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Chevalier B, Coppin L, Romanet P, Cuny T, Maiza JC, Abeillon J, Forestier J, Walter T, Gilly O, Le Bras M, Smati S, Nunes ML, Geslot A, Grunenwald S, Mouly C, Arnault G, Wagner K, Koumakis E, Cortet-Rudelli C, Merlen É, Jannin A, Espiard S, Morange I, Baudin É, Cavaille M, Tauveron I, Teissier MP, Borson-Chazot F, Mirebeau-Prunier D, Savagner F, Pasmant É, Giraud S, Vantyghem MC, Goudet P, Barlier A, Cardot-Bauters C, Odou MF. Beyond MEN1, when to think about MEN4? Retrospective study on 5600 patients in the French population & literature review. J Clin Endocrinol Metab 2024:dgae055. [PMID: 38288531 DOI: 10.1210/clinem/dgae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 03/13/2024]
Abstract
CONTEXT Germline CDKN1B variants predispose patients to multiple endocrine neoplasia type 4 (MEN4), a rare MEN1-like syndrome, with <100 reported cases since its discovery in 2006. Although CDKN1B mutations are frequently suggested to explain cases of genetically-negative MEN1, the prevalence and phenotype of MEN4 patients is poorly known, and genetic counseling is unclear. OBJECTIVE To evaluate the prevalence of MEN4 in MEN1-suspected patients and characterize the phenotype of MEN4 patients. DESIGN Retrospective observational nationwide study. Narrative review of literature and variant class reassessment. PATIENTS We included all adult patients with class 3/4/5 CDKN1B variants identified by the laboratories from the French TENGEN network between 2015 and 2022 through germline genetic testing for MEN1 suspicion. After class reassessment, we compared the phenotype of symptomatic patients with class 4/5 CDKN1B variants, i.e. with genetically-confirmed MEN4 diagnosis, in our series and in literature with 66 matched MEN1 patients from the UMD-MEN1 database. RESULTS From 5600 MEN1-suspected patients analyzed, four patients with class 4/5 CDKN1B variant were found (0.07%). They presented with multiple duodenal NET, PHPT and adrenal nodule, isolated PHPT, PHPT and pNET. We listed 29 patients with CDKN1B class 4/5 variants from literature. Compared to matched MEN1 patients, MEN4 patients presented lower NET incidence and older age at PHPT diagnosis. CONCLUSION The prevalence of MEN4 is low. PHPT and PA represent the main associated lesions, NETs are rare. Our results suggest a milder and later phenotype than in MEN1. Our observations will help to improve genetic counseling and management of MEN4 families.
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Affiliation(s)
- Benjamin Chevalier
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, Lille, France
- University of Lille, Lille, France
- Department of Nuclear Medicine, Lille University Hospital, Lille, France
| | - Lucie Coppin
- University of Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer - Heterogeneity Plasticity and Resistance to Therapies, Lille, France
- CHU Lille, Service de Biochimie et Biologie moléculaire « Hormonologie, Métabolisme-Nutrition, Oncologie » , Lille, France
| | - Pauline Romanet
- Aix Marseille Univ, APHM, INSERM, UMR1251 MMG, Laboratory of Molecular Biology GEnOPé, Biogénopôle, Hôpital de la Timone, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, INSERM, UMR1251 MMG, MARMARA Institute, CRMR HYPO, Department of Endocrinology, Hôpital de la Conception, Marseille, France
| | - Jean-Christophe Maiza
- Department of Endocrinology, Diabetes, and Nutrition, GHSR, Centre Hospitalo-Universitaire de la Réunion, Saint-Pierre, La Réunion, France
| | - Juliette Abeillon
- Hospices Civils de Lyon, Fédération d'Endocrinologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Julien Forestier
- Service d'Oncologie Médicale et Hépatogastroentérologie, Hospices Civil de Lyon, Lyon, France
| | - Thomas Walter
- Service d'Oncologie Médicale et Hépatogastroentérologie, Hospices Civil de Lyon, Lyon, France
- Université de Lyon, Lyon, France
| | - Olivier Gilly
- Department of Metabolic and Endocrine Disease, CHU Nîmes, Université Montpellier, Nîmes, France
| | - Maëlle Le Bras
- Nantes Université, CHU Nantes, Service d'endocrinologie, diabétologie, nutrition, l'institut du thorax, F-44000 Nantes, France
| | - Sarra Smati
- Nantes Université, CHU Nantes, Service d'endocrinologie, diabétologie, nutrition, l'institut du thorax, F-44000 Nantes, France
| | - Marie Laure Nunes
- Department of Endocrinology, Diabetes and Nutrition, University Hospital (CHU) and University of Bordeaux, Bordeaux, France
| | - Aurore Geslot
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle cardio-vasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Solange Grunenwald
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle cardio-vasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Céline Mouly
