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Epaillard N, Lusque A, Jacot W, Mailliez A, Bachelot T, Arnedos M, Le Du F, Brain E, Ferrero JM, Massard V, Desmoulins I, Mouret-Reynier MA, Levy C, Gonçalves A, Leheurteur M, Petit T, Filleron T, Bosquet L, Pistilli B, Frenel JS. Incidence and outcome of brain and/or leptomeningeal metastases in HER2-low metastatic breast cancer in the French ESME cohort. ESMO Open 2024; 9:103447. [PMID: 38703431 PMCID: PMC11087908 DOI: 10.1016/j.esmoop.2024.103447] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is the second most common cancer that metastasizes to the brain. Particularly up to half of patients with human epidermal growth factor receptor 2 (HER2)-positive (HER2+) metastatic breast cancer (mBC) may develop brain metastases over the course of the disease. Nevertheless, little is known about the prevalence and the outcome of brain and leptomeningeal metastases (BLMM) in HER2-low BC. We compared the cumulative incidence of BLMM and associated outcomes among patients with HER2-low, HER2-negative (HER2-) and HER2+ mBC. PATIENTS AND METHODS This cohort study was conducted from the Epidemiological Strategy and Medical Economics (ESME) mBC database and included patients treated for mBC between 2012 and 2020 across 18 French comprehensive cancer centers and with known HER2 and hormone receptor (HR) status. The cumulative incidence of BLMM after metastatic diagnosis was estimated using a competing risk methodology with death defined as a competing event. RESULTS 19 585 patients were included with 6118 (31.2%), 9943 (50.8%) and 3524 (18.0%) being HER2-low, HER2- and HER2+ mBC, respectively. After a median follow-up of 48.6 months [95% confidence interval (CI) 47.7-49.3 months], BLMM were reported in 4727 patients: 1192 (25.2%) were diagnosed with BLMM at first metastatic diagnosis and 3535 (74.8%) after metastatic diagnosis. Multivariable analysis adjusted for age, histological grade, metastases-free interval and HR status showed that the risk of BLMM at metastatic diagnosis was similar in patients with HER2- compared to HER2-low mBC [odds ratio (OR) (95% CI) 1.00 (0.86-1.17)] and higher in those with HER2+ compared to HER2-low [OR (95% CI) 2.23 (1.87-2.66)]. Similar results were found after metastatic diagnosis; the risk of BLMM was similar in HER2- compared to HER2-low [subdistribution hazard ratio (sHR) (95% CI) 1.07 (0.98-1.16)] and higher in the HER2+ group [sHR (95% CI) 1.56 (1.41-1.73)]. CONCLUSIONS The prevalence and evolution of BLMM in HER2-low mBC are similar to those in patients with HER2- tumors. In contrast to patients with HER2+ mBC, the prognosis of BLMM remains dismal in this population.
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Affiliation(s)
- N Epaillard
- Department of Medical Oncology, Gustave Roussy, Villejuif.
| | - A Lusque
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT Oncopole, Toulouse
| | - W Jacot
- Department of Medical Oncology, Institut régional du Cancer, Montpellier
| | - A Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - M Arnedos
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - F Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes
| | - E Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud
| | - J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice
| | - V Massard
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy
| | - I Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon
| | | | - C Levy
- Department of Medical Oncology, Centre François Baclesse, Caen
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli Calmette, Marseille
| | - M Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rouen
| | - T Petit
- Department of Medical Oncology, Centre Paul Strauss ICANS, Strasbourg
| | - T Filleron
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT Oncopole, Toulouse
| | - L Bosquet
- Health Data and Partnership Department, Unicancer, Paris
| | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif; INSERM U1279, Gustave Roussy, Villejuif
| | - J S Frenel
- Department of Medical Oncology, Institut de Cancerologie de L'Ouest, Saint-Herblain, France
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Blay JY, Cropet C, Mansard S, Loriot Y, De La Fouchardière C, Haroche J, Topart D, Tougeron D, You B, Italiano A, Le Brun-Ly V, Ferrero JM, Penel N, Fabbro M, Troussard X, Malka D, Ray-Coquard I, Leboulleux S, Fléchon A, Maubec E, Charles J, Dalle S, Taieb S, Garcia GCTE, Mandache AM, Colignon N, Gavrel M, Nowak F, Hoog Labouret N, Mahier Aït Oukhatar C, Gomez-Roca C. Long term activity of vemurafenib in cancers with BRAF mutations: the ACSE basket study for advanced cancers other than BRAF V600-mutated melanoma. ESMO Open 2023; 8:102038. [PMID: 37922690 PMCID: PMC10774964 DOI: 10.1016/j.esmoop.2023.102038] [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: 08/09/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND BRAF inhibitors are approved in BRAFV600-mutated metastatic melanoma, non-small-cell lung cancer (NSCLC), Erdheim-Chester disease (ECD), and thyroid cancer. We report here the efficacy, safety, and long-term results of single-agent vemurafenib given in the AcSé vemurafenib basket study to patients with various BRAF-mutated advanced tumours other than BRAFV600-mutated melanoma and NSCLC. PATIENTS AND METHODS Patients with advanced tumours other than BRAFV600E melanoma and progressing after standard treatment were eligible for inclusion in nine cohorts (including a miscellaneous cohort) and received oral vemurafenib 960 mg two times daily. The primary endpoint was the objective response rate (ORR) estimated with a Bayesian design. The secondary outcomes were disease control rate, duration of response, progression-free survival (PFS), overall survival (OS), and vemurafenib safety. RESULTS A total of 98 advanced patients with various solid or haematological cancers, 88 with BRAFV600 mutations and 10 with BRAFnonV600 mutations, were included. The median follow-up duration was 47.7 months. The Bayesian estimate of ORR was 89.7% in hairy cell leukaemias (HCLs), 33.3% in the glioblastomas cohort, 18.2% in cholangiocarcinomas, 80.0% in ECD, 50.0% in ovarian cancers, 50.0% in xanthoastrocytomas, 66.7% in gangliogliomas, and 60.0% in sarcomas. The median PFS of the whole series was 8.8 months. The 12-, 24-, and 36-month PFS rates were 42.2%, 23.8%, and 17.9%, respectively. Overall, 54 patients died with a median OS of 25.9 months, with a projected 4-year OS of 40%. Adverse events were similar to those previously reported with vemurafenib. CONCLUSION Responses and prolonged PFS were observed in many tumours with BRAF mutations, including HCL, ECD, ovarian carcinoma, gliomas, ganglioglioma, and sarcomas. Although not all cancer types responded, vemurafenib is an agnostic oncogene therapy of cancers.
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Affiliation(s)
- J Y Blay
- Department of Medicine, CentreLeon bErard, Lyon.
| | | | - S Mansard
- Dermatology Department, Hôpital Estaing, University Hospital of Clermont Ferrand, Clermont-Ferrand
| | - Y Loriot
- Department of Medicine, Gustave Roussy, Villejuif
| | | | - J Haroche
- Department of Internal Medicine, Institut E3M, French Reference Centre for Histiocytosis, Pitié-Salpȇtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris
| | - D Topart
- Onco-urology Department, Hôpital Saint ELOI, Montpellier
| | - D Tougeron
- Gastroenterology and Hepatology Department, Poitiers University Hospital and Faculty of Medicine of Poitiers, Poitiers
| | - B You
- Centre d'Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Hospices Civils de Lyon (IC-HCL), EA 3738 CICLY, Lyon
| | - A Italiano
- Department of Medicine, Institut Bergonié, Bordeaux; Faculty of Medicine, University of Bordeaux, Bordeaux
| | - V Le Brun-Ly
- Department of Medicine, CHU Limoges, Medical Oncology, Limoges
| | - J M Ferrero
- Department of Medicine, Centre A. Lacassagne, Nice
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille; Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille
| | - M Fabbro
- Department of Medicine, Institut de Cancerologie de Montpellier, Montpellier
| | | | - D Malka
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris
| | | | - S Leboulleux
- Department of Medicine, Gustave Roussy, Villejuif
| | | | - E Maubec
- Assistance Publique-Hôpitaux de Paris, Department of Dermatology, Hôpital Avicenne, Bobigny; University Sorbonne Paris Nord - Campus de Bobigny, Bobigny and UMR 1124, Campus Saint-Germain-des-Prés, Paris
| | - J Charles
- Dermatology, Allergology & Photobiology Department, CHU Grenoble Alpes, Grenoble; Institute for Advanced Biosciences, INSERM U1209, CNRS UMR5309, Université Grenoble Alpes, La Tronche
| | - S Dalle
- Department of Dermatology, Hospices Civils de Lyon, CRCL, Université Claude Bernard Lyon1, Lyon
| | - S Taieb
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | | | | | - N Colignon
- Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris
| | - M Gavrel
- Department of Medicine, Gustave Roussy, Villejuif
| | - F Nowak
- Institut National Du Cancer, Boulogne-Billancourt
| | | | | | - C Gomez-Roca
- Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse (IUCT-Oncopole), Clinical Research Unit, Toulouse, France
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Le Du F, Carton M, Bachelot T, Saghatchian M, Pistilli B, Brain E, Loirat D, Vanlemmens L, Vermeulin T, Emile G, Gonçalves A, Ung M, Robert M, Jaffre A, Desmoulins I, Jouannaud C, Uwer L, Marc Ferrero J, Mouret-Reynier MA, Jacot W, Chevrot M, Delaloge S, Diéras V. Real-World Impact of Adjuvant Anti-HER2 Treatment on Characteristics and Outcomes of Women With HER2-Positive Metastatic Breast Cancer in the ESME Program. Oncologist 2023; 28:e867-e876. [PMID: 37589218 PMCID: PMC10546827 DOI: 10.1093/oncolo/oyad137] [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: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Although adjuvant cancer treatments increase cure rates, they may induce clonal selection and tumor resistance. Information still lacks as whether (neo)adjuvant anti-HER2 treatments impact the patterns of recurrence and outcomes of HER2-positive (HER2+) metastatic breast cancer (MBC). We aimed to assess this in the large multicenter ESME real-world database. PATIENTS AND METHODS We examined the characteristics and outcomes (overall survival (OS) and progression-free survival under first-line treatment (PFS1)) of HER2+ patients with MBC from the French ESME program with recurrent disease, as a function of the previous receipt of adjuvant trastuzumab. Multivariable analyses used Cox models adjusted for baseline demographic, prognostic factors, adjuvant treatment received, and disease-free interval. RESULTS Two thousand one hundred and forty-three patients who entered the ESME cohort between 2008 and 2017 had a recurrent HER2+ MBC. Among them, 56% had received (neo)adjuvant trastuzumab and 2.5% another anti-HER2 in this setting. Patients pre-exposed to trastuzumab were younger, had a lower disease-free interval, more HR-negative disease and more metastatic sites. While the crude median OS appeared inferior in patients exposed to adjuvant trastuzumab, as compared to those who did not (37.2 (95%CI 34.4-40.3) versus 53.5 months (95% CI: 47.6-60.1)), this difference disappeared in the multivariable model (HR = 1.05, 95%CI 0.91-1.22). The same figures were observed for PFS1. CONCLUSIONS Among patients with relapsed HER2+ MBC, the receipt of adjuvant trastuzumab did not independently predict for worse outcomes when adjusted to other prognostic factors.
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Affiliation(s)
- Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | | | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint Cloud, Paris, France
| | - Delphine Loirat
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | | | | | - George Emile
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, CRCT, Inserm, Toulouse, France
| | - Marie Robert
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - René Gauducheau, Saint-Herblain, France
| | - Anne Jaffre
- Anne jaffré Department of Medical Information, Institut Bergonié, Bordeaux, France
| | | | | | - Lionel Uwer
- Institut de Cancérologie de Lorraine, Nancy, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - William Jacot
- Department of Medical Oncology, Institut du cancer de Montpellier, Montpellier, France
| | - Michaël Chevrot
- Health Data and Partnership Department, Unicancer, Paris, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
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4
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Carausu M, Carton M, Diéras V, Petit T, Guiu S, Gonçalves A, Augereau P, Ferrero JM, Levy C, Ung M, Desmoulins I, Debled M, Bachelot T, Pistilli B, Frenel JS, Mailliez A, Chevrot M, Cabel L. Association of Endocrine Therapy for HR+/ERBB2+ Metastatic Breast Cancer With Survival Outcomes. JAMA Netw Open 2022; 5:e2247154. [PMID: 36520434 PMCID: PMC9856509 DOI: 10.1001/jamanetworkopen.2022.47154] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Evidence suggests that patients with human epidermal growth factor receptor 2-positive (ERBB2+ [formerly HER2+]) metastatic breast cancer (MBC) have different clinical characteristics and outcomes according to their hormone receptor (HR) status. The place of endocrine therapy (ET) for patients with HR+/ERBB2+ is still not clearly defined in this setting. OBJECTIVE To evaluate the association of HR status and first-line inclusion of ET with outcomes among patients with ERBB2+ MBC. DESIGN, SETTING, AND PARTICIPANTS This cohort study was an analysis of clinical data from the French clinical Epidemiological Strategy and Medical Economics (ESME) cohort, including patients with MBC who started treatment between 2008 and 2017. The last date of follow-up was June 18, 2020. Data were analyzed from May 2021 to May 2022. EXPOSURES Patients were treated with first-line ERBB2-targeted therapy and either chemotherapy (CT) with or without ET or ET alone. For the study of the association of maintenance ET with outcomes, we included patients treated with first-line ERBB2-targeted therapy with CT and with or without maintenance ET. MAIN OUTCOMES AND MEASURES Median overall survival (OS) and median first-line progression-free survival (PFS) were reported using the Kaplan-Meier method. Cox proportional hazards models and a propensity score were constructed to report and adjust for prognostic factors. Multivariable analysis included age at MBC, time to MBC, number of metastatic sites, type of metastases, and Eastern Cooperative Oncology Group performance status. RESULTS Among 4145 women with ERBB2+ MBC, 2696 patients had HR+ (median [IQR] age, 58.0 [47.0-67.0] years) and 1449 patients had HR- (56.0 [47.0-64.0] years) tumors. The median OS for patients with HR+ vs HR- tumors was 55.9 months (95% CI, 53.7-59.4 months) vs 42.0 months (95% CI, 38.8-45.2 months), confirmed in multivariable analysis (hazard ratio, 1.40; 95% CI, 1.26-1.56; P < .001). The median PFS for patients with HR+ vs HR- tumors was 12.2 months (95% CI, 11.5-12.9 months) vs 9.8 months (95% CI, 9.2-11.0 months; P = .01), and the HR was 1.15 (95% CI, 1.06-1.26; P < .001). In multivariable analysis, no significant difference was found in OS or PFS for 1520 patients treated with ERBB2-targeted therapy with CT and with or without ET vs 203 patients receiving ERBB2-targeted therapy with ET, regardless of type of ERBB2-targeted therapy (trastuzumab or trastuzumab with pertuzumab). This result was confirmed by matching patients using a propensity score. Using the time-dependent ET variable among patients with ERBB2-targeted therapy with CT, those with maintenance ET had significantly better PFS (hazard ratio, 0.70; 95% CI, 0.60-0.82; P < .001) and OS (hazard ratio, 0.47; 95% CI, 0.39-0.57; P < .001). CONCLUSIONS AND RELEVANCE These results suggest that ET-containing first-line regimens may be associated with benefits among a subgroup of patients with HR+/ERBB2+ MBC.
