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Sterlé M, Puszkiel A, Burlot C, Pereira E, Bellesoeur A, De Percin S, Beinse G, Fumet JD, Favier L, Niogret J, Blanchet B, Royer B, Bengrine-Lefevre L, Schmitt A. Improving olaparib exposure to optimize adverse effects management. Ther Adv Med Oncol 2024; 16:17588359241248328. [PMID: 38665845 PMCID: PMC11044803 DOI: 10.1177/17588359241248328] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Background Olaparib is an inhibitor of the human poly-(ADP-ribose)-polymerase enzymes (PARP1/2) needed to repair single-strand DNA breaks. It is used in breast, ovarian, prostate and pancreatic cancer. Objectives This work aimed to describe the pharmacokinetics/pharmacodynamics (PK/PD) relationship between olaparib plasma concentrations and common adverse effects (i.e. anaemia and hypercreatininaemia), in a real-life setting, to propose a target concentration for therapeutic drug monitoring. Methods Two PK/PD models describing the evolution of haemoglobinaemia and creatininaemia as a function of time were developed, based on data from, respectively, 38 and 37 patients receiving olaparib. The final model estimates were used to calculate the incidence of anaemia and creatinine increase according to plasma trough concentrations for 1000 virtual subjects to define target exposure. Results The final models correctly described the temporal evolution of haemoglobinaemia and creatininaemia for all patients. The haemoglobinaemia PK/PD model is inspired by Friberg's model, and the creatininaemia PK/PD model is an indirect response model. Model parameters were in agreement with physiological values and close to literature values for similar models. The mean (population) plasma haemoglobin concentration at treatment initiation, as estimated by the model, was 11.62 g/dL, while creatinine concentration was 71.91 µmol/L. Using simulations, we have identified a target trough concentration of 3500-4000 ng/mL, above which more than 20% of patients would report grade ≥3 anaemia. Conclusion Based on real-world data, we were able to properly describe the time course of haemoglobinaemia and plasma creatininaemia during olaparib treatment.
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Affiliation(s)
- Marylise Sterlé
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
- INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Alicja Puszkiel
- Biologie du Médicament – Toxicologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, UMR-S1144, Paris, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Chloé Burlot
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France
- INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Eva Pereira
- Biologie du Médicament – Toxicologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Audrey Bellesoeur
- Institut Curie, Département d’Oncologie Médicale, Paris, France
- Institut Curie, Département de Radio-Pharmacologie, Saint-Cloud, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | | | - Guillaume Beinse
- Oncology Department, Cochin Hospital (AP-HP), CARPEM, Paris, France
- Cordeliers Research Center, Paris-Sorbonne University, INSERM, Team Personalized Medicine, Pharmacogenomics and Therapeutic Optimization, Paris, France
| | - Jean-David Fumet
- Oncology Department, Centre Georges-François Leclerc, INSERM U1231, UFR des Sciences de Santé, Dijon, France
| | - Laure Favier
- Oncology Department, Centre Georges-François Leclerc, INSERM U1231, UFR des Sciences de Santé, Dijon, France
| | - Julie Niogret
- Oncology Department, Centre Georges-François Leclerc, INSERM U1231, UFR des Sciences de Santé, Dijon, France
| | - Benoit Blanchet
- Biologie du Médicament – Toxicologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Bernard Royer
- Pharmacology and Toxicology Laboratory, CHRU Besançon, Besançon, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, Paris, France
| | - Leïla Bengrine-Lefevre
- Oncology Department, Centre Georges-François Leclerc, INSERM U1231, UFR des Sciences de Santé, Dijon, France
| | - Antonin Schmitt
- Pharmacy Department, Centre Georges-François Leclerc, 1 rue Pr Marion, Dijon 21079, France
- INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
- Groupe de Pharmacologie Clinique Oncologique GPCO, France
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Malka D, Verret B, Faron M, Guimbaud R, Caramella C, Edeline J, Galais MP, Bengrine-Lefevre L, Smith D, Dupont-Bierre E, De Baere T, Goéré D, Dartigues P, Lacroix L, Boige V, Gelli M, Pignon JP, Ducreux M. Hepatic arterial oxaliplatin plus intravenous 5-fluorouracil and cetuximab for first-line treatment of colorectal liver metastases: A multicenter phase II trial. Eur J Cancer 2023; 195:113400. [PMID: 37922632 DOI: 10.1016/j.ejca.2023.113400] [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: 08/14/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The efficacy and tolerability of hepatic arterial infusion (HAI) oxaliplatin plus systemic 5-fluorouracil and cetuximab as frontline treatment in patients with colorectal liver metastases (CRLM) are unknown. METHODS In this multicenter, single-arm phase II study, patients with CRLM not amenable to curative-intent resection or requiring complex/major liver resection, and no prior chemotherapy for metastatic disease, received HAI oxaliplatin and intravenous 5-fluorouracil, leucovorin and cetuximab, every two weeks until disease progression, limiting toxicity or at least 3 months after complete response or curative-intent resection/ablation. The primary endpoint was overall response rate (ORR). RESULTS 35 patients, mostly with bilateral (89%), multiple CRLM (>4, 86%; >10, 46%) were enrolled in eight centers. The ORR was 88% (95% CI, 71%-96%) among evaluable patients (n = 32), and 95% (95% CI 70-100%) among the 22 wild-type RAS/BRAF evaluable patients. After a median follow-up of 8.8 years (95% CI, 8.7-not reached), median progression-free survival was 17.9 months (95% CI, 15-23) and median overall survival (OS) was 46.3 months (95% CI, 40.0-not reached). 23 of the 35 patients (66%), including 22 (79%) of the 25 patients with wild-type RAS tumor, underwent curative-intent surgical resection and/or ablation of CRLM. HAI catheter remained patent in 86% of patients, allowing for a median of eight oxaliplatin infusions (range, 1-19). Treatment toxicity was manageable, without toxic death. CONCLUSION HAI oxaliplatin plus systemic 5-fluorouracil and cetuximab appears highly effective in the frontline treatment of patients with unresectable CRLM and should be investigated further.
