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Lorusso D, Mouret-Reynier MA, Harter P, Cropet C, Caballero C, Wolfrum-Ristau P, Satoh T, Vergote I, Parma G, Nøttrup TJ, Lebreton C, Fasching PA, Pisano C, Manso L, Bourgeois H, Runnebaum I, Zamagni C, Hardy-Bessard AC, Schnelzer A, Fabbro M, Schmalfeldt B, Berton D, Belau A, Lotz JP, Gropp-Meier M, Gladieff L, Lück HJ, Abadie-Lacourtoisie S, Pujade-Lauraine E, Ray-Coquard I. Updated progression-free survival and final overall survival with maintenance olaparib plus bevacizumab according to clinical risk in patients with newly diagnosed advanced ovarian cancer in the phase III PAOLA-1/ENGOT-ov25 trial. Int J Gynecol Cancer 2024; 34:550-558. [PMID: 38129136 PMCID: PMC10982633 DOI: 10.1136/ijgc-2023-004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE In the PAOLA-1/ENGOT-ov25 trial (NCT02477644), adding maintenance olaparib to bevacizumab provided a substantial progression-free survival benefit in patients with newly diagnosed advanced ovarian cancer and homologous recombination deficiency (HRD)-positive tumors, irrespective of clinical risk. Subsequently, a clinically meaningful improvement in overall survival was reported with olaparib plus bevacizumab in the HRD-positive subgroup. We report updated progression-free survival and overall survival by clinical risk and HRD status. METHODS Patients in clinical response after first-line platinum-based chemotherapy plus bevacizumab received maintenance olaparib (up to 24 months) plus bevacizumab (up to 15 months in total) or placebo plus bevacizumab. This post hoc analysis evaluated 5-year progression-free survival and mature overall survival in patients classified by clinical risk and HRD status. RESULTS Of 806 randomized patients, 74% were higher-risk and 26% were lower-risk. In higher-risk HRD-positive patients, the hazard ratio (HR) for progression-free survival was 0.46 (95% confidence interval (95% CI) 0.34 to 0.61), with 5-year progression-free survival of 35% with olaparib plus bevacizumab versus 15% with bevacizumab alone; and the HR for overall survival was 0.70 (95% CI 0.50 to 1.00), with 5-year overall survival of 55% versus 42%, respectively. In lower-risk HRD-positive patients, the HR for progression-free survival was 0.26 (95% CI 0.15 to 0.45), with 5-year progression-free survival of 72% with olaparib plus bevacizumab versus 28% with bevacizumab alone; and the HR for overall survival was 0.31 (95% CI 0.14 to 0.66), with 5-year overall survival of 88% versus 61%, respectively. No benefit was seen in HRD-negative patients regardless of clinical risk. CONCLUSION This post hoc analysis indicates that in patients with newly diagnosed advanced HRD-positive ovarian cancer, maintenance olaparib plus bevacizumab should not be limited to those considered at higher risk of disease progression. Five-year progression-free survival rates support long-term remission and suggest an increased potential for cure with particular benefit suggested in lower-risk HRD-positive patients.
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Affiliation(s)
- Domenica Lorusso
- Istituto Tumori Milano + Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Milan, Italy
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies, (MITO), Italy
| | - Marie-Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, Clermont Ferrand, France
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
| | - Philipp Harter
- Department of Gynaecology & Gynaecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
| | - Claire Cropet
- Department of Biostatistics, Centre Léon Bérard, Lyon, France
| | - Cristina Caballero
- Servicio de Oncología Médica, Hospital General Universitario de Valencia, Valencia, Spain
- Grupo Español de Investigación en Cáncer de Ovario, (GEICO), Spain
| | - Pia Wolfrum-Ristau
- Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, Austria
- Arbeitsgemeinschaft Gynaekologische Onkologie Study Group, (AGO-Austria), Austria
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Gynecologic Oncology Trial and Investigation Consortium, (GOTIC), Japan
| | - Ignace Vergote
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium, European Union
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Belgium, European Union
| | - Gabriella Parma
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
- Mario Negri Gynecologic Oncology Group, (MANGO), Italy
| | - Trine J Nøttrup
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Nordic Society of Gynecologic Oncology, (NSGO), Denmark
| | - Coriolan Lebreton
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Peter A Fasching
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Gynecology and Obstetrics Translational Medicine, Universitätsfrauenklinik Erlangen, Erlangen, Germany
| | - Carmela Pisano
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies, (MITO), Italy
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale Napoli, Naples, Italy
| | - Luis Manso
- Grupo Español de Investigación en Cáncer de Ovario, (GEICO), Spain
- Department of Medical Oncology, Hospital 12 de Octubre, Madrid, Spain
| | - Hugues Bourgeois
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Medical Oncology Department, Centre Jean Bernard - Clinique Victor Hugo, Le Mans, France
| | - Ingo Runnebaum
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Claudio Zamagni
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies, (MITO), Italy
- IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - Anne-Claire Hardy-Bessard
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Oncologie Médicale, Centre CARIO - HPCA, Plérin Sur Mer, Plérin, France
| | - Andreas Schnelzer
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Frauenklinik und Poliklinik Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michel Fabbro
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Institut du Cancer de Montpellier, Montpellier, France
| | - Barbara Schmalfeldt
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Berton
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- L'Institut de Cancérologie de l'Ouest (ICO), Centre René Gauducheau, Saint Herblain, France
| | - Antje Belau
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Universitätsmedizin Greifswald, Frauenklinik & Frauenarztpraxis, Greifswald, Germany
| | - Jean-Pierre Lotz
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Hôpital Tenon, APHP, Paris, France
| | - Martina Gropp-Meier
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Onkologie Ravensburg, Ravensburg, Germany
| | - Laurence Gladieff
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Oncopole CLAUDIUS REGAUD IUCT-Oncopole, Toulouse, France
| | - Hans-Joachim Lück
- Arbeitsgemeinschaft Gynäkologische Onkologie Studiengruppe, (AGO), Germany
- Gynäkologisch-Onkologische Praxis, Hannover, Germany
| | - Sophie Abadie-Lacourtoisie
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- ICO Paul Papin, Angers, France
| | - Eric Pujade-Lauraine
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Medical Oncology Department, ARCAGY Research, Paris, France
| | - Isabelle Ray-Coquard
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, (GINECO), France
- Department of Medical Oncology, Centre Léon Berard, Lyon, France
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Freyer G, Floquet A, Tredan O, Carrot A, Langlois-Jacques C, Lopez J, Selle F, Abdeddaim C, Leary A, Dubot-Poitelon C, Fabbro M, Gladieff L, Lamuraglia M. Bevacizumab, olaparib, and durvalumab in patients with relapsed ovarian cancer: a phase II clinical trial from the GINECO group. Nat Commun 2024; 15:1985. [PMID: 38443333 PMCID: PMC10914754 DOI: 10.1038/s41467-024-45974-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
Most patients with advanced ovarian cancer (AOC) ultimately relapse after platinum-based chemotherapy. Combining bevacizumab, olaparib, and durvalumab likely drives synergistic activity. This open-label phase 2 study (NCT04015739) aimed to assess activity and safety of this triple combination in female patients with relapsed high-grade AOC following prior platinum-based therapy. Patients were treated with olaparib (300 mg orally, twice daily), the bevacizumab biosimilar FKB238 (15 mg/kg intravenously, once-every-3-weeks), and durvalumab (1.12 g intravenously, once-every-3-weeks) in nine French centers. The primary endpoint was the non-progression rate at 3 months for platinum-resistant relapse or 6 months for platinum-sensitive relapse per RECIST 1.1 and irRECIST. Secondary endpoints were CA-125 decline with CA-125 ELIMination rate constant K (KELIM-B) per CA-125 longitudinal kinetics over 100 days, progression free survival and overall survival, tumor response, and safety. Non-progression rates were 69.8% (90%CI 55.9%-80.0%) at 3 months for platinum-resistant relapse patients (N = 41), meeting the prespecified endpoint, and 43.8% (90%CI 29.0%-57.4%) at 6 months for platinum-sensitive relapse (N = 33), not meeting the prespecified endpoint. Median progression-free survival was 4.1 months (95%CI 3.5-5.9) and 4.9 months (95%CI 2.9-7.0) respectively. Favorable KELIM-B was associated with better survival. No toxic deaths or major safety signals were observed. Here we show that further investigation of this triple combination may be considered in AOC patients with platinum-resistant relapse.
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Affiliation(s)
- Gilles Freyer
- Department of Medical Oncology, Lyon 1 University, Lyon, France.
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France.
- Institut de Cancérologie des HCL, Lyon, France.
| | - Anne Floquet
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Department of Medical Oncology - Gynecological Tumors, Institut Bergonié, Bordeaux, France
| | - Olivier Tredan
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Aurore Carrot
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- EMR 3738, UFR Lyon-Sud, Université Lyon1, Lyon, France
| | - Carole Langlois-Jacques
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Biostatistics and Bioinformatics Department, Hospices Civils de Lyon, Lyon, France
| | - Jonathan Lopez
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Selle
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Cyril Abdeddaim
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Gynecologic Oncology Department, Centre Oscar Lambret, Lille, France
| | - Alexandra Leary
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Coraline Dubot-Poitelon
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Medical Oncology, Institut Curie Saint Cloud, Paris, France
| | - Michel Fabbro
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Laurence Gladieff
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Medical Oncology, Institut Claudius Regaud IUCT-Oncopole, Toulouse, France
| | - Michele Lamuraglia
- GINECO (Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire, Paris, France
- Medical Oncology, Institut de Cancérologie du CHUSE, Saint-Etienne, France
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3
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Classe JM, Frenel JS, Berton D, Gladieff L, Ferron G, Lecuru F, Bourgin C, Narducci F, Loaec C. [State of results of HIPEC for epithelial ovarian cancer in the primary treatment or for relapse]. Bull Cancer 2024; 111:261-266. [PMID: 36906402 DOI: 10.1016/j.bulcan.2023.01.019] [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: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 03/11/2023]
Abstract
Peritoneal carcinomatosis is an unavoidable development of ovarian cancer, from the first treatment to relapses, and is the main cause of patients death. Hyperthermic intraperitoneal chemotherapy (HIPEC), is a hope for cure for patients with ovarian cancer. HIPEC is based on direct application of chemotherapy on the perioneum with high concentration of chemotherapy enhanced with specific effects of hyperthermia. Theoretically, HIPEC could be proposed at different steps of ovarian cancer development. But the hypothesis of efficiency of a new treatment must be assessed before being routinely applied. Numerous clinical series are already published about HIPEC used in primary treatment of ovarian cancer or for relapses. These series are mostly retrospectives and based on heterogeneous parameters as inclusion criteria of patients, intra peritoneal chemotherapy, concentration, temperature, duration of HIPEC. Taking into account this heterogeneity it is not possible to draw strong scientific conclusions about HIPEC efficiency to treat ovarian cancer patients. We proposed a review allowing a better understanding of current recommendations of the use of HIPEC in ovarian cancer patients.
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Affiliation(s)
- Jean-Marc Classe
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France; Nantes Université, Nantes, France.
| | - Jean-Sébastien Frenel
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France
| | - Dominique Berton
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France
| | - Laurence Gladieff
- Institut Claudius Regaud-IUCT-O, Département d'oncologie médicale, Toulouse, France
| | - Gwenaël Ferron
- Institut Claudius Regaud-IUCT-O, Département d'oncologie médicale, Toulouse, France
| | - Fabrice Lecuru
- Institut Curie, Paris, Université de Paris, Service de chirurgie sénologique, gynécologique et plastie, Paris, France
| | - Charlotte Bourgin
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France
| | - Fabrice Narducci
- Oscar Lambret, Département de Gynecologie Oncologique, Lille, France
| | - Cécile Loaec
- Institut de Cancerologie de l'Ouest, Département d'oncologie chirurgicale, Saint-Herblain, France
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Gladieff L. [HIPEC morbidity and implications for post-surgical treatment. A medical oncologist advice]. Bull Cancer 2024; 111:248-253. [PMID: 36822957 DOI: 10.1016/j.bulcan.2023.01.011] [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: 10/25/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 02/23/2023]
Abstract
The fear that the medical oncologist may have is that HIPEC integrated into a multidisciplinary care pathway will negatively impact the treatments that will follow. This fear is largely related to the side effects, which are themselves dependent on the medication used. Cisplatin, most frequently used for epithelial ovarian cancers, has essentially renal toxicity, which can be avoided by the use of sodium thiosulfate. Oxaliplatin induces more severe toxicities post surgery than mitomycin C in colorectal cancers. However, the data from randomized trials are reassuring for the medical oncologist concerning the course of postoperative treatment, as long as HIPEC is performed according to a standardized protocol, within trained teams, and after multidisciplinary discussion concerning its modalities.
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Affiliation(s)
- Laurence Gladieff
- Institut Claudius Regaud IUCT-Oncopole, département d'oncologie médicale, 1, avenue Irène Joliot-Curie, 31059 Toulouse cedex, France.
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Oaknin A, Gladieff L, Martínez-García J, Villacampa G, Takekuma M, De Giorgi U, Lindemann K, Woelber L, Colombo N, Duska L, Leary A, Godoy-Ortiz A, Nishio S, Angelergues A, Rubio MJ, Fariñas-Madrid L, Yamaguchi S, Lorusso D, Ray-Coquard I, Manso L, Joly F, Alarcón J, Follana P, Romero I, Lebreton C, Pérez-Fidalgo JA, Yunokawa M, Dahlstrand H, D'Hondt V, Randall LM. Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trial. Lancet 2024; 403:31-43. [PMID: 38048793 DOI: 10.1016/s0140-6736(23)02405-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The GOG240 trial established bevacizumab with chemotherapy as standard first-line therapy for metastatic or recurrent cervical cancer. In the BEATcc trial (ENGOT-Cx10-GEICO 68-C-JGOG1084-GOG-3030), we aimed to evaluate the addition of an immune checkpoint inhibitor to this standard backbone. METHODS In this investigator-initiated, randomised, open-label, phase 3 trial, patients from 92 sites in Europe, Japan, and the USA with metastatic (stage IVB), persistent, or recurrent cervical cancer that was measurable, previously untreated, and not amenable to curative surgery or radiation were randomly assigned 1:1 to receive standard therapy (cisplatin 50 mg/m2 or carboplatin area under the curve of 5, paclitaxel 175 mg/m2, and bevacizumab 15 mg/kg, all on day 1 of every 3-week cycle) with or without atezolizumab 1200 mg. Treatment was continued until disease progression, unacceptable toxicity, patient withdrawal, or death. Stratification factors were previous concomitant chemoradiation (yes vs no), histology (squamous cell carcinoma vs adenocarcinoma including adenosquamous carcinoma), and platinum backbone (cisplatin vs carboplatin). Dual primary endpoints were investigator-assessed progression-free survival according to Response Evaluation Criteria in Solid Tumours version 1.1 and overall survival analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03556839, and is ongoing. FINDINGS Between Oct 8, 2018, and Aug 20, 2021, 410 of 519 patients assessed for eligibility were enrolled. Median progression-free survival was 13·7 months (95% CI 12·3-16·6) with atezolizumab and 10·4 months (9·7-11·7) with standard therapy (hazard ratio [HR]=0·62 [95% CI 0·49-0·78]; p<0·0001); at the interim overall survival analysis, median overall survival was 32·1 months (95% CI 25·3-36·8) versus 22·8 months (20·3-28·0), respectively (HR 0·68 [95% CI 0·52-0·88]; p=0·0046). Grade 3 or worse adverse events occurred in 79% of patients in the experimental group and in 75% of patients in the standard group. Grade 1-2 diarrhoea, arthralgia, pyrexia, and rash were increased with atezolizumab. INTERPRETATION Adding atezolizumab to a standard bevacizumab plus platinum regimen for metastatic, persistent, or recurrent cervical cancer significantly improves progression-free and overall survival and should be considered as a new first-line therapy option. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | | | | | - Guillermo Villacampa
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Vall d'Hebron Institute of Oncology, Barcelona, Spain; The Institute of Cancer Research, London, UK
| | | | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Kristina Lindemann
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Linn Woelber
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Department, European Institute of Oncology IRCCS Milan, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Linda Duska
- University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | | | | | | | | | - Lorena Fariñas-Madrid
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Domenica Lorusso
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | | | - Luis Manso
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Ignacio Romero
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - J Alejandro Pérez-Fidalgo
- University Hospital of Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; CIBERONC, Valencia, Spain
| | | | - Hanna Dahlstrand
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | | | - Leslie M Randall
- Massey Comprehensive Cancer Center, VCUHealth, Richmond, VA, USA
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6
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Pujade-Lauraine E, Selle F, Scambia G, Asselain B, Marmé F, Lindemann K, Colombo N, Mądry R, Glasspool R, Vergote I, Korach J, Lheureux S, Dubot C, Oaknin A, Zamagni C, Heitz F, Gladieff L, Rubio-Pérez MJ, Scollo P, Blakeley C, Shaw B, Ray-Coquard I, Redondo A. Maintenance olaparib rechallenge in patients with platinum-sensitive relapsed ovarian cancer previously treated with a PARP inhibitor (OReO/ENGOT-ov38): a phase IIIb trial. Ann Oncol 2023; 34:1152-1164. [PMID: 37797734 DOI: 10.1016/j.annonc.2023.09.3110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Poly(ADP-ribose) polymerase (PARP) inhibitor maintenance therapy is the standard of care for some patients with advanced ovarian cancer. We evaluated the efficacy and safety of PARP inhibitor rechallenge. PATIENTS AND METHODS This randomized, double-blind, multicenter trial (NCT03106987) enrolled patients with platinum-sensitive relapsed ovarian cancer who had received one prior PARP inhibitor therapy for ≥18 and ≥12 months in the BRCA-mutated and non-BRCA-mutated cohorts, respectively, following first-line chemotherapy or for ≥12 and ≥6 months, respectively, following a second or subsequent line of chemotherapy. Patients were in response following their last platinum-based chemotherapy regimen and were randomized 2 : 1 to maintenance olaparib tablets 300 mg twice daily or placebo. Investigator-assessed progression-free survival (PFS) was the primary endpoint. RESULTS Seventy four patients in the BRCA-mutated cohort were randomized to olaparib and 38 to placebo, and 72 patients in the non-BRCA-mutated cohort were randomized to olaparib and 36 to placebo; >85% of patients in both cohorts had received ≥3 prior lines of chemotherapy. In the BRCA-mutated cohort, the median PFS was 4.3 months with olaparib versus 2.8 months with placebo [hazard ratio (HR) 0.57; 95% confidence interval (CI) 0.37-0.87; P = 0.022]; 1-year PFS rates were 19% versus 0% (Kaplan-Meier estimates). In the non-BRCA-mutated cohort, median PFS was 5.3 months for olaparib versus 2.8 months for placebo (HR 0.43; 95% CI 0.26-0.71; P = 0.0023); 1-year PFS rates were 14% versus 0% (Kaplan-Meier estimates). No new safety signals were identified with olaparib rechallenge. CONCLUSIONS In ovarian cancer patients previously treated with one prior PARP inhibitor and at least two lines of platinum-based chemotherapy, maintenance olaparib rechallenge provided a statistically significant, albeit modest, PFS improvement over placebo in both the BRCA-mutated and non-BRCA-mutated cohorts, with a proportion of patients in the maintenance olaparib rechallenge arm of both cohorts remaining progression free at 1 year.
