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Chibaudel B, Dourthe LM, Andre T, Henriques J, Bourgeois V, Etienne PL, Desrame J, Carola E, Dupuis O, Baba-Hamed N, Auby D, Louvet C, Maillard E, Romano O, Tournigand C, Garcia-Larnicol ML, Shmueli ES, Healey Bird B, Ghiringhelli F, De Gramont A. STRATEGIC-1: Multi-line therapy trial in unresectable wild-type KRAS/NRAS/BRAF metastatic colorectal cancer—A GERCOR-PRODIGE randomized open-label phase III study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3504 Background: The management of unresectable metastatic colorectal cancer (mCRC) is a comprehensive treatment strategy involving several lines of therapy, maintenance, salvage surgery, and treatment-free intervals. Besides chemotherapy (fluoropyrimidine, oxaliplatin, irinotecan), anti-angiogenic and anti-epidermal growth factor receptor (EGFR) agents have become available. Ultimately, strategy trials are needed to define the optimal use and the best sequencing of these agents. Methods: Patients with previously untreated RAS/BRAF wild-type unresectable mCRC were randomly assigned (1:1 ratio) to receive either FOLFIRI-cetuximab followed by mFOLFOX6-bevacizumab (arm A) or OPTIMOX-bevacizumab followed by FOLFIRI-bevacizumab followed by EGFR mab +/- irinotecan (arm B). This trial was designed as a superiority study (hypothesis arm B > arm A) with Duration of Disease Control (DDC) as primary endpoint, defined as the sum of PFS of each active sequence of treatment (Chibaudel B, J Clin Oncol, 2011). Secondary endpoints were overall survival (OS), Time to Failure of Strategy (TFS), Progression-free survival (PFS) and response rate (RECIST version 1.1) per sequence, salvage surgery rate, safety, and Quality of life (QoL). Results: Between October 2013 and May 2019, 263 eligible patients were randomized (arm A, n = 131; arm B, N = 132). After a median follow-up of 51.2 months (95% CI 43.3-57.4), 188 events for DDC were observed. Efficacy outcomes are presented in table. Median DDC was similar in both arms (HR 0.97, 95% CI 0.72-1.29; P = 0.805). Salvage surgery for metastasis (+/- radiofrequency ablation) was done in 36 (27.5%) patients in arm A and 28 (21.2%) in arm B. Median time until definitive deterioration of QoL (global health status) were 18.3 and 18.0 months (P = 0.628). The safety profiles were consistent with the established safety profiles of each treatment regimen. Conclusions: STRATEGIC-1 is the first randomized phase III study comparing multi-line standard treatment strategies in patients with KRAS/NRAS/BRAF wild-type mCRC. This study did not meet its primary endpoint of DDC. The treatment strategy starting with FOLFIRI-cetuximab followed by mFOLFOX6-bevacizumab led to higher response rates and to a trend for better median OS exceeding 3 years. These findings may add to our understanding of treatment sequencing in mCRC. Clinical trial information: NCT01910610. [Table: see text]
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Affiliation(s)
- Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Thierry Andre
- Department of Medical Oncology, Hopital Saint-Antoine, APHP, Paris, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | | | - Pierre-Luc Etienne
- Medical Oncology Department, Hôpital Privé des Côtes d'Armor, Plerin, France
| | - Jérôme Desrame
- Cancerology Institute, Hôpital Privé Jean Mermoz, Lyon, France
| | - Elisabeth Carola
- Pôle d'Oncologie Médicale, Groupe Hospitalier Public du Sud de l'Oise, Creil, France
| | | | - Nabil Baba-Hamed
- Medical Oncology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Dominique Auby
- Department of Medical Oncology, CH de Mont-de-Marsan, Hospital Layné, Mont-De-Marsan, France
| | - Christophe Louvet
- Medical Oncology Department, Institut Mutualiste Montsouris, Paris, France
| | | | - Olivier Romano
- Medical Oncology Department, Lille Metropole Cancer Institute, Villeneuve D'ascq, France
| | | | | | - Einat Shacham Shmueli
- Cancer center, The Chaim Sheba Medical Center, Ramat Gan, Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Brian Healey Bird
- Bon Secours Hospital Cork, Cancer Trials Ireland, and University College Cork, Cork, Ireland
| | - François Ghiringhelli
- Medical Oncology Department, Centre Georges-François Leclerc, University of Bourgogne Franche-Comté, Dijon, France
| | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
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Boisteau E, François E, Aparicio T, Le Malicot K, Boulahssass R, Lecomte T, Laurent-Puig P, Guiu B, Paillaud E, Galais MP, Lopez-Trabada Ataz D, Tougeron D, Dourthe LM, Guimbaud R, Samalin E, Moreau M, Louvet C, Lepage C, Lièvre A. SOCRATE-PRODIGE 55 trial: A randomized phase II study to evaluate second-line ramucirumab alone or with paclitaxel in older patients with advanced gastric cancer. Dig Liver Dis 2022; 54:747-754. [PMID: 35351371 DOI: 10.1016/j.dld.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patients ≥ 70 years old constitute 40% of patients with advanced gastric cancer (GC). Ramucirumab plus Paclitaxel is a therapeutic option validated in the second-line treatment of advanced GC, but as older patients are at higher risk of severe toxicity, due to comorbidities and/or frailty, we aimed to evaluate second-line Ramucirumab alone or combined with Paclitaxel in terms of overall survival (OS) and quality of life (QoL) in patients ≥ 70 years-old with advanced GC. METHODS In this multicenter, randomized, open-label, non-comparative, prospective phase II clinical trial, the main inclusion criteria are: patients ≥ 70 years old, with advanced GC having progressed after first-line chemotherapy or in the six months following the last administration of adjuvant chemotherapy, with WHO performance status <2. They are randomized to receive either ramucirumab alone (arm A) or ramucirumab plus Paclitaxel (arm B). The primary endpoint is 6-month OS and QoL evaluated with the EORTC QLQ-ELD14 questionnaire. The secondary endpoints include other parameters of QoL, time to definitive deterioration (TTDD) in QoL and TTDD in autonomy, treatment toxicities, other parameters of survival and disease control, identification of geriatric and nutritional prognostic scores and predictive factors of treatment safety and efficacy. OS of 60% is expected at 6 months (H0:40%). Using a Simon-minimax design, with one-sided α risk of 2% and 80% power for OS, and considering 5% lost to follow-up, it is necessary to randomize 56 patients in each arm. PERSPECTIVES As older patients are at higher risk of chemotherapy toxicity, ramucirumab alone could be an interesting alternative to Paclitaxel plus ramucirumab, as a second-line therapy for patients ≥ 70 years old with advanced GC, and needs to be evaluated.
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Affiliation(s)
- Emeric Boisteau
- Service des Maladies de l'Appareil Digestif, INSERM U1242, CHU de Rennes, CHU Pontchaillou, Université de Rennes 1, Rennes Cedex9 35033, France
| | - Eric François
- Service d'Oncologie, Center Antoine Lacassagne, Nice, France
| | - Thomas Aparicio
- Service de Gastroentérologie, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
| | - Karine Le Malicot
- FFCD EPICAD INSERM LNC-UMR 1231, Université de Bourgogne Franche-Comté Dijon, France
| | | | - Thierry Lecomte
- Service d'Hépato-Gastroentérologie, CHU de Tours, Tours, France; INSERM UMR 1069, "Nutrition, Croissance et Cancer", Université de Tours, France
| | - Pierre Laurent-Puig
- INSERM U 775 - Faculté des Sciences Fondamentales et Biomédicales, Center Universitaire des Saints-Pères, Université des Saints Pères, Paris Descartes, Paris, France
| | - Boris Guiu
- Département de Radiologie, CHU St-Eloi, Montpellier, France
| | - Elena Paillaud
- Hôpital Européen Georges Pompidou, Service de Gériatrie, APHP, Paris Cancer Institute CARPEM, Paris 75015, France
| | | | | | - David Tougeron
- Service d'Hépato-gastroentérologie, CHU de Poitiers, La Milétrie, et l'Université de Poitiers, Poitiers, France
| | | | - Rosine Guimbaud
- Département d'Oncologie Médicale, Pôle Digestif, CHU Toulouse, Toulouse, France
| | - Emmanuelle Samalin
- Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Marie Moreau
- Fédération Francophone de Cancérologie Digestive (FFCD), Dijon, France
| | - Christophe Louvet
- Service d'Oncologie Médicale, Institut Mutualiste Montsouris, Paris, France
| | - Côme Lepage
- Service d'Hépato-gastroentérologie, CHU de Dijon, Dijon, France
| | - Astrid Lièvre
- Service des Maladies de l'Appareil Digestif, INSERM U1242, CHU de Rennes, CHU Pontchaillou, Université de Rennes 1, Rennes Cedex9 35033, France.
