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Rousseau F, Ranchon F, Bardin C, Bakrin N, Lavoué V, Bengrine-Lefevre L, Falandry C. Ovarian cancer in the older patient: where are we now? What to do next? Ther Adv Med Oncol 2023; 15:17588359231192397. [PMID: 37724138 PMCID: PMC10505350 DOI: 10.1177/17588359231192397] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/19/2023] [Indexed: 09/20/2023] Open
Abstract
In recent years, major advances have been made toward the individualization of epithelial ovarian cancer care, leading to an overall improvement of patient outcomes. However, real-life data indicate that the oldest populations do not benefit from this, due to aspects related to cancer (more aggressive histopathological features), treatment (i.e. frequently suboptimal), and the host (increased toxicities in patients with lower physiological reserve). A specific risk-benefit perspective should therefore be taken when considering surgery, chemotherapy, and maintenance treatments: the decision for cytoreductive surgery should include geriatric vulnerability and surgical complexity, neo-adjuvant chemotherapy being an option when primary surgery appears at high risk; carboplatin paclitaxel association remains the standard even in vulnerable older patients; and bevacizumab and poly(ADP-ribose) polymerase inhibitors maintenance are interesting options provided they are prescribed according to their indications with a close monitoring of their toxicities. Future studies should aim to individualize care without limiting access of older patients to innovation. A specific focus is needed on age-specific translational analyses (focusing on tumor mutational burden and impaired biological pathways), a better patient stratification according to geriatric parameters, an adaptation of both oncological treatment and geriatric interventions, and treatment adaptations not a priori but according to formal pharmacokinetic data.
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Affiliation(s)
- Frédérique Rousseau
- Institut Paoli Calmettes Institute, Marseille, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Florence Ranchon
- Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Hospices Civils de Lyon, Pierre-Bénite, France
- CICLY Centre pour l’Innovation en Cancérologie de Lyon, Oullins, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Christophe Bardin
- Service de Pharmacie Clinique, Hôpital Cochin AP-HP Centre Université Paris Cité, Paris, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Naoual Bakrin
- Hospices Civils de Lyon, Service de Chirurgie Digestive, CHU Hôpital Lyon-Sud, Pierre-Bénite Cedex, France
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Vincent Lavoué
- Service de Gynécologie, CHU de Rennes, Hôpital Sud, Rennes, France
- UMR S1085, IRSET-INSERM, Université de Rennes, Rennes, France
- Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN)
| | - Leila Bengrine-Lefevre
- Département d’Oncologie Médicale, Centre Georges-Francois Leclerc, Dijon, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Claire Falandry
- Hospices Civils de Lyon, Unité de Gériatrie, Centre Hospitalier de la Croix Rousse, 103, Grande Rue de la Croix-Rousse, Lyon 69004, France
- Université de Lyon, CarMeN Laboratory, INSERM U.1060/Université Lyon 1/INRA U1397/INSA Lyon/Hospices Civils Lyon Bâtiment CENS-ELI 2D; Hôpital Lyon Sud Secteur 2; Pierre-Bénite 69310, France
- Université Claude Bernard Lyon 1, Pierre-Bénite 69310, France Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
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Mahiou K, Vincent L, Peignaux-Casasnovas K, Costaz H, Padeano MM, Amet A, Dabakuyo S, Mamguem Kamga A, Bengrine-Lefevre L, Coutant C. Impact of therapeutic strategy on disease-free and overall survival of early-stage cervical cancer: Surgery alone versus preoperative radiation. Cancer Rep (Hoboken) 2023; 6:e1823. [PMID: 37076763 PMCID: PMC10172169 DOI: 10.1002/cnr2.1823] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is no international consensus for management of early-stage cervical cancer (ESCC). This study aimed to retrospectively investigate disease-free survival (DFS) and overall survival (OS) in patients with ESCC according to the therapeutic strategy used, surgery alone versus preoperative radiation following by surgery. METHODS Data were retrospectively collected from 1998 to 2015 using the Gynecological Cancer Registry of the Côte d'Or. The inclusion criteria were FIGO 2018 ≤ IB2; squamous cell carcinoma, adenocarcinoma or adenosquamous type. Survival curves were compared using the log-rank test. RESULTS One hundred twenty-six patients were included. Median survival was 90 months. There was no significant difference in DFS (HR = 0.91, 95%CI [0.32-2.53], p = 0.858) or in OS between surgery alone versus preoperative radiation following by surgery (HR = 0.97, 95%CI [0.31-2.99], p = 0.961). In the subgroup of patients with stage ≥IB1, there was no significant difference in DFS (HR = 3.26, p = 0.2) or in OS (HR = 3.87, p = 0.2). CONCLUSION Our study did not identify any difference in survival according to the treatment strategy. Preoperative radiation following by surgery can be an alternative to surgery alone for ESCC.
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Affiliation(s)
- Katia Mahiou
- Department of Surgical Oncology, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
| | - Laura Vincent
- Department of Surgical Oncology, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
| | | | - Hélène Costaz
- Department of Surgical Oncology, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
| | - Marie-Martine Padeano
- Department of Surgical Oncology, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
| | - Alix Amet
- Department of Surgical Oncology, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
- Department of Education, University of Burgundy-Franche Comté, Dijon, France
| | - Sandrine Dabakuyo
- Côte d'Or Breast and Gynaecological Cancer Registry, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
| | - Ariane Mamguem Kamga
- Côte d'Or Breast and Gynaecological Cancer Registry, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
| | - Leila Bengrine-Lefevre
- Department of Medical Oncology, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges François Leclerc Cancer Center -UNICANCER, Dijon, France
- Department of Education, University of Burgundy-Franche Comté, Dijon, France
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Barben J, Billa O, Collot J, Collot T, Manckoundia P, Bengrine-Lefevre L, Dabakuyo-Yonli TS, Quipourt V. Quality of life and perceived burden of the primary caregiver of patients aged 70 and over with cancer 5 years after initial treatment. Support Care Cancer 2023; 31:147. [PMID: 36729239 PMCID: PMC9892678 DOI: 10.1007/s00520-023-07594-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/14/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Long-term effects of being the primary caregiver of an older patient with cancer are not known. This study aimed to assess health-related quality of life (HRQoL) in primary caregivers of patients aged 70 and older with cancer, 5 years after initial treatment. Secondly, to compare the HRQoL between former primary caregivers whose caregiving relationship had ceased (primary caregiver no longer directly assisting the patient because of patient death or removal to another city or admission to an institution) and current caregivers, and to determine the perceived burden of the primary caregivers. METHODS Prospective observational study including primary caregivers of patients aged 70 and older with cancer. HRQoL and perceived burden were assessed using the SF-12 and Zarit Burden Interview (ZBI) at baseline and 5 years after initial treatment. RESULTS Ninety-six caregivers were initially included; at 5 years, 46 caregivers completed the SF-12 and ZBI between June 15 and October 26, 2020. Primary caregiver's HRQoL scores had significantly decreased over time for physical functioning (mean difference = -10, p=0.04), vitality (MD= -10.5, p=0.02), and role emotional (MD= -8.1, p=0.01) dimensions. The comparison at 5 years according to caregiving status showed no difference for all HRQoL dimensions. There was no decrease in perceived burden at 5 years. CONCLUSION Some dimensions of HRQoL decreased at 5 years with a stable low perceived burden. TRIAL REGISTRATION NCT04478903.