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Affiliation(s)
- E Pujade-Lauraine
- Association de Recherche Cancers Gynécologiques (ARCAGY)-Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris; GINECO, Paris.
| | - F Selle
- GINECO, Paris; Department of Medical Oncology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - G Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica, Rome; Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Milan, Italy
| | - B Asselain
- Association de Recherche Cancers Gynécologiques (ARCAGY)-Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Paris; GINECO, Paris
| | - F Marmé
- University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim; Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Studiengruppe, Essen, Germany
| | - K Lindemann
- Department of Gynaecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo; Nordic Society of Gynecologic Oncology (NSGO), Oslo, Norway
| | - N Colombo
- University of Milan-Bicocca and IEO European Institute of Oncology IRCCS, Milan; Mario Negri Gynecologic Oncology Group (MANGO), Italy
| | - R Mądry
- Uniwersytet Medyczny im.K.Marcinkowskiego w Poznaniu, Poznań; Polish Gynecologic Oncology Group (PGOG), Poznan, Poland
| | - R Glasspool
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; National Cancer Research Institute (NCRI), London; Scottish Gynaecological Cancer Trials Group (SGCTG), Edinburgh, UK
| | - I Vergote
- University Hospitals Leuven, Leuven Cancer Institute, Leuven; Belgian and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium
| | - J Korach
- Sheba Medical Center, Tel Aviv University, Tel Hashomer, Ramat Gan; Israeli Society of Gynecologic Oncology (ISGO), Tel Aviv, Israel
| | - S Lheureux
- Princess Margaret Hospital, Department of Medical Oncology, Toronto; Princess Margaret Consortium, Toronto, Canada
| | - C Dubot
- GINECO, Paris; Oncologie Médicale, Institut Curie Saint Cloud, Paris, France
| | - A Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona; Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain
| | - C Zamagni
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Milan, Italy; IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - F Heitz
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen; Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin; Berlin Institute of Health, Berlin; AGO Studiengruppe, Wiesbaden, Germany
| | - L Gladieff
- GINECO, Paris; Institut Claudius Regaud IUCT-Oncopole, Toulouse, France
| | - M J Rubio-Pérez
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain; Reina Sofia University Hospital, Cordoba, Spain
| | - P Scollo
- Multicenter Italian Trials in Ovarian Cancer and Gynecologic Malignancies (MITO), Milan, Italy; Kore University Enna, Enna; Dipartimento di Ginecologia e Ostetricia, Ospedale Cannizzaro, Catania, Italy
| | | | - B Shaw
- AstraZeneca, Cambridge, UK
| | - I Ray-Coquard
- GINECO, Paris; Medical Oncology Department, Centre Léon Bérard and University Claude Bernard Lyon, Lyon, France
| | - A Redondo
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), Madrid, Spain; La Paz University Hospital-IdiPAZ, Madrid, Spain
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7
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Al Saati A, Vande Perre P, Plenecassagnes J, Gilhodes J, Monselet N, Cabarrou B, Lignon N, Filleron T, Telly D, Perello-Lestrade E, Feillel V, Staub A, Martinez M, Chipoulet E, Collet G, Thomas F, Gladieff L, Toulas C. Multigene Panel Sequencing Identifies a Novel Germline Mutation Profile in Male Breast Cancer Patients. Int J Mol Sci 2023; 24:14348. [PMID: 37762649 PMCID: PMC10531866 DOI: 10.3390/ijms241814348] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Even though male breast cancer (MBC) risk encompasses both genetic and environmental aetiologies, the primary risk factor is a germline pathogenic variant (PV) or likely pathogenic variant (LPV) in BRCA2, BRCA1 and/or PALB2 genes. To identify new potential MBC-specific predisposition genes, we sequenced a panel of 585 carcinogenesis genes in an MBC cohort without BRCA1/BRCA2/PALB2 PV/LPV. We identified 14 genes carrying rare PVs/LPVs in the MBC population versus noncancer non-Finnish European men, predominantly coding for DNA repair and maintenance of genomic stability proteins. We identified for the first time PVs/LPVs in PRCC (pre-mRNA processing), HOXA9 (transcription regulation), RECQL4 and WRN (maintenance of genomic stability) as well as in genes involved in other cellular processes. To study the specificity of this MBC PV/LPV profile, we examined whether variants in the same genes could be detected in a female breast cancer (FBC) cohort without BRCA1/BRCA2/PALB2 PV/LPV. Only 5/109 women (4.6%) carried a PV/LPV versus 18/85 men (21.2%) on these genes. FBC did not carry any PV/LPV on 11 of these genes. Although 5.9% of the MBC cohort carried PVs/LPVs in PALLD and ERCC2, neither of these genes were altered in our FBC cohort. Our data suggest that in addition to BRCA1/BRCA2/PALB2, other genes involved in DNA repair/maintenance or genomic stability as well as cell adhesion may form a specific MBC PV/LPV signature.
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Affiliation(s)
- Ayman Al Saati
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
- DIAD, Inserm, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France;
- Université de Toulouse, Université Toulouse III-Paul Sabatier, Toulouse, France
| | - Pierre Vande Perre
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
- DIAD, Inserm, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France;
| | - Julien Plenecassagnes
- Bioinformatics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France;
| | - Julia Gilhodes
- Biostatistics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (J.G.); (N.M.); (B.C.); (T.F.)
| | - Nils Monselet
- Biostatistics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (J.G.); (N.M.); (B.C.); (T.F.)
| | - Bastien Cabarrou
- Biostatistics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (J.G.); (N.M.); (B.C.); (T.F.)
| | - Norbert Lignon
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Thomas Filleron
- Biostatistics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (J.G.); (N.M.); (B.C.); (T.F.)
| | - Dominique Telly
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
| | - Emilie Perello-Lestrade
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
| | - Viviane Feillel
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Anne Staub
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | | | - Edith Chipoulet
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Gaëlle Collet
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Fabienne Thomas
- DIAD, Inserm, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France;
- Université de Toulouse, Université Toulouse III-Paul Sabatier, Toulouse, France
- Pharmacology Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Laurence Gladieff
- Oncogenetics Department, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (N.L.); (V.F.); (A.S.); (E.C.); (G.C.); (L.G.)
| | - Christine Toulas
- Oncogenetics Laboratory, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France; (A.A.S.); (D.T.); (E.P.-L.)
- DIAD, Inserm, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France;
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8
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Pautier P, Genestie C, Gladieff L, Kurtz JE, Lortholary A, de La Motte Rouge T, Gaillard AL, Ducassou A, Dubot C, Rouleau E, Narducci F, Demontoy S, Hennequin C. Recommandations pour la pratique clinique Nice/Saint-Paul-de-Vence 2022–2023 : Prise en charge du cancer du col de l'utérus avancé. Bull Cancer 2023; 110:6S44-6S50. [PMID: 37573038 DOI: 10.1016/s0007-4551(23)00333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
French recommendations for clinical practice, Nice/Saint-Paul-de-Vence 2022-2023: Management of advanced cervical cancer The prognosis of cervical cancer remained pejorative until recently, first-line treatment consisting of platinum-based chemotherapy, associated with bevacizumab whenever possible, without any other therapeutic innovation for several years. However in 2022, immunotherapy appeared in the therapeutic landscape. Pembrolizumab can now be prescribed, thanks to the early access status granted by the HAS in September 2022, in patients with PD-L1 positive tumors. In parallel, bevacizumab generic is now reimbursed, allowing its association with chemotherapy on top of pembrolizumab, if indicated. For patient relapsing after platinium salts, and who never received immunotherapy, cemiplimab could be delivered and reimboursed since spring 2023, whatever could be PD-L1 status. Pretherapeutic work-up includes imaging combining MRI and PET/CT or CT of the chest, abdomen and pelvis, as well as evaluation of PD-L1 status on tumor and immune cells to define the CPS score that will determine eligibility to pembrolizumab treatment (CPS > 1). Possibilities of locoregional treatment depend on individual situations and are discussed on a case-by-case basis in multidisciplinary meetings. Early supportive care is always recommended and inclusion in clinical trials must be systematically considered.
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Affiliation(s)
- Patricia Pautier
- Département d'oncologie médicale, service de gynécologie, Gustave-Roussy, Villejuif, France.
| | | | - Laurence Gladieff
- Département d'oncologie médicale, institut Claudius-Régaud, Toulouse, France
| | - Jean-Emmanuel Kurtz
- Département d'oncologie médicale, institut de cancérologie de Strasbourg, Strasbourg, France
| | - Alain Lortholary
- Service d'oncologie médicale, institut de cancérologie Catherine-de-Sienne, Nantes, France
| | | | | | - Anne Ducassou
- Département de radiothérapie, institut Claudius-Régaud, Toulouse, France
| | - Coraline Dubot
- Département d'oncologie médicale, centre François-Baclesse, Caen, France
| | - Etienne Rouleau
- Service de génétique des tumeurs, Gustave-Roussy, Villejuif, France
| | - Fabrice Narducci
- Département de cancérologie gynécologique, centre Oscar-Lambret, Lille, France
| | - Sylvain Demontoy
- Département de radiothérapie, institut du cancer de Montpellier, Montpellier, France
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9
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Selle F, Joly F, Gladieff L, Prulhière K, Leary A, Kalbacher E, Rouleau E, Ray-Coquard I. Prise en charge des carcinomes ovariens de haut grade séreux et/ou endométrioïdes de stades avancés (III-IV) et testing HRD-BRCA en 2023 : actualisation selon les données publiées et/ou présentées en 2022. Bull Cancer 2023; 110:6S5-6S9. [PMID: 37573039 DOI: 10.1016/s0007-4551(23)00329-6] [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] [Indexed: 08/14/2023]
Abstract
Management of high grade, serous and/or endometrioid, advanced (stages III-IV) ovarian carcinomas and HRD-BRCA testing in 2023: update according to data published/presented in 2022 Molecular analysis of ovarian carcinomas must be now systematically performed to determine BRCA1 and BRCA2 status as well as genomic instability score. Several types of tests are available. From a clinical perspective, new data from phase III clinical trials presented in 2022 confirm the key role of PARP inhibitors in first-line medical treatment of high-grade serous ovarian cancers. A new algorithm that includes all new evidence is proposed for selection of first-line therapy.
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Affiliation(s)
- Frédéric Selle
- Service d'oncologie médicale, groupe hospitalier Diaconesses Croix Saint-Simon, 75020 Paris, France; Groupe d'investigateurs nationaux pour les études des cancers de l'ovaire, 8 rue Lamennais, 75008 Paris, France.
| | - Florence Joly
- Groupe d'investigateurs nationaux pour les études des cancers de l'ovaire, 8 rue Lamennais, 75008 Paris, France; Département d'oncologie médicale, centre François-Baclesse, 14000 Caen, France
| | - Laurence Gladieff
- Groupe d'investigateurs nationaux pour les études des cancers de l'ovaire, 8 rue Lamennais, 75008 Paris, France; Département d'oncologie médicale, IUCT-Oncopole, 1 avenue Irène-Joliot-Curie IUCT, 31059 Toulouse cedex 9, France
| | - Karine Prulhière
- Groupe d'investigateurs nationaux pour les études des cancers de l'ovaire, 8 rue Lamennais, 75008 Paris, France; Service d'oncologie, Polyclinique de Courlancy, Reims, France
| | - Alexandra Leary
- Groupe d'investigateurs nationaux pour les études des cancers de l'ovaire, 8 rue Lamennais, 75008 Paris, France; Service d'oncologie médicale, Gustave-Roussy, Villejuif, France
| | - Elsa Kalbacher
- Groupe d'investigateurs nationaux pour les études des cancers de l'ovaire, 8 rue Lamennais, 75008 Paris, France; Département d'oncologie médicale, institut Gustave-Roussy, France
| | - Etienne Rouleau
- Laboratoire de génétique moléculaire, CLCC institut Gustave-Roussy, 94805 Villejuif, France
| | - Isabelle Ray-Coquard
- Groupe d'investigateurs nationaux pour les études des cancers de l'ovaire, 8 rue Lamennais, 75008 Paris, France; Département d'oncologie médicale, centre Léon-Bérard, université Claude-Bernard, Lyon 1, 69008 Lyon, France
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10
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Mailliez A, D'Hondt V, Lusque A, Caron O, Cabel L, Goncalves A, Debled M, Gladieff L, Ferrero JM, Petit T, Mouret-Reynier MA, Eymard JC, Levy C, Uwer L, Leheurteur M, Desmoulins I, Bachelot T, Frenel JS, de la Motte Rouge T, Simon G, Jacot W, Delaloge S. Survival outcomes of metastatic breast cancer patients by germline BRCA1/2 status in a large multicenter real-world database. Int J Cancer 2023; 152:921-931. [PMID: 36161271 PMCID: PMC10092337 DOI: 10.1002/ijc.34304] [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: 04/05/2022] [Revised: 07/17/2022] [Accepted: 08/09/2022] [Indexed: 01/12/2023]
Abstract
The outcomes and best treatment strategies for germline BRCA1/2 mutation (gBRCAm) carriers with metastatic breast cancer (MBC) remain uncertain. We compared the overall survival and the first line progression free survival (PFS1) of patients with a gBRCAm identified at initiation of first-line treatment with those of BRCA wild-type (WT) and not-tested (NT) individuals in the ESME real-world database of MBC patients between 2008 and 2016 (NCT03275311). Among the 20 624 eligible patients, 325 had a gBRCAm, 1138 were WT and 19 161 NT. Compared with WT, gBRCAm carriers were younger, and had more aggressive diseases. At a median follow-up of 50.5 months, median OS was 30.6 (95%CI: 21.9-34.3), 35.8 (95%CI: 32.2-37.8) and 39.3 months (95% CI: 38.3-40.3) in the gBRCAm, WT and NT subgroups, respectively. Median PFS1 was 7.9 (95%CI: 6.6-9.3), 7.8 (95%CI: 7.3-8.5) and 9.7 months (95%CI, 9.5-10.0). In the multivariable analysis conducted in the whole cohort, gBRCAm status had however no independent prognostic impact on OS and PFS1. Though, in the triple-negative subgroup, gBRCAm patients had better OS and PFS1 (HR vs WT = 0.76; 95%CI: 0.60-0.97; P = .027 and 0.69; 95% CI: 0.55-0.86; P = .001, respectively). In contrast, in patients with HR+/HER2 negative cancers, PFS1 appeared significantly and OS non significantly lower for gBRCAm carriers (PFS1: HR vs WT = 1.23; 95%CI: 1.03-1.46; P = .024; OS:HR = 1.22, 95% CI: 0.97-1.52, P = .089). In conclusion, gBRCA1/2 status appears to have divergent survival effects in MBC according to IHC subtype.
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Affiliation(s)
| | - Veronique D'Hondt
- Institut régional du Cancer Montpellier/Val d'Aurelle, Montpellier, France
| | - Amelie Lusque
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - Luc Cabel
- Institut Curie, Paris et Saint Cloud, France
| | | | | | | | | | | | | | | | | | - Lionel Uwer
- Institut de Cancerologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | | | | | | | | | | | | | - William Jacot
- Institut régional du Cancer Montpellier/Val d'Aurelle, Montpellier, France
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11
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Brouillard-Saby F, Saint-Martin C, Ray-Coquard I, Gladieff L, Pomel C, Colombo PE, Classe JM, Chevrier M, Joly F, De la Motte Rouge T, Floquet A, Sabatier R, Barranger E, Costaz H, Leblanc E, Marchal F, Pautier P, Bosquet L, Rodrigues M. Efficacy of chemotherapy according to BRCA status in patients with high-grade serous ovarian carcinoma at first platinum-sensitive relapse. Int J Gynecol Cancer 2023; 33:577-584. [PMID: 36631150 DOI: 10.1136/ijgc-2022-003993] [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] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Chemotherapy for high-grade serous ovarian cancers in platinum-sensitive relapse includes carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin. According to in vitro data, BRCA mutated patients are sensitive to replicative stress agents but BRCA status is not yet used for the choice of chemotherapy at relapse. Our aim was to assess these doublets according to BRCA status in first platinum-sensitive relapse. METHODS The ESME ovarian cancer database comprises a multicenter retrospective cohort of patients with ovarian cancer treated in French cancer centers between January 2011 and December 2017. Patients with high-grade serous ovarian cancers at first platinum-sensitive relapse who received one of these doublets were included. The objective was to compare progression-free survival of each chemotherapy doublet according to BRCA status. RESULTS Among the 10 263 patients in the database, 1539 patients had a first platinum-sensitive relapse: 825 BRCA wild type patients (53.6%) and 304 BRCA mutated patients (19.8%) (7 patients had a homologous recombination mutation and BRCA status was unkown for 403 patients). Median progression-free survival was longer in BRCA mutated patients than in BRCA wild type patients when receiving carboplatin/pegylated liposomal doxorubicin without maintenance treatment (15.8 vs 11.8 months; p<0.001). In contrast, we observed no difference in patients treated with carboplatin/paclitaxel (14.6 vs 14.3 months, respectively; p=0.70) or in those treated with carboplatin/gemcitabine (12.0 vs 9.8 months, respectively; p=0.18). In BRCA wild type patients without maintenance, better progression-free survival occurred with carboplatin/paclitaxel (median progression-free survival 14.3 months) than with carboplatin/gemcitabine and carboplatin/pegylated liposomal doxorubicin (9.8 and 11.8 months, respectively; p=0.017). In BRCA mutated patients without maintenance, there was no difference between the three doublets (median progression-free survival of 14.6, 12.0, and 15.8 months with carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin, respectively; p=0.40). CONCLUSION While treatment with carboplatin/paclitaxel, carboplatin/gemcitabine, and carboplatin/pegylated liposomal doxorubicin shows comparable efficacy in BRCA mutated patients, treatment with carboplatin/paclitaxel appears to be more effective than carboplatin/gemcitabine and carboplatin/pegylated liposomal doxorubicin in BRCA wild type patients with high-grade serous ovarian cancers at first platinum-sensitive relapse.
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Affiliation(s)
| | | | - Isabelle Ray-Coquard
- Medical Oncology, Centre Leon Berard, Lyon, France.,Hesper Lab, Université Claude Bernard Lyon 1, Villeurbanne, France
| | | | - Christophe Pomel
- Surgical Oncology, Institut Jean Perrin, Clermont-Ferrand, France
| | | | - Jean-Marc Classe
- Surgical Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | | | - Florence Joly
- Medical Oncology, Centre Francois Baclesse, Caen, France
| | | | - Anne Floquet
- Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Renaud Sabatier
- Medical Oncology, Paoli-Calmettes Institute, Marseille, France.,SESSTIM, Marseille, France
| | | | - Hélène Costaz
- Surgical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Eric Leblanc
- Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - Frédéric Marchal
- Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, Lorraine, France
| | | | | | - Manuel Rodrigues
- Medical Oncology, Institut Curie, Paris, France .,INSERM U830, Institut Curie, Paris, France
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12
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Bellier C, Gladieff L, Le Du F, Berton D, Bonnard C, Suau D, Richard AC, Brenner O, Lahouegue A, Freyer G, Floquet A, Frank S, Kfoury M. Olaparib First-Line Maintenance Monotherapy in BRCA-Mutated Epithelial Ovarian Cancer: Descriptive Analysis of the First French Real-World Data Study. Drugs Real World Outcomes 2023:10.1007/s40801-022-00349-9. [PMID: 36630055 DOI: 10.1007/s40801-022-00349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Olaparib, a poly(ADP-ribose) polymerase inhibitor, was approved by the European Commission in June 2019, following the results of the SOLO-1/GOG 3004 trial as maintenance monotherapy in adult patients with BRCA-mutated epithelial ovarian cancer. OBJECTIVE This study aimed to provide a descriptive analysis of the first real-world data from patients with BRCA-mutated ovarian cancer who received olaparib as first-line maintenance monotherapy in the French cohort Temporary Authorisation for Use (Autorisation Temporaire d'Utilisation de cohorte, ATUc) programme from 11 March, 2019 to 16 January, 2020. METHODS Eligible patients were aged 18 years and over with confirmed epithelial ovarian, primary peritoneal or Fallopian tube cancer and a deleterious or suspected deleterious germline or somatic BRCA 1/2 mutation. Patients were in complete or partial clinical response at the end of first-line platinum-based chemotherapy. Olaparib maintenance therapy was initiated within 8 weeks of the patients' last dose of chemotherapy. Real-world data were collected through treatment access request forms completed by physicians. Clinical and safety data were collected monthly until the end of the ATUc programme. RESULTS A total of 107 centres in metropolitan France and the French Overseas Departments and Territories requested the inclusion for 238 patients, of whom 194 received maintenance olaparib. In total, 87.6% of the primary tumour locations were ovary, the most common histology was high-grade serous (93.0%) and the most common International Federation of Gynaecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique) stage was IIIC (56.8%). BRCA testing was performed in routine practice, prior to inclusion into the ATUc programme. All patients had a BRCA mutation: 52.5% had a somatic mutation, 38.4% had a germinal mutation and 9.1% had germinal and somatic mutations. Twenty-four (12%) patients experienced serious adverse drug reactions at the last safety follow-up (17 February, 2020). The most common were anaemia (12 [6%] patients), neutropenia (3 [2%] patients) and thrombocytopenia (3 [2%] patients). CONCLUSIONS The rapid enrolment into the ATUc programme highlighted the strong unmet need for patients with ovarian cancer and a BRCA mutation in first-line maintenance treatment. Olaparib was well tolerated and no new safety signals were observed in this real-world patient population.
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You B, Bolze PA, Lotz JP, Massardier J, Gladieff L, Floquet A, Hajri T, Descargues P, Langlois-Jacques C, Bin S, Villeneuve L, Roux A, Alves-Ferreira M, Grazziotin-Soares D, Dherret G, Gerentet C, Rousset P, Freyer G, Golfier F. Avelumab in patients with gestational trophoblastic tumors with resistance to polychemotherapy: Cohort B of the TROPHIMMUN phase 2 trial. Gynecol Oncol 2023; 168:62-67. [PMID: 36401942 DOI: 10.1016/j.ygyno.2022.11.005] [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: 09/19/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE There is a need for innovative treatments in women with gestational trophoblastic tumors (GTT) resistant to chemotherapy. The TROPHIMMUN trial assessed the efficacy of avelumab in patients with resistance to single-agent chemotherapy (cohort A), or to polychemotherapy (cohort B). Cohort B outcomes are reported here. METHODS In the cohort B of this phase 2 multicenter trial (NCT03135769), women with GTT progressing after polychemotherapy received avelumab 10 mg/kg intravenously every 2 weeks until human chorionic gonadotropin (hCG) normalization, followed by 3 consolidation cycles. The primary endpoint was the rate of hCG normalization enabling treatment discontinuation (2-stage Simon design). RESULTS Between February 2017 and August 2020, 7 patients were enrolled. Median age was 37 years (range: 29-47); disease stage was I or III in 42.9% and 57.1%; FIGO score was 9-10 in 28.6%, 11 in 28.6%, and 16 in 14.3%, respectively. Median follow-up was 18.2 months. One patient (14.3%) experienced hCG normalization enabling treatment discontinuation. However, resistance to avelumab was observed in the remaining 6 patients (85.7%). The cohort B was stopped for futility. Grade 1-2 treatment-related adverse events occurred in 57.1%, most commonly fatigue (42.9%), nausea, diarrhea, infusion-related reaction, muscle pains, dry eyes (each 14.3%). The median resistance-free survival was 1.4 months (95% CI 0.7-5.3). CONCLUSIONS Although avelumab is active in patients with single-agent chemotherapy-resistant GTT (cohort A), it was associated with limited efficacy in patients with resistance to polychemotherapy (cohort B). The prognosis of patients with polychemotherapy resistance remains poor, and innovative immunotherapy-based therapeutic combinations are needed.