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Affiliation(s)
- David Malka
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Département d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France.
| | - Benjamin Verret
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Matthieu Faron
- Service de Biostatistique et Epidémiologie, Gustave Roussy, Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France; Département de Chirurgie Générale et Digestive, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Caroline Caramella
- Département d'Imagerie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | | | | | - Denis Smith
- Centre Hospitalier Universitaire Saint-André, Bordeaux, France
| | | | - Thierry De Baere
- Département d'Imagerie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Diane Goéré
- Département de Chirurgie Générale et Digestive, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Peggy Dartigues
- Département de Pathologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Ludovic Lacroix
- Département de Biologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Valérie Boige
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Maximiliano Gelli
- Département de Chirurgie Générale et Digestive, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Pierre Pignon
- Service de Biostatistique et Epidémiologie, Gustave Roussy, Oncostat U1018 INSERM, labeled Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France
| | - Michel Ducreux
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Centre Hospitalier Universitaire Paul Brousse, Villejuif, France
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Neuzillet C, Bouché O, Tournigand C, Chibaudel B, Bauguion L, Bengrine-Lefevre L, Lopez-Trabada Ataz D, Mabro M, Metges JP, Péré-Vergé D, Conroy T, Lièvre A, Andre M, Desseigne F, Goldwasser F, Henriques J, Anota A, Hammel P. Effect of Adapted Physical Activity in Patients With Advanced Pancreatic Cancer: The APACaP GERCOR Randomized Trial. J Natl Compr Canc Netw 2023; 21:1234-1242.e17. [PMID: 38081120 DOI: 10.6004/jnccn.2023.7065] [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: 05/24/2023] [Accepted: 07/27/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND The impact of adapted physical activity (APA) on health-related quality of life (HRQoL) in patients with advanced pancreatic ductal adenocarcinoma (aPDAC) is unknown. This study evaluated whether APA in addition to standard care improved HRQoL in patients who have aPDAC who are receiving first-line chemotherapy. PATIENTS AND METHODS Patients with locally advanced/metastatic PDAC and an ECOG performance status of 0 to 2 were randomized (1:1) to receive standard care (standard arm) or standard care plus a home-based 16-week APA program (APA arm). The primary objective was the effect of the APA program on 3 dimensions of the EORTC QLQ-C30: global health status, physical function, and fatigue at week 16 (W16), with a one-sided type I error of 0.017 for each dimension. The primary HRQoL analysis was performed in patients with available baseline and W16 scores for the dimensions (ie, the modified intention-to-treat population 1 [mITT1]), and secondary longitudinal HRQoL analyses using the mixed model for repeated measures (MMRM) and time until definitive deterioration (TUDD) methods were performed in the mITT1 population and in patients with baseline and at least one follow-up questionnaire (mITT2 population). A difference of ≥5 points was considered to be clinically relevant. RESULTS Of 326 included patients, 313 were randomized to the standard (n=157) or APA (n=156) arms. In the mITT1 population (n=172), the mean differences in global health status, physical function, and fatigue at W16 adjusted from baseline were -0.98 (SD, 23.9; P=.39), -2.08 (SD, 21.3; P=.26), and 4.16 (SD, 29.2; P=.17), respectively, showing a non-statistically significant benefit with APA. In the mITT2 population (n=259), APA was associated with statistically significant and clinically relevant improvement in 5 and 8 dimensions of the HRQoL in the longitudinal MMRM and TUDD analyses, respectively. CONCLUSIONS APA improved several dimensions of HRQoL in patients with aPDAC receiving first-line chemotherapy and standard care.