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Affiliation(s)
- Marcela Carausu
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss/ICANS, Strasbourg, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut régional du Cancer Montpellier, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Angers, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Michaël Chevrot
- Health Data and Partnership Department, Unicancer, Paris, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
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5
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Bidard FC, Hardy-Bessard AC, Dalenc F, Bachelot T, Pierga JY, de la Motte Rouge T, Sabatier R, Dubot C, Frenel JS, Ferrero JM, Ladoire S, Levy C, Mouret-Reynier MA, Lortholary A, Grenier J, Chakiba C, Stefani L, Plaza JE, Clatot F, Teixeira L, D'Hondt V, Vegas H, Derbel O, Garnier-Tixidre C, Canon JL, Pistilli B, André F, Arnould L, Pradines A, Bièche I, Callens C, Lemonnier J, Berger F, Delaloge S, PISTILLI B, DALENC F, BACHELOT T, DE LA MOTTE ROUGE T, SABATIER R, DUBOT C, FRENEL JS, FERRERO JM, LADOIRE S, LEVY C, MOURET-REYNIER MA, HARDY-BESSARD AC, LORTHOLARY A, GRENIER J, CHAKIBA C, STEFANI L, SOULIE P, JACQUIN JP, PLAZA JE, CLATOT F, TEIXEIRA L, D'HONDT V, VEGAS H, DERBEL O, GARNIER TIXIDRE C, DELBALDO C, MOREAU L, CHENEAU C, PAITEL JF, BERNARD-MARTY C, SPAETH D, GENET D, MOULLET I, BONICHON-LAMICHHANE N, DEIANA L, GREILSAMER C, VENAT-BOUVET L, DELECROIX V, MELIS A, ORFEUVRE H, NGUYEN S, LEGOUFFE E, ZANNETTI A, LE SCODAN R, DOHOLLOU N, DALIVOUST P, ARSENE O, MARQUES N, PETIT T, MOLLON D, DAUBA J, BONNIN N, MORVAN F, GARDNER M, MARTI A, LEVACHE CB, LACHAIER E, ACHILLE M, VALMAR C, BOUAITA R, MEDIONI J, FOA C, BERNARD-MARTY C, DEL PIANO F, GOZY M, ESCANDE A, LEDUC N, LUCAS B, MILLE D, AMMARGUELLAT H, NAJEM A, TROUBOUL F, BARTHELEMY P, DESCLOS H, MAYEUR D, LORCHEL F, GUINET F, LAURENTY AP, BOUDRANT A, GISSEROT O, ALLEAUME C, DE GRAMONT A. Switch to fulvestrant and palbociclib versus no switch in advanced breast cancer with rising ESR1 mutation during aromatase inhibitor and palbociclib therapy (PADA-1): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 2022; 23:1367-1377. [PMID: 36183733 DOI: 10.1016/s1470-2045(22)00555-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND In advanced oestrogen receptor-positive, HER2-negative breast cancer, acquired resistance to aromatase inhibitors frequently stems from ESR1-mutated subclones, which might be sensitive to fulvestrant. The PADA-1 trial aimed to show the efficacy of an early change in therapy on the basis of a rising ESR1 mutation in blood (bESR1mut), while assessing the global safety of combination fulvestrant and palbociclib. METHODS We did a randomised, open-label, phase 3 trial in 83 hospitals in France. Women aged at least 18 years with oestrogen receptor-positive, HER2-negative advanced breast cancer and an Eastern Cooperative Oncology Group performance status of 0-2 were recruited and monitored for rising bESR1mut during first-line aromatase inhibitor (2·5 mg letrozole, 1 mg anastrozole, or 25 mg exemestane, orally once per day, taken continuously) and palbociclib (125 mg orally once per day on days 1-21 of a 28-day cycle) therapy. Patients with newly present or increased bESR1mut in circulating tumour DNA and no synchronous disease progression were randomly assigned (1:1) to continue with the same therapy or to switch to fulvestrant (500 mg intramuscularly on day 1 of each 28-day cycle and on day 15 of cycle 1) and palbociclib (dosing unchanged). The randomisation sequence was generated within an interactive web response system using a minimisation method (with an 80% random factor); patients were stratified according to visceral involvement (present or absent) and the time from inclusion to bESR1mut detection (<12 months or ≥12 months). The co-primary endpoints were investigator-assessed progression-free survival from random assignment, analysed in the intention-to-treat population (ie, all randomly assigned patients), and grade 3 or worse haematological adverse events in all patients. The trial is registered with Clinicaltrials.gov (NCT03079011), and is now complete. FINDINGS From March 22, 2017, to Jan 31, 2019, 1017 patients were included, of whom 279 (27%) developed a rising bESR1mut and 172 (17%) were randomly assigned to treatment: 88 to switching to fulvestrant and palbociclib and 84 patients to continuing aromatase inhibitor and palbociclib. At database lock on July 31, 2021, randomly assigned patients had a median follow-up of 35·3 months (IQR 29·2-41·4) from inclusion and 26·0 months (13·8-34·3) from random assignment. Median progression-free survival from random assignment was 11·9 months (95% CI 9·1-13·6) in the fulvestrant and palbociclib group versus 5·7 months (3·9-7·5) in the aromatase inhibitor and palbociclib group (stratified HR 0·61, 0·43-0·86; p=0·0040). The most frequent grade 3 or worse haematological adverse events were neutropenia (715 [70·3%] of 1017 patients), lymphopenia (66 [6·5%]), and thrombocytopenia (20 [2·0%]). The most common grade 3 or worse adverse events in step 2 were neutropenia (35 [41·7%] of 84 patients in the aromatase inhibitor and palbociclib group vs 39 [44·3%] of 88 patients in the fulvestrant and palbociclib group) and lymphopenia (three [3·6%] vs four [4·5%]). 31 (3·1%) patients had grade 3 or worse serious adverse events related to treatment in the overall population. Three (1·7%) of 172 patients randomly assigned had one serious adverse event in step 2: one (1·2%) grade 4 neutropenia and one (1·2%) grade 3 fatigue among 84 patients in the aromatase inhibitor and palbociclib group, and one (1·1%) grade 4 neutropenia among 88 patients in the fulvestrant and palbociclib group. One death by pulmonary embolism in step 1 was declared as being treatment related. INTERPRETATION PADA-1 is the first prospective randomised trial showing that the early therapeutic targeting of bESR1mut results in significant clinical benefit. Additionally, the original design explored in PADA-1 might help with tackling acquired resistance with new drugs in future trials. FUNDING Pfizer.
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Affiliation(s)
- François-Clément Bidard
- Department of Medical Oncology, Institut Curie, Université Versailles Saint-Quentin, Université Paris-Saclay, Saint-Cloud, France; Circulating Tumour Biomarkers Laboratory, Inserm CIC-BT 1428, Institut Curie, Paris, France.
| | | | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius-Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Pierga
- Circulating Tumour Biomarkers Laboratory, Inserm CIC-BT 1428, Institut Curie, Paris, France; Department of Medical Oncology, Institut Curie and Université de Paris, Paris, France
| | | | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli Calmettes, Aix-Marseille Université, Marseille, France
| | - Coraline Dubot
- Department of Medical Oncology, Institut Curie, Université Versailles Saint-Quentin, Université Paris-Saclay, Saint-Cloud, France
| | | | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Alain Lortholary
- Department of Medical Oncology, Hopital Privé du Confluent, Nantes, France
| | - Julien Grenier
- Department of Medical Oncology, Institut Sainte Catherine, Avignon, France
| | - Camille Chakiba
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Laetitia Stefani
- Department of Medical Oncology, Centre Hospitalier Annecy Genvoi, Pringy-Metz-Tessy, France
| | - Jérôme Edouard Plaza
- Department of Medical Oncology, UNEOS Site Hôpital Robert Schuman, Vantoux, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Luis Teixeira
- Department of Medical Oncology, Hôpital Saint Louis, Paris, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - Hélène Vegas
- Department of Medical Oncology, Centre Hospitalier de Tours, Hôpital Bretonneau, Tours, France
| | - Olfa Derbel
- Department of Medical Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Claire Garnier-Tixidre
- Department of Medical Oncology, Institut Daniel Hollard, G H Mutualiste de Grenoble, Grenoble, France
| | - Jean-Luc Canon
- Department of Medical Oncology, Grand Hôpital de Charleroi, Charleroi, Belgique
| | | | - Fabrice André
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Laurent Arnould
- Department of Pathology, Centre Georges François Leclerc, Dijon, France
| | - Anne Pradines
- INSERM U1037 CNRS ERL5294 UPS, Cancer Research Center of Toulouse, Toulouse, France; Prospective Biology Unit, Medical Laboratory, Claudius Regaud Institute, Toulouse University Cancer Institute, Toulouse, France
| | - Ivan Bièche
- Pharmacogenomic Unit, Genetics Laboratory, Department of Diagnostic and Theranostic Medicine, Institut Curie, PSL University, Saint-Cloud, Paris, France
| | - Céline Callens
- Pharmacogenomic Unit, Genetics Laboratory, Department of Diagnostic and Theranostic Medicine, Institut Curie, PSL University, Saint-Cloud, Paris, France
| | | | - Frédérique Berger
- Biometry Unit, Institut Curie, PSL University, Saint-Cloud, Paris, France
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6
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Mallet A, Lusque A, Levy C, Pistilli B, Brain E, Pasquier D, Debled M, Thery JC, Gonçalves A, Desmoulins I, De La Motte Rouge T, Faure C, Ferrero JM, Eymard JC, Mouret-Reynier MA, Patsouris A, Cottu P, Dalenc F, Petit T, Payen O, Uwer L, Guiu S, Sébastien Frenel J. Real-world evidence of the management and prognosis of young women (⩽40 years) with de novo metastatic breast cancer. Ther Adv Med Oncol 2022; 14:17588359211070362. [PMID: 35082924 PMCID: PMC8785354 DOI: 10.1177/17588359211070362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Breast cancer (BC) in young women merits a specific approach given the associated fertility, genetic and psychosocial issues. De novo metastatic breast cancer (MBC) in young women is an even more serious condition, with limited data available. Methods: We evaluated management of women aged ⩽40 years with de novo MBC in a real-life national multicentre cohort of 22,463 patients treated between 2008 and 2016 (NCT0327531). Our primary objective was to compare overall survival (OS) in young women versus women aged 41–69 years. The secondary objectives were to compare first-line progression-free survival (PFS1) and to describe treatment patterns. Results: Of the 4524 women included, 598 (13%) were ⩽40 years. Median age at MBC diagnosis was 36 years (range = 20–40). Compared with women aged 41–69 years, young women had more grade III tumours (49% versus 35.7%, p < 0.0001), human epidermal growth factor receptor 2 amplified (HER2+) disease (34.6% versus 26.4%, p < 0.0001) and HR–/HER2– disease known as “triple negative breast cancer” (TNBC) (17.1% versus 12.7%, p < 0.0001). BRCA testing was performed for 260 young women, with a BRCA1/2 mutation in 44 (17% of those tested) In young HR+/HER2– patients, chemotherapy (CT) was given as the frontline treatment more frequently compared with older ones (89.6% versus 68.8%, respectively, p < 0.0001). After median follow-up of 49.7 months (95% confidence interval, CI = 48.0–51.7), the median OS of young women was 58.5 months, 20.7 months and not attained in HR+/HER2–, TNBC and HER2+ subgroups, respectively. After adjustment for histological subtype, tumour grade, and number and type of metastasis, young women had significantly better OS compared with older ones, except for the TNBC subgroup, for which the outcome was similar. PFS1 was statistically different only in the TNBC subgroup, with 7.8 months for young women and 6.3 months for older women ( p = 0.0015). Conclusion: De novo MBC affects a significant proportion of young women. A subgroup of these patients achieves long OS and merits multidisciplinary care.
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Affiliation(s)
- Amélie Mallet
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – René Gauducheau, Saint-Herblain, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Claudius Regaud – IUCT Oncopole, Toulouse, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Paris, France
| | - David Pasquier
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | | | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Christelle Faure
- Department of Surgery Oncology, Centre Léon Bérard, Lyon, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | | | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – Paul Papin, Angers, France
| | - Paul Cottu
- Department of Medical Oncology, Etablissement Hospitalier Institut Curie, Paris, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud – IUCT Oncopole, Toulouse, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - Olivier Payen
- Department of Real World Data, Data Unit, Unicancer, Paris, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Jean Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – René Gauducheau, Boulevard Jacques Monod, 44805 Saint-Herblain, France
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7
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Gaillard T, Carton M, Mailliez A, Desmoulins I, Mouret-Reynier MA, Petit T, Leheurteur M, Dieras V, Ferrero JM, Uwer L, Guiu S, Gonçalves A, Levy C, Debled M, Dalenc F, Patsouris A, Bachelot T, Eymard JC, Chevrot M, Conversano A, Robain M, Hequet D. De novo metastatic breast cancer in patients with a small locoregional tumour (T1-T2/N0): Characteristics and prognosis. Eur J Cancer 2021; 158:181-188. [PMID: 34689042 DOI: 10.1016/j.ejca.2021.09.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The estimated rate of de novo metastatic breast cancer (dnMBC) at the time of diagnosis is between 5 to 12%. International guidelines recommend metastatic work-up (MWU) only in women with advanced breast cancer. The purpose of this study was to describe the characteristics and prognosis of patients with dnMBC diagnosed without an initial indication for MWU. METHODS We conducted a retrospective, comparative study in dnMBC patients selected from the ESME-MBC cohort. Patients were treated in France between 2008 and 2016. We compared two populations: patients in whom dnMBC was diagnosed by staging although not indicated by guidelines (non-guideline staging [NGS]) and those in whom dnMBC was diagnosed by guideline staging (GS). RESULTS During the study period, 22,463 patients with MBC were included in the ESME cohort. Among them, 6698 were dnMBC patients. In 247 of these patients (6% of dnMBC and 1% of the overall population), dnMBC was diagnosed by non-guideline staging. Women in this group were significantly younger (57 vs. 59 years, p = 0.02) and had fewer metastatic sites at diagnosis than dnMBC-GS patients. The two groups were not significantly different in terms of the other characteristics. Overall survival (OS) and progression-free survival (PFS) were better in the dnMBC-NGS group than in the dnMBC-GS group. The impact on survival was confirmed by univariate and multivariate analysis (HR 1.83 [1.31-2.57], p < 0.01). CONCLUSION This study provides the first description of a very specific population. These patients with dnMBC-NGS were younger and more likely to have oligometastatic disease with a better prognosis.
