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Ruhstaller T, Thuss-Patience P, Hayoz S, Schacher S, Knorrenschild JR, Schnider A, Plasswilm L, Budach W, Eisterer W, Hawle H, Mariette C, Hess V, Mingrone W, Montemurro M, Girschikofsky M, Schmidt SC, Bitzer M, Bedenne L, Brauchli P, Stahl M. Neoadjuvant chemotherapy followed by chemoradiation and surgery with and without cetuximab in patients with resectable esophageal cancer: a randomized, open-label, phase III trial (SAKK 75/08). Ann Oncol 2019; 29:1386-1393. [PMID: 29635438 DOI: 10.1093/annonc/mdy105] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background This open-label, phase III trial compared chemoradiation followed by surgery with or without neoadjuvant and adjuvant cetuximab in patients with resectable esophageal carcinoma. Patients and methods Patients were randomly assigned (1 : 1) to two cycles of chemotherapy (docetaxel 75 mg/m2, cisplatin 75 mg/m2) followed by chemoradiation (45 Gy, docetaxel 20 mg/m2 and cisplatin 25 mg/m2, weekly for 5 weeks) and surgery, with or without neoadjuvant cetuximab 250 mg/m2 weekly and adjuvant cetuximab 500 mg/m2 fortnightly for 3 months. The primary end point was progression-free survival (PFS). Results In total, 300 patients (median age, 61 years; 88% male; 63% adenocarcinoma; 85% cT3/4a, 90% cN+) were assigned to cetuximab (n = 149) or control (n = 151). The R0-resection rate was 95% for cetuximab versus 97% for control. Postoperative treatment-related mortality was 6% in both arms. Median PFS was 2.9 years [95% confidence interval (CI), 2.0 to not reached] with cetuximab and 2.0 years (95% CI, 1.5-2.8) with control [hazard ratio (HR), 0.79; 95% CI, 0.58-1.07; P = 0.13]. Median overall survival (OS) time was 5.1 years (95% CI, 3.7 to not reached) versus 3.0 years (95% CI, 2.2-4.2) for cetuximab and control, respectively (HR, 0.73; 95% CI, 0.52-1.01; P = 0.055). Time to loco-regional failure after R0-resection was significantly longer for cetuximab (HR 0.53; 95% CI, 0.31-0.90; P = 0.017); time to distant failure did not differ between arms (HR, 1.01; 95% CI, 0.64-1.59, P = 0.97). Cetuximab did not increase adverse events in neoadjuvant or postoperative settings. Conclusion Adding cetuximab to multimodal therapy significantly improved loco-regional control, and led to clinically relevant, but not-significant improvements in PFS and OS in resectable esophageal carcinoma. Clinical trial information NCT01107639.
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Affiliation(s)
- T Ruhstaller
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
| | | | - S Hayoz
- SAKK Coordinating Center, Berne, Switzerland
| | - S Schacher
- Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | | | - A Schnider
- City Hospital Triemli, Zürich, Switzerland
| | - L Plasswilm
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland; University of Berne, Berne, Switzerland
| | - W Budach
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - W Eisterer
- Medical University of Innsbruck, Innsbruck, Austria
| | - H Hawle
- SAKK Coordinating Center, Berne, Switzerland
| | - C Mariette
- Hôpital Universitaire C. Huriez, Lille, France
| | - V Hess
- University Hospital of Basel, Basel, Switzerland
| | - W Mingrone
- Cantonal Hospital of Olten, Olten, Switzerland
| | - M Montemurro
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - S C Schmidt
- Charité - University Medicine, Berlin, Germany
| | - M Bitzer
- University Hospital of Tübingen, Tübingen, Germany
| | - L Bedenne
- Hospital Center Regional University of Dijon, Dijon, France
| | - P Brauchli
- SAKK Coordinating Center, Berne, Switzerland
| | - M Stahl
- Kliniken Essen-Mitte, Essen, Germany
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Aparicio T, Bouché O, Taieb J, Maillard E, Kirscher S, Etienne PL, Faroux R, Khemissa Akouz F, El Hajbi F, Locher C, Rinaldi Y, Lecomte T, Lavau-Denes S, Baconnier M, Oden-Gangloff A, Genet D, Paillaud E, Retornaz F, François E, Bedenne L. Bevacizumab+chemotherapy versus chemotherapy alone in elderly patients with untreated metastatic colorectal cancer: a randomized phase II trial-PRODIGE 20 study results. Ann Oncol 2019; 29:133-138. [PMID: 29045659 PMCID: PMC5834151 DOI: 10.1093/annonc/mdx529] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Metastatic colorectal cancer frequently occurs in elderly patients. Bevacizumab in combination with front line chemotherapy (CT) is a standard treatment but some concern raised about tolerance of bevacizumab for these patients. The purpose of PRODIGE 20 was to evaluate tolerance and efficacy of bevacizumab according to specific end points in this population. Patients and methods Patients aged 75 years and over were randomly assigned to bevacizumab + CT (BEV) versus CT. LV5FU2, FOLFOX and FOLFIRI regimen were prescribed according to investigator’s choice. The composite co-primary end point, assessed 4 months after randomization, was based on efficacy (tumor control and absence of decrease of the Spitzer QoL index) and safety (absence of severe cardiovascular toxicities and unexpected hospitalization). For each arm, the treatment will be consider as inefficient if 20% or less of the patients met the efficacy criteria and not safe if 40% or less met the safety criteria. Results About 102 patients were randomized (51 BEV and 51 CT), median age was 80 years (range 75–91). Primary end point was met for efficacy in 50% and 58% and for safety in 61% and 71% of patients in BEV and CT, respectively. Median progression-free survival was 9.7 months in BEV and 7.8 months in CT. Median overall survival was 21.7 months in BEV and 19.8 months in CT. The 36-month overall survival rate was 27% in BEV and 10.1% in CT. Severe toxicities grade 3/4 were mainly non-hematologic toxicities (80.4% in BEV, 63.3% in CT). Conclusion Bevacizumab combined with CT was safe and efficient. Both arms met the primary safety and efficacy criteria.
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Affiliation(s)
- T Aparicio
- Gastroenterology Department, CHU Saint Louis, APHP, Paris, France.,Université Paris 7, Sorbonne Paris Cité, Paris, France
| | - O Bouché
- Digestive Oncology Department, CHU Robert Debré, Reims, France
| | - J Taieb
- Digestive Oncology Department, CHU Georges Pompidou, APHP, Paris, France
| | - E Maillard
- Statistics Department, Fédération Francophone de Cancérologie Digestive, Dijon, France
| | - S Kirscher
- Oncology Department, Institut Sainte Catherine, Avignon, France
| | - P-L Etienne
- Oncology Department, CARIO, HPCA, Plérin, France
| | - R Faroux
- Gastroenterology Department, CHG Vendée, La Roche sur Yon, France
| | | | - F El Hajbi
- Oncology Department, Centre Oscar Lambret, Lille, France
| | - C Locher
- Gastroenterology Department, CH Meaux, Meaux, France
| | - Y Rinaldi
- Gastroenterology Departement, Hôpital Européen, Marseille, France
| | - T Lecomte
- Gastroenterology Department, CHU Trousseau, Tours, France
| | | | - M Baconnier
- Gastroenterology Department, CH Annecy Genevois, Pringy, France
| | - A Oden-Gangloff
- Gastroenterology Department, CHU Charles Nicolle, Rouen, France
| | - D Genet
- Oncology Department, Clinique Chenieux, Limoges, France
| | - E Paillaud
- Geriatric Department, CHU Henri Mondor, APHP, Créteil, France
| | - F Retornaz
- Geriatric Department, Hôpital Européen, Marseille, France
| | - E François
- Gastroenterology Department, Centre Antoine Lacassagne, Nice, France
| | - L Bedenne
- Gastroenterology Department, CHU Le Bocage, INSERM U 866, Dijon, France
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Jooste V, Manfredi S, Napoleon M, Drouillard A, Marref I, Bedenne L, Faivre J, Bouvier AM. Patterns of care and outcomes in oesophageal cancer. Dig Liver Dis 2018; 50:1238-1243. [PMID: 30126823 DOI: 10.1016/j.dld.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/26/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The optimal treatment for oesophageal cancer is a matter of debate. The aim of this study was to describe patterns of care and survival in a well-defined population for squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the oesophagus. DESIGN Data were provided by the Digestive Cancer Registry of Burgundy (France). Recurrence, excess mortality and net survival were calculated. RESULTS Among non-metastatic patients, the proportion of patients resected for cure decreased between 2004 and 2013 from 16% to 9% for SCC and 48% to 22% for AC. The administration of chemoradiation increased from 45 to 53% for SCC and 21 to 30% for AC. A complete clinical response to chemoradiation was reported in 40% of the patients. Five-year net survival did not vary according to histology. It was 55% in the selected group of patients resected for cure, 44% in patients treated with chemoradiation with a complete clinical response. In multivariate analysis, treatment modality only was associated with survival. In metastatic patients, 3-year net survival was 14% for those treated with chemoradiation. CONCLUSION Chemoradiation has become the most frequently administered treatment. Cancelling or postponing surgery after chemoradiation with complete response should be assessed by a randomized clinical trial.
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Affiliation(s)
- Valerie Jooste
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon-Bourgogne University Hospital, Dijon, France
| | - Sylvain Manfredi
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon-Bourgogne University Hospital, Dijon, France
| | - Marie Napoleon
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon-Bourgogne University Hospital, Dijon, France
| | - Antoine Drouillard
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon-Bourgogne University Hospital, Dijon, France
| | - Imene Marref
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon-Bourgogne University Hospital, Dijon, France
| | - Laurent Bedenne
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon-Bourgogne University Hospital, Dijon, France
| | - Jean Faivre
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon-Bourgogne University Hospital, Dijon, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University 'Bourgogne Franche-Comté', Dijon-Bourgogne University Hospital, Dijon, France.
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Aparicio T, Bouché O, Taieb J, Maillard E, Kirscher S, Etienne PL, Faroux R, Khemissa Akouz F, El Hajbi F, Locher C, Rinaldi Y, Lecomte T, Lavau-Denes S, Baconnier M, Oden-Gangloff A, Genet D, Paillaud E, Retornaz F, François E, Bedenne L. Bevacizumab+chemotherapy versus chemotherapy alone in elderly patients with untreated metastatic colorectal cancer: a randomized phase II trial-PRODIGE 20 study results. Ann Oncol 2018; 29:2270. [PMID: 29718089 DOI: 10.1093/annonc/mdx808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aparicio T, Ducreux M, Faroux R, Barbier E, Manfredi S, Lecomte T, Etienne PL, Bedenne L, Bennouna J, Phelip JM, François E, Michel P, Legoux JL, Gasmi M, Breysacher G, Rougier P, De Gramont A, Lepage C, Bouché O, Seitz JF, Adenis A, Alessio A, Aouakli A, Azzedine A, Bedjaoui A, Bidault A, Blanchi A, Botton A, Cadier-Lagnes A, Fatisse A, Gagnaire A, Gilbert A, Gueye A, Hollebecque A, Lemaire A, Mahamat A, Marre A, Patenotte A, Rotenberg A, Roussel A, Thirot-Bidault A, Votte A, Weber A, Zaanan A, Dupont-Gossart A, Villing A, Queuniet A, Coudert B, Denis B, Garcia B, Lafforgue B, Landi B, Leduc B, Linot B, Paillot B, Rhein B, Winkfield B, Barberis C, Becht C, Belletier C, Berger C, Bineau C, Borel C, Brezault C, Buffet C, Cornila C, Couffon C, De La Fouchardière C, Giraud C, Lecaille C, Lepere C, Lobry C, Locher C, Lombard-Bohas C, Paoletti C, Platini C, Rebischung C, Sarda C, Vilain C, Briac-Levaché C, Auby D, Baudet-Klepping D, Bechade D, Besson D, Cleau D, Festin D, Gargot D, Genet D, Goldfain D, Luet D, Malka D, Peré-Vergé D, Pillon D, Sevin-Robiche D, Smith D, Soubrane D, Tougeron D, Zylberait D, Carola E, Cuillerier E, Dorval Danquechin E, Echinard E, Janssen E, Maillard E, Mitry E, Norguet-Monnereau E, Suc E, Terrebonne E, Zrihen E, Pariente E, Almaric F, Audemar F, Bonnetain F, Desseigne F, Dewaele F, Di Fiore F, Ghiringhelli F, Husseini F, Khemissa F, Kikolski F, Morvan F, Petit-Laurent F, Riot F, Subtil F, Zerouala-Boussaha F, Caroli-Bosc F, Boilleau-Jolimoy G, Bordes G, Cavaglione G, Coulanjon G, Deplanque G, Gatineau-Saillant G, Goujon G, Medinger G, Roquin G, Brixi-Benmansour H, Castanie H, Lacroix H, Maechel H, Perrier H, Salloum H, Senellart H, Baumgaertner I, Cumin I, Graber I, Trouilloud I, Boutin J, Butel J, Charneau J, Cretin J, Dauba J, Deguiral J, Egreteau J, Ezenfis J, Forestier J, Goineau J, Lacourt J, Lafon J, Martin J, Meunier J, Moreau J, Provencal J, Taieb J, Thaury J, Tuaillon J, Vergniol J, Villand J, Vincent J, Volet J, Bachet J, Barbare J, Souquet J, Grangé J, Dor J, Paitel J, Jouve J, Raoul J, Cheula J, Gornet J, Sabate J, Vantelon J, Vaillant J, Aucouturier J, Barbieux J, Herr J, Lafargue J, Lagasse J, Latrive J, Plachot J, Ramain J, Robin J, Spano J, Douillard J, Beerblock K, Bouhier-Leporrier K, Slimane Fawzi K, Cany L, Chone L, Dahan L, Gasnault L, Rob L, Stefani L, Wander L, Baconnier M, Ben Abdelghani M, Benchalal M, Blasquez M, Carreiro M, Charbit M, Combe M, Duluc M, Fayolle M, Gignoux M, Giovannini M, Glikmanas M, Mabro M, Mignot M, Mornet M, Mousseau M, Mozer M, Pauwels M, Pelletier M, Porneuf M, Ramdani M, Schnee M, Tissot M, Zawadi M, Clavero-Fabri M, Gouttebel M, Kaminsky M, Galais M, Abdelli N, Barrière N, Bouaria N, Bouarioua N, Delas N, Gérardin N, Hess-Laurens N, Stremsdoerfer N, Berthelet O, Boulat O, Capitain O, Favre O, Amoyal P, Bergerault P, Burtin P, Cassan P, Chatrenet P, Chiappa P, Claudé P, Couzigou P, Feydy P, Follana P, Geoffroy P, Godeau P, Hammel P, Laplaige P, Lehair P, Martin P, Novello P, Pantioni P, Pienkowski P, Pouderoux P, Prost P, Ruszniewski P, Souillac P, Texereau P, Thévenet P, Haineaux P, Benoit R, Coriat R, Lamy R, Mackiewicz R, Beorchia S, Chaussade S, Hiret S, Jacquot S, Lavau Denes S, Montembault S, Nahon S, Nasca S, Nguyen S, Oddou-Lagraniere S, Pesque-Penaud S, Fratte S, Chatellier T, Mansourbakht T, Morin T, Walter T, Boige V, Bourgeois V, Derias V, Guérin-Meyer V, Hautefeuille V, Jestin Le Tallec V, Lorgis V, Quentin V, Sebbagh V, Veuillez V, Adhoute X, Coulaud X, Becouarn Y, Coscas Y, Courouble Y, Le Bricquir Y, Molin Y, Rinaldi Y, Lam Y, Ladhib Z. Overweight is associated to a better prognosis in metastatic colorectal cancer: A pooled analysis of FFCD trials. Eur J Cancer 2018; 98:1-9. [DOI: 10.1016/j.ejca.2018.03.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
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Aparicio T, Bouché O, Francois E, Retornaz F, Barbier E, Taieb J, Kirscher S, Etienne PL, Faroux R, Khemissa Akouz F, El Hajbi F, Locher C, Rinaldi Y, Lecomte T, Lavau-Denes S, Baconnier M, Oden-Gangloff A, Genet D, Bedenne L, Paillaud E, Zawadi MA, Volet J, Cavaglione G, Lepere C, Rougier P, Zaanan A, Besson D, Fawzi KS, Adenis A, Gatineau-Sailliant G, Brezault C, Coriat R, Tougeron D, Hautefeuille V, Chone L, Molin Y, Seitz JF, Le Tallec VJ, Ben Abdelghani M, Villing AL, Aouakli A, Sebbagh V, Bedjaoui A, Mitry E, Carola E, Boulat O, Queuniet AM, Capitain O, Jouve JL, Baumgaertner I, Almaric F, Bonnetain F, Subtil F. Geriatric analysis from PRODIGE 20 randomized phase II trial evaluating bevacizumab + chemotherapy versus chemotherapy alone in older patients with untreated metastatic colorectal cancer. Eur J Cancer 2018; 97:16-24. [DOI: 10.1016/j.ejca.2018.03.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 12/27/2022]
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Azria D, Doyen J, Jarlier M, Martel-Lafay I, Hennequin C, Etienne P, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah J, Mahé M, Bécouarn Y, Dupuis O, Lledo G, Seitz J, Bedenne L, Gourgou-Bourgade S, Juzyna B, Conroy T, Gérard J. Late toxicities and clinical outcome at 5 years of the ACCORD 12/0405-PRODIGE 02 trial comparing two neoadjuvant chemoradiotherapy regimens for intermediate-risk rectal cancer. Ann Oncol 2018; 28:2436-2442. [PMID: 28961836 DOI: 10.1093/annonc/mdx351] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Outcome of intermediate risk rectal cancer may be improved by the addition of oxaliplatin during 5-fluoruracil concomitant neoadjuvant chemoradiotherapy. The purpose of this study is to analyze the main clinical results of the ACCORD12 trial (NCT00227747) in rectal cancer after 5 years of follow-up. Patients and methods Inclusion criteria were as follows: rectal adenocarcinoma accessible to digital examination staged T3-T4 Nx M0 (or T2 Nx distal anterior rectum). Two neoadjuvant chemoradiotherapy regimens were randomized: CAP45 (RT 45 Gy + capecitabine) and CAPOX50 (RT 50 Gy + capecitabine and oxaliplatin). Main end point was sterilization of the operative specimen. Acute and late toxicities were prospectively analyzed with dedicated questionnaires. Results Between November 2005 and July 2008, 598 patients were included in the trial. After a median follow-up of 60.2 months, there was no difference between treatment arms in multivariate analysis either for disease-free survival or overall survival (OS) [P = 0.9, hazard ratio (HR)=1.02; 95% confidence interval (CI), 0.76-1.36 and P = 0.3, HR = 0.87; 95% CI, 0.66-1.15, respectively]. There was also no difference of local control in univariate analysis (P = 0.7, HR = 0.92; 95% CI, 0.51-1.66). Late toxicities were acceptable with 1.6% G3 anal incontinence, and <1% G3 diarrhea, G3 rectal bleeding, G3 stenosis, G3-4 pain, G3 urinary incontinence, G3 urinary retention and G3 skeletal toxicity. There was a slight increase of erectile dysfunction over time with a 63% rate of erectile dysfunction at 5 years. There was no significant statistical difference for these toxicities between treatment arms. Conclusions The CAPOX50 regimen did not improve local control, disease-free survival and overall survival in the ACCORD12 trial. Late toxicities did not differ between treatment arms.
