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Voisin A, Terret C, Schiffler C, Bidaux AS, Vanacker H, Perrin-Niquet M, Barbery M, Vinceneux A, Eberst L, Stephan P, Garin G, Spaggiari D, Pérol D, Grinberg-Bleyer Y, Cassier PA. Xevinapant combined with pembrolizumab in patients with advanced, pretreated colorectal and pancreatic cancer: results of the phase 1b/2 CATRIPCA trial. Clin Cancer Res 2024:741876. [PMID: 38502104 DOI: 10.1158/1078-0432.ccr-23-2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/19/2023] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Xevinapant is an orally available inhibitor of apoptosis proteins (IAP) inhibitor. Preclinical data suggest that IAP antagonism may synergize with immune checkpoint blockers (ICB) by modulating the NF-KB pathway in immune cells. PATIENTS AND METHODS Adult patients (pts) with non MSI-H advanced/metastatic PDAC or CRC were enrolled in this phase 1b/2 and received pembrolizumab 200mg q3w, IV and ascending doses of oral xevinapant (100, 150 and 200mg daily for 14 days on/7 days off). Dose escalation followed a 3+3 design with a 21-day dose-limiting toxicity (DLT) evaluation period. Following the determination of the recommended phase II dose (RP2D), 14 patients with PDAC and 14 patients with CRC were enrolled in expansion cohorts to assess preliminary efficacy. RESULTS Forty-one pts (26 males) with a median age of 64 years were enrolled: 13 in the dose escalation and 28 in the two expansion cohorts. No DLT was observed during dose-escalation. The RP2D was identified as xevinapant 200mg/d + pembrolizumab 200mg q3w. The most common adverse events (AE) were fatigue (37%), gastrointestinal AE (decreased appetite in 37%, nausea in 24%, stomatitis in 12 % and diarrhea and vomiting in 10% each), and cutaneous AE (pruritus, dry skin and rash seen in 20, 15 and 15% of patients respectively). The best overall response according to RECIST1.1 was partial response (PR, confirmed) in one (3%) , stable disease (SD) in four (10%) and progressive disease in 35 (88%). CONCLUSIONS Xevinapant combined with pembrolizumab was well tolerated with no unexpected adverse events. However, anti-tumor activity was low.
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Affiliation(s)
- Allison Voisin
- Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | | | | | | | | | | | - Maud Barbery
- Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | | | | | - Pierre Stephan
- Centre de Recherche en Cancérologie de Lyon, Lyon, France
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Vanacker H, Treilleux I, Schiffler C, Bieche I, Campone M, Patsouris A, Arnedos M, Cottu PH, Jacquin JP, Dalenc F, Pinton A, Servant N, Attignon V, Rouleau E, Morel A, Legrand F, Jimenez M, Andre F, Bachelot T. p4EBP1 staining predicts outcome in ER-positive endocrine-resistant metastatic breast cancer patients treated with everolimus and exemestane. Br J Cancer 2024; 130:613-619. [PMID: 38182687 PMCID: PMC10876520 DOI: 10.1038/s41416-023-02549-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND To identify patients most likely to respond to everolimus, a mammalian target of rapamycin (mTOR) inhibitor, a prospective biomarker study was conducted in hormone receptor-positive endocrine-resistant metastatic breast cancer patients treated with exemestane-everolimus therapy. METHODS Metastatic tumor biopsies were processed for immunohistochemical staining (p4EBP1, PTEN, pAKT, LKB1, and pS6K). ESR1, PIK3CA and AKT1 gene mutations were detected by NGS. The primary endpoint was the association between the p4EBP1 expression and clinical benefit rate (CBR) at 6 months of everolimus plus exemestane treatment. RESULTS Of 150 patients included, 107 were evaluable for the primary endpoint. p4EBP1 staining above the median (Allred score ≥6) was associated with a higher CBR at 6 months (62% versus 40% in high-p4EBP1 versus low-p4EBP1, χ2 test, p = 0.026) and a longer progression-free survival (PFS) (median PFS of 9.2 versus 5.8 months in high-p4EBP1 versus low-p4EBP1; p = 0.02). When tested with other biomarkers, only p4EBP1 remained a significant predictive marker of PFS in multivariate analysis (hazard ratio, 0.591; p = 0.01). CONCLUSIONS This study identified a subset of patients with hormone receptor-positive endocrine-resistant metastatic breast cancer and poor outcome who would derive less benefit from everolimus and exemestane. p4EBP1 may be a useful predictive biomarker in routine clinical practice. CLINICAL TRIAL REGISTRATION NCT02444390.
