45 results on '"PROGRESSION-free survival"'
Search Results
2. Point de vue sur la qualité de vie.
- Author
-
Ysebaert, Loïc
- Abstract
Quality of life evaluation is a cornerstone of randomized controlled trials in hematology but is now rarely considered as such, and is a often only a secondary endpoint in most studies. For CLL patients, how can we abandon PFS to move to OS in good QOL? [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
3. Évaluation de l'utilisation du daratumumab en association avec le lénalidomide et la dexaméthasone dans un centre de lutte contre le cancer 5 ans après sa mise sur le marché : étude en vie réelle.
- Author
-
Delépine, Anne, Ferry, Isabelle, Escalup, Laurence, and Glaisner, Sylvie
- Subjects
- *
PROGRESSION-free survival , *MULTIPLE myeloma , *OVERALL survival , *DARATUMUMAB , *MONOCLONAL antibodies , *LOW vision - Abstract
Daratumumab is a humanized monoclonal antibody IgG1 anti-CD38, available since august 2016. It is indicated, among other indications, for the treatment of multiple myeloma in association with lénalidomide and dexaméthasone (DRd protocol). POLLUX trial demonstrated an improvement of overall survival and progression-free survival in patients receiving DRd compared to Rd only. This study is monocentric and observationnal and retrospective and included all patients receiving DRd for multiple myeloma in a cancer centre between august 2016 and decembre 2020. 49 patients received intravenous daratumumab at 16 mg/kg; after 6 months of therapy, overall response rate is 79.6% ; after 12 months of therapy 79.1% of the patients did not progress and 78.9% of the patients are still alive. Our results are less than POLLUX study in which the 12 months overall survival is 92.1% (versus 79.1%), 12 months progression-free survival is 85.7% (versus 78.9%) and overall response rate is 92.9% (versus 79.6%). These results can be explained by a population with a poorer prognosis in our cohort. This real-life study allows a realistic vision of the benefits of a treatment by DRd over a population that was non selected. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
4. Les anti-BCMA dans la prise en charge du myélome multiple réfractaire.
- Author
-
Van de Wyngaert, Zoé
- Subjects
- *
BISPECIFIC antibodies , *MULTIPLE myeloma , *MONOCLONAL antibodies , *PROGRESSION-free survival , *PROTEASOME inhibitors - Abstract
Anti-BCMA targeting agents are an interesting therapeutic option for refractory multiple myeloma, especially for patients exposed or refractory to proteasome inhibitors, IMiD or anti-CD38 monoclonal antibodies. Ide-cel and cilta-cel are both CAR-T cells targeting BCMA. The KarMMa and CARTITUDE trials have demonstrated efficacy of CAR-T cell therapy among heavily treated patients, including triple-refractory patients. Overall response rates (ORR) are over 70%, with a significant proportion of patients achieving negative minimal residual disease <10-5. Median progression-free survival (PFS) is significantly longer than with standard treatments. Cilta-cel yields prolonged PFS and even deeper ORR compared to ide-cel, but it is only available in a few centers. Main adverse effects associated with CAR-T cell therapy are cytokine-release syndrome (CRS), which is frequent (described in more than 80 % patients) but mostly grade 1-2, and specific neurotoxicity, seen in around 20 % patients. These results issued from clinical trials, among highly selected patients, are being confirmed by a real-life study conducted in the United States following FDA approval of ide-cel. Teclistamab and elranatamab are the only two bi-specific antibodies available off-the shelf in France. Results from the MajesTEC and MagnetisMM studies are promising, with around 60% ORR and a median PFS of a little less than a year. Most frequent adverse events are hematologic toxicity (especially neutropenia), mostly grade 3-4; and infections, described in around 60% patients. CRS are frequent, but mostly grade 1-2. There is very few specific neurotoxicity. Combinations with other drugs, and use of these agents at earlier stages of multiple myeloma management are interesting perspectives, that might change our practice in the near future. However, limited availability of CAR-T cells remains a major restrain to a wider use. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
5. [An update on total neoadjuvant treatment of adenocarcinoma of the rectum].
- Author
-
Medioni M, Cervantes B, Huguet F, Bachet JB, Parc Y, André T, Lefèvre JH, and Cohen R
- Subjects
- Humans, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Induction Chemotherapy, Progression-Free Survival, Fluorouracil administration & dosage, Fluorouracil therapeutic use, Capecitabine administration & dosage, Randomized Controlled Trials as Topic, Leucovorin administration & dosage, Leucovorin therapeutic use, Organoplatinum Compounds administration & dosage, Organoplatinum Compounds therapeutic use, Neoadjuvant Therapy, Rectal Neoplasms therapy, Rectal Neoplasms pathology, Rectal Neoplasms mortality, Adenocarcinoma therapy, Adenocarcinoma pathology, Adenocarcinoma mortality, Neoplasm Recurrence, Local therapy
- Abstract
A major advance has been made in the management of rectal cancer, with the emergence in 2021 of total neoadjuvant treatment. The main publications from the RAPIDO and PRODIGE-23 trials reported a significant improvement in progression-free survival and the pathological complete response rate. The aim of this review is to synthesize recent data on neoadjuvant treatment of rectal cancer, to explain the long-term results of the RAPIDO and PRODIGE-23 trials, and to put them into perspective, considering current advances in de-escalation strategies. The update of the 5-year survival data from the RAPIDO trial highlights an increased risk of loco-regional relapse, with 11.7% of relapses in the experimental group and 8.1% in the control group, while the update of the PRODIGE-23 trial confirms the benefits of this treatment regimen, with a significant improvement in overall survival. In addition, the results of the OPRA and PROPSPECT trials confirm the benefit of total neoadjuvant treatment with induction chemotherapy, as well as the possibility of surgical de-escalation in the OPRA trial and radiotherapy in the PROSPECT trial. The challenge for the future is to identify patients who require total neoadjuvant treatment with the aim of curative surgery to obtain a cure without local or distant relapse, and those for whom therapeutic de-escalation can be envisaged., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
6. [Transfusions and iron chelation in myelodysplastic syndromes].
- Author
-
Pascal L
- Subjects
- Humans, Aged, Iron Chelating Agents therapeutic use, Blood Transfusion, Progression-Free Survival, Myelodysplastic Syndromes complications, Myelodysplastic Syndromes drug therapy, Iron Overload drug therapy, Iron Overload etiology
- Abstract
Iron overload (IO) is probably as toxic in elderly patients with low-risk myelodysplastic syndromes (MDS) as in young thalassemic patients. This impact is more difficult to demonstrate because of associated comorbidities. Cardiovascular disease increases vulnerability to the toxic effects of IO. In recent years, registry studies have shown a survival benefit of Iron Chelation Therapy (ICT) in these patients. These findings are now corroborated by an improvement in event-free survival in a single randomized study: the Telesto study. The EFS curves separate after two years of follow-up. This indicates inertia in the occurrence of complications. The benefits of ICT are also very slowly being revealed. It is possible to offer ICT to patients with transfusion-dependent MDS with a life expectancy of at least two years. In Telesto, patients had a serum ferritin (F) level of at least 1000ng/mL, recommendations using this F threshold as a trigger for chelation seem to be reinforced. It remains an open question whether chelation should be started earlier for effective suppression of IO-related oxidative stress. ICTs could be used in transfusion-dependent MDS patients with life expectancy greater than two years. including possibly higher risk patients responding to hypomethylating agents., (Copyright © 2023 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
7. [Updates in hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer in 2021]
- Author
-
Essia, Mezni, Renaud, Sabatier, Anthony, Goncalves, and Cécile, Vicier
- Subjects
Selective Estrogen Receptor Modulators ,Clinical Trials as Topic ,Class I Phosphatidylinositol 3-Kinases ,Pyridines ,Receptor, ErbB-2 ,Imidazoles ,Breast Neoplasms ,Antibodies, Monoclonal, Humanized ,Piperazines ,Progression-Free Survival ,Androstadienes ,Oxazepines ,Receptors, Estrogen ,Antineoplastic Combined Chemotherapy Protocols ,Benzamides ,Letrozole ,Humans ,Female ,Leuprolide ,Immune Checkpoint Inhibitors ,Aged ,Phosphoinositide-3 Kinase Inhibitors - Abstract
Overall, 2021 was marked by the confirmation of the major interest of cell cycle inhibitors for hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative advanced breast cancers with very high overall survival data exceeding five years for hormone-sensitive disease. Studies have also confirmed the efficacy and safety of this therapeutic class in the elderly population. New cell cycle inhibitors are under development (SHR6390). New combinations are also being evaluated, notably palbociclib with SAR439859 (a new selective estrogen receptor degrader: SERD). Targeting of the Phosphoinositide 3-kinases (PI3K) pathway by taselisib, in hormone-resistant disease with a Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Alpha (PIK3CA) mutation, modestly improves progression-free survival but with a non-negligible toxicity of the treatment.
- Published
- 2021
8. [The impact of restaging transurethral resection on recurrence and progression free survival in patients with T1 high grade bladder cancer].
- Author
-
Brun A, Koutlidis N, Thibault T, Escoffier A, Bardet F, and Cormier L
- Subjects
- Humans, Progression-Free Survival, Neoplasm, Residual pathology, Neoplasm, Residual surgery, Neoplasm Staging, Retrospective Studies, Neoplasm Recurrence, Local surgery, Cystectomy, Urinary Bladder pathology, Urinary Bladder Neoplasms pathology
- Abstract
Introduction: Restaging transurethral resection (re-TUR) of high grade T1 bladder cancer (HGT1-BC) is recommended but the impact in terms of recurrence-free survival (RFS) and progression-free survival (PFS) is discussed. The objective of this study was to evaluate our practice of re-TUR for these tumors and its impact on overall survival (OS), RFS and PFS., Materials and Methods: A retrospective observational study was conducted between 2010 and 2020. The inclusion criteria was the presence of newly diagnosed HGT1-BC. Patients with incomplete resection, suspicion of infiltrating tumor, upper tract urothelial cancer, or metastatic disease were ineligible. Two groups were defined : Group 1 with re-TUR and Group 2 without re-TUR. RFS and PFS were evaluated., Results: A total of 78 patients were included, including 50 (64,1%) in group 1. There were no significant differences between the two groups. The mean time to re-TUR was 8 weeks and 60% residual tumor was found. Initial under-staging was found in 12% of cases. RFS and PFS were significantly better in Group 1 (P=0.0019; P=0,02). No significant were found between the groups in OS and specific survival (SS)., Conclusion: Performing a re-TUR for high grade T1 bladder tumors allows detection of residual tumor and decreases the risk of under-evaluation. It is associated with a significant improvement in RFS and PFS with no impact on OS and SS., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
9. [The role of radiotherapy to the primary tumor and metastases in patients with oligometastatic prostate cancer]
- Author
-
T, Le Roy, D, Baron, B, Vandendorpe, B, Bataille, J M, Hannoun-Levi, P, Blanchard, E, Lartigau, I, Latorzeff, and D, Pasquier
- Subjects
Male ,Clinical Trials, Phase II as Topic ,Clinical Trials, Phase III as Topic ,Lymphatic Metastasis ,Humans ,Prostatic Neoplasms ,Bone Neoplasms ,Prospective Studies ,Radiosurgery ,Watchful Waiting ,Progression-Free Survival ,Randomized Controlled Trials as Topic - Abstract
Oligometastatic prostate cancer is among the most studied oligometastatic cancers in the literature. However few prospective studies have assessed stereotactic body radiotherapy (SBRT) for prostate cancer oligometastases. Two randomised phase II trials show a progression-free survival benefit compared with observation. Prospective registry data show very good local control and low toxicity too. Inclusion in ongoing trials should be strongly encouraged to define the role of SBRT in addition to systemic therapy. Radiation therapy to the primary tumour has been studied in randomised trials and provides an overall survival benefit in patients with low metastatic burden. The benefit is inversely correlated with the number of bone lesions using conventional imaging, up to three metastases. Radiotherapy to the primary tumour is recommended by the learned societies for patients with low metastatic burden. Its role in combination with second generation anti androgen therapy needs to be clarified.
