1
|
Merle P, Bouattour M, Blanc JF, Peron JM, Debette-Gratien M, Nahon P, Nguyen-Khac E, Phelip JM, Assenat E, Bourgeois V, Richou C, Heurgue A, Bronowicki JP, Ollivier-Hourmand I, Uguen T, Cattan S, Thevenon S, Boucheny C, Pradat P. Cabozantinib (CABO) tolerance and efficacy for patients with advanced hepatocellular carcinoma (HCC) after failure of sorafenib (SOR) in a French population: CLERANCE, a phase 4 trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.573] [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: 01/25/2023] Open
Abstract
573 Background: CABO is approved in second (2L) or third line (3L) systemic therapy for pts with advanced HCC after SOR failure, based on results of the CELESTIAL phase 3. CLERANCE was designed to evaluate safety and efficacy of CABO in pts with HCC in real-world practice in a French population. Methods: This prospective, French multicentre (n=17), interventional study aims to recruit 110 pts with unresectable HCC when a decision of CABO treatment was made in 2L or 3L after prior sorafenib (SOR) failure, according to the French health authority approved label. The primary endpoint is the incidence of treatment-related adverse events (TRAE) of grade > 2 (NCI-CTCAE v5) by a central review committee. Secondary endpoints include overall survival (OS), objective response rate (ORR) (RECIST v1.1 per investigator assessed), progression-free survival (PFS), time to progression (TTP) and profiles of CABO administration. Results: Of 110 pts enrolled, the final analysis focused on the 99 pts who starting CABO (11 pts withdrawn due to screen failure) and followed up to 12 mo (data cut-off: November 8, 2021). Pts were mainly males (89%), 69 years median age (range 24-85), Child-Pugh A (94.9%) / B7 (5.1%), and ALBI score-1 (33%), 2 (60%), 3 (5%), not evaluated (NE) (2%). About 59% pts received CABO in 2L after SOR, whereas 41% were in 3L after SOR and another line (TKI or IO). SOR was discontinued due to tumor progression (68%) or intolerance (32%) with a median duration of 4.2 mo (95% CI 3.5-4.8) and a median dose of 800 mg (95% CI 631-800). In the 99 pts starting CABO, 128 treatment-emergent adverse events (TEAE) of grade > 2 were reported, 40 of them classified as TRAE: hand foot skin reaction (14%), diarrhea (11%), asthenia and/or anorexia and/or weight loss (12%), arterial hypertension (4%). The ORR was 7% with 58% of disease control rate (DCR). Median PFS was 6.2 mo (95% CI, 5.3-8.7), TTP 8.2 mo (95% CI 6.1-12.8), without any difference when CABO used in 2L or 3L line (with prior IO [11%] or not). OS was 11.5 mo (95% CI 9.2-14.6) since start of CABO and 23 mo (95% CI 17.3-29.4) since the first systemic line. ALBI score at 1 was an independent marker of better OS in multivariate analysis (Exp[b] 3.26, 95% CI 1.86-5.69, p<0.0001). The median duration of CABO was 5.2 mo (95% CI 3.5-6.0), the median daily dose 40 mg (95% CI 32.3-43.6), 66% of pts needed dose reduction, and permanent CABO discontinuation in 75.8% pts, due to: i) death (7%), tumor progression (54%) (median time to progression 5.3 mo; 95% CI 3.7-12.8), or AE (15.2%) (median time to AE 2.6 mo; 95% CI 1.5-7.7). Conclusions: In this final analysis of CLERANCE, most pts could start CABO (90%) 2L or 3L among the 110 enrolled pts. In real-life setting in CLERANCE, tolerability and efficacy were similar to those observed in CELESTIAL. The baseline ALBI score at 1 was strongly and independently associated with a better outcome. Clinical trial information: NCT03963206 .
Collapse
Affiliation(s)
| | - Mohamed Bouattour
- Department of Medical Oncology, Beaujon University Hospital, Clichy, France
| | - Jean-Frédéric Blanc
- Hôpital Haut-Lévêque, CHU de Bordeaux, Service Hépato-Gastroentérologie et Oncologie Digestive, Bordeaux, France
| | - Jean-Marie Peron
- Service d’Hépato-Gastroentérologie, Hôpital Purpan, Toulouse, France
| | | | - Pierre Nahon
- Service d’Hépatologie, APHP Hôpital Avicenne, Paris, France
| | | | | | - Eric Assenat
- Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - Vincent Bourgeois
- Service d'Oncologie Digestive, Centre Hospitalier de Boulogne sur Mer, Boulogne Sur Mer, France
| | - Carine Richou
- Service d’Hépato-Gastroentérologie, Hôpital Jean Minjoz, Besancon, France
| | - Alexandra Heurgue
- Service d'Hépato-Gastro-entérologie, Hôpital Robert-Debré, Reims, France
| | | | | | - Thomas Uguen
- Service d’Hépato-Gastroentérologie, Hôpital Pontchaillou, Rennes, France
| | | | - Sylvie Thevenon
- Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Lyon, France
| | - Camille Boucheny
- Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Lyon, France
| | - Pierre Pradat
- Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Lyon, France
| |
Collapse
|
2
|
Barrau M, Duprat M, Veyrard P, Tournier Q, Williet N, Phelip JM, Waeckel L, Cheifetz AS, Papamichael K, Roblin X, Paul S. A Systematic Review on the interest of Drug Tolerant assay in the monitoring of Inflammatory Bowel Disease. J Crohns Colitis 2022; 17:633-643. [PMID: 36301958 DOI: 10.1093/ecco-jcc/jjac164] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 02/08/2023]
Abstract
Many patients with inflammatory bowel disease (IBD) are treated with anti-tumor necrosis factor (TNF) therapies, of which infliximab (IFX) is most commonly used. Loss of response (LOR) to anti-TNF therapy due to immunogenic failure accounts for 20% of subsequent medical intervention and is defined, using a drug sensitive assay, as low or undetectable concentration of drug with high titers of anti-drug antibodies (ADAb). We performed a systematic review to investigate the use of a drug tolerant assay during both induction and maintenance to monitor patients treated with anti-TNFs. After the search on PubMed, 90 publications were reviewed. Most ADAb detection methods are drug sensitive, cannot detect ADAb in the presence of drug, and therefore cannot be used close to drug administration, when the drug concentration is too high. To overcome this major limitation, several drug-tolerant techniques have been developed and will be discussed in this review. Using drug-tolerant assays ADAb against infliximab (IFX) or adalimumab (ADM) can be detected during induction and predict primary non-response or LOR. Drug sensitive assays do not allow detection of ADAb during the induction phase as IFX or ADM concentration is typically high.
Collapse
Affiliation(s)
- Mathilde Barrau
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Manon Duprat
- Department of Immunology, CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC 1408 Vaccinology, F42023 Saint-Etienne, France
| | - Pauline Veyrard
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Quentin Tournier
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Nicolas Williet
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Jean Marc Phelip
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Louis Waeckel
- Department of Immunology, CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC 1408 Vaccinology, F42023 Saint-Etienne, France
| | - Adam S Cheifetz
- Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center Instructor in Medicine, Harvard Medical School
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center Instructor in Medicine, Harvard Medical School
| | - Xavier Roblin
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Stephane Paul
- Department of Immunology, CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC 1408 Vaccinology, F42023 Saint-Etienne, France
| |
Collapse
|
3
|
Phelip JM, Malka D. Reply to M. Salati et al. J Clin Oncol 2022; 40:1390-1391. [PMID: 35235375 DOI: 10.1200/jco.22.00057] [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)
- Jean Marc Phelip
- Jean Marc Phelip, MD, PhD, CHU Saint-Étienne, Saint-Étienne, France; and David Malka, MD, Gustave Roussy Institute, Paris, France
| | - David Malka
- Jean Marc Phelip, MD, PhD, CHU Saint-Étienne, Saint-Étienne, France; and David Malka, MD, Gustave Roussy Institute, Paris, France
| |
Collapse
|
4
|
Phelip JM, Desrame J, Edeline J, Barbier E, Terrebonne E, Michel P, Perrier H, Dahan L, Bourgeois V, Akouz FK, Soularue E, Ly VL, Molin Y, Lecomte T, Ghiringhelli F, Coriat R, Louafi S, Neuzillet C, Manfredi S, Malka D. Modified FOLFIRINOX Versus CISGEM Chemotherapy for Patients With Advanced Biliary Tract Cancer (PRODIGE 38 AMEBICA): A Randomized Phase II Study. J Clin Oncol 2021; 40:262-271. [PMID: 34662180 DOI: 10.1200/jco.21.00679] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Whether triplet chemotherapy is superior to doublet chemotherapy in advanced biliary tract cancer (BTC) is unknown. METHODS In this open-label, randomized phase II-III study, patients with locally advanced or metastatic BTC and an Eastern Cooperative Oncology Group performance status of 0 or 1 were randomly assigned (1:1) to receive oxaliplatin, irinotecan, and infusional fluorouracil (mFOLFIRINOX), or cisplatin and gemcitabine (CISGEM) for a maximum of 6 months. We report the results of the phase II part, where the primary end point was the 6-month progression-free survival (PFS) rate among the patients who received at least one dose of treatment (modified intention-to-treat population) according to Response Evaluation Criteria in Solid Tumors version 1.1 (statistical assumptions: 6-month PFS rate ≥ 59%, 73% expected). RESULTS A total of 191 patients (modified intention-to-treat population, 185: mFOLFIRINOX, 92; CISGEM, 93) were randomly assigned in 43 French centers. After a median follow-up of 21 months, the 6-month PFS rate was 44.6% (90% CI, 35.7 to 53.7) in the mFOLFIRINOX arm and 47.3% (90% CI, 38.4 to 56.3) in the CISGEM arm. Median PFS was 6.2 months (95% CI, 5.5 to 7.8) in the mFOLFIRINOX arm and 7.4 months (95% CI, 5.6 to 8.7) in the CISGEM arm. Median overall survival was 11.7 months (95% CI, 9.5 to 14.2) in the mFOLFIRINOX arm and 13.8 months (95% CI, 10.9 to 16.1) in the CISGEM arm. Adverse events ≥ grade 3 occurred in 72.8% of patients in the mFOLFIRINOX arm and 72.0% of patients in the CISGEM arm (toxic deaths: mFOLFIRINOX arm, two; CISGEM arm, one). CONCLUSION mFOLFIRINOX triplet chemotherapy did not meet the primary study end point. CISGEM doublet chemotherapy remains the first-line standard in advanced BTC.
Collapse
Affiliation(s)
- Jean Marc Phelip
- INSERM U1059, Université Jean Monnet, CHU de Saint Etienne, Hôpital Nord, Saint-Etienne, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Samy Louafi
- Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | | | - Sylvain Manfredi
- INSERM U1231, Université Bourgogne, Franche Comté, CHU Le Bocage, Dijon, France
| | - David Malka
- Gustave Roussy, Université Paris Saclay, Villejuif, France
| | | |
Collapse
|
5
|
Williet N, Petrillo A, Roth G, Ghidini M, Petrova M, Forestier J, Lopez A, Thoor A, Weislinger L, De Vita F, Taieb J, Phelip JM. Gemcitabine/Nab-Paclitaxel versus FOLFIRINOX in Locally Advanced Pancreatic Cancer: A European Multicenter Study. Cancers (Basel) 2021; 13:cancers13112797. [PMID: 34199796 PMCID: PMC8200096 DOI: 10.3390/cancers13112797] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Gemcitabine/nab-paclitaxel (GN) and FOLFIRINOX (FFX) are two standard first-line therapies for metastatic pancreatic cancer (PC) but have rarely been compared, especially in patients with locally advanced PC (LAPC). By carefully selecting patients, it is likely these two regimens lead to similar survival outcomes. Through a multicenter European study, biases regarding practice habits are reduced. Hence, we observed no difference between GN and FFX as first-line treatments in patients with LAPC in terms of either survival, tumor response or tumor resection rate. Further trials are needed to confirm these data. Abstract Background: Gemcitabine/nab-paclitaxel (GN) and FOLFIRINOX (FFX) are two standard first-line therapies for metastatic pancreatic cancer (PC) but have rarely been compared, especially in patients with locally advanced PC (LAPC). Methods: This is a retrospective European multicenter study including patients with LAPC treated with either GN or FFX as the first-line therapy between 2010 and 2019. Coprimary objectives were progression-free survival (PFS) and overall survival (OS), both estimated using the Kaplan–Meier method. Results: A total of 147 patients (GN: n = 60; FFX: n = 87) were included. Tumor resection rates were similar between the two groups (16.7% vs. 16.1%; p = 1), with similar R0 resection rates (88.9%). Median PFS rates were not statistically different: 9 months (95% CI: 8–13.5) vs. 12.1 months (95% CI: 10.1–14.6; p = 0.8), respectively. Median OS rates were 15.7 months (95% CI: 12.6–20.2) and 16.7 months (95% CI: 14.8–20.4; p = 0.7), respectively. Abdominal pain at the baseline (HR = 2.03, p = 0.03), tumors located in the tail of the pancreas (HR = 4.35, p = 0.01), CA19-9 > 200 UI/L (HR = 2.03, p = 0.004) and tumor resection (HR = 0.37, p = 0.007) were independent prognostic factors for PFS, similarly to OS. CA19-9 ≤ 200 UI/L (OR = 2.6, p = 0.047) was predictive of the tumor response. Consolidation chemoradiotherapy, more often used in the FFX group (11.7% vs. 50.6%; p < 0.001), was not predictive. Conclusion: This retrospective study did not show any difference between GN and FFX as the first-line treatment in patients with LAPC.