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Affiliation(s)
- Jérémy Barben
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France. .,Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France. .,Breast and Gynaecological Cancer Registry, Centre George François Leclerc, Dijon, France. .,National Clinical Research Platform for Quality of Life in Oncology, Dijon, France. .,UMR INSERM U1231, University of Burgundy, Dijon, France.
| | - Oumar Billa
- Breast and Gynaecological Cancer Registry, Centre George François Leclerc, Dijon, France ,National Clinical Research Platform for Quality of Life in Oncology, Dijon, France ,UMR INSERM U1231, University of Burgundy, Dijon, France
| | - Julie Collot
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
| | - Thomas Collot
- Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France ,UMR INSERM U1093, University of Burgundy, Dijon, France
| | - Leila Bengrine-Lefevre
- Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France ,Medical Oncology Department, Centre George François Leclerc, Dijon, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Breast and Gynaecological Cancer Registry, Centre George François Leclerc, Dijon, France ,National Clinical Research Platform for Quality of Life in Oncology, Dijon, France ,UMR INSERM U1231, University of Burgundy, Dijon, France
| | - Valérie Quipourt
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France ,Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France
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Neuzillet C, Bouché O, Tournigand C, Chibaudel B, Bouguion L, Bengrine-Lefevre L, Lopez-Trabada Ataz D, Mabro M, Metges JP, Péré-Vergé D, Conroy T, Lievre A, Andre M, Desseigne F, Goldwasser F, Henriques J, Anota A, Hammel P. Adapted physical activity in patients (Pts) with advanced pancreatic cancer (APACaP): Results from a prospective national randomized GERCOR trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4007 Background: The benefit of adapted physical activity (APA) on health-related quality of life (HRQoL) in Pts with advanced pancreatic ductal adenocarcinoma (aPDAC) treated by chemotherapy (CTx) has never been prospectively assessed. Methods: Pts with aPDAC and ECOG performance status (PS) 0–2 were randomized 1:1 to receive usual care (UC) including first-line CTx at the investigator’s choice (standard arm), or UC plus a home-based 16-week APA program (APA arm). The APA program consisted of personalized aerobic and resistance exercises, with a weekly remote supervision by an APA professional trainer, and unsupervised sessions with a family member or friend (APA partner). The primary objective was the effect on HRQoL at week 16 (W16) measured by 3 dimensions of the EORTC QLQ-C30, global health status (GHS), physical functioning (PF), and fatigue (FA), with a one-sided type I error of 0.016 for each dimension. The primary HRQoL analysis was performed in Pts with available baseline and W16 scores for the 3 targeted dimensions (mITT1). Secondary analyses of HRQoL changes by the mixed model for repeated measures (MMRM) and time until definitive deterioration (TUDD) methods included Pts with baseline and ≥1 follow-up score (mITT2). Differences > 5 points in scores were considered clinically significant. Results: A total of 313 Pts (median age: 64 years; men: 55%, ECOG PS 0-1: 93%; metastatic: 77%; FOLFIRINOX: 78%, gemcitabine-based: 13%) were included from 11/2014 to 10/2020 (standard arm: n = 157, APA arm: n = 156). In the mITT1 population (n = 172), mean differences in HRQoL at W16 adjusted from baseline were -0.98 (SD 23.87; p = 0.39), -2.08 (SD 21.34; p = 0.26), and 4.16 (SD 29.18; p = 0.18) for GHS, PF, and FA, respectively. In the mITT2 population (n = 259), APA was associated with significant improvements in 5 (GHS, PF, cognitive functioning [CF], social functioning [SF], appetite loss) and 8 (GHS, CF, emotional functioning [EF], SF, insomnia, constipation, pain, financial difficulties) dimensions of HRQoL by MMRM and TUDD, respectively (Table). Secondary endpoints, including overall survival, progression-free survival, and chemotherapy toxicity will be presented. Conclusions: APA in combination with usual care improved several dimensions of HRQoL in Pts with aPDAC receiving first-line CTx. Clinical trial information: NCT02184663. [Table: see text]
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Affiliation(s)
- Cindy Neuzillet
- 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, Reims University Hospital, Reims, France
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Lucile Bouguion
- Department of Hepato-Gastroenterology, Hospital Center Departmental Vendée, La Roche-Sur-Yon, France
| | | | | | | | - Jean-Philippe Metges
- CHU Brest–Institut de Cancerologie et d’Hematologie ARPEGO Network, Brest, France
| | | | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Astrid Lievre
- Department of Gastroenterology, Rennes University Hospital, 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, Hopital Cochin, Université Paris Descartes, CARPEM, APHP, Paris, France
| | - Julie Henriques
- Methodology and Quality of Life in Oncology Unit, Department of Oncology University Hospital, INSERM UMR 1098, Besançon, France
| | - Amélie Anota
- Department of Methodology and quality of life, University Hospital Besançon; Direction of Clinical Research and Innovation, Centre Léon Bérard; French National Platform Quality of Life and Cancer, Besançon, France
| | - Pascal Hammel
- Digestive and Medical Oncology Department, Hospital Paul Brousse, University Paris-Saclay, Villejuif, France
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Mahiou K, Vincent L, Peignaux-Casasnovas K, Costaz H, Padeano MM, Amet A, Dabakuyo TS, Bengrine-Lefevre L, Coutant C. Impact of therapeutic strategy on disease-free and overall survival of early-stage cervical cancer: Surgery alone versus preoperative radiotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17517] [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
e17517 Background: At present, there is no international consensus for management of early-stage cervical cancer. This study aimed to retrospectively investigate disease-free survival (DFS) and overall survival (OS) in patients with early cervical cancer according to the therapeutic strategy used, surgery alone versus pre-operative radiotherapy following by surgery. Methods: Data from patients with early-stage cervical cancer were retrospectively collected from January 1998 to December 2015 using the Breast & Gynecological Cancer Registry of the Côte d’Or, regrouping data from 7 centers. The inclusion criteria were: FIGO 2009 stage IB1 or lower; epidermoid, adenocarcinoma or adenosquamous type. The exclusion criteria were: history of pelvic radiation; concomitant radiochemotherapy; adjuvant radiotherapy; total radiation dose less than 50 Gy, or more than 66 Gy or not documented. In the surgery group, patients had only a surgical treatment for early-stage cervical cancer. The surgical treatment was either a hysterectomy, a trachelectomy or a conization. In the radiation group; patients had radiotherapy, brachytherapy and/or radiotherapy followed by surgery. DFS and OS were determined using the Kaplan-Meier method .Survival curves were compared using the log-rank test. Results: A total of 126 patients were included. Median survival in the whole population was 90 months (47-148); 72 months for those receiving primary surgery, and 135.5 months for those receiving primary radiation therapy. There was no significant difference in DFS between the surgery and radiation groups (HR=2.82, 95%CI (0.82-9.65), p=0.08). Similarly, there was no significant difference in OS between groups (HR=1.35, 95%CI (0.6-3.05), p=0.5). In the sub-group of patients with stage IB1 (FIGO 2009), there was no significant difference in DFS (HR=3.26, 95%CI (0.4-26.76), p=0.2) or in OS (HR=3.87, 95%CI (0.49-30.35), p=0.2) between groups. Conclusions: Cervical cancer counts among the only solid tumors for which increasing mortality has been observed in recent years. Radiation therapy is still a major source of morbidity for young patients. Therefore, key issues remain outstanding for the future management of young patients with cervical cancer and include reducing the morbidity of existing therapeutic options by identifying subgroups of patients at low or intermediate risk, and facilitating fertility-sparing surgery.