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Affiliation(s)
- Benoit You
- Centre de Référence des Maladies Trophoblastiques, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France; Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
| | - Pierre-Adrien Bolze
- Centre de Référence des Maladies Trophoblastiques, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Jean-Pierre Lotz
- Centre de Référence des Maladies Trophoblastiques, Lyon, France; Hôpital Tenon, Pôle Onco-Hématologie Hôpitaux Universitaires de l'Est Parisien, APHP, Université Pierre et Marie Curie, Paris, France
| | - Jérome Massardier
- Centre de Référence des Maladies Trophoblastiques, Lyon, France; Service de Gynécologie, Obstétrique, Unité de Diagnostic Anténatal, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Laurence Gladieff
- Département d'oncologie médicale, Institut Claudius Regaud, IUCT-ONCOPOLE, Toulouse, France
| | | | - Touria Hajri
- Centre de Référence des Maladies Trophoblastiques, Lyon, France
| | - Pierre Descargues
- Centre de Référence des Maladies Trophoblastiques, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Carole Langlois-Jacques
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Sylvie Bin
- Unité Recherche et Epidémiologie Cliniques - Pôle de Santé Publique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Laurent Villeneuve
- Unité Recherche et Epidémiologie Cliniques - Pôle de Santé Publique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adeline Roux
- Unité Recherche et Epidémiologie Cliniques - Pôle de Santé Publique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Marine Alves-Ferreira
- Unité Recherche et Epidémiologie Cliniques - Pôle de Santé Publique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Daniele Grazziotin-Soares
- Centre de Référence des Maladies Trophoblastiques, Lyon, France; Hôpital Tenon, Pôle Onco-Hématologie Hôpitaux Universitaires de l'Est Parisien, APHP, Université Pierre et Marie Curie, Paris, France
| | - Guillemine Dherret
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Christine Gerentet
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Pascal Rousset
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France; Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gilles Freyer
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France; Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Francois Golfier
- Centre de Référence des Maladies Trophoblastiques, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, EA 3738 CICLY, Lyon, France; Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
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14
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Jiao Y, Truong T, Eon-Marchais S, Mebirouk N, Caputo SM, Dondon MG, Karimi M, Le Gal D, Beauvallet J, Le Floch É, Dandine-Roulland C, Bacq-Daian D, Olaso R, Albuisson J, Audebert-Bellanger S, Berthet P, Bonadona V, Buecher B, Caron O, Cavaillé M, Chiesa J, Colas C, Collonge-Rame MA, Coupier I, Delnatte C, De Pauw A, Dreyfus H, Fert-Ferrer S, Gauthier-Villars M, Gesta P, Giraud S, Gladieff L, Golmard L, Lasset C, Lejeune-Dumoulin S, Léoné M, Limacher JM, Lortholary A, Luporsi É, Mari V, Maugard CM, Mortemousque I, Mouret-Fourme E, Nambot S, Noguès C, Popovici C, Prieur F, Pujol P, Sevenet N, Sobol H, Toulas C, Uhrhammer N, Vaur D, Venat L, Boland-Augé A, Guénel P, Deleuze JF, Stoppa-Lyonnet D, Andrieu N, Lesueur F. Association and performance of polygenic risk scores for breast cancer among French women presenting or not a familial predisposition to the disease. Eur J Cancer 2023; 179:76-86. [PMID: 36509001 DOI: 10.1016/j.ejca.2022.11.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Three partially overlapping breast cancer polygenic risk scores (PRS) comprising 77, 179 and 313 SNPs have been proposed for European-ancestry women by the Breast Cancer Association Consortium (BCAC) for improving risk prediction in the general population. However, the effect of these SNPs may vary from one country to another and within a country because of other factors. OBJECTIVE To assess their associated risk and predictive performance in French women from (1) the CECILE population-based case-control study, (2) BRCA1 or BRCA2 (BRCA1/2) pathogenic variant (PV) carriers from the GEMO study, and (3) familial breast cancer cases with no BRCA1/2 PV and unrelated controls from the GENESIS study. RESULTS All three PRS were associated with breast cancer in all studies, with odds ratios per standard deviation varying from 1.7 to 2.0 in CECILE and GENESIS, and hazard ratios varying from 1.1 to 1.4 in GEMO. The predictive performance of PRS313 in CECILE was similar to that reported in BCAC but lower than that in GENESIS (area under the receiver operating characteristic curve (AUC) = 0.67 and 0.75, respectively). PRS were less performant in BRCA2 and BRCA1 PV carriers (AUC = 0.58 and 0.54 respectively). CONCLUSION Our results are in line with previous validation studies in the general population and in BRCA1/2 PV carriers. Additionally, we showed that PRS may be of clinical utility for women with a strong family history of breast cancer and no BRCA1/2 PV, and for those carrying a predicted PV in a moderate-risk gene like ATM, CHEK2 or PALB2.
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Affiliation(s)
- Yue Jiao
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Thérèse Truong
- Université Paris-Saclay, UVSQ, INSERM, U1018, Gustave Roussy, CESP, Team Exposome and Heredity, Villejuif, France
| | - Séverine Eon-Marchais
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Noura Mebirouk
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Sandrine M Caputo
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Marie-Gabrielle Dondon
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Mojgan Karimi
- Université Paris-Saclay, UVSQ, INSERM, U1018, Gustave Roussy, CESP, Team Exposome and Heredity, Villejuif, France
| | - Dorothée Le Gal
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Juana Beauvallet
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Édith Le Floch
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Claire Dandine-Roulland
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Delphine Bacq-Daian
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Robert Olaso
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Juliette Albuisson
- Centre de Lutte contre le Cancer Georges François Leclerc, Dijon, France
| | | | - Pascaline Berthet
- Département de Biopathologie, Centre François Baclesse, Caen, France; INSERM, U1245, Rouen, France
| | - Valérie Bonadona
- Université Claude Bernard Lyon 1, Villeurbanne, France; CNRS UMR 5558, Centre Léon Bérard, Unité de Prévention et épidémiologie Génétique, Lyon, France
| | - Bruno Buecher
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Olivier Caron
- Gustave Roussy, Département de Médecine Oncologique, Villejuif, France
| | - Mathias Cavaillé
- Université Clermont Auvergne, UMR INSERM, U1240, Clermont Ferrand, France; Département d'Oncogénétique, Centre Jean Perrin, Clermont Ferrand, France
| | - Jean Chiesa
- UF de Génétique Médicale et Cytogénétique, CHRU Caremeau, Nîmes, France
| | - Chrystelle Colas
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France; INSERM, U830, Paris, France
| | - Marie-Agnès Collonge-Rame
- Service Génétique et Biologie du Développement - Histologie, CHU Hôpital Saint-Jacques, Besançon, France
| | - Isabelle Coupier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France; INSERM, U896, CRCM Val d'Aurelle, Montpellier, France
| | - Capucine Delnatte
- Institut de Cancérologie de l'Ouest, Unité d'Oncogénétique, Saint Herblain, France
| | - Antoine De Pauw
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Hélène Dreyfus
- Clinique Sainte Catherine, Avignon, CHU de Grenoble, Grenoble, France; Hôpital Couple-Enfant, Département de Génétique, Grenoble, France
| | | | - Marion Gauthier-Villars
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Paul Gesta
- CH Georges Renon, Service d'Oncogénétique Régional Poitou-Charentes, Niort, France
| | - Sophie Giraud
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier Est, Bron, France
| | - Laurence Gladieff
- Institut Claudius Regaud - IUCT-Oncopole, Service d'Oncologie Médicale, Toulouse, France
| | - Lisa Golmard
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Christine Lasset
- Université Claude Bernard Lyon 1, Villeurbanne, France; CNRS UMR 5558, Centre Léon Bérard, Unité de Prévention et épidémiologie Génétique, Lyon, France
| | | | - Mélanie Léoné
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier Est, Bron, France
| | | | - Alain Lortholary
- Service d'Oncologie Médicale, Centre Catherine de Sienne, Nantes, France; Hôpital Privé du Confluent, Nantes, France
| | - Élisabeth Luporsi
- Service de Génétique UF4128 CHR Metz-Thionville, Hôpital de Mercy, Metz, France
| | - Véronique Mari
- Unité d'Oncogénétique, Centre Antoine Lacassagne, Nice, France
| | - Christine M Maugard
- Génétique Oncologique Moléculaire, UF1422, Département d'Oncobiologie, LBBM, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UF6948 Génétique Oncologique Clinique, évaluation Familiale et Suivi, Strasbourg, France
| | | | | | - Sophie Nambot
- Centre de Lutte contre le Cancer Georges François Leclerc, Dijon, France; Institut GIMI, CHU de Dijon, Hôpital d'Enfants, France; Oncogénétique, Dijon, France
| | - Catherine Noguès
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France; Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - Cornel Popovici
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Fabienne Prieur
- CHU de Saint-Etienne; Hôpital Nord, Service de Génétique, Saint-Etienne, France
| | - Pascal Pujol
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France; INSERM, U896, CRCM Val d'Aurelle, Montpellier, France
| | | | - Hagay Sobol
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Christine Toulas
- Institut Claudius Regaud - IUCT-Oncopole, Service d'Oncologie Médicale, Toulouse, France
| | - Nancy Uhrhammer
- Centre Jean Perrin, LBM OncoGenAuvergne, Clermont Ferrand, France
| | - Dominique Vaur
- Département de Biopathologie, Centre François Baclesse, Caen, France; INSERM, U1245, Rouen, France
| | - Laurence Venat
- Hôpital Universitaire Dupuytren, Service d'Oncologie Médicale, Limoges, France
| | - Anne Boland-Augé
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Pascal Guénel
- Université Paris-Saclay, UVSQ, INSERM, U1018, Gustave Roussy, CESP, Team Exposome and Heredity, Villejuif, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Dominique Stoppa-Lyonnet
- Department of Genetics, Institut Curie, Paris, France; Département d'Oncogénétique, Centre Jean Perrin, Clermont Ferrand, France; Université Paris-Cité, Paris, France
| | - Nadine Andrieu
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Fabienne Lesueur
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France.
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15
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Selle F, Boffa JJ, Etienne G, Angelergues A, Augereau P, Berton D, Dielenseger P, Fabbro M, Falandry C, Follana P, Gladieff L, Joly F, Kurtz JE, Matta C, Mouret-Reynier MA, Schmitt A, Scotté F, Marjollet C, Floquet A. Gestion pratique des inhibiteurs de PARP : Un consensus national DELPHI. Bull Cancer 2022; 109:1245-1261. [DOI: 10.1016/j.bulcan.2022.06.011] [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] [Received: 04/19/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 10/14/2022]
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Bini M, Quesada S, Meeus P, Rodrigues M, Leblanc E, Floquet A, Pautier P, Marchal F, Provansal M, Campion L, Causeret S, Gourgou S, Ray-Coquard I, Classe JM, Pomel C, De La Motte Rouge T, Barranger E, Savoye AM, Guillemet C, Gladieff L, Demarchi M, Rouzier R, Courtinard C, Romeo C, Joly F. Real-World Data on Newly Diagnosed BRCA-Mutated High-Grade Epithelial Ovarian Cancers: The French National Multicenter ESME Database. Cancers (Basel) 2022; 14:cancers14164040. [PMID: 36011033 PMCID: PMC9406396 DOI: 10.3390/cancers14164040] [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: 07/01/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary BRCA-mutated high-grade epithelial ovarian cancers represent a specific subset of gynecological malignancies. Real-world comprehensive data have been elusive to date. As such, we conducted a comprehensive description of clinicopathological and therapeutical characteristics via the Epidemiological Strategy and Medical Economics (ESME) data warehouse, which collects data from 18 French comprehensive cancer centers from the Unicancer network. This led to useful findings regarding the natural disease history of these patients in clinical practice, prior to the advent of poly-ADP ribose polymerase inhibitors. Abstract Background: In spite of the frequency and clinical impact of BRCA1/2 alterations in high-grade epithelial ovarian cancer (HGEOC), real-world information based on robust data warehouse has been scarce to date. Methods: Consecutive patients with BRCA-mutated HGEOC treated between 2011 and 2016 within French comprehensive cancer centers from the Unicancer network were extracted from the ESME database. The main objective of the study was the assessment of clinicopathological and treatments parameters. Results: Out of the 8021 patients included in the ESME database, 266 patients matching the selection criteria were included. BRCA1 mutation was found in 191 (71.8%) patients, while 75 (28.2%) had a BRCA2 mutation only; 95.5% of patients received a cytoreductive surgery. All patients received a taxane/platinum-based chemotherapy (median = six cycles). Complete and partial response were obtained in 53.3% and 20.4% of the cases, respectively. Maintenance therapy was administered in 55.3% of the cases, bevacizumab being the most common agent. After a median follow up of 51.7 months, a median progression-free survival of 28.6 months (95% confidence interval (CI) [26.5; 32.7]) and an estimated 5-year median overall survival of 69.2% (95% CI [61.6; 70.3]) were reported. Notably, BRCA1- and BRCA2-mutated cases exhibited a trend towards different median progression-free survivals, with 28.0 (95% CI [24.4; 32.3]) and 33.3 months (95% CI [26.7; 46.1]), respectively (p-value = 0.053). Furthermore, five-year OS for BRCA1-mutated patients was 64.5% (95% CI [59.7; 69.2]), while it was 82.5% (95% CI [76.6; 88.5]) for BRCA2-mutated ones (p-value = 0.029). Conclusions: This study reports the largest French multicenter cohort of BRCA-mutated HGEOCs based on robust data from the ESME, exhibiting relevant real-world data regarding this specific population.
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Affiliation(s)
- Marta Bini
- Centre Léon Bérard, 69008 Lyon, France
- Instituto Nazionale dei Tumori, 20133 Milano, Italy
| | - Stanislas Quesada
- Centre Léon Bérard, 69008 Lyon, France
- Institut Régional du Cancer de Montpellier, 34298 Montpellier, France
| | | | | | | | | | | | - Frédéric Marchal
- Institut de Cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | | | - Loïc Campion
- Institut de Cancérologie de l’Ouest, 44805 Saint-Herblain, France
| | | | - Sophie Gourgou
- Institut Régional du Cancer de Montpellier, 34298 Montpellier, France
| | | | - Jean-Marc Classe
- Department of Surgery, Institut de Cancerologie de l’Ouest, Boulevard Professor Monod, 44805 Saint Herblain, France
| | | | | | | | | | | | | | - Martin Demarchi
- Institut de Cancérologie Strasbourg ICANS, 67200 Strasbourg, France
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17
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Thomas QD, Boussere A, Classe JM, Pomel C, Costaz H, Rodrigues M, Ray-Coquard I, Gladieff L, Rouzier R, Rouge TDLM, Gouy S, Barranger E, Sabatier R, Floquet A, Marchal F, Guillemet C, Polivka V, Martin AL, Colombo PE, Fiteni F. Optimal timing of interval debulking surgery for advanced epithelial ovarian cancer: A retrospective study from the ESME national cohort. Gynecol Oncol 2022; 167:11-21. [PMID: 35970603 DOI: 10.1016/j.ygyno.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/30/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Interval debulking surgery is recommended after 3-4 cycles (standard IDS) of neoadjuvant chemotherapy (NACT) for epithelial ovarian cancer (EOC) not able to received upfront complete debulking surgery. However, real world practices frequently report performing IDS after ≥5 NAC cycles (delayed IDS). The aim of this work was to evaluate the impact on survival of the number of NACT cycles before IDS. METHODS We identified from a French national database, women with newly diagnosed EOC who underwent IDS from January 2011 to December 2016. Progression free survival (PFS) and overall survival (OS) were compared using Cox model with adjustments for confounding factors provided by two propensity score methods: inverse probability of treatment weighting (IPTW) and matched-pair analysis. RESULTS 928 patients treated by IDS for which our propensity score could be applied were identified. After a median follow-up of 49.0 months (95% CI [46.0;52.9]); from the IPTW analysis, median PFS was 17.6 months and 11.5 months (HR = 1.42; CI 95% [1.22-1.67]; p < 0.0001); median OS was 51.2 months and 44.3 months (HR = 1.29; CI 95% [1.06-1.56]; p = 0.0095) for the standard and delayed IDS groups. From the matched-pair analysis (comparing 352 patients for each group), standard IDS was associated with better PFS (HR = 0,77; CI 95% [0.65-0.90]; p = 0.018) but not significantly associated with better OS (HR = 0,84; CI 95% [0.68-1,03]; p = 0.0947). CONCLUSIONS Carrying IDS after ≥5 NACT cycles seems to have a negative effect on patients survival. The goal of IDS surgery is complete resection and should not be performed after >3-4 NACT cycles.
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Affiliation(s)
- Quentin Dominique Thomas
- Departement of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, Montpellier, France.
| | - Amal Boussere
- Department of Biometry, Institut du Cancer de Montpellier, Montpellier University, Montpellier, France
| | - Jean-Marc Classe
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Saint Herblain, France
| | - Christophe Pomel
- Department of Surgical Oncology, Centre de Lutte Contre le Cancer Jean Perrin, Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, UMR INSERM-UCA, Clermont-Ferrand, France
| | - Hélène Costaz
- Department of Surgical Oncology, Centre Georges-François Leclerc, Dijon, France
| | | | | | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Régaud IUCT-O, Toulouse, France
| | - Roman Rouzier
- Department of Surgical Oncology, Centre François Baclesse, Caen, France
| | | | - Sébastien Gouy
- Department of Surgery, Gustave Roussy, Villejuif, France
| | | | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anne Floquet
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Frédéric Marchal
- Departement of Surgery, Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Cécile Guillemet
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Valentine Polivka
- Department of Biometry, Institut du Cancer de Montpellier, Montpellier University, Montpellier, France
| | | | - Pierre-Emmanuel Colombo
- Departement of Surgery, Institut du Cancer de Montpellier, Montpellier University, Montpellier, France
| | - Frédéric Fiteni
- Departement of Medical Oncology, University Hospital of Nîmes, University of Montpellier, UMR UA11 INSERM, IDESP Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier, France
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Betrian S, Angeles MA, Gil Moreno A, Cabarrou B, Deslandres M, Ferron G, Mery E, Floquet A, Guyon F, Pérez-Benavente A, Spagnolo E, Rychlik A, Gladieff L, Hernández Gutiérrez A, Martinez A. Survival impact of histological response to neoadjuvant chemotherapy according to number of cycles in patients with advanced ovarian cancer. Int J Gynecol Cancer 2022; 32:ijgc-2021-003313. [PMID: 35858711 DOI: 10.1136/ijgc-2021-003313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We sought to evaluate the impact of chemotherapy response score according to the number of cycles of neoadjuvant chemotherapy, on disease-free survival and overall survival, in patients with advanced epithelial ovarian cancer ineligible for primary debulking surgery. METHODS This multicenter retrospective study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV epithelial ovarian cancer who underwent 3-4 or 6 cycles of a platinum and taxane-based neoadjuvant chemotherapy, followed by complete cytoreduction surgery (CC-0) or cytoreduction to minimal residual disease (CC-1), between January 2008 and December 2015, in four institutions. Disease-free survival and overall survival were assessed according to the histological response to chemotherapy defined by the validated chemotherapy response score. RESULTS A total of 365 patients were included: 219 (60.0%) received 3-4 cycles of neoadjuvant chemotherapy, and 146 (40.0%) had 6 cycles of neoadjuvant chemotherapy before cytoreductive surgery. There were no significant differences in early relapses, disease-free survival, and overall survival according to the number of neoadjuvant chemotherapy cycles. However, regardless of the number cycles of neoadjuvant chemotherapy, persistent extensive histological disease (chemotherapy response score 1-2) was significantly associated with a higher peritoneal cancer index, minimal residual disease (CC-1), and early relapses. Median disease-free survival in patients with complete or near-complete response (score 3) was 28.3 months (95% CI 21.6 to 36.8), whereas it was 16.3 months in patients with chemotherapy response score 1-2 (95% CI 14.7 to 18.0, p<0.001). CONCLUSION In our cohort, the number of neoadjuvant chemotherapy cycles was not associated with disease-free survival or overall survival. Chemotherapy response score 3 improved oncological outcome regardless of the number of neoadjuvant chemotherapy cycles.
