101
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Sargos P, Baumann BC, Eapen LJ, Bahl A, Murthy V, Roubaud G, Orré M, Efstathiou JA, Shariat S, Larré S, Richaud P, Christodouleas JP. Adjuvant radiotherapy for pathological high-risk muscle invasive bladder cancer: time to reconsider? Transl Androl Urol 2016; 5:702-710. [PMID: 27785427 PMCID: PMC5071208 DOI: 10.21037/tau.2016.08.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Radical cystectomy with extended pelvic lymph-node dissection, associated with neo-adjuvant chemotherapy, remains the standard of care for advanced, non-metastatic muscle-invasive bladder cancer (MIBC). Loco-regional control is a key factor in the outcome of patients since it is related to overall survival (OS), disease-free survival (DFS) and cause-specific survival. The risk of loco-regional recurrence (LRR) is correlated to pathological factors as well as the extent of the lymphadenectomy. In addition, neither pre- nor post-operative chemotherapy have shown a clear impact on LRR-free survival. Several recent publications have led to the development of a nomogram predicting the risk of LRR, in order to identify patients most likely to benefit from adjuvant radiotherapy. Given the high risk of LRR for selected patients and improvements in radiation techniques that can reduce toxicity, there is a growing interest in adjuvant radiotherapy; international cooperative groups have come together to provide the rationale in favor of adjuvant radiotherapy. Clinical trials in order to reduce the risk of pelvic relapse are opened based on this optimizing patient selection. The aim of this critical literature review is to provide an overview of the rationale supporting the studies of adjuvant radiation for patients with pathologic high-risk MIBC.
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Affiliation(s)
- Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Brian C Baumann
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Libni J Eapen
- Department of Radiation Oncology, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amit Bahl
- Department of Radiation Oncology, University Hospitals Bristol, Bristol, UK
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Mathieu Orré
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Stephane Larré
- Department of Urology, Reims University Hospital, Reims, France
| | - Pierre Richaud
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - John P Christodouleas
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
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102
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Fizazi K, Flechon A, Le Teuff G/, Mardiak J, Pagliaro LC, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard JC, Malhaire JP, Linassier C, Habibian M, Reckova M, Logothetis C, Culine S. Mature results of the GETUG 13 phase III trial in poor-prognosis germ-cell tumors (GCT). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | | | - Jozef Mardiak
- Department of Clinical Oncology, National Cancer Institute, Commenius University, Bratislava, Slovakia
| | | | | | - Pierre Kerbrat
- Medical Oncology Eugene Marquis Comprehensive Cancer Center, Rennes, France
| | | | - Remy Delva
- Institut de Cancérologie de l'Ouest, Angers, France
| | | | | | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Gwenaelle Gravis
- Medical Oncology, Institut Paoli Calmette, Hôpital de Jour, Marseille, France
| | | | | | | | | | | | | | - Stephane Culine
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
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103
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Sargos P, Latorzeff I, Fléchon A, Roubaud G, Brouste V, Gaston R, Piéchaud T, Orré M. EP-1386: Adjuvant pelvic radiotherapy for pathological high-risk muscle-invasive bladder cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32636-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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104
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Sargos P, Latorzeff I, Flechon A, Roubaud G, Brouste V, Gaston R, Piechaud T, Richaud P, Orre M. Adjuvant pelvic radiotherapy for pathological high-risk muscle-invasive bladder cancer: A multicenter retrospective study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
369 Background: Radical cystectomy (RC) and pelvic lymph-node dissection (PLND) are standard procedures in the management of non-metastatic muscle invasive bladder cancer (MIBC). Loco-regional recurrence (LRR) is a common early event associated with a poor prognosis. The aim of this study is to evaluate adjuvant radiotherapy (RT) for pathological high-risk MIBC. Methods: We retrospectively reviewed data from patients treated by RC from 3 institutions. Inclusion criteria were MIBC, histologically proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. LRR free-survival, overall survival (OS) and metastasis-free survival (MFS) were evaluated. Acute toxicities were recorded according to CTCAE V4.0 scale. Results: Between January 2000 and December 2013, 57 patients with a median age of 66 years (45-84) were included. Post-operative pathological staging was pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% of pN0, 26% of pN1 and 42% of pN2. For 2 patients, no PLND was performed. Median number of lymph-nodes retrieved was 10 (2-33). Forty-eight patients (84%) received platin-based chemotherapy, 7 in neo-adjuvant and 41 in adjuvant setting. For RT, clinical target volume 1 (CTV 1) alwyas encompasses pelvic lymph nodes and cystectomy bed for 37 patients (65%). Median dose for CTV 1 was 45 Gy (4-50). Dose complement of 16 Gy (5-22) corresponding to CTV 2 was achieved in 53 of cases, depending on pathological features. Intensity Modulated RT was performed in one third of patients. With a median follow-up of 40.4 months, LRR occurred in 8 patients (14%). Three-year loco-regional free survival, MFS and OS were 45% (IC 95%: 0.30-0.60), 39% (IC 95%: 0.25-0.52) and 49% (IC 95%: 0.33-0.63), respectively. Acute grade ≥ 3 toxicities were observed in 5 patients (9%). One patient died with intestinal fistula in septic context. No survival or toxicity predictive factor was identified. Conclusions: Adjuvant radiotherapy for pathological high-risk MIBC is safe and may have oncological benefits. Thus, new prospective trials evaluating this approach with modern RT techniques should be undertaken.
