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We review the recent advances in neurological toxicities of immune checkpoint inhibitors, with a focus on underlying pathophysiologic mechanisms and the implications on their therapeutical management.A growing number of cancer patients benefit from immune checkpoint agents and oncologists are increasingly confronted with these novel autoimmune syndromes. During the last years, further progresses have occurred in this field, notably in the identification of specific clinical patterns, such as the association of myasthenic syndrome with myositis and myocarditis, and polyradiculoneuropathies accompanied by cerebrospinal fluid lymphocytic pleocytosis. In addition, recent immune-histological studies improved the understanding of the pathophysiologic mechanisms behind immune-related neurotoxicities.Neurological toxicity is rare compared with other organs and systems, but its potential morbidity and mortality requires a prompt management. If there is a consensus for steroids as a first-line treatment, no exhaustive clinical data exist for other treatments. Recent advances in the knowledge of pathophysiological mechanisms (behind these toxicities) should be taken into account for the management of these patients. Drugs targeting T-cell mediated inflammation should be preferred in patients who are refractory to steroids, whereas therapies targeting humoral mechanisms should be considered in specific cases associated with autoantibodies such as immune-related myasthenic syndrome.

The latest IPCC report in 2021 reported alarming findings on global warming (“Climate change is widespread, rapid, and intensifying”). Besides, on the one hand, young activists’ mobilization shows their awareness on climate emergency but on the other hand, their actions don’t always follow alternatives for transition.In order to fill the gap, schools, both a place for the transmission of knowledge and the learning of citizenship, appear as the ideal place to develop climate and ocean literacy and encourage young people to take action.Research and neurosciences studies have highlighted the effectiveness of active learning methods as well as the importance of enhancing climate literacy during early age. Indeed, between 8 and 12, children develop a set of core values which will the basis of their lifelong commitment to ethical actions. That’s why Choisis ta planète aims at empowering the young generations to show that alternative paths are possible and value responsible actions to build a better future.Since 2012, the French organization Choisis ta planète has been providing support to worldwide organizations taking action to build a more just and sustainable future. Our field of expertise is the creation of educational short movies with children and for children. We work in partnership with local organizations that are expert on issues related to climate change. The goal is to present concrete solutions and the main characters are always children. So far, we have created 24 short movies made in 8 countries, in relation to 14 of the 17 sustainable development goals. The movies have been presented in 107 international festivals and they are broadcast to a large audience every year, through a network of partner organizations, schools and libraries.In 2022, we will focus on SDG 14 – Life below water. We are in the process of identifying expert organizations to partner with them and create innovative awareness-raising materials with them. First (January-march), we will meet the organizations to collect information and draft the scenario. Then (April-June), we will work with the partner organizations to agree on the values and messages they want to convey and find children who will be the characters. Finally (July), there will be 2 weeks of repeat and film shooting in order to finalize and broadcast the movie in September.We are looking forward to sharing our work, materials and experience in the session on Climate and ocean literacy!

The International Initiative on Thrombosis and Cancer is an independent academic working group of experts aimed at establishing global consensus for the treatment and prophylaxis of cancer-associated thrombosis. The 2013, 2016, and 2019 International Initiative on Thrombosis and Cancer clinical practice guidelines have been made available through a free, web-based mobile phone application. The 2022 clinical practice guidelines, which are based on a literature review up to Jan 1, 2022, include guidance for patients with cancer and with COVID-19. Key recommendations (grade 1A or 1B) include: (1) low-molecular-weight heparins (LMWHs) for the initial (first 10 days) treatment and maintenance treatment of cancer-associated thrombosis; (2) direct oral anticoagulants for the initial treatment and maintenance treatment of cancer-associated thrombosis in patients who are not at high risk of gastrointestinal or genitourinary bleeding, in the absence of strong drug-drug interactions or of gastrointestinal absorption impairment; (3) LMWHs or direct oral anticoagulants for a minimum of 6 months to treat cancer-associated thrombosis; (4) extended prophylaxis (4 weeks) with LMWHs to prevent postoperative venous thromboembolism after major abdominopelvic surgery in patients not at high risk of bleeding; and (5) primary prophylaxis of venous thromboembolism with LMWHs or direct oral anticoagulants (rivaroxaban or apixaban) in ambulatory patients with locally advanced or metastatic pancreatic cancer who are treated with anticancer therapy and have a low risk of bleeding.