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Affiliation(s)
- D Azria
- Department of Radiation oncology, Montpellier Cancer Institute, Montpellier
| | - J Doyen
- Department of Radiation oncology, Antoine-Lacassagne Center, Nice;; University of Côte d'Azur, Nice;.
| | - M Jarlier
- Biometrics Unit, Montpellier Cancer Institute, Montpellier
| | - I Martel-Lafay
- Department of Radiation Oncology, Léon-Bérard Center, Lyon
| | - C Hennequin
- Department of Radiation Oncology, Saint-Louis Hospital, Paris
| | - P Etienne
- Department of Radiation Oncology, Armorican Center of Radiotherapy and Radiology, Plérin
| | - V Vendrely
- Department of Radiation Oncology, Teaching Hospital CHU of Bordeaux, Bordeaux
| | - E François
- University of Côte d'Azur, Nice;; Department of Medical Oncology, Antoine-Lacassagne Center, Nice
| | - G de La Roche
- Department of Medical Oncology, Oncology Institute of Loire, Saint Priest en Jarez
| | - O Bouché
- Department of Medical Oncology, Teaching Hospital CHU of Reims, Reims
| | - X Mirabel
- Department of Radiation Oncology, Oscar-Lambret Center, Lille
| | - B Denis
- Department of Medical Oncology, Teaching Hospital CHU Louis Pasteur, Colmar
| | - L Mineur
- Department of Radiation Oncology, Sainte-Catherine Institute, Avignon
| | - J Berdah
- Sainte-Marguerite Private Hospital, Toulon-Hyères
| | - M Mahé
- Department of Radiation Oncology, West Oncology Institute, Saint-Herblain
| | - Y Bécouarn
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - O Dupuis
- Department of Medical Oncology, Jean Bernard Center, Le Mans
| | - G Lledo
- Department of Medical Oncology, Jean Mermoz Private Hospital, Lyon
| | - J Seitz
- Department of Medical Oncology, Teaching Hospital CHU La Timone, Marseille
| | - L Bedenne
- Department of Medical Oncology, Teaching Hospital CHU of Dijon, Dijon
| | | | | | - T Conroy
- Department of Medical Oncology, Oncology Institute of Lorraine, Vandoeuvre-les-Nancy, France
| | - J Gérard
- Department of Radiation oncology, Antoine-Lacassagne Center, Nice;; University of Côte d'Azur, Nice
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Locher C, Batumona B, Afchain P, Carrère N, Samalin E, Cellier C, Aparicio T, Becouarn Y, Bedenne L, Michel P, Parc Y, Pocard M, Chibaudel B, Bouché O. Small bowel adenocarcinoma: French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis 2018; 50:15-19. [PMID: 29174568 DOI: 10.1016/j.dld.2017.09.123] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND This document is a summary of the French intergroup guidelines regarding the management of small bowel adenocarcinoma published in October 2016. METHOD This collaborative work, co-directed by most French Medical Societies, summarizes clinical practice recommendations (guidelines) on the management of small bowel adenocarcinoma. Given the lack of specific data in the literature, all references are given by analogy with colon cancer. The classification used is the AJCC (American Joint Committee on Cancer) pTNM classification (7th edition 2009). RESULTS Small bowel adenocarcinoma has a poor prognosis; less than 30% of patients survive for 5 years after the (first) diagnosis (5-year survival of less than 30%). Due to the rarity of the disease and the retrospective data, most recommendations are based on expert agreement. The initial evaluation is based on chest-abdomen-pelvis CT scan, CEA assay, GI endoscopy and colonoscopy in order detect lesions associated with a predisposing disease. Surgical treatment is currently the only curative option for stage I and II. Adjuvant chemotherapy can be discussed for Stage III and Stage II with T4 (expert agreement). With regard to metastatic tumors, treatment with fluoropyrimidine combined with platinum salts should be considered (expert agreement). CONCLUSION Few specific data exist in the literature on this type of tumor; most of the recommendations come from expert agreements or by analogy with colon cancer. Thus, each case must be discussed within a multidisciplinary team.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Yann Parc
- APHP Saint Antoine, Paris Cedex 12, France
| | | | - Benoit Chibaudel
- Institut Hospitalier Franco-Britannique, Levallois-Perret, France
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Bedenne L, Le Malicot K, Drouillard A. Is it still time for meta-analyses in operable esophageal cancers, or rather for a change of paradigm? J Thorac Dis 2017; 9:3594-3597. [DOI: 10.21037/jtd.2017.09.35] [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: 11/06/2022]
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Emile JF, Julié C, Le Malicot K, Lepage C, Tabernero J, Mini E, Folprecht G, Van Laethem JL, Dimet S, Boulagnon-Rombi C, Allard MA, Penault-Llorca F, Bennouna J, Laurent-Puig P, Taieb J, Thaler J, Greil R, Gaenzer J, Eisterer W, Tschmelitsch J, Keil F, Samonigg H, Zabernigg A, Schmid F, Steger G, Steinacher R, Andel J, Jagdt B, Lang A, Fridrik M, Függer R, Hofbauer F, Woell E, Geissler D, Lenauer A, Prager M, D'Haens G, Demolin G, Kerger J, Deboever G, Ghillebert G, Polus M, Van Cutsem E, Kalantari HR, Delaunoit T, Goeminne JC, Peeters M, Vergauwe P, Houbiers G, Humblet Y, Janssens J, Schrijvers D, Vanderstraeten E, Van Laethem JL, Vermorken J, Van Daele D, Ferrante M, Forget F, Hendlisz A, Yilmaz M, Nielsen SE, Vestermark L, Larsen J, Zawadi MA, Bouche O, Mineur L, Bennouna-Louridi J, Dourthe LM, Ychou M, Boucher E, Taieb J, Pezet D, Desseigne F, Ducreux M, Texereau P, Miglianico L, Rougier P, Fratte S, Levache CB, Merrouche Y, Ellis S, Locher C, Ramee JF, Garnier C, Viret F, Chauffert B, Cojean-Zelek I, Michel P, Lecaille C, Borel C, Seitz JF, Smith D, Lombard-Bohas C, Andre T, Gornet JM, Fein F, Coulon-Sfairi MA, Kaminsky MC, Lagasse JP, Luet D, Etienne PL, Gasmi M, Vanoli A, Nguyen S, Aparicio T, Perrier H, Stremsdoerfer N, Laplaige P, Arsene D, Auby D, Bedenne L, Coriat R, Denis B, Geoffroy P, Piot G, Becouarn Y, Bordes G, Deplanque G, Dupuis O, Fruge F, Guimbaud R, Lecomte T, Lledo G, Sobhani I, Asnacios A, Azzedine A, Desauw C, Galais MP, Gargot D, Lam YH, Abakar-Mahamat A, Berdah JF, Catteau S, Clavero-Fabri MC, Codoul JF, Legoux JL, Goldfain D, Guichard P, Verge DP, Provencal J, Vedrenne B, Brezault-Bonnet C, Cleau D, Desir JP, Fallik D, Garcia B, Gaspard MH, Genet D, Hartwig J, Krummel Y, Budnik TM, Palascak-Juif V, Randrianarivelo H, Rinaldi Y, Aleba A, Darut-Jouve A, de Gramont A, Hamon H, Wendehenne F, Matzdorff A, Stahl MK, Schepp W, Burk M, Mueller L, Folprecht G, Geissler M, Mantovani-Loeffler L, Hoehler T, Asperger W, Kroening H, von Weikersthal LF, Fuxius S, Groschek M, Meiler J, Trarbach T, Rauh J, Ziegenhagen N, Kretzschmar A, Graeven U, Nusch A, von Wichert G, Hofheinz RD, Kleber G, Schmidt KH, Vehling-Kaiser U, Baum C, Schuette J, Haag GM, Holtkamp W, Potenberg J, Reiber T, Schliesser G, Schmoll HJ, Schneider-Kappus W, Abenhardt W, Denzlinger C, Henning J, Marxsen B, Derigs HG, Lambertz H, Becker-Boost I, Caca K, Constantin C, Decker T, Eschenburg H, Gabius S, Hebart H, Hoffmeister A, Horst HA, Kremers S, Leithaeuser M, Mueller S, Wagner S, Daum S, Schlegel F, Stauch M, Heinemann V, Maiello E, Latini L, Zaniboni A, Amadori D, Aprile G, Barni S, Mattioli R, Martoni A, Passalacqua R, Nicolini M, Pasquini E, Rabbi C, Aitini E, Ravaioli A, Barone C, Biasco G, Tamberi S, Gambi A, Verusio C, Marzola M, Lelli G, Boni C, Cascinu S, Bidoli P, Vaghi M, Cruciani G, Di Costanzo F, Sobrero A, Mini E, Petrioli R, Aglietta M, Alabiso O, Capuzzo F, Falcone A, Corsi DC, Labianca R, Salvagni S, Chiara S, Ciuffreda L, Ferraù F, Giuliani F, Lonardi S, Gebbia N, Mantovani G, Sanches E, Mellidez JC, Santos P, Freire J, Sarmento C, Costa L, Pinto AM, Barroso S, Santo JE, Guedes F, Monteiro A, Sa A, Furtado I, Salazar R, Aguilar EA, Herrero FR, Tabernero J, Valera JS, Ayerbes MV, Batlle JF, Gil S, Esteve AA, Garcia-Giron C, Vivanco GL, Salvia AS, Orduña VA, Garcia RV, Gallego J, Sureda BM, Remon J, Safont Aguilera MJ, Nogueras LC, Merino BQ, Castro CG, de Prado PM, Pericay CP, Figueiras MC, Jordan IG, Gome Reina MJ, Garcia ALL, Garcia-Ramos AA, Cervantes A, Martos CF, Gaspar EM, Montero IC, Emperador PE, Carbonero AL, Castillo MG, Garcia TG, Lopez JG, Flores EG, Morales MG, Muñoz ML, Martín AL, Maurel J, Camara JC, Garcia RD, Salgado M, Busquier IH, Ruiz TC, Muñoa AL, Aliguer MN, de Taranco AVO, Ureña MM, Gaspa FL, Ponce JJ, Roig CB, Jimenez PV, Brotons AG, Rodriguez SA, Martinez JA, Ruiz LC, Ruiz MC, Bridgewater J, Glynne-Jones R, Tahir S, Hickish T, Cassidy J, Samuel L. Prospective validation of a lymphocyte infiltration prognostic test in stage III colon cancer patients treated with adjuvant FOLFOX. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.04.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Legoux JL, Aparicio T, Maillard E, Phelip JM, Jouve JL, Locher C, Michel P, Lecomte T, Bouche O, Bedenne L. Classic or simplified LV5FU2 regimen: Multivariate analysis from a phase III study in metastatic colorectal cancer in elderly patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3550] [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
3550 Background: In the early 2000s, classic LV5FU2 (C) (folinic acid, 5FU bolus, then 5FU infusion on D1 and D2) was replaced with simplified LV5FU2 (S) (folinic acid and 5FU bolus on D1 only), considered as effective and less toxic. No trial proved this assertion. The LV5FU2 companion in the FOLFIRI or FOLFOX regimen was C or S. The FFCD 2001-02 study compared in a 2 x 2 factorial design, in not-pretreated elderly patients (75+) with metastatic colorectal cancer, C or S, with or without irinotecan. No significant differences in PFS and OS were observed in the comparison with or without irinotecan. The median OS was 15.2 months in C versus 11.4 months in S, HR = 0.71 (0.55–0.92) and objective response rate was 37.1% in C vs S 25.6% in S, p = 0.004. The aim of this study was to present the factors associated with these differences. Methods: Prognostic factors associated with OS were studied using a Cox model. The multivariate analysis used the significantly different items from the univariate analysis and the differences observed at the inclusion. For each of these items, a subgroup analysis was performed. The second- and third-line treatments were analysed. Results: The 282 patients from the intent-to-treat study were included in the model. In OS, the prognostic factors were C versus S, number of metastatic sites, alkaline phosphatases (AP) and CEA. The interaction test in each subgroup for OS was not significant but C was significantly better in the following subgroup: age > 80 years, male, Karnofsky 100%, 1-2 Charlson index, AP ≤ 2N, leucocyte count > 11,000, CEA > 2N, CA 19-9 ≤2N. No differences were observed in the NCI toxicities but 130 serious adverse events in S versus 102 in C. A second-line was used for 55% patients in C, 46% in S, 81% of them with oxaliplatin or irinotecan in C, 76% after S. The third-line administration (20%) and targeted therapy (15%) were similar in C and S. Conclusions: C-LV5FU2 was superior both in subgroups with better and lower prognostics and this difference cannot be explained by an imbalance between the populations. The toxicity was not higher and a second-line was more often possible after C. The switch from C to S without scientific proof was perhaps a mistake in our practices. Clinical trial information: NCT00303771.
