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Verry C, Dufort S, Villa J, Gavard M, Iriart C, Grand S, Charles J, Chovelon B, Cracowski JL, Quesada JL, Mendoza C, Sancey L, Lehmann A, Jover F, Giraud JY, Lux F, Crémillieux Y, McMahon S, Pauwels PJ, Cagney D, Berbeco R, Aizer A, Deutsch E, Loeffler M, Le Duc G, Tillement O, Balosso J. Theranostic AGuIX nanoparticles as radiosensitizer: A phase I, dose-escalation study in patients with multiple brain metastases (NANO-RAD trial). Radiother Oncol 2021; 160:159-165. [PMID: 33961915 DOI: 10.1016/j.radonc.2021.04.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [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: 02/09/2021] [Revised: 04/09/2021] [Accepted: 04/28/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Brain metastasis impacts greatly on patients' quality of life and survival. The phase I NANO-RAD trial assessed the safety and maximum tolerated dose of systemic administration of a novel gadolinium-based nanoparticle, AGuIX, in combination with whole brain radiotherapy in patients with multiple brain metastases not suitable for stereotactic radiotherapy. MATERIALS AND METHODS Patients with measurable brain metastases received escalating doses of AGuIX nanoparticles (15, 30, 50, 75, or 100 mg/kg intravenously) on the day of initiation of WBRT (30 Gy in 10 fractions) in 5 cohorts of 3 patients each. Toxicity was assessed using NCI Common Terminology Criteria for Adverse Events v4.03. RESULTS Fifteen patients with 354 metastases were included. No dose-limiting toxic effects were observed up to AGuIX 100 mg/kg. Plasma elimination half-life of AGuIX was similar for all groups (mean 1.3 h; range 0.8-3 h). Efficient targeting of metastases (T1 MRI enhancement, tumor selectivity) and persistence of AGuIX contrast enhancement were observed in metastases from patients with primary melanoma, lung, breast, and colon cancers. The concentration of AGuIX in metastases after administration was proportional to the injected dose. Thirteen of 14 evaluable patients had a clinical benefit, with either stabilization or reduction of tumor volume. MRI analysis showed significant correlation between contrast enhancement and tumor response, thus supporting a radiosensitizing effect. CONCLUSION Combining AGuIX with radiotherapy for patients with brain metastases is safe and feasible. AGuIX specifically targets brain metastases and is retained within tumors for up to 1 week; ongoing phase II studies will more definitively assess efficacy.
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Affiliation(s)
- Camille Verry
- Radiotherapy Department, Grenoble Alps University Hospital, Grenoble, France; INSERM UA7, University of Grenoble Alps, Synchrotron Radiation for Biomedical Research (ESRF), Grenoble, France.
| | | | - Julie Villa
- Radiotherapy Department, Grenoble Alps University Hospital, Grenoble, France
| | - Marylaure Gavard
- Clinical Research Vigilance, Grenoble Alps University Hospital, Grenoble, France
| | - Carole Iriart
- Radiotherapy Department, Grenoble Alps University Hospital, Grenoble, France
| | - Sylvie Grand
- Neuroradiology Department, Grenoble Alps University Hospital, Grenoble, France
| | - Julie Charles
- Dermatology Department, Grenoble Alps University Hospital, Grenoble, France
| | - Benoit Chovelon
- Unit of Hormonal and Nutritional Biochemistry, Institute of Biology and Pathology, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Luc Cracowski
- Clinical Investigation Center, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Investigation Center, Grenoble Alps University Hospital, Grenoble, France
| | - Christophe Mendoza
- Clinical Investigation Center, Grenoble Alps University Hospital, Grenoble, France
| | - Lucie Sancey