Ce papier s'interesse a la creation des nouvelles connaissances dans les organisations de l'aviation civile. En nous basant sur des entrevues realisees aupres de pilotes et de controleurs aeriens, nous evaluons l'impact et les effets des interactions des professionnels de la securite aerienne sur la complexification des connaissances organisationnelles, sur les procedures implantees et sur la fiabilite qui en decoule. Les resultats de nos analyses indiquent d'importantes lacunes communicationnelles qui peuvent mener a une reduction de la fiabilite des operations de l'aviation civile, surtout lorsque les processus en cause sont lies a des tentatives de maximisation des profits.

Natural glycopeptides have been shown to possess interesting biological activities. In this work, we have developed a general solid-phase approach to C-terminal glycopeptides. Taking advantage of oxime resin ester bond nucleophile susceptibility, we optimised the nucleophilic cleavage step with glycosylamines and demonstrated the generality and scope of this method. In addition, this reaction has high functional group tolerance and can be used for the preparation of longer C-terminal glycopeptides, demonstrated with the synthesis of a glycododecapeptide in one single step. The results pave the way to access efficiently novel medically relevant compounds.

International audience; 716 IDH2 mutations are commonly associated with 1p/19q codeletion in diffuse adult gliomas Diffuse gliomas are classified according to the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System, 1 which combines histological and molecular features. Diagnosis requires the assessment of mutations in the isocitrate dehydrogenase genes (IDH1 and IDH2), key genetic alterations characterizing gliomas with favorable outcome. 2 Because IDH1 and IDH2 are highly similar enzymes, the WHO classification, as most of the current studies, combines these mutations into the same molecular group; however, it is unclear whether these tumors share the same characteristics. We analyzed data from 1517 patients included in the French POLA Network to investigate differences between IDH1-and IDH2-mutant gliomas. Inclusion criteria were the written consent of the patient for clinical data collection and genetic analysis and sufficient material for molecular studies allowing classification according to the 2016 WHO classification. IDH1-R132H mutational status was evaluated using automated immunohistochemistry in all cases (n = 1517). Direct sequencing 3 was performed in 978 cases and demonstrated IDH mutation in 573 cases (this includes confirmation of IDH1-R132H mutation in 468 cases, other IDH1 mutations in 61 cases, and IDH2 mutation in 44 cases). The 1p/19q codeletion status was determined based on single nucleotide polymor-phism arrays, comparative genomic hybridization arrays, and/ or microsatellite marker analysis. 3 The following data were recorded: age, sex, follow-up, and MRI features (tumor location , extension, contrast enhancement, edema). All statistical analysis was done using IBM SPSS statistics software version 23. Chi-square test was used to compare qualitative variables. Continuous variables were compared using the Mann– Whitney U-test, and the Kaplan–Meier method was used to estimate survival distributions. Among the 1517 patients, 1025 had an IDH-mutant tumor: 96% were IDH1-mutant and 4% IDH2-mutant. Integrated diagnoses are summarized in Fig. 1. The frequency of 1p/19q code-letion was higher in the IDH2-mutant group compared with the IDH1-mutant group (91% vs 48%, P < 0.001). Wang and coworkers previously reported higher frequency of 1p/19q codeletion in IDH2-mutant gliomas (9/18 samples) compared with IDH1-mutant. 4 The percentage of each category in our study does not reflect the normal distribution of glioma because of the inclusion criteria in the POLA Network (ie, high-grade glioma with oligodendroglial component). However, the higher proportion of 1p/19q codeleted glioma in the IDH2-mutant group cannot be attributed to the inclusion criteria. Because the main population of glioma associated with IDH2 mutation was 1p/19q codeleted anaplastic oligodendroglioma, we focused on this subgroup to search for differences compared with IDH1 mutation. Among these patients (n = 474), we did not observe any difference in terms of age, sex, progression free survival, or overall survival between IDH1-and IDH2-mutant tumors. However, IDH2-mutant anaplastic oli-godendrogliomas presented more frequently with multilobar extension (56% of the IDH2-mutant vs 35% of the IDH1-mutant, P = 0.015) and edema (79% vs 57%, P = 0.02). Furthermore, bifrontal location with corpus callosum involvement was more frequent in IDH2-mutant compared with IDH1-mutant tumors (41% vs 16%, P < 0.001). IDH mutation is supposed to be one of the first " hits " of gliomagenesis, 5 resulting in production of an oncome-tabolite, D-2-hydroxyglutarate (D-2HG), which impacts the α-ketoglutarate–dependent dioxygenase functions. Previous studies demonstrated that the potential for IDH-mutant enzymes to produce D-2HG depends on the mutation type. 6 Based on our observations, we could hypothesize that the higher D-2HG accumulation induced by IDH2 mutation may lead to a phenotype that is favorable to 1p/19q chromosomal loss. It may also impact distinct cellular pathways that promote a more invasive phenotype. Whether IDH1 or IDH2 mutations impact distinct glial precursor cells with differential invasive properties remains to be elucidated. In conclusion, our results illustrate that IDH2-mutant glio-mas are commonly associated with 1p/19q codeletion. Most of IDH2-mutant anaplastic oligodendroglioma 1p/19q codeleted are multilobar. Understanding the genomic events involved in these specificities may represent a step forward for therapeutic development.