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Thiery-Vuillemin A, Gravis G, Schlürmann F, Bompas E, Rolland F, Gross-Goupil M, Vano YA, Guillot A, Barthélémy P, Joly C, Laramas M, Dourthe LM, Maurina T, Gauthier H, Taillandy K, Meurisse A, Vernerey D, Albiges L. Randomized phase II study to assess the efficacy and tolerability of sunitinib by dose administration regimen in anti-angiogenic naïve patients with metastatic renal cell carcinoma (mRCC): Final analysis of SURF study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
344 Background: SUN is approved in mRCC setting at the dose of 50mg daily for 4 weeks followed by 2 weeks rest (4/2 schedule). The 4/2 schedule often requires dose modifications for toxicity. Current recommendation is to reduce the dose to 37.5mg per day. Alternative schedules (2 weeks of treatment followed by one-week rest (2/1 schedule) have shown promising results. SURF trial evaluated prospectively schedule 2/1 when toxicity occurs. Methods: SURF [NCT02689167] is a prospective, non-comparative randomized study. Patients (pts) with mRCC (clear cell) were included at SUN initiation. When a dose adjustment of SUN was required, patients were randomized between 4/2 schedule at 37.5mg daily and experimental 2/1 schedule at 50mg daily. Primary objective was to assess duration of SUN treatment among the 73 first evaluable pts. Overall 226 pts were enrolled with 133 randomized. All other analyses are shown for the 133 randomized patients. Results: Pts were 75.2% males, with a median age 63.7 years for 94% with a Karnofsky ≥ 80%. Of them, 54.9% had partial/total nephrectomy. IMDC risk score was favourable (45.1%), intermediate (46.6%) or poor (8.3%). Pts characteristics were well balanced between 2 arms. Metastatic sites were lungs (60.5%), bones (16.3%), lymph nodes (15.5%). At 6 months, 48 patients (65.8%) of the 2/1 schedule were still on treatment (above predefined threshold for positivity). Other data are listed on the table. No new safety signal was identified. Permanent SUN discontinuation due to toxicity was 22.2% in control arm vs 12.3% in experimental arm. Conclusions: SURF is the largest prospective randomised trial evaluating two different SUN schedules modifications in mRCC in case of toxicity. This positive trial confirms the role of adapting SUN to a 2/1 schedule rather than reducing SUN dose to the classical 4/2 schedule. Clinical trial information: NCT02689167. [Table: see text]
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Affiliation(s)
| | | | | | | | - Frederic Rolland
- Institut de Cancérologie de l'Ouest, Department of Medical Oncology, Saint-Herblain, France
| | - Marine Gross-Goupil
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux, France
| | - Yann-Alexandre Vano
- Department of Medical Oncology, Georges Pompidou Hospital, University Paris Descartes, Paris, France
| | - Aline Guillot
- Institut de Cancerologie Lucien Neurwith, Saint-Etienne, France
| | | | - Charlotte Joly
- Oncology Department, Hôpital Henri Mondor, APHP, Créteil, France
| | | | | | | | | | | | - Aurelia Meurisse
- Methodology and Quality of Life Unit, Department of Oncology University Hospital, Besancon, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, Department of Oncology, University Hospital of Besancon, Besançon, France
| | - Laurence Albiges
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
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Payne H, Robinson A, Rappe B, Hilman S, De Giorgi U, Joniau S, Bordonaro R, Mallick S, Dourthe LM, Flores MM, Gumà J, Baron B, Duran A, Pranzo A, Serikoff A, Mott D, Herdman M, Pavesi M, De Santis M. A European, prospective, observational study of enzalutamide in patients with metastatic castration-resistant prostate cancer: PREMISE. Int J Cancer 2021; 150:837-846. [PMID: 34648657 PMCID: PMC9298797 DOI: 10.1002/ijc.33845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/12/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022]
Abstract
In randomized clinical trials, the androgen‐receptor inhibitor enzalutamide has demonstrated efficacy and safety in metastatic castration‐resistant prostate cancer (mCRPC). This study captured efficacy, safety and patient‐reported outcomes (PROs) of enzalutamide in mCRPC patients in a real‐world European setting. PREMISE (NCT0249574) was a European, long‐term, prospective, observational study in mCRPC patients prescribed enzalutamide as part of standard clinical practice. Patients were categorized based on prior docetaxel and/or abiraterone use. The primary endpoint was time to treatment failure (TTF), defined as time from enzalutamide initiation to permanent treatment discontinuation for any reason. Secondary endpoints included prostate‐specific antigen (PSA) response, time to PSA progression, time to disease progression and safety. PROs included EuroQol 5‐Dimension, 5‐Level questionnaire, Functional Assessment of Cancer Therapy—Prostate and Brief Pain Inventory—Short Form. Overall, 1732 men were enrolled. Median TTF with enzalutamide was 12.9 months in the chemotherapy‐ and abiraterone‐naïve cohort (Cohort 1) and 8.4 months in the postchemotherapy and abiraterone‐naïve cohort (Cohort 2). Clinical outcomes based on secondary endpoints also varied between cohorts. Cohorts 1 and 2 showed small improvements in health‐related quality of life and pain status. The proportions of patients reporting treatment‐emergent adverse events (TEAEs) were 51.0% and 62.2% in Cohorts 1 and 2, respectively; enzalutamide‐related TEAEs were similar in both cohorts. The most frequent TEAE across cohorts was fatigue. These data from unselected mCRPC patients in European, real‐world, clinical‐practice settings confirmed the benefits of enzalutamide previously shown in clinical trial outcomes, with safety results consistent with enzalutamide's known safety profile.
What's new?
In clinical trials, the androgen‐receptor inhibitor enzalutamide has demonstrated efficacy and safety in metastatic castration‐resistant prostate cancer (mCRPC). However, results in the real world may differ from those in controlled studies. This large, prospective study thus assessed unselected mCRPC patients with different prior treatment histories, who were then treated with enzalutamide. The results confirm and validate the benefits of enzalutamide in real‐world, clinical‐practice settings that were previously seen in clinical‐trial outcomes. These include improved health‐related quality of life (HRQoL).
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Affiliation(s)
- Heather Payne
- Department of Oncology, University College Hospital, London, UK
| | - Angus Robinson
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | | | - Serena Hilman
- Department of Oncology, Weston General Hospital, Weston-super-Mare, UK
| | - Ugo De Giorgi
- Department of Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Moisés Mira Flores
- Department of Radiotherapy Oncology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Josep Gumà
- Oncology Institute of Southern Catalonia, Sant Joan University Hospital, IISPV, URV, Reus, Spain
| | | | | | | | | | | | | | - Marco Pavesi
- Office of Health Economics, London, UK.,Data Center, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
| | - Maria De Santis
- Department of Urology, Charité University Hospital, Berlin, Germany.,Medical University of Vienna, Vienna, Austria
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Metges JP, Genet D, Tougeron D, Ligeza C, Ducreux M, Borg C, Guimbaud R, Phelip JM, Dourthe LM, Kim S. Real-world safety and effectiveness of regorafenib in metastatic colorectal cancer: the French CORRELATE cohort. Future Oncol 2021; 17:3343-3353. [PMID: 34011165 DOI: 10.2217/fon-2021-0266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: We report real-world evidence with regorafenib in previously treated metastatic colorectal cancer from the French cohort of the international, prospective, observational CORRELATE study. Patients & methods: Patients receiving regorafenib according to French health authority approval were included. The primary end point was treatment-emergent adverse events. Overall survival and progression-free survival were secondary end points. Results: Two hundred and forty-two patients (61% male, median age: 66 years) were enrolled. The most common grade ≥3 drug-related treatment-emergent adverse events were hand-foot skin reaction (10.3%), asthenia/fatigue (9.9/1.2%) and hypertension (6.2%). Median overall survival and progression-free survival were 6.8 (95% CI: 6.3-7.6) and 2.8 months (95% CI: 2.6-3.0), respectively. Conclusion: The real-world safety and effectiveness data of regorafenib in metastatic colorectal cancer in France align with findings from Phase III clinical trials and the global CORRELATE population.
