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Girard N, Greillier L, Zalcman G, Cadranel J, Moro-Sibilot D, Mazières J, Audigier-Valette C, Bennouna J, Besse B, Cortot A, Couraud S, Duruisseaux M, Giroux-Leprieur E, Toffart AC, Westeel V, Wislez M. Proposals for managing patients with thoracic malignancies during COVID-19 pandemic. Respir Med Res 2020; 78:100769. [PMID: 32563968 PMCID: PMC7246014 DOI: 10.1016/j.resmer.2020.100769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 12/25/2022]
Abstract
The objective of this document is to formalize a degraded mode management for patients with thoracic cancers in the context of the COVID-19 pandemic. The proposals are based on those of the French High Council for Public Health, on published data outside the context of COVID-19, and on a concerted analysis of the risk-benefit ratio for our patients by a panel of experts specialized on thoracic oncology under the aegis of the French-Language Society of Pulmonology (SPLF)/French-language oncology group. These proposals are evolving (10 April 2020) according to the situations encountered, which will enrich it, and are to be adapted to our institutional organisations and to the evolution of resources during the COVID-19 epidemic. Patients with symptoms and/or COVID-19+ are not discussed in this document and are managed within the framework of specific channels.
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Bejan-Angoulvant T, Naccache JM, Caille A, Borie R, Nunes H, Ferreira M, Cadranel J, Crestani B, Cottin V, Marchand-Adam S. Evaluation of efficacy and safety of rituximab in combination with mycophenolate mofetil in patients with nonspecific interstitial pneumonia non-responding to a first-line immunosuppressive treatment (EVER-ILD): A double-blind placebo-controlled randomized trial. Respir Med Res 2020; 78:100770. [PMID: 32777737 DOI: 10.1016/j.resmer.2020.100770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Nonspecific interstitial pneumonia (NSIP) are rare but severe diseases, with high mortality and morbidity, with no effective pharmacological treatment allowing for long-term remission, and therefore no clear therapeutic recommendations. Classic immunosuppressants are used as first-line treatment, with only one third of patients being responders and no clear recommendations exist for the choice of the second-line therapy. The EvER-ILD study is the first one to prospectively evaluate the efficacy and safety of rituximab and mycophenolate mofetil (MMF) versus placebo and MMF in a broad range of NSIP patients that did not respond to a first-line therapy. A pharmacokinetic-pharmacodynamic analysis based on rituximab serum concentrations will allow identification of potential factors associated with therapeutic response and/or adverse effects. METHODS EvER-ILD study is a French multicenter, prospective, randomized, double blind, placebo-controlled, superiority trial. Patients with severe and progressive NSIP non-responding to a first line immunosuppressive treatment will be randomized in 2 groups of treatment: one course of rituximab plus 6 months MMF (RTX-MMF group) and one course of placebo plus 6 months MMF (Placebo-MMF group). The primary outcome is the change in Forced Vital Capacity (FVC, % of predicted) from baseline to 6 months. Several clinical, biological, and quality of life secondary outcomes will be measured at 3, 6 and 12 months. A sample size of 122 patients (61 patients per group) would allow to show a point difference between groups in the change of FVC at 6 months, based on a common standard deviation for FVC change of 8% with a power of 90%, alpha 5% two-sided, and anticipating an extreme 10% drop-out rate. ETHICS AND DISSEMINATION The protocol was approved by the French Research Ethics Committee (CPP Tours Ouest 1 2016-R28) on November 10, 2016, and by the French competent authority (ANSM, reference 160771A-22) on December 1st, 2016. This article refers to protocol V2, dated November 18, 2016. An independent data safety monitoring board will review safety and tolerability data for the duration of the trial. Results will be disseminated via peer reviewed publication and presentation at international conferences. TRIAL REGISTRATION NUMBER NCT02990286 (clinicaltrials.gov), EudraCT 2016-003026-16 (European Medicines agency).
