the MAPK/ERK pathway and inhibitors of these proteins have significantly improved the outcome of metastatic melanoma. We report for the first time two sequential episodes of pneumonitis presumably induced by trametinib (a MEK inhibitor) and vemurafenib (a BRAF inhibitor) in a 50 year-old man. Case presentation While receiving trametinib for a metastatic melanoma, the patient developed non-febrile acute respiratory failure in the context of bilateral ground-glass opacities and sub pleural reticulations on high resolution computed tomography. An excess of lymphocytes was found in the bronchoalveolar lavage fluid. Outcome was favorable after simple drug discontinuation. He subsequently developed a similar clinical-imaging picture 6 months into vemurafenib. A transthoracic lung biopsy disclosed interstitial lymphocytic infiltrate, poorly-formed granulomas with multinucleated giant cells and scattered eosinophils. Outcome was again favorable after simple drug discontinuation. Conclusion These two episodes in the same patient suggest that MAPK/ERK inhibitors may cause interstitial lung disease and may exert cross toxicity. This side effect is of particular interest for physicians in charge of patients with melanoma but this drug family is currently under development for several other solid tumors.
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Affiliation(s)
- Violaine Giraud
- AP-HP, Department of Pulmonary Medicine and Thoracic Oncology, Hôpital A. Paré, Boulogne, & université de Versailles SQY, Boulogne, France. .,Service de Pneumologie et d'Oncologie Thoracique, Hôpital Ambroise Paré, 9, avenue Charles de Gaulle, Boulogne, 92 104, France.
| | | | | | - Claire Danel
- AP-HP, Department of Pathology, Hôpital Bichat Claude Bernard, Paris, France.
| | - Sylvie Labrune
- AP-HP, Department of Pulmonary Medicine and Thoracic Oncology, Hôpital A. Paré, Boulogne, & université de Versailles SQY, Boulogne, France.
| | - Philippe Camus
- Department of Pulmonary Medicine, CHU Le Bocage and www.pneumotox.com, Dijon, 21079, France.
| | - Philippe Saiag
- AP-HP, Department of Dermatology, Hôpital A. Paré, Boulogne, France.
| | - Thierry Chinet
- AP-HP, Department of Pulmonary Medicine and Thoracic Oncology, Hôpital A. Paré, Boulogne, & université de Versailles SQY, Boulogne, France.
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Jutant EM, Puyo P, El Hajjam M, Blivet S, Houdart E, Aubier M, Lacombe P, Chinet T. Severe, chronic cough caused by pulmonary arteriovenous malformations in a patient with hereditary haemorrhagic telangiectasia: case report. BMC Pulm Med 2015; 15:28. [PMID: 25887242 PMCID: PMC4380104 DOI: 10.1186/s12890-015-0024-0] [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: 09/02/2014] [Accepted: 03/10/2015] [Indexed: 11/22/2022] Open
Abstract
Background Patients with pulmonary arteriovenous malformations usually complain of dyspnoea upon exertion, fatigue or migraine, or may be asymptomatic. We describe a patient with an unreported manifestation of a pulmonary arteriovenous malformation: a severe chronic cough. Case presentation A 51-year old Caucasian non-smoking female police officer presented with a chronic cough. She had been diagnosed with hereditary haemorrhagic telangiectasia in 1992. She complained of a severe, dry cough at the time of the diagnosis and a pulmonary arteriovenous malformation in the upper left lobe as demonstrated by CT of the chest. The fistula was occluded and the cough disappeared rapidly but resumed in 1994. Recanalisation of the fistula led to a new embolisation procedure, and the cough disappeared. Similar episodes occurred in 1998 and 2004, leading to embolisation of a fistula in the right lower lobe and reperfused fistula in the upper left lobe, respectively. The patient was referred to our research team in 2010 because of reappearance of her dry cough that was more pronounced during exercise and exposure to volatile irritants, and absent during the night. Despite extensive investigations, no cause was found other than reperfusion of the fistula in the left upper lobe. The malformation was not accessible to embolisation, leading us to recommend surgical excision of the malformation. A surgeon undertook atypical resection of the left upper lobe in 2012. The cough disappeared immediately after surgery and has not recurred. Conclusion Physicians caring for patients with pulmonary arteriovenous malformations should know that a severe, chronic cough can be caused by the malformation. A cough associated with a pulmonary arteriovenous malformation can be treated effectively by embolisation but may resume in cases of reperfusion of the malformation. In our case, the severity of the cough led to surgical excision because embolisation was not possible. The mechanism of action of this cough remains to be determined.
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Affiliation(s)
- Etienne-Marie Jutant
- APHP, Department of Pulmonology and Thoracic Oncology, Ambroise Paré Hospital, Boulogne, France.
| | - Philippe Puyo
- Foch Hospital, Department of Thoracic Surgery, Suresnes, France.
| | - Mostafa El Hajjam
- APHP, Department of Radiology, Ambroise Paré Hospital, Boulogne, France.
| | - Sandra Blivet
- APHP, Department of Pulmonology and Thoracic Oncology, Ambroise Paré Hospital, Boulogne, France.
| | - Emmanuel Houdart
- APHP, Department of Neuroradiology, Lariboisière Hospital, Paris, France.
| | - Michel Aubier
- APHP, Department of Pulmonology, Bichat Hospital, Paris, France.
| | - Pascal Lacombe
- APHP, Department of Radiology, Ambroise Paré Hospital, Boulogne, France.
| | - Thierry Chinet
- APHP, Department of Pulmonology and Thoracic Oncology, Ambroise Paré Hospital, Boulogne, France.