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Affiliation(s)
- Jean-Philippe Metges
- Institut de Cancérologie et d'Hématologie Réseau ARPEGO, CHRU de Brest - Hôpital Morvan, Brest, 29200, France
| | - Dominique Genet
- Service d'Oncologie, Clinique François Chenieux, Limoges, 87000, France
| | - David Tougeron
- Service d'Hépato-gastro-entérologie, CHU de Poitiers, Faculté de Médecine de Poitiers, Poitiers, 86021, France
| | - Catherine Ligeza
- Service d'Oncologie Médicale, Clinique Mutualiste de l'Estuaire, Saint-Nazaire, 44600, France
| | - Michel Ducreux
- Service de Gastro-entérologie, Institut Gustave Roussy, Villejuif, Université Paris-Saclay, 94805, France
| | - Christophe Borg
- Service d'Oncologie Médicale, Hôpital Nord Franche Comté, Site du Mittan, Montbéliard, 25200, France
| | - Rosine Guimbaud
- Oncologie Médicale Digestive, CHU de Toulouse, Toulouse, 31300, France
| | - Jean-Marc Phelip
- Service de Gastro-entérologie, CHU de Saint-Etienne Hôpital Nord, Saint Priest en Jarez, 42270, France
| | | | - Stefano Kim
- Service d'Oncologie Médicale, CHU de Besançon, Besançon, 25000, France
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Barthelemy P, Albiges L, Escudier B, Lebret T, Bigot P, Stein U, Dourthe LM, De La Cruz J, Tindel M, Thiery-Vuillemin A. Prospective observational study on pazopanib in patients treated for advanced/metastatic renal cell carcinoma (RCC): APOLON Study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.629] [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
629 Background: Pazopanib (PZP), has been granted for advanced or metastatic RCC. In addition to pivotal clinical trials, real-world evidence (RWE) is required to evaluate effectiveness and safety in clinical routine practices. Methods: APOLON is a non-interventional, multicentric prospective study to assess PZP Progression-Free Survival (PFS) (8-month PFS rate as primary endpoint), Overall Survival (OS), Objective Response Rate (ORR), tolerability, subsequent post-pazopanib therapy sequences. It is conducted in France with 55 sites (hospital or private practitioners) in patients with mRCC, naïve to anti-VEGF therapy, who initiated PZP treatment. Data are collected at baseline and at 1, 2-3, 6, 9, 12, 18, 24, 30, 36 months (mo). Patients (n= 218) were recruited from Nov 2017 to Jan 2019. This interim analysis presents results 6 months after last patient was enrolled. Results: Patients were 71,1% males, with a median age of 69.6 years. They had clear-cell type RCC for 97.7% with a favourable (26.4%), intermediate (52.9%) or poor (20.7%) IMDC risk score. Comorbidities were: hypertension (75.1%), diabetes (26%), arterial disorders (20.1%), other pathologies (47.3%); 81.7% received co-medications. ECOG-PS was 0 (42.9%), 1 (40%), 2 (15.7%), Metastases were mainly located in lungs (62.8%), bones (28.9%), mediastinal (17.9%)/abdominal (17%) lymph nodes, glands (pancreas, thyroid, adrenals) (17.4%). Of them, 56% had an history of partial/total nephrectomy, 28.1% previous local treatments for metastases. Median PFS, assessed by investigator, was 11.3 mo (95%CI: 8.7-13), with an 8-mo PFS rate at 62.9%. ORR was 47.2% and 1-year OS rate was 71.2%. Treatment-related serious adverse events were reported in 17.3% of patients. No new safety signal was identified. After a median follow-up of 8.8 mo, of the 121 patients with discontinuation, 74 received post-PZP lines comprising firstly nivolumab (67.6%), cabozantinib (16.2%), sunitinib (10.8%), other (5.6%). Conclusions: APOLON study represents real-life population including elderly and frail patients with clinically meaningful ORR and PFS with PZP. Reported adverse events were consistent with known safety PZP profile.
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Affiliation(s)
| | - Laurence Albiges
- Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Bernard Escudier
- Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Pierre Bigot
- Service d’Urologie CHU Angers, Université d’Angers, Angers, France
| | - Ulrich Stein
- Medical Oncology - CHRU Jean Minjoz, Besançon, France
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Thiery-Vuillemin A, Poulsen MH, Lagneau E, Ploussard G, Birtle A, Dourthe LM, Beal-Ardisson D, Pintus E, Trepiakas R, Lefresne F, Lukac M, Van Sanden S, Pissart G, Reid A. Impact of Abiraterone Acetate plus Prednisone or Enzalutamide on Patient-reported Outcomes in Patients with Metastatic Castration-resistant Prostate Cancer: Final 12-mo Analysis from the Observational AQUARiUS Study. Eur Urol 2019; 77:380-387. [PMID: 31594705 DOI: 10.1016/j.eururo.2019.09.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 03/12/2019] [Accepted: 09/10/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Few studies have examined patient-reported outcomes (PROs) with abiraterone acetate plus prednisone (abiraterone) versus enzalutamide in metastatic castration-resistant prostate cancer (mCRPC). OBJECTIVE To determine the impact of abiraterone and enzalutamide on PROs. DESIGN, SETTING, AND PARTICIPANTS AQUARiUS (NCT02813408) was a prospective, 12-mo, observational study in patients with mCRPC from Denmark, France, and the UK. INTERVENTION Abiraterone or enzalutamide treatment according to routine practise. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PROs were collected over 12 mo using Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), Brief Fatigue Inventory-Short Form (BFI-SF), Brief Pain Inventory-Short Form, and European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (QLQ-C30) at baseline and routine visits. Outcomes included mean change in PROs, patients with clinically meaningful worsening (CMW) in PROs, and safety. Data were analysed using repeated measures linear and logistic models adjusted for baseline characteristics. RESULTS AND LIMITATIONS Abiraterone-treated (N = 105) and enzalutamide-treated (N = 106) patients were included. Key PRO items (cognitive impairments and fatigue) were significantly (p < 0.05) in favour of abiraterone versus enzalutamide during the study. "Perceived cognitive impairment" and "comments from others" (FACT-Cog); "fatigue right now", "usual level of fatigue", and "worst level of fatigue" (BFI-SF); and "cognitive functioning" and "fatigue" (QLQ-C30) were significantly in favour of abiraterone over enzalutamide for three or more consecutive periods up to month 12. From study initiation, significantly fewer patients receiving abiraterone experienced one or more CMW episode in cognition and fatigue. Fatigue and asthenia (adverse events) were lower with abiraterone than with enzalutamide (5% vs 15% and 10% vs 11%, respectively). There were no treatment-related deaths. Limitations included lack of randomisation. CONCLUSIONS In a real-world setting, this 12-mo analysis suggests an advantage of abiraterone acetate plus prednisone over enzalutamide on fatigue and cognitive function; this finding occurred early after treatment initiation. This difference should be considered when choosing treatment. PATIENT SUMMARY This study looked at the effect of two treatments (abiraterone acetate plus prednisone and enzalutamide) for metastatic castration-resistant prostate cancer on patient quality of life over 12 mo. Using established questionnaires, patients reported that they experienced less fatigue and cognitive impairments (including memory loss and reduced thinking abilities) with abiraterone acetate plus prednisone than with enzalutamide.