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Affiliation(s)
| | | | | | | | | | - Alix Amet
- Centre Georges-François Leclerc, Dijon, France
| | - Tienhan Sandrine Dabakuyo
- Biostatistics and Quality of Life Unit/Centre Georges François Leclerc and EA 4184, Faculty of Medicine, Dijon, France
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Ladoire S, Rederstorff E, Goussot V, Parnalland S, Briot N, Ballot E, Truntzer C, Ayati S, Bengrine-Lefevre L, Bremaud N, Coudert B, Desmoulins I, Favier L, Fraisse C, Fumet JD, Hennequin A, Hervieu A, Ilie S, Kaderbhai C, Lagrange A, Martin N, Mazilu I, Mayeur D, Palmier R, Simonet-Lamm AL, Vincent J, Zanetta S, Arnould L, Coutant C, Bertaut A, Ghiringhelli F. Parallel evolution and differences in seroprevalence of SARS-CoV-2 antibody between patients with cancer and health care workers in a tertiary cancer centre during the first and second wave of COVID-19 pandemic: canSEROcov-II cross-sectional study. Eur J Cancer 2022; 165:13-24. [PMID: 35189537 PMCID: PMC8806022 DOI: 10.1016/j.ejca.2022.01.005] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
Abstract
Background Patients with cancer are a population at high risk of severe infection from SARS-CoV-2. Patients with cancer regularly attend specialised healthcare centres for management and treatment, where they are in contact with healthcare workers (HCWs). Numerous recommendations target both patients with cancer and HCWs to minimise the spread of SARS-CoV-2 during these interactions. Objective To investigate the parallel evolution of the COVID-19 epidemic in these 2 populations over time, we studied the seroprevalence of anti-SARS-CoV-2 antibodies after both the first and second waves of the pandemic, and in both cancer patients and HCWs from a single specialised anti-cancer centre. Factors associated with seropositivity were identified in both populations. Methods We conducted a cross-sectional study after the second wave of the COVID pandemic in France. All participants were invited to undergo serological testing for SARS-CoV-2 and complete a questionnaire collecting data about their working conditions (for HCWs) or medical management (for patients) during this period. Results after the second wave were compared to those of a previous study among 1011 patients with cancer and 663 HCWs performed in the same centre after the first wave, using the same evaluations. Findings We included 502 HCWs and 507 patients with cancer. Seroprevalence of anti-SARS-CoV-2 antibodies was higher after the second wave than after the first wave in both HCWs (15.1% versus 1.8%; p < 0.001), and patients (4.1% versus 1.7%; p = 0.038). By multivariate analysis, the factors found to be associated with seropositivity after the second wave for HCWs were: working in direct patient care (p = 0.050); having worked in a dedicated COVID-19 unit (p = 0.0036); contact with a person with COVID-19-positive in the workplace (p = 0.0118) or outside of the workplace (p = 0.0297). Among patients with cancer, only a contact with someone who tested positive for COVID-19 was found to be significantly associated with positive serology. The proportion of reported contacts with individuals with COVID-19-positive was significantly lower among patients with cancer than among HCWs (7.6% versus 40.7%, respectively; p < 0.0001) Interpretation Between the first and second waves of the epidemic in France, the seroprevalence of anti-SARS-CoV-2 antibodies increased to a lesser extent among patients with cancer than among their HCWs, possibly due to better self-protection, notably social distancing. The risk factors for infection identified among HCWs plead in favour of numerous intra-hospital contaminations, especially for HCWs in contact with high-risk patients. This underlines the compelling need to pursue efforts to implement strict hygiene and personal protection measures (including vaccination) to protect HCWs and patients with cancer.
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Affiliation(s)
- Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France.
| | - Emilie Rederstorff
- Clinical Research Center (CRC), Centre Georges François Leclerc, Dijon, France
| | - Vincent Goussot
- Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Sophie Parnalland
- Clinical Research Center (CRC), Centre Georges François Leclerc, Dijon, France
| | - Nathalie Briot
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - Elise Ballot
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges-François Leclerc Cancer Center, Dijon, France
| | - Caroline Truntzer
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges-François Leclerc Cancer Center, Dijon, France
| | - Siavoshe Ayati
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Nathalie Bremaud
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Bruno Coudert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laure Favier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Cléa Fraisse
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Jean-David Fumet
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Audrey Hennequin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Alice Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Silvia Ilie
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Courèche Kaderbhai
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Lagrange
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Nils Martin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Irina Mazilu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Didier Mayeur
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Rémi Palmier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Julie Vincent
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Sylvie Zanetta
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laurent Arnould
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Charles Coutant
- University of Burgundy-Franche Comté, France; Department of Oncologic Surgery, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Bertaut
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, 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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Bellio H, Bertaut A, Hervieu A, Zanetta S, Hennequin A, Vincent J, Palmier R, Bengrine-Lefevre L, Ghiringhelli F, Fumet JD. Phase I Dose-Escalation Trial of an Innovative Chemotherapy Regimen Combining a Fractionated Dose of Irinotecan Plus Bevacizumab, Oxaliplatin, 5-Fluorouracil, and Folinic Acid (bFOLFIRINOX-3) in Chemorefractory Metastatic Colorectal Cancer. Cancers (Basel) 2021; 13:cancers13215472. [PMID: 34771635 PMCID: PMC8582415 DOI: 10.3390/cancers13215472] [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: 09/27/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary Treatment of non-resectable metastatic colorectal cancer (mCRC) involves chemotherapy based on 5-fluorouracil, oxaliplatin and irinotecan and monoclonal antibodies targeting VEGF or EGFR. After an initial progression, it is usual to change the chemotherapy regimen and targeted therapy, with rather moderate results. Several studies have focused on the interest of using again already used molecules and rechallenge with oxaliplatin and irinotecan bi fractionation (FOLFIRI3) have previously shown efficacy in chemorefractory patients, but desynchronized triplet chemotherapy was never tested. The aim of this study was to evaluate the safety and efficacy of a new regimen so-called: FOLFIRINOX-3 bevacizumab in chemorefractory metastatic colorectal cancer. Abstract The care of metastatic colorectal cancers is based on combination chemotherapies including 5-fluorouracil, oxaliplatin, irinotecan, and monoclonal antibodies targeting the epidermal growth factor receptor or vascular endothelial growth factor. The regimen is determined based on the patient’s molecular biology and general condition. Irinotecan bifractionation showed efficacy in chemorefractory patients in a previous study, FOLFIRI-3, but a desynchronized triplet has never been tested. The aim of bFOLFIRINOX-3 is to determine the safety, tolerance, and efficacy of a new regimen (FOLFIRINOX-3 bevacizumab) in chemorefractory patients. The aim of this study was to evaluate the safety and efficacy of FOLFIRINOX-3 bevacizumab in chemorefractory metastatic colorectal cancer (mCRC). A standard phase I, “3 + 3” design study was performed. The standard protocol comprised simplified FOLFOX 4 (folinic acid 400 mg/m2), 5-fluorouracil (a 400 mg/m2 bolus followed by 2400 mg/m2 for 46 h), oxaliplatin (85 mg/m2) and irinotecan (administered before and after 5-fluorouracil infusion), plus bevacizumab (5 mg/kg). In a “3 + 3” design, three different doses of irinotecan were tested: 60, 70 and 90 mg/m2. The primary endpoint was the maximum tolerable dose (MTD) of irinotecan. The secondary endpoints included the objective response (at 8 and 16 weeks) according to the RECIST 1.1 criteria and progression free survival. Thirteen patients were enrolled, and twelve patients were finally evaluated for dose-limiting toxicity (DLT). The dose level defined was 70 mg/m2 irinotecan. A total of three DLTs were observed (grade 3 diarrhea): two DLTs at the 90 mg/m2 dose level and one at the 70 mg/m2 dose level. The most frequently described adverse events were asthenia (93%), diarrhea (77%), nausea (62%) and peripheral sensory neuropathy (46%). The most frequent biological event was thrombopenia (54%). Regarding efficacy, among the 11 evaluable patients, no progression was observed at 8 weeks, and the partial response rate was 18.2%. At 16 weeks, a partial response rate of 27.3% was observed, and five patients had a stable disease. The new regimen of bFOLFIRINOX-3 with irinotecan at 70 mg/m2 was well tolerated. In chemorefractory patients, this protocol shows a high response rate.
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Affiliation(s)
- Hélène Bellio
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
- Correspondence: (H.B.); (J.-D.F.)
| | - Aurélie Bertaut
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Alice Hervieu
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Sylvie Zanetta
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Audrey Hennequin
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Julie Vincent
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Rémi Palmier
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - Leila Bengrine-Lefevre
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
| | - François Ghiringhelli
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
- UMR INSERM 1231, 7 Boulevard Jeanne d’Arc, 21000 Dijon, France
| | - Jean-David Fumet
- Platform of Transfer in Biological Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France; (A.B.); (A.H.); (S.Z.); (A.H.); (J.V.); (R.P.); (L.B.-L.); (F.G.)