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Affiliation(s)
| | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | | | | | | | - Christophe Locher
- Department of Hepato-Gastroenterology, Meaux Hospital, Meaux, France
| | - Pierre Michel
- Digestive Oncology Unit, Iron Group, Rouen Hospital, University of Normandy, Rouen, France
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Ruhstaller T, Thuss-Patience PC, Hayoz S, Schacher-Kaufmann S, Riera-Knorrenschild J, Schnider A, Plasswilm L, Budach W, Eisterer W, Hawle H, Mariette C, Hess V, Mingrone WB, Wagner AD, Girschikofsky M, Schmidt SC, Bitzer M, Bedenne L, Brauchli P, Stahl M. Intergroup phase III trial of neo-adjuvant chemotherapy, followed by chemoradiation and surgery with and without cetuximab in locally advanced esophageal carcinoma: First results from the SAKK 75/08 trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4019 Background: We compared chemoradiotherapy followed by surgery with the addition of neoadjuvant and adjuvant cetuximab (cetux) in patients with esophageal carcinoma. Methods: Pts with resectable esophageal cancer (T2N1-3;T3-4aNx) received two cycles of induction chemotherapy (docetaxel 75mg/m2, cisplatin 75mg/m2) followed by chemoradiation (45 Gy, docetaxel 20mg/m2 and cisplatin 25mg/m2 weekly) and surgery or the same treatment with addition of neoadjuvant cetux 250mg/m2 weekly and adjuvant cetux 500mg/m2 bi-weekly for three months. Primary endpoint was progression-free survival (PFS). After a median follow-up of 4y 166 of the planned 180 events occurred (plateau reached). Results: 300 pts were treated between 2010-13: 88% male, median age 61y, 63% adenocarcinoma, 85% cT3/4a, 90% cN+. 84% completed neoadjuvant therapy, 87% were operated (cetux: 89%, control: 86%), 67% started and 50% completed adjuvant cetux-therapy. The R0 resection rate was 95% in the cetux-arm and 97% in the control-arm, there were 10 and 14 treatment-related deaths and 9 and 4 postoperative in-hospital deaths, respectively. Major differences in adverse events (grade >2) with addition of cetux were higher rate of allergic reactions and hypomagnesemia, but lower rate of dysphagia (-15%) and esophagitis (-4%) during chemoradiation. Conclusions: The addition of cetuximab to a multimodal therapy showed a statistically significant reduction of loco-regional recurrences which led to a statistically non-significant, but clinically relevant improvement of PFS and OS. Clinical trial information: NCT01107639. [Table: see text]
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Affiliation(s)
| | | | - Stefanie Hayoz
- SAKK - Swiss Group for Clinical Cancer Research, Coordinating Center, Bern, Switzerland
| | | | | | | | - Ludwig Plasswilm
- Department of Radiation-Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | | | - Hanne Hawle
- SAKK - Swiss Group for Clinical Cancer Research, Coordinating Center, Bern, Switzerland
| | | | - Viviane Hess
- University of Basel and University Hospital Basel, Medical Oncology, Basel, Switzerland
| | | | | | | | | | | | | | - Peter Brauchli
- SAKK - Swiss Group for Clinical Cancer Research, Coordinating Center, Bern, Switzerland
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Gérard JP, André T, Bibeau F, Conroy T, Legoux JL, Portier G, Bosset JF, Cadiot G, Bouché O, Bedenne L. Rectal cancer: French Intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis 2017; 49:359-367. [PMID: 28179091 DOI: 10.1016/j.dld.2017.01.152] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This document is a summary of the French Intergroup guidelines regarding the management of rectal adenocarcinoma published in February 2016. METHOD This collaborative work, under the auspices of most of the French medical societies involved in the management of rectal cancer, is based on the previous guidelines published in 2013. Recommendations are graded into 3 categories according to the level of evidence of data found in the literature. RESULTS In agreement with the ESMO guidelines (2013), non-metastatic rectal cancers have been stratified in 4 risk groups according to endoscopy, MRI or endorectal-ultrasonography. Locally-advanced tumors are limited to groups 3 and 4 (T3≥4cm or T3c-d or N1-2 or T4). These tumors are usually treated using neoadjuvant treatment and total proctectomy (TME). Adjuvant treatment depends on the pathological findings. Very early (group 1) or early (group 2) tumors are managed mainly by surgery, and organ preservation may be an option in selected cases. For metastatic tumors, the recommendations are based on less robust evidence and chemotherapy plays a major role. CONCLUSION Such recommendations are constantly being optimized and each individual case must be discussed within a Multi-Disciplinary Team.
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Aparicio T, Bouché O, Francois E, Maillard E, Kirscher S, Taieb J, Etienne PL, Faroux R, Khemissa Akouz F, El Hajbi F, Locher C, Rinaldi Y, Lecomte T, Lavau-Denes S, Baconnier M, Oden-Gangloff A, Genet D, Paillaud E, Retornaz F, Bedenne L. Prognostic factor analysis for elderly patients treated for metastatic colorectal cancer in the randomized phase II trial PRODIGE 20. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.131] [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: 11/14/2022] Open
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Anota A, Boulin M, Dabakuyo-Yonli S, Hillon P, Cercueil JP, Minello A, Jouve JL, Paoletti X, Bedenne L, Guiu B, Bonnetain F. An explorative study to assess the association between health-related quality of life and the recommended phase II dose in a phase I trial: idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma. BMJ Open 2016; 6:e010696. [PMID: 27342239 PMCID: PMC4932346 DOI: 10.1136/bmjopen-2015-010696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The objective of this study was to explore the association between health-related quality of life (HRQoL) and the recommended phase 2 dose in a phase I clinical trial according to the Time to HRQoL deterioration approach (TTD). SETTING This is a phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads performed in cirrhotic patients with hepatocellular carcinoma. Patients had to complete the EORTC QLQ-C30 HRQoL questionnaire at baseline and at days 15, 30 and 60 after TACE. PARTICIPANTS Patients aged ≥18 years with HCC unsuitable for curative treatments were evaluated for the study (N=21). PRIMARY AND SECONDARY OUTCOME MEASUREMENTS The primary objective was to determine the maximum tolerated dose (MTD) of idarubicin loaded after a single TACE session. MTD was defined as the dose level closest to that causing dose-limiting toxicity in 20% of patients. HRQoL was the secondary end point. RESULTS Between March 2010 and March 2011, 9, 6 and 6 patients were included at idarubicin dose levels of 5, 10 and 15 mg, respectively. Calculated MTD of idarubicin was 10 mg. At the 10 mg idarubicin dose, patients presented a longer TTD than at 5 mg, for global health status (HR=0.91 (95% CI 0.18 to 4.72)), physical functioning (HR=0.38 (0.04 to 3.22)), fatigue (HR=0.67 (0.18 to 2.56)) and pain (HR=0.47 (0.05 to 4.24)). CONCLUSIONS These HRQoL results were consistent with the estimated MTD, with a median TTD for global health status of 41 days (21 to NA) at 5 mg, 23 days (20 to NA) at 10 mg and 25 days (17 to NA) at 15 mg. These results show the importance of studying HRQoL in phase I trials. TRIAL REGISTRATION NUMBER NCT01040559; Post-results.
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Affiliation(s)
- Amélie Anota
- Quality of Life in Oncology National Platform, Besançon, France
- Methodological and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Mathieu Boulin
- INSERM U866, University of Burgundy, Dijon, France
- Department of Pharmacy, University Hospital, Dijon, France
| | - Sandrine Dabakuyo-Yonli
- Quality of Life in Oncology National Platform, Besançon, France
- Biostatistics and Quality of Life Unit (EA 4184), Centre Georges Francois Leclerc, Dijon, France
| | - Patrick Hillon
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Jean-Pierre Cercueil
- INSERM U866, University of Burgundy, Dijon, France
- Department of Interventional Radiology, University Hospital, Dijon, France
| | - Anne Minello
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Jean-Louis Jouve
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Xavier Paoletti
- Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Paris, France
| | - Laurent Bedenne
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, Montpellier, France
| | - Franck Bonnetain
- Quality of Life in Oncology National Platform, Besançon, France
- Methodological and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
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Bennouna J, Etienne PL, Bogart E, Galais MP, Benabdelghani M, Francois E, Michel P, Dahan L, Metges JP, Ghiringhelli F, Conroy T, Kotecki N, Bedenne L, El Hajbi F, Samalin E, Piessen G, Delaine-Clisant S, Penel N, Mariette C, Adenis A. LBA-04 The E-DIS study, a randomized discontinuation trial of first-line chemotherapy (CT) in patients with metastatic squamous-cell esophageal cancer (MSEC): efficacy and quality of life results. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw237.04] [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: 11/12/2022] Open
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Bennouna J, Etienne PL, Bogart E, Galais MP, Benabdelghani M, Francois E, Michel P, Dahan L, Metges JP, Ghiringhelli F, Conroy T, Kotecki N, Bedenne L, El Hajbi F, Samalin E, Piessen G, Delaine-Clisant S, Penel N, Mariette C, Adenis A. LBA-04The E-DIS study, a randomized discontinuation trial of first-line chemotherapy (CT) in patients with metastatic squamous-cell esophageal cancer (MSEC): efficacy and quality of life results. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw237.4] [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: 11/14/2022] Open
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Aparicio T, Maillard E, Ducreux M, Bouche O, Rougier P, De Gramont A, Manfredi S, Lecomte T, Etienne PL, Bedenne L, Bennouna J, Phelip JM, Francois E, Michel P, Legoux JL, Gasmi M, Faroux R, Breysacher G, Lepage C, Seitz JF. Obesity in metastatic colorectal cancer: Pooled analysis of FFCD trials. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | | | | | - Pierre Michel
- Digestive Oncology Unit, IRON group, CHU Rouen, University of Normandy, Rouen, France
| | | | | | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche Sur Yon, France
| | | | - Come Lepage
- CHU Le Bocage HGE, INSERM U866, Dijon, France
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Adenis A, Bennouna J, Etienne PL, Bogart E, Francois E, Galais MP, Ben Abdelghani M, Kotecki N, Michel P, Metges JP, Dahan L, Piessen G, Conroy T, Ghiringhelli F, Bedenne L, El Hajbi F, Samalin E, Delaine SC, Penel N, Mariette C. Discontinuation of first-line chemotherapy (CT) after 6 weeks of CT in patients (pts) with metastatic squamous-cell esophageal cancer (MSEC): A randomized phase II trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | | | | | - Pierre Michel
- Digestive Oncology Unit, IRON group, CHU Rouen, University of Normandy, Rouen, France
| | - Jean-Philippe Metges
- Cancer Institute University Hospital Morvan and Observatory of Cancer Inserm 1078 - Mission 8.1 Canceropole Grand Ouest, Brest, France
| | - Laetitia Dahan
- La Timone, Marseille University Hospital, Marseille, France
| | | | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les Nancy, France
| | | | | | | | | | | | | | - Christophe Mariette
- Department of Digestive and Oncologic Surgery, Claude Huriez University Hospital, Lille, France
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Aparicio T, Francois E, Cristol-Dalstein L, Carola E, Maillard E, Paillaud E, Retornaz F, Faroux R, André T, Bedenne L, Seitz JF. PRODIGE 34-FFCD 1402-ADAGE: Adjuvant chemotherapy in elderly patients with resected stage III colon cancer: A randomized phase 3 trial. Dig Liver Dis 2016; 48:206-7. [PMID: 26748426 DOI: 10.1016/j.dld.2015.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Thomas Aparicio
- Gastroenterology and Digestive Oncology, CHU Avicenne, APHP, Bobigny, France.
| | | | | | | | - Emilie Maillard
- Fédération Francophone de Cancérologie Digestive, Burgundy University, INSERM U866, Dijon, France
| | | | | | - Roger Faroux
- Gastroenterology, CH de la Roche sur Yon, La Roche sur Yon, France
| | | | - Laurent Bedenne
- Fédération Francophone de Cancérologie Digestive, Burgundy University, INSERM U866, Dijon, France
| | - Jean-François Seitz
- Hepato-Gastroenterology and Digestive Oncology, CHU La Timone, APHM, Marseille, France
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Kotecki N, Hiret S, Etienne PL, Penel N, Tresch E, François E, Galais MP, Ben Abdelghani M, Michel P, Dahan L, Ghiringelli F, Bedenne L, Samalin E, Piessen G, Bennouna J, Peugniez C, El Hajbi F, Clisant S, Kramar A, Mariette C, Adenis A. First-Line Chemotherapy for Metastatic Esophageal Squamous Cell Carcinoma: Clinico-Biological Predictors of Disease Control. Oncology 2016; 90:88-96. [PMID: 26784946 DOI: 10.1159/000442947] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of tumor control (TC) in metastatic esophageal squamous cell carcinoma patients receiving first-line chemotherapy. METHODS A development cohort of 68 patients from a prospective multicenter trial (NCT01248299) was used to identify predictors of TC at first radiological tumor assessment and to generate a predictive score for TC. That score was applied in an independent retrospective single-center validation cohort of 60 consecutive patients. RESULTS Multivariate analysis identified three predictors of TC: body mass index ≥18.5 (OR 4.5, 95% CI 0.91-22.5), absence of bone metastasis (OR 4.6, 95% CI 0.91-23.2) and albumin ≥35 g/l (OR 3.5, 95% CI 1.0-12.1). Based on the presence or absence of these three independent prognosticators, we built a predictive model using a score from 0 to 3. In the development cohort, the TC rates were 14.3 and 78.0% and in the validation cohort 12.5 and 44.2%, for scores of 0-1 and 2-3, respectively. With negative predictive values of 85 and 88% in the development and validation cohorts, respectively, we were able to identify patients with a very low probability of TC. CONCLUSION We have developed and validated a score that can be easily determined at the bedside to predict TC in metastatic esophageal squamous cell carcinoma patients.