Collapse
Affiliation(s)
- Nicolas Williet
- Department of Hepatogastroenterology, University Hospital of Saint-Etienne, 42000 Saint-Etienne, France;
- Correspondence:
| | - Angelica Petrillo
- Department of Precision Medecine, University of Study of Campania «L. Vanvitelli», 81100 Naples, Italy; (A.P.); (F.D.V.)
| | - Gaël Roth
- Hepato-Gastroenterology Department, University Hospital of Grenoble, 38043 Grenoble, France; (G.R.); (A.T.)
| | - Michele Ghidini
- Department of Medical Oncology, Cancer Center, Hospital of Cremona, 26100 Cremona, Italy;
| | - Mila Petrova
- Department of Medical Oncology, MHAT Nadezhda, 1220 Sofia, Bulgaria;
| | - Julien Forestier
- Department of Medical Oncology, Hôpital Edouard Herriot, 69622 Lyon, France;
| | - Anthony Lopez
- Hepato-Gastroenterology Department, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (A.L.); (L.W.)
| | - Audrey Thoor
- Hepato-Gastroenterology Department, University Hospital of Grenoble, 38043 Grenoble, France; (G.R.); (A.T.)
| | - Lucie Weislinger
- Hepato-Gastroenterology Department, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; (A.L.); (L.W.)
| | - Ferdinando De Vita
- Department of Precision Medecine, University of Study of Campania «L. Vanvitelli», 81100 Naples, Italy; (A.P.); (F.D.V.)
| | - Julien Taieb
- Department of Gastroenterology and Gastro-Intestinal Oncology, Hôpital Européen Georges-Pompidou, APHP, Paris Descartes University, Sorbonne Paris Cité, 75004 Paris, France;
| | - Jean Marc Phelip
- Department of Hepatogastroenterology, University Hospital of Saint-Etienne, 42000 Saint-Etienne, France;
| |
Collapse
|
6
|
Tournier Q, Paul S, Williet N, Berger AE, Veyrard P, Boschetti G, Le Roy B, Killian M, Phelip JM, Flourie B, Nancey S, Roblin X. Early detection of anti-drug antibodies during initiation of anti-tumour necrosis factor therapy predicts treatment discontinuation in inflammatory bowel disease. Aliment Pharmacol Ther 2021; 53:1190-1200. [PMID: 33872404 DOI: 10.1111/apt.16333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/22/2020] [Accepted: 02/28/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Anti-drug antibodies develop mostly during the induction therapy with anti-tumour necrosis factor (TNF) drugs and can be revealed by means of a drug-tolerant assay. AIM To investigate whether the early detection of anti-drug antibodies during the induction therapy was predictive of treatment discontinuation. METHODS In a prospective study, consecutive patients with inflammatory bowel disease (IBD), who should start an anti-TNF, were enrolled and followed regularly during 24 months or less in case of non- or loss of response (LOR) or adverse events requiring treatment discontinuation. Anti-TNF levels and anti-drug antibodies were measured at week 2 for adalimumab (ADA) and weeks 2 and 6 for infliximab (IFX) using a drug-tolerant assay. RESULTS One hundred and eight patients were enrolled (54 under ADA). At week 2, antibodies to ADA and to IFX were detected in 76% and 67% of patients. Time to treatment discontinuation was significantly shorter (P < 0.001) in patients with antibodies to ADA ≥2.0 µg/mL-eq (6.0 vs 24 months, HR = 18.51, 95% CI [4.35-78.71]) or with antibodies to IFX ≥4.0 µg/mL-eq (5.5 vs >24 months, HR = 13.89, 95% CI [4.08-47.31]) at week 2 compared to patients without positive antibodies. Antibodies to ADA and to IFX were predictive of treatment failure within 24 months with a sensitivity of 79% and 62%, and specificities and positive predictive values of 100%. In multivariate analysis, antibodies to ADA or to IFX at week 2 were the only factors associated with treatment discontinuation. CONCLUSIONS The prevalence of antibodies to anti-TNF is high when detected early using a drug-tolerant assay, and their appearance predicts further treatment discontinuation.
Collapse
Affiliation(s)
- Quentin Tournier
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Stephane Paul
- Department of Immunology, CIC1408, GIMAP CIRI INSERM U1111, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Nicolas Williet
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Anne-Emmanuelle Berger
- Department of Immunology, CIC1408, GIMAP CIRI INSERM U1111, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pauline Veyrard
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gilles Boschetti
- Department of Gastroenterology, Lyon Sud Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1 and INSERM U1111, Lyon, France
| | - Bertrand Le Roy
- Department of Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Martin Killian
- Department of Internal Medicine, CIC1408, GIMAP CIRI INSERM U1111, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jean Marc Phelip
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bernard Flourie
- Department of Gastroenterology, Lyon Sud Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1 and INSERM U1111, Lyon, France
| | - Stephane Nancey
- Department of Gastroenterology, Lyon Sud Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1 and INSERM U1111, Lyon, France
| | - Xavier Roblin
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Department of Gastroenterology, Lyon Sud Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1 and INSERM U1111, Lyon, France
| |
Collapse
|
7
|
Boige V, FRANCOIS E, BEN Abdelghani M, Phelip JM, Le Brun-Ly V, Mineur L, Galais MP, Villing AL, Hautefeuille V, Miglianico L, De La Fouchardiere C, Genet D, Levasseur N, Levache CB, Lachaux N, Gourgou S, Castan F, Bouché O. Maintenance treatment with cetuximab versus observation in RAS wild-type metastatic colorectal cancer: Results of the randomized phase II PRODIGE 28-time UNICANCER study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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
15 Background: Compared to observation, maintenance therapy with a fluoropyrimidine +/- bevacizumab showed significant improvement in progression-free survival (PFS) but not in overall survival (OS) in patients with unresectable metastatic colorectal cancer (mCRC) and disease control after first-line doublet chemotherapy (CT) +/- bevacizumab. Few studies are available on the role of maintenance therapy after induction anti-EGFR-based CT, and the benefit from anti-EGFR maintenance monotherapy during CT-free intervals (CFI) in patients with RAS wild-type (wt) mCRC. Methods: RAS wt unresectable mCRC patients with controlled disease after FOLFIRI + cetuximab (8 cycles) were randomized (1:1) to receive maintenance with bi-weekly cetuximab alone (arm A) or observation (arm B) until disease progression (PD)/unacceptable toxicity/death. Randomization was stratified according to tumor response, center, baseline Köhne Score, CEA and platelet count. In case of tumor progression during the CFI, FOLFIRI + cetuximab was to be reintroduced for 8 cycles, followed by a new CFI. Tumor response was assessed per RECIST1.1 every 8 weeks. The primary objective of this multicenter non-comparative randomized phase II trial was 6-month PFS rate after initiation of maintenance therapy. A total of 134 randomized and evaluable patients (67 per arm) were required (Fleming’s one-step design, one-sided α=5%, β=20%, H0: 40%; H1: 55%). Secondary endpoints were overall response rate (ORR), time to strategy failure, PFS, OS, safety, quality of life, circulating tumor cells and circulating tumor DNA detection and dynamic changes during treatment. Results: From January 2014 to April 2019, 214 patients were included and 139 randomized (67 arm A/72 arm B) in 35 centers. Baseline characteristics were: males, 67%/69%; median age, 64/68 years; ECOG PS 0, 54%/46%; previous adjuvant therapy, 25%/14%; single metastatic site, 58%/47%; right-sided primary, 24%/18%. The ORR in the overall and the randomized population was 55% and 72%, respectively. The median follow-up was 30 months. The 6-month PFS rate after initiation of maintenance therapy was 30% 95%CI[19; 42] in the maintenance arm, and 6% 95%CI[2;14] in the observation arm, with a median PFS of 5.3 95%CI[3.7;6.5] and 2.0 95%CI[1.8;2.8] months, respectively. Any grade treatment-related toxicity, including skin rash (40%/4%), diarrhea (33%/8%), and hypomagnesemia (46%/10%) was more frequent in arm A. Conclusions: Based on the study hypothesis, the cetuximab maintenance arm did not meet the primary objective. However, the clinically meaningful difference in PFS without any overlap in the confidence intervals between the two arms warrants further investigation. Clinical trial information: NCT02404935.
Collapse
Affiliation(s)
| | - Eric FRANCOIS
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | - Jean Marc Phelip
- Saint Etienne University Hospital, Saint Priest En Jarez, France
| | - Valerie Le Brun-Ly
- Department of Medical Oncology, CHU Limoges-Hôpital Dupuytren, Limoges, France
| | | | | | | | | | | | | | | | | | | | | | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | - Florence Castan
- Biometrics Department, Institut du Cancer de Montpellier, Montpellier, France
| | | |
Collapse
|
8
|
Nassar A, Phelip JM, Goéré D, Loriau J, Gallois C, Michel P, Penna C, Taieb J, Brouquet A, Benoist S. What is the Best Therapeutic Strategy for Metachronous Resectable Colorectal Liver Metastases After Adjuvant Oxaliplatin-Based Chemotherapy? A Multidisciplinary Inter-Group Survey. World J Surg 2020; 45:822-830. [PMID: 33210163 DOI: 10.1007/s00268-020-05837-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND To report the current clinical practice of French physicians for metachronous resectable liver metastasis (LM) occurring after a FOLFOX adjuvant chemotherapy for primary cancer. METHODS Twenty four clinical situations were proposed to a panel of experts via 4 learned societies. Clinical situations varied according time of recurrence (early between 6 and 12 month or > 12 month), extension of LM (limited ≤ 2 or extended > 2 lesions), presence of a neuropathy or not, and of a RAS or BRAF mutation. RESULTS A total of 157 physicians participated in this study. A consensus was reached in 17 (71%) clinical situations. For an early limited recurrence, whatever presence of neuropathy, the preferred therapeutic approach (45%) was upfront surgery. For an early extended recurrence, whatever presence of neuropathy, there was a consensus (64%) for a preoperative chemotherapy by FOLFIRI + biologic agent. For a late recurrence without neuropathy, there was a consensus (50%) for a preoperative FOLFOX chemotherapy, whatever the extension of LM. For a late recurrence with neuropathy, upfront surgery was chosen (52%) for limited LM, and preoperative chemotherapy by FOLFIRI + biologic agent (73%) for extended LM. No response was influenced by the RAS mutation status. There was a strong consensus for intensified preoperative chemotherapy in all clinical situations for BRAF-mutated LM. CONCLUSIONS This national survey provides an overview of the practice patterns in the treatment of LM occurring after adjuvant FOLFOX for primary. It could be a basis to establish expert's recommendations for the clinical practice.
Collapse
Affiliation(s)
- Alexandra Nassar
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Jean Marc Phelip
- Department of Hepato-Gastroenterology and Digestive Oncology, St Etienne University Hospital, St Etienne, France
| | - Diane Goéré
- Department of Digestive Surgery, Saint Louis Hospital, APHP, Paris, France
| | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Claire Gallois
- Department of Gastroenterology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Pierre Michel
- Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | - Christophe Penna
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Julien Taieb
- Department of Gastroenterology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Antoine Brouquet
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Stéphane Benoist
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France.
| |
Collapse
|
9
|
Di Fiore F, Bouché O, Lepage C, Sefrioui D, Gangloff A, Schwarz L, Tuech JJ, Aparicio T, Lecomte T, Boulagnon-Rombi C, Lièvre A, Manfredi S, Phelip JM, Michel P. COVID-19 epidemic: Proposed alternatives in the management of digestive cancers: A French intergroup clinical point of view (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR). Dig Liver Dis 2020; 52:597-603. [PMID: 32418773 PMCID: PMC7255323 DOI: 10.1016/j.dld.2020.03.031] [Citation(s) in RCA: 32] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Patients treated for malignancy are considered at risk of severe COVID-19. This exceptional pandemic has affected countries on every level, particularly health systems which are experiencing saturation. Like many countries, France is currently greatly exposed, and a complete reorganization of hospitals is ongoing. We propose here adaptations of diagnostic procedures, therapies and care strategies for patients treated for digestive cancer during the COVID-19 epidemic. METHODS French societies of gastroenterology and gastrointestinal (GI) oncology carried out this study to answer two main questions that have arisen (i) how can we limit high-risk situations for GI-cancer patients and (ii) how can we limit contact between patients and care centers to decrease patients' risk of contamination while continuing to treat their cancer. All recommendations are graded as experts' agreement according to the level of evidence found in the literature until March 2020. RESULTS A proposal to adapt treatment strategies was made for the main GI oncology situations. Considering the level of evidence and the heterogeneous progression of the COVID-19 epidemic, all proposals need to be considered by a multidisciplinary team and implemented with patient consent. CONCLUSION COVID-19 epidemic may significantly affect patients treated for digestive malignancies. Healthcare teams need to consider adapting treatment sequences when feasible and according to the epidemic situation.
