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Resume Introduction L’adjonction du palbociclib a l’hormonotherapie ameliore la survie sans progression chez les patients atteints d’un cancer du sein metastatique positif aux recepteurs hormonaux. Cette nouvelle therapie ciblee expose cependant les patients a une toxicite hematologique severe pouvant conduire a un report ou un arret du traitement et donc potentiellement a une baisse de son efficacite. L’objectif de cette etude etait d’identifier les facteurs predictifs d’hematotoxicite chez ces patients. Methodes Cette etude retrospective a inclus tous les patients ayant initie un traitement de palbociclib pour un cancer du sein metastatique positif aux recepteurs hormonaux entre le 1er decembre 2016 et le 1er janvier 2019. Toutes les donnees ont ete collectees via les dossiers electroniques ou papiers. Une hematotoxicite precoce et severe a ete definie comme l’apparition d’une toxicite hematologique grade 4 ou grade 3 ayant necessite une reduction de dose durant les trois premiers cycles. Resultats Cent quatre-vingt-un patients ont ete inclus. Quarante-six patients (25,4 %) ont developpe une hematotoxicite severe et precoce. Apres analyse multivariee, les facteurs predictifs de cette hematotoxicite sont le Performance Status de l’OMS superieur ou egal a 2 (p = 0,024) et des antecedents de radiotherapie osseuse dans l’annee (p = 0,003). Un taux de neutrophiles inferieur a 3,37 g/L avant la mise en place du palbociclib est egalement un facteur predictif de developper une hematotoxicite avec une sensibilite de 76 % et une specificite de 71 %. Conclusion Le Performance Status, les antecedents de radiotherapie osseuse dans l’annee et un taux bas de neutrophiles avant traitement sont associes a une augmentation du risque d’hematotoxicite chez les patients traites pour un cancer du sein metastatique.

Oncological at home-treatment improves patient quality of life and autonomy but requires close watchfulness of adverse events and compliance to treatment. For nearly ten years, pharmaceutical consultations for home-based anticancer oral therapies patients are proposed on medical request in Avignon-Provence Cancer Institute (ICAP). Organizational changes led us to modify this management by integrating dedicated nurses to create an Oral Therapy Unit (OTU).Needs and expectations assessment questionnaires were proposed to healthcare professionals and patients treated by oral therapies. The analysis of these questionnaires allows to set up an OTU, integrating a dedicated nurse, adapted to the expectations of patients and healthcare professionals. About 8 months later, a new evaluation was carried out to assess the impact of this new support for patient care and health professionals' organization.The results of the studies carried out before OTU implementation highlight the importance of multi-professional support for patients from the start of treatment and during the follow-up. With the new OTU pathway, professionals expect a patient course improvement (94%), a better compliance (88%), a therapeutic accidents reduction (81%) and an improvement in the patient-caregiver relationship (69%). Regarding the organization, 56% of them are expecting to save medical and pharmaceutical time.The OTU creation in our institution and these new multi-professionals' teams' management of patients has obtained a favourable opinion from healthcare professionals and patient satisfaction.

In case of a new breast symptom or an abnormal result of breast imaging, some women have a problem finding a quick answer to allay their anxiety. The Institut Sainte-Catherine in Avignon has set up a new form of accelerated disease management through the opening of a new dedicated consultation called SOS SEIN 84. We present the result of a prospective quality study of our first new patients.

Prognostic signification of micrometastases ou isolated tumor cells (ITC) has not yet been clearly precised. Management of the axilla in case of micrometastases or ITC depends on the local pratices: no surgical completion or axillary lymph node dissection (ALND). Axillary lymph node status is the most important prognostic factor in patients with breast cancer; morbidity of ALND is now well known whereas its therapeutic benefit has not been demonstrated. This study is based on a retrospective database of 1375 patients who underwent sentinel node (SN) biopsy for breast cancer. In case of micrometastase or ITC in SN with completion axillary dissection, we examined if non-sentinel lymph node status has changed the indications of adjuvant treatments (chimiotherapy or radiotherapy). The results of our study show that non-sentinel lymph node status modify systemic therapy for a very few patients (less than 4% concerning chimiotherapy and less than 15% concerning radiotherapy).