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Pfister C, Gravis G, Flechon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Soulie M, Allory Y, Harter V, Culine S. Perioperative dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin in muscle-invasive bladder cancer (VESPER): survival endpoints at 5 years in an open-label, randomised, phase 3 study. Lancet Oncol 2024; 25:255-264. [PMID: 38142702 DOI: 10.1016/s1470-2045(23)00587-9] [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: 06/08/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The optimal perioperative chemotherapy for patients with muscle-invasive bladder cancer is not defined. The VESPER (French Genito-Urinary Tumor Group and French Association of Urology V05) trial reported improved 3-year progression-free survival with dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) versus gemcitabine and cisplatin (GC) in patients who received neoadjuvant therapy, but not in the overall perioperative setting. In this Article, we report on the secondary endpoints of overall survival and time to death due to bladder cancer at 5-year follow-up. METHODS VESPER was an open-label, randomised, phase 3 trial done at 28 university hospitals or comprehensive cancer centres in France, in which adults (age ≤18 years and ≤80 years) with primary bladder cancer and histologically confirmed muscle-invasive urothelial carcinoma were randomly allocated (1:1; block size four) to treatment with dd-MVAC (every 2 weeks for a total of six cycles) or GC (every 3 weeks for a total of four cycles). Overall survival and time to death due to bladder cancer (presented as 5-year cumulative incidence of death due to bladder cancer) was analysed by intention to treat (ITT) in all randomly assigned patients. Overall survival was assessed by the Kaplan-Meier method with the treatment groups compared with log-rank test stratified for mode of administration of chemotherapy (neoadjuvant or adjuvant) and lymph node involvement. Time to death due to bladder cancer was analysed with an Aalen model for competing risks and a Fine and Gray regression model stratified for the same two covariates. Results were presented for the total perioperative population and for the neoadjuvant and adjuvant subgroups. The trial is registered with ClinicalTrials.gov, NCT01812369, and is complete. FINDINGS From Feb 25, 2013, to March 1, 2018, 500 patients were randomly assigned, of whom 493 were included in the final ITT population (245 [50%] in the GC group and 248 [50%] in the dd-MVAC group; 408 [83%] male and 85 [17%] female). 437 (89%) patients received neoadjuvant chemotherapy. Median follow-up was 5·3 years (IQR 5·1-5·4); 190 deaths at the 5-year cutoff were reported. In the perioperative setting (total ITT population), we found no evidence of association of overall survival at 5 years with dd-MVAC treatment versus GC treatment (64% [95% CI 58-70] vs 56% [50-63], stratified hazard ratio [HRstrat] 0·79 [95% CI 0·59-1·05]). Time to death due to bladder cancer was increased in the dd-MVAC group compared with in the GC group (5-year cumulative incidence of death: 27% [95% CI 21-32] vs 40% [34-46], HRstrat 0·61 [95% CI 0·45-0·84]). In the neoadjuvant subgroup, overall survival at 5 years was improved in the dd-MVAC group versus the GC group (66% [95% CI 60-73] vs 57% [50-64], HR 0·71 [95% CI 0·52-0·97]), as was time to death due to bladder cancer (5-year cumulative incidence: 24% [18-30] vs 38% [32-45], HR 0·55 [0·39-0·78]). In the adjuvant subgroup, the results were not conclusive due to the small sample size. Bladder cancer progression was the cause of death for 157 (83%) of the 190 deaths; other causes of death included cardiovascular events (eight [4%] deaths), deaths related to chemotherapy toxicity (four [2%]), and secondary cancers (four [2%]). INTERPRETATION Our results on overall survival at 5 years were in accordance with the primary endpoint analysis (3-year progression-free survival). We found no evidence of improved overall survival with dd-MVAC over GC in the perioperative setting, but the data support the use of six cycles of dd-MVAC over four cycles of GC in the neoadjuvant setting. These results should impact practice and future trials of immunotherapy in bladder cancer. FUNDING French National Cancer Institute.
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Affiliation(s)
- Christian Pfister
- Department of Urology, Charles Nicolle University Hospital, Rouen, France; Clinical Investigation Center, Onco-Urology, Inserm 1404, Rouen, France.