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Affiliation(s)
- Sarah Betrian
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Martina Aida Angeles
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Antonio Gil Moreno
- Gynecology, Vall d'Hebron Hospital, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Marion Deslandres
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Gwenael Ferron
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Eliane Mery
- Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Anne Floquet
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | | | | | - Emanuela Spagnolo
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Agnieszka Rychlik
- Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Warszawa, Poland
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | | | - Alejandra Martinez
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
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Bétrian SL, Penault Llorca F, Pautier P, Joly F, Ray-Coquard IL, Costaz H, Sauterey B, Floquet A, De La Motte Rouge T, Gourgou S, Marchal F, Guillemet C, Petit T, Rouzier R, Simon G, Gladieff L. ODALIE Study, a retrospective analysis of a real-life cohort of patients with de novo advanced high grade epithelial ovarian cancer treated with a first-line platinum- and taxane-based chemotherapy combined with bevacizumab. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17577] [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
e17577 Background: PARP inhibitors (PARPi) demonstrated improvement in progression-free survival (PFS) following a first line platinum-based chemotherapy including bevacizumab for HRD-positive advanced ovarian carcinoma (OC) patients (pts) (PAOLA-1 study). We aimed to describe real-world (rw) clinical outcomes in patients with de novo high grade epithelial advanced ovarian cancer (HGEOC) treated with a first-line platinum- and taxane-based chemotherapy combined with bevacizumab. Methods: Using the Epidemiological Strategy and Medical Economics (ESME) Ovarian Cancer (OC) Data Platform [NCT03275298], a French EHR-derived database centralizing deidentified data of consecutive patients diagnosed and/or treated in 18 French comprehensive cancer centers since 2011, we identified all patients with de novo FIGO stage III/IV HGEOC diagnosed between 01 October 2012 and 31 January 2017, with a documented response to a first-line platinum-based chemotherapy and a maintenance treatment with bevacizumab ( PAOLA-like control group population). Data cut-off was 06 August 2020. Endpoints (overall survival, PFS and time to subsequent treatment) were estimated using the Kaplan-Meier method. Subgroups were analysed according to the BRCA-derived status. Results: Of 10,263 OC cases in the ESME-OC cohort, 382 patients, with a median follow-up of 47.8 months (CI 95% 44.4-49.1), were analysed. Median age was 61 years (q1-q3: 56-68). 290 pts (75.9%) had a FIGO stage III, 361 pts (94.5%) had at least one surgery, 141 (39.1%) and 210 (58.5%) of them had a primary cytoreductive surgery and an interval surgery respectively. BRCA deleterious mutations were present in 72 pts (22.3%). Median progression free survival was 23.2 months (CI 95% 20.9-24.8) in overall population and 25.3 months (CI 95% 19.7-23.8) in BRCA mutated pts, comparable to the control arm of PAOLA-1 when considering the difference in the PFS definition (from first CT versus from randomization in PAOLA study). Estimated 24-months overall survival rate was 45.7% (95% CI: 40.7- 50.7) and 53.9% (95% CI: 42.4 - 65.5) in BRCA mutated pts. Conclusions: Analyses of our large real-world French ESME-OC cohort are powerful tools to confirm clinical outcomes in HGEOC pts. Our data confirmed the reproducibility of the results observed in randomized clinical trials for de novo HGEOC pts with a documented response to a first line with bevacizumab maintenance therapy.
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Affiliation(s)
| | | | - Patricia Pautier
- GINECO, French Sarcoma Group and Gustave Roussy Cancer Center, Villejuif, France
| | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | | | | | - Anne Floquet
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, and Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens, Bordeaux, France
| | | | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | - Frédéric Marchal
- Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | | | | | | | | | - Laurence Gladieff
- Institut Claudius Regaud, IUCT-Oncopole and GINECO, Toulouse, France
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Classe JM, Ferron G, Ouldamer L, Gauthier T, Emambux S, Gladieff L, Dupre PF, Anota A. CHRONO: randomized trial of the CHROnology of surgery after Neoadjuvant chemotherapy for Ovarian cancer. Int J Gynecol Cancer 2022; 32:1071-1075. [PMID: 35321888 DOI: 10.1136/ijgc-2021-003320] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In patients treated for advanced ovarian cancer not suitable for complete primary surgery, interval surgery after three courses of neoadjuvant chemotherapy has been considered standard management since the EORTC randomized trial published in 2010. An alternative approach with delayed surgery after six courses of neoadjuvant chemotherapy was reported in retrospective series. PRIMARY OBJECTIVES To assess the efficacy on progression free survival of interval cytoreduction surgery after three cycles of neoadjuvant chemotherapy compared with delayed surgery after six cycles of neoadjuvant chemotherapy. STUDY HYPOTHESIS In women with ovarian cancer not suitable for primary surgical cytoreduction, surgery after six cycles of neoadjuvant chemotherapy will prove better disease-free survival than cytoreductive surgery after only three cycles. TRIAL DESIGN CHRONO is a multicenter, randomized phase III trial. After three courses of neoadjuvant chemotherapy, eligible patients will be randomized (1:1) to either completion surgery followed by an additional five cycles of chemotherapy (control arm) or an additional three cycles of neoadjuvant chemotherapy followed by completion surgery and then two additional cycles of chemotherapy (experimental arm). Patients in both groups will receive eight total cycles of chemotherapy. MAJOR INCLUSION/EXCLUSION CRITERIA The main inclusion criteria are histologically confirmed epithelial high-grade serous or endometrioid ovarian cancer, documented FIGO stage IIIB-IVA unsuitable for complete primary surgery but considered resectable after three courses of neoadjuvant chemotherapy. The main exclusion criteria are mucinous, clear cell, carcinosarcoma, or low-grade serous histologies. PRIMARY ENDPOINT The primary endpoint is progression-free survival. SAMPLE SIZE 210 eligible patients ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: The estimated date for completing accrual will be Q2 2023. The estimated date for presentation of the first results is Q3 2028. TRIAL REGISTRATION NUMBER NCT03579394.
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Affiliation(s)
- Jean-Marc Classe
- Department of Surgical Oncology, Institut de Cancerologie de l'Ouest, Saint Herblain, France
| | - Gwennael Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France
| | - Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Sheik Emambux
- Department of Medical Oncology, Centre Hospitalier Universitaire, Poitiers, France
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse, France
| | - Pierre-Francois Dupre
- Department of Gynecology and Surgery, Centre Hospitalier Universitaire, Brest, France
| | - Amélie Anota
- Department of Biostatistics, Centre Leon Berard, Lyon, France
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Falandry C, Pommeret F, Gladieff L, Tinquaut F, Lorusso D, Mouret-Reynier MA, D'Hondt V, Mollon-Grange D, Floquet A, Abadie-Lacourtoisie S, Brachet PE, Stefani L, Rousseau F, Frenel JS, Del Piano F, Komulainen M, Warkus T, Trédan O, Pujade-Lauraine E, Freyer G. Validation of the geriatric vulnerability score in older patients with ovarian cancer: an analysis from the GCIG-ENGOT-GINECO EWOC-1 study. Lancet Healthy Longev 2022; 3:e176-e185. [PMID: 36098291 DOI: 10.1016/s2666-7568(22)00002-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Older patients with ovarian cancer represent a heterogeneous population. The French National Group of Investigators for the Study of Ovarian and Breast Cancer developed the geriatric vulnerability score (GVS) to identify geriatric parameters predictive of poor outcomes. A prospective validation of the GVS was needed. METHODS The EWOC-1 study (NCT02001272) was an international, open-label, phase 2, three-arm trial designed according to a two-step process. Patients aged 70 years or older with newly diagnosed stage III or IV ovarian cancer were identified and the GVS determined. Those with a GVS of 3 or greater were randomly assigned to the EWOC-1 trial, stratified by country and surgical outcome, to receive three different carboplatin with or without paclitaxel regimens; those not included in the EWOC-1 trial were followed up in the EWOC-1 registry. External validation of the GVS was a secondary endpoint of the trial. Three validation cohorts were identified: the total population (validation cohort 1 [V1], n=447), the registry-only population (validation cohort 2 [V2], n=327), and the carboplatin-paclitaxel-treated population (validation cohort 3 [V3], n=320). FINDINGS From Dec 11, 2013, to Nov 16, 2018, 447 patients were included in 48 academic centres in six countries; 120 in the EWOC-1 trial and 327 in the EWOC-1 registry. Median follow-up was 19·7 (95% CI 8·5-29·7) months for the total cohort; missing values were low (<2%). According to the maximum likelihood analysis, the hazard ratio (HR) of death in V1 was 1·8 (95% CI 1·1-3·1, p=0·029) for those with a GVS of 1; 2·4 (1·4-4·0, p=0·0009) with a GVS of 2; 4·1 (2·5-7·0, p<0·0001) for a GVS of 3; 5·5 (3·3-9·3, p<0·0001) for a GVS of 4; and 9·1 (4·7-17·5, p<0·0001) for a GVS of 5 compared with a score of 0. Whatever the validation cohort, GVS of 3 or more significantly segregated two groups with different overall survival: V1 (median 13·2 [95% CI: 10·8-18·7] vs 40·8 [32·0-45·6] months; HR 2·8 [95% CI 2·2-3·7]; p<0·0001); V2 (11·9 [95% CI 8·8-18·1] vs 40·8 [32·0-45·6] months, HR 3·5 [2·5-4·9]; p<0·0001); and V3 (18·1 [95% CI 15·8-31·8] vs 43·0 [40·6-49·7] months, HR 2·6 [1·9 to 3·7]; p<0·0001). INTERPRETATION The GVS has high prognostic performance for overall survival in patients with advanced ovarian cancer, independently of geographic and historic effect (V1), as well as treatment patterns (V3), validated in an international population. Even though the GVS is time consuming it will allow the stratification of populations for clinical research and might permit the orientation of the geriatric intervention to specific domains. FUNDING French National Cancer Institute. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Claire Falandry
- GINECO, Paris, France; Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
| | - Fanny Pommeret
- GINECO, Paris, France; Institut Gustave Roussy, Villejuif, France
| | - Laurence Gladieff
- GINECO, Paris, France; Institut Claudius Regaud-IUCT Oncopole, Toulouse, France
| | - Fabien Tinquaut
- GINECO, Paris, France; Institut de Cancérologie de la Loire, St Priest en Jarez, France
| | - Domenica Lorusso
- MITO and IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Véronique D'Hondt
- GINECO, Paris, France; Institut du Cancer de Montpellier, Montpellier, France
| | | | - Anne Floquet
- GINECO, Paris, France; Institut Bergonié, Bordeaux, France
| | | | | | - Laetitia Stefani
- GINECO, Paris, France; Centre Hospitalier Annecy Genevois, Pringy, France
| | | | - Jean-Sébastien Frenel
- GINECO, Paris, France; Institut de Cancérologie de l'Ouest-site René Gauducheau, Nantes, France
| | | | | | | | | | | | - Gilles Freyer
- GINECO, Paris, France; Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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Joly F, Fabbro M, Follana P, Lequesne J, Medioni J, Lesoin A, Frenel JS, Abadie-Lacourtoisie S, Floquet A, Gladieff L, You B, Gavoille C, Kalbacher E, Briand M, Brachet PE, Giffard F, Weiswald LB, Just PA, Blanc-Fournier C, Leconte A, Clarisse B, Leary A, Poulain L. A phase II study of Navitoclax (ABT-263) as single agent in women heavily pretreated for recurrent epithelial ovarian cancer: The MONAVI – GINECO study. Gynecol Oncol 2022; 165:30-39. [DOI: 10.1016/j.ygyno.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 12/31/2022]
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Genestie C, Gladieff L, Frère-Belda MAL, Lortholary A, Vaur D, Treilleux I, Lyonnet DS. Diagnostic histologique et moléculaire des cancers de l'ovaire - recommandations pour la pratique clinique Saint-Paul 2021: Histological and molecular diagnosis of ovarian. Bull Cancer 2021; 108:S33-S38. [PMID: 34955160 DOI: 10.1016/s0007-4551(21)00585-3] [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] [Indexed: 11/29/2022]
Abstract
Oncogenetic testing is now part of standard management in high grade ovarian cancer, including at least mutational status of BRCA1/BRCA2 genes. If necessary, tumor genetic testing is followed by constitutional testing to either confirm the constitutional origin of variants identified in BRCA1/2 genes or detect variants in other predisposition genes. The whole process including prescription of tumoral testing, retrieval of analysis report and communication of results must be formalized, as well as information on possible consequences of the results for the patient and her family. Tumor material must meet criteria of size and cellularity to allow high-quality analysis. These samples are processed during the preanalytical phase with two major steps : time of cold ischemia and fixation. Only pathogenic (Class V) and likely pathogenic (Class IV) variants shown in tumor tissue are mentioned in the report. Currently, only BRCA1 and BRCA2 genes are routinely studied but, in the future, analysis will be extended to other genes involved in homologous recombination repair. In patients without BRCA mutation, other biomarkers reflecting sensitivity to PARP inhibitors, such as HRD scores (homologous recombination deficiency) that appeared recently, will have to be implemented in routine practice in order to better select patients for these treatments and choose optimal therapy.
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Affiliation(s)
| | - Laurence Gladieff
- Département d'oncologie médicale et unité d'oncogénétique, institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | | | - Dominique Vaur
- Laboratoire de biologie et de génétique du cancer, Centre François-Baclesse, Caen, France
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Berton D, Pautier P, Lorusso D, Gennigens C, Gladieff L, Kryzhanivska A, Ranganathan S, Tian C, Bourayou N, Vergote I. 956 Retifanlimab (INCMGA00012) in patients with recurrent MSI-H or dMMR endometrial cancer: results from the POD1UM-101 study. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundManagement of patients with recurrent endometrial cancer after failure on platinum-based therapy remains a clinical challenge. Retifanlimab (INCMGA00012) is an investigational humanized immunoglobulin G4 monoclonal antibody against programmed cell death 1 (PD-1). We previously reported encouraging results from a preplanned interim analysis in patients with microsatellite instability-high (MSI-H) recurrent endometrial cancer treated with retifanlimab in POD1UM-101 [1]. Here, we provide top-line results from the full cohort of patients in the POD1UM-101 study.MethodsEligible patients have histologically proven, unresectable recurrent MSI-H or deficient mismatch repair (dMMR) endometrial cancer (per local testing), ECOG PS ≤1, disease progression during or following 1 to ≤5 prior systemic treatments, measurable disease (per RECIST v1.1), and are naïve to prior immune checkpoint inhibitors. MSI-H and dMMR status were centrally confirmed using PCR and IHC, respectively. Patients receive retifanlimab 500 mg every 4 weeks for up to 2 years. The primary study endpoint is safety. Confirmed best overall response and duration of response (DOR) were evaluated by independent central review (ICR) using RECIST v1.1.ResultsAs of July 6, 2021, 76 patients with centrally confirmed MSI-H (65 [85.5%]) or dMMR (11 [14.5%]) endometrial cancer had received ≥1 dose of retifanlimab; median age was 67.0 (49–88) years, 70 (92.1%) had endometrioid histology, 67 (88.2%) had metastatic disease, and 61 (80.3%) had visceral metastases. Sixty-eight (89.5%) patients had prior surgery or procedure, 54 (71.1%) patients were treated with radiotherapy, and 75 (98.7%) patients had received prior systemic therapy for advanced disease (33 [43.4%] received ≥2 prior systemic therapies for advanced disease). Median retifanlimab exposure was 7.4 (0.03–23.0) months. At data cutoff, 2 (2.6%) patients completed treatment and 30 (39.5%) were on treatment. Grade ≥3 treatment emergent AEs (TEAEs) occurred in 33 (43.4%) patients, including 10 (13.2%) with anemia and 7 (9.2%) with an immune-related AE (nephritis, n=2; autoimmune hepatitis, hepatitis, myositis, rash, and pneumonitis, n=1 each). There were no treatment-related AEs with fatal outcome. Centrally confirmed objective responses were observed in 33 (43.4%) patients (95% CI, 32.1–55.3), with 11 (14.5%) complete and 22 (28.9%) partial responses. Of the 33 patients with objective response, 25 (75.8%) had DOR for ≥6 months; median DOR was not reached. Median follow-up time for response was 8.4 (range, 1.9–28.3) months.ConclusionsRetifanlimab was well tolerated and demonstrated encouraging antitumor activity in patients with pretreated recurrent MSI-H or dMMR endometrial cancer, consistent with that achieved with other PD-1 therapies.AcknowledgementsThis study is sponsored by Incyte Corporation (Wilmington, DE).Trial RegistrationClinicaltrialsgov NCT03059823, EudraCT 2017-000865-63ReferenceBerton-Rigaud D, et al. J ImmunoTher Cancer 2020;8(Suppl 3):A164–A165 [Abstract 268].Ethics ApprovalThis study was approved by institutional review boards or independent ethics committees in Belgium (Aan de Commissie Medische Ethiek University Hospitals Leuven [CEC: S62335]; Ethics Committee of Hospital-Faculty University of Liège [LEC: 2019/48]); Bulgaria (Ethics Committee for Clinical Trials, Sofia [RA: IAL-24443/08.06.2017; CEC: КИ-80/08.06.2017]); Finland (HUS Tutkimuseettiset toimikunnat Biomedicum Helsinki [RA: KLnro 124/2019]); France (CPP Île-de-France X Hôpital, Aulnay-sous-Bois cedex [RA: MED MSA NAT-2019-08-00080; CEC: CN-RIPH 19.02.17.56415/CPP 27-2019]); Germany (Ethik-Kommission der Albert-Ludwigs-Universität Freiburg, Freiburg [RA: 3102/012; EC: 506/18]; Ethics Committee at the Technical University of Dresden, Dresden [RA: 3102/012; EC: EK 4854 AB]; Ethics Committee of the State of Berlin, Berlin [RA: 3102/012; EC: 17/0411 EK 12/15]); Italy (Comitato Etico del Policlinico Gemelli Fondazione Policlinico Universitario ”Agostino Gemelli”, Roma (RM) [no approval number issued by RA or EC]; Comitato Etico IRCCS di Candiolo, Candiolo-TO [no approval number issued by RA or EC]); Latvia (Ethics Committee for Clinical Research at Development Society of Pauls Stradins Clinical University Hospital, Riga [no approval number issued by RA or EC]); Lithuania (Lithuanian Bioethics Committee, Vilnius [no approval number issued by RA or EC]); Poland (Komisja Bioetyczna przy Uniwersytecie Medycznym, Poznań [RA: UR.DBL.474.0350.2017; CEC: 622/17]); Spain (Comité de Ética de Investigación con Medicamentos, Madrid Centro Actividades Ambulatoria [RA: 17-073 (Locator: 2VK42NE57D); CEC: 17/211]); Ukraine (Ethical Committee at Prykarpatsky Regional Clinical Oncology Center of Ivano-Frankivsk Regional Rada, Ivano-Frankivsk [no approval number issued by RA or EC]); United States (IntegReview IRB, Austin, TX [no approval number issued by IRB]; The University of Texas MD Anderson Cancer Center Institutional Review Board, Houston, TX [no approval number issued by IRB]).
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Daix M, Gladieff L, Martinez A, Ferron G, Angeles MA. Pocket memo based on the ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma: definition of prognostic risk groups. Int J Gynecol Cancer 2021; 31:1615-1616. [PMID: 34645685 DOI: 10.1136/ijgc-2021-003110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Manon Daix
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France .,Mont Legia - Department of Gynecology, Centre Hospitalier Chrétien, Liege, Wallonie, Belgium
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, Occitanie, France
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Caputo SM, Golmard L, Léone M, Damiola F, Guillaud-Bataille M, Revillion F, Rouleau E, Derive N, Buisson A, Basset N, Schwartz M, Vilquin P, Garrec C, Privat M, Gay-Bellile M, Abadie C, Abidallah K, Airaud F, Allary AS, Barouk-Simonet E, Belotti M, Benigni C, Benusiglio PR, Berthemin C, Berthet P, Bertrand O, Bézieau S, Bidart M, Bignon YJ, Birot AM, Blanluet M, Bloucard A, Bombled J, Bonadona V, Bonnet F, Bonnet-Dupeyron MN, Boulaire M, Boulouard F, Bouras A, Bourdon V, Brahimi A, Brayotel F, Bressac de Paillerets B, Bronnec N, Bubien V, Buecher B, Cabaret O, Carriere J, Chiesa J, Chieze-Valéro S, Cohen C, Cohen-Haguenauer O, Colas C, Collonge-Rame MA, Conoy AL, Coulet F, Coupier I, Crivelli L, Cusin V, De Pauw A, Dehainault C, Delhomelle H, Delnatte C, Demontety S, Denizeau P, Devulder P, Dreyfus H, d’Enghein CD, Dupré A, Durlach A, Dussart S, Fajac A, Fekairi S, Fert-Ferrer S, Fiévet A, Fouillet R, Mouret-Fourme E, Gauthier-Villars M, Gesta P, Giraud S, Gladieff L, Goldbarg V, Goussot V, Guibert V, Guillerm E, Guy C, Hardouin A, Heude C, Houdayer C, Ingster O, Jacquot-Sawka C, Jones N, Krieger S, Lacoste S, Lallaoui H, Larbre H, Laugé A, Le Guyadec G, Le Mentec M, Lecerf C, Le Gall J, Legendre B, Legrand C, Legros A, Lejeune S, Lidereau R, Lignon N, Limacher JM, Doriane Livon, Lizard S, Longy M, Lortholary A, Macquere P, Mailliez A, Malsa S, Margot H, Mari V, Maugard C, Meira C, Menjard J, Molière D, Moncoutier V, Moretta-Serra J, Muller E, Nevière Z, Nguyen Minh Tuan TV, Noguchi T, Noguès C, Oca F, Popovici C, Prieur F, Raad S, Rey JM, Ricou A, Salle L, Saule C, Sevenet N, Simaga F, Sobol H, Suybeng V, Tennevet I, Tenreiro H, Tinat J, Toulas C, Turbiez I, Uhrhammer N, Vande Perre P, Vaur D, Venat L, Viellard N, Villy MC, Warcoin M, Yvard A, Zattara H, Caron O, Lasset C, Remenieras A, Boutry-Kryza N, Castéra L, Stoppa-Lyonnet D. Classification of 101 BRCA1 and BRCA2 variants of uncertain significance by cosegregation study: A powerful approach. Am J Hum Genet 2021; 108:1907-1923. [PMID: 34597585 DOI: 10.1016/j.ajhg.2021.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/01/2021] [Indexed: 12/18/2022] Open
Abstract
Up to 80% of BRCA1 and BRCA2 genetic variants remain of uncertain clinical significance (VUSs). Only variants classified as pathogenic or likely pathogenic can guide breast and ovarian cancer prevention measures and treatment by PARP inhibitors. We report the first results of the ongoing French national COVAR (cosegregation variant) study, the aim of which is to classify BRCA1/2 VUSs. The classification method was a multifactorial model combining different associations between VUSs and cancer, including cosegregation data. At this time, among the 653 variants selected, 101 (15%) distinct variants shared by 1,624 families were classified as pathogenic/likely pathogenic or benign/likely benign by the COVAR study. Sixty-six of the 101 (65%) variants classified by COVAR would have remained VUSs without cosegregation data. Of note, among the 34 variants classified as pathogenic by COVAR, 16 remained VUSs or likely pathogenic when following the ACMG/AMP variant classification guidelines. Although the initiation and organization of cosegregation analyses require a considerable effort, the growing number of available genetic tests results in an increasing number of families sharing a particular variant, and thereby increases the power of such analyses. Here we demonstrate that variant cosegregation analyses are a powerful tool for the classification of variants in the BRCA1/2 breast-ovarian cancer predisposition genes.
