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Borie R, Cadranel J, Galicier L, Couderc LJ. [Pulmonary involvement due to HHV-8 virus during the course of HIV infection]. Rev Mal Respir 2012; 29:1209-23. [PMID: 23228679 DOI: 10.1016/j.rmr.2012.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 02/08/2012] [Indexed: 12/01/2022]
Abstract
HHV-8 is a herpes virus discovered in 1994 in Kaposi sarcoma cells. Its involvement was later demonstrated in multicentric Castleman disease and in primary lymphoma effusion lymphoma. These diseases arise almost exclusively in immunocompromised patients, mostly in association with HIV infection. Apart from Kaposi's sarcoma, combined antiretroviral therapy does not seem to have reduced the incidence of these diseases, which remain rare. In these three diseases, pulmonary involvement is common and may be the presenting feature. Kaposi's sarcoma of the lung is usually asymptomatic but may require specific therapy. Pulmonary involvement is mostly associated with cutaneous disease. Patients with Castleman disease typically present with fever and lymphadenopathy, associated with interstitial lung disease without opportunistic infection. Patients with primary lymphoma effusion presents with fever and an exudative lymphocytic pleural effusion, without a pleural mass on the CT-scan. Rapid diagnosis of these conditions avoids unnecessary invasive examinations and leads to prompt specific treatment.
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152
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Godet C, Beraud G, Cadranel J. [Bacterial pneumonia in HIV-infected patients (excluding mycobacterial infection)]. Rev Mal Respir 2012; 29:1058-66. [PMID: 23101646 DOI: 10.1016/j.rmr.2012.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/19/2011] [Indexed: 11/17/2022]
Abstract
Respiratory infections are the most common complications in HIV patients, regardless of the degree of immunosuppression. Even though antiretroviral therapy has a protective effect on the risk of bacterial pneumonia, this still remains high (including those with CD(4)>500/mm(3)). The most frequently isolated bacteria are Streptococcus pneumoniae and Haemophilus influenzae. The clinical and radiological presentations of lower respiratory tract infections in HIV patients are quite variable. The clinical presentation is more severe and the radiological presentation is more atypical if the immunosuppression is severe. The first-line antibiotic therapy is an injectable third-generation cephalosporin (ceftriaxone or cefotaxime) or co-amoxiclav. Pneumococcal vaccination (as well as influenza vaccine) is recommended. Although rare, Nocardia spp. and Rhodococcus equi seem more common among AIDS patients.
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153
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Cadranel J, Philippe B, Hennequin C, Bergeron A, Bergot E, Bourdin A, Cottin V, Jeanfaivre T, Godet C, Pineau M, Germaud P. Voriconazole for chronic pulmonary aspergillosis: a prospective multicenter trial. Eur J Clin Microbiol Infect Dis 2012; 31:3231-9. [PMID: 22782438 PMCID: PMC3479377 DOI: 10.1007/s10096-012-1690-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/21/2012] [Indexed: 11/28/2022]
Abstract
Early evidence suggests the efficacy of voriconazole for chronic pulmonary aspergillosis (CPA). We conducted a prospective, open, multicenter trial to evaluate the efficacy and safety of voriconazole for proven CPA in minimally or non-immunocompromised patients. Patients had CPA confirmed by chest computed tomography (CT) and/or endoscopy, positive Aspergillus culture from a respiratory sample, and positive serologic test for Aspergillus precipitins. Patients received voriconazole (200 mg twice daily) for a period of 6-12 months and were followed for 6 months after the end of therapy (EOT). The primary endpoint was global success at 6 months, defined as complete or partial (≥50 % improvement) radiological response and mycological eradication. Forty-one patients with confirmed CPA were enrolled. All patients had A. fumigatus as the etiologic agent. By EOT, five patients had died from comorbidities and seven had discontinued voriconazole due to toxicity. The global success rate at 6 months was 13/41 (32 %): 10/19 (53 %) for chronic necrotizing aspergillosis and 3/22 (14 %) for chronic cavitary aspergillosis (p = 0.01). The respective success rates at EOT were 58 and 32 %. Clinical symptoms and quality of life also improved during treatment. Voriconazole is effective for CPA, with acceptable toxicity. The response rate is higher and obtained more rapidly in necrotizing than cavitary forms.