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Affiliation(s)
- T Gaillard
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France.
| | - M Carton
- Department of Biostatistics, Institut Curie, Paris & Saint-Cloud, France
| | - A Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - I Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - M A Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - T Petit
- Department of Medical Oncology, ICANS Centre Paul Strauss, Strasbourg, France
| | - M Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - V Dieras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - L Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - S Guiu
- Department of Medical Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli Calmette, Marseille, France
| | - C Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - M Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - F Dalenc
- Department of Medical Oncology, IUCT-Oncopole Institut Claudius Regaud, Toulouse, France
| | - A Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Angers & Nantes, France
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - J C Eymard
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - M Chevrot
- Real World Data Department, Unicancer Data Office, Paris, France
| | - A Conversano
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - M Robain
- Real World Data Department, Unicancer Data Office, Paris, France
| | - D Hequet
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
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8
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Bardet F, Dalban C, Chevreau C, Negrier S, Laguerre B, Gravis G, Gross-Goupil M, Oudard S, Barthélémy P, Ferrero JM, Thiery-Vuillemin A, Mahammedi H, Narciso B, Geoffrois L, Tantot F, Escudier B, Ladoire S, Albiges L. Prognosis impact of serous metastases (SMs) in clear cell renal cell carcinoma patients in the GETUG-AFU-26 NIVOREN phase II trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16566] [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: 11/20/2022] Open
Abstract
e16566 Background: Nivolumab monotherapy (N) is a standard of care for patients with metastatic clear cell renal cell carcinoma (ccRCC) after failure of antiangiogenic therapies. IMDC criteria is the established prognostic model in anyline of systemic treatment including with N. While liver, bone and brain have been reported to convey a dismal prognosis, little is known about the pejorative prognostic impact of serous metastatic sites (pleura, peritoneum, pericardium) in patients receiving anti-PD (L) -1 treatment. Methods: We aimed to assess survival, and activity of N in patients included in the GETUG-AFU 26 NIVOREN phase II prospective trial ( NCT03013335 ), according to serous metastases (SMs). Results: Overall, 720 patients with metastatic ccRCC, and treated with N. Baseline RECIST metastases data were available for 708 patients included in this analysis. Among them, 142 (20%) had SMs (pleura, n=91 ; peritoneum, n=50 ; pericardium, n=1). Median PFS (4.5 vs 2.6 mo ; HR :1.31 ; p=0.0079), and OS (26.1 vs 15 mo ; HR :1.67 ; p<0.0001) were significantly lower in patients with SMs. The dismal prognostic impact was observed both with pleura and peritoneum SMs. These 2 sites were not significantly associated. Using multivariate Cox models, SMs remained significantly associated with poor survival, independently of IMDC category, gender, age, and number of previous lines of therapy. Objective response rate in patients with SMs was not significantly different from others patients (16.4 vs 22.1%; p=0.147). SMs were not statistically associated with known poor prognosis metastatic sites (cerebral, bone, and liver.) Conclusions: SMs are a strong independent prognostic impact in patients receiving N for metastatic ccRCC Poor prognostic metastatic sites should be considered when assessing the prognosis of patients with metastatic ccRCC
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Affiliation(s)
| | | | | | - Sylvie Negrier
- Departement of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Gwenaelle Gravis
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | | | - Stephane Oudard
- Department of Medical Oncology, European Georges-Pompidou Hospital, APHP. Centre, France; Paris University, Faculty of Medicine, Paris, France
| | | | | | | | | | | | | | | | | | | | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris Sud, Boston, MA
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9
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Saleh K, Carton M, Dieras V, Heudel PE, Brain E, D'Hondt V, Mailliez A, Patsouris A, Mouret-Reynier MA, Goncalves A, Ferrero JM, Petit T, Emile G, Uwer L, Debled M, Dalenc F, Jouannaud C, Ladoire S, Leheurteur M, Cottu P, Veron L, Savignoni A, Courtinard C, Robain M, Delaloge S, Deluche E. Impact of body mass index on overall survival in patients with metastatic breast cancer. Breast 2020; 55:16-24. [PMID: 33307392 PMCID: PMC7725947 DOI: 10.1016/j.breast.2020.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/14/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND High Body mass index (BMI) is a risk factor for breast cancer among postmenopausal women and an adverse prognostic factor in early-stage. Little is known about its impact on clinical outcomes in patients with metastatic breast cancer (MBC). METHODS The National ESME-MBC observational cohort includes all consecutive patients newly diagnosed with MBC between Jan 2008 and Dec 2016 in the 18 French comprehensive cancer centers. RESULTS Of 22 463 patients in ESME-MBC, 12 999 women had BMI data available at MBC diagnosis. Median BMI was 24.9 kg/m2 (range 12.1-66.5); 20% of women were obese and 5% underweight. Obesity was associated with more de novo MBC, while underweight patients had more aggressive cancer features. Median overall survival (OS) of the BMI cohort was 47.4 months (95% CI [46.2-48.5]) (median follow-up: 48.6 months). Underweight was independently associated with a worse OS (median OS 33 months; HR 1.14, 95%CI, 1.02-1.27) and first line progression-free survival (HR, 1.11; 95%CI, 1.01; 1.22), while overweight or obesity had no effect. CONCLUSION Overweight and obesity are not associated with poorer outcomes in women with metastatic disease, while underweight appears as an independent adverse prognostic factor.
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Affiliation(s)
- Khalil Saleh
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Véronique Dieras
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Pierre-Etienne Heudel
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, INSERM U1194, University of Montpellier, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest Nantes & Angers, 15 Rue André Boquel, 49055, Angers, France
| | - Marie-Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont Ferrand, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189, Nice, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de La Porte de L'Hôpital, 67000, Strasbourg, France
| | - George Emile
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue Du Général Harris, 14000, Caen, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, 229 Cours de L'Argonne, F-33000, Bordeaux, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue Du Général Koenig, 51100, Reims, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, 1 Rue Professeur Marion, 21079, Dijon, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue D'Amiens, 76000, Rouen, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Lucie Veron
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Alexia Savignoni
- Department of Biostatistics, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Elise Deluche
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France; Department of Medical Oncology, CHU de Limoges, 2 Avenue Martin Luther King, Limoges, France
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10
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Kinj R, Doyen J, Hannoun-Lévi JM, Naghavi AO, Chand ME, Baudin G, Ferrero JM, François E, Evesque L, Borchiellini D, Benezery K, Bondiau PY. Stereotactic Pelvic Reirradiation for Locoregional Cancer Relapse. Clin Oncol (R Coll Radiol) 2020; 33:e15-e21. [PMID: 32641243 DOI: 10.1016/j.clon.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/09/2020] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
AIMS Up to 40% of patients who have received radiation for a pelvic malignancy will develop locoregional recurrence in the previously irradiated volume. Stereotactic body radiotherapy (SBRT) has been used in the oligometastatic setting, and provides an ablative approach ideal for reirradiation. The purpose of this study was to evaluate the outcomes after SBRT reirradiation of extraosseous recurrences in the pelvis. MATERIALS AND METHODS This single institution retrospective study evaluated patients treated with SBRT reirradiation in the pelvis from January 2011 to February 2018. Patients with more than five oligometastatic lesions, >7 cm in size, and recurrence within the prostate were excluded. RESULTS In total, 30 patients were treated with SBRT with a median follow-up of 29.4 months. The primary tumour sites were most commonly rectum (30.8%) and prostate (30.8%). The median time interval between irradiation for the primary and SBRT reirradiation was 48 months (3-245). The typical reirradiation treatment was 35 Gy in five fractions, the median gross tumour volume size was 10.2 (0.3-110.5) ml and the most common target was the iliac nodes (40%). There were three (10%) acute grade 3 toxicities and no late grade 3 or more toxicities. At 12/24 months, local relapse-free survival, metastasis-free survival, progression-free survival and overall survival were 67.7%/50.7%, 67%/41.7%, 34.8%/14.9% and 83.2%/62.5%, respectively. On univariate analysis, improved local control was associated with low gross tumour volume (<10 ml) (P = 0.003) and prostate primary (P = 0.02), but was no longer significant on multivariate analysis. The proximity of organ at risk to the target did not significantly correlate with worse toxicity (P = 0.14) or tumour coverage (gross tumour volume: P = 0.8, planning target volume: P = 0.4). CONCLUSION SBRT pelvic reirradiation in oligometastatic patients is a safe and effective treatment modality. Careful consideration should be taken with larger tumour size, as it may be associated with worse oncological and toxicity outcome.
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Affiliation(s)
- R Kinj
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - J Doyen
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France; University of Côte d'Azur, Nice, France
| | - J M Hannoun-Lévi
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France; University of Côte d'Azur, Nice, France
| | - A O Naghavi
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - M E Chand
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - G Baudin
- Department of Radiology, Centre Antoine Lacassagne, Nice, France
| | - J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - E François
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - L Evesque
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - D Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - K Benezery
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - P Y Bondiau
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
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11
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Deluche E, Antoine A, Bachelot T, Lardy-Cleaud A, Dieras V, Brain E, Debled M, Jacot W, Mouret-Reynier MA, Goncalves A, Dalenc F, Patsouris A, Ferrero JM, Levy C, Lorgis V, Vanlemmens L, Lefeuvre-Plesse C, Mathoulin-Pelissier S, Petit T, Uwer L, Jouannaud C, Leheurteur M, Lacroix-Triki M, Courtinard C, Perol D, Robain M, Delaloge S. Contemporary outcomes of metastatic breast cancer among 22,000 women from the multicentre ESME cohort 2008-2016. Eur J Cancer 2020; 129:60-70. [PMID: 32135312 DOI: 10.1016/j.ejca.2020.01.016] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [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: 11/25/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/26/2022]
Abstract
AIM Real-world data inform the outcome comparisons and help the development of new therapeutic strategies. To this end, we aimed to describe the full characteristics and outcomes in the Epidemiological Strategy and Medical Economics (ESME) cohort, a large national contemporary observational database of patients with metastatic breast cancer (MBC). METHODS Women aged ≥18 years with newly diagnosed MBC and who initiated MBC treatment between January 2008 and December 2016 in one of the 18 French Comprehensive Cancer Centers (N = 22,109) were included. We assessed the full patients' characteristics, first-line treatments, overall survival (OS) and first-line progression-free survival, as well as updated prognostic factors in the whole cohort and among the 3 major subtypes: hormone receptor positive and HER2-negative (HR+/HER2-, n = 13,656), HER2-positive (HER2+, n = 4017) and triple-negative (n = 2963) tumours. RESULTS The median OS of the whole cohort was 39.5 months (95% confidence interval [CI], 38.7-40.3). Five-year OS was 33.8%. OS differed significantly between the 3 subtypes (p < 0.0001) with a median OS of 43.3 (95% CI, 42.5-44.5) in HR+/HER2-; 50.1 (95% CI, 47.6-53.1) in HER2+; and 14.8 months (95% CI, 14.1-15.5) in triple-negative subgroups, respectively. Beyond performance status, the following variables had a constant significant negative prognostic impact on OS in the whole cohort and among subtypes: older age at diagnosis of metastases (except for the triple-negative subtype), metastasis-free interval between 6 and 24 months, presence of visceral metastases and number of metastatic sites ≥ 3. CONCLUSIONS The ESME program represents a unique large-scale real-life cohort on MBC. This study highlights important situations of high medical need within MBC patients. DATABASE REGISTRATION: clinicaltrials.gov Identifier NCT032753.
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Affiliation(s)
- Elise Deluche
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France; Department of Medical Oncology, CHU de Limoges, France
| | - Alison Antoine
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Audrey Lardy-Cleaud
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Veronique Dieras
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, Rennes, 35000, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, Paris & Saint-Cloud, 75005, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, Bordeaux, 33000, France
| | - William Jacot
- Department of Medical Oncology, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, Montpellier, 34298, France
| | - Marie Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, Clermont Ferrand, 63011, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, Marseille, 13009, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, Toulouse, 31059, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest Nantes & Angers, 15 Rue André Boquel, Angers, 49055, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, Nice, 06189, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue Du Général Harris, Caen, 14000, France
| | - Veronique Lorgis
- Department of Medical Oncology, Institut de Cancérologie de Bourgogne, Dijon, 21079, France
| | - Laurence Vanlemmens
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, Lille, 59000, France
| | - Claudia Lefeuvre-Plesse
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, Rennes, 35000, France
| | | | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de La Porte de L'Hôpital, Strasbourg, 67000, France
| | - Lionel Uwer
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, Vandœuvre-lès-Nancy, 54519, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue Du Général Koenig, Reims, 51100, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue D'Amiens, Rouen, 76000, France
| | - Magali Lacroix-Triki
- Department of BioPathology, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, Paris, 75654, France
| | - David Perol
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, Paris, 75654, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France.
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Darlix A, Louvel G, Fraisse J, Jacot W, Brain E, Debled M, Mouret-Reynier MA, Goncalves A, Dalenc F, Delaloge S, Campone M, Augereau P, Ferrero JM, Levy C, Fumet JD, Lecouillard I, Cottu P, Petit T, Uwer L, Jouannaud C, Leheurteur M, Dieras V, Robain M, Chevrot M, Pasquier D, Bachelot T. Impact of breast cancer molecular subtypes on the incidence, kinetics and prognosis of central nervous system metastases in a large multicentre real-life cohort. Br J Cancer 2019; 121:991-1000. [PMID: 31719684 PMCID: PMC6964671 DOI: 10.1038/s41416-019-0619-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Metastatic breast cancer (MBC) behaviour differs depending on hormone receptors (HR) and human epidermal growth factor receptor (HER2) statuses. METHODS The kinetics of central nervous system (CNS) metastases (CNS metastasis-free survival, CNSM-FS) and subsequent patient's prognosis (overall survival, OS) according to the molecular subtype were retrospectively assessed in 16703 MBC patients of the ESME nationwide multicentre MBC database (Kaplan-Meier method). RESULTS CNS metastases occurred in 4118 patients (24.6%) (7.2% at MBC diagnosis and 17.5% later during follow-up). Tumours were HER2-/HR+ (45.3%), HER2+/HR+ (14.5%), HER2+/HR- (14.9%) and triple negative (25.4%). Median age at CNS metastasis diagnosis was 58.1 years (range: 22.8-92.0). The median CNSM-FS was 10.8 months (95% CI: 16.5-17.9) among patients who developed CNS metastases. Molecular subtype was independently associated with CNSM-FS (HR = 3.45, 95% CI: 3.18-3.75, triple-negative and HER2-/HR+ tumours). After a 30-month follow-up, median OS after CNS metastasis diagnosis was 7.9 months (95% CI: 7.2-8.4). OS was independently associated with subtypes: median OS was 18.9 months (HR = 0.57, 95% CI: 0.50-0.64) for HER2+/HR+ , 13.1 months (HR = 0.72, 95% CI: 0.65-0.81) for HER2+/HR-, 4.4 months (HR = 1.55, 95% CI: 1.42-1.69) for triple-negative and 7.1 months for HER2-/HR+ patients (p <0.0001). CONCLUSIONS Tumour molecular subtypes strongly impact incidence, kinetics and prognosis of CNS metastases in MBC patients. CLINICAL TRIAL REGISTRATION NCT03275311.
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Affiliation(s)
- Amélie Darlix
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, France.
| | - Guillaume Louvel
- Department of Radiation Therapy, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Julien Fraisse
- Biometrics Unit, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), University of Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Institut du Cancer de Montpellier, University of Montpellier 208 Rue des Apothicaires, 34298, Montpellier, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris & Saint-Cloud, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Marie Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont Ferrand, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard-Vaillant, 94800, Villejuif, France
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Boulevard Jacques Monod, 44805, Saint Herblain, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, 15 rue André Boquel, 49055, Angers, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de valambrose, 06189, Nice, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Jean-David Fumet
- Department of Medical Oncology, Centre Georges François Leclerc, 1 rue Professeur Marion, 21079, Dijon, France
| | - Isabelle Lecouillard
- Department of Radiation Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris & Saint-Cloud, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de la Porte de l'Hôpital, 67000, Strasbourg, France
| | - Lionel Uwer
- Medical Oncology Department, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue du Général Koenig, 51100, Reims, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000, Rouen, France
| | - Véronique Dieras
- Department of Radiation Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Mathieu Robain
- Department of Research and Development, Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Michaël Chevrot
- Department of Research and Development, Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008, Lyon, France
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Lavaud P, Gravis G, Foulon S, Joly F, Oudard S, Priou F, Latorzeff I, Mourey L, Soulié M, Delva R, Krakowski I, Laguerre B, Théodore C, Ferrero JM, Beuzeboc P, Habibian M, Rolland F, Deplanque G, Pouessel D, Zanetta S, Berdah JF, Dauba J, Baciuchka M, Platini C, Linassier C, Tubiana-Mathieu N, Machiels JP, Kouri CE, Ravaud A, Suc E, Eymard JC, Hasbini A, Bousquet G, Culine S, Boher JM, Tergemina-Clain G, Legoupil C, Fizazi K. Anticancer Activity and Tolerance of Treatments Received Beyond Progression in Men Treated Upfront with Androgen Deprivation Therapy With or Without Docetaxel for Metastatic Castration-naïve Prostate Cancer in the GETUG-AFU 15 Phase 3 Trial. Eur Urol 2018; 73:696-703. [DOI: 10.1016/j.eururo.2017.09.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/19/2017] [Indexed: 12/19/2022]
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14
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Gobbini E, Ezzalfani M, Dieras V, Bachelot T, Brain E, Debled M, Jacot W, Mouret-Reynier MA, Goncalves A, Dalenc F, Patsouris A, Ferrero JM, Levy C, Lorgis V, Vanlemmens L, Lefeuvre-Plesse C, Mathoulin-Pelissier S, Petit T, Uwer L, Jouannaud C, Leheurteur M, Lacroix-Triki M, Cleaud AL, Robain M, Courtinard C, Cailliot C, Perol D, Delaloge S. Time trends of overall survival among metastatic breast cancer patients in the real-life ESME cohort. Eur J Cancer 2018; 96:17-24. [PMID: 29660596 DOI: 10.1016/j.ejca.2018.03.015] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [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: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 12/25/2022]
Abstract
AIM Real-life analysis of overall survival (OS) trends among metastatic breast cancer (MBC) patients may help define medical needs and evaluate the impact of public health investments. The present study aimed to evaluate the independent impact of the year of MBC diagnosis on OS in the Epidemio-Strategy-Medical-Economical (ESME)-MBC cohort. METHODS ESME-MBC (NCT03275311) is a French, national, multicentre, observational cohort including 16,702 consecutive newly diagnosed MBC patients (01 January 2008-31 December 2014). Of 16,680 eligible patients, 15,085 had full immunohistochemistry data, allowing classification as hormone receptor-positive and HER2-negative (HR+/HER2-, N = 9907), HER2-positive (HER2+, N = 2861) or triple-negative (HR-/HER2-, N = 2317) subcohorts. Multivariate analyses of OS were conducted among the full ESME cohort and subcohorts. RESULTS Median OS of the whole cohort was 37.22 months (95% confidence interval [CI], 36.3-38.04). Year of diagnosis was an independent predictor of OS (hazard ratio 0.98 [95% CI, 0.97-1.00], P = .01) together with age, subtype, disease-free interval, visceral metastases and number of organs involved. Median OS of HR+/HER2-, HER2+ and HR-/HER2- subcohorts was, respectively, 42.12 (95% CI, 40.90-43.10), 44.91 (95% CI, 42.51-47.90) and 14.52 (95% CI, 13.70-15.24) months. Year of diagnosis was a strong independent predictor of OS in HER2+ subcohort (hazard ratio 0.91 [95% CI, 0.88-0.94], P < .001), but not in HR+/HER2- nor HR-/HER2- subcohorts (hazard ratio 1.00 [95% CI, 0.98-1.01], P = .80 and 1.00 [95% CI, 0.97-1.02], P = .90, respectively). CONCLUSIONS The OS of MBC patients has slightly improved over the past decade. However, this effect is confined to HER2+ cases, highlighting the need of new strategies in the other subtypes.