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Dumoulin J, Rozensztajn N, Paradis M, Sellier J, Abel A, Giraud P, Labrune S, Chinet T. [Miliary cerebral carcinomatosis secondary to EGFR mutation-positive lung adenocarcinoma]. Rev Mal Respir 2015; 33:67-71. [PMID: 25794997 DOI: 10.1016/j.rmr.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Miliary brain metastases are a rare form of brain metastatic lesions. CASE REPORT We report the case of a 58-year-old patient with lung adenocarcinoma and an EGFR mutation, who had metastatic lesions in the bones, pleura and pericardia at the time of diagnosis. The patient was treated with tyrosine kinase inhibitor. A few months later, he presented with progressive neuropsychiatric symptoms, which were attributed to miliary brain metastases based on the radiological pattern (micronodules, some of which were calcified) and the elimination of alternative possible diagnoses. Despite tumour stability in the thorax and metastatic sites other than the brain, his neurological condition deteriorated, even after cerebral radiotherapy, leading to his death eight months after the diagnosis of lung cancer. CONCLUSION Miliary brain metastases are a rare form of brain metastases with unusual clinical presentation. The diagnosis is based on the radiological pattern of cerebral miliary dissemination, with sometimes calcified tumor nodules. Despite its rarity, several cases have been reported in lung adenocarcinoma in the presence of EGFR mutations.
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Affiliation(s)
- J Dumoulin
- Service de pneumologie et d'oncologie thoracique, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - N Rozensztajn
- Service de pneumologie et d'oncologie thoracique, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - M Paradis
- Équipe de liaison et de soins en addictologie et psychiatrie de liaison, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - J Sellier
- Service de radiologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - A Abel
- Service de soins palliatifs, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - S Labrune
- Service de pneumologie et d'oncologie thoracique, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - T Chinet
- Service de pneumologie et d'oncologie thoracique, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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Nedelec E, Giraud V, Tubiana S, Gomis T, Beauchet A, Chinet T. Formation des médecins généralistes à la spirométrie pour le dépistage de la BPCO : étude pilote. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.478] [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: 10/24/2022]
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Dinh-Xuan AT, Annesi-Maesano I, Berger P, Chambellan A, Chanez P, Chinet T, Degano B, Delclaux C, Demange V, Didier A, Garcia G, Magnan A, Mahut B, Roche N. Contribution of exhaled nitric oxide measurement in airway inflammation assessment in asthma. A position paper from the French Speaking Respiratory Society. Rev Mal Respir 2014; 32:193-215. [PMID: 25704902 DOI: 10.1016/j.rmr.2014.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/27/2014] [Indexed: 01/06/2023]
Abstract
Nitric oxide (NO) is both a gas and a ubiquitous inter- and intracellular messenger with numerous physiological functions. As its synthesis is markedly increased during inflammatory processes, NO can be used as a surrogate marker of acute and/or chronic inflammation. It is possible to quantify fractional concentration of NO in exhaled breath (FENO) to detect airway inflammation, and thus improve the diagnosis of asthma by better characterizing asthmatic patients with eosinophilic bronchial inflammation, and eventually improve the management of targeted asthmatic patients. FENO measurement can therefore be viewed as a new, reproducible and easy to perform pulmonary function test. Measuring FENO is the only non-invasive pulmonary function test allowing (1) detecting, (2) quantifying and (3) monitoring changes in inflammatory processes during the course of various respiratory disorders, including corticosensitive asthma.
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Affiliation(s)
- A T Dinh-Xuan
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de physiologie-explorations fonctionnelles, université Paris-Descartes, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - I Annesi-Maesano
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Inserm et université de médecine Pierre-et-Marie-Curie, 75571 Paris cedex 12, France
| | - P Berger
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Centre de recherche cardio-thoracique Inserm U1045, université de Bordeaux, 33076 Bordeaux cedex, France
| | - A Chambellan
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Inserm UMR 1087, institut du thorax, 44007 Nantes cedex, France
| | - P Chanez
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de pneumologie, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France
| | - T Chinet
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de pneumologie, CHU Ambroise-Paré, 92104 Boulogne, France
| | - B Degano
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Explorations fonctionnelles, hôpital Jean-Minjoz, centre hospitalier régional universitaire, 25000 Besançon, France
| | - C Delclaux
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - V Demange
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Département épidémiologie en entreprise, INRS, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - A Didier
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de pneumologie, CHU de Toulouse, 24, chemin de Pouvourville - TSA, 31059 Toulouse cedex 9, France
| | - G Garcia
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de physiologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France
| | - A Magnan
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Inserm UMR 915, institut du thorax, CHU de Nantes, 44007 Nantes cedex, France
| | - B Mahut
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Cabinet de pédiatrie, 4, avenue de la Providence, 92160 Antony, France
| | - N Roche
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de pneumologie et soins intensifs respiratoires, Hôtel Dieu, groupe hospitalier Cochin-Broca, 75014 Paris, France
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