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Introduction D’apres les recommandations de l’ANSM de mars 2011, nous avons souhaite faire un bilan sur le monitoring des prescriptions informatisees d’aminosides et de glycopeptides. Materiels et methode Tous les patients ayant eu une prescription informatisee de vancomycine et/ou d’aminosides de janvier 2013 a mars 2015 ont ete recenses (logiciel Pharma ® ). Les donnees patients ont ete collectees (logiciel Medis ® ) : poids, etat de la fonction renale, contexte clinique au moment de la prescription, evolution des patients par la suite. Les donnees sur les dosages plasmatiques nous ont ete transmises par le laboratoire de biologie. Les posologies ont ete considerees comme non conforme (NC) si un ecart de ±20 % par rapport aux recommandations (RE) etaient observees. Les dosages etaient consideres NC s’ils etaient superieurs ou inferieurs aux normales. Resultats et discussion Au total, 122 prescriptions analysees (7 patients ont ete exclus : dialyse, poids non indique) des services informatises : pneumologie (53/122 prescriptions), medecine interne (51/122 prescriptions), puis les services de geriatrie, SSR, HAD, neurologie. Vancomycine : 28 prescriptions analysees, 78 % de posologies NC (dose de charge et/ou dose d’entretien inferieures aux RE). La moyenne des doses de charge et des doses d’entretien representait la moitie des doses recommandees. Cinquante-sept pourcent des dosages sont conformes, 7 patients auraient du beneficier d’un dosage (duree de traitement > 3 jours) mais ils ne l’ont pas eu. Amikacine : 34 prescriptions analysees, 17,6 % avec des posologies NC, moyenne des posologies 13,5 mg/kg/j. Dix-neuf pourcent des resultats des dosages NC. Gentamicine : 60 prescriptions analysees, 47 % de posologies NC, moyenne 2,3 mg/kg/j. Cinquante pourcent des dosages sont NC. Les durees moyennes de traitement etaient de 7 jours pour la vancomycine, 4 pour l’amikacine, 3 pour la gentamicine. Pour 1 patient traite par amikacine, sa fonction renale s’est degradee durant son traitement, passant d’une Clcr de 75 a 53 mL/min selon MDRD. Conclusion Les posologies de ces ATB sont souvent diminuees par rapport aux recommandations. L’absence de dose de charge de vancomycine peut etre liee au fait que le traitement a pu etre initie dans un service non informatise. Quarante pourcent des patients sous vancomycine sont decedes et 83 % d’entre eux avaient une posologie NC. Notre constat est que les praticiens sont frileux a l’idee d’instaurer une dose pleine de ces ATB car, bien que les pharmaciens emettent des interventions pharmaceutiques, elles ne sont pas tout le temps prises en compte. Un rappel des recommandations et la presentation des ces resultats ont ete fait aux praticiens via la COMEDIMS. Une reevaluation est prevue dans un an afin de voir s’il y a eu une amelioration des pratiques.

Background: Primary treatment goals in less aggressive metastatic breast cancer (MBC) are prolonged survival, good quality of life and control of the disease and its symptoms. High activity, oral administration and no alopecia make capecitabine monotherapy attractive in slowly evolving disease. Methods: We retrospectively analysed 226 patients who had received single-agent capecitabine as 1st-line chemotherapy at our institution. Results: The median interval between breast cancer diagnosis and MBC was 52 months (range 0–479); 76% had received endocrine therapy for MBC, 58% had visceral involvement and 30% had 3 or more metastatic sites. The median starting dose was 1,000 mg/m2 twice daily. Disease was improved in 56% of the patients (median duration: 13.2 months) and stabilised in 20%. Median time to treatment failure was 8.8 months (95% CI: 7.1–10.5); median overall survival from initiating capecitabine was 23.6 months (95% CI: 19.7–27.4). Prior adjuvant chemotherapy, endocrine therapy for MBC, visceral disease, hormone receptor status and initial capecitabine dose did not influence time to treatment failure. Among 161 patients Conclusion: Based on these findings, 1st-line capecitabine should be considered in slowly progressing disease, offering an active, well-tolerated oral treatment with minimal toxicity and no alopecia. More toxic treatments may be reserved for more aggressive disease.

