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Hoba J, Grancher A, Hautefeuille V, Turpin A, Bouhier-Leporrier K, Galais MP, Bignon AL, Di Fiore A, Desgrippes R, Miglianico L, Avisse B, Baconnier M, Lam YH, Dutherage M, Sefrioui D, Malicot KL, Phelip JM, Michel P, Gillibert A, Di Fiore F. Relative dose intensity of first-line triplet chemotherapy in metastatic colorectal cancer. Dig Liver Dis 2024:S1590-8658(24)00772-2. [PMID: 38851974 DOI: 10.1016/j.dld.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Relative dose intensity (RDI) is a measurement of chemotherapy (CT) dose defined as the actual dose received divided by the standard calculated dose during a set period. The study objective was to assess the impact of a RDI ≥ 80% on response and survival of patients treated in first line CT by FOLFOXIRI or FOLFIRINOX ± Bevacizumab (BV) for an unresectable metastatic colorectal cancer (mCRC). MATERIALS AND METHODS It was a retrospective, non-interventional, multicenter study calculating RDI from the first cycles of CT to the first CT-scan evaluation (CT-scan1). Objective response and disease control rates (ORR and DCR), progression-free survival (PFS) and overall survival (OS) were compared between patients with RDI ≥ 80% and <80% and results were adjusted for age, gender, ECOG, tumor location, number of metastatic sites, RAS and BRAF status, the CT regimen, the use of BV, the delay from C1 to CT scan1. RESULTS Among 152 screened patients, 100 met inclusion criteria, with a mean (± standard deviation) age at 59.0 (± 10.7) years. The ECOG performance status was 0-1 in 96 (96%) patients; metastases were synchronous in 95 (95%), RAS and BRAF were mutated in 60 (60%) and 22 (22%), respectively. ORR was observed in 51 (51%) at CT-scan1 with median PFS and OS of 10.5 and 21.9 months, respectively. A RDI ≥ 80% was observed in 44 (44%) patients without impact on ORR (ORa: 1.04, 95% CI: 0.37 to 2.89, p = 0.94) but was significantly associated to improved PFS and OS with HRa 0.50 (95%CI: 0.29 to 0.87, p = 0.013) and 0.52 (95% CI: 0.29 to 0.91, p = 0.023), respectively. CONCLUSION Our results suggest a low level of FOLFOXIRI or FOLFIRINOX +/- BV exposure in first-line mCRC is associated with a significant trend on PFS and OS.
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Affiliation(s)
- Julien Hoba
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Department of Hepatogastroenterology F 76000, Rouen, France
| | - Adrien Grancher
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Department of Hepatogastroenterology F 76000, Rouen, France
| | - Vincent Hautefeuille
- Gastroenterology and Digestive Oncology, Hôpital Universitaire d'Amiens, Amiens, France
| | - Anthony Turpin
- Medical Oncology Department, University hospital, Lille, France and University of Lille, Lille, France
| | | | | | - Anne-Laure Bignon
- Hepatogastroenterology Department, University Hospital of Caen, Caen, France
| | | | - Romain Desgrippes
- Hepato-gastroenterology department, Centre Hospitalier de Saint-Malo, Saint-Malo F-35403, France
| | | | | | - Mathieu Baconnier
- Department of Gastroenterology, General Hospital, 74960 Annecy, France
| | - You-Heng Lam
- Department of Gastroenterology, General Hospital, 49300 Cholet, France
| | - Marie Dutherage
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Department of Hepatogastroenterology F 76000, Rouen, France
| | - David Sefrioui
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Department of Hepatogastroenterology F 76000, Rouen, France
| | - Karine Le Malicot
- Biostatistics Department, Fédération Francphone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231 University of Burgundy and Franche Comté, Dijon, France
| | - Jean-Marc Phelip
- Hepatogastroenterology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pierre Michel
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Department of Hepatogastroenterology F 76000, Rouen, France
| | - André Gillibert
- Department of Biostatistics, CHU Rouen, F 76000, Rouen, France
| | - Frédéric Di Fiore
- Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Department of Hepatogastroenterology F 76000, Rouen, France.
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Machover D, Almohamad W, Castagné V, Desterke C, Gomez L, Goldschmidt E. Treatment of patients with carcinomas in advanced stages with 5-fluorouracil, folinic acid and pyridoxine in tandem. Sci Rep 2024; 14:12054. [PMID: 38802419 PMCID: PMC11130240 DOI: 10.1038/s41598-024-62860-z] [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: 12/18/2023] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
The effect of high-dose pyridoxine (PN) on activity of 5-fluorouracil (FUra) and folinic acid (FA)-containing regimens was studied in 50 patients including 14 with digestive tract, and 36 with breast carcinomas (BC) in advanced stages with poor prognostic characteristics. Patients with colorectal, and pancreas adenocarcinoma received oxaliplatin, irinotecan, FUra, FA (Folfirinox), and patients with squamous cell carcinoma of the esophagus had paclitaxel, carboplatin, FUra, FA (TCbF). Patients with BC received AVCF (doxorubicin, vinorelbine, cyclophosphamide, FUra, FA) followed by TCbF or TCbF only, and patients who overexpressed HER2 received TCbF plus trastuzumab and pertuzumab. PN (1000-3000 mg/day iv) preceded each administration of FUra and FA. 47 patients (94%) responded, including 16 (32%) with CR. Median tumor reduction was 93%. Median event-free survival (EFS) was 37.7 months. The 25 patients with tumor shrinkage ≥ 91% had EFS of 52% from 42 months onwards. Unexpected toxicity did not occur. PN enhances potency of chemotherapy regimens comprising FUra and FA.