- Published
- 2021
10. [Postoperative radiotherapy for prostate cancer: when to propose it? What is the place for androgen deprivation?]
- Author
-
N, Benziane-Ouaritini, P, Sargos, J B, Beauval, S, Supiot, and I, Latorzeff
- Subjects
Male ,Postoperative Care ,Prostatectomy ,Salvage Therapy ,Time Factors ,Antineoplastic Agents, Hormonal ,Prostatic Neoplasms ,Androgen Antagonists ,Progression-Free Survival ,Meta-Analysis as Topic ,Humans ,Radiotherapy, Adjuvant ,Neoplasm Recurrence, Local ,Randomized Controlled Trials as Topic - Abstract
While there is no high-level evidence showing superiority of surgery over radiation treatment, radical prostatectomy is the most common treatment option for patients with localized, non-metastatic disease. Nearly 30% of all patients undergoing surgery will develop a biochemical recurrence in 10 years. In fact, more than 30% of contemporary patients treated with RP will harbor aggressive disease characteristics at final pathology.We conducted a review of the literature evaluating the timing of radiotherapy and the place of androgen deprivation after prostatectomie totale.Four trials randomizing adjuvant radiotherapy and surveillance found an advantage in biochemical relapse-free survival in favor of immediate irradiation after radical prostatectomy, called adjuvant. However, in these studies, more than 40% of patients in the arm without adjuvant radiotherapy did not relapse at 10 years of follow-up. More recently, the question of the optimal time of this post-operative, adjuvant RT or during biological relapse has arisen through three trials (RADICALS-RT, RAVES, GETUG-AFU 17). These trials did not show a benefit for adjuvant radiotherapy in terms of event-free survival, a PSA-based endpoint, while confirming the toxicities observed during irradiation immediately after surgery. The optimal duration of hormonal therapy when associated with post-prostatectomy radiation therapy remains controversial.Early salvage radiotherapy is a new standard of treatment and adjuvant radiotherapy could be reserved for very selected patients. The role of hormone therapy is well defined in salvage situation, but its duration is still being studied.
- Published
- 2021
11. [Evaluation of quality of life: Clinical relevance for patient]
- Author
-
C, Dossun, B V, Popescu, and D, Antoni
- Subjects
Psychometrics ,Artificial Intelligence ,Health Status ,Neoplasms ,Surveys and Questionnaires ,Quality of Life ,Humans ,Patient Reported Outcome Measures ,Medical Oncology ,Progression-Free Survival - Abstract
The quality of life of patients and its evaluation remains one of the primordial objectives in oncology. Different methods and tools of evaluation of quality of life have been developed with the objective of having a global evaluation, throughout different aspects, be it physical, emotional, psychological or social. The quality of life questionnaires improve and simplify the reevaluation and follow-up of patients during clinical trials. Patient reported outcome measures (PROMs) are an evaluation of the quality of life as experienced by the patients (patient-reported-outcomes [PROs]) and allow for physicians a personalized treatment approach. In radiotherapy, PROMs are a useful tool for the follow-up of patients during or after treatment. The technological advances, notably in data collecting, but also in their integration and treatment with regard to artificial intelligence will allow integrating these evaluation tools in the management of patients in oncology.
- Published
- 2021
12. [Targeting the cyclin-dependent kinases 4/6 in advanced breast cancers]
- Author
-
Florence, Coussy, Elise, Deluche, Barbara, Pistilli, Sylvain, Ladoire, Jean-Marc, Ferrero, and Paul, Cottu
- Subjects
Pyridines ,Ubiquitin-Protein Ligases ,Cell Cycle ,Aminopyridines ,Cyclin-Dependent Kinase 4 ,Breast Neoplasms ,Cyclin-Dependent Kinase 6 ,Piperazines ,Progression-Free Survival ,Retinoblastoma Binding Proteins ,Clinical Trials, Phase III as Topic ,Purines ,Humans ,Benzimidazoles ,Female ,Protein Kinase Inhibitors ,Proportional Hazards Models ,Randomized Controlled Trials as Topic - Abstract
The historical median survival of advanced luminal breast cancer does not exceed four years. The deciphering of the mechanisms of resistance to hormone therapy has led to the development of inhibitors of cyclin D dependent kinases (CDK4 and 6). Three drugs, palbociclib, ribociclib and abemaciclib, very similar pharmacologically, have been evaluated in the context of pivotal, randomized phase III trials. Strikingly and regardless of the endocrine therapy backbone, and in both hormone-sensitive and hormone-resistant patients, the addition of a CDK4 / 6 inhibitor doubles progression-free survival with a hazard ratio always around 0.55. The benefit in overall survival begins to be demonstrated. This review presents all published results, as well as the main safety data.
- Published
- 2020
13. [Plan of the day adaptive radiotherapy for bladder cancer: Dosimetric and clinical results]
- Author
-
M, Cabaillé, R, Gaston, S, Belhomme, A, Giraud, J, Rouffilange, G, Roubaud, and P, Sargos
- Subjects
Aged, 80 and over ,Male ,Organs at Risk ,Radiotherapy ,Radiotherapy Planning, Computer-Assisted ,Urinary Bladder ,Rectum ,Radiotherapy Dosage ,Cone-Beam Computed Tomography ,Middle Aged ,Patient Positioning ,Progression-Free Survival ,Urinary Bladder Neoplasms ,Intestine, Small ,Humans ,Female ,Organ Motion ,Neoplasm Recurrence, Local ,Organ Sparing Treatments ,Aged ,Radiotherapy, Image-Guided ,Retrospective Studies - Abstract
To account of individual intra-pelvic anatomical variations in muscle invasive bladder cancer (MIBC) irradiation, adaptive radiotherapy (ART) using a personalized plan library may have dosimetric and clinical benefits.The data from ten patients treated for localized MIBC according to the "plan of the day" (P0oD) individualized ART technique were collected and retrospectively analysed. Target volumes and organs at risk (OAR) were delineated at different bladder fill rates, resulting in two or three treatment plans. Daily Cone-Beam CT (CBCT) was used for the selection of PoD at each fraction. Retrospectively, we delineated rectal, intestinal and target volumes on each CBCT, to assess target volume coverage and dose sparing to healthy tissues. A comparison with the conventional radiotherapy technique was performed. The secondary objectives were toxicity and efficacy.The target coverage was respected with the adaptive treatment: 97.3% for the bladder Clinical Target Volume (CTV) (99.5; [60.1-100]) and 98% for the bladder+lymph nodes CTV (98.6; [85.4-100]). Concerning OAR, the volume of healthy tissue spared was 43.7% on average and the V45Gy for the small bowel was 43,4cc (35; [0-129]) (versus 57,6cc). The rectal D50 was on average 18,7Gy for the adaptive treatment (15.9; [2.4-44.1]) versus 17Gy with the conventional approach. With a median follow-up of 2.94 years (95% CI: [0.92-4.02]), we observed three grade 3 toxicities (30%). No grade 4 toxicity was observed. The 2-year overall survival and progression-free survival rates were 65.6% (95% CI: [26-87.6]) and 45.7% (95% CI: [14.3-73]), respectively.The ART technique using a PoD strategy showed a reduction of the irradiated healthy tissue volume while maintaining a similar bladder coverage, with an acceptable rate of toxicity.
- Published
- 2020
14. [Tolerance of Tamoxifen as an adjuvant therapy and long-term follow up of 55 premenopausal breast cancer women, cared for at the Institut de cancérologie de Lorraine, treated with Tamoxifen]
- Author
-
Perle, Sebaoun, Marchal, Frederic, Georges, Weryha, Sara El, Hamdaoui, Julia, Salleron, and Anne, Lesur
- Subjects
Adult ,Selective Estrogen Receptor Modulators ,Time Factors ,Antineoplastic Agents, Hormonal ,Aromatase Inhibitors ,Incidence ,Breast Neoplasms ,Cancer Care Facilities ,Progression-Free Survival ,Ovarian Cysts ,Tamoxifen ,Premenopause ,Chemotherapy, Adjuvant ,Hot Flashes ,Humans ,Female ,France ,Prospective Studies ,Amenorrhea ,Follow-Up Studies ,Retrospective Studies - Abstract
Objectives: the purpose of this study is to assess TAM safety in terms of side effects and hormonal status, the persistence of the treatment over a five years time-frame and to report the remote follow-up data.Fifty five patients were included patients between January 2001 and November 2002 at the Institut de cancérologie de Lorraine. The subjects were aged 50 years or less, premenopausal at diagnosis and treated with adjuvant TAM therapy at a daily dose of 20 mg, for an expected duration of 5 years, at a daily. After 2 years, prospective evaluation was completed and monitoring of ovarian function was performed as usual in the institution (1x/year). All data were retrospectively evaluated in 2019.In these 55 patients, the cumulative incidences of cysts and hot flushes 5 years after treatment were 68.5 % and 77.6 %, respectively. Of the 33 patients with chemoreactive amenorrhea, half had cycles which resumed within a median of 9 months. In the 10 patients without chemotherapy-induced amenorrhea, 4 had a cycle stop. Of these, 3 patients had cycles that, resumed within 1, 4 and 8 months. 34 patients (61.3 %) had taken Tamoxifen for at least 5 years. After 15 years of treatment, overall and progression-free survival was 90.7 % and 67.4 %, respectively.The observation of the tolerance to the treatment for 5 years and beyond, contributes to the quality of information delivered to future patients starting the treatment, allowing a better understanding and in the long term a better observance.
- Published
- 2020
15. [Impact of NGS results on patient outcome with a multiform glioblastoma].