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Manfredi S, Bouché O, Rougier P, Dahan L, Loriot MA, Aparicio T, Etienne PL, Lafargue JP, Lécaille C, Legoux JL, Le Malicot K, Maillard E, Lecomte T, Khemissa F, Breysacher G, Michel P, Mitry E, Bedenne L. High-Dose FOLFIRI plus Bevacizumab in the Treatment of Metastatic Colorectal Cancer Patients with Two Different UGT1A1 Genotypes: FFCD 0504 Study. Mol Cancer Ther 2015; 14:2782-8. [PMID: 26494856 DOI: 10.1158/1535-7163.mct-15-0293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/21/2015] [Indexed: 11/16/2022]
Abstract
High-dose FOLFIRI has an acceptable safety profile and promising efficacy. UDP-glucuronosyltransferase: (UGT1A1) polymorphism may be predictive of toxicity and efficacy of irinotecan. This phase II study aimed to evaluate the combination of high-dose FOLFIRI plus bevacizumab in patients with previously untreated metastatic colorectal cancer (MCRC) based on their UGT1A1 genotype. Patients with the UGT1A1 *1/*1 (group 1) or *1/*28 (group 2) genotype received bevacizumab plus high-dose FOLFIRI every 2 weeks. Using the Bryant and Day design with objective response rate and toxicity as the primary endpoints, 54 patients in each group were required with a planned interim analysis after inclusion of 17 patients per group. We planned to stop the trial at the interim analysis if ≤ 7 patients exhibited an objective response (OR) and/or ≥ 3 patients exhibited severe toxicity. At the interim analysis, ORs were higher than the number expected: 52.9% (group 1) and 58.8% (group 2). More than three toxic events occurred in both groups and, according to the interim analysis rule, the trial was closed due to unacceptable toxicity. Recruitment was stopped when 86 patients were included and an analysis on overall population was done for overall survival (OS) and progression-free survival (PFS). The median PFS was 10.7 months (group 1) and 10.4 months (group 2). The median OS was 25.5 months (group 1) and 23.9 months (group 2). This trial does not support the use of the intensive treatment with HD-FOLFIRI plus bevacizumab combination for MCRC in patients with the UGTA1*1/UGT1A1*1 or UGT1A1*1/UGT1A1*28 genotype.
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Affiliation(s)
- Sylvain Manfredi
- Hepato-Gastroenterology and Digestive Oncology Department, University Hospital Dijon, INSERM U 866, Digestive Cancer Registry of Burgundy, Dijon, France. Fédération Francophone de Cancérologie Digestive, INSERM U866, Dijon, France.
| | - Olivier Bouché
- Department of Gastroenterology, CHU Robert Debré, Reims, France
| | - Philippe Rougier
- Assistance Publique Hôpitaux de Paris, Hôpital Européen G Pompidou and Université Paris Descartes, Paris, France
| | - Laetitia Dahan
- Department of Gastroenterology, Assistance Publique - Hôpitaux de Marseille, Hôpital la Timone, et Aix-Marseille Université, Marseille, France
| | - Marie Anne Loriot
- Assistance Publique Hôpitaux de Paris, Hôpital Européen G Pompidou and Université Paris Descartes, Paris, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Avicenne Hospital, HUPSSD, APHP and University Paris 13, Bobigny, France
| | - Pierre Luc Etienne
- Department of Medical Oncology, Clinique Armoricaine de Radiologie, St-Brieuc, France
| | | | - Cedric Lécaille
- Department of Gastroenterology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Jean Louis Legoux
- Department of Gastroenterology, Centre Hospitalier Régional, Orléans, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, INSERM U866, Dijon, France
| | - Emilie Maillard
- Fédération Francophone de Cancérologie Digestive, INSERM U866, Dijon, France
| | - Thierry Lecomte
- Department of Gastroenterology, CHU de Tours and Université François Rabelais, Chambray les Tours, France
| | - Faiza Khemissa
- Department of Gastroenterology, Centre Hospitalier, Perpignan, France
| | | | - Pierre Michel
- Department of Gastroenterology, Rouen University Hospital and University of Rouen, Rouen, France
| | - Emmanuel Mitry
- Department of Medical Oncology, Institut Curie, Paris - St. Cloud and Université Versailles St. Quentin, UFR des Sciences de la Santé, Saint Cloud, France
| | - Laurent Bedenne
- Hepato-Gastroenterology and Digestive Oncology Department, University Hospital Dijon, INSERM U 866, Digestive Cancer Registry of Burgundy, Dijon, France. Fédération Francophone de Cancérologie Digestive, INSERM U866, Dijon, France
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Aparicio T, Lavau-Denes S, Phelip JM, Maillard E, Jouve JL, Gargot D, Gasmi M, Locher C, Adhoute X, Michel P, Khemissa F, Lecomte T, Provençal J, Breysacher G, Legoux JL, Lepère C, Charneau J, Cretin J, Chone L, Azzedine A, Bouché O, Sobhani I, Bedenne L, Mitry E. Randomized phase III trial in elderly patients comparing LV5FU2 with or without irinotecan for first-line treatment of metastatic colorectal cancer (FFCD 2001-02). Ann Oncol 2015; 27:121-7. [PMID: 26487578 DOI: 10.1093/annonc/mdv491] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Metastatic colorectal cancer (mCRC) frequently occurs in elderly patients. However, data from a geriatric tailored randomized trial about tolerance to and the efficacy of doublet chemotherapy (CT) with irinotecan in the elderly are lacking. The benefit of first-line CT intensification remains an issue in elderly patients. PATIENTS AND METHODS Elderly patients (75+) with previously untreated mCRC were randomly assigned in a 2 × 2 factorial design (four arms) to receive 5-FU (5-fluorouracil)-based CT, either alone (FU: LV5FU2 or simplified LV5FU2) or in combination with irinotecan [IRI: LV5FU2-irinotecan or simplified LV5FU2-irinotecan (FOLFIRI)]. The CLASSIC arm was defined as LV5FU2 or LV5FU2-irinotecan and the SIMPLIFIED arm as simplified LV5FU2 or FOLFIRI. The primary end point was progression-free survival (PFS). Secondary end points were overall survival (OS), safety and objective response rate (ORR). RESULTS From June 2003 to May 2010, 71 patients were randomly assigned to LV5FU2, 71 to simplified LV5FU2, 70 to LV5FU2-irinotecan and 70 to FOLFIRI. The median age was 80 years (range 75-92 years). No significant difference was observed for the median PFS: FU 5.2 months versus IRI 7.3 months, hazard ratio (HR) = 0.84 (0.66-1.07), P = 0.15 and CLASSIC 6.5 months versus SIMPLIFIED 6.0 months, HR = 0.85 (0.67-1.09), P = 0.19. The ORR was superior in IRI (P = 0.0003): FU 21.1% versus IRI 41.7% and in CLASSIC (P = 0.04): CLASSIC 37.1% versus SIMPLIFIED 25.6%. Median OS was 14.2 months in FU versus 13.3 months in IRI, HR = 0.96 (0.75-1.24) and 15.2 months in CLASSIC versus 11.4 months in SIMPLIFIED, HR = 0.71 (0.55-0.92). More patients presented grade 3-4 toxicities in IRI (52.2% versus 76.3%). CONCLUSION In this elderly population, adding irinotecan to an infusional 5-FU-based CT did not significantly increase either PFS or OS. Classic LV5FU2 was associated with an improved OS compared with simplified LV5FU2. CLINICALTRIALSGOV NCT00303771.
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Affiliation(s)
- T Aparicio
- Department of Gastroenterology, CHU Avicenne, APHP and University Paris 13, Sorbonne Paris Cité, Bobigny
| | | | - J M Phelip
- Department of Gastroenterology, CHU Saint Etienne-Hôpital Nord, Saint Priest en Jarez
| | - E Maillard
- FFCD Data Center, Fédération Francophone de Cancérologie Digestive, Dijon
| | - J L Jouve
- Department of Gastroenterology, CHU Le Bocage, Dijon
| | - D Gargot
- Department of Gastroenterology, CH Blois, Blois
| | - M Gasmi
- Department of Gastroenterology, CHU Hôpital Nord, Marseille
| | - C Locher
- Department of Gastroenterology, CH Meaux, Meaux
| | - X Adhoute
- Department of Gastroenterology, CHU Haut Lévèque, Pessac
| | - P Michel
- Department of Gastroenterology, CHU Charles Nicolle, Rouen
| | - F Khemissa
- Department of Gastroenterology, CH Saint Jean, Perpignan
| | - T Lecomte
- Department of Gastroenterology, CHU Trousseau, Tours
| | - J Provençal
- Department of Oncology, CH Chambery, Chambery
| | - G Breysacher
- Department of Gastroenterology, CH Pasteur, Colmar
| | - J L Legoux
- Department of Gastroenterology, CH de la Source, Orléans
| | - C Lepère
- Department of Digestive Oncology, CHU Georges Pompidou, APHP, Paris
| | - J Charneau
- Department of Gastroenterology, CH Duchenne, Boulogne sur Mer
| | - J Cretin
- Department of Oncology, Clinique Bonnefon, Alès
| | - L Chone
- Department of Gastroenterology, CHU Nancy, Vandoeuvre-les-Nancy
| | - A Azzedine
- Department of Gastroenterology, CH Avignon, Avignon
| | - O Bouché
- Department of Gastroenterology, CHU Robert Debré, Reims
| | - I Sobhani
- Department of Gastroenterology, CHU Henri Mondor, APHP, Créteil
| | - L Bedenne
- FFCD Data Center, Fédération Francophone de Cancérologie Digestive, Dijon Department of Gastroenterology, CHU Le Bocage, Dijon
| | - E Mitry
- Department of Oncology, Institut Curie, Saint-Cloud University Versailles-St Quentin, St Quentin, France
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Vincent J, Mariette C, Pezet D, Huet E, Bonnetain F, Bouché O, Conroy T, Roullet B, Seitz JF, Herr JP, Di Fiore F, Jouve JL, Bedenne L. Early surgery for failure after chemoradiation in operable thoracic oesophageal cancer. Analysis of the non-randomised patients in FFCD 9102 phase III trial: Chemoradiation followed by surgery versus chemoradiation alone. Eur J Cancer 2015; 51:1683-93. [PMID: 26163097 DOI: 10.1016/j.ejca.2015.05.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two randomised trials concerning thoracic oesophageal cancer concluded that for squamous cell carcinoma, chemoradiation alone leads to the same overall survival (OS) as chemoradiation followed by surgery. One of these trials, FFCD 9102, randomised only fit, compliant and operable responders to induction chemoradiation between continuation of chemoradiation and surgery. In the present analysis, the outcome in the patients not eligible for randomisation was calculated to determine if attempt of surgery should be recommended. METHODS Eligible patients had operable T3-N0/N1-M0 thoracic oesophageal cancer. After initial chemoradiation, patients with no clinical response, or with contraindication to follow any attributed treatment, were not randomised. OS was studied first in the whole population of not randomised patients, and then specifically in clinical non-responders. The impact of surgery on OS was studied in these two populations. FINDINGS Of the 451 registered patients in the trial, 192 were not randomised. Among them, 111 were clinical non-responders. Median OS was significantly shorter for non-randomised patients (11.5 months) than for randomised patients (18.9 months; p=0.0024). However, for the 112 non-randomised patients who underwent surgery, median OS was not different from that in randomised patients: 17.3 versus 18.9 months (p=0.58). Concerning clinical non-responders, median OS was longer for those who underwent surgery compared to non-operated patients: 17.0 versus 5.5 months (hazard ratio (HR)=0.39 [0.25-0.61]; p<0.0001), and again was not different from that in responding, randomised patients (p=0.40). INTERPRETATION In patients with locally advanced thoracic oesophageal cancer, overall survival did not differ between responders to induction chemoradiation and patients having surgery after clinical failure of chemoradiation. Surgery should therefore be considered in those patients who are still operable.
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Affiliation(s)
| | | | - Denis Pezet
- Hôtel-Dieu University Hospital, Clermont-Ferrand, France
| | | | | | | | - Thierry Conroy
- Alexis Vautrin Anticancer Centre, Vandoeuvre-lès Nancy, France
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Putora PM, Bedenne L, Budach W, Eisterer W, Van Der Gaast A, Jäger R, Van Lanschot JJB, Mariette C, Schnider A, Stahl M, Ruhstaller T. Oesophageal cancer: exploring controversies overview of experts' opinions of Austria, Germany, France, Netherlands and Switzerland. Radiat Oncol 2015; 10:116. [PMID: 25994051 PMCID: PMC4461999 DOI: 10.1186/s13014-015-0418-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/05/2015] [Indexed: 11/27/2022] Open
Abstract
Background Oesophageal carcinoma is a rare disease with often dismal prognosis. Despite multiple trials addressing specific issues, currently, many questions in management remain unanswered. This work aimed to specifically address areas in the management of oesophageal cancer where high level evidence is not available, performing trials is very demanding and for many questions high-level evidence will not be available in the forseeable future. Methods Two experts of each national, oesophageal cancer research group from Austria, France, Germany, the Netherlands and Switzerland were asked to provide statements to controversial issues. After an initial survey, further questions were formulated and answered by all experts. The answers were then discussed and qualitatively analysed for consensus and controversy. Results Topics such as indications for PET-CT, reasons for induction chemotherapy, radiotherapy dose, the choice of definitive chemo-radiotherapy versus surgery in squamous cell cancer, the role of radiotherapy in adenocarcinoma and selected surgical issues were identified as topics of interest and discussed. Conclusion Areas of significant controversy exist in the management of oesophageal cancer, mostly due to high-level evidence. This is not expected to change in the upcoming years. Electronic supplementary material The online version of this article (doi:10.1186/s13014-015-0418-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
| | - Laurent Bedenne
- University Hospital Le Bocage, Dijon, France Federation Francophone de Cancérologie Digestive (FFCD), Dijon, France.
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University of Düsseldorf, German Oesophageal Study Group (GOSG), Düsseldorf, Germany.
| | - Wolfgang Eisterer
- Department of Internal Medicine V, Innsbruck Medical University, West-Austrian Study Group (AGMT), Innsbruck, Austria.
| | - Ate Van Der Gaast
- Department of Medical Oncology, Erasmus University Medical Center, ChemoRadiotherapy for Oesophageal cancer versus Surgery alone Study Group (CROSS), Rotterdam, The Netherlands.
| | - Robert Jäger
- Department of Radiation Oncology, Innsbruck Medical University, West-Austrian Study Group (AGMT), Innsbruck, Austria.
| | - J Jan B Van Lanschot
- Department of Surgery, Erasmus University Medical Center, ChemoRadiotherapy for Oesophageal cancer versus Surgery alone Study Group (CROSS), Rotterdam, The Netherlands.
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital Lille, Federation Francophone de Cancérologie Digestive (FFCD), Lille, France.
| | - Annelies Schnider
- Department of Surgery, City-Hospital Triemli, Swiss Group for Clinical Cancer Research (SAKK), Zurich, Switzerland.
| | - Michael Stahl
- Kliniken Essen-Mitte, Klinik für Internistische Onkologie und Hämatologie, German Oesophageal Study Group (GOSG), Essen, Germany.
| | - Thomas Ruhstaller
- Department of Haematology and Oncology, Swiss Group for Clinical Cancer Research (SAKK), Kantonsspital St. Gallen, St. Gallen, Switzerland.