- Institute Light and Matter, UMR5306, Lyon1 University-CNRS, Lyon University, Villeurbanne, France
| | - Audrey Lehmann
- Pharmacy Department, Grenoble Alps University Hospital, Grenoble, France
| | - Florence Jover
- Radiotherapy Department, Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Yves Giraud
- Radiotherapy Department, Grenoble Alps University Hospital, Grenoble, France
| | - François Lux
- Institute Light and Matter, UMR5306, Lyon1 University-CNRS, Lyon University, Villeurbanne, France
| | - Yannick Crémillieux
- NH TherAguix SA, Meylan, France; Institut des Sciences Moléculaires, UMR5255, Université de Bordeaux, France
| | - Stephen McMahon
- Center for Cancer Research and Cell Biology, Queen's University Belfast, United Kingdom
| | | | - Daniel Cagney
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - Ross Berbeco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - Ayal Aizer
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - Eric Deutsch
- Radiation Oncology Department, INSERM1030 Molecular Radiotherapy and Therapeutic Innovations, Paris-Saclay University, Gustave Roussy, Villejuif, France
| | | | | | - Olivier Tillement
- Institute Light and Matter, UMR5306, Lyon1 University-CNRS, Lyon University, Villeurbanne, France
| | - Jacques Balosso
- Radiotherapy Department, Grenoble Alps University Hospital, Grenoble, France
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Verry C, Dufort S, Le Duc G, Mendoza C, Lux F, Arnaud J, Sancey L, Adolle A, Gavard M, Jover F, Grand S, Iriart C, Villa J, Balosso J, Tillement O. OC-0561: Nano-Rad first in man study: AGuIX nanoparticles as radiosensitizing agent for radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00583-1] [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: 10/22/2022]
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de Leiris N, Leenhardt J, Boussat B, Montemagno C, Seiller A, Phan Sy O, Roux J, Laramas M, Verry C, Iriart C, Fiard G, Long JA, Descotes JL, Vuillez JP, Riou L, Djaileb L. Does whole-body bone SPECT/CT provide additional diagnostic information over [18F]-FCH PET/CT for the detection of bone metastases in the setting of prostate cancer biochemical recurrence? Cancer Imaging 2020; 20:58. [PMID: 32787923 PMCID: PMC7425051 DOI: 10.1186/s40644-020-00333-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess whether whole-body (WB) bone SPECT/CT provides additional diagnostic information over [18F]-FCH PET/CT for the detection of bone metastases in the setting of prostate cancer biochemical recurrence (PC-BR). METHODS Patients referred for a PC-BR and whom benefited from a WB bone SPECT/CT and FCH PET/CT were retrospectively included. Tests were classified as positive, equivocal, or negative for bone metastases. A best valuable comparator (BVC) strategy including imaging and follow-up data was used to determine the metastatic status in the absence of systematic histological evaluation. RESULTS Between January 2011 and November 2017, 115 consecutive patients with a PC-BR were evaluated. According to the BVC, 30 patients had bone metastases and 85 patients did not present with bone lesions. The sensitivity, specificity, positive and negative predictive values were respectively 86.7% [69.3-96.2], 98.8% [93.6-100.0], 96.3% [78.7-99.5], and 95.5% [89.4-98.1] for WB bone SPECT/CT and 93.3% [77.9-99.2], 100.0% [95.8-100.0], 100.0 and 97.7% [91.8-99.4] for FCH PET/CT. There was no significant difference in diagnostic accuracy of bone metastases between WB Bone SPECT/CT (AUC 0.824 [0.74-0.90]) and FCH PET/CT (AUC 0.829 [0.75-0.90], p = 0.41). CONCLUSION Despite good performances for the diagnosis of bone metastases in PC-BR, WB bone SPECT/CT does not provide additive diagnostic information over concomitant FCH PET/CT.
