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Introduction: Concerns about the proper schedule for discontinuing immunotherapy have been raised by many clinicians, as well as the minimal check-up required to assess residual disease before stopping immunotherapy. In fact, there currently exist no recommendations concerning immunotherapy prescription and optimal assessment in the event of persistent oncological response in cases of metastatic non-small cell lung cancer (NSCLC)., Methods: We conducted an online survey among board-certified French Thoracic Oncologists belonging to two professional associations. The survey included multiple-choice questions that either stood alone or were included in case reports., Results: The survey was sent to 490 physicians, of whom 88 responded. For minimal residual disease assessment after 2 years of immunotherapy, PET-scan is prescribed by 92% of respondents and cerebral MRI by 59%. In the event of complete response after 2 years of treatment, 83% of physicians stop prescribing pembrolizumab and 70% discontinue nivolumab. In the event of partial response, 88% of respondents continue immunotherapy. In this case, only 33% use a complementary locoregional treatment such as radiotherapy., Conclusion: Our survey highlights a pronounced tendency to stop immunotherapy in the event of complete oncological response. In the event of partial morphologic response, on the other hand, there is a tendency to continue immunotherapy. However, the use of locoregional treatments remains more heterogeneous., (Copyright © 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The National Lung Screening Trial found that, in a selected population with a high risk of lung cancer, an annual low-dose CT-scan decreased lung cancer mortality by 20% and overall mortality by 7% compared to annual chest X-Ray. In France, a work group stated that individual screening should be considered in this setting. However, the economic impact of an organized and generalized (to all eligible individuals) screening in France was never reported., Methods: This is a modeling study using French population demographic data and published data from randomized screening trials. We used the same selection criteria as NLST: 55-74-year-old smokers for at least 30 pack-years, current smoker or quit less than 15 years. We computed a second model including also 50-54-year-old individuals. Then, we used different participation rates: 65%, 45%, and 32%., Results: According to the considered model, there would be 1,650,588 to 2,283,993 subjects eligible to screening in France. According to the model and participation rate, lung cancer screening would diagnose 3600 to 10,118 stages 1/2 lung cancer each year. There would be 5991 to 16,839 false-positives, of whom 1416 to 3981 would undergo unnecessary surgery. Screening policy would cost 105 to 215 € million per year. However, increasing the price of a cigarette pack by 0.05 to 0.10 € would fully cover the screening costs., Conclusion: Participation rate is a key point for screening impact. Screening could be easily funded by a small increase in cigarette prices., (Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Annual screening for lung cancer using low-dose CT-scans is associated with decreased mortality. A survey conducted in Rhône-Alpes area in France found that clinicians need education and information on this topic. Script concordance tests (SCT) are a tool for assessing clinical reasoning in situations of uncertainty. They have not previously been used in France in the context of continuing medical education., Method: We created a questionnaire with 5 multiple-choice questions (MCQ) and two SCT scenarios. The questionnaire was sent to all clinicians and residents who are members of French-Speaking Respiratory Society or the French Young Pulmonologist Association., Results: One hundred and ninety answers were analyzed. Seventy percent stated that decreasing mortality was the best criterion for assessing the effectiveness of a cancer screening policy, and 75% that low-dose CT scan was the best test to achieve this in lung cancer screening. Forty-five percent knew the eligibility criteria of the population, and 62% that low-dose CT scan should be performed annually. Participation in tumor boards and certification in oncology were significantly associated with a better score at MCQ and SCT. SCT and MCQ scores were significantly correlated (Spearman's Rho 0.339; P<0.0001)., Conclusion: SCT are feasible by electronic survey and seem relevant. Improving knowledge of clinicians on lung cancer screening is still critical., (Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: In response to questions regarding the appropriate intensity of care for some patients, "a decision support aid regarding the intensity of care in case of worsening condition of a patient with a chronic disease" has been established at the Grenoble university hospital. According to patient's wishes and the experience of the medical and paramedical team who are responsible for him, a level of intensity of care will be suggested., Methods: We propose a prospective and multicenter study conducted in the Rhône-Alpes-Auvergne area. All lung cancer patients admitted to a pulmonology unit in 2014 would be included. This document would be used if a decision to withhold life-sustaining treatment exists. We would assess the relationship between the planned intensity of care and those established when the patient develops organ failure. Patient characteristics and factors associated with proposed levels and types of care would be analyzed. Patient and family opinions will be obtained at 3 months. The number of subjects to be included is 468., Expected Results: Therefore, we hope to be able to define the wishes of patients' and to propose an appropriate and adapted aid for decisions if they develop organ failure., (Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Bevacizumab is recommended in first line chemotherapy for