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Rodrigues M, Joly F, Ray-Coquard I, Costaz H, Classe JM, Floquet A, De La Motte Rouge T, Colombo PE, Gross MP, Leblanc E, Pomel C, Marchal F, Barranger E, Savoye A, Guillemet C, Petit T, Pautier P, Rouzier R, Courtinard C, Gladieff L. 746P Real-world clinical outcomes of patients with de novo advanced high-grade epithelial ovarian cancer eligible to niraparib maintenance in France. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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28
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O'Malley DM, Oaknin A, Monk BJ, Selle F, Rojas C, Gladieff L, Berton D, Leary A, Moore KN, Estevez-Diz MDP, Hardy-Bessard AC, Alexandre J, Opperman CP, de Azevedo CRAS, Randall LM, Feliu WO, Ancukiewicz M, Ray-Coquard I. Phase II study of the safety and efficacy of the anti-PD-1 antibody balstilimab in patients with recurrent and/or metastatic cervical cancer. Gynecol Oncol 2021; 163:274-280. [PMID: 34452745 DOI: 10.1016/j.ygyno.2021.08.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This phase II clinical trial evaluated the safety and antitumor activity of balstilimab, an anti-PD-1 antibody, in patients with previously-treated, recurrent/metastatic cervical cancer. METHODS Eligible patients were 18 years or older with recurrent and/or metastatic cervical cancer and who had relapsed after a prior platinum-based treatment regimen for advanced disease. Balstilimab was administered intravenously at 3 mg/kg once every two weeks, for up to 24 months. The primary endpoint was objective response rate (ORR, RECIST v1.1) as assessed by an independent review committee. RESULTS At data cutoff, 161 women (median age, 53 years [range 25-81]) were enrolled and treated with balstilimab. Of these, 140 had measurable disease at baseline and one prior line of platinum-based therapy in the metastatic, persistent, or recurrent setting; these patients were included in the efficacy analyses. The ORR was 15% (95% CI, 10.0%-21.8%) and included 5 patients with a complete response and 16 with a partial response. The median duration of response was 15.4 months. In patients with PD-L1-positive tumors the ORR was 20%, however patients with PD-L1-negative tumors also responded to balstilimab (ORR, 7.9%). Responses were not restricted to tumors of squamous cell histology, and an ORR of 12.5% was seen in the subset of patients with cervical adenocarcinoma. The disease control rate was 49.3% (95% CI, 41.1%-57.5%). Immune-mediated enterocolitis (3.1%) and diarrhea (1.9%) were the most common grade 3 or higher treatment-related adverse events. CONCLUSION Balstilimab demonstrated meaningful and durable clinical activity, with manageable safety, in patients with previously-treated, recurrent/metastatic cervical cancer.
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Affiliation(s)
- David M O'Malley
- The Ohio State University, James Comprehensive Cancer Center, Columbus, OH, United States. David.O'
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), Creighton University School of Medicine, Phoenix, AZ, United States.
| | - Frédéric Selle
- Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris, France.
| | - Carlos Rojas
- Centro de Investigacion Clinica, Bradford Hill, Santiago, Chile.
| | - Laurence Gladieff
- Institut Claudius Regaud-Institut Universitaire du Cancer (IUCT)-Oncopole, Toulouse, France.
| | | | | | - Kathleen N Moore
- Stephenson Oklahoma Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | | | | | | | | | | | - Leslie M Randall
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States.
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Prat M, Le Naour A, Coulson K, Lemée F, Leray H, Jacquemin G, Rahabi MC, Lemaitre L, Authier H, Ferron G, Barret JM, Martinez A, Ayyoub M, Delord JP, Gladieff L, Tabah-Fisch I, Prost JF, Couderc B, Coste A. Circulating CD14 high CD16 low intermediate blood monocytes as a biomarker of ascites immune status and ovarian cancer progression. J Immunother Cancer 2021; 8:jitc-2019-000472. [PMID: 32503947 PMCID: PMC7279676 DOI: 10.1136/jitc-2019-000472] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2020] [Indexed: 12/21/2022] Open
Abstract
Background Besides the interest of an early detection of ovarian cancer, there is an urgent need for new predictive and prognostic biomarkers of tumor development and cancer treatment. In healthy patients, circulating blood monocytes are typically subdivided into classical (85%), intermediate (5%) and non-classical (10%) populations. Although these circulating monocyte subsets have been suggested as biomarkers in several diseases, few studies have investigate their potential as a predictive signature for tumor immune status, tumor growth and treatment adaptation. Methods In this study, we used a homogeneous cohort of 28 chemotherapy-naïve patients with ovarian cancer to evaluate monocyte subsets as biomarkers of the ascites immunological status. We evaluated the correlations between circulating monocyte subsets and immune cells and tumor burden in peritoneal ascites. Moreover, to validate the use of circulating monocyte subsets tofollow tumor progression and treatment response, we characterized blood monocytes from ovarian cancer patients included in a phase 1 clinical trial at baseline and following murlentamab treatment. Results We demonstrate here a robust expansion of the intermediate blood monocytes (IBMs) in ovarian cancer patients. We establish a significant positive correlation between IBM percentage and tumor–associate macrophages with a CCR2high/CD163high/CD206high/CD86lowprofile. Moreover, IBM expansion is associated with a decreased effector/regulatory T-cell ratio in ascites and with the presence of soluble immunosuppressive mediators. We also establish that IBM proportion positively correlates with the peritoneum tumor burden. Finally, the study of IBMs in patients with ovarian cancer under immunotherapy during the phase clinical trial supports IBMs to follow the evolution of tumor development and the treatment adaptation. Conclusions This study, which links IBM level with immunosuppression and tumor burden in peritoneum, identifies IBMs as apotential predictive signature of ascites immune status and as a biomarker ofovarian cancer development and treatment response. Trial registration number EudraCT: 2015-004252-22 NCT02978755.
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Affiliation(s)
- Mélissa Prat
- UMR152 Pharmadev, Université Toulouse III Paul Sabatier, Toulouse, Occitanie, France.,UMR152 Pharmadev, IRD, Toulouse, France
| | - Augustin Le Naour
- UMR152 Pharmadev, Université Toulouse III Paul Sabatier, Toulouse, Occitanie, France.,UMR152 Pharmadev, IRD, Toulouse, France.,UMR1037, CRCT, Toulouse, Midi-Pyrénées, France.,Institut Claudius Regaud, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | - Kimberley Coulson
- UMR152 Pharmadev, Université Toulouse III Paul Sabatier, Toulouse, Occitanie, France.,UMR152 Pharmadev, IRD, Toulouse, France
| | - Fanny Lemée
- Gamamabs Pharma, Toulouse, Languedoc-Roussillon-Midi, France
| | - Hélène Leray
- UMR1037, CRCT, Toulouse, Midi-Pyrénées, France.,Institut Claudius Regaud, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | - Godefroy Jacquemin
- UMR152 Pharmadev, Université Toulouse III Paul Sabatier, Toulouse, Occitanie, France.,UMR152 Pharmadev, IRD, Toulouse, France
| | - Mouna Chirine Rahabi
- UMR152 Pharmadev, Université Toulouse III Paul Sabatier, Toulouse, Occitanie, France.,UMR152 Pharmadev, IRD, Toulouse, France
| | - Léa Lemaitre
- UMR1037, CRCT, Toulouse, Midi-Pyrénées, France.,Institut Claudius Regaud, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | - Hélène Authier
- UMR152 Pharmadev, Université Toulouse III Paul Sabatier, Toulouse, Occitanie, France.,UMR152 Pharmadev, IRD, Toulouse, France
| | - Gwenaël Ferron
- Institut Claudius Regaud, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | | | - Alejandra Martinez
- Institut Claudius Regaud, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | - Maha Ayyoub
- UMR1037, CRCT, Toulouse, Midi-Pyrénées, France
| | - Jean-Pierre Delord
- Institut Claudius Regaud, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | - Laurence Gladieff
- Institut Claudius Regaud, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | | | | | - Bettina Couderc
- UMR1037, CRCT, Toulouse, Midi-Pyrénées, France.,Institut Claudius Regaud, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | - Agnès Coste
- UMR152 Pharmadev, Université Toulouse III Paul Sabatier, Toulouse, Occitanie, France .,UMR152 Pharmadev, IRD, Toulouse, France
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Ribeiro Guerra M, Coignard J, Eon-Marchais S, Dondon MG, Le Gal D, Beauvallet J, Mebirouk N, Belotti M, Caron O, Gauthier-Villars M, Coupier I, Buecher B, Lortholary A, Fricker JP, Gesta P, Noguès C, Faivre L, Berthet P, Luporsi E, Delnatte C, Bonadona V, Maugard CM, Pujol P, Lasset C, Longy M, Bignon YJ, Adenis-Lavignasse C, Venat-Bouvet L, Dreyfus H, Gladieff L, Mortemousque I, Audebert-Bellanger S, Soubrier F, Giraud S, Lejeune-Dumoulin S, Limacher JM, Chiesa J, Fajac A, Floquet A, Eisinger F, Tinat J, Fert-Ferrer S, Colas C, Frebourg T, Damiola F, Barjhoux L, Cavaciuti E, Mazoyer S, Tardivon A, Lesueur F, Stoppa-Lyonnet D, Andrieu N. Diagnostic chest X-rays and breast cancer risk among women with a hereditary predisposition to breast cancer unexplained by a BRCA1 or BRCA2 mutation. Breast Cancer Res 2021; 23:79. [PMID: 34344426 PMCID: PMC8336294 DOI: 10.1186/s13058-021-01456-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background Diagnostic ionizing radiation is a risk factor for breast cancer (BC). BC risk increases with increased dose to the chest and decreases with increased age at exposure, with possible effect modification related to familial or genetic predisposition. While chest X-rays increase the BC risk of BRCA1/2 mutation carriers compared to non-carriers, little is known for women with a hereditary predisposition to BC but who tested negative for a BRCA1 or BRCA2 (BRCA1/2) mutation. Methods We evaluated the effect of chest X-rays from diagnostic medical procedures in a dataset composed of 1552 BC cases identified through French family cancer clinics and 1363 unrelated controls. Participants reported their history of X-ray exposures in a detailed questionnaire and were tested for 113 DNA repair genes. Logistic regression and multinomial logistic regression models were used to assess the association with BC. Results Chest X-ray exposure doubled BC risk. A 3% increased BC risk per additional exposure was observed. Being 20 years old or younger at first exposure or being exposed before first full-term pregnancy did not seem to modify this risk. Birth after 1960 or carrying a rare likely deleterious coding variant in a DNA repair gene other than BRCA1/2 modified the effect of chest X-ray exposure. Conclusion Ever/never chest X-ray exposure increases BC risk 2-fold regardless of age at first exposure and, by up to 5-fold when carrying 3 or more rare variants in a DNA repair gene. Further studies are needed to evaluate other DNA repair genes or variants to identify those which could modify radiation sensitivity. Identification of subpopulations that are more or less susceptible to ionizing radiation is important and potentially clinically relevant. Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01456-1.
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Affiliation(s)
- Maximiliano Ribeiro Guerra
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France.,Department of Public Health, Faculty of Medicine, Federal University of Juiz de Fora - UFJF, Minas Gerais, Brazil
| | - Juliette Coignard
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Séverine Eon-Marchais
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Marie-Gabrielle Dondon
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Dorothée Le Gal
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Juana Beauvallet
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Noura Mebirouk
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | | | - Olivier Caron
- Gustave Roussy, Département de Médecine Oncologique, Université Paris-Saclay, Villejuif, France
| | | | - Isabelle Coupier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France.,INSERM 896, CRCM Val d'Aurelle, Montpellier, France
| | | | - Alain Lortholary
- Centre Catherine de Sienne, Service d'Oncologie Médicale, Nantes, France
| | | | - Paul Gesta
- CH Georges Renon, Service d'Oncogénétique Régional Poitou-Charentes, Niort, France
| | - Catherine Noguès
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli Calmettes, Marseille, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Laurence Faivre
- Institut GIMI, CHU de Dijon, Hôpital d'Enfants, Dijon, France.,Centre de Lutte contre le Cancer Georges François Leclerc, Dijon, France
| | - Pascaline Berthet
- Centre François Baclesse, Unité de pathologie gynécologique, Caen, France
| | - Elisabeth Luporsi
- Service de Génétique UF4128 CHR Metz-Thionville, Hôpital de Mercy, Metz, France
| | - Capucine Delnatte
- Centre René Gauducheau, Unité d'Oncogénétique, Nantes, Saint Herblain, France
| | - Valérie Bonadona
- Université Claude Bernard Lyon 1, Villeurbanne, France.,CNRS UMR 5558, Lyon, France.,Centre Léon Bérard, Unité de Prévention et Epidémiologie Génétique, Lyon, France
| | - Christine M Maugard
- Génétique Oncologique moléculaire, UF1422, Département d'Oncobiologie, LBBM, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,UF6948 Génétique Oncologique Clinique, Evaluation familiale et suivi, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pascal Pujol
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France.,INSERM 896, CRCM Val d'Aurelle, Montpellier, France
| | - Christine Lasset
- Université Claude Bernard Lyon 1, Villeurbanne, France.,CNRS UMR 5558, Lyon, France.,Centre Léon Bérard, Unité de Prévention et Epidémiologie Génétique, Lyon, France
| | | | - Yves-Jean Bignon
- Département d'oncogénétique, Centre Jean Perrin, Université Clermont Auvergne, UMR INSERM 1240, Clermont Ferrand, France
| | | | | | - Hélène Dreyfus
- Clinique Sainte Catherine, Avignon, France.,Hôpital Couple-Enfant, Département de Génétique, CHU de Grenoble, Grenoble, France
| | - Laurence Gladieff
- Institut Claudius Regaud - IUCT-Oncopole, Service d'Oncologie Médicale, Toulouse, France
| | | | | | | | - Sophie Giraud
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier EST, Bron, France
| | | | | | - Jean Chiesa
- Service d'Oncologie Médicale, CHRU Hôpital Caremeau, Nîmes, France
| | - Anne Fajac
- Service d'Oncogénétique, Hôpital Tenon, Paris, France
| | | | - François Eisinger
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli Calmettes, Marseille, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Julie Tinat
- Groupe Hospitalier Pellegrin, Service de génétique médicale, CHU De Bordeaux, Bordeaux, France
| | | | - Chrystelle Colas
- Institut Curie, Service de Génétique, Paris, France.,Institut Curie, Hopital René Huguenin, Saint-Cloud, France
| | - Thierry Frebourg
- Département de Génétique, Hopital Universitaire de Rouen, Rouen, France
| | - Francesca Damiola
- Department of Biopathology, Pathology Research platform, Centre Léon Bérard, Lyon, France
| | - Laure Barjhoux
- GCS AURAGEN, Plateforme de Génétique, Hôpital Edouart Herriot, Lyon, France
| | - Eve Cavaciuti
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Sylvie Mazoyer
- Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS UMR5292, Université Lyon 1, Université Saint Etienne, Lyon, France
| | - Anne Tardivon
- Service de Radiologie, Institut Curie, Paris, France
| | - Fabienne Lesueur
- INSERM, U900, Paris, France.,Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Service de Génétique, Paris, France.,INSERM, U830, Paris, France.,Université Paris-Descartes, Paris, France
| | - Nadine Andrieu
- INSERM, U900, Paris, France. .,Institut Curie, Paris, France. .,Mines ParisTech, Fontainebleau, France. .,PSL Research University, Paris, France.
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De Nonneville A, Zemmour C, Frank S, Joly F, Ray-Coquard I, Costaz H, Classe JM, Floquet A, De la Motte Rouge T, Colombo PE, Sauterey B, Leblanc E, Pomel C, Marchal F, Barranger E, Savoye AM, Guillemet C, Petit T, Pautier P, Rouzier R, Gladieff L, Simon G, Courtinard C, Sabatier R. Clinicopathological characterization of a real-world multicenter cohort of endometrioid ovarian carcinoma: Analysis of the French national ESME-Unicancer database. Gynecol Oncol 2021; 163:64-71. [PMID: 34294414 DOI: 10.1016/j.ygyno.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prognostic significance of endometrioid epithelial ovarian cancer (EOC) is controversial. We compared clinical, pathological, and biological features of patients with endometrioid and serous EOC, and assessed the independent effect of histology on outcomes. METHODS We conducted a multicenter retrospective analysis of patients with EOC selected from the French Epidemiological Strategy and Medical Economics OC database between 2011 and 2016. Our main objective was to compare overall survival (OS) in endometrioid and serous tumors of all grades. Our second objectives were progression-free survival (PFS) and prognostic features. RESULTS Out of 10,263 patients included, 3180 cases with a confirmed diagnosis of serous (N = 2854) or endometrioid (N = 326) EOC were selected. Patients with endometrioid histology were younger, more often diagnosed at an early stage, with lower-grade tumors, more frequently dMMR/MSI-high, and presented more personal/familial histories of Lynch syndrome-associated cancers. BRCA1/2 mutations were more frequently identified in the serous population. Endometrioid patients were less likely to receive chemotherapy, with less bevacizumab. After median follow-up of 51.7 months (95CI[50.1-53.6]), five-year OS rate was 81% (95CI[74-85]) in the endometrioid subgroup vs. 55% (95CI[53-57] in the serous subset (p < 0.001, log-rank test). In multivariate analyses including [age, ECOG-PS, FIGO, grade, and histology], the endometrioid subtype was independently associated with better OS (HR = 0.38, 95CI[0.20-0.70], p= 0.002) and PFS (HR = 0.53, 95CI[0.37-0.75], p < 0.001). CONCLUSIONS Clinicopathological features at diagnosis are not the same for endometrioid and serous EOC. Endometrioid histology is an independent prognosis factor in EOC. These observations suggest the endometrioid population requires dedicated clinical trials and management.