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Affiliation(s)
- Antoine Thiery-Vuillemin
- Department of Medical Oncology, CHU Jean Minjoz, Franche-Comté, France; UMR1098, INSERM, Besançon, France.
| | - Mads Hvid Poulsen
- Department for Urology, Odense Hospital, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Edouard Lagneau
- Oncologie Medicale, Institut de Cancérologie de Bourgogne, Dijon, France
| | | | - Alison Birtle
- Royal Lancaster Infirmary and Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | | | | | - Elias Pintus
- Oncology, Frimley Health NHS Foundation Trust, Slough, UK
| | | | | | - Martin Lukac
- Parexel International Czech Republic s.r.o, on behalf of Janssen Pharmaceutica NV, Beerse, Belgium
| | | | | | - Alison Reid
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
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Boegemann M, Khaksar S, Bera G, Birtle A, Dopchie C, Dourthe LM, Everaert E, Hatzinger M, Hercher D, Hilgers W, Matus G, Alvarez LG, Antoni L, Lukac M, Pissart G, Robinson P, Elliott T. Abiraterone acetate plus prednisone for the Management of Metastatic Castration-Resistant Prostate Cancer (mCRPC) without prior use of chemotherapy: report from a large, international, real-world retrospective cohort study. BMC Cancer 2019; 19:60. [PMID: 30642291 PMCID: PMC6332550 DOI: 10.1186/s12885-019-5280-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background With the recent introduction of novel treatment options, real-world data from patients with metastatic castration-resistant prostate cancer (mCRPC) are required to better understand the impact on routine clinical practice. This study primarily aimed to describe the time to treatment failure (TTF) of mCRPC patients treated with abiraterone acetate plus prednisone or the corticosteroid of choice (AAP) in the pre-chemotherapy setting. Other relevant outcomes, clinical and treatment characteristics of these patients were also evaluated. Methods This retrospective, observational study collected data from chemotherapy-naïve mCRPC patients treated with AAP from four European countries. Kaplan-Meier curves were used to estimate TTF, progression-free survival (PFS), and time to first skeletal-related event. The impact of baseline characteristics on TTF and PFS was explored using univariate and multivariate Cox proportional hazard models. Log-rank test was used to assess the potential role of duration of response to ADT in predicting response to AAP treatment. Results Data from 481 eligible patients (Belgium: 68; France: 61; Germany: 150; UK: 202) were analysed. At AAP initiation, the median age of patients was 75.0 years (interquartile range [IQR]: 69.0–81.0), and the median PSA was 56.2 ng/mL (IQR: 22.2–133.1), with over 50% of patients presenting an ECOG score of 0 or 1. Visceral metastases were present in 7.5% of patients; an exclusion criterion in the COU-AA-302 clinical trial. The median TTF with AAP was 10.0 months (95%CI: 9.2–11.1) and the median PFS was 10.8 months (95%CI: 9.6–11.8). Shorter TTF was significantly associated with higher ALP (> 119 units/L), higher PSA (> 56.2 ng/mL), or poorer ECOG PS scores at AAP initiation (p < 0.05). Patients with longer duration of response to ADT (≥12 months) presented longer TTF and longer time to progression (p < 0.0001). Conclusions This European real-world study provides valuable insights into the characteristics, treatment, and outcomes of chemotherapy-naïve patients with mCRPC who received AAP in routine clinical practice. Treatment effectiveness of AAP in the real-world is maintained despite patients having poorer clinical features at initiation than those observed in the COU-AA-302 trial population. Electronic supplementary material The online version of this article (10.1186/s12885-019-5280-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Boegemann
- Department of Urology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, GB A1, D-48149, Muenster, Germany.
| | - Sara Khaksar
- St Luke's Cancer Centre, The Royal Surrey County Hospital, Guildford, UK
| | - Guillaume Bera
- Groupe Hospitalier Bretagne Sud, Hôpital du Scorff, Lorient, France
| | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital & University of Manchester, Manchester, UK
| | | | | | | | | | - Dirko Hercher
- Refrath Urological Center, Bergisch Gladbach, Germany
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Thiery-Vuillemin A, Hvid Poulsen M, Lagneau E, Ploussard G, Birtle A, Dourthe LM, Beal-Ardisson D, Pintus E, Trepiakas R, Antoni L, Lukac M, Van Sanden S, Pissart G, Reid A. Impact of abiraterone acetate plus prednisone or enzalutamide on fatigue and cognition in patients with metastatic castration-resistant prostate cancer: initial results from the observational AQUARiUS study. ESMO Open 2018; 3:e000397. [PMID: 30116592 PMCID: PMC6088345 DOI: 10.1136/esmoopen-2018-000397] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 05/11/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Abiraterone acetate plus prednisone (AAP) and enzalutamide (ENZ) are commonly prescribed for metastatic castration-resistant prostate cancer (mCRPC). Data comparing their effects on patient-reported outcomes (PROs) from routine clinical practice are limited. Methods AQUARiUS (NCT02813408) is an ongoing, two-cohort, prospective, observational, non-randomised, multicentre, phase IV European study assessing the effects of AAP and ENZ on PROs in 211 patients with mCRPC over 12 months. Patients receive AAP or ENZ per routine clinical practice. Data on cognition, fatigue, pain and health-related quality of life are measured using the Functional Assessment of Cancer Therapy-Cognitive Function, Brief Fatigue Inventory-Short Form, Brief Pain Inventory-Short Form and European Organization for Research and Treatment of Cancer Quality of Life-C30 questionnaires, respectively. Results This 3-month analysis was conducted in 105 patients; 46 received AAP and 59 received ENZ. There were statistically significant differences in mean change from baseline favouring AAP over ENZ at months 1, 2 and 3 for perceived cognitive impairments and cognitive functioning. At each time-point, ENZ-treated patients had a significantly higher risk of experiencing clinically meaningful worsening in perceived cognitive impairments versus those receiving AAP. Statistically significant differences in mean change from baseline favouring AAP over ENZ were seen for usual level of fatigue and fatigue interference at months 2 and 3 and for current fatigue and worse level of fatigue at month 3. Differences favouring AAP versus ENZ were seen for the fatigue scale of the QLQ-C30 questionnaire (months 1 and 3). There was a significantly higher risk of clinically meaningful worsening in usual level of fatigue with ENZ versus AAP at month 3. No significant differences between cohorts were observed for pain (BPI-SF) at any time-point. Conclusion This analysis suggests more favourable outcomes with AAP versus ENZ for cognition and fatigue in the first 3 months of treatment initiation for mCRPC. These findings require confirmation from future analyses of data from AQUARiUS from a larger number of patients with a longer follow-up period.
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Affiliation(s)
- Antoine Thiery-Vuillemin
- Department of Medical Oncology, CHU Jean MINJOZ, Franche-Comté, France; UMR1098, INSERM, Besançon, France.
| | | | - Edouard Lagneau
- Oncologie Medicale, Institut de Cancérologie de Bourgogne, Dijon, France
| | | | - Alison Birtle
- Royal Lancaster Infirmary and Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | | | | | - Elias Pintus
- oncology, Frimley Health NHS Foundation Trust, Slough, UK
| | | | - Laurent Antoni
- EMEA oncology, Janssen Pharmaceutica N.V, Beerse, Belgium
| | - Martin Lukac
- CRO, PAREXEL International Czech Republic s.r.o, on behalf of Janssen Pharmaceutica N.V, Beerse, Belgium
| | | | | | - Alison Reid
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
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Thiery Vuillemin A, Poulsen MH, Dourthe LM, Trepiakas R, Lagneau E, Pintus EP, Beal-Ardisson D, Birtle AJ, Ploussard G, Besson H, Lukac M, Robinson P, Reid AH. Six-month patient-reported outcome (PRO) results from AQUARiUS, a prospective, observational, multicenter phase 4 study in patients (Pts) with metastatic castration-resistant prostate cancer (mCRPC) receiving abiraterone acetate + prednisone (AAP) or enzalutamide (ENZ). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Martin Lukac
- PAREXEL International Czech Republic s.r.o, on behalf of Janssen Pharmaceutica NV, Beerse, Belgium
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11
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O’Connor Juan M, Öhler L, Scheithauer W, Metges JP, Dourthe LM, de Groot Jan W, Thaler J, Yeh KH, Lin JK, Falcone A, Punt CJ, Kalinovsky J, Fiala-Buskies S, Cervantes A, Petersen LN, Ducreux M. Real-world dosing of regorafenib in metastatic colorectal cancer (mCRC): Interim analysis from the prospective, observational CORRELATE study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx263.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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12
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Ducreux M, Öhler L, Scheithauer W, Metges JP, Dourthe LM, De Groot JW, Thaler J, Yeh KH, Lin JK, Falcone A, Punt CJA, Kalinovsky J, Fiala-Buskies S, Cervantes A, O'Connor JM. Impact of tumor location on outcomes in patients with metastatic colorectal cancer (mCRC) treated with regorafenib (REG): An interim analysis from the prospective, observational CORRELATE study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3567 Background: The anatomical location of the primary tumor has been associated with outcomes in mCRC, with left-sided (L) tumors having a better prognosis than right-sided (R) tumors and location predicting response to treatment. REG significantly improved overall survival (OS) vs placebo in patients with mCRC who progressed on available treatments in 2 randomized, phase 3 trials (CORRECT, CONCUR). This exploratory analysis evaluated outcomes by primary tumor location in patients with mCRC treated with REG in the CORRELATE study. Methods: CORRELATE is an observational study designed to characterize the safety and effectiveness of REG in unselected patients for whom the decision to treat with REG has been made by the treating physician according to the local health authority label. Primary L tumors were located in the rectum, splenic flexure, recto-sigmoid, descending, or sigmoid colon; R tumors were in the appendix, hepatic flexure, cecum, or ascending colon. OS was analyzed by the Kaplan–Meier method and comparisons were by a 2-sided log-rank test. Results: Primary tumor location was available for 474 patients (L, n = 375 [79%]; R, n = 99 [21%]). Median time from initial diagnosis and from diagnosis of metastatic disease to treatment was slightly longer in L vs R tumors (32 vs 28 months and 25 vs 22 months, respectively). A higher proportion of patients with L vs R tumors, respectively, had prior radiotherapy (34% vs 13%) and a lower proportion had a partial colectomy (40% vs 70%). Best response to prior systemic therapy (partial response + stable disease) was 72% for L tumors and 68% for R tumors with a median duration of treatment of 26 and 22 months, respectively. REG treatment duration was similar in the 2 groups. Median OS (95% CI) was 6.7 months (6.1, 7.7) for L tumors vs 6.3 months (4.9, 8.1) for R tumors (P = 0.3); median progression-free survival (95% CI) was 2.8 months (2.6, 3.0) vs 2.6 months (2.4, 3.0) (P = 0.5), respectively. Conclusions: Interim results from this observational study suggest that OS is similar in patients with R and L tumors treated with REG. Clinical trial information: NCT02042144.