- Service d'endocrinologie, maladies métaboliques et nutrition, pôle cardio-vasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex, France
| | - Gwenaelle Arnault
- Endocrinologie-Diabétologie-Nutrition, CHBA, 20 boulevard Maurice Guillaudot, 56000 Vannes, France
| | - Kathy Wagner
- Department of Pediatrics, CHU-Lenval, Nice, France
| | - Eugénie Koumakis
- Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, Reference Center for Rare Genetic Bone Disorders, OSCAR Filière, Rheumatology Department, Cochin Hospital, AP-HP Centre-Paris University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France, INSERM U1160, Institut Imagine
| | - Christine Cortet-Rudelli
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, Lille, France
| | - Émilie Merlen
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, Lille, France
| | - Arnaud Jannin
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, Lille, France
- University of Lille, Lille, France
- University of Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer - Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Stéphanie Espiard
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, Lille, France
- University of Lille, Lille, France
| | - Isabelle Morange
- Aix Marseille Univ, APHM, INSERM, UMR1251 MMG, MARMARA Institute, CRMR HYPO, Department of Endocrinology, Hôpital de la Conception, Marseille, France
| | - Éric Baudin
- Department of Endocrine Oncology and Imaging, Gustave Roussy Cancer Campus Grand Paris, France
| | - Mathias Cavaille
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand France; Département d'Oncogénétique, Centre Jean Perrin, Clermont Ferrand, France
| | - Igor Tauveron
- Service d'Endocrinologie, Diabétologie et Maladies Métaboliques, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Laboratoire GReD, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marie-Pierre Teissier
- Université de Limoges, Unité INSERM 1094 & IRD, 2 rue Marcland 87025 Limoges, France et Service d'Endocrinologie-Diabétologie et Maladies métaboliques, Centre hospitalier universitaire Dupuytren 2, 16 rue B. Descottes. 87042, Limoges, France
| | - Françoise Borson-Chazot
- Hospices Civils de Lyon, Fédération d'Endocrinologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Delphine Mirebeau-Prunier
- Unité Mixte de Recherche (UMR) MITOVASC, INSERM U1083, CNRS 6015, Université d'Angers, Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire d'Angers, Angers 49933, France
| | | | - Éric Pasmant
- Service de Génétique et Biologie Moléculaires, Hôpital Cochin, DMU BioPhyGen, Assistance Publique-Hôpitaux de Paris, AP-HP, Centre-Université de Paris, Paris, France
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université de Paris, CARPEM, Paris, France
| | - Sophie Giraud
- Genetics Department, Hospices Civils de LYON (HCL), University Hospital, East Pathology Center, Bron Cedex, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, Lille, France
- University of Lille, Lille, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), European Genomic Institute for Diabetes (EGID), CHU Lille, Lille, France
| | - Pierre Goudet
- Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Universitaire François Mitterand, Dijon, France
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, UMR1251 MMG, Laboratory of Molecular Biology GEnOPé, Biogénopôle, Hôpital de la Timone, Marseille, France
| | - Catherine Cardot-Bauters
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital, Lille, France
| | - Marie Françoise Odou
- CHU Lille, Service de Biochimie et Biologie moléculaire « Hormonologie, Métabolisme-Nutrition, Oncologie , Lille, France
- University of Lille, Inserm, CHU Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, Lille, France
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Lusho S, Durando X, Bidet Y, Molnar I, Kossai M, Bernadach M, Lacrampe N, Veyssiere H, Cavaille M, Gay-Bellile M, Radosevic-Robin N, Abrial C. PERCEPTION Trial protocol: Comparison of predictive and prognostic capacities of neutrophil, lymphocyte, and platelet counts and tumor-infiltrating lymphocytes in triple negative breast cancer. Medicine (Baltimore) 2020; 99:e23418. [PMID: 33327268 PMCID: PMC7738079 DOI: 10.1097/md.0000000000023418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Triple negative breast cancer affects 10% to 20% of all women diagnosed with breast cancer. Due to its characteristics, treatment strategies are limited and metastatic recurrences are common in the first 5 years after treatment. However, not all patients affected by this disease develop metastases. Tumor-infiltrating lymphocytes have shown to be reliable predictive biomarkers of treatment response and metastatic recurrences. However, we need to develop simpler and faster ways to predict response to cytotoxic treatment and the possibility