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Affiliation(s)
- Cindy Neuzillet
- GERCOR, Paris, France
- Department of Medical Oncology, Institut Curie - Site Saint Cloud, Versailles Saint-Quentin University, Paris Saclay University, Saint-Cloud, France
| | - Olivier Bouché
- Department of Digestive Oncology, Université de Reims Champagne-Ardenne, CHU Reims, Reims, France
| | - Christophe Tournigand
- Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, University Paris Est Créteil, Créteil, France
| | - Benoist Chibaudel
- Department of Medical Oncology, Hôpital Franco-Britannique - Fondation Cognacq-Jay, Levallois Perret, France
| | - Lucile Bauguion
- Department of Hepato-Gastroenterology, Hospital Center Departmental Vendée, La Roche-sur-Yon, France
| | - Leïla Bengrine-Lefevre
- Department of Medical Oncology, Georges-François Leclerc Cancer Center, UNICANCER, Dijon, France
| | | | - May Mabro
- Department of Medical Oncology, Foch Hospital, Suresnes, France
| | | | - Denis Péré-Vergé
- Department of Hepato-Gastroenterology, Centre Hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - Thierry Conroy
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, APEMAC, équipe MICS, Nancy, France
| | - Astrid Lièvre
- Department of Gastroenterology, Rennes University Hospital, Rennes 1 University, Rennes, France
| | - Morgan Andre
- Department of Gastroenterology, Centre Hospitalier Intercommunal Mont-de-Marsan-Pays des Sources, Mont de Marsan, France
| | | | - François Goldwasser
- Department of Medical Oncology, CARPEM, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Julie Henriques
- Unit of Methodology and Quality of Life in Oncology, Besançon University Hospital, Besançon, France
- Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Amélie Anota
- Unit of Methodology and Quality of Life in Oncology, Besançon University Hospital, Besançon, France
- Department of Clinical Research and Innovation & Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
| | - Pascal Hammel
- GERCOR, Paris, France
- Department of Medical and Digestive Oncology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
- Department of Digestive and Medical Oncology, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Villejuif, France
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Perret M, Bertaut A, Niogret J, Marilier S, Jouanny P, Manckoundia P, Bengrine-Lefevre L, Quipourt V, Barben J. Associated Factors to Efficacy and Tolerance of Immunotherapy in Older Patients with Cancer Aged 70 Years and Over: Impact of Coprescriptions. Drugs Aging 2023; 40:837-846. [PMID: 37429982 DOI: 10.1007/s40266-023-01048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Immunotherapy with immune checkpoint blockers (ICB) significantly improves the prognosis for an increasing number of cancers. However, data on geriatric populations taking ICB are rare. OBJECTIVE This study aimed to identify factors associated with the efficacy and tolerance of ICB in an older population. PATIENTS AND METHODS This retrospective monocentric study included consecutive patients aged ≥ 70 years with solid cancer who received ICB between January 2018 and December 2019. Efficacy was assessed by progression-free survival (PFS) and tolerance was defined as cessation of immunotherapy due to the occurrence of any adverse event. RESULTS One hundred and five patients (65.7% men) were included, mainly at the metastatic stage (95.2%); 50.5% had lung cancer. Most (80%) patients were treated with anti-PD1 (nivolumab, pembrolizumab), 19.1% with anti-PD-L1 (atezolizumab, durvalumab, and avelumab) and 0.9% with anti-CTLA4 ICB (ipilimumab). Median PFS was 3.7 months [95% confidence interval (CI) (2.75-5.70)]. PFS was shorter in univariate analysis when ICB was taken concomitantly with an antiplatelet agent (AP) [hazard ratio (HR) = 1.93; 95% CI (1.22-3.04); p = 0.005]. Tolerance was lower in univariate analysis for lung cancer [odds ratio (OR) = 3.03; 95% CI (1.07-8.56), p < 0.05] and in patients taking proton pump inhibitors (PPI) [OR = 5.50; 95% CI (1.96-15.42), p < 0.001]. There was a trend toward poorer tolerance among patients living alone [OR = 2.26; 95% CI (0.76-6.72); p = 0.14]. CONCLUSIONS In older patients taking ICB for solid cancers, concomitant AP may influence efficacy and concomitant PPI may influence tolerance. Further studies are needed to confirm these results.
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Affiliation(s)
- Marie Perret
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
| | - Aurélie Bertaut
- Unit of Methodology and Biostatistics, Centre Georges François Leclerc, Dijon, France
| | - Julie Niogret
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
- Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Sophie Marilier
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
| | - Pierre Jouanny
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
| | - Patrick Manckoundia
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- UMR INSERM U1093, University of Burgundy, Dijon, France
| | - Leïla Bengrine-Lefevre
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
- Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Valérie Quipourt
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France
| | - Jérémy Barben
- Geriatrics, Hospital of Champmaillot, Dijon-Bourgogne University Hospital, Dijon, France.
