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Greillier L, Gounant V, Couraud S, Cortot AB, Mennecier B, Girard N, Besse B, Brouchet L, Debieuvre D, Falcoz PE, Ferretti GR, Guittet L, Fournel P, Khalil A, Laurent F, Molinier O, Quoix E, Souquet PJ, Thomas PA, Trédaniel J, Westeel V, Lemarié E, Barlési F, Zalcman G, Milleron B. Comment intégrer les résultats de l’essai NLST dans notre pratique ? Une réponse multidisciplinaire sous l’égide de l’IFCT et du GOLF. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bylicki O, Segura C, Chouaid C, Lavolé A, Barlesi F, Gervais R, Westeel V, Crequit J, Corre R, Vergnenègre A, Zalcman G, Monnet I, Le Caer H, Fournel P, Linard P, Perol D, Perol M. Efficacité du pemetrexed en 2e ligne dans les CBNPC avancé après un intervalle libre ou un traitement de maintenance par gemcitabine ou erlotinib dans l’étude IFCT-GFPC 05-02. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pérol M, Chouaid C, Pérol D, Barlési F, Gervais R, Westeel V, Crequit J, Léna H, Vergnenègre A, Zalcman G, Monnet I, Le Caer H, Fournel P, Falchero L, Poudenx M, Vaylet F, Ségura-Ferlay C, Devouassoux-Shisheboran M, Taron M, Milleron B. Randomized, phase III study of gemcitabine or erlotinib maintenance therapy versus observation, with predefined second-line treatment, after cisplatin-gemcitabine induction chemotherapy in advanced non-small-cell lung cancer. J Clin Oncol 2012; 30:3516-24. [PMID: 22949150 DOI: 10.1200/jco.2011.39.9782] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This phase III study investigated whether continuation maintenance with gemcitabine or switch maintenance with erlotinib improves clinical outcome compared with observation in patients with advanced non-small-cell lung cancer (NSCLC) whose disease was controlled after cisplatin-gemcitabine induction chemotherapy. PATIENTS AND METHODS Four hundred sixty-four patients with stage IIIB/IV NSCLC without tumor progression after four cycles of cisplatin-gemcitabine were randomly assigned to observation or to gemcitabine (1,250 mg/m(2) days 1 and 8 of a 3-week cycle) or daily erlotinib (150 mg/day) study arms. On disease progression, patients in all three arms received pemetrexed (500 mg/m(2) once every 21 days) as predefined second-line therapy. The primary end point was progression-free survival (PFS). RESULTS PFS was significantly prolonged by gemcitabine (median, 3.8 v 1.9 months; hazard ratio [HR], 0.56; 95% CI, 0.44 to 0.72; log-rank P < .001) and erlotinib (median, 2.9 v 1.9 months; HR, 0.69; 95% CI, 0.54 to 0.88; log-rank P = .003) versus observation; this benefit was consistent across all clinical subgroups. Both maintenance strategies resulted in a nonsignificant improvement in overall survival (OS); patients who received second-line pemetrexed or with a performance status of 0 appeared to derive greater benefit. Exploratory analysis showed that magnitude of response to induction chemotherapy may affect the OS benefit as a result of gemcitabine maintenance. Maintenance gemcitabine and erlotinib were well tolerated with no unexpected adverse events. CONCLUSION Gemcitabine continuation maintenance or erlotinib switch maintenance significantly reduces disease progression in patients with advanced NSCLC treated with cisplatin-gemcitabine as first-line chemotherapy. Response to induction chemotherapy may affect OS only for continuation maintenance.
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Souquet P, Fournel P, Locher C, Sabourin J, Garcia E, Licour M, Karam N. Mutact: An Observational Study of EGFR Mutation Status and Management of Patients with Non-Small Cell Lung Cancer (NSCLC) Adenocarcinoma. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33865-5] [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] Open
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Greillier L, Martel-Lafay I, Arpin D, Pourel N, Chabaud S, Lamy R, Madroszyk A, Fournel P. A Randomised Phase II Study of Cetuximab (C) in Combination with Two Cisplatin-Based Concurrent Chemoradiotherapy Regimens in Patients (PTS) with Stage III Non-Small Cell Lung Cancer (NSCLC). Final Results of the GFPC 08-03 Trial. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fournel P. Limited-stage small cell lung cancer: how to optimize therapy? ONKOLOGIE 2012; 35:332-3. [PMID: 22722452 DOI: 10.1159/000338963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Borget I, Perol M, Perol D, Lavole A, Greillier L, Bizieux-Thaminy A, Westeel V, Berard H, Auliac JB, Zalcman G, Dujon C, Robinet G, Fournel P, Thomas P, Margery J, Oster JP, Chabaud S, Vergnenegre A, Chouaid C. Cost-utility analysis of maintenance therapy with either gemcitabine or erlotinib versus observation with predefined second-line treatment after cisplatin-gemcitabine induction chemotherapy in advanced NSCLC: IFCT-GFPC 0502-eco phase III study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e16560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16560 Background: The IFCT–GFPC 0502 phase III study reported a prolongation of progression-free survival with maintenance with either gemcitabine or erlotinib versus observation after cisplatin-gemcitabine induction chemotherapy in advanced NSCLC. The aim of this analysis is to assess the incremental cost-effectiveness ratio (ICER) of these strategies in the global population and in pre specified sub-groups. Methods: A cost-utility analysis was performed to evaluate ICER of maintenance therapy with either gemcitabine or erlotinib, compared to observation, from randomization until end of follow up. Direct medical costs (including drugs costs, hospitalization, follow-up examinations, second-line treatment and palliative costs) were prospectively collected per patient alongside the trial, until death, from the third party payer perspective. Utility data were extracted from literature. Sensitivity analyses were performed. Results: The ICER for maintenance therapy with gemcitabine and erlotinib were respectively 84,011 and 183,261 euros per quality-adjusted life years (QALY). Gemcitabine maintenance therapy had a favourable ICER in patients with PS = 0 (51,168 €/Qaly), in responders to induction chemotherapy (65,554€/Qaly) and in patients with squamous cell carcinoma (44,884€/Qaly); erlotinib had a favourable ICER in patients with PS = 0 (162,371 €/Qaly) and objective response to induction (101,569 €/Qaly ). Conclusions: Gemcitabine and erlotinib maintenance therapy have acceptable ICER but with a wide variation function of histology, PS and response to the first line chemotherapy.
