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Saillard C, Cuvelier S, Villaron-Goetgheluck C, Boher JM, Almeida-Lopez L, Le Corroller AG, Denis P, Rivieccio C, Calvin S, Vey N, Bannier-Braticevic C. Tripartite prehabilitation of patients with acute myeloid leukaemia and high-risk myelodysplastic syndromes during intensive chemotherapy before allogeneic haematopoietic stem cell transplantation (COHABILIT): protocol for an innovating prospective multicentre study. BMJ Open 2024; 14:e076321. [PMID: 38553062 PMCID: PMC10982723 DOI: 10.1136/bmjopen-2023-076321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Acute myeloid leukaemia (AML) and high-risk myelodysplastic syndromes (MDS) are often treated with intensive chemotherapy followed by allogeneic haematopoietic stem cell transplantation (allo-HSCT). The pretransplant treatment results in a general deterioration of the patient's health and quality of life. Furthermore, allo-HSCT can be responsible for significant toxicity with risks of graft-versus-host disease (GvHD). Developing strategies to prevent physical deconditioning, undernutrition and psychological distress could help maintain a satisfactory general state of health before transplantation and thus limit these deleterious effects. This protocol evaluates the feasibility and adherence to a personalised prehabilitation programme, which can be modulated and assisted by connected objects, provided from the diagnosis to the allo-HSCT. METHODS AND ANALYSIS This multicentre interventional study will include 50 patients treated for AML or high-risk MDS with intensive chemotherapy and eligible for allo-HSCT. The intervention consists of a coached, supervised or self-directed physical activity programme, organised during the hospitalisation phases and periods at home. At the same time, patients will receive a weekly dietary follow-up. The whole intervention is controlled and modulated through the use of a dedicated application and connected objects allowing adaptation and individualisation. The rate of participation in the prescribed physical activity sessions will assess the feasibility of this study. In addition, the evolution of physical capacities (Short Physical Performance Battery, grip and quadriceps strengths), psychosocial parameters (Functional Assessment of Cancer Therapy - Leukaemia, Functional Assessment of Cancer Therapy - Fatigue, subjective well-being, Hospital Anxiety and Depression Scale, self-efficacy, Coach-Athlete Relationship Questionnaire, interviews) and clinical status (weight, lean body mass, survival rate, number of infections, days of hospitalisation, GvHD) will be evaluated. ETHICS AND DISSEMINATION The study procedures have been approved by the National Ethics Committee (21.00223.000003). Consent is given in person by each participant. The information collected on the participants contains only a non-identifiable study identifier. The results of this protocol will be published in a scientific paper and communicated to the medical staff of the medical centre. TRIAL REGISTRATION NUMBER NCT03595787.
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Affiliation(s)
- Colombe Saillard
- Department of Haematology, Paoli-Calmettes Institute, Marseille, France
| | - Sarah Cuvelier
- Management Sport Cancer Laboratory, Aix-Marseille University, Marseille, France
| | | | - Jean-Marie Boher
- Department of Clinical Research and Innovations, Paoli-Calmettes Institute, Marseille, France
| | - Leonor Almeida-Lopez
- Department of Clinical Research and Innovations, Paoli-Calmettes Institute, Marseille, France
| | - Anne-Gaelle Le Corroller
- Economic and Social Sciences of Health and Medical Information Processing Laboratory (SESSTIM CANBIOS), National Institute of Health and Medical Research, Paris, France
| | - Pauline Denis
- Department of Sport, Paoli-Calmettes Institute, Marseille, France
| | - Céline Rivieccio
- Department of Sport, Paoli-Calmettes Institute, Marseille, France
| | - Sarah Calvin
- Management Sport Cancer Laboratory, Aix-Marseille University, Marseille, France
| | - Norbert Vey
- Department of Haematology, Paoli-Calmettes Institute, Marseille, France
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Vale CL, Fisher DJ, Godolphin PJ, Rydzewska LH, Boher JM, Burdett S, Chen YH, Clarke NW, Fizazi K, Gravis G, James ND, Liu G, Matheson D, Murphy L, Oldroyd RE, Parmar MKB, Rogozinska E, Sfumato P, Sweeney CJ, Sydes MR, Tombal B, White IR, Tierney JF. Which patients with metastatic hormone-sensitive prostate cancer benefit from docetaxel: a systematic review and meta-analysis of individual participant data from randomised trials. Lancet Oncol 2023; 24:783-797. [PMID: 37414011 DOI: 10.1016/s1470-2045(23)00230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Adding docetaxel to androgen deprivation therapy (ADT) improves survival in patients with metastatic, hormone-sensitive prostate cancer, but uncertainty remains about who benefits most. We therefore aimed to obtain up-to-date estimates of the overall effects of docetaxel and to assess whether these effects varied according to prespecified characteristics of the patients or their tumours. METHODS The STOPCAP M1 collaboration conducted a systematic review and meta-analysis of individual participant data. We searched MEDLINE (from database inception to March 31, 2022), Embase (from database inception to March 31, 2022), the Cochrane Central Register of Controlled Trials (from database inception to March 31, 2022), proceedings of relevant conferences (from Jan 1, 1990, to Dec 31, 2022), and ClinicalTrials.gov (from database inception to March 28, 2023) to identify eligible randomised trials that assessed docetaxel plus ADT compared with ADT alone in patients with metastatic, hormone-sensitive prostate cancer. Detailed and updated individual participant data were requested directly from study investigators or through relevant repositories. The primary outcome was overall survival. Secondary outcomes were progression-free survival and failure-free survival. Overall pooled effects were estimated using an adjusted, intention-to-treat, two-stage, fixed-effect meta-analysis, with one-stage and random-effects sensitivity analyses. Missing covariate values were imputed. Differences in effect by participant characteristics were estimated using adjusted two-stage, fixed-effect meta-analysis of within-trial interactions on the basis of progression-free survival to maximise power. Identified effect modifiers were also assessed on the basis of overall survival. To explore multiple subgroup interactions and derive subgroup-specific absolute treatment effects we used one-stage flexible parametric modelling and regression standardisation. We assessed the risk of bias using the Cochrane Risk of Bias 2 tool. This study is registered with PROSPERO, CRD42019140591. FINDINGS We obtained individual participant data from 2261 patients (98% of those randomised) from three eligible trials (GETUG-AFU15, CHAARTED, and STAMPEDE trials), with a median follow-up of 72 months (IQR 55-85). Individual participant data were not obtained from two additional small trials. Based on all included trials and patients, there were clear benefits of docetaxel on overall survival (hazard ratio [HR] 0·79, 95% CI 0·70 to 0·88; p<0·0001), progression-free survival (0·70, 0·63 to 0·77; p<0·0001), and failure-free survival (0·64, 0·58 to 0·71; p<0·0001), representing 5-year absolute improvements of around 9-11%. The overall risk of bias was assessed to be low, and there was no strong evidence of differences in effect between trials for all three main outcomes. The relative effect of docetaxel on progression-free survival appeared to be greater with increasing clinical T stage (pinteraction=0·0019), higher volume of metastases (pinteraction=0·020), and, to a lesser extent, synchronous diagnosis of metastatic disease (pinteraction=0·077). Taking into account the other interactions, the effect of docetaxel was independently modified by volume and clinical T stage, but not timing. There was no strong evidence that docetaxel improved absolute effects at 5 years for patients with low-volume, metachronous disease (-1%, 95% CI -15 to 12, for progression-free survival; 0%, -10 to 12, for overall survival). The largest absolute improvement at 5 years was observed for those with high-volume, clinical T stage 4 disease (27%, 95% CI 17 to 37, for progression-free survival; 35%, 24 to 47, for overall survival). INTERPRETATION The addition of docetaxel to hormone therapy is best suited to patients with poorer prognosis for metastatic, hormone-sensitive prostate cancer based on a high volume of disease and potentially the bulkiness of the primary tumour. There is no evidence of meaningful benefit for patients with metachronous, low-volume disease who should therefore be managed differently. These results will better characterise patients most and, importantly, least likely to gain benefit from docetaxel, potentially changing international practice, guiding clinical decision making, better informing treatment policy, and improving patient outcomes. FUNDING UK Medical Research Council and Prostate Cancer UK.
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Affiliation(s)
- Claire L Vale
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK.
| | - David J Fisher
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Peter J Godolphin
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Larysa H Rydzewska
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | | | - Sarah Burdett
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Yu-Hui Chen
- Department of Biostatistics and Computational Biology ECOG-ACRIN Cancer Research Group, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Noel W Clarke
- Department of Surgery and Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, Paris, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Glenn Liu
- Department of Urology, Department of Medicine, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Matheson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Laura Murphy
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Robert E Oldroyd
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Ewelina Rogozinska
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Patrick Sfumato
- Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Bertrand Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Ian R White
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Jayne F Tierney
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
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Miguet C, Jauffret C, Zemmour C, Boher JM, Sabiani L, Houvenaeghel G, Blache G, Brun C, Lambaudie E. Enhanced Recovery after Surgery and Endometrial Cancers: Results from an Initial Experience Focused on Elderly Patients. Cancers (Basel) 2023; 15:3244. [PMID: 37370854 DOI: 10.3390/cancers15123244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Endometrial cancer is the fifth most common cancer among French women and occurs most frequently in the over-70-year-old population. Recent years have seen a significant shift towards minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocols in endometrial cancer management. However, the impact of ERAS on endometrial cancer has not been well-established. We conducted a prospective observational study in a comprehensive cancer center, comparing the outcomes between endometrial cancer patients who received care in an ERAS pathway (261) and those who did not (166) between 2006 and 2020. We performed univariate and multivariate analysis. Our primary objective was to evaluate the impact of ERAS on length of hospital stay (LOS), with the secondary objectives being the determination of the rates of early discharge, post-operative morbidity, and rehospitalization. We found that patients in the ERAS group had a significantly shorter length of stay, with an average of 3.18 days compared to 4.87 days for the non-ERAS group (estimated decrease -1.69, p < 0.0001). This effect was particularly pronounced among patients over 70 years old (estimated decrease -2.06, p < 0.0001). The patients in the ERAS group also had a higher chance of early discharge (47.5% vs. 14.5% in the non-ERAS group, p < 0.0001), for which there was not a significant increase in post-operative complications. Our study suggests that ERAS protocols are beneficial for the management of endometrial cancer, particularly for older patients, and could lead to the development of ambulatory pathways.
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Affiliation(s)
- Céline Miguet
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Camille Jauffret
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Christophe Zemmour
- Biostatistics and Methodology Unit, Department of Clinical Research and Investigation, Institute Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, 13009 Marseille, France
| | - Jean-Marie Boher
- Biostatistics and Methodology Unit, Department of Clinical Research and Investigation, Institute Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, 13009 Marseille, France
| | - Laura Sabiani
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
- Inserm, CNRS, Institute Paoli-Calmettes, CRCM, Aix Marseille University, 13009 Marseille, France
| | - Guillaume Blache
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Clément Brun
- Department of Anaesthesiology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
- Inserm, CNRS, Institute Paoli-Calmettes, CRCM, Aix Marseille University, 13009 Marseille, France
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Gravis G, Marino P, Olive D, Penault-LLorca F, Delord JP, Simon C, Lamrani-Ghaouti A, Sabatier R, Ciccolini J, Boher JM. A non-inferiority randomized phase III trial of standard immunotherapy by checkpoint inhibitors vs. reduced dose intensity in responding patients with metastatic cancer: the MOIO protocol study. BMC Cancer 2023; 23:393. [PMID: 37131154 PMCID: PMC10155443 DOI: 10.1186/s12885-023-10881-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Immunotherapy (IO) has become a standard of care for treating various types of metastatic cancers and has significantly improved clinical outcome. With the exception of metastatic melanoma in complete response for which treatment can be stopped at 6 months, these treatments are currently administered until either disease progression for some IO, 2 years for others, or unacceptable toxicity. However, a growing number of studies are reporting maintenance of response despite discontinuation of therapy. There is currently no evidence of a dose effect of IO in pharmacokinetic studies. Maintaining efficacy despite a reduction in treatment intensity by decreasing the frequency of administration in patients with highly selected metastatic cancer, is the hypothesis evaluated in the MOIO study. METHOD/DESIGN This non-inferiority, randomized phase III study aims to compare the standard regimen to a 3 monthly regimen of variousIO drugs in adult patients with metastatic cancer in partial (PR) or complete response (CR) after 6 months of standard IO dosing (except melanoma in CR). This is a French national study conducted in 36 centers. The main objective is to demonstrate that the efficacy of a three-monthly administration is not unacceptably less efficacious than a standard administration. Secondary objectives are cost-effectiveness, quality of life (QOL), anxiety, fear of relapse, response rate, overall survival and toxicity. After 6 months of standard IO, patients with partial or complete response will be randomized 1:1 between standard IO or a reduced intensity dose of IO, administered every 3 months. The randomization will be stratified on therapy line,, tumor type, IO type and response status. The primary endpoint is the hazard ratio of progression-free survival. With a planned study duration of 6 years, including 36 months enrolment time, 646 patients are planned to demonstrate with a statistical level of evidence of 5% that the reduced IO regimen is non-inferior to the standard IO regimen, with a relative non-inferiority margin set at 1.3. DISCUSSION Should the hypothesis of non-inferiority with an IO reduced dose intensity be validated, alternate scheduling could preserve efficacy while being cost-effective and allowing a reduction of the toxicity, with an increase in patient's QOL. TRIAL REGISTRATION NCT05078047.
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Affiliation(s)
- Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille University, CRCM,, Marseille, France.
| | - Patricia Marino
- Institut Paoli-Calmettes SESSTIM UMR 1252, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Daniel Olive
- Institut Paoli Calmettes, Aix Marseille Université, CRCM, Inserm U1068, Marseille, France
| | - Frederique Penault-LLorca
- Centre Jean Perrin, Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire Et Stratégies Théranostiques, Clermont Ferrand, France
| | | | | | | | - Renaud Sabatier
- Institut Paoli Calmettes, Aix Marseille Université, CRCM, Inserm U1068, Marseille, France
| | | | - Jean-Marie Boher
- Department of Biostatistics and Methodology, Institut Paoli Calmettes, and Aix-Marseille University, Unité Mixte de Recherche S1252, Institut de Recherche Pour Le Développement, 13009, Marseille, France
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Tallet A, Boher JM, Tyran M, Mailleux H, Piana G, Benkreira M, Fau P, Salem N, Gonzague L, Petit C, Darréon J. Is MRI-Linac helpful in SABR treatments for liver cancer? Front Oncol 2023; 13:1130490. [PMID: 37007109 PMCID: PMC10061121 DOI: 10.3389/fonc.2023.1130490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveTo determine the MRI-Linac added value over conventional image-guided radiation therapy (IGRT) in liver tumors Stereotactic ablative radiation therapy (SABR).Materials and methodsWe retrospectively compared the Planning Target Volumes (PTVs), the spared healthy liver parenchyma volumes, the Treatment Planning System (TPS) and machine performances, and the patients’ outcomes when using either a conventional accelerator (Versa HD®, Elekta, Utrecht, NL) with Cone Beam CT as the IGRT tool or an MR-Linac system (MRIdian®, ViewRay, CA).ResultsFrom November 2014 to February 2020, 59 patients received a SABR treatment (45 and 19 patients in the Linac and MR-Linac group, respectively) for 64 primary or secondary liver tumors. The mean tumor size was superior in the MR-Linac group (37,91cc vs. 20.86cc). PTV margins led to a median 74%- and 60% increase in target volume in Linac-based and MRI-Linac-based treatments, respectively. Liver tumor boundaries were visible in 0% and 72% of the cases when using CBCT and MRI as IGRT tools, respectively. The mean prescribed dose was similar in the two patient groups. Local tumor control was 76.6%, whereas 23.4% of patients experienced local progression (24.4% and 21.1% of patients treated on the conventional Linac and the MRIdian system, respectively). SABR was well tolerated in both groups, and margins reduction and the use of gating prevented ulcerous disease occurrence.ConclusionThe use of MRI as IGRT allows for the reduction of the amount of healthy liver parenchyma irradiated without any decrease of the tumor control rate, which would be helpful for dose escalation or subsequent liver tumor irradiation if needed.
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Affiliation(s)
- Agnès Tallet
- Department of Oncology Radiation Therapy, Institut Paoli-Calmettes, Marseille, France
- Centre de Recherche en Cancérologie de Marseille, Unité Mixte de Recherche (UMR1068), Marseille, France
- *Correspondence: Agnès Tallet, ; Julien Darréon,
| | - Jean-Marie Boher
- Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France
| | - Marguerite Tyran
- Department of Oncology Radiation Therapy, Institut Paoli-Calmettes, Marseille, France
| | - Hugues Mailleux
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes, Marseille, France
| | - Mohamed Benkreira
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Pierre Fau
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
| | - Naji Salem
- Department of Oncology Radiation Therapy, Institut Paoli-Calmettes, Marseille, France
| | - Laurence Gonzague
- Department of Oncology Radiation Therapy, Institut Paoli-Calmettes, Marseille, France
| | - Claire Petit
- Department of Oncology Radiation Therapy, Institut Paoli-Calmettes, Marseille, France
| | - Julien Darréon
- Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
- *Correspondence: Agnès Tallet, ; Julien Darréon,
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Cuvelier S, Goetgheluck-Villaron C, Cohen M, Tallet A, Almeida LL, Boher JM, Jowett S, Justafré S, Dantin P, Viens P, Calvin S. Abstract P6-05-40: Aqua polo: Preliminary feasibility and efficacy study of a programme of adapted, supervised water polo to reduce fatigue and improve women’s psychological and social recovery after breast cancer treatment. A mixed-method design. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-40] [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: 03/06/2023]
Abstract
Abstract
Introduction : Physical activity has been shown to have many benefits, including reducing cancer-related fatigue (CRF) and improving psychological and physical recovery from breast cancer. Some authors have shown the benefits of aquatic practice, while others have detailed the benefits of group and supervised practice. We hypothesise that an innovative sports coaching proposal could allow a significant adherence of patients and contribute to their health improvement. The main objective is to study the feasibility of an adapted water polo programme (aqua polo) for women after breast cancer. Secondary we will analyse the effect of such a practice on patients’ recovery and to study the relationship between coaches and participants. The use of mixed methods will allow to question precisely the underlying processes. Methods and analysis : This is a prospective, non-randomised, monocentric study with a sample of 24 breast cancer patients after treatment. The intervention is a 20 week programme (1 session per week) of aqua polo in a real sports setting. The variables measured are patient participation, quality of life (QLQ BR23), CRF (R-PFS) and post-traumatic growth (PTG-I) as well as different variables to observe physical capacity (strength with dynamometer, step-test and arm amplitude). The quality of the coach-patient relationship will be evaluated (CART-Q) to explore its dynamics. Participatory observations and interviews will be carried out to report on the interactions between the coach and the participants during the sessions. Ethics and dissemination : Study procedures have been approved by the Institutional Review Board of the Institute (IPC 2019-028) and the National Ethics Committee (SI:20.01.20.54741). Consent is given in person to each participant. The information collected on the participants contain only a non-identifiable study identifier. The results of this protocol will be published in a scientific paper and communicated to the medical staff of the medical center. Trial registration number ID-RCB: 2019-A03003-54 Keywords: Quality of the relationship, Aquatic exercise, Quality of life, Sport
Citation Format: Sarah Cuvelier, Charlène Goetgheluck-Villaron, Monique Cohen, Agnès Tallet, Leonor Lopez Almeida, Jean-Marie Boher, Sophia Jowett, Sébastien Justafré, Pierre Dantin, Patrice Viens, Sarah Calvin. Aqua polo: Preliminary feasibility and efficacy study of a programme of adapted, supervised water polo to reduce fatigue and improve women’s psychological and social recovery after breast cancer treatment. A mixed-method design. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-40.
