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Blay JY, Chevret S, Le Cesne A, Brahmi M, Penel N, Cousin S, Bertucci F, Bompas E, Ryckewaert T, Soibinet P, Boudou-Rouquette P, Saada Bouzid E, Soulie P, Valentin T, Lotz JP, Tosi D, Neviere Z, Cancel M, Ray-Coquard I, Gambotti L, Legrand F, Lamrani-Ghaouti A, Simon C, Even C, Massard C. Pembrolizumab in patients with rare and ultra-rare sarcomas (AcSé Pembrolizumab): analysis of a subgroup from a non-randomised, open-label, phase 2, basket trial. Lancet Oncol 2023; 24:892-902. [PMID: 37429302 DOI: 10.1016/s1470-2045(23)00282-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Sarcoma is a heterogeneous group of diseases with few treatment options. Immunotherapy has shown little activity in studies including unselected sarcomas, but immune checkpoint blockers have shown activity in specific histotypes. We evaluated the activity of pembrolizumab in rare and ultra-rare sarcomas. METHODS AcSé Pembrolizumab is an ongoing phase 2, basket, multitumour study investigating the activity of pembrolizumab monotherapy in rare cancers. Here, we report the results obtained in patients with selected histotypes of rare sarcomas (incidence of less than one case per 1 000 000 people per year) recruited at 24 French hospitals. Key inclusion criteria were age 15 years or older, Eastern Cooperative Oncology Group performance status of 0-1, and advanced disease that was untreated and resistant to treatment. Patients were given pembrolizumab 200 mg intravenously on day 1 of every 21-day cycle for a maximum of 24 months. The primary endpoint was objective response rate at week 12 using Response Evaluation Criteria in Solid Tumours version 1.1, assessed by local investigators. The primary endpoint and safety were analysed in the intention-to-treat population. The AcSé Pembrolizumab study is registered with ClinicalTrials.gov, NCT03012620. FINDINGS Between Sept 4, 2017, and Dec 29, 2020, 98 patients were enrolled, of whom 97 received treatment and were included in analyses (median age 51 years [IQR 35-65]; 53 [55%] were male; 44 [45%] were female; no data were collected on race or ethnicity). 34 (35%) patients had chordomas, 14 (14%) had alveolar soft part sarcomas, 12 (12%) had SMARCA4-deficient sarcomas or malignant rhabdoid tumours, eight (8%) had desmoplastic small round cell tumours, six (6%) had epithelioid sarcomas, four (4%) had dendritic cell sarcomas, three (3%) each had clear cell sarcomas, solitary fibrous tumours, and myxoid liposarcomas, and ten (10%) had other ultra-rare histotypes. As of data cutoff (April 11, 2022), median follow-up was 13·1 months (range 0·1-52·8; IQR 4·3-19·7). At week 12, objective response rate was 6·2% (95% CI 2·3-13·0), with no complete responses and six partial responses in the 97 patients. The most common grade 3-4 adverse events were anaemia (eight [8%] of 97), alanine aminotransferase and aspartate aminotransferase increase (six [6%]), and dyspnoea (five [5%]). 86 serious adverse events were reported in 37 patients. Five deaths due to adverse events were reported, none of which were determined to be related to treatment (two due to disease progression, two due to cancer, and one due to unknown cause). INTERPRETATION Our data show the activity and manageable toxicity of pembrolizumab in some rare and ultra-rare sarcoma histotypes, and support the PD-1/PD-L1 pathway as a potential therapeutic target in selected histotypes. The completion of the basket study will provide further evidence regarding the activity and toxicity of pembrolizumab in identified rare types of cancer. FUNDING The Ligue contre le cancer, INCa, MSD. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jean-Yves Blay
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France.
| | - Sylvie Chevret
- Service de Biostatistique, Hôpital Saint Louis (AP-HP), Université Paris Cité, Paris, France
| | - Axel Le Cesne
- Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | - Mehdi Brahmi
- Centre Léon Bérard & Université Claude Bernard Lyon 1, Lyon, France
| | | | | | | | - Emmanuelle Bompas
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Nantes, France
| | | | | | | | | | - Patrick Soulie
- Institut de Cancérologie de l'Ouest, Centre Paul Papin, Angers, France
| | | | | | - Diego Tosi
- Institut Régional du Cancer de Montpellier, Centre Val d'Aurelle, Montpellier, France
| | | | | | | | | | | | | | | | - Caroline Even
- Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
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2
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Toulemonde E, Chevret S, Battistella M, Neidhardt EM, Nardin C, Le Du F, Meyer N, Véron M, Gambotti L, Lamrani-Ghaouti A, Jamme P, Chaffaut C, De Pontville M, Saada-Bouzid E, Beylot-Barry M, Simon C, Jouary T, Marabelle A, Mortier L. Safety and efficacy of the anti-PD1 immunotherapy with nivolumab in trichoblastic carcinomas. Cancer Immunol Immunother 2023:10.1007/s00262-023-03449-9. [PMID: 37067554 DOI: 10.1007/s00262-023-03449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Trichoblastic carcinoma is a rare malignant cutaneous adnexal tumor with a risk of local invasion and distant metastasis. As of today, there is no consensus for the treatment of locally advanced or metastatic trichoblastic carcinoma. "AcSé Nivolumab" is a multi-center Phase II basket clinical trial (NCT03012581) evaluating the safety and efficacy of nivolumab in several cohorts of rare, advanced cancers. Here we report the results of nivolumab in patients with trichoblastic carcinoma. Of the eleven patients enrolled in the study, five patients had been previously treated by sonic hedgehog inhibitors. The primary endpoint 12-week objective response rate was 9.1% (N = 1/11) with 1 partial response. Six patients who progressed under previous lines of treatment showed stable disease at 12 weeks, reflecting a good control of the disease with nivolumab. Furthermore, 54.5% of the patients (N = 6/11) had their disease under control at 6 months. The 1-year overall survival was 80%, and the median progression-free survival was 8.4 months (95%CI, 5.7 to NA). With 2 responders (2 complete responses), the best response rate to nivolumab at any time was 18.2% (95%CI, 2.3-51.8%). No new safety signals were identified, and adverse events observed herein were previously described and well known with nivolumab monotherapy. These results are promising, suggesting that nivolumab might be an option for patients with advanced trichoblastic carcinomas. Further studies on larger cohorts are necessary to confirm these results and define the role of nivolumab in the treatment of trichoblastic carcinomas.
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Affiliation(s)
- E Toulemonde
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France.
| | - S Chevret
- Department of Biostatistics, Saint Louis Hospital, AP-HP, Paris, France
| | - M Battistella
- Department of Pathology, Saint Louis Hospital, AP-HP, Université Paris Cité, INSERM U976, Paris, France
- CARADERM Network, Lille, France
| | - E M Neidhardt
- Department of Oncology, Centre Léon Berard, Lyon, France
| | - C Nardin
- Department of Dermatology, CHU Besançon and INSERM 1098, Besançon, France
| | - F Le Du
- Department of Oncology, CLCC Eugène Marquis, Rennes, France
| | - N Meyer
- Department of Oncodermatology, IUC and CHU Toulouse, Toulouse, France
| | - M Véron
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France
| | - L Gambotti
- Department of Clinical Research, Institut National Contre Le Cancer (INCa), Paris, France
| | | | - P Jamme
- Department of Dermatology, Claude Huriez Hospital, CHU de Lille, Lille, France
| | - C Chaffaut
- Department of Biostatistics, Saint Louis Hospital, AP-HP, Paris, France
| | - M De Pontville
- Department of Dermatology, CHU Caen, Caen, France
- CARADERM Network, Lille, France
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine Lacassagne, Côte d'Azur University, Nice, France
| | - M Beylot-Barry
- Department of Dermatology, CHU Bordeaux, INSERM U1312, Bordeaux, France
- CARADERM Network, Lille, France
| | - C Simon
- Département R&D Unicancer, Paris, France
| | - T Jouary
- Department of Dermatology, François Mitterrand Hospital, Pau, France
- CARADERM Network, Lille, France
| | - A Marabelle
- Department of Therapeutic Innovations and Early Clinical Trials, INSERM U1015 & CIC1428, University of Paris Saclay, Gustave Roussy, Villejuif, France
| | - L Mortier
- Department of Dermatology, Claude Huriez Hospital, CARADERM and University of Lille, U1189 Inserm, 59000, Lille, France
- CARADERM Network, Lille, France
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3
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Roustit M, Demarcq O, Laporte S, Barthélémy P, Chassany O, Cucherat M, Demotes J, Diebolt V, Espérou H, Fouret C, Galaup A, Gambotti L, Gourio C, Guérin A, Labruyère C, Paoletti X, Porcher R, Simon T, Varoqueaux N. Les essais plateformes ☆. Therapie 2023; 78:19-28. [PMID: 36581520 PMCID: PMC9721267 DOI: 10.1016/j.therap.2022.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Les essais plateformes connaissent depuis quelques années un essor important, amplifié récemment par la pandémie de coronavirus disease 2019 (COVID-19). La mise en œuvre d’un essai plateforme s’avère particulièrement utile dans certaines pathologies, notamment lorsqu’il y a un nombre important de candidats médicaments à évaluer, une évolution rapide du traitement de référence ou dans les situations de besoin urgent d’évaluation, au cours desquelles la mutualisation des protocoles et des infrastructures permet d’optimiser le nombre de patients à inclure, les coûts et les délais de réalisation de l’investigation. Toutefois, la spécificité des essais plateformes soulève des problématiques méthodologiques, éthiques et règlementaires, qui ont fait l’objet de la table ronde et qui sont exposées dans cet article. La table ronde a également été l’occasion d’aborder la complexité de la promotion et de la gestion des données liée à la multiplicité des partenaires, le financement et la gouvernance de ces essais, et le niveau d’acceptabilité de leurs résultats par les autorités compétentes.