- Author
-
Rom M, Schott R, Pencreac'h E, Cébula H, Cox D, Bender L, Antoni D, Lhermitte B, and Noel G
- Subjects
- Humans, Biomarkers, Tumor genetics, DNA Methylation, DNA Modification Methylases genetics, DNA Repair Enzymes genetics, High-Throughput Nucleotide Sequencing, Prognosis, Tumor Suppressor Protein p53 genetics, Tumor Suppressor Proteins genetics, Brain Neoplasms diagnosis, Brain Neoplasms genetics, Glioblastoma diagnosis, Glioblastoma genetics
- Abstract
Purpose: Although some genetic alterations in glioblastoma (GBM) have been characterized, the prognostic value of these gene mutations is not yet established in patients treated with standard therapy., Patients and Method: 40 patients with newly diagnosed GBM, treated between July 2017 and December 2019, and who had genomic analysis were analyzed. Next-generation sequencing techniques (NGS) were used with a panel of 26 genes. Patients were grouped according to MGMT status, the presence or absence of at least one mutated gene on the panel, and p53 expression by immunohistochemistry., Results: the median follow-up was 11.5 months (1.0-37). For all patients, the median duration of progression-free survival was 8 months (95% CI, 5.3-10.7) and the median overall survival (OS) was 17 months (95% CI, 7.5-26.5). Progression-free and overall survival were significantly different according to MGMT status but not according to NGS and p53 status. Three groups of patients according to different combined status could be distinguished due to significant differences in overall survival., Conclusion: we have shown that the presence of MGMT promoter methylation is a good prognostic factor. By grouping the patients according to their MGMT, NGS and p53 status, three groups of patients could be separated according to their overall survival. However, these results must be confirmed on a larger number of patients., (Copyright © 2022 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
16. [Indications and management of hematologic microtransplantation: Recommendations of the French Society of Bone Marrow transplantation and cellular Therapy (SFGM-TC)]
- Author
-
Jérôme, Cornillon, Martin, Carre, Yves, Chalandon, Patrice, Chevallier, Teresa, Coman, Mhamed, Harif, Hélène, Labuissière-Wallet, Jean-Baptiste, Mear, Christophe, Picard, Ibrahim, Yakoub-Agha, and Micha, Srour
- Subjects
Age Factors ,Hematopoietic Stem Cell Transplantation ,Graft vs Host Disease ,Antineoplastic Agents ,Chimerism ,Combined Modality Therapy ,Hematopoietic Stem Cell Mobilization ,Progression-Free Survival ,Leukemia, Myeloid, Acute ,Host vs Graft Reaction ,Myelodysplastic Syndromes ,Granulocyte Colony-Stimulating Factor ,Humans ,Cytokine Release Syndrome ,Societies, Medical - Abstract
Microtransplantation (MT) is based on injection of HLA-mismatched G-CSF mobilized hematopoietic stem cells, in combination with chemotherapy but without use of conditioning regimen nor immunosuppressive drugs. As a result, a transient microchimerism is induced without engraftment. Its efficacy relies both on host immune system stimulation (recipient versus tumor) and on a graft versus tumor effect. Data are scarce and concern mostly Asian patients with acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (HR-MDS). In comparison to conventional treatment without MT, higher complete remission rates and longer disease free survival and overall survival have been reported. Safety seems acceptable. The most frequent adverse event is non-severe cytokine release syndrome. Risk of GVHD remains very low. Here, we summarize the published data and detail the practical aspects of the procedure. Current data are not strong enough to provide recommendations on indications. Nevertheless, it seems reasonable to propose MT to patients with AML or HR-MDS, regardless of age, presenting an indication for allogeneic stem cell transplantation but ineligible for it. MT is still under investigation and rather be proposed within clinical trials.
- Published
- 2019
17. [Retrospective study: Late surgery post chemotherapy versus after 3-4 cures in treatment of advanced ovarian cancer]
- Author
-
Quiterie, de Fréminville, Idlir, Licaj, Jean-Sebastien, Frenel, Lea, Hamel-Senecal, Guy, Thomas, Pierre-Emmanuel, Brachet, Elodie, Coquan, Alexandra, Leconte, Jean-Marc, Classe, and Florence, Joly
- Subjects
Adult ,Ovarian Neoplasms ,Chemotherapy, Adjuvant ,Humans ,Antineoplastic Agents ,Female ,France ,Length of Stay ,Middle Aged ,Neoadjuvant Therapy ,Progression-Free Survival ,Aged ,Retrospective Studies - Abstract
Treatment in locally advanced ovarian cancer is optimal surgery followed by chemotherapy. Patients with significant tumor spread, OMS2, age75 years old are poor candidates for aggressive primary surgery. Interval surgery, after neo-adjuvant chemotherapy, aims to achieve more complete surgery, increase survival, and reduce surgical morbidity. The primary endpoint was progression-free survival. Secondary outcomes were overall survival and postoperative morbidity and mortality.This is a retrospective study conducted in 2 French referral centers between January 2000 and December 2015. Patients who could not benefit from a complete initial surgery were operated after 3 cures of chemotherapy at the François Baclesse center and after least 5 cures at the center René Gauducheau.The population analyzed included 104 patients, 43 (41.0%) patients treated at the René Gauducheau center (group 1) and 61 (59.0%) patients treated at the François Baclesse center (group 2). Progression-free and overall survival were similar between the 2 groups, they were, respectively, 15.9 months and 34 months in group 1 vs. 15.4 months and 37.6 months in group 2 (P=0.72; P=0.65). Mean hospital stay and postoperative morbidity were similar in both groups.For weak patients, to limit invasive surgery, doing more than 5 courses of chemotherapy may be a reasonable option.
- Published
- 2019
18. [Radiotherapy of oligometastases: Sequences and interactions with systemic therapies, example of kidney cancer]
- Author
-
M, Wespiser, M, Goujon, T, Nguyen Tan Hon, T, Maurina, F, Kleinclauss, G, Créhange, and A, Thiery-Vuillemin
- Subjects
Practice Guidelines as Topic ,Metastasectomy ,Humans ,Immunotherapy ,Molecular Targeted Therapy ,Neoplasm Metastasis ,Radiosurgery ,Radiation Tolerance ,Kidney Neoplasms ,Progression-Free Survival ,Adenocarcinoma, Clear Cell - Abstract
This article is a review of the literature that aims to clarify the place of systemic and locoregional treatments, with a focus on radiotherapy and surgery in the management of patients with oligometastatic kidney cancer. We have selected articles of interest published in Medline indexed journals. We have also analysed the related guidelines: National Comprehensive Cancer Network (NCCN) 2019, European Association of Urology (EAU) 2019, European Society of Medical Oncology (ESMO) 2019, Association française d'urologie (Afu) 2018 as well as some abstracts of international congresses. The main treatments evaluated were surgery and radiotherapy. We defined the different scenarios conventionally encountered in clinical practice. The evolution of systemic therapies (increased overall survival and response rate) is likely to increase the number of patients potentially accessible to locoregional treatments. The complete analysis of the literature underlines the place of locoregional treatments whatever the scenarios mentioned. Data on stereotactic radiotherapy found a local control rate consistently above 70% in all studies with a maintained response and positive impact on overall survival and progression-free survival. The improvement of overall survival by sequential use of the various therapeutic classes confirms the need for optimization of locoregional treatments in the model of oligometastatic kidney cancer. The dogma of radioresistance must definitely be set aside with current irradiation techniques.
- Published
- 2019
19. [Is sarcopenia a morbi-mortality factor in the treatment of localized muscle-invasive bladder cancer?]
- Author
-
G, Fraisse, Y, Renard, C, Lebacle, A, Masson-Lecomte, F, Desgrandchamps, C, Hennequin, T, Bessede, and J, Irani
- Subjects
Male ,Survival Rate ,Sarcopenia ,Urinary Bladder Neoplasms ,Humans ,Female ,Cystectomy ,Tomography, X-Ray Computed ,Combined Modality Therapy ,Neoadjuvant Therapy ,Progression-Free Survival ,Aged ,Retrospective Studies - Abstract
Sarcopenia evaluated from the measurement of skeletal muscle index (SMI) has been evaluated as a predictive factor of morbidity and mortality after surgery. The objective of this study was to evaluate whether it was predictive of morbidity and mortality in patients managed by cystectomy or tri-modality therapy (TMT), combining radiotherapy and chemotherapy after endoscopic resection of the tumour, for localized muscle-invasive bladder cancer.In all, 146 consecutive patients from 2 university hospital centres treated by cystectomy between January 2012 and April 2017 or TMT between October 2008 and October 2014 were included. The SMI was measured on axial computed-tomography at the level of the transverse process of L3, before treatment. Sarcopenia was assessed in two ways: either by SMI without muscle mass adjustment or according to the definition by Martin and al. based on gender and patient BMI, then called "adjusted sarcopenia". The primary endpoint was overall survival (OS) for sarcopenia. The secondary endpoints were OS, progression-free survival (PFS) and survival without re-admission (SRH) for the total population and for each treatment group. Survival analyses were performed using the Cox model. The association between sarcopenia and complications has been investigated by the ChiThe characteristics of sarcopenic (n=67) and non-sarcopenic (n=79) patients were comparable except for 2 criteria: older patients in the sarcopenic group and a higher proportion of neo-adjuvant chemotherapy in non-sarcopenic patients. Sarcopenia was not significantly associated with any type of survival. Sarcopenia was not associated with the proportion or severity of complications.Unlike unadjusted SMI, sarcopenia was not associated with survival or complications.3.
- Published
- 2019
20. [Multiple myeloma and autologous haematopoietic stem-cell transplantation without cryopreservation: experiences of the Clinical Hematology Department of Casablanca, Morocco]
- Author
-
Salma, Fares, Halima, Hadri, Mohamed, Rachid, Tarik, Moutiqui, Bouchra, Oukkache, and Asmaa, Quessar
- Subjects
Adult ,Male ,without cryopreservation ,cellules souches hématopoïétiques ,Remission Induction ,Hematopoietic Stem Cell Transplantation ,autogreffe ,Middle Aged ,autologous ,Transplantation, Autologous ,Progression-Free Survival ,Survival Rate ,Morocco ,Myélome multiple ,Multiple myeloma ,haematopoietic stem-cell transplantation ,Humans ,Female ,Case Series ,Longitudinal Studies ,Prospective Studies ,sans cryoconservation ,Aged ,Follow-Up Studies - Abstract
La chimiothérapie à haute dose suivie d´autogreffe des cellules souches hématopoïétiques (ASCT) reste le traitement de choix du myélome multiple chez les sujets âgés ≤ 65 ans. Dans les pays en développement, l´ASCT sans cryoconservation, permet de réduire les coûts d´hospitalisation et des installations nécessaires. Pour évaluer cette procédure, une étude prospective, longitudinale et ouverte a été conduite au Service d´Hématologie Clinique de Casablanca au Maroc. Sur 24 mois, 64 patients ont été colligés. Après le traitement d´induction, la réponse globale (Rémission complète + Très bonne réponse partielle) était à 67,2% (43 patients). La richesse moyenne du greffon autologue était de 12.97x106 CD34+/Kg [2.4- 53x106 CD34+/Kg] et la durée médiane d´hospitalisation était de 20,5 jours [14-60 jours]. La réponse globale en post autogreffe était de 84% (54 patients). A 24 mois, l´estimation de la survie globale (OS) était à 83,5%, la médiane d´OS n´était pas atteinte et la survie sans progression (PFS) à 65,9% avec une médiane de la PFS à 24,1 mois avec un intervalle de confiance à 95% [21,7-26,5mois]. L´ASCT sans cryoconservation reste une excellente alternative dans notre contexte, ce qui permet de réduire les délais d´attente, et les coûts de congélation.