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154
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Ferrand H, Foulon S, Mangiapan G, Naccache JM, Taillé C, Bouaud J, Mayaud C, Cadranel J, Séroussi B, Lioté H. Validation des performances du logiciel Pneumodoc®pour l’aide au diagnostic d’imputabilité médicamenteuse des pneumopathies infiltrantes diffuses. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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155
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Rozensztajn N, Ruppert AM, Mathiot N, Poulot V, Giroux Leprieur E, Duruisseaux M, Lavole A, Antoine M, Cadranel J, Wislez M. Facteurs associés à une progression précoce sous inhibiteurs de tyrosine kinase de l’EGFR (ITK EGFR). Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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156
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Duruisseaux M, Antoine M, Mathiot N, Giroux Leprieur E, Fleury Feith J, Rozensztajn N, Cadranel J, Wislez M. Impact pronostic des sous-types mucineux et non mucineux des carcinomes bronchiolo-alvéolaires. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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157
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Cadranel J, Gervais R, Antoine M, Merle P, Moro-Sibilot D, Westeel V, Bigay-Game L, Quoix E, Friard S, Barlesi F, Zaegel M, Moreau L, Monnet I, Duhamel J, Oliviero G, Souquet PJ, Thiberville L, Baudrin L, Morin F, Zalcman G. Essai IFCT-0504 : traitement de première ligne des cancers bronchiolo-alvéolaires (CBA) étendus, par erlotinib (E) ou carboplatine/paclitaxel (C/P) - impact du type cytologique mucineux (M) ou non mucineux (NM). Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.053] [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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158
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Andréjak C, Véziris N, Lescure X, Cadranel J, Jounieaux V. Essai CaMoMy : évaluation de la capacité de deux schémas thérapeutiques (Clarithromycine ou Moxifloxacine) à négativer les cultures à six mois de malades porteurs d’une infection pulmonaire à Mycobacterium xenopi. PHRC national 2010. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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159
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Giroux Leprieur E, Antoine M, Poulot V, Belmont L, Duruisseaux M, Gounant V, Milleron B, Lacave R, Cadranel J, Wislez M. Caractéristiques associées à la résistance à un doublet à base de platine dans les cancers bronchiques non à petites cellules (CBNPC) de stades IIIb-IV. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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160
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Gounant V, Roynard P, Prengel C, Khalil A, Wislez M, Lavole A, Cadranel J, Bernaudin JF, Fleury-Feith J. Intérêt de la congélation cellulaire en cytopathologie tumorale broncho pulmonaire. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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161
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Ruppert AM, Beau-Faller M, Belmont L, Lavolé A, Gounant V, Cadranel J, Wislez M. Un regard simple sur la biologie du cancer bronchique : MET. Rev Mal Respir 2011; 28:1241-9. [DOI: 10.1016/j.rmr.2011.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 12/11/2022]
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162
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Fleury-Feith J, Gounant V, Antoine M, Cadranel J, Bernaudin JF. Cytoponctions transbronchiques : influence des profils cellulaires recueillis sur la valeur prédictive négative. Ann Pathol 2011. [DOI: 10.1016/j.annpat.2011.09.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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163
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Belmont L, Milleron B, Antoine M, Colombat M, Khalil A, Cadranel J, Bernaudin JF, Carette MF, Fleury-Feith J. Intérêt diagnostique de l’association cytologie-histopathologie dans les ponctions transthoraciques guidées par tomodensitométrie. Ann Pathol 2011. [DOI: 10.1016/j.annpat.2011.09.173] [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]
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164
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Boitiaux JF, Debray MP, Nicaise-Roland P, Adle-Biassette H, Danel C, Clerici C, Aubier M, Mariette X, Cadranel J, Crestani B. Idiopathic interstitial lung disease with anti-SSA antibody. Rheumatology (Oxford) 2011; 50:2245-50. [DOI: 10.1093/rheumatology/ker267] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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165
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Bron C, Catherinot E, Cadranel J, Oksenhendler E, Rivaud E, Couderc LJ. [Pulmonary non-infectious diseases in common variable immunodeficiency]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:214-219. [PMID: 21920280 DOI: 10.1016/j.pneumo.2011.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2011] [Indexed: 05/31/2023]
Abstract
Few studies have described pulmonary non-infectious diseases (PNID) in patients with common variable immunodeficiency (CVID). Indeed the most frequent complications in these patients are infectious. The aim of our study is to analyze the characteristics of PNID in a retrospective study of patients with CVID of two pneumology departments in Paris (France), from 1990 to 2008. PNID was observed in 11 patients. Mean immunoglobulin serum level was 3.46g/L. The PNID observed were: arteriovenous pulmonary fistula: three; interstitial lung disease: three; asthma: two; mediastinal lymphadenopathy: four; emphysema: one; mesothelioma: one. Our study outlines the broad spectrum of pulmonary manifestations related to CVID. Clinicians should be aware of the diagnosis of PNID even in patients without classic infectious manifestations.