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Gravis G, Sfumato P, Ploussard G, Savoie PH, Durand M, Mathieu R, Rebillard X, Pignot G, Beauval JB, Ahallal Y, Vincendeau S, Guerin M, Boudin L, Crouzet S, Salem N, Vicier C, Boher JM, Marino P, Walz J. Safety and quality of life analyses of apalutamide plus active surveillance vs active surveillance alone for low, intermediate risk prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.352] [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: 03/16/2023] Open
Abstract
352 Background: Active surveillance (AS) is a standard of care for low-risk prostate cancer (PC). However, 20 to 50% of patients (pts) will ultimately require a local treatment following AS. The aim of this study is to assess whether apalutamide could decrease the proportion of pts requiring local treatment within 3 years. We report the 1-year safety and quality of life analyses. Methods: multicentric phase II study conducted in patients with low to intermediate risk PC randomized between apalutamide 6 months (240 mg/d) with AS vs AS alone. Toxicity was evaluated each month during treatment and every 3 months thereafter for both arms. Quality of life (SF12) was assessed at baseline, 6 and 12 months post enrollment. Results: Patients were randomized: 51 in apalutamide and 40 in AS arm. Only 50 pts received apalutamide (one refusal). Median age was 64 yrs (47-76), median PSA 5.9 (1.5-21.5), only 2 pts had Gleason ISUP 2, 14% had >T2, the median cancer positive cores was 14.3%. The median testosterone level was 4.7 mg/l. Only 88 were available for safety analyses (48 in apalutamide arm). Maximal grades of reported adverse events during the first year were for the experimental arm: 25%, 56%, 19% and control arm: 20%, 15% 12.5% for G1, G2, G3 respectively. In the experimental arm, grade 1/2 related adverse events (AE) were cutaneous (25%) and HTA (15%), nausea 15%, diarrhea 10%, arthralgia or musculoskeletal event 17% and anemia 6%. Attention disorders were observed in 6% and hypothyroidism in 8%. The most frequent sexual dysfunctions were erectile dysfunction observed in 29% (7.5% in AS arm), gynecomastia in 60%, loss of libido in 21%, and nipple pain in 33%. One-year post enrollment, the testosterone level was 4.86 mg/l (1.5-9.8) vs 4.6 (2-7.7) in apalutamide and AS arm, respectively. Digestive symptoms were Grade 3. Related AEs were an HTA for 2 pts, rash for 1 pt, asthenia for 1 pt, erectile dysfunction for 1 pt, and decreased libido for 1 pt. One serious related AE was reported: grade 2 cerebral ischemic attack. A reduced dose was required for 16.67% of pts and 33.3% had transient discontinuation. The treatment was stopped for toxicity in 3 pts; 94% completed the 6 months of treatment. No differences were observed in physical component summary (PCS) and mental component summary (MCS) of SF12 for treatment vs AS at 6 mo (PCS: 55.1 vs 56.4; MCS 43.4 vs 41.4) and 12 mo (PCS: 53.6 vs 54.1; MCS 44.1 vs 42.9). Conclusions: This is a large randomized study evaluating apalutamide with active surveillance vs active surveillance. No new safety issues were observed and the safety profile was consistent relative to those previously described with apalutamide and castration, no falls or fracture were observed. No detrimental effect of apalutamide on QOL was observed during and after treatment. AEs are important for pts candidates for active surveillance. Clinical trial information: NCT03088124 .
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Affiliation(s)
- Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Universite, CRCM, Marseille, France
| | - Patrick Sfumato
- Paoli Calmettes Institute, Department of Clinical Research and Innovation, Statistics and Methodology Unit, Marseille, France
| | | | - Pierre-Henri Savoie
- Department of Urology, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Matthieu Durand
- Department of Urology, Pasteur University Hospital, Nice, France
| | | | | | | | - Jean-Baptiste Beauval
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, Quint Fonsegrives, France
| | - Youness Ahallal
- Department of Urology, Pasteur University Hospital, Nice, France
| | | | - Mathilde Guerin
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, CRCM, Marseille, France
| | - Laurys Boudin
- Department of Oncology, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Sebastien Crouzet
- Urology Department, Edouard Herriot Hospital, University of Lyon, Lyon, France
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | | | - Jean-Marie Boher
- Department of Clinical Research and Innovation, Statistics and Methodology Unit, Paoli-Calmettes Institute, Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes, SESSTIM, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
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8
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Houvenaeghel G, de Nonneville A, Chopin N, Classe JM, Mazouni C, Chauvet MP, Reyal F, Tunon de Lara C, Jouve E, Rouzier R, Daraï E, Gimbergues P, Coutant C, Azuar AS, Villet R, Crochet P, Rua S, Bannier M, Cohen M, Boher JM. The need to tailor the omission of axillary lymph node dissection to patients with good prognosis and sentinel node micro-metastases. Cancer Med 2023; 12:4023-4032. [PMID: 36127853 PMCID: PMC9972015 DOI: 10.1002/cam4.5257] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Results of IBCSG-23-01-trial which included breast cancer patients with involved sentinel nodes (SN) by isolated-tumor-cells or micro-metastases supported the non-inferiority of completion axillary-lymph-node-dissection (cALND) omission. However, current data are considered insufficient to avoid cALND for all patients with SN-micro-metastases. METHODS To investigate the impact of cALND omission on disease-free-survival (DFS) and overall survival (OS), we analyzed a cohort of 1421 patients <75 years old with SN-micro-metastases who underwent breast conservative surgery (BCS). We used inverse probability of treatment weighting (IPTW) to obtain adjusted Kaplan-Meier estimators representing the experience in the analysis cohort, based on whether all or none had been subject to cALND omission. RESULTS Weighted log-rank tests comparing adjusted Kaplan-Meier survival curves showed significant differences in OS (p-value = 0.002) and borderline significant differences in DFS (p-value = 0.090) between cALND omission versus cALND. Cox's regression using stabilized IPTW evidenced an average increase in the risk of death associated with cALND omission (HR = 2.77, CI95% = 1.36-5.66). Subgroup analyses suggest that the rates of recurrence and death associated with cALND omission increase substantially after a large period of time in the half sample of women less likely to miss cALND. CONCLUSIONS Using IPTW to estimate the causal treatment effect of cALND in a large retrospective cohort, we concluded cALND omission is associated with an increased risk of recurrence and death in women of <75 years old treated by BCS in the absence of a large consensus in favor of omitting cALND. These results are particularly contributive for patients treated by BCS where cALND omission rates increase over time.
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Affiliation(s)
- Gilles Houvenaeghel
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Alexandre de Nonneville
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | | | - Jean-Marc Classe
- Institut René Gauducheau, Site hospitalier Nord, St Herblain, France
| | | | | | | | | | - Eva Jouve
- Centre Claudius Regaud, Toulouse, France
| | | | | | | | | | | | | | | | - Sandrine Rua
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Marie Bannier
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Monique Cohen
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Jean-Marie Boher
- Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009 and Aix-Marseille University, Unité Mixte de Recherche S1252, Institut de Recherche pour le Développement, Marseille, France
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9
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Calvin S, Cuvelier S, Boher JM, Villaron-Goetgheluck C, Justafre S, Fürst S, Bacci M, Linon C, Dantin P, Viens P, Blaise D. An Elite Sport-Inspired Coaching Strategy for Patients after Allogeneic Hematopoietic Stem Cell Transplantation: The Rebond Program. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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Cabarrou B, Leconte E, Sfumato P, Boher JM, Filleron T. A stratified adaptive two-stage design with co-primary endpoints for phase II clinical oncology trials. BMC Med Res Methodol 2022; 22:278. [PMID: 36289451 PMCID: PMC9608934 DOI: 10.1186/s12874-022-01748-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Given the inherent challenges of conducting randomized phase III trials in older cancer patients, single-arm phase II trials which assess the feasibility of a treatment that has already been shown to be effective in a younger population may provide a compelling alternative. Such an approach would need to evaluate treatment feasibility based on a composite endpoint that combines multiple clinical dimensions and to stratify older patients as fit or frail to account for the heterogeneity of the study population to recommend an appropriate treatment approach. In this context, stratified adaptive two-stage designs for binary or composite endpoints, initially developed for biomarker studies, allow to include two subgroups whilst maintaining competitive statistical performances. In practice, heterogeneity may indeed affect more than one dimension and incorporating co-primary endpoints, which independently assess each individual clinical dimension, would therefore appear quite pertinent. The current paper presents a novel phase II design for co-primary endpoints which takes into account the heterogeneity of a population. Methods We developed a stratified adaptive Bryant & Day design based on the Jones et al. and Parashar et al. algorithm. This two-stage design allows to jointly assess two dimensions (e.g. activity and toxicity) in two different subgroups. The operating characteristics of this new design were evaluated using examples and simulation comparisons with the Bryant & Day design in the context where the study population is stratified according to a pre-defined criterion. Results Simulation results demonstrated that the new design minimized the expected and maximum sample sizes as compared to parallel Bryant & Day designs (one in each subgroup), whilst controlling type I error rates and maintaining a competitive statistical power as well as a high probability of detecting heterogeneity. Conclusions In a heterogeneous population, this two-stage stratified adaptive phase II design provides a useful alternative to classical one and allows to identify a subgroup of interest without dramatically increasing sample size. As heterogeneity is not limited to older populations, this new design may also be relevant to other study populations such as children or adolescents and young adults or the development of targeted therapies based on a biomarker. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01748-w.
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Affiliation(s)
- Bastien Cabarrou
- grid.417829.10000 0000 9680 0846Biostatistics & Health Data Science Unit, Institut Claudius Regaud - IUCT-O, 1 avenue Irène Joliot-Curie, 31059 Cedex 9 Toulouse, France
| | - Eve Leconte
- grid.22147.320000 0001 2190 2837Toulouse School of Economics, University of Toulouse Capitole, Toulouse, France
| | - Patrick Sfumato
- grid.418443.e0000 0004 0598 4440Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Marie Boher
- grid.418443.e0000 0004 0598 4440Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France ,grid.464064.40000 0004 0467 0503Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - Thomas Filleron
- grid.417829.10000 0000 9680 0846Biostatistics & Health Data Science Unit, Institut Claudius Regaud - IUCT-O, 1 avenue Irène Joliot-Curie, 31059 Cedex 9 Toulouse, France
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11
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Gravis G, Olive D, Marino P, Penault-Llorca FM, Delord JP, Lamrani-Ghaouti A, Simon C, Sabatier R, Ciccolini J, Boher JM. A non-inferiority randomized phase III trial of standard immunotherapy versusreduced dose intensity in responding patients with metastatic cancer: MOIO study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps2674] [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
TPS2674 Background: Immunotherapy (IO) is increasingly used for treating various metastatic cancers. With respect to the pharmacologically-active levels of IO drugs and their pharmacokinetics features, standard scheduling lead to plasma exposures largely exceeding the thresholds associated with target engagement. Indeed, phase I studies have shown that saturation of the target can persist far beyond the serum IO drugs half-life. In silico modeling has suggested that alternate scheduling (i.e. 3-monthly dosing) could be performed without compromising efficacy. Indeed, prolonged IO half-lives, time-varying clearance plus plasma concentrations far above the threshold associated with maximal target-engagement, suggest that the rhythm of IO administration could be slowed down. A phase II showed that extending IO dosing intervals did not compromise efficacy, while reducing toxicity in metastatic renal cell cancer. Methods: This non-inferiority, randomized, French national multicenter (36 centers involved) phase III study (NCT05078047) aims to compare the standard scheduling of a variety of IO drugs VS. 3-monthly scheduling in adult patients with metastatic cancer in partial (PR) or complete response (CR) after 6 months of standard IO dosing (except melanoma in CR). The main objective is to demonstrate the non-inferiority in Progression-Free Survival (PFS) of the reduced intensity group compared to the standard regimen. Secondary objectives are cost-effectiveness, quality of life, anxiety and fear of relapse, response rate, overall survival, and toxicity. A 1:1 randomization by minimization will be conducted on the following stratification factors: therapy line (first line vs others), tumor type, IO type (anti-PD-1 vs anti-PD-L1) and response status (PR, CR). A total of 646 pts will be randomized to get the 498 events necessary to prove non-inferiority between groups. The main analysis will conclude that reduced dose intensity is non-inferior to standard scheduling if the hazard ratio for PFS, estimated by a Cox model after adjustment for stratification factors, is significantly lower than the predefined 1.30 non-inferiority margin. In order to minimize the number of patients exposed to suboptimal treatment, an independent data monitoring committee will specifically review the efficacy data and recommend the early termination of the trial if lack of efficacy is evidenced. Ancillary studies of pharmacokinetics and immune-monitoring will be conducted to provide mechanistic insights supporting the clinical outcomes observed in both groups. Conclusion Should the hypothesis of non-inferiority with an IO reduced dose intensity be validated, alternate scheduling could preserve efficacy while being cost-effective and allowing a reduction of the toxicity, with an increase in patient’s quality of life. Clinical trial information: NCT05078047.
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Affiliation(s)
- Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes,Aix-Marseille Universite, CRCM, Marseille, France
| | - Daniel Olive
- Centre De Recherche En Cancérologie De Marseille, Inserm U1068, Cnrs U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes, SESSTIM, INSERM, IRD, Aix Marseille University, Marseille, France
| | | | | | | | | | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Joseph Ciccolini
- SMARTc, CRCM Inserm U1068, Aix-Marseille University, Marseille, France
| | - Jean-Marie Boher
- Department of Clinical Research and Innovation, Statistics and Methodology Unit, Paoli-Calmettes Institute, Marseille, France
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12
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Vale CL, Fisher D, Godolphin P, Rydzewska LH, Boher JM, Burdett S, Chen YH, Gravis G, James ND, Liu G, Murphy L, Parmar MKB, Rogozinska E, Sfumato P, Sweeney C, Sydes MR, Tombal BF, White IR, Tierney JF. Defining more precisely the effects of docetaxel plus ADT for men with mHSPC: Meta-analysis of individual participant data from randomized trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5070 Background: Adding docetaxel to androgen deprivation therapy(ADT) improves survival in metastatic, hormone-sensitive prostate cancer (mHSPC), but uncertainty remains about who benefits most. To investigate this thoroughly and reliably, the STOPCAP M1 collaborationconducted a meta-analysis of individual participant data (IPD) from relevant trials. Methods: Methods were included in a registered protocol ( CRD42019140591 ). Updated IPD from the GETUG-15, CHAARTED and STAMPEDE trials were harmonised and checked. The main outcomes were overall survival (OS), progression-free survival (PFS) and failure-free survival (FFS). Overall pooled effects were estimated using intention-to-treat, 2-stage, fixed-effect meta-analysis, adjusted for age, PSA, Gleason sum score, performance status, and timing of metastatic disease (missing covariate values imputed), with 1-stage and random-effects sensitivity analyses. We assessed subgroup effects using 2-stage, fixed-effect meta-analysis of within-trial interactions, adjusted for the same covariates. We based these on PFS to maximise power, and OS whenever interactions were found. To explore multiple subgroup interactions, and to derive subgroup-specific absolute treatment effects, we used 1-stage, flexible parametric modelling and standardisation. Results: We obtained IPD for all 2261 men randomised, with median FU of 6 years (all patients). There were clear relative benefits of docetaxel on OS (HR = 0.79, 95% CI 0.70 to 0.88, p<0.0001), PFS (HR = 0.70, 95% CI 0.63 to 0.77, p<0.0001) and FFS (HR = 0.64, 95% CI 0.58 to 0.71, p<0.0001). With evidence of non-proportional hazards, we also estimated 5-year absolute differences: OS 10% (95% CI 6 to 15%), PFS 9% (95% CI 5 to 13%) and FFS 9% (95% CI 6 to 12%). The relative effect of docetaxel on PFS differed by volume of metastases (interaction p=0.027; high volume HR = 0.60, 95% CI 0.52 to 0.68; low volume HR = 0.78, 95% CI 0.64 to 0.94), and timing of metastatic disease (interaction p=0.077; synchronous HR = 0.67, 95% CI 0.60 to 0.75; metachronous HR = 0.89, 95% CI 0.67 to 1.18). OS results were similar. When metastatic disease volume and timing were combined, docetaxel appeared to improve PFS and OS for all men, except those with low volume, metachronous disease (Table). Conclusions: This IPD meta-analysis provides the most detailed assessment of the effects of docetaxel for mHSPC, and suggests that men with low volume, metachronous disease should be managed differently to those with other types of metastatic disease. [Table: see text]
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Affiliation(s)
| | - David Fisher
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | | | | | - Sarah Burdett
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | - Gwenaelle Gravis
- Institut Paoli-Calmettes Aix-Mareseille Université, Marseille, France
| | | | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Laura Murphy
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | | | | | - Christopher Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Bertrand F. Tombal
- Institut de Recherche Clinique, Université Catholique de Louvain, Louvain, Belgium
| | - Ian R White
- MRC Clinical Trials Unit at UCL, London, United Kingdom
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13
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Cuvelier S, Blaise D, Boher JM, Villaron-Goetgheluck C, Justafré S, Pakradouni J, Granata A, Furst S, Dantin P, Viens P, Calvin S. A study of elite sport-inspired coaching for patients after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2021; 56:2755-2762. [PMID: 34262141 PMCID: PMC8277989 DOI: 10.1038/s41409-021-01401-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/16/2021] [Accepted: 06/25/2021] [Indexed: 11/20/2022]
Abstract
A need for social support is often expressed after hospitalization post HSCT. Emotional support and positive psychological constructs play an important role in post-HSCT recovery. Interventions generating positive affect can influence the health and well-being of transplant patients. It has been established that coaching in elite sport area leads to performance by playing a decisive role in maintaining the athlete’s feelings of hope and autonomy in order to enable him or her to achieve their goals. In this single-center, prospective, one-arm study, we evaluated, in 32 post-HSCT patients, the acceptability of a coaching program inspired by elite sport coaching. Benefits were evaluated by questionnaires and semi-structured interviews. The coaching program was accepted by 97% of the patients. Analysis of the scores on the “Means” sub-dimension of Hope showed a significant increase over time (p = 0.0249 < 0.05) for every patient. Qualitative analysis of patient’s satisfaction pointed out that this support facilitated the transition to a life without illness in particular in the non-hospital context of coaching sessions. Our results show that a “sport-inspired coaching“ may offer an innovative approach supporting psychological and social recovery after HSCT and helping to start and/or maintain the processes leading to psychological well-being.