- Published
- 2019
21. [Solitary bone plasmocytoma: Experience from the radiotherapy department at Mohammed-V military teaching hospital in Rabat (Morocco)]
- Author
-
Khalid, Hadadi, M, Hommadi, Maroa, Belemlih, Noha, Zaghba, Abdelhak, Maghous, El-Amin, Marnouch, K A, Saghir, Mohamed, Elmarjany, Hassan, Sifat, Mohamed, Oukabli, and Hamid, Mansouri
- Subjects
Adult ,Male ,Bone Neoplasms ,Radiotherapy Dosage ,Middle Aged ,Hospitals, Military ,Prognosis ,Progression-Free Survival ,Morocco ,Disease Progression ,Humans ,Female ,Radiotherapy, Intensity-Modulated ,Radiotherapy, Conformal ,Hospitals, Teaching ,Multiple Myeloma ,Aged ,Plasmacytoma ,Retrospective Studies - Abstract
The primary objective was to determine in our department the progression-free survival rate of patients with solitary bone plasmocytoma and secondarily to evaluate its diagnostic, therapeutic and evolutionary aspects.This is a retrospective review of 12 patients monitored and treated in the radiotherapy department of the Mohammed-V military medical teaching hospital in Rabat for a solitary bone plasmocytoma between January 2012 and December 2018. The average age of our patients were 53.8 years old (range: 31-72 years old). Pain was the most common telltale sign. The site of the lesions was spinal in four cases, iliac in four cases, mandibular, ribal, humeral and at the level of the astragalus in one case respectively. All patients received radiotherapy. This irradiation was delivered alone in 60% of cases or associated with surgery in 40% of cases. The average dose of radiotherapy was 47.3Gy (range: 45 to 50.4Gy) and this was delivered by a modulated volumetric arc therapy technique in ten patients and conformal tridimensional radiotherapy in two patients.Local control, defined by stability or radiological regression, was obtained in ten patients and four patients progressed to multiple myeloma, two of whom died. The average duration of follow-up was 51 months.Radiation therapy is the standard treatment for solitary bone plasmocytoma. It ensures good local control in 90% of cases. The prognosis is affected by progression to multiple myeloma, which justifies rigorous monitoring after treatment and suggests a reflection on the exact place of chemotherapy.
- Published
- 2019
22. [Updates in hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer in 2021].
- Author
-
Mezni E, Sabatier R, Goncalves A, and Vicier C
- Subjects
- Aged, Androstadienes therapeutic use, Antibodies, Monoclonal, Humanized therapeutic use, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Benzamides therapeutic use, Breast Neoplasms chemistry, Breast Neoplasms mortality, Breast Neoplasms pathology, Class I Phosphatidylinositol 3-Kinases genetics, Clinical Trials as Topic, Female, Humans, Imidazoles therapeutic use, Letrozole therapeutic use, Leuprolide therapeutic use, Oxazepines therapeutic use, Phosphoinositide-3 Kinase Inhibitors therapeutic use, Piperazines therapeutic use, Progression-Free Survival, Pyridines therapeutic use, Receptor, ErbB-2, Receptors, Estrogen, Selective Estrogen Receptor Modulators therapeutic use, Breast Neoplasms therapy, Immune Checkpoint Inhibitors therapeutic use
- Abstract
Overall, 2021 was marked by the confirmation of the major interest of cell cycle inhibitors for hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative advanced breast cancers with very high overall survival data exceeding five years for hormone-sensitive disease. Studies have also confirmed the efficacy and safety of this therapeutic class in the elderly population. New cell cycle inhibitors are under development (SHR6390). New combinations are also being evaluated, notably palbociclib with SAR439859 (a new selective estrogen receptor degrader: SERD). Targeting of the Phosphoinositide 3-kinases (PI3K) pathway by taselisib, in hormone-resistant disease with a Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Alpha (PIK3CA) mutation, modestly improves progression-free survival but with a non-negligible toxicity of the treatment., (Copyright © 2022 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
23. Mise à jour 2021 des recommandations pour la pratique clinique de Nice/Saint-Paul-de-Vence dans le cancer de l’ovaire épithélial de haut grade: Updated 2021 recommendations for the clinical practice of Nice/Saint-Paul-de-Vence in epithelial high grade ovarian cancer.
- Author
-
Joly F and Ray-Coquard I
- Subjects
- Antineoplastic Agents, Immunological therapeutic use, Bevacizumab therapeutic use, Female, Genes, BRCA1, Genes, BRCA2, Humans, Maintenance Chemotherapy, Poly(ADP-ribose) Polymerase Inhibitors therapeutic use, Progression-Free Survival, Carcinoma, Ovarian Epithelial drug therapy, Carcinoma, Ovarian Epithelial genetics, Carcinoma, Ovarian Epithelial pathology, Carcinoma, Ovarian Epithelial surgery, Neoplasm Recurrence, Local drug therapy, Neoplasm Recurrence, Local genetics, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Ovarian Neoplasms drug therapy, Ovarian Neoplasms genetics, Ovarian Neoplasms pathology, Ovarian Neoplasms surgery
- Abstract
Since the previous 2013 and 2016 recommendations for clinical practice (RPC) Nice/Saint-Paul-de-Vence for gynecological cancers, the management of ovarian cancer has become more complex with the evolution of the quality criteria recommended for surgery and the integration of molecular biology for the decision of medical treatments, especially for high grade epithelial ovarian cancers. Surgical indications have become more precise both in the first line and in the context of relapse. Treatments with PARP inhibitors is a major advance in medical management with significant efficacy in maintenance after response to platinum-based chemotherapy. The benefit already known in the case of late relapse has also been demonstrated in first-line treatment with progression-free survival never observed in this pathology with patients with very long responses, especially in the case of BRCA gene abnormalities (somatic or constitutional). In 2021, medical and surgical strategies in front line including PARP inhibitors associated or not with bevacizumab as a maintenance complement after platinum chemotherapy are guided by both response to platinum agents and molecular profiling including BRCA (somatic or constitutional) genetic status and homologous recombination pathway (HRD) abnormalities, that should be early tested. On behalf of the GINECO national oncologist group, we have updated the guidelines for high grade ovarian epithelial cancer (excepted rare tumors) in order to allow rapid dissemination of the latest advances to the medical community and improve daily practice., (Copyright © 2021 Société FranÇaise du Cancer. Publié par Elsevier Masson SAS. Tous droits réservés.)
- Published
- 2021
- Full Text
- View/download PDF
24. [Efficacy of combined paclitaxel/cetuximab in cutaneous squamous-cell carcinoma: A retrospective analysis of 14 patients]
- Author
-
E, Casassa, L, Riffaud, V, Sibaud, S, Boulinguez, C, Chira, D, Gangloff, M, Montastruc, L, Lamant, C, Paul, and N, Meyer
- Subjects
Adult ,Aged, 80 and over ,Male ,Lung Neoplasms ,Skin Neoplasms ,Paclitaxel ,Cetuximab ,Kaplan-Meier Estimate ,Middle Aged ,Combined Modality Therapy ,Progression-Free Survival ,Treatment Outcome ,Antineoplastic Combined Chemotherapy Protocols ,Carcinoma, Squamous Cell ,Humans ,Female ,Aged ,Retrospective Studies - Published
- 2018
25. [Stereotactic body radiation therapy for hepatocellular carcinoma: Results from a retrospective multicentre study]
- Author
-
N, Scher, G, Janoray, F-G, Riet, A-G, Le Bayon, K, Debbi, S, Lévy, P, Louisot, P, Garaud, E, Chajon, I, Barillot, É, Salamé, R, de Crevoisier, S, Chapet, and G, Calais
- Subjects
Aged, 80 and over ,Male ,Salvage Therapy ,Carcinoma, Hepatocellular ,Liver Neoplasms ,Radiotherapy Dosage ,Middle Aged ,Radiosurgery ,Progression-Free Survival ,Abdominal Pain ,Hepatitis ,Duodenal Ulcer ,Humans ,Female ,France ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
The purpose of this paper was to describe local control, overall survival, progression-free survival and toxicity of CyberKnifeRecords of all the patients treated for hepatocellular carcinoma at the Eugene-Marquis cancer centre, Rennes and the Bretonneau hospital, Tours (France), between November 2010 and December 2016, were reviewed. Radiation therapy was performed as a salvage treatment, while awaiting liver transplantation or if no other treatment was possible.One hundred and thirty-six patients were consecutively included in the study. The median follow-up was 13months. Median total dose prescribed, fractionation and overall treatment time were respectively 45Gy, three fractions and 5 days. Overall survival, progression-free survival and local control rates at 1year and 2years were 79.8 % and 63.5 %, 61.3 % and 39.4 %; 94.5 % and 91 %. Two grade 3 acute toxicity events and two grade 4 late toxicity events corresponding to a duodenal ulcer have been reported. Seven patients underwent classic radiation-induced hepatitis and 13 patients showed non-classical radiation-induced hepatitis. Barcelona Clinic Liver Cancer stage, World Health Organisation grade and planning target volume were correlated with overall survival in univariate Cox analysis.Stereotactic body radiation therapy is effective and well-tolerated for inoperable hepatocellular carcinoma or as a bridge to liver transplantation. Toxicity is mainly related to cirrhotic background and requires a selection of patients and strict dose constraints.
- Published
- 2018
26. [Postoperative radiotherapy for prostate cancer: when to propose it? What is the place for androgen deprivation?]
- Author
-
Benziane-Ouaritini N, Sargos P, Beauval JB, Supiot S, and Latorzeff I
- Subjects
- Humans, Male, Meta-Analysis as Topic, Neoplasm Recurrence, Local, Postoperative Care methods, Progression-Free Survival, Prostatectomy, Prostatic Neoplasms pathology, Prostatic Neoplasms surgery, Radiotherapy, Adjuvant, Randomized Controlled Trials as Topic, Salvage Therapy methods, Time Factors, Androgen Antagonists therapeutic use, Antineoplastic Agents, Hormonal therapeutic use, Prostatic Neoplasms drug therapy, Prostatic Neoplasms radiotherapy
- Abstract
Purpose: While there is no high-level evidence showing superiority of surgery over radiation treatment, radical prostatectomy is the most common treatment option for patients with localized, non-metastatic disease. Nearly 30% of all patients undergoing surgery will develop a biochemical recurrence in 10 years. In fact, more than 30% of contemporary patients treated with RP will harbor aggressive disease characteristics at final pathology., Material and Mehods: We conducted a review of the literature evaluating the timing of radiotherapy and the place of androgen deprivation after prostatectomie totale., Results: Four trials randomizing adjuvant radiotherapy and surveillance found an advantage in biochemical relapse-free survival in favor of immediate irradiation after radical prostatectomy, called adjuvant. However, in these studies, more than 40% of patients in the arm without adjuvant radiotherapy did not relapse at 10 years of follow-up. More recently, the question of the optimal time of this post-operative, adjuvant RT or during biological relapse has arisen through three trials (RADICALS-RT, RAVES, GETUG-AFU 17). These trials did not show a benefit for adjuvant radiotherapy in terms of event-free survival, a PSA-based endpoint, while confirming the toxicities observed during irradiation immediately after surgery. The optimal duration of hormonal therapy when associated with post-prostatectomy radiation therapy remains controversial., Conclusion: Early salvage radiotherapy is a new standard of treatment and adjuvant radiotherapy could be reserved for very selected patients. The role of hormone therapy is well defined in salvage situation, but its duration is still being studied., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
27. [Evaluation of quality of life: Clinical relevance for patient].