Collapse
Affiliation(s)
- Frederic Di Fiore
- Department of Hepatogastroenterology, Normandie Université, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, F 76000 Rouen, France.
| | - Olivier Bouché
- Digestive Oncology, CHU Reims, University Reims Champagne Ardennes, France
| | - Come Lepage
- Hepato-Gastroenterology Department, University Hospital Le Bocage, EPICAD INSERM LNC-UMR 1231, Université de Bourgogne et Franche Comté, Dijon, France
| | - David Sefrioui
- Department of Hepatogastroenterology, Normandie Université, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, F 76000 Rouen, France
| | - Alice Gangloff
- Department of Hepatogastroenterology, Normandie Université, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, F 76000 Rouen, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Normandie Université, UNIROUEN, Inserm U1245, IRON group, F 76000 Rouen, France
| | - Jean Jacques Tuech
- Department of Digestive Surgery, Normandie Université, UNIROUEN, Inserm U1245, IRON group, F 76000 Rouen, France
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, Université de Paris, Paris, France
| | - Thierry Lecomte
- Gastroenterology and Endoscopy Department, Trousseau Hospital, University F Rabelais Tours, France
| | | | - Astrid Lièvre
- Rennes 1 University, Rennes, France; Association pour le Dépistage des Cancers en Ille-et-Vilaine, ADECI35, Rennes, France; Department of Gastroenterology, CHU Pontchaillou, Rennes, France; INSERM UMR 1242, COSS "Chemistry, Oncogenesis, Stress Signaling", Rennes, France
| | - Sylvain Manfredi
- Hepato-Gastroenterology Department, University Hospital Le Bocage, EPICAD INSERM LNC-UMR 1231, Université de Bourgogne et Franche Comté, Dijon, France
| | - Jean Marc Phelip
- Department of Gastroenterology and Digestive Oncology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Pierre Michel
- Department of Hepatogastroenterology, Normandie Université, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, F 76000 Rouen, France.
| |
Collapse
|
10
|
Galle PR, Kudo M, Llovet JM, Finn RS, Karwal M, Pezet D, Kim TY, Yang TS, Zagonel V, Tomasek J, Phelip JM, Touchefeu Y, Koh SJ, Stirnimann G, Wang C, Ogburn K, Abada P, Widau RC, Zhu AX. Impact of baseline hepatitis B viremia and management on outcomes in patients (Pts) with advanced hepatocellular carcinoma (HCC) and elevated alpha-fetoprotein (AFP): Outcomes from REACH-2. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.569] [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
569 Background: REACH (NCT01140347) and REACH-2 (NCT02435433) were global, randomized, blinded, placebo (PL)-controlled phase 3 trials of ramucirumab (RAM) in pts with advanced HCC following sorafenib. REACH-2 limited enrollment to pts with AFP ≥400 ng/mL, and met its primary OS endpoint, consistent with the prespecified REACH subgroup with baseline AFP ≥400 ng/mL. Analysis of pooled individual pt data from REACH (AFP ≥400 ng/mL) and REACH-2 showed improved OS with RAM vs PL for pts with hepatitis B virus (HBV) etiology (7.7 vs 4.5 mos; HR 0.74, 95% CI 0.55, 0.99). Here we investigate survival and liver function in REACH-2 pts with HBV etiology tested for serum HBV DNA. Methods: Pts had advanced HCC, Child-Pugh A, ECOG PS 0/1, AFP ≥400 ng/mL, prior sorafenib treatment, and were randomized (2:1) to receive RAM 8 mg/kg or PL Q2W. Pretreatment serum HBV DNA was quantified by HBV-specific PCR (Roche) by a central lab. HBV DNA > 15 IU/mL were detectable (HBV DNA+), < 15 IU/mL were undetectable (HBV DNA-). OS in pooled treatment arms was evaluated using Kaplan-Meier method and Cox proportional hazards model. Liver function was assessed at baseline and before each cycle with the ALBI linear predictor. Outcomes were assessed by concomitant antiviral therapy. Adverse events (AEs) were graded by NCI-CTCAE v4.0. Results: Of 107 REACH-2 pts with HBV etiology, 106 had available PCR samples and were included in a pooled analysis (70 RAM and 36 PL pts). 48 pts were HBV DNA+ and 58 pts were HBV DNA-. HBV DNA+ pts had poorer median OS vs HBV DNA- pts (5.3 vs 10.1 mos, unstratified HR 1.45 95% CI 0.93, 2.28). HBV DNA+ pts taking concomitant antiviral therapy (n = 36) had numerically improved OS compared with those without (n = 12) (5.8 vs 4.0 mos). No difference in OS was noted for HBV DNA- pts by antiviral therapy use (n = 39 antiviral; n = 19 no antiviral) (10.2 vs 9.7 mos for yes vs no antiviral). In pts taking antiviral therapy, regardless of HBV DNA serology, liver function was improved and liver injury/failure related AEs were less frequent. Conclusions: Our data reinforce the use of antiviral therapy to improve outcomes in pts with advanced HBV-associated HCC and elevated AFP. Clinical trial information: NCT02435433.
Collapse
Affiliation(s)
| | | | | | | | - Mark Karwal
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Jean Marc Phelip
- Saint Etienne University Hospital, Saint Priest en Jarez, France
| | | | - Su-Jin Koh
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Guido Stirnimann
- University Clinic for Visceral Surgery, Freiburgstrasse, Switzerland
| | | | | | | | | | | |
Collapse
|
11
|
Phelip JM, Tougeron D, Léonard D, Benhaim L, Desolneux G, Dupré A, Michel P, Penna C, Tournigand C, Louvet C, Christou N, Chevallier P, Dohan A, Rousseaux B, Bouché O. Metastatic colorectal cancer (mCRC): French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR). Dig Liver Dis 2019; 51:1357-1363. [PMID: 31320305 DOI: 10.1016/j.dld.2019.05.035] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This document is a summary of the French intergroup guidelines regarding the management of metastatic colorectal cancer (mCRC) published in January 2019, and available on the French Society of Gastroenterology website (SNFGE) (www.tncd.org). METHODS This collaborative work was realized by all French medical and surgical societies involved in the management of mCRC. Recommendations are graded in three categories (A, B and C), according to the level of evidence found in the literature, up until December 2018. RESULTS The management of metastatic colorectal cancer has become complex because of increasing available medical, radiological and surgical treatments alone or in combination. The therapeutic strategy should be defined before the first-line treatment, mostly depending on the presentation of the disease (resectability of the metastases, symptomatic and/or threatening disease), of the patient's condition (ECOG PS, comorbidities), and tumor biology (RAS, BRAF, MSI). The sequence of targeted therapies also seems to have an impact on the outcome (angiogenesis inhibition beyond progression). Surgical resection of metastases was the only curative intent treatment to date, joined recently by percutaneous tumor ablation tools (radiofrequency, microwave). Localized therapies such as hepatic intra-arterial infusion, radioembolization and hyperthermic intraperitoneal chemotherapy, also have seen their indications specified (liver-dominant disease and resectable peritoneal carcinomatosis). New treatments have been developed in heavily pretreated patients, increasing overall survival and preserving quality of life (regorafenib and trifluridine/tipiracil). Finally, immune checkpoint inhibitors have demonstrated high efficacy in MSI mCRC. CONCLUSION French guidelines for mCRC management are put together to help offer the best personalized therapeutic strategy in daily clinical practice, as the mCRC therapeutic landscape is complexifying. These recommendations are permanently being reviewed and updated. Each individual case must be discussed within a multidisciplinary team (MDT).
Collapse
Affiliation(s)
- Jean Marc Phelip
- Department of Gastroenterology and Digestive Oncology, University Hospital of Saint Etienne, Saint Etienne, France.
| | - David Tougeron
- Department of Gastroenterology, University Hospital of Poitiers, Poitiers, France
| | - David Léonard
- Department of Surgical Oncology, Clinique de la Loire, Saumur, France
| | - Leonor Benhaim
- Department of Surgical Oncology, GustaveRoussy Cancer Center, UNICANCER, Villejuif, France
| | - Grégoire Desolneux
- Department of Surgical Oncology, Bergonie Institute, UNICANCER, Bordeaux, France
| | - Aurélien Dupré
- Department of Surgical Oncology, Leon Berard Cancer Center, UNICANCER, Lyon, France
| | - Pierre Michel
- Department of Gastroenterology and Digestive Oncology, University Hospital of Rouen, Rouen, France
| | - Christophe Penna
- Department of Surgical Oncology, Bicêtres Hospital, APHP, Paris, France
| | - Christophe Tournigand
- Department of Gastroenterology and Digestive Oncology, Henri-Mondor University Hospital, APHP, Creteil, France
| | - Christophe Louvet
- Department of Medical Oncology, Institut Mutualiste Montsouris (IMM), Paris, France
| | - Nikki Christou
- Department of Digestive, Endocrine and General Surgery, University Hospital of Limoges, France
| | | | - Anthony Dohan
- Department of Abdominal and Interventional Radiology, Cochin Unversity Hospital, APHP, Paris, France
| | - Benoist Rousseaux
- Department of Medical Oncology, Henri Mondor Hospital, APHP, Creteil, France; Memorial Sloan Kettering Cancer Center, Solid Tumor Department, New York, USA
| | - Olivier Bouché
- Department of Digestive Oncology, University Hospital of Reims, Reims, France
| |
Collapse
|
12
|
Derosiere A, Nicolai V, Malka D, Pozet A, Lazartigues J, Turpin A, Tougeron D, Walter T, Artru P, Bachet JB, Phelip JM, Lepage C, Lievre A, Caulet M, Norguet E, Lourenco N, Coriat R, Sefrioui D, Dremaux J, Hautefeuille V. Prognosis and chemosensitivity of non-V600E BRAF mutations in metastatic colorectal carcinoma (mCRC): An AGEO French multicenter retrospective cohort. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3575 Background: BRAF mutations are present in 5-15% of mCRC. V600E BRAF mutations account for ~80% of cases and are mostly found in right-sided tumors. Non-V600E BRAF mutations are rare (~2% of mCRC), mostly left-sided. Although BRAF V600E mutations are associated with a dismal prognosis, some studies suggest that non-V600E BRAF mutations may be associated with a favorable outcome. The chemosensitivity of non-V600E BRAF-mutated mCRC has never been studied. Methods: From 2017 to 2018, all consecutive patients (pts) with non-V600E BRAF-mutated mCRC (next generation sequencing) treated in the participating centers were included. Survival analyses were performed using Kaplan-Meier method and LogRank test. Results: A total of 108 pts in 34 centers in France were included between October 2017 and August 2018 (median age, 66 years [range, 58-77]; ECOG performance status 0-1, 86%). The primary was mostly left-sided (66%). Main metastatic sites were the liver (73%), lungs (33%), lymph nodes (39%) and peritoneum (26%). D594 (34%), G469 (15%), K601 (11%), N581 (7%) and L597 (7%) were the most frequent mutations. A concomitant RAS mutation was found in 22% of pts. Microsatellite instability (MSI) was found in 3/67 pts (4.5%). First-line chemotherapy (CTx) (n = 69) efficacy was (overall response rate/disease control rate) 49%/77% (anti-EGFR-containing CTx [n = 20], 75%/85%; antiangiogenic-containing CTx [n = 22], 55%/73%). Median overall survival (mOS) was 25.6 months (95% CI : 17.1-43.8) overall; it was 8.0 months with best supportive care alone (n = 10), 16.0 months with palliative CTx alone (n = 63), and attained 105.1 months with curative-intent management of metastases (n = 35). mOS did not differ according to sidedness (p = 0.22), type of mutation (p = 0.52), or its functional impact on BRAF (p = 0.19). Conclusions: Non-V600E BRAF-mutated mCRC retain sensitivity to CTx + biologics and harbor a good prognosis (especially when amenable to curative-intent surgery), regardless of the type of mutation and its impact on BRAF kinase function. Contrarily to BRAF V600E mutations, non-V600E mutations may occur along with RAS mutations, but uncommonly with MSI.
Collapse
Affiliation(s)
| | | | - David Malka
- Digestive Oncology, Gustave Roussy, Villejuif, France
| | | | | | | | | | - Thomas Walter
- Edouard Herriot University Hospital, St Didier Au Mont D'or, France
| | | | | | - Jean Marc Phelip
- Saint Etienne University Hospital, Saint Priest EN Jarez, France
| | - Come Lepage
- Dijon University Hospital, INSERM U1231, Dijon, France
| | | | | | | | | | | | - David Sefrioui
- Digestive Oncology Unit, Iron Group, Rouen University Hospital, Rouen, France
| | | | | |
Collapse
|
13
|
Touchefeu Y, Guimbaud R, Louvet C, Dahan L, Samalin E, Barbier E, Le Malicot K, Cohen R, Gornet JM, Aparicio T, Nguyen S, Azzedine A, Etienne PL, Phelip JM, Hammel P, Chapelle N, Sefrioui D, Mineur L, Lepage C, Bouche O. Prognostic factors in patients treated with second-line chemotherapy for advanced gastric cancer: results from the randomized prospective phase III FFCD-0307 trial. Gastric Cancer 2019; 22:577-586. [PMID: 30311042 DOI: 10.1007/s10120-018-0885-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to determine prognostic factors in patients treated with second-line therapy (L2) for locally advanced or metastatic gastric and gastro-esophageal junction (GEJ) adenocarcinoma in a randomized phase III study with predefined L2. METHODS In the FFCD-0307 study, patients were randomly assigned to receive in L1 either epirubicin, cisplatin, and capecitabine (ECX arm) or fluorouracil, leucovorin, and irinotecan (FOLFIRI arm). L2 treatment was predefined (FOLFIRI for the ECX arm and ECX for the FOLFIRI arm). Chi square tests were used to compare the characteristics of patients treated in L2 with those of patients who did not receive L2. Prognostic factors in L2 for progression-free survival (PFS) and overall survival (OS) were analyzed using a Cox model. RESULTS Among 416 patients included, 101/209 (48.3%) patients in the ECX arm received FOLFIRI in L2, and 81/207 (39.1%) patients in the FOLFIRI arm received ECX in L2. Patients treated in L2, compared with those who only received L1 had : a better ECOG score (0-1: 90.4% versus 79.7%; p = 0.0002), more frequent GEJ localization (40.8% versus 27.6%; p = 0.005), and lower platelet count (median: 298000 versus 335000/mm3; p = 0.02). In multivariate analyses, age < 60 years at diagnosis (HR 1.49, 95% CI 1.09-2.03, p = 0.013) and ECOG score 2 before L2 (HR 2.62, 95% CI 1.41-4.84, p = 0.005) were the only significant poor prognostic factors for OS. CONCLUSION Age ≥ 60 years at diagnosis and ECOG score 0/1 before L2 were the only favorable prognostic factors for OS.