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Affiliation(s)
- Sarah Cuvelier
- Management Sport Cancer Laboratory (UR 20122035V), Faculty of Sport Sciences, Aix-Marseille University, Marseille, France
| | - Didier Blaise
- Department of Onco-Hematology, Transplant and Cellular Therapy Program, Institut Paoli Calmettes, Marseille, France.,Cancer Research Center of Marseille, INSERM (UMR 1068), CNRS (UMR 7258), Marseille, France
| | - Jean-Marie Boher
- Department of Clinical Research and Innovation. Institut Paoli Calmettes, Marseille, France
| | - Charlène Villaron-Goetgheluck
- Management Sport Cancer Laboratory (UR 20122035V), Faculty of Sport Sciences, Aix-Marseille University, Marseille, France
| | - Sebastien Justafré
- Management Sport Cancer Laboratory (UR 20122035V), Faculty of Sport Sciences, Aix-Marseille University, Marseille, France
| | - Jihane Pakradouni
- Department of Clinical Research and Innovation. Institut Paoli Calmettes, Marseille, France
| | - Angela Granata
- Department of Onco-Hematology, Transplant and Cellular Therapy Program, Institut Paoli Calmettes, Marseille, France
| | - Sabine Furst
- Department of Onco-Hematology, Transplant and Cellular Therapy Program, Institut Paoli Calmettes, Marseille, France
| | - Pierre Dantin
- Management Sport Cancer Laboratory (UR 20122035V), Faculty of Sport Sciences, Aix-Marseille University, Marseille, France
| | - Patrice Viens
- Management Sport Cancer Laboratory (UR 20122035V), Faculty of Sport Sciences, Aix-Marseille University, Marseille, France.,Departement of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Sarah Calvin
- Management Sport Cancer Laboratory (UR 20122035V), Faculty of Sport Sciences, Aix-Marseille University, Marseille, France.
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14
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Lambaudie E, Bannier/Braticevic C, Villaron/Goetgheluck C, Zemmour C, Boher JM, Ben Soussan P, Pakradouni J, Brun C, Lopez Almeida L, Marino P. TRAINING-Ovary 01 (connecTed pRehabiliAtIoN pelvIc caNcer surGery): multicenter randomized study comparing neoadjuvant chemotherapy for patients managed for ovarian cancer with or without a connected pre-habilitation program. Int J Gynecol Cancer 2020; 31:920-924. [PMID: 33262113 DOI: 10.1136/ijgc-2020-002128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients undergoing neoadjuvant chemotherapy before surgery for advanced ovarian cancer may have impaired functional capacity, nutritional status, and emotional well-being. PRIMARY OBJECTIVES TRAINING-01 aims to determine if a connected pre-habilitation program during neoadjuvant chemotherapy for patients treated for an advanced ovarian cancer will improve physical capacity before major abdomino-pelvic surgery. STUDY HYPOTHESIS A pre-habilitation program during neoadjuvant chemotherapy will bring a fitter patient to surgery and will decrease treatment morbidity and improve oncological outcomes. TRIAL DESIGN This study is a prospective, multi-center, phase III study. The pre-habilitation program consists of providing multi-dimensional support during neoadjuvant chemotherapy using connected devices. The control group will receive usual care. MAJOR INCLUSION/EXCLUSION CRITERIA Eligible patients will be women with International Federation of Gynecology and Obstetrics stage III-IV advanced ovarian cancer undergoing neoadjuvant chemotherapy. Patients must be able to perform a cardiopulmonary exercise test. PRIMARY ENDPOINTS The primary endpoint will be the comparison of the variation in maximum oxygen uptake (VO2 max) between baseline and surgery in the pre-habilitation group and control groups. SAMPLE SIZE 136 patients (68 per arm) will be recruited to demonstrate a medium standardized effect d=0.5 in the variations of VO2 max between baseline and surgery. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS The duration of the study includes 24 months of recruitment and 5 years of follow up. We anticipate reporting primary endpoint results in 2024. TRIAL REGISTRATION TRAINING-01-IPC 2018-039 (NCT04451369).
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Affiliation(s)
- Eric Lambaudie
- Department of Surgery, Institut Paoli-Calmettes, Marseille, France .,Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | | | | | - Christophe Zemmour
- Department of Clinical Research and Innovation, Statistics and Methodology Unit, Paoli-Calmettes Institute, Marseille, France
| | - Jean-Marie Boher
- Department of Clinical Research and Innovation, Statistics and Methodology Unit, Paoli-Calmettes Institute, Marseille, France
| | - Patrick Ben Soussan
- Department of Clinical Psychology, Paoli-Calmettes Institute, Marseille, France
| | - Jihane Pakradouni
- Department of Clinical Research and Innovation, Paoli-Calmettes Institute, Marseille, France
| | - Clement Brun
- Department of Anesthesiology, Paoli-Calmettes Institute, Marseille, France
| | - Leonor Lopez Almeida
- Department of Clinical Research and Innovation, Paoli-Calmettes Institute, Marseille, France
| | - Patricia Marino
- Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,SESSTIM U1252, Paoli-Calmettes Institute, Marseille, France
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15
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Le Floch AC, Eisinger F, D'Incan E, Rey J, Charbonnier A, Caymaris L, Stoler M, Mancini J, Boher JM, Sfumato P, Vey N. Corrigendum to "Socioeconomic deprivation is associated with decreased survival in patients with acute myeloid leukemia" [Cancer Epidemiol. 66 (2020) 101699]. Cancer Epidemiol 2020; 69:101832. [PMID: 33067156 DOI: 10.1016/j.canep.2020.101832] [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: 11/28/2022]
Affiliation(s)
| | - François Eisinger
- Aix-Marseille University, Marseille, France; Département d'Anticipation et de Suivi du Cancer DASC, Institut Paoli-Calmettes, Marseille, France
| | - Evelyne D'Incan
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Jérôme Rey
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Aude Charbonnier
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | | | - Marion Stoler
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Julien Mancini
- Aix-Marseille University, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" Group, Hop Timone, BIOSTIC, Marseille, France
| | - Jean-Marie Boher
- Clinical Trial Office and Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Patrick Sfumato
- Clinical Trial Office and Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Norbert Vey
- Hematology Department, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, Marseille, France.
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16
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Tallet A, Racadot S, Boher JM, Cohen M, Barrou J, Houvenaeghel G, Gutowski M, Delmond L, Lemanski C. The actual benefit of intraoperative radiation therapy using 50 kV x-rays in early breast cancer: A retrospective study of 676 patients. Breast J 2020; 26:2145-2150. [PMID: 32233012 DOI: 10.1111/tbj.13827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 01/22/2023]
Abstract
This French study reports the 5-year results of partial-breast irradiation using intraoperative radiation therapy (IORT) with 50 kV x-rays, in select early breast cancer patients. We report a retrospective analysis of 676 consecutive early breast cancer patients treated between November 2011 and December 2015 by partial-breast irradiation using the INTRABEAM® system. Patients were highly selected based on the ASTRO and GEC-ESTRO criteria and underwent breast-conservative surgery and IORT, completed with additional whole-breast irradiation (WBI) when unexpected unfavorable prognostic factors were found at the final pathology report. Patients' outcomes relative to local and distant control, overall and breast cancer-specific survival, and toxicity are presented, as well as rates of additional WBI. Additional WBI was mandatory in one third of patients (31%), mainly due to lymph node involvement and extensive intraductal component. With a median follow-up time of 54 months, the 5-year local recurrence rate was 1.7% [95%CI: 0.9-3.3]; the median time to local recurrence was 23 months; ipsilateral breast recurrences mainly occurred in the same quadrant (7/11); in the restricted population, meeting all predefined criteria and treated with IORT alone (406 patients), the local recurrence rate was 1.5% [95%CI: 0.6-3.6]. Five-year distant tumor control was 98.6% [95%CI: 97.2-99.3], and the median time to distant recurrence was 22 months. Five-year overall survival was 96.5% [95%CI: 94.2-97.8], and 5-year breast cancer-specific survival was 98.9% [95%CI: 97.6-99.7]. In patients treated with IORT alone, there was no grade 3 toxicity, only four grade 3 (mainly fibrosis) affected patients treated with IORT and WBI. Grade 1-2 toxicity rates were 14% and 34.4% in patients treated with IORT alone and IORT plus WBI, respectively. Partial-breast irradiation using IORT by a 50 kV photon device is safe and well-tolerated in select patients with early breast cancer and is a valuable option in patients reluctant for adjuvant WBI.
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Affiliation(s)
- Agnès Tallet
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France.,CRCM, Institut Paoli-Calmettes, Marseille, France
| | - Séverine Racadot
- Department of Radiation-Oncology, Centre Leon Bérard, Lyon, France
| | - Jean-Marie Boher
- Biostatistics, Institut Paoli-Calmettes, Marseille, France.,Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Monique Cohen
- Department of Surgical-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Julien Barrou
- Aix-Marseille Univ, CNRS, INSERM, Marseille, France.,Department of Surgical-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Houvenaeghel
- CRCM, Institut Paoli-Calmettes, Marseille, France.,Aix-Marseille Univ, CNRS, INSERM, Marseille, France.,Department of Surgical-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Marian Gutowski
- Department of Surgical-Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - Laure Delmond
- Department of Surgical-Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - Claire Lemanski
- Department of Radiation-Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
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17
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Le Floch AC, Eisinger F, D'Incan E, Rey J, Charbonnier A, Caymaris L, Stoler M, Julien M, Boher JM, Patrick S, Norbert V. Socioeconomic deprivation is associated with decreased survival in patients with acute myeloid leukemia. Cancer Epidemiol 2020; 66:101699. [PMID: 32179456 DOI: 10.1016/j.canep.2020.101699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 02/19/2020] [Accepted: 02/29/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Socioeconomic deprivation is associated with poor prognosis in patients with solid tumors. However, few studies have assessed the association between socioeconomic parameters and prognosis in Acute Myeloid Leukemia (AML), and these report conflicting results. Our monocentric study assessed the impact of socioeconomic deprivation using the validated EPICES (Evaluation of Deprivation and Inequalities in Health Examination Centers) score in a prospective cohort of intensively treated AML patients. METHODS EPICES questionnaires were given to patients receiving intensive chemotherapy for newly diagnosed AML at the Paoli Calmettes Institute between July 2012 and December 2014. Study participants were categorized as non-deprived (score <30.17), deprived (score 30.17-48.51), or very-deprived (score ≥ 48.52). The primary endpoint was Overall Survival (OS). The independence of EPICES score effects was analyzed via Cox regression with adjustment for confounding factors. RESULTS 209 AML patients received the questionnaire, 149 (71.3 %) patients responded. The median EPICES score was 23.6; 26.8 % and 10.1 % of patients were deprived and very deprived, respectively. OS was 23.16 months (95 %CI [17.15-33.31]). According to multivariate analysis, a very-deprived EPICES score, European Leukemia Net categories, age, smoking, and the absence of allogeneic stem cell transplantation were independent factors associated with decreased OS. CONCLUSION Our results underscore the importance of integrating nonbiological factors in the prognostic stratification of AML patients. The very deprived population exhibited worse OS, confirming that socioeconomic parameters play a role in patient outcomes in AML. Very deprived patients with AML should receive specific attention and adapted clinical management.
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Affiliation(s)
| | - François Eisinger
- Aix-Marseille University, Marseille, France; Département d'Anticipation et de Suivi du Cancer DASC, Institut Paoli-Calmettes, Marseille, France
| | - Evelyne D'Incan
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Jérôme Rey
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Aude Charbonnier
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | | | - Marion Stoler
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Mancini Julien
- Aix-Marseille University, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" Group, Hop Timone, BIOSTIC, Marseille, France
| | - Jean-Marie Boher
- Clinical Trial Office and Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Sfumato Patrick
- Clinical Trial Office and Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Vey Norbert
- Hematology Department, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, Marseille, France.
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18
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Longué M, Cabarrou B, Wallet J, Brodowicz T, Roché H, Boher JM, Delord JP, Penel N, Filleron T. The importance of jointly analyzing treatment administration and toxicity associated with targeted therapies: a case study of regorafenib in soft tissue sarcoma patients. Ann Oncol 2019; 29:1588-1593. [PMID: 29722789 DOI: 10.1093/annonc/mdy168] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Different methods have been proposed to analyze adverse events (AEs) associated with targeted therapies. While these AEs lead to dose adjustments for many patients, conventional reporting methods do not take drug administration into consideration. This paper underlines the importance of jointly reporting AEs and drug administration using prevalence, and proposes a complementary approach to reporting. Patients and methods The prevalence method estimates the probability of progression-free patients being in a particular health state (state 1: AEs with full dose; state 2: AEs with reduced dose; state 3: no AEs with reduced dose) at different time points. To take into account the impact of dose adjustments on efficacy, the weighted prevalence method can be used by assigning utility weights to the different health states. The benefit of these methods was illustrated using data from a phase II trial of regorafenib. Results Only 4.6% of progression-free patients developed mucositis/stomatitis (grade ≥2) at 3 months. The prevalence of patients not experiencing this AE but whose dose was reduced or treatment interrupted was 58.1%. The weighted prevalence of the regorafenib toxicity profile and dose reduction was higher in the control arm. Conclusion This case study confirms the importance of jointly analyzing AEs and drug administration. The weighted prevalence approach is an average score that incorporates the dimension of drug administration into AE assessment. This can be helpful for regulatory agencies as well as for clinicians to evaluate the benefit-risk ratio of therapies in their treatment choice. Clinical trial NCT01900743.
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Affiliation(s)
- M Longué
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - B Cabarrou
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - J Wallet
- Department of Biostatistics, Centre Oscar Lambret, Lille, France
| | - T Brodowicz
- Comprehensive Cancer Center Vienna - MusculoSkeletal Tumors, Medical University Vienna - General Hospital, Vienna, Austria
| | - H Roché
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - J M Boher
- Department of Biostatistics, Institut Paoli Calmette, Marseille, France
| | - J P Delord
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - T Filleron
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O, Toulouse, France.
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19
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Schuurhuizen CSEW, Marino P, Braamse AMJ, Buffart LM, Joly F, Fizazi K, Habibian M, Boher JM, Soulie M, Oudard S, Konings IRHM, Verheul HMW, Dekker J, Gravis G. Impact of Patient- and Clinician-Reported Cumulative Toxicity on Quality of Life in Patients With Metastatic Castration-Naïve Prostate Cancer. J Natl Compr Canc Netw 2019; 16:1481-1488. [PMID: 30545995 DOI: 10.6004/jnccn.2018.7069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/03/2018] [Indexed: 11/17/2022]
Abstract
Background: Current toxicity evaluation is primarily focused on high-grade adverse events (AEs) reported by clinicians. However, the cumulative effect of multiple lower-grade AEs may also impact patients' quality of life (QoL). Further, patient-reported toxicity may be more representative of patients' treatment experiences. This study aimed to determine whether cumulative toxicity comprising all-grade AEs is more associated with QoL than cumulative toxicity comprising high-grade AEs only, and whether patient-reported cumulative toxicity is more associated with QoL than clinician-reported cumulative toxicity. Methods: Patients with metastatic castration-naïve prostate cancer participating in the phase III GETUG-AFU 15 trial completed questionnaires on AEs (at 3 and 6 months) and QoL (at baseline and 3 and 6 months). Clinicians reported AEs during clinical visits. Cumulative toxicity scores were calculated for clinicians and patients in 3 ways: total number of high-grade AEs, total number of all-grade AEs, and total number of all AEs multiplied by their grade (severity score). Relationships between cumulative toxicity scores and QoL were studied using longitudinal regression analyses; unstandardized (B) and standardized regression coefficients (β) are reported. Results: Of 385 patients, 184 with complete QoL and toxicity data were included. Clinician-reported all-grade AEs (B, -2.2; 95% CI, -3.3 to -1.1; P<.01) and severity score (B, -1.4; 95% CI, -2.2 to -0.7; P<.01) were associated with deteriorated physical QoL, whereas the total number of high-grade AEs was not. All patient-reported scores were significantly (P<.01 for all) associated with deteriorated physical and global QoL. Standardized regression coefficients indicated that patient-reported toxicity scores were more associated with QoL outcomes than clinician-reported scores, with the strongest association found for the all-grade AEs and severity cumulative toxicity scores. Conclusions: Patient- and clinician-based cumulative toxicity scores comprising all-grade AEs better reflect impact on patient QoL than toxicity scores comprising high-grade AEs only. To assess the effect of toxicity on QoL, patient-reported cumulative toxicity scores are preferred.