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Affiliation(s)
- Elisa Gobbini
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Monia Ezzalfani
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Véronique Dieras
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, 75005 Paris & Saint-Cloud, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, 75005 Paris & Saint-Cloud, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33000 Bordeaux, France
| | - William Jacot
- Department of Medical Oncology, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, 34298 Montpellier, France
| | - Marie Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011 Clermont Ferrand, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Nantes & Angers, 15 rue André Boquel, 49055 Angers, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189 Nice, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France
| | - Veronique Lorgis
- Department of Medical Oncology, Centre Georges François Leclerc, 1 rue Professeur Marion, 21079 Dijon, France
| | - Laurence Vanlemmens
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Claudia Lefeuvre-Plesse
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | | | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de la Porte de l'Hôpital, 67000 Strasbourg, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Christelle Jouannaud
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000 Rouen, France
| | - Magali Lacroix-Triki
- Department of BioPathology, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Audrey Lardy Cleaud
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France
| | - Christian Cailliot
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France
| | - David Perol
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France.
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Darlix A, Griguolo G, Thezenas S, Kantelhardt E, Thomssen C, Dieci MV, Miglietta F, Conte P, Braccini AL, Ferrero JM, Bailleux C, Jacot W, Guarneri V. Hormone receptors status: a strong determinant of the kinetics of brain metastases occurrence compared with HER2 status in breast cancer. J Neurooncol 2018; 138:369-382. [PMID: 29488184 DOI: 10.1007/s11060-018-2805-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/15/2017] [Accepted: 02/15/2018] [Indexed: 01/12/2023]
Abstract
Breast cancer (BC) metastatic behavior varies according to the hormone receptors (HR) and HER2 statuses. Indeed, patients with triple-negative (TN) and HER2+ tumors are at higher risk of brain metastases (BM). The objective of this multinational cohort was to evaluate BM kinetics depending on the BC subtype. We retrospectively analyzed a series of BC patients with BM diagnosed in four European institutions (1996-2016). The delay between BC and BM diagnoses (BM-free survival) according to tumor biology was estimated with the Kaplan-Meier method. A multivariate analysis was performed using the Cox proportional hazards regression model. 649 women were included: 32.0% HER2-/HR+, 24.8% TN, 22.2% HER2+/HR- and 21.0% HER2+/HR+ tumors. Median age at BM diagnosis was 56 (25-85). In univariate analysis, BM-free survival differed depending on tumor biology: HER2-/HR+ 5.3 years (95% CI 4.6-5.9), HER2+/HR+ 4.4 years (95% CI 3.4-5.2), HER2+/HR- 2.6 years (95% CI 2.2-3.1) and TN 2.2 years (95% CI 1.9-2.7) (p < 0.001). It was significantly different between HR+ and HR- tumors (5.0 vs. 2.5 years, p < 0.001), and between HER2+ and HER2- tumors (3.2 vs. 3.8 years, p = 0.039). In multivariate analysis, estrogen-receptors (ER) and progesterone-receptors (PR) negativity, but not HER2 status, were independently associated with BM-free survival (hazard ratio = 1.36 for ER, p = 0.013, 1.31 for PR, p = 0.021, and 1.01 for HER2+ vs. HER2- tumors, p = 0.880). HR- and HER2+ tumors are overrepresented in BC patients with BM, supporting a higher risk of BM in these biological subtypes. HR status, but not HER2 status, impacts the kinetics of BM occurrence.
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Affiliation(s)
- Amélie Darlix
- Department of Medical Oncology, Institut régional du Cancer Montpellier ICM, 208 rue des Apothicaires, 34298, Montpellier Cedex 5, France.
| | - Gaia Griguolo
- Division of Medical Oncology 2, Instituto Oncologico Veneto IRCCS, 35128, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124, Padova, Italy
| | - Simon Thezenas
- Biometry Unit, Institut régional du Cancer Montpellier ICM, 34298, Montpellier, France
| | - Eva Kantelhardt
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06097, Halle (Saale), Germany
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, 06120, Halle (Saale), Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, 06097, Halle (Saale), Germany
| | - Maria Vittoria Dieci
- Division of Medical Oncology 2, Instituto Oncologico Veneto IRCCS, 35128, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124, Padova, Italy
| | - Federica Miglietta
- Division of Medical Oncology 2, Instituto Oncologico Veneto IRCCS, 35128, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124, Padova, Italy
| | - PierFranco Conte
- Division of Medical Oncology 2, Instituto Oncologico Veneto IRCCS, 35128, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124, Padova, Italy
| | - Antoine Laurent Braccini
- Department of Medical Oncology and Radiotherapy, Centre Azuréen de Cancérologie, 06250, Mougins, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 06100, Nice, France
| | - Caroline Bailleux
- Department of Medical Oncology, Centre Antoine Lacassagne, 06100, Nice, France
| | - William Jacot
- Department of Medical Oncology, Institut régional du Cancer Montpellier ICM, 208 rue des Apothicaires, 34298, Montpellier Cedex 5, France
| | - Valentina Guarneri
- Division of Medical Oncology 2, Instituto Oncologico Veneto IRCCS, 35128, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35124, Padova, Italy
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Darlix A, Griguolo G, Thezenas S, Kantelhardt E, Thomssen C, Dieci MV, Miglietta F, Conte P, Braccini AL, Ferrero JM, Bailleux C, Jacot W, Guarneri V. CMET-29. HORMONE RECEPTORS STATUS: A STRONG DETERMINANT OF THE KINETICS OF BRAIN METASTASES OCCURRENCE COMPARED WITH HER2 STATUS IN BREAST CANCER. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.176] [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: 11/14/2022] Open
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Villanueva CB, Barthelemy P, Ferrero JM, Jacquin JP, Bonnetain F, Mansi L, Pivot X. Abstract OT1-04-07: VICTORIANE: A randomized phase 3 study assessing the addition of oral vinorelbine to aromatase inhibitors for the treatment of patients with metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-04-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background : The addition of anti-proliferative agents such new inhibitors of CDK4/6 to hormonotherapy have significantly improved the efficacy in patients with metastatic breast cancer (MBC). Oral vinorelbine provided the opportunity to give new schedules of chemotherapy with favourable tolerability and prolonged exposure. The present trial was designed to evaluate the clinical effects of the addition of oral vinorelbine to aromatase inhibitors in first line treatment for MBC.
Methods : In this phase III, randomized, prospective, open trial named VICTORIANE (NCT02730091), postmenopausal women with HR+/HER2– with MBC are randomized (1:1) between letrozole or anastrozole once a day (Arm A) versus oral vinorelbine 50 mg three times a every week with letrozole or anastrozole (Arm B). Continuous daily schedule (days 1-28 of each 28 days cycle) is planned until disease progression or discontinuation for other reasons. A minimisation algorithm was used stratifying treatment allocation according to the existence of visceral metastases, prior adjuvant hormonal treatment and centers. The study is conducted in compliance with the principles of good clinical practice and the declaration of Helsinki.
Key inclusion criteria include, histologicaly proven HER2-negative and Estrogen Receptor-positive breast cancer, metastatic setting, no prior systemic anti-cancer therapy for MBC, recurrence after prior hormonal therapy in the adjuvant setting is allowed if disease free interval is greater than 24 months from the completion of treatment, normal liver, bone marrow and renal functions, Performans status greater than 2. Non inclusion criteria include symptomatic visceral disease, or disease burden precluding endocrine therapy, and prior therapy with vinorelbine.
The primary endpoints is progression-free survival (PFS; local assessment, RECIST v1.1) and secondaries endpoints are overall survival, health-related quality of life, overall response rate and safety. Analysis of the primary endpoint will be performed with a stratified log-rank test (95% confidence interval). A 30 percent reduction in the risk of events (Hazard Ratio (HR) = 0.70) was assumed under H1 in the arm B. This reduction was estimated based on an absolute gain of 3.857 months in terms of median PFS, from 9 months (arm A) to 12.857 months (arm B). Global recruitment of the planned 340 pts is ongoing and should be completed in march 2018. Final results will be expected in 2019.
Citation Format: Villanueva CB, Barthelemy P, Ferrero JM, Jacquin JP, Bonnetain F, Mansi L, Pivot X. VICTORIANE: A randomized phase 3 study assessing the addition of oral vinorelbine to aromatase inhibitors for the treatment of patients with metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-04-07.
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Affiliation(s)
- CB Villanueva
- University Hospital of Besançon, Besançon, France; University Hospital of Strasbourg, Strasbourg, France; Centre Lacassagne de Nice, Nice, France; Institut de Cancérologie Lucien Neuwich, Saint Priest en Jarez, France; Université de Franche Comté, Besançon, France
| | - P Barthelemy
- University Hospital of Besançon, Besançon, France; University Hospital of Strasbourg, Strasbourg, France; Centre Lacassagne de Nice, Nice, France; Institut de Cancérologie Lucien Neuwich, Saint Priest en Jarez, France; Université de Franche Comté, Besançon, France
| | - JM Ferrero
- University Hospital of Besançon, Besançon, France; University Hospital of Strasbourg, Strasbourg, France; Centre Lacassagne de Nice, Nice, France; Institut de Cancérologie Lucien Neuwich, Saint Priest en Jarez, France; Université de Franche Comté, Besançon, France
| | - JP Jacquin
- University Hospital of Besançon, Besançon, France; University Hospital of Strasbourg, Strasbourg, France; Centre Lacassagne de Nice, Nice, France; Institut de Cancérologie Lucien Neuwich, Saint Priest en Jarez, France; Université de Franche Comté, Besançon, France
| | - F Bonnetain
- University Hospital of Besançon, Besançon, France; University Hospital of Strasbourg, Strasbourg, France; Centre Lacassagne de Nice, Nice, France; Institut de Cancérologie Lucien Neuwich, Saint Priest en Jarez, France; Université de Franche Comté, Besançon, France
| | - L Mansi
- University Hospital of Besançon, Besançon, France; University Hospital of Strasbourg, Strasbourg, France; Centre Lacassagne de Nice, Nice, France; Institut de Cancérologie Lucien Neuwich, Saint Priest en Jarez, France; Université de Franche Comté, Besançon, France
| | - X Pivot
- University Hospital of Besançon, Besançon, France; University Hospital of Strasbourg, Strasbourg, France; Centre Lacassagne de Nice, Nice, France; Institut de Cancérologie Lucien Neuwich, Saint Priest en Jarez, France; Université de Franche Comté, Besançon, France
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18
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Delaloge S, Pérol D, Courtinard C, Brain E, Asselain B, Bachelot T, Debled M, Dieras V, Campone M, Levy C, Jacot W, Lorgis V, Veyret C, Dalenc F, Ferrero JM, Uwer L, Kerbrat P, Goncalves A, Mouret-Reynier MA, Petit T, Jouannaud C, Vanlemmens L, Chenuc G, Guesmia T, Robain M, Cailliot C. Paclitaxel plus bevacizumab or paclitaxel as first-line treatment for HER2-negative metastatic breast cancer in a multicenter national observational study. Ann Oncol 2016; 27:1725-32. [PMID: 27436849 DOI: 10.1093/annonc/mdw260] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 04/19/2016] [Accepted: 06/21/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bevacizumab combined with paclitaxel as first-line chemotherapy for patients with HER2-negative metastatic breast cancer (MBC) has led to mixed results in randomized trials, with an improvement in progression-free survival (PFS) but no statistically significant overall survival (OS) benefit. Real-life data could help in assessing the value of this combination. PATIENTS AND METHODS This study aimed to describe the outcome following first-line paclitaxel with or without bevacizumab in the French Epidemiological Strategy and Medical Economics (ESME) database of MBC patients, established in 2014 by Unicancer. The primary and secondary end points were OS and PFS, respectively. RESULTS From 2008 to 2013, 14 014 MBC patient files were identified, including 10 605 patients with a HER2-negative status. Of these, 3426 received paclitaxel and bevacizumab (2127) or paclitaxel (1299) as first-line chemotherapy. OS adjusted for major prognostic factors was significantly longer in the paclitaxel and bevacizumab group compared with paclitaxel [hazard ratio (HR) 0.672, 95% confidence interval (CI) 0.601-0.752; median survival time 27.7 versus 19.8 months]. Results were consistent in all supportive analyses (using a propensity score for adjustment and as a matching factor for nested case-control analyses) and sensitivity analyses. Similar results were observed for the adjusted PFS, favoring the combination (HR 0.739, 95% CI 0.672-0.813; 8.1 versus 6.4 months). CONCLUSIONS In this large-scale, real-life setting, patients with HER2-negative MBC who received paclitaxel plus bevacizumab as first-line chemotherapy had a significantly better OS and PFS than those receiving paclitaxel. Despite robust methodology, real-life data are exposed to important potential biases, and therefore, results need to be treated with caution. Our data cannot therefore support extension of current use of bevacizumab in MBC.
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Affiliation(s)
- S Delaloge
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif
| | - D Pérol
- Department of Biostatistics, Centre Léon Bérard, Lyon
| | - C Courtinard
- Department of Research and Development, R&D Unicancer, Paris
| | - E Brain
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud
| | - B Asselain
- Department of Research and Development, R&D Unicancer, Paris
| | - T Bachelot
- Department of Biostatistics, Centre Léon Bérard, Lyon
| | - M Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux
| | - V Dieras
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud
| | - M Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes and Angers
| | - C Levy
- Department of Medical Oncology, Centre François Baclesse, Caen
| | - W Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier
| | - V Lorgis
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - C Veyret
- Department of Medical Oncology, Centre Henri Becquerel, Rouen
| | - F Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice
| | - L Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy
| | - P Kerbrat
- Department of Medical Oncology, Centre Eugène Marquis, Rennes
| | - A Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | | | - T Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg
| | - C Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, Reims
| | - L Vanlemmens
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | | | - T Guesmia
- Department of Research and Development, R&D Unicancer, Paris
| | - M Robain
- Department of Research and Development, R&D Unicancer, Paris
| | - C Cailliot
- Department of Research and Development, R&D Unicancer, Paris
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19
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Thariat J, Creisson A, Chamignon B, Dejode M, Gastineau M, Hébert C, Boissin F, Topfer C, Gilbert E, Grondin B, Guennoc H, Mari V, Buzzo S, Saja D, Duboue N, Boulahssass R, Tosi A, Verne S, Ducray J, Benard-Thiery I, Ferrero JM. [Integrating patient education in your oncology practice]. Bull Cancer 2016; 103:674-90. [PMID: 27286758 DOI: 10.1016/j.bulcan.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/14/2015] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient education is the process by which health professionals impart information to patients and their caregivers that will alter their health behaviors; improve their health status to better manage their lives with a chronic disease. Patient education implies a profound paradigm shift in the conception of care among health professionals, and should result in structural care changes. Patient education has been promoted by the French Health system for 30years, including in the 2009 HPST law and Cancer Plan 2014-2019. A patient education program was designed in our hospital for breast cancer patients. MATERIAL AND METHODS A multidisciplinary and transversal team of health professionals and resource patients was trained before grant application for funding of the program by the regional health care agency. Management of the project required that a functional unit be built for recording of all patient education related activities. A customized patient education program process was built under the leadership of a coordinator and several patient education project managers during bimonthly meetings, using an accurate timeline and a communication strategy to ensure full institutional support and team engagement. RESULTS The grant was prepared in four months and the program started within the next four months with the aim to include 120 patients during year 1. The program includes a diagnosis of patient abilities and well-being resources, followed by collective and individual workshops undertaken in 4months for each patient. DISCUSSION Patient education is positively evaluated by all participants and may contribute to better health care management in the long term but the financial and human resources allocated to such programs currently underestimate the needs. Sustainability of patient education programs requires that specific tools and more commitment be developed to support health care professionals and to promote patient coping and empowerment in the long term.