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Aparicio T, Bouche O, Francois E, Maillard E, Kirscher S, Taïeb J, Etienne PL, Faroux R, Khemissa F, El Hajbi F, Locher C, Rinaldi Y, Lecomte T, Lavau-Denes S, Baconnier M, Oden-Gangloff A, Genet D, Paillaud E, Retornaz F, Bedenne L. PRODIGE 20: Bevacizumab + chemotherapy (BEV-CT) versus chemotherapy alone (CT) in elderly patients (pts) with untreated metastatic colorectal cancer (mCRC)—A randomized phase II trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas Aparicio
- Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Emilie Maillard
- Biostatistic Unit, Fédération Francophone de Cancérologie Digestive, Dijon, France
| | | | - Julien Taïeb
- APHP and Paris Descartes University, Paris, France
| | | | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France
| | | | | | - Christophe Locher
- Department of Hepato-Gastroenterology, Meaux Hospital, Meaux, France
| | | | | | | | | | - Alice Oden-Gangloff
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University, Rouen, France
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Thaler J, Greil R, Gaenzer J, Eisterer W, Tschmelitsch J, Samonigg H, Zabernigg A, Schmid F, Steger G, Steinacher R, Andel J, Lang A, Függer R, Hofbauer F, Woell E, Geissler D, Lenauer A, Prager M, Van Laethem JL, Van Cutsem E, D'Haens G, Demolin G, Kerger J, Deboever G, Ghillebert G, Polus M, Van Cutsem E, RezaieKalantari H, Delaunoit T, Goeminne JC, Peeters M, Vergauwe P, Houbiers G, Humblet Y, Janssens J, Schrijvers D, Vanderstraeten E, Van Laethem JL, Vermorken J, Van Daele D, Ferrante M, Forget F, Hendlisz A, Yilmaz M, Nielsen SE, Vestermark L, Larsen J, Ychou M, Zawadi A, Zawadi MA, Bouche O, Mineur L, Bennouna-Louridi J, Dourthe LM, Ychou M, Boucher E, Taieb J, Pezet D, Desseigne F, Ducreux M, Texereau P, Miglianico L, Rougier P, Fratte S, Levache CB, Merrouche, Y, Ellis S, Locher C, Ramee JF, Garnier C, Viret F, Chauffert B, Cojean-Zelek I, Michel P, Lecaille C, Borel C, Seitz JF, Smith D, Lombard-Bohas C, Andre T, Gornet JM, Fein F, Coulon-Sfairi MA, Kaminsky MC, Lagasse JP, Luet D, Etienne PL, Gasmi M, Vanoli A, Nguyen S, Aparicio T, Perrier H, Stremsdoerfer N, Laplaige P, Arsene D, Auby D, Bedenne L, Coriat R, Denis B, Geoffroy P, Piot G, Becouarn Y, Bordes G, Deplanque G, Dupuis O, Fruge F, Guimbaud R, Lecomte T, Lledo G, Sobhani I, Asnacios A, Azzedine A, Desauw C, Galais MP, Gargot D, Lam YH, Abakar-Mahamat A, Berdah JF, Catteau S, Clavero-Fabri MC, Codoul JF, Legoux JL, Goldfain D, Guichard P, Verge DP, Provencal J, Vedrenne B, Brezault-Bonnet C, Cleau D, Desir JP, Fallik D, Garcia B, Gaspard MH, Genet D, Hartwig J, Krummel Y, MatysiakBudnik T, Palascak-Juif V, Randrianarivelo H, Rinaldi Y, Aleba A, Darut-Jouve A, de Gramont A, Hamon H, Wendehenne F, Matzdorff A, Stahl MK, Schepp W, Burk M, Mueller L, Folprecht G, Geissler M, Mantovani-Loeffler L, Hoehler T, Asperger W, Kroening H, von Weikersthal LF, Fuxius S, Groschek M, Meiler J, Trarbach T, Rauh J, Ziegenhagen N, Kretzschmar A, Graeven U, Nusch A, von Wichert G, Hofheinz RD, Kleber G, Schmidt KH, Vehling-Kaiser U, Baum C, Schuette J, Haag GM, Holtkamp W, Potenberg J, Reiber T, Schliesser G, Schmoll HJ, Schneider-Kappus W, Abenhardt W, Denzlinger C, Henning J, Marxsen B, GuenterDerigs H, Lambertz H, Becker-Boost I, Caca K, Constantin C, Decker T, Eschenburg H, Gabius S, Hebart H, Hoffmeister A, Horst HA, Kremers S, Leithaeuser M, Mueller S, Wagner S, Daum S, Schlegel F, Stauch M, Heinemann V, Labianca R, Colucci G, Amadori D, Mini E, Falcone A, Boni C, Maiello E, Latini L, Zaniboni A, Amadori D, Aprile G, Barni S, Mattioli R, Martoni A, Passalacqua R, Nicolini M, Pasquini E, Rabbi C, Aitini E, Ravaioli A, Barone C, Biasco G, Tamberi S, Gambi A, Verusio C, Marzola M, Lelli G, Boni C, Cascinu S, Bidoli P, Vaghi M, Cruciani G, Di Costanzo F, Sobrero A, Mini E, Petrioli R, Aglietta M, Alabiso O, Capuzzo F, Falcone A, Corsi DC, Labianca R, Salvagni S, Chiara S, Ferraù F, Giuliani F, Lonardi S, Gebbia N, Mantovani G, Sanches E, Sanches E, Mellidez JC, Santos P, Freire J, Sarmento C, Costa L, Pinto AM, Barroso S, Santo JE, Guedes F, Monteiro A, Sa A, Furtado I, Tabernero J, Salazar R, Aguilar EA, Herrero FR, Tabernero J, Valera JS, ValladaresAyerbes M, FeliuBatlle J, Gil S, Garcia-Giron C, Vivanco GL, Salvia AS, Orduña VA, Garcia RV, Gallego J, Sureda BM, Remon J, Safont Aguilera MJ, CireraNogueras L, Merino B, Castro CG, de Prado PM, PijaumePericay C, ConstenlaFigueiras M, Jordan I, GomeReina MJ, Garcia ALL, Garcia-Ramos AA, Cervantes A, Martos CF, MarcuelloGaspar E, Montero IC, Emperador PE, Carbonero AL, Castillo MG, Garcia TG, Lopez JG, Flores EG, GuillotMorales M, LlanosMuñoz M, Martín AL, Maurel J, Camara JC, Garcia RD, Salgado M, HernandezBusquier I, Ruiz TC, LacastaMuñoa A, Aliguer M, Ortiz de Taranco AV, Ureña MM, Gaspa FL, Ponce JJ, Roig CB, Jimenez PV, GalanBrotons A, AlbiolRodriguez S, Martinez JA, Ruiz LC, CentellesRuiz M, Bridgewater J, Glynne-Jones R, Tahir S, Hickish T, Cassidy J, Samuel L. Prognostic value of KRAS mutations in stage III colon cancer: post hoc analysis of the PETACC8 phase III trial dataset. Ann Oncol 2015; 26:822-825. [DOI: 10.1093/annonc/mdv070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aparicio T, Linot B, Le Malicot K, Bouché O, Boige V, François E, Ghiringhelli F, Legoux JL, Ben Abdelghani M, Phelip JM, Faroux R, Dahan L, Taieb J, Bedenne L. FOLFIRI+bevacizumab induction chemotherapy followed by bevacizumab or observation in metastatic colorectal cancer, a phase III trial (PRODIGE 9--FFCD 0802). Dig Liver Dis 2015; 47:271-2. [PMID: 25677925 DOI: 10.1016/j.dld.2015.01.146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology, Avicenne Hospital, Bobigny, France.
| | - Benjamin Linot
- Department of Oncology, Institut de Cancérologie de l'Ouest Nantes-Angers, France
| | | | | | - Valérie Boige
- Department of Gastrointestinal Oncology, Gustave Roussy, Villejuif, France
| | - Eric François
- Department of Gastroenterology, Centre Antoine Lacassagne, Nice, France
| | | | | | | | - Jean-Marc Phelip
- Department of Gastroenterology, CHU Bellevue Nord, Saint Etienne, France
| | - Roger Faroux
- Department of Gastroenterology, CH Les Oudaries, La Roche sur Yon, France
| | - Laetitia Dahan
- Department of Gastroenterology, CHU La Timone, Aix-Marseille University, Marseille, France
| | - Julien Taieb
- Department of Gastroenterology, Georges Pompidou Hospital, Paris, France
| | - Laurent Bedenne
- Department of Gastroenterology, CHU Le Bocage, Dijon, France
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Cottet V, Bouvier V, Rollot F, Jooste V, Bedenne L, Faivre J, Launoy G, Bouvier AM. Incidence and Patterns of Late Recurrences in Rectal Cancer Patients. Ann Surg Oncol 2015; 22:520-527. [DOI: 10.1245/s10434-014-3990-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Guimbaud R, Louvet C, Ries P, Ychou M, Maillard E, André T, Gornet JM, Aparicio T, Nguyen S, Azzedine A, Etienne PL, Boucher E, Rebischung C, Hammel P, Rougier P, Bedenne L, Bouché O. Prospective, Randomized, Multicenter, Phase III Study of Fluorouracil, Leucovorin, and Irinotecan Versus Epirubicin, Cisplatin, and Capecitabine in Advanced Gastric Adenocarcinoma: A French Intergroup (Fédération Francophone de Cancérologie Digestive, Fédération Nationale des Centres de Lutte Contre le Cancer, and Groupe Coopérateur Multidisciplinaire en Oncologie) Study. J Clin Oncol 2014; 32:3520-6. [DOI: 10.1200/jco.2013.54.1011] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose To compare epirubicin, cisplatin, and capecitabine (ECX) with fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatments in patients with advanced gastric or esophagogastric junction (EGJ) adenocarcinoma. Patients and Methods This open, randomized, phase III study was carried out in 71 centers. Patients with locally advanced or metastatic gastric or EGJ cancer were randomly assigned to receive either ECX as first-line treatment (ECX arm) or FOLFIRI (FOLFIRI arm). Second-line treatment was predefined (FOLFIRI for the ECX arm and ECX for the FOLFIRI arm). The primary criterion was time-to-treatment failure (TTF) of the first-line therapy. Secondary criteria were progression-free survival (PFS), overall survival (OS), toxicity, and quality of life. Results In all, 416 patients were included (median age, 61.4 years; 74% male). After a median follow-up of 31 months, median TTF was significantly longer with FOLFIRI than with ECX (5.1 v 4.2 months; P = .008). There was no significant difference between the two groups in median PFS (5.3 v 5.8 months; P = .96), median OS (9.5 v 9.7 months; P = .95), or response rate (39.2% v 37.8%). First-line FOLFIRI was better tolerated (overall rate of grade 3 to 4 toxicity, 69% v 84%; P < .001; hematologic adverse events [AEs], 38% v 64.5%; P < .001; nonhematologic AEs: 53% v 53.5%; P = .81). Conclusion FOLFIRI as first-line treatment for advanced gastric and EGJ cancer demonstrated significantly better TTF than did ECX. Other outcome results indicate that FOLFIRI is an acceptable first-line regimen in this setting and should be explored as a backbone regimen for targeted agents.
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Affiliation(s)
- Rosine Guimbaud
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Christophe Louvet
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Pauline Ries
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Marc Ychou
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Emilie Maillard
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Thierry André
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Jean-Marc Gornet
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Thomas Aparicio
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Suzanne Nguyen
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Ahmed Azzedine
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Pierre-Luc Etienne
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Eveline Boucher
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Christine Rebischung
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Pascal Hammel
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Philippe Rougier
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Laurent Bedenne
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
| | - Olivier Bouché
- Rosine Guimbaud, Centre Hospitalier Universitaire Toulouse, Toulouse; Christophe Louvet, Institut Mutualiste Montsouris; Thierry André, Hôpital Saint Antoine; Jean-Marc Gornet, Centre Hospitalier Universitaire Saint Louis (Assistance Publique-Hôpitaux de Paris); Pascal Hammel, Hôpital Beaujon; Philippe Rougier, Hôpital Européen Georges Pompidou, Paris; Pauline Ries, Institut Paoli Calmettes, Marseille; Marc Ychou, Institut Régional du Cancer Val d'Aurelle, Montpellier; Emilie Maillard, Fédération
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Boulin M, Bedenne L, Guiu B. Editorial: IDASPHERE phase I trial for chemoembolisation for HCC - authors' reply: a necessary step for treatment optimisation and standardisation. Aliment Pharmacol Ther 2014; 40:210-1. [PMID: 24946061 DOI: 10.1111/apt.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/22/2014] [Indexed: 12/08/2022]
Affiliation(s)
- M Boulin
- INSERM U866, University of Burgundy, Dijon, France; Department of Pharmacy, University Hospital, Dijon, France.
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Mariette C, Dahan L, Mornex F, Maillard E, Thomas PA, Meunier B, Boige V, Pezet D, Robb WB, Le Brun-Ly V, Bosset JF, Mabrut JY, Triboulet JP, Bedenne L, Seitz JF. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol 2014; 32:2416-22. [PMID: 24982463 DOI: 10.1200/jco.2013.53.6532] [Citation(s) in RCA: 418] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Although often investigated in locally advanced esophageal cancer (EC), the impact of neoadjuvant chemoradiotherapy (NCRT) in early stages is unknown. The aim of this multicenter randomized phase III trial was to assess whether NCRT improves outcomes for patients with stage I or II EC. METHODS The primary end point was overall survival. Secondary end points were disease-free survival, postoperative morbidity, in-hospital mortality, R0 resection rate, and prognostic factor identification. From June 2000 to June 2009, 195 patients in 30 centers were randomly assigned to surgery alone (group S; n = 97) or NCRT followed by surgery (group CRT; n = 98). CRT protocol was 45 Gy in 25 fractions over 5 weeks with two courses of concomitant chemotherapy composed of fluorouracil 800 mg/m(2) and cisplatin 75 mg/m(2). We report the long-term results of the final analysis, after a median follow-up of 93.6 months. RESULTS Pretreatment disease was stage I in 19.0%, IIA in 53.3%, and IIB in 27.7% of patients. For group CRT compared with group S, R0 resection rate was 93.8% versus 92.1% (P = .749), with 3-year overall survival rate of 47.5% versus 53.0% (hazard ratio [HR], 0.99; 95% CI, 0.69 to 1.40; P = .94) and postoperative mortality rate of 11.1% versus 3.4% (P = .049), respectively. Because interim analysis of the primary end point revealed an improbability of demonstrating the superiority of either treatment arm (HR, 1.09; 95% CI, 0.75 to 1.59; P = .66), the trial was stopped for anticipated futility. CONCLUSION Compared with surgery alone, NCRT with cisplatin plus fluorouracil does not improve R0 resection rate or survival but enhances postoperative mortality in patients with stage I or II EC.