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20
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Sfumato P, Filleron T, Giorgi R, Cook RJ, Boher JM. Goftte: A R package for assessing goodness-of-fit in proportional (sub) distributions hazards regression models. Comput Methods Programs Biomed 2019; 177:269-275. [PMID: 31319955 DOI: 10.1016/j.cmpb.2019.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 05/05/2019] [Accepted: 05/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE In this paper, we introduce a new R package goftte for goodness-of-fit assessment based on cumulative sums of model residuals useful for checking key assumptions in the Cox regression and Fine and Gray regression models. METHODS Monte-Carlo methods are used to approximate the null distribution of cumulative sums of model residuals. To limit the computational burden, the main routines used to approximate the null distributions are implemented in a parallel C++ programming environment. Numerical studies are carried out to evaluate the empirical type I error rates of the different testing procedures. The package and the documentation are available to users from CRAN R repositories. RESULTS Results from simulation studies suggested that all statistical tests implemented in goftte yielded excellent control of the type I error rate even with modest sample sizes with high censoring rates. CONCLUSIONS As compared to other R packages goftte provides new useful method for testing functionals, such as Anderson-Darling type test statistics for checking assumptions about proportional (sub-) distribution hazards. Approximations for the null distributions of test statistics have been validated through simulation experiments. Future releases will provide similar tools for checking model assumptions in multiplicative intensity models for recurrent data. The package may help to spread the use of recent advocated goodness-of-fit techniques in semiparametric regression for time-to-event data.
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Affiliation(s)
- P Sfumato
- Institut Paoli-Calmettes, Biostatistics Unit, Marseille, France
| | - T Filleron
- Institut Claudius Regaud-IUCT-O, Biostatistics Unit, Toulouse, France
| | - R Giorgi
- Hopital Timone, BioSTIC, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - R J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - J M Boher
- Institut Paoli-Calmettes, Biostatistics Unit, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.
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21
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Houvenaeghel G, Cohen M, Raro P, De Troyer J, de Lara CT, Gimbergues P, Gauthier T, Faure-Virelizier C, Vaini-Cowen V, Lantheaume S, Regis C, Darai E, Ceccato V, D'Halluin G, Del Piano F, Villet R, Jouve E, Beedassy B, Theret P, Gabelle P, Zinzindohoue C, Opinel P, Marsollier-Ferrer C, Dhainaut-Speyer C, Colombo PE, Lambaudie E, Tallet A, Boher JM. Overview of the pathological results and treatment characteristics in the first 1000 patients randomized in the SERC trial: axillary dissection versus no axillary dissection in patients with involved sentinel node. BMC Cancer 2018; 18:1153. [PMID: 30463611 PMCID: PMC6249981 DOI: 10.1186/s12885-018-5053-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/17/2017] [Accepted: 11/06/2018] [Indexed: 01/26/2023] Open
Abstract
Background Three randomized trials have concluded at non inferiority of omission of complementary axillary lymph node dissection (cALND) for patients with involved sentinel node (SN). However, we can outline strong limitations of these trials to validate this attitude with a high scientific level. We designed the SERC randomized trial (ClinicalTrials.gov, number NCT01717131) to compare outcomes in patients with SN involvement treated with ALND or no further axillary treatment. The aim of this study was to analyze results of the first 1000 patients included. Methods SERC trial is a multicenter non-inferiority phase 3 trial. Multivariate logistic regression analysis was used to identify independent factors associated with adjuvant chemotherapy administration and non-sentinel node (NSN) involvement. Results Of the 963 patients included in the analysis set, 478 were randomized to receive cALND and 485 SLNB alone. All patient demographics and tumor characteristics were balanced between the two arms. SN ITC was present in 6.3% patients (57/903), micro metastases in 33.0% (298), macro metastases in 60.7% (548) and 289 (34.2%) were non eligible to Z0011 trial criteria. Whole breast or chest wall irradiation was delivered in 95.9% (896/934) of patients, adjuvant chemotherapy in 69.5% (644/926), endocrine therapy in 89.6% (673/751) and the proportions were similar in the two arms. The overall rate of positive NSN was 19% (84/442) for patients with cALND. Crude rates of positive NSN according to SN status were 4.5% for ITC (1/22), 9.5% for micro metastases (13/137), 23.9% for macro metastases (61/255) and were respectively 29.36% (64/218), 9.33% (7/75) and 7.94% (10/126) when chemotherapy was administered after cALND, before cALND and for patients without chemotherapy. Conclusion The main objective of SERC trial is to demonstrate non inferiority of cALND omission. A strong interaction between timing of cALND and chemotherapy with positive NSN rate was observed. Trial registration This study is registered with ClinicalTrials.gov, number NCT01717131 October 19, 2012. Electronic supplementary material The online version of this article (10.1186/s12885-018-5053-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilles Houvenaeghel
- Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd de Sainte Marguerite, 13009, Marseille, France. .,Department of surgery, Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd Ste Marguerite, Marseille, France.
| | - Monique Cohen
- Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd de Sainte Marguerite, 13009, Marseille, France.,Department of surgery, Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd Ste Marguerite, Marseille, France
| | - Pédro Raro
- Institut de Cancérologie de l'Ouest - Site Paul Papin, 15 rue André Boquel, 10059 49055, Angers Cedex 02, CS, France
| | - Jérémy De Troyer
- Polyclinique Urbain V, Chemin du Pont des Deux Eaux, 84000, Avignon, France
| | | | - Pierre Gimbergues
- Centre Jean Perrin, 58 rue Montalembert BP 392, 63011, Clermont Ferrand Cedex, France
| | - Tristan Gauthier
- HME CHU Dupuytren, 2 avenue Martin Luther King, 87000, Limoges, France
| | | | | | - Stéphane Lantheaume
- Clinique Pasteur, 294 boulevard Charles de Gaulle, 07500, Guilherand Granges, France
| | - Claudia Regis
- Centre Oscar Lambret, 3 rue F. Combemal, 59000, Lille, France
| | - Emile Darai
- Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Vivien Ceccato
- Institut Jean Godinot, 1 rue du Général Koenig, 51056, Reims, France
| | - Gauthier D'Halluin
- Centre Clinical, 2 chemin Frégenueil CS 42510 Soyaux, 16025, Angoulème, France
| | | | - Richard Villet
- Groupe Hospitalier Des Diaconesses Croix Saint Simon, Site Reuilly, 18 rue Sergent Bauchat, 75012, Paris, France
| | - Eva Jouve
- Institut Universitaire du Cancer Toulouse, Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - Bassoodéo Beedassy
- Hôpital Sainte Musse (CHITS), Service de chirurgie viscérale, Rue Henri Sainte-Claire Deville, 83056, Toulon, France
| | - Pierrick Theret
- CH Saint Quentin, 1 avenue Michel de l'Hospital, B.P. 608, 02321, Saint Quentin Cedex, France
| | - Philippe Gabelle
- GHM de Grenoble, La Clinique des Eaux Claires, 8 rue du Dr Calmette, 38028, Grenoble Cedex 1, France
| | | | - Pierre Opinel
- CHR du Pays d'Aix, Avenue des Tamaris, 13616, Aix en Provence Cedex 1, France
| | | | | | - Pierre-Emmanuel Colombo
- ICM - Institut Régional du Cancer Montpellier, 208 avenue des Apothicaires - Parc Euromédecine, 34298, Montpellier Cedex 5, France
| | - Eric Lambaudie
- Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd de Sainte Marguerite, 13009, Marseille, France.,Department of surgery, Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd Ste Marguerite, Marseille, France
| | - Agnès Tallet
- Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd de Sainte Marguerite, 13009, Marseille, France.,Department of radiotherapy, Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd Ste Marguerite, Marseille, France
| | - Jean-Marie Boher
- Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd de Sainte Marguerite, 13009, Marseille, France.,Department of biostatistics, Institut Paoli Calmettes & CRCM & Aix Marseille Univ, 232 Bd Ste Marguerite, Marseille, France
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22
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Cabarrou B, Sfumato P, Mourey L, Leconte E, Balardy L, Martinez A, Delord JP, Boher JM, Brain E, Filleron T. Addressing heterogeneity in the design of phase II clinical trials in geriatric oncology. Eur J Cancer 2018; 103:120-126. [PMID: 30223225 DOI: 10.1016/j.ejca.2018.07.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/12/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cancer in the elderly is a major public issue. However, older patients have long been debarred from clinical trials. There is a high unmet medical need for specific trials addressing oncology strategies adapted to older patients' conditions. While randomised phase III trials remain the gold standard, they usually require large numbers of patients. In this perspective, late single-arm phase II trials assessing treatment feasibility might prove a good alternative. However, it is essential to take into account the heterogeneity in an ageing population characterised by frailty. Standard parallel phase II studies in defined frail and non-frail populations also require a high number of patients. Used in molecular subtyping and treatment effect heterogeneity, stratified adaptive designs can improve statistical performance, but they have never been used in geriatric oncology. This report describes their potential benefits and useful applications as compared with standard designs. METHODS In a heterogeneous population, stratified adaptive designs allowed us to select subgroups of interest in two stages. Operational characteristics were evaluated through simulations of clinical trials under different scenarios. RESULTS Simulations showed that the use of stratified adaptive designs can efficiently minimise both the number of patients to be included and accrual duration with competitive statistical power and high heterogeneity detection rate at interim analysis. CONCLUSION Compared with classical phase II designs, stratified adaptive phase II trial methodology offers a promising approach to improve clinical research in geriatric oncology. These designs may also be efficient in other populations such as children or adolescents and young adults.
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Affiliation(s)
- Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - Patrick Sfumato
- Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France
| | - Loïc Mourey
- Medical Oncology Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - Eve Leconte
- TSE-R, Université Toulouse 1 Capitole, Toulouse, France
| | - Laurent Balardy
- Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Jean-Pierre Delord
- Medical Oncology Department, Institut Claudius Regaud-IUCT-O, Toulouse, France
| | - Jean-Marie Boher
- Biostatistics Unit, Institut Paoli-Calmettes, Marseille, France; Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - Etienne Brain
- Medical Oncology Department, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Thomas Filleron
- Biostatistics Unit, Institut Claudius Regaud-IUCT-O, Toulouse, France.
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23
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Cabarrou B, Sfumato P, Leconte E, Boher JM, Filleron T. Designing phase II clinical trials to target subgroup of interest in a heterogeneous population: A case study using an R package. Comput Biol Med 2018; 100:239-246. [PMID: 30055524 DOI: 10.1016/j.compbiomed.2018.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/21/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022]
Abstract
Phase II trials that evaluate target therapies based on a biomarker must be well designed in order to assess anti-tumor activity as well as clinical utility of the biomarker. Classical phase II designs do not deal with this molecular heterogeneity and can lead to an erroneous conclusion in the whole population, whereas a subgroup of patients may well benefit from the new therapy. Moreover, the target population to be evaluated in a phase III trial may be incorrectly specified. Alternative approaches are proposed in the literature that make it possible to include two subgroups according to biomarker status (negative/positive) in the same study. Jones, Parashar and Tournoux et al. propose different stratified adaptive two-stage designs to identify a subgroup of interest in a heterogeneous population that could possibly benefit from the experimental treatment at the end of the first or second stage. Nevertheless, these designs are rarely used in oncology research. After introducing these stratified adaptive designs, we present an R package (ph2hetero) implementing these methods. A case study is provided to illustrate both the designs and the use of the R package. These stratified adaptive designs provide a useful alternative to classical two-stage designs and may also provide options in contexts other than biomarker studies.
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Affiliation(s)
- B Cabarrou
- Institut Claudius Regaud-IUCT-O. Biostatistics Unit, Toulouse, France
| | - P Sfumato
- Institut Paoli Calmettes. Biostatistics Unit, Marseille, France
| | | | - J M Boher
- Institut Paoli Calmettes. Biostatistics Unit, Marseille, France; Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - T Filleron
- Institut Claudius Regaud-IUCT-O. Biostatistics Unit, Toulouse, France.
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24
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Annede P, Mailleux H, Sfumato P, Ferré M, Autret A, Varela Cagetti L, Macagno A, Fau P, Chargari C, Tallet A, Resbeut M, Zemmour C, Gonzague L, Boher JM. Multivariate normal tissue complication probability modeling of vaginal late toxicity after brachytherapy for cervical cancer. Brachytherapy 2018; 17:922-928. [PMID: 30061056 DOI: 10.1016/j.brachy.2018.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/22/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore the best variables combination for a predictive model of vaginal toxicity in cervical cancer patients undergoing brachytherapy (BT). METHODS AND MATERIALS Clinical and 3-dimensional dosimetric parameters were retrospectively extracted from an institutional database of consecutive patients undergoing intracavitary BT after external beam radiation therapy from 2006 to 2013 for a cervical cancer. A least absolute shrinkage and selection operator selection procedure in Cox's proportional hazards regression model was performed to select a set of relevant predictors for a multivariate normal tissue complication probability model of Grade ≥2 vaginal late toxicity. Outcomes reliability was internally assessed by bootstrap resampling method. RESULTS One hundred sixty-nine women were included in the present study with a median followup time of 3.8 years (interquartile range [IQR], 1.9-5.6 years). The 2 years and 5 years cumulative incidence rates of Grade ≥2 late vaginal toxicity were 19.9% and 27.5%, respectively. Among 31 metrics and six clinical factors extracted, the optimal model included two dosimetric variables: V70Gy and D5% (the percentage volume that received a dose greater or equal to 70 Gy and the minimum dose given to the hottest 5% volume, respectively). Area under the ROC curve at 2 and 5 years of followup were 0.85 and 0.91, respectively. Regarding internal validation, median area under the ROC curve of bootstrap predictions was 0.83 (IQR, 0.78-0.88) and 0.89 (IQR, 0.85-0.93) at 2 and 5 years of followup, respectively. CONCLUSIONS A multivariate normal tissue complication probability model for severe vaginal toxicity based on two dosimetric variables (V70Gy and D5%) provides reliable discrimination capability in a cohort of cervical cancer treated with external beam radiation therapy and BT.
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Affiliation(s)
- Pierre Annede
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France; Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France.
| | - Hugues Mailleux
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Patrick Sfumato
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France
| | - Marjorie Ferré
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Aurélie Autret
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France
| | | | - Alban Macagno
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Pierre Fau
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Cyrus Chargari
- Radiotherapy Department, Gustave Roussy, Villejuif, France; Effets biologiques des rayonnements, Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Agnès Tallet
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Michel Resbeut
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Christophe Zemmour
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France
| | - Laurence Gonzague
- Department of Radiotherapy, Paoli Calmettes Institute, Marseille, France
| | - Jean-Marie Boher
- Unit of Biostatistics and Methodology, Paoli Calmettes Institute, Comprehensive Cancer Centre, Marseille, France
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Lavaud P, Gravis G, Foulon S, Joly F, Oudard S, Priou F, Latorzeff I, Mourey L, Soulié M, Delva R, Krakowski I, Laguerre B, Théodore C, Ferrero JM, Beuzeboc P, Habibian M, Rolland F, Deplanque G, Pouessel D, Zanetta S, Berdah JF, Dauba J, Baciuchka M, Platini C, Linassier C, Tubiana-Mathieu N, Machiels JP, Kouri CE, Ravaud A, Suc E, Eymard JC, Hasbini A, Bousquet G, Culine S, Boher JM, Tergemina-Clain G, Legoupil C, Fizazi K. Anticancer Activity and Tolerance of Treatments Received Beyond Progression in Men Treated Upfront with Androgen Deprivation Therapy With or Without Docetaxel for Metastatic Castration-naïve Prostate Cancer in the GETUG-AFU 15 Phase 3 Trial. Eur Urol 2018; 73:696-703. [DOI: 10.1016/j.eururo.2017.09.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/19/2017] [Indexed: 12/19/2022]
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26
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Gravis G, Boher JM, Chen YH, Liu G, Fizazi K, Carducci MA, Oudard S, Joly F, Jarrard DM, Soulie M, Eisenberger MJ, Habibian M, Dreicer R, Garcia JA, Hussain MHM, Kohli M, Vogelzang NJ, Picus J, DiPaola R, Sweeney C. Burden of Metastatic Castrate Naive Prostate Cancer Patients, to Identify Men More Likely to Benefit from Early Docetaxel: Further Analyses of CHAARTED and GETUG-AFU15 Studies. Eur Urol 2018; 73:847-855. [PMID: 29475737 DOI: 10.1016/j.eururo.2018.02.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Docetaxel (D) at the time of starting androgen deprivation therapy (ADT) for metastatic castrate naive prostate cancer shows a clear survival benefit for patients with high-volume (HV) disease. It is unclear whether patients with low-volume (LV) disease benefit from early D. OBJECTIVE To define the overall survival (OS) of aggregate data of patient subgroups from the CHAARTED and GETUG-AFU15 studies, defined by metastatic burden (HV and LV) and time of metastasis occurrence (at diagnosis or after prior local treatment [PRLT]). DESIGN, SETTING, AND PARTICIPANTS Data were accessed from two independent phase III trials of ADT alone or ADT+D-GETUG-AFU15 (N=385) and CHAARTED (N=790), with median follow-ups for survivors of 83.2 and 48.2 mo, respectively. The definition of HV and LV disease was harmonized. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was OS. RESULTS AND LIMITATIONS Meta-analysis results of the aggregate data showed significant heterogeneity in ADT+D versus ADT effect sizes between HV and LV subgroups (p=0.017), and failed to detect heterogeneity in ADT+D versus ADT effect sizes between upfront and PRLT subgroups (p=0.4). Adding D in patients with HV disease has a consistent effect in improving median OS (HV-ADT: 34.4 and 35.1 mo, HV-ADT+D: 51.2 and 39.8 mo in CHAARTED and GETUG-AFU15, respectively; pooled average hazard ratio or HR (95% confidence interval [CI]) 0.68 ([95% CI 0.56; 0.82], p<0.001). Patients with LV disease showed much longer OS, without evidence that D improved OS (LV-ADT: not reached [NR] and 83.4; LV-ADT+D: 63.5 and NR in CHAARTED and GETUG-AFU15, respectively; pooled HR (95% CI) 1.03 (95% CI 0.77; 1.38). Aggregate data showed no evidence of heterogeneity of early D in LV and HV subgroups irrespective of whether patients had PRLT or not. Post hoc subgroup analysis was based on aggregated data from two independent phase III randomized trials. CONCLUSIONS There was no apparent survival benefit in the CHAARTED and GETUG-AFU15 studies with D for LV. Across both studies, early D showed consistent effect and improved OS in HV patients. PATIENT SUMMARY Patients with a higher burden of metastatic prostate cancer starting androgen deprivation therapy (ADT) have a poorer prognosis and are more likely to benefit from early docetaxel. Low-volume patients have longer overall survival with ADT alone, and the toxicity of docetaxel may outweigh its benefits.