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, Marseille, France
| | - Aude Flechon
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | - Hakim Mahammedi
- Department of Medical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Aline Guillot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, St Priest, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, Caen, France
| | - Michel Soulie
- Department of Urology, Rangueil University Hospital, Toulouse, France
| | - Yves Allory
- Department of Pathology, Curie Institute, Saint-Cloud, France
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France
| | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Université de Paris, Paris, France
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Kim C, Kwak W, Won DH, Kim J, Hwang DB, Kim N, Kang M, Jeon Y, Park YI, Park JW, Yun JW. Loss of Dact2 alleviates cisplatin-induced nephrotoxicity through regulation of the Igfl-MAPK pathway axis. Cell Biol Toxicol 2023; 39:3197-3217. [PMID: 37603122 DOI: 10.1007/s10565-023-09827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Abstract
Wnt signaling is a principal pathway regulating the essential activities of cell proliferation. Here, we investigated the effect of Wnt/β-catenin signaling on in vivo drug-induced renal injury through the deletion of Dact2, a Wnt antagonist, and deciphered the underlying mechanism. Wild-type (WT) and Dact2 knockout (KO) mice were administered a single intraperitoneal injection of cisplatin to induce renal injury. The injury was alleviated in Dact2 KO mice, which showed lower levels of blood urea nitrogen and creatinine. RNA sequencing revealed 194 differentially expressed genes (DEGs) between WT and Dact2 KO mouse kidney before cisplatin treatment. Among them, higher levels of Igf1, one of the Wnt target genes responsible for "Positive regulation of cell proliferation" in KO mice, were confirmed along with the induction of Ki67 expression. In RNA-seq analysis comparing WT and Dact2 KO mice after cisplatin treatment, genes related to "Apoptosis" and "Activation of mitogen-activated protein kinase (MAPK) activity" were among the downregulated DEGs in KO mice. These results were corroborated in western blotting of proteins related to apoptosis and proapoptotic MAPK pathway; the expression of which was found to be lower in cisplatin-treated KO mice. Importantly, β-catenin was found to directly bind to and regulate the transcription of Igf1, leading to the alleviation of cisplatin-induced cytotoxicity by the Wnt agonist, CHIR-99021. In addition, Igf1 knockdown accelerated cisplatin-induced cytotoxicity, accompanied by the MAPK upregulation. Our findings suggest that Dact2 knockout could protect cisplatin-induced nephrotoxicity by inhibiting apoptosis, possibly through the regulation of the Igf1-MAPK axis associated with Wnt/β-catenin signaling.
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Affiliation(s)
- Changuk Kim
- Department of Biotechnology, The Catholic University of Korea, Bucheon, 14662, Republic of Korea
| | - Woori Kwak
- Department of Biotechnology, The Catholic University of Korea, Bucheon, 14662, Republic of Korea
| | - Dong-Hoon Won
- Department of Biotechnology, The Catholic University of Korea, Bucheon, 14662, Republic of Korea
| | - Jina Kim
- Department of Biotechnology, The Catholic University of Korea, Bucheon, 14662, Republic of Korea
| | - Da-Bin Hwang
- Department of Biotechnology, The Catholic University of Korea, Bucheon, 14662, Republic of Korea
| | - Nahyun Kim
- Department of Biotechnology, The Catholic University of Korea, Bucheon, 14662, Republic of Korea
| | - Minhwa Kang
- Laboratory of Veterinary Toxicology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - Young Jeon
- Laboratory of Veterinary Toxicology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - Yong Il Park
- Department of Biotechnology, The Catholic University of Korea, Bucheon, 14662, Republic of Korea
| | - Jun Won Park
- Division of Biomedical Convergence, College of Biomedical Science, Kangwon National University, Chuncheon, 24341, Republic of Korea
| | - Jun-Won Yun
- Laboratory of Veterinary Toxicology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea.
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Dumont C, Aregui A, Hauchecorne M, Lefèvre M, Aussedat Q, Reignier PL, Gauthier H, Hennequin C, Fossey-Diaz V, Xylinas E, Pachev A, Desgrandchamps F, Masson-Lecomte A, Culine S. Safety and efficacy of preoperative chemotherapy for muscle-invasive bladder cancer in elderly patients. World J Urol 2023; 41:2715-2722. [PMID: 37555987 DOI: 10.1007/s00345-023-04561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE This study aimed at describing the feasibility and oncological outcomes of standard cisplatin-based neoadjuvant chemotherapy (C-NAC) for muscle-invasive bladder cancer (MIBC) in patients aged ≥ 75 and assess the impact of baseline geriatric parameters. METHODS This retrospective study included patients with stage cT2-4NanyM0 MIBC aged 75 and older treated with ≥ 1 cycle of C-NAC from 2011 to 2021 at a high-volume academic center. Primary outcome was overall survival (OS). Secondary outcomes were chemotherapy feasibility (administration of ≥ 4 cycles), safety, and pathological downstaging. RESULTS Fifty-six patients were included. Median age was 79 (range 75-90). C-NAC regimen was ddMVAC in 41 patients and GC in 15. Seventy-three percent of patients received ≥ 4 cycles of C-NAC. Grade ≥ 3 toxicity was observed in 55% of patients. The febrile neutropenia rate was 7%. Thirty patients underwent cystectomy, and 13 underwent chemoradiotherapy. Three-year OS was 63%. Geriatric parameters polypharmacy, undernutrition, and age-adjusted Charlson comorbidity index ≥ 8 predicted worse OS. CONCLUSION Standard-of-care C-NAC and local treatments are feasible in selected elderly MIBC patients, with efficacy and safety findings similar to that observed in pivotal trials with younger patients. The prognostic impact of geriatric parameters underlines the need for specialized evaluation before treatment initiation.