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Affiliation(s)
| | | | | | | | - Mario Campone
- Institut de cancérologie de l'ouest Pays de Loire Nantes-Angers, Saint-Herblain, France
| | - Anne Patsouris
- Institut de cancérologie de l'ouest Pays de Loire Nantes-Angers, Saint-Herblain, France
| | | | | | | | - Florence Dalenc
- ICR, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | | | | | | | | | - Alain Morel
- Institut de cancérologie de l'ouest Pays de Loire Nantes-Angers, Saint-Herblain, France
- Univ Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, F-49000, Angers, France
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Noh H, Anota A, Mongondry R, Meyrand R, Dupuis C, Schiffler C, Marijnen P, Rinaldi S, Lachuer J, Keski-Rahkonen P, Gunter MJ, Fléchon A, Fervers B, Pérol O. Impact of a one-year supervised physical activity program on long-term cancer-related fatigue and mediating effects of the gut microbiota in metastatic testicular cancer patients: protocol of the prospective multicentre, randomized controlled phase-III STARTER trial. BMC Cancer 2024; 24:84. [PMID: 38225551 PMCID: PMC10790440 DOI: 10.1186/s12885-024-11824-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Testicular germ cell tumours (TGCTs) are the most common malignancy in men aged 15-40 years, with increasing incidence worldwide. About 33 ~ 50% of the patients present with metastatic disease at diagnosis. TGCT survivors experience short- and long-term sequelae, including cancer-related fatigue (CRF). Physical activity (PA) has established effects on reducing CRF and other sequelae and improving health-related quality of life (HRQoL). However, its impact on TGCT survivors has so far received little attention. The gut microbiota plays a crucial role in various physiological functions, including cognition and metabolism, and may mediate the effects of PA on CRF and other sequelae, but this has not been investigated in randomized controlled trials. METHODS This national, multicentre, phase-III trial will evaluate the impact of a one-year supervised PA program on CRF and other short- and long-term sequelae in metastatic TGCT patients receiving cisplatin-based chemotherapy combined with etoposide+/-bleomycin. It will also investigate potential mediating effects of the gut microbiota and its metabolites involved in the gut-brain axis on the relationship between PA and CRF and other sequelae. A total of 236 men ≥ 18 years of age with metastatic TGCT (seminoma and non-seminoma) will be enrolled before starting first-line chemotherapy in several French hospitals. The primary (CRF) and secondary (cognitive/psychological/metabolic sequelae, HRQoL, etc.) outcomes and gut microbiota and relevant metabolites will be assessed at inclusion, during and at the end of the one-year intervention, and annually until 10 years since inclusion to assess long-term sequelae, more specifically CRF, cardiovascular toxicities, and second primary cancer occurrence in this population. DISCUSSION This trial will provide comprehensive and novel insights into the effects of a long-term supervised PA program on CRF and other sequelae in metastatic TGCT patients receiving first-line chemotherapy. It will also contribute to understanding the potential role of the gut microbiota and its metabolites in mediating the effects of PA on these outcomes. The findings of this study will help the development of effective PA interventions to improve the health of TGCT survivors and may have implications for other cancer populations as well. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov (NCT05588700) on 20 Oct. 2022.
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Affiliation(s)
- Hwayoung Noh
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France.
- INSERM U1296, Léon Bérard Cancer Centre, Lyon, France.
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
| | - Amélie Anota
- Direction of Clinical Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Rodolf Mongondry
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
| | - Renaud Meyrand
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
| | - Carmen Dupuis
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
| | - Camille Schiffler
- Direction of Clinical Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Philippe Marijnen
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Joel Lachuer
- INSERM U1052, Cancer Research Center of Lyon (CRCL), University Lyon 1, Lyon, France
- ProfileXpert, SFR santé Lyon-Est, CNRS UMR-S3453, INSERM US7, Lyon, France
| | - Pekka Keski-Rahkonen
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, London, UK
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon, France
| | - Béatrice Fervers
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
- INSERM U1296, Léon Bérard Cancer Centre, Lyon, France
| | - Olivia Pérol
- Departement of Prevention Cancer Environment, Léon Bérard Cancer Centre, Lyon, France
- INSERM U1296, Léon Bérard Cancer Centre, Lyon, France
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4
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Duffaud F, Blay JY, Le Cesne A, Chevreau C, Boudou-Rouquette P, Kalbacher E, Penel N, Perrin C, Laurence V, Bompas E, Saada-Bouzid E, Delcambre C, Bertucci F, Cancel M, Schiffler C, Monard L, Bouvier C, Vidal V, Gaspar N, Chabaud S. Regorafenib in patients with advanced Ewing sarcoma: results of a non-comparative, randomised, double-blind, placebo-controlled, multicentre Phase II study. Br J Cancer 2023; 129:1940-1948. [PMID: 37914801 PMCID: PMC10703915 DOI: 10.1038/s41416-023-02413-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/23/2023] [Accepted: 08/21/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The REGOBONE multi-cohort study explored the efficacy and safety of regorafenib for patients with advanced bone sarcomas; this report details the Ewing sarcoma (ES) cohort. METHODS Patients with relapsed ES progressing despite prior standard therapy, were randomised (2:1) to receive regorafenib or placebo. Patients on placebo could crossover to receive regorafenib after centrally confirmed progression. The primary endpoint was the progression-free rate at 8 weeks. With one-sided α of 0.05, and 80% power, at least 14/24 progression-free patients at 8 weeks were needed for success. RESULTS From September 2014 to November 2019, 41 patients were accrued. 36 patients were evaluable for efficacy: 23 on regorafenib and 13 on placebo. Thirteen patients (56%; one-sided 95% CI [37.5%-[)) were progression-free at 8 weeks on regorafenib vs. 1 (7.7%; 95% CI [0.4%-[) on placebo. Median PFS was 11.4 weeks on regorafenib, and 3.9 weeks on placebo. Ten placebo patients crossed over to receive regorafenib after progression. The most common grade ≥3 regorafenib-related adverse events were pain (22%), asthenia (17%), thrombocytopenia (13%) and diarrhoea (13%). CONCLUSION Although the primary endpoint was not met statistically in this randomised cohort, there is evidence to suggest that regorafenib might modestly delay tumour progression in relapsed ES after failure of prior chemotherapy.
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Affiliation(s)
- Florence Duffaud
- APHM Hopital La Timone, Medical Oncology Unit, and Aix-Marseille University (AMU), Marseille, France.