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Affiliation(s)
- Matthieu Roustit
- Inserm CIC1406, university Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France.
| | - Olivier Demarcq
- Pfizer, direction des affaires médicales, 75668 Paris, France
| | - Silvy Laporte
- Inserm, U 1059 Sainbiose, Mines Saint-Étienne, unité de recherche clinique, innovation, pharmacologie, université Jean Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Michel Cucherat
- metaEvidence.org, service hospitalo-universitaire de pharmacologie et toxicologie, hospices civils de Lyon, 69000 Lyon, France
| | | | - Vincent Diebolt
- F-CRIN, UMS 015, Pavillon Leriche, hôpital Purpan/CHU de Toulouse, 31059 Toulouse, France
| | - Hélène Espérou
- Inserm, pôle de recherche clinique, Institut de santé publique, 75013 Paris, France
| | - Cécile Fouret
- Medtronic, direction des affaires scientifiques, 75014 Paris, France
| | | | - Laetitia Gambotti
- Département recherche clinique, Institut national du cancer, 92100 Boulogne-Billancourt, France
| | | | | | - Carine Labruyère
- Inserm, U 1059 Sainbiose, Mines Saint-Étienne, unité de recherche clinique, innovation, pharmacologie, université Jean Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - Xavier Paoletti
- Inserm U900, équipe de statistique pour la médecine de précision (STAMPM), Institut Curie, université de Versailles St Quentin/Paris-Saclay, 92210 St-Cloud, France
| | - Raphael Porcher
- Inserm, Inra, centre d'épidémiologie clinique, université Paris Cité, METHODS Team, CRESS, Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 75004 Paris, France
| | - Tabassome Simon
- Service de pharmacologie, plateforme de recherche clinique de l'Est parisien, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75012 Paris, France
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4
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Roustit M, Demarcq O, Laporte S, Barthélémy P, Chassany O, Cucherat M, Demotes J, Diebolt V, Espérou H, Fouret C, Galaup A, Gambotti L, Gourio C, Guérin A, Labruyère C, Paoletti X, Porcher R, Simon T, Varoqueaux N. Platform trials. Therapie 2023; 78:29-38. [PMID: 36529559 PMCID: PMC9756081 DOI: 10.1016/j.therap.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
For the past few years, platform trials have experienced a significant increase, recently amplified by the COVID-19 pandemic. The implementation of a platform trial is particularly useful in certain pathologies, particularly when there is a significant number of drug candidates to be assessed, a rapid evolution of the standard of care or in situations of urgent need for evaluation, during which the pooling of protocols and infrastructure optimizes the number of patients to be enrolled, the costs, and the deadlines for carrying out the investigation. However, the specificity of platform trials raises methodological, ethical, and regulatory issues, which have been the subject of the round table and which are presented in this article. The round table was also an opportunity to discuss the complexity of sponsorship and data management related to the multiplicity of partners, funding, and governance of these trials, and the level of acceptability of their findings by the competent authorities.
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Affiliation(s)
- Matthieu Roustit
- Inserm CIC1406, university Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France,Corresponding author. Centre d’investigation clinique – Inserm CIC1406, CHU Grenoble Alpes, 38043 Grenoble cedex 09, France
| | - Olivier Demarcq
- Pfizer, direction des affaires médicales, 75668 Paris, France
| | - Silvy Laporte
- Inserm, U 1059 Sainbiose, Mines Saint-Étienne, unité de recherche clinique, innovation, pharmacologie, université Jean Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP–HP, 75004 Paris, France
| | - Michel Cucherat
- metaEvidence.org, service hospitalo-universitaire de pharmacologie et toxicologie, hospices civils de Lyon, 69000 Lyon, France
| | | | - Vincent Diebolt
- F-CRIN, UMS 015, Pavillon Leriche, hôpital Purpan/CHU de Toulouse, 31059 Toulouse, France
| | - Hélène Espérou
- Inserm, pôle de recherche clinique, Institut de santé publique, 75013 Paris, France
| | - Cécile Fouret
- Medtronic, direction des affaires scientifiques, 75014 Paris, France
| | | | - Laetitia Gambotti
- Département recherche clinique, Institut national du cancer, 92100 Boulogne-Billancourt, France
| | | | | | - Carine Labruyère
- Inserm, U 1059 Sainbiose, Mines Saint-Étienne, unité de recherche clinique, innovation, pharmacologie, université Jean Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - Xavier Paoletti
- Inserm U900, équipe de statistique pour la médecine de précision (STAMPM), Institut Curie, université de Versailles St Quentin/Paris-Saclay, 92210 St-Cloud, France
| | - Raphael Porcher
- Inserm, Inra, centre d’épidémiologie clinique, université Paris Cité, METHODS Team, CRESS, Hôtel-Dieu, Assistance publique–Hôpitaux de Paris, 75004 Paris, France
| | - Tabassome Simon
- Service de pharmacologie, plateforme de recherche clinique de l’Est parisien, Sorbonne université, Assistance publique–Hôpitaux de Paris, 75012 Paris, France
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5
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Zhao J, Tostivint I, Xu L, Huang J, Gambotti L, Boffa JJ, Yang M, Wang L, Sun Z, Chen X, Liou-Schischmanoff A, Baumelou A, Ma T, Lu G, Li L, Chen D, Piéroni L, Liu B, Qin X, He W, Wang Y, Gu HF, Sun W. Efficacy of Combined Abelmoschus manihot and Irbesartan for Reduction of Albuminuria in Patients With Type 2 Diabetes and Diabetic Kidney Disease: A Multicenter Randomized Double-Blind Parallel Controlled Clinical Trial. Diabetes Care 2022; 45:e113-e115. [PMID: 35613364 PMCID: PMC9274216 DOI: 10.2337/dc22-0607] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/20/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Jing Zhao
- Department of Nephrology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Isabelle Tostivint
- Department of Nephrology, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France.,Centre of Integrative Chinese Medicine, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Lingdong Xu
- Department of Nephrology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jihan Huang
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Laetitia Gambotti
- Department of Clinical Research, National Cancer Institute, Boulogne-Billancourt, France
| | - Jean-Jacques Boffa
- Centre of Integrative Chinese Medicine, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France.,Department of Nephrology, Sorbonne University, Hospital Tenon, Paris, France
| | - Min Yang
- Department of Nephrology, The First People's Hospital of Changzhou, Changzhou, China
| | - Ling Wang
- Department of Nephrology, The First People's Hospital of Xuzhou, Xuzhou, China
| | - Zhuxing Sun
- Department of Nephrology, Wuxi People's Hospital, Wuxi, China
| | - Xiaolan Chen
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, China
| | - Amélie Liou-Schischmanoff
- Centre of Integrative Chinese Medicine, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France.,Department of Pharmacy, Sorbonne University, Pitié Salpêtrière, Paris, France
| | - Alain Baumelou
- Department of Nephrology, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France.,Centre of Integrative Chinese Medicine, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Teng Ma
- Department of Nephrology, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Guoyuan Lu
- Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ling Li
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Dai Chen
- Department of Nephrology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
| | - Laurence Piéroni
- Department of Biochemistry - Hormonology, Sorbonne University, Hospital Tenon, Paris, France
| | - Bingkai Liu
- Centre of Integrative Chinese Medicine, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Xiao Qin
- Department of Nephrology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Weiming He
- Department of Nephrology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuejuan Wang
- Department of Nephrology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Harvest F Gu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Wei Sun
- Department of Nephrology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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6
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Ray-Coquard IL, Penel N, Bompas E, Coquan E, Soulie P, Cousin S, Bertucci F, Tosi D, Heudel PE, Abdeddaim C, Pautier P, Kalbacher E, Selle F, Floquet A, Gambotti L, Simon C, Lamrani-Ghaouti A, Chevret S, Even C. Potential clinical activity of pembrolizumab monotherapy in ovarian sex cords, rare epithelial carcinoma, and other rare ovarian tumor histotypes: The French AcSé pembrolizumab study from Unicancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5572 Background: AcSé Pembrolizumab is a Phase 2, non-randomized parallel arms, multicentric basket trial investigating the efficacy and safety of pembrolizumab monotherapy in different cohorts of patients with rare cancers (NCT03012620). Here we report the results in the rare ovarian tumors cohort. Methods: Selected histotypes were all rare ovarian cancers (incidence < 6/100,000/year). Main inclusion criteria were age > 18, ECOG PS≤1, resistant disease to platinum based chemotherapy, and systematic histological central review by expert pathologist from TMRG network. Patients (pts) received pembrolizumab 200 mg IV on Day 1 of every 21-day cycle for a maximum of 2 years. The primary endpoint was the confirmed objective response rate according to RECIST v1.1 at 12 weeks. Secondary endpoints included best response rate, duration of response, progression-free survival (PFS), overall survival (OS), and safety. The 7 subgroups of pts analyzed were carcinosarcoma (CS), clear cell carcinoma (CCC), low grade serous carcinoma (LGSC), mucinous carcinoma (MEOC), sex cord tumors (SCT), germ cell tumor (GCT), and smarcA4 deficient hypercalcemic ovarian tumor (SCHOCCT). Results: 62 pts from 22 centers, were included from 08/2017 to 12/2020. Median Age was 53.5 years old [36-64]. Median number of previous lines of chemotherapy was 2 (range 1-4). The median number of cycles was 8 (range, 1-35) with 44 pts (70.9%) who discontinued the trial after a mean number of 6.8 cycles. There were 2 pts (3.2%) with partial response (PR) at 12 weeks. The best response in ITT was complete response (CR) in 1 patient (1%), PR in 3 (14.3%), and stable disease (SD) in 21 (33.8%). The occurrence of best response depended on the histotype with 1 CR (33%) in GCT (cancerized teratoma), 2 PR (20%) in CCC, and 1 PR (4%) in LGSC. 4/4 pts (100%) reported PD as best response in SCOOHT (Table 1). Median duration of response or stabilized disease was 7.8 months [IQR, 4.1 to 9.0]. At the data cut off, 6-month PFS was 29% [19.7-42.8] and 6-month OS was 77.8% [67.7-89.3] on the overall population. Outcomes differed according to subgroups and will be presented. There were a total of 62 adverse events (AEs) reported in 28 pts. For 5 pts (8%) AEs lead to drug discontinuation. AEs were of grade 1 (n = 9), grade 2 (n = 8), or grade ≥ 3 (n = 45: 42 grade 3, 2 grade 4, and 1 grade 5). Conclusions: Pembrolizumab is safe and well tolerate in this population of rare ovarian cancer pts. AcSé study reports prolonged responses in very selected subtypes of rare ovarian tumor (CCC, cancerized teratoma, and LGCS). Acknowledgements: TMRG (national cancer network dedicated to rare gynecological tumors), GINECO group for partnership, La Ligue Nationale contre le Cancer, INCa and MSD. Clinical trial information: NCT03012620. [Table: see text]