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Affiliation(s)
- Clément Dumont
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France.
- Université Paris Cité, Paris, France.
| | - Amélie Aregui
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Mathilde Hauchecorne
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Madeleine Lefèvre
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Quiterie Aussedat
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Pierre-Louis Reignier
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Hélène Gauthier
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
| | - Christophe Hennequin
- Université Paris Cité, Paris, France
- Radiotherapy Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Virginie Fossey-Diaz
- Oncogeriatrics Coordination Unit, AP-HP.Nord Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Université Paris Cité, Paris, France
- Urology Department, Bichat-Claude Bernard Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Atanas Pachev
- Radiology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - François Desgrandchamps
- Université Paris Cité, Paris, France
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Alexandra Masson-Lecomte
- Université Paris Cité, Paris, France
- Urology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, Paris, France
| | - Stéphane Culine
- Medical Oncology Department, Saint-Louis Hospital, AP-HP.Nord Université Paris Cité, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France
- Université Paris Cité, Paris, France
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Culine S, Harter V, Krucker C, Gravis G, Fléchon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Fontugne J, Allory Y, Pfister C. Refining the Characterization and Outcome of Pathological Complete Responders after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Lessons from the Randomized Phase III VESPER (GETUG-AFU V05) Trial. Cancers (Basel) 2023; 15:cancers15061742. [PMID: 36980628 PMCID: PMC10046214 DOI: 10.3390/cancers15061742] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023] Open
Abstract
Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy and pelvic lymph node dissection is the optimal treatment for patients with muscle-invasive bladder cancer. In recent years, the VESPER trial showed a statistically significant higher progression-free survival with dd-MVAC (dose dense methotrexate, vinblastine, doxorubicin, and cisplatin) compared to GC (gemcitabine and cisplatin). In the present report, we refine the characterization and outcome of patients whose cystectomy specimens were pathologically free of cancer (pathological complete response, pCR). We confirm that these patients portend a better outcome as compared to patients with invasive disease (≥pT1N0) at cystectomy. Nested variant and lymphovascular invasion were identified as adverse predictive factors of pCR. Progression-free survival probability three years after pCR on cystectomy was about 85%, regardless of the NAC regimen. A lower creatinine clearance and the delivery of less than four cycles were associated with a higher risk of relapse. Predicting the efficacy of NAC remains a major challenge. The planned analysis of molecular subtypes in the VESPER trial could help predict which patients may achieve complete response and better outcome.
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Affiliation(s)
- Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Nord, Université de Paris Cité, Avenue Claude Vellefaux, 75010 Paris, France
- Correspondence: ; Tel.: +33-142-494-247
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, 14000 Caen, France
| | - Clémentine Krucker
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, 13009 Marseille, France
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France
| | - Christine Chevreau
- Department of Medical Oncology, ICR-IUCT Oncopole, 31100 Toulouse, France
| | - Hakim Mahammedi
- Department of Medical Oncology, Jean Perrin Cancer Center, 63011 Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Center, 35042 Rennes, France
| | - Aline Guillot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42270 St Priest en Jarez, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, 14000 Caen, France
| | - Jacqueline Fontugne
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
- Department of Pathology, Institut Curie, 92210 Saint-Cloud, France
- Université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Yves Allory
- CNRS, UMR144, Molecular Oncology Team, Equipe Labellisée Ligue Contre le Cancer, PSL Research University, Institut Curie, 75005 Paris, France
- Department of Pathology, Institut Curie, 92210 Saint-Cloud, France
- Université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Christian Pfister
- Department of Urology, Clinical Investigation Center, Inserm 1404, Charles Nicolle University Hospital, 76000 Rouen, France