BACKGROUND: The aim of this study was to correlate MRI features and molecular characteristics in anaplastic oligodendrogliomas (AOs). METHODS: The MRI characteristics of 50 AO patients enrolled in the French national network for high-grade oligodendroglial tumors were analyzed. The genomic profiles and IDH mutational statuses were assessed using high-resolution single-nucleotide polymorphism arrays and direct sequencing, respectively. The gene expression profiles of 25 1p/19q-codeleted AOs were studied on Affymetrix expression arrays. RESULTS: Most of the cases were frontal lobe contrast-enhanced tumors (52%), but the radiological presentations of these cases were heterogeneous, ranging from low-grade glioma-like aspects (26%) to glioblastoma-like aspects (22%). The 1p/19q codeletion (n = 39) was associated with locations in the frontal lobe (P = .001), with heterogeneous intratumoral signal intensities (P = .003) and with no or nonmeasurable contrast enhancements (P = .01). The IDH wild-type AOs (n = 7) more frequently displayed ringlike contrast enhancements (P = .03) and were more frequently located outside of the frontal lobe (P = .01). However, no specific imaging pattern could be identified for the 1p/19q-codeleted AO or the IDH-mutated AO. Within the 1p/19q-codeleted AO, the contrast enhancement was associated with larger tumor volumes (P = .001), chromosome 9p loss and CDKN2A loss (P = .006), genomic instability (P = .03), and angiogenesis-related gene expression (P < .001), particularly for vascular endothelial growth factor A and angiopoietin 2. CONCLUSION: In AOs, the 1p/19q codeletion and the IDH mutation are associated with preferential (but not with specific) imaging characteristics. Within 1p/19q-codeleted AO, imaging heterogeneity is related to additional molecular alterations, especially chromosome 9p loss, which is associated with contrast enhancement and larger tumor volume.