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Affiliation(s)
- Nicolas de Leiris
- Nuclear Medicine Department, Grenoble Alpes University Hospital, Grenoble, France. .,INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble, France.
| | - Julien Leenhardt
- Nuclear Medicine Department, Grenoble Alpes University Hospital, Grenoble, France.,INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble, France
| | - Bastien Boussat
- Public Health Department, Grenoble-Alpes University Hospital, Grenoble, France
| | | | | | - Olivier Phan Sy
- Nuclear Medicine Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Julie Roux
- Nuclear Medicine Department, Grenoble Alpes University Hospital, Grenoble, France.,INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble, France
| | - Mathieu Laramas
- Department of Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Camille Verry
- Department of Radiotherapy, Grenoble Alpes University Hospital, Grenoble, France
| | - Carole Iriart
- Department of Radiotherapy, Grenoble Alpes University Hospital, Grenoble, France
| | - Gaelle Fiard
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Alexandre Long
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Philippe Vuillez
- Nuclear Medicine Department, Grenoble Alpes University Hospital, Grenoble, France.,INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble, France
| | - Laurent Riou
- INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble, France
| | - Loïc Djaileb
- Nuclear Medicine Department, Grenoble Alpes University Hospital, Grenoble, France.,INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble, France
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Peilleron N, Long J, Fiard G, Carnicelli D, Rambeaud J, Terrier N, Iriart C, Lanchon C, Boillot B, Thuillier C, Arnoux V, Overs C, Poncet D, Descotes J. Traumatismes fermés parenchymateux de grade V : néphrectomie différée après contrôle de l’hémostase par embolisation. Prog Urol 2014; 24:826. [DOI: 10.1016/j.purol.2014.08.096] [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: 11/28/2022]
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Thuillier C, Carnicelli D, Iriart C, Descotes J. Faisabilité du Penile Cuff Test (PCT) en préopératoire des gestes de désobstruction prostatiques chez une population âgée. Prog Urol 2014; 24:788-9. [DOI: 10.1016/j.purol.2014.08.015] [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: 11/25/2022]
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Long JA, Fiard G, Skowron O, Descotes JL, Boillot B, Terrier N, Thuillier C, Arvin-berod A, Arnoux V, Chodez M, Lanchon C, Iriart C, Rambeaud JJ. Traumatismes fermés du rein avec extravasation urinaire : résultats à long terme d’une attitude conservatrice. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.060] [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: 11/24/2022]
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Damron BI, Helitzer DL, Iriart C, Newbill SL, Cardinali G. Patient navigation for mammography screening: The need for system changes. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12051] [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: 11/20/2022] Open
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Abstract
As their expansion slows in the United States, managed care organizations will continue to enter new markets abroad. Investors view the opening of managed care in Latin America as a lucrative business opportunity. As public-sector services and social security funds are cut back, privatized, and reorganized under managed care, with the support of international lending agencies such as the World Bank, the effects of these reforms on access to preventive and curative services will hold great importance throughout the developing world. Many groups in Latin America are working on alternative projects that defend health as a public good, and similar movements have begun in Africa and Asia. Increasingly, this organizing is being recognized not only as part of a class struggle but also as part of a struggle against economic imperialism--which has now taken on the new appearance of rescuing less developed countries from rising health care costs and inefficient bureaucracies through the imposition of neoliberal managed-care solutions exported from the United States.
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Affiliation(s)
- H Waitzkin
- Division of Community Medicine, University of New Mexico, Albuquerque 87131, USA
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Abstract
The accomplishments of Latin American social medicine remain little known in the English-speaking world. In Latin America, social medicine differs from public health in its definitions of populations and social institutions, its dialectic vision of "health-illness," and its stance on causal inference. A "golden age" occurred during the 1930s, when Salvador Allende, a pathologist and future president of Chile, played a key role. Later influences included the Cuban revolution, the failed peaceful transition to socialism in Chile, the Nicaraguan revolution, liberation theology, and empowerment strategies in education. Most of the leaders of Latin American social medicine have experienced political repression, partly because they have tried to combine theory and political practice--a combination known as "praxis." Theoretic debates in social medicine take their bearings from historical materialism and recent trends in European philosophy. Methodologically, differing historical, quantitative, and qualitative approaches aim to avoid perceived problems of positivism and reductionism in traditional public health and clinical methods. Key themes emphasize the effects of broad social policies on health and health care; the social determinants of illness and death; the relationships between work, reproduction, and the environment; and the impact of violence and trauma.