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Affiliation(s)
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | | | | | | | - Francois Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Diego Tosi
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | | | - Cyril Abdeddaim
- Centre de Lutte Contre le Cancer-Centre Oscar Lambret, Lille, France
| | - Patricia Pautier
- GINECO, French Sarcoma Group and Gustave Roussy Cancer Center, Villejuif, France
| | - Elsa Kalbacher
- Groupe d’Investigateurs Nationaux pour l’Etute des Cancers Ovariens and CHRU Jean Minjoz, Besançon, France
| | | | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, Bordeaux, France
| | | | | | | | | | - Caroline Even
- Head and Neck Department, Gustave Roussy, Villejuif, France
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7
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Blay JY, Penel N, Ray-Coquard IL, Cousin S, Bertucci F, Bompas E, Eymard JC, Saada-Bouzid E, Soulie P, Boudou-Rouquette P, Dufresne A, Le Cesne A, Mir O, Gambotti L, Legrand F, Simon C, Lamrani-Ghaouti A, Chevret S, Massard C. High clinical activity of pembrolizumab in chordoma, alveolar soft part sarcoma (ASPS) and other rare sarcoma histotypes: The French AcSé pembrolizumab study from Unicancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11520] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11520 Background: AcSé Pembrolizumab is a Phase 2, non-randomized parallel arms, open-label, multicentric study from Unicancer investigating the efficacy and safety of pembrolizumab monotherapy in different cohorts of patients with rare cancers (NCT03012620). Here we report the results of pembrolizumab in the rare sarcoma cohort. Methods: Selected histotypes were all rare sarcomas patients (pts) (incidence < 0.2/100,000/year). Main inclusion criteria were age > 18, ECOG PS≤1 and advanced or metastatic disease resistant to standard treatment. Patients received pembrolizumab 200 mg IV as a 30-minute infusion on Day 1 of every 21-day cycle for a maximum of 2 years. The primary endpoint was the confirmed objective response rate according to RECIST v1.1 at 12 weeks. Secondary endpoints included clinical benefit rate, duration of response, progression-free survival (PFS), overall survival (OS), and safety. Five groups of pts were distinguished, namely chordoma, alveolar soft-part sarcoma (ASPS), desmoplastic small round cell tumor (DSRCT), smarca4 deficient malignant rhabdoid tumor (SMRT), and other histotypes. Results: 98 patients including 34 with chordoma, 14 ASPS, 11 SMRT, 8 DSCRT and 31 with other histotypes, were included from July 2017 to December 2020. The median number of cycles was 5 (range, 1 to 35) with 78 (79.6%) patients who discontinued the trial after a median of 4 cycles. There were 6 (7.3%) partial response (PR) at 12 weeks. The best response was CR in 1 patient (1%), PR in 14 patients (14.3%), and stable disease (SD) in 33 (33.7%). Median duration of response was 8.2 months [IQR, 4.1 to 9.0]. The occurrence of best response depended on the histotype, with 3 (8.8%) responses in chordoma, 7 (50%) in ASPS, 3 (27%) in SMRT, 1 (12.5%) in DSCRT and 1 (3.2%) in other histotypes (p = 0.0011). At the data cut off, median PFS was 2.75 months, and median OS was 19.7 months on the overall population. Outcomes differed according to the histotype group, with the 12 months PFS rates at 31.2% (chordoma), 35.7% (ASPS), 18.2% (SMRT), 0% (DSCRT) and 3.3% (other), respectively (p < 0.0001), and median PFS at 6.6 (chordoma), 7.5 (ASPS), 1.1 (SMRT), 2.1 (DSCRT) and 2.1 months (other), while 1-year OS rates were 76.6% (chordoma), 85.7% (ASPS), 36.4% (SMRT), 17.5% (DSCRT) and 42.9% (other) with median OS only reached for SMRT (2.4 months), DSRCT (10 months), and the other histotype group (7.1 months) (p = 0.004). The side effect profile of pembrolizumab was similar to other tumor type. Conclusions: Pembrolizumab is safe and well tolerate in this pop od STS pts, AcSé study reports high levels response rate and prolonged activity in selected subtypes of rare sarcomas. Clinical trial information: NCT03012620.
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Affiliation(s)
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | - Sophie Cousin
- Medical Oncology, Institute Bergonié, Bordeaux, France
| | - Francois Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | | | | | | | | | | | | | | | - Olivier Mir
- Gustave Roussy Cancer Institute, Villejuif, France
| | | | | | | | | | | | - Christophe Massard
- Gustave Roussy-Department of Therapeutic Innovation and Early Trials (DITEP), Paris, France
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8
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Brunet A, Ayrolles A, Gambotti L, Maatoug R, Estellat C, Descamps M, Girault N, Kalalou K, Abgrall G, Ducrocq F, Vaiva G, Jaafari N, Krebs MO, Castaigne E, Hanafy I, Benoit M, Mouchabac S, Cabié MC, Guillin O, Hodeib F, Durand-Zaleski I, Millet B. Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015-16 terrorist attacks. BMC Psychiatry 2019; 19:351. [PMID: 31703570 PMCID: PMC6842179 DOI: 10.1186/s12888-019-2283-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/11/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to clinicians in this context. METHODS This study protocol is a two-arm non-randomized, multicenter controlled trial, comparing RT to treatment as usual for the treatment of trauma-related disorders. RT consists of actively recalling one's traumatic event under the influence of the ß-blocker propranolol, once a week, for 10-25 min with a therapist, over 6 consecutive weeks. This protocol evaluates the feasibility, effectiveness, and cost-utility of implementing RT as part of a large multi-center (N = 400) pragmatic trial with a one-year follow-up. DISCUSSION Paris MEM is the largest trial to date assessing the efficiency of RT in the aftermath of a large-scale man-made disaster. RT could possibly reinforce the therapeutic arsenal for the treatment of patients suffering from trauma-related disorders, not only for communities in western countries but also worldwide for terror- or disaster-stricken communities. TRIAL REGISTRATION Clinical Trials (ClinicalTrials.gov). June 3, 2016. NCT02789982.
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Affiliation(s)
- A. Brunet
- Département de Psychiatrie adulte, boulevard de l’Hôpital, 75013 Paris, France
- Department of Psychiatry, McGill University, Montréal, Canada
| | - A. Ayrolles
- Département de Psychiatrie adulte, boulevard de l’Hôpital, 75013 Paris, France
- Département de Psychiatrie adulte, Hôpital Universitaire de la Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, boulevard de l’Hôpital, 75013 Paris, France
| | - L. Gambotti
- Département de Psychiatrie adulte, Hôpital Universitaire de la Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, boulevard de l’Hôpital, 75013 Paris, France
| | - R. Maatoug
- Département de Psychiatrie adulte, boulevard de l’Hôpital, 75013 Paris, France
- Département de Psychiatrie adulte, Hôpital Universitaire de la Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, boulevard de l’Hôpital, 75013 Paris, France
| | - C. Estellat
- Département de Psychiatrie adulte, Hôpital Universitaire de la Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, boulevard de l’Hôpital, 75013 Paris, France
| | - M. Descamps
- Département de Psychiatrie adulte, boulevard de l’Hôpital, 75013 Paris, France
- Department of Psychiatry, McGill University, Montréal, Canada
| | - N. Girault
- Département de Psychiatrie adulte, boulevard de l’Hôpital, 75013 Paris, France
- Département de Psychiatrie adulte, Hôpital Universitaire de la Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, boulevard de l’Hôpital, 75013 Paris, France
| | - K. Kalalou
- Unité de recherche clinique, EPS de Ville Evrard, G03, 5 rue du Dr Delafontaine, 93200 Saint-Denis, France
| | - G. Abgrall
- Assistance Publique - Hôpitaux de Paris -, Hôtel-Dieu, 75004 Paris, France
| | - F. Ducrocq
- France CHRU de Lille, Pôle de Psychiatrie Médecine Légale et Santé en milieu Pénitentiaire, SCA-Lab CNRS UMR 9193, 59037 cedex Lille, France
| | - G. Vaiva
- France CHRU de Lille, Pôle de Psychiatrie Médecine Légale et Santé en milieu Pénitentiaire, SCA-Lab CNRS UMR 9193, 59037 cedex Lille, France
| | - N. Jaafari
- CIC INSERM U802, CHU de Poitiers, Unité de recherche clinique intersectorielle en psychiatrie du Centre Hospitalier Henri Laborit, 86022 Poitiers, France
| | - M. O. Krebs
- Centre Hospitalier Sainte Anne, Service Hospitalo-Universitaire, Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - E. Castaigne
- Service de Psychiatrie, CHU de Bicêtre, HUPS, APHP 78, rue du général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - I. Hanafy
- CH Marne La Vallée, Service de Médecine Légale, 77420 Marne-La-Vallée, France
| | - M. Benoit
- Clinical Neuroscience Department Hospital Pasteur 1, France University of Côte d’Azur, 30 avenue de la voie, 06002 NICE cedex 1 Romaine, France
| | - S. Mouchabac
- Département de psychiatrie et de psychologie médicale de l’adulte, Hôpital universitaire Saint-Antoine, Université Pierre et Marie Curie, Paris VI - AP-HP, 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - M. C. Cabié
- Pôle Paris 11 Les Hôpitaux de Saint Maurice, 12-14 rue Val d’Osne, 94410 St Maurice, France
| | - O. Guillin
- Service Hospitalo-universitaire, CH du Rouvray, 4 rue Paul Eluard, 76300 Sotteville-lès-Rouen, France
- unité Inserm U1079 Faculté de médecine et de pharmacie, 76000 Rouen, France
| | - F. Hodeib
- Département de Psychiatrie adulte, boulevard de l’Hôpital, 75013 Paris, France
- Département de Psychiatrie adulte, Hôpital Universitaire de la Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, boulevard de l’Hôpital, 75013 Paris, France
| | - I. Durand-Zaleski
- ECEVE, UMR 1123 URCEco Ile de France Hôtel Dieu, 1 place du Parvis de Notre Dame, 75004 Paris, France
| | - B. Millet
- Département de Psychiatrie adulte, boulevard de l’Hôpital, 75013 Paris, France
- Département de Psychiatrie adulte, Hôpital Universitaire de la Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, boulevard de l’Hôpital, 75013 Paris, France