Collapse
Affiliation(s)
- Y Touchefeu
- Gastrointestinal Oncology Unit, Institut des Maladies de l'Appareil Digestif, University Hospital, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - R Guimbaud
- Digestive Medical Oncology IUCT Rangueil, CHU de Toulouse, Toulouse, France
| | - C Louvet
- Oncology Multidisciplinary Research Group (GERCOR), 151 rue du Faubourg Saint Antoine, 75011, Paris, France
| | - L Dahan
- Digestive Oncology Unit, AP-HM, La Timone Hospital, Aix-Marseille Université, Marseille, France
| | - E Samalin
- Digestive Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | - E Barbier
- Fédération Francophone de Cancérologie Digestive-EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - K Le Malicot
- Fédération Francophone de Cancérologie Digestive-EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - R Cohen
- Department of Oncology, Sorbonne Université, AP-HP, hôpital Saint-Antoine, 75012, Paris, France
| | - J M Gornet
- Department of Gastroenterology, AP-HP Hôpital Saint Louis, Paris, France
| | - T Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, University Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - S Nguyen
- Oncology Multidisciplinary Research Group (GERCOR), 151 rue du Faubourg Saint Antoine, 75011, Paris, France
| | - A Azzedine
- Department of oncology, CH Montélimar, Montélimar, France
| | - P L Etienne
- Oncology Department, CARIO, HPCA, Plérin, France
| | - J M Phelip
- Service HGE et Oncologie Digestive, CHU de Saint Etienne, Unité HESPER EA-7425 Université Jean Monnet/Claude Bernard Lyon 1, Villeurbanne, France
| | - P Hammel
- Digestive Oncology Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - N Chapelle
- Gastrointestinal Oncology Unit, Institut des Maladies de l'Appareil Digestif, University Hospital, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - D Sefrioui
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, UNIROUEN, Inserm U1245, IRON group, Normandie University, 76000, Rouen, France
| | - L Mineur
- Institut Sainte Catherine, Avignon, France
| | - C Lepage
- Gastroenterology Department, INSERM UMR1231, CHU de Dijon, University Bourgogne Franche-Comté, Dijon, France
| | - O Bouche
- Digestive Oncology, CHU REIMS, Reims, France
| |
Collapse
|
14
|
Roblin X, Vérot C, Paul S, Duru G, Williet N, Boschetti G, Del Tedesco E, Peyrin-Biroulet L, Phelip JM, Nancey S, Flourie B. Is the Pharmacokinetic Profile of a First Anti-TNF Predictive of the Clinical Outcome and Pharmacokinetics of a Second Anti-TNF? Inflamm Bowel Dis 2018; 24:2078-2085. [PMID: 29718216 DOI: 10.1093/ibd/izy111] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to evaluate prospectively the clinical outcomes and pharmacokinetics of a second anti-TNF according to the pharmacokinetics of the first anti-TNF in patients with inflammatory bowel disease (IBD). METHODS In patients in loss of response (LOR) to a first optimized anti-TNF and switched to a second anti-TNF, pharmacokinetics of anti-TNF were measured at the switch time, 30 weeks later, at the time of LOR, or at the end of the study (102 weeks). RESULTS At the switch time, patients (n = 59) belonged to 4 groups according to the pharmacokinetics of the first anti-TNF: group 1 (n = 18), therapeutic trough levels; group 2 (n = 13) undetectable trough levels with antibodies against anti-TNF; group 3 (n = 13) without antibodies against anti-TNF; and group 4 (n = 15) subtherapeutic trough levels. After switching, the failure rates at week 30 and during the follow-up were as follows, respectively: in group 1 with therapeutic levels, 50% and 78%, despite therapeutic levels of the second anti-TNF in 83% of cases; in group 2 with undetectable levels and antibodies, 15% and 69% with undetectable levels of the second anti-TNF and antibodies in 85% of cases; in group 3 with undetectable levels without antibodies, 0% and 31% with therapeutic levels in 77% of cases; in group 4 with subtherapeutic levels, 13% and 33% with therapeutic levels in 73% of cases. Clinical remission rates were significantly lower (P ≤ 0.05) in groups 1 and 2 with therapeutic or undetectable levels with antibodies than in the 2 other groups. CONCLUSION In the case of LOR with therapeutic levels of the first anti-TNF or undetectable levels with antibodies, the switch to a second anti-TNF results in pharmacokinetic profile similar to the first one and again in LOR in most of the patients.
Collapse
Affiliation(s)
- Xavier Roblin
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Céline Vérot
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Stéphane Paul
- Department of Immunology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gérard Duru
- Department of Statistics, University Claude Bernard Lyon 1, Lyon, France
| | - Nicolas Williet
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gilles Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon, University Claude Bernard Lyon and INSERM, Lyon, France
| | - Emilie Del Tedesco
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - Jean Marc Phelip
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Stéphane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon, University Claude Bernard Lyon and INSERM, Lyon, France
| | - Bernard Flourie
- Department of Gastroenterology, Hospices Civils de Lyon, University Claude Bernard Lyon and INSERM, Lyon, France
| |
Collapse
|
15
|
Williet N, Di Bernardo T, Saban-Roche L, Magne N, Phelip JM. Intensification of induction chemotherapy before chemoradiotherapy improves progression-free survival in patients with locally advanced pancreatic cancers. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16221] [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)
- Nicolas Williet
- Hopital Nord, CHU de Saint-Etienne, Saint-Priest en Jarez, FR
| | | | - Lea Saban-Roche
- Department of medical Oncology, Institut de Cancerologie de la Loire, Saint-Priest-En-Jarez, France
| | - Nicolas Magne
- Lucien Neuwirth Cancer Institute, Saint-Priest-En-Jarez, France
| | | |
Collapse
|
16
|
Dahan L, Phelip JM, Le Malicot K, Williet N, Desrame J, Volet J, Petorin C, Malka D, Rebischung C, Aparicio T, Lecaille C, Rinaldi Y, Turpin A, Bignon AL, Bachet JB, Seitz JF, Lepage C, Francois E. FOLFIRINOX until progression, FOLFIRINOX with maintenance treatment, or sequential treatment with gemcitabine and FOLFIRI.3 for first-line treatment of metastatic pancreatic cancer: A randomized phase II trial (PRODIGE 35-PANOPTIMOX). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4000] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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)
| | | | | | | | | | | | | | - David Malka
- Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | - Cedric Lecaille
- Department of Gastroenterology, Polyclinique Nord Aquitaine, Bordeaux, France
| | | | | | | | | | | | - Come Lepage
- CHU Le Bocage HGE, INSERM U1231, Dijon, France
| | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| |
Collapse
|
17
|
Roblin X, Boschetti G, Williet N, Nancey S, Marotte H, Berger A, Phelip JM, Peyrin-Biroulet L, Colombel JF, Del Tedesco E, Paul S, Flourie B. Azathioprine dose reduction in inflammatory bowel disease patients on combination therapy: an open-label, prospective and randomised clinical trial. Aliment Pharmacol Ther 2017; 46:142-149. [PMID: 28449228 DOI: 10.1111/apt.14106] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/09/2017] [Accepted: 03/26/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Infliximab (IFX) combined with azathioprine (AZA) is more effective than IFX monotherapy in inflammatory bowel disease (IBD). AIM To identify the AZA optimal dose that is required for efficacy when receiving combination therapy. METHODS Patients with IBD in durable remission on combination therapy were enrolled in a 1-year, open-label, prospective trial after randomisation into three groups: AZA steady (2-2.5 mg/kg/day, n=28) vs AZA down (dose was halved 1-1.25 mg/kg/day, n=27) vs AZA stopped (n=26). Primary endpoint was failure defined as occurrence of a clinical relapse and/or any change in IBD therapy. RESULTS Eighty-one patients were included. Five (17.9%), 3 (11.1%), and 8 (30.8%) patients experienced failure at 1 year in groups AZA steady, AZA down and AZA stopped, respectively (P=.1 across the groups). The median trough levels of IFX at inclusion were close to those measured at the end of follow-up in group AZA steady (3.65 vs 3.45 μg/mL, P=.9) and in group AZA down (3.95 vs 3.60 μg/mL, P=.5), whereas these levels dropped from 4.25 to 2.15 μg/mL (P=.02) in group AZA stopped. Four (14.3%), four (14.8%) and 11 (42.3%) patients experienced an unfavourable evolution of IFX pharmacokinetics in groups AZA steady, AZA down and AZA stopped, respectively. A threshold of 6-TGN <105 pmoles/8.108 RBC was associated with an unfavourable evolution of IFX pharmacokinetics. CONCLUSIONS Under combination therapy, AZA dose reduction, but not withdrawal, appears to be as effective as continuation of AZA at full dose.
Collapse
Affiliation(s)
- X Roblin
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - G Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon, INSERM U1111, Lyon, France
| | - N Williet
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - S Nancey
- Department of Gastroenterology, Hospices Civils de Lyon, INSERM U1111, Lyon, France
| | - H Marotte
- Department of Rheumatology, University Hospital of Saint Etienne, Saint Etienne, France
| | - A Berger
- Department of Immunology, CIC1408, GIMAP EA3064, University Hospital of Saint Etienne, Saint Etienne, France
| | - J M Phelip
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, University Hospital of Nancy, Nancy, France
| | - J F Colombel
- Division of Gastroenterology, Inflammatory Bowel Disease Center, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - E Del Tedesco
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - S Paul
- Department of Immunology, CIC1408, GIMAP EA3064, University Hospital of Saint Etienne, Saint Etienne, France
| | - B Flourie
- Department of Gastroenterology, Hospices Civils de Lyon, INSERM U1111, Lyon, France
| |
Collapse
|
18
|
Dohan A, Gallix B, Guiu B, Le Malicot K, Reinhold C, Soyer P, Bennouna J, Ghiringhelli F, Boige V, Taieb J, Bouche O, Francois E, Phelip JM, Borel C, Faroux R, Seitz JF, Jacquot S, Lepage C, Aparicio T, Hoeffel C. Survival prediction in patients treated by FOLFIRI and bevacizumab for metastatic colorectal cancer (PRODIGE 9) using contrast-enhanced CT texture analysis (SPECTRA). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3601] [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: 11/20/2022] Open
Abstract
3601 Background: Quantitative assessment of tumor architecture changes may help to early identify non-responder patients and propose a tailored treatment strategy. Our objective was to build and validate a radiomics signature able to predict early the lack of response to chemotherapy including FOLFIFRI and bevacizumab using baseline and first evaluation CT and to compare it to the RECIST and morphological criteria. Methods: For 230 patients of PRODIGE 9 study and treated by FOLFIRI and bevacizumab, a computed analysis (CA) was performed on the dominant liver lesion (DLL) at baseline and 2 months post-chemotherapy. RECIST evaluation was performed at 2 and 6 months. The sum of the target liver lesions (STL), the density of the DLL, CA parameters and their changes rates were correlated with the 2-year survival status. A radiomics signature combining 3 parameters was built in one arm and validated in the second arm. Survival was estimated with the Kaplan-Meier method and compared with log-rank test. Results: The strongest predictive factors for 2-year survival status were decrease in STL(AUC = .69±.05[95%CI:.60-.77]), change rate in kurtosis(ssf = 0) (AUC = .66±.05[95%CI:.57-.74]), and the baseline density of the DLL (AUC = .68±.05[95%CI:.59-.77]). Using multivariate analysis, predictive factors of 2-year survival status were the decrease in STL > 15%(HR = 1.92, P= .002), the increase in kurtosis value(ssf = 0) > 93% (HR = 2.16, P= .001), and baseline DLL > 64.3UH (HR = 1.70, P= .02). Then, the SPECTRA-score was built by according 1 point for each of the 3 criteria. Patients with a SPECTRA-score > 1 had a lower overall survival in the training ( P= .001) and in the validation cohort ( P= .002). Non-response according to RECIST at 6 months had the same prognostic value as SPECTRA-score>1 at 2 months. Conclusions: A radiomics signature combining STL, density and CA on baseline and first evaluation CT is be able to predict which patient will have a poor outcome with same performances than standard evaluation with RECIST1.1 at 6 months in mCRC patients. Clinical trial information: NCT00952029.
Collapse
Affiliation(s)
- Anthony Dohan
- Lariboisière Hospital, Viscéral and Vascular Radiology Department, INSERM U965, Paris, France
| | - Benoit Gallix
- McGill University Health Centre, Montréal, QC, Canada
| | - Boris Guiu
- University Hospital, Radiology department, Montpellier, France
| | | | | | - Philippe Soyer
- Lariboisière Hospital, Viscéral and Vascular Radiology Department, INSERM U965, Paris, France
| | | | | | - Valerie Boige
- Service d'Oncologie Digestive, Gustave Roussy, Villejuif, France
| | - Julien Taieb
- Hopital Européen Georges Pompidou, Paris, France
| | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | | | - Christian Borel
- Department of Oncology, Paul Strauss Center, Strasbourg, France
| | - Roger Faroux
- Centre Hospitalier Departemental Les Oudairies, La Roche-Sur-Yon, France
| | | | - Stephane Jacquot
- Department of Radiotherapy and Oncology, Clinique Privée Clémentville, Montpellier, France
| | - Come Lepage
- CHU Le Bocage HGE, INSERM U866, Dijon, France
| | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | - Christine Hoeffel
- University Hospital, Hôpital Maison Blanche, Radiology Department, Reims, France
| |
Collapse
|
19
|
Legoux JL, Aparicio T, Maillard E, Phelip JM, Jouve JL, Locher C, Michel P, Lecomte T, Bouche O, Bedenne L. Classic or simplified LV5FU2 regimen: Multivariate analysis from a phase III study in metastatic colorectal cancer in elderly patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3550] [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
3550 Background: In the early 2000s, classic LV5FU2 (C) (folinic acid, 5FU bolus, then 5FU infusion on D1 and D2) was replaced with simplified LV5FU2 (S) (folinic acid and 5FU bolus on D1 only), considered as effective and less toxic. No trial proved this assertion. The LV5FU2 companion in the FOLFIRI or FOLFOX regimen was C or S. The FFCD 2001-02 study compared in a 2 x 2 factorial design, in not-pretreated elderly patients (75+) with metastatic colorectal cancer, C or S, with or without irinotecan. No significant differences in PFS and OS were observed in the comparison with or without irinotecan. The median OS was 15.2 months in C versus 11.4 months in S, HR = 0.71 (0.55–0.92) and objective response rate was 37.1% in C vs S 25.6% in S, p = 0.004. The aim of this study was to present the factors associated with these differences. Methods: Prognostic factors associated with OS were studied using a Cox model. The multivariate analysis used the significantly different items from the univariate analysis and the differences observed at the inclusion. For each of these items, a subgroup analysis was performed. The second- and third-line treatments were analysed. Results: The 282 patients from the intent-to-treat study were included in the model. In OS, the prognostic factors were C versus S, number of metastatic sites, alkaline phosphatases (AP) and CEA. The interaction test in each subgroup for OS was not significant but C was significantly better in the following subgroup: age > 80 years, male, Karnofsky 100%, 1-2 Charlson index, AP ≤ 2N, leucocyte count > 11,000, CEA > 2N, CA 19-9 ≤2N. No differences were observed in the NCI toxicities but 130 serious adverse events in S versus 102 in C. A second-line was used for 55% patients in C, 46% in S, 81% of them with oxaliplatin or irinotecan in C, 76% after S. The third-line administration (20%) and targeted therapy (15%) were similar in C and S. Conclusions: C-LV5FU2 was superior both in subgroups with better and lower prognostics and this difference cannot be explained by an imbalance between the populations. The toxicity was not higher and a second-line was more often possible after C. The switch from C to S without scientific proof was perhaps a mistake in our practices. Clinical trial information: NCT00303771.