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Affiliation(s)
- Christophe Mariette
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France.
| | - Laetitia Dahan
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Françoise Mornex
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Emilie Maillard
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Pascal-Alexandre Thomas
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Bernard Meunier
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Valérie Boige
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Denis Pezet
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - William B Robb
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Valérie Le Brun-Ly
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Jean-François Bosset
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Jean-Yves Mabrut
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Jean-Pierre Triboulet
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Laurent Bedenne
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
| | - Jean-François Seitz
- Christophe Mariette, William B. Robb, and Jean-Pierre Triboulet, ONCOLille Site de Recherche Intégrée sur le Cancer, Université Lille-Nord de France, and Lille University Hospital; Christophe Mariette, Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Lille; Laetitia Dahan and Jean-François Seitz, La Timone Hospital, Aix-Marseille University; Pascal-Alexandre Thomas, Hôpital Nord, Marseille; Françoise Mornex, Pierre-Bénite Hospital; Jean-Yves Mabrut, Croix-Rousse University Hospital, Lyon; Emilie Maillard, Fédération Française de Cancérologie Digestive; Laurent Bedenne, University Hospital, Dijon; Bernard Meunier, University Hospital, Rennes; Valérie Boige, Gustave Roussy, Villejuif; Denis Pezet, University Hospital, Clermont-Ferrand; Valérie Le Brun-Ly, University Hospital, Limoges; and Jean-François Bosset, University Hospital, Besançon, France
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Taieb J, Tabernero J, Mini E, Subtil F, Folprecht G, Van Laethem JL, Thaler J, Bridgewater J, Petersen LN, Blons H, Collette L, Van Cutsem E, Rougier P, Salazar R, Bedenne L, Emile JF, Laurent-Puig P, Lepage C. Oxaliplatin, fluorouracil, and leucovorin with or without cetuximab in patients with resected stage III colon cancer (PETACC-8): an open-label, randomised phase 3 trial. Lancet Oncol 2014; 15:862-73. [PMID: 24928083 DOI: 10.1016/s1470-2045(14)70227-x] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since the 1990s, fluorouracil-based adjuvant chemotherapy has significantly reduced the risk of tumour recurrence in patients with stage III colon cancer. We aimed to assess whether the addition of cetuximab to standard adjuvant oxaliplatin, fluorouracil, and leucovorin chemotherapy (FOLFOX4) in patients with stage III colon cancer improved disease-free survival (DFS). METHODS For this open-label, randomised phase 3 study done in nine European countries, we enrolled patients through an interactive voice response system to the central randomisation centre, with a central stratified permuted block randomisation procedure. We randomly assigned patients with resected (R0) stage III disease (1:1) to receive 12 cycles of FOLFOX4 twice a week with or without cetuximab. Patients were stratified by N-status (N1 vs N2), T-status (T1-3 vs T4), and obstruction or perforation status (no obstruction and no perforation vs obstruction or perforation or both). A protocol amendment (applied in June, 2008, after 2096 patients had been randomly assigned to treatment-restricted enrolment to patients with tumours wild-type at codons 12 and 13 in exon 2 of the KRAS gene (KRAS exon 2 wild-type). The primary endpoint was DFS. Analysis was intention to treat in all patients with KRAS exon 2 wild-type tumours. The study is registered at EudraCT, number 2005-003463-23. FINDINGS Between Dec 22, 2005, and Nov 5, 2009, 2559 patients from 340 sites in Europe were randomly assigned. Of these patients, 1602 had KRAS exon 2 wild-type tumours (intention-to-treat population), 791 in the FOLFOX4 plus cetuximab group and 811 in the FOLFOX4 group. Median follow-up was 3·3 years (IQR 3·2-3·4). In the experimental and control groups, DFS was similar in the intention-to-treat population (hazard ratio [HR] 1·05; 95% CI 0·85-1·29; p=0·66), and in patients with KRAS exon 2/BRAF wild-type (n=984, HR 0·99; 95% CI 0·76-1·28) or KRAS exon 2-mutated tumours (n=742, HR 1·06; 95% CI 0·82-1·37). We noted heterogeneous responses to the addition of cetuximab in preplanned subgroup analyses. Grade 3 or 4 acne-like rash (in 209 of 785 patients [27%] vs four of 805 [<1%]), diarrhoea (113 [14%] vs 70 [9%]), mucositis (63 [8%] vs 10 [1%]), and infusion-related reactions (55 [7%] vs 30 [4%]) were more frequent in patients treated with FOLFOX4 plus cetuximab than in those patients who received FOLFOX4 alone. INTERPRETATION The addition of cetuximab to FOLFOX4 did not improve DFS compared with FOLFOX4 alone in patients with KRAS exon 2 wild-type resected stage III colon cancer. This trial cannot conclude on the benefit of cetuximab in the studied population, but the heterogeneity of response suggests that further investigation of the role of FOLFOX4 plus cetuximab in specific patient subgroups is warranted. FUNDING Fédération Francophone de Cancérologie Digestive (FFCD), Merck KGaA, and Sanofi-Aventis.
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Affiliation(s)
- Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Paris Descartes University, Hôpital Européen Georges Pompidou, Paris, France.
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Enrico Mini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabien Subtil
- Francophone Federation of Digestive Oncology, Cedex Dijon, France; University of Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France; Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
| | - Gunnar Folprecht
- 1st Medical Department, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Josef Thaler
- Department of Internal Medicine IV, Klinikum Kreuzschwestern Wels, Austria
| | | | | | - Hélène Blons
- Université Paris Descartes, Sorbonne Paris Cité, France; Assistance Publique Hôpitaux de Paris, Department of Biology, Hôpital Européen Georges Pompidou, Paris, France; UMR-S775, INSERM, Centre Universitaire des Saints Pères, Paris, France
| | - Laurence Collette
- Statistics Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Philippe Rougier
- Department of Gastroenterology and Digestive Oncology, Paris Descartes University, Hôpital Européen Georges Pompidou, Paris, France
| | - Ramon Salazar
- Catalan Institute of Oncology (IDIBELL), Barcelona, Spain
| | - Laurent Bedenne
- Hepato-Gastroenterology Department Dijon University Hospital and INSERM U 866, France
| | - Jean-François Emile
- EA4340 and Pathology Department, Versailles University and Ambroise Paré Hospital APHP, Boulogne, France
| | - Pierre Laurent-Puig
- Université Paris Descartes Sorbonne Paris Cité France; UMR-S775, INSERM, Bases Moléculaires de la Réponse aux Xénobiotiques, Paris France; Assistance Publique Hôpitaux de Paris, Department of Biology, Hôpital Européen Georges Pompidou, Paris, France
| | - Come Lepage
- Hepato-Gastroenterology Department Dijon University Hospital and INSERM U 866, France
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Boulin M, Hillon P, Cercueil JP, Bonnetain F, Dabakuyo S, Minello A, Jouve JL, Lepage C, Bardou M, Wendremaire M, Guerard P, Denys A, Grandvuillemin A, Chauffert B, Bedenne L, Guiu B. Idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma: results of the IDASPHERE phase I trial. Aliment Pharmacol Ther 2014; 39:1301-13. [PMID: 24738629 DOI: 10.1111/apt.12746] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/23/2013] [Accepted: 03/20/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND A phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads was performed in cirrhotic patients with hepatocellular carcinoma (HCC). AIM To estimate the maximum-tolerated dose (MTD) and to assess safety, efficacy, pharmacokinetics and quality of life. METHODS Patients received a single TACE session with injection of 2 mL drug-eluting beads (DEBs; DC Bead 300-500 μm) loaded with idarubicin. The idarubicin dose was escalated according to a modified continuous reassessment method. MTD was defined as the dose level closest to that causing dose-limiting toxicity (DLT) in 20% of patients. RESULTS Twenty-one patients were enrolled, including nine patients at 5 mg, six patients at 10 mg, and six patients at 15 mg. One patient at each dose level experienced DLT (acute myocardial infarction, hyperbilirubinaemia and elevated aspartate aminotransferase (AST) at 5-, 10- and 15-mg, respectively). The calculated MTD of idarubicin was 10 mg. The most frequent grade ≥3 adverse events were pain, elevated AST, elevated γ-glutamyltranspeptidase and thrombocytopenia. At 2 months, the objective response rate was 52% (complete response, 28%, and partial response, 24%) by modified Response Evaluation Criteria in Solid Tumours. The median time to progression was 12.1 months (95% CI 7.4 months--not reached); the median overall survival was 24.5 months (95% CI 14.7 months--not reached). Pharmacokinetic analysis demonstrated the ability of DEBs to release idarubicin slowly. CONCLUSIONS Using drug-eluting beads, the maximum-tolerated dose of idarubicin was 10 mg per TACE session. Encouraging responses and median time to progression were observed. Further clinical investigations are warranted (NCT01040559).
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Affiliation(s)
- M Boulin
- INSERM U866, University of Burgundy, Dijon, France; Department of Pharmacy, University Hospital, Dijon, France
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Hamza S, Bouvier AM, Rollot F, Lepage C, Faivre J, Bedenne L. Toxicity of oxaliplatin plus fluorouracil/leucovorin adjuvant chemotherapy in elderly patients with stage III colon cancer: a population-based study. Ann Surg Oncol 2014; 21:2636-41. [PMID: 24639190 DOI: 10.1245/s10434-013-3438-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Results concerning the side effects of oxaliplatin associated with fluorouracil and leucovorin (FOLFOX) in older patients are controversial. The objective of this study was to assess the use and the toxicity of FOLFOX in patients aged 70 years and older as administered in current practice. METHODS Among 305 stage III colon cancers registered in a well-defined population in Burgundy between 2004 and 2009, 210 had adjuvant chemotherapy, including 156 with FOLFOX. The cumulated rates of toxicity were calculated by using the Kaplan-Meier method. The risks of overall toxicity and of severe toxicity (grade 3 or 4) in patients less than 70 years and in older patients were compared by using a Cox model. RESULTS There was no difference between the group of the patients less than 70 years and the older age group for the cumulative incidence of hematologic, neurologic, digestive, and general toxicity. There was also no difference between the two groups for the severity of side effects (grade 3 or 4, 31.4 vs. 39.0 %; p = 0.576). The multivariate analysis indicated after adjustment on sex and the Charlson comorbidity score that there was no difference between the two age groups for toxicity (hazard ratio = 1.28; 95 % CI 0.68-2.41; p = 0.439). CONCLUSIONS Cancer registries can be used to evaluate the toxicity of chemotherapy at the population level. Tolerance to the FOLFOX regimen among elderly patients did not significantly differ from that in younger patients. This treatment should be considered regardless of patients' age alone, but consideration should be given to the capacity of patients to tolerate adverse events.
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Affiliation(s)
- Samia Hamza
- Digestive Cancer Registry of Burgundy, INSERM U866, University Hospital, University of Burgundy, Dijon, France
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Conroy T, Galais MP, Raoul JL, Bouché O, Gourgou-Bourgade S, Douillard JY, Etienne PL, Boige V, Martel-Lafay I, Michel P, Llacer-Moscardo C, François E, Créhange G, Abdelghani MB, Juzyna B, Bedenne L, Adenis A. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol 2014; 15:305-14. [PMID: 24556041 DOI: 10.1016/s1470-2045(14)70028-2] [Citation(s) in RCA: 243] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Definitive chemoradiotherapy is a curative treatment option for oesophageal carcinoma, especially in patients unsuitable for surgery. The PRODIGE5/ACCORD17 trial aimed to assess the efficacy and safety of the FOLFOX treatment regimen (fluorouracil plus leucovorin and oxaliplatin) versus fluorouracil and cisplatin as part of chemoradiotherapy in patients with localised oesophageal cancer. METHODS We did a multicentre, randomised, open-label, parallel-group, phase 2/3 trial of patients aged 18 years or older enrolled from 24 centres in France between Oct 15, 2004, and Aug 25, 2011. Eligible participants had confirmed stage I-IVA oesophageal carcinoma (adenocarcinoma, squamous-cell, or adenosquamous), Eastern Cooperative Oncology Group (ECOG) status 0-2, sufficient caloric intake, adequate haematological, renal, and hepatic function, and had been selected to receive definitive chemoradiotherapy. Patients were randomly assigned (1:1) to receive either six cycles (three concomitant to radiotherapy) of oxaliplatin 85 mg/m(2), leucovorin 200 mg/m(2), bolus fluorouracil 400 mg/m(2), and infusional fluorouracil 1600 mg/m(2) (FOLFOX) over 46 h, or four cycles (two concomitant to radiotherapy) of fluorouracil 1000 mg/m(2) per day for 4 days and cisplatin 75 mg/m(2) on day 1. Both groups also received 50 Gy radiotherapy in 25 fractions (five fractions per week). Random allocation to treatment groups was done by a central computerised randomisation procedure by minimisation, stratified by centre, histology, weight loss, and ECOG status, and was achieved independently from the study investigators. The primary endpoint was progression-free survival. Data analysis was primarily done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00861094. FINDINGS 134 participants were randomly allocated to the FOLFOX group and 133 to the fluorouracil and cisplatin group (intention-to-treat population), and 131 patients in the FOLFOX group and 128 in the fluorouracil and cisplatin group actually received the study drugs (safety population). Median follow-up was 25·3 months (IQR 15·9-36·4). Median progression-free survival was 9·7 months (95% CI 8·1-14·5) in the FOLFOX group and 9·4 months (8·1-10·6) in the fluorouracil and cisplatin group (HR 0·93, 95% CI 0·70-1·24; p=0·64). One toxic death occurred in the FOLFOX group and six in the fluorouracil-cisplatin group (p=0·066). No significant differences were recorded in the rates of most frequent grade 3 or 4 adverse events between the treatment groups. Of all-grade adverse events that occurred in 5% or more of patients, paraesthesia (61 [47%] events in 131 patients in the FOLFOX group vs three [2%] in 128 patients in the cisplatin-fluorouracil group, p<0·0001), sensory neuropathy (24 [18%] vs one [1%], p<0·0001), increases in aspartate aminotransferase concentrations (14 [11%] vs two [2%], p=0·002), and increases in alanine aminotransferase concentrations (11 [8%] vs two [2%], p=0·012) were more common in the FOLFOX group, whereas serum creatinine increases (four [3%] vs 15 [12%], p=0·007), mucositis (35 [27%] vs 41 [32%], p=0·011), and alopecia (two [2%] vs 12 [9%], p=0·005) were more common in the fluorouracil and cisplatin group. INTERPRETATION Although chemoradiotherapy with FOLFOX did not increase progression-free survival compared with chemoradiotherapy with fluorouracil and cisplatin, FOLFOX might be a more convenient option for patients with localised oesophageal cancer unsuitable for surgery. FUNDING UNICANCER, French Health Ministry, Sanofi-Aventis, and National League Against Cancer.