advanced non-squamous non-small cell lung cancer (NSCLC). Paclitaxel is a doublet drug also widely used in cisplatin-based regimens. Paclitaxel plus bevacizumab is a standard regimen as first line treatment of metastatic breast cancer. Since there is no guideline for third line treatment of NSCLC, some oncology units use paclitaxel-bevacizumab in some NSCLC patient after relapse of the second line. The aim of this study was to assess retrospectively the feasibility and efficacy of this treatment option in stage IV NSCLC., Methods: Patients who had received the combination of paclitaxel (80 to 90 mg/m(2) in a weekly schedule) and bevacizumab (7.5 to 15 mg/kg every 21 days) in the thoracic oncology departments of two university hospitals in the Rhone-Alpes Department were retrospectively reviewed., Results: Twelve patients underwent this treatment. Their mean age was 56 years and their performance status was less or equal to 1 in 50 % of the cases. The chemotherapy was given as fifth line in 67 % of the patients and 67 % were antiangiogenic naïve. They received a mean of 6 courses. The overall response rate was 33 % and the disease control rate 66 %. Median progression-free survival was 5.1 months (95 %CI 1.0-9.1). Ten patients (82 %) experienced toxicity, the majority grade 1 to 2 events, and only one a grade 3 event (febrile neutropenia). There were no severe bleeding episodes., Conclusion: Combined paclitaxel-bevacizumab chemotherapy seems feasible in patients with NSCLC. The toxicity profile is acceptable. This regimen should be evaluated in further prospective studies., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Anemia is fairly common in lung neoplasms and adequate management can influence both the prognosis and the quality of life of patients. Anemia can stem from diverse mechanisms, and its management must include the search for correctable causes (iron deficiency, inflammation, disease- or treatment-related), and their subsequent treatment. Use of erythropoiesis stimulating agents, namely recombinant erythropoietin, results in hemoglobin increase, fewer blood transfusions, and better quality of life. However, there is also a significant increase in thromboembolic risk associated with this treatment, and their effect on overall survival is still debated. Thus, their use must be restricted to patients treated with palliative intent, receiving chemotherapy but no radiotherapy, with a baseline hemoglobin level under 100 g/L, and target hemoglobin level must not exceed 120 g/L., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Around 5 to 25% of lung cancer worldwide occurs in lifelong non-smokers (less than 100 cigarettes in lifetime). Lung cancer in never smokers (LCINS) shows many clinical, epidemiological and molecular differences compared to those related to tobacco. It is therefore often considered as a separate entity. LCINS is also a good model for the study of lung cancer risk factors and tumoral mutation profiles (usually more common and specific). However, most data has come from retrospective studies and/or from Asian populations, although this disease shows high geographic lability. The BioCAST/IFCT-1002 is a national, multicentric, prospective study promoted by the French intergroup IFCT. The first objective is to describe the clinical and molecular epidemiology of LCINS in a French population. Detailed data (including exposure to many risk factors) are collected directly from the patient through a standardized questionnaire completed during a telephone interview. All patients also undergo blood sampling for the analysis of genomic polymorphisms and the characterization of epigenetic anomalies. BioCAST hopes to provide concrete answers for clinicians and patients about this entity., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Pneumonia due to Mycobacterium malmoense is rare and usually occurs in damaged lung as is the case with Aspergillus infections. We report the case of a patient who developed chronic necrotizing pulmonary aspergillosis following an infection by atypical mycobacteria. A 53-year-old woman was hospitalized because of weight loss and fever. Direct examination of sputum smear was positive for acid fast bacilli and PCR and culture led to the diagnosis of infection with M. malmoense. Treatment was begun with clarithromycin, rifampicin and ethambutol. Despite initial improvement and excellent adherence to treatment, fever and weight loss recurred 6 months later. Relapse of the mycobacterial infection was excluded and the final diagnosis was necrotizing pulmonary aspergillosis. Infection with A. fumigatus complicating the treatment of M. malmoense is unusual. The management is challenging because of strong interactions between voriconazole and rifampicin, and thus requires a multidisciplinary and specialized approach., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Cisplatin-based chemotherapy and concurrent radiotherapy are the standard treatments for locally advanced unresectable NSCLC. New therapeutic combinations using molecular targeted drugs are needed., Methods: Eligible patients with previously untreated stage III non squamous, NSCLC will receive thoracic radiation (66 Gy) along with cisplatin (75 mg/m(2)) and pemetrexed (500 mg/m(2)) on day 1 administered intravenously every 21 days for four cycles; weekly cetuximab will be added from the first week of therapy. The primary objective of this phase II study (IFCT 0803) is to assess the disease control rate at the 16th week, one month after the completion of the treatment. Based on a two-stage Simon approach, a total of 106 patients are required with an interim analysis of the first 34 planned., Expected Results: This trial will provide information on the feasibility, efficacy and tolerability of this new therapeutic combination. Should the primary objective be achieved, a phase III randomised study testing the position of cetuximab could be considered., (Copyright © 2011. Published by Elsevier Masson SAS.)