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Bylicki O, Ferlay C, Chouaid C, Lavolle A, Barlesi F, Gervais R, Westeel V, Crequit J, Corre R, Vergnenegre A, Zalcman G, Monnet I, Le Caer H, Fournel P, Linard P, Perol D, Perol M. Efficacy of pemetrexed as second-line therapy in advanced NSCLC after either treatment-free interval or maintenance therapy with gemcitabine or erlotinib in IFCT-GFPC 05-02 phase III study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.7574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7574 Background: Continuous exposure of tumor cells to maintenance therapy in advanced NSCLC might lead to resistance to subsequent treatments. IFCT–GFPC 0502 study showed a progression-free survival (PFS) benefit with gemcitabine (G) or erlotinib (E) maintenance compared to observation (O) after cisplatin-G induction chemotherapy. The trial included a pre-defined second-line therapy with pemetrexed (P), allowing post-hoc assessment of its efficacy according to previous maintenance treatment or treatment-free interval. Methods: Stage IIIB/IV NSCLC patients (pts) with a PS of 0-1 were randomized after 4 cycles of cisplatin-G chemotherapy to O or to receive maintenance therapy with G or E until disease progression. P was given as second-line treatment on disease progression in all arms. PFS and OS were assessed from the beginning of P therapy according to randomization arm. Tumor response to P and tolerance were also analyzed. Results: Of the 464 pts randomized to either O (155), G (154) or E (155), 360 pts (78 %) received P as second-line therapy, i.e. 130 (84%), 114 (74%) and 116 (75%) in O, G and E arm, respectively. Baseline characteristics remained well balanced between arms (overall median age of 58 years, 28% female, 91% stage IV, 41% PS 0, 65/19/16%, adenocarcinoma/squamous/other, 10% non-smokers and 56% responders to induction CT). Median number of delivered P cycles was 3 (1-40) in all arms. Response rate was 19%, 7% and 15% for non-squamous pts in O, G and E, respectively. Median PFS did not significantly differ between G and O (4.2 vs 3.9 months, HR [95% CI] 0.81 [0.62-1.06]) or E and O (4.2 vs 3.9 months, HR 0.83 [0.64-1.09]). OS data showed a non-significant improvement with G vs O (HR 0.81 [0.61-1.07]) or E vs O (HR 0.80 [0.61-1.05]), with a median of 7.5, 8.3 and 9.1 months for O, G and E, respectively. Results were similar when analysis was restricted to non-squamous pts. Grade 3-4 treatment-related AEs were similar in O (33.1%), G (31.6%) and E (25%). Conclusions: Maintenance therapy with continuation of G or switch to E does not impair the efficacy of second-line P by comparison with administration after a treatment-free interval.
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Fournel P, Pourel N. Les cancers bronchiques. ONCOLOGIE 2012. [DOI: 10.1007/s10269-012-2166-5] [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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Couraud S, Fournel P, Moro-Sibilot D, Pérol M, Souquet PJ. [Which organization for the management of thoracic cancer? Results from a French survey in Rhône-Alpes region]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:1-9. [PMID: 22197158 DOI: 10.1016/j.pneumo.2011.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 04/03/2011] [Accepted: 04/28/2011] [Indexed: 05/31/2023]
Abstract
This survey, conducted in Rhône-Alpes region (France), aims to better understand the actual conditions of practice in thoracic oncology. A questionnaire was distributed to all oncologists, pulmonologists, radiotherapy physicians and thoracic surgeons in the region. Of 401 questionnaires, the response rate was 56%. Among the responders 46% reported exercising the Thoracic Oncology (TO). Most physicians practicing TO are pulmonologists (62%). The majority (45%) are engaged in secondary hospital or university hospital (27%). However, practitioners with the most important activity exerts in university hospitals and cancer centre (71% of physicians practicing in secondary hospitals and 75% of those in private practice reported to manage fewer than 80 new NSCLC cases per year in structure). Furthermore, 91% are regularly involved in a multidisciplinary team. Radiation oncologist, pulmonologists and thoracic surgeons are assiduous to these meeting; however radiologists and, to a lesser extent, pathologists are less attentive. Moreover, 92% of practitioners belong to cancer networks. Similarly, over one third of working together in a cooperative clinical research institution and nearly half are involved in clinical trials (with nearly half in secondary hospital). These results highlight the reality of practice in Rhône-Alpes and will serve as the basis for coordinating authorities to correct dysfunctions or monitor certain activities of interest (clinical trials).
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Barlesi F, Gervais R, Chouaid C, Souquet P, Lavolé A, Monnet I, Étienne-Mastroiani B, Bérard H, Zalcman G, Domas J, Pichon E, Janicot H, Pérol M, Schott R, Vaylet F, Genet D, Moro-Sibilot D, Fournel P, Falchero L, Amador ML, Scherpereel A. AVAPERL : essai randomisé comparant bevacizumab (BEV)+pemetrexed (PEM) versus BEV en traitement (TRT) de maintenance (MTC) après une chimiothérapie (CT) par CDDP/PEM/BEV chez les patients (pts) avec cancer bronchique non à petites cellules non épide. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fournel P. RTOG 94-10: keenly awaited results validating the best therapeutic strategy for locally advanced non-small cell lung cancer. J Natl Cancer Inst 2011; 103:1425-7. [PMID: 21903746 DOI: 10.1093/jnci/djr348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Cartier L, Auberdiac P, Khodri M, Malkoun N, Chargari C, Thorin J, Mélis A, Talabard JN, de Laroche G, Fournel P, Tiffet O, Schmitt T, Magné N. Correlation of dosimetric parameters obtained with the analytical anisotropic algorithm and toxicity of chest chemoradiation in lung carcinoma. Med Dosim 2011; 37:152-6. [PMID: 21925864 DOI: 10.1016/j.meddos.2011.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 06/15/2011] [Accepted: 06/23/2011] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to analyze and revisit toxicity related to chest chemoradiotherapy and to correlate these side effects with dosimetric parameters obtained using analytical anisotropic algorithm (AAA) in locally unresectable advanced lung cancer. We retrospectively analyzed data from 47 lung cancer patients between 2005 and 2008. All received conformal 3D radiotherapy using high-energy linear accelerator plus concomitant chemotherapy. All treatment planning data were transferred into Eclipse 8.05 (Varian Medical Systems, Palo Alto, CA) and dosimetric calculations were performed using AAA. Thirty-three patients (70.2%) developed acute pneumopathy after radiotherapy (grades 1 and 2). One patient (2.1%) presented with grade 3 pneumopathy. Thirty-one (66%) presented with grades 1-2 lung fibrosis, and 1 patient presented with grade 3 lung fibrosis. Thirty-four patients (72.3%) developed grade 1-2 acute oesophagic toxicity. Four patients (8.5%) presented with grades 3 and 4 dysphagia, necessitating prolonged parenteral nutrition. Median prescribed dose was 64 Gy (range 50-74) with conventional fractionation (2 Gy per fraction). Dose-volume constraints were respected with a median V20 of 23.5% (maximum 34%) and a median V30 of 17% (maximum 25%). The median dose delivered to healthy contralateral lung was 13.1 Gy (maximum 18.1 Gy). At univariate analysis, larger planning target volume and V20 were significantly associated with the probability of grade ≥2 radiation-induced pneumopathy (p = 0.022 and p = 0.017, respectively). No relation between oesophagic toxicity and clinical/dosimetric parameters could be established. Using AAA, the present results confirm the predictive value of the V20 for lung toxicity as already demonstrated with the conventional pencil beam convolution approach.