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Affiliation(s)
- David Machover
- INSERM U935-UA09, University Paris-Saclay, Paul-Brousse Hospital, 12, Avenue Paul-Vaillant-Couturier, 94800, Villejuif, France.
| | - Wathek Almohamad
- Department of Medical Oncology, University Paris-Saclay, Paul-Brousse Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 94800, Villejuif, France
| | - Vincent Castagné
- Department of Pharmacy, University Paris-Saclay, Paul-Brousse Hospital, APHP, 94800, Villejuif, France
| | - Christophe Desterke
- INSERM U935-UA09, University Paris-Saclay, Paul-Brousse Hospital, 12, Avenue Paul-Vaillant-Couturier, 94800, Villejuif, France
| | - Léa Gomez
- Department of Biophysics and Nuclear Medicine, University Paris-Saclay, Kremlin-Bicêtre Hospital, APHP, 94270, Le Kremlin-Bicêtre, France
| | - Emma Goldschmidt
- Department of Medical Oncology, University Paris-Saclay, Paul-Brousse Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 94800, Villejuif, France
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3
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Huguet F, Riou O, Pasquier D, Modesto A, Quéro L, Michalet M, Bordron A, Schipman B, Orthuon A, Lisbona A, Vendrely V, Jaksic N. Radiation therapy of the primary tumour and/or metastases of digestive metastatic cancers. Cancer Radiother 2024; 28:66-74. [PMID: 37806823 DOI: 10.1016/j.canrad.2023.04.007] [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: 02/09/2023] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 10/10/2023]
Abstract
Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended.
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Affiliation(s)
- F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, AP-HP, DMU Orphé, Sorbonne université, Paris, France; Laboratory of Cancer Biology and Therapeutics, centre de recherche Saint-Antoine, U938, Inserm, Paris, France.
| | - O Riou
- Institut de recherche en cancérologie de Montpellier, U1194, Inserm, université de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, institut régional du cancer de Montpellier, Montpellier, France
| | - D Pasquier
- Service d'oncologie radiothérapie, centre Oscar-Lambret, Lille, France; Université de Lille, CNRS, école centrale de Lille, UMR 9189 - CRIStAL, Lille, France
| | - A Modesto
- Département de radiothérapie, institut universitaire du cancer de Toulouse, Toulouse, France; Centre de recherche du cancer de Toulouse, UMR 1037, Inserm, université Toulouse-III Paul-Sabatier, Toulouse, France
| | - L Quéro
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP Nord, DMU Icare, Paris, France; Université Paris Cité, U1160, Inserm, Paris, France
| | - M Michalet
- Institut de recherche en cancérologie de Montpellier, U1194, Inserm, université de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, ICM, institut régional du cancer de Montpellier, Montpellier, France
| | - A Bordron
- Département de radiothérapie, centre hospitalier universitaire de Brest, Brest, France
| | - B Schipman
- Institut de cancérologie de Bourgogne, Dijon, France
| | - A Orthuon
- Institut de cancérologie de Bourgogne, Dijon, France
| | - A Lisbona
- Institut de cancérologie de l'Ouest, centre René-Gauducheau, Saint-Herblain, France
| | - V Vendrely
- Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - N Jaksic
- Institut de cancérologie et radiothérapie Brétillien, Saint-Malo, France
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Muzellec L, Campion L, Bachet JB, Taieb J, Fremont E, Senellart H, Moreau J, Bouché O, Garric M, Guimbaud R, Greilsamer C, Bodère A, Lièvre A, Girot P, Edeline J, Tougeron D, Bennouna J, Touchefeu Y. Prognostic score for synchronous metastatic rectal cancer: A real-world study. Dig Liver Dis 2023; 55:1411-1416. [PMID: 37005173 DOI: 10.1016/j.dld.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Prognostic factors of metastatic rectal cancer are not well known. AIM The objective of this study was to identify prognostic factors of overall survival (OS) in a cohort of patients with non-resectable synchronous metastatic rectal cancer. METHODS Patients were retrospectively enrolled from 18 French centres. Univariate and multivariate analyses were performed to identify prognostic factors for OS. A simple score was derived from this a development cohort RESULTS: A total of 243 patients with metastatic rectal cancer were included in the study. Median OS was 24.4 months, 95% CI [19.4-27.2]. Among patients with non-resected metastases (n=141), six independent prognostic factors associated with better OS were identified in multivariate analysis: primary tumour surgery, WHO score 0-1, middle or upper rectal tumour, lung metastases only, systemic chemotherapy and targeted agent in first line. A prognostic score individualized three groups, each factor counting for one point in the score (<3, = 3 et > 3). Their median OS were respectively 27.9 months, 95% CI [21.7-35.1], 17.1 months [11.9-19.7] (HR2/1=2.08, 95%, CI [1.31-3.30], p2/1=0.002) and 9.1 months [4.9-11.7] (HR3/2=2.32, 95% CI [1.38-3.92], p3/2=0.001). CONCLUSION A prognostic score for non-resectable synchronous metastatic rectal cancer can be proposed to classify patients in three prognostic groups.