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Fontaine-Delaruelle C, Mazières J, Cadranel J, Mastroianni B, Dubos-Arvis C, Dumont P, Monnet I, Pichon E, Locatelli-Sanchez M, Dixmier A, Coudert B, Fraboulet S, Foucher P, Dansin E, Baize N, Vincent M, Missy P, Morin F, Moro-Sibilot D, Couraud S. Somatic profile in lung cancers is associated to reproductive factors in never-smokers women: Results from the IFCT-1002 BioCAST study. Respir Med Res 2020; 77:58-66. [PMID: 32416585 DOI: 10.1016/j.resmer.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/30/2019] [Accepted: 01/24/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lung cancer in women is on the rise, with a higher proportion occurring in lifelong never-smokers. Lung cancer in never-smokers (LCINS) exhibits a high frequency of driver oncogene alterations. In this study, we aimed to investigate whether exposure to reproductive factors in women with LCINS may modulate the molecular pattern. METHODS All newly diagnosed LCINSs were included in a prospective, observational study (IFCT-1002 BioCAST). Each patient responded to a questionnaire including reproductive factors. Biomarker test results were also collected. RESULTS Two hundred and sixty women were included in this analysis, and 166 alterations were characterized. EGFR mutation frequency proved greater among patients with late menarche (74% in age>14 vs. 40% and 41% for 12-14 and ≤12 years, respectively; P=0.020) and tended to decrease with increasingly late age at menopause. In multivariate analysis, EGFR mutation frequency increased by 23% per increment of 1 year of age at menarche (P=0.048), and by 9% for each year at age at first birth (P=0.035). ALK alteration frequency was greater in women with high parity (50% in≥5 vs. 12% and 7% for 1-4 and nulliparity, respectively; P=0.021). CONCLUSION In a cohort of women LCINSs, female hormonal factors appear to impact molecular pattern.
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Ruppert AM, Lavolé A, Makinson A, Le Maître B, Cadranel J. [How to reduce lung cancer mortality among people living with HIV?]. Rev Mal Respir 2020; 37:267-274. [PMID: 32197931 DOI: 10.1016/j.rmr.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
Lung cancer is the leading cause of cancer related death among people living with HIV (PLHIV). Tobacco exposure is higher among PLHIV (38.5%) and mainly explains the increased risk of lung cancer. To reduce lung cancer mortality, two approaches need to be implemented: lung cancer screening with low-dose thoracic CT scan and smoking cessation. Low dose CT scan is feasible in PLHIV. The false positive rate is not higher than in the general population, except for cases with CD4 <200/mm3. The impact on survival remains to be assessed. Despite the high prevalence, smoking cessation research among PLHIV is scarce. Very low quality data from 11 studies showed that more intensive smoking cessation interventions were effective in achieving short-term abstinence. A single randomized phase 3 trial showed the superiority of varenicline compared to placebo in long-term smoking cessation. The maximum benefit of reducing lung cancer mortality should be obtained by combining smoking cessation and lung cancer screening.
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Maitre T, Cottenet J, Godet C, Bonniaud P, Cadranel J, Quantin C. Aspergilloses pulmonaires chroniques en France : prévalence, pronostic et pathologies pulmonaires préexistantes sur la base nationale du Programme de médicalisation des systèmes d’information de 2009 à 2018. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mazieres J, Cropet C, Montané L, Barlesi F, Souquet P, Quantin X, Dubos-Arvis C, Otto J, Favier L, Avrillon V, Cadranel J, Moro-Sibilot D, Monnet I, Westeel V, Le Treut J, Brain E, Trédaniel J, Jaffro M, Collot S, Ferretti G, Tiffon C, Mahier-Ait Oukhatar C, Blay J. Vemurafenib in non-small-cell lung cancer patients with BRAFV600 and BRAFnonV600 mutations. Ann Oncol 2020; 31:289-294. [DOI: 10.1016/j.annonc.2019.10.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 12/21/2022] Open
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Anquetil C, Salem J, Manouchehri A, Lambotte O, Lebrun-Vignes B, Spano J, Klatzmann D, Rosenzwajg M, Fautrel B, Cadranel J, Johnson D, Moslehi J, Benveniste O, Allenbach Y. Phénotype et pronostic des atteintes systémiques induites sous inhibiteurs de check-points immunitaires. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Marques C, Plaisier E, Cacoub P, Cadranel J, Saadoun D. [Review on anti-glomerular basement membrane disease or Goodpasture's syndrome]. Rev Med Interne 2019; 41:14-20. [PMID: 31776042 DOI: 10.1016/j.revmed.2019.10.338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/20/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023]
Abstract
Anti-glomerular basement membrane (anti-GBM) disease or Goodpasture's syndrome is a small vessel vasculitis affecting the capillary beds of kidneys and lungs. It is an autoimmune disease mediated by autoantibodies targeting the glomerular and alveolar basement membranes, leading to pneumorenal syndrome. It is a rare, monophasic and severe disease, associating rapidly progressive glomerulonephritis and alveolar hemorrhage. The presence of antineutrophil cytoplasmic antibodies (ANCA) is reported in 20 to 60% of cases. Management should be prompt and combine plasma exchange with systemic corticosteroids and immunosuppressive therapy by cyclophosphamide. The objective of this review is: 1) to describe the pathogenesis, clinical and histological features of the disease; 2) to characterize double-positive anti-GBM/ANCA patients; 3) to highlight the prognostic factors of renal and global survival, and 4) to focus on the treatment of anti-GBM disease.