- Department of Medical Oncology, Georges François Leclerc Cancer Center—UNICANCER, 1 rue du Professeur Marion, 21000 Dijon, France
- Maison de L’université Esplanade Erasme, University of Burgundy-Franche Comté, 21000 Dijon, France
- Correspondence: (H.B.); (J.-D.F.)
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9
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Ladoire S, Goussot V, Redersdorff E, Cueff A, Ballot E, Truntzer C, Ayati S, Bengrine-Lefevre L, Bremaud N, Coudert B, Desmoulins I, Favier L, Fraisse C, Fumet JD, Hanu R, Hennequin A, Hervieu A, Ilie S, Kaderbhai C, Lagrange A, Martin N, Mazilu I, Mayeur D, Palmier R, Simonet-Lamm AL, Vincent J, Zanetta S, Arnould L, Coutant C, Bertaut A, Ghiringhelli F. Seroprevalence of SARS-CoV-2 among the staff and patients of a French cancer centre after first lockdown: The canSEROcov study. Eur J Cancer 2021; 148:359-370. [PMID: 33780664 PMCID: PMC7914029 DOI: 10.1016/j.ejca.2021.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 01/08/2023]
Abstract
Background In view of the potential gravity of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection for patients with cancer, epidemiological data are vital to assess virus circulation among patients and staff of cancer centres. We performed a prospective study to investigate seroprevalence of SARS-CoV-2 antibodies among staff and patients with cancer at a large cancer centre, at the end of the period of first national lockdown in France and to determine factors associated with the risk of SARS-CoV-2 infection. Methods After the first lockdown, all medical and non-medical staff, as well as all patients attending the medical oncology department were invited to undergo serological testing for SARS-CoV-2 between 11 May and 30 June 2020. All participants were also invited to complete a questionnaire collecting data about their living and working conditions, and for patients, medical management during lockdown. Findings A total of 1,674 subjects (663 staff members, 1011 patients) were included. Seroprevalence was low in both staff (1.8%) and patients (1.7%), despite more features of high risk for severe forms among patients. None of the risk factors tested in our analysis (working or living conditions, comorbidities, management characteristics during lockdown) was found to be statistically associated with seroprevalence in either staff or patients. There was no significant difference in the proportion of symptomatic and asymptomatic subjects between staff and patients. Only fever, loss of smell, and loss of taste were significantly more frequent among seropositive patients, in both staff and patients. Interpretation We report very low seroprevalence of antibodies against SARS-CoV-2 in the staff (caregiving and non-caregiving) and patients of a large cancer care centre in which strict hygiene, personal protection, and social distancing measures were implemented.
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Affiliation(s)
- Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France.
| | - Vincent Goussot
- Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Emilie Redersdorff
- Clinical Research Center (CRC), Centre Georges François Leclerc, Dijon, France
| | - Adele Cueff
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - Elise Ballot
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges, François Leclerc Cancer Center, Dijon, France
| | - Caroline Truntzer
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; Bioinformatic Core Facility Georges, François Leclerc Cancer Center, Dijon, France
| | - Siavoshe Ayati
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Nathalie Bremaud
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Bruno Coudert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laure Favier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Cléa Fraisse
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Jean-David Fumet
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Roxana Hanu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Audrey Hennequin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Alice Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Silvia Ilie
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Courèche Kaderbhai
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Lagrange
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Nils Martin
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Irina Mazilu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Didier Mayeur
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Rémi Palmier
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Julie Vincent
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Sylvie Zanetta
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Laurent Arnould
- Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Department of Pathology and Tumor Biology, Centre Georges François Leclerc, Dijon, France
| | - Charles Coutant
- University of Burgundy-Franche Comté, France; Department of Oncologic Surgery, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Bertaut
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France; Research Platform in Biological Oncology, Georges François Leclerc Cancer Center, Dijon, France; Centre de Recherche INSERM LNC-UMR1231, Dijon, France; University of Burgundy-Franche Comté, France
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10
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Mamguem Kamga A, Bengrine-Lefevre L, Quipourt V, Favier L, Darut-Jouve A, Marilier S, Arveux P, Desmoulins I, Dabakuyo-Yonli TS. Long-term quality of life and sexual function of elderly people with endometrial or ovarian cancer. Health Qual Life Outcomes 2021; 19:56. [PMID: 33579310 PMCID: PMC7881660 DOI: 10.1186/s12955-021-01675-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 07/06/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background With the growing number of older endometrial cancer (EC) and ovarian cancer (OC) survivors, data on long-term health-related quality of life (HRQoL) became an important issue in the management of older patients. So, the aim of this study was to describe and compare according to age long-term HRQoL, sexual function, and social deprivation of adults with either EC or OC. Methods A cross-sectional study was set up using data from the Côte d’Or gynecological cancer registry. A series of questionnaires assessing HRQoL (SF-12), sexual function (FSFI), anxiety/depression (HADS), social support (SSQ6) and deprivation (EPICES) were offered to women with EC or OC diagnosed between 2006 and 2013. HRQoL, sexual function, anxiety/depression, social support and deprivation scores were generated and compared according to age (< 70 years and ≥ 70 years). Results A total of 145 women with EC (N = 103) and OC (N = 42) participated in this study. Fifty-six percent and 38% of EC and OC survivors respectively were aged 70 and over. Treatment did not differ according to age either in OC or EC. The deprivation level did not differ between older and younger survivors with OC while older survivors with EC were more precarious. The physical HRQoL was more altered in older EC survivors. This deterioration concerned only physical functioning (MD = 24, p = 0.012) for OC survivors while it concerned physical functioning (MD = 30, p < 0.0001), role physical (MD = 22, p = 0.001) and bodily pain (MD = 21, p = 0.001) for EC survivors. Global health (MD = 11, p = 0.011) and role emotional (MD = 12, p = 0.018) were also deteriorated in elderly EC survivors. Sexual function was deteriorated regardless of age and cancer location with a more pronounced deterioration in elderly EC survivors for desire (p = 0.005), arousal (p = 0.015) and orgasm (p = 0.007). Social support, anxiety and depression were not affected by age regardless of location. Conclusion An average 6 years after diagnosis, the impact of cancer on HRQoL is greatest in elderly survivors with either EC or OC.
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Affiliation(s)
- Ariane Mamguem Kamga
- Epidemiology and Quality of Life Research Unit, Lipids, Nutrition, Cancer Research Center, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue Professeur Marion, BP 77980, 21079, Dijon Cedex, France
| | - Leila Bengrine-Lefevre
- Medical Oncology Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000, Dijon, France.,Geriatric Oncology Coordination Unit in Burgundy, University Hospital, 21079, Dijon, France
| | - Valérie Quipourt
- Geriatric Oncology Coordination Unit in Burgundy, University Hospital, 21079, Dijon, France.,Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, 21079, Dijon, France
| | - Laure Favier
- Medical Oncology Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000, Dijon, France
| | | | - Sophie Marilier
- Geriatric Oncology Coordination Unit in Burgundy, University Hospital, 21079, Dijon, France.,Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, 21079, Dijon, France
| | - Patrick Arveux
- Epidemiology and Quality of Life Research Unit, Lipids, Nutrition, Cancer Research Center, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue Professeur Marion, BP 77980, 21079, Dijon Cedex, France.,Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, University Paris-Sud, UVSQ Gustave Roussy, Villejuif, France
| | - Isabelle Desmoulins
- Medical Oncology Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000, Dijon, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Epidemiology and Quality of Life Research Unit, Lipids, Nutrition, Cancer Research Center, INSERM U1231, Georges Francois Leclerc Centre - UNICANCER, 1 rue Professeur Marion, BP 77980, 21079, Dijon Cedex, France. .,National Quality of Life and Cancer Platform, Dijon, France.