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Affiliation(s)
- Léa Muzellec
- Nantes Université, CHU Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, F-44000 Nantes, France
| | - Loïc Campion
- Biometrics, Institut de Cancérologie de l'Ouest, Saint Herblain 44800, France; CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001, 44000 Nantes, France
| | - Jean-Baptiste Bachet
- Department of Gastroenterology and Digestive Oncology, Assistance publique-Hôpitaux de Paris, Groupe hospitalier Pitié Salpêtrière, France
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Université Paris Descartes, Hopital Européen Georges Pompidou, Paris, France
| | - Elodie Fremont
- Department of Gastroenterology, Centre Hospitalier Universitaire de Poitiers, France
| | - Hélène Senellart
- Medical Oncology department, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Johanna Moreau
- Department of Gastroenterology and Digestive Oncology, Hôpital Robert Debré, CHU Reims, France
| | - Olivier Bouché
- Department of Gastroenterology and Digestive Oncology, Hôpital Robert Debré, CHU Reims, France
| | - Marie Garric
- Oncologie Médicale Digestive, CHU de Toulouse, Toulouse, France
| | - Rosine Guimbaud
- Oncologie Médicale Digestive, CHU de Toulouse, Toulouse, France
| | | | - Anaïs Bodère
- Department of Gastroenterology and Digestive Oncology, Centre Hospitalier Universitaire de Rennes, France
| | - Astrid Lièvre
- Department of Gastroenterology and Digestive Oncology, Centre Hospitalier Universitaire de Rennes, France
| | - Paul Girot
- Nantes Université, CHU Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, F-44000 Nantes, France
| | - Julien Edeline
- Medical Oncology department, Centre Eugène Marquis, Rennes, France
| | - David Tougeron
- Department of Gastroenterology, Centre Hospitalier Universitaire de Poitiers, France
| | - Jaafar Bennouna
- Department of Medical Oncology, Hospital Foch, F-92150 Suresnes, France
| | - Yann Touchefeu
- Nantes Université, CHU Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Hépato-Gastroentérologie, Inserm CIC 1413, F-44000 Nantes, France.
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5
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The Evolving Neoadjuvant Treatment Paradigm for Patients with Locoregional mismatch Repair Proficient Rectal Cancer. Curr Treat Options Oncol 2022; 23:453-473. [PMID: 35312962 DOI: 10.1007/s11864-022-00961-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/29/2022]
Abstract
OPINION STATEMENT The standard of care for locally advanced rectal cancer (LARC) has included preoperative chemoradiation, total mesorectal excision surgery and post operative adjuvant chemotherapy based on histopathology. The current therapeutic landscape in LARC has many different options with different directions of travel - depending on the goal of treatment. Enthusiasm for delivering total neoadjuvant therapy (TNT) for patients with locally advanced rectal cancer (LARC) is increasing in the light of recently published randomised phase III trials - RAPIDO and PRODIGE-23. There is a wide diversity of different potential schedules and a multitude of approaches, which include induction neoadjuvant chemotherapy (NACT) with a range of chemotherapy options (CAPEOX, FOLFOX, FOLFOXIRI) and a varying duration of 6-18 weeks, or consolidation NACT. These schedules either precede or follow short-course preoperative radiation therapy (SCPRT) using 5 × 5Gy or long-course chemoradiation (LCCRT) using 45-60Gy respectively. The different strategies of induction and consolidation neoadjuvant chemotherapy have been compared and have similar long-term outcomes, but consolidation chemotherapy may facilitate organ-sparing. The results are driving novel paradigms with both intensification and de-intensification treatment strategies. The ideal combination, sequence or duration of such a TNT approach remains undefined. As yet, there are no robust clinical, genetic, molecular, immune or imaging features (alone or integrated), which either direct or aid these choices. Currently, the selection of neoadjuvant treatment is driven by the impact on avoidance or feasibility of surgery or reducing the risk of metastases rather than prevention of local recurrence. Most believe that TNT will improve overall survival, despite the present lack of evidence. Both the inherent heterogeneity in LARC and the observed range of different responses underline the need for response biomarkers to individually tailor therapy rather than 'a one size fits all' approach.
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Tharin Z, Blanc J, Alaoui IC, Bertaut A, Ghiringhelli F. Influence of first line chemotherapy strategy depending on primary tumor location in metastatic colorectal cancer. J Gastrointest Oncol 2021; 12:1509-1517. [PMID: 34532106 DOI: 10.21037/jgo-20-593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background Primary tumor location (PTL) is a major prognostic factor in metastatic colorectal cancer (mCRC) with left side which present better prognosis than right sided. Uncertainty exists regarding comparative effectiveness of irinotecan or oxaliplatin doublet in mCRC in function of PTL. Methods We conducted a retrospective comparing clinical outcomes from both regimens in function of sidedness. Patients with newly diagnosed mCRC candidates to first-line chemotherapy were selected. Clinical outcomes were assessed and stratified by tumor location (left, right and rectal) and type of treatment. Results Overall, 702 patients met the inclusion criteria. Primary colon cancer was right-sided in 248 (35.3%) patients, left-sided in 296 (42.2%) and rectal in 158 (22.5%) patients. Whatever PTL monochemotherapy give poor progression-free survival (PFS) and overall survival (OS). Triplet give better PFS and OS only for rectal cancer. When looking at doublet in first line. Folinic acid, 5FU, and irinotecan (FOLFIRI) give better PFS in rectal cancer [PFS of 21.2 (95% CI: 14.9-NR) versus 12.2 (95% CI: 10.1-13.4) months for the folinic acid, 5FU, and oxaliplatin (FOLFOX) group, P=0.009] and at trend for better PFS in right side tumor [14.9 (95% CI: 8.8-20.8) versus 11.3 (95% CI: 8.4-13.2) months for the FOLFOX group. P=0.0755]. No difference was observed in term of OS. Conclusions our results support that either FOLFIRI or FOLFOX regimens give similar efficacy in both left and right metastatic colic cancer. FOLFIRI and FOLFIRINOX regimens might be preferred for metastatic rectal carcinoma.