| | - Jean-Yves Blay
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - Axel Le Cesne
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Christine Chevreau
- Medical Oncology Department, Institut Universitaire de Cancérologie de Toulouse, Oncopole, Toulouse, France
| | | | - Elsa Kalbacher
- Medical Oncology Department, CHU J Minjoz, Besançon, France
| | - Nicolas Penel
- Medical Oncology Department, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | | | - Emmanuelle Bompas
- Medical Oncology Department, Centre René Gauduchau, Saint Herblain, France
| | - Esma Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | | | - François Bertucci
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
| | - Mathilde Cancel
- Medical Oncology Department, Centre Hospitalier Régional Universitaire Bretonneau, Tours, France
| | | | | | - Corinne Bouvier
- APHM Hopital La Timone, Pathology Department, and Aix-Marseille University, Marseille, France
| | - Vincent Vidal
- APHM Hopital La Timone, Radiology Department, and Aix-Marseille University Marseille, Marseille, France
| | - Nathalie Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - Sylvie Chabaud
- Department of Statistics, Centre Léon Bérard, Lyon, France
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Racadot S, Arnaud A, Schiffler C, Metzger S, Pérol D, Kirova Y. Cicaderma® in radiation-related dermatitis of breast cancer: Results from the multicentric randomised phase III CICA-RT. Clin Transl Radiat Oncol 2023; 41:100647. [PMID: 37441546 PMCID: PMC10334129 DOI: 10.1016/j.ctro.2023.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 07/15/2023] Open
Abstract
Background and purpose To prevent the occurrence of grade ≥ 2 radiodermatitis after post-operative breast irradiation in patients with non metastatic breast cancer. Methods This prospective randomised open-label multicenter study allocated patients from 3 French institutions, ≥18 years, requiring postoperative radiotherapy for histologically proven, early-stage (non-metastatic) unilateral breast adenocarcinoma or in situ breast cancer, with R0 or R1 post-operative status, to receive hygiene rules, associated with either Cicaderma® (Arm A), or preventive treatment according to the investigator preference (mainly hyaluronic acid (ialuset®), essential oils, or water spray, or no medication (Arm B). The primary outcome was to compare the efficacy of Cicaderma® versus local standard management in preventing the occurrence of grade ≥ 2 radiodermatitis. Main secondary objectives include Cicaderma® impact on radiotherapy discontinuation and on skin toxicity (pruritus), pain, quality of life, satisfaction. Results The CICA-RT study enrolled from June 2020 to April 2021, 258 women with a median age of 61 (22-91) years in 3 institutions. Patients received either Cicaderma® (A: N = 130) or standard practice (B: N = 128). In the 123 patients who initiated radiotherapy in each arm, 95 (77%, 95%CI 68.8%-84.3%) patients did not develop grade ≥ 2 dermatitis. Sensitivity and per-protocol analyses confirmed the absence of differences between arms. Conclusion This prospective study did not meet its primary endpoint of superiority of Cicaderma® over routine practice skin care in terms of prevention of acute radioinduced dermatitis of grade 2 or higher. However, Cicaderma® showed a significant decrease in the occurrence of pruritus with less patients reporting at least once grade ≥ 2 pruritus (A: N = 38, 31%; B: N = 58, 47%; p = 0.009).ClinicalTrials.gov identifier NCT04300829.
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Affiliation(s)
| | - Antoine Arnaud
- Radiotherapy Department, Institut Sainte-Catherine, Avignon, France
| | - Camille Schiffler
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Séverine Metzger
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - David Pérol
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Youlia Kirova
- Radiotherapy Department, Institut Curie, Paris, France
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Le Cesne A, Chevreau C, Perrin C, Italiano A, Hervieu A, Blay JY, Piperno-Neumann S, Saada-Bouzid E, Bertucci F, Firmin N, Kalbacher E, Narciso B, Schiffler C, Yara S, Jimenez M, Bouvier C, Vidal V, Chabaud S, Duffaud F. Regorafenib in patients with relapsed advanced or metastatic chordoma: results of a non-comparative, randomised, double-blind, placebo-controlled, multicentre phase II study. ESMO Open 2023; 8:101569. [PMID: 37285716 DOI: 10.1016/j.esmoop.2023.101569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND REGOBONE multicohort study explored the efficacy and safety of regorafenib for patients with advanced bone sarcomas; this report details the cohort of patients with relapsed advanced or metastatic chordoma. METHODS Patients with relapsed chordoma progressing despite 0-2 prior lines of systemic therapy, were randomised (2 : 1) to receive regorafenib (160 mg/day, 21/28 days) or placebo. Patients on placebo could cross over to receive regorafenib after centrally-confirmed progression. The primary endpoint was the progression-free rate at 6 months (PFR-6) (by RECIST 1.1). With one-sided α of 0.05, and 80% power, at least 10/24 progression-free patients at 6 months (PFR-6) were needed for success. RESULTS From March 2016 to February 2020, 27 patients were enrolled. A total of 23 patients were assessable for efficacy: 7 on placebo, 16 on regorafenib, 16 were men, median age was 66 (32-85) years. At 6 months, in the regorafenib arm, 1 patient was not assessable, 6/14 were non-progressive (PFR-6: 42.9%; one-sided 95% CI = 20.6) 3/14 discontinued regorafenib due to toxicity; and in the placebo arm, 2/5 patients were non-progressive (PFR-6: 40.0%; one-sided 95% CI = 7.6), 2 were non-assessable. Median progression-free survival was 8.2 months (95% CI 4.5-12.9 months) on regorafenib and 10.1 months (95% CI 0.8 months-non evaluable [NE]) on placebo. Median overall survival rates were 28.3 months (95% CI 14.8 months-NE) on regorafenib but not reached in placebo arm. Four placebo patients crossed over to receive regorafenib after centrally-confirmed progression. The most common grade ≥3 regorafenib-related adverse events were hand-foot skin reaction (22%), hypertension (22%), pain (22%), and diarrhoea (17%), with no toxic death. CONCLUSION This study failed to show any signal of benefit for regorafenib in patients with advanced/metastatic recurrent chordoma.
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Affiliation(s)
- A Le Cesne
- Medical Oncology Department, Gustave Roussy, Villejuif
| | - C Chevreau
- Medical Oncology Department, Institut Universitaire de Cancérologie de Toulouse, Oncopole, Toulouse
| | - C Perrin
- Medical Oncology Unit, Centre Eugène Marquis, Rennes
| | - A Italiano
- Medical Oncology Department, Institut Bergonié, Bordeaux
| | - A Hervieu
- Medical Oncology Department, Centre Georges Francois Leclerc, Dijon
| | - J Y Blay
- Medical Oncology Department, Centre Léon Bérard, Lyons. https://twitter.com/jeanyvesblay
| | | | - E Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice
| | - F Bertucci
- Medical Oncology Department, Institut Paoli Calmettes, Marseille
| | - N Firmin
- Medical Oncologie Department, Centre Valdorelle, Montpellier
| | - E Kalbacher
- Medical Oncology Department, CHU J Minjoz, Besançon
| | - B Narciso
- Medical Oncology Department, CHU Bretonneau, Tours
| | - C Schiffler
- Department of Statistics, Centre Léon Bérard, Lyons
| | | | | | - C Bouvier
- Aix Marseille Univ, APHM Hopital La Timone, Pathology Department, Marseille
| | - V Vidal
- Aix Marseille Univ, APHM Hopital La Timone, Radiology Department, Marseille
| | - S Chabaud
- Department of Statistics, Centre Léon Bérard, Lyons
| | - F Duffaud
- Aix Marseille University (AMU), APHM Hopital La Timone, Medical Oncology Unit, APHM, Marseille, France.