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Affiliation(s)
- Alexandre De Nonneville
- Aix-Marseille Univ., CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - Christophe Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Paoli-Calmettes Institute, Aix Marseille Univ., INSERM, IRD, SESSTIM, Marseille, France
| | - Sophie Frank
- Department of Medical Oncology, Institut Curie, 26 rue d'Ulm, 75248 Paris, France
| | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Hèlène Costaz
- Department of Surgical Oncology, Centre Georges François Leclerc, 1 rue Professeur Marion, 21079 Dijon, France
| | - Jean-Marc Classe
- Department of Surgical Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Boulevard Jacques Monod, 44805 Saint Herblain, France
| | - Anne Floquet
- Department of Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Thibault De la Motte Rouge
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Pierre-Emmanuel Colombo
- Department of Surgical Oncology, Institut du Cancer de Montpellier, 208 Rue des Apothicaires, 34298 Montpellier, France
| | - Baptiste Sauterey
- Department of medical Oncology, Institut de Cancérologie de l'Ouest Centre Paul Papin, 5 Rue Moll, 49000 Angers, France
| | - Eric Leblanc
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Christophe Pomel
- Department of Surgical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011 Clermont Ferrand, France
| | - Frédéric Marchal
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Emmanuel Barranger
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189 Nice, France
| | - Aude-Marie Savoye
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Cécile Guillemet
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000 Rouen, France
| | - Thierry Petit
- Department of Medical Oncology, Institut de cancérologie Strasbourg Europe, Centre Paul Strauss, 17 rue Albert Calmette, 67033 Strasbourg, France
| | - Patricia Pautier
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Roman Rouzier
- Department of Breast and Gynecological Surgery, Institut Curie, 35, Rue Dailly, 92 210 Saint-Cloud, France
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Gaëtane Simon
- Data Office, Unicancer, 101 Rue de Tolbiac, 75654 Paris, France
| | - Coralie Courtinard
- Data Office, Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux, France
| | - Renaud Sabatier
- Aix-Marseille Univ., CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
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Ray-Coquard IL, Leary A, Bigot F, Montane L, Fabbro M, Hardy-Bessard AC, Selle F, Chakiba C, Lortholary A, Berton D, Chevalier-Evain V, Provansal M, Gladieff L, Kaminsky MC, Pignata S, Braicu EI, Caux C, Stern MH, Bellesoeur A, Kalbacher E. ROCSAN trial (GINECO-EN203b/ENGOT-EN8): A multicentric randomized phase II/III evaluating dostarlimab in combination with niraparib versus niraparib alone compared to chemotherapy in the treatment of endometrial/ovarian carcinosarcoma after at least one line of platinum based chemotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps5604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS5604 Background: Gynecological carcinosarcomas (CS) are rare and highly aggressive tumors with a 5-year overall survival (OS) < 10%. After initial treatment majority of patients (pts) relapse and receive diverse chemotherapies (CT) producing modest benefits. The median PFS in relapse after platinum based CT is less than 4 months and median OS less than 1 year. New innovative strategies are urgently needed. Since CS showed high DNA damage response activity and potentially a high tumor mutation load resulting in neo-antigens, a synergy between PARPi and anti-PD1 is expected. Methods: ROCSAN is a multicentric, randomized, open-label, integrated Phase II/III study. In the Phase II, 63 pts with recurrent or progressing endometrial or ovarian CS after at least a first line of platinum-based CT will be randomized (2:2:1) to receive either niraparib in monotherapy, niraparib in combination with dostarlimab or standard CT (paclitaxel, doxorubicine, gemcitabine, topotecan). Stratification factors include the number of previous CT lines (1 vs 2-3), FIGO stage at diagnosis (I-II vs III-IV), CS localisation (ovarian vs endometrial), and performance status (0-1 vs 2). The primary objective of the Phase II is to select the best experimental strategy between niraparib and dostarlimab/niraparib combination based on Response Rate at 4 months (RR-4M by RECIST1.1). A single stage design with a 10% unacceptable RR-4M and a 30% targeted RR-4M was used to determine Phase II sample size, assuming a 10% one sided alpha for each comparison and more than 90% power. A pick-the-winner selection design could be used in case of promising efficacy in each experimental arm. At the interim analysis, an Independent Data Monitoring Committee will make recommendation for the selection of the optimal experimental arm. The Steering committee could then support to continue enrolment for the international Phase III which is calibrated to detect an improvement in median OS from 7 months (Standard CT) to 11.7 months (best experimental arm). Assuming a 5% alpha level and 80% power, 133 additional pts could be randomized (2:1). Secondary endpoints include safety, PFS, PFS2, TTST, ORR, duration of response, patient report outcomes (assessed via EORTC QLQ-C30 OV28, HADS, PRO-CTCAE). A translational program supported by European Community is associated to the clinical study to identify predictive biomarkers of response/resistance to study treatments, to correlate with immune environment, a special focus on genetic instability and the EMT process will be included. Trial is currently recruiting only in France for the phase II part, the first pt was randomized in July 2020. Clinical trial information: NCT 03651206.
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Affiliation(s)
| | - Alexandra Leary
- Gustave Roussy Cancer Center, INSERM U981, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Villejuif, France
| | | | | | | | - Anne-Claire Hardy-Bessard
- Medical Oncology Department, CARIO-HPCA and Cooperative Gynecological Cancer Research Group (GINECO), Plerin, France
| | - Frederic Selle
- Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | | | - Alain Lortholary
- Institut of Cancerology Catherine de Sienne GINECO-Hôpital Privé du Confluent, Nantes, France
| | - Dominique Berton
- GINECO & Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Saint-Herblain, France
| | | | - Magali Provansal
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Laurence Gladieff
- Institut Claudius Regaud, IUCT-Oncopole and GINECO, Toulouse, France
| | | | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, Naples, Italy
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White-Koning M, Paludetto MN, Le Louedec F, Gladieff L, Chevreau C, Chatelut E, Puisset F. Correction to: Formulae recently proposed to estimate renal glomerular filtration rate improve the prediction of carboplatin clearance. Cancer Chemother Pharmacol 2021; 88:171. [PMID: 33847805 DOI: 10.1007/s00280-021-04268-4] [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: 11/29/2022]
Affiliation(s)
- Melanie White-Koning
- Centre de Recherches en Cancérologie de Toulouse (CRCT), INSERM UMR1037, 2 Avenue Hubert Curien, CS53717, 31037, Toulouse CEDEX 1, France.,Université Paul Sabatier Toulouse III, Université de Toulouse, 118 Route de Narbonne, 31062, Toulouse CEDEX 9, France
| | - Marie Noëlle Paludetto
- Centre de Recherches en Cancérologie de Toulouse (CRCT), INSERM UMR1037, 2 Avenue Hubert Curien, CS53717, 31037, Toulouse CEDEX 1, France.,Université Paul Sabatier Toulouse III, Université de Toulouse, 118 Route de Narbonne, 31062, Toulouse CEDEX 9, France.,Pharmacy Department, Institut Universitaire du Cancer Toulousain (IUCT) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Félicien Le Louedec
- Centre de Recherches en Cancérologie de Toulouse (CRCT), INSERM UMR1037, 2 Avenue Hubert Curien, CS53717, 31037, Toulouse CEDEX 1, France.,Pharmacy Department, Institut Universitaire du Cancer Toulousain (IUCT) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Laurence Gladieff
- Oncology Department, Institut Universitaire du Cancer Toulousain (IUCT) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Christine Chevreau
- Oncology Department, Institut Universitaire du Cancer Toulousain (IUCT) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France
| | - Etienne Chatelut
- Centre de Recherches en Cancérologie de Toulouse (CRCT), INSERM UMR1037, 2 Avenue Hubert Curien, CS53717, 31037, Toulouse CEDEX 1, France.,Université Paul Sabatier Toulouse III, Université de Toulouse, 118 Route de Narbonne, 31062, Toulouse CEDEX 9, France
| | - Florent Puisset
- Centre de Recherches en Cancérologie de Toulouse (CRCT), INSERM UMR1037, 2 Avenue Hubert Curien, CS53717, 31037, Toulouse CEDEX 1, France. .,Université Paul Sabatier Toulouse III, Université de Toulouse, 118 Route de Narbonne, 31062, Toulouse CEDEX 9, France. .,Pharmacy Department, Institut Universitaire du Cancer Toulousain (IUCT) Oncopole, Institut Claudius Regaud, 1 avenue Irène Joliot-Curie, Toulouse CEDEX 9, 31059, France.
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Angeles MA, Martínez-Gómez C, Del M, Migliorelli F, Daix M, Provendier A, Picard M, Ruiz J, Chantalat E, Leray H, Martinez A, Gladieff L, Ferron G. Risk factors for gastric perforation after cytoreductive surgery in patients with peritoneal carcinomatosis: Splenectomy and increased body mass index. PLoS One 2021; 16:e0248205. [PMID: 33661999 PMCID: PMC7932550 DOI: 10.1371/journal.pone.0248205] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Gastric perforation after cytoreductive surgery (CRS) is an infrequent complication. There is lack of evidence regarding the risk factors for this postoperative complication. The aim of this study was to assess the prevalence of postoperative gastric perforation in patients undergoing CRS for peritoneal carcinomatosis (PC) and to evaluate risk factors predisposing to this complication. Methods We designed a unicentric retrospective study to identify all patients who underwent an open upfront or interval CRS after a primary diagnosis of PC of different origins between March 2007 and December 2018 at a French Comprehensive Cancer Center. The main outcome was the occurrence of postoperative gastric perforation. Results Five hundred thirty-three patients underwent a CRS for PC during the study period and 13 (2.4%) presented a postoperative gastric perforation with a mortality rate of 23% (3/13). Neoadjuvant chemotherapy was administered in 283 (53.1%) patients and 99 (18.6%) received hyperthermic intraperitoneal chemotherapy (HIPEC). In the univariate analysis, body mass index (BMI), peritoneal cancer index, splenectomy, distal pancreatectomy, and histology were significantly associated with postoperative gastric perforation. After multivariate analysis, BMI (OR [95%CI] = 1.13 [1.05–1.22], p = 0.002) and splenectomy (OR [95%CI] = 26.65 [1.39–509.67], p = 0.029) remained significantly related to the primary outcome. Conclusions Gastric perforation after CRS is a rare event with a high rate of mortality. While splenectomy and increased BMI are risk factors associated with this complication, HIPEC does not seem to be related. Gastric perforation is probably an ischemic complication due to a multifactorial process. Preventive measures such as preservation of the gastroepiploic arcade and prophylactic suture of the greater gastric curvature require further assessment.
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Affiliation(s)
- Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Carlos Martínez-Gómez
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France
| | - Mathilde Del
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal des Vallées de l’Ariège, St Jean de Verges, France
| | - Manon Daix
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Anaïs Provendier
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Muriel Picard
- Intensive Care Unit, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Jean Ruiz
- Intensive Care Unit, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Elodie Chantalat
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Hélène Leray
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
- INSERM CRCT Team 19, ONCOSARC – Oncogenesis of sarcomas, Toulouse, France
- * E-mail:
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Mailliez A, D'Hondt V, Lusque A, Caron O, Cabel L, Goncalves A, Debled M, Gladieff L, Ferrero JM, Petit T, Mouret-Reynier MA, Eymard JC, Frenel JS, De La Motte Rouge T, Simon G, Delaloge S. Abstract PD10-08: Outcomes of germline BRCA carriers versus non-carriers in the french national metastatic breast cancer ESME cohort 2008-2016. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd10-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Approximately 5% of breast cancer (BC) patients (pts) carry a deleterious germline BRCA mutation (gBRCAm). Retrospective studies suggest that overall survival (OS) is equivalent between gBRCAm carriers and non-carriers with metastatic BC (MBC). We aimed to use the large ESME multicentre national MBC database to compare outcomes of gBRCAm carriers, gBRCA wild-type (WT) and not tested (NT) pts. METHODS: We used the large ESME MBC database (NCT03275311), a unique national cohort of all consecutive pts who initiated a first-line treatment for MBC between 2008 and 2016 in one of the 18 French Comprehensive Cancer Centers. All pts with data available regarding gBRCA testing were selected for the present analysis. 26 pts with non-BRCA germline mutations were classified in the WT group. The primary endpoint was OS from date of treatment initiation in the 3 groups of patients: gBRCAm, gBRCA WT and gBRCA NT.Secondary endpoints were progression-free survival under first line treatment (PFS1), clinical and biological characteristics of the 3 groups and prognostic factors for OS. Multivariable analyses included the main known prognostic factors (age at MBC, MBC subtype, disease-free interval, presence of visceral disease, number of metastatic sites). They were conducted using Cox proportional analyses. RESULTS: 20624 pts were included in this analysis (414 gBRCAm, 1710 WT, 18500 gBRCA NT). Pts and disease characteristics are summarized in table 1. As expected, patients with gBRCAm were younger and had a higher rate of TNBC and G3 tumors.
Median follow-up was 50.5 months (95%CI 49.7-51.5). Non-adjusted median OS was 30.6 months [21.9-34.3] in the gBRCAm group, 35.8 [32.2-37.8] in the WT and 39.3 [38.3-40.3] in NT groups. Median PFS1 was 7.9 months [6.6-9.3] in the gBRCAm group, 7.8 [7.3-8.5] in the WT and 9.7 months [ 9.5-10.0] in the NT groups. In multivariable analyses, OS and PFS were not significantly different between MBC patients with gBRCA and others (respective HRs 1.01 [0.88;1.17], p=0.87 and 0.94 [0.84;1.06], p=0.31). CONCLUSION: In this large scale real-life ESME MBC database analysis, outcomes of gBRCAm carriers with MBC do not differ from non carriers or not tested subgroups, when adjusted for other prognostic factors.
Table 1: characteristics of patients and diseasegBRCAm. gBRCA WT. gBRCA NT Pvalue (chi-2)N = 414 N = 1710 N = 18500 Age (years) median [range]45 [23-82]48 [20- 88]61 [22-103]p<0.0001Grade 3 N (%) Missing data202 (57.7) 64598 (41.1) 2545337 (34.5)3036p<0.0001Triple negative breast cancer N (%)158 (38.2)370 (21.6)2331 (12.6)p<0.0001De novo MBC N (%)74 (17.9)359 (21)5914 (32)p<0.0001Disease-free interval (months) median [range]39.0 [-1.5- 425.7]36.3 [-2.1- 549.6]31.8 [-2.9- 657.8]p<0.0001Metastatic sites ≥3 N (%)113 (27.3)349 (20.4)3943 (21.3)p=0.008Visceral metastases N (%)279 (67.4)964 (56.4)10659(57.6)p=0.0002Central Nervous System Metastases N (%)66 (15.9)132 (7.7)1145 (6.2)p<0.0001
Citation Format: Audrey Mailliez, Veronique D'Hondt, Amelie Lusque, Olivier Caron, Luc Cabel, Antony Goncalves, Marc Debled, Laurence Gladieff, Jean-Marc Ferrero, Thierry Petit, Marie-Ange Mouret-Reynier, Jean-Christophe Eymard, Jean-Sébastien Frenel, Thibault De La Motte Rouge, Gaëtane Simon, Suzette Delaloge. Outcomes of germline BRCA carriers versus non-carriers in the french national metastatic breast cancer ESME cohort 2008-2016 [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD10-08.
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Affiliation(s)
| | - Veronique D'Hondt
- 2Institut Régional du Cancer Montpellier / Val d’Aurelle, Montpellier, France
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Pujol P, Barberis M, Beer P, Friedman E, Piulats JM, Capoluongo ED, Garcia Foncillas J, Ray-Coquard I, Penault-Llorca F, Foulkes WD, Turnbull C, Hanson H, Narod S, Arun BK, Aapro MS, Mandel JL, Normanno N, Lambrechts D, Vergote I, Anahory M, Baertschi B, Baudry K, Bignon YJ, Bollet M, Corsini C, Cussenot O, De la Motte Rouge T, Duboys de Labarre M, Duchamp F, Duriez C, Fizazi K, Galibert V, Gladieff L, Gligorov J, Hammel P, Imbert-Bouteille M, Jacot W, Kogut-Kubiak T, Lamy PJ, Nambot S, Neuzillet Y, Olschwang S, Rebillard X, Rey JM, Rideau C, Spano JP, Thomas F, Treilleux I, Vandromme M, Vendrell J, Vintraud M, Zarca D, Hughes KS, Alés Martínez JE. Clinical practice guidelines for BRCA1 and BRCA2 genetic testing. Eur J Cancer 2021; 146:30-47. [PMID: 33578357 DOI: 10.1016/j.ejca.2020.12.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022]
Abstract
BRCA1 and BRCA2 gene pathogenic variants account for most hereditary breast cancer and are increasingly used to determine eligibility for PARP inhibitor (PARPi) therapy of BRCA-related cancer. Because issues of BRCA testing in clinical practice now overlap with both preventive and therapeutic management, updated and comprehensive practice guidelines for BRCA genotyping are needed. The integrative recommendations for BRCA testing presented here aim to (1) identify individuals who may benefit from genetic counselling and risk-reducing strategies; (2) update germline and tumour-testing indications for PARPi-approved therapies; (3) provide testing recommendations for personalised management of early and metastatic breast cancer; and (4) address the issues of rapid process and tumour analysis. An international group of experts, including geneticists, medical and surgical oncologists, pathologists, ethicists and patient representatives, was commissioned by the French Society of Predictive and Personalised Medicine (SFMPP). The group followed a methodology based on specific formal guidelines development, including (1) evaluating the likelihood of BRCAm from a combined systematic review of the literature, risk assessment models and expert quotations, and (2) therapeutic values of BRCAm status for PARPi therapy in BRCA-related cancer and for management of early and advanced breast cancer. These international guidelines may help clinicians comprehensively update and standardise BRCA testing practices.
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Affiliation(s)
- Pascal Pujol
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France; CREEC, UMR IRD 224-CNRS 5290 Université Montpellier, Montpellier, France.
| | | | - Philp Beer
- Wellcome Trust Sanger institute, Cambridge, United Kingdom; Glasgow Precision Oncology Laboratory, United Kingdom.
| | - Eitan Friedman
- The Susanne Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Josep M Piulats
- Unidad Funcional de Cáncer de Próstata, Servicio de Oncología Médica, Hospital Universitari de Bellvitge-Institut Català d'Oncologia (ICO), Hospitalet de Llobregat, Spain; Servicio de Oncología Médica, Institut Català d'Oncologia (ICO), Hospitalet de Llobregat, Spain.
| | - Ettore D Capoluongo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università Federico II, CEINGE Biotecnologie Avanzate, Naples, 80145, Italy.
| | - Jesus Garcia Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jimenez Diaz-UAM, Madrid, Spain.
| | - Isabelle Ray-Coquard
- Oncologie Médicale, Centre Leon Bérard; Univ Lyon, Université Claude Bernard Lyon1, Hesper EA 7425, F - 69003, Lyon, France.
| | - Frédérique Penault-Llorca
- Department of Biology and Pathology, Centre Jean Perrin, Clermont Ferrand, France; UMR INSERM 1240, Université Clermont Auvergne, Clermont Ferrand, France.
| | - William D Foulkes
- McGill University, Division of Medical Genetics, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Genomics England, Queen Mary University of London, London, UK; Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.
| | - Helen Hanson
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
| | - Steven Narod
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada; Canada Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Banu K Arun
- Anderson Cancer Center, The University of Texas, Department of Breast Medical Oncology, Division of Cancer Medicine, USA.
| | | | - Jean-Louis Mandel
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France; Université de Strasbourg, Illkirch, France.
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy.
| | - Diether Lambrechts
- Laboratory of Translational Genetics (VIB-KU Leuven), ON IV Herestraat 49 - box 912, 3000, Leuven Belgium.
| | - Ignace Vergote
- Department of Gynaecologic Oncology University Hospitals Leuven, Gasthuisberg Herestraat 49, 3000 Leuven, Belgium.
| | - Michèle Anahory
- Pech de Laclause, Bathmanabane & Associés Law Firm, Paris, France.
| | - Bernard Baertschi
- French National Institute for Health and Medical Research (INSERM) Ethics Committee, France University of Geneva, Geneva, Switzerland.
| | - Karen Baudry
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Yves-Jean Bignon
- Department of Oncogenetics, Centre Jean Perrin, CBRV, Clermont-Ferrand, France; INSERM-U1240-Molecular Imaging and Theranostic Strategies (IMOST), Clermont-Ferrand, France.
| | - Marc Bollet
- Institut Hartmann, 4, rue Kléber, et Institut Rafael, 3 bd Bineau, 92309 Levallois-Perret cedex, France.
| | - Carole Corsini
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Olivier Cussenot
- CeRePP, Hopital Tenon, Paris, France; Sorbonne Université, Institut Universitaire de Cancérologie, GRC n°5 ONCOTYPE-URO, Hopital Tenon, APHP, Paris, France; Department of Urology, Assistance Publique- Hôpitaux de Paris, Hopital Tenon, Paris, France.
| | - Thibault De la Motte Rouge
- Inserm, Oncogenesis, Stress and Signaling, 35000 Rennes, France; Service d'oncologie médicale, CRLCC Eugène-Marquis, 35000 Rennes, France; UMR 1242, Inserm, Univ Rennes, CLCC Eugène Marquis, Rue Bataille Flandres Dunkerque, 35042, Rennes, France.
| | | | - Florence Duchamp
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | | | - Karim Fizazi
- Institut Gustave Roussy and University of Paris Sud, Villejuif, France.
| | - Virginie Galibert
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France.
| | | | - Pascal Hammel
- Department of Pancreatology, Hôpital Beaujon (AP-HP), Université Denis Diderot-Paris VII, Clichy, France.
| | | | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, 208 rue des Apothicaires, 34298, Montpellier Cedex 5, France; Translational Research Unit, Institut du Cancer de Montpellier (ICM), Univ. Montpellier, Montpellier, France.
| | - Tatiana Kogut-Kubiak
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Pierre-Jean Lamy
- Institut d'analyse génomique-Imagenome, Labosud, Montpellier, France.
| | - Sophie Nambot
- Centre de Génétique et Centre de Référence Maladies Rares (Anomalies du Développement de l'Interrégion Est), Hôpital d'Enfants, CHU Dijon Bourgogne, Dijon, France; Inserm UMR 1231 GAD (Génétique des Anomalies du Développement), Université de Bourgogne, Dijon, France; Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (FHU TRANSLAD), CHU Dijon Bourgogne et Université de Bourgogne-Franche Comté, Dijon, France.
| | - Yann Neuzillet
- Service d'urologie et de transplantation rénale, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - Sylviane Olschwang
- Aix Marseille Université, INSERM GMGF UMR 1251, France; Département de Génétique Médicale, Hôpital Européen & Groupe Ramsay Générale de Santé, Hôpital Clairval, Aix Marseille Université, Marseille, France.
| | | | - Jean-Marc Rey
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Chloé Rideau
- Department of Cancer Genetics, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Jean-Philippe Spano
- Department of Medical Oncology, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, Paris, France; Inserm UMRS 1136, Sorbonne Université, Paris, France.
| | - Frédéric Thomas
- IRD, CREEC et MIVE911 avenue Agropolis, BP 64501, Montpellier 34 394, France.
| | - Isabelle Treilleux
- Department of Pathology, Centre Léon Bérard, 28 rue Laënnec, 69373, Lyon Cédex 08, France.
| | | | - Julie Vendrell
- IRCM, INSERM 1194, Department of Pathology and Oncobiology, Laboratoire de biologie des tumeurs solides, CHU Montpellier, Univ Montpellier, Montpellier, France.
| | - Michèle Vintraud
- Department of Radiotherapy, Hartmann Radiotherapy Center, Levallois-Perret, France.
| | - Daniel Zarca
- The Paris Breast Centre- L'Institut Français du Sein- 15 rue Jean Nicot, 75007, Paris, France.