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Affiliation(s)
- Juliette Thariat
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France.
| | - Anne Creisson
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Blandine Chamignon
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Magali Dejode
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Marie Gastineau
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Christophe Hébert
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Fabienne Boissin
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Christelle Topfer
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Elise Gilbert
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Benoit Grondin
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Helène Guennoc
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Veronique Mari
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Solange Buzzo
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Dominique Saja
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Nathalie Duboue
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Rabia Boulahssass
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Alexia Tosi
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Suzanne Verne
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Julie Ducray
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Isabelle Benard-Thiery
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
| | - Jean Marc Ferrero
- Centre Lacassagne, équipe éducation thérapeutique patient, 33, avenue Valombrose, 06189 Nice cedex 2, France
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20
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Lavaud P, Gravis G, Legoupil C, Joly F, Oudard S, Priou F, Mourey L, Soulie M, Latorzeff I, Delva R, Krakowski I, Laguerre B, Theodore C, Ferrero JM, Beuzeboc P, Habibian M, Foulon S, Boher JM, Tergemina-Clain G, Fizazi K. Efficacy and tolerance of treatments received beyond progression in men with metastatic hormone-naive prostate cancer treated with androgen deprivation therapy (ADT) with or without docetaxel in the GETUG-AFU 15 phase III trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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)
| | - Gwenaelle Gravis
- Medical Oncology, Institut Paoli Calmette, Hôpital de Jour, Marseille, France
| | | | | | - Stephane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | - Franck Priou
- Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France
| | - Loic Mourey
- Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Michel Soulie
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | | | | | | | | | | | | | | | | | | | | | - Karim Fizazi
- Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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21
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Boulahssass R, Gonfrier S, Ferrero JM, Marine S, Saja D, Mari V, Piche T, Bereder JM, Delotte J, Turpin JM, Ouvrier D, Barrière J, Largillier R, Rambaud C, Benchimol D, Follana P, Otto J, Guigay J, Francois E, Guerin O. A clinical score to predict the early death at 100 days after a comprehensive geriatric assessment (CGA) in elderly metastatic cancers , analysis from a prospective cohort study with 1048 patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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22
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Boulahssass R, Gonfrier S, Ferrero JM, Auben F, Rambaud C, Mari V, Turpin JM, Piche T, Isabelle B, Bereder JM, Hannoun Levi JM, Delotte J, Largillier R, Evesque L, Follana P, Borchiellini D, Benchimol D, Guigay J, Francois E, Guerin O. A clinical score to predict early death at 100 days after a comprehensive geriatric assessment (CGA) in elderly cancer patients: A prospective study with 815 patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Philippe Follana
- Département d'Oncologie Médicale, Centre Antoine Lacassagne, Nice, France
| | | | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Barranger E, Antomarchi J, Chamorey E, Cavrot C, Flipo B, Follana P, Peyrottes I, Chapellier C, Ferrero JM, Ihrai T. Effect of Neoadjuvant Chemotherapy on the Surgical Treatment of Patients With Locally Advanced Breast Cancer Requiring Initial Mastectomy. Clin Breast Cancer 2015; 15:e231-5. [PMID: 25887149 DOI: 10.1016/j.clbc.2015.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 11/20/2014] [Revised: 03/04/2015] [Accepted: 03/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to assess the rate of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (nCT) in patients for whom mastectomy (MT) was, initially, the only conceivable surgical option. PATIENTS AND METHODS Between 2007 and 2012, 168 patients from a single center received nCT. Among these patients, we focused on the ones who received nCT (n = 119, [70.8%]) to decrease tumor size and thus to potentially allow a conservative surgical treatment. For these patients, MT was initially the only possible surgical treatment. RESULTS Among the 119 patients included, 118 presented with an invasive ductal carcinoma. The mean tumor size before nCT, measured using magnetic resonance imaging, was 41.6 mm (range, 15-110 mm) and 25.3 mm (range, 0-90 mm) after nCT. Eighty-six patients (72.3%) underwent BCS, and oncoplastic techniques were used in 29 patients (33.6%). Only 4.3% (5 patients) of patients who were treated with BCS needed additional surgery because of positive surgical margins. The median follow-up was 41.1 months (95% confidence interval [CI], 35.2-48.3). Five-year overall survival after BCS and MT were 77% (95% CI, 63-92) and 77% (95% CI, 63-95) respectively. Five-year disease-free survival after BCS and MT were 74% (95% CI, 64-86) and 59% (95% CI, 40-89) (not significant), respectively. CONCLUSION nCT for selective patients with "chemosensitive" breast tumor leads to a significant "MT to BCS" conversion rate. The type of surgery does not seem to affect the patient's overall and disease-free survival rates. Oncoplastic procedures can help to extend BCS after nCT.
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Affiliation(s)
- Emmanuel Barranger
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France.
| | - Julie Antomarchi
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France
| | - Emmanuel Chamorey
- Département de recherche Clinique et innovation et statistiques, Centre Antoine Lacassagne, Nice, France
| | - Constance Cavrot
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France
| | - Bernard Flipo
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France
| | - Philippe Follana
- Département d'oncologie médicale, Centre Antoine Lacassagne, Nice, France
| | - Isabelle Peyrottes
- Département d'anatomie-pathologique, Centre Antoine Lacassagne, Nice, France
| | | | - Jean Marc Ferrero
- Département d'oncologie médicale, Centre Antoine Lacassagne, Nice, France
| | - Tarik Ihrai
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France
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Doyen J, Trastour C, Ettore F, Peyrottes I, Toussant N, Gal J, Ilc K, Roux D, Parks SK, Ferrero JM, Pouysségur J. Expression of the hypoxia-inducible monocarboxylate transporter MCT4 is increased in triple negative breast cancer and correlates independently with clinical outcome. Biochem Biophys Res Commun 2014; 451:54-61. [PMID: 25058459 DOI: 10.1016/j.bbrc.2014.07.050] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [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: 07/02/2014] [Accepted: 07/10/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND (18)Fluor-deoxy-glucose PET-scanning of glycolytic metabolism is being used for staging in many tumors however its impact on prognosis has never been studied in breast cancer. METHODS Glycolytic and hypoxic markers: glucose transporter (GLUT1), carbonic anhydrase IX (CAIX), monocarboxylate transporter 1 and 4 (MCT1, 4), MCT accessory protein basigin and lactate-dehydrogenase A (LDH-A) were assessed by immunohistochemistry in two cohorts of breast cancer comprising 643 node-negative and 127 triple negative breast cancers (TNBC) respectively. RESULTS In the 643 node-negative breast tumor cohort with a median follow-up of 124 months, TNBC were the most glycolytic (≈70%), followed by Her-2 (≈50%) and RH-positive cancers (≈30%). Tumoral MCT4 staining (without stromal staining) was a strong independent prognostic factor for metastasis-free survival (HR=0.47, P=0.02) and overall-survival (HR=0.38, P=0.002). These results were confirmed in the independent cohort of 127 cancer patients. CONCLUSION Glycolytic markers are expressed in all breast tumors with highest expression occurring in TNBC. MCT4, the hypoxia-inducible lactate/H(+) symporter demonstrated the strongest deleterious impact on survival. We propose that MCT4 serves as a new prognostic factor in node-negative breast cancer and can perhaps act soon as a theranostic factor considering the current pharmacological development of MCT4 inhibitors.
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Affiliation(s)
- J Doyen
- Department of Radiation Oncology, Centre A. Lacassagne, Nice, France
| | - C Trastour
- Department of Gynecology, Archet II Hospital, 06202 Nice, France
| | - F Ettore
- Department of Pathology, Centre A. Lacassagne, Nice, France
| | - I Peyrottes
- Department of Pathology, Centre A. Lacassagne, Nice, France
| | - N Toussant
- Department of Pathology, Centre A. Lacassagne, Nice, France
| | - J Gal
- Department of Medical Statistics, Centre A. Lacassagne, Nice, France
| | - K Ilc
- Institute for Research on Cancer & Aging (IRCAN), University of Nice, Centre A. Lacassagne, 06189 Nice, France
| | - D Roux
- Institute for Research on Cancer & Aging (IRCAN), University of Nice, Centre A. Lacassagne, 06189 Nice, France
| | - S K Parks
- Centre Scientifique de Monaco (CSM), Monaco
| | - J M Ferrero
- Department of Medical Oncology, Centre A. Lacassagne, Nice, France
| | - J Pouysségur
- Institute for Research on Cancer & Aging (IRCAN), University of Nice, Centre A. Lacassagne, 06189 Nice, France; Centre Scientifique de Monaco (CSM), Monaco.
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25
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Fizazi K, Laplanche A, Lesaunier F, Delva R, Gravis G, Rolland F, Priou F, Ferrero JM, Houede N, Mourey L, Theodore C, Krakowski I, Berdah JF, Baciuchka M, Laguerre B, Davin JL, Martin AL, Habibian M, Faivre L, Culine S. Docetaxel-estramustine in localized high-risk prostate cancer: Results of the French Genitourinary Tumor Group GETUG 12 phase III trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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)
- Karim Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Cancer Campus, Grand Paris, Villejuif, France
| | | | | | - Remy Delva
- Institut de Cancérologie de l'Ouest, Angers, France
| | - Gwenaelle Gravis
- Medical Oncology, Institut Paoli Calmette, Hôpital de Jour, Marseille, France
| | | | - Frank Priou
- Centre Hospitalier La Roche sur Yon, La Roche sur Yon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Stephane Culine
- Department of Medical Oncology - Hopital Saint-Louis - APHP, Paris, France
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Awada A, Bondarenko IN, Bonneterre J, Nowara E, Ferrero JM, Bakshi AV, Wilke C, Piccart M. A randomized controlled phase II trial of a novel composition of paclitaxel embedded into neutral and cationic lipids targeting tumor endothelial cells in advanced triple-negative breast cancer (TNBC). Ann Oncol 2014; 25:824-831. [PMID: 24667715 DOI: 10.1093/annonc/mdu025] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND EndoTAG-1, composed of paclitaxel embedded in liposomal membranes targeting tumor endothelial cells, was evaluated for safety and efficacy in advanced triple-negative breast cancer (TNBC). PATIENTS AND METHODS One hundred and forty patients were treated with weekly EndoTAG-1 (22 mg/m(2)) plus paclitaxel (70 mg/m(2)), twice weekly EndoTAG-1 (2× 44 mg/m(2)), or weekly paclitaxel (90 mg/m(2)) for greater than or equal to four cycles (3-week treatment + 1-week rest) or until progression/toxicity. Primary end point was progression-free survival (PFS) rate evaluated centrally after four cycles of therapy (week 16). The study was not powered for intergroup comparisons. RESULTS The PFS rate at week 16 was 59.1% [one-sided 95% CI: 45.6, ∞] on combination treatment, 34.2% [21.6, ∞] on EndoTAG-1, and 48.0% [30.5, ∞] on paclitaxel. Median PFS reached 4.2, 3.4, and 3.7 months, respectively. After complete treatment (week 41 analysis), median overall survival (OS) was 13.0, 11.9, and 13.1 months for the modified Intention-to-Treat (ITT) population and 15.1, 12.5, and 8.9 months for the per-protocol population, respectively. The clinical benefit rate was 53%, 31%, and 36% for the treatment groups. Safety analysis revealed known toxicities of the drugs with slight increases of grade 3/4 neutropenia on combination therapy. CONCLUSION Treatment of advanced TNBC with a combination of EndoTAG-1 and standard paclitaxel [Taxol® (Bristol-Myers Squibb GmbH), or equivalent generic formulation] was well tolerated and showed antitumor efficacy. The positive trend needs to be confirmed in a randomized phase III trial. STUDY REGISTRATION European Clinical Trials Database: EudraCT number 2006-002221-23. ClinicalTrials.gov identifier: NCT00448305.
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Affiliation(s)
- A Awada
- Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - I N Bondarenko
- Dnepropetrovsk State Medical Academy, Dnepropetrovsk, Ukraine
| | - J Bonneterre
- Oscar Lambret Center of Fight Against Cancer, Lille, France
| | - E Nowara
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - J M Ferrero
- Antoine Lacassagne Center of Fight Against Cancer, Nice, France
| | - A V Bakshi
- Kaushalya Medical Foundation, Thane, India
| | - C Wilke
- Medigene AG, Martinsried, Germany
| | - M Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
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Gravis G, Marino P, Joly F, Oudard S, Priou F, Esterni B, Latorzeff I, Delva R, Krakowski I, Laguerre B, Rolland F, Théodore C, Deplanque G, Ferrero JM, Pouessel D, Mourey L, Beuzeboc P, Zanetta S, Habibian M, Berdah JF, Dauba J, Baciuchka M, Platini C, Linassier C, Labourey JL, Machiels JP, El Kouri C, Ravaud A, Suc E, Eymard JC, Hasbini A, Bousquet G, Soulie M, Fizazi K. Patients' self-assessment versus investigators' evaluation in a phase III trial in non-castrate metastatic prostate cancer (GETUG-AFU 15). Eur J Cancer 2014; 50:953-62. [PMID: 24424105 DOI: 10.1016/j.ejca.2013.11.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Toxicity, which is a key parameter in the evaluation of cancer treatments, can be underestimated by clinicians. We investigated differences between patients and physicians in reporting adverse events of androgen deprivation therapy (ADT) with or without docetaxel in a multicentre phase III trial in non-castrate metastatic prostate cancer. METHODS The 385 patients included were invited to complete a 26-symptom questionnaire 3 and 6 months after the start of treatment, among which eighteen symptoms were also assessed by physicians, reported in medical records and graded using the Common Toxicity Criteria of the National Cancer Institute. Positive and negative agreements as well as Kappa concordance coefficients were computed. FINDINGS Data were available for 220 and 165 patients at 3 and 6 months respectively. Physicians systematically under-reported patients' symptoms. Positive agreement rates (at respectively 3 and 6 months) for the five most commonly reported symptoms were: 61.0% and 64.3% hot flushes, 50.0% and 43.6% fatigue, 29.4% and 31.1% sexual dysfunction, 24.4% and 14.4% weigh gain/loss, 16.7% and 19.3% for joint/muscle pain. For symptoms most frequently reported as disturbing or very disturbing by patients, the clinicians' failure to report them ranged from 50.8% (hot flushes) to 89.5% (joint/muscle pain) at 3 months, and from 48.2% (hot flushes) to 88.4% (joint/muscle pain) at 6 months. INTERPRETATION Physicians often failed to report treatment-related symptoms, even the most common and disturbing ones. Patients' self-evaluation of toxicity should be used in clinical trials to improve the process of drug assessment in oncology. FUNDING French Health Ministry and Institut National du Cancer (PHRC), Sanofi-Aventis, Astra-Zeneca, and Amgen.