- Geriatric Oncology Coordination Unit in Burgundy, Dijon-Bourgogne University Hospital, Dijon, France.
- UMR INSERM U1231, University of Burgundy, Dijon, France.
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Barben J, Mamguem Kamga A, Dabakuyo-Yonli T, Hacquin A, Putot A, Manckoundia P, Bengrine-Lefevre L, Quipourt V. Cervical cancer in older women, does age matter? J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dolat M, Macaire P, Goirand F, Vincent J, Hennequin A, Palmier R, Bengrine-Lefevre L, Ghiringhelli F, Royer B, Schmitt A. Association of 5-FU Therapeutic Drug Monitoring to DPD Phenotype Assessment May Reduce 5-FU Under-Exposure. Pharmaceuticals (Basel) 2020; 13:ph13110416. [PMID: 33238487 PMCID: PMC7700344 DOI: 10.3390/ph13110416] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
In order to limit 5-fluorouracil (5-FU) toxicity, some health agencies recommend evaluating dihydropyrimidine dehydrogenase (DPD) deficiency before any 5-FU treatment introduction. In our study, we investigated relationships between 5-FU clearance and markers of DPD activity such as uracilemia (U), dihydrouracilemia (UH2)/U ratio, or genotype of the gene encoding DPD (DPYD). All patients with gastrointestinal cancers who received 5-FU-based regimens form March 2018 to June 2020 were included in our study. They routinely benefited of a pre-therapeutic DPYD genotyping and phenotyping. During 5-FU infusion, blood samples were collected to measure 5-FU steady-state concentration in order to adapt 5-FU doses at the following cycles. A total of 169 patients were included. Median age was 68 (40–88) years and main primary tumor sites were colorectal (40.8%) and pancreas (31.4%), metastatic in 76.3%. 5-FU was given as part of FOLFIRINOX (44.4%), simplified FOLFOX-6 (26.6%), or docetaxel/FOLFOX-4 (10.6%). Regarding DPD activity, median U and UH2/U were, respectively, 10.8 ng/mL and 10.1, and almost 15% harbored a heterozygous mutation. On the range of measured U and UH2/U, no correlation was observed with 5-FU clearance. Moreover, in patients with U < 16 ng/mL, 5-FU exposure was higher than in other patients, and most of them benefited of dose increase following 5-FU therapeutic drug monitoring (TDM). If recent guidelines recommend decreasing 5-FU dose in patients harboring U ≥ 16 ng/mL, our study highlights that those patients are at risk of under-exposure and that 5-FU TDM should be conducted in order to avoid loss of efficacy.
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Affiliation(s)
- Marine Dolat
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - Pauline Macaire
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
- INSERM U1231, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Françoise Goirand
- Laboratoire de Pharmacologie/Toxicologie, CHU de Dijon, 21000 Dijon, France;
| | - Julie Vincent
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - Audrey Hennequin
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - Rémi Palmier
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - Leïla Bengrine-Lefevre
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
| | - François Ghiringhelli
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
- INSERM U1231, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Bernard Royer
- Laboratoire de Pharmacologie Clinique, CHU Jean-Minjoz, 3, Boulevard Alexandre-Fleming, 25030 Besançon, France;
- INSERM, EFS BFC, UMR1098, Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Université Bourgogne Franche-Comté, 25000 Besançon, France
| | - Antonin Schmitt
- Centre Georges-François Leclerc, 21000 Dijon, France; (M.D.); (P.M.); (J.V.); (A.H.); (R.P.); (L.B.-L.); (F.G.)
- INSERM U1231, University of Burgundy Franche-Comté, 21000 Dijon, France
- Correspondence:
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Macaire P, Paris J, Vincent J, Ghiringhelli F, Bengrine-Lefevre L, Schmitt A. Impact of granulocyte colony-stimulating factor on FOLFIRINOX-induced neutropenia prevention: A population pharmacokinetic/pharmacodynamic approach. Br J Clin Pharmacol 2020; 86:2473-2485. [PMID: 32386071 DOI: 10.1111/bcp.14356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/21/2020] [Accepted: 04/30/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Granulocyte colony-stimulating factor (G-CSF) is frequently prescribed to prevent chemotherapy-induced neutropenia, but the administration schedule remains empirical in case of bimonthly chemotherapy such as FOLFIRINOX regimen. This pharmacokinetic/pharmacodynamic (PK/PD) study was performed to determine the effect of different G-CSF regimens on the incidence and duration of neutropenia following FOLFIRINOX administration in order to propose an optimal G-CSF dosing schedule. METHODS A population PK/PD model was developed to describe individual neutrophil time course from absolute neutrophil counts (ANC) obtained in 40 advanced cancer patients receiving FOLFIRINOX regimen. The structural model considered ANC dynamics, neutropenic effect of cytotoxics and the stimulating effect of G-CSF on neutrophils. Final model estimates were used to simulate different G-CSF dosing schedules for 1000 virtual subjects. The incidence and duration of neutropenia were then calculated for different G-CSF dosing schedules. RESULTS The final model successfully described the myelosuppressive effect induced by the 3 cytotoxics for all patients. Simulations showed that pegfilgrastim administration reduced the risk of severe neutropenia by 22.9% for subjects with low ANC at the start of chemotherapy. Median duration in this group was also shortened by 3.1 days when compared to absence of G-CSF. Delayed G-CSF administration was responsible for higher incidence and longer duration of neutropenia compared to absence of administration. CONCLUSION The PK/PD model well described our population's ANC data. Simulations showed that pegylated-G-CSF administration 24 hours after the end of chemotherapy seems to be the optimal schedule to reduce FOLFIRINOX-induced neutropenia. We also underline the potential negative effect of G-CSF maladministration.