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Affiliation(s)
| | | | | | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
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105
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Roubaud G, Brouste V, Beuzeboc P, Fléchon A, Tosi D, Lavau-Denes S, Chevreau C, Culine S, Oudard S, Quivy A, Pourquier P, Houédé N. Early objective response may not be a prognostic factor of survival for patients with metastatic urothelial carcinoma: from a retrospective analysis of a cohort of 113 patients. J Negat Results Biomed 2015; 14:18. [PMID: 26555878 PMCID: PMC4641378 DOI: 10.1186/s12952-015-0037-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 11/02/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aims to better define prognostic factors for patients with metastatic urothelial carcinoma (mUC), and to identify patients who will benefit from first-line cisplatin-based chemotherapy. We test the hypothesis that early objective response (EOR), defined as the occurrence of an objective response following 2 or 3 courses of chemotherapy, could be a prognostic factor for overall survival (OS) and thus be used to guide treatment decisions. Data from 113 patients with evaluable mUC receiving first-line cisplatin-based treatment between January 2004 and December 2006 was collected retrospectively from prospectively-maintained databases across seven French cancer centers. Clinical factors potentially associated with survival and EOR were analyzed in univariate and multivariate analysis. RESULTS One hundred three patient records were complete and available for inclusion in the multivariate model. Four factors were independently associated with OS: Performance status 1 and 2 (HR 2.3 [95 % CI 1.3-3.9], p = 0.002; HR 3.4 [95 % CI 1.6-7.2], p = 0.001 respectively); presence of visceral metastases (HR 2.2 [95 % CI 1.3-3.9], p = 0.004); abnormal hemoglobin levels (HR 1.7 [95 % CI 1.01-2.8], p = 0.045); disease progression (HR 10.1 [95 % CI 4.2-24.1], p < 0.001). CONCLUSIONS This study confirms the prognostic factors previously reported in first-line chemotherapy for mUC. However, we failed to demonstrate that EOR was an independent predictive factor of OS. Nevertheless, an early response evaluation is recommended since early progression is an important parameter that can be used to decide whether treatment should be interrupted and changed for alternative strategies integrating the concept of personalized medicine or new immune therapies.
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Affiliation(s)
- Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 229, Cours de l'Argonne, 33076, Bordeaux, France.
| | - Véronique Brouste
- Institut Bergonié, Clinical and Epidemiological Research Unit, 33000, Bordeaux, France.
| | - Phillipe Beuzeboc
- Department of Medical Oncology, Institut Curie, 25 rue d'Ulm, 75005, Paris, France.
| | - Aude Fléchon
- Department of Medical Oncology, Institut Léon Berard, 69000, Lyon, France.
| | - Diego Tosi
- Department of Medical Oncology, Institut Val d'Aurelle, 34000, Montpellier, France.
| | | | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, 31000, Toulouse, France.
| | - Stéphane Culine
- Centre Hospitalier Universitaire Saint Louis, 75010, Paris, France.
| | | | - Amandine Quivy
- Department of Medical Oncology, Institut Bergonié, 229, Cours de l'Argonne, 33076, Bordeaux, France.
| | - Philippe Pourquier
- Institut de Recherche en Cancérologie de Montpellier & Université de Montpellier 1, INSERM U896, F-34000, Montpellier, France.
| | - Nadine Houédé
- Department of Medical Oncology, Institut Bergonié, 229, Cours de l'Argonne, 33076, Bordeaux, France.
- Department of Medical Oncology, CHU Caremeau, 30029, Nîmes, France.
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106
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Labrize F, Cany L, Massard C, Loriot Y, Sargos P, Gross-Goupil M, Roubaud G. Enzalutamide and sleep apnea: an emerging central nervous system side-effect? Ann Oncol 2015; 27:206. [PMID: 26445811 DOI: 10.1093/annonc/mdv481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Labrize
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - L Cany
- Department of Medical Oncology, Clinique Francheville, Périgueux
| | - C Massard
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif
| | - Y Loriot
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - M Gross-Goupil
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - G Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux
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107
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Houede N, Roubaud G, Mahammedi H, Vedrine L, Joly F, Mourey L, Pfister C, Culine S, Goberna A, Lortal B, Pulido M, Pourquier P, Bellera C. 2594 Safety and efficacy of Temsirolimus (Torisel®) as second line treatment for patients with recurrent bladder cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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108
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Gillon P, Godbert Y, Dupin C, Bubien V, Italiano A, Roubaud G. Long clinical benefit achieved in two patients with malignant paraganglioma treated by metronomic cyclophosphamide. Future Oncol 2015; 10:2121-5. [PMID: 25471026 DOI: 10.2217/fon.14.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Treatment of malignant paraganglioma remains a challenge with an overall 5-year survival rate between 34 and 60%. Systemic treatment is recommended in case of unresectable malignant paraganglioma. Recent advances in molecular biology provided rationale to use antiangiogenic agents in this setting. Metronomic cyclophosphamide could be efficient by antiangiogenic effect and immune stimulation with a good safety profile. Here, we report two cases of malignant paraganglioma in frail and symptomatic patients, achieving a long-term clinical benefit with such regimen, after progression or toxicity with sunitinib.
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Affiliation(s)
- Pauline Gillon
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
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109
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Chakiba C, Cornelis F, Descat E, Gross-Goupil M, Sargos P, Roubaud G, Houédé N. Dynamic contrast enhanced MRI-derived parameters are potential biomarkers of therapeutic response in bladder carcinoma. Eur J Radiol 2015; 84:1023-8. [DOI: 10.1016/j.ejrad.2015.02.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/27/2015] [Accepted: 02/23/2015] [Indexed: 12/27/2022]
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110
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Pouessel D, Aarab Terrisse S, Mouillet G, Breitkopf K, Theodore C, Joly Lobbedez F, Roubaud G, Flechon A, Tourani JM, Massard C, Thiery-Vuillemin A, Oudard S, Sevin E, Chevret S, Culine S. Activity of docetaxel (D) and new generation hormonotherapies (NGH) in patients with metastatic castrate-resistant prostate cancer (mCRPC) following front line cabazitaxel (C). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Damien Pouessel
- Department of Medical Oncolgy, Hopital Saint-Louis, Paris, France
| | | | | | | | | | - Florence Joly Lobbedez
- Département d'Oncologie médicale, Cancérologie gynécologique et urologique Centre François Baclesse - CHU Côte de Nacre, Caen, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | | | | | | | | | | | | | | | - Stephane Culine
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
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111
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Houédé N, Beuzeboc P, Gourgou S, Tosi D, Moise L, Gravis G, Delva R, Fléchon A, Latorzeff I, Ferrero JM, Oudard S, Tartas S, Laguerre B, Topart D, Roubaud G, Agherbi H, Rebillard X, Azria D. Abiraterone acetate in patients with metastatic castration-resistant prostate cancer: long term outcome of the Temporary Authorization for Use programme in France. BMC Cancer 2015; 15:222. [PMID: 25884302 PMCID: PMC4392747 DOI: 10.1186/s12885-015-1257-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/25/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND COU-AA-301 trial has proved that abiraterone acetate (AA), a selective inhibitor of androgen biosynthesis, improved overall survival (OS) of patients with metastatic castration resistant prostate cancer (mCRPC) after a first line of docetaxel. Based on this result, a Temporary Authorization for Use (TAU) was performed between December 2010 and July 2011 to provide patients with mCRPC the opportunity to receive AA before its commercialization. The aim of this study was to evaluate safety and efficacy of AA treatment in this TAU. METHODS Between December 2010 and July 2011, we conducted an ambispective, multicentric cohort study and investigated data from 20 centres participating to the AA TAU for patients presenting mCRPC and already treated by a first line of chemotherapy (CT). Statistical analyses of the data were performed using the Stata software v13 to identify predictive and prognostic factors. RESULTS Among the 408 patients, 306 were eligible with a follow-up at 3 years. Median OS was 37.1 months from beginning of CT and 14.6 months from AA introduction. 211 patients (69%) received ≥ 3 months of AA and 95 patients (31%) were treated less than 3 months. In the multivariate analyses, duration of AA was significantly correlated with PSA decrease at 3 months. Additionally, shorter time under AA treatment, presence of multiple sites of metastasis and previous hormonal treatment duration were three independent factors associated with poorer OS. At the time of analysis ten patients were still under treatment for more than 3 years. CONCLUSIONS Biochemical response monitored by PSA changes at 3 months is a strong predictive factor for AA treatment duration. Some high responders' patients could beneficiate from AA for more than 3 years.