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Affiliation(s)
| | - Patricia Marino
- Institut Paoli-Calmettes, Marseilles, France; Inserm, UMR 912 'Economic & Social Sciences, Health Systems & Societies (SESSTIM)', Aix-Marseille Université, IRD, Marseilles, France
| | - Florence Joly
- Medical Oncology, Centre François Baclesse - CHU Côte de Nacre, Caen, France
| | - Stéphane Oudard
- Medical Oncology Department, Georges Pompidou Hospital and Rene Descartes University, Paris, France
| | - Franck Priou
- Medical Oncology, Centre Hospitalier Les Oudairies, La Roche-sur-Yon, France
| | | | - Igor Latorzeff
- Radiotherapy Department, Clinique Pasteur, Toulouse, France
| | - Remy Delva
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - Ivan Krakowski
- Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-les-nancy, France
| | | | - Fréderic Rolland
- Medical Oncology, Centre René Gauducheau, Saint-Herblain, France
| | | | - Gael Deplanque
- Medical Oncology, Groupe Hospitalier Saint Joseph, Paris, France
| | | | - Damien Pouessel
- Medical Oncology, Centre Val d'Aurelle-Paul Lamarque, Montpellier, France
| | - Loïc Mourey
- Medical Oncology, Institut Claudius Régaud, Toulouse, France
| | | | - Sylvie Zanetta
- Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | | | - Jerome Dauba
- Medical Oncology, Hôpital Layné, Mont de Marsan, France
| | | | - Christian Platini
- Medical Oncology, Centre Régional Hospitalier, Metz-Thionville, France
| | | | | | - Jean Pascal Machiels
- Medical Oncology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Claude El Kouri
- Medical Oncology, Centre Catherine de Sienne, Nantes, France
| | - Alain Ravaud
- Medical Oncology, Hôpital Saint-André, Bordeaux, France
| | - Etienne Suc
- Medical Oncology, Clinique Saint-Jean Languedoc, Toulouse, France
| | | | - Ali Hasbini
- Medical Oncology, Clinique armoricaine de radiologie, Saint-Brieux, France
| | | | - Michel Soulie
- Urology Department, Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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Gravis G, Fizazi K, Joly F, Oudard S, Priou F, Esterni B, Latorzeff I, Delva R, Krakowski I, Laguerre B, Rolland F, Théodore C, Deplanque G, Ferrero JM, Pouessel D, Mourey L, Beuzeboc P, Zanetta S, Habibian M, Berdah JF, Dauba J, Baciuchka M, Platini C, Linassier C, Labourey JL, Machiels JP, El Kouri C, Ravaud A, Suc E, Eymard JC, Hasbini A, Bousquet G, Soulie M. Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): a randomised, open-label, phase 3 trial. Lancet Oncol 2013; 14:149-58. [PMID: 23306100 DOI: 10.1016/s1470-2045(12)70560-0] [Citation(s) in RCA: 483] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Early chemotherapy might improve the overall outcomes of patients with metastatic non-castrate (ie, hormone-sensitive) prostate cancer. We investigated the effects of the addition of docetaxel to androgen-deprivation therapy (ADT) for patients with metastatic non-castrate prostate cancer. METHODS In this randomised, open-label, phase 3 study, we enrolled patients in 29 centres in France and one in Belgium. Eligible patients were older than 18 years and had histologically confirmed adenocarcinoma of the prostate and radiologically proven metastatic disease; a Karnofsky score of at least 70%; a life expectancy of at least 3 months; and adequate hepatic, haematological, and renal function. They were randomly assigned to receive to ADT (orchiectomy or luteinising hormone-releasing hormone agonists, alone or combined with non-steroidal antiandrogens) alone or in combination with docetaxel (75 mg/m(2) intravenously on the first day of each 21-day cycle; up to nine cycles). Patients were randomised in a 1:1 ratio, with dynamic minimisation to minimise imbalances in previous systemic treatment with ADT, chemotherapy for local disease or isolated rising concentration of serum prostate-specific antigen, and Glass risk groups. Patients, physicians, and data analysts were not masked to treatment allocation. The primary endpoint was overall survival. Efficacy analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00104715. FINDINGS Between Oct 18, 2004, and Dec 31, 2008, 192 patients were randomly allocated to receive ADT plus docetaxel and 193 to receive ADT alone. Median follow-up was 50 months (IQR 39-63). Median overall survival was 58·9 months (95% CI 50·8-69·1) in the group given ADT plus docetaxel and 54·2 months (42·2-not reached) in that given ADT alone (hazard ratio 1·01, 95% CI 0·75-1·36). 72 serious adverse events were reported in the group given ADT plus docetaxel, of which the most frequent were neutropenia (40 [21%]), febrile neutropenia (six [3%]), abnormal liver function tests (three [2%]), and neutropenia with infection (two [1%]). Four treatment-related deaths occurred in the ADT plus docetaxel group (two of which were neutropenia-related), after which the data monitoring committee recommended treatment with granulocyte colony-stimulating factor. After this recommendation, no further treatment-related deaths occurred. No serious adverse events were reported in the ADT alone group. INTERPRETATION Docetaxel should not be used as part of first-line treatment for patients with non-castrate metastatic prostate cancer. FUNDING French Health Ministry and Institut National du Cancer (PHRC), Sanofi-Aventis, AstraZeneca, and Amgen.
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Affiliation(s)
- Gwenaelle Gravis
- Medical Oncology and Biostatistics, Institut Paoli-Calmettes, Marseille, France.
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Houede N, Pulido M, Mourey L, Joly F, Ferrero JM, Bellera C, Priou F, Lalet C, Laroche A, Canal-Raffin M, Piazza PV. First results of a phase II trial to assess the efficacy of efavirenz in patients with metastatic androgen-independent prostate cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.251] [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: 11/20/2022] Open
Abstract
251 Background: This Phase II trial assessed the efficacy of efavirenz, a non-nucleoside reverse transcriptase inhibitor in patients with asymptomatic HRPC [hormone refractory prostate cancer] who progressed, before docetaxel based chemotherapy. Preclinical studies showed that efavirenz, via Line-1 inhibition, could block proliferation and induced re-differentiation of prostate cancer cell line. We then investigated if efavirenz treatment can delay biological and clinical progression. Methods: The primary objective was to assess the efficacy of efavirenz in patients, with no clinical symptom related to disease progression. Each patient received efavirenz 600 mg/day until objective biological progression or study discontinuation. It was possible to increase the dose (up to 1200 mg daily) in case of PSA progression at 3 months. Efficacy was measured in terms of 3-month non-progression. Based on a 2-stage Simon’s design, a total of 16 non-progressions out of 54 eligible patients were required to claim efficacy. Results: 61 patients were enrolled in the study with 53 eligible for the primary endpoint. At baseline, median age was 71 years and median PSA level was 49.6 ng/mL. A total of 15/53 (28%) non-progressions were observed at 3 months. As patients are still being followed, overall survival, PSA progression free survival and symptomatic progression free survival at one year will be presented. Sixty patients were assessable for toxicity. Of these, 9 (15%) experienced at least one grade III/IV toxicity i.e. neuropsychiatric adverse events already reported in efavirenz-treated HIV patients. With regard to pharmacokinetics (PK), preliminary data indicates variability in the 3-month efavirenz concentration. Ongoing preliminary analyses suggest a better response in patients with elevated (>3000ng/ml) plasmatic concentration. Conclusions: Current analyses do not allow to claim efficacy of Efavirenz at the 600 mg dose. The ongoing analysis of the relationship between plasmatic concentration of efavirenz and treatment efficacy could confirm that higher doses of efavirenz may constitute an efficient treatment. A phase I dose escalation study is currently being performed.
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Affiliation(s)
- Nadine Houede
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Marina Pulido
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Loic Mourey
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Florence Joly
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Jean Marc Ferrero
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Carine Bellera
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Franck Priou
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Caroline Lalet
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Audrey Laroche
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Mireille Canal-Raffin
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
| | - Pier Vi Piazza
- Institut Bergonié, Bordeaux, France; Institut Claudius Regaud, Toulouse, France; Centre François Baclesse, Caen, France; Centre Antoine-Lacassagne, Nice, France; Centre Hospitalier Departemental Les Oudairies, La Roche sur Yon, France; Alienor Farma, Pessac, France; Laboratoire Santé Travail Environnement \(INSERM U897\), Bordeaux, France
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Virág L, Jost N, Papp R, Koncz I, Kristóf A, Kohajda Z, Harmati G, Carbonell-Pascual B, Ferrero JM, Papp JG, Nánási PP, Varró A. Analysis of the contribution of I(to) to repolarization in canine ventricular myocardium. Br J Pharmacol 2012; 164:93-105. [PMID: 21410683 DOI: 10.1111/j.1476-5381.2011.01331.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The contribution of the transient outward potassium current (I(to)) to ventricular repolarization is controversial as it depends on the experimental conditions, the region of myocardium and the species studied. The aim of the present study was therefore to characterize I(to) and estimate its contribution to repolarization reserve in canine ventricular myocardium. EXPERIMENTAL APPROACH Ion currents were recorded using conventional whole-cell voltage clamp and action potential voltage clamp techniques in canine isolated ventricular cells. Action potentials were recorded from canine ventricular preparations using microelectrodes. The contribution of I(to) to repolarization was studied using 100 µM chromanol 293B in the presence of 0.5 µM HMR 1556, which fully blocks I(Ks). KEY RESULTS The high concentration of chromanol 293B used effectively suppressed I(to) without affecting other repolarizing K(+) currents (I(K1), I(Kr), I(p)). Action potential clamp experiments revealed a slowly inactivating and a 'late' chromanol-sensitive current component occurring during the action potential plateau. Action potentials were significantly lengthened by chromanol 293B in the presence of HMR 1556. This lengthening effect induced by I(to) inhibition was found to be reverse rate-dependent. It was significantly augmented after additional attenuation of repolarization reserve by 0.1 µM dofetilide and this caused the occurrence of early afterdepolarizations. The results were confirmed by computer simulation. CONCLUSIONS AND IMPLICATIONS The results indicate that I(to) is involved in regulating repolarization in canine ventricular myocardium and that it contributes significantly to the repolarization reserve. Therefore, blockade of I(to) may enhance pro-arrhythmic risk.
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Affiliation(s)
- L Virág
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
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Andre F, Peletekian C, Jimenez M, Ferrero JM, Delaloge S, Roman RS, Dessen P, Bonnefoi H. OT1-03-02: SAFIR01: A Molecular Screening Trial for Metastatic Breast Cancer Patients. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot1-03-02] [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: 11/16/2022]
Abstract
Abstract
Background: High number of new drugs are targeting molecular alterations that occur in a few number of patients. Molecular screening that consists in the assessment of single molecular alteration during the screening phase of the therapeutic trial is not suitable. Indeed, this modality of screening is associated with a high rate of screen failure due to the low incidence of the molecular alteration. In order to optimize molecular screening, we have launched a clinical trial that aims at performing array CGH and hot spot mutations in patients with metastatic breast cancer.
Patients and Methods. The trial plans to include 400 patients with metastatic breast cancer and included the first patient in may 2011. This trial is being sponsored by French federation of Cancer centers (UNICANCER) and involves 20 centers. Biopsy is being performed on metastatic site. Both frozen and FFPE samples are obtained. DNA extraction is being performed in the investigation center after control for the % of cancer cells. Array CGH and PIK3CA/AKT mutations (SANGE method) are being performed in four genomic platforms. A pilot study that included 106 patients has shown the feasibility of such technologies in the context of daily practice. Data from array CGH are being sent to a bioinformatician who forward the results on both pre-selected targets, DNA instability and some targets of interest selected based on log2(ratio) and function. Recommendations for trials are then being sent to each investigator. There is no limitation for previous lines and it is recommended to perform biopsy in patients who do not present progressive disease. This trial is being funded by French NCI (750 000 euros)
Conclusion: SAFIR01 is a trial that aims at using high throughput technologies in order to drive patients with molecular alterations to specific therapeutic trials. Further amendments are being planned including implementation of high throughput sequencing and performance of functional testing. Further trial will compare this high throughput approach to standard methods for target identification.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT1-03-02.
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Affiliation(s)
- F Andre
- 1Gustave Roussy Institute; Unicancer; Curie Institute; Bergonie Institute; Centre antoine lacassagne, Nice, France
| | - C Peletekian
- 1Gustave Roussy Institute; Unicancer; Curie Institute; Bergonie Institute; Centre antoine lacassagne, Nice, France
| | - M Jimenez
- 1Gustave Roussy Institute; Unicancer; Curie Institute; Bergonie Institute; Centre antoine lacassagne, Nice, France
| | - JM Ferrero
- 1Gustave Roussy Institute; Unicancer; Curie Institute; Bergonie Institute; Centre antoine lacassagne, Nice, France
| | - S Delaloge
- 1Gustave Roussy Institute; Unicancer; Curie Institute; Bergonie Institute; Centre antoine lacassagne, Nice, France
| | - Roman S Roman
- 1Gustave Roussy Institute; Unicancer; Curie Institute; Bergonie Institute; Centre antoine lacassagne, Nice, France
| | - P Dessen
- 1Gustave Roussy Institute; Unicancer; Curie Institute; Bergonie Institute; Centre antoine lacassagne, Nice, France
| | - H Bonnefoi
- 1Gustave Roussy Institute; Unicancer; Curie Institute; Bergonie Institute; Centre antoine lacassagne, Nice, France
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Ferrero JM, Largillier R, Michel C, Amiot V, Milano G, Hébert C, Mari V, Courdi A, Figl A, Follana P, Barrière J, Chamorey E. A phase I study of UFT-oral vinorelbine in metastatic breast cancer. Oncology 2011; 81:73-8. [PMID: 21968516 DOI: 10.1159/000330770] [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: 03/14/2011] [Accepted: 06/28/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite current treatment options, metastatic breast cancer (MBC) remains essentially incurable, requiring research on new drugs or combinations to improve survival and quality of life. PATIENTS AND METHODS This phase I study was designed to define the maximum-tolerated dose (MTD), dose-limiting toxicity (DLT) and recommended dose of all-oral tegafur-uracil (UFT)/folinic acid combined with vinorelbine as chemotherapy for MBC. Starting doses were 40 mg/m(2)/week of oral vinorelbine administered continuously and 250 mg/m(2)/day of UFT plus 90 mg/day of folinic acid from day 1 to day 28, followed by a 1-week rest period. RESULTS Ten patients were included. Eight were evaluable for toxicity and antitumor response. The second dose level was shown to be the MTD. At this dose, 2 out of 5 patients receiving oral vinorelbine at 40 mg/m(2)/week and UFT at 300 mg/m(2)/day developed DLT consisting of grade 3 asthenia and grade 3 nausea despite standard prophylaxis. Other toxicities were grade 1 diarrhea and anemia. There were no treatment-related deaths. CONCLUSIONS The recommended dose for this combination seems to be the first dose level. A stable response was observed for 6 patients (average 33 weeks). This combination appears to be well-tolerated and offers an alternative to intravenous chemotherapy.
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Affiliation(s)
- J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
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Cardona K, Trenor B, Rajamani S, Romero L, Ferrero JM, Saiz J. Effects of late sodium current enhancement during LQT-related arrhythmias. A simulation study. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2010:3237-40. [PMID: 21096605 DOI: 10.1109/iembs.2010.5627184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Long QT syndrome is a repolarization disorder characterized by marked prolongation of QT interval. A clear consequence of long QT syndrome is the occurrence of a polymorphic ventricular tachycardia called Torsade de Pointes, which has been related to early after depolarizations (EADs) formation. This repolarizing disorder has been observed under pathological situations, such as heart failure, oxidative stress, ventricular hypertrophy and/or in the presence of pure class III antiarrhythmics. Under such pathologies electrophysiological changes affect the electrical activity of the cell. Lately, the enhancement of late sodium current (I(NaL)) and its role has become a source of interest. In this work, a mathematical model of I(NaL) has been proposed and incorporated to the ten Tussher model of the human ventricular action potential (AP), specifically in M cells. We simulated and analyzed the effects of I(NaL) enhancement in combination with LQT-related pathologies and administration of I(Kr) blockers, on the AP. This study demonstrates that I(NaL) prolongs AP duration (APD) in a rate-dependent manner. Indeed, a 10-fold increase of I(NaL) prolongs APD in 80% for a stimulation rate of 1 Hz and 100% for 0.25 Hz. Also, intracellular sodium concentration [Na(+)](i) significantly increases in the presence of enhanced I(NaL), increasing the probability of EADs formation through calcium overload in cells prone to develop EADs.