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Berghmans T, Pasleau F, Paesmans M, Bonduelle Y, Cadranel J, Cs Toth I, Garcia C, Giner V, Holbrechts S, Lafitte JJ, Lecomte J, Louviaux I, Markiewicz E, Meert AP, Richez M, Roelandts M, Scherpereel A, Tulippe C, Van Houtte P, Van Schil P, Wachters C, Westeel V, Sculier JP. Surrogate markers predicting overall survival for lung cancer: ELCWP recommendations. Eur Respir J 2011; 39:9-28. [PMID: 21737547 DOI: 10.1183/09031936.00190310] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present systematic review was performed under the auspices of the European Lung Cancer Working Party (ELCWP) in order to determine the role of early intermediate criteria (surrogate markers), instead of survival, in determining treatment efficacy in patients with lung cancer. Initially, the level of evidence for the use of overall survival to evaluate treatment efficacy was reviewed. Nine questions were then formulated by the ELCWP. After reviewing the literature with experts on these questions, it can be concluded that overall survival is still the best criterion for predicting treatment efficacy in lung cancer. Some intermediate criteria can be early predictors, if not surrogates, for survival, despite limitations in their potential application: these include time to progression, progression-free survival, objective response, local control after radiotherapy, downstaging in locally advanced nonsmall cell lung cancer (NSCLC), complete resection and pathological TNM in resected NSCLC, and a few circulating markers. Other criteria assessed in these recommendations are not currently adequate surrogates of survival in lung cancer.
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167
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Borget I, Cadranel J, Pignon JP, Quoix E, Coudert B, Westeel V, Dansin E, Madelaine J, Madroszyk A, Friard S, Daniel C, Morin F, Chouaid C. Cost-effectiveness of three strategies for second-line erlotinib initiation in nonsmall-cell lung cancer: the ERMETIC study part 3. Eur Respir J 2011; 39:172-9. [DOI: 10.1183/09031936.00201210] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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168
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Cadranel J, Giroux Leprieur E. [Sampling and search for the EGFR mutation: what's taking, when and how to test?]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67 Suppl 1:S9-S14. [PMID: 21777768 DOI: 10.1016/s0761-8417(11)70004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Since the IPASS study, that has shown a benefit in term of progression-free survival in first line of treatment in non-small cell lung cancer (NSCLC) with activating EGFR mutations, and the restricted prescription of this treatment to the presence of these mutations, the determination of the mutational status has became necessary at the diagnosis. This research study of these mutations, present in about 10% of non-selected NSCLC, has to be preferred in case of clinical factors predictive of mutations (sex, race, tobacco status, adenocarcinoma), but don't have to be exclusive, the correlation between these clinical factors and the presence of the mutations being imperfect. Also, the research study of the EGFR mutations should be performed for patients non eligible for chemotherapy (PS>2). Molecular testing could be performed on biopsies, and also on cytology, knowing that there is a mismatch between the tumor and the metastasis for EGFR status. Samples should be prepared according to standardized protocols, avoiding fixation with Bouin. The gold-standard for molecular testing is still sequencing, but alternative targeted tests (allele-specific PCR...) seem to be more sensitive. Some immunohistochemistry tests are in development for EGFR mutations, but have to be validated on large prospective cohorts. At last, new tumoral sampling have to be performed in case of progression under gefitinib in first line, to look for acquired resistance EGFR mutations, or for other resistance molecular markers (Met amplification).