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Couraud S, Fournel P, Moro-Sibilot D, Pérol M, Souquet PJ. Are Clinical Guidelines Applied in Routine Daily Practice? A French Regional Survey of Physicians' Clinical Practices in Lung Cancer Management (EPOTRA). Clin Lung Cancer 2011; 12:298-306. [DOI: 10.1016/j.cllc.2011.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 04/14/2011] [Accepted: 04/25/2011] [Indexed: 11/26/2022]
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Couraud S, Fournel P, Moro-Sibilot D, Pérol M, Souquet PJ. Professional practice and accessibility to equipment in thoracic oncology. Results of a survey in Rhônes-Alpes region (France). Bull Cancer 2011; 98:bdc.2011.1366. [PMID: 21659060 DOI: 10.1684/bdc.2011.1366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This survey, conducted in region Rhône-Alpes (France), aims to assess some data in thoracic oncology practice including availability of specialized equipments. This study is based on a questionnaire mailed to oncologists and pulmonologists in the region. Of 401 questionnaires, the response rate was 56%. Responses of 71 (20%) physicians practicing thoracic oncology are presented in this article. Eighty percent of physicians routinely screen occupational exposure in case of lung cancer. The oncologists are less likely than pulmonologists to screen it (50% vs. 12%, p = 0.0015). Sixty-one percent of practitioners do not routinely propose smoking cessation in stage IV. Sixty-nine percent of practitioners' reports obtain an appointment for PET-scanner within 15 days and 72% indicate that this equipment is located within 50 km of their place of practice. Sixty-two percent reports using a surgical team specialized in chest disease, which is located in their city in 77% of cases. Sixty-one percent say that the period between the decision of an emergency radiotherapy and the start of it is less than one week. In 73% radiotherapy department is located in their city of practice. Forty-one percent of practitioners say they have a centralized and specialized preparation unit for cancer drugs. It seems that specialized equipment in Rhône-Alpes is adapted to practice with the exception of units dedicated to the preparation of cytotoxic drugs.
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Corre R, Chouaid C, Barlesi F, Le Caer H, Dansin E, Vergnenegre A, Fournel P. Study ESOGIA-GFPC 08-02: Phase III, randomized, multicenter trial involving subjects over age 70 with stage IV non-small cell lung cancer and comparing a “classical” strategy of treatment allocation (dual-agent therapy based on carboplatin or monotherapy with docetaxel alone), based on performance status and age, with an “optimized” strategy allocating the same treatments according to a simplified geriatric screening scale, plus a more thorough geriatric evaluation if necessary. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Martel-Lafay I, Montella A, Clavère P, Labat JP, Benchalal M, Talabard JN, Teissier É, d’Hombres A, Fournel P, Pommier P. Chimioradiothérapie concomitante pour cancer bronchique localement évolué : impact de la qualité de la radiothérapie sur la survie globale : résultats de l’essai de l’Intergroupe francophone de cancérologie thoracique (IFCT) et du Groupe français de pneumo-cancérologie (GFPC) 02.01. Cancer Radiother 2010. [DOI: 10.1016/j.canrad.2010.07.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Aupérin A, Le Péchoux C, Rolland E, Curran WJ, Furuse K, Fournel P, Belderbos J, Clamon G, Ulutin HC, Paulus R, Yamanaka T, Bozonnat MC, Uitterhoeve A, Wang X, Stewart L, Arriagada R, Burdett S, Pignon JP. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 2010; 28:2181-90. [PMID: 20351327 DOI: 10.1200/jco.2009.26.2543] [Citation(s) in RCA: 1268] [Impact Index Per Article: 90.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The previous individual patient data meta-analyses of chemotherapy in locally advanced non-small-cell lung cancer (NSCLC) showed that adding sequential or concomitant chemotherapy to radiotherapy improved survival. The NSCLC Collaborative Group performed a meta-analysis of randomized trials directly comparing concomitant versus sequential radiochemotherapy. METHODS Systematic searches for trials were undertaken, followed by central collection, checking, and reanalysis of updated individual patient data. Results from trials were combined using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival; secondary outcomes were progression-free survival, cumulative incidences of locoregional and distant progression, and acute toxicity. RESULTS Of seven eligible trials, data from six trials were received (1,205 patients, 92% of all randomly assigned patients). Median follow-up was 6 years. There was a significant benefit of concomitant radiochemotherapy on overall survival (HR, 0.84; 95% CI, 0.74 to 0.95; P = .004), with an absolute benefit of 5.7% (from 18.1% to 23.8%) at 3 years and 4.5% at 5 years. For progression-free survival, the HR was 0.90 (95% CI, 0.79 to 1.01; P = .07). Concomitant treatment decreased locoregional progression (HR, 0.77; 95% CI, 0.62 to 0.95; P = .01); its effect was not different from that of sequential treatment on distant progression (HR, 1.04; 95% CI, 0.86 to 1.25; P = .69). Concomitant radiochemotherapy increased acute esophageal toxicity (grade 3-4) from 4% to 18% with a relative risk of 4.9 (95% CI, 3.1 to 7.8; P < .001). There was no significant difference regarding acute pulmonary toxicity. CONCLUSION Concomitant radiochemotherapy, as compared with sequential radiochemotherapy, improved survival of patients with locally advanced NSCLC, primarily because of a better locoregional control, but at the cost of manageable increased acute esophageal toxicity.
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Fournel P. [First-line chemotherapy for metastatic non-small cell carcinoma: what are the options]. Rev Mal Respir 2009; 26:1091-6. [PMID: 20032844 DOI: 10.1016/s0761-8425(09)73535-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Until recently, first-line chemotherapy for advanced non-small cell lung cancer (NSCLC) was based on ASCO guidelines. Since several years, first-line chemotherapy is a platin-based doublet for patients with a good performans status. For elderly or unfit patients, a single-drug chemotherapy or a combination without cisplatin was recommended. The association of an anti-angiogenic therapy, bevacizumab, with carboplatin-paclitaxel or cisplatin-gemcitabine regimens improves progression-free survival for patients with non-epidermoid tumors. The combination of cisplatin and pemetrexed is better in terms of survival than cisplatine-gemcitabine in these tumors. The choice of treatment according to histology is becoming a new concept. Another is maintenance therapy. The main objective is to reduce duration of platin-based chemotherapy while improving quality of life and progression-free survival. This concept is ongoing validation. The combination of cetuximab with platin-chemotherapy improves survival for all histologic types. We should integrate this new approach among other available treatments. First-line therapy for advanced NSCLC is changing. In the future, first-line therapy will be chosen according to clinical features and biomarkers such as gene mutations of EGFR.