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Affiliation(s)
| | | | | | | | | | | | | | - Kun-Huei Yeh
- National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Kou Lin
- Taipei Veterans General Hospital, Taipei, Taiwan
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13
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Ducreux M, Öhler L, Scheithauer W, Metges JP, Dourthe LM, De Groot JW, Thaler J, Yeh KH, Lin JK, Falcone A, Punt CJA, Contijoch AM, Fiala-Buskies S, Cervantes-Ruiperez A, O Connor JM. Safety and effectiveness of regorafenib (REG) in patients with metastatic colorectal cancer (mCRC) in routine clinical practice: An interim analysis (IA) from the prospective, observational CORRELATE study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
700 Background: REG significantly improved overall survival (OS) vs placebo in patients with mCRC who progressed on available treatments in the randomized, double-blind, phase 3 trials CORRECT and CONCUR. CORRELATE aims to characterize the safety and effectiveness of REG for the treatment of mCRC in an unselected real-world patient population treated in routine clinical practice. Here we report the results of a planned IA. Methods: This global study aims to recruit 1000 patients with mCRC previously treated with approved therapies and for whom the decision to treat with REG has been made by the treating physician according to the local health authority approved label. Dose interruptions and reductions are permitted for the management of adverse events (AEs). The primary endpoint is the incidence of treatment-emergent AEs (TEAE; NCI-CTCAE v4.03). Secondary endpoints include OS, progression-free survival, and the disease control rate. The first planned interim analysis includes the first 500 patients observed for at least 3 months. Here, we report an IA of safety. Results: Median age was 65 years (range: 29–89) and 61% of patients were male. Most patients had a baseline ECOG PS 0/1 vs 2–4 (41%/43% vs 8%) and 50% had KRAS mutations. Most common metastatic sites at study entry were liver (52%) and lung (43%). The median treatment duration was 2.4 months (range: 0.1–10.6). The daily starting REG dose was 160 mg, 120 mg, and 80 mg in 53%, 34%, and 12% of patients, respectively; 26% of patients had dose reductions, 21% due to TEAEs. TEAEs of any grade occurred in 91% of patients, and in 76% TEAEs were considered REG related. Grade ≥ 3 TEAEs occurred in 55% of patients. In 31%, grade ≥ 3 TEAEs were REG related, with fatigue (7%), hand-foot skin reaction (5%), and hypertension (5%) being most common. Grade 5 TEAEs occurred in 13% of patients and were REG related in < 1%. Conclusions: In this observational study, the planned IA showed that the rate of REG-related grade ≥ 3 TEAEs appeared to be somewhat lower than rates observed in the phase 3 trials in patients with mCRC. The starting dose for approximately half the patients was less than 160 mg/day. Clinical trial information: NCT02042144.
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Affiliation(s)
- Michel Ducreux
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | | | | | | | | | | | | | - Kun-Huei Yeh
- National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Kou Lin
- Taipei Veterans General Hospital, Taipei, Taiwan
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Adenis A, de la Fouchardiere C, Paule B, Burtin P, Tougeron D, Wallet J, Dourthe LM, Etienne PL, Mineur L, Clisant S, Phelip JM, Kramar A, Andre T. Erratum to: Survival, safety, and prognostic factors for outcome with Regorafenib in patients with metastatic colorectal cancer refractory to standard therapies: results from a multicenter study (REBECCA) nested within a compassionate use program. BMC Cancer 2016; 16:518. [PMID: 27457763 PMCID: PMC4959046 DOI: 10.1186/s12885-016-2559-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Antoine Adenis
- Medical Oncology, Centre Oscar Lambret and Catholic University, Lille, France. .,Department of Medical Oncology, Centre Oscar Lambret, 3, rue F Combemale, 59000, Lille, France.
| | | | - Bernard Paule
- Medical Oncology, Paul Brousse University Hospital, Villejuif, France
| | | | | | - Jennifer Wallet
- Methodology and Biostatistics, Centre Oscar Lambret, Lille, France
| | | | | | - Laurent Mineur
- Radiation and Medical Oncology, Institut Sainte-Catherine, Avignon, France
| | | | | | - Andrew Kramar
- Methodology and Biostatistics, Centre Oscar Lambret, Lille, France
| | - Thierry Andre
- Medical Oncology, Saint Antoine Hospital, and University Pierre et Marie Curie (UMPC), Paris VI, Paris, France
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15
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Malka D, Metges JP, Elias D, Bennouna J, Bonnetain F, Dourthe LM, Ben Abdelghani M, Radji A, Laplaige P, Petit Laurent F, Barue V, Gandon S, Rivoire M. Bevacizumab plus chemotherapy (bev/CT) as first-line therapy for patients with potentially resectable metastatic colorectal cancer (mCRC): Final results of the French noninterventional PICASSO study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David Malka
- Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Philippe Metges
- Cancer Institute University Hospital Morvan and Observatory of Cancer Inserm 1078 - Mission 8.1 Canceropole Grand Ouest, Brest, France
| | | | - Jaafar Bennouna
- Institut de Cancérologie de l'Ouest – site René Gauducheau, Saint Herblain, France
| | - Franck Bonnetain
- Methodology and Quality of Life Unit, Department of Oncology, EA 3181, University Hospital;French National Platform Quality of Life and Cancer, Besancon, France
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16
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Ben Abdelghani M, Borg C, Dourthe LM, Deplanque G, Taïeb J, Metges JP, Laplaige P, Lotz V, Amrate A, Lledo G. Aflibercept in combination with FOLFIRI for the second-line treatment of patients with metastatic colorectal cancer: First interim safety data from AFEQT trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
661 Background: In the randomized phase 3 VELOUR trial, aflibercept + FOLFIRI demonstrated a statistically significant overall survival benefit compared with FOLFIRI alone in metastatic colorectal cancer (mCRC) patients (pts) previously treated with an oxaliplatin-based regimen. Evidence from the VELOUR trial supported the initiation of a French clinical trial; AFEQT [NCT01670721] to capture utility values from QoL instruments and collect safety data from a target population similar to that in VELOUR. Interim data collected by French investigators are reported. Methods: AFEQT is single-arm, open-label trial evaluating safety and health-related QoL of aflibercept in mCRC pts previously treated with an oxaliplatin-based regimen. Estimated total enrollment is 200 mCRC pts. Eligible pts received aflibercept (4 mg/kg) q2wks on day 1 of each cycle followed by FOLFIRI up to disease progression, unacceptable toxicity, death, or investigator/patient decision, whichever occurred first. FOLFIRI starting dose and subsequent additional dose modifications were at the discretion of the treating physician. Safety assessments followed each cycle and continued until 30 days after last drug administration. The percentage of pts with grade 3/4 adverse events (G3/4 AEs) in the safety population of AFEQT was compared with that of VELOUR. Results: At data cut-off, the safety population comprised 123 pts with at least 1 completed cycle of treatment. Median age of pts was 64.6 vs. 61 years in VELOUR. At least 1 G3/4 AE was experienced by 67.5% of pts vs. 83.5% in VELOUR. Most reported G3/4 AEs were G3. There were no reports of G4 hypertension or diarrhea. Additional data will be reported during the meeting. Conclusions: In VELOUR, AEs occurred early in treatment, were often of single occurrence, generally reversible, and consistent with AEs commonly seen by oncologists. Interim safety analysis from AFEQT did not identify any new safety signal. Clinical trial information: NCT01670721. [Table: see text]
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Affiliation(s)