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Affiliation(s)
- Zoé Tharin
- Department of Medical Oncology, Center GF Leclerc, Dijon, France
| | - Julie Blanc
- Department of Biostatistics, Center GF Leclerc, Dijon, France
| | | | - Aurélie Bertaut
- Department of Biostatistics, Center GF Leclerc, Dijon, France
| | - Francois Ghiringhelli
- Department of Medical Oncology, Center GF Leclerc, Dijon, France.,Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France.,University of Burgundy-Franche Comté, Dijon, France.,UMR INSERM1231, Dijon, France
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Pharmacologic modulation of 5-fluorouracil by folinic acid and high-dose pyridoxine for treatment of patients with digestive tract carcinomas. Sci Rep 2021; 11:12668. [PMID: 34135415 PMCID: PMC8209008 DOI: 10.1038/s41598-021-92110-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 06/04/2021] [Indexed: 01/02/2023] Open
Abstract
Supplementation of cancer cells exposed to 5-fluorouracil (FUra) and folinic acid (FA) with high concentration pyridoxal 5′-phosphate, the cofactor of vitamin B6, potentiates the cytotoxicity of FUra in a synergistic interaction mode. We report a pilot study in 13 patients with previously untreated advanced carcinoma of the digestive tract to assess the impact of high-dose pyridoxine (PN) on the antitumor activity of regimens comprising FUra and FA. Five patients had colorectal adenocarcinoma (CRC); 5 had pancreas adenocarcinoma (PC); and 3 had squamous cell carcinoma of the esophagus (EC). Patients with CRC and with PC received oxaliplatin, irinotecan, FUra and FA, and patients with EC had paclitaxel, carboplatin, FUra and FA. PN iv from 1000 to 3000 mg/day preceded each administration of FA and FUra. Eleven patients responded. Two patients with CRC attained CRs and 3 had PRs with reduction rates ≥ 78%. Two patients with PC attained CRs, and 2 had PRs with reduction rates ≥ 79%. Responders experienced disappearance of most metastases. Of 3 patients with EC, 2 attained CRs. Median time to attain a response was 3 months. Unexpected toxicity did not occur. Results suggest that high-dose vitamin B6 enhances antitumor potency of regimens comprising FUra and FA.
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8
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[Neoadjuvant treatment for rectal cancer]. Bull Cancer 2021; 108:855-867. [PMID: 34140155 DOI: 10.1016/j.bulcan.2021.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 02/01/2023]
Abstract
The management of patients with locally advanced rectal cancer has improved significantly in the past few years with preoperative radiotherapy (RT) and total mesorectal excision. The rate of local recurrence is now around 5 % while the risk of metastatic recurrence has not been reduced which is about 30 %. The benefit of adjuvant chemotherapy remains questionable apart from patients with ypN+tumor after preoperative chemoradiotherapy (CRT) for whom FOLFOX is an option. In recent years, several therapeutic trials have evaluated the benefit of extending the time between the end of RT and surgery and/or the benefit of neoadjuvant chemotherapy, administered as induction (before RT) or in consolidation (after RT and before surgery). The first results of two positive phase 3 trials, PRODIGE 23 and RAPIDO, have been reported in 2020. The two regimens evaluated in these trials are markedly different but have shown that neoadjuvant chemotherapy significantly reduces the risk of distant metastasis. Current developments largely related to a de-escalation of therapy: organ conservation according to a "Watch and Wait" strategy or local resection of the scar, administration of neoadjuvant chemotherapy without RT. These therapeutic strategies have not yet been validated but should be in the news tomorrow. The purpose of this review is to present recent data reported in patients with locally advanced rectal cancer.
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Breton C, Aparicio T, Le Malicot K, Ducreux M, Lecomte T, Bachet JB, Taieb J, Legoux JL, De Gramont A, Bennouna J, Bouché O, Boussari O, Manfredi S, Gornet JM. Predictive factors of severe early treatment-related toxicity in patients receiving first-line treatment for metastatic colorectal cancer: Pooled analysis of 2190 patients enrolled in Fédération Francophone de Cancérologie Digestive (FFCD) trials. Eur J Cancer 2021; 153:40-50. [PMID: 34130228 DOI: 10.1016/j.ejca.2021.04.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/25/2021] [Indexed: 11/29/2022]
Abstract
AIM Few studies have explored the association between baseline characteristics and the occurrence of early toxicities in patients treated with first-line chemotherapy for metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Individual patient data of 2190 patients enrolled in 10 prospective FFCD (Fédération Francophone de Cancérologie Digestive) trials were analysed. Severe early toxicity was defined as the occurrence of grade ≥III toxicity within 3 months after initiation of chemotherapy (ET3). RESULTS Patients received monotherapy based on 5-FU (n = 1068), a cytotoxic doublet (n = 395) or tritherapy with a cytotoxic doublet plus anti-VEGF agent or a cytotoxic triplet (n = 727). The patients received 5-FU (100%), Irinotecan (39.6%), Oxaliplatin (13.4%), Bevacizumab (29.6%) or Aflibercept (1.8%). ET3 occurred in 244 patients (22.8%) with monotherapy, 248 patients (62.8%) with doublet and 392 patients (53.9%) with tritherapy. The most frequent ET3s were related to biological abnormalities and/or gastrointestinal, general and vascular disorders. The prognostic factors for the occurrence of an ET3 in multivariate analysis were a performance status of 2 rather than 0-1 (OR 2.57; 95% CI [1.16, 5.73]; p = 0.02), tritherapy versus monotherapy (OR 2.31; 95% CI [0.84, 6.33]; p = 0.02), alkaline phosphatase > 300 UI/l (OR 3.07; 95% CI [1.79, 5.27]; p < 0.001) and non-resected primary tumour versus resection (OR 1.59; 95% CI [1.06, 2.39]; p = 0.02). Median overall survival in patients without ET3 was significantly longer than that in patients with ET3 (HR 0.87; 95% CI [0.80-0.96]; p = 0.004). CONCLUSION ET3 is frequent whatever the treatment regimen and is associated with certain baseline characteristics. The clinical impact of ET3 on prognosis in mCRC warrants further investigation.