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Corre R, Vergnenègre A, Le Caer H, Fournel P. P69 Study ESOGIA-GFPC 08–02 – elderly selection on geriatric index assessment. Crit Rev Oncol Hematol 2009. [DOI: 10.1016/s1040-8428(09)70107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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121
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Martel-Lafay I, Fourneret P, Ayadi M, Brun O, Buatois F, Carrie C, Chilles A, Claude L, Cottin-Durrleman G, Farsi F, Fournel P, Mongodin B, Pouchard I, Balestrière V, Suchaud J. Guide de bonne pratique pour la radiothérapie thoracique exclusive ou postopératoire des carcinomes non à petites cellules. Cancer Radiother 2009; 13:55-60. [DOI: 10.1016/j.canrad.2008.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 05/07/2008] [Accepted: 05/13/2008] [Indexed: 12/25/2022]
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Rosell R, Vergnenegre A, Fournel P, Massuti B, Camps C, Isla D, Sanchez JM, Moran T, Sirera R, Taron M. Pharmacogenetics in lung cancer for the lay doctor. Target Oncol 2008. [DOI: 10.1007/s11523-008-0083-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moro-Sibilot D, Barlesi F, Timsit JF, Debieuvre D, Fournel P, Gervais R, Mazieres J, Milleron B, Morin F, Perol M, Soria JC, Souquet PJ, Vergnenègre A, Zalcman G. [How to treat the relapse of NSCLC after surgery and chemotherapy? IFTC 0702 randomized phase III study]. Rev Mal Respir 2008; 25:91-6. [PMID: 18288059 DOI: 10.1016/s0761-8425(08)70474-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND As chemotherapy gains wider acceptance for the treatment of earlier stages of NSCLC, particularly in the adjuvant and neoadjuvant setting, physicians face a growing population of high performance status patients who have relapsed after their first-line chemotherapy. The type of second-line chemotherapy after initial adjuvant or neoadjuvant treatment with a platinum-based regimen remains largely undefined. The current study has been designed to compare the classical mono chemotherapy docetaxel with a docetaxel cisplatin doublet. METHODS Patients will be randomized in 2 arms. Arm: docetaxel cisplatin (cycles repeated every 21 days), 4 cycles followed by 2 cycles of docetaxel alone in case of objective response or stabilisation. Arm B: docetaxel alone (cycles repeated every 21 days), 4 cycles followed by 2 cycles of docetaxel alone in case of objective response or stabilisation. EXPECTED RESULTS 300 patients will be randomized with a statistical hypothesis of a progression free survival of 3 months in the control arm and of 4.5 months in the experimental arm.
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Rolland E, Le Pechoux C, Curran W, Furuse K, Fournel P, Uitterhoeve L, Clamon G, Ulutin H, Stewart L, Auperin A. Concomitant Radio-chemotherapy (CT-RT) versus Sequential CT-RT In Locally Advanced Non-Small-Cell Lung Cancer (NSCLC): A Meta-Analysis Using Individual Patient Data (IPD) From Randomised Clinical Trials (RCTs). Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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125
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Fournel P. Articulation de la chimiothérapie avec la radiothérapie dans les stades localement avancés du CBNPC. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)78140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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LeCaer H, Fournel P, Jullian H, Chouaid C, Letreut J, Thomas P, Paillotin D, Perol M, Gimenez C, Vergnenegre A. An open multicenter phase II trial of docetaxel–gemcitabine in Charlson score and performance status (PS) selected elderly patients with stage IIIB pleura/IV non-small-cell lung cancer (NSCLC): The GFPC 02-02a study. Crit Rev Oncol Hematol 2007; 64:73-81. [PMID: 17669664 DOI: 10.1016/j.critrevonc.2007.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 02/27/2007] [Accepted: 06/12/2007] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED The aim of this study was to determine the impact of patient selection based on age, comorbidity and performance status on the efficacy of platinum-free combination therapy on non-small-cell lung cancer after 65 years of age. We analyzed the overall response rate, the median survival time, the 1-year survival rate, toxicity and quality of life after one to three 6-week cycles of docetaxel 30mg/m(2) weekly and gemcitabine 900mg/m(2) at weeks 1, 2, 4 and 5. Fifty patients (median age 73.7 years) were eligible. The mean number of comorbid conditions per patient was 0.8 [Balducci L. Lung cancer and aging. ASCO 2005. Educational book. p. 587-91; Piquet J, Blanchon F, Grivaux M, et al. Primary bronchial carcinoma in elderly subjects in France. Rev Mal Respir 2003;20:691-9; Jatoi A, Hillman S, Stella P, et al. Should elderly non-small-cell lung cancer patients be offered elderly-specific trials? Results of a pooled analysis from the North Central Cancer Treatment Group. J Clin Oncol 2005;23:9113-9; Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist 2000;5:224-37]. Forty-five patients were assessable: 17 (34%) had an objective response, 18 (36%) had stable disease and 10 progressed (20%). The median survival time was 7 months and the 1-year survival rate 23.5%. The main grade III-IV adverse event was neutropenia (32% of patients). CONCLUSION Platinum-free dual-agent chemotherapy gives similar results in patients over 65, selected on the basis of their precise age and comorbidity, to that reported in younger subjects.
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Fournel P. [Combination of chemotherapy and radiotherapy for locally advanced non-small cell lung cancer]. Rev Mal Respir 2007; 24:6S94-6S100. [PMID: 18235400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite the progress in therapeutic strategies, overall survival of stage III non small cell lung cancers (NSCLC) is poor. Currently, the standard treatment for unresectable locally advanced NSCLC is concurrent chemoradiotherapy. However, oesophagitis is a major toxicity and this schedule should be reserved for patients with good performance status. Several platinum-based chemotherapies have been evaluated concurrently with radiotherapy and cisplatin-etoposide regimen remains the standard because full dose chemotherapy can be administered. Cisplatin-vinorelbine offers a good efficacy/toxicity profile. The optimal sequencing of concurrent chemoradiotherapy and chemotherapy is not well defined. Consolidation chemotherapy with docetaxel failed to show a better outcome. The new technologies in radiotherapy and dose escalation will certainly improve the efficacy of chemoradiotherapy and reduce toxicity. The integration of targeted therapies in the management of stage III NSCLC is also under investigation.
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Nourissat A, Mille D, Delaroche G, Jacquin JP, Vergnon JM, Fournel P, Seffert P, Porcheron J, Michaud P, Merrouche Y, Chauvin F. Estimation of the risk for nutritional state degradation in patients with cancer: development of a screening tool based on results from a cross-sectional survey. Ann Oncol 2007; 18:1882-6. [PMID: 17878178 DOI: 10.1093/annonc/mdm355] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In routine practice, the evaluation of the nutritional status of patients with cancer is not always performed although there is frequent modification as disease progresses. The validated screening and evaluation tools currently available are time-consuming and costly. In this study we analysed factors that could be used to identify patients likely to need nutritional surveillance or intervention. PATIENTS AND METHODS A cross-sectional survey was carried out for 2 weeks in June 2006 on 477 patients with cancer. RESULTS 30.2% of the patients had lost more than 10% of their body weight since the start of the illness. After adjustment, the factors significantly associated with weight loss were: depressive state (OR = 3.49; P = 0.002), digestive or ENT tumours (OR = 3.20; P = <0.001), chemotherapy (OR = 2.66; P = 0.011), male gender (OR = 2.30; P = 0.001) and professional status (OR = 2.08; P = 0.02). Using a logistic model, we calculated the risk of weight loss as a function of the presence of the identified predictive factors. CONCLUSION We report a simple screening tool, which will not replace the available evaluation methods but will enable targeting of the patients most likely, after a specific evaluation, to benefit from nutritional intervention. This remains to be validated in further prospective studies.
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Chouaid C, Monnet I, Robinet G, Perol M, Fournel P, Vergnenegre A. Economic impact of gefitinib for refractory non-small-cell lung cancer: a Markov model-based analysis. Curr Med Res Opin 2007; 23:1509-15. [PMID: 17559745 DOI: 10.1185/030079907x199718] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Few data are available on the economics of target therapy or refractory non-small-cell lung cancer (NSCLC). OBJECTIVE To determine the mean global management costs (MC) per patient treated with gefitinib for NSCLC, and the costs of the different management phases. METHOD A Markov approach was used to model treatment costs in a cohort of 106 patients treated with gefitinib as part of a compassionate-use program (third-line treatment) in six public-sector teaching hospitals. The economic analysis adopted the health care payer's perspective, and only direct costs were taken into account. RESULTS The mean duration of gefitinib treatment was 4.6 +/- 5.8 months (1-29 months); median survival was 4 months, 1-year and 2-year survival rates were 12.3% and 4.7%, respectively. The mean total management cost was 39,979 euros +/- 20,279. The model showed that first- and second-line treatments accounted for respectively 29.5% and 44.1% of this cost, while gefitinib periods represented 10.7%, periods of remission 1.25%, and terminal care 14.5%. A sensitivity analysis showed that the price of gefitinib had little influence on the total cost. CONCLUSION The cost of third-line gefitinib therapy for NSCLC appears acceptable from the healthcare payer's perspective, but this needs to be confirmed in dedicated cost-effectiveness studies.