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Goto Y, Cadranel J, Weinberg B, Duruisseaux M, Liu S, Tolba K, Branden E, Doebele R, Heining C, Schlenk R, Laskin J, Cheema P, Jones M, Trombetta D, Muscarella L, Cseh A, Solca F, Renouf D. NRG1-fusion-driven solid tumours: A case series indicating the therapeutic potential of afatinib. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz420.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Liu S, Duruisseaux M, Tolba K, Branden E, Goto Y, Weinberg B, Renouf D, Doebele R, Heining C, Schlenk R, Cheema P, Cadranel J, Jones M, Drilon A, Trombetta D, Muscarella L, Cseh A, Solca F, Laskin J. Targeting NRG1-fusions in multiple tumour types: Afatinib as a novel potential treatment option. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Duruisseaux M, Laskin J, Tolba K, Brandén E, Goto Y, Doebele R, Cheema P, Cadranel J, Jones M, Drilon A, Trombetta D, Muscarella L, Cseh A, Solca F, Liu S. P1.14-25 Targeting NRG1-Fusions in Lung Adenocarcinoma: Afatinib as a Novel Potential Treatment Strategy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Novello S, Brustugun O, Cadranel J, Griesinger F, Hochmair M, Pérol M, Popat S, Bent-Ennakhil N, Kruhl C, Felip E. Brigatinib in ALK TKI-pretreated ALK+ metastatic non-small cell lung cancer (mNSCLC): The use via expanded access to brigatinib (UVEA-Brig) study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Baldacci S, Figeac M, Antoine M, Descarpentries C, Kherrouche Z, Jamme P, Copin M, Tulasne D, Nanni I, Beau-Faller M, Melaabi S, Levallet G, Quoix E, Moro-Sibilot D, Friard S, Missy P, Barlesi F, Cadranel J, Cortot A. P2.14-53 High MET Overexpression Does Not Predict the Presence of MET Exon 14 Splice Mutations in NSCLC: Results from the IFCT Predict.amm Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mascaux C, Sauvajeon S, Cadranel J, Chouaid C, Stern J, Vergnenegre A, Cortot C, Guery L, Belkhiria K, De la Porte I, Urbieta M, Perol M. Crossed looks on lung cancer perception and knowledge from general public and physicians in France: Results of a two-fold survey. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz263.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Créquit P, Cadranel J, Mal H, Grigoriu B, Berghmans T. [Lung transplantation for lepidic invasive adenocarcinoma: From a clinical question to an ethical consideration]. Rev Mal Respir 2019; 36:919-923. [PMID: 31521430 DOI: 10.1016/j.rmr.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/01/2019] [Indexed: 01/15/2023]
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Camuset J, Naccache JM, Dhalluin X, Febvre M, Wallyn F, Ouennoure O, Copin MC, Assouad J, Antoine M, Cadranel J, Fournier C. [Transbronchial cryobiopsy in diffuse interstitial lung diseases]. Rev Mal Respir 2019; 36:455-460. [PMID: 31005425 DOI: 10.1016/j.rmr.2018.10.618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the diagnostic approach to interstitial lung disease (ILD), the use of transbronchial cryobiopsy (TBC) may offer an alternative to surgical lung biopsy (SLB). We report the diagnostic effectiveness and the safety of TBC in ILD based on the preliminary experience in two French university centers. METHODS Twenty four patients underwent TBC for the diagnosis of ILD in the operating room between 2014 and 2017. All the histological diagnoses obtained were then reviewed and validated during multidisciplinary discussions (MDD). RESULTS Patients had an average of 3 TBC.TBC samples were analyzable in 22/24 (91.7%) patients. In these, samples allowed a histological diagnosis to be made in 14/22 (63.6%) patients and a diagnosis with certainty in 13/22 (59%) after MDD. The overall diagnostic yield from TBC was 13/24 (54.2%). Nine (37.5%) patients had a pneumothorax. Five (20.8%) patients had a bleeding. There were no deaths. Taking into account a possible initial learning curve and considering only the 15 patients who had their TBC after 2015, we note that a diagnosis could be made after MDD for 12 of them, that is, 80%. CONCLUSION A prospective randomized study is needed to evaluate the technique in France in order to specify its diagnostic performance and its safety profile in comparison to SLB.