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Pivot X, Romieu G, Debled M, Pierga JY, Kerbrat P, Bachelot T, Lortholary A, Espié M, Fumoleau P, Serin D, Jacquin JP, Jouannaud C, Rios M, Abadie-Lacourtoisie S, Venat-Bouvet L, Cany L, Catala S, Khayat D, Gambotti L, Pauporté I, Faure-Mercier C, Paget-Bailly S, Henriques J, Grouin JM. 6 months versus 12 months of adjuvant trastuzumab in early breast cancer (PHARE): final analysis of a multicentre, open-label, phase 3 randomised trial. Lancet 2019; 393:2591-2598. [PMID: 31178155 DOI: 10.1016/s0140-6736(19)30653-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [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] [Received: 01/20/2019] [Revised: 02/16/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2013, the interim analysis of the Protocol for Herceptin as Adjuvant therapy with Reduced Exposure (PHARE) trial could not show that 6 months of adjuvant trastuzumab was non-inferior to 12 months. Here, we report the planned final analysis based on the prespecified number of occurring events. METHODS PHARE is an open-label, phase 3, non-inferiority randomised trial of patients with HER2-positive early breast cancer comparing 6 months versus 12 months of trastuzumab treatment concomitant with or following standard neoadjuvant or adjuvant chemotherapy. The study was undertaken in 156 centres in France. Eligible patients were women aged 18 years or older with non-metastatic, operable, histologically confirmed adenocarcinoma of the breast and either positive axillary nodes or negative axillary nodes but a tumour of at least 10 mm. Participants must have received at least four cycles of a chemotherapy for this breast cancer and have started receiving adjuvant trastuzumab-treatment. Eligible patients were randomly assigned to either 6 months or 12 months of trastuzumab therapy duration between the third and sixth months of adjuvant trastuzumab. The randomisation was stratified by concomitant or sequential treatment with chemotherapy, oestrogen receptor status, and centre. The primary objective was non-inferiority in the intention-to-treat population in the 6-month group in terms of disease-free survival with a prespecified hazard margin of 1·15. This trial is registered with ClinicalTrials.gov, number NCT00381901. FINDINGS 3384 patients were enrolled and randomly assigned to either 12 months (n=1691) or 6 months (n=1693) of adjuvant trastuzumab. One patient in the 12-month group and three patients in the 6-month group were excluded, so 1690 patients in each group were included in the intention-to-treat analysis. At a median follow-up of 7·5 years (IQR 5·3-8·8), 704 events relevant to disease-free survival were observed (345 [20·4%] in the 12-month group and 359 [21·2%] in the 6-month group). The adjusted hazard ratio for disease-free survival in the 12-month group versus the 6-month group was 1·08 (95% CI 0·93-1·25; p=0·39). The non-inferiority margin was included in the 95% CI. No differences in effects pertaining to trastuzumab duration were found in any of the subgroups. After the completion of trastuzumab treatment, rare adverse events occurred over time and the safety analysis remained similar to the previously published report. In particular, we found no change in the cardiac safety comparison, and only three additional cases in which the left ventricular ejection fraction decreased to less than 50% have been reported in the 12-month group. INTERPRETATION The PHARE study did not show the non-inferiority of 6 months versus 12 months of adjuvant trastuzumab. Hence, adjuvant trastuzumab standard duration should remain 12 months. FUNDING The French National Cancer Institute.
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Affiliation(s)
| | | | | | | | | | | | | | - Marc Espié
- University Hospital Saint-Louis, Paris, France
| | | | | | | | | | - Maria Rios
- Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France
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Curtit E, Henriques J, Paget-Bailly S, Ladoire S, Darut-Jouve A, Debled M, Romieu G, Garnier-Tixidre C, Jacquin JP, Soulie P, Jouannaud C, Rios M, Petit T, Bachelot TD, Faure-Mercier C, Gambotti L, Blanché H, Deleuze JF, Cox D, Pivot X. Prognosis value of a genetic score based on germline genetic variants in a prospective cohort of early triple-negative breast cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1529 Background: Triple-negative breast cancers (TNBC) are a heterogeneous group of tumors with poor outcome. In this study, the association between germline genetic variants and invasive disease-free survival (iDFS) was analyzed in TNBC patients. Methods: A genome wide-association study (GWAS) aimed to identify variants (single nucleotide polymorphisms – SNPs) associated with prognosis in 1121 patients with TNBC in the SIGNAL prospective cohort. Associations between gene variants and iDFS were assessed in univariate Cox regression models. Variants were combined in a score to identify risk categories. A prognostic model based on breast cancer stage and genetic variants was estimated using a multivariate Cox regression. Interaction between stage and genetic score was tested. Discrimination of the model was assessed by the Harrell’s C statistic and internal validity by bootstrap method. Results: The characteristics of the 1121 patients were representative of a population with early TNBC. Four SNPs on chromosomes 9 and 2 were found significantly associated to iDFS in univariate Cox models. Homozygous status for the most frequent allele was associated with poorer iDFS for two SNPs and this status was present in 50% and 57% of the population. For the two other SNPs, the most frequent allele was associated with more favorable iDFS. Three prognostic categories were derived from the genetic score. The following table presents the results from the multivariate Cox model including genetic score and disease stage. Clinical trial information: RECF1098. Conclusions: In a prospective cohort of 1121 patients with early TNBC, 4 genetic variants (SNPs) were associated with iDFS. A score involving SNPs provided similar prognostic indications as breast cancer stages. A search assessing the function and the role of the involved genes is ongoing.[Table: see text]
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Affiliation(s)
- Elsa Curtit
- University Hospital - Medical Oncology Department, Besançon, France
| | - Julie Henriques
- Methodology and Quality of Life Unit, Department of Oncology University Hospital, Besançon, France
| | - Sophie Paget-Bailly
- Methodological and Quality of Life Unit in Oncology (INSERM UMR 1098), University Hospital, Besançon, France
| | - Sylvain Ladoire
- Dpt of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | | | | | | | - Jean-Philippe Jacquin
- GINECO-Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | | | | | | | - Thierry Petit
- Paul Strauss Cancer Center and University of Strasbourg, Strasbourg, France
| | | | | | | | | | | | | | - Xavier Pivot
- Administrateur de l’Institut Régional du Cancer, Strasbourg Cedex, France
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11
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Nicolian S, Butel T, Gambotti L, Durand M, Filipovic-Pierucci A, Mallet A, Kone M, Durand-Zaleski I, Dommergues M. Cost-effectiveness of acupuncture versus standard care for pelvic and low back pain in pregnancy: A randomized controlled trial. PLoS One 2019; 14:e0214195. [PMID: 31009470 PMCID: PMC6476478 DOI: 10.1371/journal.pone.0214195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 01/23/2019] [Indexed: 01/13/2023] Open
Abstract
Objective To assess the cost-effectiveness of acupuncture for pelvic girdle and low back pain (PGLBP) during pregnancy. Design Pragmatic-open-label randomised controlled trial. Setting Five maternity hospitals Population Pregnant women with PGLBP Method 1:1 randomization to standard care or standard care plus acupuncture (5 sessions by an acupuncturist midwife). Main outcome measure Efficacy: proportion of days with self-assessed pain by numerical rating scale (NRS) ≤ 4/10. Cost effectiveness (societal viewpoint, time horizon: pregnancy): incremental cost per days with NRS ≤ 4/10. Indirect non-healthcare costs included daily compensations for sick leave and productivity loss caused by absenteeism or presenteeism. Results 96 women were allocated to acupuncture and 103 to standard care (total 199). The proportion of days with NRS ≤ 4/10 was greater in the acupuncture group than in the standard care group (61% vs 48%, p = 0.007). The mean Oswestry disability score was lower in the acupuncture group than with standard care alone (33 versus 38, Δ = 5, 95% CI: 0.8 to 9, p = 0.02). Average total costs were higher in the control group (€2947) than in the acupuncture group (€2635, Δ = —€312, 95% CI: -966 to +325), resulting from the higher indirect costs of absenteeism and presenteeism. Acupuncture was a dominant strategy when both healthcare and non-healthcare costs were included. Costs for the health system (employer and out-of-pocket costs excluded) were slightly higher for acupuncture (€1512 versus €1452, Δ = €60, 95% CI: -272 to +470). Conclusion Acupuncture was a dominant strategy when accounting for employer costs. A 100% probability of cost-effectiveness was obtained for a willingness to pay of €100 per days with pain NRS ≤ 4.
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Affiliation(s)
- Stephanie Nicolian
- AP-HP, Service de Gynécologie-Obstétrique- Hôpital Universitaire Pitié-Salpêtrière- Charles Foix, Paris, France
- AP-HP, Centre intégré de médecine chinoise—Hôpital Universitaire Pitié-Salpêtrière- Charles Foix, Paris, France
- INSERM and AP-HP, CIC-1421, Hôpital Universitaire Pitié-Salpêtrière- Charles Foix, Paris, France
| | - Thibault Butel
- AP-HP Unité de recherche clinique en économie de la santé—hôpital Hôtel-Dieu, Paris, France
| | - Laetitia Gambotti
- AP-HP Unité de recherche Clinique, Hôpital Universitaire Pitié-Salpêtrière- Charles Foix, Paris, France
| | - Manon Durand
- INSERM and AP-HP, CIC-1421, Hôpital Universitaire Pitié-Salpêtrière- Charles Foix, Paris, France
| | | | - Alain Mallet
- AP-HP Unité de recherche Clinique, Hôpital Universitaire Pitié-Salpêtrière- Charles Foix, Paris, France
| | - Mamadou Kone
- AP-HP Unité de recherche Clinique, Hôpital Universitaire Pitié-Salpêtrière- Charles Foix, Paris, France
| | | | - Marc Dommergues
- AP-HP, Service de Gynécologie-Obstétrique- Hôpital Universitaire Pitié-Salpêtrière- Charles Foix, Paris, France
- Sorbonne Université, Paris, France
- * E-mail:
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Gambotti L, Schwob E, Schouman T, Murcier G, Goudot P, Mallet A, Bertolus C. Are elderly patients presenting with squamous cell carcinoma of the oral cavity given the appropriate treatment? Surg Oncol 2018; 27:715-721. [PMID: 30449498 DOI: 10.1016/j.suronc.2018.04.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 12/11/2017] [Accepted: 04/30/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES There is no consensus for the specific management of elderly patients presenting with oral cavity squamous cell carcinomas (OC SCC). We report our findings in the treatment of primary OC SCC, for patients of 70 years of age or more, in a French university hospital center. PATIENTS AND METHODS One hundred and twenty five patients diagnosed between 2000 and 2010, were included retrospectively. Independent risk factors of post-operative complications were identified using a logistic regression. The overall survival (OS) was estimated using the Kaplan Meier method. Independent factors of survival were calculated using a Cox model. RESULTS The patient's median age was 78. Women presented significantly more premalignant lesions, less alcohol intoxication, and less tobacco consumption. Half of the population sample was staged T4 in the TNM classification. Eighty eight percent of the patients received a curative treatment. The independent risk factors for post-operative complications were T3/T4 stages (OR 4.3 [1.3-14.4]), lymph node metastasis (OR 6.9 [2.1-22.7]), and alcohol abuse (OR 3.5 [1.1-11.0]). The median OS was 14.0 months. The independent negative prognostic factors for OS for patients treated curatively were: age >79 years (HR 1.9 [1.2-3.2]), stage T2/T3/T4 tumor vs. T1 (HR = 3.0 [1.5-6.0], P = 0.001) and substandard surgery (HR = 1.8 [1.1-2.9], P = 0.03). CONCLUSIONS The management of OC SCC in elderly patients is complex and requires collaboration among gerontologists, surgeons and oncologists. The treatment choice is related to the disease extent and preoperative morbid conditions.