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jose E Alés Martínez
- Medical Oncology Department, Hospital Nuestra Señora de Sonsoles, Ávila, Ávila, Spain.
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Balança CC, Salvioni A, Scarlata CM, Michelas M, Martinez-Gomez C, Gomez-Roca C, Sarradin V, Tosolini M, Valle C, Pont F, Ferron G, Gladieff L, Vergez S, Dupret-Bories A, Mery E, Rochaix P, Fournié JJ, Delord JP, Devaud C, Martinez A, Ayyoub M. PD-1 blockade restores helper activity of tumor-infiltrating, exhausted PD-1hiCD39+ CD4 T cells. JCI Insight 2021; 6:142513. [PMID: 33332284 PMCID: PMC7934837 DOI: 10.1172/jci.insight.142513] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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: 07/24/2020] [Accepted: 12/09/2020] [Indexed: 01/03/2023] Open
Abstract
Tumor antigen-specific CD4 T cells accumulate at tumor sites, evoking their involvement in antitumor effector functions in situ. Contrary to CD8 cytotoxic T lymphocyte exhaustion, that of CD4 T cells remains poorly appreciated. Here, using phenotypic, transcriptomic, and functional approaches, we characterized CD4 T cell exhaustion in patients with head and neck, cervical, and ovarian cancer. We identified a CD4 tumor-infiltrating lymphocyte (TIL) population, defined by high PD-1 and CD39 expression, which contained high proportions of cytokine-producing cells, although the quantity of cytokines produced by these cells was low, evoking an exhausted state. Terminal exhaustion of CD4 TILs was instated regardless of TIM-3 expression, suggesting divergence with CD8 T cell exhaustion. scRNA-Seq and further phenotypic analyses uncovered similarities with the CD8 T cell exhaustion program. In particular, PD-1hiCD39+ CD4 TILs expressed the exhaustion transcription factor TOX and the chemokine CXCL13 and were tumor antigen specific. In vitro, PD-1 blockade enhanced CD4 TIL activation, as evidenced by increased CD154 expression and cytokine secretion, leading to improved dendritic cell maturation and consequently higher tumor-specific CD8 T cell proliferation. Our data identify exhausted CD4 TILs as players in responsiveness to immune checkpoint blockade.
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Affiliation(s)
| | - Anna Salvioni
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France
| | - Clara-Maria Scarlata
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France.,Immune Monitoring Core Facility
| | - Marie Michelas
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France
| | - Carlos Martinez-Gomez
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France.,Department of Surgery, and
| | - Carlos Gomez-Roca
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Victor Sarradin
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Marie Tosolini
- Technological Pole and Bioinformatic Platform, Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France
| | - Carine Valle
- Technological Pole and Bioinformatic Platform, Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France
| | - Frédéric Pont
- Technological Pole and Bioinformatic Platform, Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France
| | | | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Sébastien Vergez
- Department of Surgery, Centre Hospitalier Universitaire, Institut Universitaire du Cancer de Toulouse, Toulouse, France.,Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Eliane Mery
- Department of Pathology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Philippe Rochaix
- Department of Pathology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | | | - Jean-Pierre Delord
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France.,Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Toulouse, France.,Université Toulouse III Paul Sabatier, Toulouse, France
| | - Christel Devaud
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France
| | - Alejandra Martinez
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France.,Department of Surgery, and
| | - Maha Ayyoub
- Cancer Research Center of Toulouse, INSERM UMR 1037, Toulouse, France.,Immune Monitoring Core Facility.,Université Toulouse III Paul Sabatier, Toulouse, France
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38
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Lonjou C, Eon-Marchais S, Truong T, Dondon MG, Karimi M, Jiao Y, Damiola F, Barjhoux L, Le Gal D, Beauvallet J, Mebirouk N, Cavaciuti E, Chiesa J, Floquet A, Audebert-Bellanger S, Giraud S, Frebourg T, Limacher JM, Gladieff L, Mortemousque I, Dreyfus H, Lejeune-Dumoulin S, Lasset C, Venat-Bouvet L, Bignon YJ, Pujol P, Maugard CM, Luporsi E, Bonadona V, Noguès C, Berthet P, Delnatte C, Gesta P, Lortholary A, Faivre L, Buecher B, Caron O, Gauthier-Villars M, Coupier I, Mazoyer S, Monraz LC, Kondratova M, Kuperstein I, Guénel P, Barillot E, Stoppa-Lyonnet D, Andrieu N, Lesueur F. Gene- and pathway-level analyses of iCOGS variants highlight novel signaling pathways underlying familial breast cancer susceptibility. Int J Cancer 2021; 148:1895-1909. [PMID: 33368296 PMCID: PMC9290690 DOI: 10.1002/ijc.33457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
Single‐nucleotide polymorphisms (SNPs) in over 180 loci have been associated with breast cancer (BC) through genome‐wide association studies involving mostly unselected population‐based case‐control series. Some of them modify BC risk of women carrying a BRCA1 or BRCA2 (BRCA1/2) mutation and may also explain BC risk variability in BC‐prone families with no BRCA1/2 mutation. Here, we assessed the contribution of SNPs of the iCOGS array in GENESIS consisting of BC cases with no BRCA1/2 mutation and a sister with BC, and population controls. Genotyping data were available for 1281 index cases, 731 sisters with BC, 457 unaffected sisters and 1272 controls. In addition to the standard SNP‐level analysis using index cases and controls, we performed pedigree‐based association tests to capture transmission information in the sibships. We also performed gene‐ and pathway‐level analyses to maximize the power to detect associations with lower‐frequency SNPs or those with modest effect sizes. While SNP‐level analyses identified 18 loci, gene‐level analyses identified 112 genes. Furthermore, 31 Kyoto Encyclopedia of Genes and Genomes and 7 Atlas of Cancer Signaling Network pathways were highlighted (false discovery rate of 5%). Using results from the “index case‐control” analysis, we built pathway‐derived polygenic risk scores (PRS) and assessed their performance in the population‐based CECILE study and in a data set composed of GENESIS‐affected sisters and CECILE controls. Although these PRS had poor predictive value in the general population, they performed better than a PRS built using our SNP‐level findings, and we found that the joint effect of family history and PRS needs to be considered in risk prediction models.
What's new?
Genetic studies have identified more than 180 single‐nucleotide polymorphisms (SNPs) associated with breast cancer susceptibility, but these studies are reaching their limits. Here, the authors evaluated SNPs in the iCOGS genotyping array using a multilevel approach, including single variant, gene, and pathway analyses. They measured the contribution of the SNPs to breast cancer in patients who have a sister with breast cancer but do not carry a BRCA1/2 mutation. They showed that a pathway‐derived polygenic risk score performed poorly in the general population, and that the best predictive model must include family history.
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Affiliation(s)
- Christine Lonjou
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Séverine Eon-Marchais
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Thérèse Truong
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France.,Inserm U1018, CESP, Team Exposome and Heredity, Villejuif, France
| | - Marie-Gabrielle Dondon
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Mojgan Karimi
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France.,Inserm U1018, CESP, Team Exposome and Heredity, Villejuif, France
| | - Yue Jiao
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | | | - Laure Barjhoux
- Department of BioPathology, Centre Léon Bérard, Lyon, France
| | - Dorothée Le Gal
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Juana Beauvallet
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Noura Mebirouk
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Eve Cavaciuti
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | | | | | | | - Sophie Giraud
- Service de Génétique, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Thierry Frebourg
- Département de Génétique, Hôpital Universitaire de Rouen, Rouen, France
| | | | - Laurence Gladieff
- Service d'Oncologie Médicale, Institut Claudius Regaud-IUCT-Oncopole, Toulouse, France
| | | | - Hélène Dreyfus
- Clinique Sainte Catherine, Avignon, France.,Département de Génétique, CHU de Grenoble, Hôpital Couple-Enfant, Grenoble, France
| | | | - Christine Lasset
- Université Claude Bernard Lyon 1, Villeurbanne, France.,CNRS UMR 5558, Lyon, France.,Centre Léon Bérard, Unité de Prévention et Epidémiologie Génétique, Lyon, France
| | | | - Yves-Jean Bignon
- Département d'Oncogénétique, Université Clermont Auvergne, UMR INSERM, U1240, Centre Jean Perrin, Clermont Ferrand, France
| | - Pascal Pujol
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France.,INSERM 896, CRCM Val d'Aurelle, Montpellier, France
| | - Christine M Maugard
- Département d'Oncobiologie, LBBM, Hôpitaux Universitaires de Strasbourg, Génétique Oncologique Moléculaire, UF1422, Strasbourg, France.,Hôpitaux Universitaires de Strasbourg, UF6948 Génétique Oncologique Clinique, Évaluation Familiale et Suivi, Strasbourg, France
| | - Elisabeth Luporsi
- ICL Alexis Vautrin, Unité d'Oncogénétique, Vandœuvre-lès-Nancy, France
| | - Valérie Bonadona
- Université Claude Bernard Lyon 1, Villeurbanne, France.,CNRS UMR 5558, Lyon, France.,Centre Léon Bérard, Unité de Prévention et Epidémiologie Génétique, Lyon, France
| | - Catherine Noguès
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France.,Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - Pascaline Berthet
- Département de Biopathologie, Centre François Baclesse, Oncogénétique, Caen, France
| | - Capucine Delnatte
- Institut de Cancérologie de l'Ouest, Unité d'Oncogénétique, Saint Herblain, France
| | - Paul Gesta
- CH Georges Renon, Service d'Oncogénétique Régional Poitou-Charentes, Niort, France
| | - Alain Lortholary
- Centre Catherine de Sienne, Service d'Oncologie Médicale, Nantes, France
| | - Laurence Faivre
- Institut GIMI, CHU de Dijon, Hôpital d'Enfants, Dijon, France.,Oncogénétique, Centre de Lutte contre le Cancer Georges François Leclerc, Dijon, France
| | | | - Olivier Caron
- Département de Médecine Oncologique, Gustave Roussy, Villejuif, France
| | | | - Isabelle Coupier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France.,INSERM 896, CRCM Val d'Aurelle, Montpellier, France
| | - Sylvie Mazoyer
- Equipe GENDEV, Centre de Recherche en Neurosciences de Lyon, Inserm U1028, CNRS UMR5292, Université Lyon 1, Université St Etienne, Lyon, France
| | - Luis-Cristobal Monraz
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Maria Kondratova
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Inna Kuperstein
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Pascal Guénel
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France.,Inserm U1018, CESP, Team Exposome and Heredity, Villejuif, France
| | - Emmanuel Barillot
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Service de Génétique, Paris, France.,Inserm, U830, Université Paris-Descartes, Paris, France
| | - Nadine Andrieu
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
| | - Fabienne Lesueur
- Inserm, U900, Institut Curie, Paris, France.,Mines ParisTech, Fontainebleau, France.,PSL Research University, Paris, France
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Angeles MA, Migliorelli F, Del M, Martínez-Gómez C, Daix M, Bétrian S, Gabiache E, Balagué G, Leclerc S, Mery E, Gladieff L, Ferron G, Martinez A. Concordance of laparoscopic and laparotomic peritoneal cancer index using a two-step surgical protocol to select patients for cytoreductive surgery in advanced ovarian cancer. Arch Gynecol Obstet 2021; 303:1295-1304. [PMID: 33389113 DOI: 10.1007/s00404-020-05874-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of our study was to assess concordance of staging laparoscopy and cytoreductive surgery (CRS) peritoneal cancer index (PCI) when applying a two-step surgical protocol. We also aimed to evaluate the accuracy of diagnostic laparoscopy to triage patients for complete cytoreduction, and to define optimal time between staging laparoscopy and CRS. METHODS We designed a retrospective review of prospectively collected data from patients with advanced ovarian cancer who underwent a diagnostic laparoscopy followed by a CRS a few weeks later (two-step surgical protocol), from January 2010 to April 2019. Only patients selected for complete cytoreduction, and with available PCI score from both surgeries were included. PCI concordance was assessed using intraclass correlation coefficient (ICC). RESULTS During the study period 543 patients underwent a laparoscopic staging for ovarian carcinomatosis. Among them, 43 patients fulfilled inclusion criteria. ICC between laparoscopic and laparotomic PCI was 0.54. After applying the linear regression equation: laparoscopic PCI + 0.2 x [days between surgeries] + 2, ICC increased to 0.79. Completeness cytoreduction score and laparoscopic PCI were significantly associated (OR 1.27, 95% CI 1.03-1.57, p = 0.03). AUC of laparoscopic PCI to predict complete cytoreduction was 0.90. CONCLUSION Concordance between laparoscopic PCI assessment and PCI score at the end of CRS is fair within a two-step surgical management. Laparoscopic assessment underestimates final PCI score by two points, and this difference increases with the delay between both surgeries. Diagnostic laparoscopy can adequately select patients for CRS, and optimal time to perform it is no more than 10 days after laparoscopy.
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Affiliation(s)
- Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Federico Migliorelli
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal Des Vallées de L'Ariège, St Jean de Verges, France
| | - Mathilde Del
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Carlos Martínez-Gómez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France.,INSERM CRCT 1, Toulouse, France
| | - Manon Daix
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Sarah Bétrian
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, Toulouse, France
| | - Erwan Gabiache
- Department of Nuclear Medicine, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, Toulouse, France
| | - Gisèle Balagué
- Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, Toulouse, France
| | - Sophie Leclerc
- Department of Anesthesiology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, Toulouse, France
| | - Eliane Mery
- Department of Anatomopathology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, Toulouse, France
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France.,INSERM CRCT 19, Toulouse, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT)-Oncopole, 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France. .,INSERM CRCT 1, Toulouse, France.
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40
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Ray-Coquard I, Harter P, Lorusso D, Dalban C, Vergote I, Fujiwara K, Gladieff L, Lück HJ, Floquet A, Chevalier-Place A, Schnelzer A, Pignata S, Selle F, Sehouli J, Brocard F, Mangili G, Pautier P, De Giorgi U, Provansal M, Heudel PE. Effect of Weekly Paclitaxel With or Without Bevacizumab on Progression-Free Rate Among Patients With Relapsed Ovarian Sex Cord-Stromal Tumors: The ALIENOR/ENGOT-ov7 Randomized Clinical Trial. JAMA Oncol 2020; 6:1923-1930. [PMID: 33030515 DOI: 10.1001/jamaoncol.2020.4574] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance To our knowledge, this is the first randomized trial in sex cord-stromal tumors, and it establishes weekly paclitaxel as standard-of-care therapy after platinum-based therapy in this setting. Objective To determine the efficacy of weekly paclitaxel with or without bevacizumab as treatment for relapsed sex cord-stromal tumors and evaluate whether the addition of bevacizumab to weekly paclitaxel improves 6-month progression-free rate. Design, Setting, and Participants This open-label, academic, international, randomized phase 2 trial (ALIENOR) was conducted at 28 referral centers in France, Germany, Italy, Japan, and Belgium in collaboration with the Rare Tumor committee of the Gynecologic Cancer InterGroup and used an adaptive bayesian design. It included 60 women with sex cord-stromal tumors that had relapsed after at least 1 platinum-based chemotherapy. Enrollment occurred from 2013 to 2016, and the final analysis database lock was on March 27, 2020 (median follow-up, 38.9 months). Interventions Participants were randomized to receive either paclitaxel (80 mg/m2, days 1, 8, and 15 every 4 weeks) alone or paclitaxel with bevacizumab (10 mg/kg, every 2 weeks) for 6 cycles followed by maintenance bevacizumab (15 mg/kg, every 3 weeks) for up to 1 year or until progression or unacceptable toxicity. Crossover to bevacizumab was permitted after progression during or following paclitaxel alone. Main Outcomes and Measures Six-month progression-free rate. Results Sixty patients (predominantly with granulosa cell tumors) were randomized, 32 to receive single-agent paclitaxel (median [interquartile range] age at inclusion, 60 [53-64] years) and 28 to receive paclitaxel-bevacizumab (median [interquartile range] age at inclusion, 55 [47-61] years; 1 did not receive treatment). The estimated 6-month progression-free rate was 71% (95% credible interval, 55%-84%) with paclitaxel alone and 72% (95% credible interval, 55%-87%) with paclitaxel-bevacizumab. The bayesian estimate for the probability that the 6-month progression-free rate distribution was higher with the combination than with paclitaxel alone was 57%, less than the predefined superiority threshold. The objective response rate increased from 25% (95% CI, 12%-43%) to 44% (95% CI, 26%-65%) with the addition of bevacizumab. One patient discontinued combination therapy within 6 months because of toxicity. Conclusions and Relevance Weekly paclitaxel is a new option for relapsed sex cord-stromal tumors. In this international randomized clinical trial of patients with relapsed sex cord-stromal tumors unsuitable for surgery, adding bevacizumab to weekly paclitaxel does not improve clinical benefit. Trial Registration ClinicalTrials.gov Identifier: NCT01770301.
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Affiliation(s)
| | - Philipp Harter
- AGO Study Group and Ev Kliniken Essen-Mitte, Essen, Germany
| | | | - Cécile Dalban
- GINECO and Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Ignace Vergote
- BGOG and University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Keiichi Fujiwara
- GOTIC and Saitama Medical University International Medical Center, Hidaka, Japan
| | - Laurence Gladieff
- GINECO and Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | | | | | - Andreas Schnelzer
- AGO Study Group and Frauenklinik Technical University Munich, Munich, Germany.,Current, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Sandro Pignata
- MITO and Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Frédéric Selle
- GINECO and Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Jalid Sehouli
- AGO Study Group and Medical University of Berlin, Charité-CVK, Berlin, Germany
| | | | | | | | - Ugo De Giorgi
- MITO and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST IRCCS, Meldola, Italy
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Tjokrowidjaja A, Lee CK, Friedlander M, Gebski V, Gladieff L, Ledermann J, Penson R, Oza A, Korach J, Huzarski T, Manso L, Pisano C, Asher R, Lord SJ, Kim SI, Lee JY, Colombo N, Park-Simon TW, Fujiwara K, Sonke G, Vergote I, Kim JW, Pujade-Lauraine E. Concordance between CA-125 and RECIST progression in patients with germline BRCA-mutated platinum-sensitive relapsed ovarian cancer treated in the SOLO2 trial with olaparib as maintenance therapy after response to chemotherapy. Eur J Cancer 2020; 139:59-67. [PMID: 32977221 DOI: 10.1016/j.ejca.2020.08.021] [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: 06/26/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Limited evidence exists to support CA-125 as a valid surrogate biomarker for progression in patients with ovarian cancer on maintenance PARP inhibitor (PARPi) therapy. We aimed to assess the concordance between CA-125 and Response Evaluation Criteria in Solid Tumours (RECIST) criteria for progression in patients with BRCA mutations on maintenance PARPi or placebo. METHODS We extracted data on progression as defined by Gynecologic Cancer InterGroup CA-125, investigator- and independent central-assessed RECIST from the SOLO2/ENGOT-ov21(NCT01874353) trial. We excluded those with progression other than by RECIST, progression on date of randomisation, and no repeat CA-125 beyond baseline. We evaluated the concordance between CA-125 progression and RECIST progression, and assessed the negative (NPV) and positive predictive value (PPV). RESULTS Of 295 randomised patients, 275 (184 olaparib, 91 placebo) were included. 171 patients had investigator-assessed RECIST progression. Of 80 patients with CA-125 progression, 77 had concordant RECIST progression (PPV 96%, 95% confidence interval 90-99%). Of 195 patients without CA-125 progression, 94 had RECIST progression (NPV 52%, 45-59%). Within treatment arms, PPV was similar (olaparib: 95% [84-99%], placebo: 97% [87-100%]) but NPV was lower in patients on placebo (olaparib: 60% [52-68%], placebo: 30% [20-44%]). Of 94 patients with RECIST but without CA-125 progression, 64 (68%) had CA-125 that remained within normal range. We observed similar findings using independent-assessed RECIST. CONCLUSIONS Almost half the patients without CA-125 progression had RECIST progression, and most of these had CA-125 within the normal range. Regular computed tomography imaging should be considered as part of surveillance in patients treated with or without maintenance olaparib rather than relying on CA-125 alone.