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Affiliation(s)
- Pauline Macaire
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | - Justine Paris
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | - Julie Vincent
- Oncology Department, Centre Georges-François Leclerc, Dijon, France
| | - François Ghiringhelli
- INSERM U1231, University of Burgundy Franche-Comté, Dijon, France.,Oncology Department, Centre Georges-François Leclerc, Dijon, France
| | | | - Antonin Schmitt
- Pharmacy Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
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Favier L, Truc G, Boidot R, Bengrine-Lefevre L. Long-term response to Olaparib in carcinomatous meningitis of a BRCA2 mutated ovarian cancer: A case report. Mol Clin Oncol 2020; 13:73-75. [PMID: 32454976 DOI: 10.3892/mco.2020.2035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 02/18/2020] [Indexed: 11/06/2022] Open
Abstract
PARP inhibitors are considered as a treatment revolution in ovarian cancer management. Leptomeningeal metastasis is a rare event with poor prognosis. The present report presents an exceptional history of long term survival for a young patient treated with olaparib for carcinomatous meningitis. A 54-year-old woman was diagnosed with ovarian cancer. After Paclitaxel and Carboplatin treatment, followed by a debulking surgery and several lines of chemotherapy due to progression, the patient's disease evolved into carcinomatous meningitis within 6 months after the end of treatment. During care, exome analysis on brain lesions was performed. Exome analysis was performed with a mean coverage of 80X by a paired-end sequencing on an Illumina NextSeq500 device. Following bioinformatics alignment and variant annotation, a pathogenic BRCA2 mutation, c.7617+1G>T, was observed, and this was already detected in her family. Additionally, the allelic frequency observed indicated that the mutation was present at the homozygous status in tumor cells. Due to the presence of a pathogenic mutation and a loss of wild-type BRCA2 allele, a maintenance treatment by Olaparib was initiated after radiotherapy and Cisplatin monotherapy. The patient received olaparib treatment for 14 months with a very good disease control and an excellent tolerance. Despite long control, the patient succumbed to meningeal and peritoneal progression.
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Affiliation(s)
- Laure Favier
- Department of Medical Oncology, Georges-François Leclerc Anticancer Center, UNICANCER, F-21079 Dijon, France
| | - Gille Truc
- Department of Radiotherapy, Georges-François Leclerc Anticancer Center, UNICANCER, F-21079 Dijon, France
| | - Romain Boidot
- Department of Biology and Pathology of Tumors, Georges-François Leclerc Anticancer Center, UNICANCER, F-21079 Dijon, France
| | - Leïla Bengrine-Lefevre
- Department of Medical Oncology, Georges-François Leclerc Anticancer Center, UNICANCER, F-21079 Dijon, France
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Réda M, Richard C, Niogret J, Fumet JD, Bertaut A, Blanc J, Truntzer C, Desmoulins I, Ladoire S, Bengrine-Lefevre L, Isambert N, Hervieu A, Lepage C, Foucher P, Borg C, Arnould L, Nambot S, Faivre L, Boidot R, Ghiringhelli F. Metastatic cancer whole-exome sequencing in daily practice. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.011] [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] [Indexed: 11/12/2022] Open
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10
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Mamguem Kamga A, Bengrine-Lefevre L, Quipourt V, Marilier S, Favier L, Arveux P, Dabakuyo-Yonli S. Qualité de vie à long terme et fonction sexuelle des personnes âgées atteintes d’un cancer de l’endomètre ou de l’ovaire. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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Carola C, Ghiringhelli F, Kim S, André T, Barlet J, Bengrine-Lefevre L, Marijon H, Garcia-Larnicol ML, Borg C, Dainese L, Steuer N, Richa H, Benetkiewicz M, Larsen AK, Gramont AD, Chibaudel B. FOLFIRI3-aflibercept in previously treated patients with metastatic colorectal cancer. World J Clin Oncol 2018; 9:110-118. [PMID: 30254966 PMCID: PMC6153125 DOI: 10.5306/wjco.v9.i5.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/11/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy and safety of the modified FOLFIRI3-aflibercept as second-line therapy in patients with metastatic colorectal cancer.