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Affiliation(s)
- Gwenaelle Gravis
- Centre de Recherche en Cancerologie de Marseille (CRCM), Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France.
| | - Jean-Marie Boher
- Biostatistic, Institut Paoli-Calmettes, Aix-Marseille Universite, Marseille, France
| | - Yu-Hui Chen
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Karim Fizazi
- Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | - Stephane Oudard
- Department of Medical Oncology, Hopital Europeen Georges Pompidou, Paris, France
| | | | - David M Jarrard
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Michel Soulie
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | | | | | | | | | | | | | - Joel Picus
- Washington University School of Medicine, St. Louis, MO, USA
| | - Robert DiPaola
- University of Kentucky College of Medicine, Lexington, KY, USA
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Castagna L, Boubdallah R, Furst S, Coso D, El Cheikh J, Faucher C, Crocchiolo R, Granata A, Chabannon C, Lemarié C, Calmels B, Boher JM, Mohty M, Blaise D. Correction: Corrigendum: Disease status is a more reliable predictive factor than histology in lymphoma patients after reduced-intensity conditioning regimen and allo-SCT. Bone Marrow Transplant 2018; 53:234. [DOI: 10.1038/bmt.2018.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lambaudie E, de Nonneville A, Brun C, Laplane C, N'Guyen Duong L, Boher JM, Jauffret C, Blache G, Knight S, Cini E, Houvenaeghel G, Blache JL. Enhanced recovery after surgery program in Gynaecologic Oncological surgery in a minimally invasive techniques expert center. BMC Surg 2017; 17:136. [PMID: 29282059 PMCID: PMC5745717 DOI: 10.1186/s12893-017-0332-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 08/31/2017] [Accepted: 12/12/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Enhanced Recovery After Surgery Programs (ERP) includes multimodal approaches of perioperative patient's clinical pathways designed to achieve early recovery after surgery and a decreased length of hospital stay (LOS). METHODS This observational study evaluated the implementation of ERP in gynaecologic oncological surgery in a minimally invasive techniques (MIT) expert center with more than 85% of procedures done with MIT. We compared a prospective cohort of 100 patients involved in ERP between December 2015 and June 2016 to a 100 patients control group, without ERP, previously managed in the same center between April 2015 and November 2015. All the included patients were referred for hysterectomy and/or pelvic or para-aortic lymphadenectomy for gynaecological cancer. The primary objective was to achieve a significant decrease of median LOS in the ERP group. Secondary objectives were decreases in proportion of patients achieving target LOS (2 days), morbidity and readmissions. RESULTS Except a disparity in oncological indications with a higher proportion of endometrial cancer in the group with ERP vs. the group without ERP (42% vs. 22%; p = 0.003), there were no differences in patient's characteristics and surgical procedures. ERP were associated with decreases of median LOS (2.5 [0 to 11] days vs. 3 [1 to 14] days; p = 0.002) and proportion of discharged patient at target LOS (45% vs. 24%; p = 0.002). Morbidities occurred in 25% and 26% in the groups with and without ERP and readmission rates were respectively of 6% and 8%, without any significant difference. CONCLUSION ERP in gynaecologic oncological surgery is associated with a decrease of LOS without increases of morbidity or readmission rates, even in a center with a high proportion of MIT. Although it is already widely accepted that MIT improves early recovery, our study shows that the addition of ERP's clinical pathways improve surgical outcomes and patient care management.
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Affiliation(s)
- Eric Lambaudie
- Département de Chirurgie Oncologique 2, Institut Paoli Calmettes et CRCM, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
| | - Alexandre de Nonneville
- Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - Clément Brun
- Département d'Anesthésie Réanimation, Institut Paoli Calmettes et CRCM, Marseille, France
| | - Charlotte Laplane
- Département de Chirurgie Oncologique 2, Institut Paoli Calmettes et CRCM, 232 Bd. Sainte-Marguerite, 13009, Marseille, France
| | - Lam N'Guyen Duong
- Département d'Anesthésie Réanimation, Institut Paoli Calmettes et CRCM, Marseille, France
| | - Jean-Marie Boher
- Aix-Marseille Univ, INSERM IRD, SESSTIM, Institut Paoli-Calmettes, Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Marseille, France
| | - Camille Jauffret
- Département de Chirurgie Oncologique 2, Institut Paoli Calmettes et CRCM, 232 Bd. Sainte-Marguerite, 13009, Marseille, France
| | - Guillaume Blache
- Département de Chirurgie Oncologique 2, Institut Paoli Calmettes et CRCM, 232 Bd. Sainte-Marguerite, 13009, Marseille, France
| | - Sophie Knight
- Département de Chirurgie Oncologique 2, Institut Paoli Calmettes et CRCM, 232 Bd. Sainte-Marguerite, 13009, Marseille, France
| | - Eric Cini
- Département de Chirurgie Oncologique 2, Institut Paoli Calmettes et CRCM, 232 Bd. Sainte-Marguerite, 13009, Marseille, France
| | - Gilles Houvenaeghel
- Département de Chirurgie Oncologique 2, Institut Paoli Calmettes et CRCM, 232 Bd. Sainte-Marguerite, 13009, Marseille, France
| | - Jean-Louis Blache
- Département d'Anesthésie Réanimation, Institut Paoli Calmettes et CRCM, Marseille, France
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Nicolle R, Blum Y, Marisa L, Loncle C, Gayet O, Moutardier V, Turrini O, Giovannini M, Bian B, Bigonnet M, Rubis M, Elarouci N, Armenoult L, Ayadi M, Duconseil P, Gasmi M, Ouaissi M, Maignan A, Lomberk G, Boher JM, Ewald J, Bories E, Garnier J, Goncalves A, Poizat F, Raoul JL, Secq V, Garcia S, Grandval P, Barraud-Blanc M, Norguet E, Gilabert M, Delpero JR, Roques J, Calvo E, Guillaumond F, Vasseur S, Urrutia R, de Reyniès A, Dusetti N, Iovanna J. Pancreatic Adenocarcinoma Therapeutic Targets Revealed by Tumor-Stroma Cross-Talk Analyses in Patient-Derived Xenografts. Cell Rep 2017; 21:2458-2470. [PMID: 29186684 PMCID: PMC6082139 DOI: 10.1016/j.celrep.2017.11.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/12/2017] [Accepted: 10/31/2017] [Indexed: 01/06/2023] Open
Abstract
Preclinical models based on patient-derived xenografts have remarkable specificity in distinguishing transformed human tumor cells from non-transformed murine stromal cells computationally. We obtained 29 pancreatic ductal adenocarcinoma (PDAC) xenografts from either resectable or non-resectable patients (surgery and endoscopic ultrasound-guided fine-needle aspirate, respectively). Extensive multiomic profiling revealed two subtypes with distinct clinical outcomes. These subtypes uncovered specific alterations in DNA methylation and transcription as well as in signaling pathways involved in tumor-stromal cross-talk. The analysis of these pathways indicates therapeutic opportunities for targeting both compartments and their interactions. In particular, we show that inhibiting NPC1L1 with Ezetimibe, a clinically available drug, might be an efficient approach for treating pancreatic cancers. These findings uncover the complex and diverse interplay between PDAC tumors and the stroma and demonstrate the pivotal role of xenografts for drug discovery and relevance to PDAC.
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Affiliation(s)
- Rémy Nicolle
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France.
| | - Yuna Blum
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France
| | - Laetitia Marisa
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France
| | - Celine Loncle
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Odile Gayet
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Vincent Moutardier
- Hôpital Nord, Marseille, France; Aix Marseille Université, Marseille, France
| | - Olivier Turrini
- Aix Marseille Université, Marseille, France; Institut Paoli-Calmettes, Marseille, France
| | | | - Benjamin Bian
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Martin Bigonnet
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Marion Rubis
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Nabila Elarouci
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France
| | - Lucile Armenoult
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France
| | - Mira Ayadi
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France
| | - Pauline Duconseil
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | | | | | - Aurélie Maignan
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Gwen Lomberk
- Division of Research, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | | | | | | | - Jonathan Garnier
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Anthony Goncalves
- Aix Marseille Université, Marseille, France; Institut Paoli-Calmettes, Marseille, France
| | | | - Jean-Luc Raoul
- Aix Marseille Université, Marseille, France; Institut Paoli-Calmettes, Marseille, France
| | | | - Stephane Garcia
- Hôpital Nord, Marseille, France; Aix Marseille Université, Marseille, France
| | - Philippe Grandval
- Aix Marseille Université, Marseille, France; Hôpital de la Timone, Marseille, France
| | | | | | | | - Jean-Robert Delpero
- Aix Marseille Université, Marseille, France; Institut Paoli-Calmettes, Marseille, France
| | - Julie Roques
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Ezequiel Calvo
- Centre Génomique du Centre de Recherche du CHUL Research Center, Ville de Québec, QC, Canada
| | - Fabienne Guillaumond
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Sophie Vasseur
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Raul Urrutia
- Division of Research, Department of Surgery, Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Aurélien de Reyniès
- Programme Cartes d'Identité des Tumeurs (CIT), Ligue Nationale Contre le Cancer, Paris, France
| | - Nelson Dusetti
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Juan Iovanna
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France.
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Gilhodes J, Zemmour C, Ajana S, Martinez A, Delord JP, Leconte E, Boher JM, Filleron T. Comparison of variable selection methods for high-dimensional survival data with competing events. Comput Biol Med 2017; 91:159-167. [PMID: 29078093 DOI: 10.1016/j.compbiomed.2017.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 05/05/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND In the era of personalized medicine, it's primordial to identify gene signatures for each event type in the context of competing risks in order to improve risk stratification and treatment strategy. Until recently, little attention was paid to the performance of high-dimensional selection in deriving molecular signatures in this context. In this paper, we investigate the performance of two selection methods developed in the framework of high-dimensional data and competing risks: Random survival forest and a boosting approach for fitting proportional subdistribution hazards models. METHODS Using data from bladder cancer patients (GSE5479) and simulated datasets, stability and prognosis performance of the two methods were evaluated using a resampling strategy. For each sample, the data set was split into 100 training and validation sets. Molecular signatures were developed in the training sets by the two selection methods and then applied on the corresponding validation sets. RESULTS Random survival forest and boosting approach have comparable performance for the prediction of survival data, with few selected genes in common. Nevertheless, many different sets of genes are identified by the resampling approach, with a very small frequency of genes occurrence among the signatures. Also, the smaller the training sample size, the lower is the stability of the signatures. CONCLUSION Random survival forest and boosting approach give good predictive performance but gene signatures are very unstable. Further works are needed to propose adequate strategies for the analysis of high-dimensional data in the context of competing risks.
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Affiliation(s)
- Julia Gilhodes
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Christophe Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Soufiane Ajana
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Alejandra Martinez
- Department of Surgery, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Jean-Pierre Delord
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | | | - Jean-Marie Boher
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O, Toulouse, France.
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31
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De Grandis M, Bardin F, Fauriat C, Zemmour C, El-Kaoutari A, Sergé A, Granjeaud S, Pouyet L, Montersino C, Chretien AS, Mozziconacci MJ, Castellano R, Bidaut G, Boher JM, Collette Y, Mancini SJC, Vey N, Aurrand-Lions M. JAM-C Identifies Src Family Kinase-Activated Leukemia-Initiating Cells and Predicts Poor Prognosis in Acute Myeloid Leukemia. Cancer Res 2017; 77:6627-6640. [PMID: 28972073 DOI: 10.1158/0008-5472.can-17-1223] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/24/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022]
Abstract
Acute myeloid leukemia (AML) originates from hematopoietic stem and progenitor cells that acquire somatic mutations, leading to disease and clonogenic evolution. AML is characterized by accumulation of immature myeloid cells in the bone marrow and phenotypic cellular heterogeneity reflective of normal hematopoietic differentiation. Here, we show that JAM-C expression defines a subset of leukemic cells endowed with leukemia-initiating cell activity (LIC). Stratification of de novo AML patients at diagnosis based on JAM-C-expressing cells frequencies in the blood served as an independent prognostic marker for disease outcome. Using publicly available leukemic stem cell (LSC) gene expression profiles and gene expression data generated from JAM-C-expressing leukemic cells, we defined a single cell core gene expression signature correlated to JAM-C expression that reveals LSC heterogeneity. Finally, we demonstrated that JAM-C controls Src family kinase (SFK) activation in LSC and that LIC with exacerbated SFK activation was uniquely found within the JAM-C-expressing LSC compartment. Cancer Res; 77(23); 6627-40. ©2017 AACR.
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Affiliation(s)
- Maria De Grandis
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Florence Bardin
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Cyril Fauriat
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Christophe Zemmour
- Unité de Biostatistique et de Méthodologie, Département de la Recherche Clinique et de l'Innovation, Institut Paoli-Calmettes, Marseille, France
| | | | - Arnauld Sergé
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Samuel Granjeaud
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Laurent Pouyet
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Camille Montersino
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Anne-Sophie Chretien
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Marie-Joelle Mozziconacci
- Département de Biopathologie, Cytogénétique et Biologie Moléculaire, Institut Paoli-Calmettes, Marseille, France
| | - Remy Castellano
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Ghislain Bidaut
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Jean-Marie Boher
- Unité de Biostatistique et de Méthodologie, Département de la Recherche Clinique et de l'Innovation, Institut Paoli-Calmettes, Marseille, France
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Yves Collette
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Stéphane J C Mancini
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Norbert Vey
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France
- Département d'Hématologie, Institut Paoli-Calmettes, Marseille, France
| | - Michel Aurrand-Lions
- Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, CRCM, Marseille, France.
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Guerin M, Rezai K, Isambert N, Campone M, Autret A, Pakradouni J, Provansal M, Camerlo J, Sabatier R, Bertucci F, Charafe-Jauffret E, Hervieu A, Extra JM, Viens P, Lokiec F, Boher JM, Gonçalves A. PIKHER2: A phase IB study evaluating buparlisib in combination with lapatinib in trastuzumab-resistant HER2-positive advanced breast cancer. Eur J Cancer 2017; 86:28-36. [PMID: 28950146 DOI: 10.1016/j.ejca.2017.08.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 06/26/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin pathway is frequently activated in HER2-positive breast cancer and may play a major role in resistance to trastuzumab. Buparlisib is a pan-class-I PI3K inhibitor with potent and selective activity against wild-type and mutant PI3K p110 isoforms. PATIENTS AND METHODS PIKHER2 phase IB study aimed primarily to determine a maximum tolerated dose (MTD) and propose a recommended phase II dose (RP2D) for buparlisib in combination with lapatinib in HER2-positive, trastuzumab-resistant, advanced breast cancer. Oral buparlisib (40, 60 or 80 mg) and lapatinib (750, 1000 or 1250 mg) were administered daily. A modified continuous reassessment method using an adaptive Bayesian model guided the dose escalation of both agents. Secondary end-points included antitumour activity and pharmacokinetic (PK) assessments. RESULTS A total of 24 patients were treated across five dose levels. Dose-limiting toxicities included transaminases elevation, vomiting, stomatitis, hyperglycemia and diarrhoea. MTD was declared at buparlisib 80 mg/d + lapatinib 1250 mg/d, but toxicities and early treatment discontinuation rate beyond cycle 1 led to select buparlisib 80 mg + lapatinib 1000 mg/d as the RP2D. Main drug-related adverse events included diarrhoea, nausea, skin rash, asthenia, depression, anxiety and transaminases increase. There was no significant evidence for drug-drug PK interaction. Disease control rate was 79% [95% confidence interval [CI] 57-92%], one patient obtained a complete remission, and six additional patients experienced stable disease for ≥ 24 weeks (clinical benefit rate of 29% [95% CI 12-51%]). CONCLUSION Combining buparlisib and lapatinib in HER2-positive trastuzumab-resistant advanced breast cancer was feasible. Preliminary evidence of antitumour activity was observed in this heavily pre-treated population. TRIAL REGISTRATION ID NCT01589861.