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Affiliation(s)
- K Cardona
- Universidad Politecnica de Valencia (I3BH), 46022 Spain
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Romero L, Carbonell B, Trenor B, Rodriguez B, Saiz J, Ferrero JM. Human and rabbit inter-species comparison of ionic mechanisms of arrhythmic risk: A simulation study. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2010:3253-6. [PMID: 21096607 DOI: 10.1109/iembs.2010.5627230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Experimental studies of pro-arrhythmic mechanisms are scarcely performed in humans due to the limited availability of human cardiomyocytes. Subsequently, extrapolation of animal experimental research to humans is widely extended. Our aim is to systematically compare the ionic mechanisms of the main cellular biomarkers of arrhythmic risk between human and rabbit using computer simulations. For this purpose four stimulation protocols were applied to the Mahajan et al. rabbit ventricular action potential (AP) model for control conditions and for ± 15 and ± 30% variations in the ionic current conductances of the main repolarization currents to quantify cellular biomarkers. Sensitivity of every simulated biomarker to every parameter modification was compared to that obtained for human in our previous work. Our results show that the ionic mechanisms involved in AP triangulation, systolic intracellular calcium concentration and AP duration (APD) accommodation to abrupt changes of pacing rate are very similar in both species. Unfortunately, significant differences were found in the ionic mechanisms related to APD, restitution properties and rate dependence of intracellular calcium and sodium concentrations. In conclusion, extrapolation of experimental research in rabbit to humans is limited by the existence of species dependent ionic mechanisms. In addition, this analysis is very useful for understanding and improvement of mathematical models.
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Affiliation(s)
- L Romero
- Universidad Politécnica de Valencia (I3BH), Spain.
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Tobon C, Ruiz C, Rodriguez JF, Hornero F, Ferrero JM, Saiz J. Vulnerability for reentry in a three dimensional model of human atria: a simulation study. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2010:224-7. [PMID: 21096955 DOI: 10.1109/iembs.2010.5627810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial tachycardias are the most common cardiac arrhythmias in clinical practice, which induce changes in atrial properties that help to perpetuate them. These changes are called "atrial remodeling". Recent studies have shown that rapid ectopic activity principally on the pulmonary veins can trigger reentrant mechanisms and lead to atrial tachycardias. However, the influences of ectopic foci location, the number of ectopic beats and its frequency on the likelihood of triggering reentries are not well known. In this work the effects of electrical remodeling were incorporated in an atrial cell model and integrated in a three-dimensional model of human atria, to develop a study of vulnerability for reentries. To carry out the study, an ectopic beat and a burst of six ectopic beats at two different frequencies were applied in six different locations in the atria. The results show greater vulnerability in the left pulmonary veins when we applied a single ectopic beat. When we increase the number of ectopic beats to six, a greater width of the vulnerable window was observed when ectopic focus frequency was high. The location, the number of ectopic beats and their frequency affect the vulnerability for reentry.
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Affiliation(s)
- C Tobon
- Universidad Politécnica de Valencia, (I3BH), Valencia, 46022 Spain.
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Ray-Coquard I, Weber B, Cretin J, Haddad-Guichard Z, Lévy E, Hardy-Bessard AC, Gouttebel MC, Geay JF, Aleba A, Orfeuvre H, Agostini C, Provencal J, Ferrero JM, Fric D, Dohollou N, Paraiso D, Salvat J, Pujade-Lauraine E. Gemcitabine-oxaliplatin combination for ovarian cancer resistant to taxane-platinum treatment: a phase II study from the GINECO group. Br J Cancer 2009; 100:601-7. [PMID: 19190632 PMCID: PMC2653739 DOI: 10.1038/sj.bjc.6604878] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Advanced ovarian carcinoma in early progression (<6 months) (AOCEP) is considered resistant to most cytotoxic drugs. Gemcitabine (GE) and oxaliplatin (OXA) have shown single-agent activity in relapsed ovarian cancer. Their combination was tested in patients with AOCEP in phase II study. Fifty patients pre-treated with platinum–taxane received q3w administration of OXA (100 mg m–2, d1) and GE (1000 mg m–2, d1, d8, 100-min infusion). Patient characteristics were a : median age 64 years (range 46–79),and 1 (84%) or 2 (16%) earlier lines of treatment. Haematological toxicity included grade 3–4 neutropaenia (33%), anaemia (8%), and thrombocytopaenia (19%). Febrile neutropaenia occurred in 3%. Non-haematological toxicity included grade 2–3 nausea or vomiting (34%), grade 3 fatigue (25%),and grade 2 alopecia (24%). Eighteen (37%) patients experienced response. Median progression-free (PF) and overall survivals (OS) were 4.6 and 11.4 months, respectively. The OXA–GE combination has high activity and acceptable toxicity in AOCEP patients. A comparison of the doublet OXA–GE with single-agent treatment is warranted.
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Affiliation(s)
- I Ray-Coquard
- Centre Léon Bérard, 28 rue Laennec, 69008 Lyon, France.
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37
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Beauclair S, Formento P, Fischel JL, Lescaut W, Largillier R, Chamorey E, Hofman P, Ferrero JM, Pagès G, Milano G. Role of the HER2 [Ile655Val] genetic polymorphism in tumorogenesis and in the risk of trastuzumab-related cardiotoxicity. Ann Oncol 2007; 18:1335-41. [PMID: 17693647 DOI: 10.1093/annonc/mdm181] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To examine the impact of a frequent her2 gene polymorphism (Ile655Val) on tumor growth and on the pharmacodynamics of treatment by trastuzumab. PATIENTS AND METHODS Experimental study: The growth characteristics of cells expressing the Ile or Val isoform were examined in vitro and after injection into nude mice. The effect of trastuzumab was determined in both experimental models. Clinical study: 61 patients with advanced breast cancers and treated by trastuzumab were genotyped for HER2 by PCR-RFLP. The influence of HER2 genotype on the trastuzumab treatment was examined. RESULTS Experimental study: HER2-expressing cells acquired the characteristics of tumor cells. The Val isoform-expressing cells showed the highest growth capacity and developed aggressive tumors sensitive to trastuzumab. Clinical study: There was no link between tumor response or survival and HER2 genotype. All cases of treatment-related cardiotoxicity were found in the Ile/Val group and there was no cardiac toxicity in the Val/Val and Ile/Ile patients. CONCLUSIONS This study establishes a clear-cut difference between the two HER2 isoforms regarding their tumorogenic potential with an advantage for the Val/HER2 isoform. In breast cancer patients treated with trastuzumab, the presence of a Val allele may constitute a risk factor for cardiac toxicity.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/adverse effects
- Base Sequence
- Blotting, Western
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Cell Transformation, Neoplastic/genetics
- Female
- Heart/drug effects
- Heart Diseases/chemically induced
- Humans
- Immunohistochemistry
- Mice
- Mice, Nude
- Middle Aged
- Molecular Sequence Data
- Mutagenesis, Site-Directed
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/genetics
- Neoplasms, Experimental/pathology
- Polymerase Chain Reaction
- Polymorphism, Genetic
- Polymorphism, Restriction Fragment Length
- Protein Isoforms/genetics
- Receptor, ErbB-2/genetics
- Transfection
- Trastuzumab
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Affiliation(s)
- S Beauclair
- Oncopharmacology unit (EA 3836), Centre Antoine Lacassagne, Nice, France
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38
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Guérin O, Formento P, Lo Nigro C, Hofman P, Fischel JL, Etienne-Grimaldi MC, Merlano M, Ferrero JM, Milano G. Supra-additive antitumor effect of sunitinib malate (SU11248, Sutent®) combined with docetaxel. A new therapeutic perspective in hormone refractory prostate cancer. J Cancer Res Clin Oncol 2007; 134:51-7. [PMID: 17593391 DOI: 10.1007/s00432-007-0247-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 05/29/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE Physiological and molecular findings indicate over-expression of HER proteins and dysregulation of neo-angiogenesis during progression of advanced prostate cancer. The aim of this study was to test a novel rational therapeutic approach by combining docetaxel with an EGFR-targeting agent (cetuximab) and with an anti-angiogenic agent (sunitinib, SUTENT). METHODS Mice bearing well-established PC3 prostate tumors (mean tumor volume/treatment group approximately 250 mm(3)) were treated every week with vehicle alone (controls), sunitinib (40 mg/kg/day, 5 days/week for 3 weeks, 0.2 ml p.o.), cetuximab (0.2 mg/kg/day, 5 days/week for 3 weeks, 0.2 ml i.p.) and docetaxel (10 mg/kg, 1 day/week for 3 weeks, 0.2 ml i.p.). RESULTS Each drug, administered as a single-agent, demonstrated comparable and moderate effects on tumor growth with approximately 50 % inhibition at the end of the 3-week dosing schedule. Computed combination ratio (CR) values for tumor growth determined on days 61, 68 and 75 after cell implantation indicated supra-additive effects for the sunitinib-docetaxel (1.53, 1.15 and 1.47, respectively) and sunitinib-cetuximab combinations (1.2, 1.32 and 1.14, respectively), and suggested additive effects only for the sunitinib-cetuximab-docetaxel combination (CR = 1). The effects on tumor growth were accompanied by a parallel diminution in tumor cell proliferation (Ki 67) and tumor vascularization (von Willebrandt factor). There were significantly higher pro-apoptotic effects (caspase-3 cleavage) observed for the sunitinib-docetaxel and sunitinib-docetaxel-cetuximab as compared to the other conditions. CONCLUSION The supra-additive anti-tumor effect observed with the sunitinib-docetaxel combination might support innovative strategies in the management of advanced prostate cancer.
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MESH Headings
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cell Proliferation
- Cetuximab
- Docetaxel
- Gene Expression Profiling
- Humans
- Indoles/administration & dosage
- Male
- Mice
- Mice, Nude
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/secondary
- Prostate-Specific Antigen/blood
- Prostatic Neoplasms/drug therapy
- Prostatic Neoplasms/pathology
- Pyrroles/administration & dosage
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Sunitinib
- Survival Rate
- Taxoids/administration & dosage
- Tumor Cells, Cultured/drug effects
- Xenograft Model Antitumor Assays
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Affiliation(s)
- O Guérin
- Nice General Hospital, Nice, France
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39
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Italiano A, Ciais C, Chamorey E, Marcy PY, Largillier R, Ferrero JM, Thyss A. Home infusions of biphosphonate in cancer patients: a prospective study. J Chemother 2006; 18:217-20. [PMID: 16736892 DOI: 10.1179/joc.2006.18.2.217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objective of the study was to determine outcome and satisfaction of cancer patients treated by home-infusions of biphosphonates. 107 patients entered the study and 97 of them chose to receive infusions of zoledronic acid (Z) in the home setting. Patient satisfaction and quality of care (QoC) were assessed by a 22-item questionnaire. Changes from baseline were determined for bone pain using a 0-10 cm visual analogue scale pain score (VAS). Patients expressed a high level of satisfaction specifically with regard to nursing care. Seventy patients experienced a significant decrease in the median pain score during the home-therapy phase not due to an increased use of analgesic therapy (P = 0.03). Z was well tolerated with no major adverse events. The authors conclude that home infusions of biphosphonates, on the condition that the supportive care team is well-organized, is a safe procedure that could be advantageous for patients by increasing satisfaction and compliance with treatment.
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Affiliation(s)
- A Italiano
- Centre Regional de Lutte Contre le Cancer Antoine-Lacassagne (Canceropôle PACA), Nice, France.
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40
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Ferrero JM, Foa C, Thezenas S, Ronchin P, Peyrade F, Valenza B, Lesbats G, Garnier G, Boublil JL, Tchiknavorian X, Chevallier D, Amiel J. A Weekly Schedule of Docetaxel for Metastatic Hormone-Refractory Prostate Cancer. Oncology 2004; 66:281-7. [PMID: 15218295 DOI: 10.1159/000078328] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2003] [Accepted: 09/22/2003] [Indexed: 11/19/2022]
Abstract
RATIONALE Docetaxel has proven its efficacy in the management of hormone-refractory prostate cancer (HRPC). Schedules of docetaxel administration differ. This prospective phase II study was designed to reevaluate the activity and toxicity of docetaxel administered weekly at an optimal dose to a large cohort of HRPC patients. PATIENTS AND METHODS Sixty-four patients were treated with docetaxel 40 mg/m(2) i.v., administered weekly for 6 consecutive weeks followed by a 2-week recovery period. Three treatment cycles were planned in the absence of progression or toxicity. The principal end point was the biochemical response based on the prostate-specific antigen (PSA) level (a decline of more than 50% for at least 4 weeks). Secondary end points were objective response to measurable disease, survival and toxicity. RESULTS Toxicity was assessed in 64 patients. Toxicity was acceptable, with no toxicity-related deaths. Twenty-one percent of the patients developed grade 3-4 hematological toxicity. Sixty-four patients were evaluable for the PSA response. Forty-one patients (64%) achieved a decrease in PSA of >50%, 13 of whom had a PSA <4 ng/ml. Two out of 12 patients with measurable disease exhibited an objective response. With respect to PSA, the median progression-free survival was 29 weeks (95% confidence interval: 18-46 weeks). The global 1-year survival rate was 58%. CONCLUSION Weekly docetaxel at a dosage of 40 mg/m(2) is a well-tolerated treatment, which has very promising activity on the reduction of PSA in metastatic HRPC. A large phase III study is underway.
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Largillier R, Namer M, Ramaioli A, Ferrero JM, Magné N, Courdi A, Leblanc-Talent P, Formento P, Ettore F, Milano G. Prognostic value of S-phase fraction in 920 breast cancer patients: focus on T1N0 status. Int J Biol Markers 2004; 18:273-9. [PMID: 14756542 DOI: 10.5301/jbm.2008.506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to reexamine the prognostic role of tumor cell kinetics measured by S-phase fraction (SPF) and to establish its clinically relevant threshold values. SPF was determined by flow cytometry in a group of 920 consecutive breast cancer patients, all followed at our institute for 10 years (1988 to 1998). Mean age was 60.5 years (27-89 years). Median follow-up was 63 months (3-150 months). All patients had initial surgical treatment. SPF quartiles were: Q1=3.08%, median value = 5.98%, Q3=10.22%. A significant difference in overall specific survival was obtained between two populations divided by a cutoff at Q1 (p < 0.0001). A multifactorial analysis including SPF and known prognostic factors such as tumor size, node status, histological grade, ER and PR status was performed using the Cox model in a population of 719 patients: univariate analysis showed that each of these factors had significant influence on overall survival. Multivariate analysis selected three of them, ranked by decreasing order of hazard ratio (HR) value: SPF (HR: 3.88, p < 0.001), tumor size (HR: 2.49, p < 0.001) and nodal status (HR: 2.28, p < 0.001). In addition, when tumors were stratified according to SPF quartile values, there were statistically different overall survival curves in patients with small tumors (< 2 cm) and in axillary node-negative patients.
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Affiliation(s)
- R Largillier
- Departments of Oncology, Centre Antoine Lacassagne, Nice, France
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42
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Abstract
Radio-frequency thermokeratoplasty (RF-TKP) is a technique used to reshape the cornea curvature by means of thermal lesions using radio-frequency currents. This curvature change allows refractive disorders such as hyperopia to be corrected. A new electrode with ring geometry is proposed for RF-TKP. It was designed to create a single thermal lesion with a full-circle shape. Finite element models were developed, and the temperature distributions in the cornea were analysed for different ring electrode characteristics. The computer results indicated that the maximum temperature in the cornea was located in the vicinity of the ring electrode outer perimeter, and that the lesions had a semi-torus shape. The results also indicated that the electrode thickness, electrode radius and electrode thermal conductivity had a significant influence on the temperature distributions. In addition, in vitro experiments were performed on rabbit eyes. At 5 W power, the lesions were fully circular. Some lesions showed non-uniform characteristics along their circular path. Lesion depth depended on heating duration (60% of corneal thickness for 20 s, and 30% for 10 s). The results suggest that the critical shrinkage temperature (55-63 degrees C) was reached at the central stroma and along the entire circular path in all the cases.