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Affiliation(s)
- Thierry Conroy
- Département d'Oncologie Médicale, Institut de Cancérologie de Lorraine and Lorraine University, Vandoeuvre-lès-Nancy, France.
| | | | - Jean-Luc Raoul
- Service d'Oncologie Médicale, Centre Eugène Marquis, Rennes, France
| | - Olivier Bouché
- Service d'Hépatogastroentérologie et de Cancérologie Digestive, Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Sophie Gourgou-Bourgade
- Unité de Biométrie, Institut régional du Cancer de Montpellier - Val d'Aurelle, Montpellier, France
| | - Jean-Yves Douillard
- Institut de Cancérologie de l'Ouest - Centre René Gauducheau, Nantes Saint-Herblain, France
| | | | - Valérie Boige
- Service de Gastroentérologie, Institut Gustave Roussy, Villejuif, France
| | | | - Pierre Michel
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Charles Nicolle, Rouen, France
| | | | - Eric François
- Pôle de Médecine, Centre Antoine Lacassagne, Nice, France
| | - Gilles Créhange
- Département de Radiothérapie, Centre Georges François Leclerc, Dijon, France
| | | | - Beata Juzyna
- R&D UNICANCER, Fédération Nationale des Centres de Lutte Contre le Cancer, Paris, France
| | - Laurent Bedenne
- Service Hépato-Gastro-Entérologie, Centre Hospitalier Universitaire du Bocage, Dijon, France
| | - Antoine Adenis
- Département de Cancérologie Digestive et Urologique, Centre Oscar Lambret, Lille, France
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Adenis A, Bennouna J, Galais MP, Tresch E, Francois E, Etienne PL, Ben Abdelghani M, Michel P, Seitz JF, Conroy T, Ghiringhelli F, Bedenne L, Samalin E, Piessen G, Hiret S, Peugniez C, Herin H, Clisant S, Kramar A, Mariette C. Predictors of disease control in patients treated with platinum-based chemotherapies for metastatic squamous-cell esophageal cancer: First results of the e-DIS trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.95] [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
95 Background: There is little evidence that chemotherapy (CT) impacts on outcome of patients with MSEC. We designed an ongoing randomized phase 2 trial to detect a progression-free survival benefit of CT continuation over CT discontinuation in disease-controlled and ECOG≤2 patients at 6 weeks after an initial CT treatment. The aim of the present study was to identify predictors of disease control at 6 weeks (DC6wkx) in MSEC patients receiving platinum-based CTs as first-line treatment for metastatic disease. Methods: Among 68/70 evaluable patients included between 1/2011 and 7/2013 who received at least 1 CT cycle, 58 were evaluable for disease assessment at 6 weeks. Ten patients were not evaluable (early death: 4, patient’s decision: 2, concomitant disease 1, early progressive disease 1, other reasons: 2). Baseline demographic, clinical, biological, and tumor characteristics were tested for prediction of DC6wkx. Significant variables for DC6wkx were identified with the chi-squared test and logistic regression. Results: Baseline patients characteristics were as follows: median age: 61.5yo; male: 57/68; ECOG 0/1/2: 13/42/13; metachronous/synchronous MSEC: 38/30; number of metastatic sites 1/2/>2: 35/20/13; metastatic location: lung 36, liver 23, bone 11, nodes 37, other 11; prior exposure to CT: 37/68; time from previous CT exposure: ≤ 6m 6/37, 6-12m 14/37, > 12m 17/37; gr>2 dysphagia (Atkinson) 19/67; BMI<18.5kg/m²: 13/68. Current CTs were FU-CDDPq3w 2/68, LV5FU2-CDDPq2w 15/68, FOLFOX 51/68, and patients received the following number of cycles 1/2/>2: 5/7/54. DC6wkx rate was 65.7%, with 16/68 PR (23.5%) and 28/68 SD (42.2%). Albumin (p<0.01), BMI (p<0.02), bone metastases (p<0.005), gender (p<0.047) and ECOG status (p<0.05) were predictive of DC6wkx. Normal or overweight BMI, grade 0 albumin, and no bone metastases, were predictive of DC6wkx in multivariate analysis. Conclusions: DC at 6 wks was 65.7% in MSEC receiving platinum-based CTs as first line treatment for metastatic disease. Normal or overweight BMI, normal albumin, and the absence of bone metastasis were significant predictors of DC6wkx in this prospective phase 2 trial. Clinical trial information: NCT01248299.
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Affiliation(s)
| | - Jaafar Bennouna
- Institut de Cancerologie de l’Ouest-site René Gauducheau, Nantes, France
| | | | | | | | | | | | - Pierre Michel
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | | | | | | | - Laurent Bedenne
- Federation Francophone de Cancerologie Digestive, Dijon, France
| | | | - Guillaume Piessen
- Department of Surgical Oncology, University Hospital of Lille, Lille, France
| | - Sandrine Hiret
- Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | | | | | | | - Andrew Kramar
- Unite de Methodologie et Biostatistique, Centre Oscar Lambret, Lille, France
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Bouvier AM, Créhange G, Azélie C, Cheynel N, Jouve JL, Bedenne L, Faivre J, Lepage C, Maingon P. Adjuvant treatments for gastric cancer: from practice guidelines to clinical practice. Dig Liver Dis 2014; 46:72-5. [PMID: 23978456 DOI: 10.1016/j.dld.2013.07.003] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/12/2013] [Accepted: 07/10/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND For gastric cancers, the benefits of adjuvant radiochemotherapy and of perioperative chemotherapy have been demonstrated since 2001 and 2006 respectively. The aim of this study was to evaluate the diffusion of adjuvant treatments in a French population. METHODS 334 incident gastric cancers UICC Stage IB, II, III or IVM0 resected for cure and recorded in the Burgundy digestive cancer registry were retrospectively included. Patients were classified as having received an effective adjuvant treatment if they had been treated by adjuvant radiochemotherapy since 2001 or perioperative chemotherapy since 2006. RESULTS The proportion of patients treated with an effective adjuvant treatment increased from 21.8% (2001-2005) to 40.1% (2006-2009). Patients treated in 2006-2009 were twice as likely to receive effective adjuvant treatment as those treated during the period 2001-2005. During the 2004-2009 period, 62.4% of cases were presented in a multidisciplinary team meeting. These patients were almost three times more likely to receive effective adjuvant treatment than patients excluded from multidisciplinary team consultation. Age was a significant factor, independent of comorbidities. CONCLUSION Administration of adjuvant treatment is still far from being considered a reference regimen in routine practice for R0 resected gastric cancer. The increase in multidisciplinary team meetings should improve the situation.
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Affiliation(s)
- Anne Marie Bouvier
- University Hospital Dijon; Digestive Cancer Registry of Burgundy; Inserm U866; University of Burgundy, Dijon, F-21079, France.
| | - Gilles Créhange
- Radiotherapy Department, Centre Georges-François Leclerc, Dijon, France
| | - Caroline Azélie
- Radiotherapy Department, Centre Georges-François Leclerc, Dijon, France
| | - Nicolas Cheynel
- University Hospital Dijon; Digestive Cancer Registry of Burgundy; Inserm U866; University of Burgundy, Dijon, F-21079, France
| | - Jean Louis Jouve
- University Hospital Dijon; Digestive Cancer Registry of Burgundy; Inserm U866; University of Burgundy, Dijon, F-21079, France
| | - Laurent Bedenne
- University Hospital Dijon; Digestive Cancer Registry of Burgundy; Inserm U866; University of Burgundy, Dijon, F-21079, France
| | - Jean Faivre
- University Hospital Dijon; Digestive Cancer Registry of Burgundy; Inserm U866; University of Burgundy, Dijon, F-21079, France
| | - Côme Lepage
- University Hospital Dijon; Digestive Cancer Registry of Burgundy; Inserm U866; University of Burgundy, Dijon, F-21079, France
| | - Philippe Maingon
- Radiotherapy Department, Centre Georges-François Leclerc, Dijon, France
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Lecomte T, Bouche O, oden-Gangloff A, Le Malicot K, Aparicio T, Mitry E, Bedenne L, Deplanque G, Volet J, Tougeron D, Bonnetain F, Moreau M, Dorval E, Loriot MA, Laurent-Puig P, Lepage C. Primary prophylactic granulocyte colony-stimulating factor (GCSF) in Gilbert’s disease patients treated with FOLFIRI first line for metastatic colorectal cancer (mCRC): Final results of the FFCD 0604 study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3614] [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] [Indexed: 11/20/2022] Open
Abstract
3614 Background: Gilbert’s disease patients (pts) (homozygotous for the UGT1A1*28 allele) have a major risk (>30%) of severe, life-threatening, neutropenia when treated with Irinotecan (IRI). The aim of this study was to demonstrate that, in these pts, treated with IRI 1st line for mCRC, primary prevention with GCSF (lenograstim) reduces under 10% the risk of grade 4 or febrile neutropenia. Methods: This is a prospective, multicenter, phase II study of FOLFIRI + bevacizumab 1st line (IRI 180 mg/m² every 2 weeks) and primary prophylactic GCSF (D5 to D11 each course) in mCRC pts with Gilbert’s disease. Pre-chemotherapy UGT1A1 genotyping was centralized and standardized using a biological molecular technique applied on DNA blood-extracted lymphocytes. Using a 2-step Fleming design, (α=5% and β=90%), 30 pts had to be included with an interim analysis (IA) planned after 20 pts and 4 months of follow-up. Results: Twenty pts from 7 centers were included between 10/2007 and 02/2012 and 19 analysed for the IA. Median pts age was 63 years (range: 45-73), 60% were females, 90% were PS 0 or 1, 80% had a colic primary site and 73% hepatic metastases. The primary site was non- resected in 1/3 of pts. The total number of administered courses of chemotherapy was 229 with a median of 12 per pt (range: 1-40). Among all these courses, 213 were administered with GCSF. IRI was administered as defined by the protocol with a nearly 100% rate of received /theoretical dose. Grade 3 neutropenia rate was 10.5%. No grade 3-4 diarrhea, no grade 4 or febrile neutropenia and no toxic death were observed. No declared SAEs were related to GCSF. In term of best response at 6 months, 7 pts were in complete or partial response and 9 had stable disease. Median progression free survival and overall survival were respectively 8.7 months (4.9; 13.4) and 24.4 months (12.6; ND). Conclusions: This study is the first to demonstrate that a pharmacogenetic approach based on a simple genetic test easy to perform can achieve a high rate of safe and performant administration of IRI in high risk mCRC pts. Clinical trial information: NCT00541125.
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Affiliation(s)
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | - Alice oden-Gangloff
- Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | - Karine Le Malicot
- Fédération Francophone de la Cancérologie Digestive Faculté de Médecine, Dijon, France
| | | | - Emmanuel Mitry
- Hôpital René Huguenin/Institut Curie, Saint-Cloud, France
| | | | | | | | - David Tougeron
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit (EA 3181) & Quality of Life and Cancer Clinical Research Plateform, Besancon, France
| | - Marie Moreau
- Federation Francophone de Cancerologie Digestive, Dijon, France
| | | | - Marie-Anne Loriot
- Georges Pompidou European Hospital, APHP, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - Come Lepage
- Centre Hospitalier Universitaire Bocage, Dijon, France
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Taïeb J, Tabernero J, Mini E, Subtil F, Folprecht G, Van Laethem JL, Thaler J, Bridgewater JA, Sanches E, Petersen L, Collette L, Van Cutsem E, Le Malicot K, Rougier P, Salazar R, Bedenne L, Emile JF, Laurent-Puig P, Lepage C. Subgroup analyses results of the PETACC8 phase III trial comparing adjuvant FOLFOX4 with or without cetuximab (CTX) in resected stage III colon cancer (CC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3525] [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] [Indexed: 11/20/2022] Open
Abstract
3525^ Background: Potential benefit of adding CTX to the current standard treatment for stage III CC, was assessed. Subgroup analyses of demographic, clinical and molecular data may improve our understanding of this patient population. Methods: Patients (pts) were randomized 28-56 days following resection. They received 12 biweekly cycles of oxaliplatin 85 mg/m2 day (d) 1, with leucovorin 200 mg/m2, 5-FU 400 mg/m2 bolus IV, followed by 5-FU 600 mg/m2 22-hr IV on d1-2 (FOLFOX4), without (arm A) or with weekly CTX (arm B) 250 mg/m2 (initial dose 400 mg/m2). Primary endpoint was disease free survival time (DFS). Secondary endpoints included overall survival (OS), treatment compliance and safety. Enrolment was restricted to KRAS wt pts in 06/2008. Planned accrual of 1,407 KRAS wild-type (wt) pts provided 90% power to detect a hazard ratio (HR) of 0.75 with 2-sided α=0.05, with interim analyses after 65% of planned events. Preplanned subgroup analyses were performed. Results: 1,602 KRAS wt pts (811 arm A, 791 arm B) and 742 mutated (m) KRAS (prior to the amendment), were randomized. BRAF status was determined in 1134 (71%) KRAS wt pts. Median follow-up was 40 months. This interim analysis showed no difference between arms for DFS (HR 1.05, 95% CI 0.85-1.29; p=0.66) or OS (HR 1.09, 95% CI 0.81-1.47; p=0.55) in KRAS wt pts or for DFS (HR 0.99, 95% CI 0.75-1.28; p=0.91) or OS (HR 0.98, 95% CI 0.67-1.44; p=0.92) in KRAS/BRAF wt pts (n=984). Similar results were seen in KRAS mutant (mt) pts without any detrimental effect. In KRAS wt pts worse outcomes were seen with CTX in pts >70 years (n=149, DFS: HR 1.97, 95% CI 0.99-3.93; p=0.05), in females (n=666, HR 1.45, 95% CI 1.03-2.03; p=0.03) and in pts with right-sided CC (n=570, HR 1.40, 95% CI 1.01-1.94; p=0.04). Conversely, a better outcome was seen in pts with pT4pN2 CC (n=146, HR 0.55, 95% CI 0.35-0.89; p=0.01). Conclusions: Adding CTX to FOLFOX4 offered no benefit to pts with resected stage III KRAS wt, KRAS/BRAF wt and KRAS mt CC. Subgroup analyses suggest that KRAS wt pts with pT4pN2 tumors may derive benefit from CTX. MSI status determination is ongoing to explore its potential interaction with poor outcome in female and/or with right-sided tumors pts. Clinical trial information: NCT00265811.
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Affiliation(s)
- Julien Taïeb
- Georges Pompidou European Hospital, Paris, France
| | | | - Enrico Mini
- Unità di Chemioterapia, Dipartimento di Farmacologia, Università degli Studi di Firenze, Firenze, Italy
| | - Fabien Subtil
- Fédération Francophone de la Cancérologie Digestive, Dijon, France
| | - Gunnar Folprecht
- University Hospital Carl Gustav Carus, University Cancer Center / Medical Department I, Dresden, Germany
| | | | - Joseph Thaler
- Department of Internal Medicine IV, Klinikum Kreuzschwestern Wels, Wels, Austria
| | | | | | - Lone Petersen
- Department of Oncology, Rigshospitalet, København, Denmark
| | | | | | - Karine Le Malicot
- Fédération Francophone de la Cancérologie Digestive Faculté de Médecine, Dijon, France
| | | | - Ramon Salazar
- Translational Research Laboratory and Department of Medical Oncology, Institut Catala d'Oncologia-IDIBELL, Hospitalet de Llobregat, Spain
| | | | - Jean Francois Emile
- Service d’Anatomie Pathologique Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Pierre Laurent-Puig
- Hôpital Européen Georges Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Come Lepage
- Centre Hospitalier Universitaire Bocage, Dijon, France
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Köhne CH, Bedenne L, Carrato A, Bouché O, Popov I, Gaspà L, Valladares M, Rougier P, Gog C, Reichardt P, Wils J, Pignatti F, Biertz F. A randomised phase III intergroup trial comparing high-dose infusional 5-fluorouracil with or without folinic acid with standard bolus 5-fluorouracil/folinic acid in the adjuvant treatment of stage III colon cancer: the Pan-European Trial in Adjuvant Colon Cancer 2 study. Eur J Cancer 2013; 49:1868-75. [PMID: 23571150 DOI: 10.1016/j.ejca.2013.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/24/2013] [Accepted: 01/29/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate whether infusional high-dose 5-flurouracil (HD-FU) provides a significant improvement in recurrence-free survival (RFS) and overall survival (OS) compared with a standard bolus 5-FU regimen (Mayo Clinic) in patients with curatively resectable stage III colon cancer. METHODS Patients (n=1601) were randomised to receive either the Mayo Clinic regimen or one of the three HD-FU regimens; LV5FU2, the Arbeitsgemeinschaft Internistische Onkologie (AIO) or the Grupo Espaňol para el Tratamiento Digestivos (TTD), the data from which were combined to provide the HD-FU arm for final analysis. RESULTS Patients were evenly balanced for age, TMN, tumor grade and vascular and lymphatic invasion. Median follow-up was approximately 42months, RFS (hazard ratio [HR]=0.997) and OS (HR=0.96) (primary end-point) were not statistically different between the two treatment arms. Infusional HD-FU was generally better tolerated than bolus 5-FU regimen. CONCLUSIONS Infusional HD-FU does not improve RFS and OS in curatively resected stage III colon cancer patients compared to the Mayo Clinic regimen, but is less toxic.