Collapse
Affiliation(s)
| | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | | | | | | | - Christophe Locher
- Department of Hepato-Gastroenterology, Meaux Hospital, Meaux, France
| | - Pierre Michel
- Digestive Oncology Unit, Iron Group, Rouen Hospital, University of Normandy, Rouen, France
| | | | | | | | | |
Collapse
|
20
|
Mineur L, François E, Phelip JM, Guimbaud R, Plassot C, Smith DM, Miglianico L. Cetuximab (CTX) in first-line treatment of elderly patients with metastatic colorectal cancer (mCRC), KRAS wild type: French multicentre prospective community-based registry and results. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.760] [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: 11/20/2022] Open
Abstract
760 Background: Pts included in clinical trials represent the unusual population in mCRC. This study aims to provide oncologist with a better understanding of the potential benefit of CT with CTX in older patients with mCRC KRAS wild type and evaluate prognostic variables on the PFS including the age. Methods: Premium cancer study is a French multicentre prospective community-based registry. 493 pts enrolled and 487 included between September 2009 to March 2012 from 94 French centers and physicians. Pts had to provide written informed consent and protocol submitted to regulatory authorities. Predefined efficacy endpoints was PFS. CTX was administrated at 250 mg/m2 weekly (n=100; 20.3%) or 500 mg/m2 every 2 weeks (n=380;77,2%), other n=13; 2.5%) CT regimen choice was at physician’s discretion.. The main analysis is PFS as well as analysis of prognostic factors of this PFS (29 items including age (< 65 years n=229; 65-74 years n= 165.; ≥75years n=93). Univariate analysis was performed for each covariate, PFS was estimated by Kaplan-Meier curves and compared by log-rank test. univariable Cox regression analysis was used to assess the association between each variable and outcome. Multivariable stepwise Cox models were then fitted for final variable selection of prognostic factors on PFS. Results: Univariate significant prognostic factors for PFS are OMS (0-1 vs 2-3), Tobacco, Site of tumor (right vs other), Number of metastatic organ (1 vs 2-3), Resecability of metastatic disease defined before CT (definitively non resectable metastases vs possible resectable), Surgery of mCRC, folliculitis or xerosis or paronychia grade 0-1 vs 2-4. Age was unidentified as a prognostic factor in univariate analysis. Four factors were independently associated with a better PFS: xerosis [hazard ratio (HR0,651); 95% confidence interval (CI) 0,494-0,857], (WHO PS) 0–1 (HR0,519 ; 95% CI 0,371–0,726) and folliculitis (HR 0,711; 95% CI0,558–0,956) metastases surgery 0,287(CI 0,205-0,403). Conclusions: CTX in combination with standard CT is effective, age is not identified as a prognostic factor for the PFS. Both groups of pts based on age benefit from CTX.
Collapse
Affiliation(s)
| | | | | | | | - Carine Plassot
- Institut Universitaire de Recherche Clinique, Montpellier, France
| | | | | |
Collapse
|
21
|
Edeline J, Bonnetain F, Phelip JM, Watelet J, Hammel P, Joly JP, Ben Abdelghani M, Rosmorduc O, Bouhier-Leporrier K, Jouve JL, Faroux R, Guerin Meyer V, Assenat E, Seitz JF, Malka D, Louvet C, Bertaut A, Juzyna B, Stanbury T, Boucher E. Gemox versus surveillance following surgery of localized biliary tract cancer: Results of the PRODIGE 12-ACCORD 18 (UNICANCER GI) phase III trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.225] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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
225 Background: No standard post-surgery adjuvant treatment is currently recommended in localized biliary tract cancer (BTC). Gemcitabine combined with platinum is the standard chemotherapy for advanced BTC. The aim of this phase III randomized trial was to assess whether GEMOX would increase relapse-free survival (RFS) while maintaining health-related quality of life (HrQoL). Methods: We performed a multicenter randomized phase III trial. Patients were randomized, within 3 months of R0 or R1 resection of a localized BTC (intra-hepatic, perihilar, extra-hepatic cholangiocarcinoma or gallbladder cancer), to receive either GEMOX 85 for 12 cycles (Experimental Arm A) or surveillance (Standard Arm B). Co-primary objectives were RFS and HrQoL. 190 patients and 126 RFS events were required to show an increase of median RFS from 18 to 30 months. Results: Between July 2009 and February 2014, 196 patients were included in 33 French centers. Baseline characteristics were balanced, with similar primary sites, R0 resection rates were 86.2% (Arm A) vs 87.9% (Arm B), lymph node invasion present in 37.2% vs 36.4%. In Arm A, a median of 12 cycles was delivered (mean: 9.3, range: 0-12). Maximal grade of adverse events were grade 3 in 57.5% vs 22.2%, and grade 4 in 17.0% vs 9.1%. During treatment one patient died in each arm. The main grade ≥ 3 adverse events in the year following inclusion were peripheral neuropathy (50.0% vs 1.1%), and neutropenia (22.3% vs 0%). Median follow-up was 44.3 months, with 54 and 64 RFS events in arms A vs B. There was no significant difference in RFS between the arms (log-rank p = 0.31), with a hazard ratio of 0.83 [95% CI: 0.58-1.19], p = 0.31 (futility boundaries were crossed). Median RFS was 30.4 [95% CI: 15.4-45.8] vs 22.0 months [95%CI: 13.6-38.3] in arms A & B respectively, and 4-years RFS was 39.3% [95%CI: 28.4%-50.0%] vs 33.2% [95%CI: 23.1-43.7%]. Global Health HrQoL scores were not different at 12 months (70.8 vs 83.3, p = 0.18) and at 24 months (75.0 vs 83.3, p = 0.50). Conclusions: Adjuvant chemotherapy in BTC with GEMOX was feasible and associated with expected toxicities and no deterioration of HrQoL. There was no significant difference in RFS between GEMOX and surveillance. Clinical trial information: NCT01313377.
Collapse
Affiliation(s)
- Julien Edeline
- Oncology Medical Eugene Marquis Comprehensive Cancer Center, Rennes, France
| | - Franck Bonnetain
- Methodology and Quality of Life Unit, Department of Oncology, INSERM UMR 1098, University Hospital of Besancon; French National Platform Quality of Life and Cancer, Besancon, France
| | | | | | | | - Jean-Paul Joly
- Department of Hepatogastroenterology, Amiens University Medical Center, Amiens, France
| | | | - Olivier Rosmorduc
- Hopital de la Pitie-Salpétrière, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | | | | | - Roger Faroux
- Centre Hospitalier Departemental Les Oudairies, La Roche Sur Yon, France
| | | | - Eric Assenat
- Institut du regional du Cancer de Montpellier (ICM), Montpellier, France
| | - Jean Francois Seitz
- Aix-Marseille University, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - David Malka
- Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | | | | | - Eveline Boucher
- Service d'Oncologie Medicale, Central Eugene Marquis, Rennes, France
| |
Collapse
|
22
|
Roblin X, Duru G, Williet N, Del Tedesco E, Cuilleron M, Jarlot C, Phelip JM, Boschetti G, Flourié B, Nancey S, Peyrin-Biroulet L, Paul S. Development and Internal Validation of a Model Using Fecal Calprotectin in Combination with Infliximab Trough Levels to Predict Clinical Relapse in Crohn's Disease. Inflamm Bowel Dis 2017. [PMID: 28002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND The best noninvasive method predicting clinical relapse remains undetermined in infliximab (IFX)-treated patients with Crohn's disease. METHODS All patients with CD on IFX maintenance treatment and in clinical remission for at least 16 weeks, between 2011 and 2014, were enrolled in a prospective single-center study. The Crohn's Disease Activity Index (CDAI), fecal calprotectin, C-reactive protein levels, antibodies (ATI), and trough level (TLI) of IFX were measured at every IFX infusion. The best thresholds of TLI (2 versus 3 μg/mL) and calprotectin (50 versus 250 μg/g stools) were identified across four logistic regression models. RESULTS One hundred nineteen patients (mean age: 34 ± 12 yrs, mean disease duration: 7.8 yrs) were included. Mean follow-up was 20.4 months, and 17% of the patients were on IFX and azathioprine at inclusion. During follow-up, 37 patients (31.1%) relapsed, 78% within the first 6 months. The clinical characteristics of the relapsed and nonrelapsed patients were similar. After logistic regression, fecal calprotectin >250 μg/g stools (OR: 4.09; 95% CI, 1.01-16.21; P = 0.049) and TLI <2 μg/mL (OR: 14.85; 95% CI, 3.67-60; P < 0.0001) were associated with loss of response. A training cohort of 55 patients was isolated randomly to implement prediction rules for loss of response. The best predictive rules were the combination of a TLI <2 μg/mL and a fecal calprotectin level >250 μg/g stools (78.3%). These rules were validated on a test cohort of 64 patients with an accuracy of 87%, (sensitivity = 0.94, specificity = 0.84, positive predictive value = 0.73, and negative predictive value = 0.97). CONCLUSIONS In IFX-treated patients with CD in clinical remission, a combination of TLI (<2 μg/mL) and fecal calprotectin (>250 μg/g of stools) is a good model for predicting loss of response. In contrast with previous data, low TLIs ranging from 2 to 3 μg/mL should neither systematically lead to the optimization of IFX use nor a switch in the treatment.
Collapse
Affiliation(s)
- Xavier Roblin
- *Department of Gastroenterology, University Hospital of Saint Etienne, France; †Mathematic Unit, University Claude Bernard, Lyon, France; ‡Department of Radiology, University Hospital of Saint Etienne, France; §Department of Gastroenterology, CHU, Lyon Sud, Lyon, France; ‖Department of Gastroenterology and Inserm, University Hospital of Nancy, Lorraine University, Vandoeuvre-les-Nancy, France; and ¶Department of Immunology, University Hospital of Saint Etienne, Saint Etienne, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Barabino G, Porcheron J, Cottier M, Cuilleron M, Coutard JG, Berger M, Molliex S, Beauchesne B, Phelip JM, Grichine A, Coll JL. Improving Surgical Resection of Metastatic Liver Tumors With Near-Infrared Optical-Guided Fluorescence Imaging. Surg Innov 2016; 23:354-9. [DOI: 10.1177/1553350615618287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective. The aim of this study was to investigate the feasibility and future clinical applications of near-infrared (NIR) fluorescence imaging to guide liver resection surgery for metastatic cancer to improve resection margins. Summary Background Data. A subset of patients with metastatic hepatic tumors can be cured by surgery. The degree of long-term and disease-free survival is related to the quality of surgery, with the best resection defined as “R0” (complete removal of all tumor cells, as evidenced by microscopic examination of the margins). Although intraoperative ultrasonography can evaluate the surgical margins, surgeons need a new tool to perfect the surgical outcome. Methods. A preliminary study was performed on 3 patients. We used NIR imaging postoperatively “ex vivo” on the resected liver tissue. The liver tumors were preoperatively labelled by intravenously injecting the patient with indocyanine green (ICG), a NIR fluorescent agent (24 hours before surgery, 0.25 mg/kg). Fluorescent images were obtained using a miniaturized fluorescence imaging system (FluoStic, Fluoptics, Grenoble, France). Results. After liver resection, the surgical specimens from each patient were sliced into 10-mm sections in the operating room and analyzed with the FluoStic. All metastatic tumors presented rim-type fluorescence. Two specimens had incomplete rim fluorescence. The pathologist confirmed the presence of R1 margins (microscopic residual resection), even though the ultrasonographic analysis indicated that the result was R0. Conclusions. Surgical liver resection guided by NIR fluorescence can help detect potentially uncertain anatomical areas that may be missed by preoperative imaging and by ultrasonography during surgery. These preliminary results will need to be confirmed in a larger prospective patient series.