of eventual cancer relapse by identifying new biomarkers. Recently, new studies are emerging, suggesting a predictive role of circulating blood cells in different types of cancer. In this study, we will assess the correlation between tumor-infiltrating lymphocytes and different elements of the blood count in patients diagnosed with triple negative breast cancer. METHODS The main objective of this study is to evaluate the correlation between the peripheral neutrophil-to-lymphocyte ratio and the amount of tumor-infiltrating lymphocytes, assessed in triple negative breast cancer patients at diagnosis. Secondary objectives include evaluation of the correlation between tumor-infiltrating lymphocytes at diagnosis and the baseline absolute neutrophil, lymphocyte, and platelet counts, as well as the platelet-to-lymphocyte ratio. The triple negative breast cancer patients will be enrolled in the PERCEPTION trial during the first year after the treatment completion. Two supplementary blood tests, at 12 months after the end of treatment and at the time of the first metastatic recurrence, will be performed. DISCUSSION The discovery of new prognostic and predictive biomarkers is crucial for triple negative breast cancer. We set up the PERCEPTION clinical trial in order to evaluate certain blood counts as early biomarkers and to assess their correlation with tumor-infiltrating lymphocytes. Demonstration of comparative predictive and/or prognostic capacities of peripheral blood counts and tumor-infiltrating lymphocytes would allow introduction of the former as simple and cheap biomarkers in triple negative breast cancer patient management. TRIAL REGISTRATION The PERCEPTION study has been registered in the French National Agency of Medical Security registry on the 2nd of July 2019 under the number 2019-A01861-56 and in the ClinicalTrials.org registry under the number NCT04068623.
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Affiliation(s)
- Sejdi Lusho
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Délégation Recherche Clinique & Innovation, Centre Jean Perrin, 58 rue Montalembert, F-63011 Clermont-Ferrand
- Centre d’Investigation Clinique, UMR501, F-63001 Clermont-Ferrand
| | - Xavier Durando
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Délégation Recherche Clinique & Innovation, Centre Jean Perrin, 58 rue Montalembert, F-63011 Clermont-Ferrand
- Centre d’Investigation Clinique, UMR501, F-63001 Clermont-Ferrand
| | - Yannick Bidet
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Centre Jean PERRIN, Laboratoire d’oncologie moléculaire
| | - Ioana Molnar
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Délégation Recherche Clinique & Innovation, Centre Jean Perrin, 58 rue Montalembert, F-63011 Clermont-Ferrand
- Centre d’Investigation Clinique, UMR501, F-63001 Clermont-Ferrand
| | - Myriam Kossai
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Centre Jean Perrin, Département d’anatomie et de cytologie pathologiques
| | - Maureen Bernadach
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Délégation Recherche Clinique & Innovation, Centre Jean Perrin, 58 rue Montalembert, F-63011 Clermont-Ferrand
| | - Nathalie Lacrampe
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Centre Jean Perrin, Département d’anatomie et de cytologie pathologiques
| | - Hugo Veyssiere
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Délégation Recherche Clinique & Innovation, Centre Jean Perrin, 58 rue Montalembert, F-63011 Clermont-Ferrand
- Centre d’Investigation Clinique, UMR501, F-63001 Clermont-Ferrand
| | - Mathias Cavaille
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Centre Jean Perrin, Département d’oncogénétique, 58 rue Montalembert, 63011 Clermont-Ferrand, France
| | - Mathilde Gay-Bellile
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Centre Jean Perrin, Département d’oncogénétique, 58 rue Montalembert, 63011 Clermont-Ferrand, France
| | - Nina Radosevic-Robin
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Centre Jean Perrin, Département d’anatomie et de cytologie pathologiques
| | - Catherine Abrial
- Université Clermont Auvergne, INSERM UMR 1240 «Imagerie Moléculaire et Stratégies Théranostiques», Centre Jean Perrin, 58 rue Montalembert, 63000 Clermont-Ferrand
- Délégation Recherche Clinique & Innovation, Centre Jean Perrin, 58 rue Montalembert, F-63011 Clermont-Ferrand
- Centre d’Investigation Clinique, UMR501, F-63001 Clermont-Ferrand