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Li G, Passebosc-Faure K, Feng G, Lambert C, Cottier M, Gentil-Perret A, Fournel P, Pérol M, Genin C. MN/CA9: a potential gene marker for detection of malignant cells in effusions. Biomarkers 2007; 12:214-20. [PMID: 17536770 DOI: 10.1080/13547500601068192] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Many cancers cause malignant effusions. The presence of malignant cells in effusions has implications in diagnosis, tumour staging and prognosis. The detection of malignant cells currently presents a challenge for cytopathologists. New adjunctive methods are needed. Although the effusions provide excellent materials for molecular assay, the available molecular markers are extremely limited, which hinders its clinical application. MN/CA9 has proved to be a valuable marker in many cancers such as lung, breast, colon, kidney, etc. The present study was to evaluate MN/CA9 as a new molecular marker for the detection of cancer cells in pleural effusions. Seventy-one pleural effusions including 59 malignant effusions from patients with cancer, and 12 patients with benign diseases as a control, were subjected to RT-PCR for detection of MN/CA9 gene expression. MN/CA9 gene expression was detected in 53/59 (89.8%) pleural effusions from cancer patients (15/16 for breast cancers, 10/11 for lung cancers, 4/4 for ovary cancers, 2/3 for colon-rectal cancers, 5/6 for cancers of unknown site, 7/8 for mesothelioma and 10/11 for other cancers). Furthermore, MN/CA9 was positive in 13/18 (72.2%) of cytologically negative effusions of cancer patients. MN/CA9 was detected in only 1/12 (8.3%) effusions from the control patients (p < 0.01). The sensitivity and specificity of MN/CA9 gene expression were, respectively, 89.8% and 91.7%. Our preliminary results suggest that MN/CA9 could be a potential marker for the detection of malignant cells in effusions. A large-scale study is needed to confirm these results.
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Vergnenegre A, Corre R, Barlési F, Bérard H, Vernejoux J, Le Caer H, Fournel P, Delhoume J, Arpin D, Thomas P, Tillon J. A randomized phase II trial of early change of a chemotherapeutic doublet compared to four cycles of chemotherapy in advanced non-small cell lung cancer (NSCLC): The 03–01 Groupe Francais de Pneumo-Cancerologie (GFPC) study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7631 Background: The optimal strategy in advanced NSCLC with stable disease is not well known. There is no published study assessing an early change of chemotherapeutic drugs in these patients. This study was designed to evaluate the efficacy and safety of early modification of chemotherapy doublets in patients with advanced non small cell lung cancer with stable disease (SD). Methods: Patients with stage IV NSCLC and measurable disease were included in a randomized phase II trial comparing for patients with stable disease after 2 cycles of a platin (P)-gemcitabine doublet (P d1: 75 mg/m2, gemcitabine 1 250 mg/m2 d1, d8 every three weeks) two subsequent cycles of this doublet (arm A) to a switch to another doublet (arm B): paclitaxel 100 mg/m2 d1, d8, d15, gemcitabine 1 250 mg/m2 d1, d8, every four weeks. Results: Between October 2003 and august 2006, 228 patients (pts) were enrolled (187 males, 41 females), median age 57 y (30–70). Evaluation (EVA) 1 showed 11.8% not assessable patients (NA), 19.3% with objective responses (OR), 25.9% with progressive diseases. 98 patients (43%) had stable diseases. 87 patients were randomized in the study. 48.3% with PS0, 51.7% with PS1 and a majority of adenocarcinoma (62.1%). 41.4% had only one metastatic site. There were no differences between the two groups. Efficacy at eva 2 is depicted above. Overall survival (OS) was similar between the two arms: 9.8 months (m) [7.0 - 14.2] for arm A, 9.2 m [7.4 - 10.5] for arm B. TTP was 5.4 m in arm A and 5.7 in arm B. There were 1 grade III/IV haematological toxicities in arm A (1.2%) and 2 in arm B (2.4%). There were 4 grade III/IV non haematological toxicities in arm A (4.8%) and 6 in arm B (7.3%). Conclusions: The switch between the two regimen is feasible without any major toxicities. Despite higher response rate in favour of the switch strategy, OS and TTP are similar between the two arms. No significant financial relationships to disclose. [Table: see text]
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LeCaer H, Barlesi F, Robinet G, Fournel P, Geriniere L, Bombaron P, Falchero L, Auliac JB, Crequit J, Chouaid C. An open multicenter phase II trial of weekly docetaxel for advanced-stage non-small-cell lung cancer in elderly patients with significant comorbidity and/or poor performance status: The GFPC 02-02b study. Lung Cancer 2007; 57:72-8. [PMID: 17391803 DOI: 10.1016/j.lungcan.2007.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 02/13/2007] [Accepted: 02/14/2007] [Indexed: 12/27/2022]
Abstract
CONTEXT The objective of this study was to evaluate the feasibility and activity of weekly docetaxel monotherapy in frail elderly patients with advanced-stage non-small-cell lung cancer, selected on the basis of their precise age, general condition, and number of comorbid disorders (Charlson score). METHODS Analysis of the response rate, toxicity, quality of life, median survival and 1-year survival rates after 1-3 six-week cycles of docetaxel 30mg/m(2) weekly. RESULTS Fifty patients were enrolled and 42 were assessable. Five patients (10%, [3.7-22.6]) had objective responses, 14 (28%, [16.9-41.6]) had stable disease, and 23 (46%, [32.6-52.8]) progressed. The main grade 3-4 toxicity was fatigue (30%). Quality of life remained stable during treatment. The median survival time was 4.3 months, and the 1-year survival rate was 21.8%. CONCLUSION In frail elderly patients selected on the basis of their age, general condition and comorbidity, weekly docetaxel monotherapy has acceptable toxicity and does not negatively affect quality of life. In contrast, it has only moderate activity.