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Affiliation(s)
- Nadine Houédé
- Department of Medical Oncology, Nîmes University Hospital, Nîmes, France. .,INSERM U1194, Montpellier, France.
| | | | - Sophie Gourgou
- Biostatistics Unit, ICM - Montpellier Cancer Institute, Montpellier, France.
| | - Diego Tosi
- Department of Medical Oncology, ICM - Montpellier Cancer Institute, Montpellier, France.
| | - Laura Moise
- Department of Medical Oncology, François Baclesse Cancer Centre, Caen, France.
| | - Gwenaëlle Gravis
- Department of Medical Oncology, Paoli Calmette Institute, Marseille, France.
| | - Remy Delva
- Department of Medical Oncology, Paul Papin Cancer Centre, Angers, France.
| | - Aude Fléchon
- Department of Medical Oncology, Leon Bérard Cancer Centre, Lyon, France.
| | | | - Jean-Marc Ferrero
- Department of Medical Oncology, Antoine Lacassagne Cancer Centre, Nice, France.
| | - Stéphane Oudard
- Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France.
| | - Sophie Tartas
- Department of Medical Oncology, Lyon University Hospital, Lyon, France.
| | - Brigitte Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Centre, Rennes, France.
| | - Delphine Topart
- Department of Medical Oncology, Montpellier University Hospital, Montpellier, France.
| | - Guilhem Roubaud
- Department of Medical Oncology, Bergonié Cancer Institute, Bordeaux, France.
| | | | - Xavier Rebillard
- Department of Urology, Clinique Beausoleil, Montpellier, France.
| | - David Azria
- INSERM U1194, Montpellier, France. .,Department of Radiation Oncology, ICM - Montpellier Cancer Institute, Montpellier, France.
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112
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Orré M, Latorzeff I, Fléchon A, Xylinas E, Roubaud G, Chapet O, Richaud P, Sargos P. Radiothérapie périopératoire dans la prise en charge des tumeurs urothéliales infiltrantes de la vessie (TVIM) : une indication à reconsidérer ? ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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113
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Houede N, Roubaud G, Mahammedi H, Vedrine L, Joly F, Mourey L, Pfister C, Culine S, Goberna A, Lortal B, Pulido M, Pourquier P, Bellera CA. Safety and efficacy of temsirolimus as second-line treatment for patients with recurrent bladder cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
304 Background: Bladder cancer is the 7th cause of death from cancer in men and 10th in women. For metastatic patients, prognosis is poor with a median overall survival of 15 months that remained unchanged for the past 15 years. No standard second-line chemotherapy is available for patients who relapse. Acquired mutations leading to a deregulation of the PI3K/AKT/mTOR pathway have been reported in more than 40% of bladder cancers suggesting the use of the mTOR (mammalian target of rapamycin) signalling pathway as an attractive target for the treatment of urothelial tumors. Methods: The main objective of this study was to assess the efficacy of temsirolimus, an mTOR inhibitor that is already used for the treatment of renal cancers, in patients with recurrent or metastatic bladder cancer who already received a first line chemotherapy. Efficacy was measured in terms of non-progression of the disease at two months of treatment following the RECIST v1.1 criteria. Based on a two-stage optimal Simon’s design, a total of 15 non-progressions out of 51 eligible and assessable patients were required to claim efficacy. Patients were treated at a weekly dose of 25 mg until progression, unacceptable toxicities or withdrawal. Results: Fifty-four patients were enrolled in the study between November 2009 and July 2014 in seven French centres. At the end of the first stage, six patients out of 17 were progression-free at 2 months leading to the inclusion of additional 37 patients in the second stage of the study. Thirty-six patients were eligible and assessable for the primary efficacy endpoint. A total of 18 (50%) non-progressions were observed at 2 months. Among them, partial response was documented for two patients and stable disease for 16. Twenty-five related adverse events were observed in 19 (35.2%) of the patients. Conclusions: Our study is providing the first clinical evidence of a potential benefit of temsirolimus for the treatment of relapsed bladder cancers. Ancillary study is ongoing to investigate the mutational status of genes which are involved in the PI3K/AKT/mTOR signalling pathway in order to identify a predictive signature of response to temsirolimus in bladder cancer. Clinical trial information: NCT0187943NCT0187943.