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Affiliation(s)
- Laetitia Gambotti
- Clinical Research Unit, Universitary Hospital Pitié Salpêtrière, AP-HP, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France.
| | - Emilie Schwob
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France
| | - Thomas Schouman
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France
| | - Gregory Murcier
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France
| | - Patrick Goudot
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France
| | - Alain Mallet
- Clinical Research Unit, Universitary Hospital Pitié Salpêtrière, AP-HP, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France; Department of Biostatistics, Universitary Hospital Pitié Salpêtrière, AP-HP, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France
| | - Chloé Bertolus
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France
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13
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Gambotti L, Pérol D, Frering B, Kaemmerlen P, Coronel B, Sebban H, Bulso V, Bachelot V, Chauvin F, Bachmann P. Safety of Percutaneous Internal Jugular Catheterization in Cancer Patients: Prospective Observational Study. J Vasc Access 2018; 5:161-7. [PMID: 16596560 DOI: 10.1177/112972980400500405] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose To determine predictors for failure and early complications of percutaneous internal jugular catheterization (IJC) in cancer patients. Methods Six hundred and thirty consecutive cancer patients who required central venous catheterization were included in a prospective observational study. The rates of failure (defined as the intervention of a second physician and/or failure at initial insertion site) and of early complications were prospectively ascertained. Logistic regression analysis estimated odds ratio (OR) and 95% confidence intervals (95% CI) for independent predictors for failure and early complications of percutaneous IJC. Results The failure rate was 6.7%, and the early complication rate was 6.7%. In multivariate analysis, left-side initial catheterization (p<0.01), prior catheterization at the same site (p=0.001) and physician inexperience (p<0.0001) were independently associated with failure. Placement requiring more than one needle pass (p<0.01 for two and p<0.0001 for three and more) and absence of fluoroscopy (p<0.0001) were independently associated with early complications. Conclusions Percutaneous IJC is a valid option in the central venous catheterization of cancer patients due to its reliability and safety. Skilled physicians must manage difficult placements. If placement requires more than one needle pass or is made without fluoroscopy, patients must be carefully followed for potential complications.
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Affiliation(s)
- L Gambotti
- Department of Public Health, Léon Bérard Center, Lyon, France
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Hansel B, Giral P, Gambotti L, Lafourcade A, Peres G, Filipecki C, Kadouch D, Hartemann A, Oppert JM, Bruckert E, Marre M, Bruneel A, Duchene E, Roussel R. A Fully Automated Web-Based Program Improves Lifestyle Habits and HbA1c in Patients With Type 2 Diabetes and Abdominal Obesity: Randomized Trial of Patient E-Coaching Nutritional Support (The ANODE Study). J Med Internet Res 2017; 19:e360. [PMID: 29117929 PMCID: PMC5700402 DOI: 10.2196/jmir.7947] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The prevalence of abdominal obesity and type 2 diabetes mellitus (T2DM) is a public health challenge. New solutions need to be developed to help patients implement lifestyle changes. OBJECTIVE The objective of the study was to evaluate a fully automated Web-based intervention designed to help users improve their dietary habits and increase their physical activity. METHODS The Accompagnement Nutritionnel de l'Obésité et du Diabète par E-coaching (ANODE) study was a 16-week, 1:1 parallel-arm, open-label randomized clinical trial. Patients with T2DM and abdominal obesity (n=120, aged 18-75 years) were recruited. Patients in the intervention arm (n=60) had access to a fully automated program (ANODE) to improve their lifestyle. Patients were asked to log on at least once per week. Human contact was limited to hotline support in cases of technical issues. The dietetic tool provided personalized menus and a shopping list for the day or the week. Stepwise physical activity was prescribed. The control arm (n=60) received general nutritional advice. The primary outcome was the change of the dietary score (International Diet Quality Index; DQI-I) between baseline and the end of the study. Secondary endpoints included changes in body weight, waist circumference, hemoglobin A1c (HbA1c) and measured maximum oxygen consumption (VO2 max). RESULTS The mean age of the participants was 57 years (standard deviation [SD] 9), mean body mass index was 33 kg/m² (SD 4), mean HbA1c was 7.2% (SD 1.1), and 66.7% (80/120) of participants were women. Using an intention-to-treat analysis, the DQI-I score (54.0, SD 5.7 in the ANODE arm; 52.8, SD 6.2 in the control arm; P=.28) increased significantly in the ANODE arm compared to the control arm (+4.55, SD 5.91 vs -1.68, SD 5.18; between arms P<.001). Body weight, waist circumference, and HbA1c changes improved significantly in the intervention. CONCLUSIONS Among patients with T2DM and abdominal obesity, the use of a fully automated Web-based program resulted in a significant improvement in dietary habits and favorable clinical and laboratory changes. The sustainability of these effects remains to be determined. TRIAL REGISTRATION ClinicalTrials.gov NCT02343107; http://clinicaltrials.gov/ct2/show/NCT02343107 (Archived by WebCite at http://www.webcitation.org/6uVMKPRzs).
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Affiliation(s)
- Boris Hansel
- Department of Endocrinology, Diabetology, Nutrition, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Diderot Université, Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Philippe Giral
- Department of Endocrinology, Hôpital Pitié-Salpêtrière, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France.,Université Pierre et Marie Curie, Université de Paris, Sorbonne Universités, Paris, France
| | - Laetitia Gambotti
- L'Unité de Recherche Clinique, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Gilbert Peres
- Université Pierre et Marie Curie, Université de Paris, Sorbonne Universités, Paris, France
| | - Claude Filipecki
- Department of Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Diana Kadouch
- Department of Endocrinology, Diabetology, Nutrition, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Agnes Hartemann
- Institute of Cardiometabolism and Nutrition, Paris, France.,Université Pierre et Marie Curie, Université de Paris, Sorbonne Universités, Paris, France.,Department of Diabetology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Michel Oppert
- Institute of Cardiometabolism and Nutrition, Paris, France.,Université Pierre et Marie Curie, Université de Paris, Sorbonne Universités, Paris, France.,Department of Nutrition, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Bruckert
- Department of Endocrinology, Hôpital Pitié-Salpêtrière, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France.,Université Pierre et Marie Curie, Université de Paris, Sorbonne Universités, Paris, France
| | - Michel Marre
- Department of Endocrinology, Diabetology, Nutrition, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Diderot Université, Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Arnaud Bruneel
- Department of Biochemistry, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emilie Duchene
- Institute of Cardiometabolism and Nutrition, Paris, France
| | - Ronan Roussel
- Department of Endocrinology, Diabetology, Nutrition, Hôpitaux Universitaires Paris-Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Diderot Université, Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Département Hospitalo-Universitaire, Fibrosis, Inflammation, Remodelling, Paris, France
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15
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Bréchot N, Demondion P, Santi F, Lebreton G, Pham T, Dalakidis A, Gambotti L, Luyt CE, Schmidt M, Hekimian G, Cluzel P, Chastre J, Leprince P, Combes A. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. European Heart Journal: Acute Cardiovascular Care 2017; 7:62-69. [DOI: 10.1177/2048872617711169] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Increased left ventricular afterload during peripheral venoarterial-extracorporeal membrane oxygenation (VA-ECMO) support frequently causes hydrostatic pulmonary oedema. Because physiological studies demonstrated left ventricular afterload decrease during VA-ECMO assistance combined with the intra-aortic balloon pump (IABP), we progressively changed our standard practice systematically to associate an IABP with VA-ECMO. This study aimed to evaluate IABP efficacy in preventing pulmonary oedema in VA-ECMO-assisted patients. Methods: A retrospective single-centre study. Results: Among 259 VA-ECMO patients included, 104 received IABP. Weinberg radiological score-assessed pulmonary oedema was significantly lower in IABP+ than IABP– patients at all times after ECMO implantation. This protection against pulmonary oedema persisted when death and switching to central ECMO were used as competing risks (subhazard ratio 0.49, 95% confidence interval (CI) 0.33–0.75; P<0.001). Multivariable analysis retained IABP as being independently associated with a lower risk of radiological pulmonary oedema (odds ratio (OR) 0.4, 95% CI 0.2–0.7; P=0.001) and a trend towards lower mortality (OR 0.54, 95% CI 0.29–1.01; P=0.06). Finally, the time on ECMO free from mechanical ventilation increased in IABP+ patients (2.2±4.3 vs. 0.7±2.0 days; P=0.0003). Less frequent pulmonary oedema and more days off mechanical ventilation were also confirmed in 126 highly comparable IABP+ and IABP– patients, propensity score matched for receiving an IABP. Conclusions: Associating an IABP with peripheral VA-ECMO was independently associated with a lower frequency of hydrostatic pulmonary oedema and more days off mechanical ventilation under ECMO.