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Robinet G, Barlesi F, Fournel P, Berard H, Corre R, Vergnenegre A, Falchero L, Souquet PJ, Tisseron-Carrasco A, Chouaid C. Second-line therapy with gefitinib in combination with docetaxel for advanced non-small cell lung cancer: a phase II randomized study. Target Oncol 2007. [DOI: 10.1007/s11523-007-0042-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fournel P, Bota S, Quoix E, Bout J, Falchero L, Paillotin D, Schouabe S. 497 Essai randomisé de phase II : chimio-radiothérapie concomitante (CT/RT) avec chimiothérapie (CT) d’induction ou CT de consolidation dans les cancers bronchiques non à petites cellules (CBNPC) de stade III non résècable (essai GFPC - IFCT 02-01). Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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135
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Fournel P. [Chemotherapy duration in advanced-stage non-small-cell lung cancers]. REVUE DE PNEUMOLOGIE CLINIQUE 2006; 62:2S34-6. [PMID: 17404537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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136
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Martel-Lafay I, Clavère P, Labat J, Benchalal M, Talabard J, Teissier E, d’Hombres A, Touboul E, Vergnenègre A, Fournel P. 1034. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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137
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Fournel P. [Stage IIIB non-small cell lung cancer. Is there a recommended treatment? ]. Rev Mal Respir 2006; 23:16S54-16S60. [PMID: 17268337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The prognosis of locally advanced inoperable non-small cell lung cancer (NSCLC) remains poor despite the advances in treatment achieved in recent years. Currently the best therapeutic strategy relies on concurrent radiotherapy and chemotherapy. This treatment should be reserved for patients of good performance status. Oesophagitis represents the limiting toxicity. If possible chemotherapy should be administered in full dosage during radiotherapy with the aim of controlling micrometastases. Combined cisplatin-etoposide remains a standard regime and cisplatin-vinorelbine offers a good efficacy/toxicity ratio. The choice between induction chemotherapy and consolidation chemotherapy remains uncertain. The addition of docetaxel as consolidation after radio-chemotherapy seems to improve survival but the results need to be confirmed by a randomised phase III trial. Recent technological advances in radiotherapy allow optimisation of the dose, improved results and reduced toxicity. The place of targeted therapies in the management strategy of stage III NSCLC is under investigation.
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Fournel P. CBNPC stades IIIB. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72048-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Douillard JY, Rosell R, De Lena M, Carpagnano F, Ramlau R, Gonzáles-Larriba JL, Grodzki T, Pereira JR, Le Groumellec A, Lorusso V, Clary C, Torres AJ, Dahabreh J, Souquet PJ, Astudillo J, Fournel P, Artal-Cortes A, Jassem J, Koubkova L, His P, Riggi M, Hurteloup P. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol 2006; 7:719-27. [PMID: 16945766 DOI: 10.1016/s1470-2045(06)70804-x] [Citation(s) in RCA: 1131] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Whether adjuvant chemotherapy improves survival of patients with non-small-cell lung cancer (NSCLC) is not known. We aimed to compare the effect of adjuvant vinorelbine plus cisplatin versus observation on survival in patients with completely resected NSCLC. METHODS 840 patients with stage IB-IIIA NSCLC from 101 centres in 14 countries were randomly assigned to observation (n=433) or to 30 mg/m(2) vinorelbine plus 100 mg/m(2) cisplatin (n=407). Postoperative radiotherapy was not mandatory and was undertaken according to every centre's policy. The primary endpoint was overall survival. Analysis was by intention to treat. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN95053737. FINDINGS 367 patients in the chemotherapy group and 431 in the control group received their assigned treatment. 301 (36%) patients had stage IB disease, 203 (24%) had stage II disease, and 325 (39%) had stage IIIA disease. Tolerance to chemotherapy mainly included neutropenia in 335 (92%) patients and febrile neutropenia in 34 (9%); seven (2%) toxic deaths were also recorded. Compliance was greater with cisplatin than with vinorelbine (median dose intensity 89% [range 17-108] vs 59% [17-100]). After a median follow-up of 76 months (range 43-116), median survival was 65.7 months (95% CI 47.9-88.5) in the chemotherapy group and 43.7 (35.7-52.3) months in the observation group. Adjusted risk for death was significantly reduced in patients assigned chemotherapy compared with controls (hazard ratio 0.80 [95% CI 0.66-0.96]; p=0.017). Overall survival at 5 years with chemotherapy improved by 8.6%, which was maintained at 7 years (8.4%). INTERPRETATION Adjuvant vinorelbine plus cisplatin extends survival in patients with completely resected NSCLC, better defining indication of adjuvant chemotherapy.
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Vergnenegre A, Combescure C, Fournel P, Bayle S, Gimenez C, Souquet PJ, Lena H, Perol M, Delhoume JY. Cost-minimization analysis of a phase III trial comparing concurrent versus sequential radiochemotherapy for locally advanced non-small-cell lung cancer (GFPC-GLOT 95–01). Ann Oncol 2006; 17:1269-74. [PMID: 16728480 DOI: 10.1093/annonc/mdl100] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We conducted an economic analysis of a phase III clinical trial comparing sequential radiochemotherapy (RT-CT) with concurrent RT-CT in patients with locally advanced non-small-cell lung cancer. PATIENTS AND METHODS The trial was a randomized multicenter study comparing three cycles of chemotherapy (arm A) followed by radiotherapy against an RT-CT combination (two cycles of platinum etoposide) followed by two cycles of platinum-vinorelbine (arm B). The economic analysis adopted the payer's perspective and only included direct costs. Costs (euro, 1996-2003) were recorded until the cut-off date. A cost minimization analysis and a sensitivity analysis were carried out. RESULTS Data from 173 patients were used in the economic study. Protocol costs tended to be higher in arm B, while relapse costs were significantly higher in arm A. The total number of hospital days was higher in arm B. The average total cost per patient was euro16,074 in arm A and euro15,245 in arm B (P=0.15). The cost minimization analysis favored arm B. This advantage persisted in the sensitivity analysis. CONCLUSIONS Concurrent RT-CT was not the more costly strategy in this phase III trial, despite lengthier hospitalization for toxicity. Other studies of similar design are needed to confirm these results in future randomized trials.
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Fournel P, Vergnenégre A, Robinet G, Léna H, Gervais R, Le Caer H, Souquet PJ, Chavaillon JM, Chouaid C, Martel-Lafay I. Induction (ICT) or consolidation chemotherapy (CT) with cisplatin (C) and paclitaxel (P) plus concurrent chemo-radiation (CT/TRT) with cisplatin and vinorelbine (V) for unresectable non-small cell lung cancer (NSCLC) patients (pts): Randomized phase II trial GFPC-GLOT-IFCT 02–01. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7048] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7048 Background: Concurrent CT/TRT is the standard treatment for unresectable stage III NSCLC, but the optimal sequencing of TRT and CT is not well defined.Consolidation CT with taxane seems to be a good approach (SWOG 95–04). Methods: Unresectable stage III NSCLC pts (weight loss < 10%, ECOG PS 0–1, no supraclavicular lymph node or superior vena cava syndrome) were eligible. in Arm A, pts received 2 cycles of C 80 mg/m2 and P 200 mg/m2 followed by a concurrent CT/TRT including TRT as 66 Gy in 33 fractions and C 80 mg/m2 d1,29 and 57 and V d1,8,29,36,57 and 64. In Arm B, the same CT/TRT began on d1 followed by 2 cycles of C and P. The primary objective was response rate at the end of treatment, assessed by RECIST criteria. 132 pts were needed. Results: From 05/2002 to 03/2005, 133 pts were included by 35 centers. 5 pts were ineligible. Both groups were well-matched for baseline characteristics. 30 pts were stage IIIAN2 and 98 stage IIIB. Toxicities (106 pts analyzable) grade 3–4 by CTC and RTOG criteria (Arm A/Arm B) were: neutropenia 36%/41%, infection 11%/15%, esophagitis 6%/13%, pneumonitis 0%/1%. 5 toxic deaths were observed (2 sepsis, 1 massive hemoptysis, 1 post-irradiation pneumonitis, 1 esophageal fistula). In Arm A, objective response rate was 36% after ICT. At the end of treatment, response rate (Arm A/Arm B) was in intent to treat: progression 19%/19%, stable-disease 6%/11%, objective response 55%/48%. 13 pts were not evaluable for response in Arm A and 14 in Arm B [ table ]. Conclusions: Toxicities and response rates are similar in both arms, but ICT followed by CT/TRT appears to provide a better therapeutic outcome. [Table: see text] No significant financial relationships to disclose.