METHODS This is a retrospective multicenter cohort, evaluating the efficacy and safety of the association of aflibercept with FOLFIRI3 (day 1: aflibercept 4 mg/kg, folinic acid 400 mg/m2, irinotecan 90 mg/m2, 5-fluorouracil infusion 2400 mg/m2 per 46 h; day 3: irinotecan 90 mg/m2) in patients with previously treated metastatic colorectal cancer. The primary endpoint was overall response rate (ORR). Secondary endpoints were disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and safety.
RESULTS Among 74 patients treated in four French centers, nine were excluded due to prior use of aflibercept (n = 3), more than one prior treatment line in irinotecan-naïve patients (n = 3), and inadequate liver function (n = 3). In the “irinotecan-naïve” patients (n = 30), ORR was 43.3% and DCR was 76.7%. Median PFS and OS were 11.3 mo (95%CI: 6.1-29.0) and 17.0 mo (95%CI: 13.0-17.3), respectively. The most common (> 5%) grade 3-4 adverse events were diarrhea (37.9%), neutropenia (14.3%), stomatitis and anemia (10.4%), and hypertension (6.7%). In the “pre-exposed irinotecan” patients (n = 35), 20 (57.1%) received ≥ 2 prior lines of treatment. ORR was 34.3% and DCR was 60.0%. Median PFS and OS were 5.7 mo (95%CI: 3.9-10.4) and 14.3 mo (95%CI: 12.8-19.5), respectively.
CONCLUSION Minimally modified FOLFIRI has improvement dramatically the FOLFIRI3-aflibercept efficacy, whatever prior use of irinotecan. A prospective randomized trial is warranted to compare FOLFIRI-aflibercept to FOLFIRI3-aflibercept.
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Affiliation(s)
- Candice Carola
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret 92300, France
| | | | - Stefano Kim
- Department of Medical Oncology, CHU Besançon, Besançon 25030, France
| | - Thierry André
- Department of Medical Oncology, Saint-Antoine Hospital, and Sorbonne Universités, UMPC, Paris 75012, France
| | - Juliette Barlet
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret 92300, France
| | | | - Hélène Marijon
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret 92300, France
| | - Marie-Line Garcia-Larnicol
- Department of Medical Oncology, Saint-Antoine Hospital, and Sorbonne Universités, UMPC, Paris 75012, France
| | - Christophe Borg
- Department of Medical Oncology, CHU Besançon, Besançon 25030, France
| | - Linda Dainese
- Department of Anatomy-Pathology, Paris Pathology Institute, Malakoff 92240, France
| | - Nils Steuer
- Department of Medical Oncology, Saint-Antoine Hospital, and Sorbonne Universités, UMPC, Paris 75012, France
| | - Hubert Richa
- Department of Gastrointestinal Surgery, Franco-British Institute, Levallois-Perret 92300, France
| | | | - Annette K Larsen
- Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, INSERM U938, Faculté de Médecine Sorbonne Université, Paris 75012, France
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret 92300, France
| | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret 92300, France
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Mitry E, Walter T, Baudin E, Kurtz JE, Ruszniewski P, Dominguez-Tinajero S, Bengrine-Lefevre L, Cadiot G, Dromain C, Farace F, Rougier P, Ducreux M. Bevacizumab plus capecitabine in patients with progressive advanced well-differentiated neuroendocrine tumors of the gastro-intestinal (GI-NETs) tract (BETTER trial)--a phase II non-randomised trial. Eur J Cancer 2014; 50:3107-15. [PMID: 25454413 DOI: 10.1016/j.ejca.2014.10.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [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: 07/31/2014] [Revised: 09/26/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022]
Abstract
AIM OF THE STUDY Gastro-intestinal neuroendocrine tumours (GI-NETs) are chemotherapy-resistant tumours. Bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF), has shown promising results in several phase II trials of gastro-entero-pancreatic-NETs. We assessed bevacizumab combined with capecitabine, specifically in GI-NET patients. PATIENTS AND METHODS BEvacizumab in The Treament of neuroEndocrine tumoRs (BETTER) was a multicentre, open-label, non-randomised, two-group phase II trial. Here we present the group of patients with progressive, metastatic, well-differentiated GI-NETs. Patients Eastern Cooperative Oncology Group-performance status (ECOG-PS)⩽2, Ki-67 proliferation rate <15% and no prior systemic chemotherapy were treated with bevacizumab (7.5 mg/kg/q3w) and capecitabine (1000 mg/m2 twice daily, orally d1-14, resumed on d22) for 6-24 months. The primary end-point was progression-free survival (PFS); secondary end-points included overall survival (OS), response rate, safety and quality of life. RESULTS Of the 49 patients included, 53% were men, median age was 60 years (41-82), primary tumour site was ileal in 82% patients and Ki-67 was <15% in 48 patients and not available for one patient. After a maximum of 24 month follow-up per patient, the median PFS by investigator assessment was 23.4 months [95% confidence interval (CI): 13.2; not reached] and the overall disease control rate was 88% (18% partial response, 70% stable disease). The 2-year survival rate was 85%. Median OS was not reached. The most frequent grade 3-4 adverse events were hypertension (31%), diarrhoea (14%) and hand-foot syndrome (10%). CONCLUSION The combination of bevacizumab and capecitabine showed clinical activity and a manageable safety profile in the treatment of GI-NETs that warrant confirmation in a randomised phase III trial.