| | | | | | | | - Julien Taïeb
- APHP and Paris Descartes University, Paris, France
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Desramé J, Dourthe LM, Debourdeau P, Mille D, Artru P, Albrand H. Raltitrexed in the management of metastatic colorectal cancer: The COMET study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.677] [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
677 Background: Raltitrexed, indicated for palliative treatment of advanced colorectal cancer (CRC), may be useful for patients (pts) with cardiovascular (CV) risk factors, or cardiotoxicity/disease progression with prior chemotherapy (CT). The COMET study, conducted in France, described the characteristics of pts with metastatic CRC (mCRC) treated with raltitrexed, focusing on pts with cardiotoxicity or disease progression with prior 5-fluorouracil (5FU)/folinic acid. Methods: A national, multicentred, cross-sectional, non-interventional study to describe the profiles of pts with mCRC treated with raltitrexed. Pts (≥18 years) with mCRC, treated with raltitrexed as a single agent or in combination therapy, were included. Following patient consent, retrospective data were recorded during a single inclusion visit based on pt medical files; during the study, data were recorded prospectively. Results: 414 pts with mCRC were analysed; 84.8% had ≥1 prior CT, 60.9% had CV risk factors and 35.2% had CV history (angina: 11.8%; myocardial infarction: 11.8%). Overall, 79.5% of pts had received a prior 5FU-based CT. Reasons for switching to raltitrexed included short 15-min infusion duration (34.8%), treatment failure (49.8%) and acute cardiotoxicity with 5FU (8.9%). After switching, 57.2% of pts received raltitrexed as combination therapy. Mean initial dosage of raltitrexed was 2.6±0.6 mg/m2. Of those who had CV risk factors (n=73) or CV history (n=67), 69.0% and 72.7% received raltitrexed after CV toxicity, respectively. Of the pts treated with second-line raltitrexed and assessed with prior acute CV events (45/414), 88.9% (40/45) had no cardiac toxicity during treatment with raltitrexed. Of those (n=206) receiving raltitrexed due to treatment failure, 62.7% had received 5FU/folinic acid during their last CT. Of the pts assessed for tumour response (183/206), tumour progression was controlled with raltitrexed in 25.7% of cases (stable disease: 18.0%; partial response: 7.7%; progressive disease: 56.3%). Conclusions: Raltitrexed appears to be effective in heavily pretreated pts with mCRC and tumour progression after 5FU therapy and could be a safe therapeutic alternative to 5FU for pts with mCRC and prior cardiac toxicity.
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18
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Michallet M, Luporsi E, Soubeyran P, Amar NA, Boulanger V, Carreiro M, Dourthe LM, Labourey JL, Lepille D, Maloisel F, Mouysset JL, Nahon S, Narciso B, Nouyrigat P, Radji R, Sakek N, Albrand H. Erratum to: BiOsimilaRs in the management of anaemia secondary to chemotherapy in HaEmatology and Oncology: results of the ORHEO observational study. BMC Cancer 2014. [PMCID: PMC4464620 DOI: 10.1186/1471-2407-14-720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Barthélémy P, Asmane-De la Porte I, Meyer N, Duclos B, Serra S, Dourthe LM, Amé S, Litique V, Giron C, Goldbarg V, Fornecker L, Quoix E, Kurtz JE. Adherence and patients' attitudes to oral anticancer drugs: a prospective series of 201 patients focusing on targeted therapies. Oncology 2014; 88:1-8. [PMID: 25247774 DOI: 10.1159/000366226] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Patient adherence is a challenge in oncology and hematology practice. Hormone therapy data in breast cancer suggest insufficient adherence and poor persistence. Limited data are available for targeted therapies (TT) including tyrosine kinase and mammalian target of rapamycin inhibitors. METHODS We performed a prospective survey using a 15-item questionnaire in patients with solid tumors and hematologic malignancies receiving oral anticancer therapy. Treatment duration, setting (adjuvant vs. metastatic), cancer type, age, and comedication were recorded. RESULTS 201 patients (median age 65.5 years) participated, 102 with TT and 99 with hormone therapy or chemotherapy (HC). The median time of drug intake was 11.0 months. Written information was more frequently given to TT patients (68.6 vs. 23.2%, p < 0.0001). TT and HC patients showed equal adherence to therapy (72.5 vs. 69.6%, p = n.s.) despite TT patients experiencing more side effects (p < 0.0001) and taking more concomitant oral medication (p = 0.0042). Forgotten doses were the leading cause of nonadherence in HC patients (83%, as compared to 54% in the TT group), whereas dose reduction by the patient was higher in the TT group (32 vs. 17%). CONCLUSIONS Despite advances in providing information to patients leading to better adherence among TT patients, efforts towards better patient education are warranted including dedicated staff for monitoring outpatient anticancer oral therapy.
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Affiliation(s)
- Philippe Barthélémy
- Pôle d'Oncologie et d'Hématologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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20
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Michallet M, Luporsi E, Soubeyran P, Amar NA, Boulanger V, Carreiro M, Dourthe LM, Labourey JL, Lepille D, Maloisel F, Mouysset JL, Nahon S, Narciso B, Nouyrigat P, Radji R, Sakek N, Albrand H. BiOsimilaRs in the management of anaemia secondary to chemotherapy in HaEmatology and Oncology: results of the ORHEO observational study. BMC Cancer 2014; 14:503. [PMID: 25011615 PMCID: PMC4227033 DOI: 10.1186/1471-2407-14-503] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/01/2014] [Indexed: 12/27/2022] Open
Abstract
Background The approval of epoetin biosimilars in the European Union requires extensive scientific evaluation and stringent regulatory procedures, including post-marketing studies. The ORHEO (place of biOsimilaRs in the therapeutic management of anaemia secondary to chemotherapy in HaEmatology and Oncology) study was an observational, longitudinal, multicentre study performed in France to evaluate the efficacy and safety of biosimilar epoetins for the treatment of chemotherapy-induced anaemia (CIA) in the clinical setting. Methods Patients >18 years with CIA (haemoglobin [Hb] <11 g/dL) in association with solid tumours, lymphoma or myeloma and eligible for treatment with an epoetin biosimilar were included in this study. Patient characteristics were recorded at baseline along with anaemia-related information, such as observed and target Hb (as chosen by the treating clinician), brand and dose of epoetin biosimilar prescribed, and details of any other treatments. Patients were then followed-up at 3 and 6 months. The primary endpoint was Hb response (defined as Hb reaching ≥10 g/dL, an increase of Hb ≥1 g/dL since inclusion visit or reaching physician-defined target Hb, with no blood transfusions in the 3 weeks prior to measurement). Other endpoints included adverse events, achievement of target Hb and associated treatments. Results Overall, 2333 patients >18 years (mean age 66.5 years) with CIA (haemoglobin [Hb] <11 g/dL) in association with solid tumours, lymphoma or myeloma and eligible for biosimilar epoetin treatment were included. 99.9% of patients received epoetin zeta (median dose 30,000 IU/week). Mean baseline Hb was 9.61 g/dL, with 35.6% of patients having moderate anaemia (Hb 8–9.5 g/dL). Hb response was achieved in 81.6% and 86.5% of patients at 3 and 6 months, respectively. Overall mean change in Hb level was 1.52 ± 1.61 and 1.72 ± 1.61 g/dL at 3 and 6 months, respectively. Transfusion and thromboembolic event rates were 9.4% and 2.4% at 3 months, and 5.8% and 1.5% at 6 months, respectively. Conclusions Epoetin zeta was effective and well tolerated in the management of CIA in patients with solid tumours, lymphoma and myeloma. Trial registration Trial registration number: NCT02140736 (date of registration: 14 May 2014).