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11
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Collot T, Niogret J, Carnet M, Chevrier S, Humblin E, Favier L, Bengrine-Lefevre L, Desmoulins I, Arnould L, Boidot R. PARP inhibitor resistance and TP53 mutations in patients treated with olaparib for BRCA-mutated cancer: Four case reports. Mol Med Rep 2020; 23:75. [PMID: 33236159 DOI: 10.3892/mmr.2020.11713] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/30/2020] [Indexed: 11/06/2022] Open
Abstract
Loss‑of‑function BRCA mutations are frequent in high‑grade serous ovarian carcinoma. BRCA1 and ‑2 mutations lead to homologous recombination (HR) deficiency. Poly(ADP‑ribose) polymerases (PARP) are enzymes involved in DNA repair. PARP inhibitors (PARPi) lead to DNA damage accumulation in cells deficient in HR. Olaparib (a PARPi) is currently used for the treatment of high‑grade serous ovarian carcinoma with germline or somatic BRCA mutations; however, numerous patients do not respond or eventually develop resistance to these agents. The TP53 gene encodes the p53 protein, which is often referred to as the 'guardian of the genome'. TP53 mutations at diagnosis are known to promote resistance to chemotherapy. In the present study, four cases of patients with BRCA‑mutated cancer treated with olaparib, who progressed following the PARPi treatment, are reported. Exome analyses were performed on a primary tumor biopsy at diagnosis, then on a progressing metastasis following olaparib treatment. Exome analyses following olaparib treatment identified de novo TP53 mutations, as well as increased frequencies of pre‑existing TP53 mutations compared with the primary tumor. In HCT116 TP53‑/‑ cells carrying BRCA2 pathogenic mutations, TP53 inactivating mutations were associated with lower sensitivity to olaparib in vitro. Thus, inactivating TP53 mutations may be associated to olaparib resistance in the presence of BRCA mutations. In conclusion, the present findings demonstrated resistance to PARPi with de novo TP53 mutations that may be clinically relevant. As TP53 mutations are easily detectable with targeted next‑generation sequencing panels, these may serve as surrogate markers for the onset of PARPi resistance in the context of routine patient management strategies.
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Affiliation(s)
- Thomas Collot
- Department of Oncology, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
| | - Julie Niogret
- Department of Oncology, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
| | - Marion Carnet
- Molecular Biology Unit, Department of Biology and Pathology of Tumors, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
| | - Sandy Chevrier
- Molecular Biology Unit, Department of Biology and Pathology of Tumors, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
| | - Etienne Humblin
- Centre de Recherche, University Bourgogne Franche-Comté, F-21078 Dijon, France
| | - Laure Favier
- Department of Oncology, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
| | - Leila Bengrine-Lefevre
- Department of Oncology, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
| | - Isabelle Desmoulins
- Department of Oncology, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
| | - Laurent Arnould
- Pathology Unit, Department of Biology and Pathology of Tumors, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
| | - Romain Boidot
- Molecular Biology Unit, Department of Biology and Pathology of Tumors, Georges-François Leclerc Cancer Center, UNICANCER, F-21079 Dijon, France
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12
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Aparicio T, Canouï-Poitrine F, Caillet P, François E, Cudennec T, Carola E, Albrand G, Bouvier AM, Petri C, Couturier B, Phelip JM, Bengrine-Lefevre L, Paillaud E. Treatment guidelines of metastatic colorectal cancer in older patients from the French Society of Geriatric Oncology (SoFOG). Dig Liver Dis 2020; 52:493-505. [PMID: 32029404 DOI: 10.1016/j.dld.2019.12.145] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several guidelines dedicated to metastatic colorectal cancer (mCRC) are available. Since 2013 no recent guidelines are specifically dedicated to older patients and based on a systematic review. MATERIALS AND METHODS A multidisciplinary Task Force with digestive oncologists, geriatricians and methodologists from the SoFOG was formed in 2016 to update recommendations on medical treatment of mCRC based on a systematic review of publications from 2000 to 2018. Search strategy has followed a standardized protocol from the formulation of clinical questions and definition of a search algorithm to the selection of complete articles for recommendations. RESULTS The four selected key questions were: For which older patients with mCRC can we considered: (1) Any chemotherapy, (2) Mono or poly-chemotherapy, (3) Anti-angiogenic therapy, (4) Other targeted therapy. Main recommendations for older patients are: (1) Omission of chemotherapy should be discussed with a geriatrician for patients with severe comorbidities, advanced dementia, uncontrolled psychiatric disorder or severe loss of autonomy. (2) If tumor response is not the main aim, a mono-chemotherapy with 5-fluorouracil combined with bevacizumab is recommended as first-line. (3) For patients with symptoms related to metastases or with a planned metastasis ablation, a doublet chemotherapy combined with bevacizumab or anti-EGFR antibody in the context of a RAS wild type tumor is recommended as first-line. Preliminary data suggest that regorafenib may be used, in its registered indication, in patients under 80 with a performance status of 0 and no autonomy alterations and that trifluridine-tipiracil may be used with a tight supervising of hematological function.
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Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, AP-HP, University of Paris, Paris, France.
| | - Florence Canouï-Poitrine
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Philippe Caillet
- Department of Geriatry, Georges Pompidou Hospital, APHP, University of Paris, Paris, France
| | - Eric François
- Department of Medical Oncology, Antoine-Lacassagne Center, University Côte d'Azur, Nice, France
| | - Tristan Cudennec
- Department of Geriatry, Ambroise Paré Hospital, APHP, University Versailles - Saint Quentin, Boulogne-Billancourt, France
| | - Elisabeth Carola
- Department of Medical Oncology, Public Sud de l'Oise Hospital, Creil, France
| | - Gilles Albrand
- Department of Geriatry, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, INSERM UMR1231 EPICAD University of Burgundy Franche Comté, Dijon, France
| | - Camille Petri
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Bérengère Couturier
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, Saint-Etienne Hospital, University Jean Monnet, Saint-Priest-en-Jarez, France
| | | | - Elena Paillaud
- Department of Geriatry, Georges Pompidou Hospital, APHP, University of Paris, Paris, 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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14
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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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Macaire P, Morawska K, Vincent J, Quipourt V, Marilier S, Ghiringhelli F, Bengrine-Lefevre L, Schmitt A. Therapeutic drug monitoring as a tool to optimize 5-FU-based chemotherapy in gastrointestinal cancer patients older than 75 years. Eur J Cancer 2019; 111:116-125. [PMID: 30849685 DOI: 10.1016/j.ejca.2019.01.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/21/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
AIMS Most clinical trials exclude elderly people, leading to a limited understanding of the benefit-to-risk ratio in this population. Despite existing data regarding the oncological management of elderly receiving fluorouracil (5-FU)-based regimen, our objective was to investigate 5-FU exposure/toxicity relationship in patients ≥75 years and compare the effectiveness of 5-FU therapeutic drug monitoring between elderly and younger patients. METHODS Hundred fifty-four patients (31 of whom are older than 75 years) with gastrointestinal cancers, who were to receive 5-FU-based regimens, were included in our study. At cycle 1 (C1), the 5-FU dose was calculated using patient's body surface area, then a blood sample was drawn to measure 5-FU concentration and 5-FU dose was adjusted at the subsequent cycles based on C1 concentration. Assessments of toxicity were performed at the beginning of every cycle. RESULTS Seventy-one percent of elderly patients required dose adjustments after C1, compared with 50% for younger patients. Percentages of patients within 5-FU area under the curve range at cycle 2 were 64% and 68%, respectively, for elderly and younger patients. The proportion of elderly patients experiencing severe toxicities fell from 15% at C1 to only 5% at cycle 3. CONCLUSION Pharmacokinetic-guided 5-FU-dosing algorithm, leading to an improved tolerability while remaining within therapeutic concentration range, is even more valuable for patients older than 75 years than in younger patients.