- Author
-
Dossun C, Popescu BV, and Antoni D
- Subjects
- Artificial Intelligence, Health Status, Humans, Progression-Free Survival, Psychometrics methods, Medical Oncology, Neoplasms radiotherapy, Patient Reported Outcome Measures, Quality of Life, Surveys and Questionnaires
- Abstract
The quality of life of patients and its evaluation remains one of the primordial objectives in oncology. Different methods and tools of evaluation of quality of life have been developed with the objective of having a global evaluation, throughout different aspects, be it physical, emotional, psychological or social. The quality of life questionnaires improve and simplify the reevaluation and follow-up of patients during clinical trials. Patient reported outcome measures (PROMs) are an evaluation of the quality of life as experienced by the patients (patient-reported-outcomes [PROs]) and allow for physicians a personalized treatment approach. In radiotherapy, PROMs are a useful tool for the follow-up of patients during or after treatment. The technological advances, notably in data collecting, but also in their integration and treatment with regard to artificial intelligence will allow integrating these evaluation tools in the management of patients in oncology., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
28. [The role of radiotherapy to the primary tumor and metastases in patients with oligometastatic prostate cancer].
- Author
-
Le Roy T, Baron D, Vandendorpe B, Bataille B, Hannoun-Levi JM, Blanchard P, Lartigau E, Latorzeff I, and Pasquier D
- Subjects
- Bone Neoplasms radiotherapy, Bone Neoplasms secondary, Clinical Trials, Phase II as Topic, Clinical Trials, Phase III as Topic, Humans, Lymphatic Metastasis radiotherapy, Male, Progression-Free Survival, Prospective Studies, Prostatic Neoplasms pathology, Randomized Controlled Trials as Topic, Watchful Waiting, Prostatic Neoplasms radiotherapy, Radiosurgery
- Abstract
Oligometastatic prostate cancer is among the most studied oligometastatic cancers in the literature. However few prospective studies have assessed stereotactic body radiotherapy (SBRT) for prostate cancer oligometastases. Two randomised phase II trials show a progression-free survival benefit compared with observation. Prospective registry data show very good local control and low toxicity too. Inclusion in ongoing trials should be strongly encouraged to define the role of SBRT in addition to systemic therapy. Radiation therapy to the primary tumour has been studied in randomised trials and provides an overall survival benefit in patients with low metastatic burden. The benefit is inversely correlated with the number of bone lesions using conventional imaging, up to three metastases. Radiotherapy to the primary tumour is recommended by the learned societies for patients with low metastatic burden. Its role in combination with second generation anti androgen therapy needs to be clarified., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
29. [Targeting the cyclin-dependent kinases 4/6 in advanced breast cancers].
- Author
-
Coussy F, Deluche E, Pistilli B, Ladoire S, Ferrero JM, and Cottu P
- Subjects
- Aminopyridines therapeutic use, Benzimidazoles therapeutic use, Breast Neoplasms enzymology, Breast Neoplasms mortality, Breast Neoplasms pathology, Cell Cycle, Clinical Trials, Phase III as Topic, Cyclin-Dependent Kinase 4 metabolism, Cyclin-Dependent Kinase 6 metabolism, Female, Humans, Piperazines therapeutic use, Progression-Free Survival, Proportional Hazards Models, Purines therapeutic use, Pyridines therapeutic use, Randomized Controlled Trials as Topic, Retinoblastoma Binding Proteins metabolism, Ubiquitin-Protein Ligases metabolism, Breast Neoplasms drug therapy, Cyclin-Dependent Kinase 4 antagonists & inhibitors, Cyclin-Dependent Kinase 6 antagonists & inhibitors, Protein Kinase Inhibitors therapeutic use
- Abstract
The historical median survival of advanced luminal breast cancer does not exceed four years. The deciphering of the mechanisms of resistance to hormone therapy has led to the development of inhibitors of cyclin D dependent kinases (CDK4 and 6). Three drugs, palbociclib, ribociclib and abemaciclib, very similar pharmacologically, have been evaluated in the context of pivotal, randomized phase III trials. Strikingly and regardless of the endocrine therapy backbone, and in both hormone-sensitive and hormone-resistant patients, the addition of a CDK4 / 6 inhibitor doubles progression-free survival with a hazard ratio always around 0.55. The benefit in overall survival begins to be demonstrated. This review presents all published results, as well as the main safety data., (Copyright © 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
30. [Multiple myeloma and autologous haematopoietic stem-cell transplantation without cryopreservation: experiences of the Clinical Hematology Department of Casablanca, Morocco].
- Author
-
Fares S, Hadri H, Rachid M, Moutiqui T, Oukkache B, and Quessar A
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Morocco, Progression-Free Survival, Prospective Studies, Remission Induction, Survival Rate, Transplantation, Autologous, Hematopoietic Stem Cell Transplantation methods, Multiple Myeloma therapy
- Abstract
High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (AHSCT) is the gold standard treatment for multiple myeloma in subjects aged ≤ 65 years. In developing countries, AHSCT without cryopreservation reduces the costs of hospitalization and all necessary equipments. We conducted a longitudinal, prospective, open study to evaluate this procedure at the Department of Clinical Hematology, Casablanca, Morocco. Data from the medical records of 64 patients were collected over a period of 24 months. After induction therapy, the overall response (complete remission + very good partial response) was 67.2% (43 patients). The mean CD34-cell count in the autograft was 12.97*10
6 /kg [2.4- 53*106 Cd34+/kg] and the median length of hospitalization was 20.5 days [14-60 days]. The overall response after autograf was 84% (54 patients). At 24 months follow-up, overall survival (OS) was 83.5%, median OS was not reached and progression-free survival (PFS) was 65.9%, with a median PFS of 24.1 months with 95% confidence interval [21.7-26.5 months]. Autologous hematopoietic stem cell transplantation without cryopreservation is an excellent alternative in our context reducing wait times and freezing costs., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Salma Fares et al.)- Published
- 2021
- Full Text
- View/download PDF
31. [Plan of the day adaptive radiotherapy for bladder cancer: Dosimetric and clinical results].
- Author
-
Cabaillé M, Gaston R, Belhomme S, Giraud A, Rouffilange J, Roubaud G, and Sargos P
- Subjects
- Aged, Aged, 80 and over, Cone-Beam Computed Tomography methods, Female, Humans, Intestine, Small diagnostic imaging, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Organ Motion, Organ Sparing Treatments methods, Organs at Risk diagnostic imaging, Patient Positioning methods, Progression-Free Survival, Radiotherapy methods, Radiotherapy Dosage, Radiotherapy, Image-Guided methods, Rectum diagnostic imaging, Retrospective Studies, Urinary Bladder diagnostic imaging, Urinary Bladder Neoplasms diagnostic imaging, Urinary Bladder Neoplasms mortality, Urinary Bladder Neoplasms pathology, Radiotherapy Planning, Computer-Assisted methods, Urinary Bladder Neoplasms radiotherapy
- Abstract
Purpose: To account of individual intra-pelvic anatomical variations in muscle invasive bladder cancer (MIBC) irradiation, adaptive radiotherapy (ART) using a personalized plan library may have dosimetric and clinical benefits., Material and Methods: The data from ten patients treated for localized MIBC according to the "plan of the day" (P0oD) individualized ART technique were collected and retrospectively analysed. Target volumes and organs at risk (OAR) were delineated at different bladder fill rates, resulting in two or three treatment plans. Daily Cone-Beam CT (CBCT) was used for the selection of PoD at each fraction. Retrospectively, we delineated rectal, intestinal and target volumes on each CBCT, to assess target volume coverage and dose sparing to healthy tissues. A comparison with the conventional radiotherapy technique was performed. The secondary objectives were toxicity and efficacy., Results: The target coverage was respected with the adaptive treatment: 97.3% for the bladder Clinical Target Volume (CTV) (99.5; [60.1-100]) and 98% for the bladder+lymph nodes CTV (98.6; [85.4-100]). Concerning OAR, the volume of healthy tissue spared was 43.7% on average and the V45Gy for the small bowel was 43,4cc (35; [0-129]) (versus 57,6cc). The rectal D50 was on average 18,7Gy for the adaptive treatment (15.9; [2.4-44.1]) versus 17Gy with the conventional approach. With a median follow-up of 2.94 years (95% CI: [0.92-4.02]), we observed three grade 3 toxicities (30%). No grade 4 toxicity was observed. The 2-year overall survival and progression-free survival rates were 65.6% (95% CI: [26-87.6]) and 45.7% (95% CI: [14.3-73]), respectively., Conclusion: The ART technique using a PoD strategy showed a reduction of the irradiated healthy tissue volume while maintaining a similar bladder coverage, with an acceptable rate of toxicity., (Copyright © 2020 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
32. Intégration des mesures intermédiaires de survie dans les évaluations économiques en cancer du sein métastatique
- Author
-
Beauchemin, Catherine and Lachaine, Jean
- Subjects
modèle de Markov ,intermediate endpoints ,survie sans progression ,overall survival ,taux de réponse objective ,cost-effectiveness analysis ,cost-utility analysis ,mesures intermédiaires de survie ,Metastatic breast cancer ,time to progression ,Markov model ,Cancer du sein métastatique ,temps avant la progression de la tumeur ,analyse coût-efficacité ,surrogate endpoints ,analyse coût-utilité ,survie globale ,progression-free survival ,objective response rate - Abstract
De nos jours, il est de plus en plus fréquent de recourir à des mesures intermédiaires d’efficacité telles que la survie sans progression (SSP) et le temps avant la progression de la tumeur (TPT) afin d’estimer l’efficacité d’un nouvel agent anticancéreux. Cependant, l’absence de mesures finales comme la survie globale (SG) complexifie la prise de décision par rapport au remboursement des nouveaux traitements anticancéreux. Ainsi, cette thèse se concentre sur différents aspects de l’intégration des mesures intermédiaires d’efficacité dans les évaluations économiques en oncologie, spécifiquement en cancer du sein métastatique. Une première étude a évalué la relation entre la SSP/TPT et la SG dans le contexte du cancer du sein métastatique. Une revue systématique de la littérature a identifié les études cliniques randomisées portant sur l’efficacité d’un traitement anticancéreux chez les femmes atteintes d’un cancer du sein métastatique et rapportant des données de SSP/TPT et de SG. Les résultats de cette étude ont démontré qu’il existe une relation statistiquement significative, d’une part, entre la SSP/TPT médiane et la SG médiane (r = 0.428; p ≤ 0,01), et d’autre part, entre l’effet de traitement sur la SSP/TPT et l’effet de traitement sur la SG (r = 0.427; p ≤ 0,01). Selon les résultats obtenus, la SSP/TPT pourrait être considérée comme un substitut valide de la SG, justifiant ainsi son utilisation dans les évaluations économiques en cancer du sein métastatique. Une deuxième étude a évalué l’utilisation des mesures intermédiaires de survie dans les évaluations économiques en cancer avancé et identifié les méthodes utilisées pour intégrer ces mesures en l’absence de données de SG. Une revue systématique de la littérature a été réalisée pour recenser les évaluations économiques de type coût-efficacité et coût-utilité ayant intégré des mesures intermédiaires de