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Affiliation(s)
- Nadine Houede
- Centre Hospitalier Régional Universitaire, Nîmes, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | | | | | - Florence Joly
- Comite Uro-Gynecologie, Centre François Baclesse, Caen, France
| | | | | | - Stephane Culine
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
| | | | | | | | | | - Carine A. Bellera
- Institut Bergonié, Regional Comprehensive Cancer Center, Bordeaux, France
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114
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Pouessel D, Chevret S, Roubaud G, Aarab-Terrisse S, Chevreau C, Vordos D, Rolland F, Boudin L, Joly F, Joly C, Beuzeboc P, Boyle HJ, Farneti D, Dauba J, Moriceau G, Alexandre I, Deplanque G, Loriot Y, Houede N, Culine S. A comparison of the outcomes after neoadjuvant (NC) or adjuvant chemotherapy (AC) for muscle-invasive urothelial bladder cancer (UC): A French contemporary retrospective multicenter cohort. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
325 Background: Our aim was to investigate outcome of patients (pts) treated with AC or NC for organ-confined UC, or with NC for clinical lymph node involvement (cN+). Methods: We retrospectively analyzed 482 pts treated in 22 French hospitals between 2000 and 2013 in 3 settings: 226 pts with radical cystectomy (RC) and AC (AC group), 193 cN0 (NC group), and 63 cN+ (cN+ group) pts received NC before a planned RC for cT2-T4, M0 UC. The primary outcome was overall survival (OS). Cancer-related survival (CRS) was also evaluated. Multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios with 95% confidence interval. Results: Median age was 62, 61.7, and 62.1 in AC, NC, and cN+, respectively. Median time between diagnosis and first treatment (RC or NC) was 2.1, 1.4 and 1.6 months, respectively (p<0.001). In AC, stages were p≤T2 (n=46) or pT≥3 (n=180), pN0 (n=37), pN+ (n=168), or pNx (n=21). Gemcitabine-cisplatin and gemcitabine-carboplatin regimen were mainly delivered as AC in 71.2% and 21.7% of pts. In NC, all pts received methotrexate-vinblastine-doxorubicin-cisplatin (MVAC) or dose-dense MVAC. Median number of cycles was 4 in each group. After NC, RC has been realized in 173 (90%) and 51 pts (82%) in NC and cN+, respectively. In 17 unoperated pts, concomitant chemoradiotherapy was performed. Median follow-up was 24.6 months. Respectively, 133 (59%), 61 (32%), and 22 (35%) pts have relapsed in AC, NC, and cN+; 74%, 63%, and 71% of them received chemotherapy for metastasis. Also 133 (59%), 41 (21%), and 18 (29%) pts died, mostly (90%) due to recurrence. Three-year OS and CRS rates were 54%, 68%, and 56% (p=0.02), and 37%, 53%, and 49% (p=0.038) in AC, NC, and cN+, respectively. In multivariate analysis, only AC (HR: 1.64, 95% CI 1.18-2.30, p=0.001) remained significantly associated with shortened OS. Conclusions: In this large retrospective study reporting real-life survivals, 3-year OS was longer in pts receiving NC, both in cN0 and in cN+ groups, than in pts treated with AC. Although several selection bias can be emphasized preventing us from drawing definitive conclusions, AC appeared to be associated with a poorer prognosis.
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Affiliation(s)
- Damien Pouessel
- Department of Medical Oncolgy, Hopital Saint-Louis, Paris, France
| | | | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | | | | | - Dimitri Vordos
- Department of Urology, Hôpital Henri Mondor, Creteil, France
| | | | - Laurys Boudin
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Florence Joly
- Comite Uro-Gynecologie, Centre François Baclesse, Caen, France
| | - Charlotte Joly
- Department of Medical Oncology, Centre Alexis Vautrin, Nancy, France
| | | | | | | | - Jérôme Dauba
- Centre Hospitalier Layné, Mont de Marsan, France
| | - Guillaume Moriceau
- Department of Medical Oncology, Institut de Cancérologie de la Loire, Saint-Priest-en Jarez, France
| | | | | | | | | | - Stephane Culine
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
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115
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Houede N, Beuzeboc P, Gourgou S, Tosi D, Moise L, Gravis G, Delva R, Flechon A, Latorzeff I, Ferrero JM, Oudard S, Tartas S, Laguerre B, Topart D, Roubaud G, Agherbi H, Rebillard X, Azria D. Abiraterone acetate in patients with metastatic castration-resistant prostate cancer: Long term outcome of the Temporary Authorization for Use program in France. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
264 Background: COU-AA-301 trial has proved that abiraterone acetate (AA), a selective inhibitor of androgen biosynthesis, improved overall survival (OS) of patients with metastatic castration resistant prostate cancer (mCRPC) after a first line of docetaxel. Based on this result, a temporary use authorisation (TUA) was performed between December 2010 and July 2011 to provide patients with mCRPC the opportunity to receive AA before its commercialization. The aim of this study was to evaluate safety and efficacy of AA treatment in this TUA. Methods: Between December 2010 and July 2011, we conducted an ambispective, multicentric cohort study and investigated data from 20 centres participating to the AA TUA for patients presenting mCRPC and already treated by a first line of chemotherapy (CT). Statistical analyses of the data were performed using the Stata software v13 to identify predictive and prognostic factors. Results: Among the 408 patients, 306 were eligible with a follow-up at 3 years. Median OS was 37.1 months from beginning of CT and 14.6 months from AA introduction. 211 patients (69%) received ≥ 3 months of AA and 95 patients (31%) were treated less than 3 months. In the multivariate analyses, duration of AA was significantly correlated with PSA decrease at 3 months. Additionally, shorter time under AA treatment, presence of multiple sites of metastasis and previous hormonal treatment duration were three independent factors associated with poorer OS. At the time of analysis ten patients were still under treatment for more than 3 years. Conclusions: Biochemical response monitored by PSA changes at 3 months is a strong predictive factor for AA treatment duration. Some high responders’ patients could beneficiate from AA for more than 3 years.