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169
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Bommenel T, Launay O, Meynard JL, Gilquin J, Katlama C, Lascaux AS, Mahamat A, Martinez V, Pradier C, Rouveix E, Simon A, Costagliola D, Abgrall S, Abgrall S, Barin F, Bentata M, Billaud E, Boue F, Burty C, Cabie A, Costagliola D, Cotte L, de Truchis P, Duval X, Duvivier C, Enel P, Gasnault J, Gaud C, Gilquin J, Grabar S, Katlama C, Khuong MA, Lang JM, Lascaux AS, Launay O, Mahamat A, Mary-Krause M, Matheron S, Meynard JL, Pavie J, Pialoux G, Pilorge F, Poizot-Martin I, Pradier C, Reynes J, Rouveix E, Simon A, Tattevin P, Tissot-Dupont H, Viard JP, Viget N, Brosseau M, Salomon V, Jacquemet N, Guiguet M, Lanoy E, Lievre L, Selinger-Leneman H, Lacombe JM, Potard V, Bricaire F, Herson S, Desplanque N, Girard PM, Meyohas MC, Picard O, Cadranel J, Mayaud C, Clauvel JP, Decazes JM, Gerard L, Molina JM, Diemer M, Sellier P, Honore P, Jeantils V, Tassi S, Mechali D, Taverne B, Bouvet E, Crickx B, Ecobichon JL, Picard-Dahan C, Yeni P, Berthe H, Dupont C, Chandemerle C, Mortier E, Tisne-Dessus D, Weiss L, Salmon D, Auperin I, Roudiere L, Fior R, Delfraissy JF, Goujard C, Jung C, Lesprit P, Vittecoq D, Fraisse P, Rey D, Beck-Wirth G, Stahl JP, Lecercq P, Gourdon F, Laurichesse H, Fresard A, Lucht F, Bazin C, Verdon R, Chavanet P, Arvieux C, Michelet C, Choutet P, Goudeau A, Maitre MF, Hoen B, Elinger P, Faller JP, Borsa-Lebas F, Caron F, Daures JP, May T, Rabaud C, Berger JL, Remy G, Arlet-Suau E, Cuzin L, Massip P, Thiercelin Legrand MF, Pontonnier G, Yasdanpanah Y, Dellamonica P, Pugliese P, Aleksandrowicz K, Quinsat D, Ravaux I, Delmont JP, Moreau J, Gastaut JA, Retornaz F, Soubeyrand J, Galinier A, Ruiz JM, Allegre T, Blanc PA, Bonnet-Montchardon D, Lepeu G, Granet-Brunello P, Esterni JP, Pelissier L, Cohen-Valensi R, Nezri M, Chapadaud S, Laffeuillade A, Raffi F, Boibieux A, Peyramond D, Livrozet JM, Touraine JL, Trepo C, Strobel M, Bissuel F, Pradinaud R, Sobesky M, Contant M. Comparative effectiveness of continuing a virologically effective first-line boosted protease inhibitor combination or of switching to a three-drug regimen containing either efavirenz, nevirapine or abacavir. J Antimicrob Chemother 2011; 66:1869-77. [DOI: 10.1093/jac/dkr208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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170
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Ruppert A, Eguia B, Fillon J, Lavole A, Wislez M, Gounant V, Epaud C, Milleron B, Frances C, Cadranel J. The role of skin toxicities in prolonged pemetrexed treatment: A case-control study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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171
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Cadranel J, Gervais R, Wislez M, Merle P, Moro-Sibilot D, Westeel V, Bigay-Game L, Quoix EA, Friard S, Barlesi F, Zaegel M, Moreau L, Monnet I, Duhamel J, Oliviero G, Souquet PJ, Thiberville L, Baudrin L, Morin F, Zalcman G. IFCT-0504 trial: Mucinous (M) and nonmucinous (NM) cytologic subtypes interaction effect in first-line treatment of advanced bronchioloalveolar carcinoma (BAC) by erlotinib (E) or carboplatin/paclitaxel (C/P). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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172
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Bachmeyer C, Fouqueray B, Fabien N, Cadranel J, Haymann JP. Autoimmune hypoparathyroidism associated with pulmonary tuberculosis. QJM 2011; 104:441-3. [PMID: 20605844 DOI: 10.1093/qjmed/hcq109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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173