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Halmos B, Tan E, Soo R, Cadranel J, Ki Lee M, Foucher P, Hsia T, Hochmair M, Griesinger F, Hida T, Kim E, Melosky B, Märten A, Carcereny E. Impact de la dose d’afatinib sur la tolérance et l’efficacité en vie réelle chez des patients avec CBNPC avancé EGFR muté. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cadranel J, Torabi E, Bava M, Nahmias L, Dje A, Colaianni A, Mollet J, Morere J, Chouaid C. #SMOKLM, une campagne originale pour sensibiliser les « 18–25 ans » aux conséquences immédiates du tabagisme. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chelabi S, Mignard X, Lacave R, Monnet I, Ollier M, Brosseau S, Theou-Anton N, Massiani M, Doucet L, De Cremoux P, Friard S, Duchemann B, Fabre E, Blons H, Giroux-Leprieur E, Azarian R, Cadranel J, Wislez M. Insertion exon 20 de l’EGFR dans les adénocarcinomes pulmonaires métastatiques : réponse au traitement et survie. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Millet F, Wislez M, Fallet V, Baud M, Canellas A, Ruppert A, Guegan S, Moal D, Cadranel J, Lavole A. Rôle de l’infirmière de coordination dans la prise en charge rapide du cancer du poumon. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Febvre M, Souidi A, Fallet V, Sanchis Borja M, Izadifar A, Baud M, Pham S, Didier M, Cadranel J. [Mediastinitis after endobronchial ultrasound-guided transbronchial needle aspiration: Should we modify our practices?]. Rev Mal Respir 2018; 35:1063-1064. [PMID: 30554592 DOI: 10.1016/j.rmr.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 11/26/2022]
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Blons H, Oudart JB, Merlio JP, Hominal S, de Fraipont F, Debieuvre D, Escande F, Audigier Valette C, Bringuier PP, Moreau Fraboulet S, Ouafik L, Moro-Sibilot D, Lemoine A, Langlais A, Missy P, Morin F, Souquet PJ, Barlesi F, Cadranel J, Beau-Faller M. Molecular heterogeneity assessment by NGS in non-small cell lung cancer (NSCLC) harboring EGFR mutations: Results of the French Cooperative Thoracic Intergroup (IFCT) Biomarkers France study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wislez M, Blons H, Domblides C, Barlesi F, Mazieres J, Monnet I, Kiakouama Maleka L, Quantin X, Taillade L, Lena H, Fraisse P, Janicot H, Audigier Valette C, Amour E, Langlais A, Rabbe N, Cadranel J, Laurent puig P, Lavolé A. Circulating tumor DNA (ctDNA) in advanced non-small cell lung cancer (NSCLC) from HIV-infected patients is associated to shorter overall survival (OS): Results from phase II trial (IFCT-1001 CHIVA). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Halmos B, Tan E, Soo R, Cadranel J, Lee M, Foucher P, Hsia T, Hochmair M, Griesinger F, Hida T, Kim E, Melosky B, Märten A, Carcereny E. P1.01-28 Impact of Afatinib Dosing on Safety and Efficacy Real-World in Patients with EGFR Mutation-Positive Advanced NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Parrot A, Voiriot G, Canellas A, Gibelin A, Nacacche JM, Cadranel J, Fartoukh M. Hémorragies intra-alvéolaires. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
L’hémorragie intra-alvéolaire (HIA), maladie rare, est une urgence thérapeutique, car elle peut conduire rapidement vers une insuffisance respiratoire aiguë asphyxiante avec décès. La triade, hémoptysie–anémie–infiltrat radiologique, suggère le diagnostic d’HIA, mais elle peut manquer dans deux tiers des cas, y compris chez des patients en détresse respiratoire. La tomodensitométrie thoracique peut aider dans les formes atypiques. Le diagnostic d’HIA repose sur la réalisation d’un lavage bronchoalvéolaire. Les étiologies en sont très nombreuses. Il importera de séparer, en urgence, les HIA d’origine non immune, avec un dépistage de celles d’origine septique qui doivent bénéficier d’une enquête microbiologique ciblée et cardiovasculaire avec la réalisation d’une échographie cardiaque, des HIA immunes (les vascularites liées aux anticorps anticytoplasme des polynucléaires neutrophiles, les connectivites et le syndrome de Goodpasture), avec la recherche d’autoanticorps et la réalisation de biopsies au niveau des organes facilement accessibles. La biopsie pulmonaire doit rester exceptionnelle. En cas d’HIA immune inaugurale, un traitement par stéroïdes et cyclophosphamide peut être débuté. Les indications du rituximab commencent à être mieux établies. Le bénéfice des échanges plasmatiques est débattu. En cas de réapparition d’infiltrats pulmonaires, chez un patient suivi pour une HIA immune, on s’efforcera d’écarter une infection dans un premier temps.
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