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Affiliation(s)
| | | | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, Montpellier Cancer Institute, Montpellier, France
| | - Diego Tosi
- Institut régional du Cancer de Montpellier, Val d’Aurelle, Montpellier, France
| | | | - Gwenaelle Gravis
- Medical Oncology, Institut Paoli Calmette, Hôpital de Jour, Marseille, France
| | | | | | - Igor Latorzeff
- Clinique Pasteur Groupe Oncorad Garonne, Toulouse, France
| | - Jean-Marc Ferrero
- Department d'Oncologie Medicale, Centre Antoine Lacassagne, Nice, France
| | - Stephane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | - Sophie Tartas
- University of Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | | | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | | | | | - David Azria
- Institut Régional du Cancer Montpellier, Montpellier, France
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116
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Gizzi M, Baciarello G, Flechon A, Beuzeboc P, Angelergues A, Roubaud G, Bompas E, Le Moulec S, Latorzeff I, Delva R, Voog E, Priou F, Duclos B, Laguerre B, Vassal C, Gross Goupil M, Patrikidou A, Fizazi K, Loriot Y. Previous enzalutamide therapy and response to subsequent taxane therapy in metastatic castration-resistant prostate cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
227 Background: Cross-resistance between taxanes and androgen receptor axis targeted agents is a matter of debate in metastatic castration-resistant prostate cancer (mCRPC). Preclinical data about response to taxanes after prior enzalutamide suggest some level of cross-resistance (van Soest et al, Eur J Cancer 2013) though this was not confirmed in other models (Al Nakouzi N, Eur Urol 2014). The first objective of this study was to assess the impact of previous enzalutamide therapy on the efficacy of subsequent taxane-based chemotherapy. The second objective was to investigate the prognosis of patients when chemotherapy was initiated in enzalutamide-pretreated patients. Methods: Data from 96 enzalutamide- and placebo-treated patients enrolled in the Prevail phase III trial were retrospectively collected from 14 centers in France. Changes in prostate specific antigen (PSA) levels, progression free survival (PFS) and RECIST criteria v 1.1 were used to determine the activity of docetaxel (n=89) or cabazitaxel (n=7) treatment. The Halabi model was used to predict survival probabilities for the enzalutamide- or placebo-pretreated patients when chemotherapy was initiated (Halabi et al, J Clin Oncol 2014). Results: Overall, 96 patients were included in this analysis (58 in the placebo arm vs. 38 in enzalutamide arm). PSA response to taxanes (defined as a decline of ≥50% from baseline) was marginally lower in enzalutamide-vs. placebo-pretreated patients (34% vs. 53%, p=0.10). PSA response in enzalutamide-pretreated patients was not different from that observed with docetaxel given every 3 weeks in TAX 327 trial (Tannock et al, NEJM 2004) (45%, p=0.20, binomial test). Median PFS and objective response rates were similar between the two groups (4.8m vs 6.7 m;p=0.14 and 45% vs 43%;p=0.83 respectively). Halabi score was well-balanced between the two groups (p=0.30). Conclusions: Taxanes retain efficacy in enzalutamide-pretreated mCRPC. At the time of first-line taxane-based chemotherapy initiation, the prognosis of enzalutamide-treated patients according to the Halabi score was not different from that of enzalutamide-naïve patients.
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Affiliation(s)
| | - Giulia Baciarello
- Department of Cancer Medicine, Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | | | | | | | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain, France
| | | | | | - Remy Delva
- Institut de Cancérologie de l'Ouest, Angers, France
| | - Eric Voog
- Clinique Victor Hugo, Le Mans, France
| | - Frank Priou
- Centre Hospitalier La Roche sur Yon, La Roche sur Yon, France
| | | | | | - Cecile Vassal
- Institut de cancérologie Lucien Neuwirth, Saint Priez en Jarez, France
| | | | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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117
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Fizazi K, Pagliaro L, Laplanche A, Fléchon A, Mardiak J, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard JC, Malhaire JP, Linassier C, Habibian M, Martin AL, Journeau F, Reckova M, Logothetis C, Culine S. Personalised chemotherapy based on tumour marker decline in poor prognosis germ-cell tumours (GETUG 13): a phase 3, multicentre, randomised trial. Lancet Oncol 2014; 15:1442-1450. [PMID: 25456363 DOI: 10.1016/s1470-2045(14)70490-5] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Poor prognosis germ-cell tumours are only cured in about half of patients. We aimed to assess whether treatment intensification based on an early tumour marker decline will improve progression-free survival for patients with germ-cell tumours. METHODS In this phase 3, multicentre, randomised trial, patients were enrolled from France (20 centres), USA (one centre), and Slovakia (one centre). Patients were eligible if they were older than 16 years, had evidence of testicular, retroperitoneal, or mediastinal non-seminomatous germ cell tumours based on histological findings or clinical evidence and highly elevated serum human chorionic gonadotropin or alfa-fetoprotein concentrations that matched International Germ Cell Cancer Consensus Group poor prognosis criteria. After one cycle of BEP (intravenous cisplatin [20 mg/m(2) per day for 5 days], etoposide [100 mg/m(2) per day for 5 days], and intramuscular or intravenous bleomycin [30 mg per day on days 1, 8, and 15]), patients' human chorionic gonadotropin and alfa-fetoprotein concentrations were measured at day 18-21. Patients with a favourable decline in human chorionic gonadotropin and alfa-fetoprotein continued BEP (Fav-BEP group) for 3 additonal cycles, whereas patients with an unfavourable decline were randomly assigned (1:1) to receive either BEP (Unfav-BEP group) or a dose-dense regimen (Unfav-dose-dense group), consisting of intravenous paclitaxel (175 mg/m(2) over 3 h on day 1) before BEP plus intravenous oxaliplatin (130 mg/m(2) over 3 h on day 10; two cycles), followed by intravenous cisplatin (100 mg/m(2) over 2 h on day 1), intravenous ifosfamide (2 g/m(2) over 3 h on days 10, 12, and 14), plus mesna (500 mg/m(2) at 0, 3, 7 and 11 h), and bleomycin (25 units per day, by continuous infusion for 5 days on days 10-14; two cycles), with granulocyte-colony stimulating factor (lenograstim) support. Centrally blocked computer-generated randomisation stratified by centre was used. The primary endpoint was progression-free survival and the efficacy analysis was done in the intention-to-treat population. The planned trial accrual was completed in May, 2012, and follow-up is ongoing. This study is registered with ClinicalTrials.gov, number NCT00104676. FINDINGS Between Nov 28, 2003, and May 16, 2012, 263 patients were enrolled and 254 were available for tumour marker assessment. Of these 51 (20%) had a favourable marker assessment, and 203 (80%) had an unfavourable tumour marker decline; 105 were randomly assigned to the Unfav-dose-dense group and 98 to the Unfav-BEP group. 3-year progression-free survival was 59% (95% CI 49-68) in the Unfav-dose-dense group versus 48% (38-59) in the Unfav-BEP group (HR 0·66, 95% CI 0·44-1·00, p=0·05). 3-year progression-free survival was 70% (95% CI 57-81) in the Fav-BEP group (HR 0·66, 95% CI 0·49-0·88, p=0·01 for progression-free survival compared with the Unfav-BEP group). More grade 3-4 neurotoxic events (seven [7%] vs one [1%]) and haematotoxic events occurred in the Unfav-dose-dense group compared with in the Unfav-BEP group; there was no difference in grade 1-2 febrile neutropenia (18 [17%] vs 18 [18%]) or toxic deaths (one [1%] in both groups). Salvage high-dose chemotherapy plus a stem-cell transplant was required in six (6%) patients in the Unfav-dose-dense group and 16 (16%) in the Unfav-BEP group. INTERPRETATION Personalised treatment with chemotherapy intensification reduces the risk of progression or death in patients with poor prognosis germ-cell tumours and an unfavourable tumour marker decline. FUNDING Institut National du Cancer (Programme Hospitalier de Recherche Clinique).