survie. Cette étude a démontré l’ampleur de l’utilisation des mesures intermédiaires de survie dans les évaluations économiques en cancer avancé. Par ailleurs, plusieurs approches ont été identifiées pour pallier l’absence de données de SG, notamment l’utilisation d’un risque de décès post-progression équivalent pour les groupes à l’étude, le recours à des comparaisons indirectes basées sur de nombreuses hypothèses, l’utilisation d’une mesure intermédiaire comme proxy de la SG, le recours à l’opinion d’experts et l’utilisation de données associées à un traitement différent ou une ligne de traitement différente. Enfin, une troisième étude s’est penchée sur le développement d’un modèle pharmacoéconomique générique canadien intégrant les mesures intermédiaires de survie en cancer du sein métastatique. Ce modèle de Markov inclut des paramètres spécifiques aux traitements sous évaluations (coût de traitement, données de survie et incidence des effets indésirables) de même que des paramètres globaux qui ne dépendent pas des traitements évalués (caractéristiques des patientes, valeurs d’utilité associées aux états de santé du modèle, pertes d’utilité et coûts des effets indésirables, coûts d’administration des traitements, coûts de suivi médical et coûts des soins prodigués en fin de vie). Le modèle a été validé en évaluant sa capacité à répliquer des résultats d’études existantes. Ce modèle permet d’uniformiser l’évaluation économique des nouveaux traitements en cancer du sein métastatique et pourrait par conséquent, devenir un outil d’aide à la décision de référence pour les organismes responsables du remboursement des médicaments au Canada. Bref, les résultats de ces trois études répondent à une problématique importante dans l’évaluation économique des traitements en oncologie et pourront contribuer à faciliter la prise de décision en santé., Nowadays, intermediate endpoints such as progression-free survival (PFS) and time to progression (TTP) are frequently used in clinical trials of advanced cancer. However, use of such endpoints instead of overall survival (OS) poses a significant challenge in the economic evaluation of anticancer drugs. This thesis focuses on different aspects of the integration of intermediate endpoints in the economic evaluation of anticancer drugs, especially in the context of metastatic breast cancer. A first study assessed the relationship between PFS/TPT and OS in metastatic breast cancer using a trial-based approach. A systematic review of the literature was performed to identify randomized clinical trials of metastatic breast cancer therapy reporting both PFS/TTP and OS data. Results of this study indicated a statistically significant relationship between the median PFS/TTP and the median OS (r = 0.428; p < 0.01), and between the treatment effect on PFS/TTP and the treatment effect on OS (r = 0.427; p < 0.01). Findings of this study suggest that PFS/TTP may be considered as a potential surrogate for OS, thus justifying its use in cost-effectiveness or cost-utility analyses of metastatic breast cancer therapy. A second study evaluated the use of intermediate endpoints in the economic evaluation of new treatments for advanced cancer and the methodological approaches adopted when OS data are unavailable or of limited use. A systematic review of the literature was conducted to identify cost-effectiveness and cost-utility analyses using an intermediate endpoint as an outcome measure. This study showed that intermediate endpoints are widely used in the economic evaluation of new treatments for advanced cancer. Several approaches are used in the absence of OS data such as assuming an equal risk of death for all treatment groups, using indirect comparison based on numerous assumptions, using of a proxy for OS, using unpublished external information (consultation with clinical experts), and using published external information from different treatment settings. Finally, a third study aimed to develop a global economic model to assess the cost-effectiveness of new treatments for metastatic breast cancer in Canada. This Markov model, which integrates intermediate endpoints, includes parameters specific to the treatments under evaluation (drug treatment, survival outcomes, and incidence of treatment-related adverse events (AEs)), as well as global parameters that are consistent regardless of the treatment under evaluation (patient characteristics, health states utilities, disutilities and costs associated with treatment-related AEs, as well as costs associated with drug administration, medical follow-up, and end-of-life care). The model was validated by assessing its ability to replicate results of existing studies. This model standardizes the economic evaluation of new therapies for metastatic breast cancer, and could thus be used as a benchmark by drug reimbursement authorities in Canada. In summary, the results of these three studies address an important challenge encountered in the economic evaluation of anticancer drugs, and therefore, can be very valuable for decision-making purposes.
- Published
- 2017
33. Radiochimiothérapie des cancers du pancréas borderline ou localement avancés : analyse rétrospective d’une cohorte de 89 patients traités au CHU de Bordeaux
- Author
-
Pouypoudat, Claudia and UB -, BU Carreire
- Subjects
Neoadjuvant treatment ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,Progression-free survival ,Pancreatic cancer ,Adenocarcinoma ,Résection chirurgicale ,Secondary resection ,Survie sans progression ,Survie globale ,Radiochimiothérapie ,Histologic response ,Overall survival ,Traitement néoadjuvant ,Réponse anatomopathologique ,Radiochemotherapy ,Adénocarcinome du pancréas - Abstract
Purpose : to assess the secondary resection rates and the overall and progression-free survivals of patients with borderline or locally advanced pancreatic cancer treated by concomitant radiochemotherapy. Methods : this retrospective study of a prospective observational cohort included all patients treated from 2010 to 2014 for non-metastatic borderline and locally advanced pancreatic adenocarcinomas. Treatment strategy consisted in chemotherapy followed by radiochemotherapy then surgery for secondary resectable tumors. Response to therapy and surgical resectability were performed using CT-scan after each sequence of treatment. All CT-scan images have been reviewed retrospectively by a radiologist according to the NCCN 2015 classification. Results : eighty-nine patients (male: 48, 53.9%; median-age: 61, range 35-82) were included. Forty-eight patients had borderline tumors and forty-one locally advanced. All patients were treated by chemotherapy, consisting in Folfirinox regimen (oxaliplatin, irinotecan, 5FU) for 80 patients (89.9 %), followed by radiochemotherapy (median dose: 59 Gy, range 45-66 Gy) for 84 patients (94.4%). Forty-two patients (47.2%; 28 borderline and 14 locally advanced tumors at baseline) could benefit surgery resulting in a complete R0 resection in 37 patients (90%). Median overall survival for the entire population was 21.5 months with a median follow-up of 47.1 months. Overall survival and progression-free survival were significantly higher for patients that underwent resection compared to others (49.7 vs 17.4 months (p, Objectif : accéder aux taux de résection secondaire et de survie globale et sans progression chez des patients atteints de cancers du pancréas borderline ou localement avancés traités par radiochimiothérapie concomitante. Méthodes : cette étude rétrospective d'une cohorte observationnelle prospective a inclus tous les patients traités de 2010 à 2014 pour un adénocarcinome du pancréas borderline ou localement avancé. Le traitement consistait en une chimiothérapie première suivie d'une radiochimiothérapie puis d'une chirurgie pour les tumeurs secondairement résécables. La réponse au traitement et la résécabilité étaient appréciées sur les scanners réalisés après chaque séquence thérapeutique. Tous les scanners ont été relus de manière rétrospective par un radiologue selon la classification NCCN 2015. Résultats : quatre-vingt neuf patients (hommes: 48, 53,9%; âge médian: 61 ans) ont été inclus. Quarante-huit patients avaient des tumeurs borderline et quarante et un des tumeurs localement avancées. Tous les patients ont été traités par une chimiothérapie, consistant en du Folifirinox (oxaliplatine, irinotecan, 5FU) pour quatre-vingts patients (89,9 %), suivie d'une radiochimiothérapie (dose médiane : 59 Gy, (45-66 Gy)) pour quatre-vingts-quatre patients (94,4%). Quarante-deux patients (47,2%; 28 tumeurs borderline et 14 tumeurs localement avancées initialement) ont pu bénéficier d'une chirurgie qui a résulté en une résection complète R0 chez trente-sept patients (90%). La survie globale médiane pour la totalité de la population était de 21,5 mois avec un suivi médian de 47,1 mois. La survie globale et sans progression étaient significativement supérieures chez les patients opérés comparativement aux patients non opérés (respectivement 49,7 vs 17,4 mois (p
- Published
- 2017
34. [Patients treated with palbociclib and endocrine therapy for metastatic breast cancer: Can we predict the occurrence of severe early hematological toxicity?]
- Author
-
Vazquez L, Arnaud A, Grenier J, and Debourdeau P
- Subjects
- Adult, Aged, Aged, 80 and over, Antineoplastic Agents therapeutic use, Breast Neoplasms chemistry, Breast Neoplasms pathology, Breast Neoplasms, Male drug therapy, Breast Neoplasms, Male pathology, Cyclin-Dependent Kinase 4 antagonists & inhibitors, Cyclin-Dependent Kinase 6 antagonists & inhibitors, Female, Fulvestrant adverse effects, Fulvestrant therapeutic use, Humans, Letrozole therapeutic use, Male, Middle Aged, Multivariate Analysis, Neutropenia chemically induced, Piperazines therapeutic use, Progression-Free Survival, Pyridines therapeutic use, Retrospective Studies, Antineoplastic Agents adverse effects, Breast Neoplasms drug therapy, Piperazines adverse effects, Pyridines adverse effects, Thrombocytopenia chemically induced
- Abstract
Introduction: The addition of palbociclib to endocrine therapy has been shown to improve progression free survival in hormone receptor positive metastatic breast cancer patients. This cyclin CDK4/6 inhibitor could expose patients to a grade 3-4 hematological toxicity, leading to treatment discontinuation or treatment interruption that is potentially associated with a lack of efficiency. The aim of this study was to identify predictive factors of severe early hematotoxicity (ESHT)., Methods: This retrospective cohort study included patients who started palbociclib in the Institut Sainte Catherine between December 1, 2016 and January 1, 2019 for the treatment of metastatic breast cancer. Individual data and hematological toxicity were collected from electronic medical records. ESHT was defined as the occurrence, during the first 3 cycles, of grade 4 or grade 3 hematological toxicity requiring palbociclib dose reduction., Results: In total, 181 patients (180 females) were included; median age was 67 years. Forty-six patients (25.4%) experienced an ESHT. Predictive factors of ESHT in multivariate analysis were a performance status (PS) of 2 or more (P=0.024) and an history of radiotherapy of bone metastasis in the previous year (P=0.003). Before palbociclib initiation, a neutrophil count below 3.37g/L was predictive of ESHT with a sensibility of 76% and a specificity of 71%., Conclusions: ECOG PS, bone radiotherapy within the year and low baseline neutrophils count are associated with ESHT in palbociclib-treated metastatic breast cancer patients. These elements could be useful for a careful monitoring leading to adapted therapy., (Copyright © 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
35. [Indications and management of hematologic microtransplantation: Recommendations of the French Society of Bone Marrow transplantation and cellular Therapy (SFGM-TC)].