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Affiliation(s)
- Nicolas Bréchot
- Medical-Surgical ICU, Hôpital Pitié–Salpêtrière, France
- INSERM U1050, Centre Interdisciplinaire de Recherche en Biologie, France
| | - Pierre Demondion
- Cardiac Surgery Department, Hôpital Pitié–Salpêtrière, France
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
| | - Francesca Santi
- Cardiac Surgery Department, Hôpital Pitié–Salpêtrière, France
| | - Guillaume Lebreton
- Cardiac Surgery Department, Hôpital Pitié–Salpêtrière, France
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
| | - Tai Pham
- Saint Michael’s Hospital, Interdepartmental Division of Critical Care, Canada
- University Paris Diderot, Sorbonne Paris Cité, France
| | | | | | - Charles-Edouard Luyt
- Medical-Surgical ICU, Hôpital Pitié–Salpêtrière, France
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
| | - Matthieu Schmidt
- Medical-Surgical ICU, Hôpital Pitié–Salpêtrière, France
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
| | - Guillaume Hekimian
- Medical-Surgical ICU, Hôpital Pitié–Salpêtrière, France
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
| | - Philippe Cluzel
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
- Radiology Department, Hôpital Pitié–Salpêtrière, France
| | - Jean Chastre
- Medical-Surgical ICU, Hôpital Pitié–Salpêtrière, France
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
| | - Pascal Leprince
- Cardiac Surgery Department, Hôpital Pitié–Salpêtrière, France
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
| | - Alain Combes
- Medical-Surgical ICU, Hôpital Pitié–Salpêtrière, France
- Sorbonne University, Institute of Cardiometabolism and Nutrition, France
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16
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Papeix C, Gambotti L, Assouad R, Ewenczyck C, Tanguy ML, Pineau F, Houis MC, Mazevet D, Maillart E, Lubetzki C. Evaluation of an integrated multidisciplinary approach in multiple sclerosis care: A prospective, randomized, controlled study. Mult Scler J Exp Transl Clin 2015; 1:2055217315608864. [PMID: 28607706 PMCID: PMC5433398 DOI: 10.1177/2055217315608864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 05/12/2015] [Accepted: 09/06/2015] [Indexed: 11/23/2022] Open
Abstract
Background Disabled multiple sclerosis (MS) patients often need intervention of multiple specialists, resulting in a complex organization of care. How this multidisciplinary care should be organized and structured has not been studied. Objective The objective of this article is to address the effectiveness of an integrated multidisciplinary approach versus usual care in MS patients. Methods This is a prospective, randomized, controlled, monocentric clinical trial in MS patients. Two treatment strategies were compared: (i) an integrated multidisciplinary (IMD) approach, consisting of a half-day individually tailored comprehensive assessment in the MS clinic; and (ii) a standard care. The primary outcome was the impact of the strategy on quality of life (QoL) measured using the MSIS-29 scale at inclusion and after six months. Results Fifty MS patients were included. Median MSIS 29 score decreased over six months in the control group (−4.89) and increased in the IMD group (+2.00), with a significant difference between the two groups (p = 0.03). However, in the multivariate analysis, after adjustment of HAD-D and INTERMED score, this difference was no longer significant. Conclusions This prospective, randomized study is the first attempt to evaluate the multidisciplinary approach in MS patients. The results show that, contrary to our expectations, an integrated multidisciplinary approach is not superior to usual care on QoL.
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Affiliation(s)
- Caroline Papeix
- AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, France
| | | | - Rana Assouad
- AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, France
| | | | | | - Fanny Pineau
- AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, France
| | | | - Dominique Mazevet
- AP-HP, Pitié-Salpêtrière Hospital, Department of Rehabilitation, France
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17
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Papeix C, Gambotti L, Assouad R, Ewenczyck C, Tanguy ML, Pineau F, Houis MC, Mazevet D, Maillart E, Lubetzki C. Evaluation of an integrated multidisciplinary approach in multiple sclerosis care: A prospective, randomized, controlled study. Mult Scler J Exp Transl Clin 2015. [PMID: 28607706 DOI: 10.1177/2055217315608864.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Disabled multiple sclerosis (MS) patients often need intervention of multiple specialists, resulting in a complex organization of care. How this multidisciplinary care should be organized and structured has not been studied. OBJECTIVE The objective of this article is to address the effectiveness of an integrated multidisciplinary approach versus usual care in MS patients. METHODS This is a prospective, randomized, controlled, monocentric clinical trial in MS patients. Two treatment strategies were compared: (i) an integrated multidisciplinary (IMD) approach, consisting of a half-day individually tailored comprehensive assessment in the MS clinic; and (ii) a standard care. The primary outcome was the impact of the strategy on quality of life (QoL) measured using the MSIS-29 scale at inclusion and after six months. RESULTS Fifty MS patients were included. Median MSIS 29 score decreased over six months in the control group (-4.89) and increased in the IMD group (+2.00), with a significant difference between the two groups (p = 0.03). However, in the multivariate analysis, after adjustment of HAD-D and INTERMED score, this difference was no longer significant. CONCLUSIONS This prospective, randomized study is the first attempt to evaluate the multidisciplinary approach in MS patients. The results show that, contrary to our expectations, an integrated multidisciplinary approach is not superior to usual care on QoL.
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Affiliation(s)
- Caroline Papeix
- AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, France
| | | | - Rana Assouad
- AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, France
| | | | | | - Fanny Pineau
- AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, France
| | | | - Dominique Mazevet
- AP-HP, Pitié-Salpêtrière Hospital, Department of Rehabilitation, France
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18
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Lemaire F, Marchenay B, Chassany O, Barthélémy P, Bouzzagou M, Comet D, Delval C, Dubray C, Fouret C, Frija-Orvoen E, Gambotti L, Lamarque V, d'Orsay G, Plattner V, Sibenaler C, Roux J, Thoby F. The European "clinical trial" regulation; relationship with the Jardé Act: a Giens workshop. Therapie 2015; 70:21-36. [PMID: 25679191 DOI: 10.2515/therapie/2014234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/06/2014] [Indexed: 11/20/2022]
Abstract
In May 2014, the European Union Parliament and Council published a new regulation on clinical trials on medicinal products for human use, which is designed to replace Directive 2001/20/EC. It will not come into effect until 2016. Nevertheless, it is essential to examine its relationship with national legislation, i.e. the Jardé Act, whose implementation has been delayed pending publication of the European regulation. The Giens workshop identified and examined the various issues that this relationship is bound to raise. In particular, it looked at trial methodology assessment procedures, the working relationship between the French National Agency of Drug Safety and Health Products (Agence Nationale de Sécurité du Médicament et des Produits de Santé, ANSM) and ethics committees during the authorization application evaluation phase, review of post-authorization/registration studies on medicinal products and medical devices, and data transparency.
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Affiliation(s)
| | | | - Olivier Chassany
- Université Paris Diderot, Paris, France - Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | - Claude Dubray
- Centre d'Investigation Clinique, Clermont-Ferrand, France
| | | | | | | | | | | | | | | | - Jacques Roux
- Laboratoire Glaxosmithkline, Marly-le-Roi, France
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19
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Lemaire F, Marchenay B, Chassany O, Barthélémy P, Bouzzagou M, Comet D, Delval C, Dubray C, Fouret C, Frija-Orvoen E, Gambotti L, Lamarque V, d’Orsay G, Plattner V, Sibenaler C, Roux J, Thoby F. Le règlement européen « essais cliniques » : articulation avec la loi Jardé : un atelier de Giens. Therapie 2015; 70:21-8. [DOI: 10.2515/therapie/2014229] [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: 11/14/2014] [Accepted: 12/06/2014] [Indexed: 11/20/2022]
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20
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Rothan-Tondeur M, Courcier S, Béhier JM, Leblanc J, Peoch N, Lefort MC, Barthélémy P, Bassompierre F, Bilbault P, Déal C, Diebolt V, Fraleux M, François B, Gambotti L, Lévy-Marchal C, Misse C, Roussel C, Sibenaler C, Simon T, Tavernier B, Thoby F. Promoting the place of the allied health professions in clinical research. Therapie 2014; 69:271-90. [PMID: 25099668 DOI: 10.2515/therapie/2014041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
Abstract
Clinical research is of major importance to today's society, as scientific evidence is increasingly demanded as a basis for progress, whether this involves developing new healthcare products, improving clinical practice and care protocols or progress in prevention. Clinical research therefore requires professionals who are both experienced and increasingly well trained. Against this background, allied health professionals are becoming involved more and more, both as team members supporting clinical research projects and as managers or coordinators of projects in their own field. Clinical research activities provide an ideal opportunity for continuing professional development. All of this means that the professional skills of the allied health professions and clinical research support professions must be enhanced, their role promoted in the context of lecturer status and in the longer term, their status recognised by the supervisory authorities.
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Affiliation(s)
| | | | | | | | | | - Nadia Peoch
- Direction des soins, CHU Toulouse, Toulouse, France
| | | | | | | | | | - Cécile Déal
- Laboratoire Novartis, Rueil-Malmaison, France
| | | | | | - Bruno François
- Centre d'investigation clinique, CHU Dupuytren, Limoges, France
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21
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Rothan-Tondeur M, Courcier S, Béhier JM, Leblanc J, Peoch N, Lefort MC, Barthélémy P, Bassompierre F, Bilbault P, Déal C, Diebolt V, Fraleux M, François B, Gambotti L, Lévy-Marchal C, Misse C, Roussel C, Sibenaler C, Simon T, Tavernier B, Thoby F. Comment promouvoir la place des paramédicaux dans la recherche clinique ? Therapie 2014; 69:271-80. [DOI: 10.2515/therapie/2014040] [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: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
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22
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Adrien J, Bertolus C, Gambotti L, Mallet A, Baujat B. Why are head and neck squamous cell carcinoma diagnosed so late? Influence of health care disparities and socio-economic factors. Oral Oncol 2014; 50:90-7. [DOI: 10.1016/j.oraloncology.2013.10.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/07/2013] [Accepted: 10/12/2013] [Indexed: 10/26/2022]
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Alla F, Rosilio M, Funck-Brentano C, Barthélémy P, Brisset S, Cellier D, Chassany O, Demarez JP, Diebolt V, Francillon A, Gambotti L, Hannachi H, Lechat P, Lemaire F, Lièvre M, Misse C, Nguon M, Pariente A, Rosenheim M, Weisslinger-Darmon N. How can the quality of medical data in pharmacovigilance, pharmacoepidemiology and clinical studies be guaranteed? Therapie 2013; 68:209-23. [PMID: 23981258 DOI: 10.2515/therapie/2013040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/20/2022]
Abstract
The development of medicinal products is subject to quality standards aimed at guaranteeing that database contents accurately reflect the source documents. Paradoxically, these standards hardly address the quality of the source data itself. The objective of this work was to propose recommendations to improve data quality in three fields (pharmacovigilance, pharmacoepidemiology and clinical studies). The analysis was focused on the data and on the critical stages presenting critical quality problems, for which the current guidelines are insufficiently detailed, unsuitable and/or poorly applied. Finally, recommendations have been proposed, mainly focused on the origin of the data and its transcription.