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Affiliation(s)
- Clémence Breton
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Thomas Aparicio
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Karine Le Malicot
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Michel Ducreux
- Gustave Roussy Cancer Campus, Villejuif, Université Paris-Saclay, France
| | - Thierry Lecomte
- Hôpital universitaire de Tours, Université de Tours, Tours, France
| | - Jean-Baptiste Bachet
- Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Julien Taieb
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Université de Paris, SIRIC CARPEM, Paris, France
| | | | | | - Jaafar Bennouna
- Hôpital universitaire de Nantes, Université de Nantes, Nantes, France
| | - Olivier Bouché
- Hôpital universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Olayide Boussari
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Sylvain Manfredi
- FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Jean-Marc Gornet
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France.
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Karoui M, Gallois C, Piessen G, Legoux JL, Barbier E, De Chaisemartin C, Lecaille C, Bouche O, Ammarguellat H, Brunetti F, Prudhomme M, Regimbeau JM, Glehen O, Lievre A, Portier G, Hartwig J, Goujon G, Romain B, Lepage C, Taieb J. Does neoadjuvant FOLFOX chemotherapy improve the prognosis of high-risk Stage II and III colon cancers? Three years' follow-up results of the PRODIGE 22 phase II randomized multicentre trial. Colorectal Dis 2021; 23:1357-1369. [PMID: 33580623 DOI: 10.1111/codi.15585] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/24/2021] [Accepted: 02/06/2021] [Indexed: 12/12/2022]
Abstract
AIM Neoadjuvant chemotherapy has proven valuable in locally advanced resectable colon cancer (CC) but its effect on oncological outcomes is uncertain. The aim of the present paper was to report 3-year oncological outcomes, representing the secondary endpoints of the PRODIGE 22 trial. METHOD PRODIGE 22 was a randomized multicentre phase II trial in high-risk T3, T4 and/or N2 CC patients on CT scan. Patients were randomized between 6 months of adjuvant FOLFOX (upfront surgery) or perioperative FOLFOX (four cycles before surgery and eight cycles after; FOLFOX perioperative). In wild-type RAS patients, a third arm testing perioperative FOLFOX-cetuximab was added. The primary endpoint was the tumour regression grade. Secondary endpoints were 3-year overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS) and time to recurrence (TTR). RESULTS Overall, 120 patients were enrolled. At interim analysis, the FOLFOX-cetuximab arm was stopped for futility. The remaining 104 patients represented our intention-to-treat population. In the perioperative group, 96% received the scheduled four neoadjuvant cycles and all but one had adjuvant FOLFOX for eight cycles. In the control arm, 38 (73%) patients received adjuvant FOLFOX. The median follow-up was 54.3 months. Three-year OS was 90.4% in both arms [hazard ratio (HR) = 0.85], 3-year DFS, RFS and TTR were, respectively, 76.8% and 69.2% (HR=0.94), 73% and 69.2% (HR = 0.86) and 82% and 72% (HR = 0.67) in the perioperative and control arms, respectively. Forest plots did not show any subgroup with significant difference for survival outcomes. No benefit from adding cetuximab was observed. CONCLUSION Perioperative FOLFOX has no detrimental effect on long-term oncological outcomes and may be an option for some patients with locally advanced CC.