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Passebosc-Faure K, Li G, Lambert C, Cottier M, Gentil-Perret A, Fournel P, Pérol M, Genin C. Evaluation of a panel of molecular markers for the diagnosis of malignant serous effusions. Clin Cancer Res 2006. [PMID: 16203775 DOI: 10.1158/1078-0432.ccr-05-0043.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Our main goal was to evaluate a panel of molecular markers for the detection of cancer cells in serous effusions and to determine their value as an adjunctive reverse transcription-PCR (RT-PCR) test to cytologic examination. EXPERIMENTAL DESIGN One hundred fourteen serous effusions from 71 patients with tumors and 43 patients with benign diseases were subjected to RT-PCR for expression of carcinoembryonic antigen (CEA), epithelial cell adhesion molecule (Ep-CAM), E-cadherin, mammaglobin, mucin 1 (MUC1) isoforms MUC1/REP, MUC1/Y, and MUC1/Z, calretinin, and Wilms' tumor 1 susceptibility gene. RESULTS CEA, Ep-CAM, E-cadherin, and mammaglobin were specifically expressed in malignant effusions. The sensitivity of RT-PCR in cytologically negative malignant effusions was 63.1% combining CEA and Ep-CAM (with 100% specificity) and reached 78.9% adding MUC1/Y or MUC1/Z (with 93% specificity). In the whole population of effusions, the combination of cytology with RT-PCR of CEA and Ep-CAM yielded a 90.1% sensitivity, a specificity and a positive predictive value of 100%, and a 86% negative predictive value for malignancy. Adding MUC1/Y or MUC1/Z to the panel, the sensitivity was 94.5% with 93% specificity, 95.7% PPV, and 90.9% negative predictive value. Moreover, CEA and mammaglobin were specifically expressed in epithelial malignancies, and mammaglobin was mainly expressed in effusions from breast carcinoma (97.3% of specificity). CONCLUSIONS A combination of cytology and RT-PCR analysis of CEA and Ep-CAM significantly improved the detection sensitivity of tumor cells in serous effusions. RT-PCR analysis of CEA, Ep-CAM, and mammaglobin in serous effusions could be a beneficial adjunct to cytology for the diagnosis of malignancy.
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Passebosc-Faure K, Li G, Lambert C, Cottier M, Gentil-Perret A, Fournel P, Pérol M, Genin C. Evaluation of a panel of molecular markers for the diagnosis of malignant serous effusions. Clin Cancer Res 2006; 11:6862-7. [PMID: 16203775 DOI: 10.1158/1078-0432.ccr-05-0043] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Our main goal was to evaluate a panel of molecular markers for the detection of cancer cells in serous effusions and to determine their value as an adjunctive reverse transcription-PCR (RT-PCR) test to cytologic examination. EXPERIMENTAL DESIGN One hundred fourteen serous effusions from 71 patients with tumors and 43 patients with benign diseases were subjected to RT-PCR for expression of carcinoembryonic antigen (CEA), epithelial cell adhesion molecule (Ep-CAM), E-cadherin, mammaglobin, mucin 1 (MUC1) isoforms MUC1/REP, MUC1/Y, and MUC1/Z, calretinin, and Wilms' tumor 1 susceptibility gene. RESULTS CEA, Ep-CAM, E-cadherin, and mammaglobin were specifically expressed in malignant effusions. The sensitivity of RT-PCR in cytologically negative malignant effusions was 63.1% combining CEA and Ep-CAM (with 100% specificity) and reached 78.9% adding MUC1/Y or MUC1/Z (with 93% specificity). In the whole population of effusions, the combination of cytology with RT-PCR of CEA and Ep-CAM yielded a 90.1% sensitivity, a specificity and a positive predictive value of 100%, and a 86% negative predictive value for malignancy. Adding MUC1/Y or MUC1/Z to the panel, the sensitivity was 94.5% with 93% specificity, 95.7% PPV, and 90.9% negative predictive value. Moreover, CEA and mammaglobin were specifically expressed in epithelial malignancies, and mammaglobin was mainly expressed in effusions from breast carcinoma (97.3% of specificity). CONCLUSIONS A combination of cytology and RT-PCR analysis of CEA and Ep-CAM significantly improved the detection sensitivity of tumor cells in serous effusions. RT-PCR analysis of CEA, Ep-CAM, and mammaglobin in serous effusions could be a beneficial adjunct to cytology for the diagnosis of malignancy.
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Fournel P. [From ASCO and WCLC 2005 to clinical practice: "conventional" treatments]. REVUE DE PNEUMOLOGIE CLINIQUE 2006; 62 Spec no 1:1S25-9. [PMID: 16719153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
MESH Headings
- Administration, Oral
- Age Factors
- Aged
- Angiogenesis Inhibitors/administration & dosage
- Angiogenesis Inhibitors/therapeutic use
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Phytogenic/administration & dosage
- Antineoplastic Agents, Phytogenic/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Camptothecin/administration & dosage
- Camptothecin/analogs & derivatives
- Camptothecin/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Small Cell/drug therapy
- Carcinoma, Small Cell/mortality
- Carcinoma, Small Cell/therapy
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- Cisplatin/therapeutic use
- Clinical Trials, Phase III as Topic
- Deoxycytidine/administration & dosage
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/therapeutic use
- Docetaxel
- Etoposide/administration & dosage
- Etoposide/therapeutic use
- Follow-Up Studies
- Humans
- Irinotecan
- Lung/pathology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Lung Neoplasms/surgery
- Lung Neoplasms/therapy
- Mediastinoscopy
- Meta-Analysis as Topic
- Middle Aged
- Neoplasm Staging
- Palliative Care
- Pneumonectomy
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Randomized Controlled Trials as Topic
- Taxoids/administration & dosage
- Taxoids/therapeutic use
- Time Factors
- Topotecan/administration & dosage
- Topotecan/therapeutic use
- Gemcitabine
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145
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Thomas P, Robinet G, Gouva S, Fournel P, Léna H, Le Caer H, Perol M, Berard H, Bombaron P, Vergnenegre A, Kleisbauer JP. Randomized multicentric phase II study of carboplatin/gemcitabine and cisplatin/vinorelbine in advanced non-small cell lung cancer. Lung Cancer 2006; 51:105-14. [PMID: 16310886 DOI: 10.1016/j.lungcan.2005.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 09/19/2005] [Accepted: 10/03/2005] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of gemcitabine and carboplatin in the treatment of previously untreated patients with advanced non-small cell lung cancer (NSCLC). METHODS A randomized phase II study was conducted by the Groupe Français de Pneumo-Cancérologie (GFPC) in 15 centers. The patients were randomized in either arm A (GC): gemcitabine 1250 mg/m2 on days 1 and 8+carboplatin AUC 6 mg/(mLmin) on day 1; or in arm B (VP): vinorelbine 30 mg/m2 weekly+cisplatin 80 mg/m2 on day 1. Treatment cycles were repeated every 3 weeks. RESULTS A total of 100 patients were randomized with stage IV or stage III NSCLC with malignant pleural effusion: 51 patients in arm A and 49 patients in arm B. A total of 190 cycles were administered in the GC arm and 172 cycles in the VP arm, with a median of four cycles per patient in each arm. The dose intensity was 84.9% for gemcitabine, 99.8% for carboplatin, 97.7% for cisplatin and 67.7% for vinorelbine. The objective response rates were 19.6% (95% CI, 9.8-33.1) for GC and 29.2% (95% CI, 17.0-44.1) for VP in an ITT analysis. The response duration was 169 days in arm A and 226 days in arm B. The TTP was similar with 140 days (GC) and 148 days (VP), respectively. Overall survival rates were 334 days in the GC combination and 304 days in the VP combination. Overall, the treatment was safe and toxicities observed were different in each arm: neutropenia was the most common toxicity in the VP treatment, whereas thrombocytopenia was more frequent in the GC combination. Anemia was similar in both arms. Non-haematologic toxicity was mild. One toxic death in arm A and three toxic deaths in arm B were observed. CONCLUSION In terms of response rate, the gemcitabine-carboplatin combination was not efficient enough to allow further phase III study. Survival data are in the same range as the standard arm. This chemotherapy is feasible and may represent an alternative to a standard cisplatin-based regimen, allowing treatment in an outpatient setting.