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Affiliation(s)
- Mathilde Guerin
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - Keyvan Rezai
- Institut Curie - Hôpital René Huguenin, Saint-Cloud, France
| | | | | | - Aurélie Autret
- Institut Paoli-Calmettes, Department of Clinical Research and Innovations, Marseille, France
| | - Jihane Pakradouni
- Institut Paoli-Calmettes, Department of Clinical Research and Innovations, Marseille, France
| | - Magali Provansal
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - Jacques Camerlo
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - Renaud Sabatier
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - François Bertucci
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - Emmanuelle Charafe-Jauffret
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Biopathology, CRCM, Marseille, France
| | | | - Jean-Marc Extra
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - Patrice Viens
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | | | - Jean-Marie Boher
- Institut Paoli-Calmettes, Department of Clinical Research and Innovations, Marseille, France; Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, Marseille, France
| | - Anthony Gonçalves
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
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de Nonneville A, Gonçalves A, Zemmour C, Cohen M, Classe JM, Reyal F, Colombo PE, Jouve E, Giard S, Barranger E, Sabatier R, Bertucci F, Boher JM, Houvenaeghel G. Adjuvant chemotherapy in pT1ab node-negative triple-negative breast carcinomas: Results of a national multi-institutional retrospective study. Eur J Cancer 2017; 84:34-43. [PMID: 28780480 DOI: 10.1016/j.ejca.2017.06.043] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Triple-negative breast cancers (TNBCs) are considered as associated with poor outcome, but prognosis of subcentimetric, node-negative disease remains controversial and evidence that adjuvant chemotherapy (CT) is effective in these small tumours remains limited. PATIENTS AND METHODS Our objective was to investigate the impact of CT on survival in pT1abN0M0 TNBC. Patients were retrospectively identified from a cohort of 22,475 patients who underwent primary surgery in 15 French centres between 1987 and 2013. As rare pathological types may display very particular prognoses in these tumours, we retained only the invasive ductal carcinomas of no special type according to the last World Health Organisation (WHO) classification which is the most common TNBC histological type. End-points were disease-free survival (DFS) and metastasis-free survival (MFS). A propensity score for receiving CT was estimated using a logistic regression including age, tumour size, Scarff Bloom and Richardson (SBR) grade and lymphovascular invasion. RESULTS Of a total of 284 patients with pT1abN0M0 ductal TNBC, 144 (51%) received CT and 140 (49%) did not. Patients receiving CT had more adverse prognostic features, such as tumour size, high grade, young age, and lymphovascular invasion. CT was not associated with a significant benefit for DFS (Hazard ratio, HR = 0.77 [0.40-1.46]; p = 0.419, log-rank test) or MFS (HR = 1.00 [0.46-2.19]; p = 0.997), with 5-year DFS and MFS in the group with CT versus without of 90% [81-94%] versus 84% [74-90%], and 90% [81-95%] versus 90% [83%-95%], respectively. Results were consistent in all supportive analyses including multivariate Cox model and the use of the propensity score for adjustment and as a matching factor for case-control analyses. CONCLUSIONS This study did not identify a significant DFS or MFS advantage for CT in subcentimetric, node-negative ductal TNBC. Although current consensus guidelines recommend consideration of CT in all TNBC larger than 5 mm, clinicians should carefully discuss benefit/risk ratio with patients, given the unproven benefits.
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Affiliation(s)
- A de Nonneville
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - A Gonçalves
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - C Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - M Cohen
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
| | - J M Classe
- Institut René Gauducheau, Saint-Herblain, France
| | - F Reyal
- Institut Curie, Paris, France
| | | | - E Jouve
- Institut Claudius Regaud, Toulouse, France
| | - S Giard
- Centre Oscar Lambret, Lille, France
| | | | - R Sabatier
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - F Bertucci
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - J M Boher
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - G Houvenaeghel
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
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Nicolle R, Blum Y, Marisa L, Loncle C, Gayet O, Moutardier V, Turrini O, Giovannini M, Bian B, Bigonnet M, Rubis M, Elarouci N, Armenoult L, Ayadi M, Duconseil P, Gasmi M, Ouaissi M, Maignan A, Lomberk G, Boher JM, Ewald J, Bories E, Garnier J, Goncalves A, Poizat F, Raoul JL, Secq V, Garcia S, Grandval P, Barraud-Blanc M, Norguet E, Gilabert M, Delpero JR, Roques J, Calvo E, Guillaumond F, Vasseur S, Urrutia R, Reyniès AD, Dusetti N, Iovanna J. Abstract 4396: Multiomics assessment of the cancer and stromal compartments of patient-derived pancreatic xenografts reveals clinically-relevant subtypes and novel targeted therapies. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Patient-derived xenografts (PDX) are appearing as a prime approach for preclinical studies despite being insufficiently characterized as a model of the human disease and its diversity. In this work, 29 PDX were obtained from either surgery or endoscopic ultrasound-guided fine needle aspirate of pancreatic adenocarcinoma. The extensive genomic profiling of these pancreatic PDX, revealed two clinically-relevant subtypes having broad similarities with human primary tumors. These subtypes are defined by highly specific DNA methylation and transcriptomic profiles (mRNA, miRNA or lncRNA) but are not distinguishable by exonic mutations or copy number aberrations. Moreover, by specifically analyzing the stroma transcriptome, as defined by the expression of murine transcripts, we found that it is able to stratify the patients with the same efficiency than the analysis of grafted human tumor cells. This finding suggest that transformed pancreatic cells drive the composition of their own stroma. Finally, the multiomics analysis pinpoints novel therapeutic targets, one of which we demonstrate to be an efficient method for treating pancreatic cancer. Overall, we show that PDX are trustworthy pre-clinical models of pancreatic adenocarcinoma including of unresectable tumors. Their multiomics profiling allow the independent analysis of the uncontaminated cancer or stromal compartments and discloses several original therapeutics targets.
Citation Format: Remy Nicolle, Yuna Blum, Laetitia Marisa, Celine Loncle, Odile Gayet, Vincent Moutardier, Olivier Turrini, Marc Giovannini, Benjamin Bian, Martin Bigonnet, Marion Rubis, Nabila Elarouci, Lucile Armenoult, Mira Ayadi, Pauline Duconseil, Mohamed Gasmi, Mehdi Ouaissi, Aurélie Maignan, Gwen Lomberk, Jean-Marie Boher, Jacques Ewald, Erwan Bories, Jonathan Garnier, Anthony Goncalves, Flora Poizat, Jean-Luc Raoul, Veronique Secq, Stephane Garcia, Philippe Grandval, Marine Barraud-Blanc, Emmanuelle Norguet, Marine Gilabert, Jean-Robert Delpero, Julie Roques, Ezequiel Calvo, Fabienne Guillaumond, Sophie Vasseur, Raul Urrutia, Aurélien de Reyniès, Nelson Dusetti, Juan Iovanna. Multiomics assessment of the cancer and stromal compartments of patient-derived pancreatic xenografts reveals clinically-relevant subtypes and novel targeted therapies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4396. doi:10.1158/1538-7445.AM2017-4396
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Affiliation(s)
- Remy Nicolle
- 1Ligue Nationale Contre le Cancer, Paris, France
| | - Yuna Blum
- 1Ligue Nationale Contre le Cancer, Paris, France
| | | | - Celine Loncle
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Odile Gayet
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | | | | | | | - Benjamin Bian
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Martin Bigonnet
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Marion Rubis
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | | | | | - Mira Ayadi
- 1Ligue Nationale Contre le Cancer, Paris, France
| | - Pauline Duconseil
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | | | | | - Aurélie Maignan
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | | | | | | | | | - Jonathan Garnier
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | - Julie Roques
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | | | - Fabienne Guillaumond
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Sophie Vasseur
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | | | | | - Nelson Dusetti
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
| | - Juan Iovanna
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Institut Paoli-Calmettes, Aix Marseille Université, Marseille, France
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Gilabert M, Boher JM, Raoul JL, Paye F, Bachellier P, Turrini O, Delpero JR. Comparison of preoperative imaging and pathological findings for pancreatic head adenocarcinoma: A retrospective analysis by the Association Française de Chirurgie. Medicine (Baltimore) 2017; 96:e7214. [PMID: 28614269 PMCID: PMC5478354 DOI: 10.1097/md.0000000000007214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/27/2017] [Accepted: 05/19/2017] [Indexed: 12/22/2022] Open
Abstract
Initial imaging of pancreatic ductal adenocarcinoma is of crucial importance in the decision-making process. The aim of this study was to compare preoperative imaging, pathological data, and outcomes in a series of patients who underwent resection for pancreatic head cancer.From January 2004 to December 2009, data were collected by the Association Française de Chirurgie on 1044 patients who received first-line R0 resection of pancreatic head cancer.On imaging (computed tomography scan 97%, echoendoscopic ultrasound 61.3%, magnetic resonance imaging 46.5%), arterial, venous, or lymph node invasion was suspected in 20, 161, and 197 patients, respectively; arterial, venous, or lymph node invasion was observed histologically in 11, 116, and 736 cases, respectively. In the patients for whom both imaging and pathological data were available, the concordance, sensitivity, specificity, positive predictive value, and negative predictive value were as follows: 97.5%, 27.3%, 98%, 20%, and 99%, for arterial invasion; 86.5%, 54%, 91%, 47.8%, and 93.2%, for venous invasion; and 38%, 21%, 86%, 78%, and 41%, respectively, for lymph node invasion. Imaging of arterial invasion had no prognostic value, while histological evidence of invasion was associated with a poor prognosis. Venous and lymph node invasion, as demonstrated by imaging and by pathological analysis, had an adverse prognostic value.Imaging gives a fair positive predictive value for venous or arterial invasion; venous invasion on imaging and histology was associated with a poor prognosis; arterial invasion on imaging does not have any significant prognostic value.
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Affiliation(s)
| | - Jean-Marie Boher
- Clinical Trial Office and Biostatistics Unit, Paoli-Calmettes Institute, Marseille
| | - Jean-Luc Raoul
- Department of Medical Oncology, Paoli-Calmettes Institute
| | - François Paye
- Department of Digestive Surgery, Hôpital Saint-Antoine, Paris
| | - Philippe Bachellier
- Hepatobiliary Surgery and Liver Transplantation, Hôpital Universitaire de Strasbourg, Strasbourg
| | - Olivier Turrini
- Department of Digestive Surgery, Paoli-Calmettes Institute, Marseille, France
| | - Jean Robert Delpero
- Department of Digestive Surgery, Paoli-Calmettes Institute, Marseille, France
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Gravis G, Boher JM, Chen YH, Liu G, Fizazi K, Carducci MA, Oudard S, Joly F, Jarrard DF, Soulie M, Eisenberger MA, Habibian M, Dreicer R, Garcia JA, Hussain M, Kohli M, Vogelzang NJ, Picus J, DiPaola RS, Sweeney C. Burden of metastatic hormone-sensitive prostate cancer to identify men more likely to benefit from early docetaxel. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
136 Background: Patients with a low burden of metastatic disease and who relapse after localized therapy with curative intent have a longer overall survival. It is unclear whether these patients benefit from early docetaxel (D). Methods: Patients in GETUG-AFU15 (N = 385, median follow-up 84 mo) and CHAARTED (N = 790, median follow up 54 mo) were randomized to ADT alone or ADT + D and outcomes described using the same definition of high volume (HV) and low volume (LV) disease. (HV: visceral metastases and/or 4 or more bone metastases with at least one outside the axis) and whether the patients had prior local therapy or not. Results: Table 1 details across both studies that de novo HV group treated with ADT alone has the shortest overall survival and D has a consistent effect in improving OS. In contrast, in both studies patients with LV disease had a much longer OS with no evidence that D improved OS. Conclusions: There was no apparent survival benefit in CHAARTED and GETUG-15 studies with D for LV whether patients had prior local treatment or not. Across both studies, early D had a consistent effect and improved OS in HV pts especially those with no prior local therapy. Partial Support and drug supply by Sanofi. Clinical trial information: NCT00104715, NCT00309985. [Table: see text]
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Affiliation(s)
- Gwenaelle Gravis
- Centre de Recherche en Cancerologie de Marseille (CRCM), Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - Jean-Marie Boher
- Biostatistic, Institut Paoli-Calmettes, Aix-Marseille Universite, Marseille, France
| | - Yu-Hui Chen
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Karim Fizazi
- Gustave Roussy, University of Paris Sud, Villejuif, France
| | | | - Stephane Oudard
- Department of Medical Oncology, Hopital Europeen Georges Pompidou, Paris, France
| | | | | | - Michel Soulie
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | | | | | | | | | | | | | - Joel Picus
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
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Boudin L, Chabannon C, Sfumato P, Sabatier R, Bertucci F, Tarpin C, Provansal M, Houvenaeghel G, Lambaudie E, Tallet A, Resbeut M, Charafe-Jauffret E, Calmels B, Lemarie C, Boher JM, Extra JM, Viens P, Gonçalves A. [Impact of Her2 and BRCA1/2 status in high-dose chemotherapy and autologous stem cells transplantation in the treatment of breast cancer: The Institut Paoli Calmettes' experience]. Bull Cancer 2017; 104:332-343. [PMID: 28214007 DOI: 10.1016/j.bulcan.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/30/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies evaluating chemotherapy high dose chemotherapy with autologous haematopoietic stem cell transplantation (HDC-ACSH) in the treatment of metastatic (MBC), locally advanced (LABC) and inflammatory (IBC) breast cancer have in common lack of biomarker information, in particular the HER2 status. PATIENTS AND METHODS All consecutive female patients treated for breast cancer with HDC and AHSCT at Institut Paoli Calmettes between 2003 and 2012 were included. Patients were categorized in three subtypes based on hormonal receptor (HR) and HER2 status of the primary tumor: luminal, (HR+/HER2-), HER2 (HER2+, any HR) and triple negative (TN) (HER2- and HR-). The main objective was the analysis of overall survival (OS) according to the IHC subtypes. RESULTS Three hundred and seventy-seven patients were included. For MBC, the TN subtype appeared to have the worst prognosis with a median OS of 19.68 months (95 % CI 11.76-44.4) compared to 44.64 months (95 % CI 40.32-67.56) for the luminal subtype and a median OS not reached for the HER2 subtype (P<0.01). For IBC, HER2 subgroup appeared to have the best prognosis with a 5-year OS of 89 % (95 % CI 64-97) compared to 57 % (95 % CI 33-76) for the TN subgroup (HR 5.38, 95 % CI 1.14-25.44; P=0.034). For CSLA, luminal subgroup appeared to have the best prognosis with a 5-year OS of 92 % (95 % CI 71-98) against 75 % (95 % CI 46-90) for HER 2 subtype and 70 % (95 %CI 97-88) for TN subtype (P=0.301). CONCLUSION The HDC-ACSH does not change the prognosis value of IHC subtype in breast cancer patients.
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Affiliation(s)
- Laurys Boudin
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France
| | - Christian Chabannon
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Institut Paoli-Calmettes, centre de thérapie cellulaire, département de biologie du cancer, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Centre d'investigations cliniques en biothérapies, Inserm CBT-1409, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Patrick Sfumato
- Institut Paoli-Calmettes, biostatistiques, département de la recherche clinique et de l'innovation (DRCI), 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Renaud Sabatier
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France; Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France
| | - François Bertucci
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France; Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France
| | - Carole Tarpin
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France
| | - Magali Provansal
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France
| | - Gilles Houvenaeghel
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France; Institut Paoli-Calmettes, département de chirurgie oncologique, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Eric Lambaudie
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France; Institut Paoli-Calmettes, département de chirurgie oncologique, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Agnes Tallet
- Institut Paoli-Calmettes, département de radiothérapie, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Michel Resbeut
- Institut Paoli-Calmettes, département de radiothérapie, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Emmanuelle Charafe-Jauffret
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France; Institut Paoli-Calmettes, biopathologie, département de biologie du cancer, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Boris Calmels
- Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Institut Paoli-Calmettes, centre de thérapie cellulaire, département de biologie du cancer, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Centre d'investigations cliniques en biothérapies, Inserm CBT-1409, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Claude Lemarie
- Institut Paoli-Calmettes, centre de thérapie cellulaire, département de biologie du cancer, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Centre d'investigations cliniques en biothérapies, Inserm CBT-1409, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Jean-Marie Boher
- Institut Paoli-Calmettes, biostatistiques, département de la recherche clinique et de l'innovation (DRCI), 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Jean-Marc Extra
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France
| | - Patrice Viens
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France; Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France
| | - Anthony Gonçalves
- Institut Paoli-Calmettes (IPC), département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille cedex 9, France; Centre de recherches en cancérologie de Marseille (CRCM), UMR Inserm 1068/CNRS 7258/AMU 105/IPC, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille université, Jardin du Pharo, 58, boulevard Charles-Livon, 13284 Marseille, France.
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Nicolle R, Blum Y, Marisa L, Garnier J, Bian B, Loncle C, Bigonnet M, Gayet O, Moutardier V, Duconseil P, Gasmi M, Ouaissi M, Turrini O, Giovannini M, Maignan A, Boher JM, Ewald J, Bories E, Barthet M, Goncalves A, Poizat F, Raoul JL, Secq V, Garcia S, Grandval P, Barraud-Blanc M, Norguet E, Gilabert M, Delpero JR, Calvo E, Reyniès AD, Dusetti N, Iovanna J. Abstract A48: Multi-omics characterization of PDAC subtypes using PDX reveals that epigenetic but not genetic analysis permit a clinically relevant classification. Cancer Res 2016. [DOI: 10.1158/1538-7445.panca16-a48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Genome-wide molecular profiles have been proven to be beneficial for the identification of clinically relevant tumor subtypes in many neoplastic diseases. While pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death, very few genomic and transcriptomic studies have been conducted. This is mainly due to the difficulty to obtain a suitable cohort of PDAC tumor samples. The major obstacle is the usually high proportion of non-transformed stromal cells, which can greatly hinder the analysis of carcinogenic-specific processes. Moreover, tumor cohorts requiring resection samples can be biased by the exclusion of inoperable patients, representing 85% of all patients presenting PDAC.
In this study, we generated Patient Derived Xenografts (PDX) with samples collected from 29 patients using either Endoscopic Ultrasound-Guided Fine-Needle Aspirates or, for operable patients, resections. The transcriptomic profiles, of both mRNA and miRNA, and the epigenetic landscape of early PDX passages consistently identified two tumor-specific molecular subtypes: a well differentiated group often referred to as classical, and an undifferentiated group previously recognized as Basal, Quasi-Mesenchymal or Squamous. Of all the genetic alterations determined by Copy Number analysis and exome sequencing, none were specific to any of the two subtypes, which therefore could not be discriminated solely on genetic basis.
These two PDAC subtypes are characterized by distinct epigenetic and transcriptomic profiles of which the analysis revealed the deregulation of several pathways previously imputed in PDAC development and carcinogenesis in general. In particular, we showed that the Wnt pathway as well as several metabolic pathways, including cytochrome P450 genes recently implicated in drug resistance, are both epigenetically and transcriptionally deregulated. Altogether, our results provide new insights on pancreatic carcinogenesis and suggest that PDAC phenotypical heterogeneity is mainly driven by epigenetic rather than genetic events.
Citation Format: Remy Nicolle, Yuna Blum, Laetitia Marisa, Jonathan Garnier, Benjamin Bian, Celine Loncle, Martin Bigonnet, Odile Gayet, Vincent Moutardier, Pauline Duconseil, Mohamed Gasmi, Mehdi Ouaissi, Olivier Turrini, Marc Giovannini, Aurélie Maignan, Jean-Marie Boher, Jacques Ewald, Erwan Bories, Marc Barthet, Anthony Goncalves, Flora Poizat, Jean-Luc Raoul, Veronique Secq, Stephane Garcia, Philippe Grandval, Marine Barraud-Blanc, Emmanuelle Norguet, Marine Gilabert, Jean-Robert Delpero, Ezequiel Calvo, Aurélien de Reyniès, Nelson Dusetti, Juan Iovanna.{Authors}. Multi-omics characterization of PDAC subtypes using PDX reveals that epigenetic but not genetic analysis permit a clinically relevant classification. [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2016 May 12-15; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(24 Suppl):Abstract nr A48.