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7
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Cassier P, Terret C, Voisin A, Schiffler C, Bidaux AS, Vanacker H, Eberst L, Lepercq M, D'Argenio A, M. Bernardin, Bouhamama A, Gilles-Afchain L, Treilleux I, Tabone-Eglinger S, Spaggiari D, Chabaud S, Grinberg-Bleyer Y, Garin G, Perol D, Vinceneux A. 480P CATRIPCA – A phase I of pembrolizumab (P) combined with Xevinapant (Debio 1143, (X)) in patients (pts) with non MSI-high advanced/metastatic pancreatic ductal adenocarcinoma (PDAC) or colorectal cancer (CRC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Claude L, Isnardi V, Schiffler C, Metzger S, Martel-Lafay I, Rit S, Sarrut D, Baudier T, Ayadi M. PH-0271 Mid-p strategy versus ITV strategy in locally advanced lung cancer. A randomized phase II study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Brenet E, Philouze P, Schiffler C, Pommier P, Crozes C, Benzerdjeb N, Monchet E, Boulagnon-Rombi C, Ton Van J, Podeur F, Servagi-Vernat S, Liem X, Merol JC, Ceruse P, Serre AA, Chabaud S, Julieron M, Deneuve S. Influence of postoperative radiotherapy target volumes in unilateral head and neck carcinoma of unknown primary: A multicentric study using propensity score. Radiother Oncol 2021; 160:1-8. [PMID: 33845043 DOI: 10.1016/j.radonc.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the impact of two radiation modalities on loco-regional control, survival and tumour emergence, after node dissection for an unilateral head and neck carcinoma of unknown primary (HNCUP). MATERIALS AND METHODS This is a multicentric retrospective study of 138 patients with unilateral HNCUP treated between 2002 and 2017. The absence of primary tumour was assessed by a systematic panendoscopy and positron emission tomography. Neck dissection was initially performed for all patients. Radiation Therapy was delivered on ipsilateral lymph node areas in 62 cases (44%: UL-RT group) and on bilateral lymph node areas and the entire pharyngeal mucosa in 77 cases (56%: COMP-RT group). Impact of radiation modalities on locoregional control and overall survival was assessed using propensity score matching method in order to balance baseline characteristics between the two groups. RESULTS The population included 80.4% men, 80.4% smokers, 32.6% P16 positive tumours and 71.0% extracapsular extension. After a median follow-up of 5 years, the locoregional control rate was 80.3% in the UL-RT group and 75.3% in the COMP-RT group (p = 0.688). The corresponding rate of contralateral lymph node recurrence was 0% versus 2.6% (p = 0.503) and the rate of tumour emergence was 11.5% versus 9.1% (p = 0.778). No significant difference was observed between the UL-RT and the COMP-RT groups for overall survival (p = 0.9516), specific survival (p = 0.4837) or tumour emergence (p = 0.9034). CONCLUSION UL-RT seems to provide similar outcomes as COMP-RT in unilateral HNCUP post-operative management.
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Affiliation(s)
- Esteban Brenet
- Head and Neck Surgery Department, Centre Hospitalo Universitaire Reims, France
| | - Pierre Philouze
- Head and Neck Surgery Department, Centre Hospitalo Universitaire Lyon Sud, France
| | | | - Pascal Pommier
- Radiotherapy Department, Centre Léon Bérard, Lyon, France
| | - Carole Crozes
- Pathological Anatomy Department, Centre Léon Bérard, Lyon, France
| | - Nazim Benzerdjeb
- Pathological Anatomy Department, Centre Hospitalo Universitaire Lyon Sud, France
| | - Elodie Monchet
- Head and Neck Surgery Department, Centre Oscar Lambret, Lille, France
| | | | - Jean Ton Van
- Head and Neck Department, Centre Oscar Lambret, Lille, France
| | - Fabien Podeur
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France
| | | | - Xavier Liem
- Radiotherapy Department, Centre Oscar Lambret, Lille, France
| | - Jean-Claude Merol
- Head and Neck Department, Centre hospilato Universitaire Reims, France
| | - Philippe Ceruse
- Head and Neck Surgery Department, Centre Hospitalo Universitaire Lyon Sud, France
| | | | - Sylvie Chabaud
- Biostatistics Department, Centre Léon Bérard, Lyon, France
| | - Morbize Julieron
- Head and Neck Surgery Department, Centre Oscar Lambret, Lille, France
| | - Sophie Deneuve
- Oncologic Surgery Department, Centre Léon Bérard, Lyon, France.