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Affiliation(s)
- Pauline Macaire
- Pharmacy Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000 Dijon, France; INSERM U1231, University of Burgundy Franche-Comté, 7 Bd Jeanne d'Arc, 21000 Dijon, France
| | - Katarzyna Morawska
- Pharmacy Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000 Dijon, France
| | - Julie Vincent
- Medical Oncology Deparment, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000 Dijon, France
| | - Valérie Quipourt
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, 21079 Dijon, France; Geriatric Oncology Coordination Unit in Burgundy, University Hospital, 21079 Dijon, France
| | - Sophie Marilier
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, 21079 Dijon, France; Geriatric Oncology Coordination Unit in Burgundy, University Hospital, 21079 Dijon, France
| | - François Ghiringhelli
- INSERM U1231, University of Burgundy Franche-Comté, 7 Bd Jeanne d'Arc, 21000 Dijon, France; Medical Oncology Deparment, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000 Dijon, France
| | - Leila Bengrine-Lefevre
- Medical Oncology Deparment, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000 Dijon, France
| | - Antonin Schmitt
- Pharmacy Department, Centre Georges-François Leclerc, 1 rue Pr. Marion, 21000 Dijon, France; INSERM U1231, University of Burgundy Franche-Comté, 7 Bd Jeanne d'Arc, 21000 Dijon, France.
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Devaux M, Gerard L, Richard C, Bengrine-Lefevre L, Vincent J, Schmitt A, Ghiringhelli F. Retrospective evaluation of FOLFIRI3 alone or in combination with bevacizumab or aflibercept in metastatic colorectal cancer. World J Clin Oncol 2019; 10:75-85. [PMID: 30815374 PMCID: PMC6390115 DOI: 10.5306/wjco.v10.i2.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/31/2018] [Accepted: 01/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The treatment of metastatic colorectal cancer (mCRC) relies of chemotherapy. The efficacy of the standard FOLFIRI-therapy could be improved by a modification of the regimen by splitting the dose of irinotecan on day 1 and day 3 in the FOLFIRI3 regimen.
AIM To determine safety and efficacy of FOLFIRI3 regimen.
METHODS This is a monocentric retrospective study evaluating the efficacy and safety of the FOLFIRI3 regimen given alone or in combination with bevacizumab or aflibercept in patients with previously treated mCRC.
RESULTS One hundred and fifty-three consecutive patients were included (18 treated with FOLFIRI3, 99 with FOLFIRI3 plus bevacizumab and 36 with FOLFIRI3 plus aflibercept). The overall response rate (ORR) and disease control rate were 51% and 62%, respectively. Similar ORRs were observed in all 3 cohorts. Median progression-free survival (PFS) and overall survival (OS) were 3.9 mo (95%CI: 3.2-4.9) and 9.4 mo (95%CI: 6.6-12), respectively. Median PFS and OS values were improved in the FOLFIRI3 plus aflibercept group. The most common grade 3-4 adverse events were diarrhoea (21.6%) and neutropenia (11.8%), and these toxicities were more frequent in the FOLFIRI3 plus aflibercept group. According to the multivariate Cox proportional model, previous surgery of metastasis and aflibercept were associated with outcomes.
CONCLUSION The modification of the FOLFIRI regimen impacted treatment response of mCRC patients. The addition of an antiangiogenic agent, in particular aflibercept, enhanced the clinical benefit and improved survival.
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Affiliation(s)
- Madeline Devaux
- Department of Medical Oncology, Centre George François Leclerc, Dijon 21000, France
| | - Laura Gerard
- Department of Medical Oncology, Centre George François Leclerc, Dijon 21000, France
| | - Corentin Richard
- Platform of Transfer in Biological Oncology, Centre George François Leclerc, Dijon 21000, France
| | | | - Julie Vincent
- Department of Medical Oncology, Centre George François Leclerc, Dijon 21000, France
| | - Antonin Schmitt
- Department of Medical Oncology, Centre George François Leclerc, Dijon 21000, France
| | - François Ghiringhelli
- Department of Medical Oncology, Centre George François Leclerc, Dijon 21000, France
- Platform of Transfer in Biological Oncology, Centre George François Leclerc, Dijon 21000, France
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Morawska K, Goirand F, Marceau L, Devaux M, Cueff A, Bertaut A, Vincent J, Bengrine-Lefevre L, Ghiringhelli F, Schmitt A. 5-FU therapeutic drug monitoring as a valuable option to reduce toxicity in patients with gastrointestinal cancer. Oncotarget 2018; 9:11559-11571. [PMID: 29545919 PMCID: PMC5837758 DOI: 10.18632/oncotarget.24338] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 09/29/2017] [Accepted: 01/23/2018] [Indexed: 12/13/2022] Open
Abstract
Aims 5-FU is used as the main backbone of chemotherapy regimens for patients with colorectal and other gastrointestinal cancers. Despite development of new strategies that allowed enhancing clinical effectiveness and tolerability of 5-FU, 10-30% of patients treated with 5-FU-based regimens experience severe treatment-related toxicity. In our study, we evaluated the 5-FU exposure-toxicity relationship and investigated the efficacy of PK-guided dosing in increasing tolerability of 5-FU-based chemotherapy. Results 50.7% of patients required dose adjustments after cycle 1. Percentage of patients within 5-FU AUC range was 49.3%, 66.9%, 61.0% at cycle 1, 2 and 3 respectively (p = 0.002 cycle 1 vs cycle 2). At all 3 cycles, lower incidences of grade I/II toxicities were observed for patients below or within range compared with those above range (19.4% vs 41.3%, p < 0.001 respectively). Conclusions Our analysis confirms that the use of BSA-guided dosing results in highly variable 5-FU exposure and strongly suggests that PK-guided dosing can improve tolerability of 5-FU based chemotherapy in patients with gastrointestinal cancers, thus supporting 5-FU therapeutic drug monitoring. Methods 155 patients with gastrointestinal cancers, who were to receive 5-FU-based regimens were included in our study. At cycle 1, the 5-FU dose was calculated using patient's Body Surface Area (BSA) method. A blood sample was drawn on Day 2 to measure 5-FU concentration. At cycle 2, the 5-FU dose was adjusted using a PK-guided dosing strategy targeting a plasma AUC range of 18-28 mg·h/L, based on cycle 1 concentration. Assessments of toxicity was performed at the beginning of every cycle.
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Affiliation(s)
| | - Françoise Goirand
- Laboratoire de Pharmacologie/Toxicologie, CHU de Dijon, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | | | | | - Adèle Cueff
- Centre Georges-François Leclerc, Dijon, France
| | - Aurélie Bertaut
- Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | | | | | - François Ghiringhelli
- Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
| | - Antonin Schmitt
- Centre Georges-François Leclerc, Dijon, France.,INSERM U1231, University of Burgundy Franche-Comté, Dijon, France
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Germain V, Dabakuyo-Yonli TS, Marilier S, Putot A, Bengrine-Lefevre L, Arveux P, Manckoundia P, Quipourt V. Management of elderly patients suffering from cancer: Assessment of perceived burden and of quality of life of primary caregivers. J Geriatr Oncol 2016; 8:220-228. [PMID: 27974265 DOI: 10.1016/j.jgo.2016.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/30/2016] [Accepted: 12/01/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the perceived burden and the quality of life (QoL) at 3 and 6months of the primary caregiver (PC) of patients aged 70 and over suffering from cancer and the predictors of QoL in this population. METHODS In this prospective observational study, 98 patients aged 70 and older with cancer and 96 PCs were included between 01/06/2014 and 18/03/2015. The Medical Outcomes Study 12-item Short Form Health Survey (SF-12) was used to assess the QoL of PCs and the Zarit Burden Interview (ZBI) was used to measure the perceived burden at 3 and 6months. The major determinants of QoL were identified using mixed linear models for the dimensions of the SF-12 that showed an average difference of at least 5 points between baseline and follow-up at 6months. RESULTS The QoL scores of PCs showed a decrease in the dimensions "role emotional" and "bodily pain" over 6months. In multivariate analysis, the main determinants of QoL for "role emotional" were the PC's age (p=0.005), a low perceived burden (p<0.0001) and a functionally independent patient (p=0.01), and for "bodily pain" was a low perceived burden (p<0.0001) and the non-use of hormone therapy during the treatment (p<0.0001). CONCLUSION The main determinants of the QoL of PCs concerned factors inherent to the PC (age and perceived burden) and patient (functional independence).