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Affiliation(s)
- Remy Nicolle
- 1Programme Cartes d’Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France,
| | - Yuna Blum
- 1Programme Cartes d’Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France,
| | - Laetitia Marisa
- 1Programme Cartes d’Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France,
| | - Jonathan Garnier
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Benjamin Bian
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Celine Loncle
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Martin Bigonnet
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Odile Gayet
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | | | - Pauline Duconseil
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | | | | | | | | | - Aurélie Maignan
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ezequiel Calvo
- 6Centre Génomique du Centre de recherche du CHUL Research Center, QB, Canada
| | - Aurélien de Reyniès
- 1Programme Cartes d’Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France,
| | - Nelson Dusetti
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Juan Iovanna
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
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Nicolle R, Blum Y, Marisa L, Garnier J, Bian B, Loncle C, Bigonnet M, Gayet O, Moutardier V, Duconseil P, Gasmi M, Ouaissi M, Turrini O, Giovannini M, Maignan A, Boher JM, Ewald J, Bories E, Barthet M, Goncalves A, Poizat F, Raoul JL, Secq V, Garcia S, Grandval P, Barraud-Blanc M, Norguet E, Gilabert M, Delpero JR, Calvo E, Reyniès AD, Iovanna J, Dusetti N. Abstract B72: Pancreatic cancer cell drives stroma composition. Cancer Res 2016. [DOI: 10.1158/1538-7445.panca16-b72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The extensive desmoplasia in pancreatic ductal adenocarcinoma (PDAC) has raised major interrogations on its role and function in the carcinogenic process. Patient-derived xenograft (PDX) offers an ideal setting to distinguish and to study the interactions between the cancerous epithelial cells and its stroma. Indeed, sequencing profiles of a mix of cancerous/Human and stroma/Mouse cells can be analyzed separately in silico by unambiguously assigning each sequence to the human or mouse genome. Using RNA sequencing, we profiled 30 pancreatic tumor PDXs and extracted the transcriptome profiles of epithelial cancerous cells as well as their corresponding stroma. On average, 70% of RNA sequencing reads were specifically attributed to a human origin, and therefore an epithelial origin, while 22% of RNA sequencing reads were mouse-specific. Using the rate of mouse sequences as a surrogate of the proportion of non-transformed cells, we observe a high variability in the infiltration level from 7% to 60%. The estimation was also consistent in whole exome sequencing (using the same sequencing process) and with the histological quantification of fibrotic tissue.
By specifically analyzing the gene expression in mouse-stromal cells, we show that their transcriptomic profile is consistent with the recent description of human PDAC in situ tumors with high levels of genes of the reported activated-stroma and normal-stroma signatures. We also show that stromal cells over-express genes involved in the SLIT/ROBO axon guidance signalling pathway, in angiogenesis as well as a large number of collagens, cytokines and ligands associated with growth and developmental pathways.
Recent studies identified two major subtypes of PDAC from transcriptomic analysis: a well differentiated, often referred as classical, and an undifferentiated, previously recognized as Basal, Quasi-Mesenchymal or Squamous. The stroma characterized in this work broadly reflects this heterogeneity with stromal gene expression signatures predictive of each subtype. For instance, collagens are significantly over-expressed in the stroma of squamous tumors. The concomitant analysis of transcriptomic profiles of both subtypes shows potential cross-talks between cancerous and stromal cells. Particularly in Squamous tumors, genes implicated in the axon-guidance and Wnt pathways are significantly upregulated in both, stroma and transformed cells. On the other hand, the stroma and transformed cells of Classical tumors shows an upregulation of complementary genes associated with several metabolic pathways.
Taken together, our transcriptomic analysis reveals that human transformed pancreatic cells determine the composition, quantitatively and qualitatively, of stroma mouse cells in a PDX model. This model also reveals a broad variability of PDAC stromas and highlights potential cross-talks between them through known and novel pathways.
Citation Format: Rémy Nicolle, Yuna Blum, Laetitia Marisa, Jonathan Garnier, Benjamin Bian, Celine Loncle, Martin Bigonnet, Odile Gayet, Vincent Moutardier, Pauline Duconseil, Mohamed Gasmi, Mehdi Ouaissi, Olivier Turrini, Marc Giovannini, Aurélie Maignan, Jean-Marie Boher, Jacques Ewald, Erwan Bories, Marc Barthet, Anthony Goncalves, Flora Poizat, Jean-Luc Raoul, Veronique Secq, Stephane Garcia, Philippe Grandval, Marine Barraud-Blanc, Emmanuelle Norguet, Marine Gilabert, Jean-Robert Delpero, Ezequiel Calvo, Aurélien de Reyniès, Juan Iovanna, Nelson Dusetti.{Authors}. Pancreatic cancer cell drives stroma composition. [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2016 May 12-15; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(24 Suppl):Abstract nr B72.
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Affiliation(s)
- Rémy Nicolle
- 1Programme Cartes d’Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France,
| | - Yuna Blum
- 1Programme Cartes d’Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France,
| | - Laetitia Marisa
- 1Programme Cartes d’Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France,
| | - Jonathan Garnier
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Benjamin Bian
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Celine Loncle
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Martin Bigonnet
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Odile Gayet
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | | | - Pauline Duconseil
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | | | | | | | | | - Aurélie Maignan
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ezequiel Calvo
- 6Centre Génomique du Centre de recherche du CHUL Research Center, Quebec, Canada
| | - Aurélien de Reyniès
- 1Programme Cartes d’Identité des Tumeurs (CIT), Ligue Nationale Contre Le Cancer, Paris, France,
| | - Juan Iovanna
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
| | - Nelson Dusetti
- 2Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Marseille, France,
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Boudin L, Gonçalves A, Sfumato P, Sabatier R, Bertucci F, Tarpin C, Provansal M, Houvenaeghel G, Lambaudie E, Tallet A, Resbeut M, Charafe-Jauffret E, Calmels B, Lemarie C, Boher JM, Extra JM, Viens P, Chabannon C. Prognostic impact of hormone receptor- and HER2-defined subtypes in inflammatory breast cancer treated with high-dose chemotherapy: a retrospective study. J Cancer 2016; 7:2077-2084. [PMID: 27877223 PMCID: PMC5118671 DOI: 10.7150/jca.15797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/11/2016] [Accepted: 09/05/2016] [Indexed: 11/05/2022] Open
Abstract
Purpose: Studies examining high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDC-AHSCT) strategies in inflammatory breast cancer (IBC), showed encouraging results in terms of disease-free survival (DFS), and overall survival (OS). The lack of data regarding HER2 status in all of these studies prevented any prognostic analysis involving breast cancer subtypes. Methods: All consecutive female patients treated for IBC with HDC and AHSCT at Institut Paoli-Calmettes between 2003 and 2012 were included. Since 2005, trastuzumab was included in initial treatment. Patient, tumor and treatment characteristics were collected. Patients were categorized in three subtypes based on hormonal receptor (HR) and HER2 status of the primary tumor: Luminal, (HR+/HER2-), HER2 (HER2+, any HR), and triple negative (TN) (HER2- and HR-). The main objective was the analysis of OS according to the IHC subtypes. Results: Sixty-seven patients were included. Eleven patients received trastuzumab. Median follow up was 80.04 months (95% CI 73.2-88.08). Five-year OS and DFS for the whole population patients were 74% (95% CI 61-83) and 65 % (95% CI 52-75), respectively. OS differed across subtypes (p=0.057) : HER2 subgroup appeared to have the best prognosis with a 5-year OS of 89% (95% CI 64-97) compared to 57% (95% CI 33-76) for the TN subgroup (HR 5.38, 95% CI 1.14-25.44; p=0.034). Conclusions: In IBC patients receiving HDC-AHSCT, OS favorably compares with data available in the literature on similar groups of patients. TN patients carried the least favourable OS and HER2 patients, half of them also receiving trastuzumab, had the best outcome. These findings provide additional information and options for patients with IBC and who could potentially benefit of HDC-AHSCT.
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Affiliation(s)
- Laurys Boudin
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Département d'Oncologie médicale, Hôpital d'Instruction des Armées Sainte Anne, Toulon, 83000, France
| | - Anthony Gonçalves
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France
| | - Patrick Sfumato
- Biostatistiques, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Renaud Sabatier
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France
| | - François Bertucci
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France
| | - Carole Tarpin
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France
| | - Magali Provansal
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France
| | - Gilles Houvenaeghel
- Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France.; Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, F -13273, France
| | - Eric Lambaudie
- Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France.; Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, F -13273, France
| | - Agnes Tallet
- Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Michel Resbeut
- Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Emmanuelle Charafe-Jauffret
- Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France.; Biopathologie, Département de Biologie du Cancer Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Boris Calmels
- Département d'Oncologie médicale, Hôpital d'Instruction des Armées Sainte Anne, Toulon, 83000, France.; Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, F-13273, France.; Centre d'Investigations Cliniques en Biothérapies, Inserm CBT-1409, Marseille, F-13009, France
| | - Claude Lemarie
- Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, F-13273, France.; Centre d'Investigations Cliniques en Biothérapies, Inserm CBT-1409, Marseille, F-13009, France
| | - Jean-Marie Boher
- Biostatistiques, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, F-13273, France
| | - Jean-Marc Extra
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France
| | - Patrice Viens
- Département d'Oncologie médicale, Institut Paoli-Calmettes (IPC), Marseille, F-13273, France.; Centre de Recherches en Cancérologie de Marseille (CRCM), UMR Inserm 1068 / CNRS 7258 / AMU 105 / IPC, Marseille, F-13009, France.; Aix-Marseille Université, Marseille, F-13284, France
| | - Christian Chabannon
- Aix-Marseille Université, Marseille, F-13284, France.; Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, F-13273, France.; Centre d'Investigations Cliniques en Biothérapies, Inserm CBT-1409, Marseille, F-13009, France
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Boher JM, Filleron T, Giorgi R, Kramar A, Cook RJ. Goodness-of-fit test for monotone proportional subdistribution hazards assumptions based on weighted residuals. Stat Med 2016; 36:362-377. [PMID: 27790725 DOI: 10.1002/sim.7153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 07/27/2016] [Accepted: 10/03/2016] [Indexed: 11/10/2022]
Abstract
Recently goodness-of-fit tests have been proposed for checking the proportional subdistribution hazards assumptions in the Fine and Gray regression model. Zhou, Fine, and Laird proposed weighted Schoenfeld-type residuals tests derived under an assumed model with specific form of time-varying regression coefficients. Li, Sheike, and Zhang proposed an omnibus test based on cumulative sums of Schoenfeld-type residuals. In this article, we extend the class of weighted residuals tests by allowing random weights of Schoenfeld-type residuals at ordered event times. In particular, it is demonstrated that weighted residuals tests using monotone weight functions of time are consistent against monotone proportional subdistribution hazards assumptions. Extensive Monte Carlo studies were conducted to evaluate the finite-sample performance of recent goodness-of-fit tests. Results from simulation studies show that weighted residuals tests using monotone random weight functions commonly used in non-proportional hazards regression settings tend to be more powerful for detecting monotone departures than other goodness-of-fit tests assuming no specific time-varying effect or misspecified time-varying effects. Two examples using real data are provided for illustrations. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jean-Marie Boher
- Institut Paoli Calmettes, Unité de Biostatistique et de Méthodologie, Marseille, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Thomas Filleron
- Cellule Biostatistique, Bureau des Essais Cliniques, IUCT-O, Toulouse, France
| | - Roch Giorgi
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,APHM, Hopıtal de la Timone, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
| | - Andrew Kramar
- Unité de Méthodologie et Biostatistique, Centre Oscar Lambret, Lille, France
| | - Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Houvenaeghel G, Boher JM, Reyal F, Cohen M, Garbay JR, Classe JM, Rouzier R, Giard S, Faure C, Charitansky H, Tunon de Lara C, Daraï E, Hudry D, Azuar P, Gimbergues P, Villet R, Sfumato P, Lambaudie E. Impact of completion axillary lymph node dissection in patients with breast cancer and isolated tumour cells or micrometastases in sentinel nodes. Eur J Cancer 2016; 67:106-118. [PMID: 27640137 DOI: 10.1016/j.ejca.2016.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/21/2016] [Accepted: 08/04/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Omission of completion axillary lymph node dissection (ALND) is a standard practice in patients with breast cancer (BC) and negative sentinel nodes (SNs) but has shown insufficient evidence to be recommended in those with SN invasion. METHODS A retrospective analysis of a cohort of patients with BC and micrometastases (Mic) or isolated tumour cells (ITCs) in SN. Factors associated with ALND were identified, and patients with ALND were matched to patients without ALND. Overall survival (OS) and recurrence-free survival (RFS) were estimated in the overall population, in Mic and in ITC cohorts. FINDINGS Among 2009 patients analysed, 1390 and 619 had Mic and ITC in SN, respectively. Factors significantly associated with ALND were SN status, histological type, age, number of SN harvested and absence of adjuvant chemotherapy. After a median follow-up of 60.4 months, ALND omission was independently associated with reduced OS (hazard ratio [HR] 2.41, 90 confidence interval [CI] 1.36-4.27, p = 0.0102), but not with increased RFS (HR 1.21, 90 CI 0.74-2.0, p = 0.52) in the overall population. In matched patients, the increased risk of death in case of ALND omission was found only in the Mic cohort (HR 2.88, 90 CI 1.46-5.69), not in the ITC cohort. The risk of recurrence was also significantly increased in the subgroup of matched Mic patients (HR 1.56, 90 CI 0.90-2.73). INTERPRETATION A separate analysis of Mic and ITC groups, matched for the determinants of ALND, suggested that patients with Mic had increased recurrence rates and shorter OS when ALND was not performed. Our results are consistent with those of previous studies for patients with ITC but not for those with Mic. Randomised controlled clinical trials are still warranted to show with a high level of evidence if ALND can be safely omitted in patients with micrometastatic disease in SN.
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Affiliation(s)
- G Houvenaeghel
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France; Aix Marseille Université, France.
| | - J M Boher
- Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009, France; Aix-Marseille University, Unité Mixte de Recherche S912, Institut de Recherche pour le Développement, 13385, Marseille, France
| | - F Reyal
- Institut Curie, 26 rue d'Ulm, 75248, Paris, France
| | - M Cohen
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France
| | - J R Garbay
- Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France
| | - J M Classe
- Institut René Gauducheau, Site hospitalier Nord, St Herblain, France
| | - R Rouzier
- Centre René Huguenin, 35 rue Dailly, Saint Cloud, France
| | - S Giard
- Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France
| | - C Faure
- Centre Léon Bérard, 28 rue Laennec, Lyon, France
| | - H Charitansky
- Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France
| | | | - E Daraï
- Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - D Hudry
- Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France
| | - P Azuar
- Hôpital de Grasse, Chemin de Clavary, Grasse, France
| | - P Gimbergues
- Centre Jean Perrin, 58 rue Montalembert, Clermont Ferrand, France
| | - R Villet
- Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, Paris, France
| | - P Sfumato
- Department of Biostatistics and Methodology, Institut Paoli Calmettes, 13009, France; Aix-Marseille University, Unité Mixte de Recherche S912, Institut de Recherche pour le Développement, 13385, Marseille, France
| | - E Lambaudie
- Institut Paoli Calmettes and CRCM, 232 Bd Ste Marguerite, Marseille, France
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Somda SM, Leconte E, Boher JM, Asselain B, Kramar A, Filleron T. Optimal scheduling of post-therapeutic follow-up of patients treated for cancer for early detection of relapses. Stat Methods Med Res 2016; 25:2457-2471. [DOI: 10.1177/0962280214524178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-therapeutic surveillance is one important component of cancer care. However, there still is no evidence-based strategies to schedule patients’ follow-up examinations. Our approach is based on the modeling of the probability of the onset of relapse at an early asymptotic or preclinical stage and its transition to a clinical stage. For that we consider a multistate homogeneous Markov model, which includes the natural history of relapse. The model also handles separately the different types of possible relapses. The optimal schedule is provided by the calendar visit that maximizes a utility function. The methodology has been applied to laryngeal cancer. The different follow-up strategies revealed to be more efficient than those proposed by different scientific societies.
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Affiliation(s)
- Serge Ma Somda
- Cellule de Biostatistique, Institut Claudius Regaud, Toulouse, France.,Centre MURAZ, Bobo Dioulasso, Burkina Faso
| | - Eve Leconte
- TSE (GREMAQ), Université Toulouse 1 Capitole, Toulouse, France
| | - Jean-Marie Boher
- Bureau des Etudes Cliniques, Institut Paoli Calmettes, Marseille, France
| | | | - Andrew Kramar
- Centre Oscar Lambret, Unité de Méthodologie et Biostatistique, Lille, France
| | - Thomas Filleron
- Cellule de Biostatistique, Institut Claudius Regaud, Toulouse, France
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Cabarrou B, Boher JM, Bogart E, Tresch-Bruneel E, Penel N, Ravaud A, Escudier B, Mahier Ait-Oukhatar C, Delord JP, Roché H, Filleron T. How to report toxicity associated with targeted therapies? Ann Oncol 2016; 27:1633-8. [PMID: 27217543 DOI: 10.1093/annonc/mdw218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/17/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the era of personalized medicine, molecularly targeted therapies (MTT) have modified the outcome of some cancer types. The price of tumor control needs to be balanced with toxicity since these new therapies are administered continuously for several months or sometimes for several years. For cytotoxic drugs, the incidence of adverse event (AE) was traditionally reported as frequency and intensity. This simple measure is not sufficient to capture the recurrent nature and duration of AE. This paper presents two methods to better describe the toxicity burden across the time: prevalence and Q-TWiST. PATIENTS AND METHODS Limitation of worst-grade method and advantages of prevalence and Q-TWiST in the analysis of toxicity were illustrated using data from a phase II trial and a hypothetically simulated clinical trial. RESULTS Prevalence integrates the recurrent nature of AE. Using prevalence, it is possible to obtain a time profile of AE. Q-TWiST method evaluates the weighted time spent in each health state and also considers the recurrent nature of side-effects in order to assess the 'risk-benefit' ratio of a treatment. When interpreting Q-TWiST results, it is necessary to take into account overall survival and progression-free survival and to define a clinically relevant difference according to the setting. CONCLUSION The two methods presented here capture different effects. They are helpful for physicians in their treatment choice (balance benefit risk), to counsel patients and to optimize supportive care. In order to ensure consistency and provide critical information required for medical decision-making, it is important to encourage the use of alternative statistical methods in the analysis of toxicities associated with MTT. CLINICAL TRIAL NCT00541008.