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10
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Duffaud F, Blay JY, Mir O, Chevreau C, Rouquette PB, Kalbacher E, Penel N, Perrin C, Laurence V, Bompas E, Saada-Bouzid E, Delcambre C, Bertucci F, Cancel M, Schiffler C, Monard L, Bouvier C, Vidal V, Gaspar N, Chabaud S. LBA68 Results of the randomized, placebo (PL)-controlled phase II study evaluating the efficacy and safety of regorafenib (REG) in patients (pts) with metastatic relapsed Ewing sarcoma (ES), on behalf of the French Sarcoma Group (FSG) and UNICANCER. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Daubié S, Pilleul F, Thivolet A, Kalenderian AC, Cuinet M, Ricoeur A, Schiffler C, Bouhamama A, Chvetzoff G, Mastier C. Cryoneurolysis in Patients with Dorsal Neuropathic Pain Secondary to Tumor Invasion. J Vasc Interv Radiol 2020; 31:917-924. [PMID: 32376175 DOI: 10.1016/j.jvir.2020.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 12/26/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of cryoneurolysis (CNL) in patients with refractory thoracic neuropathic pain related to tumor invasion. MATERIALS AND METHODS Between January 2013 and May 2017, this single-center and retrospective study reviewed 27 computed tomography-guided CNLs performed on 26 patients for refractory thoracic neuropathic pain related to tumor invasion. Patients with cognitive impairment were excluded. Pain levels were recorded on a visual analog scale (VAS) before the procedure, on days 1, 7, 14, 28 and at each subsequent follow-up appointment. CNL was clinically successful if the postprocedural VAS decreased by 3 points or more. To determine the duration of clinical success, the end of pain relief was defined as either an increased VAS of 2 or more points, the introduction of a new analgesic treatment, a death with controlled pain, or for lost to follow-up patients, the latest follow-up appointment date with controlled pain. RESULTS Technical success rate was 96.7% and clinical success rate was 100%. Mean preprocedural pain score was 6.4 ± 1.7 and decreased to 2.4 ± 2.4 at day 1; 1.8 ± 1.7 at day 7 (P < .001); 3.3 ± 2.5 at day 14; 3.4 ± 2.6 at day 28 (P < .05). The median duration of pain relief was 45 days (range 14-70). Two minor complications occurred. CONCLUSIONS Cryoneurolysis is a safe procedure that significantly decreased pain scores in patients with thoracic neuropathic pain related to tumor invasion, with a median duration of clinical success of 45 days.
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Affiliation(s)
- Sophie Daubié
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France.
| | - Frank Pilleul
- CREATIS, UMR CNRS (Unités Mixtes de Recherche Centre National de Recherche Scientifique) 5220 - INSERM 1206, Lyon, France
| | - Arnaud Thivolet
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | | | - Marie Cuinet
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Alexis Ricoeur
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Camille Schiffler
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Amine Bouhamama
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Gisele Chvetzoff
- DISSPO (Département des Soins de Support du Patient en Oncologie), Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
| | - Charles Mastier
- Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France
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12
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Duffaud F, Blay JY, Italiano A, Bompas E, Rios M, Penel N, Mir O, Piperno-Neumann S, Chevreau C, Delcambre C, Bertucci F, Boudou Rouquette P, Vegas H, Perrin C, Thyss A, Schiffler C, Monard L, Bouvier C, Vidal V, Chabaud S. Results of the randomized, placebo (PL)-controlled phase II study evaluating the efficacy and safety of regorafenib (REG) in patients (pts) with locally advanced (LA) or metastatic relapsed chondrosarcoma (CS), on behalf of the French Sarcoma Group (FSG) and UNICANCER. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Frappaz D, Taillandier L, Bonneville Levard A, Sorre J, Ricard D, Carrie S, Schiffler C, Weller M. OS3.4 Karnofsky and WHO performance scores of brain tumour patients may limit inclusion in protocols though they depend on clinician status. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Inclusion criteria for oncological protocols often use the Karnofsky performance score (KPS) >=70 or the WHO performance score (PS) 0–2 as a cut-off value. Inclusion of neuro-oncology patients may be hampered, when general condition is preserved, while performance is decreased due to physical handicap. The goal of this study is to compare the KPS and PS assessments according to the status of the clinician.
MATERIAL AND METHODS
A cross-sectional survey was conducted through ANOCEF and EANO networks. Clinicians evaluated KPS and PS in 6 clinical situations concerning neuro oncology patients (from youngest and fittest to oldest, crippled with comorbidities).
RESULTS
The rate of PS <70 or PS> 2 increased significantly from case 1 to 6.
Sex or nationality of the clinicians had no impact when adjusting on clinician characteristics. Conversely, speciality (residents/general practitioner vs neurosurgeons vs neurologists vs oncologists), impacted KPS or PS evaluations (p<.0001 and p=0.0046, respectively). Residents or general practitioner estimate KPS much lower than the others specialities. Neurosurgeons estimate PS more severely. Clinicians who were not used to including patients in clinical trials proposed lower KPS scores (p = 0.0008). This tendancy was not shown on PS. Eldest physicians significantly rated more severely than the youngest (p = 0.0459 and p <.0001 for KPS and PS, respectively).
In a multivariate analysis, age and speciality were correlated with KPS and PS rating even if adjusted on cases.
Discordant decision for protocol inclusion (i:e: (KPS) >=70 vs PS 0–2) showed little discrepancy in case 1 (2.3%), while discrepancy increased to respectively 16, 46, 39, 33 and 43% for cases 2 to 6: in nearly all cases, the KPS would have denied access to a trial, while WHO Ps would have allowed
CONCLUSION
Rating of KP and PS is subjective in neuro oncology patients: influenced by speciality, age and inclusion habit (for KPS) of clinicians, PS 0–2 allows usually more inclusion than KPS>=70 in more severely disabled patients. A Neuro oncology specific KPS and/or PS definition is warranted to allow more widely inclusion of patients with exclusive neurologic handicap.
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Affiliation(s)
- D Frappaz
- Centre Léon Bérard et IHOP, Lyon, France
| | | | | | - J Sorre
- Santor Edition, Paris, France
| | | | - S Carrie
- Centre Léon Bérard, Lyon, France
| | | | - M Weller
- University Hospital, Zurich, France
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14
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Swalduz A, Souquet PJ, Pérol M, Moro-Sibilot D, Schiffler C, Chabaud S, Fayet Y, Rogasik M, Labrosse H, Farsi F, Brun P, Decroisette C, Bombaron P, Bringuier PP, Haddad V, Forest F, Peoc’h M, Lantuejoul S, de Fraipont F, Ray-Coquard I, Fournel P. Compliance to regional recommendations for molecular analyses and management of advanced lung cancer patients. Future Oncol 2019; 15:2139-2149. [DOI: 10.2217/fon-2018-0943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We performed a clinical audit of the management of patients with EGFR mutations, 1 year after the introduction of EGFR tyrosine kinase inhibitor ( EGFR-TKI) in first-line treatment. Methods: Compliance was defined by tumor molecular profiling for stage IIIB and IV non-small-cell lung cancer and first-line treatment as recommended by the French guidelines. Results: Among the 169 EGFR-mutated patients, compliance was 76.4%. The most common noncompliance criterion was chemotherapy given in first-line treatment instead of EGFR-TKI. No dedicated multidisciplinary meeting and type of institutions were independent unfavorable predictors for compliance. Compliance to guidelines was significantly correlated with time-to-first subsequent treatment improvement (2.5 vs 9.1 months; p < 0.0001). Conclusion: Implementation of new standards of care is challenging. Our results reinforce the role of multidisciplinary meetings to provide a better access to innovating therapeutics.