Background: Lung cancer in the elderly is considerably increasing in frequency, representing a public health issue. Those patients are underrepresented in clinical trials and probably not optimally treated., Methods: We performed a survey of the management and the outcome of lung cancer patients aged 70 and more in France between August 2002 and September 2003 according to age categories (70-74, 75-79 and > or =80 years). One thousand six hundred and twenty-seven patients were analysed for descriptive data and 1595 for survival., Results: Median age was 75 (70-96) and male:female ratio was 4.26 with a decrease across the age categories from 5.1 to 3.0. Tobacco-linked comorbidities were frequent. The median value of Charlson's index was 2. About 58% had a performance status (PS) 0 or 1, 30% a PS 2 and 12% a PS>2. The proportion of never-smokers (11.6%) increased significantly with age categories. Regarding imaging procedures, as much as 83.3% of the patients had at least a chest CT-scan and a brain CT-scan (or MRI) and an abdominal ultrasound or CT-scan. Best Supportive Care (BSC) as only treatment was administered to 16.1% of the patients. Among patients specifically treated, 22.9% were operated, 21.8% received mediastinal irradiation and 71.5% chemotherapy. Overall, median survival time was 9.14 months with 23.5% deaths occurring before 3 months. Low category of age, good PS, non-smoking and high body mass index (BMI) were favorable independent prognostic factors of survival. Age, PS and tobacco smoking were prognostic of early death., Conclusions: A large majority of elderly lung cancer patients in France are managed like younger counterparts regarding diagnostic procedures and treatment. Age remains an independent prognostic factor as well for overall survival as for early death., (Copyright 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The development of a sero-sanguinous pleural effusion is a rare, often overlooked, manifestation of a ruptured infected aneurysm of the abdominal aorta., Case Report: A man of 84years was referred for management of a left-sided pleural effusion associated with symptoms of infection. He had presented two months previously with methicillin resistant staphylococcal septicaemia, the origin of which was a plantar ulcer. The patient was apyrexial and had no abdominal pain. A thoraco-abdominal CT scan without contrast showed a peri-aortic abdominal mass suggesting a tumour. A contrast enhanced scan and peri-aneurysmal aspiration showed that it was an infected aneurysm of the abdominal aorta that had ruptured into the left pleural cavity. The progress was unfavourable despite double antibiotic therapy., Conclusion: In the face of a sero-sanguinous pleurisy, particularly if associated with unexplained symptoms of infection, a search should be made for an abdominal aortic aneurysm. Surgical treatment of the aneurysm should be undertaken if the general condition of the patient and the localisation and morphology of the aneurysm permit.