Introduction L’algie vasculaire de la face (AVF) est une des cephalees primitives les plus severes, elle est pourtant toujours caracterisee par une insuffisance diagnostique (delai diagnostique moyen : plus de 6 ans) et une prise en charge parfois inadaptee (5 a 20 % des patients ont une intervention chirurgicale qui n’ameliore pas la maladie). Depister les patients souffrant d’une AVF pour recourir a un avis specialise est donc utile, de telle sorte que la prise en charge soit adaptee et des procedures inutiles, notamment chirurgicales, evitees. Objectif Le but de cette etude est de valider un auto-questionnaire diagnostique elabore pour le depistage de L’AVF. Materiel et methode L’etude des principales series de la litterature nous a permis de determiner la frequence respective de chacun des criteres diagnostiques de l’IHS pour l’AVF. Nous avons retenu les trois criteres diagnostiques les plus frequemment presents et nous avons elabore a partir de ces 3 criteres un auto-questionnaire comprehensible pour les patients. Les reponses a chaque question etaient oui ou non. L’auto-questionnaire a ete administre consecutivement a 37 patients souffrant d’AVF et 59 migraineux. L’auto-questionnaire etait compare au gold standard (diagnostic d’AVF ou de migraine fait par le neurologue base sur les criteres diagnostiques de l’IHS). Nous avons calcule la sensibilite et la specificite des 3 questions et de chaque paire de questions. Resultats L’auto-questionnaire a 3 questions (stricte unilateralite de la douleur, duree des crises Conclusion L’auto-questionnaire base sur la recherche de la duree de la crise et de l’injection conjonctivale ou du larmoiement pourrait etre un outil de choix pour le depistage de l’AVF.

1092 Background: X is one of the most active agents in pretreated MBC. Data on X monotherapy as first-line CT are limited, although a recent randomized phase III trial showed a survival benefit vs oral CMF (Stockler et al SABCS 2006). We retrospectively analyzed MBC pts receiving first-line X at our institution. Methods: Between 01/2002 and 09/2006, 167 pts received X (bid, days 1–14 q3w). Response classifications (improvement in disease [ID], stable disease [SD], or progressive disease [PD]) were as described by Hennessy et al (Ann Oncol 2005). Results: Median age was 68 years (range 34–91). Prior adjuvant therapy included CT in 47% and tamoxifen in 49% of pts. Median interval between initial surgery and MBC was 4.4 years (range 0–39). Before X, most pts (79%) had received endocrine therapy (ET) for MBC (median 2 lines, median duration 2.1 years). Median no. of metastatic sites was 2; bone and visceral metastases were each present in 60% of pts. The initial X dose was 1,500–2,500mg/d in 23%, 3,000mg/d in 47%, and 3,150–4,800mg/d in 29% of pts. ID was seen in 57% of pts (median duration 11.7 months [95% CI 3.8–28.6]). A further 20% had SD for =6 weeks. Median time to X failure (TTF) and OS were 9.0 [95% CI 7.1–11.0] and 25.8 months [95% CI 22.1–29.5], respectively. None of the following influenced TTF: age (3,000mg). Toxicities were typical of X monotherapy. X was continued for =12 months in 46 pts without cumulative toxicity. Conclusions: X appears highly active as first-line CT for MBC pts, including those who had received ET for MBC and/or adjuvant CT. Long-term treatment is well tolerated. The safety profile is consistent with previous reports. High activity, oral administration, lack of alopecia, and low hematologic toxicity make X a very attractive first- line CT for slowly progressing disease and/or after ET failure. No significant financial relationships to disclose.

1095 Background: Based on results of randomized trials of Xeloda (X) vs CMF or taxanes (T) as first-line CT for MBC, very favorable tolerability, and patients’ (pts) preference for oral therapy, front-line X is now often used in our institution, especially for slowly progressing disease. As other CT regimens, especially T, have demonstrated improved OS, we analyzed post-X CT in these pts. Methods: Analysis was restricted to pts who began X before Jan 05, all of whom have now discontinued because of progression or toxicity. Results: In 90 eligible pts, median TTF and OS from initiation of X are 9 [95% CI 7–11] and 26 [22–30] months, respectively. 75% of pts received second-line CT. Three subgroups can be analyzed: (A) 65 pts (median age 58y, range 34–84) received further CT (median 2 regimens, range 1–6) after stopping X, including T (85% of pts), anthracycline (a/c: 42%), vinorelbine (45%), or mitomycin C (20%). 24 pts received =2 regimens including a/c and T; 7 pts received neither T nor a/c (vinorelbine, n = 6; UFT, n = 1). Median OS from initiation of X was 30 months [95% CI 27–32]. 30 pts are alive after a 16-month median follow-up since X failure; they may receive another CT; (B) 3 pts are currently receiving endocrine therapy after X failure and may receive another CT later; (C) 22 pts (24%) (median age 77y, 19 =70y) died without receiving further CT. Median OS from initiation of X was 11 months (range 0.5–23). 4 of these pts (aged 57, 71, 74, and 84y) received endocrine therapy for 2–10 months. Ability to administer further CT varies with age: of pts No significant financial relationships to disclose.