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Veyssière H, Passildas J, Ginzac A, Lusho S, Bidet Y, Molnar I, Bernadach M, Cavaille M, Radosevic-Robin N, Durando X. XENOBREAST Trial: A prospective study of xenografts establishment from surgical specimens of patients with triple negative or luminal b breast cancer. F1000Res 2020; 9:1219. [PMID: 34249349 PMCID: PMC8258709 DOI: 10.12688/f1000research.26873.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: Patient-derived xenografts (PDX) can be used to explore tumour pathophysiology and could be useful to better understand therapeutic response in breast cancer. PDX from mammary tumours are usually made from metastatic tumours. Thus, PDX from primary mammary tumours or after neoadjuvant treatment are still rare. This study aims to assess the feasibility to establish xenografts from tumour samples of patients with triple negative or luminal B breast cancer in neoadjuvant, adjuvant or metastatic setting. Methods: XENOBREAST is a single-centre and prospective study. This feasibility pilot trial aims to produce xenografts from tumour samples of patients with triple negative or luminal B breast cancer. Patient enrolment is expected to take 3 years: 85 patients will be enrolled and followed for 28 months. Additional blood samples will be taken as part of the study. Surgical specimens from post-NAC surgery, primary surgery or surgical excision of the metastases will be collected to establish PDX. Histomolecular characteristics of the established PDX will be investigated and compared with the initial histomolecular profile of the collected tumours to ensure that they are well-established. Ethics and dissemination: XENOBREAST belongs to category 2 interventional research on the human person. This study has been approved by the Sud Méditerranée IV – Montpellier ethics committee. It is conducted notably in accordance with the Declaration of Helsinki and General Data Protection Regulation (GDPR). Study data and findings will be published in peer-reviewed medical journals. We also plan to present the study and all data at national congresses and conferences. Registration: ClinicalTrials.gov ID
NCT04133077; registered on October 21, 2019.
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Affiliation(s)
- Hugo Veyssière
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Division de Recherche Clinique, Délégation Recherche Clinique & Innovation, Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Centre d'Investigation Clinique, UMR501, F-63001, Clermont-Ferrand, 63011, France
| | - Judith Passildas
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Division de Recherche Clinique, Délégation Recherche Clinique & Innovation, Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Centre d'Investigation Clinique, UMR501, F-63001, Clermont-Ferrand, 63011, France
| | - Angeline Ginzac
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Division de Recherche Clinique, Délégation Recherche Clinique & Innovation, Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Centre d'Investigation Clinique, UMR501, F-63001, Clermont-Ferrand, 63011, France
| | - Sejdi Lusho
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Division de Recherche Clinique, Délégation Recherche Clinique & Innovation, Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Centre d'Investigation Clinique, UMR501, F-63001, Clermont-Ferrand, 63011, France
| | - Yannick Bidet
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Département d'oncogénétique, Laboratoire d'Oncologie Moléculaire, Centre Jean Perrin, Clermont-Ferrand, 63011, France
| | - Ioana Molnar
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Division de Recherche Clinique, Délégation Recherche Clinique & Innovation, Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Centre d'Investigation Clinique, UMR501, F-63001, Clermont-Ferrand, 63011, France
| | - Maureen Bernadach
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Division de Recherche Clinique, Délégation Recherche Clinique & Innovation, Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Centre d'Investigation Clinique, UMR501, F-63001, Clermont-Ferrand, 63011, France.,Département d'Oncologie Médicale, Centre Jean Perrin, Clermont-Ferrand, 63011, France
| | - Mathias Cavaille
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Département d'oncogénétique, Laboratoire d'Oncologie Moléculaire, Centre Jean Perrin, Clermont-Ferrand, 63011, France
| | - Nina Radosevic-Robin
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Département d'anatomie et de cytologie pathologiques, Centre Jean Perrin, Clermont-Ferrand, 63011, France
| | - Xavier Durando
- Université Clermont Auvergne, INSERM UMR 1240 « Imagerie Moléculaire et Stratégies Théranostiques », Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Division de Recherche Clinique, Délégation Recherche Clinique & Innovation, Centre Jean Perrin, Clermont-Ferrand, 63011, France.,Centre d'Investigation Clinique, UMR501, F-63001, Clermont-Ferrand, 63011, France.,Département d'Oncologie Médicale, Centre Jean Perrin, Clermont-Ferrand, 63011, France
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