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Affiliation(s)
- H Waitzkin
- Division of Community Medicine, Department of Family and Community Medicine, University of New Mexico, 2400 Tucker Ave. NE, Albuquerque, NM 87131, USA
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Abstract
There is little knowledge about Latin American social medicine in the English-speaking world. Social medicine groups exist in Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, and Mexico. Dictatorships have created political and economic conditions which are more adverse in some countries than others; in certain instances, practitioners of social medicine have faced unemployment, arrest, torture, exile, and death. Social medicine groups have focused on the social determinants of illness and early death, the effects of social policies such as privatisation and public sector cutbacks, occupational and environmental causes of illness, critical epidemiology, mental health effects of political trauma, the impact of gender, and collaborations with local communities, labour organisations, and indigenous people. The groups' achievements and financial survival have varied, depending partly on the national context. Active professional associations have developed, both nationally and internationally. Several groups have achieved publication in journals and books, despite financial and technical difficulties that might be lessened through a new initiative sponsored by the US National Library of Medicine. The conceptual orientation and research efforts of these groups have tended to challenge current relations of economic and political power. Despite its dangers, Latin American social medicine has emerged as a productive field of work, whose findings have become pertinent throughout the world.
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Affiliation(s)
- H Waitzkin
- Division of Community Medicine, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
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Abstract
This article presents the results of the comparative research project, "Managed Care in Latin America: Its Role in Health System Reform." Conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States, the study focused on the exportation of managed care, especially from the United States, and its adoption in Latin American countries. Our research methods included qualitative and quantitative techniques. The adoption of managed care reflects the process of transnationalization in the health sector. Our findings demonstrate the entrance of the main multinational corporations of finance capital into the private sector of insurance and health services, and these corporations' intention to assume administrative responsibilities for state institutions and to secure access to medical social security funds. International lending agencies, especially the World Bank, support the corporatization and privatization of health care services, as a condition of further loans to Latin American countries. We conclude that this process of change, which involves the gradual adoption of managed care as an officially favored policy, reflects ideologically based discourses that accept the inexorable nature of managed care reforms.
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Affiliation(s)
- C Iriart
- Division of Community Medicine, University of New Mexico, Albuquerque 87131, USA.
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Abstract
This article presents the results of the comparative research project "Managed Care in Latin America: Its Role in Health Reform". The project was conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States. The study's objective was to analyze the process by which managed care is exported, especially from the United States, and how managed care is adopted in Latin American countries. Our research methods included qualitative and quantitative techniques. Adoption of managed care reflects transnationalization of the health sector. Our findings demonstrate the entrance of large multinational financial capital into the private insurance and health services sectors and their intention of participating in the administration of government institutions and medical/social security funds. We conclude that this basic change involving the slow adoption of managed care is facilitated by ideological changes with discourses accepting the inexorable nature of public sector reform.
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Affiliation(s)
- C Iriart
- Division of Community Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
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Affiliation(s)
- K Stocker
- Department of Anthropology, University of New Mexico, Albuquerque 87131, USA
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Linger C, Spinelli H, Iriart C. [The Internet and its incorporation into the health sector]. Rev Panam Salud Publica 1997; 1:315-23. [PMID: 9303814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The governmental and health sector reforms that are being carried out in the countries of the Region demand the rapid training of health personnel to face the challenges posed by the process of change. This report explores the many possibilities of the Internet to serve as a mode of communication and updating of health professionals and technicians and as a vehicle for the dissemination of information on subjects of interest to scientists and researchers.
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Affiliation(s)
- C Linger
- Organización Panamericana de la Salud, Buenos Aires, Argentina
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Abstract
Este trabajo situa a la cuestión sanitaria en el debate modernidad-posmodernidad. Tal análisis se realiza desde una posición filosófica que plantea la crisis de la modernidad y cuestiona la torsión ideológica que a la misma le propicía la posmodernidad obturando las visiones cuestionadoras. Propiciando una vision alternativa de lo político pensada desde el plano de la potencia, recuperando el rol del sujeto en la decisión de producir transformaciones.
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Affiliation(s)
- C Iriart
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, 13084-100, Brasil
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