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Affiliation(s)
- Aurélie Swalduz
- Department of Chest Diseases & Thoracic Oncology, University Hospital of Saint-Étienne, 42270, Saint Priest en Jarez, France
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
| | - Pierre-Jean Souquet
- Department of Respiratory Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Maurice Pérol
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
| | - Denis Moro-Sibilot
- Pulmonology & Thoracic Oncology Department, Grenoble University Hospital, 38700, Grenoble, France
- Medicine Faculty, Joseph Fourrier University, 38043, La Tronche, France
| | - Camille Schiffler
- Department of Biostatistics, Centre Léon Bérard, 69008, Lyon, France
| | - Sylvie Chabaud
- Department of Biostatistics, Centre Léon Bérard, 69008, Lyon, France
| | - Yohan Fayet
- Équipe Évaluation Médicales et Sarcome (EMS), Centre Léon Bérard, 69008 Lyon, France
| | - Muriel Rogasik
- Équipe Évaluation Médicales et Sarcome (EMS), Centre Léon Bérard, 69008 Lyon, France
| | | | - Fadila Farsi
- Réseau Espace Santé Cancer Rhône-Alpes, 69008, Lyon, France
| | - Philippe Brun
- Department of Respiratory Medicine, Valence Hospital, 26953, Valence, France
| | - Chantal Decroisette
- Department of Respiratory Medicine, Annecy Genevois Hospital, 74370, Metz-Tessy, France
| | - Pierre Bombaron
- Department of Respiratory Medicine, Mermoz Private Hospital, 69008, Lyon, France
| | - Pierre-Paul Bringuier
- Molecular Diagnostics Laboratory, Edouard-Herriot Hospital, Hospices Civils de Lyon, 69003, Lyon, France
| | - Véronique Haddad
- Department of Biopathology, Centre Léon Bérard, 69008, Lyon, France
| | - Fabien Forest
- Department of Pathology, University Hospital of Saint Étienne, 42270, Saint Priest en Jarez, France
| | - Michel Peoc’h
- Department of Pathology, University Hospital of Saint Étienne, 42270, Saint Priest en Jarez, France
| | - Sylvie Lantuejoul
- Medicine Faculty, Joseph Fourrier University, 38043, La Tronche, France
- Department of Biopathology, Centre Léon Bérard, 69008, Lyon, France
| | - Florence de Fraipont
- Institue of Biology & Pathology, Grenoble University Hospital, 38043, Grenoble, France
| | - Isabelle Ray-Coquard
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
- Université Claude Bernard Lyon 1, 69008, Lyon, France
| | - Pierre Fournel
- Department of Medical Oncology, Institut Lucien Neuwirth, 42270, Saint-Priest-en-Jarez, France
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15
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Bachelot TD, Treilleux I, Schiffler C, Bieche I, Campone M, Patsouris A, Arnedos M, Cottu PH, Jacquin JP, Dalenc F, Attignon V, Rouleau E, Morel A, Legrand F, Jimenez M, Andre F. mTORC1 activation assessed in metastatic sample to predict outcome in patients with metastatic breast cancer treated with everolimus-exemestan: Results from the SAFIRTOR study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1024 Background: Using samples from TAMRAD study (Treilleux, Ann Oncol, 2015), we previously reported that p4EBP1, a downstream protein of mTOR, was associated with higher benefit to everolimus (eve). SAFIRTOR study was designed to validate clinical utility of this biomarker. Methods: Patients (pts) with ER+, HER2 negative, AI resistant MBC were prospectively included (NCT02444390). All pts had a biopsy of a metastatic site and were then treated with standard eve + exemestane (exe) combination. The primary end point was to validate that p4EBP1 expression is associated with longer PFS in patients treated with eve. 120 evaluable pts were needed for the pre planed statistical analysis. All samples were collected and processed in a standardized procedure in order to allow phophoproteins IHC staining. In addition to p4EBP1, we explored prognostic value of pS6K, pAkt, PTEN and LKB1, together with genomic alterations assessed by NGS and CGH arrays. Results: 150 pts were included, 30 pts had no adequate sample, and further 13 had missing clinical data, 107 were evaluable for primary objective. Median age was 62, they had previously progressed on AI treatment, either in the adjuvant (22 pts) or the metastatic setting (83 pts). 20 were considered as primary hormone resistant, 87 as secondary resistant. The median Allread score for p4EBP1 was 5.5 (range: 0-6.5). Analysis of the primary endpoint showed that p4EBP1 staining above the median is associated with a longer PFS on eve+exe. (median PFS: 9.3 months, 95CI 6.3-13.1 for high p4EBP1 versus 5.8 months, 95CI 3.7-7.8 for low p4EBP1, p = 0.02). Prognostic value of high pEBP1 remained significant when assessed in a multivariate analysis along classical clinico-biological prognostic factors for MBC (HR 0.57, 95%CI 0.38-0.88, p = 0.01). In this AI resistant population, the tumor of 42 (46%), 33 (35%) and 5 (5.3%) pts carried an activating mutation for ESR1, PIK3CA and AKT1, respectively. None of these mutational statuses were correlated to outcome. Conclusions: This prospective study validates p4EBP1 expression analysis to select patients most likely to benefit from everolimus + exemestane. Clinical trial information: NCT02444390.