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Affiliation(s)
- Karim Fizazi
- Institut Gustave Roussy, Department of Cancer Medicine, Villejuif, France.
| | - Lance Pagliaro
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Agnes Laplanche
- Institut Gustave Roussy, Department of Biostatistics, Villejuif, France
| | - Aude Fléchon
- Centre Léon Bérard, Department of Cancer Medicine, Lyon, France
| | | | | | - Pierre Kerbrat
- Centre Eugène Marquis, Department of Cancer Medicine, Rennes, France
| | | | - Remy Delva
- Institut de Cancérologie de l'Ouest, Department of Cancer Medicine, Angers, France
| | - Frederic Rolland
- Institut de Cancérologie de l'Ouest, Department of Cancer Medicine, Nantes, France
| | | | - Guilhem Roubaud
- Institut Bergonié, Department of Cancer Medicine, Bordeaux, France
| | - Gwenaëlle Gravis
- Institut Paoli Calmette, Department of Cancer Medicine, Marseille, France
| | | | | | - Claude Linassier
- Centre Hospitalo-Universitaire, Department of Cancer Medicine, Tours, France
| | | | | | - Florence Journeau
- Institut Gustave Roussy, Department of Biostatistics, Villejuif, France
| | | | | | - Stephane Culine
- Hôpital Saint Louis, Department of Cancer Medicine, Paris, France
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118
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Sargos P, Latorzeff I, Grellety T, Hoepffner J, Gross-Goupil M, Houédé N, Dupin C, Richaud P, Roubaud G. Cystite hémorragique chez les patients traités par cabazitaxel pour un cancer de la prostate métastatique : un syndrome de rappel après radiothérapie pelvienne? Cancer Radiother 2014. [DOI: 10.1016/j.canrad.2014.07.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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119
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Selle F, Wittnebel S, Biron P, Gravis G, Roubaud G, Bui BN, Delva R, Bay JO, Fléchon A, Geoffrois L, Caty A, Soares DG, de Revel T, Fizazi K, Gligorov J, Micléa JM, Dubot C, Provent S, Temby I, Gaulet M, Horn E, Brindel I, Lotz JP. A phase II trial of high-dose chemotherapy (HDCT) supported by hematopoietic stem-cell transplantation (HSCT) in germ-cell tumors (GCTs) patients failing cisplatin-based chemotherapy: the Multicentric TAXIF II study. Ann Oncol 2014; 25:1775-1782. [PMID: 24894084 DOI: 10.1093/annonc/mdu198] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-dose chemotherapy (HDCT) is an effective salvage treatment of germ-cell tumors (GCTs) patients. In the first salvage setting, 30%-70% of patients may achieve durable remissions. Even when HDCT is administered as subsequent salvage treatment, up to 20% of patients may still be definitively cured. However, patients with refractory/relapsed disease still have a very poor long-term prognosis, requiring earlier intervention of HDCT. PATIENTS AND METHODS This phase II trial was addressed to nonrefractory patients failing Cisplatin-based chemotherapy. Inclusion criteria included seminomatous GCT in relapse after two lines of chemotherapy, nonseminomatous GCT in relapse after first or second lines, partial remission after first line, primary mediastinal GCT in first relapse. Patients received two cycles combining Epirubicin and Paclitaxel (Epi-Tax), followed by three consecutive HDCT, one using a Paclitaxel/Thiotepa (Thio-Tax) association and two using the 5-day Ifosfamide-Carboplatin-Etoposide regimen. The main objective was to determine the complete response rate. RESULTS Forty-five patients were included between September 2004 and December 2007: 44 received the first HDCT cycle, 39 two HDCT cycles, 29 could receive the whole protocol. Sixteen patients did not receive the entire protocol, including eight (17.7%) for toxic side-effects. Two patients (4.4%) died of toxicities, and 17 (37.7%) of disease progression. With a median follow-up time of 26 months (range, 4-51), the final overall response rate was 48.8% (including a complete response rate of 15.5% and a partial response/negative serum markers rate of 26.6%) in an intent-to-treat analysis. The median progression-free survival (PFS) and overall survival (OS) times were 22 months [95% confidence interval (CI) 2-not reached] and 32 months (95% CI 4-49), respectively. The 2-year PFS was a plateau setup at 50% (95% CI 32-67) and the 2-year OS was 66% (95% CI 44-81). CONCLUSION The TAXIF II protocol was effective in nonrefractory GCT patients failing Cisplatin-based chemotherapy. The toxic death rate remained acceptable in the field of HDCT regimens. TRIAL REGISTRATION NUMBER NCT00231582.
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Affiliation(s)
- F Selle
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris.