- Author
-
Cornillon J, Carre M, Chalandon Y, Chevallier P, Coman T, Harif M, Labuissière-Wallet H, Mear JB, Picard C, Yakoub-Agha I, and Srour M
- Subjects
- Age Factors, Antineoplastic Agents therapeutic use, Chimerism, Combined Modality Therapy methods, Cytokine Release Syndrome etiology, Graft vs Host Disease etiology, Graft vs Host Disease immunology, Graft vs Host Disease therapy, Granulocyte Colony-Stimulating Factor, Hematopoietic Stem Cell Mobilization, Hematopoietic Stem Cell Transplantation standards, Host vs Graft Reaction immunology, Humans, Leukemia, Myeloid, Acute ethnology, Progression-Free Survival, Societies, Medical, Hematopoietic Stem Cell Transplantation methods, Leukemia, Myeloid, Acute therapy, Myelodysplastic Syndromes therapy
- Abstract
Microtransplantation (MT) is based on injection of HLA-mismatched G-CSF mobilized hematopoietic stem cells, in combination with chemotherapy but without use of conditioning regimen nor immunosuppressive drugs. As a result, a transient microchimerism is induced without engraftment. Its efficacy relies both on host immune system stimulation (recipient versus tumor) and on a graft versus tumor effect. Data are scarce and concern mostly Asian patients with acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (HR-MDS). In comparison to conventional treatment without MT, higher complete remission rates and longer disease free survival and overall survival have been reported. Safety seems acceptable. The most frequent adverse event is non-severe cytokine release syndrome. Risk of GVHD remains very low. Here, we summarize the published data and detail the practical aspects of the procedure. Current data are not strong enough to provide recommendations on indications. Nevertheless, it seems reasonable to propose MT to patients with AML or HR-MDS, regardless of age, presenting an indication for allogeneic stem cell transplantation but ineligible for it. MT is still under investigation and rather be proposed within clinical trials., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
36. [Efficacy of combined paclitaxel/cetuximab in cutaneous squamous-cell carcinoma: A retrospective analysis of 14 patients].
- Author
-
Casassa E, Riffaud L, Sibaud V, Boulinguez S, Chira C, Gangloff D, Montastruc M, Lamant L, Paul C, and Meyer N
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell radiotherapy, Carcinoma, Squamous Cell secondary, Carcinoma, Squamous Cell surgery, Cetuximab administration & dosage, Combined Modality Therapy, Female, Humans, Kaplan-Meier Estimate, Lung Neoplasms secondary, Lung Neoplasms therapy, Male, Middle Aged, Paclitaxel administration & dosage, Progression-Free Survival, Retrospective Studies, Skin Neoplasms radiotherapy, Skin Neoplasms surgery, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Squamous Cell drug therapy, Skin Neoplasms drug therapy
- Published
- 2020
- Full Text
- View/download PDF
37. [Retrospective study: Late surgery post chemotherapy versus after 3-4 cures in treatment of advanced ovarian cancer].
- Author
-
de Fréminville Q, Licaj I, Frenel JS, Hamel-Senecal L, Thomas G, Brachet PE, Coquan E, Leconte A, Classe JM, and Joly F
- Subjects
- Adult, Aged, Chemotherapy, Adjuvant methods, Female, France, Humans, Length of Stay, Middle Aged, Neoadjuvant Therapy methods, Ovarian Neoplasms mortality, Ovarian Neoplasms pathology, Progression-Free Survival, Retrospective Studies, Antineoplastic Agents therapeutic use, Ovarian Neoplasms drug therapy, Ovarian Neoplasms surgery
- Abstract
Introduction: Treatment in locally advanced ovarian cancer is optimal surgery followed by chemotherapy. Patients with significant tumor spread, OMS>2, age>75 years old are poor candidates for aggressive primary surgery. Interval surgery, after neo-adjuvant chemotherapy, aims to achieve more complete surgery, increase survival, and reduce surgical morbidity. The primary endpoint was progression-free survival. Secondary outcomes were overall survival and postoperative morbidity and mortality., Method: This is a retrospective study conducted in 2 French referral centers between January 2000 and December 2015. Patients who could not benefit from a complete initial surgery were operated after 3 cures of chemotherapy at the François Baclesse center and after least 5 cures at the center René Gauducheau., Results: The population analyzed included 104 patients, 43 (41.0%) patients treated at the René Gauducheau center (group 1) and 61 (59.0%) patients treated at the François Baclesse center (group 2). Progression-free and overall survival were similar between the 2 groups, they were, respectively, 15.9 months and 34 months in group 1 vs. 15.4 months and 37.6 months in group 2 (P=0.72; P=0.65). Mean hospital stay and postoperative morbidity were similar in both groups., Conclusion: For weak patients, to limit invasive surgery, doing more than 5 courses of chemotherapy may be a reasonable option., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
38. [Is sarcopenia a morbi-mortality factor in the treatment of localized muscle-invasive bladder cancer?]
- Author
-
Fraisse G, Renard Y, Lebacle C, Masson-Lecomte A, Desgrandchamps F, Hennequin C, Bessede T, and Irani J
- Subjects
- Aged, Combined Modality Therapy, Female, Humans, Male, Neoadjuvant Therapy methods, Progression-Free Survival, Retrospective Studies, Survival Rate, Tomography, X-Ray Computed, Urinary Bladder Neoplasms pathology, Cystectomy methods, Sarcopenia etiology, Urinary Bladder Neoplasms therapy
- Abstract
Introduction: Sarcopenia evaluated from the measurement of skeletal muscle index (SMI) has been evaluated as a predictive factor of morbidity and mortality after surgery. The objective of this study was to evaluate whether it was predictive of morbidity and mortality in patients managed by cystectomy or tri-modality therapy (TMT), combining radiotherapy and chemotherapy after endoscopic resection of the tumour, for localized muscle-invasive bladder cancer., Materials and Methods: In all, 146 consecutive patients from 2 university hospital centres treated by cystectomy between January 2012 and April 2017 or TMT between October 2008 and October 2014 were included. The SMI was measured on axial computed-tomography at the level of the transverse process of L3, before treatment. Sarcopenia was assessed in two ways: either by SMI without muscle mass adjustment or according to the definition by Martin and al. based on gender and patient BMI, then called "adjusted sarcopenia". The primary endpoint was overall survival (OS) for sarcopenia. The secondary endpoints were OS, progression-free survival (PFS) and survival without re-admission (SRH) for the total population and for each treatment group. Survival analyses were performed using the Cox model. The association between sarcopenia and complications has been investigated by the Chi
2 test., Results: The characteristics of sarcopenic (n=67) and non-sarcopenic (n=79) patients were comparable except for 2 criteria: older patients in the sarcopenic group and a higher proportion of neo-adjuvant chemotherapy in non-sarcopenic patients. Sarcopenia was not significantly associated with any type of survival. Sarcopenia was not associated with the proportion or severity of complications., Conclusion: Unlike unadjusted SMI, sarcopenia was not associated with survival or complications., Level of Evidence: 3., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)- Published
- 2020
- Full Text
- View/download PDF
39. [Tolerance of Tamoxifen as an adjuvant therapy and long-term follow up of 55 premenopausal breast cancer women, cared for at the Institut de cancérologie de Lorraine, treated with Tamoxifen].
- Author
-
Sebaoun P, Frederic M, Weryha G, Hamdaoui SE, Salleron J, and Lesur A
- Subjects
- Adult, Amenorrhea chemically induced, Antineoplastic Agents, Hormonal administration & dosage, Aromatase Inhibitors therapeutic use, Breast Neoplasms mortality, Cancer Care Facilities, Chemotherapy, Adjuvant, Female, Follow-Up Studies, France, Hot Flashes chemically induced, Hot Flashes epidemiology, Humans, Incidence, Ovarian Cysts chemically induced, Ovarian Cysts epidemiology, Progression-Free Survival, Prospective Studies, Retrospective Studies, Selective Estrogen Receptor Modulators administration & dosage, Selective Estrogen Receptor Modulators adverse effects, Tamoxifen administration & dosage, Time Factors, Antineoplastic Agents, Hormonal adverse effects, Breast Neoplasms drug therapy, Premenopause, Tamoxifen adverse effects
- Abstract
Introduction: Objectives: the purpose of this study is to assess TAM safety in terms of side effects and hormonal status, the persistence of the treatment over a five years time-frame and to report the remote follow-up data., Methods: Fifty five patients were included patients between January 2001 and November 2002 at the Institut de cancérologie de Lorraine. The subjects were aged 50 years or less, premenopausal at diagnosis and treated with adjuvant TAM therapy at a daily dose of 20 mg, for an expected duration of 5 years, at a daily. After 2 years, prospective evaluation was completed and monitoring of ovarian function was performed as usual in the institution (1x/year). All data were retrospectively evaluated in 2019., Results: In these 55 patients, the cumulative incidences of cysts and hot flushes 5 years after treatment were 68.5 % and 77.6 %, respectively. Of the 33 patients with chemoreactive amenorrhea, half had cycles which resumed within a median of 9 months. In the 10 patients without chemotherapy-induced amenorrhea, 4 had a cycle stop. Of these, 3 patients had cycles that, resumed within 1, 4 and 8 months. 34 patients (61.3 %) had taken Tamoxifen for at least 5 years. After 15 years of treatment, overall and progression-free survival was 90.7 % and 67.4 %, respectively., Conclusion: The observation of the tolerance to the treatment for 5 years and beyond, contributes to the quality of information delivered to future patients starting the treatment, allowing a better understanding and in the long term a better observance., (Copyright © 2019 Société Française du Cancer. Publié par Elsevier Masson SAS. Tous droits réservés.)
- Published
- 2019
- Full Text
- View/download PDF
40. [Radiotherapy of oligometastases: Sequences and interactions with systemic therapies, example of kidney cancer].
- Author
-
Wespiser M, Goujon M, Nguyen Tan Hon T, Maurina T, Kleinclauss F, Créhange G, and Thiery-Vuillemin A
- Subjects
- Adenocarcinoma, Clear Cell diagnostic imaging, Adenocarcinoma, Clear Cell radiotherapy, Adenocarcinoma, Clear Cell secondary, Adenocarcinoma, Clear Cell surgery, Humans, Immunotherapy methods, Kidney Neoplasms diagnostic imaging, Kidney Neoplasms mortality, Molecular Targeted Therapy, Neoplasm Metastasis radiotherapy, Practice Guidelines as Topic, Progression-Free Survival, Radiation Tolerance, Kidney Neoplasms pathology, Metastasectomy, Radiosurgery methods
- Abstract
This article is a review of the literature that aims to clarify the place of systemic and locoregional treatments, with a focus on radiotherapy and surgery in the management of patients with oligometastatic kidney cancer. We have selected articles of interest published in Medline indexed journals. We have also analysed the related guidelines: National Comprehensive Cancer Network (NCCN) 2019, European Association of Urology (EAU) 2019, European Society of Medical Oncology (ESMO) 2019, Association française d'urologie (Afu) 2018 as well as some abstracts of international congresses. The main treatments evaluated were surgery and radiotherapy. We defined the different scenarios conventionally encountered in clinical practice. The evolution of systemic therapies (increased overall survival and response rate) is likely to increase the number of patients potentially accessible to locoregional treatments. The complete analysis of the literature underlines the place of locoregional treatments whatever the scenarios mentioned. Data on stereotactic radiotherapy found a local control rate consistently above 70% in all studies with a maintained response and positive impact on overall survival and progression-free survival. The improvement of overall survival by sequential use of the various therapeutic classes confirms the need for optimization of locoregional treatments in the model of oligometastatic kidney cancer. The dogma of radioresistance must definitely be set aside with current irradiation techniques., (Copyright © 2019. Published by Elsevier Masson SAS.)