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Affiliation(s)
- Victor Germain
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France; Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Côte d'Or Breast and Gynaecological Cancer Registry, Centre George François Leclerc, 1 rue du Professeur Marion, BP 77980, Dijon Cedex, France; National Clinical Research Platform for Quality of Life in Oncology, France
| | - Sophie Marilier
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France; Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France
| | - Alain Putot
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France; Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France
| | - Leila Bengrine-Lefevre
- Medical Oncology Department, Centre George François Leclerc, 1 rue du Professeur Marion, BP 77980, Dijon Cedex, France
| | - Patrick Arveux
- Côte d'Or Breast and Gynaecological Cancer Registry, Centre George François Leclerc, 1 rue du Professeur Marion, BP 77980, Dijon Cedex, France; National Clinical Research Platform for Quality of Life in Oncology, France
| | - Patrick Manckoundia
- Department of Geriatric Rehabilitation, Hospital of Champmaillot, University Hospital, Dijon F-21079, France; UMR Inserm/U1093 Cognition, Action, Sensorimotor Plasticity, University of Burgundy, Dijon, France.
| | - Valérie Quipourt
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France; Geriatric Oncology Coordination Unit in Burgundy, University Hospital, Dijon, France
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Guion-Dusserre JF, Bertaut A, Ghiringhelli F, Vincent J, Quipourt V, Marilier S, Tharin Z, Bengrine-Lefevre L. Folfirinox in elderly patients with pancreatic or colorectal cancer-tolerance and efficacy. World J Gastroenterol 2016; 22:9378-9386. [PMID: 27895425 PMCID: PMC5107701 DOI: 10.3748/wjg.v22.i42.9378] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/14/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To study the tolerance and the efficiency of FOLFIRINOX in elderly patients diagnosed with colorectal or pancreatic cancer.
METHODS This retrospective study included elderly patients aged over 70 years of age treated at Georges-Francois Leclerc Center by FOLFIRINOX for histological proved colorectal or pancreatic cancer between January 2009 and January 2015. Chemotheapy regimen consisted of oxaliplatin (85 mg/m2 in over 120 min) followed by leucovorin (400 mg/m2 in over 120 min), with the addition, after 30 min of irinotecan (180 mg/m2 in over 90 min) then 5 fluorouracil (5FU) (400 mg/m2 administred intravenous bolus), followed by 5FU (2400 mg/m2 intraveinous infusion over 46 h) repeated every 2 wk. Geriatric parameters were recorded at the beginning. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events 4.03. Tumor response was evaluated by CT scan. Treatment continued until disease progression, unacceptable toxicities or patient refusal.
RESULTS Fifty-two patients aged from 70 to 87 years were treated by FOLFIRINOX, 34 had colorectal cancer and 18 had pancreatic cancer. Most of them were in good general condition, 82.7% had a 0-1 performance status and 61.5% had a Charlson Comorbidity Index < 10. The most frequent severe toxicities were neutropenia (17 patients, n = 32.7%) and diarrhea (35 patients n = 67.3%); 10 of the case of neutropenia and 5 of diarrhea registered a grade 4 toxicity. Thirty-nine patients (75%) initially received an adapted dose of chemotherapy. The dosage was adjusted for 26% of patients during the course of treatment. Tumor response evaluated by RECIST criteria showed a controlled disease for 25 patients (48.1%), a stable disease for 13 and a partial response for 12 patients. Time under treatment was higher for colorectal cancer with a median time of 2.44 mo (95%CI: 1.61-3.25). Overall survival was 43.88 mo for colorectal cancer and 12.51 mo for pancreatic cancer. In univariate or multivariate analysis, none of geriatric parameters were linked to overall survival. Only the type of tumor (pancreatic/colorectal) was linked in both analysis.
CONCLUSION For people over 70 years old, FOLFIRINOX regimen seems to induce manageable toxicities but similar, even higher, median survival rates compared to younger people.
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Limagne E, Euvrard R, Thibaudin M, Rébé C, Derangère V, Chevriaux A, Boidot R, Végran F, Bonnefoy N, Vincent J, Bengrine-Lefevre L, Ladoire S, Delmas D, Apetoh L, Ghiringhelli F. Accumulation of MDSC and Th17 Cells in Patients with Metastatic Colorectal Cancer Predicts the Efficacy of a FOLFOX-Bevacizumab Drug Treatment Regimen. Cancer Res 2016; 76:5241-52. [PMID: 27496709 DOI: 10.1158/0008-5472.can-15-3164] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 07/05/2016] [Indexed: 01/08/2023]
Abstract
Host immunity controls the development of colorectal cancer, and chemotherapy used to treat colorectal cancer is likely to recruit the host immune system at some level. Athough preclinical studies have argued that colorectal cancer drugs, such as 5-fluorouracil (5-FU) and oxaliplatin, exert such effects, their combination as employed in the oncology clinic has not been evaluated. Here, we report the results of prospective immunomonitoring of 25 metastatic colorectal cancer (mCRC) patients treated with a first-line combination regimen of 5-FU, oxaliplatin, and bevacizumab (FOLFOX-bevacizumab), as compared with 20 healthy volunteers. Before this therapy was initiated, T regulatory cells (Treg), Th17, and granulocytic myeloid-derived suppressor cells (gMDSC) were increased significantly in mCRC, but only a high level of gMDSC was associated with a poor prognosis. Chemotherapy modulated the Treg/Th17 balance by decreasing Treg and increasing Th17 cell frequency by 15 days after the start of treatment. Increased Th17 frequency was associated with a poor prognosis. FOLFOX-bevacizumab treatment elicited a decrease in gMDSC in 15 of 25 patients and was associated with a better survival outcome. Notably, the gMDSCs that expressed high levels of PD-L1, CD39, and CD73 exerted a robust immunosuppressive activity, relative to other myeloid cells present in blood, which could be reversed by blocking the CD39/CD73 and PD-1/PD-L1 axes. Our work underscores the critical prognostic impact of early modifications in Th17 and gMDSC frequency in mCRC. Furthermore, it provides a clinical rationale to combine FOLFOX-bevacizumab chemotherapy with inhibitors of ATP ectonucleotidases and/or anti-PD-1/PD-L1 antibodies to more effectively treat this disease. Cancer Res; 76(18); 5241-52. ©2016 AACR.
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Affiliation(s)
- Emeric Limagne
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France. Plateforme de Transfert en Biologie Cancérologique, CGFL, Dijon, France.
| | - Romain Euvrard
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France
| | - Marion Thibaudin
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France
| | - Cédric Rébé
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France. Plateforme de Transfert en Biologie Cancérologique, CGFL, Dijon, France
| | - Valentin Derangère
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France. Plateforme de Transfert en Biologie Cancérologique, CGFL, Dijon, France
| | - Angélique Chevriaux
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France. Plateforme de Transfert en Biologie Cancérologique, CGFL, Dijon, France
| | - Romain Boidot
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France. Plateforme de Transfert en Biologie Cancérologique, CGFL, Dijon, France
| | - Frédérique Végran
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France. Plateforme de Transfert en Biologie Cancérologique, CGFL, Dijon, France
| | - Nathalie Bonnefoy
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France. INSERM U1194, Université de Montpellier, Montpellier, France. OREGA Biotech, Ecully, France
| | | | | | - Sylvain Ladoire
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France. Plateforme de Transfert en Biologie Cancérologique, CGFL, Dijon, France
| | - Dominique Delmas
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France
| | - Lionel Apetoh
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France
| | - François Ghiringhelli
- INSERM, U866, Dijon, France. UFR des Sciences de Santé, Université de Bourgogne-Franche Comté, Dijon, France. Centre Georges François Leclerc, Dijon, France. Plateforme de Transfert en Biologie Cancérologique, CGFL, Dijon, France.