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Affiliation(s)
| | | | | | | | - Mario Campone
- Institut de Cancérologie de l'Ouest, René Gauducheau, St Herblain, France
| | - Anne Patsouris
- Institute of West Cancerology Paul Papin, Angers, France
| | | | | | - Jean-Philippe Jacquin
- GINECO-Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | - Florence Dalenc
- Department of Medicalo Oncology, Institut Claudius Regaud, IUCT-Oncopole, CRCT, Inserm, Toulouse, France
| | | | | | - Alain Morel
- CRLCC Paul Papin, CRNA INSERM 892, Angers, France
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16
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El Guerche-Séblain C, Moureau A, Schiffler C, Dupuy M, Pepin S, Samson SI, Vanhems P, Schellevis F. Epidemiology and burden of influenza in healthy children aged 6 to 35 months: analysis of data from the placebo arm of a phase III efficacy trial. BMC Infect Dis 2019; 19:308. [PMID: 30947693 PMCID: PMC6449994 DOI: 10.1186/s12879-019-3920-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Despite World Health Organization recommendations, in many countries young children are not targeted for influenza vaccination. To help inform influenza vaccination policy, we examined the occurrence and burden of influenza in healthy children aged 6 to 35 months using data from a recent phase III placebo-controlled influenza vaccine trial conducted in countries in the Northern and Southern Hemispheres. Methods This was an analysis of data from participants included in the placebo arm of a phase III clinical trial in healthy children aged 6 to 35 months (EudraCT no. 2013–001231-51). Included children had never been vaccinated for influenza and were observed for one influenza season. Outcome measures included the occurrence of influenza-like illness (ILI), laboratory-confirmed influenza, virus types/subtypes, severe symptoms and complications of confirmed influenza, and healthcare use associated with confirmed influenza. Results Data from 2210 participants were analysed. ILI was reported for 811 participants (36.7%). Of these, 255 participants (31.4%) had 263 virologically confirmed episodes of influenza. The overall influenza attack rate was 11.5%. The most common influenza virus detected was A(H3N2) (40.7%), followed by B/Yamagata (23.6%), A(H1N1) (18.6%), and B/Victoria (8.0%). Grade 3 fever was reported in 24.3% of confirmed episodes, acute lower respiratory infection in 8.7%, acute otitis media in 6.1%, and pneumonia in 1.9%. In most influenza episodes (93.2%), antipyretics, analgesics, or non-steroidal anti-inflammatory drugs were taken. Antibiotics were prescribed for 41.4% of influenza episodes. More than half of the influenza episodes (57.0%) resulted in outpatient visits. Influenza resulted in overnight hospitalisation in 1.1% of episodes. Conclusions Influenza is associated with a significant burden of disease in healthy children. This analysis also revealed that antibiotics continue to be frequently used for young children with influenza. Trial registration EudraCT no. 2013–001231-51. Electronic supplementary material The online version of this article (10.1186/s12879-019-3920-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Annick Moureau
- Global Clinical Biostatistics Department, Sanofi Pasteur, Marcy l'Étoile, France
| | | | - Martin Dupuy
- Global Biostatistics Department, Sanofi Pasteur, Marcy l'Étoile, France
| | - Stephanie Pepin
- Global Clinical Sciences, Sanofi Pasteur, Marcy l'Étoile, France
| | | | - Philippe Vanhems
- Epidemiology and International Health Team, Emergent Pathogens Laboratory, Fondation Mérieux, International Center for Research in Infectiology, National Institute of Health and Medical Research, U1111, National Center of Scientific Research, Mixed Scientific Unit 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - François Schellevis
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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17
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Carbonnaux M, Brahmi M, Schiffler C, Meeus P, Sunyach MP, Bouhamama A, Karanian M, Tirode F, Pissaloux D, Vaz G, Ray-Coquard I, Blay JY, Dufresne A. Very long-term survivors among patients with metastatic soft tissue sarcoma. Cancer Med 2019; 8:1368-1378. [PMID: 30916474 PMCID: PMC6488206 DOI: 10.1002/cam4.1931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Metastatic soft tissue sarcomas (STS) are a group of rare and heterogeneous mesenchymal tumors with a poor prognosis. The aim of this study was to evaluate the incidence of long-term survivors and describe their presentation and management in a large cohort of patients with metastatic STS. METHODS We collected information of patients with metastatic STS managed in Centre Leon Berard between 1985 and 2015 aiming to compare the group of patients alive 5 years after the diagnosis of metastases vs the others. Prognostic factors of patients and tumors characteristics were investigated by logistic regression analysis. For "long-term survivors," we explored therapeutic strategies at metastatic stage. RESULTS Out of 436 patients enrolled, 39 (9%) were still alive 5 years after diagnostic of metastases with a median survival of 146 months (12 years). This "long-term survivors" group included more female and younger patients, with better performance status, more synovial sarcoma or endometrial stromal sarcoma, more patients with simple genomic sarcomas, lower tumor grade, smaller tumor, and longer disease-free interval. In multivariate analysis, age below 55 at metastatic stage (P = 0.0002) and grade 1 tumor (P < 0.0001) were significantly associated with the "long-term survivors." Their therapeutic management was usually aggressive (intensified or polychemotherapy, repeated local treatment of metastases), leading to 62% of complete response in first-line setting. CONCLUSIONS Very long-term survivors are observed in metastatic STS. Selection of patients in good condition with less aggressive tumor and administration of intensive treatment may lead to obtain these motivating results in a poor prognosis disease.