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Alla F, Rosilio M, Funck-Brentano C, Barthélémy P, Brisset S, Cellier D, Chassany O, Demarez JP, Diebolt V, Francillon A, Gambotti L, Hannachi H, Lechat P, Lemaire F, Lièvre M, Misse C, Nguon M, Pariente A, Rosenheim M, Weisslinger-Darmon N. Comment garantir des données médicales de qualité dans les études cliniques, pharmaco-épidémiologiques et en pharmacovigilance ? Therapie 2013; 68:209-16. [DOI: 10.2515/therapie/2013035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/20/2022]
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Gambotti L, Schwob E, Goudot P, Bertolus C. Oral cavity squamous cell carcinoma in the elderly: A retrospective study in 129 patients over 11 years (2000-2010). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17023 Background: There is no consensus for the management of elderly patients with oral cavity squamous cell carcinomas (OC SCC). Surgeons have to estimate for each patient the benefit or the risk of aggressive treatments in this population. We report the experience of one French university hospital center in the treatment of OC SCC in patients aged > = 70 years. Methods: One hundred and twenty nine patients aged > = 70 years with a primary OC SCC diagnosed between 2000 and 2010 were included retrospectively. Independent risk factors of post-operative complication were identified using a logistic regression. Overall survival (OS) was estimated with Kaplan Meier method. Independent factors of survival were calculated using a Cox model. Results: Mean age was 78 (+/-6), sex ratio was 1.2. Women presented significantly more precancerous lesions (36% vs 21%, p=0.04), less alcohol intoxication (13% vs 59%, p<0.001) and less tobacco consumption (41% vs 81%, p<0.001). Half of the sample was stage T4 of TNM classification. Eighty eight percent of the patients received a curative treatment, including surgery for 101 patients. Among them, the surgical treatment was considered as “standard” (vs “substandard”) for 70%. Thirty percent of the surgical patients presented a post-operative complication. Independent risk factors of complications were T3/T4 stage (OR 4.5 [1.3-15.1]) N+ (vs N0 of TNM classification) (OR 7.3 [2.2-24.0]) and alcohol intoxication (OR 3.6 [1.1-11.4]). The median OS was 13.6 months (43.8 months for T1). There was no significant difference of OS between standard or substandard treatment groups. The independent negative prognostic factors for OS were age > 79 years (HR 1.8 [1.2-2.7]), N+ (HR 1.9 [1.3-2.9]) and ASA score 3/4 (HR 1.8 [1.1-2.9]). Conclusions: In our experience, surgeons probably made the good choice between standard or substandard treatment according to the patient profile but this choice must be oriented by professional guidelines.
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Polo SE, Theocharis SE, Grandin L, Gambotti L, Antoni G, Savignoni A, Asselain B, Patsouris E, Almouzni G. Clinical significance and prognostic value of chromatin assembly factor-1 overexpression in human solid tumours. Histopathology 2011; 57:716-24. [PMID: 21083601 DOI: 10.1111/j.1365-2559.2010.03681.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS Chromatin assembly factor-1 (CAF-1), whose function is critical for maintaining chromatin stability during DNA replication and repair, has been identified as a proliferation marker in breast cancer. The aim was to investigate CAF-1 as a proliferation marker in a wide variety of solid tumours, and to assess its potential value in predicting clinical outcome. METHODS AND RESULTS Using immunocytochemistry on paraffin-embedded tissue sections, the CAF-1 labelling index was compared with known proliferation markers Ki-67 and minichromosome maintenance (MCM), and its association with clinicopathological data and patients' outcome analysed. CAF-1 expression showed a strong positive correlation with Ki-67, used routinely to detect proliferating cells, while it generally displayed weaker correlations with MCM markers, known to label cells with replicative potential. CAF-1 expression was associated significantly with histological grade in breast, cervical, endometrial and renal cell carcinomas, and with disease stage in endometrial and renal carcinomas. Furthermore, high expression of CAF-1 was an independent predictor of adverse clinical outcome in renal, endometrial and cervical carcinomas. CONCLUSIONS CAF-1 is a proliferation marker in various malignant tumours with prognostic value in renal, endometrial and cervical carcinomas, which supports the value of CAF-1 as a clinical marker of cancer progression.
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Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L, Chalumeau NC, Boutin DLTH, Cacoub P, Cluzel P, Koskas F, Kieffer E, Piette JC, Amoura Z. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore) 2010; 89:1-17. [PMID: 20075700 DOI: 10.1097/md.0b013e3181cba0a3] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [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: 11/26/2022] Open
Abstract
We conducted a single-center retrospective study to compare the characteristics of Takayasu arteritis (TA) among white, North African, and black patients in a French tertiary care center (Hospital Pitié-Salpêtrière, Paris). Eighty-two patients were studied (82.9% female) during a median follow-up of 5.1 years (range, 1 mo to 30 yr). Among these 82 patients, 39 (47.6%) were white, 20 (24.4%) were North African, and 20 (24.4%) were black patients. Median age at diagnosis was 39.3 years (range, 14-70 yr) in white patients vs. 28.4 years (range, 12-54 yr) in North African (p = 0.02), and 28.0 years (range, 13-60 yr) in black patients (p = 0.08). Patients aged >40 years at TA onset were more frequently white than non-white (40.0% vs. 18.6%, p = 0.03). North African patients had more frequent occurrence of ischemic stroke (p = 0.03) and poorer survival (p = 0.01) than white patients. Type V of the Hata classification was the most frequent type among white (38.5%), North African (65.0%), and black patients (40.0%). Corticosteroids were used in 96.1% of patients. Fifty-three percent of white and North African patients, and 44% of black patients required a second line of immunosuppressive treatment (p = 0.60). Vascular surgical procedures were respectively performed in 46.1%, 50.0%, and 55.0% of white, North African, and black patients, p = 0.81. The 5-year and 10-year survival rates were 100% and 95.0%, respectively, in white patients; 67.4% at both 5 years and 10 years in North African patients; and 100% at both 5 years and 10 years in black patients. This study is one of the first direct comparisons of TA profiles among patients of distinct ethnic backgrounds. Our data support the idea that late-onset TA or an overlap between TA and large-vessel giant cell arteritis may be observed in white patients. North African patients have a higher occurrence of ischemic stroke and poorer survival than white patients.
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Affiliation(s)
- Laurent Arnaud
- From Service de Médecine Interne (LA, JH, NL, NCC, DB, P Cacoub, JCP, ZA), Service de Radiologie (DT, P Cluzel), Service de Santé Publique (LG), and Service de Chirurgie Vasculaire (FK, EK); and Hôpital Pitié-Salpêtrière, AP-HP, Université Paris 6, Paris, France
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Arnaud L, Haroche J, Malek Z, Archambaud F, Gambotti L, Grimon G, Kas A, Costedoat-Chalumeau N, Cacoub P, Toledano D, Cluzel P, Piette JC, Amoura Z. Is18F-fluorodeoxyglucose positron emission tomography scanning a reliable way to assess disease activity in takayasu arteritis? ACTA ACUST UNITED AC 2009; 60:1193-200. [DOI: 10.1002/art.24416] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Brechot N, Gambotti L, Lafitte S, Roudaut R. Usefulness of right ventricular isovolumic relaxation time in predicting systolic pulmonary artery pressure. European Journal of Echocardiography 2008; 9:547-54. [DOI: 10.1093/ejechocard/jen121] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kirova YM, Gambotti L, De Rycke Y, Vilcoq JR, Asselain B, Fourquet A. Risk of second malignancies after adjuvant radiotherapy for breast cancer: a large-scale, single-institution review. Int J Radiat Oncol Biol Phys 2007; 68:359-63. [PMID: 17379448 DOI: 10.1016/j.ijrobp.2006.12.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 12/08/2006] [Accepted: 12/12/2006] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to estimate the risk of second malignancies (SM) after radiation therapy (RT) for breast cancer (BC) in a large, institutional, homogeneous cohort of patients. METHODS AND MATERIALS We retrospectively studied 16,705 patients with nonmetastatic BC treated at the Institut Curie in Paris between 1981 and 1997. Adjuvant RT was given to 13,472 of these patients, and no RT was given to 3,233. The SM included all first nonBCs occurring during follow-up. Cumulative risks for each group were calculated using Kaplan-Meier estimates, censoring for contralateral cancer or death. RESULTS Median patient age at diagnosis of BC was 55 years for the whole population, and 53 and 60 years for patients who had and had not undergone irradiation, respectively. At the 10.5-year median follow-up, 709 patients were diagnosed with SM (113 in the non-RT and 596 in the RT group). There was a significant increase in the rate of sarcomas and lung cancers in the RT group compared with non-RT group (p 0.02). Treatment with RT was not found to increase the risk of other types of cancers such as thyroid cancer, malignant melanoma, gastrointestinal or genitourinary, and hematologic SM. CONCLUSIONS This study suggests that adjuvant RT increased the rate of sarcomas and lung cancers, whereas it did not increase the rate of other malignancies.
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Affiliation(s)
- Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France.