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Malka D, Castan F, Francois E, Bouche O, Bennouna J, Ghiringhelli F, De La Fouchardiere C, Borg C, Samalin E, Bachet JB, Raoul JL, Cvitkovic F, Miglianico L, Bengrine-Lefevre L, Dahan L, Lecaille C, Aparicio T, Perrier H, Gourgou S, Taïeb J. FOLFOX alone or combined to rilotumumab or panitumumab as first-line treatment in patients (pts) with advanced gastroesophageal adenocarcinoma (AGEA): An open-label, randomized phase II trial (PRODIGE 17 ACCORD 20 MEGA). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.4013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Florence Castan
- Biometrics Department, Institut du Cancer Montpellier, Montpellier, France
| | - Eric Francois
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Olivier Bouche
- Centre Hospitalier Universitaire Robert Debré, Reims, France
| | | | | | | | | | | | | | - Jean-Luc Raoul
- Service d'Oncologie Médicale, Institut Paoli Calmette, Marseille, France
| | | | | | | | - Laetitia Dahan
- La Timone, Marseille University Hospital, Marseille, France
| | | | - Thomas Aparicio
- Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France
| | | | - Sophie Gourgou
- Biostatistics Unit, CTD INCa, ICM-Montpellier Cancer Institute, Montpellier, France
| | - Julien Taïeb
- APHP and Paris Descartes University, Paris, France
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Chibaudel B, Tournigand C, Bonnetain F, Maindrault-Goebel F, Lledo G, André T, Larsen AK, Bengrine-Lefevre L, Louvet C, de Gramont A. Platinum-sensitivity in metastatic colorectal cancer: Towards a definition. Eur J Cancer 2013; 49:3813-20. [DOI: 10.1016/j.ejca.2013.07.150] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/29/2013] [Accepted: 07/31/2013] [Indexed: 11/16/2022]
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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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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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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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Mitry E, Walter T, Baudin E, Kurtz JE, Ruszniewski P, Dominguez S, Bengrine-Lefevre L, Cadiot G, Kraemer S, Ducreux M. Efficacy and safety of bevacizumab combined with capecitabine in progressive, metastatic well-differentiated digestive endocrine tumors (BETTER study). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4071 Background: Neuroendocrine digestive tumors are highly vascularized neoplasms known to express the vascular endothelial growth factor (VEGF). We assessed the activity of bevacizumab (Bv), a monoclonal antibody directed against VEGF combined with capecitabine (CAP). Methods: In this multicenter, open-label, non-randomized, two-group phase II trial, one group assessed Bv (7.5 mg/m² on d1/3 weeks) combined with CAP (1,000 mg/m2 twice daily, orally d1-14, resumed on day 22). Eligible patients (pts) had progressive, metastatic well-differentiateddigestive tract endocrine tumors (WHO 2000 classification), ECOG-PS ≤2, Ki 67 index < 15%, no prior systemic chemotherapy and acceptable organ functions. The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival, response rate, safety and quality of life. Pts were treated for a minimum of 6 months and study duration was 24 months. Results: From Jun 2007 to Oct 2009, 49 pts were enrolled, 26 (53.1%) were men; median age 60.3 years (41.2-82.3); ECOG-PS was 0/1 in 46 (93.9%) pts. Primary tumor site was: small intestine 40 (81.6%) pts, caecum 3 (6.1%), rectum 4 (8.2%) and stomach 2 (4.1%). Ki-67 proliferative index was 0-2% in 17 (35.4%) pts, 3-4% in 14 (29.2%), 5-9% in 13 (27.1%), 10-14% in 4 (8.3%) Metastatic sites were liver: 46 (93.9%) pts, lymph nodes: 24 (49.0%), peritoneum 23 (46.9%). Median treatment duration was 13.8 months; median number of cycles was 19. At 24 months, median PFS was 23.4 months [95%CI: 13.2; not reached] based on 26 events. PFS rate at 18 months was 55%. Tumor control rate was 87.8% (n=43) including partial response in 9 (18.4%) pts and stable disease in 34 (69.4%) pts. Survival rate at 24 months was 85%, median overall survival was not reached, 8 patients died. CTC grade 3/4 Adverse Events (AEs) occurred in 41 (83.7%) pts, mainly digestive 14 (28.6%) pts. Main G3/4 Bv targeted AE was hypertension in 15 (30.6%) pts. Conclusions: In this chemotherapy resistant tumor, the combination of capecitabine and bevacizumab, assessed in a phase II study, shows such encouraging results that this combination may become a reference in the medical treatment of ileal NET.
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Chibaudel B, Bonnetain F, Tournigand C, Bengrine-Lefevre L, Teixeira L, Artru P, Desramé J, Larsen AK, André T, Louvet C, de Gramont A. Simplified prognostic model in patients with oxaliplatin-based or irinotecan-based first-line chemotherapy for metastatic colorectal cancer: a GERCOR study. Oncologist 2011; 16:1228-38. [PMID: 21859820 DOI: 10.1634/theoncologist.2011-0039] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The present study was done to establish a prognostic model for patients and trials using an oxaliplatin-based or irinotecan-based first-line chemotherapy in metastatic colorectal cancer. PATIENTS AND METHODS Eight hundred three patients treated with FOLFOX or FOLFIRI in three prospective trials were randomly separated into learning (n = 535) and validation (n = 268) samples. Eleven baseline variables were evaluated in univariate and multivariate analysis as prognostic factors for overall survival, and a prognostic score was developed. RESULTS Independent prognostic factors identified in multivariate analysis for overall survival were performance status (PS) (p < .001), serum lactate dehydrogenase (LDH) (p < .001), and number of metastatic sites (p = .005). A prognostic score based on these three variables was found efficient (Harrell's C index 0.61). This new model was improved by selecting only PS and LDH (Harrell's C index 0.64). Three risk groups for death could be identified: a low-risk group (n = 184; median overall survival [OS] 29.8 months), an intermediate-risk group (n = 223; median OS 19.5 months), and a high-risk group (n = 128; median OS 13.9 months). Median survival for the low-, intermediate-, and high-risk groups were 26.8, 21.1, and 16.5 months, respectively, in the validation sample (Harrell's C index 0.63). CONCLUSIONS Serum LDH level was the main prognostic factor in predicting survival, followed by WHO PS. We identified three risk groups for death depending on these two baseline parameters. This simple prognostic model can be useful for clinician's use and patient stratification in future clinical trials.
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Affiliation(s)
- Benoist Chibaudel
- Department of Medical Oncology, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France.
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28
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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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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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Baylatry MT, Joly AC, Pelage JP, Bengrine-Lefevre L, Prugnaud JL, Laurent A, Fernandez C. Simple liquid chromatography method for the quantification of irinotecan and SN38 in sheep plasma: application to in vivo pharmacokinetics after pulmonary artery chemoembolization using drug eluting beads. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:738-42. [PMID: 20171941 DOI: 10.1016/j.jchromb.2010.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/09/2010] [Accepted: 01/16/2010] [Indexed: 11/26/2022]
Abstract
A rapid and simple liquid chromatography-fluorescence detection (LC-FD) method was developed and validated for the simultaneous quantification of irinotecan (CPT11) and SN38 in sheep plasma. Camptothecin (CPT) was used as the internal standard. A single step protein precipitation with acetonitrile was used for sample preparation. The separation was achieved using a 5 microm C18 column (250 mm x 4.5 mm, 5 microm) with a mobile phase composed of 36 mM sodium dihydrogen phosphate dehydrate and 4 mM sodium 1 heptane sulfonate-acetonitrile (72:28), the pH of the mobile phase was adjusted to 3. The flow rate was 1.45 mL/min and the fluorescence detection was operated at 355/515 nm (excitation/emission wavelengths). The run time was 13 min. The method was validated with respect to selectivity, extraction recovery, linearity, intra- and inter-day precision and accuracy, limit of quantification and stability. The method has a limit of quantification of 5 ng/mL for both CPT11 and SN38. The assay was linear over concentrations ranging from 5 to 5000 ng/mL and to 240 ng/mL for CPT11 and SN38, respectively. This method was used successfully to perform plasma pharmacokinetic studies of CPT11 after pulmonary artery embolization (PACE) in a sheep model. It was also validated for CPT11 and SN38 analysis in sheep lymph and human plasma.
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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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