- Published
- 2019
- Full Text
- View/download PDF
41. [Solitary bone plasmocytoma: Experience from the radiotherapy department at Mohammed-V military teaching hospital in Rabat (Morocco)].
- Author
-
Hadadi K, Hommadi M, Belemlih M, Zaghba N, Maghous A, Marnouch EA, Saghir KA, Elmarjany M, Sifat H, Oukabli M, and Mansouri H
- Subjects
- Adult, Aged, Bone Neoplasms diagnostic imaging, Bone Neoplasms surgery, Disease Progression, Female, Hospitals, Military, Hospitals, Teaching, Humans, Male, Middle Aged, Morocco, Multiple Myeloma etiology, Multiple Myeloma mortality, Plasmacytoma diagnostic imaging, Plasmacytoma surgery, Prognosis, Progression-Free Survival, Radiotherapy Dosage, Radiotherapy, Conformal, Radiotherapy, Intensity-Modulated, Retrospective Studies, Bone Neoplasms radiotherapy, Plasmacytoma radiotherapy
- Abstract
Purpose: The primary objective was to determine in our department the progression-free survival rate of patients with solitary bone plasmocytoma and secondarily to evaluate its diagnostic, therapeutic and evolutionary aspects., Patients and Methods: This is a retrospective review of 12 patients monitored and treated in the radiotherapy department of the Mohammed-V military medical teaching hospital in Rabat for a solitary bone plasmocytoma between January 2012 and December 2018. The average age of our patients were 53.8 years old (range: 31-72 years old). Pain was the most common telltale sign. The site of the lesions was spinal in four cases, iliac in four cases, mandibular, ribal, humeral and at the level of the astragalus in one case respectively. All patients received radiotherapy. This irradiation was delivered alone in 60% of cases or associated with surgery in 40% of cases. The average dose of radiotherapy was 47.3Gy (range: 45 to 50.4Gy) and this was delivered by a modulated volumetric arc therapy technique in ten patients and conformal tridimensional radiotherapy in two patients., Results: Local control, defined by stability or radiological regression, was obtained in ten patients and four patients progressed to multiple myeloma, two of whom died. The average duration of follow-up was 51 months., Conclusion: Radiation therapy is the standard treatment for solitary bone plasmocytoma. It ensures good local control in 90% of cases. The prognosis is affected by progression to multiple myeloma, which justifies rigorous monitoring after treatment and suggests a reflection on the exact place of chemotherapy., (Copyright © 2019 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
42. [Olaparib and pancreatic cancer: A challenging Lesson].
- Author
-
Louvet C, Samalin E, and Michel P
- Subjects
- Adenocarcinoma genetics, Adenocarcinoma mortality, Clinical Trials, Phase III as Topic, Genes, BRCA1, Genes, BRCA2, Germ-Line Mutation, Humans, Pancreatic Neoplasms genetics, Pancreatic Neoplasms mortality, Placebos, Progression-Free Survival, Randomized Controlled Trials as Topic, Adenocarcinoma drug therapy, Antineoplastic Agents therapeutic use, Pancreatic Neoplasms drug therapy, Phthalazines therapeutic use, Piperazines therapeutic use
- Published
- 2019
- Full Text
- View/download PDF
43. [Stereotactic body radiation therapy for hepatocellular carcinoma: Results from a retrospective multicentre study].
- Author
-
Scher N, Janoray G, Riet FG, Le Bayon AG, Debbi K, Lévy S, Louisot P, Garaud P, Chajon E, Barillot I, Salamé É, de Crevoisier R, Chapet S, and Calais G
- Subjects
- Abdominal Pain etiology, Aged, Aged, 80 and over, Carcinoma, Hepatocellular mortality, Duodenal Ulcer etiology, Female, Follow-Up Studies, France epidemiology, Hepatitis etiology, Humans, Liver Neoplasms mortality, Male, Middle Aged, Progression-Free Survival, Radiotherapy Dosage, Retrospective Studies, Salvage Therapy, Carcinoma, Hepatocellular radiotherapy, Liver Neoplasms radiotherapy, Radiosurgery adverse effects
- Abstract
Purpose: The purpose of this paper was to describe local control, overall survival, progression-free survival and toxicity of CyberKnife
® -based stereotactic body radiation therapy of hepatocellular carcinoma., Material and Methods: Records of all the patients treated for hepatocellular carcinoma at the Eugene-Marquis cancer centre, Rennes and the Bretonneau hospital, Tours (France), between November 2010 and December 2016, were reviewed. Radiation therapy was performed as a salvage treatment, while awaiting liver transplantation or if no other treatment was possible., Results: One hundred and thirty-six patients were consecutively included in the study. The median follow-up was 13months. Median total dose prescribed, fractionation and overall treatment time were respectively 45Gy, three fractions and 5 days. Overall survival, progression-free survival and local control rates at 1year and 2years were 79.8 % and 63.5 %, 61.3 % and 39.4 %; 94.5 % and 91 %. Two grade 3 acute toxicity events and two grade 4 late toxicity events corresponding to a duodenal ulcer have been reported. Seven patients underwent classic radiation-induced hepatitis and 13 patients showed non-classical radiation-induced hepatitis. Barcelona Clinic Liver Cancer stage, World Health Organisation grade and planning target volume were correlated with overall survival in univariate Cox analysis., Conclusion: Stereotactic body radiation therapy is effective and well-tolerated for inoperable hepatocellular carcinoma or as a bridge to liver transplantation. Toxicity is mainly related to cirrhotic background and requires a selection of patients and strict dose constraints., (Copyright © 2019 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)- Published
- 2019
- Full Text
- View/download PDF
44. Assessing cancer drugs for reimbursement: methodology, relationship between effect size and medical need
- Author
-
Rima de Sahb-Berkovitch, Marie-Christine Woronoff-Lemsi, Mathieu Molimard, Jean-Pierre Armand, Marc Bardou, Loïc Bergougnoux, Christine Bouchet, Dominic Cellier, Bachir Dahmani, Bertrand Diquet, Thierry Lecomte, Nathalie Hoog Labouret, Claire Labreveux, François Meyer, Gilles Paintaud, Pascal Piedbois, Martine Pigeon, Olivier Amédée Manesme, Rémy Defrance, Dominique Tonelli, Karen Pinachyan, and Sophie Tardieu
- Subjects
medicine.medical_specialty ,Survival ,Cost-Benefit Analysis ,Population ,MEDLINE ,Subgroup analysis ,Antineoplastic Agents ,Neoplasms ,medicine ,Clinical endpoint ,media_common.cataloged_instance ,Humans ,Pharmacology (medical) ,Progression-free survival ,European Union ,European union ,education ,Intensive care medicine ,Reimbursement ,media_common ,education.field_of_study ,Health Services Needs and Demand ,business.industry ,Hazard ratio ,Europe ,Treatment Outcome ,Insurance, Health, Reimbursement ,business - Abstract
Reimbursement is assessed by the Transparency Commission from the Health Authority (HAS) using a medical benefit (SMR) score that gives access to reimbursement, an "improvement of medical service rendered" (ASMR) that determines the added therapeutic value, and the target population. Assessing cancer drugs for reimbursement raises the same issues as other therapeutic classes, with some key differences. Overall survival (OS) is considered by the Transparency Commission as the endpoint for assessing clinical benefit, and yet it is not an applicable primary endpoint in all types of cancer. Later lines of treatment, particularly during the development process, may make it difficult to interpret OS as the primary endpoint. Therefore, progression-free survival (PFS) for metastatic situations and disease-free survival (DFS) in adjuvant situations are wholly relevant endpoints for decisions on the reimbursement of a new cancer drug. Effect size is assessed using actuarial survival curves of the product versus the comparator, and it is difficult to summarise them into one single parameter. Results are generally interpreted based on median survival, which is fragmented because it only measures one point of the curve. The hazard ratio measures the effect of treatment throughout the duration of survival and is therefore more comprehensive in quantifying clinical benefit. Determining an effect size threshold for granting reimbursement is difficult given the diversity of cancer settings and the level of medical need, which influences assessment of the clinical relevance of the observed difference. Rapid progress in comparators (700 molecules in development) and the identification of predictive factors of efficacy (biomarkers, histology, etc.) during development may lead to different ASMR scores per population, or to the restriction of the target population to a subgroup of the marketing authorisation (MA) population in which the expected effect size is greater. To address these issues, the roundtable recommends the possibility of early scientific opinions by the office of the Transparency Commission in order to discuss comparators and the relevance of responder subgroups. It also recommends the possibility of granting a temporary ASMR, on condition of subsequent confirmation by production of data, when reimbursement appears justified in a subpopulation of the MA for which only subgroup analysis is available.
- Published
- 2010
45. [Bevacizumab in combination with first-line treatment for metastatic non-small cell lung cancer in clinical practice. Results of the EOLE study].
- Author
-
Chouaid C, Falchero L, Schott R, Bonnetain F, Taguieva-Pioger N, and Bennouna J
- Subjects
- Aged, Carcinoma, Non-Small-Cell Lung epidemiology, Carcinoma, Non-Small-Cell Lung pathology, Female, Follow-Up Studies, France epidemiology, Humans, Lung Neoplasms epidemiology, Lung Neoplasms pathology, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Metastasis, Treatment Outcome, Angiogenesis Inhibitors administration & dosage, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bevacizumab administration & dosage, Carcinoma, Non-Small-Cell Lung drug therapy, Lung Neoplasms drug therapy
- Abstract
Introduction: The EOLE cohort aimed to describe, in routine clinical practice, the characteristics and management of patients receiving bevacizumab in combination with first-line metastatic chemotherapy for advanced metastatic or recurrent non squamous non-small cell lung cancer (nsNSCLC), as well as its efficacy and safety., Methods: A total of 423 patients were enrolled in this prospective, national, multicenter study. Data were collected every 3 months over an 18-month period., Results: Amongst the 407 patients analyzed (mean age 60±10 years, male 68%, ECOG-PS≤1 88%, smokers or former smokers 87%, cardiovascular comorbidities 40%), all except for 2 patients received bevacizumab (7.5 or 15mg/kg/3 weeks in 99% of patients) in combination with doublet chemotherapy. A total of 160 (60%) patients who completed induction received bevacizumab maintenance therapy. Median progression-free survival was 6.9 months (95% CI=[6.0-7.5]). Median overall survival (12.8 months [10.4-14.7]) was longer in patients with ECOG-PS≤1 (14.4 months [12.3-15.9] versus 4.9 months [3.4-8.3] if ECOG-PS=2). A total of 131 (32%) patients experienced at least one serious adverse event (SAE), and 51 (12%) at least one bevacizumab-related SAE., Conclusion: EOLE confirms the efficacy and safety of bevacizumab in aNSCLC patients, in current medical practice., (Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.