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Haroche J, Amoura Z, Charlotte F, Gambotti L, Wechsler B, Cacoub P, Costedoat-Chalumeau N, Cluzel P, Grenier PA, Piette JC. Maladie d'Erdheim-Chester: étude monocentrique de 24 patients. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Arnaud L, Haroche J, Gambotti L, Limal N, Cacoub P, Le-Thi-Huong Boutin D, Papo T, Kieffer E, Amoura Z, Piette JC. Maladie de Takayasu: étude rétrospective monocentrique de 82 cas. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.098] [Citation(s) in RCA: 3] [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: 10/24/2022]
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Bollet MA, Sigal-Zafrani B, Gambotti L, Extra JM, Meunier M, Nos C, Dendale R, Campana F, Kirova YM, Diéras V, Fourquet A. Pathological response to preoperative concurrent chemo-radiotherapy for breast cancer: results of a phase II study. Eur J Cancer 2006; 42:2286-95. [PMID: 16893641 DOI: 10.1016/j.ejca.2006.03.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 02/25/2006] [Accepted: 03/17/2006] [Indexed: 11/28/2022]
Abstract
This study evaluated, in terms of pathological complete response (pCR) and acute toxicity, preoperative concurrent (5-fluorouracil (5-FU)-vinorelbine) chemoradiotherapy for large breast cancers. A total of 60 women were included in the study. Chemotherapy consisted of 4 cycles of 5-FU, 500 mg/m2/d, continuous infusion (d1-d5) and vinorelbine, 25 mg/m2 (d1; d6). Starting with the second cycle, radiotherapy delivered 50 Gy to the breast and 46 Gy to the internal mammary and supra/infra-clavicular lymph nodes. Breast surgery and axillary lymph node dissection were then performed. Four patients did not complete their chemotherapy. Breast conservation was possible in 69% of patients. The rate of pCR was 27%. Three factors were associated with pCR: histological grade 3, absence of hormonal receptors and high mitotic index. Grade 4 haematological toxicity occurred in 22% of patients. In conclusion, chemoradiotherapy demonstrated good efficacy, both in terms of pCR and in allowing breast conservation with acceptable tolerance.
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Affiliation(s)
- Marc A Bollet
- Department of Radiotherapy, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France.
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Martinez V, Caumes E, Gambotti L, Ittah H, Morini JP, Deleuze J, Gorin I, Katlama C, Bricaire F, Dupin N. Remission from Kaposi's sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy. Br J Cancer 2006; 94:1000-6. [PMID: 16570046 PMCID: PMC2361239 DOI: 10.1038/sj.bjc.6603056] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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] [Indexed: 12/27/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) reduces the incidence and improves the prognosis of Kaposi's sarcoma (KS). This study was designed to identify factors associated with KS clinical responses in HIV-infected patients during HAART. We reviewed the files of 138 HIV-1-infected patients with KS. Epidemiologic and HIV-related clinical and biological parameters were recorded at KS diagnosis (baseline) and every 6 months thereafter. In a subset of 73 antiretroviral-naive patients, we compared the clinical outcome of KS according to the use or nonuse of protease inhibitors (PI). After 6 months of follow-up, KS remission was more frequent in patients who were naive of HAART and who were at ACTG stage S0 at baseline (P=0.03 and 0.02). Undetectable HIV viral load was strongly associated with KS remission (P⩽0.004 at all time points), while CD4 cell count was not. Among the 73 antiretroviral-naive patients at baseline, and who were studied for 24 months, KS outcome did not differ between patients who were prescribed PI-containing and PI-sparing regimens. Intercurrent multicentric Castleman's disease was associated with poor outcome after 60 months of follow-up (P⩽0.0001). Fourteen deaths occurred after a median follow-up of 37.5 months, eight of which were KS related. Suppression of HIV replication appears to be crucial to control KS. Non-PI-based regimens were equivalent to PI-based regimens as regards the clinical and virological outcome of antiretroviral-naive HIV-infected patients with KS.
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Affiliation(s)
- V Martinez
- Service de Dermatologie, Hôpital Tarnier-Cochin, AP-HP, UPRES 1833, Université Paris V 89, rue d'Assas, Paris 75006, France.
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Bollet M, Gambotti L, Sigal-Zafrani B, Extra JM, Nos C, Dendale R, Campana F, Kirova Y, Dieras V, Fourquet A. Pathological response to preoperative concurrent chemoradiotherapy for breast cancers considered too large for initial conserving surgery: results of a phase II study. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gambotti L, Batisse D, Colin-de-Verdiere N, Delaroque-Astagneau E, Desenclos JC, Dominguez S, Dupont C, Duval X, Gervais A, Ghosn J, Larsen C, Pol S, Serpaggi J, Simon A, Valantin MA, Velter A. Acute hepatitis C infection in HIV positive men who have sex with men in Paris, France, 2001-2004. Euro Surveill 2005; 10:115-7. [PMID: 16077209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
In mid-2004, three Parisian hospital wards informed the Institut de veille sanitaire of recent acute hepatitis C in HIV-infected (HIV+) men who had sex with men (MSM). These cases for whom none of the usual bloodborne routes for hepatitis C (HCV) transmission was found, reported having had unprotected sex. In October 2004, we conducted a retrospective investigation in Parisian hospital wards to explore HCV modes of transmission in recent acute hepatitis C in HIV+ MSM. Patient demographics, clinical and biological status of HIV infection, reasons for HCV testing, sexual behaviour and risk factors for HCV transmission within the 6 months before hepatitis onset were collected from medical records. An anonymous self-administered questionnaire on sexual behaviour within the six months before hepatitis onset was also offered to all cases. We identified 29 cases of acute hepatitis C in HIV+ MSM with onset from April 2001 to October 2004. HIV infection was asymptomatic for 76%. Median age at hepatitis C onset was 40 (28-54) years. In all records, were noted unprotected anal sex, fisting in 21% and a concomitant sexually transmitted infection (STI) in 41%. Median time between HIV diagnosis and HCV infection was 6.5 years (0-22). From the 11 self-administered questionnaires completed, 10 reported an STI, 8 'hard' sexual practices, 6 bleeding during sex and 5 fisting. HCV transmission probably occurred through bleeding during unprotected traumatic anal sex among HIV+ MSM and may be facilitated by STI mucosal lesions. This report stresses the continuous need to strongly advocate safer sex to MSM.
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Affiliation(s)
- L Gambotti
- Institut de veille sanitaire, Saint-Maurice, France
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Gambotti L, Acute Hepatitis C Collaborating Group C. Acute hepatitis C infection in HIV positive men who have sex with men in Paris, France, 2001-2004. Euro Surveill 2005; 10:3-4. [PMID: 29183542 DOI: 10.2807/esm.10.05.00535-en] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In mid-2004, three Parisian hospital wards informed the Institut de veille sanitaire of recent acute hepatitis C in HIV-infected (HIV+) men who had sex with men (MSM). These cases for whom none of the usual bloodborne routes for hepatitis C (HCV) transmission was found, reported having had unprotected sex. In October 2004, we conducted a retrospective investigation in Parisian hospital wards to explore HCV modes of transmission in recent acute hepatitis C in HIV+ MSM. Patient demographics, clinical and biological status of HIV infection, reasons for HCV testing, sexual behaviour and risk factors for HCV transmission within the 6 months before hepatitis onset were collected from medical records. An anonymous self-administered questionnaire on sexual behaviour within the six months before hepatitis onset was also offered to all cases. We identified 29 cases of acute hepatitis C in HIV+ MSM with onset from April 2001 to October 2004. HIV infection was asymptomatic for 76%. Median age at hepatitis C onset was 40 (28-54) years. In all records, were noted unprotected anal sex, fisting in 21% and a concomitant sexually transmitted infection (STI) in 41%. Median time between HIV diagnosis and HCV infection was 6.5 years (0-22). From the 11 self-administered questionnaires completed, 10 reported an STI, 8 "hard" sexual practices, 6 bleeding during sex and 5 fisting. HCV transmission probably occurred through bleeding during unprotected traumatic anal sex among HIV+ MSM and may be facilitated by STI mucosal lesions. This report stresses the continuous need to strongly advocate safer sex to MSM.
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Affiliation(s)
- L Gambotti
- Institut de Veille Sanitaire, Saint-Maurice, France
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Scélo G, Gambotti L, Boulez JC, Bejui-Hugues J, Carret JP, Chémorin C, Berland M, Dumas AM, Bégou G, Duchemin-Pelletier B, Girard R, Fabry J, Vanhems P. Missing data and participation or non-participation in a surgical-site infection surveillance network. J Hosp Infect 2004; 56:81-2. [PMID: 14706282 DOI: 10.1016/j.jhin.2003.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Giard M, Gambotti L, Besson H, Fabry J, Vanhems P. Facteurs associés à une prise en charge tardive des patients infectés par le VIH : revue de la littérature. Santé Publique 2004; 16:147-56. [PMID: 15185592 DOI: 10.3917/spub.041.0147] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In the United States, Australia and Europe, many HIV infected individuals are still diagnosed and/or treated late in the course of the disease. This literature review of studies published over a ten year period between 1993 and 2003 has identified the following principle factors associated with the late diagnosis of HIV: male gender, aged older than 45 years, heterosexual intercourse, the lack of previous screening. It also identified the factors linked to the delay in beginning anti-retroviral treatment as being male gender, the lack of awareness or denial of the possibility of HIV infection, intravenous drug use, lack of post-screening follow-up or counseling, lack of social protection, and the lack of regular medical visits and care. Early detection and suitable early treatment of the HIV virus are the main determining factors which will effectively contribute to the control and maintenance of the virus in as much as they are focused upon these particular at-risk populations.
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Affiliation(s)
- M Giard
- Laboratoire d'Epidémiologie et de Santé Publique, INSERM U271, et Service d'Epidémiologie, Hôpital Edouard Herriot, Faculté de Médecine, 8, avenue Rockefeller, 69373 Lyon, France
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Pe´rol D, Albrand G, Terret C, Fingal C, Gambotti L, Lallemand Y, Roux P, Bachmann P, Doroz J. Evaluation of elderly patient's nutritional status in oncology. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gambotti L, Pe´rol D, Frering B, Coronel B, Sebban H, Andre´o R, Bachelot V, Bachmann P. Risk factors for failure and immediate complications of internal jugular central venous access (IJCVA) in cancer patients. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gambotti L, Trépo C, Chidiac C, Touraine JL, Peyramond D, Baratin D, Fabry J, Vanhems P. Factors associated with the time elapsed between initial detection of HIV antibodies and first contact for healthcare in HIV seroconverters of the Lyon University Hospitals. J Acquir Immune Defic Syndr 2002; 29:319-20. [PMID: 11873086 DOI: 10.1097/00126334-200203010-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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