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Affiliation(s)
- Mehdi Karoui
- Department of Digestive and Oncological Surgery, AP-HP; Hôpital Européen Georges Pompidou, Paris University, Paris, France
| | - Claire Gallois
- Department of Hepato-gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, AP-HP, Paris University, Paris, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Lille University Hospital, Lille, France
| | - Jean-Louis Legoux
- Department of Hepato-gastroenterology and Digestive Oncology, CHR La Source, Orléans, France
| | - Emilie Barbier
- Biostatistics, FFCD, EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | | | - Cedric Lecaille
- Department of Oncology, Polyclinique Bordeaux Nord, Bordeaux, France
| | - Olivier Bouche
- Department of Digestive Oncology, CHU Robert Debré, Reims, France
| | | | - Francesco Brunetti
- Department of Digestive Surgery, AP-HP, CHU Henri Mondor, Créteil, France
| | | | | | - Olivier Glehen
- Department of Digestive Surgery, CHU Lyon Sud, Lyon, France
| | - Astrid Lievre
- Department of Gastroenterology, CHU Rennes, Rennes 1 University, Rennes, France
| | | | - Johannes Hartwig
- Department of Gastroenterology, Infirmerie Protestante, Caluire-et-Cuire, France
| | - Gael Goujon
- Department of Gastroenterology, Paris VII, AP-HP, BCHU Bichat, Paris, France
| | - Benoit Romain
- Department of Digestive Surgery, CHU Hautepierre, Strasbourg, France
| | - Come Lepage
- Hepato-gastroenterology and Digestive Oncology Department, FFCD, EPICAD INSERM LNC-UMR 1231, CHU Dijon, University of Burgundy and Franche Comté, Dijon, France
| | - Julien Taieb
- Department of Hepato-gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, AP-HP, Paris University, Paris, France
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11
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Abdalla S, Benoist S, Lefèvre JH, Penna C, Brouquet A. New treatment strategies for non-metastatic rectal cancer. J Visc Surg 2021; 158:497-505. [PMID: 33926836 DOI: 10.1016/j.jviscsurg.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The most widely practiced (standard) treatment of non-metastatic rectal cancer is based on proctectomy with mesorectal excision (partial or total according to the location of the tumor and commonly called TME). Surgery is preceded by CAP50-type chemoradiotherapy (capecitabineand 50 Grays radiation) and performed 6-8 weeks after the end of chemoradiotherapy. The development of new endoscopic, surgical, radiation-based and chemotherapeutic modalities leads surgeons to envisage customized treatment to find the best compromise between functional and oncologic results according to the locoregional extension of the tumor. Superficial lesions are amenable to transanal excision. T2-3 tumors<4cm are amenable to rectal preservation when neoadjuvant treatment obtains a complete response, allowing local excision or close surveillance. Intensification endocavitary radiotherapy and induction and consolidation chemotherapy regimens to avoid recourse to salvage abdomino-perineal resection (APR) are under investigation. For locally advanced rectal cancers (T3-4 and all N+ irrespective of T), the following scenarios can be envisaged: for initially resectable tumors (T3N0, T1-T3N+, circumferential resection margin>2mm), neoadjuvant chemotherapy alone aims to minimize the risk of local recurrence while avoiding the sequelae of radiotherapy. In case of initially non-resectable tumors (T4, circumferential resection margin<1mm), induction chemotherapy before chemoradiotherapy and consolidation chemotherapy after short course radiotherapy provide better results than standard treatment in terms of complete response and recurrence-free survival, and should be routinely proposed in this indication.
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Affiliation(s)
- S Abdalla
- Department of digestive and oncological surgery, Bicêtre hospital, Paris Sud university hospital Group, Assistance Publique-Hôpitaux de Paris, 63, rue Gabriel-Péri, 94275 Le Kremlin Bicêtre, France; Paris Sud Faculty of Medicine, Paris Saclay university, 94275 Le Kremlin-Bicêtre, France
| | - S Benoist
- Department of digestive and oncological surgery, Bicêtre hospital, Paris Sud university hospital Group, Assistance Publique-Hôpitaux de Paris, 63, rue Gabriel-Péri, 94275 Le Kremlin Bicêtre, France; Paris Sud Faculty of Medicine, Paris Saclay university, 94275 Le Kremlin-Bicêtre, France
| | - J H Lefèvre
- General and Digestive Surgery Department, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Faculty of Medicine Sorbonne University Paris VI, Paris, France
| | - C Penna
- Department of digestive and oncological surgery, Bicêtre hospital, Paris Sud university hospital Group, Assistance Publique-Hôpitaux de Paris, 63, rue Gabriel-Péri, 94275 Le Kremlin Bicêtre, France; Paris Sud Faculty of Medicine, Paris Saclay university, 94275 Le Kremlin-Bicêtre, France
| | - A Brouquet
- Department of digestive and oncological surgery, Bicêtre hospital, Paris Sud university hospital Group, Assistance Publique-Hôpitaux de Paris, 63, rue Gabriel-Péri, 94275 Le Kremlin Bicêtre, France; Paris Sud Faculty of Medicine, Paris Saclay university, 94275 Le Kremlin-Bicêtre, France.