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Affiliation(s)
- Mauricette Michallet
- Service d'Hématologie, Pavillon Marcel Bérard 1G, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, Lyon- Pierre Bénite 69495, France.
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Adenis A, Dourthe LM, Mineur L, Tougeron D, Tournigand C, Etienne PL, Paule B, Laplaige P, Tresch E, Morère JF, Hollebecque A, Ferru A, Desseigne F, Malka D, Michel P, Arvis P, Clisant S, Phelip JM, De La Fouchardiere C, André T. Regorafenib (REG) in the real-life setting: First results from a large French compassionate-use program in patients (pts) with previously treated metastatic colorectal cancer (mCRC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e14599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Antoine Adenis
- Medical Oncology Dpt, Centre Oscar Lambret, Lille, France
| | | | - Laurent Mineur
- Radiotherapy and Oncology GI and Liver Unit, Institut Sainte-Catherine, Avignon, France
| | - David Tougeron
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | | | | | | | | | | | | | | | - Aurelie Ferru
- Department of Oncology, Poitiers University Hospital, Poitiers, France
| | | | | | - Pierre Michel
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, Rouen, France
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22
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Barthelemy P, Dourthe LM, Serra S, Asmane-De la Porte I, Prim N, Ame S, Litique V, Giron C, Goldbarg V, Fornecker L, Duclos B, Kurtz JE. Adherence and patients’ attitude toward oral anticancer drugs: A prospective series of 226 patients focusing onto targeted therapies. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17543] [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
e17543 Background: Patients’ adherence has been identified as a challenge in oncology and hematology practice. Hormone therapy data in breast cancer suggest insufficient adherence and poor persistence. Limited data is available for targeted therapies such as tyrosine kinase (TK) and mTOR inhibitors whereas poor adherence to TK treatment was linked to treatment failure in GIST and CML. Methods: We report the result of a prospective survey in 226 patients (pts), with solid tumors and hematologic malignancies receiving oral anticancer therapy including chemotherapy or hormone therapy (CT), and targeted therapies (TT). Treatment duration and setting (adjuvant vs metastatic), cancer type, age, co-medication were analyzed. Patients were given a 15-item questionnaire and asked to anonymously answer questions regarding their attitude towards oral anticancer drugs. To analyze adherence, patients were asked whether they voluntarily or not missed any drug dosing during the last month. Results: 226 patients (median age 65.5 y.o) participated, 115 with TT and 111 with CT, with a median time of drug intake of 10.5 months. Both TT and CT patients stated to be well informed about treatment modalities in (92%), mostly by their oncologist or hematologist (87%). Written information was more frequently given in TT pts (67.0 vs 27.0%, p<0.0001). TT pts declared to be more often fully adherent to therapy (84.3 vs 66.7%, p=0.01) despite experiencing more side-effects (p<0.0001) and taking more concomitant oral medication (p=0.029). The mean treatment duration was 28.0 vs 20.3 months in TT vs CT pts (NS), but in both groups non-adherence was observed at any time since initial prescription. Conclusions: Despite advances in patients’ information leading to better treatment adherence in TT pts, efforts are still warranted such as the onset of dedicated staff for early and prolonged monitoring of outpatient anticancer oral therapy.
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Affiliation(s)
| | | | | | | | - Nathalie Prim
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Shanti Ame
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Cathy Giron
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Luc Fornecker
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Brigitte Duclos
- Centre Hospitalier Régional Universitaire Strasbourg, Strasbourg, France
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Hardy-Bessard AC, Mouret-Reigner MA, Facchini T, Dourthe LM. Le cancer du sein métastatique après la première ligne de chimiothérapie. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Breton JL, Robinet G, Dansin E, Rotarski M, Le Groumellec A, Dourthe LM, Hamid A, Ecstein-Fraisse E. [Management of non-small cell lung carcinoma following docetaxel-cisplatin. Results of an epidemiologic survey]. Rev Mal Respir 2008; 24:1099-106. [PMID: 18176386 DOI: 10.1016/s0761-8425(07)74259-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this epidemiologic survey was to describe the management of second-line therapy for patients with stage IIIB-IV non-small cell lung carcinoma (NSCLC) following docetaxel-cisplatin as first-line therapy. METHODS Between June 2003 and December 2004, 265 patients were enrolled. The data registered were the choice of cytotoxics, the safety profile, the efficacy and the clinical benefit. RESULTS Two hundred and sixty one patients were treated with docetaxel-cisplatin as a first-line regimen and 181 received a second line. This second line was a single agent regimen in 58% of cases and a gemcitabine based treatment in 60.8%. The main criterion for the choice of second-line therapy was the safety profile in 34.3% of cases. The overall response rate was 16.6% after the second line and clinical benefit was reported in 43.6% of patients. CONCLUSION In more than 2/3 of patients with NSCLC the docetaxel-cisplatin combination leaves the opportunity to give a second-line treatment, providing satisfying results in terms of clinical benefit. In this study gemcitabine was the most widely prescribed second-line treatment, mainly as a single agent.
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25
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Desramé J, Duvic C, Béchade D, Bredin C, Raynaud JJ, Defuentes G, Dourthe LM, Algayres JP. [Is the frequency of hemolytic uremic syndrome as a complication of gemcitabine underestimated? The role of systematic screening]. Gastroenterol Clin Biol 2006; 30:332-4. [PMID: 16565677 DOI: 10.1016/s0399-8320(06)73184-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Desramé J, Duvic C, Bredin C, Béchade D, Artru P, Brézault C, Defuentes G, Poirier JM, Dourthe LM, Coutant G, Chaussade S, de Gramont A, Algayres JP. [Hemolytic uremic syndrome as a complication of gemcitabine treatment: report of six cases and review of the literature]. Rev Med Interne 2005; 26:179-88. [PMID: 15777580 DOI: 10.1016/j.revmed.2004.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 11/23/2004] [Indexed: 11/23/2022]
Abstract
UNLABELLED Hemolytic uremic syndrome is a rare condition during gemcitabine therapy. METHODS We report six new cases of hemolytic uremic syndrome related to gemcitabine, three issued from a retrospective study of 136 consecutive patients treated with gemcitabine for which a systematic screening of this side effect has been performed and 29 cases with clinical data available identified in the literature in order to better characterised frequency and clinical presentation of this side effect. RESULTS In our series, frequency of HUS is 2.2% and is higher than this previously reported (0.015%) or estimated with the data of clinical trials analysed (0.072 %). For 35 cases with clinical data available, the patients were always treated for a local advanced and/or metastatic disease. For our cases and for literature cases, at the time of diagnosis of hemolytic uremic syndrome, mean number of doses received (mean+/-standard deviation. Minimum/maximum)) (personal cases: 26.5+/-6.6. 16/36, literature cases: 21+/-11. 8/54), cumulative dose received (g/m2) (personal cases : 24.5+/-6.3. 16/31.6, literature cases: 21.7+/-12.4. 2.4/54) and duration of treatment (months) (personal cases: 8.2+/-1.9. 5.6/11, literature cases: 8.5+/-4.0. 3/18) are very closed and high individual variations observed for these factors are not consistent with a time and/or dose dependant toxicity. New-onset hypertension or exacerbation of underlying hypertension is the most common clinical manifestation, with mild anemia; thrombocytopenia is inconstant. The degree of severity of renal failure is highly variable. The existence of subacute clinical form with progressive worsening of the symptoms and biological form at the time of diagnosis suggest the interest of a systematic clinical and biological screening of this side effect, before each injection of gemcitabine. Early prognosis is linked to the evolution of hemolytic uremic syndrome and after hemolytic uremic syndrome healing, cancer progression. Treatment include gemcitabine discontinuation, antihypertensive drugs and if necessary fresh frozen plasma. CONCLUSIONS Systematic clinical and biological screening of hemolytic uremic syndrome during gemcitabine therapy should allow to better know this complication, to recognize and treat it earlier with a potential positive impact for patients.
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Affiliation(s)
- J Desramé
- Clinique médicale, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France.