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Affiliation(s)
- Emmanuel Mitry
- Medical Oncology Department, Curie Institute, Paris, France.
| | - Thomas Walter
- Medical Oncology Department, Edouard Herriot Hospital, Lyon, France.
| | - Eric Baudin
- Nuclear Medicine and Endocrine Oncology Department, Gustave Roussy Institute, Villejuif, France.
| | - Jean-Emmanuel Kurtz
- Hematology and Oncology Department, University Hospital, Strasbourg, France.
| | - Philippe Ruszniewski
- Gastroenterology and Pancreatology Department, Beaujon Hospital, Clichy, France.
| | | | | | - Guillaume Cadiot
- Hepato-Gastroenterology and Digestive Oncology Department, Robert Debré Hospital, Reims, France.
| | - Clarisse Dromain
- Radio Diagnostic Department, Gustave Roussy Institute, Villejuif, France.
| | - Françoise Farace
- Laboratory of Translational Research, Gustave Roussy Institute, Villejuif, France.
| | - Philippe Rougier
- Hepato-Gastroenterology and Digestive Oncology Department, Georges Pompidou European Hospital, Université Paris V, Paris, France.
| | - Michel Ducreux
- Gastrointestinal Oncology Department, Gustave Roussy Institute, Villejuif, France.
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Ghebriou D, Avenin D, Baba-Hamed N, Chaoui D, Hubert S, Fossey Diaz V, Lobey C, Mir O, Bengrine-Lefevre L, Landre T, Kirova Y, Maley K, Minard A, Rollot-Trad F, Pechinot-Guedj F, Ghebriou D. The FROG observatory on the tolerance of chemotherapy in the elderly in real life. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Walter T, Baudin E, Kurtz J, Ruszniewski P, Bengrine-Lefevre L, Cadiot G, Dominguez-Tinajero S, Kraemer S, Ducreux M, Mitry E. A Phase II Trial of Bevacizumab with Capecitabine in Progressive, Metastatic Well-Differentiated Digestive Endocrine Tumors (Better Study). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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15
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Farace F, Lombard-Bohas C, Mitry E, Ychou M, Bengrine-Lefevre L, Lecomte T, Joly K, Ducreux M, Baudin E. Predictive Value of Circulating Endothelial Cell (CEC) Levels in Metastatic or Locally Advanced Neuroendocrine Digestive Tumor Patients Treated With Chemotherapy and Bevacizumab. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32775-7] [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: 11/27/2022] Open
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16
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Bengrine-Lefevre L, Viel E, Brugirard M, Tournigand C, Perez-Staub N, Chibaudel B, Teixeira L, Marijon H, Gervais H, Garcia ML, Bourges O, Maindrault-Goebel F, Andre T, De Gramont A. Survival according to residual disease after interval laparotomy in advanced epithelial ovarian cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Tournigand C, Bengrine-Lefevre L, Chibaudel B, de Gramont A. [Management of metastatic colorectal cancer]. Rev Prat 2010; 60:1103-1107. [PMID: 21197743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The treatment of metastatic colorectal cancer has evolved significantly in recent years. Overall survival was significantly increased through the use of irinotecan and oxaliplatin, in combination with 5FU and leucovorin. More recently, new drugs directed against angiogenic factors or against an intracellular signaling pathway have demonstrated their effectiveness: bevacizumab (VEGF inhibitor) and cetuximab or panitumumab (inhibitors of EGF receptor) are the first molecules whose effect has been demonstrated in advanced colorectal cancer. Undoubtedly, advances in biology can both identify new targets, and therefore new treatments, but also better define patient groups most likely to get a benefit of these treatments.
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Bengrine-Lefevre L, Afchain P, Chibaudel B, Gervais H, Tournigand C, De Gramont A, Louvet C. [Nasal septum perforation and bevacizumab]. Rev Med Interne 2010; 32:e43-5. [PMID: 21470582 DOI: 10.1016/j.revmed.2010.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 02/10/2010] [Accepted: 04/10/2010] [Indexed: 11/17/2022]
Abstract
A 52-year-old woman, with a metastatic breast cancer, presented with a nasal septum perforation while receiving a treatment combining paclitaxel and bevacizumab. This is the fifth reported case of nasal septum perforation probably related to an anti-angiogenic therapy. A literature review and a discussion concerning the different causes of nasal septum perforation were performed.