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Ruppert AM, Lerolle U, Carette MF, Lavole A, Khalil A, Bazelly B, Antoine M, Cadranel J, Milleron B. Coexisting pulmonary nodules in operable lung cancer: prevalence and probability of malignancy. Lung Cancer 2011; 74:233-8. [PMID: 21511355 DOI: 10.1016/j.lungcan.2011.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/07/2011] [Accepted: 03/21/2011] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Coexistence of pulmonary nodules in operable non small cell lung cancer (NSCLC) may influence the therapeutic indication. The aim of this study was to evaluate prospectively the prevalence and the probability of malignancy of pulmonary nodules in operable lung cancer. METHODS From a prospective database, all surgically treated patients diagnosed with NSCLC from 1998 to 2003 were retrospectively reviewed. Patients presenting pulmonary nodule(s) were identified. RESULTS Two hundred thirty nine patients had a complete resection for a NSCLC and 56 patients (24%) presented altogether 88 nodules on thoracic CT. Twenty-four of these nodules (27%) were malignant, 28 (32%) benign and 36 (41%) of undetermined nature. Five factors associated with nodule's malignancy were identified: tumour histology (non-squamous (non-SCC) 44% vs. SCC 7%, p=0.001), localization of the nodules in an upper lobe (vs. other lobe, p=0.004), co localization in the same lobe as the NSCLC (vs. another lobe, p=0.03), nodule size (p=0.05) and shape (speculated vs. non spiculated, p=0.02). From these factors, a probability score was assessed with a malignancy rate in SCC of 0% in nodules presenting ≤ 1 feature, 33% with 2 features and 100% with ≥ 3 features and in non-SCC of 40% with 1 feature, 82% with 2 features and 100% with 3 ≥ features. CONCLUSION Diagnosis of satellite nodules associated with early stage NSCLC is common. We developed a predictive score to estimate the probability of malignancy which may be a precious aid in the management of pulmonary nodules associated to a NSCLC.
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Ruppert AM, Wislez M, Poulot V, Lacave R, Antoine M, Cadranel J. [A simple view on lung cancer biology: The EGFR pathway]. Rev Mal Respir 2011; 28:565-77. [PMID: 21549910 DOI: 10.1016/j.rmr.2011.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
Abstract
Epidermal growth factor receptor (EGFR) is a cell membrane tyrosine kinase receptor. Activating mutations at exon 19 and 21 of the EGFR gene are associated with the occurrence and development of lung adenocarcinoma. These gain of function mutations predict responsiveness to EGFR tyrosine kinase inhibitors (TKis), erlotinib or gefitinib and are also a favorable prognostic factor in lung cancer. Sequencing is the recommended technique to detect the mutations, but other more sensitive technics are under evaluation. Treatment as first line therapy by gefitinib is limited to lung cancer patients harboring an EGFR mutation. Erlotinib can be given regardless of the EGFR status as second or third line therapy, as well as maintenance therapy in patients with a stable disease after platinum based chemotherapy. In EGFR mutated tumors, most patients present a recurrence of the disease, despite an initial response on EGFR TKis. Two mechanisms of secondary resistance have been identified, the selection of the T790M mutation in EGFR exon 20 and the MET amplification. Other molecular anomalies as the ras mutations or the EMLA-ALK protein fusion are mutually exclusive with the EGFR mutations and are associated with primary resistance to EGFR TKis.
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175
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Rivière F, Roszensztajn N, Wislez M, Cadranel J. [A typic thoracic image]. Rev Mal Respir 2010; 27:1081-4. [PMID: 21111280 DOI: 10.1016/j.rmr.2010.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 03/11/2010] [Indexed: 11/29/2022]
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