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Affiliation(s)
- Claus-Henning Köhne
- Department of Oncology and Hematology, Klinikum Oldenburg, European Medical School Oldenburg/Groningen, Carl von Ossietzky University, Oldenburg, Germany.
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Bedenne L, Hamza S, Jouve JL. Radiochimiothérapie comme traitement médical du cancer de l’œsophage. La chirurgie est-elle toujours nécessaire ? ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2265-y] [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: 10/27/2022]
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Gérard JP, Azria D, Gourgou-Bourgade S, Martel-Lafay I, Hennequin C, Etienne PL, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah JF, Mahé MA, Bécouarn Y, Dupuis O, Lledo G, Seitz JF, Bedenne L, Juzyna B, Conroy T. Clinical outcome of the ACCORD 12/0405 PRODIGE 2 randomized trial in rectal cancer. J Clin Oncol 2012; 30:4558-65. [PMID: 23109696 DOI: 10.1200/jco.2012.42.8771] [Citation(s) in RCA: 286] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The ACCORD 12 trial investigated the value of two different preoperative chemoradiotherapy (CT-RT) regimens in T3-4 Nx M0 resectable rectal cancer. Clinical results are reported after follow-up of 3 years. PATIENTS AND METHODS Between November 2005 and July 2008, a total of 598 patients were randomly assigned to preoperative CT-RT with CAP45 (45-Gy RT for 5 weeks with concurrent capecitabine) or CAPOX50 (50-Gy RT for 5 weeks with concurrent capecitabine and oxaliplatin). Total mesorectal excision was planned 6 weeks after CT-RT. The primary end point was sterilization of the operative specimen, which was achieved in 13.9% versus 19.2% of patients, respectively (P = .09). Clinical results were analyzed for all randomly assigned patients according to the intention-to-treat principle. RESULTS At 3 years, there was no significant difference between CAP45 and CAPOX50 (cumulative incidence of local recurrence, 6.1% v 4.4%; overall survival, 87.6% v 88.3%; disease-free survival, 67.9% v 72.7%). Grade 3 to 4 toxicity was reported in four patients in the CAP45 group and in two patients in the CAPOX50 group. Bowel continence, erectile dysfunction, and social life disturbance were not different between groups. In multivariate analysis, the sterilization rate (Dworak score) of the operative specimen was the main significant prognostic factor (hazard ratio, 0.32; 95% CI, 0.21 to 0.50). CONCLUSION At 3 years, no significant difference in clinical outcome was achieved with the intensified CAPOX regimen. When compared with other recent randomized trials, these results indicate that concurrent administration of oxaliplatin and RT is not recommended.
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Phelip J, Vendrely V, Jouve J, Subtil F, Gasmi M, Michel P, Smith D, Seitz J, Bedenne L, Chauffert B. Multicentric Phase II Randomized Trial Comparing Chemoradiation (CHRT) with 5-Fluorouracil, Cisplatin (CDDP) and 50 GY versus Chemotherapy Alone (CH) with Gemcitabine (G) Plus Oxaliplatin (O) for Locally advanced Biliary Tract Cancer (FFCD9902). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33310-x] [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: 11/24/2022] Open
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45
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Taieb J, Tabernero J, Mini E, Subtil F, Folprecht G, Van Laethem J, Thaler J, Bridgewater J, Van Cutsem E, Rougier P, Collette L, Praet M, Schneider M, Bouché O, Lepage C, Girault C, Emile J, Laurent-Puig P, Bedenne L. Adjuvant Folfox4 with or without Cetuximab (CTX) in Patients (PTS) with Resected Stage III Colon Cancer (CC): Dfs and OS Results and Subgroup Analyses of the PETACC8 Intergroup Phase III Trial. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34317-9] [Citation(s) in RCA: 1] [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: 10/25/2022] Open
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46
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Ferrand F, Malka D, Bourredjem A, Allonier C, Bouché O, Louafi S, Boige V, Mousseau M, Raoul JL, Bedenne L, Leduc B, Deguiral P, Faron M, Pignon JP, Ducreux M. Impact of primary tumour resection on survival of patients with colorectal cancer and synchronous metastases treated by chemotherapy: results from the multicenter, randomised trial Fédération Francophone de Cancérologie Digestive 9601. Eur J Cancer 2012; 49:90-7. [PMID: 22926014 DOI: 10.1016/j.ejca.2012.07.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/19/2012] [Accepted: 07/20/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the impact of primary tumour resection on overall survival (OS) of patients diagnosed with stage IV colorectal cancer (CRC). DESIGN Among the 294 patients with non-resectable colorectal metastases enrolled in the Fédération Francophone de Cancérologie Digestive (FFCD) 9601 phase III trial, which compared different first-line single-agent chemotherapy regimens, 216 patients (73%) presented with synchronous metastases at study entry and constituted the present study population. Potential baseline prognostic variables including prior primary tumour resection were assessed by univariate and multivariate Cox analyses. Progression-free survival (PFS) and OS curves were compared with the logrank test. RESULTS Among the 216 patients with stage IV CRC (median follow-up, 33 months), 156 patients (72%) had undergone resection of their primary tumour prior to study entry. The resection and non-resection groups did not differ for baseline characteristics except for primary tumour location (rectum, 14% versus 35%; p=0.0006). In multivariate analysis, resection of the primary was the strongest independent prognostic factor for PFS (hazard ratio (HR), 0.5; 95% confidence interval [CI], 0.4-0.8; p=0.0002) and OS (HR, 0.4; CI, 0.3-0.6; p<0.0001). Both median PFS (5.1 [4.6-5.6] versus 2.9 [2.2-4.1] months; p=0.001) and OS (16.3 [13.7-19.2] versus 9.6 [7.4-12.5]; p<0.0001) were significantly higher in the resection group. These differences in patient survival were maintained after exclusion of patients with rectal primary (n=43). CONCLUSION Resection of the primary tumour may be associated with longer PFS and OS in patients with stage IV CRC starting first-line, single-agent chemotherapy.
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Affiliation(s)
- F Ferrand
- Institut Gustave Roussy, Gastro-intestinal Unit, Department of Oncologic Medicine, Université Paris Sud, Villejuif, France
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Conroy T, Galais MP, Raoul JL, Bouche O, Gourgou-Bourgade S, Douillard JY, Etienne PL, Boige V, Martel-Lafay I, Michel P, Llacer-Moscardo C, Berille J, Bedenne L, Adenis A. Phase III randomized trial of definitive chemoradiotherapy (CRT) with FOLFOX or cisplatin and fluorouracil in esophageal cancer (EC): Final results of the PRODIGE 5/ACCORD 17 trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.18_suppl.lba4003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4003 Background: CRT is one of the best treatment options for localized EC. As new combinations are required to improve safety and survival, we launched a randomized phase II study to assess the complete response (CR) rate of CRT with FOLFOX versus 5FU/cisplatin in 97 pts with localized EC (Conroy 2010). The trial having met its objectives, it has been pursued as a phase III trial. Stratified randomization was performed centrally in a 1:1 ratio according to histological type, pretreatment weight loss in the prior 6 months (<10% vs ≥10%), ECOG PS (0 vs 1 vs 2), and center. Methods: Pts with technically unresectable cancer or those with surgical contraindications or who refused to undergo surgery were eligible. Eligibility criteria also included age >18 years (y), PS ≤ 2, previously untreated adenocarcinoma or squamous cell EC (any T, N0 or N1, M0 or M1a). The radiation dose was 50 Gy (2Gy/fr) 5 d/wk for 5 wks in both arms. In Arm A, pts received 6 bimonthly cycles (cy): oxaliplatin 85 mg/m2 d1 and leucovorin 200 mg/m2 followed by 5-FU 400 mg/m2 bolus d1 then 1,600 mg/m2 46h continuous infusion (ci) ; the first 3 cy were delivered during RT, the 3 other after. In Arm B, pts received 4 cy: cisplatin 75 mg/m2 d1 followed by 5FU 1,000 mg/m2/d ci d1-4, the first 2 cy during RT and 2 other after. The primary endpoint was PFS. Main secondary endpoints were OS, grade 3-4 toxicities, and quality of life. A total of 266 pts would provide 90% power to detect a 20% 3y-PFS difference (α=0.05). Results: 267 pts were enrolled between 10/2004 and 08/2011. Treatment cohorts were well balanced: male 81%; median age 61 y; PS 0 53%, squamous cell 85.8%, stage III 52%, IVA 6.0% and IVB 3.0%. Full treatment was delivered to 67.9% and 72.2% of pts in arms A/B, respectively. 7 toxic deaths occurred in each arm. Grade 3/4 toxicities per pt (%) in arms A/B were neutropenia 30.6/31.3, febrile neutropenia 5.3/7.0, anemia 5.4/11.0, asthenia 17.6/10.2, respectively. The median FU time was 25.3 mos. 3y-PFS was 18.2/17.4 % (HR=1.07; 95%CI =0.80-1.43) and median OS was 20.2 /17.5 m (HR=1.06; 95%CI =0.77-1.46). Conclusions: CRT with FOLFOX does not improve PFS compared to cisplatin and 5-FU and has similar toxicities.
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Affiliation(s)
| | | | | | | | | | | | | | - Valérie Boige
- Service de Gastro-Enterologie, Institut Gustave Roussy, Villejuif, France
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Conroy T, Galais MP, Raoul JL, Bouche O, Gourgou-Bourgade S, Douillard JY, Etienne PL, Boige V, Martel-Lafay I, Michel P, Llacer-Moscardo C, Berille J, Bedenne L, Adenis A. Phase III randomized trial of definitive chemoradiotherapy (CRT) with FOLFOX or cisplatin and fluorouracil in esophageal cancer (EC): Final results of the PRODIGE 5/ACCORD 17 trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.lba4003] [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] [Indexed: 11/20/2022] Open
Abstract
LBA4003 The full, final text of this abstract will be available at abstract.asco.org at 12:01 AM (EDT) on Saturday, June 2, 2012, and in the Annual Meeting Proceedings online supplement to the June 20, 2012, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
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Affiliation(s)
| | | | | | | | | | | | | | - Valérie Boige
- Service de Gastro-Enterologie, Institut Gustave Roussy, Villejuif, France
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Abstract
389 Background: The main end point of this trial was pathological response and published in 2010. We present the main clinical outcome after 3 years follow up. Methods: A total of 598 patients were included by 56 different French institutions between 2005 and 2008. Inclusion criteria were: resectable rectal adenocarcinoma accessible to digital examination and staged T3,4 Nx M0. Low anterior T2 were also eligible.Two neoadjuvant treatments were compared: CAP 45 (Radiotherapy 45 Gy/5 weeks with concurrent chemotherapy: capecitabine 1 600 mg/m2/day) versus CAPOX 50 (RT 50 Gy/5weeks with the same capecitabine plus oxaliplatin 50 mg/m2 /q week). Adjuvant chemotherapy was given to 253 patients and well balanced between both arms. All patients were analysed according to the intent to treat principle. Results: With a median follow up time of 36 months the main clinical results are presented in the table . There was no significant difference in local control, survival, toxicity and functional results. In an exploratory analysis, clinical complete response (24 pts) before surgery and pathological complete response (92 pts) were associated with an excellent disease free survival at 3 years respectively 92% and 90%. These results must be interpreted in reference with 3 other recent randomized trials involving the same patients: STAR 01 (Italy) NSABP R 04 (USA) (Table) CAO/ARO 04 (Germany). Conclusions: It is possible to conclude from this trial and the 3 other trials that: (1) oxaliplatin should not be included in the protocol (increased early toxicity and no effect on the pCR rate) (2) capecitabine is as efficient as fluorouracil (3) RT dose escalation to 50 Gy is improving pCR without increasing toxicity. A “CAP 50” regimen appears as safe and efficient in this neoadjuvant situation. [Table: see text]
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Affiliation(s)
- Jean-Pierre Gérard
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; University Hospital, Dijon, France
| | - David Azria
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; University Hospital, Dijon, France
| | - Sophie Gourgou-Bourgade
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; University Hospital, Dijon, France
| | - Thierry Conroy
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; University Hospital, Dijon, France
| | - Laurent Bedenne
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France; CRLCC Val d'Aurelle, Montpellier, France; Centre Val d'Aurelle, Montpellier, France; Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France; University Hospital, Dijon, France
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50
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Brixi-Benmansour H, Jouve JL, Mitry E, Bonnetain F, Landi B, Hentic O, Bedenne L, Cadiot G. Phase II study of first-line FOLFIRI for progressive metastatic well-differentiated pancreatic endocrine carcinoma. Dig Liver Dis 2011; 43:912-6. [PMID: 21831734 DOI: 10.1016/j.dld.2011.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 06/22/2011] [Accepted: 07/01/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic endocrine carcinomas are rare and heterogeneous. Published results concerning treatment of advanced tumours are inconsistent and responses to standard chemotherapy remain unsatisfactory. AIM To investigate the ability of the FOLFIRI regimen to manage progressive unresectable metastatic well-differentiated endocrine carcinomas of the pancreas as first-line chemotherapy. METHODS 20 patients with metastatic or advanced well-differentiated endocrine carcinomas of the pancreas and progressive disease were enrolled in a prospective multicentre phase II trial to receive chemotherapy with FOLFIRI schedule (irinotecan 180mg/m(2) infusion combined with simplified LV5FU2) every 14 days. The primary end point was the non-progression rate at 6 months. RESULTS The 6-month non-progression rate was 80% (95% confidence interval [56-94%]), with stabilisation in 15 patients and 1 objective response. Overall survival at 24 months was 65% [40-82%]. Median progression-free survival was 9.1 months [6.5-17.3 months]. The median number of administered cycles was 12 [range 1-28]. Grade 3/4 haematologic toxicity occurred in 5 patients (25%) and grade 3 digestive toxicity in 11. CONCLUSION The FOLFIRI regimen, as first-line chemotherapy, achieved stabilisation in most patients whose tumours had been progressing and was well-tolerated. It could be an alternative therapy for advanced well-differentiated endocrine carcinomas of the pancreas.
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Affiliation(s)
- Hedia Brixi-Benmansour
- Service d'Hépato-Gastroentérologie et d'Oncologie Digestive, CHU de Reims, Hôpital Robert-Debré, Reims F-51092 Cedex, France
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