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Affiliation(s)
- B Cabarrou
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O Toulouse, Toulouse
| | - J M Boher
- Department of Biostatistics, Institut Paoli Calmette, Marseille
| | | | | | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Ravaud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux
| | - B Escudier
- Department of Medical Oncology, Gustave Roussy, Villejuif
| | | | - J P Delord
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O Toulouse, Toulouse, France
| | - H Roché
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O Toulouse, Toulouse, France
| | - T Filleron
- Department of Biostatistics, Institut Claudius Regaud, IUCT-O Toulouse, Toulouse
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de Nonneville A, Goncalves A, Zemmour C, Classe JM, Cohen M, Lambaudie E, Reyal F, Giard S, Rouzier R, Villet R, Boher JM, Houvenaeghel G. Benefit of adjuvant chemotherapy and/or trastuzumab in T1ab node-negative human epidermal growth factor receptor 2–positive breast carcinomas: Results of a national multi-institutional study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.590] [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)
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | | | | | | | | | - Sylvia Giard
- Department of Surgery, Centre Oscar Lambret, Lille, France
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Gonçalves A, Guerin M, Isambert N, Campone M, Resai K, Autret A, Pakradouni J, Robert A, Provansal M, Charafe-Jauffret E, Sabatier R, Hervieu A, Extra JM, Viens P, Lokiec F, Boher JM. Abstract A118: PIKHER2: A phase Ib study evaluating oral BKM120 in combination with lapatinib in trastuzumab-resistant HER2-positive advanced breast cancer. Mol Cancer Ther 2015. [DOI: 10.1158/1535-7163.targ-15-a118] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Phosphatidylinositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR)-pathway is frequently activated in HER2-positive breast cancer and may play a major role in resistance to trastuzumab. Lapatinib is a dual anti-HER2/EGFR tyrosine kinase inhibitor with clinical activity after trastuzumab failure in HER2-positive advanced breast cancer (ABC). BKM120 is a pan-class I PI3K inhibitor with potent and selective activity against wild-type and mutant PI3K p110α. PIKHER2 phase Ib study aimed primarily to determine maximum tolerated dose (MTD) and propose a recommended phase II dose (RP2D) for BKM120 in combination with lapatinib in HER2-positive, trastuzumab-resistant, ABC. Secondary objectives included safety, antitumor activity, pharmacokinetics and biomarker assessments. Methods: PIKHER2 was a multi-center study, enrolling HER2 positive (IHC 3+ or FISH positive) ABC, with disease progressing either while on trastuzumab for metastatic disease or within 12 months of the last infusion for patients who received trastuzumab as adjuvant/neoadjuvant treatment. Oral BKM120 (B; 40, 60 or 80 mg) and lapatinib (L; 750, 1000 or 1250 mg) were administered daily. A modified CRM using an adaptive Bayesian model guided the dose escalation of both agents. PIK3CA mutational status and PTEN/hormone receptor expression IHC was evaluated on available tumor tissue. Results: A total of 24 HER2-positive ABC pts, with a median number of previous lines of cytotoxics = 2 (1-5) and previous lines of anti-HER2 = 2 (1-6) for advanced stage, were treated across 5 dose-levels (B,40 + L,750; B, 60 + L,750; B,80 + L,750; B,80 + L,1000; B,80 + L,1250). Following cycle 1, 5 pts experienced DLTs: G3 ALT elevation, G3 vomiting, G3 stomatitis, G3 hyperglycemia and G3 diarrhea. MTD was reached at B,80 + L,1250 but toxicities and early treatment discontinuation beyond cycle 1 led us to select B,80 + L,1000 as the RP2D. Main drug-related adverse events were: diarrhea (83% of pts, G3 in 21%), nausea/vomiting (83% of pts, G3 in 4%), skin toxicity (75% of pts, G3 in 21%), asthenia (70% of patients, no G3), depression (58% of pts, G3 in 4%), anxiety (42% of pts, no G3), transaminases increase (29% of pts, G3 in 17%). B and L PK parameters values were consistent with those already published for both drugs. A large inter-individual variability was observed for both drugs. There was no significant evidence for drug-drug PK interaction. Disease control rate (DCR) was 79% [57-92%], one patient obtained a complete remission and 6 additional patients experienced stable disease for ≥ 24 weeks (clinical benefit rate, CBR of 29% [12-51%]). PIK3CA mutations and PTEN loss were observed in 4 of 14 and 1 of 21 patients, respectively. DCR and CBR were higher in hormone receptor-negative tumors. Conclusion: Combining BKM120 and lapatinib in HER2-positive trastuzumab-resistant was feasible. Preliminary evidences of antitumor activity were observed in this heavily pre-treated population.
Citation Format: Anthony Gonçalves, Mathilde Guerin, Nicolas Isambert, Mario Campone, Keyvan Resai, Aurélie Autret, Jihane Pakradouni, Alexie Robert, Magali Provansal, Emmanuelle Charafe-Jauffret, Renaud Sabatier, Alice Hervieu, Jean-Marc Extra, Patrice Viens, François Lokiec, Jean-Marie Boher. PIKHER2: A phase Ib study evaluating oral BKM120 in combination with lapatinib in trastuzumab-resistant HER2-positive advanced breast cancer. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr A118.
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Affiliation(s)
| | | | | | - Mario Campone
- 3Institut de Cancérologie de l'Ouest, Nantes, France
| | - Keyvan Resai
- 4Institut Curie - Centre René Huguenin, Saint-Cloud, France
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Gravis G, Boher JM, Joly F, Soulié M, Albiges L, Priou F, Latorzeff I, Delva R, Krakowski I, Laguerre B, Rolland F, Théodore C, Deplanque G, Ferrero JM, Culine S, Mourey L, Beuzeboc P, Habibian M, Oudard S, Fizazi K. Androgen Deprivation Therapy (ADT) Plus Docetaxel Versus ADT Alone in Metastatic Non castrate Prostate Cancer: Impact of Metastatic Burden and Long-term Survival Analysis of the Randomized Phase 3 GETUG-AFU15 Trial. Eur Urol 2015. [PMID: 26610858 DOI: 10.1016/j.eururo.2015.11.005.] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of chemotherapy in metastatic non castrate prostate cancer (mNCPC) is debated. Survival benefits of docetaxel (D) added to androgen-deprivation therapy (ADT) were shown in the CHAARTED trial in patients with metastatic high-volume disease (HVD). OBJECTIVE To assess the impact of metastatic burden and to update overall survival (OS) data of the GETUG-AFU15 study. DESIGN, SETTING, AND PARTICIPANTS Randomized phase 3 trial of ADT plus D versus ADT alone in 385 mNCPC patients; median follow-up of 7 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary end point was OS. Secondary end points were biochemical progression-free survival (bPFS) and radiographic progression-free survival (rPFS). Retrospective analysis was by tumor volume. RESULTS AND LIMITATIONS After a median follow-up of 83.9 mo, median OS in the overall population was 62.1 mo (95% confidence interval [CI], 49.5-73.7) and 48.6 mo (95% CI, 40.9-60.6) for ADT plus D and ADT arms, respectively (hazard ratio [HR]: 0.88 [95% CI, 0.68-1.14]; p=0.3). Median OS in ADT plus D and ADT arms, respectively, was for HVD patients: 39.8 mo (95% CI, 28.0-53.4) versus 35.1 mo (95% CI, 29.9-43.6) (HR: 0.78 [95% CI, 0.56-1.09]; p=0.14), for low-volume disease (LVD) patients; median was not reached (NR; 95% CI, 69.5-NR) and 83.4 mo (95% CI, 61.8-NR) (HR: 1.02 [95% CI, 0.67-1.55]; p=0.9). For upfront metastatic patients, OS was 52.6 mo (95% CI, 43.3-66.8) and 41.5 mo (95% CI, 36.3-54.5), respectively (HR: 0.93 [95% CI, 0.69-1.25]; p=0.6). The bPFS (HR: 0.73 [95% CI, 0.56-0.94]; p=0.014) and rPFS (HR: 0.75 [95% CI, 0.58-0.97]; p=0.030) were significantly longer in the ADT plus D arm. Limitations included the retrospective analysis of metastatic extent and the lack of statistical power to detect a significant difference in subgroups. CONCLUSIONS The post hoc analyses of the GETUG-AFU15 study demonstrated a nonsignificant 20% reduction in the risk of death in the HVD subgroup. Patients with LVD had no survival improvement with early D. PATIENT SUMMARY In this study, docetaxel added to castration did not improve survival in patients with metastatic hormone-sensitive prostate cancer, partly due to methodological issues. However, early chemotherapy should be discussed with all patients, given the data of three randomized trials including GETUG-AFU15.
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Affiliation(s)
| | - Jean-Marie Boher
- Biostatistics, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille Université, UMR_S 912 (SESSTIM), IRD, Marseille, France; INSERM, UMR_S 912 (SESSTIM), Marseille, France
| | - Florence Joly
- Medical Oncology, Centre François Baclesse - CHU Côte de Nacre, Caen, France
| | - Michel Soulié
- Urology Department, Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | - Laurence Albiges
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Franck Priou
- Medical Oncology, Centre Hospitalier Les Oudairies, La Roche-sur-Yon, France
| | - Igor Latorzeff
- Radiotherapy Department, Clinique Pasteur, Toulouse, France
| | - Remy Delva
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - Ivan Krakowski
- Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France
| | | | - Frédéric Rolland
- Medical Oncology, Centre René Gauducheau, Saint-Herblain, France
| | | | - Gael Deplanque
- Medical Oncology, Groupe Hospitalier Saint Joseph, Paris, France
| | | | | | | | | | | | - Stéphane Oudard
- Medical Oncology Department, Georges Pompidou Hospital and René Descartes University, Paris, France
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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Gravis G, Boher JM, Joly F, Soulié M, Albiges L, Priou F, Latorzeff I, Delva R, Krakowski I, Laguerre B, Rolland F, Théodore C, Deplanque G, Ferrero JM, Culine S, Mourey L, Beuzeboc P, Habibian M, Oudard S, Fizazi K. Androgen Deprivation Therapy (ADT) Plus Docetaxel Versus ADT Alone in Metastatic Non castrate Prostate Cancer: Impact of Metastatic Burden and Long-term Survival Analysis of the Randomized Phase 3 GETUG-AFU15 Trial. Eur Urol 2015; 70:256-62. [PMID: 26610858 DOI: 10.1016/j.eururo.2015.11.005] [Citation(s) in RCA: 300] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of chemotherapy in metastatic non castrate prostate cancer (mNCPC) is debated. Survival benefits of docetaxel (D) added to androgen-deprivation therapy (ADT) were shown in the CHAARTED trial in patients with metastatic high-volume disease (HVD). OBJECTIVE To assess the impact of metastatic burden and to update overall survival (OS) data of the GETUG-AFU15 study. DESIGN, SETTING, AND PARTICIPANTS Randomized phase 3 trial of ADT plus D versus ADT alone in 385 mNCPC patients; median follow-up of 7 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary end point was OS. Secondary end points were biochemical progression-free survival (bPFS) and radiographic progression-free survival (rPFS). Retrospective analysis was by tumor volume. RESULTS AND LIMITATIONS After a median follow-up of 83.9 mo, median OS in the overall population was 62.1 mo (95% confidence interval [CI], 49.5-73.7) and 48.6 mo (95% CI, 40.9-60.6) for ADT plus D and ADT arms, respectively (hazard ratio [HR]: 0.88 [95% CI, 0.68-1.14]; p=0.3). Median OS in ADT plus D and ADT arms, respectively, was for HVD patients: 39.8 mo (95% CI, 28.0-53.4) versus 35.1 mo (95% CI, 29.9-43.6) (HR: 0.78 [95% CI, 0.56-1.09]; p=0.14), for low-volume disease (LVD) patients; median was not reached (NR; 95% CI, 69.5-NR) and 83.4 mo (95% CI, 61.8-NR) (HR: 1.02 [95% CI, 0.67-1.55]; p=0.9). For upfront metastatic patients, OS was 52.6 mo (95% CI, 43.3-66.8) and 41.5 mo (95% CI, 36.3-54.5), respectively (HR: 0.93 [95% CI, 0.69-1.25]; p=0.6). The bPFS (HR: 0.73 [95% CI, 0.56-0.94]; p=0.014) and rPFS (HR: 0.75 [95% CI, 0.58-0.97]; p=0.030) were significantly longer in the ADT plus D arm. Limitations included the retrospective analysis of metastatic extent and the lack of statistical power to detect a significant difference in subgroups. CONCLUSIONS The post hoc analyses of the GETUG-AFU15 study demonstrated a nonsignificant 20% reduction in the risk of death in the HVD subgroup. Patients with LVD had no survival improvement with early D. PATIENT SUMMARY In this study, docetaxel added to castration did not improve survival in patients with metastatic hormone-sensitive prostate cancer, partly due to methodological issues. However, early chemotherapy should be discussed with all patients, given the data of three randomized trials including GETUG-AFU15.
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Affiliation(s)
| | - Jean-Marie Boher
- Biostatistics, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille Université, UMR_S 912 (SESSTIM), IRD, Marseille, France; INSERM, UMR_S 912 (SESSTIM), Marseille, France
| | - Florence Joly
- Medical Oncology, Centre François Baclesse - CHU Côte de Nacre, Caen, France
| | - Michel Soulié
- Urology Department, Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | - Laurence Albiges
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Franck Priou
- Medical Oncology, Centre Hospitalier Les Oudairies, La Roche-sur-Yon, France
| | - Igor Latorzeff
- Radiotherapy Department, Clinique Pasteur, Toulouse, France
| | - Remy Delva
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - Ivan Krakowski
- Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France
| | | | - Frédéric Rolland
- Medical Oncology, Centre René Gauducheau, Saint-Herblain, France
| | | | - Gael Deplanque
- Medical Oncology, Groupe Hospitalier Saint Joseph, Paris, France
| | | | | | | | | | | | - Stéphane Oudard
- Medical Oncology Department, Georges Pompidou Hospital and René Descartes University, Paris, France
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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Rahal S, Boher JM, Extra JM, Tarpin C, Charafe-Jauffret E, Lambaudie E, Sabatier R, Thomassin-Piana J, Tallet A, Resbeut M, Houvenaeghel G, Laborde L, Bertucci F, Viens P, Gonçalves A. Immunohistochemical subtypes predict the clinical outcome in high-risk node-negative breast cancer patients treated with adjuvant FEC regimen: results of a single-center retrospective study. BMC Cancer 2015; 15:697. [PMID: 26466893 PMCID: PMC4607139 DOI: 10.1186/s12885-015-1746-3] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 10/09/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anthracycline-based adjuvant chemotherapy improves survival in patients with high-risk node-negative breast cancer (BC). In this setting, prognostic factors predicting for treatment failure might help selecting among the different available cytotoxic combinations. METHODS Between 1998 and 2008, 757 consecutive patients with node-negative BC treated in our institution with adjuvant FEC (5FU, epirubicin, cyclophosphamide) chemotherapy were identified. Data collection included demographic, clinico-pathological characteristics and treatment information. Molecular subtypes were derived from estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and Scarff-Bloom-Richardson (SBR) grade. Disease-free survival (DFS), distant disease-free survival (DDFS) and overall survival (OS) were estimated using the Kaplan-Meier Method, and prognostic factors were examined by multivariate Cox analysis. RESULTS After a median follow-up of 70 months, the 5-year DFS, DDFS and OS were 90.6 % (95 % confidence interval (CI): 88.2-93.1), 92.8 % (95 % CI: 90.7-95) and 95.1 % (95 % CI, 93.3-96.9), respectively. In the multivariate analysis including classical clinico-pathological parameters, only grade 3 maintained a significant and independent adverse prognostic impact. In an alternative multivariate model where ER, PR and grade were replaced by molecular subtypes, only luminal B/HER2-negative and triple-negative subtypes were associated with reduced DFS and DDFS. CONCLUSIONS Node-negative BC patients receiving adjuvant FEC regimen have a favorable outcome. Luminal B/HER2-negative and triple-negative subtypes identify patients with a higher risk of treatment failure, which might warrant more aggressive systemic treatment.
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Affiliation(s)
- S Rahal
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
| | - J M Boher
- Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
| | - J M Extra
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
| | - C Tarpin
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
| | - E Charafe-Jauffret
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - E Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
| | - R Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - J Thomassin-Piana
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
| | - A Tallet
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France.
| | - M Resbeut
- Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France.
| | - G Houvenaeghel
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - L Laborde
- Data Management and Analysis Center, Institut Paoli-Calmettes, Marseille, France.
| | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - P Viens
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France.
- Centre de Recherche en Cancérologie de Marseille, U1068 INSERM, U7258 CNRS, Marseille, France.
- Aix-Marseille University, Marseille, France.
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Albiges L, Xie W, Chen YH, Boher JM, Valenca LB, Bernard BD, Culine S, Habibian M, Carducci MA, DiPaola RS, Liu G, Pomerantz M, Nakabayashi M, Kantoff PW, Fizazi K, Gravis G, Sweeney C. Disease burden and outcome in metastatic hormone sensitive prostate cancer (mHSPC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5052] [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)
- Laurence Albiges
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Wanling Xie
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Jean-Marie Boher
- Biostatistic, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | | | | | - Stephane Culine
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
| | | | | | | | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Mark Pomerantz
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mari Nakabayashi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - Gwenaelle Gravis
- Medical Oncology, Institut Paoli Calmette, Hôpital de Jour, Marseille, France
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