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Affiliation(s)
- E J Berjano
- Electronic Engineering Department, Valencia Polytechnic University, Valencia, Spain.
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43
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Diéras V, Guastalla JP, Ferrero JM, Curé H, Weber B, Winckel P, Lortholary A, Mayer F, Paraiso D, Magherini E, Pujade-Lauraine E. A multicenter phase II study of cisplatin and docetaxel (Taxotere) in the first-line treatment of advanced ovarian cancer: a GINECO study. Cancer Chemother Pharmacol 2004; 53:489-95. [PMID: 14767617 DOI: 10.1007/s00280-004-0762-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2003] [Accepted: 12/17/2003] [Indexed: 11/30/2022]
Abstract
PURPOSE A multicenter phase II study to evaluate the antitumor effect and safety of docetaxel in combination with cisplatin as first-line chemotherapy for advanced ovarian cancer. METHODS Enrolled in the study were 45 patients who were to receive six courses of docetaxel 75 mg/m(2) plus cisplatin 75 mg/m(2) every 21 days with hydration and steroid prophylaxis after initial debulking surgery. Imaging techniques and radiography were used to assess clinical tumor response, and second-look surgery was required for patients with complete clinical responses and for those without clinically measurable disease. RESULTS The overall clinical response rate in 29 patients with clinically measurable disease was 58% (41% complete response). A complete pathologic response was seen in 9 of 34 patients who underwent second-look laparotomy, while microscopic disease was found in 10 patients. The median time to progression was 14.4 months (95% CI 8.4-20.4 months), with a median overall survival of 43 months (95% CI 21.1-65.0 months). Patients received a median number of six cycles at a dose intensity of 98%. Grade 3-4 neutropenia was seen in 80% of patients, but was manageable. No patients withdrew because of fluid retention. CONCLUSIONS The combination of docetaxel with cisplatin confers high clinical and pathologically verified tumor response rates and is well tolerated in the first-line management of advanced ovarian cancer.
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Affiliation(s)
- Véronique Diéras
- Department of Medical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
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Rodríguez B, Ferrero JM, Trénor B. Mechanistic investigation of extracellular K+ accumulation during acute myocardial ischemia: a simulation study. Am J Physiol Heart Circ Physiol 2002; 283:H490-500. [PMID: 12124193 DOI: 10.1152/ajpheart.00625.2001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this study, we have used computer simulations to study the mechanisms of extracellular K+ accumulation during acute ischemia. A modified version of the Luo-Rudy phase II action potential model was used to simulate the electrical behavior of one ventricular myocyte during 14 min of simulated ischemia. Our results show the following: 1) only the integrated effect of activation of ATP-dependent K+ current, an ischemic Na+ inward current, and inhibition of Na(+)-K(+) pump activity in the absence of coronary flow replicates the biphasic time course of extracellular K+ concentration observed during acute ischemia; 2) the time to onset of the plateau phase and the plateau level value are determined by the rate of stimulation and by the rate of alteration of the three mechanisms. However, acidosis and reduction of extracellular volume produce only a slight anticipation of the plateau phase; and 3) cellular K+ loss is mainly due to an increase of K+ efflux via the time-independent K+ current and ATP-dependent K+ current rather than to a decrease of K+ influx.
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Affiliation(s)
- B Rodríguez
- Laboratorio Integrado de Bioingeniería, Departamento de Ingeniería Electrónica, Universidad Politécnica de Valencia, Camino de Vera s/n, 46021 Valencia, Spain
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45
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Spielmann M, Llombart-Cussac A, Kalla S, Espié M, Namer M, Ferrero JM, Diéras V, Fumoleau P, Cuvier C, Perrocheau G, Ponzio A, Kayitalire L, Pouillart P. Single-agent gemcitabine is active in previously treated metastatic breast cancer. Oncology 2001; 60:303-7. [PMID: 11408796 DOI: 10.1159/000058524] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This phase II study was designed to assess the efficacy and safety of gemcitabine in patients with metastatic breast cancer (MBC) previously treated with an anthracycline- or anthracenedione-containing regimen as first-line therapy for metastatic disease. PATIENTS AND METHODS Forty-seven patients with MBC were enrolled in five French centers. Patients were eligible if they had received one prior chemotherapy regimen with an anthracycline or anthracenedione for metastatic disease, if they had responded to that prior regimen, and if they had relapsed at least 6 months after the first response. Fifteen patients received more than one prior anthracycline regimen; thus, gemcitabine was third-line therapy for 30% of patients. Gemcitabine 1,200 mg/m(2) was administered as a 30-min intravenous infusion on days 1, 8, and 15 of a 28-day cycle for a maximum of eight cycles after the best response was obtained. RESULTS Objective responses were seen in 12 of 41 assessable patients (4 complete responses and 8 partial responses), for an objective response rate of 29% (95% confidence interval, 16-46%). The median response duration was 8.1 months (range: 2.5-27.4 months). Serious hematological toxicity was minimal, with grade 4 neutropenia in 2% of the patients (no neutropenic fever), grade 3 neutropenia in 28% of the patients, and grade 3 thrombocytopenia in 6% of the patients. Among the nonhematological toxicities, asthenia was the most common. CONCLUSIONS Gemcitabine given at this dose and schedule is a well-tolerated treatment with definitive antitumor activity in pretreated MBC patients. This result warrants future exploration of the use of gemcitabine as a single agent and in combination in patients with MBC.
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MESH Headings
- Adult
- Aged
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/therapeutic use
- Breast Neoplasms/drug therapy
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/secondary
- Deoxycytidine/administration & dosage
- Deoxycytidine/adverse effects
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/therapeutic use
- Drug Administration Schedule
- Female
- Humans
- Infusions, Intravenous
- Leukopenia/chemically induced
- Middle Aged
- Nausea/chemically induced
- Neoplasm Metastasis
- Remission Induction
- Safety
- Vomiting/chemically induced
- Gemcitabine
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46
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Ferrero JM, Ramaioli A, Largillier R, Formento JL, Francoual M, Ettore F, Namer M, Milano G. Epidermal growth factor receptor expression in 780 breast cancer patients: a reappraisal of the prognostic value based on an eight-year median follow-up. Ann Oncol 2001; 12:841-6. [PMID: 11484962 DOI: 10.1023/a:1011183421477] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Because new therapeutic approaches target tumors expressing epidermal growth factor receptor (EGFR), the aim was to undertake a thorough analysis of the expression profile of EGFR in breast cancer and to reassess its prognostic value. PATIENTS AND METHODS Tumor EGFR levels were determined by a specific ligand binding assay in 780 consecutive breast cancer patients followed in our institute between 1980 and 1993. Mean age was 61 years (25-85 years). All patients had undergone tumor resection with axillary lymph node dissection: 373 patients (47.8%) underwent mastectomy, 37 (5%) subcutaneous mastectomy and 370 (47.2%) tumorectomy. RESULTS EGFR levels ranged between non-detectable up to 789 fmol/mg protein. EGFR median value was 9 fmol/mg protein and only a small proportion of patients exhibited a relatively marked EGFR expression. There was no link between tumor size, grade, node status and EGFR tumoral levels. There was a constant and significant decrease in EGFR tumoral levels according to patient age. A significant inverse relationship was found between estradiol receptors (ER) and EGFR. Median follow-up was 97 months with a minimum at 4 months and a maximum at 228 months. From univariate analysis it was found that histological grade, tumor size, node status and ER status were all significant predictors of survival, considering metastasis-free as well as overall survival. Using multivariable analysis, only histological grade, tumor size and node status remained independent predictors of survival. CONCLUSION EGFR determination is of limited value as a prognostic indicator in breast cancer.
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47
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Monserrat M, Saiz J, Ferrero JM, Ferrero JM, Thakor NV. Ectopic activity in ventricular cells induced by early afterdepolarizations developed in Purkinje cells. Ann Biomed Eng 2000; 28:1343-51. [PMID: 11212952 DOI: 10.1114/1.1326032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The development of early afterdepolarizations (EADs) in Purkinje fibers and their propagation to ventricular muscle cells are studied by computer modeling. The Purkinje-ventricular system has been simulated by a two-dimensional model of a Purkinje fiber (PF) connected to a thin sheet of ventricular muscle tissue (VMT). EADs are induced in the PF by enhancing the fast second inward current, iCa,f, and blocking the delayed K+ current, iK, while the VMT is kept under physiological conditions. Different phenomena are observed depending on the EAD conditions applied. For 70% iK blockade and iCa,f enhancement greater than 60%, a single phase 3 EAD developed in the PF propagates to the VMT generating an ectopic beat. For 80% iK blockade and iCa,f enhancement in the range from 0% to 70%, multiple ectopic beats appear in the VMT. However, for iK blockades over 80%, action potentials in PF cells do not repolarize and the ectopic activity in the VMT disappears. In our simulations, the ionic mechanism underlying phase 3 EAD development is the reactivation of the fast sodium current in the PF. Our results demonstrate that there exists a critical range of EAD conditions that favor the development of EADs in the PF and their propagation to the VMT as ectopic activity. This phenomenon could underlie the genesis of some triggered arrhythmias.
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Affiliation(s)
- M Monserrat
- Departamento de Ingenieria Electronica, Universidad Politecnica de Valencia, Spain.
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Ferrero JM, Ramaioli A, Formento JL, Francoual M, Etienne MC, Peyrottes I, Ettore F, Leblanc-Talent P, Namer M, Milano G. P53 determination alongside classical prognostic factors in node-negative breast cancer: an evaluation at more than 10-year follow-up. Ann Oncol 2000. [PMID: 10847456 DOI: 10.1023/a: 1008359722254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is heterogeneity of methods and conflicting results concerning the prognostic value of p53 in node-negative breast cancer. The clinical value of a quantitative method for measuring tumoralp53 content still needs to be evaluated. PATIENTS AND METHODS A long-term retrospective study was conducted on 297 node-negative patients with a median follow-up greater than 10 years (11 years, 101-172 months). Classic prognostic factors were considered including age, tumor size, histoprognostic grade and estradiol (ER) and progesterone receptors (PR). In addition, the value of p53 determination (immunoluminometric assay in tumor cytosol) was assessed for this long follow-up period. RESULTS p53 concentrations were significantly linked to the histological grade (P = 0.001), to tumor size (P = 0.02) and ER status (P = 0.01). Higher p53 tumoral concentrations were found in tumors with large size, pejorative histological grade and negative ER status. In contrast, p53 tumoral concentrations were not influenced by menopausal or PR status. Multivariate Cox analysis demonstrates that tumor size was the only significant predictor of disease-free survival (P = 0.049) with a risk factor at 1.38. As regards specific survival, univariate Cox analysis indicates that p53 taken as a continuous variable is a significant predictor (P = 0.024) together with histological grade, tumor size and ER status. In a multivariate Cox analysis there were two significant and independent variables for predicting overall survival: tumor size (P = 0.031) and, ER status (P = 0.015) with the highest risk factor (RR = 2.14). CONCLUSIONS The present investigation points out that the prognostic power of p53 tumor determination evaluated at more than 10 years median survival is not higher than the well-recognized classic prognostic factors in node-negative breast cancer. The present data highlight the need to assess the prognostic value of potentially new biological factors in node-negative breast cancer on cohorts of patients followed over periods in excess of 10 years.
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Ferrero JM, Ramaioli A, Formento JL, Francoual M, Etienne MC, Peyrottes I, Ettore F, Leblanc-Talent P, Namer M, Milano G. P53 determination alongside classical prognostic factors in node-negative breast cancer: an evaluation at more than 10-year follow-up. Ann Oncol 2000; 11:393-7. [PMID: 10847456 DOI: 10.1023/a:1008359722254] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is heterogeneity of methods and conflicting results concerning the prognostic value of p53 in node-negative breast cancer. The clinical value of a quantitative method for measuring tumoralp53 content still needs to be evaluated. PATIENTS AND METHODS A long-term retrospective study was conducted on 297 node-negative patients with a median follow-up greater than 10 years (11 years, 101-172 months). Classic prognostic factors were considered including age, tumor size, histoprognostic grade and estradiol (ER) and progesterone receptors (PR). In addition, the value of p53 determination (immunoluminometric assay in tumor cytosol) was assessed for this long follow-up period. RESULTS p53 concentrations were significantly linked to the histological grade (P = 0.001), to tumor size (P = 0.02) and ER status (P = 0.01). Higher p53 tumoral concentrations were found in tumors with large size, pejorative histological grade and negative ER status. In contrast, p53 tumoral concentrations were not influenced by menopausal or PR status. Multivariate Cox analysis demonstrates that tumor size was the only significant predictor of disease-free survival (P = 0.049) with a risk factor at 1.38. As regards specific survival, univariate Cox analysis indicates that p53 taken as a continuous variable is a significant predictor (P = 0.024) together with histological grade, tumor size and ER status. In a multivariate Cox analysis there were two significant and independent variables for predicting overall survival: tumor size (P = 0.031) and, ER status (P = 0.015) with the highest risk factor (RR = 2.14). CONCLUSIONS The present investigation points out that the prognostic power of p53 tumor determination evaluated at more than 10 years median survival is not higher than the well-recognized classic prognostic factors in node-negative breast cancer. The present data highlight the need to assess the prognostic value of potentially new biological factors in node-negative breast cancer on cohorts of patients followed over periods in excess of 10 years.
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Ferrero JM, Etienne MC, Formento JL, Francoual M, Rostagno P, Peyrottes I, Ettore F, Teissier E, Leblanc-Talent P, Namer M, Milano G. Application of an original RT-PCR-ELISA multiplex assay for MDR1 and MRP, along with p53 determination in node-positive breast cancer patients. Br J Cancer 2000; 82:171-7. [PMID: 10638986 PMCID: PMC2363171 DOI: 10.1054/bjoc.1999.0896] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The long-term prognostic value of tumoural MDR1 and MRP, along with p53 and other classical parameters, was analysed on 85 node-positive breast cancer patients receiving anthracycline-based adjuvant therapy. All patients underwent tumour resection plus irradiation and adjuvant chemotherapy (the majority receiving fluorouracil-epirubicin-cyclophosphamide). Median follow-up for the 54 alive patients was 7.8 years. Mean age was 53.7 years (range 28-79) and 54 patients were post-menopausal. MDR1 and MRP expression were quantified according to an original reverse transcription polymerase chain reaction multiplex assay with colourimetric enzyme-linked immunosorbent assay detection (beta2-microglobulin as control). P53 protein was analysed using an immunoluminometric assay (Sangtec). MDR1 expression varied within an 11-fold range (mean 94, median 83), MRP within a 45-fold range (mean 315, median 242) and p53 protein from the limit of detection (0.002 ng mg(-1)) up to 35.71 ng mg(-1) (mean 1.18, median 0.13 ng mg(-1)). P53 protein was significantly higher in oestrogen receptor (ER)-negative than in ER-positive tumours (P = 0.039). The higher the p53, the lower the MDR1 expression (P = 0.015, r= -0.27). P53 was not linked to progesterone receptor (PR) status, S phase fraction, or MRP Significantly greater MDR1 expression was observed in grade I tumours (P = 0.029). No relationship was observed between MDR1 and MRP. Neither MDR1 nor MRP was linked to ER or PR status. Unlike MDR1, MRP was correlated with the S phase: the greater the MRP, the lower the S phase (P = 0.006, r = -0.42). Univariate Cox analyses revealed that MDR1, MRP, p53 and S phase had no significant influence on progression-free or specific survival. A tendency suggested that the greater the p53, the shorter the progression-free survival (P = 0.076 as continuous and 0.069 as dichotomous).
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Affiliation(s)
- J M Ferrero
- Centre Antoine Lacassagne, Oncopharmacology Unit, Nice, France
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