Collapse
Affiliation(s)
- Gabriele Barabino
- Université Jean Monnet, Saint Etienne, France
- Saint Etienne University Hospital, Saint Etienne, France
- INSERM-UJF U823, Institut Albert Bonniot, Grenoble, France
| | - Jack Porcheron
- Saint Etienne University Hospital, Saint Etienne, France
| | | | | | | | | | - Serge Molliex
- Saint Etienne University Hospital, Saint Etienne, France
| | | | | | | | - Jean-Luc Coll
- INSERM-UJF U823, Institut Albert Bonniot, Grenoble, France
| |
Collapse
|
24
|
Aparicio T, Bennouna J, Le Malicot K, Ghiringhelli F, Boige V, Taieb J, Bouche O, Phelip JM, Francois E, Borel C, Faroux R, Seitz JF, Jacquot S, Genet D, Khemissa F, Suc E, Desseigne F, Texereau P, Jouve JL. Final results of PRODIGE 9, a randomized phase III comparing no treatment to bevacizumab maintenance during chemotherapy-free intervals in metastatic colorectal cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3531] [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)
| | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | | | | | - Valerie Boige
- Service d'Oncologie Digestive, Gustave Roussy, Villejuif, France
| | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Paris, France
| | | | | | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Christian Borel
- Department of Oncology, Paul Strauss Center, Strasbourg, France
| | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche Sur Yon, France
| | | | - Stephane Jacquot
- Department of radiotherapy and oncology, CLINIQUE PRIVÉE CLÉMENTVILLE, Montpellier, France
| | | | | | - Etienne Suc
- Department of Oncology, Clinique Saint Jean du Languedoc, Toulouse, France
| | | | - Patrick Texereau
- Department of Hepato-Gastroenterology, Hôpital Layne, Mont-De-Marsan, France
| | | |
Collapse
|
25
|
Neuzillet C, Brieau B, Manuceau G, Rousseau B, Dahan L, Boussaha T, Vasseur P, Tougeron D, Lecomte T, Coriat R, Bachet JB, Phelip JM, Zaanan A, Bouche O, Desramé J, Thirot-Bidault A, Trouilloud I, Locher C, Tournigand C, Lièvre A. Platinum rechallenge in patients with advanced biliary tract carcinoma (ABTC) after failure of gemcitabine (GEM)-platinum combination: A national AGEO retrospective study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4076] [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)
| | | | | | - Benoit Rousseau
- Oncology Department, Hôpital Henri Mondor, APHP, Créteil, France
| | - Laetitia Dahan
- La Timone, Marseille University Hospital, Marseille, France
| | - Tarek Boussaha
- Hôpital Saint-Antoine - Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - David Tougeron
- Gastroenterology Department, Poitiers University Hospital, Poitiers, France
| | | | | | | | | | - Aziz Zaanan
- department of Gastroenterology and GI oncology, Hopital Européen Georges Pompidou, Paris, France
| | | | | | - Anne Thirot-Bidault
- Department of Hepato-Gastroenterology, Bicêtre Hospital, Kremlin-Bicêtre, France
| | | | - Christophe Locher
- Department of Hepato-Gastroenterology, Meaux Hospital, Meaux, France
| | | | | | | |
Collapse
|
26
|
Aparicio T, Maillard E, Ducreux M, Bouche O, Rougier P, De Gramont A, Manfredi S, Lecomte T, Etienne PL, Bedenne L, Bennouna J, Phelip JM, Francois E, Michel P, Legoux JL, Gasmi M, Faroux R, Breysacher G, Lepage C, Seitz JF. Obesity in metastatic colorectal cancer: Pooled analysis of FFCD trials. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | | | | | | | | | | | | | | | | | | | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | | | | | - Pierre Michel
- Digestive Oncology Unit, IRON group, CHU Rouen, University of Normandy, Rouen, France
| | | | | | - Roger Faroux
- Centre Hospitalier Départemental Les Oudairies, La Roche Sur Yon, France
| | | | - Come Lepage
- CHU Le Bocage HGE, INSERM U866, Dijon, France
| | | |
Collapse
|
27
|
Phelip JM, Mineur L, De la Fouchardière C, Chatelut E, Quesada JL, Roblin X, Pezet D, Mendoza C, Buc E, Rivoire M. High Resectability Rate of Initially Unresectable Colorectal Liver Metastases After UGT1A1-Adapted High-Dose Irinotecan Combined with LV5FU2 and Cetuximab: A Multicenter Phase II Study (ERBIFORT). Ann Surg Oncol 2016; 23:2161-6. [PMID: 26739304 DOI: 10.1245/s10434-015-5072-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this study was to assess the efficacy and tolerance of induction chemotherapy combining LV5FU2 with increased doses of irinotecan adapted to UGT1A1 genotyping and cetuximab in untreated potentially resectable liver metastases of colorectal cancer. METHODS Twenty-six patients, PS 0-1, with class II hepatic metastases received chemotherapy combining irinotecan 260 mg/m(2) on day 1 for UGT1A1 6/6 and 6/7 genotypes and 220 mg/m(2) for UGT1A1 7/7 genotypes, with leucovorin on day 1, 5FU 400 mg/m(2) bolus on day 1 and continuous 5FU infusion for 46 h, and cetuximab on day 1 (day 1 = day 14). Primary prevention with lenograstim (day 5-9) was given to UGT1A1 6/7 and 7/7 genotypes. The primary endpoint was the response rate (RECIST1.1), and the secondary endpoints were tolerance (NCI-CTC criteria) and R0 resection rate. RESULTS The average number of cycles per patient was 6 (±1.9). The UGT1A1 genotype was 6/6 in 34.6 %, 6/7 in 53.9 %, and 7/7 in 11.5 % of patients. At 6 cycles, 18 patients (69.2 %) presented a partial response, 5 patients (19.2 %) had stable disease, 2 patients (7.7 %) died independently of chemotherapy, and 1 patient (3.9 %) refused the treatment after 3 cycles. Four patients received 2 more cycles and the cumulative response rate at 8 cycles was 76.9 % (20/26). There was no progression. Among assessable patients (n = 23), the overall response rate was 82.6 % and 21 patients (80.7 %) had a metastasis resection. The most frequent grade 3-4 toxicities were neutropenia (31 %), diarrhea (20.8 %), and anorexia (16.4 %). There were no deaths due to toxicity. CONCLUSIONS High-dose FOLFIRI combined with cetuximab yielded high response rates and enabled complete resection of class II hepatic metastases in most patients. It seemed to be well-tolerated among healthy selected patients thanks to irinotecan dose adaptation according to UGT1A1 pharmacogenomics status. This intensified chemotherapy regimen needs to be confirmed in a randomized, phase III study.
Collapse
Affiliation(s)
- Jean Marc Phelip
- Department of Gastroenterology and Digestive Oncology, LINA EA4624 Jean Monet University, University Hospital of Saint Etienne, 42055, Saint Etienne Cedex 2, France.
| | | | | | | | | | - Xavier Roblin
- Department of Gastroenterology and Digestive Oncology, LINA EA4624 Jean Monet University, University Hospital of Saint Etienne, 42055, Saint Etienne Cedex 2, France
| | - Denis Pezet
- University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | | | - Emmanuel Buc
- University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | | |
Collapse
|
28
|
Aparicio T, Lavau-Denes S, Phelip JM, Maillard E, Jouve JL, Gargot D, Gasmi M, Locher C, Adhoute X, Michel P, Khemissa F, Lecomte T, Provençal J, Breysacher G, Legoux JL, Lepère C, Charneau J, Cretin J, Chone L, Azzedine A, Bouché O, Sobhani I, Bedenne L, Mitry E. Randomized phase III trial in elderly patients comparing LV5FU2 with or without irinotecan for first-line treatment of metastatic colorectal cancer (FFCD 2001-02). Ann Oncol 2015; 27:121-7. [PMID: 26487578 DOI: 10.1093/annonc/mdv491] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 07/27/2015] [Accepted: 10/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Metastatic colorectal cancer (mCRC) frequently occurs in elderly patients. However, data from a geriatric tailored randomized trial about tolerance to and the efficacy of doublet chemotherapy (CT) with irinotecan in the elderly are lacking. The benefit of first-line CT intensification remains an issue in elderly patients. PATIENTS AND METHODS Elderly patients (75+) with previously untreated mCRC were randomly assigned in a 2 × 2 factorial design (four arms) to receive 5-FU (5-fluorouracil)-based CT, either alone (FU: LV5FU2 or simplified LV5FU2) or in combination with irinotecan [IRI: LV5FU2-irinotecan or simplified LV5FU2-irinotecan (FOLFIRI)]. The CLASSIC arm was defined as LV5FU2 or LV5FU2-irinotecan and the SIMPLIFIED arm as simplified LV5FU2 or FOLFIRI. The primary end point was progression-free survival (PFS). Secondary end points were overall survival (OS), safety and objective response rate (ORR). RESULTS From June 2003 to May 2010, 71 patients were randomly assigned to LV5FU2, 71 to simplified LV5FU2, 70 to LV5FU2-irinotecan and 70 to FOLFIRI. The median age was 80 years (range 75-92 years). No significant difference was observed for the median PFS: FU 5.2 months versus IRI 7.3 months, hazard ratio (HR) = 0.84 (0.66-1.07), P = 0.15 and CLASSIC 6.5 months versus SIMPLIFIED 6.0 months, HR = 0.85 (0.67-1.09), P = 0.19. The ORR was superior in IRI (P = 0.0003): FU 21.1% versus IRI 41.7% and in CLASSIC (P = 0.04): CLASSIC 37.1% versus SIMPLIFIED 25.6%. Median OS was 14.2 months in FU versus 13.3 months in IRI, HR = 0.96 (0.75-1.24) and 15.2 months in CLASSIC versus 11.4 months in SIMPLIFIED, HR = 0.71 (0.55-0.92). More patients presented grade 3-4 toxicities in IRI (52.2% versus 76.3%). CONCLUSION In this elderly population, adding irinotecan to an infusional 5-FU-based CT did not significantly increase either PFS or OS. Classic LV5FU2 was associated with an improved OS compared with simplified LV5FU2. CLINICALTRIALSGOV NCT00303771.
Collapse
Affiliation(s)
- T Aparicio
- Department of Gastroenterology, CHU Avicenne, APHP and University Paris 13, Sorbonne Paris Cité, Bobigny
| | | | - J M Phelip
- Department of Gastroenterology, CHU Saint Etienne-Hôpital Nord, Saint Priest en Jarez
| | - E Maillard
- FFCD Data Center, Fédération Francophone de Cancérologie Digestive, Dijon
| | - J L Jouve
- Department of Gastroenterology, CHU Le Bocage, Dijon
| | - D Gargot
- Department of Gastroenterology, CH Blois, Blois
| | - M Gasmi
- Department of Gastroenterology, CHU Hôpital Nord, Marseille
| | - C Locher
- Department of Gastroenterology, CH Meaux, Meaux
| | - X Adhoute
- Department of Gastroenterology, CHU Haut Lévèque, Pessac
| | - P Michel
- Department of Gastroenterology, CHU Charles Nicolle, Rouen
| | - F Khemissa
- Department of Gastroenterology, CH Saint Jean, Perpignan
| | - T Lecomte
- Department of Gastroenterology, CHU Trousseau, Tours
| | - J Provençal
- Department of Oncology, CH Chambery, Chambery
| | - G Breysacher
- Department of Gastroenterology, CH Pasteur, Colmar
| | - J L Legoux
- Department of Gastroenterology, CH de la Source, Orléans
| | - C Lepère
- Department of Digestive Oncology, CHU Georges Pompidou, APHP, Paris
| | - J Charneau
- Department of Gastroenterology, CH Duchenne, Boulogne sur Mer
| | - J Cretin
- Department of Oncology, Clinique Bonnefon, Alès
| | - L Chone
- Department of Gastroenterology, CHU Nancy, Vandoeuvre-les-Nancy
| | - A Azzedine
- Department of Gastroenterology, CH Avignon, Avignon
| | - O Bouché
- Department of Gastroenterology, CHU Robert Debré, Reims
| | - I Sobhani
- Department of Gastroenterology, CHU Henri Mondor, APHP, Créteil
| | - L Bedenne
- FFCD Data Center, Fédération Francophone de Cancérologie Digestive, Dijon Department of Gastroenterology, CHU Le Bocage, Dijon
| | - E Mitry
- Department of Oncology, Institut Curie, Saint-Cloud University Versailles-St Quentin, St Quentin, France
| | | |
Collapse
|
29
|
Roblin X, Marotte H, Leclerc M, Del Tedesco E, Phelip JM, Peyrin-Biroulet L, Paul S. Combination of C-reactive protein, infliximab trough levels, and stable but not transient antibodies to infliximab are associated with loss of response to infliximab in inflammatory bowel disease. J Crohns Colitis 2015; 9:525-31. [PMID: 25895875 DOI: 10.1093/ecco-jcc/jjv061] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Antibodies to infliximab [ATI] and trough levels to infliximab [TRI] are associated with loss of response in inflammatory bowel diseases [IBD]. The best way to predict loss of response [LOR] to infliximab [IFX] is unknown. METHODS We conducted a prospective observational cohort study enrolling all IBD patients who were in clinical remission at Week 14 after IFX treatment initiation. TRI, ATI and C-reactive protein [CRP] level were measured at Week 22 [T1] and thereafter at every other IFX infusion. Loss of clinical response was defined by a flare requiring therapeutic change [IFX dose intensification, initiation of another drug class, and/or surgery]. RESULTS A total of 93 patients [59 Crohn's disease, mean duration of follow-up 17.2 months] were included; 32 patients [34.4%] lost clinical response during follow-up. Cumulative probability of LOR was 50% at 20 months. Mean TRI at T1 was significantly lower in IBD patients with stable ATI as compared with those with transient ATI or without ATI [0.052, 3.34 ,and 4.29 µg/ml, respectively; p = 0.001 between no ATI vs stable ATI, and p = 0.005 between stable and transient ATI] [p = 0.0001]. Three independent factors were predictive of LOR after Cox proportional hazards modelling: TRI > 5.5 µg/ml (hazard ratio [HR]: 0.21; 95% confidence interval [CI]: 0.05-0.89;p = 0.034) at T1, CRP > 5mg/l [HR: 2.5; 95% CI: 1.16-5.26; p = 0.019] at T1, and stable ATI defined by two consecutive ATI > 20ng/ml [HR: 3.77; 95% CI: 1.45-10.0; p = 0.007]. Transient ATI did not influence LOR. CONCLUSIONS LOR can be predicted based on a combination of CRP, TRI and stable ATI with a high degree of accuracy.