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Affiliation(s)
- Angelina Tjokrowidjaja
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; Department of Medical Oncology, St George Hospital, Kogarah, NSW 2217, Australia.
| | - Chee K Lee
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; Department of Medical Oncology, St George Hospital, Kogarah, NSW 2217, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, 31059 Toulouse, France
| | | | - Richard Penson
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amit Oza
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada
| | - Jacob Korach
- Gynecologic Oncology Department, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, 52621 Tel Aviv, Israel
| | - Tomasz Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Luis Manso
- Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Carmela Pisano
- Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), 80131 Naples, Italy
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Sarah J Lord
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Nicoletta Colombo
- Gynecology Program, European Institute of Oncology, IRCCS, 20141 Milan, Italy; School of Medicine and Surgery, University Milan Bicocca, 20126 Milan, Italy
| | - Tjoung-Won Park-Simon
- Department of Gynaecology and Obstetrics, Medical University Hannover, 30625 Hannover, Germany
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama 350-0495, Japan
| | - Gabe Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Ignace Vergote
- Department of Oncology, KU Leuven - University of Leuven, B-3000 Leuven, Belgium; Division of Gynaecological Oncology, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, South Korea
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O'Malley D, Oaknin A, Monk B, Leary A, Selle F, Alexandre J, Randall L, Rojas C, Neffa M, Kryzhanivska A, Gladieff L, Berton D, Meniawy T, Lugowska I, Bondarenko I, Moore K, Ortuzar Feliu W, Ancukiewicz M, Shapiro I, Ray-Coquard I. LBA34 Single-agent anti-PD-1 balstilimab or in combination with anti-CTLA-4 zalifrelimab for recurrent/metastatic (R/M) cervical cancer (CC): Preliminary results of two independent phase II trials. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2264] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bellier C, Gladieff L, Le Du F, Garnier Tixidre C, Berton-Rigaud D, Bonnard C, Lahrache A, Debbache A, Kacher-Damache A, Delplanque M, Suau D, Richard AC, Brenner O, Lahouegue A, Urbieta M, Gavoille C, Freyer G, Floquet A, Frank S, Kfoury M. 827P First real-life data on olaparib in 1st line (1stL) maintenance BRCA1/2 mutated epithelial ovarian cancer (EOC) in France: Descriptive analysis of 201 patients (pts) enrolled in the cohort temporary authorization for use (ATUc). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Selle F, Heudel PE, Hardy-Bessard AC, Pozet A, Meunier J, Gladieff L, Lotz JP, Provansal M, Augereau P, Berton D, Bonichon-Lamichhane N, Orfeuvre H, Pautier P, Kalbacher E, Tazi Y, Spaeth D. GINECO Prospective Non-interventional PROSPECTYON Study: Trabectedin Plus Pegylated Liposomal Doxorubicin for Platinum-sensitive Recurrent Ovarian Cancer. Anticancer Res 2020; 40:3939-3945. [PMID: 32620635 DOI: 10.21873/anticanres.14385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Trabectedin and pegylated liposomal doxorubicin (PLD) is an effective combination therapy for platinum-sensitive recurrent ovarian cancer (ROC), particularly for disease relapsing within 6-12 months of platinum therapy. The non-interventional PROSPECTYON study evaluated trabectedin/PLD in French clinical practice. PATIENTS AND METHODS Patients with ROC after at least one platinum-based regimen received 1.1 mg/m2 trabectedin plus 30 mg/m2 PLD every 3 weeks. Efficacy and safety were evaluated in subgroups according to platinum-free interval [6-12 versus ≥12 months (partially or fully platinum sensitive, respectively)]. RESULTS Recurrent disease was partially platinum-sensitive in 58 patients and fully sensitive in 33 patients treated between July 2014 and June 2016. Patients in both subgroups received a median of six cycles of trabectedin and PLD. The most common grade 3 or more toxicities were haematological. Median progression-free survival was 6 months for both subgroups. CONCLUSION Trabectedin/PLD is a valuable treatment option for partially or fully platinum-sensitive ROC.
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Affiliation(s)
- FrÉdÉric Selle
- Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris, France
| | | | | | - Astrid Pozet
- Methodology and Quality of Life Unit in Oncology (INSERM UMR 1098), Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | | | | | | | | | | | | | | | | | | | | | - Yousef Tazi
- Centre de Radiothérapie-Clinique Sainte-Anne, Strasbourg, France
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You B, Bolze PA, Lotz JP, Massardier J, Gladieff L, Joly F, Hajri T, Maucort-Boulch D, Bin S, Rousset P, Devouassoux-Shisheboran M, Roux A, Alves-Ferreira M, Grazziotin-Soares D, Langlois-Jacques C, Mercier C, Villeneuve L, Freyer G, Golfier F. Avelumab in Patients With Gestational Trophoblastic Tumors With Resistance to Single-Agent Chemotherapy: Cohort A of the TROPHIMMUN Phase II Trial. J Clin Oncol 2020; 38:3129-3137. [PMID: 32716740 PMCID: PMC7499607 DOI: 10.1200/jco.20.00803] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Women with gestational trophoblastic tumors (GTT) resistant to single-agent chemotherapy receive alternative chemotherapy regimens, which, although effective, cause considerable toxicity. All GTT subtypes express programmed death-ligand 1 (PD-L1), and natural killer (NK) cells are involved in trophoblast immunosurveillance. Avelumab (anti-PD-L1) induces NK cell-mediated cytotoxicity. The TROPHIMMUN trial assessed avelumab in women with chemotherapy-resistant GTT. METHODS In this phase II multicenter trial (ClinicalTrials.gov identifier: NCT03135769), women with GTT who experienced disease progression after single-agent chemotherapy received avelumab 10 mg/kg intravenously every 2 weeks until human chorionic gonadotropin (hCG) normalization, followed by 3 consolidation cycles. Rate of hCG normalization was the primary endpoint (2-step Simon design). RESULTS Between December 2016 and September 2018, 15 patients were treated. Median age was 34 years; disease stage was I or III in 53.3% and 46.7% of women, respectively; and International Federation of Gynecology and Obstetrics (FIGO) score was 0-4 in 33.3%, 5-6 in 46.7%, and ≥ 7 in 20% of patients. Prior treatment included methotrexate (100%) and actinomycin D (7%). Median follow-up was 25 months, and median number of avelumab cycles was 8 (range, 2-11). Grade 1-2 treatment-related adverse events occurred in 93% of patients, most commonly (≥ 25%) fatigue (33.3%), nausea/vomiting (33.3%), and infusion-related reaction (26.7%). One patient had grade 3 uterine bleeding (treatment unrelated). Eight patients (53.3%) had hCG normalization after a median of 9 avelumab cycles; none subsequently relapsed. Probability of normalization was not associated with disease stage, FIGO score, or baseline hCG. One patient subsequently had a healthy pregnancy. In avelumab-resistant patients (46.7%), hCG was normalized with actinomycin D (42.3%) or combination chemotherapy/surgery (57.1%). CONCLUSION In patients with single-agent chemotherapy-resistant GTT, avelumab had a favorable safety profile and cured approximately 50% of patients. Avelumab could be a new therapeutic option, particularly in patients who would otherwise receive combination chemotherapy.
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Affiliation(s)
- Benoit You
- Centre de Référence des Maladies Trophoblastiques, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, CICLY, Lyon, France.,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon, Centre d'Investigation de Thérapeutiques en Oncologie et Hématologie de Lyon, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Adrien Bolze
- Centre de Référence des Maladies Trophoblastiques, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, CICLY, Lyon, France.,Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jean-Pierre Lotz
- Centre de Référence des Maladies Trophoblastiques, Lyon, France.,Hôpital Tenon, Pôle Onco-Hématologie Hôpitaux Universitaires de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Jérome Massardier
- Centre de Référence des Maladies Trophoblastiques, Lyon, France.,Service de Gynécologie Obstétrique, Unité de Diagnostic Anténatal, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Laurence Gladieff
- Département d'Oncologie Médicale, Institut Claudius Regaud, IUCT-ONCOPOLE, Toulouse, France
| | - Florence Joly
- Clinical Research Department, Centre François Baclesse, Caen Cedex, France
| | - Touria Hajri
- Centre de Référence des Maladies Trophoblastiques, Lyon, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, CICLY, Lyon, France.,Service de Biostatistique, Hospices Civils de Lyon, Lyon; and CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Sylvie Bin
- Unité Recherche et Epidémiologie Cliniques - Pôle de Santé Publique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Pascal Rousset
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, CICLY, Lyon, France.,Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | - Adeline Roux
- Unité Recherche et Epidémiologie Cliniques - Pôle de Santé Publique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Marine Alves-Ferreira
- Unité Recherche et Epidémiologie Cliniques - Pôle de Santé Publique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Daniele Grazziotin-Soares
- Centre de Référence des Maladies Trophoblastiques, Lyon, France.,Hôpital Tenon, Pôle Onco-Hématologie Hôpitaux Universitaires de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Carole Langlois-Jacques
- Service de Biostatistique, Hospices Civils de Lyon, Lyon; and CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Catherine Mercier
- Service de Biostatistique, Hospices Civils de Lyon, Lyon; and CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Laurent Villeneuve
- Unité Recherche et Epidémiologie Cliniques - Pôle de Santé Publique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Gilles Freyer
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, CICLY, Lyon, France.,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon, Centre d'Investigation de Thérapeutiques en Oncologie et Hématologie de Lyon, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Francois Golfier
- Centre de Référence des Maladies Trophoblastiques, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, CICLY, Lyon, France.,Service de Chirurgie Gynécologique et Oncologique, Obstétrique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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You B, Bolze PA, Lotz JP, Massardier J, Gladieff L, Joly F, Hajri T, Maucort-Boulch D, Bin S, Rousset P, Villeneuve L, Roux A, Alves-Ferreira M, Grazziotin D, Mercier C, Freyer G, Golfier F. Avelumab in patients with gestational trophoblastic tumors resistant to monochemotherapy: Final outcomes of TROPHIMMUN phase II trial, cohort A. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.18_suppl.lba6008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA6008 Background: Patients with gestational trophoblastic tumors (GTT) resistant to monochemotherapy are treated with historic chemotherapy regimens known to be effective, but toxic. PD-L1 is constitutively expressed in all GTT subtypes (Bolze et al. Int J Gynecol Cancer 2017). HLA-G and natural killer (NK) cells are involved in GTT immune-surveillance. The anti-PD-L1 monoclonal antibody avelumab (Pfizer & Merck KGaA) triggers cytotoxicity through NK cells. The objective of TROPHIMMUN trial was to assess the efficacy of avelumab in patients with chemoresistant GTT. Methods: In the cohort A of this academic multicenter trial (NCT03135769), avelumab was given at 10 mg/kg Q2W in patients with GTT resistant to monochemotherapy. Avelumab was prescribed until hCG normalization, and then for 3 consolidation cycles. The primary objective was the rate of patients with hCG normalization, with a 2 step Simon design. Results: 15 patients (median 34 y old) followed by the French Gestational Trophoblastic Center were treated from Dec 2016 to Sept 2019 (stage I/III: 53%/47%; FIGO score 0-4: 33%; score 5-6: 47%; score >6: 20%). They all had progressed with previous methotrexate, and 1 patient with actinomycin-D. They received median 8 avelumab cycles (range: 2-11). The tolerability was favorable. 93 % of patients developed drug-related grade 1-2 toxicities (86% grade 1), mainly including fatigue (33% patients); nausea-vomiting (33%); infusion-related reactions (27%); thyroid disorder (20%); dry eyes (20%) & diarrhea (20%). A grade 3 uterus bleeding (treatment unrelated) was observed in 1 patient. Median follow-up was 30 months. Successful hCG normalizations were obtained in 8 patients (53%, median 9 avelumab cycles), either during avelumab treatment in 7 patients, or after avelumab discontinuation in 1 patient. None presented relapse afterwards, and 1 patient had a subsequent healthy pregnancy. Avelumab resistances requiring switch to chemotherapy were observed in 7 patients (47%), who normalized hCG with subsequent actinomycin-D (42%), or surgery/polychemotherapy (57%). The likelihood of success with avelumab was not related to the FIGO score, or disease stages. Conclusions: TROPHIMMUN is the first trial of immunotherapy in GTT patients. The anti-PD-L1 monoclonal antibody avelumab was effective, with a favorable safety profile compared to chemotherapy, in patients with resistance to mono-chemotherapy. About 50 % patients could be cured of their chemoresistant diseases. Avelumab may be a new therapeutic option. Clinical trial information: NCT03135769 .
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Affiliation(s)
- Benoit You
- Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, EMR UCBL/HCL 3738, Lyon, GINECO & GINEGEPS, Lyon, France
| | - Pierre-Adrien Bolze
- Centre de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Lyon, France
| | | | - Jerome Massardier
- Centre de Référence des Maladies Trophoblastiques, Hospices Civils de Lyon, Lyon, France
| | | | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Touria Hajri
- Centre de Reference des Maladies Trophoblastiques, Lyon, France
| | | | | | | | - Laurent Villeneuve
- Hospice Civils Lyon Unite Rechercher Clinique Pole Information Medicale, Lyon, France
| | | | | | | | | | | | - Francois Golfier
- Centre de Reference des Maladies Trophoblastiques, Centre Hospitalier Lyon-Sud, EMR3738, Université Lyon 1, Lyon, France
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Tjokrowidjaja A, Lee CK, Friedlander M, Gebski V, Gladieff L, Ledermann JA, Penson RT, Oza AM, Korach J, Huzarski T, Manso L, Pisano C, Asher R, Colombo N, Park-Simon TW, Fujiwara K, Sonke GS, Vergote I, Kim JW, Pujade-Lauraine E. Concordance between CA-125 and RECIST progression (PD) in patients with germline BRCA-mutated platinum-sensitive, relapsed ovarian cancer treated with a PARP inhibitor (PARPi) as maintenance therapy after response to chemotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6014 Background: There are no data to support CA-125 as a surrogate biomarker for ovarian cancer PD in patients on maintenance therapy with a PARPi. We aimed to assess the concordance of PD by CA-125 with RECIST PD in patients treated with maintenance PARPi. Methods: We extracted data on PD as defined by GCIG CA-125 and investigator-assessed RECIST from the SOLO2/ENGOT-Ov21 (NCT01874353) trial. Patients were categorized into: (i) CA-125 and RECIST non-PD concordant; (ii) CA-125 and RECIST PD concordant; and (iii) CA-125 and RECIST discordant. We excluded those with PD other than by RECIST, PD on date of randomization, and no repeat CA-125 beyond baseline. To assess the concordance of CA-125 PD with RECIST PD and CA-125 non-PD with RECIST non-PD, we computed the positive predictive value (PPV), i.e. the probability that patients with CA-125 PD also had RECIST PD, and negative predictive value (NPV), i.e. probability that patients with no CA-125 PD also did not have RECIST PD, respectively. Results: Of 295 randomised patients, 275 (184 olaparib, 91 placebo) were included in the primary analysis. 80 (29%) had CA-125 PD and 77 had concordant RECIST PD, resulting in a PPV of 96% (95% CI 90%-99%). Of 195 patients without CA-125 PD, 101 also did not have RECIST PD, resulting in a NPV of 52% (95% CI 45%-59%; Table). Among those with RECIST PD (n = 171), a greater proportion of patients with RECIST-only PD had a normal baseline CA-125 than those with both CA-125 and RECIST PD (94% vs 69%; p< 0.001). Of 94 patients without CA-125 PD but had RECIST PD, 65 (69%) had CA-125 that remained within normal range, while 27 (29%) had rising and elevated CA-125 that did not meet the criteria for GCIG CA125-PD. Discordance between RECIST PD and CA-125 non-PD was similar in early (≤12 weeks) and late ( > 12 weeks) PD (56% vs 55%, respectively; p= 0.96). Conclusions: Almost half the patients with RECIST PD did not have CA-125 PD and most had CA-125 still within the normal range. Regular imaging should be considered as part of surveillance in patients on maintenance olaparib rather than relying on CA-125 alone. [Table: see text]
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Affiliation(s)
| | - Chee Khoon Lee
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
| | | | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | | | | | - Amit M. Oza
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jacob Korach
- ISGO & Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tomasz Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Luis Manso
- GEICO & Hospital 12 de Octubre, Madrid, Spain
| | - Carmela Pisano
- MITO & Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Rebecca Asher
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
| | | | - Tjoung-Won Park-Simon
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Gabe S. Sonke
- DGOG and Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Ignace Vergote
- BGOG and University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
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Lavoué V, Akladios C, Gladieff L, Classe JM, Lécuru F, Collinet P. Onco-gynecologic surgery in the COVID-19 era: Risks and precautions-A position paper from FRANCOGYN, SCGP, SFCO, and SFOG. J Gynecol Obstet Hum Reprod 2020; 49:101787. [PMID: 32407899 PMCID: PMC7212982 DOI: 10.1016/j.jogoh.2020.101787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Vincent Lavoué
- Service de chirurgie gynécologique. CHU de Rennes. Hôpital Sud, 16 BD de Bulgarie, 35000 Rennes, France.
| | - Cherif Akladios
- Service de chirurgie gynécologique, CHU de Strasbourg, Strasbourg, France
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Glehen O, Kepenekian V, Bouché O, Gladieff L, Honore C. [Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups]. ACTA ACUST UNITED AC 2020; 157:S25-S32. [PMID: 32328206 PMCID: PMC7177067 DOI: 10.1016/j.jchirv.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
La pandémie de COVID-19 modifie profondément l’organisation et l’accès aux soins, en particulier pour les pathologies néoplasiques péritonéales, dont la prise en charge curative mobilise des moyens importants en personnel, bloc opératoire et réanimation. Les groupes BIG-RENAPE et RENAPE proposent des pistes de réflexion et de priorisation pour leur prise en charge. Un renforcement des critères habituels de sélection est nécessaire pour une prise en charge à visée curative : patients jeunes, avec peu de co-morbidités et une extension péritonéale limitée. Il est souhaitable de prioriser les pathologies pour lesquelles la chirurgie de cytoréduction associée ou non à une chimiohyperthermie intrapéritonéale (CHIP) est le traitement de référence et celles pour lesquelles la chimiothérapie systémique ne peut être une alternative temporaire ou prolongée : pseudomyxomes péritonéaux ; mésothéliomes péritonéaux malins résécables ; métastases péritonéales d’origine colorectale si résécables, non répondeuses à la chimiothérapie systémique et/ou après 12 cures, carcinoses ovariennes en 1re intention si résécables et limitées ou en situation intervallaire après un maximum de 6 cycles de chimiothérapie systémique. L’adjonction d’une CHIP devra être discutée au cas par cas, en centre expert. La priorisation des indications devra prendre en considération les conditions locales et la phase de la période épidémique pour permettre une prise en charge péri-opératoire optimale.
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Affiliation(s)
- O Glehen
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud - Hospices Civils de Lyon, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France.,EA 3738, Université Lyon 1, Lyon, France
| | - V Kepenekian
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud - Hospices Civils de Lyon, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France.,EA 3738, Université Lyon 1, Lyon, France
| | - O Bouché
- Service d'hépato-gastro-entérologie et cancérologie digestive, hôpital Robert-Debré, Reims, France
| | - L Gladieff
- Département d'oncologie médicale, institut universitaire du cancer de Toulouse, Toulouse, France
| | - C Honore
- Département de chirurgie, institut Gustave-Roussy, Villejuif, France
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Glehen O, Kepenekian V, Bouché O, Gladieff L, Honore C. Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups. J Visc Surg 2020; 157:S25-S31. [PMID: 32387058 PMCID: PMC7177076 DOI: 10.1016/j.jviscsurg.2020.04.013] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The Covid-19 pandemic is profoundly changing the organization of healthcare access. This is particularly so for peritoneal neoplastic diseases, for which curative treatment mobilizes substantial personnel, operating room and intensive care resources. The BIG-RENAPE and RENAPE groups have made tentative proposals for prioritizing care provision. A tightening of the usual selection criteria is needed for curative care: young patients with few or no comorbidities and limited peritoneal extension. It is desirable to prioritize disease conditions for which cytoreduction surgery with or without associated hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the gold-standard treatment, and for which systemic chemotherapy cannot be a temporary or long-term alternative: pseudomyxoma peritonei, resectable malignant peritoneal mesotheliomas, peritoneal metastases of colorectal origin if they are resectable and unresponsive to systemic chemotherapy after up to 12 courses, first-line ovarian carcinomatosis if resectable or in interval surgery after at most six courses of systemic chemotherapy. Addition of HIPEC must be discussed case by case in an expert center. The prioritization of indications must consider local conditions and the phase of the epidemic to allow optimal peri-operative care.
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Affiliation(s)
- O Glehen
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud - Hospices Civils de Lyon, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France; EA 3738, Université Lyon 1, Lyon, France.
| | - V Kepenekian
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud - Hospices Civils de Lyon, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France; EA 3738, Université Lyon 1, Lyon, France
| | - O Bouché
- Service d'hépato-gastro-entérologie et cancérologie digestive, hôpital Robert-Debré, Reims, France
| | - L Gladieff
- Département d'oncologie médicale, institut universitaire du cancer de Toulouse, Toulouse, France
| | - C Honore
- Département de chirurgie, institut Gustave-Roussy, Villejuif, France
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