Introduction: Although an association between thymic tumour and autoimmune disease (including autoimmune cytopenia) has been established, the association between thymic tumour and autoimmune neutropenia has rarely been reported, with only 13 cases described in the literature., Observation: We report on a 30 year old man diagnosed with autoimmune neutropenia who had been treated for invasive thymic tumour one year previously. He successfully responded to cyclosporin and steroids therapy. A few months later, the patient presented with autoimmune haemolytic anaemia after prematurely halting his own immunosuppressive treatment., Conclusion: This observation brings additional insights about the clinical features, biology and treatment of autoimmune neutropenia associated with thymic tumours and underlines the potential severity of such an association. Furthermore, the association of a thymic tumour with both autoimmune neutropaenia and autoimmune haemolytic anaemia has not been reported previously.

Background: As chemotherapy gains wider acceptance for the treatment of earlier stages of NSCLC, particularly in the adjuvant and neoadjuvant setting, physicians face a growing population of high performance status patients who have relapsed after their first-line chemotherapy. The type of second-line chemotherapy after initial adjuvant or neoadjuvant treatment with a platinum-based regimen remains largely undefined. The current study has been designed to compare the classical mono chemotherapy docetaxel with a docetaxel cisplatin doublet., Methods: Patients will be randomized in 2 arms. Arm: docetaxel cisplatin (cycles repeated every 21 days), 4 cycles followed by 2 cycles of docetaxel alone in case of objective response or stabilisation. Arm B: docetaxel alone (cycles repeated every 21 days), 4 cycles followed by 2 cycles of docetaxel alone in case of objective response or stabilisation., Expected Results: 300 patients will be randomized with a statistical hypothesis of a progression free survival of 3 months in the control arm and of 4.5 months in the experimental arm.

Background: Positron emission tomography with 2-[18]-fluoro-2-deoxy-D-glucose coupled to a dedicated CT scanner (FDG-PET-CT) is an accurate test for the diagnosis of malignancy of pulmonary nodules. We have assessed the diagnostic accuracy of this test at the Lyon Sud Hospital Centre (LSHC)., Methods: We examined retrospectively 93 patients with no past history of cancer who had had a FDG-PET-CT evaluation for the diagnosis of pulmonary nodules or mass lesions between the 1st January 2005 and the 30th June 2006 at the CHLS. The results of the PET scans were compared with the histological findings or follow-up imaging., Results: The sensitivity was 97.85 (IC 95% Sc =[93.4; 100]), the specificity was 79.2% (IC95% Sc=[67.6; 90.7]), the positive predictive value was 81.5%, the negative predictive value was 97.4% and the accuracy was 88.2%., Conclusions: In current practice these results support the validity of FDG-PET-CT at the LSHC for the diagnosis of malignancy of pulmonary nodules and mass lesions while giving nuclear medicine physicians the opportunity to improve their standards of practice.

Second line treatments of non-small cell lung cancer are currently largely used because of their effectiveness in terms of survival and quality of life. Three drugs are currently licensed for this indication (docetaxel, pemetrexed and erlotinib), and possibly others will follow in the years to come. A true therapeutic strategy can thus be applied in advanced non-small cell lung cancer. The questions which need to be resolved are the optimum choice of treatments (mono-chemotherapy? Poly-chemotherapy? Therapeutic biological?) related to the still poorly understood "characteristics" of patients and tumours, as well as the specific question as to whether patients who have received adjuvant chemotherapy and then relapse should receive "first line" or "second line" therapy?

Patients with poor performance status (PS) and advanced lung cancer have been underrepresented in clinical trials. As a consequence, the management of these patients in clinical practice is often empirical. Recent data indicate that patients with advanced non-small cell lung cancer (NSCLC) and a PS of 2 tend to benefit from first line chemotherapy with respect to symptom improvement and perhaps overall survival. Whether single-agent or combination chemotherapy is preferable remains debatable. In previously treated patients with NSCLC, EGFR tyrosine kinase inhibitors produced a substantial rate of clinical benefit and led to an improvement in survival compared with placebo in studies that included a significant percentage of patients with poor PS.

Introduction: Nocardial pneumonias are due to a genus of aerobic, filamentous, partly acid-alcohol fast, mainly Gram positive, actinomycetes., Case Report: We report here two cases of nocardial pneumonia. The first was a 62 year old man with a history of fludaribine treatment and bone marrow transplant for lymphocytic leukaemia. During the investigation of pyrexia evidence of N. farcinica infection was found in the bronchial secretions. The second case was a man of 61 receiving long term corticosteroids and cytotoxic chemotherapy. Investigation of a pneumonia with pleural effusion found evidence, on culture of blood and pleural fluid, of disseminated infection with N. nova (cerebral, pleural, pulmonary and splenic)., Conclusion: Nocardiosis is a rare cause of pneumonia mainly occurring in immuno-compromised adults (corticosteroid therapy, HIV infection, transplantation, cancer or leukaemia). It should be suspected in the presence of pleuro-pulmonary symptoms associated with neurological and cutaneous signs, general deterioration and weight loss. The microbiology laboratory should be advised of this eventuality as soon as possible in order to optimise the search for the organism.