Collapse
Affiliation(s)
- X Roblin
- Department of Gastroenterology, F-42055, CHU Saint Etienne, France
| | - H Marotte
- Department of Rheumatology, F-42055, CHU Saint Etienne, France
| | - M Leclerc
- Department of Gastroenterology, F-42055, CHU Saint Etienne, France
| | - E Del Tedesco
- Department of Gastroenterology, F-42055, CHU Saint Etienne, France
| | - J M Phelip
- Department of Gastroenterology, F-42055, CHU Saint Etienne, France
| | - L Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Université de Lorraine, Nancy, France
| | - S Paul
- Department of Immunology, F-42055, CHU Saint Etienne, France
| |
Collapse
|
30
|
Adenis A, Dourthe LM, Mineur L, Tougeron D, Tournigand C, Etienne PL, Paule B, Laplaige P, Tresch E, Morère JF, Hollebecque A, Ferru A, Desseigne F, Malka D, Michel P, Arvis P, Clisant S, Phelip JM, De La Fouchardiere C, André T. Regorafenib (REG) in the real-life setting: First results from a large French compassionate-use program in patients (pts) with previously treated metastatic colorectal cancer (mCRC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e14599] [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)
- Antoine Adenis
- Medical Oncology Dpt, Centre Oscar Lambret, Lille, France
| | | | - Laurent Mineur
- Radiotherapy and Oncology GI and Liver Unit, Institut Sainte-Catherine, Avignon, France
| | - David Tougeron
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | | | | | | | | | | | | | | | - Aurelie Ferru
- Department of Oncology, Poitiers University Hospital, Poitiers, France
| | | | | | - Pierre Michel
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
| | | | | | | | | | | |
Collapse
|
31
|
Roblin X, Marotte H, Rinaudo M, Del Tedesco E, Moreau A, Phelip JM, Genin C, Peyrin-Biroulet L, Paul S. Association between pharmacokinetics of adalimumab and mucosal healing in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2014; 12:80-84.e2. [PMID: 23891927 DOI: 10.1016/j.cgh.2013.07.010] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/10/2013] [Accepted: 07/05/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Little is known about the association between pharmacokinetic features of adalimumab and mucosal healing in patients with inflammatory bowel disease (IBD). METHODS We conducted a cross-sectional study of 40 patients with Crohn's disease (CD) or ulcerative colitis (UC) who received adalimumab maintenance therapy and underwent endoscopic evaluation of disease activity and pharmacokinetic analysis (measurements of trough levels and antibodies against adalimumab). Patients in clinical remission were identified based on CD activity index scores less than 150 or Mayo scores less than 3 (for those with UC). Patients with mucosal healing were identified based on Mayo endoscopic scores less than 2 (for UC) or the disappearance of all ulcerations (for CD). RESULTS The median trough level of adalimumab was higher in patients in clinical remission (6.02 μg/mL) than in patients with active disease (3.2 μg/mL; P = .012). Trough levels of adalimumab were also higher in patients with mucosal healing (6.5 μg/mL) than in patients without (4.2 μg/mL; P < .005). These results did not vary with type of IBD. On multivariate analysis, trough levels of adalimumab (relative risk, 0.62; 95% confidence interval, 0.40-0.94; P = .026) and duration of adalimumab treatment (relative risk, 0.82; 95% confidence interval, 0.68-0.97; P = .026) were associated independently with healing mucosa. An absence of mucosal healing was associated with trough levels of adalimumab less than 4.9 μg/mL (likelihood ratio, 4.3; sensitivity, 66%; specificity, 85%). CONCLUSIONS Trough levels of adalimumab are significantly higher in IBD patients who are in clinical remission and in those with mucosal healing. Detection of antibodies against adalimumab predicts a lack of mucosal healing.
Collapse
Affiliation(s)
- Xavier Roblin
- Service de Gastrologie-Entérologie-Hépatologie, University Hospital de Saint-Etienne, France.
| | - Hubert Marotte
- Service de Rhumatologie, University Hospital de Saint-Etienne, France
| | - Melanie Rinaudo
- Laboratoire d'Immunologie et d'Immunomonitoring, University Hospital de Saint-Etienne, France
| | - Emilie Del Tedesco
- Service de Gastrologie-Entérologie-Hépatologie, University Hospital de Saint-Etienne, France
| | - Amelie Moreau
- Service de Gastrologie-Entérologie-Hépatologie, University Hospital de Saint-Etienne, France
| | - Jean Marc Phelip
- Service de Gastrologie-Entérologie-Hépatologie, University Hospital de Saint-Etienne, France
| | - Christian Genin
- Laboratoire d'Immunologie et d'Immunomonitoring, University Hospital de Saint-Etienne, France
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Henri Poincaré University, Nancy 1, France
| | - Stephane Paul
- Service de Gastrologie-Entérologie-Hépatologie, University Hospital de Saint-Etienne, France
| |
Collapse
|
32
|
Phelip JM, Bageacu S, Baconnier M, Barabino G, Del Tedesco E, Benhamou PY, Roblin X. Comparison of adiponectin concentration between pancreatic cancer and colorectal cancer. J Gastrointest Oncol 2012; 2:232-9. [PMID: 22811857 DOI: 10.3978/j.issn.2078-6891.2011.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 07/26/2011] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Adiponectin (ADP) is an adipocytokine secreted by the adipose tissue which can be a useful marker in oncogenesis. Preliminary studies suggest that adiponectin rates differ according to the type of cancer. AIM OF STUDY Compare ADP plasma levels in pancreatic cancer (PC) and colorectal cancer (CRC) in a prospective monocentric study. PATIENTS AND METHODS The study included all the incident cases of PC gathered from a university hospital in France from January 2006 till September 2007. A control population of incident cases of colorectal cancer (CRC), matching on age, gender, and tumor staging was set in the same period. In addition to demographic data, the other parameters analyzed were: ADP rate, insulinoresistance (Homa-test), presence of a dysmetabolic syndrome, evolution of weight and data concerning the tumor (staging, tumor markers: ACE, CA19.9). RESULTS 33 CRC and 53 PC were analyzed. Type 2 diabetes was found in 18.2% of the CRC cases and 39.6% of the PC (p = 0.037). The mean ADP level was significantly higher in PC versus CRC (20.9 microgram/l versus 15.9 microgram/l; p = 0.03). In multivariate analysis , after adjusting for gender, age, bilirubinemia and weigth loss, the variables independently associated with a high level of ADP (> 10 microG/L) were type 2 diabetes (OR = 0.05, p = 0.01), insulinoresistance (OR = 0.42, p = 0.05) and PC (OR = 12.03, p = 0.047). CONCLUSION ADP concentration is higher in PC patients than in CRC patients. ADP concentration > 10 microgram/l was independently associated with pancreatic cancer. Our data confirm that adiponectin rates differ strongly according to the type of cancer.
Collapse
|
33
|
Affiliation(s)
- Gabriele Barabino
- Digestive Surgery Unit, University Hospital CHU Nord, Saint Etienne, France.
| | | | | | | | | | | |
Collapse
|
34
|
Bageacu S, Coatmeur O, Lemaitre JP, Lointier P, Del Tedesco E, Phelip JM, Roblin X. Appendicectomy as a potential therapy for refractory ulcerative proctitis. Aliment Pharmacol Ther 2011; 34:257-8. [PMID: 21679209 DOI: 10.1111/j.1365-2036.2011.04705.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
35
|
Roblin X, Phelip JM. Biological plausibility between proton pump inhibitory therapy and hip fracture: hyperhomocysteinemia can be the link. Am J Gastroenterol 2009; 104:1052. [PMID: 19240711 DOI: 10.1038/ajg.2008.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
36
|
Roblin X, Phelip JM. Risks of combining immunosuppressive and biological treatments in inflammatory bowel disease. Arch Intern Med 2008; 168:667-668. [PMID: 18362263 DOI: 10.1001/archinte.168.6.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
37
|
Phelip JM, Ducros V, Faucheron JL, Flourie B, Roblin X. Association of hyperhomocysteinemia and folate deficiency with colon tumors in patients with inflammatory bowel disease. Inflamm Bowel Dis 2008; 14:242-8. [PMID: 17941074 DOI: 10.1002/ibd.20309] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Folate deficiency associated with hyperhomocysteinemia might increase the risk of developing colorectal cancer. The aim of this study was to evaluate factors associated with colonic carcinogenesis, in particular, folate and homocysteinemia levels, in a cross-sectional study of patients with inflammatory bowel disease (IBD). METHODS IBD patients with carcinogenic lesions discovered during colonoscopy [dysplasia-associated lesion or masses (DALM), colorectal cancer] were included and compared with the whole population of IBD patients with a normal colonoscopy performed during the same period. The following parameters were collected at the time of colonoscopy: age, sex, type, duration, activity, and extent of the disease, treatment, smoking status, and vitamin B12, folate, and homocysteinemia levels. Univariate and multivariate analyses were performed after adjusting for the main parameters. RESULTS One hundred and fourteen patients [41 with ulcerative colitis (UC), 73 with Crohn's disease (CD)] were included. Twenty-six carcinogenic lesions were isolated: 18 DALM (7 high-grade and 11 low-grade dysplasia) and 8 colorectal cancers. In univariate analysis, the factors associated with carcinogenesis were: active smoking (P = 0.03), folate level < 145 pmol/L (P = 0.02), hyperhomocysteinemia > 15 micromol/L (P = 0.003), duration of disease > 10 years (P = 0.006), and UC (P = 0.02). In multivariate analysis, patients with hyperhomocysteinemia associated with folate deficiency had 17 times as many carcinogenic lesions as patients with normal homocysteinemia whatever the folate status and duration of the disease (P = 0.01). Patients with hyperhomocysteinemia without folate deficiency had 2.5 times as many carcinogenic lesions as patients with normal homocysteinemia (P = 0.08). CONCLUSIONS Our data suggest that in IBD patients with normal homocysteinemia, the increase in carcinogenic risk is negligible. Conversely, in patients with hyperhomocysteinemia, folate deficiency may be associated with increased colorectal carcinogenesis in IBD patients.
Collapse
Affiliation(s)
- Jean Marc Phelip
- Department of Gastroenterology, University Hospital of Grenoble, France.
| | | | | | | | | |
Collapse
|
38
|
Phelip JM, Sturm N, Roblin X, Baconnier M, Rebischung C, Chevallier C, Zarski JP. [Osteosarcoma: a rare cause of primary liver tumor]. ACTA ACUST UNITED AC 2008; 31:836-7. [PMID: 18166862 DOI: 10.1016/s0399-8320(07)73974-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
39
|
Abstract
BACKGROUND A high prevalence of osteoporosis is observed in Crohn's disease. Recent data have shown that homocysteinaemia is an important risk factor in low-bone mineralization and fracture. AIM To look for an association between homocysteinaemia and low-bone mineralization in Crohn's disease patients. PATIENTS AND METHODS Ninety-two consecutive patients (sex ratio M/F 0.87; mean age: 36.6 +/- 13.2 years) were recruited between 2003 and 2005. Bone densitometry was performed on inclusion. The following parameters were analysed: age, sex, Crohn's Disease Activity Index, duration and extent of Crohn's disease, smoking status, corticosteroid treatment, immunosuppressive drugs, plasma homocysteine, folate and vitamin B12 concentration. RESULTS The prevalence of a high homocysteine level (>15 micromol/L) was 60%. Osteoporosis and low-bone mineralization observed in 26 (28%), and 60 (65%) patients, respectively. On a multivariate analysis, associated factors for osteoporosis and low-bone mineralization were respectively: hyperhomocysteinaemia (OR: 61.4; CI: 95: 23-250; P < 0.001), and ileal Crohn's disease [OR: 13.8; CI: 95: 2.5-150; P = 0.036] for osteoporosis and hyperhomocysteinaemia [OR: 63.7; CI: 95: 8.5-250; P < 0.001] and disease duration of at least 5 years [OR: 11.4; CI: 95: 1.31-99; P = 0.039] for low-bone mineralization. Results were similar whichever site osteoporosis was detected. CONCLUSION Hyperhomocysteinaemia was observed in 60% of our Crohn's disease patients and was strongly associated with low-bone mineralization and osteoporosis (OR: 61.4).
Collapse
Affiliation(s)
- X Roblin
- Department of Gastroenterology and Liver Diseases, CHU de Grenoble, Grenoble, France.
| | | | | | | | | |
Collapse
|
40
|
|
41
|
Roblin X, Germain E, Phelip JM, Ducros V, Pofelski J, Heluwaert F, Oltean P, Faucheron JL, Bonaz B. Hyperhomocystéinémie et facteurs associés au cours des MICI : étude prospective chez 81 patients. Rev Med Interne 2006; 27:106-10. [PMID: 16376461 DOI: 10.1016/j.revmed.2005.11.005] [Citation(s) in RCA: 9] [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: 06/02/2005] [Accepted: 11/04/2005] [Indexed: 12/31/2022]
Abstract
BACKGROUND A high prevalence (52%) of hyperhomocysteinemia is observed in Crohn disease (CD), however it is not well documented in ulcerative colitis (UC). Furthermore, in the different works studying hyperhomocysteinemia the associated factors are different. AIM Prospective evaluation of hyperhomocysteinemia in inflammatory bowel disease (IBD) patients, of the risk factors and the determination of a potential risk of colorectal carcinoma in case of hyperhomocysteinemia. PATIENTS AND METHODS IBD patients followed in our department were prospectively recruited between November 2003-September 2004. To be included patients should have passed a coloscopy in the two years. Patients with kidney failure or drugs supposed, to interfere with homocystéine metabolism (folates, vitamin B12, methotrexate) were excluded from the study. The following parameters were analysed: age, sex, clinical activity indexes (CDAI for Crohn disease and CAI for ulcerative colitis), length-extent and type of the disease (CD or UC), smoking, plasma homocystein concentration, folates and vitamin B12. RESULTS Eighty-one patients (60 CD, 21 UC, mean age 43.8 +/- 17.3) were included, 30 had an active disease at inclusion and 16 were smokers. The prevalence of high homocystein concentration was 55.6%. In univariate analysis a low rate of folates was the only risk factor for a high homocystein concentration (74 vs. 52.8%; P = 0.018). Smoking was almost an associated factor. In multivariate analysis, a low rate of folate was the only risk factor of hyperhomocysteinemia, OR = 3.59 [1.27-10.17]. Five endoscopic lesions considered as precancerous were described; these patients had all a hyperhomocysteinemia. CONCLUSION The prevalence of hyperhomocysteinemia is high in UC and in CD. A low folate rate is the only risk factor observed in our study. There is a possible link between colorectal cancer and hyperhomocysteinemia. A high Plasma homocystein concentration must be search in inflammatory bowel disease patients and a substitutive treatment of folates and vitamin B12 is necessary in case of hyperhomocysteinemia.