This work aimed to prospectively record all primary central nervous system tumor (PCNST) cases in France, for which histological diagnosis is available. The objectives were to (i) create a national registry and a network to perform epidemiological studies; (ii) implement clinical and basic research protocols; and (iii) harmonize the health care of patients affected by PCNST. For 5 years, 25 756 cases of newly diagnosed and histologically confirmed PCNST have been recorded. Histological diagnoses included glioma (48.9%), all other neuroepithelial tumors (5%), meningioma (28.8%), nerve sheath tumors (8.4%), lymphoma (3.2%) and others (5.7%). Cryopreservation was reported for 6018 PCNST specimens. Tumor resections (R) were performed in 78% cases, while biopsies accounted for 22%. Median age (MA), sex, percentage R and number of cryopreserved tumors were detailed for each histology; for example, out of 6053 glioblastomas (MA 63 years, male 59.4%, R 62%, 1611 were cryopreserved), and out of 37 atypical teratoid/rhabdoid tumors (MA 2 years, male 56.8%, R 94%, 17 were cryopreserved). This database or databank dedicated to PCNST cases contains detailed data on clinical, histological and other characteristics, such as the inclusion of data on cryopreserved specimens that are not available in other European registries. Therefore, this is a valuable resource that can be used for planning future epidemiological and clinical research.

The incidence of brain metastases (BM) has increased due to the improvement of therapeutics and diagnostic imaging, but also to an aging population. The initial symptoms may develop suddenly or insidiously over weeks or months. The symptoms depend on the location of the BM and related complications (hydrocephalus, tumor hemorrhage, cerebral herniation). Headaches are the most frequent symptoms (50%); they are related to intracranial hypertension. Cognitive deficits are commonly described at diagnosis (67 to 90.5%). Cognitive assessment is essential because of its impact on patients' prognosis and quality of life. Nevertheless, these deficits remain underestimated. The Karnofsky Perfomance Scale and the Mini Mental State Examination (MMSE) seem inadequate. A short battery was proposed and internationally validated, assessing seven domains: attention (Digit Symbol Test WAIS-III), episodic memory (Hopkins Verbal Learning Test [HVLT]), working memory (Digit Span Test WAIS-III), verbal fluency (Controlled Oral Word Association Test [COWA]), fine motor dexterity (Grooved Pegboard Test), information processing speed (Trail Making Test [TMT] A) and executive functions (TMT B). This battery is relevant, feasible and associated with a good compliance. These cognitive tests are currently recommended to assess cognitive functions in patients with BM.

Background Paraneoplastic neurologic syndrome (PNS) represents the remote effects of cancer on the nervous system. Diagnostic criteria for the syndrome were published by the PNS Euronetwork and form the basis of a database to collect standardized clinical data from patients with PNS. Objectives To analyze various types of PNS, frequent tumor and antibody associations, clinical characteristics of individual syndromes, and possible therapeutic and prognostic strategies. Design Prospective case series and database study. Setting Twenty European centers. Patients Patients were recruited from January 1, 2000, to December 31, 2008. Main Outcome Measures Based on diagnostic criteria published by the PNS Euronetwork consortium, clinical characteristics of classic PNS and several other less well-characterized syndromes associated with cancer were assessed. Results Data from 979 patients were analyzed, representing the largest PNS investigation to date. The findings elucidate the clinical evolution of paraneoplastic cerebellar syndrome according to the onconeural antibodies present, the heterogeneity and prognosis of dysautonomic disorders, and the clinical variability of paraneoplastic limbic encephalitis. Conclusion The study results confirm that PNS influences oncologic patient survival. Tumors are the main cause of death, but some types of PNS (such as dysautonomia) have a poorer prognosis than malignant neoplasms.