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Affiliation(s)
- L Bengrine-Lefevre
- Service d'oncologie médicale, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France.
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Tournigand C, Guy-Coichard C, Bengrine-Lefevre L, Garcia ML, Frederic B, de Gramont A. 177 Establishing a program of quality improvement in a medical oncology unit. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041624.14] [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: 11/04/2022]
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Abstract
INTRODUCTION Choriocarcinoma is a rare tumour which results from the anarchic proliferation of a gonadic or extra gonadic germinal cell. CASE REPORT A 45 year old pre menopausal woman of African origin presented with a persistent cough and deterioration of general status. The chest X-ray revealed a cavitated mass of the right upper lobe. Other lesions were associated (liver, kidney and scalp). Choriocarcinoma, suspected in the presence of an elevated ssHCG without a gravid uterus, was confirmed by biopsy excision of a haemorrhagic cutaneous lesion of the scalp. Despite the poor prognosis methotrexate based chemotherapy resulted in control of the disease and a good remission.
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Affiliation(s)
- A-S Olezac
- Service de Pneumologie, Hôpital Saint-Antoine, Paris, France
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Tournigand C, Bengrine-Lefevre L. [What are the new therapeutic strategies in metastatic colorectal cancer including biotherapies?]. Rev Med Interne 2009; 30:411-5. [PMID: 19231039 DOI: 10.1016/j.revmed.2008.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 11/24/2008] [Accepted: 12/10/2008] [Indexed: 10/21/2022]
Abstract
Colorectal cancer remains one of the major causes of cancer death. Recent identification of new molecular targets led to the development of novel agents directed against growth factor receptors or key factors of angiogenesis. Recent phase III trials demonstrated a significant clinical benefit with bevacizumab, a VEGF inhibitor, and with EGFR-inhibitors, namely cetuximab and panitumumab. In this article we review the diverse treatment options combining cytotoxic and targeted therapies available for patients with metastatic colorectal cancer.
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Affiliation(s)
- C Tournigand
- Service d'oncologie médicale, hôpital Saint-Antoine, 75571 Paris cedex 12, France.
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Bidard FC, Tournigand C, André T, Mabro M, Figer A, Cervantes A, Lledo G, Bengrine-Lefevre L, Maindrault-Goebel F, Louvet C, de Gramont A. Efficacy of FOLFIRI-3 (irinotecan D1,D3 combined with LV5-FU) or other irinotecan-based regimens in oxaliplatin-pretreated metastatic colorectal cancer in the GERCOR OPTIMOX1 study. Ann Oncol 2009; 20:1042-7. [PMID: 19153116 DOI: 10.1093/annonc/mdn730] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Second-line irinotecan-based chemotherapy is commonly used in metastatic colorectal cancers after first-line oxaliplatin-based chemotherapy. No standard schedule of irinotecan has been established in this situation. PATIENTS AND METHODS Metastatic colorectal cancer patients included in the OPTIMOX1 phase III study received first-line oxaliplatin-based chemotherapy (FOLFOX). No second line was defined in the protocol, but data concerning second line were prospectively registered. Inclusion criterion was patients receiving an irinotecan-based second-line chemotherapy. Second-line progression-free survival (PFS) and tumor response were evaluated according to type of irinotecan-based regimen administered. RESULTS A total of 342 patients received irinotecan-based chemotherapy as second-line chemotherapy: FOLFIRI-3 [n = 109, irinotecan 100 mg/m(2) days 1 and 3 combined with leucovorin (LV) 400 mg/m(2) day 1 and 46-h continuous 5-fluorouracil (5-FU) 2000 mg/m(2)], FOLFIRI-1 (n = 112, irinotecan 180 mg/m(2) day 1 combined with LV 400 mg/m(2) day 1, 5-FU bolus 400 mg/m(2) and 46-h continuous 5-FU 2400 mg/m(2)) and other various irinotecan-based regimens (n = 121). Median second-line PFS was 3.0 months (FOLFIRI-3: 3.7 months; FOLFIRI-1: 3.0 months; other regimens: 2.3 months). In multivariate analysis, FOLFIRI-3 regimen (relative risk 0.43, 95% confidence interval 0.28-0.68, P = 0.0003) and lactate deshydrogenase level at inclusion (P = 0.0006) in OPTIMOX1 were associated with a longer second-line PFS. CONCLUSION In unselected patients pretreated with oxaliplatin, PFS in second line appeared to be improved by FOLFIRI-3 regimen.
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Affiliation(s)
- F-C Bidard
- Department of Medical Oncology, Hospital Saint Antoine, Paris, France
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