| | - S Wittnebel
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - P Biron
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - G Gravis
- Department of Medical Oncology, Institut Paoli Calmette, Marseille
| | - G Roubaud
- Department of Medicine, Institut Bergonié, Bordeaux
| | - B N Bui
- Department of Medicine, Institut Bergonié, Bordeaux
| | - R Delva
- Department of Chemotherapy, Centre Paul Papin, Angers
| | - J O Bay
- Department of Medicine, Centre Hospitalier Universitaire, Clermont-Ferrand
| | - A Fléchon
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - L Geoffrois
- Department of Medicine, Centre Alexis Vautrin, Nancy
| | - A Caty
- Department of Medicine, Centre Oscar Lambret, Lille
| | - D G Soares
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - T de Revel
- Department of Hematology, Hôpital D'Instruction des Armées Percy, Clamart
| | - K Fizazi
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - J Gligorov
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris
| | - J M Micléa
- Cytapheresis and Cell Therapy Unit, Hôpital St Louis (AP-HP), Paris
| | - C Dubot
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - S Provent
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - I Temby
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris
| | - M Gaulet
- Statistic, 3ES-Cegedim Strategic Data, Boulogne, France
| | - E Horn
- Department of Internal Medicine, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - I Brindel
- Department of Clinical Research, Hôpital St Louis (AP-HP), Paris, France
| | - J P Lotz
- Department of Medical Oncology and Cellular Therapy, APREC (Alliance Pour la Recherche En Cancérologie), Hôpital Tenon (Hôpitaux Universitaires de l'Est-Parisien, AP-HP), Paris; Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ Paris 06), Paris
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120
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Pouessel D, Chevret S, Bompas E, Boudin L, Joly C, Grellety T, Aarab Terrisse S, Boyle HJ, Roubaud G, Chevreau C, Dauba J, Moriceau G, Alexandre I, Deplanque G, Chapelle A, Vauleon E, Colau A, Audenet F, Culine S. Pathologic down-staging following standard (SD) MVAC (methotrexate-vinblastine-doxorubicine-cisplatin) or dose-dense MVAC (DD) neoadjuvant chemotherapy (NC) for muscle-invasive urothelial bladder cancer (UC): A retrospective multicenter cohort of the French Genitourinary Tumor Group (GETUG/AFU). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Damien Pouessel
- Department of Medical Oncolgy, Hopital Saint-Louis - APHP, Paris, France
| | | | - Emmanuelle Bompas
- Department of Medical Oncology - Institut de Cancérologie de l'Ouest, Nantes, France
| | - Laurys Boudin
- Department of Medical Oncology - Institut Paoli-Calmettes, Marseille, France
| | - Charlotte Joly
- Department of Medical Oncology - Centre Alexis Vautrin, Nancy, France
| | - Thomas Grellety
- Department of Medical Oncology - CHU Saint-Andre, Bordeaux, France
| | | | | | - Guilhem Roubaud
- Department of Medical Oncology - Institut Bergonie, Bordeaux, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Jérôme Dauba
- Département d'Oncologie Médicale, Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France
| | - Guillaume Moriceau
- Department of Medical Oncology - Institut de Cancérologie de la Loire, Saint-Priest-en Jarez, France
| | | | | | | | | | - Alexandre Colau
- Department of Urology - Hôpital des Diaconesses, Paris, France
| | - Francois Audenet
- Department of Urology - Hopital Europeen Georges Pompidou, Paris, France
| | - Stephane Culine
- Department of Medical Oncology - Hopital Saint-Louis - APHP, Paris, France
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121
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Pagliaro LC, Laplanche A, Flechon A, Mardiak J, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard JC, Malhaire JP, Linassier C, Habibian M, Journeau F, Reckova M, Culine S, Fizazi K. Validation of a prognostic classification system for mediastinal nonseminomatous germ-cell tumors (MGCT). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Jozef Mardiak
- 2nd Oncology Department, Comenius University, Medical School and National Cancer Institute, Bratislava, Slovakia
| | | | | | | | - Remy Delva
- Institut de Cancérologie de l'Ouest, Angers, France
| | | | | | - Guilhem Roubaud
- Department of Medical Oncology - Institut Bergonie, Bordeaux, France
| | - Gwenaelle Gravis
- Medical Oncology, Institut Paoli Calmette, Hôpital de Jour, Marseille, France
| | | | | | - Claude Linassier
- Department of Medical Oncology, Centre Hospitalier Universitaire Tours, Tours, France
| | | | | | | | - Stephane Culine
- Department of Medical Oncology - Hopital Saint-Louis - APHP, Paris, France
| | - Karim Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Cancer Campus, Grand Paris, Villejuif, France
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122
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Grellety T, Houédé N, Hoepffner JL, Rivière J, Mérino C, Lieutenant V, Gross-Goupil M, Richaud P, Dupin C, Sargos P, Roubaud G. Hemorrhagic cystitis in patients treated with cabazitaxel: a radiation recall syndrome? Ann Oncol 2014; 25:1248-9. [PMID: 24692580 DOI: 10.1093/annonc/mdu132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Grellety
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - N Houédé
- Department of Medical Oncology, Institut Bergonié, Bordeaux Department of Medical Oncology, CHU Caremeau, Nîmes
| | | | - J Rivière
- Urology Department, Saint Augustin Clinic, Bordeaux
| | - C Mérino
- Department of Pathology CAP, Bordeaux
| | - V Lieutenant
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - M Gross-Goupil
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - P Richaud
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - C Dupin
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - G Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux
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123
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Fizazi K, Pagliaro LC, Flechon A, Mardiak J, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard JC, Malhaire JP, Linassier C, Habibian M, Journeau F, Logothetis C, Culine S, Laplanche A. A phase III trial of personalized chemotherapy based on serum tumor marker decline in poor-prognosis germ-cell tumors: Results of GETUG 13. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.18_suppl.lba4500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4500 Background: Poor-prognosis GCT (IGCCCG, J Clin Oncol 1997) remains a challenge with no improvement in the 50% survival demonstrated in phase III trials for 25 years. Day 21 serum tumor marker decline rate identified a subgroup of patients (pts) with a better outcome (J Clin Oncol 2004, 22: 3868-76). The hypothesis we tested in this study is that treatment allocation based on early tumor marker decline will improve the progression-free survival (PFS). Methods: Pts with IGCCCG poor-prognosis GCT were treated with a first cycle of BEP. AFP and hCG were assessed at day 18–21: 1) Pts with a favorable decline continued BEP for a total of 4 courses (Fav-BEP); 2) Pts with an unfavorable decline were randomized to receive either BEP (Unfav-BEP) or a dose-dense regimen (Unfav-dose-dense), consisting of paclitaxel-BEP plus day-10 oxaliplatin x 2 cycles, followed by 2 cycles of cisplatin, ifosfamide, and continuous infusion bleomycin (depending on lung function) + G-CSF. The primary endpoint was PFS (hypothesis: 20% difference, type 1 error: 5%, power 80%, 196 randomized pts needed). Results: 263 pts were enrolled and 254 were evaluable at day 21 (6 early deaths, 3 withdrawals): 51 pts (20%) had favorable tumor marker decline and 203 had unfavorable decline (randomized: 105 Unfav-dose-dense arm, 98 Unfav-BEP). The prognostic value of early tumor marker decline (Fav-BEP vs Unfav-BEP) was confirmed: 70% vs 48% for 3-year PFS (p=0.01), and 84% vs 65% for overall survival (OS) (p=0.02). The 3-year PFS was 59% in the Unfav-dose-dense arm vs 48% in the Unfav-BEP arm (p=0.05; HR: 0.66 [0.44-1.00]). 3-year OS was 73% and 65%, respectively. More ≥ grade 2 neurotoxicity (21% vs 4%) and more hematotoxicity occurred in the dose-dense arm, with no excess febrile neutropenia (17% each arm) or toxic deaths (1 each arm). Salvage high-dose chemotherapy + stem-cell transplant were required in 6% in the Unfav-dose-dense arm and 16% in the Unfav-BEP arm (p=0.01). Conclusions: An algorithm of individualized treatment intensification determined by the rate of early tumor marker decline reduces the risk of progression or death in men with poor-prognosis GCT. Clinical trial information: NCT00104676.