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27
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Houlgatte A, Dourthe LM, Bernard O. [Update on about testicular cancer]. Bull Cancer 2002; 89:47-56. [PMID: 11847026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The last two years publications are mainly concerning the following themes: the detection of testicular tumor for high risk patients. The treatment of stage one non seminomatous germ cell tumors is also detailed with reference to the three therapeutic options. The surgical treatment is evoked through laparoscopic surgery, surgery of residual masses and salvage surgery. Recent acquisitions in chemotherapy matters allow a simplification of protocols. They induced an improvement in the patient's quality of life with an equivalent efficiency. The salvage chemotherapy is evaluated and its results are assessed. The innovations in imaging are essentially focused on position emission tomography in the evaluation of these tumours but also on magnetic resonance imaging.
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Affiliation(s)
- Alain Houlgatte
- Service d'urologie, Hôpital du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris Cedex 05, France.
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28
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Ceccaldi B, Dourthe LM, Garcin JM, Vergeau B, Chanudet X, Larroque P. [Leiomyosarcoma of the right ventricle]. Bull Cancer 2000; 87:547-50. [PMID: 10969212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A 58-year-old woman has dyspnea and palpitations which reveal a leiomyosarcoma of the right ventricle. The medical imaging shows a lobulated sessile tumor attached to the ventricular septum and the tricuspid valve extending into the pulmonary artery trunk. The resection is performed with a tricuspid valvoplasty. In spite of chemotherapy (epirubicin-cyclophosphamide), relapse is observed with pulmonary metastases 17 months after the surgery. The death becomes on 18 months in congestive heart failure. From this case, the authors make a review of the literature about this exceptional tumour, and talk over the low possibilities of treatment, despite the capacities of the new ways of diagnosis.
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Affiliation(s)
- B Ceccaldi
- Service de médecine interne et pathologie cardiovasculaire, Hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé
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Isambert N, Gros P, Commegeille P, Mansuy L, Bernard O, Dourthe LM, Ponties JE, Hauteville D. [Malignant paraganglioma of the uterus]. Ann Med Interne (Paris) 2000; 151:311-3. [PMID: 10922962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We report a malignant uterine paraganglioma in a 41-year-old woman who underwent a hysterectomy for meno-metrorrhagia. It was initially thought to be a leiomyoma in necrobiosis. The clinical outcome was characterized by an early regional recurrence (in the left Fallopian tube). Later, vertebral and lung metastasis occurred, leading to death 22 months after the initial diagnosis. Paragangliomas are uncommon neuroendocrine tumors, related to pheochromocytomas. They are mainly found in the para-aortic and retroperitoneal region, and less commonly in the pelvic area. Location in the uterus is extremely rare: 5 cases were previously reported and only one malignant.
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Affiliation(s)
- N Isambert
- Service de Médecine Interne et Oncologie, Hôpital d'Instruction des Armées Bégin, Saint-Mandé
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Dourthe LM, Ceccaldi B, Fournier R, Houlgatte A, Merrer J. [Current chemotherapy of locally advanced or metastatic bladder tumors]. Ann Urol (Paris) 2000; 34:3-8. [PMID: 10763417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Standard chemotherapy of transitional cell carcinoma of the bladder is actually the combination of cisplatine, methothrexate, vinblastine and doxorubicine (MVAC). Although a high response rate, long term survival are rarely observed. More effective agents without toxicity are necessary. Several agents have demonstrated activity alone or in combinations. Combinations regimens use, paclitaxel, gemcitabine and Gallium nitrate, who prove activity alone or in combination with cisplatine or carboplatine, with a response rate of 40 to 70% in patient with visceral localisations. The optimal regimen is not yet determined.
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Affiliation(s)
- L M Dourthe
- Service the radiothérapie et d'oncologie médicale, Hôpital d'instruction des armées du Val-de-Grâce, Paris
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Dourthe LM, Coulon MA, Piperno Neumann S, Morere JF, Breau JL. [Peritoneal mesothelioma, a new complication of pica syndrome: apropos of a case]. Rev Med Interne 1999; 20:1047-8. [PMID: 10586447 DOI: 10.1016/s0248-8663(00)87089-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
INTRODUCTION Due to ifosfamide urotoxicity, encephalopathy is a frequent complication accompanying treatment with this drug. The various clinical, physiological and therapeutical aspects of ifosfamide-related encephalopathy are reviewed. We report two cases and review current literature. EXEGESIS Ifosfamide-related encephalopathy has polymorphous and non-specific clinical picture. The disease severity is variable, as related deaths have been reported. Clinical signs disappear with treatment discontinuation. Routes of administration, doses, tumoral site and gender have been implicated in the disease physiopathology. Admittedly, metabolite mitochondrial toxicity would be the underlying mechanism. Treatment would be based on intravenous methylene blue. A clinical trial aimed at studying prophylaxis is in progress. A few number of patients have been cured until now. CONCLUSION Further studies are required to confirm the involved physiopathological mechanisms and methylene blue effects.
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Affiliation(s)
- L M Dourthe
- Service de radiothérapie et d'oncologie médicale, hôpital d'instruction des armées du Val-de-Grâce, Paris, France
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Dourthe LM, Coutant G, Bechade D, Bili H, Algayres JP, Daly JP. [Postpartum thyroiditis: a silent entity]. Presse Med 1999; 28:339. [PMID: 10083878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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34
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Dupuy O, Dourthe LM, Mayaudon H, Ceccaldi B, Lechevalier D, Gros P, Gessain A, Bauduceau B. [Castleman disease and solitary plasmacytoma of the acromion]. Rev Med Interne 1999; 20:83-4. [PMID: 10220826 DOI: 10.1016/s0248-8663(99)83015-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Ceccaldi B, Dourthe LM, Houlgatte A, Merrer J. [Metastatic pure seminomas of the testicle: role of chemotherapy]. Bull Cancer 1998; 85:887-91. [PMID: 9835865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
40% of testicular tumours are seminomatous tumours. The low mass tumours (LMT) (stages IIA and IIB of the Royal Mardsen Hospital classification) are usually treated by radiotherapy and the high mass tumours (HMT) (stage IIC, III and IV) by chemotherapy. Chemotherapy regimens are platinum-based polychemotherapy. We report 9 cases of seminomatous testicular tumours (4 LMT and 5 HMT) treated by chemotherapy (BEP modified or CBDCA-etoposide regimens), three courses, with one supplement course if necessary and surgery if residual masses are more than 3 cm long. The rate of complete remission are 100% for LMT and 60% for HMT. This could be an indication to treat in addition with orchidectomy the LMT with chemotherapy and not with radiotherapy (standard-gold) which is more toxic.
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Affiliation(s)
- B Ceccaldi
- Service de radiothérapie-oncologie médicale, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris
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Dourthe LM, Ouachet M, Fizazi K, Droz JP. [Testicular germ cell tumors]. Bull Cancer 1998:26-39. [PMID: 9817070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Testicle germ cells tumors are the most common young men neoplasm. The incidence is maximal in Scandinavian countries. Cryptorchidism is a predisposing factor. Diagnosis is clinic, first treatment is radical orchidectomy by inguinal incision, after study of tumor markers. Histology shows seminoma or non seminomatous tumor. Carcinoma in situ is the precursor of invasive germ cell tumors. Germ cell tumors have no p53 mutation, and have isochrome of the short arm of chromosome 12 as a specific marker. With the results of histological, biochemical and radiographic evaluation, patient are classified as follows: good, intermediate and poor risk prognosis. Standard treatment of stage I seminoma is prophylactic irradiation. Stage II with less than 3 cm lymph node too. Other situations need a cisplatin based chemotherapy. In case of metastatic residuals masses more than 3 cm, surgery need to be discussed. Stage I non seminomatous germ cell tumors are treated by retroperitoneal lymphadenectomy, by surveillance or by two cycles of adjuvant chemotherapy with cisplatin, etoposide and bleomycin (BEP). Standard treatment of good prognosis stage II and III is three cycles of BEP, four for poor prognosis. Residual mass need surgery, adjuvant chemotherapy is necessary in presence of viable germ cell. Standard treatment for relapses is chemotherapy with cisplatin, ifosfamide and vinblastine with a 30% remission rate. The place of high dose chemotherapy with autologous stem cell transplantation is not yet standardised. New drugs, as paclitaxel, are under studies.
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Affiliation(s)
- L M Dourthe
- Service de radiothérapie oncologie, Hôpital d'instruction des armées du Val-de-Grâce, Paris
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Desrame J, Bili H, Dourthe LM, Bronstein JA, Jean R, Bechade D, Coutant G, Algayres JP, Daly JP. Lymphome non hodgkinien primitif de la voie biliaire principale. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)80159-8] [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: 11/30/2022]
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