Collapse
Affiliation(s)
- X Roblin
- Département d'hépatogastroentérologie, département de biologie appliquée, CHU de Grenoble, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Phelip JM, Grosclaude P, Launoy G, Colonna M, Danzon A, Velten M, Tretarre B, Bouvier AM, Faivre J. Are there regional differences in the management of colon cancer in France? Eur J Cancer Prev 2005; 14:31-7. [PMID: 15677893 DOI: 10.1097/00008469-200502000-00005] [Citation(s) in RCA: 9] [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: 10/25/2022]
Abstract
The purpose of this study was to assess possible regional disparities in the management of colon cancer in France. In 1995, 1605 patients with a colon cancer in eight areas covered by a population-based cancer registry were studied. Pre-therapeutic work-up, stage at diagnosis and therapeutic modalities were assessed. There were no differences between areas concerning the resection or the stage at diagnosis. The proportion of patients with a colonoscopy alone varied between 42.7 and 70.4% (P<0.001). The use of both colonoscopy and barium enema was even more heterogeneous (extremes from 11.7 to 40.2%, P<0.001). There were significant differences in the performance of abdominal computed tomography and tumour markers. The number of examined lymph nodes was lower than the recommendation in 47.3% of cases with extremes ranging from 36.9 to 60.9%. Adjuvant chemotherapy was performed on average in 49.4% of cases in stage II (in which it is not recommended) with extremes from 18.8 to 72.5% (P<0.001) and in 79.6% of the cases in stage III (in which it is recommended) with extremes from 63.6 to 94.4% (P=0.08). In conclusion, these results should alert practitioners and health care authorities in order to homogenize practices.
Collapse
Affiliation(s)
- J M Phelip
- Côte-d'Or and Saône-et-Loire Cancer Registry, CRI INSERM 95 05 et DRED 1789 Faculté de médecine, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Lepage C, Bouvier AM, Phelip JM, Hatem C, Vernet C, Faivre J. Incidence and management of malignant digestive endocrine tumours in a well defined French population. Gut 2004; 53:549-53. [PMID: 15016750 PMCID: PMC1774002 DOI: 10.1136/gut.2003.026401] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2003] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Little is known about the epidemiology of malignant digestive endocrine tumours. The aim of this study was to report on their incidence and management in a well defined population. METHODS Data were obtained from the population based Digestive Cancer Registry of Burgundy (France) over a 24 year period. Incidence rates were calculated by sex, age groups, and period of diagnosis. Treatment and stage at diagnosis were also investigated. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed. RESULTS Between 1976 and 1999, 229 cases were recorded. Age standardised incidence rates were 0.76/100,000 for men and 0.50/100,000 for women. They increased over time in both sexes. The resectability rate was 74.1%. Among recorded cases, 26.6% did not extend beyond the organ, 20% had lymph node metastases, and 53.3% had visceral metastases or were unresectable. There was no improvement in the resection rate or in the stage at diagnosis over the study period. The overall relative survival rate was 66.9% at one year, 50.4% at five years, and 40.6% at 10 years. Stage at diagnosis, age at diagnosis, and subsite were independent significant prognostic factors. CONCLUSIONS Although their incidence is increasing, malignant digestive endocrine tumours remain a rare cancer, representing 1% of digestive cancers. Stage at diagnosis and prognosis at a population level are worse than those reported in hospital series. In the short term, new therapeutic possibilities represent the best way to improve their prognosis.
Collapse
Affiliation(s)
- C Lepage
- Faculté de Médecine, Registre Bourguignon des Cancers Digestifs, INSERM EPI 0106, Dijon, France.
| | | | | | | | | | | |
Collapse
|
44
|
Blanc P, Phelip JM, Bertolino JG, Atger J, Roblin X. L’estomac pastèque : une cause rare d’anémie ferriprive, de traitement chirurgical ; un nouveau cas et revue de la littérature. ACTA ACUST UNITED AC 2003; 128:462-4. [PMID: 14559197 DOI: 10.1016/s0003-3944(03)00175-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors report a new case of water-melon stomach, without portal hypertension, and responsible for a iron deficiency anemia cured by antrectomy. Water-melon stomach is a particular form of gastric antral vascular ectasia, characterized by a specific and striking endoscopic aspect. The diagnostic, histologic, pathogenic and therapeutic aspects are reviewed.
Collapse
Affiliation(s)
- P Blanc
- Service chirurgie viscérale, CH Gap, 1, place Auguste-Muret, 05000 Gap, France.
| | | | | | | | | |
Collapse
|
45
|
Roblin X, Phelip JM, Milionis HJ. Unexplained hypertransaminasaemia: a clue to the diagnosis of Addison's disease. Eur J Gastroenterol Hepatol 2003; 15:929; author reply 929-30. [PMID: 12867806 DOI: 10.1097/00042737-200308000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
46
|
Faivre-Finn C, Bouvier-Benhamiche AM, Phelip JM, Manfredi S, Dancourt V, Faivre J. Colon cancer in France: evidence for improvement in management and survival. Gut 2002; 51:60-4. [PMID: 12077093 PMCID: PMC1773269 DOI: 10.1136/gut.51.1.60] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2001] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cancer registries recording all cases diagnosed in a well defined population represent the only way to assess real changes in the management of colon cancer at the population level. AIMS To determine trends over a 23 year period in treatment, stage at diagnosis, and prognosis of colon cancer in the Côte-d'Or region, France. PATIENTS A total of 3389 patients with colon cancer diagnosed between 1976 and 1998. METHODS Time trends in clinical presentation, surgical treatment, chemotherapy treatment, stage at diagnosis, postoperative mortality, and survival were studied. A non-conditional logistic regression was performed to obtain an odds ratio for each period adjusted for the other variables. To estimate the independent effect of the period on prognosis, a relative survival analysis was performed. RESULTS Between 1976 and 1991, the resection rate increased from 69.3% to 91.9% and then remained stable. This increase was particularly marked in the older age group (56.4% to 90.5%). The proportion of stage III patients treated with adjuvant chemotherapy rose from 4.1% for the 1989-1990 period to 45.7% for the 1997-1998 period. Over the 23 years of the study the proportion of stage I and II patients increased from 39.6% to 56.6%, associated with a corresponding decrease in the proportion of patients with advanced stages. Postoperative mortality decreased from 19.5% to 7.3%. This led to an improvement in five year relative survival (from 33.0% for the 1976-1979 period to 55.3% for the 1992-1995 period). CONCLUSIONS Advances in the management of colon cancer have resulted in improving the prognosis of this disease. However, progress is still possible, particularly in the older age group.
Collapse
Affiliation(s)
- C Faivre-Finn
- Registre Bourguignon des Cancers Digestifs (INSERM EPI 106), Faculté de Medecine, BP 87900, 21079 Dijon, France.
| | | | | | | | | | | |
Collapse
|
47
|
Lejeune C, Prost P, Michiels C, Roullaud-Guenfoudi MP, Phelip JM, Martin L, Rassiat E, Faivre J. [Disposable versus reusable biopsy forceps. A prospective cost analysis in the gastrointestinal endoscopy unit of the Dijon University Hospital]. Gastroenterol Clin Biol 2001; 25:669-73. [PMID: 11673734] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
AIMS The goal of this study was to compare the cost of a biopsy session performed with a disposable and a reusable endoscopic biopsy forceps. MATERIAL AND METHODS Over a 10-month period, 15 new reusable forceps (10 gastric and 5 colonic) were prospectively tracked. A biopsy session performed with a reusable forceps included its current purchase price, the sterilization cost and the number of uses. A biopsy session performed with a disposable forceps was calculated with its current purchase price and its incineration cost. RESULTS At the end of the study, only one reusable forceps had broken and the number of uses was 65. The cost of a biopsy session performed with a gastric reusable forceps was euro 7.52 (including euro 1.92 of sterilization cost) and euro 8.67 for a reusable colonic forceps (with the same sterilization cost). The cost of a biopsy session performed with a gastric or a colonic disposable forceps was euro 11.98. From 44 uses for a colonic forceps and 37 uses for a gastric one, a biopsy session performed with a reusable forceps was already cheaper. CONCLUSION In this study, a biopsy session performed with a reusable forceps was less expensive than with a disposable one. However, the extra cost generated by the disposable forceps may be offset by an easier inventory control and the reduction of the cross contamination risk.
Collapse
Affiliation(s)
- C Lejeune
- Registre Bourguignon des Cancers Digestifs (INSERM-InVS 4 T006 C), Faculté de Médecine, Dijon
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Cancer prevalence is a crucial indicator that allows the magnitude of the problem of colorectal cancer to be monitored. Population-based cancer registries with long-standing activity are the most appropriate tools for providing prevalence data. All colorectal cases registered between 1976 and 1995 in the Côte d'Or Cancer Registry have been considered in this study. Total prevalence (20 years) was the number of patients with a previously diagnosed colorectal cancer, alive on 31 December 1995. Cumulative recurrence rates up to 5 years after diagnosis were calculated and applied to the number of prevalent cases to estimate the number of recurrences by one-year intervals up to 5 years. The overall age-standardized prevalence rate was 170.8/100000, which yielded an estimated 185857 French people alive with a history of colorectal cancer. The 5-year prevalence rates were 149.4/100000, which represented 46.4% of prevalent cases. Five-year prevalence rates regularly increased with periods of diagnosis. These results represent useful indicators for monitoring the colorectal cancer problem and for health care planning.
Collapse
Affiliation(s)
- A M Benhamiche-Bouvier
- Registre Bourguignon des Cancers Digestifs (INSERM CRI 9505), Faculté de Médecine, DIJON, France.
| | | | | | | | | |
Collapse
|
49
|
Tazi MA, Faivre J, Lejeune C, Bolard P, Phelip JM, Benhamiche AM. Interval cancers in a community-based programme of colorectal cancer screening with faecal occult blood test. Eur J Cancer Prev 1999; 8:131-5. [PMID: 10335459 DOI: 10.1097/00008469-199904000-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Interval cancers represent the major limitation of screening for colorectal cancer with the faecal occult blood test. The aim of this study was to describe the characteristics of interval cancers and the sensitivity of the screening programme in a well-defined French population. During five screening rounds, 398 cancers were diagnosed in those of the population having performed at least one screening test; 57.8% of them were interval cancers. The proportion of interval cancers was higher among cancers of the rectal ampulla (72.2%) than among cancers of other sites (52.9%) (P < 0.001). The proportion of TNM stage I and II were higher among screen-detected cancers (73.8%) than among interval cancers (57.4%). The overall sensitivity of the screening programme was 62.9% within 1 year, and 48.7% within 2 years. An improvement in the sensitivity of the faecal occult blood test for colorectal cancer screening is needed, without an unacceptable loss of specificity.
Collapse
Affiliation(s)
- M A Tazi
- Registre Bourguignon des Cancers Digestifs, Dijon, France
| | | | | | | | | | | |
Collapse
|
50
|
Barraya R, Benhamiche AM, Rassiat E, Phelip JM, Jouve JL, Faivre J. [Incidence of treatment modalities for cancer of the small intestine in Burgundy (France)]. Gastroenterol Clin Biol 1999; 23:215-20. [PMID: 10353016] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AIMS To determine the epidemiological characteristics and management of cancers of the small bowel, on a population-based survey. METHODS The registry of digestive tumors of Burgundy recorded all new cases of cancers of the small intestine in the departments of Côte d'Or and Saône et Loire (1,052,000 inhabitants). RESULTS Two hundred and ten new cases of malignant tumors of the small intestine were recorded between 1976 and 1995 including 4 main histological types: adenocarcinomas (39.5%), carcinoids (26.2%), lymphomas (18.6%) and sarcomas (10.5%). Age-standardized incidence rates for males and females were respectively 8.8 and 5.6 per 1,000,000 inhabitants. There was evidence of lymph node invasion in 29.5% and visceral metastasis in 31.4%. Treatment was primarily surgical (90.5%), with a post-operative death rate of 17.1%. The rate of curative surgery remained constant over time, averaging 58.6%, 20% of the patients underwent chemotherapy, with a high proportion of lymphomas, often in association with surgery. The relative survival rates at 1, 3 and 5 years were 51.2, 38.3 and 32.7%, respectively. The multivariate analysis showed that survival was linked to age, and strongly to histological type and stage of diagnosis. CONCLUSION Cancers of the small intestine are an heterogeneous group of rare tumors, often diagnosed at advanced stage. No significant improvement has been achieved in their management over the past 20 years.
Collapse
Affiliation(s)
- R Barraya
- Registre Bourguignon des Cancers Digestifs (INSERM CRI 9505 et équipe associée INSERM-DGS), Faculté de Médecine, Dijon
| | | | | | | | | | | |
Collapse
|