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Affiliation(s)
- Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | | | - Jozef Mardiak
- 2nd Oncology Department, Comenius University, Medical School and National Cancer Institute, Bratislava, Slovakia
| | | | | | | | - Remy Delva
- Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | | | | | | | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, INSERM UMR 891, Marseille, France
| | | | | | - Claude Linassier
- Department of Medical Oncology, Centre Hospitalier Universitaire Tours, Tours, France
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Fizazi K, Pagliaro LC, Flechon A, Mardiak J, Geoffrois L, Kerbrat P, Chevreau C, Delva R, Rolland F, Theodore C, Roubaud G, Gravis G, Eymard JC, Malhaire JP, Linassier C, Habibian M, Journeau F, Logothetis C, Culine S, Laplanche A. A phase III trial of personalized chemotherapy based on serum tumor marker decline in poor-prognosis germ-cell tumors: Results of GETUG 13. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.lba4500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4500 The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Saturday, June 1, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
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Affiliation(s)
- Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | | | - Jozef Mardiak
- 2nd Oncology Department, Comenius University, Medical School and National Cancer Institute, Bratislava, Slovakia
| | | | | | | | - Remy Delva
- Institut de Cancérologie de l'Ouest Paul Papin, Angers, France
| | | | | | | | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, INSERM UMR 891, Marseille, France
| | | | | | - Claude Linassier
- Department of Medical Oncology, Centre Hospitalier Universitaire Tours, Tours, France
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Roubaud G, Kind M, Coindre JM, Maki RG, Bui B, Italiano A. Clinical activity of sorafenib in patients with advanced gastrointestinal stromal tumor bearing PDGFRA exon 18 mutation: a case series. Ann Oncol 2012; 23:804-805. [PMID: 22294526 DOI: 10.1093/annonc/mdr631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
| | | | - J-M Coindre
- Departments of Pathology, Institut Bergonié, Bordeaux, France
| | - R G Maki
- Department of Medicine and Pediatrics, Sarcoma Service, Memorial Sloan Kettering Cancer Center, New York, USA.
| | - B Bui
- Departments of Medical Oncology
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Roubaud G, Gross-Goupil M, Wallerand H, de Clermont H, Dilhuydy MS, Ravaud A. Combination of gemcitabine and doxorubicin in rapidly progressive metastatic renal cell carcinoma and/or sarcomatoid renal cell carcinoma. Oncology 2011; 80:214-8. [PMID: 21720184 DOI: 10.1159/000329078] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 04/29/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Metastatic renal cell carcinoma (mRCC) can be rapidly progressive when tumors exhibit sarcomatoid or Fuhrman grade 4 features. Efficacy of gemcitabine (Gem) with doxorubicin (Dox) in sarcomatoid or rapidly progressive mRCC has been reported. We retrospectively evaluated Gem + Dox in a consecutive cohort of this particular patient population. PATIENTS AND METHODS Patients had an Eastern Cooperative Oncology Group performance status of 2 or more and rapidly progressive mRCC or mRCC with sarcomatoid features. Gem (1,500 mg/m(2)) and Dox (50 mg/m(2)) were given every 2 weeks with granulocyte colony-stimulating factor. RESULTS Twenty-nine patients were treated. Sarcomatoid features were predominant in 6 patients, while 14 tumors were Fuhrman grade 4. All patients had progressive mRCC within 4 months. No grade 4 toxicity or drug-related death was reported. One partial response (7 months), 1 mixed response, and 14 stable diseases (≥4 months for 9 patients) were observed and no response was seen in sarcomatoid tumors. The median disease-free survival was 3.7 months (≥6 months for 8 patients) and the median overall survival was 4.8 months (>12 months for 5 patients). CONCLUSION This study showed a lower response rate than previously reported. Nevertheless, some patients had prolonged survival outcomes. This combination could be an option in sarcomatoid histology (NCCN guidelines) or rapidly progressive disease, but this population represents an unmet medical need.
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Affiliation(s)
- G Roubaud
- Department of Medical Oncology, Hôpital Saint André, Bordeaux, France
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Reyal F, Bollet MA, Roubaud G, Vincent-Salomon A, Salmon RJ. Les sous-types moléculaires du cancer du sein. Apport des technologies à haut débit. ONCOLOGIE 2010. [DOI: 10.1007/s10269-010-1907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Roubaud G, Dilhuydy M, Pasticier G, de Clermont H, Smith D, Ravaud A. 4533 POSTER Combination of gemcitabine and doxorubicin in sarcomatoid and/or rapidly progressive metastatic renal cell carcinoma (MRCC). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tournat H, Huchet A, Ouhabrache N, Thomas IC, Roubaud G, Maire JP. Évolution métastatique osseuse d'un méningiome récidivant : à propos d'un cas. Cancer Radiother 2006; 10:590-4. [PMID: 16876455 DOI: 10.1016/j.canrad.2006.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 06/19/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
We report the case of a 57-year-old man who presented with two local recurrences and metastatic dissemination of a papillary meningioma of the sphenoid 3 years after surgery. Treatment consisted in a combination of surgery for the local recurrence in the initial site, radiotherapy and chemotherapy for bone metastases. Evolution of the disease spread over 7.5 years. The literature relating metastatic meningiomas is reviewed; prognostic factors and main therapeutic protocols are discussed.
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Affiliation(s)
- Helène Tournat
- Service d'Oncologie Médicale et de Radiothérapie, Hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
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