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146
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Fournel P. [Therapeutic strategies in non-small-cell lung carcinoma: how to optimize patient management?]. REVUE DE PNEUMOLOGIE CLINIQUE 2005; 61:4S23-30. [PMID: 16273007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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147
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Fournel P, Robinet G, Thomas P, Souquet PJ, Léna H, Vergnenégre A, Delhoume JY, Le Treut J, Silvani JA, Dansin E, Bozonnat MC, Daurés JP, Mornex F, Pérol M. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Français de Pneumo-Cancérologie NPC 95-01 Study. J Clin Oncol 2005; 23:5910-7. [PMID: 16087956 DOI: 10.1200/jco.2005.03.070] [Citation(s) in RCA: 388] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE We conducted a phase III study to compare the survival impact of concurrent versus sequential treatment with radiotherapy (RT) and chemotherapy (CT) in unresectable stage III non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients were randomly assigned to one of the two treatment arms. In the sequential arm, patients received induction CT with cisplatin (120 mg/m2) on days 1, 29, and 57, and vinorelbine (30 mg/m2/wk) from day 1 to day 78, followed by thoracic RT at a dose of 66 Gy in 33 fractions (2 Gy per fraction and 5 fractions per week). In the concurrent arm, the same RT was started on day 1 with two concurrent cycles of cisplatin 20 mg/m2/d and etoposide 50 mg/m2/d (days 1 to 5 and days 29 to 33); patients then received consolidation therapy with cisplatin 80 mg/m2 on days 78 and 106 and vinorelbine 30 mg/m2/wk from days 78 to 127. RESULTS Two hundred five patients were randomly assigned. Pretreatment characteristics were well balanced between the two arms. There were six toxic deaths in the sequential arm and 10 in the concurrent arm. Median survival was 14.5 months in the sequential arm and 16.3 months in the concurrent arm (log-rank test P = .24). Two-, 3-, and 4-year survival rates were better in the concurrent arm (39%, 25%, and 21%, respectively) than in the sequential arm (26%, 19%, and 14%, respectively). Esophageal toxicity was significantly more frequent in the concurrent arm than in the sequential arm (32% v 3%). CONCLUSION Although not statistically significant, clinically important differences in the median, 2-, 3-, and 4-year survival rates were observed, with a trend in favor of concurrent chemoradiation therapy, suggesting that is the optimal strategy for patients with locally advanced NSCLC.
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148
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Vergnenègre A, Daniel C, Léna H, Fournel P, Kleisbauer JP, Le Caer H, Letreut J, Paillotin D, Pérol M, Bouchaert E, Preux PM, Robinet G. Docetaxel and concurrent radiotherapy after two cycles of induction chemotherapy with cisplatin and vinorelbine in patients with locally advanced non-small-cell lung cancer. A phase II trial conducted by the Groupe Francais de Pneumo-Cancerologie (GFPC). Lung Cancer 2005; 47:395-404. [PMID: 15713523 DOI: 10.1016/j.lungcan.2004.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 08/12/2004] [Accepted: 08/18/2004] [Indexed: 10/26/2022]
Abstract
CONTEXT The most satisfactory treatment for patients with locally advanced non-small-cell lung cancer (NSCLC) is combination chemotherapy-radiotherapy (CT-RT). The optimal treatment modalities remain to be determined. OBJECTIVE We conducted a multicenter phase II trial of the docetaxel-radiotherapy combination after induction chemotherapy with cisplatin-vinorelbine. The main endpoint was the objective response rate. PATIENTS AND METHODS Patient with inoperable stage locally advanced NSCLC received induction chemotherapy consisting of two cycles of cisplatin 100 mg/m2 on D1 and vinorelbine 25 mg/m2 on D1, D8, D15 and D22. Patients with responses or stable disease then received concurrent RT-CT consisting of 25 mg/m2/week docetaxel and single-fraction radiotherapy (66 grays (Gy) in 33 fractions) over 6.5 weeks. RESULTS Fifty-six patients were enrolled from 1 July 2000 to 31 December 2001. Sixteen patients left the trial after induction chemotherapy, eight for progression, five for toxicity, and two for intercurrent events. One patient underwent surgery after induction chemotherapy. In total, 40 of the 56 patients received RT-CT. Twelve (30%) of these 40 patients experienced grade III or IV pulmonary or esophageal toxicity. In the intention-to-treat analysis, the objective response rate was 46.4% (95% CI 33.0-60.2). The median time to progression was 6.2 months [1.1-26.0]. The median survival time was 13 months [0.3-44.9 months]. Nine patients progressed during RT-CT, six with brain metastases. CONCLUSION Weekly docetaxel with concurrent radiotherapy, following chemotherapy is acceptable. The tumor response rate is moderate. Further trials are required to determine the risk-benefit relationship of this treatment schedule, and the possible benefit of adding other cytotoxic drugs.
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149
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Vergnenègre A, Chouaïd C, Corre R, Gimenez C, Vernejoux J, Bérard H, Fournel P, Arpin D, David P, Preux P. P-590 A randomized phase II trial of early change of a chemotherapeuticdoublet versus four cycles of chemotherapy in advanced non small cell lung cancer (NSCLC): Interim analysis of the 03-01 Groupe Français de Pneumo-Cancérologie (GFPC) study. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81083-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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150
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Le Caer H, Gimenez C, Fournel P, Chouaid C, Robinet G, Jullian H, Vergnenegre A, Bayle S, Barlesi F, Barriere JR. A multicenter phase II study of docetaxel (D) or docetaxel/gemcitabine (G) weekly in advanced non-small cell lung cancer (NSCLC) in elderly and/or poor performance status (PS) patients (pts).(GFPC 0202). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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