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12
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Conroy T, Bosset JF, Etienne PL, Rio E, François É, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, de la Fouchardière C, Lamfichekh N, Juzyna B, Jouffroy-Zeller C, Rullier E, Marchal F, Gourgou S, Castan F, Borg C. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2021; 22:702-715. [PMID: 33862000 DOI: 10.1016/s1470-2045(21)00079-6] [Citation(s) in RCA: 524] [Impact Index Per Article: 174.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment of locally advanced rectal cancer with chemoradiotherapy, surgery, and adjuvant chemotherapy controls local disease, but distant metastases remain common. We aimed to assess whether administering neoadjuvant chemotherapy before preoperative chemoradiotherapy could reduce the risk of distant recurrences. METHODS We did a phase 3, open-label, multicentre, randomised trial at 35 hospitals in France. Eligible patients were adults aged 18-75 years and had newly diagnosed, biopsy-proven, rectal adenocarcinoma staged cT3 or cT4 M0, with a WHO performance status of 0-1. Patients were randomly assigned (1:1) to either the neoadjuvant chemotherapy group or standard-of-care group, using an independent web-based system by minimisation method stratified by centre, extramural extension of the tumour into perirectal fat according to MRI, tumour location, and stage. Investigators and participants were not masked to treatment allocation. The neoadjuvant chemotherapy group received neoadjuvant chemotherapy with FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2, and fluorouracil 2400 mg/m2 intravenously every 14 days for 6 cycles), chemoradiotherapy (50 Gy during 5 weeks and 800 mg/m2 concurrent oral capecitabine twice daily for 5 days per week), total mesorectal excision, and adjuvant chemotherapy (3 months of modified FOLFOX6 [intravenous oxaliplatin 85 mg/m2 and leucovorin 400 mg/m2, followed by intravenous 400 mg/m2 fluorouracil bolus and then continuous infusion at a dose of 2400 mg/m2 over 46 h every 14 days for six cycles] or capecitabine [1250 mg/m2 orally twice daily on days 1-14 every 21 days]). The standard-of-care group received chemoradiotherapy, total mesorectal excision, and adjuvant chemotherapy (for 6 months). The primary endpoint was disease-free survival assessed in the intention-to-treat population at 3 years. Safety analyses were done on treated patients. This trial was registered with EudraCT (2011-004406-25) and ClinicalTrials.gov (NCT01804790) and is now complete. FINDINGS Between June 5, 2012, and June 26, 2017, 461 patients were randomly assigned to either the neoadjuvant chemotherapy group (n=231) or the standard-of-care group (n=230). At a median follow-up of 46·5 months (IQR 35·4-61·6), 3-year disease-free survival rates were 76% (95% CI 69-81) in the neoadjuvant chemotherapy group and 69% (62-74) in the standard-of-care group (stratified hazard ratio 0·69, 95% CI 0·49-0·97; p=0·034). During neoadjuvant chemotherapy, the most common grade 3-4 adverse events were neutropenia (38 [17%] of 225 patients) and diarrhoea (25 [11%] of 226). During chemoradiotherapy, the most common grade 3-4 adverse event was lymphopenia (59 [28%] of 212 in the neoadjuvant chemotherapy group vs 67 [30%] of 226 patients in the standard-of-care group). During adjuvant chemotherapy, the most common grade 3-4 adverse events were lymphopenia (18 [11%] of 161 in the neoadjuvant chemotherapy group vs 42 [27%] of 155 in the standard-of-care group), neutropenia (nine [6%] of 161 vs 28 [18%] of 155), and peripheral sensory neuropathy (19 [12%] of 162 vs 32 [21%] of 155). Serious adverse events occurred in 63 (27%) of 231 participants in the neoadjuvant chemotherapy group and 50 (22%) of 230 patients in the standard-of-care group (p=0·167), during the whole treatment period. During adjuvant therapy, serious adverse events occurred in 18 (11%) of 163 participants in the neoadjuvant chemotherapy group and 36 (23%) of 158 patients in the standard-of-care group (p=0·0049). Treatment-related deaths occurred in one (<1%) of 226 patients in the neoadjuvant chemotherapy group (sudden death) and two (1%) of 227 patients in the standard-of-care group (one sudden death and one myocardial infarction). INTERPRETATION Intensification of chemotherapy using FOLFIRINOX before preoperative chemoradiotherapy significantly improved outcomes compared with preoperative chemoradiotherapy in patients with cT3 or cT4 M0 rectal cancer. The significantly improved disease-free survival in the neoadjuvant chemotherapy group and the decreased neurotoxicity indicates that the perioperative approach is more efficient and better tolerated than adjuvant chemotherapy. Therefore, the PRODIGE 23 results might change clinical practice. FUNDING Institut National du Cancer, Ligue Nationale Contre le Cancer, and R&D Unicancer.
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Affiliation(s)
- Thierry Conroy
- Institut de Cancérologie de Lorraine, Université de Lorraine, Nancy, France; APEMAC, Université de Lorraine, Nancy, France.
| | - Jean-François Bosset
- Hôpital Nord Franche-Comté, Montbéliard, France; University Hospital of Besançon, Besançon, France
| | | | - Emmanuel Rio
- Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint-Herblain, France
| | | | | | - Véronique Vendrely
- Centre Hospitalier et Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Xavier Artignan
- Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | | | | | | | - Clotilde Morand
- Centre Hospitalier Départemental, Site de la Roche-sur-Yon, La Roche-sur-Yon, France
| | | | | | | | | | - Eric Rullier
- Centre Hospitalier et Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Frédéric Marchal
- Institut de Cancérologie de Lorraine, Université de Lorraine, Nancy, France
| | - Sophie Gourgou
- Institut Régional du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Florence Castan
- Institut Régional du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Christophe Borg
- Hôpital Nord Franche-Comté, Montbéliard, France; University Hospital of Besançon, Besançon, France
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Drug-Drug Interactions of Irinotecan, 5-Fluorouracil, Folinic Acid and Oxaliplatin and Its Activity in Colorectal Carcinoma Treatment. Molecules 2020; 25:molecules25112614. [PMID: 32512790 PMCID: PMC7321123 DOI: 10.3390/molecules25112614] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/24/2022] Open
Abstract
The combination of folinic acid, 5-fluorouracil, oxaliplatin and/or irinotecan (FOLFOXIRI) is the standard of care for metastatic colorectal cancer (CRC). This strategy inhibits tumor growth but provokes drug resistance and serious side effects. We aimed to improve FOLFOXIRI by optimization of the dosing and the sequence of drug administration. We employed an orthogonal array composite design and linear regression analysis to obtain cell line-specific drug combinations for four CRC cell lines (DLD1, SW620, HCT116, LS174T). Our results confirmed the synergy between folinic acid and 5-fluorouracil and additivity, or even antagonism, between the other drugs of the combination. The drug combination administered at clinical doses resulted in significantly higher antagonistic interactions compared to the low-dose optimized drug combination (ODC). We found that the concomitant administration of the optimized drug combination (ODC) was comparatively active to sequential administration. However, the administration of oxaliplatin or the active metabolite of irinotecan seemed to sensitize the cells to the combination of folinic acid and 5-fluorouracil. ODCs were similarly active in non-cancerous cells as compared to the clinically used doses, indicating a lack of reduction of side effects. Interestingly, ODCs were inactive in CRC cells chronically pretreated with FOLFOXIRI, suggesting the occurrence of resistance. We were unable to improve FOLFOXIRI in terms of efficacy or specificity. Improvement of CRC treatment should come from the optimization of targeted drugs and immunotherapy strategies.