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Tae JH, Ha MS, Chi BH, Chang IH, Kim TH, Myung SC, Nguyen TT, Kim M, Lee KE, Kim Y, Woo HK, Kyoung DS, Kim H, Choi SY. Neoadjuvant versus adjuvant chemotherapy in upper tract urothelial carcinoma: A nationwide cohort study. BMC Urol 2022; 22:175. [PMID: 36352437 PMCID: PMC9644507 DOI: 10.1186/s12894-022-01112-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose This study aimed to evaluate the trend of adjuvant chemotherapy (AC) and neoadjuvant chemotherapy (NAC) in patients who underwent radical nephroureterectomy with bladder cuff excision (NUx) for upper tract urothelial carcinoma (UTUC) to compare the perioperative outcomes and overall survival (OS) between AC and NAC using nationwide population-based data. Materials and methods We collected data on patients diagnosed with UTUC and treated with NUx between 2004 and 2016 using the National Health Insurance Service database, and evaluated the overall treatment trends. The AC and NAC groups were propensity score-matched. Cox proportional hazard and Kaplan-Meier analyses were used to assess survival. Results Of the 8,705 enrolled patients, 6,627 underwent NUx only, 94 underwent NAC, and 1,984 underwent AC. The rate of NUx without perioperative chemotherapy increased from 70.8 to 78.2% (R2 = 0.632; p < 0.001). The rates of dialysis (p = 0.398), TUR-BT (p = 1.000), and radiotherapy (p = 0.497) after NUx were similar. In the Kaplan-Meier curve, the NAC and AC groups showed no significant difference (p = 0.480). In multivariate analysis, treatment with AC or NAC was not associated with OS (hazard ratio 0.83, 95% confidence interval 0.49–1.40, p = 0.477). Conclusion The use of NUx without perioperative chemotherapy has tended to increase in South Korea. Dialysis, TUR-BT, and radiotherapy rates after NUx were similar between the NAC and AC groups. There was no significant difference in OS between the NAC and AC groups. Proper perioperative chemotherapy according to patient and tumor conditions should be determined by obtaining more evidence of UTUC.
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Pfister C, Gravis G, Fléchon A, Chevreau C, Mahammedi H, Laguerre B, Guillot A, Joly F, Soulié M, Allory Y, Harter V, Culine S. Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin or Gemcitabine and Cisplatin as Perioperative Chemotherapy for Patients With Nonmetastatic Muscle-Invasive Bladder Cancer: Results of the GETUG-AFU V05 VESPER Trial. J Clin Oncol 2022; 40:2013-2022. [PMID: 35254888 DOI: 10.1200/jco.21.02051] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The optimal perioperative chemotherapy regimen for patients with nonmetastatic muscle-invasive bladder cancer is not defined. PATIENTS AND METHODS Between February 2013 and March 2018, 500 patients were randomly assigned in 28 French centers and received either six cycles of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) once every 2 weeks or four cycles of gemcitabine and cisplatin (GC) once every 3 weeks before surgery (neoadjuvant group) or after surgery (adjuvant group). We report the primary end point of the GETUG-AFU V05 VESPER trial (ClinicalTrials.gov identifier: NCT01812369): progression-free survival (PFS) at 3 years. Secondary end points were time to progression and overall survival. RESULTS Four hundred thirty-seven patients (88%) received neoadjuvant chemotherapy; 60% of patients received the planned six cycles in the dd-MVAC arm, 84% received four cycles in the GC arm, and thereafter, 91% and 90% of patients underwent surgery, respectively. Organ-confined response (< ypT3N0) was observed more frequently in the dd-MVAC arm (77% v 63%, P = .001). In the adjuvant group, 40% of patients received six cycles in the dd-MVAC arm, and 81% of patients received four cycles in the GC arm. For all patients in the clinical trial, 3-year PFS was improved in the dd-MVAC arm, but the study did not meet its primary end point (3-year rate: 64% v 56%, hazard ratio [HR] = 0.77 [95% CI, 0.57 to 1.02], P = .066); nevertheless, the dd-MVAC arm was associated with a significantly longer time to progression (3-year rate: 69% v 58%, HR = 0.68 [95% CI, 0.50 to 0.93], P = .014). In the neoadjuvant group, PFS at 3 years was significantly higher in the dd-MVAC arm (66% v 56%, HR = 0.70 [95% CI, 0.51 to 0.96], P = .025). CONCLUSION In the VESPER trial, dd-MVAC improved 3-years PFS over GC. In the neoadjuvant group, a better bladder tumor local control and a significant improvement in 3-year PFS were observed in the dd-MVAC arm.
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Affiliation(s)
- Christian Pfister
- Department of Urology, Charles Nicolle University Hospital, Rouen, France.,Clinical Investigation Center, Onco-Urology, Inserm 1404, Rouen, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, Marseille, France
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | - Hakim Mahammedi
- Department of Medical Oncology, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - Aline Guillot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, St Priest, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, Caen, France
| | - Michel Soulié
- Department of Urology, Rangueil University Hospital, Toulouse, France
| | - Yves Allory
- Department of Pathology, Curie Institute, Saint-Cloud, France
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France
| | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP, Faculté de Paris, France
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