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Affiliation(s)
- Mélodie Carbonnaux
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Université Claude Bernard, Lyon, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Université Claude Bernard, Lyon, France
| | | | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, Lyon, France
| | - Marie-Pierre Sunyach
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Université Claude Bernard, Lyon, France
| | | | - Marie Karanian
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - Franck Tirode
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Gualter Vaz
- Department of Surgery, Centre Léon Bérard, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Université Claude Bernard, Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Université Claude Bernard, Lyon, France
| | - Armelle Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Université Claude Bernard, Lyon, France
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18
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Duffaud F, Mir O, Boudou-Rouquette P, Piperno-Neumann S, Penel N, Bompas E, Delcambre C, Kalbacher E, Italiano A, Collard O, Chevreau C, Saada E, Isambert N, Delaye J, Schiffler C, Bouvier C, Vidal V, Chabaud S, Blay JY. Efficacy and safety of regorafenib in adult patients with metastatic osteosarcoma: a non-comparative, randomised, double-blind, placebo-controlled, phase 2 study. Lancet Oncol 2018; 20:120-133. [PMID: 30477937 DOI: 10.1016/s1470-2045(18)30742-3] [Citation(s) in RCA: 194] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Regorafenib has proven activity in patients with pretreated gastrointestinal stromal tumours and colorectal and hepatocellular carcinoma. We designed REGOBONE to assess the efficacy and safety of regorafenib for patients with progressive metastatic osteosarcoma and other bone sarcomas. This trial comprised four parallel independent cohorts: osteosarcoma, Ewing sarcoma, chondrosarcoma, and chordoma. In this Article, we report the results of the osteosarcoma cohort. METHODS In this non-comparative, double-blind, placebo-controlled, phase 2 trial, patients aged 10 years or older with histologically confirmed osteosarcoma whose disease had progressed after treatment with one to two previous lines of chemotherapy for metastatic disease and an Eastern Cooperative Oncology Group performance status of 0 or 1 were enrolled. Patients were randomly assigned (2:1) to receive either oral regorafenib (160 mg/day, for 21 of 28 days) or matching placebo. Patients in both groups also received best supportive care. Randomisation was done using a web-based system and was stratified (permuted block) by age at inclusion (<18 vs ≥18 years old). Investigators and patients were masked to treatment allocation. Patients in the placebo group, after centrally confirmed progressive disease, could cross over to receive regorafenib. The primary endpoint was the proportion of patients without disease progression at 8 weeks. Analyses were done by modified intention to treat (ie, patients without any major entry criteria violation who initiated masked study drug treatment were included). All participants who received at least one dose of study drug were included in the safety analyses. This study is registered with ClinicalTrials.gov, number NCT02389244, and the results presented here are the final analysis of the osteosarcoma cohort (others cohorts are ongoing). FINDINGS Between Oct 10, 2014, and April 4, 2017, 43 adult patients were enrolled from 13 French comprehensive cancer centres. All patients received at least one dose of assigned treatment and were evaluable for safety; five patients were excluded for major protocol violations (two in the placebo group and three in the regorafenib group), leaving 38 patients who were evaluable for efficacy (12 in the placebo group and 26 in the regorafenib group). 17 of 26 patients (65%; one-sided 95% CI 47%) in the regorafenib group were non-progressive at 8 weeks compared with no patients in the placebo group. Ten patients in the placebo group crossed over to receive open-label regorafenib after centrally confirmed disease progression. 13 treatment-related serious adverse events occurred in seven (24%) of 29 patients in the regorafenib group versus none of 14 patients in the placebo group. The most common grade 3 or worse treatment-related adverse events during the double-blind period of treatment included hypertension (in seven [24%] of 29 patients in the regorafenib group vs none in the placebo group), hand-foot skin reaction (three [10%] vs none), fatigue (three [10%] vs one [3%]), hypophosphataemia (three [10%] vs none), and chest pain (three [10%] vs none). No treatment-related deaths occurred. INTERPRETATION Regorafenib demonstrated clinically meaningful antitumour activity in adult patients with recurrent, progressive, metastatic osteosarcoma after failure of conventional chemotherapy, with a positive effect on delaying disease progression. Regorafenib should be further evaluated in the setting of advanced disease as well as potentially earlier in the disease course for patients at high risk of relapse. Regorafenib might have an important therapeutic role as an agent complementary to standard cytotoxic chemotherapy in the therapeutic armamentarium against osteosarcoma. FUNDING Bayer HealthCare.
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Affiliation(s)
- Florence Duffaud
- Medical Oncology Unit, Aix Marseille University, APHM Hôpital La Timone, Marseille, France.
| | - Olivier Mir
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | | | - Nicolas Penel
- Medical Oncology Department, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | - Emanuelle Bompas
- Medical Oncology Department, Centre René Gauduchau, Saint Herblain, France
| | | | - Elsa Kalbacher
- Medical Oncology Department, CHRU Jean Minjoz, Besançon, France
| | - Antoine Italiano
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | - Olivier Collard
- Medical Oncology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, St Priest en Jarez, France
| | - Christine Chevreau
- Medical Oncology Department, Institut Universitaire de Cancérologie de Toulouse, Oncopole, Toulouse, France
| | - Esma Saada
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | | | | | | | - Corinne Bouvier
- Pathology Department, Aix Marseille University, APHM Hôpital La Timone, Marseille, France
| | - Vincent Vidal
- Radiology Department, Aix Marseille University, APHM Hôpital La Timone, Marseille, France
| | - Sylvie Chabaud
- Department of Statistics, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
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19
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Frappaz D, Taillandier L, Levard-Bonneville A, Sore J, Ricard D, Schiffler C, Weller M. P05.28 Karnofsky performance score of brain tumor patients depends on clinician status. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Frappaz
- Centre Léon Bérard et IHOP, Lyon, France
| | | | | | - J Sore
- Santor Edition, Paris, France
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Duffaud F, Blay JY, Mir O, Boudou-Rouquette P, Piperno-Neumann S, Penel N, Bompas E, Delcambre C, Kalbacher E, Italiano A, Collard O, Chevreau C, Thyss A, Isambert N, Delaye J, De Sousa Carvalho N, Schiffler C, Bouvier C, Vidal V, Chabaud S. Results of randomized, placebo (PL)-controlled phase II study evaluating efficacy and safety of regorafenib (REG) in patients (pts) with metastatic osteosarcoma (metOS), on behalf of the French Sarcoma Group (FSG) and Unicancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.11504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Olivier Mir
- Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | | | | | | | | | | | - Olivier Collard
- Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | | | | | - Nicolas Isambert
- Service d'oncologie médicale CLCC Georges-François Leclerc, Dijon, France
| | | | | | | | - Corinne Bouvier
- Assistance Publique - Hopitaux De Marseille, Marseille, France
| | - Vincent Vidal
- Assistance Publique - Hôpitaux de Marseille, Marseille, France
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