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Brouquet A, Bachet JB, Huguet F, Karoui M, Artru P, Sabbagh C, Lefèvre JH, Vernerey D, Mariette C, Vicaut E, Benoist S. NORAD01-GRECCAR16 multicenter phase III non-inferiority randomized trial comparing preoperative modified FOLFIRINOX without irradiation to radiochemotherapy for resectable locally advanced rectal cancer (intergroup FRENCH-GRECCAR- PRODIGE trial). BMC Cancer 2020; 20:485. [PMID: 32471382 PMCID: PMC7257230 DOI: 10.1186/s12885-020-06968-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Preoperative radiochemotherapy (RCT) is recommended in France prior to total mesorectal excision in patients with mid or low locally advanced rectal cancer (LARC) (cT3/T4 and/or N+) because it has been shown to improve local control. Preoperative RCT has also disadvantages including the absence of proven impact on metastatic recurrence and the risk of late side effects on bowel and genitourinary function. In patients with primarily resectable LARC, preoperative systemic chemotherapy without pelvic irradiation could be used as an alternative to RCT. METHODS This study is a multicenter, open-label randomized, 2-arm phase III non-inferiority trial. Patients with mid or low resectable LARC (cT3N0 or cT1-T3N+ with circumferential resection margin [CRM] > 2 mm on pretreatment MRI) will be randomized to either modified FOLFIRINOX for 3 months or RCT (Cap50 intensified-modulated radiotherapy). All patients have restaging MRI after preoperative treatment. The primary endpoint is 3-year progression-free survival (PFS) from the time to randomization including progression during preoperative treatment. Secondary endpoints are treatment related toxicity, treatment compliance, R0 resection rate, sphincter saving surgery rate, postoperative morbidity and mortality rates, loco-regional recurrence free survival, overall survival, bowel and sexual functions at diagnosis, quality of life, radiologic and pathologic response after preoperative treatment. The number of patients required is 574. DISCUSSION The choice of modified FOLFIRINOX for preoperative chemotherapy is supported by recent and consistent data on safety and efficacy of this regimen on rectal cancer. The use of preoperative chemotherapy instead of RCT could be associated with pronounced advantages in terms of functional results and quality of life in cancer survivors. However and first of all, the non-inferiority of preoperative chemotherapy compared to RCT on oncologic outcome has to be validated. If this study demonstrates the non-inferiority of chemotherapy compared to RCT, this can lead to a crucial change in clinical practice in a large subset of rectal cancer patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03875781 (March 15, 2019). Version 1.1.
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Affiliation(s)
- Antoine Brouquet
- Service de Chirurgie Digestive et Oncologique, Hôpital Bicêtre, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique, Hôpitaux de Paris, 63, rue Gabriel Péri, Le Kremlin Bicetre, 94275, France. .,Faculté de Médecine Paris Sud, Université Paris Saclay, Lrekmlin Bicêtre, 94275, France.
| | - Jean-Baptiste Bachet
- Service d'Oncologie Digestive, Hôpital de la Pitié Salpétrière, Assistance Publique, Hôpitaux de Paris, Paris, 75013, France
| | - Florence Huguet
- Service de Radiothérapie, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Paris, 75020, France
| | - Mehdi Karoui
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique, Hôpitaux de Paris, Paris, 75015, France
| | | | - Charles Sabbagh
- Service de Chirurgie Digestive, CHU Amiens, Amiens, 60000, France
| | - Jérémie H Lefèvre
- Service de Chirurgie Générale et Digestive, Hôpital Saint Antoine, Assistance Publique, Hôpitaux de Paris, Paris, 75012, France
| | | | - Christophe Mariette
- Service de Chirurgie Digestive et Oncologique, CHU Lille, Lille, 59000, France
| | - Eric Vicaut
- Unité de Recherche Clinique Paris VII, Assistance Publique, Hôpitaux de Paris, Paris, 75010, France
| | - Stephane Benoist
- Service de Chirurgie Digestive et Oncologique, Hôpital Bicêtre, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique, Hôpitaux de Paris, 63, rue Gabriel Péri, Le Kremlin Bicetre, 94275, France.,Faculté de Médecine Paris Sud, Université Paris Saclay, Lrekmlin Bicêtre, 94275, France
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15
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The treatment of rectal cancer with synchronous liver metastases: A matter of strategy. Crit Rev Oncol Hematol 2019; 139:91-95. [DOI: 10.1016/j.critrevonc.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/14/2022] Open
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Total neoadjuvant approach with FOLFOXIRI plus bevacizumab followed by chemoradiotherapy plus bevacizumab in locally advanced rectal cancer: the TRUST trial. Eur J Cancer 2019; 110:32-41. [DOI: 10.1016/j.ejca.2019.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/31/2018] [Accepted: 01/06/2019] [Indexed: 01/22/2023]
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