Recurrent glioblastoma multiforme (GBM) is resistant to most therapeutic endeavours, with low response rates and survival rarely exceeding 6 months. There are no standard chemotherapeutic regimens and new therapeutic approaches have to be found. We report an open-label, uncontrolled, multicentre phase II trial of lonidamine (LND) and diazepam in 16 patients with GBM at first relapse and a Karnofsky performance statusor = 70. The treatment regimen consisted of LND 450 mg/day and diazepam 15 mg/day orally of every 28-day cycle until progression or unacceptable toxicity. Patients received a median of three cycles (range, 1-12). No complete or partial response was observed. Therefore, according to the design of the study, no additional patients were enrolled and the trial was closed. Nevertheless, seven stabilizations (50%) were observed. Median time to progression was 8 weeks (range, 5-19 weeks). Median overall survival from recurrence was 15 weeks (range, 14-61 weeks). No grade 3-4 toxicity, except somnolence, was observed and there were no therapy-related deaths. Dose reduction for diazepam due to somnolence (grade III) was performed in 9 patients. The combination of LND and diazepam is well tolerated. LND and diazepam, acting on two distinct mitochondrial sites involved in cellular energy metabolism, may exert a cytostatic effect on tumour growth as shown by the high percentage of stable patients. The LND-diazepam at the used dosing schedule did not show a complete or partial response. LND plus diazepam may be interesting in the adjuvant setting or associated to chemotherapy to act on different targets and increase the therapeutic index.

Glioblastomas are highly malignant but locally invasive tumors. In only rare instances do extra-neural metastasis occur. We report herein 2 cases of such dissemination occurring 9 and 15 month after the initial diagnosis and treatment of supratentorial gliomas. Metastasis involved the lung, the kidney and the liver in one case and the bones in the other case. Both patients died within 3 month after diagnosis of the systemic metastasis despite chemotherapy.

This paper summarizes the recent advances in the field of neuro-oncology. Improvement in the surgical procedures and radiosurgery, correlation between genetic alteration and the chemosensitivity of some primary brain tumors, definition of optimal therapeutic regimen in primary central nervous system lymphoma and better insights in the physiopathology of paraneoplastic syndrome represent the most significant contribution in the field over the past three years.

Phosphorothioate oligodeoxynucleotides with CpG motifs (CpG-ODNs) activate various immune cell subsets and induce production of numerous cytokines. To evaluate whether CpG-ODNs can induce rejection of established tumors, Lewis rats were inoculated intracerebrally with syngeneic CNS-1 glioma cells and subsequently injected with CpG-ODNs into the tumor bed. Although all of the control rats (n = 14) died within 23 days, 88% of the animals (n = 8) treated with a single CpG-ODN injection 5 days after tumor inoculation showed long-term survival (90 days; P0.002). CpG-ODNs increased tumoral infiltration with macrophage/microglial cells, CD8, and natural killer lymphocytes. CpG-ODN-cured animals were further protected against a second tumor challenge. CpG-ODNs had no effect on a s.c. CNS1 tumor in nude mice, which suggested that CpG-ODN is not directly cytotoxic and that immunostimulation is required for the antitumoral effect. These findings suggest that intratumoral injections of CpG-ODNs represent a new immunotherapeutic approach in human gliomas, which overcome the need for the selection and purification of a tumoral antigen.

Phosphorothioate oligodeoxynucleotides with CpG motifs (CpG-ODNs) activate various immune cell subsets and induce production of numerous cytokines. To evaluate whether CpG-ODNs can induce rejection of established malignant tumor, A/J mice were challenged by the s.c. implantation of a syngenic neuroblastoma cell line (neuro2a) and subsequently injected with CpG-ODNs in the vicinity of the tumor. Daily injections of 10 microg CpG-ODNs for 15 days seemed to be the most potent regimen, leading to the eradication of 5-mm-diameter tumors in one-half of the animals and a significant tumor growth inhibition when compared with controls (88% reduction volume; P0.001). CpG-ODN-cured animals were further protected against a new tumor challenge. The antitumoral effect of CpG-ODNs was dependent on CpG motifs, and natural killer cells seemed to play a critical role in tumor rejection. We conclude that immunostimulatory CpG-ODNs may induce the rejection of established tumors and warrant further evaluation as a potential immunotherapeutic agent.